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. MIDIICABJOURN.ALL1 CORRESPONDENCE. [MARCH 6, 'T'j learn wvhen they findl themselves in the firing line is that SIR,-If the issues involved were not so serious the alcolhol is daily offered the.m. Wlhat are they to believe 2 letter of Dr. -Thomas Dutton,- in the BRITIs MEDICAL -I H-a, 'etc., - JOURNAL of February 20th woulid be absolutely ludicrous. Oxford, March 2nd. W. COLLIEr. Dr. Dutton's chief complaint against me is that I njLitve only expressed what hie is pleased to call a "pins opinion " Sin,-I hold no brief for alcohol, aiid I lhave no desire to upon this subject, wlhereas had I done otherwise I venture be drawn into a discussion on the etlics of its administra- to suggest that he would have been amongst the first to tioll, but it appears to me tllat there is some misconception challenge my riglht to speak for other people. of fact in regard to the issue of the rum ration to the I am perfectly satisfied that the personal opinion whiclh troops. I hold is one that is held by nLumbers of others who have I have spent six m:onths as an officer in the R.A.M.C. in taken the trouble to inform tlhemselves as to the injurious France, and have gained a good deal of first-liand ex- properties of alcohol in minute doses. Dr. DuLtton's argu- perience in various parts of tlle country. ment falls to the ground in that very graphic illustration First, in answer to Dr. Mercier's suggestive question, which he uses against me, in which he tells thie story of ruLn is not a food ration, and was never intended to be; the his cousin who admits to having been narcotized to sleep English army is stupplied at the present time as it has in the trenches by his ration of rum-a very unenviable never been supplied before, and it is true to say that it is condition to be in, to say the least of it, in the event of one now the best fed army in the world. Bacon is issued for of tllose sudden onslaughts of the enemy of wlliclh we so breakfast, and there is ample meat for two full meals often read. Dr. Dutton refuses to place vodka and rum in a day; the bread is good, and the jam is varied and often the same category, because, as he explains, one possesses excellent in quality. There is plenty of tea, sugar, and " irritating properties, -while the other is matured," bLit lie cheese in the ration, sufficient potatoes, and occasionally vutterly ignores the fact that they possess the one property vegetables, while in the cold weatlher 2 oz. of butter is in common of producing intoxication, ancd I ventur-e to issued a week. In short, more food is given out than suggest that it was this that the Russian Governmenlit had is eaten, and certainly no nmore is needed. its eye upon w-7hen it issued its proclamation of pro- In tlle second place, rtum is an extra ration, and it is by hibition; and rumiwitlh its 40 to 50 per cent. of alcohol is no means given so frequently as suggested. I personally not one whit behind vodka in its ability to produce intoxi- lhave only lhad it issued to me on two occasions. It is only cation; the crucial point of the whole question is, that given out in cold weatlher, and is almost exclusively this ration possesses the power of narcotizina the finer given to the troops actually in the trenches. This answers sensibilities of thle men to whom it is given, and that they the point raised by Dr. Astley Cooper, in wllicll lie suggests are thereby rendered less efficient for the important that the rum ration only becomes harmful when added to duties whiclh they have to perform. A few weeks ago the amount consumed outside. It is safe to say that the two bluejackets strolled into a hall in London in which ruin ration is in no circumstances issued to men hllo lhave some boy scouts were being drilled, and offered to teach tlle had opportunities of getting alcohol in the towns. boys signalling, a proposition gladly agreed to by the officer Hot coffee is suggested as a substitute for rulml in the in charge; when this was over they gave some exhibitions trenches. Delightful in tlleory, but lhardly practical I of speed signalling the.one to the other. When they had Whlere no fires at all are allowed; wlhere everythliiog is finished. they told the officer that whllat they had done was water-loggecl; whlere figliting talies place at intervals only at half speed because they had liad a grog before all niglt, and no one can approaclh, lhow is hot coffee to be coming in; wlien asked if that made any difference their obtained? There is plentv of tea in the rations, buit no reply was, yes, 50 per cent. difference. Now these men fuiel and no fire to boil it with. Wlho wants icedl coffee or were lnot teetotalers, and tllerefore were free from bias, cold tea under suclh conditions ? Along the lines of but their testimony coincided exactly with the restults coiiimmunication and at tlle base coffee is to be had for the obtainied years before by Aschaffenburg and Kraepelin aslking almost anywhere, but here no rluim is issued or relative to the effects of small doses of alcohol on tllc required. In the firing line there is lno suibstittute for performance of delicate and complex operations. alcolhol. It may be given or withheld, but tlhere is I would only sav in conclusion, that in the -whole of this notllinlg else. controversy tlle protagonists of the rulml ration lha-ve utterly Dr. Simpson is evidently under the impression, as a failed to bring forward a single argument based upon result of casual conversationis with soldier friends, that scientific researcli to prove that rulmi can produce any otlher rations are issued in a lhaplhazard sort of way, but this is result than that of giving a deceptive feeling of warmth, by no means so. Thle officer in commai-land of eaclh unit and of drugging the men who take it to sleep, while on is required to make a daily retulrn of hiis total numbers, tlle otlher hand abtundance of evidence has been and can and the exact number of rationis are issued. Only in be produced, backed up by scientific investigation, proving exceptional circumstances are more than a day's rations that functional activity is seriously inhibited- by doses of at a time given out. alcohol much smaller than that given to our soldiers in T'here are tllree courses open to a man for thle disposal the trenches in this ration. It seems a great pity, of his alcolhol ration. He will. eitlher (a.) drinli it, or therefore, that the War Office should go to the trouble (b) sell it, or (c) store it. A teetotaler will generally sell and expense of sending out hunidreds of tlhousandls of it, and there. is no hardship to him -in tlhis; whlile Dr. gallolns of this worse than useless substance for con- Sinmpson's frienid witlh the "wwater-bottle lnearly fulls" of ouir in the field.-I :uni evidently had adopted the latter couLrse. He was stumption by army am, etc., Ply-m-outh, Feb. 25th. ROBERT SInPSON. probably a Scotsman. Lastly, it is stated that alcolhol miiakes a man colder afterwards, altlhouglh it warams at the timiie. I wouldIask SIR, The lectures on military hlygiene flow being given your,correspondent .wlwetlher, if lie had to stanid for four by Major Lelean under the direction of the Armv Council davs anid niglhts without reliqf in trenches with-i water and the University are interesting because they are up to hiis knees and somnetiimies to his waist, hiis principles officially representative of the views of the Armiiy Council, -woutld lprevent hiim from receiving a stimnulant which whlich latter body, as I showed a fortnight ago, includes wNould wvarm hll and cheer limin twice a day, or would no medical officer. tlley not?. Is it better to be warm-ii inside occasionallv As the views of the Council on the furnlisllinig of tlle or never to be warm at all runm ration to the soldier are diametrically opposed to Inl concluLsion, I kmow from experience the great tllose of Lord Kitchener, it is extreluely important that appreciation in wlichl the officers and men in the firingy ttheir errors should be fully discussed. The need for this line lhold this extra ration, and it would be ungenerous to discussion is the more urgent since the Army Council has deprive thle many for tile stern principles of the few. just refused to receive a deputation of the National Tenm- I would recall the words of the Earl of Albemarle on perance Federation, whiclh desired to lay before tlle Army Waterloo: " Just before it began the regiment filed past a Council the overwhelming scientific and military evidence big tubfuhl of gin, and each officer and man had a potful of against the issue of the rum ration, liquor given to him. Heavy rain lhad soaked th-e troops to It is regrettable that Major Lele'a`n be'gan his considera- *the skin, and no fermented liquor I have ever drLnk was tion of the rum ration with the* ongenerous and unjust so delicious as that tin. pot full of schnapps." Buit tthey assertion that some who are "interested in promoting .won Waterloo !-I amu, etc., temperance " do not "keep an oppnnmind on the alcohol Birmingham, Feb. 23r. EI. MUSGRAVE WOODATAN. pioblemi. The contrary is thoe case, -fqi the man whose