Lectures on Clinical Psychiatry by Kraepelin Emil

Author:Kraepelin, Emil [Kraepelin, Emil]
Language: eng
Format: epub
Published: 2014-05-17T16:00:00+00:00

XVIII. Chronic Alcoholism

Gentlemen,—It is only in a comparatively very small number of cases, in the province of clinical alienism, that we are able to form anything like a reliable idea of the causes of the morbid phenomena, and still more seldom can we give an account of the way in which those causes work. For obvious reasons, we most nearly approach the latter goal of clinical inquiry in cases of poisoning, particularly in those which daily experience frequently brings before us. We know that acute alcoholic poisoning produces changes in the cortex of the brain which can easily be pointed out, and that the expression of these changes in intoxication consists of difficulty in comprehension, shallowness of the train of thought, and increased psychomotor excitability, with loss of strength and disturbance of the finer control of the movements. It is also known that the effect of large doses of alcohol may continue for from twenty-four to forty-eight hours, and that, by the regular repetition of the doses before the effect of the previous dose has passed away, a permanent reduction of the mental capacity for work in various departments is produced in a few days, and disappears only very slowly, even when the administration of the poison has ceased. These facts, which have been discovered by actual experiment, are calculated to give us a certain comprehension of the onset of the mental disturbance called chronic alcoholism.

If you examine the merchant, aged thirty-three, who entered our hospital of his own accord a few days ago, you will probably hardly notice any symptom of disease in him. He is perfectly collected and clear, and gives well-ordered information about his whole circumstances. His features are rather flabby and bloated. The knee and skin reflexes are very active, and when he spreads out his fingers there is a fine tremor. The gums and mouth are very red, and the tongue is a little furred.

The patient states that he entered the asylum because he had drunk hard latterly. He did well at school, but when he was about sixteen he was induced by his father’s drinking habits to drink beer pretty regularly, and got a taste for it, which, with many fluctuations, has gradually become more and more strongly developed. His marriage, when he was twenty-six, brought about an improvement for a little while, but afterwards things got worse and worse, until finally he spent nearly the whole day in a certain state of intoxication. In this condition, he was irritable, scolded on trivial occasions with the lowest expressions, became careless and negligent in his work, and ate only very little at home. On his wife’s persuasion, the patient, who is good-natured and easily influenced at home, let himself be admitted here, and remained nearly four months in the hospital, where all the disturbances disappeared very quickly. He was urgently advised by us to remain a complete abstainer, and he followed this advice for eighteen months. His capacity for work had been greatly increased, so that he earned considerably more than before.

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