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This Practice Is'tceersfuii'italmost Completelybanishingf MARtCH6S*', 191T51 (.CORRESPONDENCE. ETHUDeU34= able amounit of alcolhol is circulatinig in their brain and In answer to Dr. C. A. McBride, I quite aaree that it is nervouis system; tlhey are entirelv dependent ou this arti- by no miieans easy alway-s to distinguish atropine delljium ficial condition, whlich constantly teniles to pass off and from delirium,,trenjens. *ut theQta *oustanftly demandcs renew-al; anfld .aiy cAreimstance inter- tlk.fipgira.e quoted; iwo cases of lgt deliriuni, which ferilg thtieeith is liable to ,ptec pit.Atc1'4u1V0ervous break- mighlt have been due to atropiie, 4ndwlhicll occurred at (oFly'. - These are n& a'ssfimptious of mine-- itlher tthe thle eiid of 1905, lave beeni excluded. -cituired capacity .-no thie acquired incapacity-they are Dr. William C. Blurns's cas'e can, in my view, only be 1ijijical facts, fully realized by niearly all wllo suffer fromn interpreted as lie interprets it-namnelv, as an avoidable higlh tolerance and easily verifiable by any miedical man deatlh 'aused by tlhe sudden withdrawal of alcohol in a whV }has tlhe opportunity of seeina suclh cases. Of couLse, patient- who hiad establishied hligh tolerance. I may addI the plhysician seeking suchl verificationi will not be assisted that it by nlo nmeans stanids aloine.-I am, etc., in hiis quest if lhe starts witlh wat seems a rather common Yeekenham, Feb 28th. FR-tANCIS HARE. preconviction-namely, that no alcoholist ever speaks the truthf. Btut hiere I can reassure hiim: alcoholists do quite frequently speak the exact trutlh. THE RUM RATION. -Now whether the above-mentioned "nervous break- Srn,-Dr. ThomlDas Dutton, in the JOurN.AL of February (lown." stops short at- minor symptoms such as nervous- 20(tb, says thlat lhe is certain that "the voice of the profes- ness, restlessness, and more or .ess insomnnia, or whiether sion is in favour of tllis extra runm ration as beingJ bene- it proceeds, tlirouglh the stage of slighlt and fleetinig ficial." Althlough I am not onbe oftAhe small ariny of hallucinations, to tlie climiiax of fi-auk delirium treiens, teetotalers to wlhom hle refers, I very much douibt -whether wvill depend( upon various circumstances, for example, the he is correct in hlis assuinption. degree of tolerance (and consequent initolerance) estab- I know that we doctors lhok different views as to the lislied, the amount of the fall in circulatintg alcohol, the action of alcolhol on the central nervouLs system, on the suddenniess and duration of the fall, and (perhaps above all) lheart muscle, and on its value as a f6od, but I certainly on the petsonality of the individual. It is customary to thouglht we wvere unani-mously of the opinion that alcollol speak of this last factor as the resisting power or resistance in snmall quantities caused a fall of body temperature, due of the patient; but that can hardly be .said to be a new to loss of lheat from dilatation of the skin vessels. I have a4sumption on my part. 'It seems little more than a re- always unlderstood tlhat in our Polar expeditionls our statement of an admitted fact. And certainly, the fact explorers wlhen exposed to very great cold carefully that all those who suffer from higlh tolerance do not fall avoided alcolhol wlhile the exposure lasted. As a nioun- into delirium trenrens wlhen alcohol. is suddenly witbheld, taincer of many years' experience, I lhave al'ways been is no argument against the view that delirium tremens tauglht, and lave taught others, that if overtake'n by bad when it does arise is invariably preceded by a sudden and weather and' cornpelled to sleep out, one should avoid considerable fall in the amount of circulating alcohol. alcolhol absolutely, except under certain conditions of A.quite pertinent analogy occuIrs to ine. A numlber of extremiie urgency. It would not be difficult to quote eti inivalided from the front have completely lost all inistanees which 'have Come utndder one's own imnmnediate their nierve; sonme lhave becomse franjkly insane (in all knowledge to prove the valuLe of this advice. Thle ruLm is4 proba,bility temnporarily). Now,iit would hardly occur to served to the mnen whlite they are actually in tlle trenelhes. aniy one to (uestion the responsibility in these cases of the So far as I can gatlher from questioniilg the m-len, it is noise and strain of active, service, because the vast givelu out betweenl 9 and 10 p.m. at nighFt, or tlhc majority of our men at tho front retain undamaged early mlolrning between 3 anid 4 o'clock; but tlle in;} tt nervous systems; and I tllilnk most of us would be point is: the miien lhave to stay in the trenclhes fo Aly satisfied to explain this imlmuniity of the majority by lhours after they have takell their rum. I havo the referring to their natural power of resistance. slightest doubt that in many ease;s it makes theni feel As I read Sir Bryan Donkin's letter, lie is of opinion more comfortable for the timiie being, but does it enable the that miyy line of reasoning is illegitimate. I lhave hitherto men to better withstand the injuriouLs effects of thle cold failed to appreciate his objections. MNfay I as briefly and exposture whlile tlhey are in the trenclhes ? This is the indicate tlle linie of aigument, which, inimy own case, hias question of vital imuportance, and no otlher. I tlhink not, led to firm conviction ? anid liave already stated miiy reasons for the opinion I lhold. As data, I lhave clear hiistories of 83 typical attaclis of Wlhen one comies to talk the matter over with tlie delirium treniens. In all thiese 83 cases thle patients were soldiers, one finds there is really no such thling as a rum clhronic alcoholists-that is to say, they consumed large ration. A ration inmplies a fixed quantity, but this is amounts of spirits every day witlhout any break. Many precisely whlat tlle soldier does not get. One sold.er told never became intoxicated; those wlho did became only me that in his trench a bottle of rum was passed down slightly intoxicated, except on quite rare occasions. All the line; the first men in tllh line got a goo(d deal more lhad progressively increased the daily amount of spirit than tlheir 2f-oz., tlle last nmen a good deal less. Over and taken. In short, all had dmunk in the manner most likely over again I was told by yotung soldiers that they did not to establish higlh tolerance. care for rum, and passedl their slhare on to their coimiades, In 82 of the 83. cases there could Te safely inferred a who often received double aDd treble their proper shiare. sudden and considerable fall in circulating aldohol. In .23 In the JOURNAL"fOr February 27th Dr. O0dfleld tells us tllat there had been sudden and complete witlhdrawal of'alcohol, a dose of rum tends to set up skin action, and tllerefore, usually by the medical man in attendance. In 36 there under suitable coniditions, may rightly be recommended had been so larce a reduction that it amouiinted to neaily by the army medical authorities. This argument would thi. same tlhin. 'Whereas the patient haad been taklihg 25 be more convincing if he had defined his suitable condi- to 40 ftlid ounces, he was suddenly reduced to 6 or 8 tions. Would lie wish to stimulate skin action in-the case ounces, very rarely as much as 10 or 12. In the remaining Of a man wlio had to expose himself to the weather-and Z- there had been no deliberate stoppage, but there had often very bad weathier, too- for many hours after tlhe been violent anid uncontrollable vomiting, practically every- skin action had_ passed,off? ,MaNr V,.S. Lelean, in a tlhing taken, even spirits, returning- immnediately. I main- lecture on military liygiene in the same JOURNAL, is fai tUihithat in these 23 cases therd is little risk in inferring a more cautious. He says that if a man went to bed studddna"nd considerable fall in circulating alcohol. In all immzediately after bis ration it is difficult to see that tlle thle 82 cases following the sudden. fall in circulating alcohol could do him any har'm. I mvself can conceive alcohol, tlhere was a definite incubation period which, with that in sonme cases, when the soldier has returned from one exception, lasted two or three, or tliree or four days; the trenches and is under proper cover and kept warm, a and tlhis was true, io matter h0ow the f&I occurred, whether ration of rum might help to indiuce sleep, and so do good. from withdraWal, retrenchment, or persistent vomiting. If rum does not really help the soldier to resist ai d I fail to see how- we can avoid the inference that sustain the injurious effects of cold and exposure, there delirium tremens depends primarily upon high tolerance are many strong reasons for urging the authorities to di8. of alcohol (acquired) a d secondarily, upon a sudden fall continue the practice. Perhaps one of the striongest is ni thle amount of cireukating alcohol. this: At the present time we find placairded up in many Thle treatment deducible frou7n this conelusion is, of parts. of the country extracts from the speeches of our coulrse, carefull taperinng in all cases of high tolerance, and great geneials, nrging ouri soldiers to avoid alcohol in their this practice is'tceersfuiI'italmoSt completely banishingf endeavours to make themserves thloroughly efficient ; and thle complication, .. - yet if they take to heart this advice, the first thing tlhey 44k.
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