136 BRANDY AND SUDDEN ILLNESS. SOME of those who advocated the granting of a spirit license to the keeper of the refreshment rooms at Roundhay Park, Leeds, having argued that brandy was necessary in cases of sudden illness, Dr. H. Arthur Allbutt sent a letter to the local papers, in which he said : "It has been argued, with a certain amount of plausibility, that it has not been wise to take away the license for the sale of intoxicants from the Park Hotel, because, forsooth, brandy may occasionally be required in cases of sudden illness occurring in the park. Now, sir, if you will give me a very small portion of space in your valu. able paper I will dispose of this specious and dangerous argument in a few words. What are the cases of illness which in popular opinion require the administration of brandy, and which are most likely to suddenly occur when the sufferers are some distance from home or medical advice? They are the following:-Apoplexy, epileptic fits, bleeding from ruptured lung blood-vessel, and syncope or fainting. Taking them in order, I may remark that in each of these cases brandy or other alcoholic preparation is highly dangerous apoplexy, because, a blood-vessel having ruptured in the brain, blood is being poured out upon or in the brain, causing pressure, and consequently the apoplectic fit. Nature endeavours to repair the mischief in her own way by sealing up the rupture in the vessel by means of a plug of coagulated blood. Now, suppose some brandy is administered, the heart is made to beat faster, blood is sent quicker and with more force to the blood-vessels of the brain, the plug of coagulum is forced out, more blood is pumped out upon the surface of the brain, and the patient either dies without recovering consciousness, or only recovers partially, remaining paralysed on one side for life. - in Epileptic fits frequently depend upon a condition of engorgement or fulness of the blood-vessels of the spinal cord. Alcohol, by increasing the heart's action, sends more blood to the already engorged vessels-it also acts specially upon the nerves which control the size or calibre of the blood-vessels. The alcohol paralyses such nerves (vaso-motor nerves), consequently the blood-vessels, not being kept under control as regards size, expand and admit more blood-which blood, owing to the diminished contractile force of the blood-vessels, becomes sluggish in the vessels, causing a condition of greater engorgement than previously existed. Hence brandy is the worst remedy in epilepsy. "In bleeding from the lungs the same argument holds good as in apoplexy. Nature endeavours to plug the ruptured vessel with a clot of blood. Alcohol displaces this clot by causing the heart to send more blood with more force to the blood-vessels of the lungs. 66 Syncope, or fainting, may depend upon a variety of causes. In elderly persons it is often associated with a fatty condition of the muscular tissue of the heart and coats of the bloodvessels. Alcohol administered often causes a rupture of some softened vessel, or a tearing of some of the soft fatty tissue of the diseased heart. Syncope may also arise from excess of heat (sun-stroke) or from severe cold. If from the former the already engorged blood-vessels of the brain are still further engorged by the administration of alcohol. If from the latter (cold), alcohol, by lowering the temperature of the body (as can be proved by the thermometer), makes recovery far more tedious and difficult, if it does not even turn the scale towards death. Syncope from hysteria, excitement, &c., requires no alcohol, as the subjects attacked can be quickly restored by throwing a little cold water over the face and chest. "It is sincerely to be trusted that no one will be carried away by any pseudo-medical arguments advanced at the town's meeting on Monday arguments brought forward in the publican interest to make persons vote in favour of the Roundhay Park license. It is my fervent hope that all lovers of morality, order, and temperance; all who have at heart the good of the town and of visitors to the town, will by an overwhelming majority confirm the decision of the Council, a decision which, if not reversed, will reflect lasting glory and honour upon them." Proceedings of the British Medical Temperance Association. QUARTERLY MEETING. THE quarterly meeting of this Association was held on Friday, February 29th, at the rooms of the Medical Society of London, 11, Chandos Street, Cavendish Square, Dr. Richardson, F.R.S., the president in the chair. NON-ALCOHOLIC TINCTURES. Dr. J. JAMES RIDGE, who exhibited a number of tinctures, said: They are all prepared by Southall Bros. & Barclay, of Birmingham. These are prepared without alcohol, and have the full strength of the various drugs which they contain. By dissolving the ordinary tinctures, and then re-dissolving extracts in these through the menstrum, the material which has been left behind has been found to be inert, showing that the active principles of these particular tinctures are taken up in a very satisfactory manner by the menstrum. Of course their price is cheaper, and the advantage in using them is that we are not likely to disturb the patients' equilib.ium in any way by administering alcohol when it is not required. If two or three drams of a tinctu e are given, we produce a very sensible effect, and it is an advantage to be able to prescribe the drugs without alcohol. The dose would be the same as the ordinary tinctures, In answer to a question, Dr. RIDGE said that the tinctures would keep clear any time. He had kept them for months, and not one of them had turned. WESTON'S WALK. Dr. NORMAN KERR referred to the walk of Mr. Weston of 5,000 miles, and said that Mr. Weston had already completed 4,200, and was going to walk the last eight days at the Victoria Coffee Hall. It had occurred to him that it would be a very interesting thing if they were to appoint a committee to take observations of Weston during the last days of his walk-to notice his physiological condition under his performance without the aid of any intoxicating drinks. The PRESIDENT thought this an excellent suggestion. They might afterwards call a special meeting of the Society and ask Mr. Weston to be present. He believed a great many members of the Society would attend, and a great many members of the profession who were not members would probably be glad to be present. A resolution was then passed appointing the president and secretary to make a series of physiological and other observations on Mr. Weston. THE INEBRIATES' HOME. Dr. NORMAN KERR then read the following statement as to the operations of the Dalrymple Home for Inebriates: "Im nediately after the passing of the Habitual Drunkards Act of 1879, a society was formed with a view to founding a Home for Inebriates, so free from all motives of gain and so publicly conducted as to afford the best possible means of testing the value of that Act. Incomplete as the Act is, it was felt that it would be a neglect of duty on the part of its promoters if opportunity were not given for a fair and satisfactory trial of the efficacy of its provision for voluntary surrender of personal freedom by the dipsomaniac desirous of cure. "The lamentable ignorance of the physical aspect of intemperance which unhappily yet pervades religious and temperance circles in Britain, and the prevailing indifference to the despair. ing cry for help from the helpless and heavily-weighted dipsomaniac, combined to throw enormous difficulties in our way. From the first the labour and the responsibility have fallen on a few individuals. Among these were the late honorary secretary, Mr. S. S. Alford, F.R.C.S., whose indefatigable and self-denying work was prematurely terminated by the fatal accident, in 1881, when he was killed between the second and third adjournments of the important discussion which he opened in this Society on dipsomania. Mr. Alford's place was in the emergency taken by myself, and I have continued to act ever since, in default of anyone else coming forward. "On February 26th, 1881, the society was registered as a philanthropic association limited by guarantee, and the committee set actively to work looking out for a site. After inspecting more than forty sites, the freehold property called the Cedars, Rickmansworth, was purchased for £3,700. The house is beautifully situated on the bank of the river Colne, and is surrounded by charming and wellwooded grounds, the premises being, to quote the language of the Times, admirably adapted for the purpose they are intended to fulfil.' Nearly £1,000 has been expended in alterations and improvements, including a new dining-hall, kitchen, &c., and the house has been fitted throughout with the latest sanitary appliances, under the able supervision of the honorary architect, Mr. H. H. Collins, F.R.I.B.A., district surveyor for the eastern division of the City of London, for whose generous and efficient services the committee are deeply grateful. This expenditure, along with the additional cost of a winter tennis court (now in course of construction), and of a complete furnishing of the house and grounds, has found ample justification in the fact that before the end of the first quarter the Home was full, and further applications for admission had to be refused. The Home has been licensed under the Habitual Drunkards Act for the reception of sixteen male patients, and has been called the Dalrymple Home, in honour of the late Dr. Dalrymple, M.P., the founder of the habitual drunkards movement in England, whose widow has been a generous supporter of the scheme. "Contrary to the forebodings of most, who anticipated a pecuniary loss during the first few years, the first term of thirteen weeks shows a small actual profit. "From a higher point of view the successful working of the Home has been remarkable and most gratifying. There has been no trouble with the patients, and no one has indulged in intoxicating drinks. Without an exception all whose terms have as yet expired have applied to be allowed to remain longer, as long, in fact, as financial or business conside. rations will admit of. There have been seventeen admissions during the quarter, nine being of patients under the Act and eight of private patients. Of the former it is specially worthy of note that four have each voluntarily surrendered his liberty for the full period allowed by the Act-viz., twelve months. One has entered for nine months, and four for three months each. Unavoidable hindrances alone have prevented the latter from coming in for longer periods. In all the cases there are hopeful signs of permanent good, though of this we are not yet in a position to judge. Twelve months is the shortest time likely to do permanent good, as the habitual inebriate is labouring under a true disease. "This marked success has been due in great part to the pleasant and healthful surroundings of the Home, and to the able and judicious treatment pursued by their medical superintendent, Mr. Joseph Smith, M.R.C.S., late Medical Officer of Health to the Guildford Rural Sanitary Authority, and a member of the honorary staff of the Surrey County Hospital, whose services the committee were fortunate enough to secure. Effectively aided by Mrs. Smith (the fact that she, her husband, and their family are all total abstainers adding greatly to the influtheir ence which they wield over guests), the superintendent has made every patient feel himself quite at home as a member of a cheerful and ennobling family circle, whose united aim is to secure to every patient restoration to sound bodily and mental health, a strengthening of moral power, and a return to the right fulfilment of the serious duties of life. Therapeutic treatment for the diseased conditions, and moral influences, have been the means employed to promote the cure of the patients admitted to the Home. "The public opening of the Home, on October 29th, 1883, by Canon Duckworth, was honoured by the presence of the presidents of several influential medical societies, and representatives from almost all the leading temperance associations; and the Home has been highly commended by the Times, Standard, Morning Post, Daily News, Daily Chronicle, Pall Mall Gazette, St. James's Gazette, Globe, Echo, Evening News, Christian World, and other general newspapers; by the Lancet, British Medical Journal and Medical Press, and by the Church of England Temperance Chronicle, the Temperance Record, and other journals. Much encouragement has been received from the magistrates and other influential local residents, as well as from the clergy and medical men in the neighbourhood. National Temperance League kindly presented a handsome gift of temperance volumes for the library, including a set of the useful and valuable Medical Temperance Journal. The "With all this success there is one regret. Many applications for admission have had to be refused. If the sum of £2,500 were forthcoming, accommodation could be added for twelve more patients, and I earnestly appeal for a prompt and liberal response from the philanthropic public. Were the committee supplied with adequate funds, they would gladly establish a home for females, and a third home for habitual drunkards of very limited means. To free the existing Dalrymple Home from debt £2,000 is still needed. 66 Satisfactory as has been the result so far of the experience of this experiment, the hopeful augury of future good, the defective provisions of the Habitual Drunkards Act and its temporary duration stand greatly in the way of complete success. The action of the Home Secretary has aided in the more effectual carrying out of the law in one or two particulars. It is an offence against the Act for any person, without the authority of the licensee or medical officer, except in case of urgent necessity, to supply any intoxicant or narcotic to any patient detained in a retreat. As it was argued that this prohibition extended only to the retreat itself, and did not forbid publicans selling or supplying liquor to the inmates in neighbouring publichouses, the Home Secretary has issued a new rule prohibiting a patient from entering a public-house, and a publican from giving to a patient intoxicating drink anywhere. Another new rule guards against the taking of an intoxicant by an inmate on the plea of health, by forbidding a patient drinking any intoxicating liquor without special written authority from the medical attendant. "A special discussion, which I had the honour of opening, at the Social Science Congress at Huddersfield, eventuated in a resolution asking for a relaxation of the present stringent regulations guarding admissions into a retreat, and more extended powers of compulsory detention. A similar resolution was adopted at the annual meeting of the British Medical Association at Liverpool. I trust that this Association will add its voice to that of these two influential bodies, and by a formal declaration of opinion, so tend to impress the public mind as to create a sentiment too strong to be disregarded by the Legislature, and a conviction too abiding to be quieted with any measure short of really thorough and effective legislation in the interests of the unhappy victims of the overpowering drink crave." Mr. GRAY, in response to a request from the chair, said that his experience extended only over a period of two years, and he was certainly of the opinion of Dr. Norman Kerr that it took time, and a long time of residence, to be of real benefit to the patients. And he might say that in all the instances where there had been a long residence of from nine to twelve months he continued to have satisfactory accounts, and probably they had been some of the worst cases. He agreed with Dr. Norman Kerr that some really of the worst cases, two or three of which both he and that gentleman had seen instances of, required a very much longer term than twelve months, and those must of course be entirely free from the temptation of getting any liquor at all. The Rickmansworth Home was upon a better foundation than his. His home he had tried to conduct as a private establishment, making all to feel as of one family. The experience of Rickmansworth was short, but there were some patients who would do well after two or three months, give every sign of cure, and then from a very slight cause the patient would get drink. On an average he received from six to eight applications a week, but the majority were brought by their parents or those interested in them, and they came in their dire necessity, and almost all of them wanted to come for the mere expense of their board. Of course he need not say that the wear and tear of those patients were very great indeed. There were many people who would place themselves under the Act were it not that they had to go before two magistrates. If they had to go merely before one it would not be such an obstruction. He thought there should be some provision in the Act by which a guardian with a witness should be sufficient to place a patient. He had had scores of applications from ladies. He had taken in two,and he was almost going to say that he hoped he should never have another female patient; they would not give their consent to leave their home, and his experience was that they were worse than the male, and if something could be done in the amendment of the Act so that the husband and a witness could place a patient in a home, much service would be done. On the other hand, a wife with a witness should be sufficient to place her husband in a home. As it was, many a man was ruining his family and many a wife was ruining her home. No doubt in some instances there was great relief in a very short time. The recuperative power of these people, even when they had been for many years drunkards, was often remarkable. There was great harm done to patients of this class from the fact that there were so many homes open in England and Scotland that were mere farces, and having patients from one place and another, of course they had very good evidence as to how these places were conducted; and there was but one cry, that the patients had been able to get the drink in one way and another, and hence no good had resulted from such homes. Very much good had been done at the proper homes by short stays, but as a rule, in the majority of cases, although they abstained two or three months, and had been very particular, and had even resisted drink when it was brought before them, yet from some neglect on the part of friends to meet them or fetch them, some patients had gone home intoxicated, although they had conducted themselves soberly for three months, and had made up their minds absolutely to abstain. His opinion was that it was very important after their sojourn had finished to fetch them away, and to keep some guard over them for the first two or three months. Probably having to wait at some station they were led off to drink, and he had known them frequently do that after being |