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environments, and are so readily affected by all untoward influences coming from any source, that they require special attendance at all times by those who have the requisite training and skill. This is especially important before and after the occurrence of fits.

The great success which has attended surgical operations of the brain in recent years, in consequence of after-treatment by the aseptic method, renders it probable that cases of epilepsy may be relieved by such measures, when arising from some forms of organic growths, the pressure of foreign substances, depressed bone, etc., and asymmetrical developments of the skull. Many cases with favorable results have already been reported.

LECTURE XXIII.

ALCOHOLIC INSANITY. Physiological Effects of Alcohol— Modification of—Per Cent. of Alcoholic

Insanity- Statistics---Acute Alcoholic Insanity-Symptoms—IllusionsHallucinations — Attention — Temperature — Termination-Examples Treatment — Chronic Alcoholic Insanity - Symptoms—Irritability-Insomnia—Loss of Memory-Paresis of Muscular System-SuspicionHallucinations-Cramps— Hyperæsthesia-Gastritis, Epileptiform Seizures-Delusions—Examples-Pathological Anatomy.

cases.

Physiological Action of Alcohol.-The physiological effects of the continued use of alcohol upon the human system are doubtless of the same general character in all

It becomes rapidly absorbed into the circulation, and by it is carried at once to those portions of the brain which are more especially concerned in the processes of thought. It speedily acts upon the vaso-motor system of nerves, and thus indirectly stimulates the action of the heart. Its influence is also communicated to the capillary vessels of the grey substance of the brain, causing a dilatation, and when its use is long continued a consequent exudation upon the delicate membranes and into the interstitial tissues. It indirectly excites to abnormal activity the nerve cells of the cortex and thus increases mental function. This increase of function is succeeded by a corresponding diminution after a longer or shorter period, accompanied by a lessening of the temperature of the whole body.

Modification of its Effects.—The effects of alcohol vary in some degree in different cases, and are more pronounced and permanent in some persons than in others. Not unfrequently a small quantity when used by a person of a sensitive and sanguine temperament, especially if accustomed to a sedentary life, has a much more profound effect than a larger amount used by one of lymphatic temperament who leads a life requiring him to be much in the open air. Persons inheriting any of the neuroses are much more susceptible to its influence, which may manifest itself in an impairment of the moral and intellectual faculties, and in the development of a craving which may remain through life.

The effects of alcohol, when taken in the form of beer or some of the lighter wines, are much less pronounced than those resulting from the daily use of whisky or brandy. In the one case it is combined with certain materials of which the physiological action upon the stomach may be highly favorable, and may aid in the more speedy elimination of the alcohol from the system, while, in the other, the effects upon the vaso-motor nerves are more direct, and remain for a longer period upon the elements of the nervous system.

Some combinations of alcohol also affect the system more unfavorably than others, those rich in carbon and hydrogen having the least toxic effect. Persons before the age of twenty, and while the brain is more sensitive to unfavorable influences, and has less of inhibitory power, are more largely affected than those in later life; a special diathesis may become established which renders all successful effort to reform much more difficult, and in the large majority of cases quite impracticable. In many such cases the need of reform is not realized, and consequently there exists no

desire for it. It is from this class that many of the dipsomaniacs come.

Per Cent. of Alcoholic Insanity.-The number of cases of insanity which are caused by the abuse of alcohol varies considerably in different institutions and countries; while in some the admissions which can be traced to this cause do not amount to more than five or six per cent of the total, in others it stands as high as fifteen or twenty. In some countries it is thought to be affected by the facilities afforded for procuring alcoholic beverages. The statistics of American asylums indicate that from ten to twelve per cent. of admissions can be traced either directly or indirectly to this agent as a cause.

At the meeting of the International Congress of Alcoholism in Paris, July, 1889, M. Ivernes, Chief of Statistics at the French Ministry of Justice, read a paper on the “Relations Existing Between the Increase of the Use of Alcohol and the Increase of Insanity and Criminality.” From this paper it appears that “statistics very plainly show that there is an increase of crime in direct proportion to the increase of alcohol taken by each inhabitant. In France, from 1873 to 1887, the average annual quantity of alcohol taken by each inhabitant was 2.72 quarts, making a total increase of 29 per cent. in amount consumed. During this time the number of crimes and offenses increased from 172,000 to 195,000, and the number of insane people from 37,000 in 1872 to 52,000 in 1885, an increase of 12 per cent. in crime and an increase of 29 per cent. in insanity."

“In Belgium, from 1868 to 1882, each inhabitant, on an average, increased the amount of alcohol used from seven quarts per annum up to nine quarts, thus making an increase of 28 per cent. The number of crimes and offenses increased, from 1868 to 1882, from 1900 for every 100,000

inhabitants to 2807; the number of insane, which was 8240 in 1868, has gone up to 10,020 in 1878, giving an increase of 24 per cent. of crime and an increase of 17 per cent. of the insane.” “In Italy, from 1872 to 1885, the alcohol consumed increased from 2.7 quarts to five quarts to each inhabitant, an increase of about 46 per cent. From 1879 to 1885 the number of criminals increased from 1400 to 1500, and the number of the insane from 15,000 to 22,000, an increase of 7 per cent. of crime and of 29 per cent. of insanity."

The writer says: “These facts clearly show that there is a direct increase of crime and insanity with the increase of the use of alcohol ; on the other hand, an additional proof of the fact that a decrease of the use of alcohol in a country is accompanied with a corresponding decrease in the number of crimes and insanity. In Norway, as was stated by . M. Cauderlier in 1844, each inhabitant on an average took ten quarts of alcohol; in 1871 only five quarts; in 1876 four quarts. During the same time the criminal statistics came down from 249 per 100,000 inhabitants to 207 and 180, while the number of insane patients came down in the same proportion."

It is to be regretted that the portions of the above paper, as I have it, which refer to France and Italy do not give the per cent. of increase in inhabitants.

The statistics are, therefore, so far imperfect, and we have to take the inference of the author on his statements.

While these statistics are too few to establish the fact that there exists any great and continuous uniformity between the use or the disuse of alcohol and the prevalence of insanity, yet they do tend to confirm the view that the use of alcohol is one of the most powerful factors in its causation.

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