Some men and women are quickly destroyed by alcohol; others resist it more or less successfully for a lifetime, as far as mere existence is concerned. Alcoholism is one of the commonest causes of insanity, but it is often an effect of insanity. It may be an early symptom of paresis, or a part of the maniacal stage of circular insanity. In poisoning by alcohol the higher nerve centres are first affected and the {109} lowest last. The sense of human dignity and of morality, the exercise of the intellect, are more or less inhibited before the motive muscles are affected. The usual effect of alcoholic poisoning is boisterous exaltation of mind, but there is a depressed type of drunkenness which weeps. Some patients at once are subjected by hallucinations and delusions, others are so depressed that they have a suicidal tendency, others may have a maniacal frenzy that is destructive or homicidal. In these neuropathic conditions muscular co-ordination is commonly well preserved--the patient is "drunk in the head and sober in the legs." In alcoholism the mental changes are gradual and progressive. The intellect is blunted, the judgment becomes foolish, the moral sense is dulled. The drunkard is always a liar. Delusions not infrequently occur, and it is one of the common symptoms of alcoholic insanity to suspect a wife or husband of conjugal infidelity. If a man that is a drunkard accuses his wife of infidelity, the chances are fifty to one that she is innocent and that he is in the first stages of insanity. This symptom is characteristic also of cocaine intoxication. Another mental disturbance of acute alcoholism is _delirium tremens_, which is inexactly called _mania a potu_ by some writers. _Delirium tremens_ is not a form of mania, but an acute hallucinatory confusion, in which the consciousness is much more impaired than it is in a mania. _Mania a potu_ is a real mania, and it is transient commonly, although it may leave permanent mental weakness with delusions.