result of their frequent indulgence. Fourth, we have habitual drunkards. As we have seen in considering the psychology of drunkenness, a single gratification of the appetite for stimulants is followed by renewed craving for the same pleasures. The urgency of this craving increases, and as time goes on the measure of such indulgences becomes more excessive and the interval between them more limited. This is not the place to discuss the large questions connected with the doctrine of the nature of volition and the freedom of the will, but no one can doubt that whether the will is only a general name for the plus quantity in ruling motives or not, that motives have a very great deal to do with the exercise of healthy volition or controlling power. But what is the result of repeated indulgences upon the motives of the man. The habit to indulge becomes stronger, the bodily craving grows in strength, and other motives lose their weight. In this way, the moral sense of the individual becomes obscured, the self-respect and the self-restraint which depend so much upon this moral estimate of one's worth are no longer guiding principles of the life: the man has become the slave of an artificial appetite, and is no longer the free ruler of his own conduct. His organism rules over him; and the rule is not that of a constitutional monarch who is ruling in conformity with the laws of health, but the tyranny of a despot who is ruling with the caprice of disease. Here, again, we find the real distinction between health and disease, and the basal principle of the legal distinction between sanity and insanity. We here pass from habitual drunkenness to dipsomania. This point was very well brought out by Dr. Crichton Browne in his evidence before the House of Commons committee which has already been referred to. "The essential distinction," he said, "appears to me to be that in habitual drunkenness the indulgence of the propensity is voluntary and may be foregone, and in dipsomania it is not so. I may mention an analogy which occurs to me. We know that self-abuse is a voluntary act: we know also that it frequently passes into what is called spermatorrhoea, which is perfectly involuntary, and so I believe that in the case of habitual drunkenness, which is at first voluntary, the vice may become involuntary and a disease. That is the only strict analogy which I know

of in medical science. The points of distinction between dipsomania and drunkenness are several. I find that as a rule dipsomaniacs urge the internal craving as an excuse: they say, "We cannot resist it." The drunkard, as a rule, urges some external excuse for his debauch: he says that he met a friend, or that it was his birthday; whereas with the dipsomaniac it is the internal craving. With the dipsomaniac, it is the vis à tergo: with the drunkard, it is the vis à fronte. The dipsomaniac is driven into the debauch by an impulse; the drunkard seeks the intoxicating effects." This seems to us to be not only a correct philosophical but physiological distinction, and it serves as a good description not only of drunkenness but of that disease of dipsomania concerning which we have already spoken.'

354. Mania a potu is very often confounded with but is really to be scientifically distinguished from drunkenness. It is not in fact intoxication at all, but is the maniacal excitement which sometimes comes on as the intoxication is passing off. This form of disease is to be distinguished from delirium tremens, with which even accurate writers not unfrequently confound it. It is independent of any constitutional habit, and may occur in a person who has never drunk as a habit. The symptoms of most value in a differential diagnosis between mania à potu and delirium tremens are perhaps these, that while the former continues from one to two months, the latter terminates in about eight days. The delusions characteristic of the one disease are also found in connection with the other.

2 355. Delirium tremens is a disease which owes its origin to constitutional habit. It is a disease of the habitual drunkard. It is, however, also the portion of that class of drinkers whom we have designated tipplers. Abstinence from indulgence in stimulants is not unfrequently the proximate cause of this disease, but an exhausting disease or a severe injury following upon a long course of intemperance, has been found to lead directly to an attack of delirium tremens.

BR. INS.-32

1 See ante p. 325, § 215.

[250] There is not much difficulty in distinguishing the delirium of drunkards from ordinary delirium. The previous history of the case is generally sufficient of itself to enable a medical man to decide the question; but there are many characteristic symptoms which would facilitate a decision even if the past history was unknown. An individual suffering from delirium tremens is sleepless, restless, timid, suspicious, and cunning. He is subject to illusions of the senses, and those in most cases are productive of fear. Most of his illusions are painful, hideous, or disgusting. The individual not unfrequently believes himself the subject of persecution. If he hears voices they are threatening, if he sees visions they are loathsome. In its inception the disease is marked by slight tremor of the hands, and in so far as these organs are concerned, by an uncertainty of muscular action. The appetite is almost always impaired; the skin is pale, cold, and clammy; the tongue moist, white, and tremulous, and the pulse small and weak; the delirium which supervenes is not constant. It is frequently found to come on at night. After a time, however, there are no remissions in the delirium, which may last for three or four days. Recovery, when it takes place, comes after sleep, which is at first uneasy, and only enjoyed in snatches, but at length becomes quiet and refreshing. When ordinary sleep does not come, a sounder sleep falls upon the sufferer: there is no more troubling, the weary one is at rest.

2356. Nature of Delusions in Delirium Tremens.-It has been remarked that the delirium of this disease bears a strong resemblance to dreaming. It is as if the patient's dreams had acquired a persistent existence independently of sleep. Every one is familiar with those dreams which are quests-dreams in which the sleeper is seeking for something that is lost-always seeking, seeking, and yet unable to say what it is that is sought; or dreams in which there is some duty to be performed-some act which is absolutely incumbent to be done. Those are tormenting dreams: they harass the spirit just as a waking memory of some other lost memory does. In delirium tremens many of the impressions are of a nature analogous to these dreams. The patient is anxious

251 to go somewhere: he must rise: he cannot stay in bed, he will be too late: it is unkind to say "lie still," he must go-or something must be done; and he will cry if his intention is thwarted, although it is a purposeless intention-a road without a goal. Almost invariably his delusions are associated with fear and suspicion. Those persons who are about him are suspected of many nefarious designs, and so painfully does the fear of coming evil oppress him that attempts to escape are not uncommon, and the patient, with a view of ridding himself of the horrors which torment his senses, and the unutterable fear which torments his mind, will endeavor to do violence to himself or others. Many cases are on record which show that atrocious crimes have been committed by persons laboring under this disease.'

357. The Pathology of Drunkenness.-It cannot be doubted that the habitual drunkard suffers from actual cerebral disease, that drunkenness after frequent repetition, from the increased action of the brain, degenerates first into constant irritation, and afterwards into real inflammation, that the coats of the vessels are thickened and lose their transparency, that the cerebral texture has diminished delicacy and elasticity, and that slight effusions of water are by no means uncommon: it might be predicted that responsibility would also be diminished with the diminution of all the functions of a healthy brain. Such pathological changes cannot take place without a corresponding change in the mental capacity; and therefore it is of the utmost importance that medical men and jurists, who may have to do with cases of responsibility, should appreciate the influence which drunkenness either in itself or in its deleterious effects upon brainsubstance may exercise upon the mental health, and therefore the citizen-capacity and citizen-responsibility of the individual.

2358. The Periodicity of Drunkenness.-253) The periodicity of inebriety is a somewhat remarkable characteristic.

1 Reg. v. Simpson, Appleby Summer Ass. 1845; Reg. v. Watson, York Winter Ass. 1845. See further, as to delirium tremens, Practical Notes by Professor Laycock, Edinburgh Medical Journal, Nov. 1862.

Some weight has been laid upon this circumstance as proving the similarity of the pathological conditions in cases of drunkenness arising from voluntary indulgence and passing into habitual excesses, and the moral mania of drunkenness. Such an inference seems warranted upon other grounds, and seems scarcely to follow directly from the mere fact of periodicity. Periods seem a somewhat basal arrangement of nature. Everything tends to become periodic. The whole progress through time of animal economy is marked by periodic changes and reversions; and when we find that this is the case, it is easy to conceive that any grafted habit should follow to a certain extent in its mode of existence the tendencies of that upon which it is grafted. Hence the periodical character of drunkenness. Even volition, which seems to be independent of conditions, becomes periodic. Habit is always busy making rust in the locks of character which are not used. Cases have come under our own observation which prove this fact. Many individuals, with the circumstances of whose cases we are familiar, seem strong to do right-seem capable of resisting any temptation, however safely the indulgence might be enjoyed, and who, after some months of this virtuous abstinence, have again returned to the old habit, have again become possessed by the Devil, which was not dead but sleeping. We find this same law exemplified in the action of the normal appetites. When hunger has been allayed, a man is disgusted at the sight of food. When lust is satisfied, a man is very virtuous. So it is sometimes in this vice of drunkenness, which has passed from the ante-room, vice, into actual disease, the Devil's inner chamber. Was it not the Devil and sin brought death? These circumstances may serve to explain to some extent the periodicity of habits of intemperance.

? 359. Conditions which conduce to Inebriety.[254] There is much truth in Montesquieu's remark, that the error of drinking to excess depends much upon the climate and temperature of the country of the persons who indulge. While some Highland drovers can drink a whole bottle of whiskey without evil effects, the same quantity of stimulants taken by an individual in a warmer and more relaxing climate