The anatomy of drunkenness

by Robert Macnish

In treating delirium tremens, particular attention must be paid to the nature of the disease, and constitution of the patient. In the first mentioned, and by far the most frequent variety, blooding, which some physicians foolishly recommend, is most pernicious. I have known more than one instance where life was destroyed by this practice. As there is generally much gastric irritation, as is indicated by the foul tongue, black and viscid evacuations, and irritable state of the stomach, I commence the treatment by administering a smart dose of calomel. As soon as this has operated, I direct tepid water strongly impregnated with salt, to be dashed over the body, and the patient immediately thereafter to be well dried and put to bed. I then administer laudanum in doses of from forty to sixty drops, according to circumstances, combining with each dose from six to twelve grains of the carbonate of ammonia: this I repeat every now and then till sleep is procured. It may sometimes be necessary to give such doses every two hours, or even every hour, for twelve or twenty successive hours, before the effect is produced. The black drop in doses proportioned to its strength, which is more than three times that of laudanum, may be used as a substitute for the latter; the acetate or muriate of morphia, in doses of a quarter or half a grain, is also a good medicine, having less tendency to produce stupor or headach than laudanum, and therefore preferable in cases where the patient is of a plethoric habit of body. It must be admitted, however, that their effects are less to be depended upon than those of laudanum, which, in all common cases will, I believe, be found the best remedy. The great object of the treatment is to soothe the apprehensions of the patient, and procure him rest. So soon as a sound sleep takes place there is generally a crisis, and the disease begins to give way; but till this occurs it is impossible to arrest its progress and effect a cure. A moderate quantity of wine will be necessary, especially if he has been a confirmed drinker, and labours under much weakness. Perhaps the best way of administering wine is along with the laudanum, the latter being dropped into the wine. Where wine cannot be had, porter may be advantageously given in combination with laudanum. The principal means, indeed, after the first purging, are opium, wine, ammonia, and tepid effusion: the latter may be tried two, three, or four times in the twenty-four hours, as occasion requires. The mind is, at the same time, to be soothed in the gentlest manner, the whimsical ideas of the patient to be humoured, and his fancies indulged as far as possible. All kinds of restraint or contradiction are most hurtful. Some recommend blisters to the head, but these are, in every case, injurious. So soon as all the symptoms of the disease have disappeared some purgative should be administered, but during its progress we must rely almost wholly upon stimulants. To cure, by means of stimuli, a complaint which arose from an over-indulgence in such agents, is apparently paradoxical; but experience confirms the propriety of the practice where, a priori, we might expect the contrary.

In the second variety of the disease, the same objections do not apply to blood-letting as in the first, but even there, great caution is necessary, especially if the disease has gone on for any length of time, if the pulse is quick and feeble or the tongue foul. At first, general blooding will often have an excellent effect, but should we not be called till after this stage it will prove a hazardous experiment. Local blooding will then sometimes be serviceable where general blooding could not be safely attempted. The patient should be purged well with calomel, have his head shaved, and kept cool with wet cloths, and sinapisms applied to his feet. When the bowels are well evacuated, and no symptoms of coma exist, opiates must be given as in the first variety, but in smaller and less frequently repeated doses.

Much yet remains to be known with regard to the pathology of delirium tremens. I believe that physicians have committed a dangerous error, in considering these two varieties as modifications of the same disease. In my opinion they are distinct affections and ought to be known under different names. This cannot be better shown than in the conflicting opinions with regard to the real nature of the disease. Dr. Clutterbuck, having apparently the second variety in his eye, conceives that delirium tremens arises from congestion or inflammation of the brain; while Dr. Ryan, referring to the first, considers it a nervous affection, originating in that species of excitement often accompanying debility. It is very evident, that such different conditions require different curative means. The genuine delirium tremens is that described under the first variety, and I agree with Dr. Ryan in the view he takes of the character of this singular disease.

General Remarks.—Such are the principal diseases brought on by drunkenness. There are still several others which have not been enumerated—nor is there any affection incident to either the body or mind which the vice does not aggravate into double activity. The number of persons who die in consequence of complaints so produced, is much greater than unprofessional people imagine. This fact is well known to medical men, who are aware that many of the cases they are called upon to attend, originate in liquor, although very often the circumstance is totally unknown either to the patient or his friends. This is particularly the case with regard to affections of the liver, stomach, and other viscera concerned in digestion. Dr. Willan, in his reports of the diseases of London, states his conviction that considerably more than one-eighth of all the deaths which take place in persons above twenty years old, happen prematurely through excess in drinking spirits. Nor are the moral consequences less striking: Mr. Poynter, for three years Under-Sheriff of London and Westminster, made the following declaration before a Committee of the House of Commons:—“I have long been in the habit of hearing criminals refer all their misery to drinking, so that I now almost cease to ask them the cause of their ruin. This evil lies at the root of all other evils of this city and elsewhere. Nearly all the convicts for murder with whom I have conversed, have admitted themselves to have been under the influence of liquor at the time of the act.” “By due observation for nearly twenty years,” says the great Judge Hales, “I have found that if the murders and manslaughters, the burglaries and robberies, and riots and tumults, the adulteries, fornications, rapes, and other great enormities, that have happened in that time, were divided into five parts, four of them have been the issues and product of excessive drinking—of tavern and ale-house meetings.” According to the Caledonian Mercury of October 26, 1829, no fewer than ninety males, and one hundred and thirty females, in a state of intoxication, were brought to the different police watchhouses of Edinburgh, in the course of the previous week—being the greatest number for many years. Nor is Glasgow, in this respect, a whit better than Edinburgh. On March 1, 1830, of forty-five cases brought before the police magistrate in Glasgow, forty were for drunkenness; and it is correctly ascertained that more than nine thousand cases of drunkenness are annually brought before the police, from this city and suburbs—a frightful picture of vice. In the ingenious Introductory Essay attached to the Rev. Dr. Beecher’s Sermons on Intemperance, the following passage occurs, and I think, instead of exaggerating it rather underrates the number of drunkards in the quarter alluded to. “Supposing that one-half of the eighteen hundred licensed houses for the sale of spirits which are in that city, send forth each a drunken man, every day, there are, in Glasgow, nine hundred drunken men, day after day, spreading around them beggary, and wretchedness, and crime!” Had the author given to each licensed house, one drunkard on an average, I do not think he would have overstepped the bounds of truth. As it is, what a picture of demoralization and wretchedness does it not exhibit!

CHAPTER XI.
SLEEP OF DRUNKARDS.

To enter at large upon the subject of sleep would require a volume. At present I shall only consider it so far as it is modified by drunkenness.

The drunkard seldom knows the delicious and refreshing slumbers of the temperate man. He is restless, and tosses in bed for an hour or two before falling asleep. Even then, his rest is not comfortable. He awakes frequently during night, and each time his mouth is dry, his skin parched, and his head, for the most part, painful and throbbing. These symptoms, from the irritable state of his constitution, occur even when he goes soberly to bed; but if he lie down heated with liquor, he feels them with double force. Most persons who fall asleep in a state of intoxication, have much headach, exhaustion, and general fever, on awaking. Some constitutions are lulled to rest by liquors, and others rendered excessively restless; but the first are no gainers by the difference, as they suffer abundantly afterwards. Phlegmatic drunkards drop into slumber more readily than the others: their sleep is, in reality, a sort of apoplectic stupor.

I. Dreams.—Dreams may be readily supposed to be common, from the deranged manifestations of the stomach and brain which occur in intoxication. They are usually of a painful nature, and leave a gloomy impression upon the mind. In general, they are less palpable to the understanding than those which occur in soberness. They come like painful grotesque conceptions across the imagination; and though this faculty can embody nothing into shape, meaning, or consistence, it is yet haunted with melancholy ideas. These visions depend much on the mental constitution of the person, and are modified by his habitual tone of thinking. It is, however, to be remarked, that while the waking thoughts of the drunkard are full of sprightly images, those of his sleep are usually tinged with a shade of perplexing melancholy.

II. Nightmare.—Drunkards are more afflicted than other people with this disorder, in so far as they are equally subject to all the ordinary causes, and liable to others, from which sober people are exempted. Intoxication is fertile in producing reveries and dreams, those playthings of the fancy; and it may also give rise to such a distortion of idea, as to call up incubus, and all its frightful accompaniments.