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7. Systems analysts use a process called ____ to represent company operations and information needs.
a. JAD c. RAD
b. Scrum d. business process modeling
ANS: D PTS: 1 REF: 10
8. A business ____ is an overview that describes a company’s overall functions, processes, organization,
products, services, customers, suppliers, competitors, constraints, and future direction.
a. matrix c. index
b. profile d. glossary
ANS: B PTS: 1 REF: 10
9. Which of the following is one of the main sectors of e-commerce?

a. C2C c. C2B
b. B2C d. BBC
10. ____ enabled computer-to-computer transfer of data between companies, usually over private
telecommunications networks.
a. EDI c. TCH
b. ACH d. O-O
ANS: A PTS: 1 REF: 14
11. Transaction processing (TP) systems ____.

a. provide job-related information to users at all levels of a company
b. simulate human reasoning by combining a knowledge base and inference rules that
determine how the knowledge is applied
c. process data generated by day-to-day business operations
d. include e-mail, voice mail, fax, video conferencing, word processing, automated
calendars, database management, spreadsheets, and high-speed Internet access
ANS: C PTS: 1 REF: 15
12. Business support systems ____.

a. provide job-related information support to users at all levels of a company
13. Knowledge management systems are called expert systems because they ____.
14. User productivity systems ____.
d. include e-mail, voice mail, fax, video and Web conferencing, word processing, automated
calendars, database management, spreadsheets, desktop publishing, presentation graphics,
company intranets, and high-speed Internet access
15. In a typical company organizational model, top managers ____.

a. develop long-range plans, called strategic plans, which define the company’s overall
mission and goals
b. provide direction, necessary resources, and performance feedback to supervisors and team
leaders
c. oversee operation employees and carry out day-to-day functions, coordinating operational
tasks and people
d. include users who rely on TP systems to enter and receive the data they need to perform
their jobs
16. In a typical company organizational model, middle managers ____.

a. develop long-range plans, called strategic plans, which define the company’s overall
mission and goals
b. provide direction, necessary resources, and performance feedback to supervisors and team
leaders
c. oversee operation employees and carry out day-to-day functions, coordinating operational
tasks and people
d. include users who rely on TP systems to enter and receive the data they need to perform
their jobs
17. A ____, or requirements model, describes the information that a system must provide.
a. process model c. business model
b. data model d. network model
18. A(n) ____ describes the logic that programmers use to write code modules.
a. process model c. business model
b. object model d. network model
19. ____ is a systems development technique that produces a graphical representation of a concept or
process that systems developers can analyze, test, and modify.
a. Prototyping c. Scrum
b. Rapid application development d. Modeling
20. ____ is a systems development technique that tests system concepts and provides an opportunity to
examine input, output, and user interfaces before final decisions are made.
a. Scrum c. Modeling
b. Prototyping d. Rapid application development
21. ____ methods include the latest trends in software development.

a. Object-oriented analysis c. Structured analysis
b. Agile/Adaptive d. Rapid application development
22. The ____ method of developing systems is well-suited to project management tools and techniques.
a. object-oriented analysis c. structured analysis
b. adaptive d. rapid application development
23. The ____ method of developing systems produces code that is modular and reusable.
b. adaptive d. rapid application development
24. The ____ method of developing systems stresses team interaction and reflects a set of community-
based values.
b. agile/adaptive d. rapid application development
25. Structured analysis is a traditional systems development technique that uses a series of phases, called
the ____, to plan, analyze, design, implement, and support an information system.
a. O-O c. MSF
b. SDLC d. RUP
26. Because it focuses on processes that transform data into useful information, structured analysis is
called a(n) ____ technique.
a. iterative c. inferred
b. process-centered d. empowered
27. In the ____, like that shown in the accompanying figure, the result of each phase, which is called a
deliverable or end product, flows sequentially into the next phase in the SDLC.
a. interactive model c. waterfall model
b. requirements model d. object model
28. In the model of the SDLC shown in the accompanying figure, the ____ usually begins with a formal
request to the IT department, called a systems request, which describes problems or desired changes in
an information system or a business process.
a. systems design phase c. systems support and security phase
b. systems planning phase d. systems analysis phase
29. In the model of the SDLC shown in the accompanying figure, the purpose of the ____ is to build a
logical model of the new system.
a. systems analysis phase c. systems design phase
b. systems implementation phase d. systems support and security phase
30. In the model of the SDLC shown in the accompanying figure, the purpose of the ____ is to create a
physical model that will satisfy all documented requirements for the system.
a. systems implementation phase c. systems analysis phase
b. systems planning phase d. systems design phase
31. In the model of the SDLC shown in the accompanying figure, during ____, the new system is
constructed.
a. systems planning c. systems design
b. systems support and security d. systems implementation
32. In the model of the SDLC shown in the accompanying figure, during ____, the IT staff maintains,
enhances, and protects the system.
a. systems support and security c. systems analysis
b. systems implementation d. systems planning
33. Whereas structured analysis treats processes and data as separate components, ____ combines data and
the processes that act on the data into things called objects.
a. the MSF c. RUP
b. the SDLC d. O-O
34. In object-oriented programming, an object is a member of a(n) ____, which is a collection of similar
objects.
a. property c. message
b. class d. instance
35. In object-oriented design, built-in processes called ____ can change an object’s properties.
a. methods c. attributes
b. functions d. features
36. Agile methods typically use a(n) ____model, which represents a series of iterations based on user
feedback.
a. gradual c. spiral
b. extreme d. evaluative
37. When building an information system, all of the following basic guidelines should be considered
except ____.
a. stick to an overall development plan
b. identify major milestones for project review and assessment
c. provide accurate and reliable cost and benefit information
d. ensure that users are not involved in the development process
38. The ____ group typically provides leadership and overall guidance, but the systems themselves are
developed by teams consisting of users, managers, and IT staff members.
a. Web support c. systems support
b. application development d. database administration
39. ____ provides vital protection and maintenance services for system software and hardware, including
enterprise computing systems, networks, transaction processing systems, and corporate IT
infrastructure.
a. User support c. Systems support and security
b. Database administration d. Network administration
40. A systems analyst needs ____.

a. solid technical knowledge and good analytical ability
b. strong oral and written communication skills
c. an understanding of business operations and processes
d. all of the above
MULTIPLE RESPONSE
Modified Multiple Choice
1. An example of a vertical system is a(n) ____.

a. inventory application c. payroll application
b. medical practice application d. database for a video chain
ANS: B, D PTS: 1 REF: 8
2. An example of a horizontal system is a(n) ____.

a. inventory application c. payroll application
b. application for a Web-based retailer d. medical practice application
ANS: A, C PTS: 1 REF: 8
3. A business process describes a specific set of ____.

a. transactions c. events
b. employees d. results
ANS: A, C, D PTS: 1 REF: 10
4. Product-oriented firms produced ____.

a. retail services c. computers
b. routers d. microchips
ANS: B, C, D PTS: 1 REF: 11
5. Database administration involves ____.

a. network administration c. data design
b. user access d. backup
ANS: B, C, D PTS: 1 REF: 29
MODIFIED TRUE/FALSE
1. System software consists of programs that support day-to-day business functions and provide users
with the information they require. _________________________
ANS: F, Application
PTS: 1 REF: 8
2. Value-added services such as consulting, financing, and technical support can be more profitable than
hardware. _________________________
ANS: T PTS: 1 REF: 11
3. Rational Unified Process documents the experience of Microsoft’s own software development teams.
_________________________
ANS: F
Microsoft Solutions Framework
MSF
PTS: 1 REF: 27
4. Rapid application development focuses on team-based fact-finding. _________________________
ANS: F
Joint application development
Joint application development (JAD)
JAD
JAD (joint application development)
PTS: 1 REF: 27
5. User support provides users with technical information, training, and productivity support.
_________________________
TRUE/FALSE
1. Most firms give their IT budgets a low priority in bad economic times.
ANS: F PTS: 1 REF: 4
2. A mission-critical system is one that is unimportant to a company’s operations.
3. In an information system, data is information that has been transformed into output that is valuable to
users.
4. In an information system, information consists of basic facts that are the system’s raw material.

5. The success or failure of an information system usually is unrelated to whether users are satisfied with
the system’s output and operations.
6. Although the business-to-business (B2B) sector is more familiar to retail customers, the volume of
business-to-consumer (B2C) transactions is many times greater.
7. TP systems are inefficient because they process a set of transaction-related commands individually
rather than as a group.
8. In a knowledge management system, a knowledge base consists of logical rules that identify data
patterns and relationships.
9. A knowledge management system uses inference rules, which consist of a large database that allows
users to find information by entering keywords or questions in normal English phrases.
10. Most large companies require systems that combine transaction processing, business support,
knowledge management, and user productivity features.
11. Because they focus on a longer time frame, middle managers need less detailed information than top
managers, but somewhat more than supervisors who oversee day-to-day operations.
ANS: F PTS: 1 REF: 18-19
12. Many companies find that a trend called empowerment, which gives employees more responsibility
and accountability, improves employee motivation and increases customer satisfaction.
13. CASE tools provide an overall framework for systems development and support a wide variety of
design methodologies, including structured analysis and object-oriented analysis.
14. It is unusual for system developers to mix and match system development methods to gain a better
perspective.
15. In the systems planning phase, a key part of the preliminary investigation is a feasibility study that
reviews anticipated costs and benefits and recommends a course of action based on operational,
technical, economic, and time factors.
16. In the systems analysis phase, the first step is requirements modeling, where business processes are
investigated and what the new system must do to satisfy users is documented.
17. In object-oriented design, objects possess characteristics called properties, which the object inherits
from its class or possesses on its own.
18. A scalable design can expand to meet new business requirements and volumes.
19. In object-oriented design, a message requests specific behavior or information from another object.
20. Microsoft offers a development approach called Microsoft Solutions Framework (MSF), which
documents the experience of its own software development teams.
21. An IT group provides technical support, which includes application development, systems support and
security, user support, database administration, network administration, and Web support.
22. Network administration includes hardware and software maintenance, support, and security.
23. Companies typically require that systems analysts have a college degree in information systems,
computer science, business, or a closely related field, and some IT experience usually is required.
24. The responsibilities of a systems analyst at a small firm are exactly the same as those at a large
corporation.
25. A corporate culture is the set of beliefs, rules, traditions, values, and attitudes that define a company
and influence its way of doing business.
COMPLETION
1. _________________________ refers to the combination of hardware, software, and services that

companies use to manage, communicate, and share information.
ANS:
Information technology (IT)
IT
PTS: 1 REF: 4
2. _________________________ is a step-by-step process for developing high-quality information

systems.
ANS: Systems analysis and design
PTS: 1 REF: 7
3. A(n) _________________________ combines information technology, people, and data to support

business requirements.
ANS: information system
PTS: 1 REF: 7
4. An IT department team includes _________________________ who plan, develop, and maintain

information systems.
ANS: systems analysts
PTS: 1 REF: 7
5. A(n) _________________________ is a set of related components that produces specific results, such
as routing Internet traffic, manufacturing microchips, and controlling complex entities like the Mars
Rover.
ANS: system
PTS: 1 REF: 7
6. In the accompanying figure showing the components of an information system,

_________________________ consist(s) of everything in the physical layer of the information
system.
ANS: hardware
PTS: 1 REF: 8
_________________________ refer(s) to the programs that control the hardware and produce the
desired information or results.
ANS: software
PTS: 1 REF: 8

_________________________ is/are the raw material that an information system transforms into
useful information.
ANS: data
PTS: 1 REF: 9

_________________________ describe(s) the tasks and business functions that users, managers, and
IT staff members perform to achieve specific results.
ANS: processes
PTS: 1 REF: 9
10. In the accompanying figure showing the components of an information system, the people, called
_________________________, interact with an information system, both inside and outside the
company.
ANS:
users
end users
PTS: 1 REF: 10
11. The newest category of company is the _________________________ whose primary business
depends on the Internet rather than a traditional business channel.
ANS:
Internet-dependent firm
dot-com company
.com company
PTS: 1 REF: 12
12. Traditional companies sometimes are called _________________________ companies because they
conduct business primarily from physical locations.
ANS: brick-and-mortar
PTS: 1 REF: 12
13. Internet-based commerce is called _________________________ and includes two main sectors: B2C
(business-to-consumer) and B2B (business-to-business).
ANS:
e-commerce
electronic commerce
I-commerce
Internet commerce
PTS: 1 REF: 13
14. _________________________ technology uses high-frequency radio waves to track physical object.
ANS:
RFID
Radio frequency identification
RFID (Radio frequency identification)
Radio frequency identification (RFID)
PTS: 1 REF: 16
15. A truck fleet dispatcher might run a series of _________________________ scenarios to determine
the impact of increased shipments or bad weather.
ANS: what-if
PTS: 1 REF: 16
16. _________________________ programs run on a company intranet and enable users to share data,
collaborate on projects, and work in teams.
ANS: Groupware
PTS: 1 REF: 17
17. The systems implementation phase of the SDLC includes an assessment, called a(n)
_________________________, to determine whether the system operates properly and if costs and
benefits are within expectation.
ANS: systems evaluation
PTS: 1 REF: 24
18. A(n) _________________________ uses various symbols and shapes to represent data flow,
processing, and storage.
ANS:
data flow diagram
DFD
data flow diagram (DFD)
DFD (data flow diagram)
PTS: 1 REF: 22
19. _________________________ design and construct Web pages, monitor traffic, manage hardware and
software, and link Web-based applications to a company’s information systems.
ANS: Web support specialists
PTS: 1 REF: 29
20. Many hardware and software companies offer _________________________ for IT professionals,
which verifies that an individual demonstrated a certain level of knowledge and skill on a standardized
test.
ANS: certification
PTS: 1 REF: 32
MATCHING
Identify the letter of the choice that best matches the phrase or definition.
a. MIS f. team leaders
b. network model g. operational employees
c. object model h. supply chain management
d. fuzzy logic i. data model
e. ERP j. prototype
1. In many large companies, these kinds of systems provide cost-effective support for users and managers
throughout the company.
2. The name for new business support systems that produced valuable information, in addition to
performing manual tasks; their primary users were managers.
3. A B2B site that allows buyers, sellers, distributors, and manufacturer to offer products, submit
specifications, and transact business.
4. Many knowledge management systems use this technique, which allows inferences to be drawn from
imprecise relationships.
5. People who oversee operational employees and carry out day-to-day functions.
6. People who rely on TP systems to enter and receive data they need to perform their jobs.
7. Describes the design and protocols of telecommunications links.
8. Describes objects, which combine data and processes.
9. Describes data structures and design.
10. An early working version of an information system.
1. ANS: E PTS: 1 REF: 15

2. ANS: A PTS: 1 REF: 16
3. ANS: H PTS: 1 REF: 14
4. ANS: D PTS: 1 REF: 17
5. ANS: F PTS: 1 REF: 19
6. ANS: G PTS: 1 REF: 19
7. ANS: B PTS: 1 REF: 19
8. ANS: C PTS: 1 REF: 19
9. ANS: I PTS: 1 REF: 19
10. ANS: J PTS: 1 REF: 20
ESSAY
1. Explain what a knowledge worker is, and why this kind of worker is required by successful
companies.
ANS:
Knowledge workers include professional staff members such as systems analysts, programmers,
accountants, researchers, trainers, and human resource specialists. Knowledge workers also use
business support systems, knowledge management systems, and user productivity systems. Knowledge
workers provide support for the organization's basic functions. Just as a military unit requires logistical
support, a successful company needs knowledge workers to carry out its mission.
PTS: 1 REF: 19 TOP: Critical Thinking
2. What are the disadvantages of each of the three system development methods?
ANS:
With structured analysis, changes can be costly, especially in later phases. Requirements are defined
early, and can change during development. Users might not be able to describe their needs until they
can see examples of features and functions. With object-oriented analysis, this somewhat newer
method of development might be less familiar to development team members. Also, the interaction of
objects and classes can be complex in larger systems. With agile/adaptive methods, team members
need a high level of technical and communications skills. Lack of structure and documentation can
introduce risk factors. Finally, the overall project might be subject to scope change as user
requirements change.
3. Discuss the five basic systems development guidelines.
ANS:
Develop a Plan
Prepare an overall project plan and stick to it. Complete the tasks in a logical sequence. Develop a
clear set of ground rules and be sure that everyone on the team understands them clearly.
Involve Users and Listen Carefully to Them

Ensure that users are involved in the development process, especially when identifying and modeling
system requirements. When you interact with users, listen closely to what they are saying.
Use Project Management Tools and Techniques

Try to keep the project on track and avoid surprises. Create a reasonable number of checkpoints — too
many can be burdensome, but too few will not provide adequate control.
Develop Accurate Cost and Benefit Information

Managers need to know the cost of developing and operating a system, and the value of the benefits it
will provide. You must provide accurate, realistic cost and benefit estimates, and update them as
necessary.
Remain Flexible
Be flexible within the framework of your plan. Systems development is a dynamic process, and
overlap often exists among tasks. The ability to react quickly is especially important when you are
working on a system that must be developed rapidly.

CASE
Critical Thinking Questions

Case 1-1
Roark has just joined the company and in his role as lead analyst, he will be responsible for
determining which systems development method the team uses to create the new application for a
major medical supplier.
1. After Roark has spent a week getting to know the members of the team, including their strengths and
weaknesses, and what has worked well (and not so well) for this particular team in the past, one theme
keeps recurring: the team has particularly weak communications skills. Which of the following
methods, then, is he least likely to use, given what he knows about the disadvantages of each method?
a. structured analysis
b. agile/adaptive methods
c. object-oriented analysis
d. rapid application development
ANS:
B
2. It is a new day at the firm. Roark has been in place for a few weeks, strengthening the communications
skills of his employees, getting them to work much better together. Now, the challenge that he faces is
not an internal one; it lies with the client, which is increasingly showing itself to be incapable of
sticking with decisions. Roark, based on his past experience with other clients like this, is afraid that
the client will throw them a curveball and want to make changes late in the game — but that they also
will be unwilling to absorb the costs of those changes. For this reason, Roark eliminates which of the
following methods of development?
a. structured analysis
b. agile/adaptive methods
c. object-oriented analysis
d. rapid application development
ANS:
A
Critical Thinking Questions

Case 1-2
Maddy has been performing at a very high level at the firm, and so when two colleagues of hers who
are currently leading other development efforts get sick or leave the company, she is asked to step in
and help manage these two other efforts.
3. When Maddy sits down at the first meeting at which the first group is gathering, she hears them
discussing the feasibility study in which they are currently engaged. She knows, then, in which phase
of the SDLC this team currently is. Which phase is it?
a. systems analysis
b. systems design
c. systems planning
d. systems implementation
ANS:
C
4. After leaving the first meeting, Maddy goes down the hall to meet with the outgoing manager of the
second team. In that meeting, he shares with her the latest draft of the systems requirement document,
which is nearly complete. In which phase is the second team currently?
a. systems analysis
b. systems design
c. systems planning
d. systems implementation
ANS:
A

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hypochondriasis, intellectual feebleness, and insanity. Two forms of
hereditary alcoholism have been recognized: First, that in which the
disease or defect of the parent is transmitted to the offspring; and
second, that in which the disease or defect is not directly transmitted
to the offspring, but a morbid tendency which manifests itself in
diseases or defects of a different kind.49
49 1. Heredite de similitude, Alcoolisme hereditaire homotype; 2. Heredite de
transformation, Alcoolisme hereditaire heterotype.
1. The appetite for strong drink is frequently transmitted from parents

to the children, just as other traits of the mind or body. Sometimes it
develops early, sometimes late in life; as a rule, however, this
hereditary propensity shows itself at an early age, and is apt to be
intensified at the time of puberty and the menopause. Objections
have been urged against the theory of hereditary alcoholism. Among
these the strongest is perhaps that the taste for drink in the offspring
of alcoholic subjects is the result rather of opportunity and example
than of heredity. The frequency with which alcoholic tendencies
develop themselves in children reared and educated away from their
parents, and the number of cases in which these tendencies show
themselves only at an advanced period of life, long after the
influence of example in childhood has ceased, sufficiently disprove
this assumption. The hereditary influence does not, however,
invariably manifest itself in the desire for drink. On the contrary, not
rarely it consists in feebleness of nervous constitution, characterized
by irritability, want of mental repose, or a restless or vicious
disposition which demands constant excitement. Hence such
individuals, although intellectually well developed, are often scarcely
more than moral imbeciles, in whom the passion for drink may be
replaced by the opium habit, addiction to gaming and to other vices,
and whose career is shaped largely by an inordinate and insatiable
craving for excitement of all kinds. Hereditary alcoholism follows the
laws of heredity in general. The tendency may be transmitted directly
from one generation to another, or may skip one or more
generations, taking in the intermediate periods some different form.
2. The second variety is that in which the symptoms of chronic
alcoholism are manifested in the offspring in the absence of the
direct action of alcohol; that is to say, not the taste for alcohol, but
the results of the gratification of that taste are transmitted, just as
epileptic or hysterical patients may transmit to their offspring epilepsy
or hysteria; thus it is not rare to encounter in the descendants of
alcoholic parents perverted sensation, both general and special,
hyperæsthesia, anæsthesia, flying neuralgias which do not always
follow the course of particular nerves, but frequently affect in a
general way the head or the members or manifest themselves as
visceral neuralgias. These persons are much troubled with headache
from slight causes and with migraine. Nor are disturbances of vision
rare, nor vertigo. Insomnia is also frequent in such individuals, and
augments the other symptoms. Digestive troubles also frequently
occur, notwithstanding a regular and perfectly temperate life. Such
persons are often subject to hallucinations of sight and hearing, and
are liable to have delirium in trifling illnesses.
The second form of hereditary alcoholism manifests itself in a wholly

different manner. The descendants, without a special appetite for
strong drink, and in the absence of the special morbid manifestations
above described, are singularly liable to mental and nervous
diseases of various kinds. Among these convulsions and epilepsy
are especially frequent; hysteria and various forms of insanity also
occur. In this group of cases we find every degree of arrest of
intellectual development, from mere feeble-mindedness to complete
idiocy. As manifestations of the influence of alcoholism upon the
offspring may be cited certain moral peculiarities otherwise
inexplicable, such as are seen in children who at a very tender age
show themselves vindictive, passionate, and cruel, to whom the
sufferings of others afford pleasure, who torment their companions
and torture their pets, and show precocious vicious tendencies of all
kinds. Later in life these persons become lazy, intolerant of
discipline, vagabonds, unstable of character, without the power of
application and without moral sense. Given to drink, defiant of law,
they constitute the great body of tramps, paupers, and criminals. The
children of alcoholic subjects are often feeble and puny, pale, badly
nourished, and curiously subject to morbid influences.
IV. Dipsomania.
Dipsomania, which has also been described under the term

oinomania, is rather a form of insanity than of alcoholic disease. The
characteristic symptoms are, however, in the greater number of
instances, due to indulgence in alcohol. The subjects of this affection
usually belong to families in which insanity, and especially this
particular form of insanity, is hereditary.
There are two forms of dipsomania—the essential and the

symptomatic. Of these, the latter is the more frequent. Its
consideration requires in this connection very few words. It manifests
itself by an irresistible desire on the part of many insane people for
alcohol. It occurs both in the prodromic and in the fully-established
periods of insanity. It is especially common in various forms of mania
and in the prodromic periods of general paralysis. The dominating
influence in essential dipsomania is heredity. Occasional causes
may bring on particular attacks, but their influence is secondary.
Dipsomania cannot be looked upon as a distinct recurrent affection
in an otherwise healthy person. At some period in their lives, and
often long before the occurrence of characteristic paroxysms,
dipsomaniacs show peculiarities indicating defects of mental
organization. Certain symptoms of dipsomania are often mistaken for
its cause. Thus, dyspepsia is more frequently an effect than a cause
of the alcoholic excesses. The despondency, irritability, restlessness,
hysterical manifestations, and insomnia which precede the attack are
not the cause of it: they are its earliest symptoms.
The affection usually begins insidiously and is progressive. As a rule,

although not always, it begins in early adult life. The manifestations
of this disease are essentially intermittent and paroxysmal, but the
impulse to drink must be regarded as a symptom which may be
replaced by other irresistible desires of an impulsive kind, such as
lead to the commission and repetition of various crimes, as the
gratification of other depraved appetites, robbery, or even homicide.
The paroxysms are at first of short duration, and are followed by
return to the previous regular and decent manner of life. They
become, however, by degrees, more violent and more prolonged. At
first lasting for a few days or a week, by and by they extend to
periods of a month or six weeks, the attack wearing itself out, and
recurring with a periodicity sometimes variable and sometimes
constant. In the intervals of these attacks for a considerable time the
patients very often lead sober, chaste, and useful lives. At length,
however, evidences of permanent mental trouble are manifested,
and the case settles into confirmed insanity. The attack is usually
preceded by evidences of mental derangement; the patient becomes
restless and irritable; sleep is irregular and unrefreshing; he
complains of general malaise, and is anxious, troubled by vague
apprehensions. He presently abandons his usual occupations and
gives himself up to disordered impulses, among which alcoholic
excesses are the most frequent and the most easily gratified.
Sometimes the patient passes his time at taverns drinking with all
comers; at others he shuts himself up in a chamber and gratifies his
desire for drink to the most extreme degree alone. Dipsomaniacs not
rarely leave their homes and associates without warning or
explanation, and pass the period of the paroxysm among associates
of the most disreputable character. The desire for drink is gratified at
all costs, and not infrequently they return to their friends without
money and without sufficient clothing, most of it having been sold or
pawned in order to purchase drink. The paroxysm is succeeded by a
period of more or less marked mental depression, during which the
patient not rarely voluntarily seeks admission to some asylum.
The true nature of dipsomania is frequently overlooked. As a

symptom of hereditary insanity it is in striking contrast with the
habitual propensity to drink which occurs in the ordinary alcoholic
subject. The latter seeks occasions to drink. He renews his excesses
not intermittently, but habitually. If in consequence of disgrace or
misfortune or under strong moral suasion he is for a time
abstemious, it is only to renew and to continue his indulgence upon
the first favorable occasion. On the contrary, the true dipsomaniac
recognizes his malady and struggles against it. Even more: for a
time he shows much skill in concealing it. He avoids occasions to
drink, and, reproaching himself for his mad and unreasonable desire,
seeks by every means to overcome his impulse to it. The ordinary
drunkard may become insane because he drinks; the dipsomaniac
drinks because he is insane.50
50 Magnan, Le Progrès médical, 1884.
Dipsomaniacs are apt to manifest precocious or retarded intellectual

development. They are from infancy or childhood especially prone to
convulsive or other paroxysmal nervous phenomena. They are often
choreic, often hysterical. This association with instability of the
nervous system is related to the fact that dipsomania is more
common in women than in men.
DIAGNOSIS.—1. Acute Alcoholism.—The diagnosis of the ordinary

form of acute alcoholism, with the exception of alcoholic coma,
requires no consideration. The diagnosis of alcoholic coma from
profound coma due to other conditions is, in the absence of the
previous history of the case, always attended with difficulty, and is in
certain cases quite impossible. It is therefore of great practical
importance to obtain the history where it is possible to do so. The
odor of alcohol upon the breath is of less positive diagnostic value
than would at first thought appear. In the first place, sympathetic
bystanders may have poured alcoholic drinks down the throat of one
found unconscious, or, in the second place, individuals who have
taken a certain amount of drink may be, and not unfrequently are,
seized with apoplexy in consequence of the excitement thereby
induced. The more common conditions with which alcoholic coma is
confounded are apoplexy from cerebral hemorrhage and narcotic
poisoning, especially opium-poisoning. To these may also be added
uræmic coma and, under exceptional circumstances, sunstroke. In
all these cases the circumstances under which the individual has
been found are of diagnostic importance.
In alcoholic coma the pupils are more commonly dilated than

contracted, the heart's action feeble, the respiration shallow, the
muscular relaxation symmetrical, and the temperature low. There is
a strong odor of alcohol upon the breath.
In apoplexy from cerebral hemorrhage the condition of the pupils will

depend upon the location of the clot. They may be moderately
dilated, firmly contracted, or unequal. The enfeeblement of the
heart's action is, as a rule, less marked than in profound alcoholic
coma. The pulse may be small or full and slow or irregular. It is
usually slow and full. The respiration is often, although not invariably,
slow and stertorous. Not uncommonly, the eyes and also the head
deviate from the paralyzed side. If the coma be not absolute, the
muscular relaxation is unilateral. The temperature is at first slightly
below the normal, but less, as a rule, than in alcoholic coma; after
several hours it rises to or above the normal.
In complete opium narcosis the insensibility is profound; the heart's

action is slow or rapid, but feeble; the respirations slow and shallow
or quiet or stertorous; the face at first flushed, afterward pallid and
cyanosed; the pupils minutely contracted or dilated as death
approaches; and the muscular relaxation complete, with abolition of
reflex movements. In cases of doubt it is important to use the
stomach-pump.
Uræmic coma is apt to be preceded by or alternate with convulsions.

The pupils are more commonly slightly contracted than dilated, but
are without diagnostic significance. The temperature is not elevated;
it may even be low. The face may be pallid, pasty, and puffy, and
there may be general anasarca if the nephritis be parenchymatous.
On the other hand, in interstitial nephritis there is hypertrophy of the
heart, without evidence of valvular disease, and some degree of
puffiness of the lower extremities. In doubtful cases the urine should
be drawn by a catheter and subjected to chemical and microscopical
examination.51 Diabetic coma occurs suddenly without convulsions.
This condition may be suspected when the emaciation is extreme or
upon the recognition of sugar in the urine.
51 The following is the method recommended by Green (Medical Chemistry,
Philadelphia, 1880) for the detection of alcohol in the urine: If its reaction be acid, the
urine is exactly neutralized by potassium acid carbonate. It is then distilled on a water-
bath in a flask or retort connected with a condensing apparatus. When about one-
sixth of the liquid has passed over the distillate will, if alcohol be present, present the
following characteristics: first, the peculiar alcoholic odor; second, a specific gravity
lower than water; third, upon being mixed with dilute sulphuric acid and treated with a
few drops of potassium bichromate solution the liquid becomes green, owing to the
separation of chromic oxide; the odor of aldehyde may at the same time be observed.
This reaction is not characteristic, but may serve to confirm other tests. Fourth, if
dilute alcohol be shaken with an excess of solid and dry potassium carbonate in a
test-tube, the greater part of the water will be appropriated by the potassium
carbonate, and two layers of liquid will be formed. The alcohol constitutes the upper
layer, and if sufficiently concentrated will burn upon the application of a flame. Finally,
a small trace of alcohol may be separated from the urine without difficulty after the
ingestion of alcoholic liquids by means of a good fractionating apparatus. Less than 1
per cent. of alcohol cannot be detected.
Sunstroke is characterized by dyspnœa, gasping respiration,

jactitation, and intense heat of the skin. The pulse varies. It may be
full and labored or feeble and frequent. The face is usually flushed.
The pupils, at first contracted, are afterward dilated. The coma is apt
to be interrupted by transient local or general convulsions.
It is impossible to lay down any rules by which the maniacal form of

acute alcoholism may be at once diagnosticated from acute mania
from other causes. For the characteristics of the convulsive form of
acute alcoholism and those forms which occur in persons of
unsound mind the reader is referred to the descriptions of those
conditions. The diagnosis of acute poisoning by alcohol in lethal
doses can only be established during life by investigation of the
history of the case.
II. Chronic Alcoholism.—The lesions of chronic alcoholism, as has

already been pointed out, are not in themselves peculiar to that
condition. Many of them occur with more or less frequency in morbid
states not induced by alcohol. It is their association and progressive
character which gives to chronic alcoholism its individuality. The
occasional prominence of certain symptoms or groups of symptoms
may thus in particular cases lead to some confusion of diagnosis,
especially where the history is unknown or the habits of the
individual are concealed. In the greater number of cases, however,
the association of symptoms is such as to render the diagnosis, even
in the absence of a direct history, a comparatively easy one.
Chronic alcoholism is a condition rather than a disease—a condition

characterized by varying lesions of the viscera and nervous system,
by profound disturbances of nutrition, and by grave mental and moral
derangements. This fact being recognized, the cardinal error of
diagnosis to be guarded against is that of overlooking the condition
upon which the disease itself with which we have to do depends or is
associated. Congestion, inflammation, sclerosis, and steatosis affect
the various organs of the body and produce their characteristic
symptoms. Profound and lasting disturbances of nutrition demand
our attention. Psychical derangements of all grades, from mere
moodiness to confirmed and hopeless insanity, take place. These
affections must be diagnosticated for themselves here as elsewhere
in clinical medicine. The recognition of the underlying condition can,
however, alone supply the key to their true pathology.
Delirium tremens is occasionally diagnosticated with difficulty from

some forms of insanity not caused by drink. Here transitory and fixed
delusions, not mere terrors and hallucinations, are of importance, not
less than the absence of the varied and complex associations of
symptoms which are characteristic of alcoholism. The delirium of the
acute infectious diseases may be mistaken for delirium tremens.
Pneumonia, typhoid fever, and the exanthemata occasionally begin
with delirium resembling in some respects delirium tremens. Here
the history of the case, the pyrexia, and the general condition of the
patient are sufficient to establish the diagnosis if the danger of error
be borne in mind.
III. Hereditary Alcoholism.—The diagnosis of this condition can only
be established by careful investigation of the family history and
systematic study of the stages of progression by which the morbid
condition presented by the patient has been reached.
IV. Dipsomania.—The diagnostic points are the hereditary

transmission of this or other forms of insanity—the mental instability
of the patient in early life and in the intervals of the paroxysms, the
intermittent or cyclical recurrence of the attack, the morbid impulses
of a different kind associated with the impulse to drink, and the
struggle of the patient against his recurring impulses to
uncontrollable excesses.
PROGNOSIS.—The prognosis in acute alcoholism of the ordinary form

is favorable, so far as the immediate attack is in question. The
prognosis in rapidly-developing, overwhelming coma from enormous
doses of alcohol is in the highest degree unfavorable. Acute coma
from moderate doses usually passes off in the course of some
hours. It occasionally, however, terminates in fatal pneumonia.
The prognosis in delirium tremens of the ordinary form is favorable. It

becomes, however, more and more grave with each recurring attack.
Delirium tremens in patients suffering from advanced disease of the
heart, lungs, liver, or kidneys, or complicated by acute diseases of
these organs, is apt to prove fatal.
The prognosis of chronic alcoholism is gloomy. If the lesions be not

advanced, permanent discontinuance of alcoholic habits may be
followed by restoration of health, but, unfortunately, the
discontinuance is too often merely temporary, the habit being too
strong to be permanently broken off.
The prognosis in hereditary alcoholism is unfavorable, both as

regards the alcoholic habit and as regards the development of
serious diseases of the nervous system under adverse
circumstances, even in the absence of the direct action of alcohol.
The prognosis in dipsomania is unfavorable. The paroxysm may
recur many times without apparent serious result; the patient in the
course of some days or weeks recovers, abandons his evil courses,
and resumes his usual occupations. After a time, however, the
insanity of which the dipsomania is the recurring manifestation
declares itself as a more or less permanent state. The outbreaks
become more frequent and more prolonged, the mental condition in
the intervals progressively more morbid, until the patient lapses by
degrees into confirmed insanity.
The prognosis in all forms of alcoholism, both acute and chronic, is

rendered in a high degree uncertain by the psychical disorders which
characterize so many of its phases. In consequence of some of
these conditions the patient loses at once his appreciation of bodily
dangers and his power to avoid them; by reason of others, to escape
imaginary evils he plunges into real ones; and finally some of them
are of such a nature that they impel him to the blind and unreasoning
commission of the most grievous crimes, including suicide and
homicide.52
52 “I believe that more suicides and combined suicides and homicides result in this
country from alcoholism in its early stages than from any other cause whatsoever” (T.
S. Clouston, Clinical Lectures on Mental Diseases, Am. ed., 1884).
TREATMENT.—The prophylaxis of alcoholism has regard to

communities at large and to individuals. The prevention of the evils
of excess by the control of the sale of drink constitutes one of the
more important objects of state medicine. At the same time, the
traffic in alcohol is curiously evasive of legal enactments. The
difficulties attending the enforcement of sumptuary laws are well
known. Restrictive laws concerning the making and sale of alcoholic
drinks, while partaking of the nature of sumptuary laws are of more
comprehensive character, being obnoxious to powerful commercial
interests and to the sense of personal liberty of large numbers of
persons of all classes. As a result of organized opposition and
individual violation they are to a great extent inoperative as regards
the prevention of alcoholism.
Aside from the question of revenue from taxation, the practical
influence of law is in this matter somewhat limited, being confined
chiefly to the prevention of the sale of liquors to minors and persons
already intoxicated, and to ineffectual attempts in certain countries to
regulate the quality of the drink sold. The penalties for personal
drunkenness which does not lead to overt acts are, as a rule, wholly
inadequate to restrain it. The best results upon anything like an
extended scale have been obtained by the co-operative action of
philanthropic individuals in endeavoring to influence the moral tone,
especially among workingmen, to diminish temptations, and to
provide for leisure hours, in the absence of drink, reasonable
amusements and occupation to occupy the time ordinarily spent in
taverns and similar places.
The decrease in the consumption of alcoholic drinks in the United

States within recent years is doubtless due in part to increasing
popular knowledge concerning the dangers of alcoholic excess and
to the growth of a more wholesome public sentiment. It is, however,
in part also due to poor wages among workingmen.
As regards the individual, prophylaxis against alcoholism consists

either in total abstinence from, or in the most guarded indulgence in,
alcoholic beverages. It is unfortunate that individuals whose moral
and physical organization is such as renders them most liable to
suffer from the consequences of alcohol are by that very fact most
prone to its temptations, and hence contribute largely to the subjects
of alcoholism. These individuals are found among the ignorant, the
very poor, and especially among neurotic subjects of all classes of
society. Due consideration of this fact cannot fail to establish the
responsibility of those fortunately not belonging to these classes, in
two respects: first, that of example; and second, that of personal
restraint from the standpoint of heredity. The influence of heredity
among races addicted to alcohol has not yet attracted the attention it
deserves. It is probable that much of the tolerance for alcohol
exhibited by individuals, families, or even nations, is to be accounted
for by heredity. Still more probable is it that most of the evils and
crimes that befall alcohol-drinking communities and individuals are
due directly or indirectly to the abuse of this agent. No argument
against the indulgence in narcotics can be more potent than that
derived from a consideration of the laws of heredity.
I. The Treatment of Acute Alcoholism.—The medical treatment of

mere drunkenness requires no consideration. The rapid elimination
of alcohol, and the transient nature of its pathological effects in
excesses which are not repeated or prolonged, explain the
spontaneous recovery, which is usually sufficiently prompt and
permanent. The physical suffering and mental distress following
unaccustomed excesses are of salutary influence. Under certain
circumstances a powerful effort of the will is sufficient to control, at all
events for a time, the more moderate effects of alcohol. A similar
result follows the use of cold douches, the Turkish bath, and full
doses of certain preparations of ammonium, particularly the officinal
solution of the acetate of ammonium. In alcoholic stupor of an acute
kind the patient may be left to himself, care being taken that the
clothing is loosened and that the position is such as to prevent local
paralysis from the nerve-pressure. Alcoholic coma, if of moderate
intensity, may be managed in the same way. Profound alcoholic
coma requires, however, more energetic measures. Frictions,
artificial warmth, stimulating enemata, as of turpentine or of hot salt
and water, an ounce to the pint, hypodermic injections of strychnia or
atrophia in minute doses and occasionally repeated, inhalations of
ammonia, and occasional cold affusions, followed by brisk frictions
with warm flannel and faradism of the respiratory muscles, may be
needed to tide over the threatened fatal collapse. The stomach
should be at once washed out with hot coffee.
In the convulsive form of acute alcoholism chloral in twenty-grain

doses, repeated at intervals until sixty grains have been given,
usually serves to arrest, or at all events to moderate, the paroxysm.
It may be administered by the mouth or in double doses by the
rectum. If chloral be inadmissible by reason of weakness of the
circulation, paraldehyde may be substituted in doses of from half a
drachm to one drachm, repeated at intervals of from one to two
hours until quietude is produced. Where the convulsive paroxysms
are of great violence it may be necessary to control them by the
cautious administration of ether by inhalation.
The mania of acute alcoholism calls for energetic management. To

avert injury to the patient himself or to those about him he must be
confined, if practicable, in a suitable apartment in a hospital; if not, in
his own house and carefully watched. Here, as a rule, paraldehyde,
chloral, or large doses of the bromides constitute our most efficient
means of medication.
In all forms of acute alcoholism it is a rule admitting of no exception

to at once withhold alcohol in every form and all doses. If, under
exceptional circumstances, great nervous depression or flagging
circulation seems to call for the use of alcohol in small amounts, it is
far better to substitute other drugs. The frequently repeated
administration of hot beef-tea or rich broths in small doses, with
capsicum and the use of the various preparations of ammonia, or
small doses of opium with or without quinia and digitalis, proves
useful in proportion to the skill and discrimination with which they are
selected and repeated. It is a good plan to commence the treatment
with an active purge.
In the acute collapse following excessive doses—lethal doses—the

stomach is to be immediately emptied by the tube or pump and
washed out with warm coffee. In the absence of the stomach-tube
emesis may be provoked by the use of mustard or sulphate of zinc
or by hypodermic injection of apomorphia. The patient must be
placed in the recumbent posture and surrounded with hot blankets.
The cold douche may be occasionally applied to the head and face,
and the muscles of respiration may be excited to action by faradism.
Artificial respiration and friction of the extremities may also be
required. Inhalations of ammonia may be used. The flagging heart
may be stimulated by occasionally tapping the præcordia with a hot
spoon—Corrgan's hammer. Hypodermic injections of digitalis may
also be employed. Overwhelming doses of alcohol, leading promptly
to collapse, usually prove fatal despite all treatment.
II. The Treatment of Chronic Alcoholism.—Whatever may be the
prominence of particular symptoms or groups of symptoms, whether
they indicate derangement of the viscera, of the nervous system, or
of the mind, whatever their combination, the fundamental therapeutic
indication in chronic alcoholism is the withdrawal of the poison. The
condition is directly due to the continuous action of a single toxic
principle: its relief when practicable, its cure when possible, are only
to be obtained by the discontinuance of that poison. This is a matter
of great, often of insurmountable, difficulty. The obstacles are always
rather moral than physical. Occasional or constant temptation, the
iron force of habit, the malaise, the faintness, the craving of the
nervous system, and, worse than all, the enfeebled intellectual and
moral tone of the confirmed drunkard, stand in the way. Even after
success seems to have been attained, and the patient, rejoicing in
improved physical health and in the regained companionship and
consideration of his family and friends, feels that he is safe, it too
often happens that in an unguarded moment he yields to temptation
and relapses into his old habits. A patient of the writer, after seven
years' abstinence from drink, again became its victim in
consequence of the incautious suggestion of a young medical man,
met at a summer hotel, to take brandy for some transient disorder,
and died after eight months of uncontrollable excesses. It is
necessary to guard the patient against the temptation to drink. To
secure this he may he sent as a voluntary patient for a length of time
to a suitable institution, or, still better, he may place himself under the
care of a conscientious, clear-headed country doctor in a sparsely-
settled region, preferably in the mountains or at the seaside. The
malaise, depression, insomnia, and other nervous symptoms when
of moderate degree are best treated by abundance of nutritious and
easily-assimilable food, taken often and in moderate amounts. To
this end gastro-intestinal disturbances may be practically
disregarded, except in so far as they regulate the selection of a
highly nutritious diet. As a matter of fact, in the early periods of
chronic alcoholism, while visceral lesions of a grave character are
yet absent, appetite and digestion alike improve in the majority of
cases upon the withdrawal of alcohol, provided a sufficiently
abundant and easily assimilable dietary is insisted upon. Grave
visceral lesions characterize a more advanced alcoholic cachexia
and necessarily complicate the treatment. Nevertheless, even here
the indication is the withdrawal of the poison. The nervous symptoms
require special medication. The whole group of tonics, from simple
bitters to quinia and strychnia, is here available. It is impossible to
lay down rules for the treatment of particular cases except in the
most general manner. In the absence of conditions calling for special
treatment, such as gastritis, hepatic or pulmonary congestion, fatty
heart, etc., good results follow the frequent administration of small
doses of quinia and strychnia; thus, the patient may take one grain of
quinia six or eight times a day, or a little gelatin-coated pill containing
1/200–1/100 of a grain of strychnia every hour during the waking day,
amounting in all to one-twentieth, one-tenth, or one-fifth of a grain in

the course of twenty-four hours. This treatment is often followed by
the relief of tremor, the quieting of nervous irritability, and the
production of good general results. The malaise, the general
depression, and especially the sinking feeling at the pit of the
stomach so often complained of by patients, are best relieved by
food. Fluid extract of coca is also useful in these conditions. The
value of cocaine in the management of the nervous symptoms of
chronic alcoholism, and in particular as a temporary substitute for
alcohol, is doubtful. The writer, having used it in a number of cases
by the mouth and hypodermically in doses of ¼–1 grain, has had
variable results. In some cases it temporarily relieved the craving
and concomitant symptoms; in others it failed wholly: in one instance
one-fourth of a grain was followed by great nervous depression. It is
desirable not to inform the patient of the nature of the remedy,
especially if its use be followed by good results, lest the cocaine
itself supplant alcohol as an habitual narcotic. Cold or tepid
sponging, the occasional hot bath at bedtime, and the Turkish bath
are useful adjuvants to the treatment. As a rule, opium is
contraindicated. Sleep often follows the administration of a cupful of
hot broth or milk at bedtime. Lupulin is here useful, and the writer
has come to regard an ethereal extract of lupulin in doses of from
one to three grains as a valuable and harmless hypnotic. If
necessary, hypnotic doses of chloral or paraldehyde may be used,
but care is required in their administration, and their early
discontinuance is advisable. If anæmia be profound, chalybeate
tonics do good, and among the preparations of iron pills of the dried
sulphate with carbonate of potassium (Blaud's pills) are especially
useful.
The obesity of drunkards, as a rule, diminishes on the withdrawal of

alcohol. Under circumstances of partial or complete abstinence from
drink measures to reduce the weight of such patients are wholly
inadmissible.
In conditions characterized by failure of mental power, in beginning

dementia or threatened insanity, the syrup of the hypophosphites,
the compound syrup of the phosphates, or cod-liver oil should be
administered. These remedies are likewise useful in various forms of
alcoholic paralysis, as are also faradism and galvanism employed
secundum artem. The various forms of alcoholic insanity require
special treatment, only to be had in institutions designed for the care
of patients suffering from mental diseases in general.
Whilst it is desirable in the treatment of all forms of chronic

alcoholism to secure the permanent discontinuance of the alcoholic
habit, the skill, judgment, and experience of the physician must
determine the degree of rapidity with which this, when practicable, is
to be done. The number of cases in which alcohol can be
discontinued at once and finally is limited; those in which it can be
wholly given up in the course of a few days constitute the largest
proportion of the cases; finally, in a small number of cases alcohol
can only be withdrawn cautiously and by degrees.53 Whilst it is in
most cases essential to remove the patient from his customary
surroundings and companionships, it is in the highest degree
important to provide for him mental occupation and amusement. To
this end a wholesome open-air life, with sufficient daily exercise to
induce fatigue, is highly desirable, as indeed is the companionship of
interested and judicious friends.
53 It must be borne in mind that in chronic alcoholism acute maladies of all kinds,
including traumatism, both accidental and surgical, act as exciting causes of delirium
tremens. The part played by the abrupt diminution or withdrawal of alcohol under such
circumstances is often an important one. It is the opinion of the writer that a certain
amount of alcohol should be administered for a time at least in the accidental injuries
and acute sicknesses of alcoholic subjects, and that the reduction should be gradually
made.
The Treatment of Delirium Tremens.—The patient should be

confined in a large, well-aired apartment, without furniture except his
bed, and when practicable he should have a constant attendant. The
favorable influence of a skilful nurse in tranquillizing these patients is
very great. The custom of strapping them to the bed by the wrists
and ankles is to be deprecated. If the case be a mild one, and
especially during convalescence, open-air exercise in the sunshine
with an attendant is of benefit; care must, however, be taken to
guard against the danger of escape.
Under no circumstances should visitors be permitted to see the

patient. In young persons the treatment may be preceded by an
active saline or mercurial purge. In elderly persons, those suffering
from cachectic conditions, or in cases characterized by marked
debility and feeble circulation—conditions frequent in persons who
have had repeated attacks—it is not desirable to purge. Alcohol
should be either wholly withdrawn or more or less rapidly diminished.
It must be replaced by abundant food in the form of concentrated
broths or meat-extracts. In cases of vomiting these must be given
hot and in small doses frequently repeated. Bitter infusions may also
be given, or milk or equal parts of milk and Vichy water. If there be
thirst, the effervescent waters may be given freely. Patients often
drink with satisfaction and apparent benefit hop tea, which may be
made simply with water or with equal parts of water and porter.
The medicinal treatment will depend to a large extent upon the

peculiarities of the case. In mild cases a combination of the watery
extract of opium in small doses, not exceeding a quarter of a grain,
with quinia and digitalis, repeated every four or six hours, is often
useful. Although the view once entertained that the graver symptoms
were the result of prolonged sleeplessness is no longer tenable, the
induction of sleep, or at all events of mental and physical repose, is
among the more important therapeutical indications. For this purpose
hypnotic doses of opium are not only not desirable, but are even, in
the majority of instances, attended with danger. The sleep which
follows repeated and increasing doses of opium in delirium tremens
has too often terminated in coma deepening into death. As
calmatives, extract of cannabis indica, hyoscyamus, or the fluid
extract of piscidia are useful. As hypnotics, the bromides, chloral,
and paraldehyde yield, in the order here given, the best results. The
bromides are better in large single doses than in small doses often
repeated, better in combination than singly. Chloral, either by the
mouth or by the rectum, in doses of from twenty to forty grains, is
often followed by beneficial sleep. It is contraindicated where the
heart's action is much enfeebled. Paraldehyde, in doses of half a
drachm to one drachm, repeated at intervals of two or three hours
until sleep is induced, is still more efficient. This drug may be
administered without the fear of its exerting a depressing influence
upon the heart. The depression characteristic of grave delirium
tremens may be combated by repeated small doses of champagne
or by carbonate of ammonium in five- or ten-grain doses; the
vomiting, by withholding food and medication by the mouth, and
giving them for some hours wholly by the rectum or hypodermically.
Excessive restlessness is sometimes favorably influenced by cold
affusion, followed by brisk friction and warm blankets with continuous
artificial heat. The cold pack has proved useful.
Digitalis may be employed, ex indicatione symptomatica, but the

enormous doses of tincture of digitalis used by the late Jones of
Jersey and others are here mentioned only to be condemned.
To sum up, the chief indications for treatment are complete isolation,
the withdrawal of alcohol, abundant, readily assimilable, nutritious
food, and control of the reflex excitability of the nervous system.
III. Hereditary Alcoholism.—The treatment of the vicious propensities

of the descendants of alcoholic parents does not fall directly within
the province of the physician. It is among the most difficult problems
of education. The recognition of the cause of evil traits manifested in
childhood and youth may do something to avert dangers commonly
unsuspected. All things considered, the outlook is not hopeful. The
recognition, on the part of the physician, of the influence of
hereditary alcoholism in cases of arrested development, feeble
organization, or declared disease of the nervous system will perhaps
do less to aid his treatment in many cases than to reconcile him to its
want of full success. The cry of warning is to those who are eating
sour grapes that the teeth of their children will be set on edge.
IV. Dipsomania.—The general indications for the treatment of

dipsomania are two: first, the management of the paroxysm; second,
the control of the general condition itself.
First, then, during the paroxysm the patient must be saved, in so far
as is possible, from the danger of injuring himself or others and from
squandering his property. If the excesses are of such a degree as to
render it practicable, the same treatment must be carried out as in
cases of acute alcoholic mania and delirium tremens—namely,
confinement in a suitable apartment under the care of an
experienced nurse and the control of the doctor. Unfortunately, this
plan is not always practicable in the early days of the outbreak. Here
tonics, coca, and repeated small doses of quinia and strychnia are of
advantage. Courses of arsenic at the conclusion of, and in the
intervals between, the paroxysms are of use, on account of the
excellent influence they exert on the general nutrition. These may be
advantageously alternated with iron, cod-liver oil, and the compound
syrup of the phosphates or of the hypophosphites. Hydrotherapy
may also be used with advantage, and the influences of a well-
regulated hydropathic establishment are much more favorable than
those of institutions specially devoted to the treatment of alcoholic
subjects. In the latter the moral atmosphere is apt to be bad; the
patients support each other, and too often conspire to obtain in
secret that which is denied them openly, or, if the discipline be too
strict for this, they sympathize with each other in their restraint, react
unfavorably upon each other in the matter of shame and loss of self-
respect, and plot together to secure their liberty.
Few dipsomaniacs in the earlier periods are proper subjects for
treatment in hospitals for the insane. If cerebral excitement or
sleeplessness persist after the paroxysms, chloral, paraldehyde, or
the bromides in large doses may be used to secure sleep. Various
combinations of the bromides are often of use where the single salts
fail. It must not be forgotten that during the paroxysm there is great
danger lest the patient do himself or others harm. When there are
indications of an impending attack, and during the period of
depression following the attacks, benefit is derived from the daily use
of bitter infusions. As a matter of fact, however, the management of
these cases is among the most unsatisfactory of medical
undertakings. The difficulty is increased by the latent character of the
mental disorder in the intervals between the attacks. Even when
such patients voluntarily enter hospitals for the insane, they cannot
be retained there sufficiently long to derive any permanent benefit.
What we want is, in the words of Clouston, “an island where whiskey
is unknown; guardianship, combined with authority, firmness,
attractiveness, and high, bracing moral tone; work in the open air, a
simple natural life, a return to mother Earth and to Nature, a diet of
fruits, vegetables, bread, milk, eggs, and fish, no opportunity for one
case to corrupt another, and suitable punishments and deprivations
for offences against the rules of life laid down. All these continued for
several years in each case, and the legal power to send patients to
this Utopia for as long a period as medical authority determines, with
or without their consent.”
THE OPIUM HABIT AND KINDRED AFFECTIONS.

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Test Bank for Systems Analysis and

Design, 9th Edition: Shelly

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Systems Analysis and Design 6th Edition Dennis

9. Which of the following is one of the main sectors of e-commerce?

11. Transaction processing (TP) systems ____.

12. Business support systems ____.

15. In a typical company organizational model, top managers ____.

16. In a typical company organizational model, middle managers ____.

21. ____ methods include the latest trends in software development.

40. A systems analyst needs ____.

Modified Multiple Choice

1. An example of a vertical system is a(n) ____.

2. An example of a horizontal system is a(n) ____.

3. A business process describes a specific set of ____.

4. Product-oriented firms produced ____.

5. Database administration involves ____.

ANS: T PTS: 1 REF: 11

4. Rapid application development focuses on team-based fact-finding. _________________________

ANS: T PTS: 1 REF: 29

ANS: F PTS: 1 REF: 4

2. A mission-critical system is one that is unimportant to a company’s operations.

ANS: F PTS: 1 REF: 7

ANS: F PTS: 1 REF: 7

ANS: F PTS: 1 REF: 7

ANS: F PTS: 1 REF: 10

ANS: F PTS: 1 REF: 14

ANS: F PTS: 1 REF: 16

ANS: F PTS: 1 REF: 17

ANS: F PTS: 1 REF: 17

ANS: T PTS: 1 REF: 17

ANS: F PTS: 1 REF: 18-19

ANS: T PTS: 1 REF: 19

ANS: T PTS: 1 REF: 20

ANS: F PTS: 1 REF: 22

ANS: T PTS: 1 REF: 23

ANS: T PTS: 1 REF: 24

ANS: T PTS: 1 REF: 24

ANS: T PTS: 1 REF: 25

ANS: T PTS: 1 REF: 27

ANS: T PTS: 1 REF: 28

ANS: T PTS: 1 REF: 29

ANS: T PTS: 1 REF: 32

ANS: F PTS: 1 REF: 33

ANS: T PTS: 1 REF: 33

1. _________________________ refers to the combination of hardware, software, and services that

2. _________________________ is a step-by-step process for developing high-quality information

ANS: Systems analysis and design

3. A(n) _________________________ combines information technology, people, and data to support

ANS: information system

4. An IT department team includes _________________________ who plan, develop, and maintain

ANS: systems analysts

6. In the accompanying figure showing the components of an information system,

8. In the accompanying figure showing the components of an information system,

9. In the accompanying figure showing the components of an information system,

ANS: systems evaluation

1. ANS: E PTS: 1 REF: 15