Introduction: Tongue is a muscular organ associated with the function of deglutition,taste and speech.It acts as an easily accessible organ for the assessment of health of an individual and shows the state of hydration of the body.It is said that tongue is the mirror of the gastrointestinal system and any abnormal functioning of the stomach and intestines will be reflected on the tongue. Some characteristic changes occur in the tongue in some particular diseases.That is why the examination of the tongue is very essential and will give some clues for diagnosis.All doctors examine the tongue and they consider the changes in size,shape,,colour,moisture,coating,nature of papillae and movements ect. Appearance of tongue in some abnormal conditions:- 1) Movements of the tongue:- a) In one sided paralysis of the body(hemiplegia)tongue moves towards the parylised side when protruded. b) Tremulus movement of the tongue is seen in diseases like thyrotoxicosis,delirium tremens and parkinsonisum.Tremor is also seen in nervous patients. c) In progressive bulbar palsy there will be wasting and paralysis of the tongue with fibrillation.Eventually the tongue gets shrivelled and lies functionless in the floor of the mouth.This condition is associated with dribbling of saliva and loss of speech. d) In chorea(involuntary rhythmic movements) the patient may not be able to keep the protruded tongue in rest,it will be moving involuntarily. 2) Moistness of the tongue:- The moistness of the tongue gives some indication about the state of hydration of the body.Water volume depletion leads to peripheral circulatory failure characterised by weakness,thirst,restlessness,anorexia,nausea,vomiting ,dry and parched tongue. Dryness of the tongue is seen in following conditions. a) Diarrhoea b) Later stages of severe illness c) Advanced uraemia d) Hypovolumic shock e) Heat exhaustion f) Hyponatraemia g) Acute intestinal obstruction h) Starvation i) Prlonged fasting. 3) Change in colour of tongue:- a) Central cyanosis:- Cyanosis is the bluish discolouration of the mucus membrane due to decrease in the amount of oxygen in the blood.This is seen in heart failure,respiratory failure and in anoxia.In cyanosis tongue,lips ect becomes pale bluish. b) Jaundice:- This is the yellowish discolouration of all mucus surfaces of the body (including tongue)due to increase of bilirubin in the blood.Jaundice is seen in hepatitis,bile duct obstruction,increased destruction of RBCs and ect… c) Advanced uremia:- This is the increase of urea and other nitrogenous waste products in the blood due to kidney failure.Here the tongue become brown in colour. d) Keto acidosis:- This is the acidosis with accumulation of ketone bodies seen mainly in diabetes mellitus.Here the tongue become brown with a typical ketone smell from the mouth. e) Riboflavin deficiency:- Deficiency of this vitamin (vitamin B2) produces megenta colour of the tongue with soreness and fissures of lips. f) Niacin deficiency:- Deficiency of niacin (vitamin B3)and some other B complex vitamins results in bright scarlet or beefy red tongue. g) Anaemia:- It is the decrease in haemoglobin percentage of the blood.In severe anaemia tongue becomes pale. 4) Coating on the tongue:- a) Bad breath:- The main cause for bad breath is formation of a pasty coating(bio film) on the tongue which lodges thousands of anaerobic bacteria resulting in the production of offenssive gases.Those who complain about bad breath may have thick coating on the posterior part of the tongue. b) Typhoid fever:- In typhoid fever tongue becomes white coared like a fur. c) Candidiasis;- It is a fungal infection which affects the mucus surfaces of the body.On the tongue there will be sloughing white lesions. d) In diabetes and hypoadrenalism there will be sloughing white lesions. e) Secondary syphilis:- Syphilis is a sexually transmitted diseased caused by trepenoma pallidum infection.In secondary stage of this disease we can see mucous patches which are painless,smooth white glystening opalescent plaques which can not be scraped off easily. f) Leokoplakia:- Here white keratotic patches are seen on the tongue and oral cavity.This is a precancerous condition. g) AIDS:- In these patients hairy leukoplakia is seen. h) Peritonitis:- It is the inflammation of the peritonium(inner covering of abdominal cavity which also covers the intestines and keep them in position) in this condition there is white furring of the tongue. i) Acute illness:- Furring is also seen in some acute diseases. 5) Papillae:- These are small projections on the rongue associated with taste.There are different type of papillae on the healthy tongue.In some diseases there are some abnormal changes which are following. a) Hairy tongue:- This condition is due to elongation of filiform papillae seen in poor oral hygeine ,general debility and indigestion. b) Geographic tongue:- Here irregular red and white patches appear on the tongue.These lesions looks like a geographic map.The excact cause is not known. c) Median rhomboid glossitis:- In this condition there is smooth nodular red  area in the posterior mid line of the tongue.This is a congenital condition. d) Nutritional deficiency:- In nutrional deficiency there is glossitis(inflammation of tongue) leading to papillary hypertrophy followed by atrophy. e) Benign migratory glossitis:- It is an inflamatory condition of the tongue where multiple annular areas of desquamation of papillae appear on the tongue which shift from area to area in few days. f) Thiamine and riboflavin deficiency:- Deficiency of these vitamins cause hypertrophied filiform and fungiform papillae. g) Niacin and iron deficiency:- In this condition there is atrophy of papillae.Smooth tongue is encountered in iron deficiency. h) Vitamin A deficiency:- This causes furrowed tongue. i) In nutritional megaloblastic anaemia tongue becomes smooth. j) Folic acid deficiency:- Here macrocytic megaloblastic anaemia with glossitis is seen. k) Cyano coblamine deficiency:- Here glossitis with macrocytic megaloblastic anaemia and peripheral neuropathy is encountered. l) Scarlet fever;- In this streptococcal infection there is bright red papillae standing out of a thick white fur ,later the white coat disappear leaving enlarged papillae on the bright red surface and is called strawberry tongue. 6) Ulcers on the tongue:– a) Apthous ulcer:- These are round painful ulcers appear in stressed individuals frequently. May be associated with food allergy.Usual sites are tongue,lips,oral mucosa and ect. b) Herpes simplex:- It is an acute vesicular eruptions produced by herpes simplex virus.When these vesicles rupture it forms ulcers. c) Ulcer in cancer:- Cancerous ulcers are having everted edges with hard base.Bleeding is also seen.Cancer of the tongue is common in tobacco chewers. d) Syphilitic ulcers:- Syphilitic fissures are longitudinal in direction.In primary syphilis extra genital chancre is seen on the tongue.In secondary syphilis multiple shallow ulcers are seen on the under surface and sides of the tongue.In tertiary syphilis gumma may be seen on the midline of the dorsum of the tongue. e) Dental ulcers:- These ulcers are produced by sharp edges of carious teeth.

One fact attendant on habitual drinking stands out so prominently that none can call it in question. It is that of the steady growth of appetite. There are exceptions, as in the action of nearly every rule; but the almost invariable result of the habit we have mentioned, is, as we have said, a steady growth of appetite for the stimulant imbibed. That this is in consequence of certain morbid changes in the physical condition produced by the alcohol itself, will hardly be questioned by any one who has made himself acquainted with the various functional and organic derangements which invariably follow the continued introduction of this substance into the body. But it is to the fact itself, not to its cause, that we now wish to direct your attention. The man who is satisfied at first with a single glass of wine at dinner, finds, after awhile, that appetite asks for a little more; and, in time, a second glass is conceded. The increase of desire may be very slow, but it goes on surely until, in the end, a whole bottle will scarcely suffice, with far too many, to meet its imperious demands. It is the same in regard to the use of every other form of alcoholic drink. Now, there are men so constituted that they are able, for a long series of years, or even for a whole lifetime, to hold this appetite within a certain limit of indulgence. To say “So far, and no farther.” They suffer ultimately from physical ailments, which surely follow the prolonged contact of alcoholic poison with the delicate structures of the body, many of a painful character, and shorten the term of their natural lives; but still they are able to drink without an increase of appetite so great as to reach an overmastering degree. They do not become abandoned drunkards. No man safe who drinks. ———————- But no man who begins the use of alcohol in any form can tell what, in the end, is going to be its effect on his body or mind. Thousands and tens of thousands, once wholly unconscious of danger from this source, go down yearly into drunkards’ graves. There is no standard by which any one can measure the latent evil forces in his inherited nature. He may have from ancestors, near or remote, an unhealthy moral tendency, or physical diathesis, to which the peculiarly disturbing influence of alcohol will give the morbid condition in which it will find its disastrous life. That such results follow the use of alcohol in a large number of cases, is now a well-known fact in the history of inebriation. The subject of alcoholism, with the mental and moral causes leading thereto, have attracted a great deal of earnest attention. Physicians, superintendents of inebriate and lunatic asylums, prison-keepers, legislators and philanthropists have been observing and studying its many sad and terrible phases, and recording results and opinions. While differences are held on some points, as, for instance, whether drunkenness is a disease for which, after it has been established, the individual ceases to be responsible, and should be subject to restraint and treatment, as for lunacy or fever; a crime to be punished; or a sin to be repented of and healed by the Physician of souls, all agree that there is an inherited or acquired mental and nervous condition with many, which renders any use of alcohol exceedingly dangerous. The point we wish to make with you is, that no man can possibly know, until he has used alcoholic drinks for a certain period of time, whether he has or has not this hereditary or acquired physical or mental condition; and that, if it should exist, a discovery of the fact may come too late. Dr. D.G. Dodge, late Superintendent of the New York State Inebriate Asylum, speaking of the causes leading to intemperance, after stating his belief that it is a transmissible disease, like “scrofula, gout or consumption,” says: “There are men who have an organization, which may be termed an alcoholic idiosyncrasy; with them the latent desire for stimulants, if indulged, soon leads to habits of intemperance, and eventually to a morbid appetite, which has all the characteristics of a diseased condition of the system, which the patient, unassisted, is powerless to relieve since the weakness of the will that led to the disease obstructs its removal. “Again, we find in another class of persons, those who have had healthy parents, and have been educated and accustomed to good social influences, moral and social, but whose temperament and physical constitution are such, that, when they once  indulge in the use of stimulants, which they find pleasurable, they continue to habitually indulge till they cease to be moderate, and become excessive drinkers. A depraved appetite is established, that leads them on slowly, but surely, to destruction.”

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 tried. 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. Take treatment for constipation.

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. Insanity. ——– 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.

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. Kleptomania. ———– 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.

Introduction Hernia is an abnormal protrusion of internal organs through an abnormal opening in the wall of the cavity.A combination of increased pressure inside the body with weakness in the wall is responsible for this condition.In this condition internal organs or parts of organs are protruded out forming a swelling which will increase the size with coughing and lifting weight,and while passing stool and urine.In lying down position the swelling goes inside except in strangulated and irreducible hernia. Causes:- 1, Weakness in the body wall:– a) Congenital weakness. b) Acquired weakness due to injuries,wasting of muscles,suppurative lesions in the wall and presence of weak natural openings,obesity,lack of exercise,repeated pregnancy. c) Surgical operation with improper suturing or sepsis of operated site. 2) Increased pressure inside the body. a) Chronic constipation. b) Recurrent cough. c) Weight lifting. d) Stricture of urethra. Common sites for hernia:– Hernia can occure anywhere in the body.However there are some common sites for hernia.Due to the presence of hard bony covering chest wall is normally not affected.Hernia in the lower back is also rare due to spine and back muscles and tough ligaments and sheeths.The common site for hernia is abdominal wall.Compared to other parts the abdominal wall is weak due to the presence  of some natural orifices.There are some areas wherein the abdominal muscles are weaker and thin and all these factors make a chance for herniation.The common sites for hernia are following. a) Inguinal hernia: Here the abdominal contents protrude through the inguinal canal (passage in the lower abdominal wall just above the inguinal ligament.It is seen on either side).This type is common in males.Initially the swelling comes only while straining and goes back while lying down. Later the large portion of intestine may come out which may not go back easily. b) Femoral hernia: This type of hernia is more in females.Here the abdominal contents pass through the femoral canal which is seen just below the junction between the thigh and lower abdominal wall(Inside the femoral triangle).The contents pass downwards and comes out through saphenous opening in the thigh and forms a swelling under the skin. c) Umbilical hernia: This is common in children.The umbilicus is the weaker part of the abdomen.The contents of the abdomen may protrude as a bulb like swelling while crying and defecating. d) Incisional hernia: These hernias are seen in operated sites. Due to improper suturing or sepsis the operated site becomes weak resulting in hernia. e) Epigastric hernia: Here the hearniation occures in the epigastrium. It is a rare type. f) Lumbar hernia: Here the hernia appear in the lumbar area on either side of the lumbar spine(in the lumbar triangle).This is also a rare type. g) Obturator hernia: This is a rare type of hernia. Here the contents pass through obturator foramen in the pelvic bone. Complications of hernia:– 1) Strangulation: If the hernial orifice is narrow the abdominal contents may not go back easily, and later the blood flow to the herniated tissues may be blocked due to constricition.This can cause death of protruded intestine. 2) Intestinal obstruction: This occures when the whole portion of the intestine is protruded in to the hernial sac. The narrow hernial orifice will block the passage of bowels. 3) Infection and peritonitis: If there is strangulation with death of a portion of intestine there will be spread of infection to the abdomen resulting in peritonitis. Treatment of hernia:– Initial treatment: In the initial stages of hernia the following steps may be useful 1) Use of hernia belt: Special types of hernia belts are available for each type of heania.This will prevent the protrusion and will reduce pain. 2) Constipation,recurrent cough,urinary obstruction ect should be treated. 3) Fat reduction will increase the strength of abdominal wall. 4) Abdominal exercises to increase the muscle tone. 5) Take plenty of leafy vegetables, fruits and fibrous diet for easy bowel movements. 6) Try other systems like Homoeopathy,Herbal medicine and ect If no relief by the above steps consult a general surgeon for surgical management. Surgical treatment. The following operations are done depending up on the type and nature of hernia. 1) Hertniotomy : In this operation the contents of hernial sac is pushed in to the abdomen and neck of the sac is ligated with transfixion ligature and the sac is cut off. 2) Herniorrhaphy: Here along with herniotomy the posterior wall is repaired. 3) Hernioplasty: This operation is done if herniotomy is not possible due to wide neck of the sac.Here the repair is done with the healp of non absorbable materials like tantalum gauze,polypropylene mesh or stainless steel mesh.

Introduction: Food poisoning is an acute gastroenteritis caused by the consumption of a food material or a drink which contains the pathogenic micro organism or their toxins or poisonous chemicals.Food poisoning is common in hostels,hotels,communal feedings, and festivel seasons. A group of persons will be affected with same type of symptoms ,and they give a history of consumption of a common food before few hours. Types of food poisoning 1) Bacterial food poisoning: Here the micro organisms called bacteria are responsible.The food material may contain the pathogenic bacteriae or their toxin and will be ingested along with the food. 2) Non bacterial food poisoning: Due to the presence of toxic chemicals like fertilizers,insectisides,heavy metals and ect. Since bacterial food poisoning is common it is discussed here. Bacterial food poisoning: All bacteria are not harmful.There are some pathogenic bacteria which secrete toxins and cause clinical manifestations.These organisms enter the human body through food articles or drinks. How food poisoning occures: 1) Presence of bacteria in the water. 2) The raw materials for the food may contain toxins. 3) Premises where the food is prepared may contain micro organisms or toxins. 4) Food handlers may have some infectious diseases. 5) Some animals like dogs,rats may contaminate the food. 6) If prepared food is kept in the room temperature for a long time and heated again can make a chance for food poisoning. 7) Purposely some body mixing toxins in the food. Some common bacterial food poisonings. 1) Salmonella food poisoning: There are three different varieties of salmonella bacteria.(salmonella typhimurium,salmonella cholera suis,salmonella enteritidis) These bacteria are present in milk, milk products and eggs. Symptoms of this food poisoning include nausea, vomiting and diarrhoea. Fever is also common. 2) Botulism: This is the dangerous type of food poisoning caused by clostridium botulinum. The spores of these organisms are seen in the soil and enters the human body through pickles and canned fish ect.Compared to other food poisonings here vomiting and diarrhoea are rare Mainly the nervous system is affected.The symptoms starts with double vision,numbness with weakness.Later there will be paralysis with cardiac and respiratory failure ending in death. 3) Staphylococcal food poisoning: It is caused by staphylo coccus aureus. These organisms usually cause skin troubles like boils and eruptions.It causes mastitis in cow.Through the milk and milk products it enders and causes gastroenteritis.There will be vomiting,abdominal cramps with diarrhoea. 4) Closteridium food poisoning: This is caused by closteridium perfringens.They are present in stool,soil and water. They enter the body through,meat,meat dishes and egg ect.If food articles are cooked and kept in room temperature for a long time and heated again before eating can result this food poisoning.Symptoms include vomiting ,diarrhoea and abdominal cramps. 5) Bacillus cereus: The spores of these organisms can survive cooking and causes enteritis. Diarrhoea and vomiting is common in this infection. How to investigate food poisoning? 1) Examine each and every person affected. 2) Water sample should be tested. 3) Kitchen, store room and food samples should be examined. 4) The cook and food handlers should be questioned and examined. 5) Samples of vomitus and stool of all victims should be tested to identify the bacteria. How to prevent food poisoning:- 1) Only purified water should be used. 2) Hygiene should be maintained by all persons keeping contact with food. 3) Workers should use masks, cap and gloves during cooking and serving. 4) Sick individuals should not come in contact with food materials. 5) Kitchen and premises should be neat and clean. 5) Vessels should be washed with soap and hot water. 6) Should not keep the prepared food for a long time in room temperature. 7) All food materials should be kept in closed containers. Animals like dog, cat, rat ect should  not come in contact with food materials. 9) Vegetables should be washed before cooking. 10) Meat should be fresh and should be purchased from recognised slaughter house.

The parts which first suffer from alcohol are those expansions of the body which the anatomists call the membranes. “The skin is a membranous envelope. Through the whole of the alimentary surface, from the lips downward, and through the bronchial passages to their minutest ramifications, extends the mucous membrane. The lungs, the heart, the liver, the kidneys are folded in delicate membranes, which can be stripped easily from these parts. If you take a portion of bone, you will find it easy to strip off from it a membranous sheath or covering; if you examine a joint, you will find both the head and the socket lined with membranes. The whole of the intestines are enveloped in a fine membrane called peritoneum . All the muscles are enveloped in membranes, and the fasciculi, or bundles and fibres of muscles, have their membranous sheathing. The brain and spinal cord are enveloped in three membranes; one nearest to themselves, a pure vascular structure, a network of blood-vessels; another, a thin serous structure; a third, a strong fibrous structure. The eyeball is a structure of colloidal humors and membranes, and of nothing else. To complete the description, the minute structures of the vital organs are enrolled in membranous matter.” These membranes are the filters of the body. “In their absence there could be no building of structure, no solidification of tissue, nor organic mechanism. Passive themselves, they, nevertheless, separate all structures into their respective positions and adaptations.” Membranous deteriorations. ————————- In order to make perfectly clear to your mind the action and use of these membranous expansions, and the way in which alcohol deteriorates them, and obstructs their work, we quote again from Dr. Richardson: “The animal receives from the vegetable world and from the earth the food and drink it requires for its sustenance and motion. It receives colloidal food for its muscles: combustible food for its motion; water for the solution of its various parts; salt for constructive and other physical purposes. These have all to be arranged in the body; and they are arranged by means of the membranous envelopes. Through these membranes nothing can pass that is not, for the time, in a state of aqueous solution, like water or soluble salts. Water passes freely through them, salts pass freely through them, but the constructive matter of the active parts that is colloidal does not pass; it is retained in them until it is chemically decomposed into the soluble type of matter. When we take for our food a portion of animal flesh, it is first resolved, in digestion, into a soluble fluid before it can be absorbed; in the blood it is resolved into the fluid colloidal condition; in the solids it is laid down within the membranes into new structure, and when it has played its part, it is digested again, if I may so say, into a crystalloidal soluble substance, ready to be carried away and replaced by addition of new matter, then it is dialysed or passed through, the membranes into the blood, and is disposed of in the excretions. “See, then, what an all-important part these membranous structures play in the animal life. Upon their integrity all the silent work of the building up of the body depends. If these membranes are rendered too porous, and let out the colloidal fluids of the blood the albumen, for example the body so circumstanced, dies; dies as if it were slowly bled to death. If, on the contrary, they  become condensed or thickened, or loaded with foreign material, then they fail to allow the natural fluids to pass through them. They fail to dialyse, and the result is, either an accumulation of the fluid in a closed cavity, or contraction of the substance inclosed within the membrane, or dryness of membrane in surfaces that ought to be freely lubricated and kept apart. In old age we see the effects of modification of membrane naturally induced; we see the fixed joint, the shrunken and feeble muscle, the dimmed eye, the deaf ear, the enfeebled nervous function. “It may possibly seem, at first sight, that I am leading immediately away from the subject of the secondary action of alcohol. It is not so. I am leading directly to it. Upon all these membranous structures alcohol exerts a direct perversion of action. It produces in them a thickening, a shrinking and an inactivity that reduces their functional power. That they may work rapidly and equally, they require to be at all times charged with water to saturation. If, into contact with them, any agent is brought that deprives them of water, then is their work interfered with; they cease to separate the saline constituents properly; and, if the evil that is thus started, be allowed to continue, they contract upon their contained matter in whatever organ it may be situated, and condense it. “In brief, under the prolonged influence of alcohol those changes which take place from it in the blood corpuscles, extend to the other organic parts, involving them in structural deteriorations, which are always dangerous, and are often ultimately fatal.”