A system of practical medicine. By American authors. Vol. 5

by Unknown

BY JAMES C. WILSON, M.D.

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DEFINITION.—Alcoholism is the term used to designate collectively the morbid phenomena caused by the abuse of alcohol.

SYNONYMS.—Alcoholismus, Ebrietas, Ebriositas, Temulentia, Drunkenness, Delirium potatorium, Mania potatorium, Delirium tremens, Chronic alcoholic intoxication, Dipsomania; Ger. Trunkenheit, Trunksucht; Fr. Ivresse, Ivrognerie.

These terms are in common use to describe such conditions and outbreaks in alcoholic individuals as amount to veritable morbid states or attacks of sickness, but they are not interchangeable, nor are they all sufficiently comprehensive to constitute true synonyms. They are names applied to various conditions due to acute or chronic alcohol-poisoning properly and distinctively comprehended under the general term alcoholism.

CLASSIFICATION.—It was formerly the custom to restrict this term to affections of the general nervous system induced by continued excesses in the use of alcoholic drinks.¹ But the nervous system bears the brunt of the attack and suffers beyond all others alike in transient and in continued excesses. The artificial restriction of the term to the cases caused by continued excesses was therefore illogical in itself, and has been productive of much needless difficulty in the treatment of the subject and in the classification of the cases. The use of the term chronic alcoholism to denote an established condition, and of acute alcoholism to describe outbreaks of various kinds which occur in individuals subject to that condition, has also proved a source of embarrassment to the student. Not less vague has been the employment of such terms as delirium tremens, mania-a-potu, and the like, which are unsatisfactory in themselves, and tend to exalt symptoms at the expense of the morbid condition of which they are only in part the manifestation. I am of the opinion—which is at variance with established usage—that the systematic discussion of alcoholism requires that all forms of sickness, including drunkenness, due to that poison must receive due consideration, and that the term acute alcoholism, hitherto used in a sense at once too comprehensive and too variable, should be reserved for those cases in which the sudden energetic action of the poison is the occasion of like sudden and intense manifestations of its effects. Furthermore, the uncertainty and lack of precision in the use of the terms acute and chronic alcoholism are due to errors of theory formerly almost universal in medical writings and popular belief concerning the disease. The chief source of these errors was the recognition only of the more acute nervous affections caused by alcoholic excess—delirium tremens, maniacal excitement, and terrifying hallucinations—and the belief that these conditions occurred only after a temporary abstinence in the course of habitual or prolonged indulgence. It has now long been known that abstinence from drink by no means necessarily precedes the outbreak of mania or delirium, and modern researches have established the existence of a chronic alcoholic intoxication of long duration extending over a period of months or years, in which such outbreaks merely exhibit the full development of symptoms that have already been occasionally and partially recognizable.

¹ Anstie, Reynolds's System of Medicine, vol. ii., 1868.

The following arrangement of the topics will facilitate the discussion of the subject in the present article, and serve, I trust, a useful purpose for the classification of cases in accordance with existing knowledge:²

I. Acute Alcoholism: Drunkenness, Debauch.
A. Ordinary or Typical Form.
B. Irregular Forms.
1. Maniacal;
2. Convulsive;
3. In persons of unsound mind.
C. Acute Poisoning by Alcohol: Lethal doses.
II. Chronic Alcoholism.
A. Visceral Derangements.
1. Local disorders:
a. Of the digestive system;
b. Of the liver;
c. Of the respiratory system;
d. Of the circulatory system;
e. Genito-urinary system.
2. Disorders of special structures:
a. Of the locomotor apparatus;
b. Of the skin.
3. General disorders:
a. The blood;
b. Obesity;
c. Cachexia.
B. Derangements of the Nervous System: Cerebro-spinal Disorders.
1. Cerebral disorders.
2. Spinal disorders.
3. Disorders of the peripheral nerves.
4. Disorders of the special senses.
C. Psychical Derangements.
1. The moral sense.
2. The will.
3. The intellect.
4. Alcoholic delirium in general.
5. Delirium tremens.
6. Alcoholic insanity:
a. Melancholia;
b. Mania;
c. Chronic delirium;
d. Dementia;
e. Paretic dementia.
III. Hereditary Alcoholism.
IV. Dipsomania.

² This classification is in part based upon that of Lentz, De l'Alcoholism et de ses Diverses manifestations, etc., Bruxelles, 1884—a prize essay.