chromatolysis. These lesions are most marked in the motor cells of the spinal cord, but they exist also, though less pronounced, in the cells of the cortex.1 Treatment. This of course varies with the different forms. Maniacal or delusional drunkenness requires strict watching and immediate isolation; the comatose form requires the use of external and internal stimulation (friction, ammonium, ether, caffein).

1 Marinesco. Semaine médicale, June 14, 1899.

CHAPTER X.

CHRONIC ALCOHOLISM.

CHRONIC alcoholism manifests itself: (1) in permanent symptoms (the chronic stigmata of alcoholism), and (2) in episodic accidents.

I. PERMANENT SYMPTOMS.

The permanent symptoms are psychic and physical.

A. PSYCHIC SYMPTOMS.

There is enfeeblement of all the psychic functions. Intellectual sphere. —Intellectual activity and capacity for work are diminished. The patient becomes dull, negligent, and clumsy.

The disorders of memory consist in definite retrograde amnesia by destruction of impressions, associated with more or less marked anterograde amnesia. The former follows the general law of amnesia. Its course is slowly progressive; but it is rare for it to reach ast complete a development as it does in general paresis. The anterograde amnesia renders it difficult or even impossible for the patient to acquire new impressions; thus the stock of ideas becomes more and more impoverished.

The judgment is constantly affected: the patient realizes but imperfectly his condition and the importance and significance of his acts.

Emotional sphere. As in most affections with a basis of intellectual enfeeblement, we find in chronic alcoholism indifference associated with morbid irritability.

The chronic alcoholic is not at all concerned with his ruined business, the misery of his family, or the compromise of his honor. Only the desire for alcohol can still arouse him from his mental torpor. The atrophy of the moral sense, which in these cases goes hand in hand with the general indifference, is such that in order to procure his favorite drinks the patient does not hesitate to make use of the most unscrupulous means and to associate with the vilest characters. If he still works, he spends his earnings on drink. If he does not work, as is the rule in such cases, he accumulates debts in the lowest drinking-dens, extorts from his relatives what little money they may have earned by hard labor, and he may even resort to stealing.

The irritability and the impulsive tendencies give rise to violent, terrible outbursts of anger, and often to assaults and attempts at murder.

Delusions may appear at times, almost always those of persecution or of morbid jealousy. When they become more developed and acquire a certain fixedness they constitute alcoholic delusional insanity which we shall study later on.

Still the patient's obscure consciousness presents at times a temporary lucidity. Strong remonstrances of friends or grave disorders of the general health

may give birth to repentance. The unhappy subject regrets his excesses, declares himself a great sinner, swears by all that is holy that he will not take another drop of wine or liquor, and announces his intention to join a temperance association. These good resolutions are carried out for several days, weeks, or even months; but almost always the patient falls again: his feeble will gives way and he can struggle no longer. He is in a vicious circle: he drinks because his will is weak, and his will is weak because he drinks.

When they attain a certain degree of intensity, the mental disorders which I have sketched constitute alcoholic dementia.

Alcoholic dementia is slowly progressive. It takes years to become fully established. Moreover,-and this is a highly important feature,-it ceases to progress with the cessation of the alcoholic excesses.

B. PHYSICAL SYMPTOMS.

The sleep is diminished, restless, disturbed by unpleasant dreams. The patient is apt to dream that he is at his occupation (occupation-dreams); the work is pressing, but in spite of his diligence he is always behind and the results are unsatisfactory. At other times veritable dramas are enacted: assassins pursue him, rats run at him, snakes and monstrous spiders creep over him (zoopsia). These dreams present all the characteristics of delirium tremens, which has been aptly called a prolonged dream. Sometimes the patient wakes up in the midst of his nightmare with his head heavy, the body covered with perspiration, still doubting the inanity of his terrors.

Attacks of vertigo and flashes of light, which often precede and usher in apoplectiform attacks, occur in some cases.

The motor disturbances consist in muscular weakness, chiefly marked in the lower extremities, a tendency to lassitude, and a constant tremor affecting especially the tongue and the hands; the digital tremor is rendered very apparent when the patient holds out his hand and slightly spreads out his fingers: it is a fine, vertical tremor, not very rapid.

The tendon reflexes are sometimes exaggerated, but much more frequently diminished or abolished; the cutaneous reflexes are usually exaggerated (plantar reflex), especially in intoxications by the essences (absinthe); sometimes they are abolished; the pupils are paretic and sometimes slightly myotic. Occasionally there is a slight degree of strabismus or of ptosis. Vision is frequently impaired, due to retrobulbar neuritis; there is diminution of the acuteness and there may be a "central scotoma having the shape of an ellipse the long axis of which is horizontal" (Babinski).

Cutaneous sensibility is reduced in the large majority of cases; the hypoæsthesia is often unilateral; in such cases it is associated with other hysteroid manifestations: hysterogenic zones, globus hystericus, absence of the pharyngeal reflex.

Among the disorders of deep sensibility are to be noted numbness, tingling, hyperæsthesias of portions of muscles which are painful on pressure or are cramped; dull pains with lancinating paroxysms resembling the lightning pains of tabes.