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

by Unknown

II. Chronic Alcoholism.—The lesions of chronic alcoholism, as has already been pointed out, are not in themselves peculiar to that condition. Many of them occur with more or less frequency in morbid states not induced by alcohol. It is their association and progressive character which gives to chronic alcoholism its individuality. The occasional prominence of certain symptoms or groups of symptoms may thus in particular cases lead to some confusion of diagnosis, especially where the history is unknown or the habits of the individual are concealed. In the greater number of cases, however, the association of symptoms is such as to render the diagnosis, even in the absence of a direct history, a comparatively easy one.

Chronic alcoholism is a condition rather than a disease—a condition characterized by varying lesions of the viscera and nervous system, by profound disturbances of nutrition, and by grave mental and moral derangements. This fact being recognized, the cardinal error of diagnosis to be guarded against is that of overlooking the condition upon which the disease itself with which we have to do depends or is associated. Congestion, inflammation, sclerosis, and steatosis affect the various organs of the body and produce their characteristic symptoms. Profound and lasting disturbances of nutrition demand our attention. Psychical derangements of all grades, from mere moodiness to confirmed and hopeless insanity, take place. These affections must be diagnosticated for themselves here as elsewhere in clinical medicine. The recognition of the underlying condition can, however, alone supply the key to their true pathology.

Delirium tremens is occasionally diagnosticated with difficulty from some forms of insanity not caused by drink. Here transitory and fixed delusions, not mere terrors and hallucinations, are of importance, not less than the absence of the varied and complex associations of symptoms which are characteristic of alcoholism. The delirium of the acute infectious diseases may be mistaken for delirium tremens. Pneumonia, typhoid fever, and the exanthemata occasionally begin with delirium resembling in some respects delirium tremens. Here the history of the case, the pyrexia, and the general condition of the patient are sufficient to establish the diagnosis if the danger of error be borne in mind.

III. Hereditary Alcoholism.—The diagnosis of this condition can only be established by careful investigation of the family history and systematic study of the stages of progression by which the morbid condition presented by the patient has been reached.

IV. Dipsomania.—The diagnostic points are the hereditary transmission of this or other forms of insanity—the mental instability of the patient in early life and in the intervals of the paroxysms, the intermittent or cyclical recurrence of the attack, the morbid impulses of a different kind associated with the impulse to drink, and the struggle of the patient against his recurring impulses to uncontrollable excesses.

PROGNOSIS.—The prognosis in acute alcoholism of the ordinary form is favorable, so far as the immediate attack is in question. The prognosis in rapidly-developing, overwhelming coma from enormous doses of alcohol is in the highest degree unfavorable. Acute coma from moderate doses usually passes off in the course of some hours. It occasionally, however, terminates in fatal pneumonia.

The prognosis in delirium tremens of the ordinary form is favorable. It becomes, however, more and more grave with each recurring attack. Delirium tremens in patients suffering from advanced disease of the heart, lungs, liver, or kidneys, or complicated by acute diseases of these organs, is apt to prove fatal.

The prognosis of chronic alcoholism is gloomy. If the lesions be not advanced, permanent discontinuance of alcoholic habits may be followed by restoration of health, but, unfortunately, the discontinuance is too often merely temporary, the habit being too strong to be permanently broken off.

The prognosis in hereditary alcoholism is unfavorable, both as regards the alcoholic habit and as regards the development of serious diseases of the nervous system under adverse circumstances, even in the absence of the direct action of alcohol.

The prognosis in dipsomania is unfavorable. The paroxysm may recur many times without apparent serious result; the patient in the course of some days or weeks recovers, abandons his evil courses, and resumes his usual occupations. After a time, however, the insanity of which the dipsomania is the recurring manifestation declares itself as a more or less permanent state. The outbreaks become more frequent and more prolonged, the mental condition in the intervals progressively more morbid, until the patient lapses by degrees into confirmed insanity.