of continuous over-indulgence in the use of this seductive agent upon the mind, body, and estate of some of his fellow creatures ?-effects, too, not limited in their influence to him who has induced them, but including within their scope wife, children, relatives, and friends. Yes, Dr. Moxon writes truly as well as eloquently, when he says of the drunkard, "the beloved wife may join her hands imploringly; his pallid, starving children may look timidly up in his face; he goes by to ruin himself and all, as you go through cobwebs on a fresh September morning.

The interest felt in the study of such questions as those which have recently formed the subjects of a series of articles on alcohol in the Contemporary Review (November and December, 1878, and January, 1879) is one which all must desire to sustain. It would be difficult, when the subject is of so much importance, to discuss the properties and uses of alcohol too frequently, or from too many points of view. I, therefore, propose once more to review the questions involved; and, in so doing, shall endeavour to point out what appears to me to be rationale of the action of alcohol, and to deduce therefrom the cases and conditions in which, as physicians, we may use it to the advantage of our patients.

The first necessity in the study of any substance, it is proposed to introduce into the body for any definite purpose, is a knowledge of its effects upon the body. Will it modify health? Will it alter tissue? If so, how is such modification exhibited; what are the characteristic features of such alteration? We ought, as Dr. Wilks (Contemporary Review, December) remarks, "in endeavouring, with any hope of success, to form a true estimate of the value of alcoholic beverages, we ought to possess a knowledge of their precise action in the animal economy, and to be able to judge correctly of their effects in individuals according to the different circumstances of life." With a substance in such general use as alcohol is, with one that has been made the subject of experiments so numerous and exact as it has been, there ought to be no difficulty in arriving at tolerably accurate knowledge on these points. Neither do I think that there is.

Here I will quote, first of all, the summary of the physiological effects of alcohol given by Dr. Brunton in his interesting paper on The Action of Alcohol (Contemporary

Review, November), and pass on to consider the results recorded by previous observers. Alcohol," writes Dr. Brunton, "appears to excite the circulation through the brain reflexly from the mouth, and to stimulate the heart reflexly from the stomach, even before it is absorbed into the blood. Shortly after it has been swallowed, however, it is absorbed from the stomach, and passes with the blood to the heart, to the brain, and to the other parts of the nervous system, on which it then begins to act directly. Under its influence the heart beats more quickly, the blood circulates more freely, and thus the functional power of the various organs in the body is increased, so that the brain may think more rapidly, the muscles act more powerfully, and the stomach digest more easily. But with this excitement, the effect of alcohol may be described as one of progressive paralysis. The higher centres suffer first, and the judgment is probably the first quality to be impaired." Fairly accurate as is this description, one evidently drawn from general observation, the results of exact and definite experimentation are necessarily more satisfactory. In the enquiries made by the late Dr. Edward Smith, so well-known twenty years ago as a diligent and painstaking enquirer into everything bearing upon health, we shall find just the kind of information that Dr. Wilks so justly says is essential in endeavouring to form a true estimate of the action of alcoholic beverages. In his experiments, Dr. Smith associated himself with a friend. The symptoms resulting from taking a moderate quantity of duly diluted alcohol, of brandy, gin, rum, ale, and porter, on an empty stomach early in the morning, are given by him in the natural order of their succession, the duration of their action and their attendant circumstances. They are recorded in the first volume of the Lancet for 1861. From the account there given, we learn that the circulation was the function first impressed; and, almost immediately, the brain became excited; shortly afterwards, the spinal cord, the respiration, and, lastly, the sympathetic system, gave evidence of being influenced by the alcohol. "In three minutes after taking the spirit and water the action of the heart was increased; and continued so from thirty to forty minutes. This was attended by a sense of dryness, heat, and evident fulness of the exposed parts of the skin, as the hands and feet, and also a general sensation of heat. The skin was

as harsh and dry as when exposed to an easterly wind. After about twenty to forty minutes, this sensation of heat gave place to one of cold, first felt in the most sensitive parts of the body in reference to temperature, viz., between the shoulders, and at length, notwithstanding the existence of a suitable atmosphere, became distressing, and led even to shivering. This was sometimes so marked, and occurred so suddenly, that it gave rise to a shock. It did not correspond with the temperature of the skin, but it was usually co-existent with the cessation of increase of the heart's action." In these details we have the action of alcohol on the circulation, and some of the consequences thereof well delineated. The heart is at first stimulated to increased activity. The blood circulates in greater volume, and with more rapidity, carrying with it increased heat to the surface and extremities. As its primary influence passes off, the central organ of the circulation works less vigorously, abnormal contraction of the capillaries follows their previously abnormal dilatation, and the recently acquired warmth of the body gives place to a sensation of cold, so considerable as to amount to "shock."

The first indication of the cerebral organisation being influenced by the alcohol, was felt by Dr. Smith almost co-incidently with increased cardiac action, and to the state of the circulation it was probably due. "A sensation of fulness at the crown and back part of the head, or at the temples, according to the kind of spirit taken," was the first symptom of nervous disorder noticed. In from three to seven minutes the mind became disturbed. In the words of Dr. Smith, "consciousness, the power of fixing the attention, the perception of light, and, we believe, of sound also, were lessened; the power of directing and co-ordinating the muscles was also lessened, whilst there was a very marked continuous purring or thrilling, and not unpleasant sensation passing from above downwards through the whole system. This latter symptom was most pronounced in from fifteen to forty minutes, and continued without much variation during twenty to thirty minutes. After this period the whole effect recorded under this head diminished, and oftentimes suddenly, as was shown by an increased perception of light, as if a veil had fallen from the eyes, and by increased consciousness; but, nevertheless, the last power to be completely regained was consciousness."

Again, the effect of alcohol is manifested in the mental condition induced. "Rum, and some other spirits," says Dr. Smith, "made us very hilarious, so much so that my friend was altogether a king; but as minutes flew away, so did our joyousness, and little by little we lessened our garrulity, and felt less happy, until at length, having gone down by degrees, we became silent, almost morose, and extremely miserable."

Through the medium of the nervous system, again, the muscular apparatus of the body becomes disordered. "The thin layers of the voluntary muscles found about the body showed great relaxation. The respiratory muscles acted in a gasping manner, so that there was a pumping and quick inspiratory effort in the earlier, and a feeble expiratory effort in the later stage. At all periods there was a sense of impediment to the respiration." Though I cite these symptoms here as evidence of the lack of nervous force induced by alcohol, they are but partly due to this cause, being probably the more direct result of that vitiated, that imperfectly aërated state of the blood, to which alcohol gives rise. To continue, "The muscles of the limbs were inactive. There were relaxation of the muscles, and stiffness of the skin of the face, forehead, and upper lip, so that the features fell. The state of the muscular system followed the commencement of the effect upon the consciousness, and other functions of the brain, and also the excited state of the heart. In reference to its cessation, the power of co-ordinating the muscles was the first regained, whilst the buzzing sensation and semi-cataleptic state continued, and the disposition to use the muscles was regained the last of all."

In the earlier of the symptoms I have detailed, we find a diminution in the nervous power of the senses; a partial paralysis, as it were, of sight and hearing, accompanied by a general excitability of the whole nervous system, as remarked in the continuous purring and thrilling passing from above downwards. We subsequently saw a perversion of nervous energy in the mental phenomena evoked. The brain, the medium of the mind, was disordered, and evinced its morbid state primarily in excitement, and secondarily, in depression. The former depending on the increased activity of the circulation throughout its substance; the latter arising from the specific action of the alcohol upon it, from the depraved condition of the

Review, Mar. 1, 1879.

blood. The spinal cord, though less powerfully and less permanently affected by the alcoholic fluid, is, nevertheless, very strikingly influenced by it, as seen in the impaired power, if not altogether of moving, at any rate of coordinating the action of the muscles.

In these experiments of Dr. Smith and his friend, we find ample evidence of the sphere in which alcohol exhibits its peculiar influence. Physiological and pathological investigations point in a similar direction. To some of these researches I will refer.

Dr. Marcet, in the course of a series of experiments detailed before the British Association at its meeting at Aberdeen, in 1859 (Medical Times and Gazette, March, 1860), showed that frogs, into which he had injected alcohol, died more quickly from poisonous shock, when both the circulation and nervous communications were free, than when any mutilation of nervous trunks had been previously practised. Thus demonstrating that the nerves themselves are conductors of the alcoholic poison; that the nervous system is influenced in all its parts, in its tracts as well as in its centres. From an ingenious comparison between the observed action of alcohol, and an experiment of M. Claude Bernard's, Dr. Marcet infers the nature of the influence of alcohol on the sympathetic system. He remarks, at page 13 of his work on Alcoholic Intoxication, "when fermented beverages are taken in moderate quantity, it is obvious from the increased rapidity of the circulation, they induce in the membranes with which they come in contact, that the alcoholic fluid exerts a local action on the nerves ramifying in those membranes. It is difficult to determine the precise seat of this action, but we may surmise that it is exerted principally on the sympathetic, this system supplying twigs which accompany arteries into their minutest divisions. If we now bear in mind the facts revealed to us by Claude Bernard, that by cutting a branch of the sympathetic nerve, the circulation of the part which is supplied by that nerve is greatly increased, and also that this very same increased rate of the circulation takes place when alcohol is present in the stomach, it is but rational to conclude that alcohol, when first absorbed by the minutest blood vessels, has the property of lessening the normal functions of the sympathetic nerves which supply those vessels." The same observer has, in the series of experiments already alluded to, shown that the