Thursday, 30 October 2014


What is piles ?
Dilatation of radicles of rectal veins within the anal canal is called piles.The medical term for piles is

hemorrhoids.Compared to arteries veins are weak due to thin walls and hence any backpressure in the veins can make them

tortuous.There are three rectal veins namely superior, middle and inferior rectal veins.Any obstructions or increase of

pressure in these veins can predispose piles.

Depending upon the situation there are two types of piles.

1) External piles.         2) Internal piles.

1) External piles:-

This type of piles is seen outside the anal opening and is covered by skin.It is black or brown in colour.This type of

piles is very painful due to rich nerve supply in this area.

2) Internal piles:-

It is inside the anal canal and internal to the anal orifice.It is covered by mucous membrane and is red or purple in

colour.These piles are painless.

Some times internal and external piles occure in same individual.

Factors responsible for piles:--

1) This is a familial disease.

2) Piles is seen only in animals maintain an erect posture. This is due to congestion in the rectal veins due to the effect

of gravity.

3) It is common in individuals having chronic constipation.Those who have a habit of visiting the toilet due to frequent

urge for stool may develop piles in future.

4) Piles is common in those who take excess of chicken, prawns, spicy food ect.Those who take vegetables and fibrous food

are rarely affected.

5) Some ladies get piles during pregnancy due to compression of rectal veins by the uterus.

6) Cancerous lesions in the rectum can obstruct blood flow and result in piles.

Signs and symptoms of piles:--

1) Pain:-

Pain is common in external piles which will be worse while straining at stool.

2) Bleeding:-

Bleeding comes in splashes while pressing for stool.Bleeding may be profuse in some cases.

3) Protruding mass:-

In external piles the swelling can be felt around the anal orifice.In case of internal piles initially it can not be

felt.When the disease progresses the piles protrude during stool and will go inside automatically.When the condition

becomes worse the protruded piles will not go back in to the anus.

4) In some cases there will be discharge of mucus with itching around the anal orifice.

Complications of piles:--

1,Infection: The infection can spread to deep veins resulting in septicaemia.
2,Fibrosis: Here the piles become fibrosed with hardening of anal orifice.
3,Thrombosis: Here the blood inside the piles will form clots and can obstruct blood flow.
4,Gangrene: Here the tissues in the piles and nearby skin die due to lack of blood supply.
5,Suppuration: When the piles suppurate it can produce abscess with discharge of pus.

Treatment of piles:--

Initially it is treated on the basis of symptoms.Constipation should be treated.If there is anaemia iron should be

give.Homoeopathic medicines can give good results. If medicinal treatment is not giving any result the following can be


1) The thrombosed external pile is excised under local anaesthesia.

2) Sclerosant injection therapy can reduce the size of piles.

3) Rubber band ligation around the neck of piles is useful in some cases.

4) Cryosurgery is very effective.

5) Anal dilatation can reduce constipation and pain.

6) Haemorrhoidectomy is the surgical removal of piles.

How to prevent piles?

1) Eat plenty of fruits and vegetables.

2) Take fibrous food.

3) Avoid excess intake of meat,prawns,crabs ect.

4) Keep a regular timing for food.

6) Drink sufficient quantity of water.

7) Keep a regularity in bowel habits.

8) Take treatment for constipation.



The nails are present at the end of each finger tip on the dorsal surface.The main function of nail is protection and it also helps for a firm grip for holding articles.It consists of a strong relatively flexible keratinous nail plate originating from the nail matrix. Under the nail plate there is a soft tissue called nail bed.Between the skin and nail plate there is a nail fold or cuticle.Normal healthy nail is slight pink in colour and the surface is convex from side to side.Finger nails grow 1 cm in three months and toe nails take 24 months for the same.

Importance of nails in disease diagnosis:

The colour ,appearance,shape and nature of the nails give some information about the general health and hygiene of a person . Nails are examined as a routine by all doctors to get some clues about underlying diseases.Just looking at nails we can makeout the hygiene of a person.The abnormal nail may be congenital or due to some diseases.The cause for changes in the nail extend from simple reasons to life threatening diseases.Hence the examination by a doctor is essential for diagnosis .Some abnormal findings with probable causes are discussed here for general awareness.

1) Hygiene:-

We can make out an unhygienic nail very easily .Deposition of dirt under the distal end of nail plate can make a chance for ingestion of pathogens while eating.If nail cutting is not done properly it can result in worm troubles in children.When the worms crawl in the anal orifice children will scratch which lodges the ova of worms under the nails and will be taken in while eating.Prominent nail can also complicate a skin disease by habitual scratching.Sharp nails in small kids cause small wounds when they do feet kicking or hand waving.

2) Colour of the nails:-

a) Nails become pale in anaemia.

b) Opaque white discolouration(leuconychia) is seen in chronic renal failure and nephrotic syndrome.

c) Whitening is also seen in hypoalbuminaemia as in cirrhosis and kidney disorders.
d) Drugs like sulpha group,anti malarial and antibiotics ect can produce discolouration in the nails.
e) Fungal infection causes black discolouration.

f) In pseudomonas infection nails become black or green.

g) Nail bed infarction occures in vasculitis especially in SLE and polyarteritis.

h) Red dots are seen in nails due to splinter haemorrhages in subacute bacterial endo carditis, rheumatoid arthritis, trauma, collagen vascular diseases.

i) Blunt injury produces haemorrhage and causes blue/black discolouration.

j) Nails become brown in kidney diseases and in decreased adrenal activity.

k) In wilsons disease blue colour in semicircle appears in the nail.

l) When the blood supply decreases nail become yellow .In jaundice and psoriasis also nail become yellowish.

m) In yellow nail syndrome all nails become yellowish with pleural effusion.

3) Shape of nails:-

a) Clubbing: Here tissues at the base of nails are thickened and the angle between the nail base and the skin is obliterated. The nail becomes more convex and the finger tip becomes bulbous and looks like an end of a drumstick. When the condition becomes worse the nail looks like a parrot beak.

Causes of clubbing:-

Congenital Injuries

Severe chronic cyanosis

Lung diseases like empyema,bronchiactesis,carcinoma of bronchus and pulmonary tuberculosis.
Abdominal diseases like crohn's disease,polyposis of colon,ulcerative colitis,liver cirrhosis ect...

Heart diseases like fallot's tetralogy,subacute bacterial endocarditis and ect..
b) Koilonychia:-

Here the nails become concave like a spoon.This condition is seen in iron deficiency anaemia.In this condition the nails become thin,soft and brittle.The normal convexity will be replaced by concavity.

c) Longitudinal ridging is seen in raynaud's disease.

d) Cuticle becomes ragged in dermatomyositis.

e) Nail fold telangiectasia is a sign in dermatomyositis ,systemic sclerosis and SLE.

4) Structure and consistancy:-

a) Fungal infection of nail causes discolouration,deformity,hypertrophy and abnormal brittleness.

b) Thimble pitting of nail is charecteristic of psoriasis ,acute eczema and alopecia aereata.
c) The inflamation of cuticle or nail fold is called paronychia.

d) Onycholysis is the seperation of nail bed seen in psoriasis,infection and after taking tetracyclines.

e) Destruction of nail is seen in lichen planus,epidermolysis bullosa.

f) Missing nail is seen in nail patella syndrome.It is a hereditary disease.

g) Nails become brittle in raynauds disease and gangrene.

h) Falling of nail is seen in fungal infection,psoriasis and thyroid diseases.

5) Growth:-

Reduction in blood supply affects the growth of nails. Nail growth is also affected in severe ilness. when the disease disappears the growth starts again resulting in formation of transverse ridges.These lines are called Beau's lines and are healpful to date the onset of illness.        


The physical disasters that follow the continued use of intoxicating beverages are sad enough, and terrible enough; but the surely attendant mental, moral and spiritual disasters are sadder and more terrible still. If you disturb the healthy condition of the brain, which is the physical organ through which the mind acts, you disturb the mind. It will not have the same clearness of perception as before; nor have the same rational control over the impulses and passions.

Heavenly order in the body.

In order to understand a subject clearly, certain general laws, or principles, must be seen and admitted. And here we assume, as a general truth, that health in the human body is normal heavenly order on the physical plane of life, and that any disturbance of that order exposes the man to destructive influences, which are evil and infernal in their character. Above the natural and physical plane, and resting upon it, while man lives in this world, is the mental and spiritual plane, or degree of life. This degree is in heavenly order when the reason is clear, and the appetites and passions under its wise control. But, if, through any cause, this fine equipoise is disturbed, or lost, then a way is opened for the influx of more subtle evil influences than such as invade the body, because they have power to act upon the reason and the passions, obscuring the one and inflaming the others.

We know how surely the loss of bodily health results in mental disturbance. If the seat of disease be remote from the brain, the disturbance is usually slight; but it increases as the trouble comes nearer and nearer to that organ, and shows itself in multiform ways according to character, temperament or inherited disposition; but almost always in a predominance of what is evil instead of good. There will be fretfulness, or ill-nature, or selfish exactions, or mental obscurity, or unreasoning demands, or, it may be, vicious and cruel propensities, where, when the brain was undisturbed by disease, reason held rule with patience and loving kindness. If the disease which has attacked the brain goes on increasing, the mental disease which follows as a consequence of organic disturbance or deterioration, will have increased also, until insanity may be established in some one or more of its many sad and varied forms.


It is, therefore, a very serious thing for a man to take into his body any substance which, on reaching that wonderfully delicate organ the brain, sets up therein a diseased action; for, diseased mental action is sure to follow. A fever is a fever, whether it be light or intensely burning; and so any disturbance of the mind's rational equipoise is insanity, whether it be in the simplest form of temporary obscurity, or in the midnight of a totally darkened intellect.

We are not writing in the interest of any special theory, nor in the spirit of partisanship; but with an earnest desire to make the truth appear. You must not accept anything simply because we say it, but because he sees it to be true. Now, as to this matter of insanity, let him think calmly. The word is one that gives us a shock; and, as we hear it, we almost involuntarily thank God for the good gift of a well-balanced mind. What, if from any cause this beautiful equipoise should be disturbed and the mind lose its power to think clearly, or to hold the lower passions in due control? Shall we exceed the truth if we say that the man in whom this takes place is insane just in the degree that he has lost his rational self-control; and that he is restored when he regains that control?

In this view, the question as to the hurtfulness of alcoholic drinks assumes a new and graver aspect. Do they disturb the brain when they come in contact with its substance; and deteriorate it if the contact be long continued? Fact, observation, experience and scientific investigation all emphatically say yes; and we know that if the brain be disordered the mind, will be disordered, likewise; and a disordered mind is an insane mind. Clearly, then, in the degree that a man impairs or hurts his brain temporarily or continuously in that degree his mind is unbalanced; in that degree he is not a truly rational and sane man.

We are holding your thought just here that you may have time to think, and to look at the question in the light of reason and common sense. So far as he does this, will he be able to feel the force of such evidence as we shall educe in what follows, and to comprehend its true meaning.

Other substances besides alcohol act injuriously on the brain; but there is none that compares with this in the extent, variety and diabolical aspect of the mental aberrations which follow its use. We are not speaking thoughtlessly or wildly; but simply uttering a truth well-known to every man of observation, and which every man, and especially those who take this substance in any form, should, lay deeply to heart. Why it is that such awful and destructive forms of insanity should follow, as they do, the use of alcohol it is not for us to say. That they do follow it, we know, and we hold, up the fact in solemn warning.

Another consideration, which should have weight with every one, is this, that no man can tell what may be the character of the legacy he has received from his ancestors. He may have an inheritance of latent evil forces, transmitted through many generations, which only await some favoring opportunity to spring into life and action. So long as he maintains a rational self-control, and the healthy order of his life be not disturbed, they may continue quiescent; but if his brain loses its equipoise, or is hurt or impaired, then a diseased psychical condition may be induced and the latent evil forces be quickened into life.


Dr. Ezra M. Hunt says: "The capacity of the alcohols for impairment of functions and the initiation and promotion of organic lesions in vital parts, is unsurpassed by any record in the whole range of medicine.  The facts as to this are so indisputable, and so far granted by the profession, as to be no longer debatable . Changes in stomach and liver, in kidneys and lungs, in the blood-vessels to the minutest capillary, and in the blood to the smallest red and white blood disc disturbances of secretion, fibroid and fatty degenerations in almost every organ, impairment of muscular power, impressions so profound on both nervous systems as to be often toxic these, and such as these, are the oft manifested results. And these are not confined to those called intemperate."

Professor Youmans says: "It is evident that, so far from being the conservator of health, alcohol is an active and powerful cause of disease, interfering, as it does, with the respiration, the circulation and the nutrition; now, is any other result possible?"

Dr. F.R. Lees says: "That alcohol should contribute to the fattening process under certain conditions, and produce in drinkers fatty degeneration of the blood, follows, as a matter of course, since, on the one hand, we have an agent that  retains waste  matter by lowering the nutritive and excretory functions, and on the other, a  direct poisoner  of the vesicles of the vital stream."

Dr. Henry Monroe says: "There is no kind of tissue, whether healthy or morbid, that may not undergo fatty degeneration; and there is no organic disease so troublesome to the medical man, or so difficult of cure. If, by the aid of the microscope, we examine a very fine section of muscle taken from a person in good health, we find the muscles firm, elastic and of a bright red color, made up of parallel fibres, with beautiful crossings or striae; but, if we similarly examine the muscle of a man who leads an idle, sedentary life, and indulges in intoxicating drinks, we detect, at once, a pale, flabby, inelastic, oily appearance. Alcoholic narcotization appears to produce this peculiar conditions of the tissues  more than any other agent with which we are acquainted.  'Three-quarters of the chronic illness which the medical man has to treat,' says Dr. Chambers, 'are occasioned by this disease.' The eminent French analytical chemist, Lecanu, found as much as one hundred and seventeen parts of fat in one thousand parts of a drunkard's blood, the highest estimate of the quantity in health being eight and one-quarter parts, while the ordinary quantity is not more than two or three parts, so that the blood of the drunkard contains forty times in excess of the ordinary quantity."

Dr. Hammond, who has written, in partial defense of alcohol as containing a food power, says: "When I say that it, of all other causes,  is most prolific  in exciting derangements of the brain, the spinal cord and the nerves, I make a statement which my own experience shows to be correct."

Another eminent physician says of alcohol: "It substitutes suppuration for growth. It helps time to produce the effects of age; and, in a word, is the genius of degeneration."

Dr. Monroe, from whom "Alcohol, taken in small quantities, or largely diluted,  as in the form of beer, causes the stomach gradually to lose its tone, and makes  it dependent upon artificial stimulus. Atony, or want of tone of the stomach, gradually supervenes, and incurable disorder of health results. Should a dose of alcoholic drink be taken daily, the heart will very often become hypertrophied, or enlarged throughout. Indeed, it is painful to witness how  many  persons are actually laboring under disease of the heart, owing chiefly to the use of alcoholic liquors."

Dr. T.K. Chambers, physician to the Prince of Wales, says: "Alcohol is really the most ungenerous diet there is. It impoverishes the blood, and there is no surer road to that degeneration of muscular fibre so much to be feared; and in heart disease it is more especially hurtful, by quickening the beat, causing capillary congestion and irregular circulation, and thus mechanically inducing dilatation."

Sir Henry Thompson, a distinguished surgeon, says: "Don't take your daily wine under any pretext of its doing you good. Take it frankly as a luxury one which must be paid for, by some persons very lightly, by some at a high price,  but always to be paid for. And, mostly, some loss of health, or of mental power, or of calmness of temper, or of judgment, is the price."

Dr. Charles Jewett says: "The late Prof. Parks, of England, in his great work on Hygiene, has effectually disposed of the notion, long and very generally entertained, that alcohol is a valuable prophylactic where a bad climate, bad water and other conditions unfavorable to health, exist; and an unfortunate experiment with the article, in the Union army, on the banks of the Chickahominy, in the year 1863, proved conclusively that, instead of guarding the human constitution against the influence of agencies hostile to health, its use gives to them additional force. The medical history of the British army in India teaches the same lesson."

But why present farther testimony? Is not the evidence complete? To the man who values good health; who would not lay the foundation for disease and suffering in his later years, we need not offer a single additional argument in favor of entire abstinence from alcoholic drinks. He will eschew them as poisons.


And here, in order to give those who are not familiar with, the process of digestion, a clear idea of that important operation, and the effect produced when alcohol is taken with food, we quote from the lecture of an English physician, Dr. Henry Monroe, on "The Physiological Action of Alcohol." He says:

"Every kind of substance employed by man as food consists of sugar, starch, oil and glutinous matters, mingled together in various proportions; these are designed for the support of the animal frame. The glutinous principles of food  fibrine, albumen  and  casein  are employed to build up the structure; while the  oil, starch  and  sugar  are chiefly used to generate heat in the body.

"The first step of the digestive process is the breaking up of the food in the mouth by means of the jaws and teeth. On this being done, the saliva, a viscid liquor, is poured into the mouth from the salivary glands, and as it mixes with the food, it performs a very important part in the operation of digestion, rendering the starch of the food soluble, and gradually changing it into a sort of sugar, after which the other principles become more miscible with it. Nearly a pint of saliva is furnished every twenty-four hours for the use of an adult. When the food has been masticated and mixed with the saliva, it is then passed into the stomach, where it is acted upon by a juice secreted by the filaments of that organ, and poured into the stomach in large quantities whenever food comes in contact with its mucous coats. It consists of a dilute acid known to the chemists as hydrochloric acid, composed of hydrogen and chlorine, united together in certain definite proportions. The gastric juice contains, also, a peculiar organic-ferment or decomposing substance, containing nitrogen something of the nature of yeast termed  pepsine , which is easily soluble in the acid just named. That gastric juice acts as a simple chemical solvent, is proved by the fact that, after death, it has been known to dissolve the stomach itself."

It is an error to suppose that, after a good dinner, a glass of spirits or beer assists digestion; or that any liquor containing alcohol even bitter beer can in any way assist digestion. Mix some bread and meat with gastric juice; place them in a phial, and keep that phial in a sand-bath at the slow heat of 98 degrees, occasionally shaking briskly the contents to imitate the motion of the stomach; you will find, after six or eight hours, the whole contents blended into one pultaceous mass. If to another phial of food and gastric juice, treated in the same way, I add a glass of pale ale or a quantity of alcohol, at the end of seven or eight hours, or even some days, the food is scarcely acted upon at all. This is a fact; and if you are led to ask why, I answer, because alcohol has the peculiar power of chemically affecting or decomposing the gastric juice by precipitating one of its principal constituents, viz., pepsine, rendering its solvent properties much less efficacious. Hence alcohol can not be considered either as food or as a solvent for food. Not as the latter certainly, for it refuses to act with the gastric juice.

"'It is a remarkable fact,' says Dr. Dundas Thompson, 'that alcohol, when added to the digestive fluid, produces a white precipitate, so that the fluid is no longer capable of digesting animal or vegetable matter.' 'The use of alcoholic stimulants,' say Drs. Todd and Bowman, 'retards digestion by coagulating the pepsine, an essential element of the gastric juice, and thereby interfering with its action. Were it not that wine and spirits are rapidly absorbed, the introduction of these into the stomach, in any quantity, would be a complete bar to the digestion of food, as the pepsine would be precipitated from the solution as quickly as it was formed by the stomach.' Spirit, in any quantity, as a dietary adjunct, is pernicious on account of its antiseptic qualities, which resist the digestion of food by the absorption of water from its particles, in direct antagonism to chemical operation."


The transforming power or alcohol is marvelous, and often appalling. It seems to open a way of entrance into the soul for all classes of foolish, insane or malignant spirits, who, so long as it remains in contact with the brain, are able to hold possession. Men of the kindest nature when sober, act often like fiends when drunk. Crimes and outrages are committed, which shock and shame the perpetrators when the excitement of inebriation has passed away. Referring to this subject, Dr. Henry Munroe says:

"It appears from the experience of Mr. Fletcher, who has paid much attention to the cases of drunkards, from the remarks of Mr. Dunn, in his 'Medical Psychology,' and from observations of my own, that there is some analogy between our physical and psychical natures; for, as the physical part of us, when its power is at a low ebb, becomes susceptible of morbid influences which, in full vigor, would pass over it without effect, so when the psychical (synonymous with the  moral ) part of the brain has its healthy function disturbed and deranged by the introduction of a morbid poison like alcohol, the individual so circumstanced sinks in depravity, and "becomes the helpless subject of the forces of evil, "which are powerless against a nature free from the morbid influences of alcohol."

Different persons are affected in different ways by the same poison. Indulgence in alcoholic drinks may act upon one or more of the cerebral organs; and, as its necessary consequence, the manifestations of functional disturbance will follow in such of the mental powers as these organs subserve. If the indulgence be continued, then, either from deranged nutrition or organic lesion, manifestations formerly developed only during a fit of intoxication may become  permanent , and terminate in insanity or dypso-mania. M. Flourens first pointed out the fact that certain morbific agents, when introduced into the current of the circulation, tend to act  primarily  and  specially  on one nervous centre in preference to that of another, by virtue of some special elective affinity between such morbific agents and certain ganglia. Thus, in the tottering gait of the tipsy man, we see the influence of alcohol upon the functions of the  cerebellum  in the impairment of its power of co-ordinating the muscles.

Certain writers on diseases of the mind make especial allusion to that form of insanity termed 'dypsomania', in which a person has an unquenchable thirst for alcoholic drinks a tendency as decidedly maniacal as that of  homicidal mania ; or the uncontrollable desire to burn, termed  pyromania ; or to steal, called  kleptomania.

Homicidal mania.

The different tendencies of homicidal mania in different individuals are often only nursed into action when the current of the blood has been poisoned with alcohol. I had a case of a person who, whenever his brain was so excited, told me that he experienced a most uncontrollable desire to kill or injure some one; so much so, that he could at times hardly restrain himself from the action, and was obliged to refrain from all stimulants, lest, in an unlucky moment, he might commit himself. Townley, who murdered the young lady of his affections, for which he was sentenced to be imprisoned in a lunatic asylum for life,  poisoned his brain with brandy  and soda-water before he committed the rash act. The brandy stimulated into action certain portions of the brain, which acquired such a power as to subjugate his will, and hurry him to the performance of a frightful deed, opposed alike to his better judgment and his ordinary desires.

As to pyromania , some years ago I knew a laboring man in a country village, who, whenever he had had a few glasses of ale at the public-house, would chuckle with delight at the thought of firing certain gentlemen's stacks. Yet, when his brain was free from the poison, a quieter, better-disposed man could not be. Unfortunately, he became addicted to habits of intoxication; and, one night, under alcoholic excitement, fired some stacks belonging to his employers, for which, he was sentenced for fifteen years to a penal settlement, where his brain would never again be alcoholically excited.


Next, I will give an example of  kleptomania . I knew, many years ago, a very clever, industrious and talented young man, who told me that whenever he had been drinking, he could hardly withstand, the temptation of stealing anything that came in his way; but that these feelings never troubled him at other times. One afternoon, after he had been indulging with his fellow-workmen in drink, his will, unfortunately, was overpowered, and he took from the mansion where he was working some articles of worth, for which he was accused, and afterwards sentenced to a term of imprisonment. When set at liberty he had the good fortune to be placed among some kind-hearted persons, vulgarly called teetotallers ; and, from conscientious motives, signed the PLEDGE, now above twenty years ago. From that time to the present moment he has never experienced the overmastering desire which so often beset him in his drinking days to take that which was not his own. Moreover, no pretext on earth could now entice him to taste of any liquor containing alcohol, feeling that, under its influence, he might again fall its victim. He holds an influential position in the town where he resides.

I have known some ladies of good position in society, who, after a dinner or supper-party, and after having taken sundry glasses of wine, could not withstand the temptation of taking home any little article not their own, when the opportunity offered; and who, in their sober moments, have returned them, as if taken by mistake. We have many instances recorded in our police reports of gentlemen of position, under the influence of drink, committing thefts of the most paltry articles, afterwards returned to the owners by their friends, which can only be accounted for, psychologically, by the fact that the  will  had been for the time completely overpowered by the subtle influence of alcohol.

Loss of mental clearness.

Alcohol, whether taken in large or small doses, immediately disturbs the natural functions of the mind and body, is now conceded by the most eminent physiologists. Dr. Brinton says: 'Mental acuteness, accuracy of conception, and delicacy of the senses, are all so far opposed by the action of alcohol, as that the maximum efforts of each are  incompatible  with the ingestion of any moderate quantity of fermented liquid. Indeed, there is scarcely any calling which demands skillful and exact effort of mind and body, or which requires the balanced exercise of many faculties, that does not illustrate this rule. The mathematician, the gambler, the metaphysician, the billiard-player, the author, the artist, the physician, would, if they could analyze their experience aright, generally concur in the statement, that  a single glass will often suffice to take , so to speak,  the edge off both mind and body , and to reduce their capacity to something below what is relatively their perfection of work.

A train was driven carelessly into one of the principal London stations, running into another train, killing, by the collision, six or seven persons, and injuring many others. From the evidence at the inquest, it appeared that the guard was reckoned sober, only he had had two glasses of ale with a friend at a previous station. Now, reasoning psychologically, these two glasses of ale had probably been instrumental in  taking off the edge  from his perceptions and prudence, and producing a carelessness or boldness of action which would not have occurred under the cooling, temperate influence of a beverage free from alcohol. Many persons have admitted to me that they were not the same after taking even one glass of ale or wine that they were before, and could not  thoroughly  trust themselves after they had taken this single glass.

Impairment of memory.

An impairment of the memory is among the early symptoms of alcoholic derangement.

"This," says Dr. Richardson, "extends even to forgetfulness of the commonest things; to names of familiar persons, to dates, to duties of daily life. Strangely, too," he adds, "this failure, like that which indicates, in the aged, the era of second childishness and mere oblivion, does not extend to the things of the past, but is confined to events that are passing. On old memories the mind retains its power; on new ones it requires constant prompting and sustainment."

In this failure of memory nature gives a solemn warning that imminent peril is at hand. Well for the habitual drinker if he heed the warning. Should he not do so, symptoms of a more serious character will, in time, develop themselves, as the brain becomes more and more diseased, ending, it may be, in permanent insanity.

Mental and moral diseases.

Of the mental and moral diseases which too often follow the regular drinking of alcohol, we have painful records in asylum reports, in medical testimony and in our daily observation and experience. These are so full and varied, and thrust so constantly on our attention, that the wonder is that men are not afraid to run the terrible risks involved even in what is called the moderate use of alcoholic beverages.

In 1872, a select committee of the House of Commons, appointed "to consider the best plan for the control and management of habitual drunkards," called upon some of the most eminent medical men in Great Britain to give their testimony in answer to a large number of questions, embracing every topic within the range of inquiry, from the pathology of inebriation to the practical usefulness of prohibitory laws. In this testimony much was said about the effect of alcoholic stimulation on the mental condition and moral character. One physician, Dr. James Crichton Brown, who, in ten years' experience as superintendent of lunatic asylums, has paid special attention to the relations of habitual drunkenness to insanity, having carefully examined five hundred cases, testified that alcohol, taken in excess, produced different forms of mental disease, of which he mentioned four classes: 1.  Mania a potu , or alcoholic mania. 2. The monomania of suspicion. 3. Chronic alcoholism, characterized by failure of the memory and power of judgment, with partial paralysis generally ending fatally. 4. Dypsomania, or an  irresistible  craving for alcoholic stimulants, occuring very frequently, paroxysmally, and with constant liability to periodical exacerbations, when the craving becomes altogether uncontrollable. Of this latter form of disease, he says: "This is invariably associated with a certain  impairment of the intellect, and of the affections and the moral powers ."

Dr. Alexander Peddie, a physician of over thirty-seven years' practice in Edinburgh, gave, in his evidence, many remarkable instances of the moral perversions that followed continued drinking.

Relation between insanity and drunkenness.

Dr. John Nugent said that his experience of twenty-six years among lunatics, led him to believe that there is a very close relation between the results of the abuse of alcohol and insanity. The population of Ireland had decreased, he said, two millions in twenty-five years, but there was the same amount of insanity now that there was before. He attributed this, in a great measure, to indulgence in drink.

Dr. Arthur Mitchell, Commissioner of Lunacy for Scotland, testified that the excessive use of alcohol caused a large amount of the lunacy, crime and pauperism of that country. In some men, he said, habitual drinking leads to other diseases than insanity, because the effect is always in the direction of the proclivity, but it is certain that there are many in whom there is a clear proclivity to insanity,  who would escape that dreadful consummation but for drinking; excessive drinking in many persons determining the insanity to which they are, at any rate, predisposed . The children of drunkards, he further said, are in a larger proportion idiotic than other children, and in a larger proportion become themselves drunkards; they are also in a larger proportion liable to the ordinary forms of acquired insanity.

Dr. Winslow Forbes believed that in the habitual drunkard the whole nervous structure, and the brain especially, became poisoned by alcohol. All the mental symptoms which you see accompanying ordinary intoxication, he remarks, result from the poisonous effects of alcohol on the brain. It is the brain which is mainly effected. In temporary drunkenness, the brain becomes in an abnormal state of alimentation, and if this habit is persisted in for years, the nervous tissue itself becomes permeated with alcohol, and organic changes take place in the nervous tissues of the brain, producing  that frightful and dreadful chronic insanity which we see in lunatic asylums, traceable entirely to habits of intoxication . A large percentage of frightful mental and brain disturbances can, he declared, be traced to the drunkenness of parents.

Dr. D.G. Dodge, late of the New York State Inebriate Asylum, who, with. Dr. Joseph Parrish, gave testimony before the committee of the House of Commons, said, in one of his answers: "With the excessive use of alcohol, functional disorder will invariably appear, and no organ will be more seriously affected, and possibly impaired, than the brain.  This is shown in the inebriate by a weakened intellect, a general debility of the mental faculties , a partial or total loss of self-respect, and a departure of the power of self-command; all of which, acting together, place the victim at the mercy of a depraved and morbid appetite, and make him utterly powerless, by his own unaided efforts, to secure his recovery from the disease which is destroying him." And he adds: "I am of opinion that there is a "great similarity between inebriety and insanity.

"I am decidedly of opinion that the former has taken its place in the family of diseases as prominently as its twin-brother insanity; and, in my opinion, the day is not far distant when the pathology of the former will be as fully understood and as successfully treated as the latter, and even more successfully, since it is more within the reach and bounds of human control, which, wisely exercised and scientifically administered, may prevent curable inebriation from verging into possible incurable insanity."

General impairment of the faculties.

Dr. Richardson, speaking of the action of alcohol on the mind, gives the following sad picture of its ravages:

"An analysis of the condition of the mind induced and maintained by the free daily use of alcohol as a drink, reveals a singular order of facts. The manifestation fails altogether to reveal the exaltation of any reasoning power in a useful or satisfactory direction. I have never met with an instance in which such a claim for alcohol has been made. On the contrary, confirmed alcoholics constantly say that for this or that work, requiring thought and attention, it is necessary to forego some of the usual potations in order to have a cool head for hard work.

"On the other side, the experience is overwhelmingly in favor of the observation that the use of "alcohol sells the reasoning powers, "make weak men and women the easy prey of the wicked and strong, and leads men and women who should know better into every grade of misery and vice. If, then, alcohol enfeebles the reason, what part of the mental constitution does it exalt and excite? It excites and exalts those animal, organic, emotional centres of mind which, in the dual nature of man, so often cross and oppose that pure and abstract reasoning nature which lifts man above the lower animals, and rightly exercised, little lower than the angels.

It excites man's worst passions.

Exciting these animal centres, it lets loose all the passions, and gives them more or less of unlicensed dominion over the man. It excites anger, and when it does not lead to this extreme, it keeps the mind fretful, irritable, dissatisfied and captious.... And if I were to take you through all the passions, love, hate, lust, envy, avarice and pride, I should but show you that alcohol ministers to them all; that, paralyzing the reason, it takes from off these passions that fine adjustment of reason, which places man above the lower animals. From the beginning to the end of its influence it subdues reason and sets the passions free. The analogies, physical and mental, are perfect. That which loosens the tension of the vessels which feed the body with due order and precision, and, thereby, lets loose the heart to violent excess and unbridled motion, loosens, also, the reason and lets loose the passion. In both instances, heart and head are, for a time, out of harmony; their balance broken. The man descends closer and closer to the lower animals. From the angels he glides farther and farther away.

A sad and terrible picture.

The  destructive  effects of alcohol on the human mind present, finally, the saddest picture of its influence. The most aesthetic artist can find no angel here. All is animal, and animal of the worst type. Memory irretrievably lost, words and very elements of speech forgotten or words displaced to have no meaning in them. Rage and anger persistent and mischievous, or remittent and impotent. Fear at every corner of life, distrust on every side, grief merged into blank despair, hopelessness into permanent melancholy. Surely no Pandemonium that ever poet dreamt of could equal that which would exist if all the drunkards of the world were driven into one mortal sphere.

As I have moved among those who are physically stricken with alcohol, and have detected under the various disguises of name the fatal diseases, the pains and penalties it imposes on the body, the picture has been sufficiently cruel. But even that picture pales, as I conjure up, without any stretch of imagination, the devastations which the same agent inflicts on the mind. Forty per cent., the learned Superintendent of Colney Hatch, Dr. Sheppard, tells us, of those who were brought into that asylum in 1876, were so brought because of the direct or indirect effects of alcohol. If the facts of all the asylums were collected with equal care, the same tale would, I fear, be told. What need we further to show the destructive action on the human mind? The Pandemonium of drunkards; the grand transformation scene of that pantomime of drink which commences with, moderation! Let it never more be forgotten by those who love their fellow-men until, through their efforts, it is closed forever."


I once had the unusual, though unhappy, opportunity of observing the same phenomenon in the brain structure of a man, who, in a paroxysm of alcoholic excitement, decapitated himself under the wheel of a railway carriage, and whose brain was instantaneously evolved from the skull by the crash. The brain itself, entire, was before me within three minutes after the death. It exhaled the odor of spirit most distinctly, and its membranes and minute structures were vascular in the extreme. It looked as if it had been recently injected with vermilion. The white matter of the cerebrum, studded with red points, could scarcely be distinguished, when it was incised, by its natural whiteness; and the pia-mater, or internal vascular membrane covering the brain, resembled a delicate web of coagulated red blood, so tensely were its fine vessels engorged.

I should add that this condition extended through both the larger and the smaller brain, the cerebrum and cerebellum, but was not so marked in the medulla or commencing portion of the spinal cord.

The spinal cord and nerves.

The action of alcohol continued beyond the first stage, the function of the spinal cord is influenced. Through this part of the nervous system we are accustomed, in health, to perform automatic acts of a mechanical kind, which proceed systematically even when we are thinking or speaking on other subjects. Thus a skilled workman will continue his mechanical work perfectly, while his mind is bent on some other subject; and thus we all perform various acts in a purely automatic way, without calling in the aid of the higher centres, except something more than ordinary occurs to demand their service, upon which we think before we perform. Under alcohol, as the spinal centres become influenced, these pure automatic acts cease to be correctly carried on. That the hand may reach any object, or the foot be correctly planted, the higher intellectual centre must be invoked to make the proceeding secure. There follows quickly upon this a deficient power of co-ordination of muscular movement. The nervous control of certain of the muscles is lost, and the nervous stimulus is more or less enfeebled. The muscles of the lower lip in the human subject usually fail first of all, then the muscles of the lower limbs, and it is worthy of remark that the extensor muscles give way earlier than the flexors. The muscles themselves, by this time, are also failing in power; they respond more feebly than is natural to the nervous stimulus; they, too, are coming under the depressing influence of the paralyzing agent, their structure is temporarily deranged, and their contractile power reduced.

This modification of the animal functions under alcohol, marks the second degree of its action. In young subjects, there is now, usually, vomiting with faintness, followed by gradual relief from the burden of the poison.

Effect on the brain centres.

The alcoholic spirit carried yet a further degree, the cerebral or brain centres become influenced; they are reduced in power, and the controlling influences of will and of judgment are lost. As these centres are unbalanced and thrown into chaos, the rational part of the nature of the man gives way before the emotional, passional or organic part. The reason is now off duty, or is fooling with duty, and all the mere animal instincts and sentiments are laid atrociously bare. The coward shows up more craven, the braggart more boastful, the cruel more merciless, the untruthful more false, the carnal more degraded. ' In vino veritas ' expresses, even, indeed, to physiological accuracy, the true condition. The reason, the emotions, the instincts, are all in a state of carnival, and in chaotic feebleness.

Finally, the action of the alcohol still extending, the superior brain centres are overpowered; the senses are beclouded, the voluntary muscular prostration is perfected, sensibility is lost, and the body lies a mere log, dead by all but one-fourth, on which alone its life hangs. The heart still remains true to its duty, and while it just lives it feeds the breathing power. And so the circulation and the respiration, in the otherwise inert mass, keeps the mass within the bare domain of life until the poison begins to pass away and the nervous centres to revive again. It is happy for the inebriate that, as a rule, the brain fails so long before the heart that he has neither the power nor the sense to continue his process of destruction up to the act of death of his circulation. Therefore he lives to die another day.