worthy of a trial. I must mention, however, that the acetate of ammonia is seldom to be procured in the highly concentrated state in which it is used by M. Masurer. Owing to the great difficulty of crystallizing it, it is rarely seen except in the fluid state, in which condition it is recommended by the French chemist. The form in which it is almost always used in this country is that of the Aq. Acet. Ammon. or Spirit of Mindeierus, in doses of half an ounce or an ounce, but whether in this shape it would be equally effectual in obviating the effects of drunkenness, remains to be

seen.

Mr Broomley of Deptford recommends a draught composed of two drachms of Aq. Ammon. Aromat. in two ounces of water, is an effectual remedy in drunk

enness.

The carbonate of ammonia might be used with a good effect. M. Dupuy, director to the veterinary school at Toulonse, tried a curious experiment with this medicine upon a horse. Having previously intoxicated the animal by injecting a demiletre of alcohol into the jugular vein, he injected five grains of the carbonate of ammonia, dissolved in an ounce of water, into the same vein, when the effects of the alcohol immediately ceased.

In

We have already mentioned that the excitement of drunkenness is succeeded by universal languor. In the first stage, the drunkard is full of energy, and capable of withstanding vigorously all external influences. the second, there is general torpor and exhaustion, and he is more than usually subject to every impression, whether of cold or contagion. Persons are often picked up half dead in the second stage. The stimulus of intoxication had enabled them to endure the chill of the atmosphere, but the succeeding weakness left them more susceptible than before of its severity. In this state the body will not sustain any farther abstraction of stimuli; and blooding and cold would be highly injurious. Vomiting is here equally necessary, as in all other instances; but the person must be kept in a warm temperature, and cherished with light and nourishing food-with soups, if such can be procured, and even with negus, if the protrastration of strength is very great.

A paroxysm of periodical drunkenness may be sometimes shortened by putting such small quantities of tartar emetic into the liquor which the person indulges in, as to bring on nausea. This, however, must be done with secrecy and caution.

It may here be mentioned, though not with a view of recommending the practice, that the vegetable acids have a strong effect both in counteracting and removing drunkenness. To illustrate this fact, the following circumstance may be mentioned:-About twenty years ago, an English regiment was stationed in Glasgow, the men of which, as is common in all regiments, became enamoured of whskey. This liquor, to which they gave the whimsical denomination of white ale, was new to them being nearly unknown in England: and they soon indulged in it to such an extent, as to attract the censure of their officers. Being obliged to be at quarters by a certain hour, they found out the plan of sobering themselves by drinking large quantities of vinegar, perhaps a gill or two at a draught. This, except in very bad cases, had the desired effect, and enabled them to enter the barrack-court, or appear on parade, in a state of tolerable sobriety. The power of the vegetable acids in resisting intoxication, is well shown in the case of cold punch-a larger portion of which can be withstood than of either grog or toddy, even when the quantity of spirit is precisely the same.

There is nothing which has so strong a tendency to dispel the effects of a debauch as hard exercise especially if the air be cold. Aperients and diaphoretics are also extremely useful for the same purpose.

For some days after drinking too much, the food

should be light and unirritating, consisting principally of vegetables. Animal food is apt to heat the body, and dispose it to inflammatory complaints.*

II. From Opium.-When a dangerous quantity of opium has been taken, the treatment, in the first instance is the same as with regard to spirits, or any other intoxicating fluid. Immediate vomiting, by the administration of similar emetics, is to be attempted, and when it has taken place, it should be encouraged by warm drinks till there is reason to believe that the stomach has been freed of the poison. These drinks, however, should not be given before vomiting is produced, for, in the event of their failing to excite it, they remain upon the stomach, and thus dissolve the opium and promote its absorption. But when vomiting occurs from the action of the emetics, it will in all probability be encouraged by warm drinks, and the stomach thus more effectually cleared of the poison. Large quantities of a strong infusion of coffee ought then to be given, or the vegetable acids, such as vinegar or lemon-juice, mixed with water. These serve to mitigate the bad consequences which often follow, even after the opium has been brought completely up. If the person show signs of apoplexy, more especially if he be of a plethoric habit, the jugular vein, or temporal artery should be opened, and a considerable quantity of blood taken away. Indeed, it may be laid down as a general rule, that as soon as the poison is rejected, the patient ought to be bled, and the operation should be repeated according to circumstances. Every means must be used to arouse him from stupor. He must be moved about, if possible, from room to room, hartshorn applied to his nostrils, and all plans adopted to prevent him from sinking into lethargy. For this purpose, camphor, assafoetida, or musk, might be adininistered with advantage. It is also a good practice to sponge the body well with cold water; and the effusion of cold water on the head and over the body, is still more effectual. In cases where vomiting cannot be brought about by the ordinary means, M. Orfila suggests that one or two grains of tartar emetic, dissolved in an ounce or two of water, might be injected into the veins. In desperate cases, the stomach pump must be had recourse to. Purgatives are latterly necessary.

Many practitioners consider vinegar and the other vegetable acids antidotes to opium. This opinion M. Orfila has most satisfactorily shown to be erroneous. In a series of well-conducted and conclusive experiments made by him, it appears that the vegetable acids aggravate the symptoms of poisoning by opium, whenever they are not vomited. They hurry them on more rapidly, render them more violent, produce death at an earlier period, and give rise to an inflammation of the stomach-an event which hardly ever occurs when they are not employed. These effects, it would appear, are partly produced by their power of dissolving opium, which they do better than the mere unassisted fluids of the stomach; consequently the absorption is more energetic. The only time when acids can be of any use, is after the person has brought up the poison by vomiting. They then mitigate the subsequent symptoms, and promote recovery; but if they be swallowed before vomiting takes place, and if this act cannot by any means be brought about, they aggravate the disorder,

*In speaking of the treatment. it is necessary to guard against confounding other affections with drunkenness :- There is a species of delirium that often attends the accession of typhus fever, from contagion, that I have known to be mistaken for ebri. ety. Among seamen and soldiers, whose habits of intoxication are common, it will sometimes require nice discernment to decide; for the vacant stare in the countenance, the look of idiotism, incoherent speech, faltering voice, and tottering walk, are so alike in both cases, that the naval and military surgeon ought at all times to be very cautious how he gives up a man to punishment, under these suspicious circumstances. Nay, the appearances of his having come from a tavern, with even the effluvium of liquor about him, are signs not always to be trusted; for these haunts of seamen and soldiers are often the sources of infection. -Trotter.

i

and death ensues more rapidly than if they had not been

taken.

Coffee has likewise a good effect when taken after the opium is got off the stomach; but it differs from the acids in this, that it does not, under any circumstances, increase the danger. While the opium is still unremoved, the coffee may be considered merely inert; and it is, therefore, a matter of indifference whether at this time it be taken or not. Afterwards, however, it produces the same beneficial effects as lemonade, tartaric acid, or vinegar. According to Orfila, the infusion is more powerful as an antidote than the decoction. Drunkenness or poisoning from the other narcotics, such as hemlock, belladonna, aconite, hyoscyamus, &c., is treated precisely in the same manner as that from opium.

III. From Tobacco.-If a person feel giddy or languid from the use of this luxury, he should lay himself down on his back, exposed to a current of cool air. Should this fail of reviving him, let him either swallow twenty or thirty drops of hartshorn, mixed with a glass of cold water, or an ounce of vinegar moderately diluted. When tobacco has been received into the stomach, so as to produce dangerous symptoms, a powerful emetic must immediately be given, and vomiting encouraged by copious drinks, till the poison is brought up. After this, vinegar ought to be freely exhibited, and lethargy prevented by the external and internal use of stimuli. If apoplectic symptoms appear, blooding must be had recourse to. The same rule applies here, with regard to acids, as in the case of opium. They should never be given till the stomach is thoroughly liberated of its contents by previous vomiting.

Accidents happen oftener with tobacco than is commonly supposed. Severe languor, retching, and convulsive attacks sometimes ensue from the application of ointment made with this plant, for the cure of the ringworm; and Santeuil, the celebrated French poet, lost his life in consequence of having unknowingly drunk a glass of wine, into which had been put some Spanish snuff.

IV. From Nitrous Oxide.-Though the inhalation of this gas is seldom attended with any risk, yet, in very plethoric habits, there might be a determination of blood to the head, sufficient to produce apoplexy. If a person therefore becomes after the experiment, convulsed, stupified, and livid in the countenance, and if these symptoms do not soon wear away, some means must be adopted for their removal. In general, a free exposure to fresh air, and dashing cold water over the face, will be quite sufficient; but if the affection is so obstinate as to resist this plan, it will then be necessary to draw some blood from the arm, or, what is still better, from the jugular vein. When, in delicate subjects, hysteria and other nervous symptoms are produced, blooding is not necessary; all that is requisite to be done being the application of cold water to the brow or temples, and of hartshorn to the nostrils. In obstinate cases, twenty or thirty drops of the latter in a glass of water, may be administered with advantage.

CHAPTER X.

PATHOLOGY OF DRUNKENNESS.

The evil consequences of drinking, both in a physical and moral point of view, seem to have been known from the most remote antiquity. They are expressly mentioned in Scripture; nor can there be a doubt that the Homeric fiction of the companions of Ulysses being turned into swine by the enchanted cup of Circe, plainly implied the bestial degradation into which men bring themselves by coming under the dominion of so detestable a habit. Having mentioned these circumstances

in favour of the accuracy of ancient knowledge, we shall simply proceed to detail the effects of drunkenness, so far as the medical practitioner is professionally interested in knowing them. The moral consequences belong more properly to the legislator and divine, and do not require to be here particularly considered.

1. State of the Liver-One of the most common consequences of drunkenness is acute inflammation. This may affect any organ, but its attacks are principally confined to the brain, the stomach, and the liver. It is unnecessary to enter into any detail of its nature and treatment. These are precisely the same as when it proceeds from any other cause. The inflammation of drunkenness is, in a great majority of cases, chronic; and the viscus which, in nine cases out of ten, suffers, is the liver.

Liquors, from the earliest ages, have been known to affect this organ. Probably the story of Prometheus stealing fire from heaven and animating clay, alluded to the effects of wine upon the human body; and the punishment of having his liver devoured by a vulture, may be supposed to refer to the consequences whict men draw upon themselves by over-indulgence-this organ becoming thereby highly diseased. Man is not the only animal so affected. Swine who are fed on the refuse of breweries, have their livers enlarged in the same manner. Their other viscera become also indurated, and their flesh so tough, that unless killed early, they are unfit to be eaten. Some fowl-dealers in London are said to mix gin with the food of the birds, by which means they are fattened, and their livers swelled to a great size. The French manage to enlarge this organ in geese, by piercing it shortly after the creatures are fledged.*

Neither malt liquors nor wine have so rapid and decided an effect upon the liver as ardent spirits. Indeed, it is alleged, although I cannot go this length, that the wine that is perfectly pure does not affect the liver; and the fact of our continental neighbours being much less troubled with hepatic complaints than the winedrinkers among ourselves, gives some countenance to the allegation; for it is well known that to suit the British market, the vinous liquors used in this country are sophisticated with brandy. In wine that is perfectly pure the alcohol exists in such a state of chemical combination, as greatly to modify its effects upon the system. In the wine generally to be met with, much of it exists mechanically or uncombined, and all this portion of spirit acts precisely in the same manner as if separately used.†

The liver is a viscus which, in confirmed topers, never escapes; and it withstands disease better than any other vital part, except, perhaps, the spleen. Sometimes, by a slow chronic action, it is enlarged to double its usual size, and totally disorganized, and yet the person suffers comparatively little. The disease frequently arises in tropical climates, from warmth and other natural causes, but an excess in spiritous liquors is more frequently the cause than is generally imagined.

The consequences which follow chronic inflammation of the liver, are very extensive. The bile, in general, is not secreted in due quantity or quality, consequently digestion is defective, the bowels, from want of their usual stimulus, become torpid. The person gets jaundiced, his skin becoming yellow, dry, and rough, and the white of his eyes discoloured As the enlargement goes on, the free passage of blood in the veins is impeded, and their extremities throw out lymph: this accumulating, forms dropsy, a disease with which a great proportion of drunkards are ultimately more or less affected.

The jaundice of drunkenness is not an original dis

They have a custom of fostering a liver romp`unt in thrit geese, which encourages its growth to the enutinous woSUÁ some pounds; and this diseased viscus is considered a great onlicacy.-Mattheir's Diary of an invalid.

+ Vide Appendix No. I.

case, but merely a symptom of the one under consideration. A very slight cause will often bring it on; it is, consequently, not always dangerous. Dropsy is, for the most part, also symptomatic of diseased liver, but sometimes, more especially in dram-drinkers, it arises from general debility of the system. In the former case, effusion always takes place in the cavity of the abdomen. In the latter, there is general anasarca throughout the body, usually coupled with more or less topical affection. In every instance, dropsy, whether general or local, is a very dangerous disease.

II. State of the Stomach, &c.-Like the liver, the stomach is more subject to chronic than acute inflammation. It is also apt to get indurated, from longcontinued, slow action going on within its substance. This disease is extremely insidious, frequently proceeding great lengths before it is discovered. The organ is often thickened to half an inch, or even an inch; and its different tunics so matted together that they cannot be separated. The pyloric orifice becomes, in many cases, contracted. The cardiac may suffer the same disorganization, and so may the esophagus; but these are less common, and, it must be admitted, more rapidly fatal. When the stomach is much thickened, it may sometimes be felt like a hard ball below the left ribs. At this point there is also a dull uneasy pain, which is augmented upon pressure.

Indigestion or spasm may arise from a mere imperfect action of this organ, without any disease of its structure; but when organic derangement takes place, they are constant attendants. In the latter case it is extremely difficult for any food to remain on the stomach; it is speedily vomited. What little is retained undergoes a painful fermentation, which produces sickness and heartburn. There is, at the same time, much obstinacy in the bowels, and the body becomes emaciated.

This disease, though generally produced by dissipation, originates sometimes from other causes, and affects the soberest people. Whenever the stomach is neglected, when acidity is allowed to become habitual, or indigestible food too much made use of, the foundation may be laid for slow infiammation, terminating in schirrus and all its bad consequences.

Vomiting of bilious matter in the mornings, is a very common circumstance among all classes of drunkards. But there is another kind of vomiting, much more dangerous, to which they are subject; and that is when inflammation of the villous coat of the stomach takes place. In such a state there is not much acute pain, but rather a dull feeling of uneasiness over the abdomen, attended with the throwing up of a dark, crude matter, resembling coffee grounds. I have seen two cases in which the vomiting stopped suddenly, in consequence of metastasis to the head. In these, the affection soon proved fatal, the persons being seized with indistinctness of vision, low delirium, and general want of muscular power: the action of the kidneys was also totally suspended for three days before death. On examination, post mortem, there was effusion in the ventricles of the brain, besides extensive inflammation along the inner surface of the upper portion of the alimentary canal.

Bilious complaints, which were formerly in a great measure unknown to the common people, are now exceedingly common among them, and proceed in a great measure from the indulgence in ardent spirits to which that class of society is so much addicted."

There is nothing more indicative of health, than a good appetite for breakfast; but confirmed topers, from the depraved state of their stomachs, lose all relish for this meal.

Persons of this description are generally of a costive babit of body, but a debauch, with those who are constitutionally saber is, for the most part, followed by more or less diarrhoea.

In the latter stages of a drunkard's life, though he has still the relish for liquor as strongly as ever, he no longer enjoys his former power of withstanding it. This proceeds from general weakness of the system, and more particularly of the stomach. This organ gets debilitated, and soon gives way, while the person is intoxicated much easier, and often vomits what he has swallowed. His appetite likewise fails; and, to restore it, he has recourse to various bitters, which only aggravate the matter, especially as they are in most cases taken under the medium of ardent spirits. Bitters are often dangerous remedies. When used moderately, and in cases of weak digestion from natural causes, they frequently produce the best effects; but a long continuance of them is invariably injurious. There is a narcotic principle residing in most bitters, which physicians have too much overlooked. It destroys the sensibility of the stomach, determines to the head, and predisposes to apoplexy and palsy. This was the effects of the famous Portland powder,* so celebrated many years ago for the cure of gout; and similar consequences will, in the long run, follow bitters as they are commonly administered. Persons addicted to intemperance, have an inordinate liking for these substances; let them be ever so nauseous, they are swallowed greedily, especially if dissolved in spirits. Their fondness for purl, herb-ale, and other pernicious morning drinks, is equally striking.

There is nothing more characteristic of a tippler than an indifference to tea, and beverages of a like nature. When a woman exhibits this quality, we may reasonably suspect her of indulging in liquor. If drunkards partake of tea, they usually saturate it largely with ardent spirits. The unadulterated fluid is too weak a stimulous for unnatural appetites.

III. State of the Brain.-Inflammation of this organ is often a consequence of intemperance. It may fol low immediately after a debauch, or it may arise secondarily from an excess of irritation being applied to the body during the stage of debility. Even an abstraction of stimulus, as by applying too much cold to the head, may bring it on in this latter state.

Dr Armstrong, in his lectures, speaks of a chronic inflammation of the brain and its membranes, proceeding, among other causes, from the free use of strong wines and liquors. According to him, it is much more common after, than before, forty years of age, although he has seen several instances occurring in young persons. The brain gets diseased, the diaineter of the vessels being diminished, while their coats are thickened and less transparent than usual. In some places they swell out and assume a varicose appearance. The organ itself has no longer the same delicate and elastic texture, becoming either unnaturally hard, or of a morbid softness. Slight effusions in the various cavities are apt to take place. Under these cirunmstances, there is a strong risk of apoplexy. To this structure is to be ascribed the mental debasement, the loss of memory, and gradual extinction of the intellectual powers. I believe that the brains of all confirmed drunkards exhibit more or less of the above appearances.

IV. State of the Kidneys.-During intoxication the action of the kidneys is always much increased; and this is a favourable circumstance, as, more than any thing else, it carries off the bad effects of drinking. The kidney, however, in confirmed drunkards, is apt to become permanently diseased, and secrets its accustomed fluid with unusual activity, not only in the moments of drunkenness, when such an increase is useful, but at all periods, even when the persons abstains from every sort of indulgence. The disease called diabetes

* The Portland Powder consisted of equal parts of the roots of round birthwort and gentian, of the leaves of germander and ground pine, and of the tops of the lesser centaury, all dried. Drs Cullen, Darwin, and Murray of Gottingen, with many other eminent physicians, bear testimony to the pernicious effects of this compound.

is thus produced, which consists in a morbid increase of the secretion, accompanied with a diseased state of the texture of the kidneys. This affection is mostly fatal.

V. State of the Bladder.-Drunkenness affects this organ in common with almost every other; hence it is subiect to paralysis, spasm, induration, &c., and to all bad consequences thence resulting-such as pain, incontinence, and retention of urine.

VI. State of the Blood and Breath.-The blood of a professed drunkard, as already stated, differs from that of a sober man. It is more dark, and approaches to the character of venous. The ruddy tint of those carbuncles which are apt to form upon the face, is no proof to the contrary, as the blood which supplies them crimsoned by exposure to the air, on the same principle as that by which the blood in the pulmonary arteries receives purification by the process of breathing. The blood of a malt-liquor drinker is not merely darker, but also more thick and sizy than in other cases, owing, no doubt, to the very nutritious nature of his habitual beverage.

The breath of a drunkard is disgustingly bad, and has always a spiritous odour. This is partly owing to the stomach, which communicates the flavour of its customary contents to respiration; and partly, also, there can be little doubt, to the absorption of the liquor by the blood, through the medium of the lacteals.

VII. State of the Perspiration.-The perspiration of a confirmed drunkard is as offensive as his breath, and has often a strong spiritous odour. I have met with two instances, the one in a Claret, the other in a Port drinker, in which the moisture which exuded from their bodies had a ruddy complexion, similar to that of the wine on which they had committed their debauch. VIII. State of the Eyes, &c.-The eyes may be affected with acute or chronic inflammation. Almost all drunkards have the latter more or less. Their eyes are red and watery, and have an expression so peculiar, that the cause can never be mistaken. This, and a certain want of firmness about the lips, which are loose, gross, and sensual, betray at once the topor Drunkenness impairs vision. The delicacy of the retina is probably affected; and it is evident, that, from longcontinued inflammation, the tunica adnata which covers the cornea must lose its original clearness and trans

parency.

Most drunkards have a constant tenderness and redness of the nostrils. This, I conceive, arises from the state of the stomach and oesophagus. The same membrane which lines them is prolonged upwards to the nose and mouth, and carries thus far its irritability.

There is no organ which so rapidly betrays the Bacchanalian propensities of its owner as the nose. It not only becomes red and fiery, like that of Bardolph, but acquires a general increase of size-displaying upon its surface various small pimples, either wholly of a deep crimson hue, or tipped with yellow, in consequence of an accumulation of viscid matter within them. The rest of the face often presents the same carbuncled appearance.

I have remarked that drunkards who have a foul, livid, and pimpled face, are less subject to liver com

Falstaff. Thou art our admiral: thou bearest the lanthorn in the poop; but 'tis in the nose of thee: thou art the knight of the burning lamp.

Bardolph. Why, Sir John, my face does you no harm. Falstaff. No, I'll be sworn! I make as good use of it as many a man doth of a death's head or a memento mori. I never see thy face but I think of hell-fire. When thou rann'st up Gads-hill in the night to catch my horse, if I did not think thou hadst been an ignis fatus, or a ball of wildfire, there's no purchase in money. O! thou art a perpetual triumph-an ever. lasting bonfire light thou hast saved me a thousand marks in links and torches, walking with me in the night betwixt tavern and tavern; but the Sack thou hast drunk me would have bought me lights as good cheap, at the dearest chandler's in Europe. I have maintained that salamander of yours with fire any time this two and thirty years-heaven reward me for it!'

plaint than those who are free from snch eruptions. In this case the determination of blood to the surface of the body seems to prevent that fluid from being directed so forcibly to the viscera as it otherwise would be. The same fact is sometimes observed in sober persons who are troubled with hepatic affection. While there is a copious rush upon the face or body, they are comparatively well, but no sooner does it go in than they are annoyed by the liver getting into disorder. IX. State of the Skin.-The skin of a drunkard, especially if he be advanced in life, has seldom the appearance of health. It is apt to become either livid or jaundiced in its complexion, and feels rough and scaly. There is a disease spoken of by Dr Darwin, under the title of Psora Ebriorum, which is peculiar to people of this description. Elderly people,' says he, who have been much addicted to spiritous drinks, as beer, wine, or alcohol, are liable to an eruption all over their bodies; which is attended with very afflicting itching, and which they probably propagate from one part of their bodies to another with their own nails by scratching themselves.' I have met with several cases of this disease, which is only one of the many forms of morbid action, which the skin is apt to assume in drunkards.

X. State of the Hair-The hair of drunkards is generally dry, slow of growth, and liable to come out; they are consequently more subject to baldness than other people. At the same time, it would be exceedingly unjust to suspect any one, whose hair was of this description, of indulgence in liquors, for we frequently find in the soberest persons that the hairs are and, few in number, and prone to decay. Baldness with such persons is merely a local affection, but in drunkards it is constitutional, and proceeds from that general defect of vital energy which pervades their whole system.

XI. Inflammations.-Drunkards are exceedingly subject to all kinds of inflammation, both from the direct excitement of the liquor, and from their often remaining out in a state of intoxication, exposed to cold and damp. Hence inflammatory affections of the lungs, intestine, bladder, kidneys, brain, &c., arising from these sources. Rheumatism is often traced to the neglect and exposure of a fit of drunkenness.

XII. Gout.-Gout is the offspring of gluttony, drunkenness, or sensuality, or of them all put together. It occurs most frequently with the wine-bibber. A very slight cause may bring it on when hereditary predisposition exists; but in other circumstances considerable excess will be required before it makes its appearance. It is one of the most afflicting conse quences of intemperance, and seems to have been known as such from an early age-mention being made of it by Hippocrates, Aretaus, and Galen. Among the Roman ladies gout was very prevalent during the latter times of the empire; and, at the present day, there are few noblemen who have it not to hand down to their offspring as a portion of their heritage.

XIII. Tremors.-A general tremor is an attendant upon almost all drunkards. This proceeds from nervous irritability. Even those who are habitually temperate, have a quivering in their hands next morning, if they indulge over night in a debauch. While it lasts, a person cannot hold any thing without shaking, neither can he write steadily. Among those who have long devoted themselves to the mysteries of Silenus, this amounts to a species of palsy, affecting the whole body, and even the lips, with a sort of paralytic trembling. On awaking from sleep, they frequently feel it so strongly, as to seem in the cold fit of an agus, being neither able to walk steadily, nor articulate distinctly. It is singular that the very cause of this distemper should be employed for its cure. When the confirmed drunkard awakes with tremor, he immediately swallows a dram: the most violent shaking is quieted by this means. The opium-eater has recourse to the same