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ON 



CHEONIC ALCOHOLIC 



INTOXICATION. 



ON 



CHRONIC ALCOHOLIC 

INTOXICATION, 



OR 



ALCOHOLIC STIMULANTS IN CONNEXION 
WITH THE NERVOUS SYSTEM; 



WITH A 



SYNOPTICAL TABLE OF CASES. 



BY 



W. MARCET, M.D., F.R.S., 

FELLOW OK THE aOYAf. COI.LKGE OF PHYSICIANS; ASSISTANT-PHYSICIAN TO TH K 
WESTMINSTER HOSPITAL, ETC., ETC, 



LONDON : 
JOHN CHURCHILL, NEW BURLINGTON STREET. 

MDCCCLX. 



J. K. ADLARD PEFNTEE, BARTHOLOMEW CLOSE, E.C. 



INTRODUCTION. 



The therapeutical properties of zinc having 
become during the last few years a subject of 
much medical interest^ I was induced to com- 
mence in 1855 a series of comparative inquiries 
respecting the action of oxide of zinc in epi- 
lepsy-j chorea, mild hysteria^ paralysis and lead 
palsy, cases of exhaustion from excessive mental 
exertions, and in another peculiar chronic dis- 
order of the nervous system which is the 
subject of the present treatise. It soon became 
obvious that in certain of the above diseases 
the treatment adopted effected a complete 
recovery, or was attended by a very marked 
improvement, that in others it was followed 
bv no material benefit, and even in a few 
instances of hysteria was open to objection. I 
observed that this substance was most remark- 
ably beneficial when given to patients suffer- 
ing from a chronic disorder of the nervous 



VI INTRODUCTION. 

system^ characterised by sleeplessness,, giddi- 
ness, headaclie, flyii^g specks passing before 
tbe eyes (mnscse volitantes), noises in tbe ears 
(tinnitus anrium), hallucinations, trembling, 
and want of co-ordination of the voluntary 
motions; the disease being frequently accom- 
panied by a morbid condition of the organs 
of digestion. It then appeared to me pro- 
bable, and I soon afterwards discovered, that 
these symptoms were owing to one and the 
same cause, viz., the excessive use of alcoholic 
stimulants. 

I now commenced a series of investigations 
as to the property of oxide of zinc in con- 
trolling and curing the disorder in question, 
taking notes of the symptoms and other 
particulars of the cases of this affection 
admitted under my care at the Westminster 
Hospital. In January, of the present year, I 
communicated to the London Western Medical 
Society a paper, showing that oxide of zinc 
was exceedingly efficacious in the treatment 
of chronic alcoholic intoxication ; and abstracts 
of this paper were published shortly afterwards 



INTRODUCTION. VU 

in the ^Medical Times and Gazette/' and in 
the ^ Lancet/2 

Subsequent observations having fully con- 
firmed the correctness of the above-mentioned 
results, I have thought it might be useful to 
publish in its present form an account of 
the chronic functional disturbance of the 
nervous system brought on by the abuse of 
spirituous stimulants, and of the treatment 
adopted in these cases. 

I was engaged in the preparation of this 
treatise for the press_, when the valuable pub- 
lication on chronic alcoholism_, by Magnus Huss 
of Stockholm^ came under my notice. In this 
work the author has fully and accurately 
described the disease now under considera- 
tion. It may be observed, however^ that his 
attention has been more particularly directed to 
the symptoms and pathology of the disorder, 
while in the present volume comparatively great 
stress has been laid on the predisposing and 
immediate causes of the illness, and especially 

1 12th February, 1859. 

2 2d April, 1859. 



Vlll INTRODUCTION. 

on its mode of treatment. In order to be 
assured of the correctness of my statements_, I 
have confined myself almost exclusively to the 
results of my own experience, avoiding as much 
as possible filling up omissions by borrowing 
from the writings of others. The folio wing^ 
therefore,, is a mere sketch of a vast and im- 
portant subject ; but, however incomplete it 
may be, it will, I trust, be found not alto- 
gether devoid of interest and usefulness. 

The reader will not meet in the present 
work with any account of the physiological 
properties of alcohol, and is referred for infor- 
mation on this subject to Dr. Carpenter^s 
treatise on the use and abuse of alcoholic 
liquors. 1 

^ See also a paper communicated by the author in 1859 
to the British Association for the Advancement of Science, 
on * An Experimental Inquiry into the action of Alcohol on 
the Nervous System.' 

36, Chapel Street, Belgbave Squake. 



CONTENTS. 



JAGE 

Definition of chronic alcholism . . 2 

Difference between chronic alcoholism and delirium 

tremens . . . . .3 

Division of the subject . . . .4 



Symptoms op Chkonic Alcoholism . . 5 

Inability to sleep . • . .9 

Giddiness, headache, hallucinations . .11 

Weakness . . . .14 

Difficulty of breathing . . .15 



Causes puEDisposiNa to Chronic Alcoholism . 17 
Influence of quality of spirituous stimulants taken 18 
„ quantity ditto ditto . 22 

„ period during which the habit of ex- 

cessive drinking has been indulged . 26 

„ age . . . . 27 

„ sex . . . .30 

„ temperament , . .31 

„ habits ; smoking tobacco . .32 



CONTENTS. 

PAGE 

Influence of profession . . .38 

„ circumstances connected with the food 

taken , . . .42 



Immediate Causes of an Attack of Cheonic 

Alcoholic Intoxication . . 46 

An exceptional excess . . .47 

Coexisting disease . . .48 

Cerebral concussion . . .55 



Affections of the Nervous System resembling 
Chronic Alcoholic Intoxication . .57 

Nervous disorder owing to mental exhaustion . ib. 
,, „ violent emotions . 61 



Prognosis . . . .62 



Treatment ^OF Chronic Alcoholism . . 64 

Inveterate nature of the habit of drinking . 65 

Means of checking the habit of drinking . 66 

Importance for the physician of obtaining the full 

confidence of his patient . . . ib. 

The cause of intemperance to be removed . 67 

Patients not inveterate drinkers . .69 

Diet to be prescribed . . .71 

Substitutes for alcoholic stimulants . .73 

Treatment adopted by Magnus Huss in cases of 

chronic alcoholism . . .74 

Principle of the treatment adopted by the author . 71 



CONTENTS. XI 



PAGE 



Physiological Peopeeties oe Oxide oe Zinc . 78 

Results of Dr. Herpin's investigations . . 79 

„ the author's ditto . .81 

Nausea and sickness produced by oxide of zinc . 82 

Oxide of zinc objectionable in certain cases . 84 

Sleep, an effect produced by oxide of zinc . 85 

Oxide of zinc, not a slow poison . .87 



Theeapetjtical Peopeeties oe Oxide oe Zinc . 91 

Dr. Golding Bird's opinion on the action of zinc . 92 
Case reported of a dog treated with oxide of zinc 

for a convulsive disorder . . . ib. 

Action of oxide of zinc in various disorders of the 

nervous system . . . ,94 

Effect of oxide of zinc in a case of gastralgia . 100 



Cheonic Alcoholism teeated with Oxide op Zinc 102 

Circumstances liable to modify the action of oxide 
of zinc in cases of chronic alcoholism . ib. 

Usual effects of oxide of zinc in simple cases of 
chronic alcoholism . . . 104 

Classification of cases selected in order to illustrate 
the therapeutical action of oxide of zinc in cases 
of chronic alcoholism . . .105 



XU CONTENTS. 

CLASS I.— Division I. 

PAGK 

Cases of chronic alcoholism not complicated by other 
diseases, and occurring during the period of intem- 
perance . . . . .106 

CLASS L— Division IL 

Cases of chronic alcoholism not complicated by other 
diseases, and occurring in patients having resumed 
habits of sobriety . . . .120 

CLASS IL— DIVISION I. 

Cases of chronic alcoholism, accompanied by other 
diseases, and occurring during the period of exces- 
sive indulgence . . . .129 

CLASS IL— DIVISION IL 

Cases of chronic alcoholism complicated by other 
diseases, and occurring after the habit of excessive 
drinking had been given up . . .136 



Observations on Synoptical Table . .140 

Synoptical Table .... 148 

Appendix . . . .171 



N 



ALCOHOLIC STIMULANTS 



IX CONXEXIOX WITH 



THE NERVOUS SYSTEM. 



The injurious effects upon health, arising 
from the abuse of wine, beer, or spirits, and 
generally from all alcoholic stimulants, have 
been usually considered under the two following 
heads : First, as the immediate consequence of 
an excessive indulgence on a particular occasion ; 
and secondly, as the result of long- continued 
intemperance. It is not my intention to dwell 
upon the immediate action of alcohol upon the 
human body, producing drunkenness ; this 
subject having been admirably treated by 
Drs. Trotter,-^ Macnish,^ Roesch,^ and more 

^ ' An Essay, Medical, Piiilosopliical, and Chemical, on 
Drunkenness,' 1804. 

^ ' The Anatomy of Drunkenness,' 1832. 

^ ' De Pabus des boissons Spiritueuses,' 1839. 

1 



Z CHEONIC ALCOHOLISM. 

recently by Dr. Carpenter in his valuable 
Prize Essay ^ On tbe Use and Abuse of Aico- 
bolic Liquors in Healtb and Disease.^ I pur- 
pose to direct tbe reader^ s attention to a most 
distressing form of disease affecting tbe nervous 
system^ wbich tbose unfortunate persons wbo 
persist in drinking to excess seldom escape^ 
and wbicb constitutes a state of prolonged or 
cbronic poisoning. This affection is known 
by tbe name of chronic alcoholic intoxication, 
or chronic alcoholism, and is tbus defined by 
Magnus Huss : " Tbe name chronic alcoholism 
applies to tbe collective symptoms of a 
disordered condition of tbe mental^ motor, and 
sensory functions of tbe nervous system, tbese 
symptoms assuming a cbronic form, and witb- 
out tbeir being immediately connected witb 
any of tbose (organic) modifications of tbe 
central or peripberic portions of tbe nervous 
system wbicb may be detected during life, or 
discovered after deatb by ocular inspection ; 
sucb symptoms, moreover, affecting individuals 
wbo bave persisted for a considerable lengtb 
of time in tbe abuse of alcobolic liquors. ^^ 
Tbe babit of indulging too freely in spirituous 



CHRONIC ALCOHOLISM. 3 

beverages, even without tlieir producing intoxi- 
cation, is often attended at first T^dtli no 
apparent evil result, and there is little or no 
warning given of the injury done to the con- 
stitution; but sooner or later, the injurious 
effects of excessive and frequent alcoholic liba- 
tions will become obvious, occurring sometimes 
under the form of delirium tremens, although 
much more frequently assuming the condition 
of the chronic disease which will be subse- 
quently described. 

The difference between delirium tremens and 
chronic alcoholism is distinctly marked : the 
former, consisting of an acute and violent dis- 
turbance of the functions of the nervous system, 
lasting generally, according to Macnish, from 
four to ten days ; whilst the latter, although 
resembling the other in a mitigated condition, 
assumes the form of a protracted illness, with 
none of the paroxysms of violent delirium so 
peculiar to delirium tremens. Chronic alco- 
holic intoxication, again, is a state of long and 
uninterrupted suffering, allowing the patient no 
rest day or night. He may have given up 
the habit of drinking before the outbreak of 



4 CHEONIO ALCOHOLISM, 

tlie disease ; or if attacked during a period of 
excessive indulgence, he may endeavour by a 
great effort to shake off his old and pernicious 
habit, but, even if successful, he will not unfre- 
quently be disappointed in the hope of regaining 
his lost health. Week after week, month after 
month, year after year, he patiently waits for the 
termination of his sufferings, and endeavours to 
apply the remains of his strength to such occu- 
pations as will tear him away for the time 
from his miseries, although usually he finds 
himself so weak that he is denied even this 
poor source of relief. 

My attention having been directed for 
several years to an inquiry into the symptoms 
and treatment of the disorder in question, I 
have decided upon communicating, in this 
little volume, the results of those inquiries 
to the Medical profession and the Public. 

I shall begin with a description of the 
symptoms of chronic alcoholic intoxication. 
The causes, predisposing the individual to 
suffer from the disease, will next be duly in- 
vestigated ; to be followed by an inquiry into 
the immediate causes of the attack, and a 



SYMPTOMS. 



short account of certain diseases resembling 
chronic alcoholism, although not depending on 
excesses in spirituous drinks. I shall after- 
wards insist more particularly on the treatment 
of the disorder, and show how effectually it 
may be placed under medical control; con» 
eluding by a faithful report of the cases 
which have fallen under my care ; the notes of 
which have been taken during the patient^s 
visits, and consequently not depending for 
accuracy upon mere recollection.^ 



SYMPTOMS OF CHUONIC ALCOHOLISM. 

Dr. Carpenter, in his Prize Essay (p. 30), 
alludes to the symptoms of chronic alcoholism 
in the following words : " It is important to re- 
mark that a slighter form of this disorder (deli- 
rium tremens), marked by tremors of the hands 
and feet, deficiency of nervous power, and occa- 
sional illusions, will sometimes occur as a con- 
sequence of habitual tippling, even without 

* A synoptical table is appended to this treatise, giving 
an account of forty-eiglit cases of chronic alcoholism treated 
by the author at the Westminster Hospital. 



6 CHEOIflO ALCOHOLISM. 

intoxication having been once produced. And 
a still slighter manifestation of the want of 
control over the muscular apparatus^ the 
trembling of the hands in the execution of a 
voluntary movement^ is familiar to every one 
as extremely frequent among the habitually 
intemperate." And Dr. Carpenter further 
observes (p. 46), " That the effects of drunken- 
ness are highly inimical to a permanent healthy 
state of the brain, is often proved at a great dis- 
tance of time from the course of intemperance, 
and long after the adoption of regular habits." 

The remote effects of alcoholic poisoning 
have been also very ably considered by a French 
author — Roesch; but he includes chronic alco- 
holism among a number of other diseases re- 
sulting indirectly from long-continued intempe- 
rance, and thus omits a classification v/hich is 
of the highest importance respecting the treat- 
ment of the disorder in question. 

The symptoms of the disease depend on 
a functional disturbance of the properties 
of the nervous system, which may last for 
weeks, months, or years, even after the 
habit of excessive drinking has been given up. 



SYMPTOMS. 



On first applying to his medical adviser^ 
the patient will probably not state the cause 
of his illness, and thus seriously mislead the 
physician in his estimation of the nature of 
the complaint. If we try to account for this 
difficulty of establishing the cause of the 
disease in cases of chronic alcoholism, it will 
be found that in some instances the patient is 
ashamed of his intemperance, and will not con- 
fess it. In others, he considers that the 
nature of his occupation is such as to require 
an excessive amount of drink ; he is seldom or 
never drunk, in his opinion he takes no more 
than is absolutely required, and he is not aware 
of his suffering from alcoholic stimulants. 
Some will positively disbelieve that their ill- 
ness can be owdng to the abuse of alcoholic 
liquors, as they have been under a pledge to 
drink very little or none at all for some 
time previously; but it will be noticed, 
in the course of the examination, that be- 
fore taking the pledge these individuals were 
thorough drunkards, and had been obliged to 
give up drinking on account of their health. 
Finally, in those instances where the mind has 



8 CHEONIC ALCOHOLISM. 

been affected tkrougli frequent fits of clrnnken- 
ness and repeated attacks of delirium tremens, 
the patient may have great aversion from 
giving plain answers to the questions of the 
physician, and thus lead him to understand 
that he never indulged too freely in spirituous 
drinks. 

There is something peculiar in the look and 
gait of individuals in the habit of drinking to 
excess, or even of habitual tipplers, which 
will greatly assist in discovering the nature 
of the complaint, even before addressing the 
patient. His peculiar complexion, often sharp 
features, or, if he be fat, the injected cheeks 
and nose, and their violet appearance, the 
trembling of the limbs, often of the whole 
body, or a want of steadiness and co-ordina- 
tion in the movements, not very unlike inci- 
pient chorea — all these are so many symptoms 
that the medical practitioner will not fail to 
observe. On conversing with such patients 
their intellect will not often be found blunted, 
and the account they give of their sufferings is 
perhaps remarkably clear. It may be, how- 
ever, that the patient has fallen into a state of 



SYMPTOMS. 9 

melancholia^ and fancies his doctor is attempt- 
ing to do him some injury^ in which case the 
sufferer will endeavour to turn aside the con- 
versation^ and adroitly avoid the subject. I 
have observed a well-marked instance of this 
kind in a boy of eighteen, whose case I had 
great difficulty at first in making out; but a 
fortnight afterwards, his health having much im- 
proved, he gave me a clear account of his illness. 
Another patient, although he had given up the 
habit of drinking to excess, taking no more on 
an average than two pints of beer daily for the 
last six years, yet assured me that he was oc- 
casionally unconscious of what he was doing, 
and that his friends sometimes thought he was 
insane. 

Want of Sleep. — One of the prominent 
symptoms of chronic alcoholism is want of 
sleep and great restlessness at night; the suf- 
ferer perpetually keeps turning over in bed, 
and, as soon as he shuts his eyes, extraordinary 
visions, mostly of a painful kind, appear before 
him. For example, a patient told me he fre- 
quently saw a funeral passing as he was endea- 
vouring to compose himself. Sleep also, when 



10 CHEONIC ALCOHOLISM. 

obtained^ is disturbed by frightful dreams, wbicli 
appear often to indicate a considerable degree 
of mental excitement ; tbe patient frequently 
dreaming tbat lie has been at his work all 
night ; he awakes in the morning exhausted, 
and almost incapable of any exertion. The 
ill effect produced on sleep by excessive drink- 
ing is well illustrated in the following case of 
A. T — J aged 25 (Case 45). He is in the habit 
of taking daily one pint of beer and three or 
four glasses of gin. Once a week — on Satur- 
day, he increases his allowance to seven or 
eight pints of beer and five or six glasses of 
gin ; he cannot sleep on the nights of Satur- 
day, Sunday, Monday, and Tuesday, but on 
Wednesday night he sleeps better, and pretty 
well on Friday night. He is also troubled 
with hallucinations and the other usual symp- 
toms of chronic alcoholism, being invariably 
worse after his Saturday's excesses. 

Trembling. — In the day-time the patient is 
seized with trembling, especially when in the 
sitting posture; some hardly tremble at all 
when walking. The trembling may be very 
slight indeed, or confined to a particular part 



SYMPTOMS. 11 

of the body, being frequently visible in the 
tongue, or it may only occur at intervals ; some 
merely tremble in the morning on getting 
up, and many aifected by chronic alcoholism 
experience more or less difficulty in dress- 
ing themselves from want of sufficient control 
over their movements. As already mentioned, 
there is often much awkwardness in the per- 
formance of voluntary motion, even when the 
body is not subject to a conspicuous trembling ; 
thus, in the act of drinking, a liquid will be spilt 
from the cup ; or a light will be put out instead 
of being snuffed. It is remarkable how long 
this condition may last, and how rapidly it 
disappears under an appropriate treatment. 

Giddiness and Headache. — The patient also 
generally complains of great giddiness^ more 
especially when suddenly raising his head from 
the recumbent posture : headache and a ringing 
noise in the ears [tinnitus aurium) are fre- 
quent, although not constant, symptoms. 

Hallucinations. — The occurrence of hallucina- 
tions, so characteristic of delirium tremens, is 
very often noticed in chronic alcoholism, although 
usually to a much more subdued extent. Thej^ 



12 CHEOlSriC ALCOHOLISM. 

mostly affect the organs of sight and of hearing. 
For instance, one of my patients, when walking 
in the street, had seen ropes dangling about his 
head; to another, objects appeared as if they 
were double; some perceived occasionally insects 
creeping about : the various visions often dis- 
appearing as soon as the attention was directed 
to them. These factitious perceptions of the 
sight appear sometimes so real that the indi- 
vidual moves aside to avoid an imaginary object 
standing in his way. A cabman (Case 47) I was 
treating for chronic alcoholism told me he fre- 
quently pulled up his horse suddenly, or drove 
to one side of the street, lest he should run 
over some obstacle he distinctly saw in front 
of his horse, and which he afterwards found 
not to exist in reality. In his case objects 
appeared to be multiplied to as many as ten 
times their real number, so that if a lamp-post, 
a man, or a cart, happened to be near him, he 
perceived ten lamp-posts, or ten men, or as 
many carts. He could not possibly make out 
which object was really to be avoided, and 
was obliged to give up driving on account of 
the risk of an accident. In most cases the 



SYMPTOMS. 13 

patient is occasionally, or perhaps constantly^ 
troubled witli shadows or a black mist or 
flying specks [muscce volitantes) passing rapidly 
before his eyes, and causing a dimness of 
sight, especially when he is looking atten- 
tively at something -, in the act of reading, for 
example, the book is suddenly darkened, and a 
state of almost complete blindness ensues, 
lasting a few minutes. I have met with one 
instance where the patient perceived spots of 
all kinds of colour.^ During the long and 
sleepless nights, aberrations of the sight fre- 
quently happen. The wife of a patient I was 
treating for chronic alcoholism told me her 
husband often fancied, whilst lying awake, 
that he saw rats and cats, and various other 
descriptions of animals, on the bedclothes ; he 
used to doze at intervals, and in the morning 
could not remember anything of the nightly 
visions. The aberrations of the sense of 
hearing are not so frequent, but I have met 

^ Magnus Huss has observed cases of chronic alcoholism 
where objects appeared peculiarly coloured. He reports 
having met with two instances of hallucinations of the 
smell, and also with hallucinations of the taste, the patients 
believing they were drinking brandy instead of water. 



i4i CHEOTiriC ALCOHOLIS]^:. 

witli patients wlio occasionally heard voices 
addressing them when nobody was present.-"- 

Weakness. — Great weakness, especially in 
the knees and hips_, is a prevalent character of 
chronic alcoholism, which may sometimes be 
considered as a condition of threatened para- 
lysis. Indeed it is occasionally so great as to 
interfere considerably with the various acts of 
voluntary motion. In one of my cases (Case 22) 
the patient could hardly walk, even with the 
assistance of a stick, and this symptom con- 
tinued after he had recovered in other respects. 
Another (Case 13) stated that thirteen years 
previously he had fallen asleep drunk, and found, 
on awaking, that his right arm, as far up as the 
shoulder, was paralysed. On that occasion he had 
been admitted into the Westminster Hospital, 
and after a treatment of thirteen or fourteen 
weeks^ duration, had completely recovered the 
power of the paralysed limb. From that time, 
however, the fingers of the right hand, v^ith 

^ Magnus Huss has frequently observed a feeliug in 
the limbs of his patients as if they were • pricked -with 
needles (formication), and also they sometimes experienced 
a peculiar sensation as if something was creeping along 
their skin. 



SYMPTOMS. 15 

the exception of the thumbs were drawn out- 
wardj as if having been affected with gout. A 
professional acquaintance told me of a remark- 
able instance where a soldier, having been 
reprimanded by an officer before his regiment 
on account of intemperate habits, proceeded 
immediately to drown his shame in beer, which 
he drank to an enormous extent. Paralysis 
of the legs and arms followed this excess, from 
which, however, he recovered in the course of 
time. 

Difficulty of hreathing . — Difficulty of breath- 
ing, perceived in the throat as a sensation of 
choking, is a frequent symptom of chronic alco- 
holic intoxication, entirely independent of any 
affection of the lungs. This symptom was par- 
ticularly marked in the case of W. B — (Case 1). 
He described the feeling as one of choking, his 
breathing being quite natural for a few minutes, 
and then becoming suddenly checked. He 
pointed to the larynx as the spot where he felt 
an obstacle to the respiration. Upon throwing 
his head backwards he emitted through the 
mouth a quantity of air, and was afterwards 
able to breathe freely until the return of 



16 cheo:n^ic alcoholism. 

anotlier spasm. This symptom is possibly 
owing to tlie frequent contact of alcoholic 
drinks with the glottis and epiglottis, and 
to the inflammation and tumefaction thereby 
induced ; the action being somewhat similar, 
although in a greatly mitigated form, to that of 
strong mineral acids, which have been known 
to produce death in children from their contact 
with the glottis and epiglottis.-^ It may be also 
that these spasms result from the irritation 
produced by alcohol on the pharynx, inducing 
a contraction of the larynx by nervous re- 
flex action. Bouchardat and Sandras have 
ascertained that, when alcohol is introduced 
into the system in excess, the blood of the 
arteries presents the aspect of venous blood, 
showing that it has not undergone the proper 
oxygenating process,^ and it is possible that 
this circumstance should induce spasmodic con- 
tractions of the glottis through the medium of 
the brain and spinal chord. It appears that the 

1 *A. S. Taylor on Poisons,' 2d edit., p. 246. 

2 On the Digestion of Alcoholic Eluids, and their office 
in nutrition. ' British and Foreign Medico- Chirurgical 
Review/ vol. ii, 184^7. 



PEEDISPOSING CATISES. 17 

habit of swallowing air^ so frequently met with 
in those who drink to excess, is in some way or 
other connected with the difficulty of breath- 
ing, which in fact instead of relieving, as it appa- 
rently does at the time, it increases. In several 
cases, having warned patients of the importance 
of refraining from swallowing air, the com- 
pliance was attended with a considerable de- 
crease of the sensation of choking. The habit 
of swallowing air, which after a time becomes 
an unconscious act, is not only extremely un- 
pleasant from the frequent breaking of wind 
which it occasions, but also the source of 
much intestinal uneasiness, and it is necessary 
to stop it as soon as possible wherever it is 
found to exist. 



CAUSES PREDISPOSING TO CHRONIC 
ALCOHOLISM. 

It is a well-known fact that persons addicted 
to excessive drinking are not equally affected 
by it. The nature of the beverage, the quantity 

2 



18 CHEONIC ALCOHOLISM. 

taken, and tlie time during whicli tlie habit has 
been indulged; the age_, sex, temperament, 
habits, and occupation of the patient ; the 
quality and quantity of the food taken, are 
so many circumstances modifying the action of 
alcohol on the body, and which may predispose 
it to suffer from chronic alcoholism. 

Quality taken. — It might be considered at 
first sight that the more spirit or alcohol the 
beverage contains, the greater its deleterious 
action on the nervous system ; and that we 
might consequently, from the known propor- 
tion of alcohol in fermented drinks, establish a 
scale showing precisely their comparative ten- 
dency to bring on chronic alcoholism. Generally 
speaking this rule holds good, and it will be 
found that raw spirits are the most hurtful; 
then follow wine, beer, and cider. Except, how- 
ever, in a general point of view, the injurious 
properties of alcoholic liquors do not always 
depend on the proportion of spirits they contain. 
Macnish furnishes us with some valuable infor- 
mation on the effects of the different qualities of 
alcoholic stimulants. In his opinion, the safest 
way to use spirits is in the form of grog ; cold 



•PEEDISPOSIN'G CAUSES. 19 

toddy ranks next in safety, tlien warm toddy, 
cold punch, and raw spirits. He adds, with re- 
spect to malt liquor, ^' it is better to drink porter 
than strong ale, and advisable, when accustomed 
to malt liquor, to take exercise in order to 
avoid becoming fat and stupid, and predisposed 
to apoplexy/^ For wine drinkers, the safest 
wines are, according to the same author, ^'^those 
possessed of the most diuretic properties, and 
which create least headache and fever; as 
Hock, Claret, Burgundj^, Bucellas, Rhenish, 
and Hermitage. Port, Sherry, or Madeira, 
and sweet wines, are apt to produce acid on 
weak stomachs. Claret is the most wholesome 
wine that is known/^ Macnish also recom- 
mends not to drink of too many different kinds 
of wines at one sitting. The fact of intoxication 
being rapidly produced by mixtures of different 
wines is generally known, although usually 
disregarded when the temptation of a great 
variety of wines is offered to the guests at a 
dinner party. Hotel and tavern-keepers, being 
frequently called upon to share the drink of 
their customers, are very liable to suffer from 
the variety of the beverages they consume. I 



20 CHEONIO ALCOHOLISM. 

have met with cases where individuals not 
only indulged in many dijfferent kinds of 
stimulants, but mixed one liquor with another 
in the same glass; ale and gin, for example, 
being drunk together. 

Cider, and such wines as possess little spirit, 
and are more or less acid, are frequently, 
and with comparative safety, used in warm 
countries, and, according to Roesch, may 
even prevent certain diseases, especially 
those resulting from a deficiency of the 
biliary secretion. Lehmann observes : " It 
is owing to ^ cider's ' great cheapness that 
in several eastern cantons of Switzerland, 
such as Thurgovie, Appeuzell, St. Gall, and 
Zurich, the results from the abuse of alcohol, 
so common in other cantons, are unknown. 
By consulting, as I have done, the medical 
practitioners in this country, one becomes 
convinced that cider is not attended with un- 
favorable efiects unless it be made from 
green fruit, or be ill prepared, or under- 
going decomposition.-''' There is no doubt, 
however, adds Roesch, that the abuse of cider 
may become the source of disease. Delbeck 



PEEDISPOSII^a CAUSES. 21 

states, that cider does not agree with many 
people, producing frequently diarrhoea and 
various forms of indigestion.^ 

We may observe that even wines of the 
same quality (bearing the same generic name), 
and grown in adjoining districts, do not act 
with equal power upon the brain. Thus I 
am informed by a gentleman, who has 
had ample opportunities of making himself 
acquainted with the properties of Rhine wine, 
that the grapes grown in some adjoining dis- 
tricts along the E,hine do not produce wines 
equally heady. I believe many individuals 
will find that wine or beer does not exert the 
same action on their brain, as an equal quantity 
of a mixture of spirits and water, prepared so 
as to contain a proportion of alcohol similar 
to that which exists in the fermented juice of 
grape or in malt liquor. This circumstance may 
be accounted for, by assuming that the alcohol 
of spirits, which is distilled, differs as to its in- 
fluence on the brain, from that of beer or wine 
which is not distilled. At all events we know 

^ These sur Tinfluence des boissons alcooliques sur la 
sante, 1854. 



22 cheo:n'ic alcoholism. 

positively that these two kinds of alcohol have 
not the same influence upon the sense of taste, 
for a wine connoisseur will be able to tell 
without difficulty whether distilled alcohol has 
been added to a sample of wine, or whether 
the wine contains none but its natural alcohol ; 
this fact showing that there is certainly a 
difference between the alcohol of distilled and 
that of non»distilled spirituous stimulants. 
It may be also that they are not with 
equal readiness removed from the body or 
decomposed therein. The nature of the pe- 
culiar condition of the alcohol in wines, 
which is altered by the process of distillation, 
appears to be owing to an action of the other 
constituents of wine upon its alcohol ; for it is 
well known that distilled alcohol, added within 
certain proportions to Port wine, is converted 
after a lapse of some years, into the non-distilled 
kind, its presence being no longer discernible 
by the taste. 

Quantity taken. — I had an opportunity not 
long ago of overhearing a conversation between 
two labourers, the eldest, who appeared to 
have nearly reached the age of seventy, endea- 



•PEEDISPOSING CAUSES. 23 

vouring to convince the other that the best 
may to attain old age was to drink freely of 
beer and spirits, and this, he observed, was the 
resnlt of his own experience. It is certain 
there are exceptions to the general rnle that 
frequent excesses in alcoholic beverages will 
ultimately destroy health; these exceptions, 
however, are but very few. We must re- 
member that the word excess, in cases of in- 
temperance, is not absolute, but to a certain 
extent relative: thus, an allowance of a spiri- 
tuous beverage all but harmless in one instance, 
might be attended with dangerous effects in 
another. The fact that some can indulge very 
freely in alcoholic drinks without suffering 
from them, is illustrated by the following in- 
stance : — J. M'B — , aged 49 ; a hawker. — 
Was engaged thirty years ago working in a dis- 
tillery at Bristol, and during the seven years he 
was thus employed used to drink rather less than 
a pint of gin daily. He travelled afterwards 
in Devonshire, where he drank a great deal of 
cider, from which he felt no further incon- 
venience than pain in the stomach and purging. 
For the last four months he has been drinking 



24 CHEONIC ALCOHOLISM, 

seven or eight glasses of rum a day. He 
exhibits no symptoms whatever of alcoholism, 
and applies to be treated merely for an eruption 
of acne on the face. 

It will be observed that most of my patients 
suffering from chronic alcoholism^ drank to a 
considerable extent both malt liquor and spirits. 
Thus W. B — (Case 1) drank one pint of gin, 
and two or three, and occasionally six or eight 
pints of beer daily. E. C — (Case 15) took half 
a pint of brandy and five or six pints of stout 
daily. G. R — (Case 18) drank from three 
glasses to a pint of spirits daily, and four or five 
pints of ale. The largest amount of alcohol I 
have known to be taken occurs in the cases of 
H. H— (Case 46), and T. D— (Case 47). The 
former, aged 42, contracted the habit of drink- 
ing when fourteen or fifteen years old, and from 
that time to the last three or four months has 
taken three or four pints of rum and as much 
beer daily .^ The latter, also aged 42, has taken, 

^ This enormous quantity must be considered as an 
approximation to the truth. I cannot help thinking that 
the patient drank frequently less than his own statement 
might lead us to believe. 



PEEDISPOSING CAUSES. 25 

for a period of eight or ten years, an allowance 
of ten small glasses of brandy, as mucli gin, 
and ten glasses of beer daily. In some cases a 
mucb smaller allowance of stimulants sufficed 
to bring on a disordered state of tbe nervous 
system, as, for example, in that of G. J — 
(Case 14), who took three or four pints of beer 
daily, and no spirits, and this man became in- 
toxicated if he drank no more than two pints of 
ale at one sitting. The following case shows 
how remarkably liable some individuals are to 
suffer from a very small amount of alcoholic 
beverage. G. B — , aged 28, (Case 35), a stoker 
in the House of Parliament. — Admitted as out- 
patient at the Westminster Hospital, on Feb. 
24th, 1859. Has always been of sober habits, 
and was only drunk once in his life, when no 
more than twelve years of age. His daily 
allowance of beer has been one pint, and he has 
taken no spirits. Three years ago he became a 
teetotaller, because he found that even so little 
as one pint of beer daily did not agree with his 
health. He has suffered from the usual symp- 
toms of chronic alcoholism for the last three 
years. 



Sd €HEONIC ALCOHOLISM* 

Time the habit has been indulged. — A very 
remarkable circumstance connected with 
chronic alcoholism is the fact of its occurring, 
or of the symptoms becoming frequently aggra- 
vatedj long after the habit of drinking to 
excess has been given up_, and even^ in many 
cases, after a complete abstinence for some 
time from alcoholic stimulants. As instances : 
C. A — (Case 2) turned teetotaller seven 
weeks before applying for relief at the West- 
minster Hospital. Gr. R — (Case 18) drank 
from youth from three glasses of spirits to a 
pint, and four or five pints of ale daily, until 
about eleven months previous to admission, 
when he gave up completely both beer and 
spirits. Q^ P — (Case 21) took twelve pints 
of beer daily for nine years, but during the 
last four years drank only two or three pints 
of ale a day. Many other instances of the 
same kind will be found recorded in the table. 
Yet, notwithstanding their abstinence, these 
individuals fell a prey to past excesses. 

I have been led to observe that the in- 
jurious effects of the long-continued abuse 
of alcoholic stimulants, are frequently not 



PEEDISPOSIIfG CATJSES; 27 

developed to any extent until the occurrence 
of another circumstance^ which is the imme- 
diate cause of the attack. It has not been pos- 
sible for me to determine satisfactorily whether 
an attack of chronic alcoholism may supervene 
long after the individual has given up drinking, 
and without his having at all suffered from 
the nervous derangement known to result from* 
frequent excesses ; but this much may be safely 
stated : that in the great majority^ if not in 
every case, the patient^ s constitution has been 
so far affected that the slightest cause will be 
sufficient to startle or frighten him, produce 
giddiness, headache, and keep him from sleeping 
at night, yet without preventing him from 
attending to his occupations, or proving of any 
material inconvenience ; and such patients are 
very liable to a regular attack of chronic 
alcoholism from some cause independent of 
drink. 

Age. — According to Macnish, a child 
nursed by a drunken nurse is hardly ever 
healthy;, it is especially subject to derange- 
ments of the digestive organs, and to con- 
vulsive affections. Dr. North has observed 



28 CHEOIfIC ALCOHOLISM. 

this latter disease to be instantly arrested by 
transferring the child to a sober woman. 
Macnish adds that the habit, in some parts of 
Scotland; of giving raw whisky to babies a few 
days old, turns them pallid, and they become 
emaciated, fretful, subject to convulsions and 
every variety of disorders of the stomach, in- 
cluding vomiting and diarrhoea, which may 
end in death. The following investigation, 
undertaken by Dr. Hunter, reported by 
Macnish and by Carpenter, shows that alco- 
holic drinks, even in moderate quantities, do 
not agree with young children. He submitted 
to experiment his two children, both of them 
having been previously unused to wine. To 
the one, a child of five years old, he gave 
every day a full glass of sherry ; to the other, 
of nearly the same age, he gave an orange. 
In the course of a week a very marked diflPer- 
ence was perceptible in the pulse, urine, and 
evacuations from the bowels of the two 
children. The pulse of the first child was 
raised, the urine high-coloured, and the evacua- 
tions destitute of their usual quantity of bile. 
In the other child no change whatever was 



PEEDISPOSES-G CAUSES. 29 

produced. He then reversed the experiment, 
giving to the first the orange, and to the 
second the wine, and the result corresponded ; 
the child who had an orange continued well, 
and the system of the other became straightway 
disordered, as in the first experiment. 

A young man betaking himself to the dis- 
gusting habit of drinking to excess may be 
considered as very liable to become intoxicated. 
Should his constitution not be strong and 
healthy, or should he not be accustomed to 
active habits, the first occurrence of disease 
may prove fatal, or, at all events, give him 
such warning as will effectually prevent his 
returning to drink. But there are other 
young drunkards, gifted with strong and 
healthy constitutions and engaged in occupa- 
tions requiring great muscular exertion in 
the open air, who are enabled to rid them- 
selves rapidly of the alcoholic poison ; for 
instance, men employed as coal porters, 
hawkers, labourers, will be able to resist 
for many years the baneful consequences 
of intemperance j but at forty-one years 
of age, those who have habitually indulged 



so CHEONIC ALCOHOLISM. 

to excess in alcoliolic liquors begin to suffer, 
probably because that age is tbe time of 
life wben youth and health often begin to 
depart. One individual becomes a prey to 
gout, another to rheumatism, another to 
bronchitis, and another to disorders of diges- 
tion. Now, those very diseases are known to 
predispose greatly to chronic alcoholism, and it 
is therefore not to be wondered at that this 
disorder should usually make its appearance at 
the above-mentioned period. The youngest 
patient coming under my treatment for chronic 
alcoholism was eighteen years of age, and the 
oldest, seventy-five. 

Sex. — Women appear to be much less sub- 
ject to suffer from the long-continued abuse of 
alcoholic liquors than men; indeed, I have 
only seen one case of chronic alcoholism 
among the female sex, which, however, I had 
not an opportunity of attending. Magnus 
Huss accounts for his having met with but 
few cases of chronic alcoholism among females, 
by assuming that the male sex is not more pre- 
disposed to alcoholism than women, but that men 
indulge in alcoholic liquors more than women. 



PEEDISPOSING CAUSES:. 31 

Of 139 patients treated by Huss^ during three 
years, there were 123 men and 16 women. It 
is well known that delirium tremens is not fre- 
quent among females ; Roesch states that, in 
his opinion, this phenomenon is not owing to 
the circumstance that fewer women drink than 
men, for the disproportion is too considerable 
not to depend upon other causes. In 170 cases 
of delirium tremens, observed by Rayer, there 
were only 7 females affected ; Bang, at Copen- 
hagen, only observed 10 among 456 patients ; 
Hoegh-Guldberg only noticed one case in 173 ; 
Kruger Hansen, 1 in 16; and the directors of 
the hospital at Christiana, 1 in 11. 

Temperament. — According to Delbeck, the 
more plethoric and sanguine the temperament, 
the more the nervous system is irritable, and 
subject to suflPer from alcohol ; individuals 
having a lymphatic temperament, being better 
able to stand spirituous beverages. Magnus 
Huss expresses a similar opinion ; he classifies 
the different temperaments as follows, accord- 
ing to their degree of influence in predis- 
posing to chronic alcoholism : 1st, the san- 
guine temperament ; 2d, the phlegmatic ; 3d, 



32 CHEOITIO ALCOHOLISM. 

the bilious ; 4tlij the lymphatic ; 5th; the 
nervous. 

Habits. — The habits of an individual are 
among the most important of the causes pre- 
disposing to chronic alcoholism. As a general 
rule, habits of indolence and idleness, inde- 
pendently of their acting as a strong in- 
ducement to drink, favour slow poisoning 
by alcohol. Where the disorder is limited 
to the mildest symptoms, I have repeatedly 
observed it to be checked in a remarkable 
degree by having recourse to exercise of the 
mind and body, and I have noticed indi- 
viduals accustomed to hard work become 
affected with symptoms owing to past excesses, 
because they had no longer any work to do. 

Smoking tobacco. — Tobacco, and more espe- 
cially that of the strongest kinds, decidedly 
predisposes the nervous system to suffer from 
the long-continued abuse of spirituous drinks, 
an observation which is not without import- 
ance and interest considering that the habit 
of drinking is frequently accompanied by that 
of smoking. If it be remembered that poisoning 
by tobacco fumes is attended with giddiness. 



PEEDISPOSIN^a CATJSES. 33 

trembling, and otlier symptoms referable to a 
disordered condition of the nervous system, it 
will obviously follow that the habit of smoking, 
and especially of smoking to excess, will act 
conjointly witb that of drinking in bringing 
on an attack of chronic alcoholism. Here are 
a few cases illustrating this fact. 

H. E — (Case 33), a clerk, admitted on the 
21 st of February, 1859, drank at Christmas 
last a considerable amount of ale and gin, and 
has been in bad health since that time ; suffering 
from trembling in the morning, weakness, and 
loss of memory, and has lately been unable 
to sleep at night. This patient has contracted 
the habit of smoking a great deal of shag 
tobacco, to which circumstance he himself 
partly ascribes his illness. E. C — (Case 15), 
six years ago took to the habit of drinking 
about half a pint of brandy daily, and five 
or six pints of stout; after keeping up this 
allowance for nearly four years he reduced it to 
eight pints of porter daily, and continued with 
that amount up to the time of his admission on 
the 16th of December, 1853. He has suffered 
for the last four years from chronic alcoholism, 

3 



34 CHKONIC ALCOHOLISM. 

one of tlie symptoms being trembling in 
the morning, especially when he has drank 
freely the evening before. He states that 
he has been a hard smoker, and has ob- 
served that smoking increased the trembling. 
A. P — (Case 41), set. 40, a gas-fitter, ad- 
mitted on the 21st March, 1859, had been in 
the habit of drinking for the last two or three 
years six or seven pints of beer daily. Six 
or seven months ago he began to exhibit 
symptoms of chronic alcoholism, and about six 
weeks previous to admission, when smoking 
three quarters of an ounce of tobacco per day, 
he suddenly became worse, his nervous system 
having evidently been much affected by the 
use of the tobacco. 

The habit of smoking being one so preva- 
lent among those who are fond of alcoholic 
stimulants, and its eifects being so directly 
connected with the slow poisoning from alco- 
holic beverages, an inquiry into this subject will 
not be out of place on the present occasion. 

It is difficult to conceive why boys take 
so much pleasure in smoking cigars or a 
pipe, when out of sight of their parents or 



PEEDISPOSIIfG CAUSES. 35 

guardians ; but vanity and pride probably here 
act a prominent part. Children desire to 
imitate their elders^ and show each other they 
can colour a pipe^ or smoke a cigar to the 
very end^ even if they have to pay the penalty 
of nausea and vomiting. Thus, the individual 
contracts a most pernicious habit, which 
he will find extreme difficulty in breaking 
off if obliged to do so in after life. When 
smoking is becoming a habit, it gradually 
ceases to cause sickness, although still occa- 
sioning nausea and giddiness, and finally 
the nausea and giddiness disappear, returning 
only on special occasions. It is then that 
tobacco smoking produces pleasurable sensa- 
tions like those resulting from the narcotism 
of opium, when the imagination changes each 
successive puff of smoke into every description 
of fanciful objects, when the bachelor forgets 
his solitude, the mind its troubles, and the 
body its pains. A painful impression on the 
mind is certainly soothed by smoking, and this 
is a frequent cause of the habit being contracted. 
One man will take to smoking to drown the 
disappointment of unsuccessful labours, and 



36 CHEOiaC ALCOHOLISM. 

another to allay the affliction from the loss of a 
friend.^ Smoking is also a frequent habit 
among those who are called upon to exercise 
much mental exertion, because it appears to 
possess the power of resting the mind when 
tired. When the body and mind are excited, as is 
usually the case after dinner, ov post pocula, or in 
a convivial meeting of friends, smoking is often 
resorted to as an instinctive means of keeping 
the excitement within certain limits. The very 
prevalent habit of smoking after dinner must 
have for its principal object that of allaying the 
discomfort arising from the stimulating action of 
the meal. At dinner a glass of Sherry or Madeira 
immediately follows the soup, these, along with 
Port, being our strongest wines. At first sight, 
it does not appear rational to commence with 
the strongest wine, which must necessarily im- 
pair more or less the taste and stimulating effects 
of the weaker, such as Hock and Claret, that 

^ Smoking appears to have the property of diminishing 
the power of mental abstraction ; it is probably on this ac- 
count that when the mind is haunted by some painful idea, 
the act of smoking assists the effort of the will to shake 
it off. 



PEEDISPOSII^'a CAUSES. 37 

may follow. But it is found agreeable to begin 
by assisting tbe appetite with a powerful stimu- 
lant, and tbe more alcobolic tbe beverage, tbe 
better it answers tbe purpose, so mucb so tbat 
some are not satisfied witb Sherry after the 
soup, but begin dinner with a glass of spirits. 
The stomach is thus induced to take more 
than is required, and after dinner a sensation 
of fulness is felt, which is conveniently re- 
lieved by a cup of strong coffee; but now an 
uneasy sensation of heat and excitement is 
experienced, from which the body partly re- 
covers by means of a full-flavoured cigar or a 
pipe. 

Finally, it is remarkable how much certain 
individuals can smoke on special occasions 
without its producing giddiness or sickness, or 
any unpleasant feeling, the same persons being 
in general easily affected by tobacco smoke. 
In all cases where the body and mind are ex- 
cited within certain limits, smoking will be 
most easily tolerated; as, for example, after 
dinner during the excitement from eating and 
drinking, in a party attended with the enjoy- 
ment of conversation, or a sporting excursion 



38 CHEOT^IC ALCOHOLISM. 

when under tlie influence of sport and exercise 
and the stimulating power of the open air. 

I may perhaps be allowed to conclude 
these observations by advising young men, 
whatever may be their position in life, not to 
take to smoking, as such habit is certainly 
not conducive to health. To adults of a 
sound constitution, who have contracted the 
habit of smoking to a moderate extent, and 
do not feel the worse for it, I would recom- 
mend to smoke only after a meal, and that 
but seldom. 

Profession. — Such professions as exhaust 
the body, from their requiring great muscular 
exercise, especially under circumstances which 
excite excessive perspiration, favour the early 
development of chronic alcoholism; and occa- 
sionally in these instances a very small pro- 
portion of alcoholic beverage will be hurtfuL 
Thus, individuals obliged to remain long before 
a blazing fire, as furnace-men and engineers on 
board steamboats or in factories, are very liable 
to suffer from spirituous stimulants. For ex- 
ample, the following cases may be mentioned : 
G. B — (Case 35), a stoker in the House of 



PEEDISPOSIN& CAUSES. 39 

Parliament^ who, at the early age of twenty- 
three^ laboured under clironic alcoholic intoxi- 
cation^ althougli lie was in tlie habit of taking 
no more than a pint of ale daily, and no spirits, 
and had become, moreover, a teetotaller three 
years previous to his admission into the hos- 
pital. T. S — (Case 3), an engineer on board a 
steamboat, consulted me for chronic alcoholism 
at the age of thirty- three. He had suffered 
previously from several attacks of delirium 
tremens. I have already recorded the case of 
an engine-driver contracting chronic alcoholism 
at fifty-six, his immunity arising probably from 
a very robust state of health. The average 
age of these three cases is thirty-seven, while 
that of the forty-seven patients whose ages have 
been reported in the synoptical table is forty- 
one. Professions affording very little or no ex- 
ercise of the mind and body predispose also to 
suffer early, and consequently when young, from 
the habit of drinking. Thus, clerks, tailors, and 
other tradesmen, cab and cart drivers, are very 
liable to disorders of the nervous system from 
intemperance, and the table appended to this 
work offers these illustrations, showing the 



40 CHEOIfIC ALCOHOLISM. 

truth of the foregoing observation : E. B — 
(Case 9), a tailor, age 41 ; G. R — (Case 18), 
general dealer, age 38 ; Gr. M — (Case 19), 
cushion maker, age 33 j W. F — (Case 24), a 
carter, age 34 ; J. H — (Case 25), a shoemaker, 
age 27 ; W. P — (Case 26), a cabman, age 29 ; 
H. E — (Case 33), a clerk, age 24. There are, 
however, two instances reported of individuals of 
sedentary occupations suflPering from chronic 
alcoholism at an advanced age : W. J — (Case 
5), a shoemaker, age 75, and D. B — (Case 27), 
greengrocer, age 72 ; and if, reckoning the last 
two cases as exceptional, we take the average 
age of the patients of this class, we shall find 
it to be thirty-two, whilst the average age of 
the forty-seven patients is forty-one. Other 
occupations requiring much exercise in the 
open air also furnish our hospitals with a 
great number of cases of chronic alco- 
holic intoxication, but these individuals are not 
affected so young as those previously men- 
tioned, their average age being thirty-nine. 
I allude especially to labourers, coal-porters, 
sailors, hawkers, and carriers. Finally, there 
are occupations and professions entailing a mo- 



PEEDISPOSIKa CArSES. 41 

derate amotiiit of exercise^ as those of butchers 
or policemen, which afford but few instances 
of the disease. 

There is no doubt but that in the higher 
class of society a great number of cases of 
chronic alcoholism may be observed_, although 
the disease is certainly most prevalent among 
those who attend our hospitals. Dr. Budd, 
alluding to the indigestion of drunkards, con- 
nected with symptoms of chronic alcoholism, 
observes^ — " The kind of disorder we are con- 
sidering is now seldom met with except in the 
lower ranks of life. Half a century ago, hard 
drinking was common in the upper classes, and 
men of fortune were often sent to Bath, to 
restore the tone of their stomach by drinking 
of its waters.^^ It is true that intoxication is 
now very seldom met with in the upper classes 
of society; but, from the great predisposition 
of many to suffer from alcohol taken even in 
small doses, there must still exist a compara- 
tively vast number of individuals, in comfort- 

* Dr. Budd, ' On the Organic Diseases and Tunctional 
Disorders of the Stomach,' p. 290. 



42 CHEOITIC ALCOHOLISM. 

able as well as wealthy circumstances^ whose 
nervous system becomes affected from tbe effects 
of the long- con tinned babit of drinking wine 
or spirits. 

Circumstances connected with the food taken. 
— In addition to tbe above^ tbere are other cir- 
cumstances which appear to increase to a con- 
siderable extent the tendency of alcoholic drinks 
to produce chronic alcoholic intoxication; 
namely, drinking early in the morning before 
breakfast, and consequently on an empty sto- 
machy and living on a spare solid diet ; in the 
latter case the beverage constituting nearly the 
whole of the food taken. 

It is a prevalent habit for labourers, in some 
parts of the country, to sleep in the tap-room 
of public-houses, where they have a free night^s 
lodging j and it is an interesting sight to see 
such work-worn individuals lying about in 
winter near the fireside on the floor, tables, and 
benches, and enjoying as complete a rest as if 
they were in a comfortable bed. Early in the 
morning they awake, and most of them begin 
with beer or spirits ; commodities within their 
immediate reach, and which they suppose will 



PEEDISPOSI^s^G CATJSDS. 43 

give them an appetite for breakfast_, and keep 
out the cold for the whole of the day. During 
the week_, the toils of the day call them out 
into the fields, and they must leave the table; 
but on Sunday, these same men continue im- 
bibing the poison from morning to evening, 
and taking very little food; as early as 
9 or 10 o^clock a.m. symptoms of drunken- 
ness in the tap-room may be observed, and 
no doubt that with many labourers the morn- 
ing dram on an empty stomach is the cause 
of their suffering, sooner or later, from chronic 
alcoholism. There is a class of men whose 
only nourishment for days in succession is beer. 
I allude more particularly to those who are 
employed in breweries. The stomach of these 
individuals becomes filled with nothing but 
beer, which must be absorbed with a much 
greater rapidity than during the normal pro- 
cess of digestion, when fluids taken as drinks 
become intimately mixed up with the food; 
and it is in no degree remarkable that this 
constant passage of alcohol from the stomach 
into the blood and brain should give rise to 
cerebral symptoms. Moreover, the appetite 



44 CHEOIfIC ALCOHOLISM. 

of such men for solid food is quickly blunted, 
not only on account of the physiological fact 
that alcohol diminishes the waste of the body, 
and consequently its requirements for new 
materials, but more especially from the long- 
continued action of the fluid on the nerves and 
lining membrane of the stomach. The first 
contact of alcoholic fluids with the mucous 
membrane of the stomach occasions in that 
organ a state of irritation and excitement, but 
when drinking has been continued for a length 
of time, the stomach becomes gradually 
benumbed, losing more or less of its sensibility 
and motility, which partly accounts for the di- 
minished appetite and want of digestive power. 
The nature of the direct action of alcohol on 
the human stomach may be inferred from some 
very interesting experiments of Baron Hum- 
boldt. This eminent physiologist immersed 
the crural nerve of a full-grown and lively frog 
in alcohol. If the leg was already exhausted 
by galvanization the alcohol evidently increased 
its excitability, and this increase lasted for a 
time on the nerve being quickly removed from 
the stimulating fluid; but if the nerve was 



PEEDISPOSTNa CAUSES. 45 

left in it for some time, its excitability became 
completely exhausted. The application of al- 
cohol exhausted instantaneously the excita- 
bility of young animals, — birds, worms, and 
insects. If the tail of an earth-worm or leech 
was dipped for only four seconds in alcohol, 
it became stiff and inexcitable as far as it had 
been immersed, and, although in frogs and 
puppies submitted to the same experiment this 
state of rigidity could sometimes be removed, 
in the earth-worm or leech it remained per- 
manent.^ 

In addition to this morbid state of the 
organs of digestion occasioning a weakness of 
their digestive power, the diminished appetite 
of those who live principally on alcoholic drinks 
causes a deficiency of the solid food taken. 
The strength of the body is also thereby im- 
paired, thus predisposing it to suffer from 
chronic alcoholism. 

' Dr. Carpenter, ' On the Use and Abuse of AlcohoKc 
Liquors/ p. 8. 



46 CHEOl^IC ALCOHOLISM. 



IMMEDIATE CAUSES OF AN ATTACK OF 
CHEONIC ALCOHOLIC INTOXICATION. 

A question of great practical importance 
now suggests itself to our notice. What is 
the nature of the last and immediate cause 
which determines an outbreak of the disease ? 

This question is one very difficult to answer, 
for in many cases the disorder creeps on 
slowly, under the influence of predisposing 
causes, so that when the urgency of the 
symptoms obliges the sufferer to have recourse 
to medical advice, he cannot state precisely 
the time when the illness began, neither can he 
ascribe it to any particular cause, except 
that of intemperance. The usual expression 
of such patients is: that drinking does not 
agree with them; and under these circum- 
stances many drop the habit entirely, or greatly 
diminish their allowance. Thus, for example : 
G. E; — (Case 18), found his health was 
gradually giving way from intemperance, 
and gave up drinking about eleven months 
previous to admission. In the case of C. P — 



. IMMEDIATE CAUSES. 47 

(Case 21), no other immediate cause of the 
illness could be detected than hard drinking ; 
he had fallen ill four years before admission_, 
and during nine years had been in the habit of 
taking no less than twelve pints of beer daily. 
An exceptional excess. — An attack of chronic 
alcoholism will frequently be determined in ha- 
bitual tipplers by an exceptional excess and a 
severe fit of drunkenness. Thus_, for instance : 
J. W — (Case 11), age 18_, after drinking all 
day from ten in the morning to twelve at 
night, was suddenly seized next morning with 
symptoms of chronic alcoholism. G. F — / 
admitted on the 10th of January, 1859, com- 
mitted an extraordinary excess during three 
days — at Christmas last, when he took six or 
seven quarterns of raw gin, and about three 
pints of beer daily, after which he suffered 
from chronic alcoholism. He is not an ha- 
bitual drunkard, and takes usually a pint of 
beer daily. W. P — (Case 26), two nights 
previous to falling ill, indulged more than 
usual, and was drunk. 

' Not reported iu the Table from want of completeness 
of notes. 



48 CHRONIC ALCOHOLISM. 

B. L — (Case 36), admitted on the 28tli 
February, 1859, was attacked with clironic alco- 
holism four years ago, but is worse now than 
previously, from drinking at Christmas last 
more than his usual allowance. 

Coeoeisting disease. — An attack of chronic 
alcoholic intoxication is frequently brought on 
by another disease, whether this disease be pro- 
duced directly by excessive drinking, or whether 
(which seldom happens) it be quite independent 
of intemperate habits. The sapae observation 
applies to delirium tremens, a disease very 
closely allied to chronic alcoholism. 

We read in the work of E-oesch : '^ An indi- 
vidual in the habit of drinking to excess, af- 
fected by a chronic or acute disease, which 
cannot be attributed directly to intemperance, 
often suffers from peculiar symptoms, and the 
alcoholic poisoning which had remained latent 
breaks forth suddenly. This happens in the 
case of delirium tremens, especially when 
drunkards become affected with inflammation 
of the lungs.^^ In one case, Roesch has ob- 
served the disease to be brought on by very 
painful attacks of rheumatism. 



IMMEDIATE CAUSES. 49 

Dr. Schmidt, at tlie General Hospital of 
Hamburg, has seldom seen a perfectly genuine 
case of delirium tremens ; this ajQPection 
appeared to him to be brought on usually by 
powerful emotions, and by external lesions, 
and inflammations, especially of the chest. He 
reports, that Channing states having met with 
delirium tremens attended six times on seven 
with an affection of the chest. The habit of 
drinking may therefore be indulged in with im- 
punity until the occurrence of some affection 
of the lungs, or rheumatism, or another ill- 
ness, causes the appearance of those symptoms 
directly referable to the abuse of alcoholic 
stimulants. The two following cases, where 
chronic alcoholism was occasioned by attacks 
of gout, are well calculated to illustrate the 
truth of the foregoing observation. T. D — 
(Case 47), a cab-driver, age 42, admitted on 
the 25th of April, 1857. He began drinking 
five or six pints of ale daily, which he kept 
up for upwards of five years. Since that time 
he increased his allowance to ten small glasses 
of brandy, as much gin, and ten glasses of 
ale daily. He went on taking this large quan- 

4 



50 CHEOiS'IC ALCOHOLISM. 

tity of ale and spirits for eight or ten years, 
being none the worse for his intemperance, 
until he was seized with gout two years before 
admission. The disease lasted a fortnight, and 
was followed by a severe attack of chronic alco- 
holism, from which he has suffered ever since. 
D. B — (Case 27), a green- grocer, age 72, 
admitted as out-patient on January the 17th, 
1859. Took to the habit of drinking to 
excess when a young man, his average allow- 
ance being four or five glasses of spirits 
and three or four pints of beer daily ; but for 
the last fourteen or fifteen years he has given 
up hard drinking, and reduced the amount to a 
pint of beer daily and an occasional glass of 
spirits. On rising in the morning he trembles 
a great deal for rather less than half an hour ; 
perceives occasionally imaginary objects, and 
a mist forms at times before his eyes ; hears 
absent people addressing him ; does not com- 
plain of headache or giddiness ; has very little 
sleep — according to his own expression, night 
after night he lies awake in the greatest 
agony. Frequently suffers from sickness and 
vomiting. These various symptoms have as- 



IMMEDIATE CAUSES. 51 

sumed an intermittent form, lasting for a 
month, and occurring at intervals of abont a 
week. The patient suffers, moreover, from 
gout, as will be seen from the following ad- 
ditional statement. There is considerable 
pain in the ankles, knees, and hands ; the 
thumb of the right hand is now greatly 
thickened; he feels an acute pain in the 
great toes of both feet, and can only walk with 
the assistance of a stick. These symptoms 
invariably occur with those of chronic alcohol- 
ism. As soon as the attack of gout passes 
off, the patient becomes also free from the 
other disease, and as often as the gout returns 
the nervous system again becomes affected. 
In this case, therefore, the occurrence of gout 
was obviously the immediate cause of the attack 
of chronic alcoholism. I have had opportu- 
nities of observing a similar effect resulting 
from rheumatism, affections of the lungs, and 
gastritis. 

Independently of the fact that the poi- 
sonous action of alcohol is often developed by 
the occurrence of another disease, chronic 
alcoholism, it may be observed, is very fre- 



52 CHEOKIC ALCOHOLISM. 

qiiently accompanied by a secondary disorder, 
whicli it is difficult to connect with the out- 
break of the former ; and, moreover, the 
morbid condition of the nervous system, owing 
to long-continued intemperance, is not unfre- 
quently concealed by the coexistence of another 
disorder, exhibiting symptoms of a more pro- 
minent and decided character; I need not 
insist on the importance of making in these 
cases a correct and complete diagnosis. A 
glance at the synoptical table will show the 
tendency of bronchitis to accompany chronic 
alcoholism. For instance, J. H — (Case 20), 
suffering from chronic alcoholism, is attacked 
every winter with bronchitis ; J. E- — (Case 23), 
admitted at first for bronchitis, to which he has 
been subject for several years ; but it was found 
subsequently, he also laboured nnder chronic 
alcoholic intoxication ; J. H — (Case 25), was 
treated at first for bronchitis, shortly after his 
admission it was discovered he was sufiering 
from chronic alcoholism. 

Aff'ections of the stomach are so very fre- 
quently the result of excessive drinking, that 
it is difficult to determine whether thev are 



IMMEDIATE CAUSES. 53 

actually the cause whicli determines the out- 
break of chronic alcoholism or constitute 
merely a coexisting disease. Dr. Budd gives 
us the following correct and interesting account 
of the disorder of the stomach so frequently 
met with in drunkards : ^' The chief characters 
of this (indigestion of drunkards) are want of 
appetite, and vomiting or dry retching in the 
morning_, with a white or furred tongue, and a 
slow pulse ; the power of digestion is much en- 
feebled, and if the patient eat at any time, 
what for others would be a very moderate 
meal, he is apt to vomit soon afterwards, and 
to be troubled with pain and flatulence, 

'^ This disorder, like the vice from which it 
springs, is most frequent in men of middle 
age, and is generally associated with more or 
less of that strange and peculiar disturbance 
of the nervous system which hard drinking 
brings on, and of which the most striking 
effects are inability to sleep or sleep broken by 
frightful dreams, despondency in the morning, 
and tremulousness of the hands and tongue.^^ 

I have often asked my patients whether 
the loss of appetite, pain in the stomach, and 



5^ CHEONIC ALCOHOLISM. 

vomiting preceded the appearance of the 
nervous symptoms, but have very seldom 
obtained a perfectly precise and satisfactory 
answer; opportunities have, however, offered 
for my observing, that an increase of the mor- 
bid condition of the digestive organs may be 
attended with a marked progress of the dis- 
turbance of the nervous system, and that an 
improvement of the digestion may be ac- 
companied with a diminution of the nervous 
symptoms. A glance at the accompanying 
table will show the frequency of disordered 
digestion in cases of chronic alcoholic intoxi- 
cation. J. T — (Case 13) complains of pain 
in the stomach as soon as he has ate or 
drank. L. M — (Case 17), on falling ill, first 
complained of pain in the stomach after taking 
food, and restlessness at night. W. F — (Case 
24) suffers from pain in the stomach and sick- 
ness, increased after taking food. W. P — 
(Case 26) complains of pain in the stomach, 
increased by eating. D. W — (Case 28) has 
lost his appetite and feels sick in the morning. 
B. L — (Case 36), appetite deficient, great 
pain in the stomach after eating. 



IMMEDIATE CArSES. 55 

Cerebral concussion. — I have met with 
an instance of chronic alcoholism suddenly 
occasioned by a fall^ producing at the 
time cerebral coDCUssion. This case was 
that of A. P- — (Case 41), a gas-fitter, in 
the habit of drinking six or seven pints of 
beer daily for the last two or three years. 
Six or seven months previous to admission, 
being then in perfect health, he fell from a 
height of twenty-five feet. The fall must 
have been attended with cerebral concussion, 
as he stated that " his nerves appeared to 
have been shaken.^^ From that time he began 
to sufier from symptoms of chronic alcoholism, 
which were subsequently increased by smoking. 
On admission he complains of want of sleep, 
with wandering of the mind and giddiness; 
trembles and feels sick in the morning, has 
no appetite, and suffers from pain in the 
stomach. I beg to remind the reader that 
the symptoms of cerebral concussion and of 
drunkenness are very much alike, and if it be 
admitted that a fit of intoxication is frequently 
the immediate cause of an attack of chronic 
alcoholism, a similar result may be ex- 



56 CHBONIC ALCOHOLISM. 

pected from cerebral concussion. The analogy 
between the symptoms of drunkenness and 
cerebral concussion has been observed by Sir 
Benjamin Brodie. (See ' Phil. Transact.' for 
1811.) He states, p. 181: ^^ Concussion of 
the brain, which may be considered as the 
slightest degree of injury, occasions a state 
of mind resembling intoxication, and the re- 
semblance in some instances is so complete, 
that the most accurate observer cannot form a 
diagnosis except from the history of the case.'' 
It may be stated, I believe, as a general 
rule, that any disease affecting subjects given 
to drinking, will, by weakening the body, 
more fully expose the nervous system to suffer 
from intemperate habits. 



ALLIED AEEECTIONS. 57 



AFFECTIONS OF THE NERYOUS SYSTEM 

RESEMBLING CHRONIC ALCOHOLIC 

INTOXICATION. 

There exist certain disorders of tlie func- 
tions of the nervous system owing to other 
causes than intemperance,, and closely re- 
sembling chronic alcoholism; these are pro- 
duced by long-continued and excessive intel- 
lectual exertions and by sudden and violent 
emotions. These affections exhibit symptoms 
which bear a close analogy to those of chronic 
alcoholism^ and I have treated them success- 
fully by the same means. 

I have preserved notes relating to several 
patients who suffered from disorders of the 
nervous system owing to excessive mental ex- 
ertions^ the principal symptoms being head- 
ache and giddiness^ with much nervous un- 
easinesSj and sometimes hallucinations ; want 
of sleep, and occasional palpitations. 

In November, 1854, I attended Mrs. B — , 
aged 24 ; for the last three months she had 



58 CHEONIC ALCOHOLISM. 

been greatly engaged with literary pursuits, 
and ascribed her illness to excessive reading 
and exertion of the mind; she suffers from 
headache, giddiness, and great nervous un- 
easiness ; she cannot sleep at night, her appe- 
tite is indifferent, and she is subject now and 
then to palpitations. 

The following is a remarkable case which 
came under my notice, where the disturbance 
of the nervous system, from excessive mental 
exertion and anxiety, had reached such a 
pitch as to become actual mental alienation. 

C. T — aged 41, a gas-rate collector, appa- 
rently in easy circumstances, of a very ner- 
vous temperament and excitable temper. He 
had also been a gas inspector and subject 
to much anxiety connected with his busi- 
ness. There exists a slight tendency to suicide, 
but he observes that he never could or would 
destroy himself. He is accompanied by his 
wife, who considers all he says as perfect 
truth. C. T. expresses himself fluently, and 
his memory appears very lucid, from the 
minute account he gives of his case. On 
September 13th, 1855, he was engaged the 



ALLIED AITECTIOIS'S. $^ 

whole day in writing, and appeared much 
excited; he went to bed at 11 o'clock, and the 
next niorning rose at 3. At 9 a.m. he pro- 
ceeded to his business, leaving his papers in 
great disorder, which he had never done before. 
He returned home at 5 p.m., and asked for 
some tea. Having shortly afterwards kissed 
his children, (his wife was then absent), he left 
home, though for no definite purpose, taking a 
few pounds with him. He wandered about 
all night, and found himself in the morning 
at Hampton Court. He continued walking, 
not knowing where he was going or why 
he had left his house, and after some days 
arrived at Southampton. He next embarked 
on a packet leaving for France, and resumed 
his rambles in Normandy, where he suffered 
great privations, sleeping in the fields and 
on the high road, and living upon nothing but 
turnips, apples, and water. Having remained 
abroad for abont one month, at the commence- 
ment of November he returned to Plymouth, 
stopping on his way at Jersey ; and then 
wandered to Teignmouth, Totness, Exeter, and 
from thence to Bristol and Clifton. He still 



60. CHE0:5fI0 ALCOHOLISM. 

had some money with him^ although he 
thought he had none, and that he wanted none. 
With the view of joining his family on the birth- 
day of one of his children, this unfortunate 
man returned home, and arrived late at night 
at his own door; the person who opened it 
unluckily did not recognise him, and closed 
the door upon him. He then set off again 
on his rambling life, and walked to Brighton 
with the object of visiting some relations 
who he knew would be kind to him ; but 
when at Brighton he never called upon them, 
although he passed under their very win- 
dows ; he does not know why he did not see 
them. From Brighton he went to Shore- 
ham, to Worthing, and to Preston, where, his 
money being entirely spent and having no 
food, he began to suffer the most bitter pangs 
of hunger. He used his utmost endeavours 
to obtain food from charitable institutions, 
and was directed to Arundel, whence, finding 
no relief, he proceeded to Chichester. In 
this town the sufferings from hunger were 
such that he was induced to procure food by 
dishonest means; he was taken up and im- 



ALLIED AFFECTIOJTS. 61 

prisoned^ with hard labour, for twelve days. 
When liberated he immediately started for 
London, to which he walked in two days, the 
distance being sixty-four miles. During the 
journey he took nothing but bread and water ; 
he proceeded immediately to his house, and 
arrived there on the 27th of November, having 
been absent from home more than two months. 

It was not until this patient had been 
thoroughly cross-questioned that I could be- 
lieve the foregoing account ; in order to 
obtain a corroborative evidence, I examined 
his naked feet, and found the soles hardened, 
resembling tough leather, and showing that he 
had certainly walked a considerable distance. 

Sudden grief may produce symptoms iden- 
tical with those of chronic alcoholism ; indeed, 
in the following case I was with some diffi- 
culty convinced that the patient was not 
addicted to the habit of excessive drinking. 

H. M. — , a coal-porter, admitted as out- 
patient on March 10th, 1859, is of regular 
habits, and has never been addicted to drinking ; 
has not been more than twice in his life the 
worse for liquor. Lost his wife eight months 



62 CHRONIC ALCOHOLISM. 

ago, at which, he was greatly distressed, and 
since then has suffered from the frequent oc- 
currence of giddiness, headache, and black 
specks before his eyes. He trembles a great 
deal, especially in the morning; cannot sleep 
well at night, but his sleep is not disturbed 
by nightmare. Is very weak, yet has not 
given up work. Has smoked a great deal 
after the death of his wife, for the purpose, 
he says, of driving care away ; he now per- 
ceives that smoking makes him very giddy, 
and he is gradually giving up the habit. 

There are other diseases having symptoms 
in common with chronic alcoholism, such as 
chorea, hysteria, the sequel of an attack of 
apoplexy, and tremors from poisoning with 
lead or mercury ; but it would be inconsistent 
with our subject to enter upon any observa- 
tions on these affections. 

Prognosis. — As may be anticipated, the 
successful treatment of chronic alcoholism de- 
pends, first of all, on the habit of drinking to 
excess being given up. As soon as this result is 
obtained, or if the patient applies for relief 
after having, of his own accord, ceased drinking, 



PEO GNOSIS. 63 

a favorable issue of the disease is to be ex- 
pected. In those instances where the complaint 
is unattended with other disorders, and if the 
patient be not in reduced circumstances, the 
treatment is very successful, the sufferer being 
cured of every symptom ; the weakness of the 
limbs, so prevalent in this disease, is some- 
times, however, troublesome to overcome en- 
tirely. But in cases where the disordered 
nervous system, consequent on intemperance, 
is accompanied by another disease, the treat- 
ment may have to be continued for some 
length of time, and will sometimes leave the 
patient still labouring under the secondary 
affection. A remarkable instance of this kind, 
which has already been alluded to, was that of 
an individual subject to gout, and who was 
seized with chronic alcoholism at every suc- 
cessive return of the gouty attacks. He was 
treated for chronic alcoholism, and gradually 
the symptoms of the morbid condition of the 
nervous system disappeared, although the at- 
tacks of gout returned. Disease of the liver 
appeared in one instance to keep up chronic 
alcoholism, although in the course of the 



64 CHEONIC ALCOHOLISM. 

treatment a marked improvement of the 
nervous symptoms was obtained. Inflam- 
mations of the Inngs also increase the 
difficulty of arresting and curing the disease. 
The same observation applies to disorders of 
the digestive organs, and rheumatic affections. 
But it must be understood that an improve- 
ment in the secondary disease is usually 
attended with a relief of chronic alcoholism. 



TREATMENT OE CHRONIC ALCOHOLIC 
INTOXICATION. 

The treatment of a chronic disease is 
usually attended with much difficulty, and a 
long period will generally be required to effect 
a complete cure, even when such an end is 
attainable. I have succeeded, however, by a 
simple method, and within a comparatively 
limited period, in restoring health in cases of 
chronic alcoholism of the severest description. 
The treatment is to be considered under two 
heads : 1, the patient must be induced to 



TEEATMENT. 65 

give up the habit of drinking, unless lie has 
done so previously ; and 2, the inordinate 
desire for alcoholic stimulants having been 
subdued, the next point is to arrest the 
disease. It is usually considered that the 
habitual abuse of spirituous liquors becomes 
so inveterate as to defy all control ; and the 
following case, related by Macnish, bears upon 
the subject ; " A gentleman accustomed to 
drink to excess answered to the exhortations 
of a friend — ^ If a bottle of brandy stood at 
one hand, and the pit of hell yawned at the 
other, and if I were convinced I should be 
pushed in as surely as I took one glass, I 
could not refrain/ '' I have observed, how- 
ever, that when health is evidently gi^^ing way 
from over-indulgence in spirituous beverages, 
drinking is often given up spontaneously, or, 
at all events, considerably diminished. By 
consulting the analytical table the reader may 
notice that in the cases of W. H — (Case 7), 
J. T— (Case 13), E. C— (Case 15), L. M— 
(Case 17), G. R— (Case 18), C. P— (Case 21), 
J. H — (Case 30), and others, the allowance 
of spirituous beverages had been spontaneously 

5 



66 CHEONIO ALCOHOLISM. 

diminished^ or altogetlier stopped^ long before 
applying for medical advice. In these in- 
stances, the patients stated they had given up 
excessive drinking because they considered 
their health was suffering from it. When the 
habit of drinking has become inveterate, I 
have invariably found it of great importance 
to begin by obtaining the full confidence of 
the patient. Dr. Trotter, describing the means 
of checking this pernicious habit, observes 
— " When the physician has once gained the 
full confidence of his patient, he will find 
little difficulty in beginning his plan of cure. 
This confidence may sometimes be 
employed to great advantage when your 
regimen is in danger of being transgressed, 
for frequent relapses and promises repeatedly 
broken, will, in such situations, render the 
physician's visits a work of great trial to his 
patience. This disease (I mean the habit of 
drunkenness) is like any other mental de- 
rangement — there is an ascendancy to be 
gained over the person committed to our care, 
which, when accomplished, brings him entirely 
under our control.^' 



TEEATME2^T. 67 

It will be necessary to begin by impressing 
upon the patient^ s mind that he is really suffer- 
ing from the habit of drinking too much^ and 
that it is of no use to commence a medical treat- 
ment unless he be decided to abstain from spiri- 
tuous stimulants, or, at all events, diminish 
considerably his usual allowance. If he appear 
ready to act according to this advice, it will 
be desirable to inquire into the cause of the 
abuse, and remove it, if possible. Should 
an individual drink from habits of indolence, 
let him exercise his mind and body ; if 
another drinks to drown dull care, let him 
have amusements ; if intemperance results 
from frequenting bad company, let such 
acquaintances be dropped ; if spirituous liquors 
be taken as a preservative against cold, let 
the clothing be increased, and a mor^ nutri- 
tious solid diet taken. 

But, as Roesch observes, — " The inordinate 
desire (passion) for drink becomes itself a 
cause of drunkenness, for when the body has 
accustomed itself to spirituous liquors, it can 
no longer do without them." In such cases 
little can be derived from an attempt to stop 



6S cheo:n'ic alcoholism. 

the cause of intemperance, and other means 
must be adopted. Macnish relates the case 
of an individual in Maryland_, much addicted 
to drinking, who heard one evening a noise 
in his kitchen, and, on opening the door to 
ascertain its cause, found his servants laughing 
at the exhibition of a young negio, who was 
engaged in mimicking his master under the 
effects of liquor ; this comic scene produced 
such an impression on him that he was never 
known to be drunk again. Dr. Pitcairn is 
reported to have cured a Highland chieftain 
by obtaining from him a promise that he 
would drop a little sealing-wax every day 
into his whisky-glass, when after a time, 
the sealing-wax having filled the glass, he 
could drink no more. A gentleman, to 
wean himself from drinking, used to add a 
glass of water to his bottle for every glass of 
Hollands he took out, till at last the drink 
got so insipid that he could no longer go on 
with it. An American physician. Dr. Kairns, 
taking advantage of the nauseating properties 
of tartar emetic, has advised this drug to be 
mixed with the patient's drink; but this 



TEEATMENT. 69 

process is condemned by E»oescli, who ob- 
serves that the trick will soon be found out, 
and drink procured that has not been pre- 
viously medicated. Tartar emetic has_, besides, 
the disadvantage of acting injuriously on the 
patient^ s health. 

There is in every class of society a num- 
ber of persons who, although they do not 
become intoxicated, suffer from chronic alco- 
holism, from drinking more spirits, wine, or 
beer than agrees with their health. Most 
of these persons lead a useful and active life, 
and apply for medical advice, being quite 
unaware of the cause of their illness. Many 
of the upper ranks of society are thus seized 
with symptoms of chronic alcoholism. The 
habit of indulging freely in wine at fre- 
quent dinner-parties, of drinking wine at 
lunch, of taking occasionally a glass of wine 
between meals, or of sipping every evening 
two or three glasses of sherry and water, or 
brandy and water; the usual good living at 
the officers^ mess or at the clubs ; the custom 
which exists for commercial travellers, not 
only of using freely stimulants at dinner, but 



70 CHEOI^'IC ALCOHOLISM. 

also of drinking wine with their customers 
when transacting business^ and finding, of 
course^ an equal pleasure in these potations^ — 
all these various circumstances, and many 
others besides, are quite sufficient to bring 
on an attack of chronic alcoholism when an 
individual is predisposed to the disease. 
Drinking is not usually in these cases an 
indomitable habit, and accordingly, the pa- 
tient will gladly give it up if he feel 
certain that by so doing his health can be 
improved. 

A general opinion is very prevalent, that an 
individual, whose health suffers from the habit 
of drinking to excess, may cure himself by 
taking to sober habits or giving up drink 
entirely; and, it is with this end in view, 
that many are induced to join temperance 
societies. I have shown, however, the fallacy 
of this idea, not only by reporting Dr. Car- 
penter^s opinion on the subject, but also by 
bringing forward a certain number of in- 
stances where patients applied for advice sub- 
sequently to their having partly or entirely 
given up the habit of hard drinking. It is 



TREATMENT. 71 

consequently necessary^ after putting an end 
to the habit of drinking to excess^ to adopt 
an active medical treatment. 

The nature of the diet to be recommended 
will vary according to circumstances. In 
general, those suffering from chronic alco- 
holism have little or no appetite. The first 
step in such cases is to begin by relieving 
this symptom, and then recommend a nutri- 
tious and easily digestible food, such as broth, 
sweetbread, carefully roasted meat, provided it 
be lean, on account of the secretion of bile 
and pancreatic juice being probably much 
below their usual standard. Strict attention 
must be paid to this part of the treatment, 
as an insufficient and unhealthy kind of food 
undoubtedly predisposes the body to suffer 
from the morbid effects of the long-continued 
habit of indulging to excess in spirituous 
beverages; and, on the contrary, a healthy 
and nutritious diet is known to be bene- 
ficial. 

The following illustration shows the im- 
portance of attending to diet in cases of 
chronic alcoholism : J. T — (Case 13), a poor 



72 CHEOIsriC ALCOHOLISM. 

labourer, formerly addicted to drinking to 
excess, had been out of work for a long 
time, and could procure little besides tea and 
bread and butter ; be complained of the usual 
nervous symptoms of chronic alcoholism, and 
also of want of appetite and great pain in the 
stomach. His circumstances, however, gradually 
improving, he was able to afford better food, 
when the appetite became keener, with a simul- 
taneous diminution of the pain and of the 
nervous symptoms. Not long afterwards, being 
again obliged to reduce his diet, the pain, 
want of appetite and symptoms of chronic 
alcoholism returned. 

With respect to the use of alcoholic stimu- 
lants, if the patient has completely given them 
up for some time, and entirely lost his taste for 
liquor, I have been in the habit of recom- 
mending about a pint of bitter beer daily, 
to be taken at meals ; but in so doing 
much care is required, as some patients, who 
formerly could drink hard without being 
the worse for it, become liable to be easily 
affected by alcoholic beverages, even of the 
mildest description. The reader need hardly 



TEEATMEKT. 73 

be reminded that tea and coffee are excellent 
substitutes for alcoholic drinks, which they 
resemble^ not only by their stimulating powers, 
but also by their remarkable property of 
diminishing the waste of the body, thus effect- 
ing an indirect process of nutrition. In cer- 
tain countries, such as Norway, where in many 
districts alcoholic drinks are seldom to be 
obtained, I have observed coffee and milk 
to be extensively used, both as food and in 
the place of beer and spirits. But although 
tea or coffee may be resorted to as beverages, 
they cannot be introduced at dinner instead 
of wine and beer. Many do not like soda 
water ; toast and water is unpalatable ; such 
beverages as lemonade are unpleasant when 
taken with solid food, and no choice there- 
fore seems to remain but to drink pure water, 
which, although insipid at first when taken 
by those who are in the habit of drinking beer 
and wine, soon becomes agreeable and refresh- 
ing, especially if ice cold. 

We shall now proceed to inquire into the 
therapeutical treatment of the morbid condition 
of the body described in the preceding pages., 



74 CHEONIC ALCOHOLISM. 

Chronic alcoholism is not to be cured^ like 
delirium tremens, in the course of a few days; 
for although under an appropriate treatment 
a marked improvement may in most cases 
occur after a short time, a much longer period 
will be required to restore the patient to 
perfect health. 

Magnus Huss has derived very satisfactory 
results from the treatment of chronic alco- 
holism with fuseloil (fuselol, or Fermentoleum 
solani), given in the form of pill with Althea 
root/ and has observed this medicine to di- 
minish considerably the trembling, uneasiness, 
formications, and feeling of weakness. He 
has found opium useful, especially when given 
with the view of checking the formications, 
twitching of the muscles, cramps, and con- 
vulsions ; but he has not noticed this drug to 
relieve the patient from the nightly halluci- 
nations, and considers it as contra-indicated 

^ The prescription used by Dr. Huss is as follows : 
R rermentolei solani, 3j ; 
Eadix althsese pulveratse, 5j ; 
Misc. 'c. Syrupi althsese, q. s., ut f. mass. e-qu. form. 

pilulse seq. N. xl. 
Two pills are to be taken six times daily. 



TEEATMEIs'T. TjS 

in cases attended with delirium during tlie 
daytime. He alludes to camphor as having 
the property of allaying the nervous un- 
easiness, tendency to delirium, and the 
occurrence of hallucinations while endea- 
vouring to fall asleep; he also recommends 
camphor as a means of checking the giddi- 
ness and faintness ; it is to be given in 
doses of from one to five grains. He has 
obtained good results from the use of Arnica 
(Flores arnicse) when, after having been cured 
of the trembling and formication, the patient 
still complained of a feeling of weakness, 
accompanied with dulness of the mental facul- 
ties, noises in the ears, and the appearance of 
flying specks when in an erect position. He 
has recourse to medicines containing iron when 
others fail in their action. Finally, Huss often 
makes use of spirituous fluids, prescribing a 
glass of brandy to be taken twice daily, or 
a daily allowance of two glasses of port or as 
much sherry, or three or four table-spoonfuls 
(esslofiel) of Tinct. Absynthii or Tinct. Cin- 
chonse ; he prescribes sometimes forty or sixty 
drops of Spiritus Etheris Sulphurici (ether 



76 CHEONIC ALCOHOLISM. 

spirituosus) to be taken twice or tliree times a 
day, or half a bottle of porter to be drunk in 
tbe forenoon. I have tried the effects of 
opium^ carbonate of ammonia, preparations of 
iron, bitters, and other medicines, which were 
attended with more or less benefit ; and in 
cases where the digestion was disordered, 
opium has been administered with very good 
results, besides my finding it very useful in 
bringing on sleep in one or two cases where 
oxide of zinc had failed to produce this result. 
I have not often observed bitters and iron to 
be beneficial at the outset of the disease, but 
the patient being in a fair way of recovery, 
steel and quinine have proved of great service. 
In some cases attended with headache, con- 
siderable relief was obtained from the applica- 
tion of a small blister behind the neck. • 
If, however, chronic alcoholism be considered 
as depending on a peculiar diseased condition 
of a certain part of the body, owing to the 
action of a poison, no remedy can be looked 
upon as decidedly efficacious imless it exerts 
its power not directly on the symptoms them- 
selves, which are but the signs of the illness, 



TEEATMEIfT. 77 

but on the principle of the disorder. Bearing 
this in mind, I have endeavoured to discover 
a treatment which, by acting immediate!}^ on the 
nervous system should remove its diseased con- 
dition — the result of the long-continued abuse 
of alcoholic stimulants, thereby acting as a 
means of arresting the symptoms of the 
illness. I am consequently not about to 
recommend one remedy for a certain symp- 
tom, and another remedy for another symptom^ 
but shall endeavour to show that there exists 
a substance, possessed of powerful and definite 
medicinal properties, and having the remark- 
able property of restoring to health, or at 
all events of greatly relieving the disordered 
nervous system of persons suffering from 
chronic alcoholism; the medicinal agent in 
question acting efficaciously in cases w^here 
the principal symptom may be either sleep- 
lessness, or hallucinations, or trembling, or 
any other; and this substance is Oxide of 
Zinc 

I shall first proceed to give an account 
of the action of oxide of zinc on the human 
body in health and in disease, and then show 



78 CHEONIC ALCOHOLISM. 

how powerful an agent it is for tlie cure 
of the particular complaint of which we are 
treating. 



PHYSIOLOGICAL PROPERTIES OE OXIDE 
OE ZINC. 

This subject has been ably investigated by 
Dr. Michaelisj of Tubingen, Dr. Bouchut, 
De la Roche, Dr. Herpin, of Geneva, and 
others. 

Oxide of zinc, although very sparingly 
soluble in water, is readily dissolved in the 
stomach and intestines. According to the 
experiments of Michaelis, the metal finds its 
way into the blood, bile, and urine ; twenty- 
four hours after the injection of a salt of zinc 
into the crural vein the bile exhibited evident 
traces of zinc. It appeared in the bile pre- 
vious to being eliminated from the body with 
the urine. This gentleman also observed, 
from experiments upon animals, that large 
doses of oxide of zinc produced erosions and 
ulcerations of the mucous membrane of the 



TEEATMEIfT. 79 

stomach, and that it may induce within the 
organs of respiration granulations analogous 
to miliary tubercles. Moreover, according to 
Michaelis, the long-continued use of moderate 
doses of oxide of zinc interferes with diges- 
tion, producing ansemia and marasmus. He 
found the blood of dogs taking oxide of zinc 
to contain 0*99 or very nearly 1 per 1000 of 
fibrin, instead of 1*92, the normal proportion. 
Dr. Bouchut, on repeating the experiments of 
Michaelis, succeeded, however, in giving to 
a strong rabbit doses of from five to ten 
grains of oxide of zinc without inconvenience 
to the animal.^ 

Dr. Herpin, after a long and careful series 
of observations on the efiects of oxide of zinc 
upon the human body, has arrived at the 
following conclusions •? 

That it is a perfectly harmless remedy, and 
may be given in doses of as much as six 
grammes (90 grains) a day, for a very con- 

^ 'Etudes sur le Lactate de Zinc dans I'Epilepsie/ par 
le Dr. Herpin. 

2 ' Du prognostic et du traitement curatif de I'Epilepsie/ 
1852, p. 565. 



80 CHEONIC ALCOHOLISM. 

siderable time, without producing any other 
inconvenience than temporary uneasiness. 

That its physiological effects are confined 
to a mild action (action legere) on the in- 
testineSj consisting usually, in the case of 
adults, of nausea which may occasion vomit- 
ing; and, in the case of children, of slight 
diarrhoea. 

That the medicine is easily made to be 
tolerated without discomfort, by beginning, in 
the case of adults, with 4*5 to 6 grains a day, 
and in the case of children with from 1 to 2*5 
grains a day, these quantities being divided 
into three or four doses; and then giving, 
every week, from 2*5 to 3 grains more daily 
to adults, and from 1 to 2*5 grains more daily 
to children. 

That the form of pill is sometimes a means 
of enabling its being tolerated. 

Finally, that the uneasiness occurs less 
frequently when the medicine is taken an hour 
after a meal, than when fasting, and that the 
first dose in the morning is always that which 
is attended with the most discomfort. 

It appears that since Dr. Herpin wrote his 



TEEATMENT. 81 

valuable treatise on epilepsy, he has slightly 
modified his opinion respecting the first of his 
conclusions, for, in a paper entitled ' Etudes 
sur le Lactate de Zinc dans TEpilepsie/ 
published by him in 1855, he observes, that 
after a long-continued use of oxide of zinc, 
when it has been taken to the extent of from 
120 to 473 grammes, unfavorable symptoms 
may occur, young women being more especially 
subject to sufier in such cases from ansemia 
and chlorosis; the symptoms, however, only 
acquiring some degree of importance, when the 
treatment has been persevered in for one 
month after the first appearance of the un- 
favorable effects. 

I have confined myself in my researches 
pn the action of zinc on the human body, 
to the use of the metal under its form 
of oxide, and have obtained the following 
results : 

1. That after taking this substance in doses 
of from two grains and upwards in the case 
of adults, a feeling of nausea is sometimes 
perceived, but seldom to the extent of pro- 
ducing vomiting. This effect is diminished if, 

6 



82 CHEONIC ALCOHOLISM. 

according to Dr. Herpiii''s practice^ the medi- 
cine be given about an hour after a meal. 

2. That after persevering with the treat- 
ment for some days^ the medicine is in most 
cases tolerated^ and the nausea and uneasiness 
produced at firsts diminish, and even dis- 
appear. 

3. That a slight giddiness attended with the 
appearance of black specks before the eyes^ 
and rumbling noises in the ears_, may accom- 
pany the nausea occasioned by oxide of zinc ; 
this is an indication of the doses being too 
highj and on diminishing them^ these symptoms 
disappear. 

4. A very important and remarkable effect 
of oxide of zinc is the power it frequently 
possesses of producing sleep. 

5. I have not noticed the long- continued 
use of oxide of zinc to produce evidently 
deleterious effects, even after it has been taken 
for a considerable length of time. 

The feeling of nausea and sickness occa- 
sioned by preparations of zinc appears to vary, 
to a certain extent, according to the form of 
the compound, for we are informed by Dr. 



TBEATMEN^T. 83 

Herpin that lactate of zinc is not so likely to 
be liable to tbis inconvenience as tbe oxide. 
The fact of oxide of zinc producing less 
uneasiness wben taken after food is obviously 
owino- to its state of dilution in a full stomach. 
Dr. Herpin bas also observed that oxide of zinc 
is better tolerated wben taken under tbe form 
of a pillj wbicb may be accounted for by 
assuming tbat tbe substance is dissolved in 
tbe stomach, under that shape^ less rapidly than 
under tbat of powder. It must be remem- 
bered^ however^ tbat oxide of zinc made up 
into pills may altogether escape absorption, 
and for tbat reason I prescribe it frequently 
as a powder. Some years ago, a female out- 
patient of the Westminster Hospital, who was 
taking pills of oxide of zinc and confection 
of roses, brought me a hard concretion she 
bad removed from her motions. I found 
it, on examination, to be one of the pills 
taken, which had consequently escaped ab- 
sorption. It is very questionable whether 
the whole of the medicine is absorbed when 
given in large quantities, for it is remarkable 
to what extent the doses may be increased 



84 CHEONIC ALCOHOLISM. 

with impunity; I have frequently prescribed 
as much as twenty grains of the substance to 
be taken twice a day^ and in two cases of 
epilepsy the dose was raised to thirty- five 
grains twice a day. With respect to the 
mechanism of its absorption^ it is first dis- 
solvedj not only by the gastric juice, but also 
by the free acid (probably lactic acid) and acid 
phosphates of the juice of the meat contained 
in the stomach; the fats of the meat taken 
also very probably combine with it, especially 
the fatty acids derived from the neutral fats 
of food; the conversion of more or less fat 
into fatty acids being a phenomenon I have 
shown to take place invariably during diges- 
tion/ and both M. ChevreuiP and MM. 
Jeannel and Moncel/ have . observed that fats 
enter into combination with metallic oxides, 
forming a peculiar kind of soap. 

It is not a little remarkable that oxide of 
zinc should in some cases produce the very 
symptoms it is intended to cure, namely, 

^ ' Proceedings of the Hoyal Society.' June, 1858. 
^ Chevreuii ' Sur les Graisses.' 

^ A paper read to the Academic de Medecine, Nov. 3d, 
1857. 



TEEATMENT. 85 

giddiness and faintness ; and for this reason 
it should not be given indiscriminately. As 
a general rule I have found it objection- 
able in chlorosis, and with females of a weak 
constitution. In some cases of hysteria I 
have also been obliged to withhold it, from its 
being decidedly objectionable j the following is 
a case in point. C. G — , aged 26, complains 
of headache and giddiness. Previous to her 
marriage, six years ago, she had been subject 
to fainting fits, but since then the affection had 
not returned. She was treated with small 
doses of oxide of zinc, and about five minutes 
after taking the first dose she felt very sick, 
and fainted. After taking a second dose, she 
fainted a second time, remaining unconscious 
for two or three minutes on each occasion. 

Sometimes, though rarely, an apparent in- 
crease of the existing symptoms will occur in 
cases of chronic alcoholism treated with oxide 
of zinc ; but on diminishing the dose, the un- 
favorable symptoms at once disappear. 

The property of oxide of zinc of frequently 
producing sleep — a power it appears to possess 
exclusive to all the other metals — is very re- 



86 CHEONIC ALCOHOLISM. 

markable. I liave observed tMs pbenomenon^ 
not only where oxide of zinc was given for the 
treatment of chronic alcoholic intoxication, but 
also when administered in other cases. A gen- 
tleman, taking oxide of zinc for chorea, com- 
plained of his feeling so drowsy after dinner that 
he was obliged to go to sleep every day at that 
time, greatly to his discomfort, as he boarded 
with a family, and was much annoyed at this 
apparent breach of sociality. W. S — , aged 11, 
treated with oxide of zinc for chorea, expe- 
rienced great drowsiness every evening at half- 
past eight o^clock, although he had never before 
felt sleepy at that hour. Another male patient, 
aged 52, taking oxide of zinc for the treatment 
of vertigo and headache, stated that since he 
had begun the powders he felt very sleepy, and 
could sleep all day long. W. J — , aged 75 
(Case 5), taking oxide of zinc, is reported as 
sleeping from one till three o'clock, p.m., al- 
though he had never slumbered so long before 
in the daytime. E. B — (Case 6), became 
very sleepy in the daytime since taking the 
powders. W. H — (Case 7), treated with oxide 
of zinc, has observed that he feels very sleepy 



TEEATMENT. 87 

in the daytime ; when sitting to read lie falls 
asleep ; he was never in the habit of sleep- 
ing in the day before taking the powders. 
J. W — (Case 11), states that the powders 
of oxide of zinc make him feel drowsy ; he 
falls asleep about one hour after taking them, 
and sleeps for an hour; had not previously 
been accustomed to sleep during the daytime. 
From the frequent necessity, in cases of 
chronic alcoholism, to continue giving oxide 
of zinc for a comparatively great length of time, 
it is important to make sure that this medicine 
cannot act as a slow poison, such as many 
other metals do, for instance mercury and 
lead. Indeed, as previously observed, it 
would appear, from Dr. Herpin^s experience, 
that unfavorable symptoms do show them- 
selves in certain cases, from a protracted 
treatment with this metallic oxide. I have 
observed, however, that when the medicine acts 
unfavorably, as is sometimes the case with 
young and weak females, and especially those 
suffering from chlorosis, the patients are at 
once very quickly affected by the drug, offer- 
ing, consequently, no opportunity of examining 



88 CHEONIC ALCOHOLISM. 

the result of a long-continued treatment. 
I have given oxide of zinc in a great number 
of cases for several months_, without producing 
any dangerous^ or even evidently inconvenient 
symptoms. The following are instances of 
this kind. 

M. R — J aged 24^ admitted under my care 
as an out-patient of the Westminster Hospital, 
in October, 1855, is suffering from epilepsy. 
She began the treatment on the 27th of Octo- 
ber, with six grains of oxide of zinc twice a 
day, the dose being rapidly increased till the 
15th of December, when she took no less than 
thirty-five grains of oxide of zinc twice a day. 
My notes of this date state : — Had a fit on 
the 13th, which was not severe; looks pale 
and feels giddy. The symptoms were pro- 
bably owing to the fit the patient had two 
days previously, and not to the zinc ; the dose 
of thirty-five grains was perhaps rather large, 
but as will subsequently be seen, if it pro- 
duced paleness and giddiness, these symptoms 
were but transitory. On January the 16th 
the dose had been gradually reduced to ten 
grains. By the 9th of February it had 



TEEATMENT. 89 

been again increased to twenty-two grains 
twice a day. On the 20tli of February^ she 
was taking fifteen grains twice a day^ and 
she continued with that quantity till the 
5th of April, having taken large doses of 
oxide of zinc for four months and a half. 
She had evidently benefited from the treat- 
ment, as on the 2d of April the following note 
of her case occurs in my note-book : — Con- 
tinues to feel quite well, no return of the fits. 
In the next case the patient continued the 
treatment with oxide of zinc for a much longer 
period. H. J — , aged 35, admitted as an out- 
patient on the 26th of May, 1855, and sufiering 
from epilepsy. He began, on the day of his ad- 
mission, with one grain of oxide of zinc twice a 
day, which was increased gradually till the 5 th 
of December, when he took thirty-five grains 
twice a day; on the 12th of December, I re- 
corded the following state of his case : — Feels 
quite well, no return of fits ; showing at least 
that this enormous dose of oxide of zinc had 
produced no ill effect. He continued taking 
from fifteen to twenty grains of the drug, with 
an interruption of a few days (when sulphate 



90 CHEOI^IO ALCOHOLISM. 

of zinc was tried), till tlie 5th of July, having 
been for nearly fourteen months under treat- 
ment with oxide of zinc, and, at all events, not 
the worse for the medicine.^ 

The following case is less remarkable, as the 
oxide of zinc was not taken for so long a period 
as in that of H. J — . It is, however, well 
calculated to show that this medicinal agent 
does not act as a slow poison. 

E;. M — admitted as an out-patient of 
the Westminster Hospital, on January 16th, 
1856, suffering from incessant trembling of 
the right arm. This patient began with one 
grain of oxide of zinc twice a day, the dose 
being gradually increased till the 24th of 
Febrnary, when he was taking fourteen grains 
of the oxide twice a day. On the 1st of 
March ten grains were prescribed for a dose, 
which he continued taking till the 14th ; after 
this date the dose was gradually raised to 
twenty grains ; this he continued taking from 

^ I remember having heard this patient complaining of 
slight loss of memory, but it was not possible to ascertain 
whether this symptom depended on the epileptic fits or on 
the oxide of zinc. 



TEEATMENT. 91 

the loth of April till tlie IGth of May^ having 
thus been treated with large doses of oxide of 
zinc for four months. The trembling had 
much diminished under this treatment, and no 
new symptom had occurred; consequently the 
medicine had certainly not produced any in- 
jurious effects. 

Many more cases might be report ed_, if 
necessary, showing that the long- continued 
use of oxide of zinc as an internal remedy, 
is attended with no evident evil results. 



THERAPEUTICAL PROPERTIES OF OXIDE 
OE ZINC. 

Oxide of zinc may be considered as a tonic 
for the nervous system, and a sedative and anti- 
spasmodic. The other compounds of zinc used 
in medicine appear to be possessed more or less 
of the same therapeutical properties as the 
oxide. Dr. Barnes has administered phos- 
phate of zinc with favorable results in cases 



92 CHKONIC ALCOHOLISM. 

of epilepsy. The sulphate lias been employed 
with advantage by Dr. Hughes, Dr. Addison, 
and Dr. Barlow for the treatment of chorea, 
and the lactate has been used in epilepsy 
by Dr. Herpin.^ 

Dr. Golding Bird has mentioned in the 
wards of Guy^s Hospital that zinc has a 
peculiar and specific influence on the nervous 
system, in about the same manner as iron 
on blood.^ I have heard it asserted, however, 
that this substance is possessed of medicinal 
power merely on account of the faith the 
patient places in its efl&cacy, meaning, in 
plain language, that it exerts no action what- 
ever. As a proof of the effects of oxide of 
zinc not arising from its influence on the 
imagination, I may perhaps be allowed to 
report, in addition to Dr. Golding Bird's valu- 
able opinion, the case of a little dog treated 
successfully with this drug. On the 2d of 
November, 1855, a small spaniel, kept in my 

* Dr. Theophilus Thompson Las found oxide of zinc 
very useful for the removal of colliquative sweating in 
phthisis. — 'Lancet/ 1854, vol. i. 

2 'Lancet/ 1851, vol. i. 



TEEATMENT. 93 

iiouse^ was suddenly seized with a peculiar 
and uninterrupted moaning. The animal 
was very restless during the nighty and 
the next morning had a fit attended with 
violent screaming and barking, which lasted 
about one minute; it was followed by other 
similar attacks, which increased in frequency 
until there was hardly any intermission be- 
tween them, the animal running round and 
round from left to right, and crying out most 
piteously. The fits continued the whole of 
the succeeding night. On the 24th, the vio- 
lence of the attacks had increased ; there was 
partial paralysis of the posterior extremities ; 
but towards the evening the paroxysms dimi- 
nished in violence and frequency. On the 
25 th they were hardly perceptible, and on 
the following day the animal had resumed 
his lively character. Since then, with the 
exception of two or three epileptiform fits, 
this little dog has had no return of the 
illness. I began the treatment in the 
present instance with opium ; the dog was 
made to take ten drops of laudanum three 
times during the first day, and then twenty 



94 CHEOITIC ALCOHOLISM. 

drops at niglit. but without stopping the fits. 
I next made him inhale chloroform until he 
became perfectly insensible^ which had no 
further effect than that of diminishing the fits 
at the time. On the 24th I gave him four 
grains of oxide of zinc in two doses. (One 
grain had been given to him on the 22d) ; the 
same on the 25th and the 26th., when the 
treatment was concluded. This case proves 
beyond doubt that oxide of zinc does not 
cure by acting on the imagination^ but that 
it is really in itself a powerful remedy.-^ 

Oxide of zinc exerts a remarkable action 
in certain cases of functional derangement 
of the nervous system. I have adminis- 
tered it in epilepsy^ chorea, cases of mild 
hysteria, paralysis and lead palsy, exhaus- 
tion from excessive mental work, and chronic 
alcoholic intoxication. I succeeded in ob- 
taining favorable results in certain cases 



^ I have not found it stated in my notes at what time 
on the 24;th the oxide of zinc was taken; but recollect dis- 
tinctly giving the remedy as a last resource, thinking the 
dog was then dying; the treatment had consequently been 
commenced at the most acute sta^-e of the disease. 



TEEATMEISTT. 95 

of epilepsy and chorea; indeed^ I liad been 
induced_, at firsts to consider this agent as a 
specific for the treatment of epilepsy, and 
under this impression had communicated to 
the ' British Medical JournaP (for the 23d 
of November, 1855), a report on the use of 
oxide of zinc in epilepsy. Since that time, 
however, having continued to prescribe the 
remedy for the treatment of this disorder, 1 
am now obliged to admit that it seldom, if 
ever, cures the disease, although it is certainly 
often attended with beneficial effects. I have 
obtained similar results in chorea; indeed 
oxide of zinc is perhaps more effectual in 
chorea than in epilepsy. Some cases of mild 
hysteria were rapidly cured under a treatment 
of oxide of zinc, in others it produced scarcely 
any effect, and in certain instances the medi- 
cine proved objectionable. In the following 
cases oxide of zinc acted most favorably. 
M. J — , aged 48, admitted on November 
16th, 1855. She suffered two years ago 
from an abscess in the forehead, and has 
complained ever since that time of constant 
headache. Is very subject to giddiness and 



96 CHEONIC ALCOHOLISM. 

fainting, but never had any fit : muscse voli- 
tantes and tinnitus aurium, no bolus hys- 
tericus. Sleeps very restlessly, appetite pretty 
good; has not menstruated for a year. On 
admission, one grain of oxide of zinc was 
ordered to be taken twice a day, which on the 
30th had been gradually increased to six 
grains twice a day. On the 19th and 21st 
she had half an ounce of castor oil. On 
December the 7th I took the following note : 
Is now quite well and strong, no more head- 
ache or giddiness, sleeps better, though not yet 
quite soundly. Is dismissed. A. M — , ad- 
mitted on the 38th November, 1855. Com- 
plains of headache; muscse volitantes, and 
tinnitus aurium for the last six weeks ; appetite 
good, bowels rather confined ; she was treated 
with oxide of zinc, and dismissed cured on the 
19th of December. I have not found paralysis 
and lead-palsy to be relieved by the internal 
use of oxide of zinc. 

Mental exhaustion. — Kemarkably favorable 
results have been obtained from the prescrip- 
tion of oxide of zinc in cases of cerebral affec- 
tion arising from excessive mental exertions; 



TEEATMEIS^T. 97 

and this disease, which is in many cases diffi- 
cult to cure, is rapidly brought under control 
by the above means. I have treated fonr 
cases of this description by means of oxide of 
zinc. The first is that of Mrs. B — (see p. 57). 
I was requested to see her on the 21st of 
November, 1855. She had been for the last 
three months almost exclusively engaged in 
literary pursuits, and ascribed her illness to 
excessive reading and exertion of the mind. 
The patient was treated with one grain of 
oxide of zinc twice a day, and a blister was 
directed to be applied behind the neck ; castor 
oil was given once. On the 23d of November 
I found her much better; on the 24th there 
was a slight relapse, which soon gave way 
under the same treatment. She expressed 
herself quite recovered on the 26th. I again 
visited her about a fortnight afterwards, and 
found her quite well. 

The next case is of considerable interest, 
as, after other means had failed, the patient 
recovered under a treatment with oxide of 
zinc. Miss E — , aged 15, has been for 
the last three years a pupil at a public 



98 CHEQNIC ALCOHOLISM, 

school,, and has applied herself with ex- 
cessive zeal to her studies. She suffers 
from headache and giddiness, occasional tin- 
nitus aurium and muscse volitantes ; mental 
abstraction become difficult. I advised her 
to give up her studies^ and began the treat- 
ment with quinine and iron, but without 
benefit; one grain of oxide of zinc was then 
ordered to be taken twice a day, and a small 
blister directed to be applied behind the neck ; 
the same part was again blistered a fortnight 
afterwards. The dose of the medicine was 
increased gradually until she took three grains 
twice a day. After taking sixty pills of oxide 
of zinc she had completely recovered, nothing 
more than an occasional and but slight 
headache being left, felt especially when con- 
fined in a room or a crowded carriage. 

In the following case excessive mental exer- 
tion was also the exciting cause of the com- 
plaint, the individual being in other respects 
predisposed to it. Again oxide of zinc proved 
most useful. J. E — , aged 19, admitted an 
out-patient of the Westminster Hospital on 
the 23d of November, 1855. About two 



TEEATMENT. 99 

years previous to admission had a fit, sub- 
sequent to a fall on his head from a height 
of four feet. The accident occurred in the 
afternoon and the fit took place on the evening 
of the same day, lasting till the middle of 
the following day; he was quite insensible 
for nearly the whole of that time ; has 
had no return of the fits since then. Is 
a numerical printer, and besides his business 
has been very busy studying Greek and Latin 
at night, which he believes to have been 
the main cause of his present illness; he 
dropped his literary pursuits a few days 
ago, but continues attending to his business. 
For the last two years has been suffering 
from headache, pain in the region of the 
heart, and palpitation. He trembles at any 
sudden and unexpected disturbance, and occa- 
sionally feels a sensation of fainting. Was 
ordered to take two grains of oxide of zinc 
twice a day. On the 30th he was much 
better ; the dose was increased to five grains. 
He returned to me for the last time on 
December the 7th, being greatly improved in 
every respect. 



100 CHEOIfIC ALCOHOLISM. 

It may be well here to remind the reader 
of the melancholy case of W. T — (page 58). 
This patient recovered completely under a 
treatment of oxide of zinc. 

Dyspepsia. — The following case is interest- 
ing, as showing that, in some cases of inveterate 
chronic gastralgia, oxide of zinc may effect, or 
assist in effecting, a perfect cure. I called on 
Mr. R— on the 1st of October, 1856, He 
was suffering from great pain in the epigastric 
region, occurring three times a day, about two 
hours after each meal. The pain was attended 
with a sensation of great weakness and mental 
depression ; he felt quite well in every other 
respect. I treated the case with quinine and 
sulphuric acid ; rhubarb and sulphate of mag- 
nesia ; iron and quinine ; and compound soap 
pill. On the 22d of November he was better, 
though still complaining of the pain. In 
January, 1857, this gentleman again requested 
me to see him ; he was suffering from the 
same symptoms as previously. On examining 
his urine, on the 3d of February, I found it to 
contain uric acid and urates, and prescribed 
ten minims of liquor potassse, to be added to 



TEEATMEKT. 101 

his beer at dinner, and ordered one grain of 
oxide of zinc, made into a pill with confection 
of roses, to be taken twice a day. On the 
7th of February there was a decided improve- 
ment. On the 12th the improvement had 
continued ; he was directed to take the liquor 
potassse twice a day, and the dose of oxide of 
zinc was increased to two grains. On March 
the 7th he only felt a slight pain in the stomach 
every two or three days ; he had been taking 
four grains of oxide of zinc for a dose. Was 
directed to omit the liquor potassse, and take 
five grains of oxide of zinc twice a day. The 
following note was recorded on the 27th of 
March : Has had no return of pains for the last 
eight or ten days ; has taken no oxide of zinc 
for a week. I then discontinued attending, 
but have heard within the last few days that 
since March, 1857, or for more than two 
years, there has been no return of the 
dyspeptic symptoms. 

I now propose returning to our subject, 
and describing the action of oxide of zinc in 
cases of chronic alcoholic intoxication. 



102 CHEONIO ALCOHOLISM. 



CHRONIC ALCOHOLISM TREATED WITH 
OXIDE OE ZINC. 

Let it first be well understood, that it is 
not advisable to give oxide of zinc indis- 
criminately in every case of disturbance of 
tbe nervous functions owing to intemperance. 
The beneficial results of this treatment are 
more especially observed in those cases of 
chronic alcoholism which are unattended by 
any organic disorder, and when the disease 
occurs in an individual of a sound constitution. 
The various afi'ections of the lungs are peculiarly 
liable to diminish, in a considerable degree, the 
property of oxide of zinc of controlling the illness 
in question. Rheumatism may next be men- 
tioned, but I must not omit to observe that 
chronic alcoholism is very frequently attended 
with a symptom resulting directly from the 
alcoholic poisoning, and which might be mis- 
taken for rheumatism. It is described by 
the patient as a weakness and pain across 
the hips, and weakness in the knees, prevent- 
ing a heavy weight being carried, or even 



TEEATMEISTT. 103 

interfering with the act of walking. This 
symptom usually gives way under a treat- 
ment with oxide of zinc, but may some- 
times remain after the patient has recovered 
in every other respect ; in some cases it will 
eventually disappear by having recourse to 
tonics. Gastric disorders^ which so frequently 
accompany chronic alcoholism, are sometimes 
rapidly subdued by oxide of zinc ; this occurs, 
no doubt, principally in those cases where the 
gastric symptoms depend entirely on the dis- 
turbance of the functions of the nervous system ; 
and that such a disorder does actually exist 
is shown by the following observation of Dr. 
Budd, in his book on 'Diseases of the Stomach/ 
Having mentioned the organic changes 
occurring in the stomach in cases of indiges- 
tion of drunkards, he states (page 287) — "But 
the gastric disorder we are considering may 
occur without either of these events, and 
when the stomach in case of death may ex- 
hibit no striking marks of disease.^^ When 
the gastric symptoms are very urgent, such as 
great pain in the stomach with much vomiting, 
I am in the habit of prescribing opium at 
night, in the form of compound soap pill. 



104 CHEONIC ALCOHOLISM. 

independently of the oxide of zinc. In some of 
these cases the substitution, for a few days_, of 
carbonate of ammonia for oxide of zinc was 
attended with benefit. 

The following is the usual effect of oxide of 
zinc- in simple cases of chronic alcoholism : 
First, the sleep is improved, the patient does 
not lie so long awake at night, and the night- 
mare becomes less frightful ; then, the halluci- 
nations decrease, the patient is no longer 
troubled with black specks passing constantly 
before his eyes, or with the sight of imaginary 
objects, such as insects or other animals crawl- 
ing about the room, and extraordinary noises 
are no longer heard; the attacks of trembling 
also diminish in frequency if not in intensity, 
and gradually pass off. This improvement is 
attended with an increase of appetite, as 
well as a marked diminution of the gastric 
symptoms; and when the patient can take 
food and digest it well, he may be looked 
upon as in a fair way towards recovery. 
Gradually, muscular power returns, and the 
mental depression, which frequently accompa- 
nies chronic alcoholism, disappears ; the patient 
becomes cheerful and happy, and expresses with 



TEEATME^fT. 105 

gratitude his joy at feeling quite well.^ When 
the disorder is complicated with an organic 
disease, I have found it advisable to begin 
with oxide of zinc, in order to alleviate as 
much as possible the functional derangement 
of the nervous system, and then to adopt 
such a course of treatment as may be con- 
sidered the most suitable to the occasion. 

The following cases have been selected as 
well adapted to illustrate the action of oxide 
of zinc in chronic alcoholism, and will be found 
worth attention. They are divided into two 
classes, the first class including those cases 
in which the disease assumecl its simple form, 
and the second including those which were 
accompanied with other disorders. Each class 
of cases is also divided into two subdivisions : 
the first comprehending patients treated for 
chronic alcoholism at the time they were over- 
indulging themselves in spirituous beverages ; 
and the second those who came under treat- 
ment some time after having given up the 
habit of drinking. 

^ It is to be understood that during the period of re-' 
coverv the symptoms are frequently not relieved in the 
above-mentioned order. 



106 CHEONIC ALCOHOLISM. 



CLASS I— Division I. 

Cases of Chronic Alcoholism not complicated 
by other diseases, and occurring during 
the period of intemperance. 

W. B — (Case 1), aged 34, a carpenter, 
admitted as out-patient at tlie Westminster 
Hospital, on November the 21st, 1855. 

Has been addicted from bis yontb to tbe 
excessive use of alcoholic liquors, and in the 
habit of taking on"^ pint of gin daily, with two or 
three pints, and occasionally six or eight pints, 
of beer. Has had a slight attack of delirium 
tremens. Cannot sleep at night, but feels com- 
posed if he has recourse to spirituous libations 
before going to bed. Ten days ago he drank 
more than usual, and now suffers from a pecu- 
liar and very unpleasant sensation of choking, 
from giddiness, great weakness in the legs, and 
trembling of the body. Since the 10th of 
November, has reduced his allowance of alcoholic 
beverages to four pints of ale and one quartern 
of gin. On the 21st, was ordered to take two 



TEEATMENT. 107 

grains of oxide of zinCj in tlie form of a pill 
witli confection of roses. 

On the 24tli, there was already a very great 
improvement ; had slept well the night before. 
No more trembling of the body, although 
the tongue remains slightly tremulous; ap- 
petite better, and is himself surprised at his 
improved condition. Zinc. Ox._, gr. v, bis die. 

27th. — Has not slept so well since the 24th. 
Still complains of uneasiness in the throat, 
and is very subject to flatulence. Zinc. Ox., 
gr. viij, bis die. 

December 1st. — The recurrence of unfavor- 
able symptoms has discontinued, and he feels 
much better ; the sensation of choking is not 
nearly so strong. Zinc. Ox., gr. x, bis die. 

8th. — Improvement continued, sleeps well, 
appetite good ; takes one pint of beer and half 
a quartern of gin, daily. Zinc. Ox., gr. xij, 
bis die. (From the 26th of December, the 
oxide of zinc was given under the form of 
powders instead of pills.) 

He continued taking the same medicament 
until the 12th of January, 1856. On the 18th 
December, fourteen grains had been prescribed 



108 CHEONIO ALCOHOLISM. 

to be taken twice a day, and a small blister 
ordered to be applied over the larynx, with tbe 
view of relieving the sensation of spasmodic 
dyspnoea ; this was attended with some slight 
benefit. 

On the 5th of January, the dose of oxide 
of zinc was increased to fifteen grains twice 
a day, and another blister was applied to the 
larynx. On the 12th, he is reported as still 
suffering from uneasiness at the glottis, although 
otherwise quite well. He was then ordered to 
give up the oxide of zinc, and take a mixture 
containing rhubarb, &c. On the 19 th, having 
observed that he used to swallow a large quantity 
of air, I advised him to give up that habit, and 
on the 26th the spasmodic dyspnoea had greatly 
diminished. On the 30th, is nearly free from 
this last symptom, sleeps quite well at night, 
and enjoys a good appetite ; takes three pints 
of beer a day and no spirits. Dismissed cured. 

This unfortunate man returned to me on the 
21st of January, 1857, having again taken to 
drinking, and that shortly after he had left off 
attending the Westminster Hospital. He had 
also again contracted the habit of swallowing 



TEEATMENT. 109 

air, and suffered mucli from spasmodic dyspnoea. 
He had resumed his old hahit, drinking from 
three to four pints of porter, with an occasional 
glass of gin, and gradually this had been in- 
creased to from four to five quarts of porter 
daily, and a quartern of gin. Has had no attack 
of delirium tremens, hut suffers at times from 
great giddiness. He awakes very often at 
night with difficulty of breathing; is very low 
in spirits; appetite good; no hallucinations. 
Has been under medical treatment at Lewis- 
ham, but without obtaining any relief. To 
take two grains of oxide of zinc, twice a day; 
and he was reminded of the importance of his 
giving up the habit of drinking. 

24th. — Sleeps better at night, is in better 
spirits, has diminished his allowance to two 
pints of porter daily. Zinci Ox., gr. iij, bis 
die. 

28th. — Improvement continues, drinks three 
pots of beer daily and a quartern of gin, endea- 
vours to swallow less air, dyspnoea much 
diminished, does not suffer from flatulence so 
much as before. Zinc. Oxy., gr. v, bis die. 
February 4th. — He now sleeps very well at 



ilO CHEONIC ALCOHOLISM. 

niglit and is on the whole much better. Ox. 
zinc., gr. viij, bis die. 

14th. — On the 4th he indulged himself a 
little in his old habit of drinking, and the 
following night suffered from sleeplessness and 
a return of dyspnoea. Zinc. Ox._, gr. xij ; Pil. 
Saponis co., gr. iij, hora somni quotidie sum. 

25th. — Is again better; to continue the 
powders. 

March 6th. — From the 28th has returned 
to the habit of drinking ; great giddiness, no 
sleep at night, loss of appetite, and much 
mental depression. 

My notes of this case end here ; W. B — 
may have attended the hospital some little time 
longer, without deriving any permanent benefit 
from the treatment ; as he never gave up, and, 
in all probability, never will give up the habit 
of drinking. 

T. S — (Case 3), aged 33, an engineer on 
board a steam-boat, admitted as out-patient 
on the 2d of April, 1856. 

Is in the habit of taking about one pint of 
spirits and four or five pints of beer daily, and 



TEEATMENT. Ill 

has suffered from several attacks of delirium 
tremens^ the last occurring about four months 
ago. He complains at present of want of 
sleep, giddiness and much nervous uneasi- 
ness. Tongue slightly tremulous ; much 
pain in the epigastric region; feels in the 
throat a peculiar sensation as of choking, es- 
pecially in the morning, which he is in the 
habit of relieving by having recourse to drink, 
also complains of great weakness. Zinci Ox., 
gr. ij, bis die. 

April 4th. — Slept very well last night, feels 
less uncomfortable ; the sensation of choking 
has completely disappeared. Has reduced 
his allowance, first to two pints of ale and 
two glasses of gin, and then to two pints 
of ale without gin. Zinc. Ox., gr. iv, bis die. 

12th. — No return of uneasiness, sleeps now 
quite well, does not suffer from spasmodic 
dyspnoea, but feels rather weak; he says he 
has taken a great deal of medicine, but felt 
no relief until I prescribed for him powders of 
oxide of zinc. Has returned to work and 
drinks about two pots of beer and two 
or three glasses of gin daily. Dismissed cured. 



112 CHEONIC ALCOHOLISM. 

G. P — (Case 4), aged 35, admitted as au 
out-patient on tlie 17th of May, 1858. 

Has been addicted for a considerable time 
to the excessive use of alcoholic liquors. Six 
years ago lie went to America, and spent 
there two years in the army, during which 
time he drank a great deal of brandy and 
water. Has been in the constant habit, 
for many years, of drinking about eight 
pints of beer daily, and also occasionally pure 
brandy. Had two attacks of delirium tremens 
within the last two years, on each occasion 
the attack lasted three or four days. On 
the 12th of May, according to his own 
expression, had a little too much drink, and 
felt unwell the next morning; since then he 
suffers from paroxysms of great trembling, 
cannot sleep at night (which is, however, a 
symptom of long standing), and is subject to 
dizziness of sight although not to headache. 
On the 15 th, as he was walking in the 
street, he fancied there were ropes dangling 
about him; complains of slight spasmodic 
dyspnoea. Appetite bad, occasional pain in 
the region of the bladder. Zinc. Ox., gr. ij, 



TEEATMEKT. 113 

bis die. To take two pints of beer daily, and 
no more. 

24th. — Feels and looks better, trembling 
now very slight, sleeps very well at night. 
Began sleeping well the first night after 
taking the powders. No hallucinations ; no 
more dyspnoea; still feels weak. Has taken 
the powders regularly, and adheres to two 
pints of ale daily. Zinc. Ox., gr. iv, bis die. 

27th. — Improvement continued, no more 
trembling, sleeps well at night, appetite pretty 
good. No more pain in the region of the 
bladder, slight constipation; continues taking 
two pints of beer daily. Left off attending. 

E. B — (Case 6), aged 40, a sailor, admitted 
as out-patient on the 10th of June, 1858. 

Tenor eleven years ago this patient con- 
tracted the habit of drinking brandy to the 
extent of about a dozen glasses a day, which 
he continued doing for eighteen months. 
During that period he was occasionally intoxi- 
cated, but used to get over it so well as to be 
able to resume his work, and to drink again 
the following morning. He ad^mits having 

8 



114 CHEONIC ALCOHOLISM. 

suffered from an attack of delirmm tremens 
in 1843, althougli not tlien in the habit of 
drinking to excess, and had indulged him- 
self, on that occasion, to a considerable extent 
in alcoholic liquors for four or five days. 
Eighteen months ago he reduced his allow- 
ance of rum from four to two glasses a day, 
taking beer occasionally to the extent of five 
or six pints when he could go ashore. Is sub- 
ject to pain in the loins, and sometimes in 
the stomach ; tongue usually pretty clean ; 
suffers now and then from headache, giddiness, 
and tinnitus aurium. Often sees a shadow 
passing before his eyes and then rapidly dis- 
appearing; is restless at night, and cannot 
sleep well. When about twenty years old had 
four series of fits, probably epileptic, but from 
the age of twenty-two had no return of those 
attacks; sometimes his legs tremble, they 
are very weak, especially the right one. In 
February last, applied for medical advice and 
obtained relief, although he never recovered 
the free use of his right leg, and the left 
remained weak. Zinc. Ox., gr. ij, bis die. 
14th. — Is stronger, but complains of the 



TREATMENT. . 115 

powders occasioning sickness^ feels very sleepy 
in the daytime, sleeps well at night. 

17th. — Improvement continues. Zinc. Ox., 
gr. ij, bis die. 

24th. — To continue the powders. 

28th. — Sleeps very well at night, no longer 
any trembling, or headache, right leg not yet 
regained its whole strength ; drinks now daily 
two pints of porter and takes a glass of gin 
occasionally. P. pulv. 

July 8th. — The powders make him very 
sick, and he has vomited after breakfast. 
Zinc. Ox., gr. iij, bis die. 

19th. — Complains of a weakness in the 
right knee, the leg occasionally giving way. 
In other respects is perfectly well. Advised 
him to take some sea-bathing, or at all events 
bathe in cold water, and give np every other 
medical treatment. 

J. P — (Case 8), aged 39, a coal-porter ; ad- 
mitted as out-patient on the 11th of October. 

For the last twenty years has been accus- 
tomed to drink five pints of beer and a glass 
of gin daily. He is, moreover, intoxicated 



116 CHEOIs^IC ALCOHOLISM. 

once a week — on Saturday night. Has been 
in bad health for the last fifteen months. On 
sitting, his legs tremble, but they remain 
quiet when he stands. Sleep very restless, 
is incessantly turning over at night, complains 
of giddiness and shooting pains across the 
temples, and occasionally a fog or cloud passes 
before his eyes. No tinnitus aurium. Is fre- 
quently sick when getting up in the morning; 
very weak in the knees, and suffers from an 
acute pain in the right hip. I directed him 
to take one pint of ale daily, From the date 
of admission till the 28th of October this 
patient was not treated with oxide of zinc, 
and obtained no relief. On the 28th of 
October I prescribed for him two grains of 
oxide of zinc to be taken twice a day. 

November 4th. — Gi-reat relief since he began 
the powders, sleeps pretty well at night. No 
longer any nightmare, not so much trembling 
in the legs or sickness in the morning, feels a 
little stronger, but still complains of weakness, 
especially in the right hip. Passing shadows 
no longer perceived. Zinc. Ox., gr. iv, bis 
die. 



TEEATMENT. 117 

llth. — Complains of a slight cough, knees 
and hips still weak, in other respects quite 
well. His legs to be rubbed with turpentine 
liniment, and to take a mixture of iron and 
quinine. 

On the 22d he returned to work, but on 
the 29th, the weakness continuing, I directed 
him to resume the oxide of zinc — gr. iv, twice 
a day, and omit the mixture. 

On the 6th of December feels much 
stronger, and now goes to work regularly. 

On the 16th, as he did not sleep quite so 
well, three grains of compound soap pill were 
prescribed to be taken every night. 

On the 23d he gave up attending the hos- 
pital, having quite recovered. 

J. W — (Case 11), aged 18, admitted as an 
out-patient on the 28th of October, 1858; a 
hawker. 

Has been for five years of intemperate 
habits, although he has considerably reduced 
his allowance of drink for the last three weeks. 
When in company of friends, that is, from 
once to three times a week, takes occasionally 



118 CHRONIC ALCOHOLISM. 

as mucli as eight pints of beer and one or 
two glasses of gin. On the 7th instant he 
drank about fifteen pints of beer and five or 
six glasses of spirits. The next day he was 
seized with great nausea, giddiness, and trem- 
bling all over the body. Besides these symp- 
toms he also sufi'ers from a pain in the left 
hip and great weakness in the legs, and does 
not sleep well at night. To take one pint of 
beer daily and no spirits, and two grains of 
oxide of zinc, twice a day. 

November 8th. — The powders have made 
him sleep in the daytime; he does not, 
however, sleep soundly at night; the pain has 
shifted to the right hip. No longer any giddi- 
ness, but trembles very much in the morning 
for about five minutes only. He is very weak, 
and thinks he could not carry a quarter of 
a hundred weight. Zinc. Ox., gr. iv, bis die. 

] 1th. — P. Pub^^ the hips to be rubbed 
with compound soap liniment. 

18th. — No longer any trembling whatever; 
he would feel quite well, were it not for the 
weakness of the hips. To take a mixture of 
iron and quinine. 



TEEATMENT. 119 

22d. — No improvement from the last medi- 
cine ; to resume the oxide — gr. iv, bis die. 

23d. — Returned to work (pushing a heavy 
wheelbarrow) yesterday evening, for about two 
hours; felt no inconvenience from it except 
stifiness. 

25th. — Is stronger, pushing his wheelbarrow 
for three hours. Zinc. Ox., gr. iv, bis die. 

December 6th. — Has not attended since 
the 25th ult., can now work as he used to do 
before he fell ill ; pain in the hips very slight, 
and felt only occasionally. Discharged cured. 



120 chro:n'Ic alcoholism. 



CLASS I.— Division II. 

Cases of Chronic Alcoholism not complicated hy 
other diseases, and occurring in patients 
having resumed habits of sobriety. 

G. H — (Case 18)^ aged 38_, a general dealer; 
admitted December 20th, 1858. 

Has been addicted to the habit of drinking 
from youth, till eleven months ago, taking from 
three glasses to a pint of spirits daily, and 
has had as much as nearly two pints of spirits 
in one day; his daily allowance of ale has 
been four or five pints ; never suffered from 
delirium tremens or any other disease, but 
gave up drinking completely eleven months 
ago, because he found it did not agree with 
his health. The symptoms he is now suffer- 
ing from have lasted since then ; these are, 
great giddiness and headache, passing clouds, 
and sudden blindness for two or three minutes, 
but no actual hallucinations. Cannot sleep at 
all at night. Trembles a little all day long. 



TEEATMEI^T. 121 

especially when moving about. Appetite very 
bad. No pain in the stomach. Has an 
eczematous eruption on the face. Has done 
no work since the 17th. 

On the 23d December he was ordered to take 
two grains of oxide of zinc twice a day. He had 
so far improved on the 27th as to feel capable 
of returning to work; he suffered no longer 
from giddiness and headache, and the appetite 
was returning ; he was now beginning to enjoy 
his breakfast, which he had not done for the 
last nine months; and he slept a great deal 
better at night. R. Zinc. Ox., gr. iv, bis die, 
and apply the following lotion to the face : 
Boracis, 9j ; Aq., 3^^^ • ^^ ^^^ ^^ ^^ January 
he felt quite well. I then ordered for him a 
mixture of liquor arsenicalis and carbonate of 
potash, and he called again for the last time 
on the 10th of January, when the eruption 
had nearly disappeared. 

W. H — (Case 7), aged 58, an emery sifter; 
admitted on the 9th of August, 1858. 

Upwards of twenty years ago he contracted 
the habit of drinking to excess. His favorite 



122 CHRO^flC ALCOHOLISM. 

beverage consisted of gin, wliicli lie gra- 
dually increased to four glasses a day, and 
he took from one to three pints of beer 
daily. He admits that this habit has lasted 
during fifteen years ; but for the last five or 
six years he has reduced his allowance to an 
average of two pints of beer daily, and no 
spirits. When eighteen years old had syphilis, 
and about twenty years ago was attacked 
with fits (apparently epileptic), but which have 
not returned since that time. His present 
illness began six years ago. He complains of 
much giddiness, with trembling ; sleeps little 
at night, is then very restless. Frequently 
fancies he sees cats and rats, has thought 
there were rats on his bed. States also that 
on several occasions during the last six years 
he has rambled a great deal in his mind, and 
according to his own impression, ^^ People about 
him have thought he was going mad.^' Also 
— -muscse volitantes, and an occasional sensa- 
tion of choking. Had delirium tremens two 
years ago, after an accidental indulgence, 
although he had then given up the habit of 
drinking to excess. He was first treated with 



TEEATMENT. 123 

a decoction of aloes, and the hospital mixture 
of iron and quassia, from whicli, however, he 
derived no benefit. 

On the 11th of October, two grains of oxide 
of zinc were prescribed for him, to be taken 
twice a day, and on the 14th the dose was in- 
creased to four grains. 

18th. — Since the 14th, feels himself better, 
sleep much improved, not so giddy ; headache 
and muscae volitantes diminished; sensation 
of choking less urgent. Zinc. Ox., gr. vj, 
bis die. 

21st. — Has slept well for the last two or 
three nights ; giddiness and headache consider- 
ably less. Has noticed that he feels sleepy in 
the day, and if he sits down to read, he falls 
asleep ; he was never subject to sleep in the 
daytime until he took the oxide of zinc ; his 
own words are " I got no sleep, or very 
little, night or day, before beginning the pow- 
ders j" he becomes sleepy about an hour after 
taking the medicine. Complains of sick- 
ness at night when he awakes ; appetite some- 
what improved. Has completely given up 
every kind of alcoholic liquor, and drinks 



124! CHEONIC ALCOHOLISM. 

notHng now but tea and water. I advised 
him to take lialf a pint of beer daily. P. pulv., 
gr. YJ, bis die. 

24tli. — Improvement continues. P. pulv., 
gr. vj, bis die. 

29tli. — Improvement remarkable ; no longer 
any uneasy sensation in the throat, very seldom 
suffers from muscse volitantes ; feels stronger, 
although still weak. P. pulv., gr. vj, bis die. 

November 1st. — Feels quite well, although 
still weak. The oxide of zinc was now dis- 
continued, and I prescribed for him the hos- 
pital mixture of iron and quinine. 

8th. — Feels stronger, allows himself one or 
two pints of ale daily. 

The patient noAV left off attending, but on 
November the 30th, I called upon him, and 
found that he had been gradually recovering 
his strength, that he slept tolerably well,- 
although not so soundly as when under treat- 
ment, and considered himself perfectly reco- 
vered from his long illness. He took very 
little beer, say less than one pint daily ; felt 
quite capable of working if he had any work 
to do. ^ 



TEEATMEIfT. 125 

J. L — (Case 29)^ aged 24_, a butclier; ad- 
mitted on the 21st of January, 1859. 

Has been in tlie habit, during eight or 
ten years, of drinking Port "wine to the 
extent of a bottle a day, with a daily allow- 
ance of half a pint of spirits, but has seldom 
been intoxicated. For the last five or six 
years he has diminished his allowance of 
stimulants, and during the preceding twelve 
months has drunk no more than about 
one pint of beer daily. The first symp- 
toms of his present illness showed themselves 
eighteen months ago. He suffers from head- 
ache, want of sleep, slight trembling in the 
morning, and perceives, at times, passing sha- 
dows. He is^very weak, especially in the hips, 
and complains of pain in the knees.^ To 
take two grains of oxide of zinc twice a day. 

On the 27th there was already an improve- 
ment in his health, and the dose was doubled ; 
on the 31st, I took the following note : — 

^ This symptom, altliough being probably independent of 
alcoholism, has appeared to me, in the present instance, so 
closely connected with the disease as not to warrant the 
case being classed under another head. 



126 CHRONIC ALCOHOLISM, 

Sleeps nearly all night, and is mucli less trou- 
bled with nightmare j no longer any passing 
shadows; appetite improved. Pain in the 
knees and weakness in the hips about the 
same. Has a refreshing sleep of about an 
hour in the afternoon; feels sick after taking 
the powders. To rub the knees with turpen- 
tine liniment, and to continue taking four 
grains of oxide of zinc twice a day. On 
February the 10th, as he stated he had sufiPered 
much from headache and giddiness during the 
preceding week, the dose of oxide of zinc was 
reduced to two grains,^ which he continued 
taking until he left off attending. The 24th 
of February I reported the following note of 
his case : — Sleeps very well, «appetite very 
good; is only subject now to a little trem- 
bling when taking active exercise, and is 
then obliged to sit down ; is improving in 
strength ; knees still painful. He observes, 
he has suffered for the last eighteen months 

• This was one of those remarkable cases in which too 
large doses of oxide of zinc have brought on symptoms, 
resembling those arising from the disease itself; by di- 
minishing the dose these unfavorable symptoms disappeared. 



TEEATMENT. 127 

from his present illness, has consulted four 
medical men, and obtained no relief until 
he underwent a treatment with oxide of zinc. 
On that day a small blister was ordered to 
be applied to the knee. March the 7th. — 
Strong exercise no longer brings on trembling, 
is free from every symptom of chronic alcohol- 
ism, and only experiences pain in the knee. Is 
directed to return a fortnight afterwards. He 
called on the 4th of April, and announced 
himself quite well, only feeling occasionally 
somewhat fain.t when actively at work. 

W. J — (Case 5), aged 75, a shoemaker ; ad- 
mitted as out-patient on June the 7th, 1858. 

When a young man he became addicted to 
hard drinking, which he continued indulging 
in for about twelve years, when, after a sharp 
attack of delirium tremens, he adopted habits 
of sobriety, taking no more than about one 
pint of porter daily, with an occasional glass of 
spirits. About six weeks previous to admis- 
sion, he became subject to trembling; since 
then, complains also of headache, occasional gid- 
diness, and slight hallucinations ; lies awake 



128 CHEON'IC ALCOHOLISM. 

for three or four hours every nighty but sleeps 
very well the remainder of the night. His 
appetite is bad. Feels weak^ and has been 
obliged to give up work. To take two grains 
of oxide of zinc twice a day. 

By the 14th of June the dose of oxide 
of zinc had been gradually increased to four 
grains ; on the 21st, is a great deal better, al- 
though still weak. Sleep improved ; headache 
diminished ; complains of a sensation of 
nausea occurring about an hour after taking 
the powders, and feels sleepy at that time.^ 
Five grains of oxide of zinc were prescribed, 
to be taken twice a day. He returned on the 
28th, on which day I took the following note. 
No longer any trembling ; sleeps now very well 
at night; powders do not produce sickness. 
To continue with five grains of oxide of zinc. 
On the 1st of July he was quite well in every 
respect, though still weak ; was ordered to take 
a mixture of iron and quinine. He called for 
the last time on the 5th of July. 

1 A blister had been applied previously, behind the neck, 
but the date of this prescription has not been recorded in 
my note-book. 



TEEATMENT. 129 



CLASS II.— Division I. 

Cases of Chronic Alcoholism, accompanied by 
other diseases, and occurring during the 
period of excessive indulgence. 

E. B — (Case 9), aged 41, a tailor; ad- 
mitted on the ISth of October, 1858. 

Has been addicted to hard drinking for the 
last twenty years, and takes on an average four 
or five pints of porter, and two or three glasses 
of gin daily ; but has drunk repeatedly as 
much as a gallon of beer in the day. Has 
been intoxicated occasionally, though not 
severely ; has suffered from ill health for 
twelve or thirteen years. For the last eight 
years his appetite has been very deficient, 
and he feels a constant pain in the stomach, 
which is increased after meals, and is attended 
with sickness, especially in the morning. Has 
had a bad cough for the past three months, 
complains of shortness of breath, and has suf- 
fered from acute pain in the region of the 

9 



130 CHROKIC ALCOHOLISM. 

kidneys, which, however, he feels now much 
less than formerly. Sleep very restless, and 
disturbed by dreadful dreams. Occasional 
headache and constant giddiness ; muscse voli- 
tantes, and now and then dimness of sight; 
occasional hallucinations especially at night 
when falling asleep, and is subject to trem- 
bling. On the 25th of October, having de- 
rived little or no benefit from the treatment 
adopted, I prescribed for him two grains of 
oxide of zinc, to be taken twice a day. This 
dose w^as increased to six grains on the 29th. 
He gave up attending from the 1st of Novem- 
ber, and on that day I took the following note 
of his state : Is now very much troubled by 
his cough, though he sleeps more comfortably 
at night. Sickness diminished ; still trembles 
a little, but less than before. Pain in stomach 
not so acute. 

This patient applied again for advice on the 
6th January, 1859, having drunk three pints 
of porter and a glass of spirits daily since he 
left the hospital. He was again suflPering from 
symptoms of chronic alcoholism, and was treated 
as before with oxide of zinc. On the 20th, 



TEEATMENT. 131 

slept well^ no more trembling, occasional 
headache ; bad appetite. On the 27th, the 
appetite was improving ; he no longer suffered 
from giddiness, and the headache was but 
trifling. He then gave up attending the 
hospital. 

W. B — (Case 10), aged 56, a labourer ; 
admitted on the 2d of October, 1858. 

He first contracted the habit of drinking 
when in France, twenty-six or thirty years ago. 
Some years later he returned to this country, 
and worked in the fields as a labourer for 
nine years, during which time he lived a sober 
life. He afterwards resided at Peckham, and 
drove a coal van, when he drank from three 
to six pints of beer daily, and occasionally a 
little rum ; this he continued doing for two 
years. During the following nine years he 
was still employed driving a coal van, although 
living in another part of the town, and allowed 
himself the same quantity of beer and spirits. 
For the next three years he was employed 
at a wharf, but was engaged more especially 
in driving a cart^ he then diminished his 



132 CHEOlfIC AiCOHOLISM. 

allowance of stimulants to two pints of beer 
and no spirits. Being employed afterwards 
at some gas works^ lie took for two years 
and a half about three pints of beer daily. 
During the last two years and a half he 
has been at work in a brewery^ and in the 
habit of drinking six or seven pints of beer 
a day, taking but little solid food — being 
sometimes a whole day without eating any- 
thing. He has not often been drunk, and never 
had delirium tremens. Within the last year 
has been very subject to giddiness; when 
reading he sometimes loses his sight entirely 
for five minutes ; he also frequently sees objects 
double^ and is troubled with muscse volitantes. 
His wife says he has frequently stated, 
during his illness, that he saw rats on his 
bed; hears a sound of bells ringing, espe- 
cially in the right ear. A fortnight before 
applying for relief, this patient was seized with 
a pain in the right lumbar region, which has con- 
tinued since then,being at times very acute,espe- 
cially when he is in bed. Has passed blood in his 
stools several times; about the 11th of October 
was suffering from this symptom, although to no 



teeatme:n"t. 133 

severe extent. Complains of pain in the 
stomach, sometimes very great after meals; 
feels very weak, especially in the left leg ; has 
a cough. W. B — was first treated for bron- 
chitis and rheumatism, but as he did not im- 
prove, I was induced to look still more closely 
into his case, and then found him suffering 
principally from the effects of long- continued 
intemperance. 

October 28th, was ordered to take two grains 
of oxide of zinc twice a day. The dose was in- 
creased to four grains on the 1st of November, 
and on the 4th to eight grains. The following 
notes were taken on the 8th : Trembling much 
diminished ; no longer any hallucinations or 
muscse volit antes, or noises in the ears. Still 
complains of want of sleep. P. gr. viij, bis 
die. On the 11th, ten grains of oxide of 
zinc were ordered for a dose, and, as he was 
complaining of his cough, I prescribed our 
hospital pectoral mixture. A few days after 
(date omitted) — Is now disturbed at night 
by cough, but no longer from uneasy sensa- 
tions and restlessness, as formerly ; has per- 
fectly recovered from the trembling; appetite 



134 CHEONIC ALCOHOLISM. 

is excellent. Takes two pints of ale daily, 
and is in very good spirits. Is cured of 
chronic alcoholism. 

J. H — (Case 25)^ aged 27_, a shoemaker; 
admitted on December the 9th, 1858. 
Eighteen months ago contracted the habit of 
drinking to excess,, taking four or five pints of beer 
and a glass of spirits daily, but during the last 
twelve months drinks three pints of beer daily, 
and spirits occasionally. Complains of cough, 
and of pain in the stomach, especially after 
eating. Is in very low spirits, and fancies at 
times that people are wishing to do him 
some injury. Trembles a great deal, more 
especially in the evening. Cannot sleep at 
night ; is troubled with ringing in the ears, 
and black specks flying before his eyes ; much 
weakness in the knees. Has been frequently 
drunk, but never had delirium tremens. He 
began suffering from the foregoing symptoms 
shortly after taking to hard drinking. 

This patient was treated at first for bron- 
chitis, with cod-liver oil, and a mixture of iron 
and quinine; from which treatment he derived 



TEEATMEIIT. 135 

little or no benefit. I then discovered he was 
suffering from the effects of alcoholic stimu- 
lantSj and prescribed for him, on January Gth, 
two grains of oxide of zinc to be taken twice 
a day. 

On the 10 th of January there was already 
a marked improvement ; the dose was in- 
creased to gr. iv. The following note was re- 
corded on the 13th : No trembling, sleeps well, 
giddiness very slight ; complains of cough, 
especially in the morning ; feels much stronger; 
drinks now very little. I prescribed half an 
ounce of cod-liver oil to be taken three times 
a day, and five grains of oxide of zinc to 
be taken twice a day. On January 17th 
the dose of oxide of zinc was reduced 
to three grains, and continued with the 
cod-liver oil till the 24th of January, when he 
called at the hospital for the last time. On 
that day the cough had rather increased, and 
he occasionally observed muscular twitchings in 
the fingers and legs. He felt no more, besides 
these symptoms, than a slight nervous uneasi- 
ness, and a shooting pain over the right eyebrow. 



136 CHEONIC ALCOHOLISM. 



CLASS II.— Division II. 

Cases of Chronic Alcoholism complicated by other 
diseases, and occurring after the habit of 
excessive drinking had been given up. 

J. R — ■ (Case 23), aged 34, a policeman ; 
admitted on the 17tli of December, 1858. 

During a period of two years he drank on 
an average one gallon of beer and three 
glasses of spirits daily ; but for the last ten 
years has given up habits of intemperance, 
taking one or one pint and a half of beer 
daily, and scarcely any spirits. He has been 
subject to coughing for several years past, 
complains of pain in the stomach when 
fasting j appetite pretty good. Trembles a 
great deal in the morning ; does not sleep well, 
and dreams a great deal ; slight hallucinations 
at night, or when he shuts his eyes ; weakness 
in legs excessive. Has never been quite well 
for the last ten years, but only gave up work 
on the 2d of November. 



TEEATMES'T. 137 

The patient was first treated with cod-liver 
oil and quinine, from which he derived no 
benefit. On January 3d, I prescribed for him 
two grains of oxide of zinc to be taken twice 
a day. On the 6th the dose was increased to 
four grains, and on the 10th to six grains. 
Was then better ; trembling diminished, sleep 
improved, in better spirits, stronger, no longer 
any hallucinations ; he complained of pain in 
the region of the right kidney, was directed 
to rub this part with compound soap liniment. 
On the 1 7th of January the dose of oxide of 
zinc was reduced to four grains. He applied 
for the last time on the 20th, the pains in the 
loins and stomach had somewhat diminished; 
felt quite well in other respects. 

D. B — (Case 37), aged 72, a greengrocer ;^ 
admitted on the 17th of January, 1859. 

This patient, it may be remembered, was 
sufi'ering from symptoms of chronic alcoholism 
complicated by an attack of gout. He had, 
from youth, taken to the habit of drinking, 
and been subject to gout from the age of 

^ Por the description of this case, see p. 50. 



138 CHEOKIC ALCOHOLISM. 

sixteen. The symptoms of cliromc alcoholism 
diminish or almost entirely leave him during 
the intervals between the attacks of gout, 
and increase on the return of this illness, the 
intermittent disorder of the nervous system 
having occurred, as far as could be ascertained, 
since the age of nineteen. On the day of his 
admission I prescribed for him two grains of 
oxide of zinc, to be taken twice a day, which 
dose was increased to gr. iij, on the 20th, when 
the nervous symptoms had already subsided. 
On the 24th, I prescribed, in addition to 
gr. V of oxide of zinc, a mixture of carbonate 
of potash and rhubarb. On the 27th the 
powders were omitted, and rr^^x of colchicum 
wine were added to the mixture, which was 
continued; on the 31st, was directed to 
rub the painful parts with compound 
soap liniment, and take three grains 
of compound soap pill every night. On 
the 3d of February the attack of gout was 
decidedly abating, and the patient had 
altogether improved much beyond his antici- 
pations. The same treatment was continued, 
and on the 14th of February the dose of 



TEEATMENT. 139 

compound soap pill was increased to gr. v. 
The 24tli of February^ the attack of gout 
had passed off. I ordered half an ounce 
of codliver oil to be taken three times a 
day, and two grains of oxide of zinc twice a 
day. On March Sd, another attack of gout was 
impending, there being a return of pain under 
the feet and swelling in the left thumb ; but no 
relapse of the nervous symptoms occurred. I 
had again recourse to the mixture of carbonate of 
potash and rhubarb, to which it|x of colchicum 
wine were subsequently added, and omitted 
the oxide of zinc. The attack of gout ran a 
mild course, and without any recurrence of 
the affection of the nervous system. On the 
14th the attack of gout was mitigated, and on 
the 24th it had passed off, leaving the thumb 
of the left hand slightly swollen, and the great 
toe disposed to swell towards the evening and 
occasionally painful at night. The patient 
was then discharged, apparently cured of the 
affection of the nervous system, though still 
predisposed to gout. 



140 CHEONIC ALCOHOLISM. 

OBSERVATIONS ON SYNOPTICAL TABLE. 

Having glanced at the synoptical table_, the 
reader will probably ask whether these cases 
include all the patients suffering from chronic 
alcoholism, who have been placed under my 
care at the Westminster Hospital. The 
answer to this inquiry is, that with the ex- 
ception of one or two patients, not reported 
because the notes of their illness were not 
deemed sufficiently complete, the synoptical 
table is to be considered as offering a faithful 
account of the whole of the cases of chronic 
alcoholism that have come under observation 
in my hospital practice, from a short time after 
mj being appointed to the Westminster Hos- 
pital. I must, however, remark that the number 
of cases described falls short to a considerable 
extent of the real number of hospital patients 
suffering from chronic alcoholism who have 
applied to me for medical advice; as, pre- 
vious to my attention being called to the 
disease in question, I must have frequently 
overlooked the influence of spirituous liquors 
on the nervous svstem ; an omission 



OBSEETATIONS ON SYNOPTICAL TAELE. 141 

partly owing to the circumstances alluded 
to in the beginning of this work^ and partly 
to the fact that^ in many instances^ the pro- 
minent symptoms depended on morbid con- 
ditions which differed widely from those 
known to be caused by the abuse of alcoholic 
beverages. 

Turning our attention to the employments 
of the patientSj we observe that of the forty- 
eight cases reported^ there are five whose occu- 
pations are unknown ; those of the other forty- 
three are as follows : 

Labourers . . 8 

Coal porters . . .3 

Carpenters (including chairmaker) 3 
Shoemakers . . .3 

Engineers . . 2 

Hawkers . . •-..?:__ 

Cabmen , . 3 

Sailor . . .1 

Emery- sifter . . 1 

Tailor . . .1 

Cutler ... 1 

Carrier . . .1 

Carter ... 1 



142 CHEONIC ALCOHOLISM. 



Grocer 


. 


1 


Greengrocer 


• • 




Painter 


. 


1 


General dealer 


■ 




Cusliiori-maker 


. 


i' 


"Workman in a 


brewery 




Policeman 


. 


f ■*■ 


Omnibus driver 


. 




Butcher 


. 


1- 


Clerk . 


. > 




Stoker 


. 


L 


Weaver . 


. 




Gas fitter 


. 


1 


Check-taker 


• " ■ 





43 



Consequently the most numerous class of 
patients are^ with the exception of shoe- 
makers^ those employed in works which re- 
quire great muscular exertion in the open air, 
and who have recourse to drink in order to stim- 
ulate their overtasked strength^ these are : eight 
labour erSj three coal porters, and three carpen- 
ters. We next observe two hawkers, two engi- 



OBSEEYATIONS ON SYITOPTICAL TABLE. 143 

neers working steam-engines^ and two cabmen. 
Hawkers drink with the idea that it assists 
them to get over their daily muscular and vocal 
exertions ; engineers may thus hope to make 
up for the loss of strength arising from exces- 
sive perspiration ; and cabmen^ having often 
nothing to do, spend their time and money 
in the tap-room, leaving their cab in the rank. 
The other classes of individuals included in 
the table have each furnished one instance of 
chronic alcoholism. 

I have not much to add in connexion 
with the quantity and quality of the spirituous 
beverages taken. The reader must recollect 
that the information contained under this 
head must be taken with reserve. Some 
patients stated they had been intoxicated 
regularly every day ; others only once a week 
— usually on Saturday evening ; others drank 
to a sufficient extent to bring on an attack of 
chronic alcoholism, although they only indulged 
to excess at irregular intervals ; others again 
would perhaps have escaped the disease, had 
they not lived too freely at Christmas. Thus 
it will be perceived there is much difficulty 



144 CHEONIC ALCOHOLISM. 

in placing in a tabular form the amount and 
nature of alcoholic beverage taken by each 
individual. 

The period during which habits of intem- 
perance existed was equally difficult to ascer- 
tain with satisfactory correctness, for it often 
occurred that the allowance of beer and 
spirits had been gradually increased; and 
it was impossible to arrive exactly at the date 
when the quantity taken had reached such an 
extent as to interfere with health. It also 
frequently happened that an individual, having 
drunk freely for a certain number of years, 
suddenly reduced his allowance within mode- 
rate limits, and then again took to intemperate 
habits -J this could not well be expressed in a 
synoptical table. 

Of the forty-five cases where the condition 
of sleep was recorded, in one only had this 
function not been affected, and in the present 
instance (Case 48) I am disposed to believe 
that the individual suffered as much, if not 
more, from smoking, as from drinking. 
Sleep, disturbed by excesses in spirituous 
beverages, has this peculiarity — that it is 



OBSEETATIONS ON SYNOPTICAL TABLE. 145 

always attended with restlessness and mental 
anxiety. I do not remember hearing a 
patient suffering from chronic alcoholism state 
that he lay in bed comfortably, although he 
could not sleep. This symptom varied consider- 
ably in degree ; in many cases, individuals were 
but slightly affected, frequently awaking from 
a sleep disturbed by nightmare ; other patients, 
more seriously attacked, not sleeping at all, 
and troubled all night with frightful halluci- 
nations. 

Respecting the other symptoms of chronic 
alcoholism, I have merely to call the reader's 
attention to the fact that hallucinations , 
trembling, and giddiness, are, with but few 
exceptions, constantly present ; and these 
symptoms, when occurring in conjunction 
with sleeplessness, appear to me as all but 
characteristic of chronic alcoholism. 

The column headed symptoms not referrible 
to the nervous system, shows how fre- 
quently chronic alcoholism is attended with 
other diseases, more especially affections 
of the digestive organs; these secondary 
disorders being frequently, in my opinion, the 

10 



146 CHRONIC ALCOHOLISM. 

immediate cause of the attack of chronic alco- 
holism. The next column, headed pre-existing 
disease, indicates that chronic alcoholism 
is very frequently preceded by one or more 
attacks of delirium tremens, and also that the 
patient may suffer previously from chronic 
alcoholic intoxication; it will be perceived, 
however, that the illness occurs not unfre- 
quently as the first indication of a disordered 
constitution from frequent indulgence in spirit- 
uous drinks. 

Finally, with respect to the treatment, it 
must be remembered that nothing is so difficult 
as to keep up a regular series of observations 
on hospital out-patients; for some apply only 
once for relief; others give up attending as 
soon as they feel themselves well enough to 
return to work ; and a few, only, can be made 
to understand the importance of calling regu- 
larly at the hospital until they are discharged. 
It wdll be satisfactory, however, to state 
that out of the forty- eight patients who were 
treated for chronic alcoholism, only six re- 
turned for advice on a recurrence of the 
unfavorable symptoms. 



OBSEEVATIONS ON SYNOPTICAL TABLE. 147 

I have endeavoured in this treatise, to 
bring prominently to light the most frequent 
form of disease produced by excessive drink- 
ing; and, although it has been considered ad- 
visable to confine the subject strictly within 
medical limits, it will be a source of satis- 
faction to me should any of the foregoing 
observations tend to strengthen the hands of 
those philanthropists who have devoted their 
time and exertions to the repression of ex- 
cesses in alcoholic stimulants. 



SYNOPTICAL 



GIVING AN 



rOETT-EiaST CASES OF 
Treated by the Author, at 



Name and Age 
of Patient. 
Profession. 



Quality and Quantity 

of Spirituous 

Beverage taken. 



W.B.,8et.34, 
carpenter 



C. A., set. 33, 

profession 
unknown 



One pint of gin 
daily ; and two 
or three, and oc- 
casionally six or 
eight pints of 
beer 

Accustomed to 
hard drinking, 
but quality and 
quantity un 
known 



T. S., set. 33, 
engineer on 
board u 
steam-boat 

G.P.,3et. 35, 
profession 
unknown 



Period of 

existence of 

Intemperance. 



Unknown 



No sleep 



Unknown, 
but turned 
teetotaller 
seven 
weeks ago 



About one pint of Unknown 
spirits, and four 
or five pints of 
beer daily 



Sleep 
(state of). 



Unknown 



Unknown 



A great deal of 
brandy and wa- 
ter, and occa- 
sionally pure 
brandy, and a- 
bout eight pints 
of beer daily 



Unknown, 
but began 
at least six 
years ago 



Want of 
sleep 



Cannotsleep 



Hallucina- 
tions. 



Unknown 



Unknown 



Hallucina- 
tions 



TABLE, 



ACCOUNT OF 



CHEONIC ALCOHOLISM, 
the Westminster Hospital. 





Other 










Symptoms 


Symptoms not 






Trembling. 


reierrible to 


referrible to the 


Pre-existing 


Eesult of 




the Nervous 
System. 


Nervous System. 


Disease. 


Treatment. 


Unknown 'Giddiness 


Great weak- 


A slight at- 


Cured, but 






ness and spas-! tack of deli- 


will not give 






modic dys- 


rium tremens 


up drinking, 






pnoea 




and applies 
again subse- 
quently. 


Unknown 


Unknown 


Palpitations 
and occasion- 
al pain in the 
heart, slight 
bruit at first 
sound 


Unknown 


Dicharged 
cured. 


Tongue 


Giddiness 


Thirst, pain in 


Several attacks 


Discharged 


slightly 




epigastrium. 


of delirium 


cured. 


tremulous 




spasmodic 
dyspnoea. 


tremens 




Fits of vio- 


Dizziness of 


Appetite bad; 


Two slight at- 


Ce^ed at- 


lent trem- 


sight 


occasional 


tacks of deli- 


tending, 


bling 




pain in region 


rium tremens 


having quite 






of the blad- 


within thelast 


recovered. 






der; urinetur- 


two years 








bid and red- 










dish. 







150 



SYNOPTICAL 



Name and Age 
of Patient. 
Profession. 



8 



W.J.,at.75, 
shoemaker 



E.B.,8et.40, 
sailor 



W.H.,set.58, 
eraery- 
sifter 



J. P.,£et.39, 
coal-porter 



E. B., set. 
41, tailor 



Quality and Quantity 

of Spirituous 

Beverage taken. 



Excessive use 
of alcoholic 
liquors, quality 
and quantity 
unknown 

Beganwith twelve 
glasses of brandy 
daily, and after 
wards took six 
glasses of rum 
and five or six 
pints of beer 
occasionally 

Gin, gradually in 
creased to four 
glasses a day, 
and from one to 
three pints of 
beer daily 



Period of 

existence of 

Intemperance. 



Sleep 
(state of). 



From youth 
until twelve 
years ago 



Ten or ele 
ven years 
ago 



More than 
twenty 
years, but 
for the last 
six years 
has reduced 
his allow 
ance 



Five pints of beerTwenty 



and a glass of 
gin daily 



Four or five pints 
of porter and 
three glasses of 
gin daily 



years 



Twenty 
years 



Does not 
sleep well 



Does not 
sleep well 



Hallucina- 
tions. 



Sleeps sel- 
dom at 
night 



Sleep very 
restless 



Cannot sleep 



Passing 
shadows 



Passing 
shadows 



Hallucina- 
tions 



Occasional 
passing 
clouds 



Occasional 
hallucina- 
tions and 
muscae 
volitantes 



TABLE. 



151 



Trembling. 


other 

Symptoms, 

referrible to 

the Nervous 

System. 


Symptoms not 
referrible to the 
Nervous System. 


Pre-existing 
Disease. 


Result of 
Treatment. 


Trembling 
for the last 
six weeks 


Giddiness 
and head- 
ache 


Does not mic- 
turate freely ; 
water high- 
coloured and 
turbid 


An attack of 
delirium tre- 
mens twelve 
years ago 


Ceased at- 
tending, 
having quite 
recovered. 


Legs trem- 
ble occa- 
sionally 


Occasional 
giddiness, 
headache, 
and tinni- 
tus aurium 


Legs very weak, 
especially the 
right 


An attack of 
delirium tre- 
mens in 1843; 
also fits (pro- 
bably epilep- 
tic) when 20 
years old 


Discharged 
cured; slight 
weakness re- 
mains. 


Trembling 


Giddiness 


Unknown 


Syphilis at set. 
18 ; at aet. 38 
fits (probably 
epileptic) ; an 
attack of deli- 
rium tremens 
two years ago 


Discharged 
cured. 


Legs trem- 
ble when he 

sits 


Giddiness 


Knees very 
weak ; acute 
pain in right 
hip, and oc- 
casionally 
shooting pain 
across the 
temples 


Unknown 


Ceased at- 
tending, 
having quite 
recovered. 


Trembling 


Headache 
and much 
giddiness ; 
tinnitus 
aurium 


Pain in epigas- 
trium ; bad 
appetite, pal- 
pitations, 
cough, short- 
ness of breath 


Unknown 


Ceased at- 
tending, 
having much 
improved. 



152 



STIfOPTICAL 



Name and Age 
of Patient. 
Profession. 



10 



11 



12 



13 



14 



Quality and Quantity 

of Spuituous 

Beverage taken. 



W.B.,3et.56, 
labourer 



J.W.,Eet.l8, 
hawker 



C.M.,£et.27, 
carrier 



J. T., get. 55 
labourer 



J. L, set. 39, 
labourer 



15E.C.,aet.49 
grocer 



Three to six pints 
of beer daily, 
and a little rura 
occasionally 



Occasionallyfrom 
seven to eight 
pints of beer 
and a glass of 
gin 

Addicted to the 
excessive use of 
alcoholic beve- 
rages, quality 
and quantity un- 
known 

Threeor fourpots 
of beer daily 
and two glasses 
of gin 



Three or four 
pints of beer 
daily, no spirits 



Half a pint of 
brandy and five 
or six pints of 
stout daily 



Period of I 

existence of | 

Intemperance- 



Sleep 
(state of). 



Twenty-six 
years 



Five years 



Unknown 



Eightornine 
years, but 
rather less 
for the last 
five years 

Unknown 



Eight years, 
but altered 
his allow 
ance lately 
to eight 
pints of 
porter a day 



Does not 
sleep well 



Very restless 
at night, 
and does 
not sleep 
well 

Veryrestless 
at night, 
and does 
not sleep 
well 



Does not 

sleep at all 

well at night 



Restless at 
night, and 
does not 
sleep well 

Cannotsleep 
well 



Hallucina- 
tions. 



Muscae vo- 
litantes 
and hallu- 
cinations 



None 



Passing 
shadows 



None 



Passing 
clouds and 
muscae vo- 
litantes 

None but 
muscae vo- 
litantes 



TABLE. 



153 



Tremblinor. 



Trembling 
of legs and 
arms 



Occasional 
trembling 
of legs 



Trembling 



None 



Occasional 
trembling 



Trembles 
every morn 
ing when 
getting up 



Other 

Symptoms 

reierrible to 

the Nervous 

System. 



Vertigo, 
transient 
blindness 



Giddiness 



Diminished 
intellect, 
and fear of 
being in- 
jured 



Great giddi- 
ness 



Tinnitus 
aurium 



Giddiness 



Symptoms not 
referrible to the 
Nervous System. 



On admission 
bronchitis and 
rheumatism ; 
has passed 
blood in stools 



Nausea and 
great weak, 
ness 



Pains in both 
hips, and legs 
weak 



Pain in umbi- 
lical region 
after 
food 



taking 



Pain in the 
stomach ; 
coughs 



Sick in the 
morning, and 
choking sen 
sation 



Pre-existing 
Disease. 



Never had deli- 
rium tremens 



Repeated at 
tacks of 
drunkenness 



Unknown 



Right arm pa 
ralysed thir 
teen years ago 



Unknown 



A slight attack 
of delirium 
tremens two 
months ago 



Eesult of 
Treatment. 



Discharged 
cured. 



Discharged 
cured. 



Ceased at- 
tending, 
having much 
improved. 



Discharged 
cured. 



Ceased at- 
tending, 
having much 
improved. 

Discharged 
cured. 



154 



SYNOPTICAL 



Name and Age 
of Patient. 
Profession. 



16 



17 



18 



19 



Quality and Quantity 

of Spirituous 

Beverage taken. 



S.H.,8et.41, 
carpenter 



Four or five pints 
of porter and a 
quartern of 
spirits daily 



L.M.,8et.46, 
painter 



G.R.,8et.38, 
general 
dealer 



G.MMset.SS, 
cushion- 
maker 



Three glasses of 
spirits and three 
pints of ale daily 



From three 
glasses of spirits 
to a pint daily 
and four or five 
pints of ale 



Six pints of beer 
daily ■ 



Period of 

existence of 

Intemperance. 



From youth; 
about a 
year ago re- 
duced his 
allowance 
to three 
pints of 
ijcer and 
one glass of 
spirits 

From youth 
until the 
last three 
years ; re- 
duced, at 
that time 
his allow- 
ance to 
three pints 
of beer and 
one glass of 
spirits 

From youth 
to about 
eleven 

months ago, 
when he 
gave up 
beer and 
spirits 

For the last 
twelve years 



Sleep 
(state of). 



Does not 
sleep at all 
at night 



Restless at 
night, and 
does not 
sleep well 



Cannot sleep 
at all at 
night 



Unknown 



Hallucina- 
tions. 



Hallucina- 
tions 



Passing 
clouds 



Passing 
clouds 



Passing 
shadows 



TABLE. 



155 



Trembling. 



Occasionally 
violent 
trembling 



No trem- 
bling, but 
occasional 
starting 



Slight trem- 
bling 



Mucli trem- 
bling at 
times 



Other 

Symptoms 

reierrible to 

the Nervous 

System. 



Much giddi- 
ness and 
headache 



Much giddi- 
ness and 
headache 



Much head- 
ache and 
giddiness ; 
and tran- 
sient blind- 
ness 



Tinnitus 
aurium and 
giddiness 



Symptoms not 
referrible to the 
Nervous System. 



Pain in epigas- 
tric region 
morning sick- 
ness 



Pain in the 
stomach after 
eating; an 
attack of hse 
moptysis 



Pre-existing 
Disease. 



None 



Appetite very 
bad, but no 
other dyspep- 
tic symptom ; 

eczema on face 



Weakness, 
shooting pains 
in left eye 



Had delirium 
tremens twice 
three years 
ago 



Eesult of 
Treatment. 



Discharged 
cured. 



None 



Unknown 



Onlyattended 
twice. 



Cured. 



Ceased at- 
tending, 
having much 
improved. 



156 



SYNOPTICAL 





Name and Age 


QuaKty and Quantity 


Period of 






• 


of Patient. 


of Spirituous 


existence of 


Sleep 


Hallucina- 


a 


Profession. 


Beverage taken. 


Intemperance. 


(state of). 


tions. 


20 


J.H.,8et.54, 


Four or five pints 


Ten years ; 


Does not 


Occasion- 




chair-maker 


of beer and three 


but for the 


sleep well 


ally pass- 






glasses of spirits 


last four 




ing clouds 






daily 


years takes 
two pints 
of beer and 
one glass 
spirits 






21 


C.P.,set.54, 


Twelve pints of 


Nine years; 


Cannot sleep 


None 




labourer 


beer daily 


but for the 
last four 
years takes 
two or three 
pints of ale 
daily 






22 


J. L., aet. 53, 


Three or four 


From youth ; 


Does not 


None 




workman 


pots of ale and 


but for the 


sleep at all 






in a brewery 


two or three 
glasses of gin 
daily 


last eight 
or nine years 
takes three 
pints of beer 
and one or 
two glasses 
of gin daily 


well 




23 


J. R., aet. 34, 


One gallon of 


Two years, 


Cannot sleep 


Slight hal- 




policeman 


beer and three 


but has been 


at all well 


lucinations 






glasses of spirits 


very mode- 


at night 


at night or 






daily 


rate for the 
last ten 
years 




when eyes 
are shut 



TABLE. 



157 





other 

Symptoms 


Symptoms not 






Trembling. 


refernbie to 


referrible to the 


Pre-existing 


Result of 




the Nervous 


Nervous System. 


Disease. 


Treatment. 




System. 








Unknown 


Headache 


Bronchitis 


Bronchitis 
every winter, 
never had 
delirium tre- 
mens 


Cured of alco- 
holism, re- 
mains under 

treatment for 
bronchitis. 


Trembling 


Transient 
loss of sight 


Unknown 


None 


Has not at- 
tended after 
first visit. 


Unknown 


Slight head- 


Knawing pains 


None 


Left off at- 




ache 


in legs, and 
such weakness 
that he can 
hardly walk 




tending much 
relieved ; 
legs continue 
very weak. 


Trembles a 


None 


Legs very 


Subject to 


Left off at- 


great deal, in 




weak, and 


bronchitis ; 


tending. 


the morning 




bronchitis 


had delirium 


having quite 


especially 






tremens twice 
during the two 
years of in- 
temperance 


recovered 
from chronic 
alcoholism, 
but still suf- 
fering from 
pain in the 
back and 
neck. 



158 



SYNOPTICAL 



Name and Age 
of Patient. 
Profession. 



Quality and Quantity 

of Spirituous 

Beverage taken. 



Period of 

existence of 

Intemperance. 



Sleep 
(state of). 



Hallucina- 
tions. 



24 jW. F., aet 
34, carter 



25 



J. H., set. 27, 
shoemaker 



Three or four 
pints of beer and 
three or four 
glasses of spirits 
daily 



Four or five pints 
of beer and one 
glass of spirits 



26 



27 



W. P., ffit. 
29, cabman 



D.B.,aBt.72, 

greengrocer 



Three or four 
glasses of gin 
and two or three 
glasses of beer 
daily 

Four or five 
glasses of spirits 
and three orfour 
pints of beer 
daily 



Began when 
young, but 

subsequent 
ly reduced 
his allow- 
ance 

Began 

twelve 
months ago, 
but for the 
last six 
months di- 
minished 
allowance 



Does not 
sleep well 



Hallucina- 
tions 



Cannot sleep 
at all 



8D. W., ffit 
j56, engineer 



Nine years 



From youth 
to fourteen 
fifteen 



or 



years ago, 
when re- 
duced al- 
lowance 



A quarter of a Unknown, 
pint of gin daily, but drinks 
and half a pint less than 
of whisky once previously 
a week for the last 

two years 



Muscae 
volitantes 



Cannot sleep 
well 



Very little 
sleep 



Sleep very 
restless 



Hallucina- 
tions and 
passing 
clouds 



Passing fog 
and hallu- 
cinations 



None 



TABLE. 



159 





Other 










Sym])toms 


Symptoms not 






Trembling. 


referrible to 


referrible to the 


Pre-existing 


Result of 




the Nervous 
System. 


Nervous System. 


Disease. 


Treatment. 


Knees trem- 


Giddiness 


Pain in the 


None 


Ceased at- 


ble 




storaach,weak- 
ness in knees ; 
slight pain in 
hips 




tending, 
having much 
improved. 


Much trem- 


Tinnitus 


Pain in the 


Unknown 


Gave up at- 


bling, es- 


auriura and 


stomach ; 




tending, 


pecially in 


giddiness 


choking sen- 




having quite 


the evening 




sation ; occa- 
sional weak- 
ness in legs ; 
coughs 




recovered, 
but still sub- 
ject to slight 
general ner- 
vous uneasi- 
ness. 


Trembling, 


Giddiness 


Choking sen- 


Subject to 


Discharged 


especially 




sation; weak- 


bronchitis, 


cured, but 


iu the 




ness in legs 


otherwise in 


slight dry 


morning 




and across 
the hips 


good health 


cough re- 
maining. 


Trembles a 


None 


Frequent sick- 


Subject to gout 


Discharged 


great deal 




ness and 




cured of al- 


in the 




vomiting; an 




coholism, 


morning 




evident at- 
tack of gout 




though not 
of the gouty 
predisposi- 
tion. 


Trembles in 


Dimness of 


Weakness and 


None 


Ceased at- 


the morn- 


sight and 


sickness in 




tending, 


ing 


headache 


the morning 




greatly re- 
lieved. 



160 



SYNOPTICAL 



29 



30 



Name and Age 
of Patient. 
Profession. 



J.L.,8et. 24, 
butcher 



Quality and Quantity 

of Spirituous 

Beverage taken. 



J. H.,fet.49, 
no profes- 
sion, but 
has been 
policeman 



31J. B.,Eet.40, 
labourer 



32 



W. D., at. 
34, profes- 
sion un- 
known 



A bottle of port 
wine daily, and 
half a pint of 
spirits 



Period of 

existence of 

Intemperance 



Daily average 
three or four 
glasses of spirits 
and two pints of 
ale 



About five quarts 
of beer and a 
pint of gin daily 



Daily average a 
quart of beer 
and about one 
pint of gin with 
peppermint 



Twelve 
fifteen 
years, but 
diminished 
allowance 
for the last 
four or five 
years, and 
during the 
last year 
one pint of 
beer daily 

Twenty 
years ; but 
for the last 
twelve 
months, 
half a pint 
of beer 
daily 

Unknown 



Sleep 
(state of). 



Hallucina- 
tions. 



Sleep 
greatly dis 
turbed bv 
horrid 
dreams 



From about 
nine years 
ago to five 
years ago, 
when he 
left off 
drinking 



Sleeps well, 
but dreams 
a great deal 



Occasional 
passing 
shadows 



None 



Very little 
sleep and 
dreadful 
dreams 



Sleep much 
disturbed 



Unknown 



Passing 
shadows 
and hallu- 
cinations 



TABLE. 



161 





Other 








Trembling. 


Symptoms 
referrible to 


Symptoms not 
referrible to the 


Pre-existing 


Eesitlt of 




the Nervous 
System. 


Nervous System. 


Disease. 


Treatment. 


Trembles a 


Headache 


Weakness in 


None 


Dismissed 


little in the 




the hip 




cured. 


morning 










Tongue 


Headache 


Pain in right 


Had an attack 


Dismissed 


slightly 


and much 


hypochon- 


of the same 


cured. 


tremulous 


giddiness, 


driac region ; 


symptoms 






dimness of 


no other 


four years 






sight and 


symptoms 


ago, and was 






tinnitus 




treated at St. 






aurium 




Thomas's 
Hospital 




Trembles in 


Much head- 


Pain in the 


Several attacks 


Ceased at- 


the morn- 


ache and 


stomach ; no 


of delirium 


tending. 


ing 


giddiness, 


appetite; pain 


tremens ; has 


much re- 




muscae vo-'in dorsalspinal 


been subject 


lieved. 




litantes, isi region; great 


to cough 






very low weakness 








spirited 








Trembling 


Headache 


Coughs ; pain 


Unknown 


Ceased at- 




and much 


in chest; sick- 




tending. 




giddiness. 


ness after 




much re- 




with faint- 


taking food 




lieved. 




ness; noises 










in the ears 









11 



162 



SYNOPTICAL 



Name and Age 
of Patient. 
Profession. 



33 



34 



35 



36 



H.E.,aet.24, 
clerk 



T.H.,«t.36, 
cutler 



G.B.,ffit.28, 
stoker in 
House of 
Parliament 



B.L.,8et.29, 
shoemaker 



Quality and Quantity 

of Spirituous 

Beverage taken. 



Has been drunk 
five or six times, 
was so last 
Christmas ; is 
very moderate 
between ex- 
cesses 



Sixteen or seven- 
teen wine-glasses 

of rum daily ; 

occasionally 

brandy instead 

of rum 



One pint of ale 
daily and no 
spirits 



On an average 
two quarterns of 
rum and three 
or four pints of 
beer daily 



Period of 

existence of 

Intemperance, 



Unknown 



Sleep 
(state of). 



Does not 
sleep well 



Fourteen Awakes 
months. often at 
During the night, but 
last seven- sleeps 
teen years pretty well 
has dimi- 
nished his 
allowance, 
being occa- 
sionally in- 
toxicated. 



Unknown, Sleeps very 
but became indifferently 
a teetotaller 
three years 
ago 



For the last 
two years 
but took to 
drinking 
five years 
ago 



Sleeps 
pretty well, 
but sleep 
disturbed 
by dreams 



Hallucina- 
tions. 



None 



Unknown 



Hallucinan 
tions 



Hallucina-a 
tions 



TABLE. 



163 





Other 










Symptoms 


Symptoms not 






Trembling. 


referrible to 


referrible to the 


Pre-existing 


Result of 




the Neryous 
System. 


Nervous System. 


Disease. 


Treatment. 


Trembles a 


No headache 


Much weak- 


Unknown 


Dismissed 


great deal 


no giddi- 


ness 




much re 


in the 


ness 






lievad. 


morning 










Trembles in 


Much head- 


Pain in the 


Has suffered 


Ceased at- 


the morn- 


ache and oc- 


back when 


from the same 


tending, 


ing 


casionally 


walking 


symptoms 


having quite 




much gid- 




t\^ice pre- 


recovered ; 




diness 




viously ; the 
first time six 
or seven years 
ago, after 
being ga- 
rotted 


still com- 
plainsof pain 
in the back. 


Trembles in 


Giddiness, 


Rheumatic 


Unknown 


Onlyattended 


the morn- 


transient 


pains ; no 




one day at 


ing 


blindness, 
headache, 
muscae 
volitantes 


dyspeptic 
symptoms 




the hospital. 


Trembles in 


Headache 


Appetite de- 


Has attended 


Dismissed 


the morn- 


and giddi- 


ficient, much 


the hospital 


cured. 


ing 


ness 


pain after 
eating in epi- 
gastric region, 
pain in dorsal 
region. 


two years ago 
for the same 
illness 





164 



SYNOPTICAL 



^ 



Name and Age Quality and Quantity 
of Patient. of Spirituous 

Profession. Beverage taken. 



37 



T.R.,ffit.48, 
weaver 



38 



From four to ten 
pints of porter 
daily ; no spirits 



Period of 

existence of 

Intemperance. 



For twenty 
years, but 
diminished 
allowance 
for the last 
two years 



J.H.,3et.56. 
labourer 



Daily average 
five or six pints 
of beer and two 
or three and a 
half quarterns 
of gin 



39B.M.,8et.44, 
omnibus- 
driver 



40 



W. B., set 
49, coal- 
porter 



Sleep 
(state of). 



Sleeps but 
very little; 
is much 
troubled 
with night 
mare 



From three 
years ago 
till the mid- 
dle of last 
year, but 
drank hard 
though not 
so much, 
previous to 
that time 



Hallucina- 
tions. 



Hallucina- 
tions 



Four or five pints 
of porter and 
two or three 
glasses of spirits 
daily 



Five or six pints 
of beer and a 
glass of spirits 
daily 



For twenty 
years 



Twenty 
vears 



Sleep much 
interrupted, 
and rest- 
less 



Slight hal- 
lucinations 



Restless at 
night; fre 
quently 
awakes 
dreaming 



Cannotsleep 
well at 
night, but 
not subject 
to night- 
mare 



Slight hal- 
lucinations 



None 



TAELE. 



165 





Other 










Symptoms 


Symptoms not 






Trembling. 


referrible to 


referrible to the 


Pre-existing 


Kesult of 




the Nervous 


Nervous System. 


Disease. 


Treatment. 




System. 








Trembles a 


Headache 


Small tumour 


Unknown 


Has not at- 


great deal 




on upper part 
of the ster- 
num, very 
painful on 
pressure. 




tended be- 
yond the 
first visit. 


Unknown 


Dizziness 


Pain in the 


Unknown 


Gave up at- 




and dimness 


back, much 




tending ; 




of sight 


emaciated; 
case of en- 
larged liver 




sinking from 
organic 
disease. 


Unknown 


Headache 


Coughs and 


Great mental 


Ceased at- 




and gid- 


spits a great 


depression 


tending, 




diness ; and 


deal, pain in 


from family 


much re- 




dimness of 


stomach after 


afflictions 


lieved. 




sight, mus- 


eating, fre- 








cae voli- 


quent sick- 






- 


tantes 


ness in the 
morning 






Trembling 


Unknown 


Cough, sick- 
ness, pain in 
stomach, and 
bad appetite 


NOHC 


Ceased at- 
tending, 
much re- 
lieved. 



166 



STN'OPTICAL 



d 


Name and Age 
of Patient. 
Profession. 


Quality and Quantity 

of Spirituous 

Beverage taken. 


Period of 

existence of 

Intemperance. 


Sleep 
(state of). 


Hallucina- 
tions. 


41 


A.P.,8et.40, 
gas-fitter 


Six or seven pints 
of beer daily 


Two or 
three years 


Want of 
sleep 


None 


42 


G. J., JBt. 27, 
check- 
taker at a 
theatre 


Four or five 
glasses of spirits 
and two or three 
glasses of ale 
daily 


From youth 
up to three 
years ago, 
and then 
diminished 
his allow- 
ance to one 
pint of beer 
and three 
glasses of 
spirits 


Cannot sleep 
well at 
night, has 
frightful 
dreams 


Unknown 


43 


T.C.,£et.48, 
coal-porter 


Two pots of beer 
daily and a little 
spirits occa- 
sionally 


For twenty- 
four years, 
but rather 
more du- 
ring the last 
two or three 
months 


Cannot sleep 
at night 


None 


44 


R. S.,Eet.32, 
labourer 


Six or seven pints 
of ale and two 
or three glasses 
of spirits daily 


For fourteen 
years up to 
a month 
before ad- 
mission 


Does not 
sleep well 


Hallucina- 
tions 



TABLE. 



167 



Trembling. 



Other 

Symptoms 

ref'crrible to 

the Nervous 

Svstem. 



Trembles in Giddiness 
the morn- 
ing 



Occasional 
trembling 



Trembling 
in the 
morning 
when takes 
more than 
usual the 
dav before 



Trembling, 
especially 
in the 
morning 



Giddiness, 
headache, 
transient 
loss of 
sight 



Muscae voli- 
tantes 



Giddiness 



Symptoms not 
referrible to tlie 
Nervous System. 



Pre-existing 
Disease. 



Six or seven 
months ago 
fell from a 
height of 
twenty-five 
feet ; no ap 
petite, morn- 
ing sickness 
gastric pain 



Pain in the 
stomach, sub- 
ject to occa 
sional rheu- 
matic pains 



In good health 
previous to 
the accident 



Three or four, 
years ago suf- 
fered from 
coup-de-soleil 



Tlesult of 
Treatment. 



Ceased at- 
tending, 
much re- 
lieved. 



A co-existing None 
attack of gout, 
digestion good 



Ceased at- 
tending, 
much re- 
lieved. 



Morning sick- None 
ness, but no 
gastric pain 



Has not at- 
tended be- 
yond the se- 
cond visit. 



Discharged 
cured. 



168 



STl^OPTICAL 





Name and Age Quality and Quantity 


Period of 


Ol «« 






of Patient. 


of Spirituous 


existence of 


bleep 


Hallucina- 


o 

1^ 


Profession. 


Beverage taken. 


Intemperance. 


(state of). 


tions. 


45 


A.T.,3et.25, 


One pint of beer 


For seven 


Cannot sleep 


Hallucina- 




labourer 


and three or 
four glasses gin 
daily, except on 
Saturday ; this 
day he takes 
seven or eight 
pints of beer 
and five or six 
glasses of gin 


years 


the four 
nights fol- 
lowing the 
Saturday 
excess ; 

sleeps pretty 
vp^ell on the 

othernights 


tions 


46 


H.H.,8et.42 


Three or four 


For about 


Cannot sleep 


No positive 




hawker 


pints of raw rum 


twenty- 




hallucina- 






daily, and three 


seven years 




tions 






or four pints of 


till the last 










beer 


three or 
four months 






47 


T.D.,£et.42, 


Began with five 


For tv^renty- 


Unknown 


Hallucina- 




cab-driver 


or six pints 
of ale daily, 
and increased 
his allowance to 
twenty glasses 
of spirits and 
five pints of ale 
daily 


five years 




tions 


48 


W. P., age 


Two or three 


For ten or 


Sleeps very 


Unknown 




unknown, 


pints of ale and 


eleven years 


well 






occupation 


a glass of spirits 










unknown 


daily 









TABLE. 



169 





Other 










Symptoms 


Symptoms not 






Trembling. 


referrible to 


refenible to the 


Pre-existing 


Kesult of 




the Nervous 


Nervous System. 


Disease. 


Treatment. 




System. 
Muscae vo- 








Trembling 


Morning sick- 


None 


Left off at- 




litantes, 


ness and gas- 




tending, 




headache 


tric pains 




having nearly 




and giddi- 






perfectly re- 




ness 






covered. 


Trembling 


Sensation of 


Gastric pains. 


Unknown 


Became an in- 




suffocation, 


morning sick- 




patient after 




sometimes 


ness 




second visit. 




very acute ; 










giddiness, 










muscae 










volitantes, 










cramps 








Unknown 


Sensation of 


Gout and hse- 


Several attacks 


Left off at- 




suffocation 


matemesis ; 


of delirium 


tending, 






coughs 


tremens 


quite re- 
covered from 
chronic al- 


' 






- - 


coholism. 


Trembling 


Giddiness 


Sickness 


Unknown 


Has not at- 


in the 


and head- 




(smokes, and 


tended be- 


morning 


ache 




has suffered 
from it) 


yond the 
first visit. 



APPENDIX, 



The author begs to observe that the state- 
ments contained at pp. 44 and 73 of the pre- 
sent treatise, respecting the property of 
alcohol, tea, and coffee of diminishing the 
waste of the body, are derived from the re- 
searches of Prout,^ Dr. Fyfe,^ Vierordt,^ 
Bocker,* and Lehmann.^ 

Pront, Dr. A. Fyfe, Vierordt, and Bocker, 
have found that alcohol, when taken, diminishes 
the amount of carbonic acid expired. Moreover, 
Bocker informs ns that the excretion of urea 
is lessened by alcohol and tea, tea likewise 
reducing the quantity of carbonic acid evolved. 

^ * Thompson's Annals of Physiology/ vol. ii. 

2 See a paper of Prout, in ' Thompson's Annals of Phy- 
siology/ vol. iv. 

^ ' Physiologie des Athmens.' 

^ • British and Poreign Medico-Chirurgical Review/ 
vol. xiv, 1854. 

^ See the account 'of * Bocker's Researches/ in the last- 
mentioned periodical. 



172 APPENDIX. 

According to Lehmann^s inquiries^ the use of 
coffee also lessens the amount of carbonic acid 
expired. 

The results obtained by Dr. Edward Smith/ 
from recent and very interesting investigations 
on the action of food upon respiration^ agree 
but partly with the above-mentioned conclu- 
sions. This gentleman found that spirits of 
wine^ ale, and stout, increased the quantity of 
carbonic acid expired. Eum commonly in- 
creased it, and sherry wine exerted, to a slight 
extent, a similar action. The amount of car- 
bonic acid evolved, when brandy and gin were 
taken, was constantly diminished. Whisky 
varied in its effects. The inhalation of the 
volatile elements of wine and spirits, lessened 
the evolution of this gas. Dr. E. Smith also 
observed that tea and coffee increased the pro- 
duction of carbonic acid, tea being more power- 
ful than coffee. 

* 'Proceedings of the Royal Society,' 1859, vol. ix, 
p. 638. 



END. 



J. E. ADLARD, PRINTEK, BARTHOLOMEW CLOSE. 



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