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    Correspondence.IS INSANITY CAUSED BY "DRINK"?

    "Audi alteram partem."

    To the Editor of THE LANCET.SIR,-A leading article in your last issue discusses th,

    question of "assigned causes" of death. Will you allovme to draw attention to the important fact that thl4assigned causes" of disease are, as a rule, no bette:than the so-called "causes" of mortality to which youremarks principally apply. The method pursued in compiling or collecting evidences of causation is to ask leadingquestions of ignorant or prejudiced sufferers and their friendsWhat, for example, can be more insufficiently supportecthan the conclusion that drink is a considerable " causeof insanity ? The insane persons brought to asylums arEnot on admission in a state to form any judgment as to thfcauses of their derangement, and the reflections to whictthey are instigated after convalescence are manifestlyworthless. By far the commonest cause of insanity is, 7am persuaded, one which few men or women would be dis.posed to admit-namely, mental enfeeblement produced bymental debauchery, associated with, culminating in, andoften seeming to be relieved by, physical abuse, whichengenders first a recourse to restoratives, and then a longingand love for drink, either for its own sake or the passing senseof vigour it inspires. In this case the craving is a symptomor an effect, not a cause.There is manifestly this fatal objection to guesses about

    the subjective experiences of a lunatic, not less than those oia "hypochondriac," or malady imaginaire of any class-namely, that it is almost impossible for a sufferer to dis-criminate between early symptoms and causes.The crucial tests which must be applied to the question

    whether drink is a considerable "cause " of insanity are firstpractical and then pathological. How many instances doesthe average general practitioner, with a fairly-long experi-ence, remember, or can he adduce, of habitual drunkards whohave become insane ? They have died of liver or kidneydisease, they have had delirium tremens-a totally differentmatter from becoming insane-and they have been attackedby apoplexy, but they have not in any considerable propor-tion gone mad. This is a notable and significant fact.The bulk of the evidence, on which the hypothesis that

    drink " is a large factor in the causation of insanity rests,comes from the asylums, where obviously the least facilitiesexist for forming a judgment. If the facts were as theyare represented to be, I venture to think that the generalpractitioners of the country would be the witnesses to thisissue of intemperance rather than the medical officers ofasylums!This point is worthy of discussion by those competent to

    throw light on the fact-that is to say, general practitionerswith extensive fields of observation. And it should be dis-cussed on the basis of records of practice, without prejudiceor a preconceived opinion.Again, how can drink produce insanity? It is difficult to

    imagine that it is possible it should do so, otherwise than byproducing degeneration of brain or nerve structure, whichwould set up special and recognisable forms of disease, orby inducing some variety of cerebritis which also would giverise to distinctive results. The proliferation of connectivetissue is one of the prominent pathological changes pro-duced by alcohol in the structure of numerous organs whereits effects have been most carefully studied. The brainand nerve-centres of lunatics should present a correspondingcondition if the cause of insanity were drink. Is it not,however, the fact that in those special forms of brain andnerve disease accompanied by " mind symptoms" which arecommonly attributed to drink-e.g., general paralysis of theinsane,-any abnormal increase of connective tissue found israther compensatory than causal, as evidenced by the pre-sence of interspaces between the atrophied corpuscles, ornerve elements, and the proliferated tissue ?

    It is not enough to say "drink is a common and increasingcause of insanity." We require to be told the particularphysical changes it induces, and by what pathological pro-cess the result is reached. And if such a cause can beshown to exist, it will of course be possible to find cases in

    the various stages of decadence to the level of lunacy, sothat the question of "causation" shall not, as now, be leftin scientific obscurity glossed over by a fashionable con-jecture which places everything in doubt.The subject is one of pressing interest, because a graver

    mischief than any which can be caused by drink is veiled.If a real advance is to be made in the elucidation ofetiology this must be accomplished by more precise methodsof inquiry, and better and more responsible "returns"

    , than those whereby the data now at the disposal of theprofession are obtained. It is of high moment that results: of all classes should be traced to their true sources, but itis better not to speak of " causes " unless we are quite


    sure that those " assigned are something more than sus.. peeted. It is with the positive in causation, as in every. other phase of development, science must deal.

    Yours obediently,Scientific Club, Savile-row. J. MORTIMER-GRANVILLE,J. MORTIMER-GRANVILLE,

    DEATH FROM CHLOROFORM.; To the Editor of TIIE LANCET.L SIR,-The report of the death from chloroform at the; Lynn Hospital, as detailed in a letter in your last issue,

    prompts me to make a few remarks upon the treatment of, these cases, especially as they have been somewhat nume-l rous of late.L I do not think that many who administer chloroform ap-; preciate the importance of immediate, systematic artificial

    respiration being adopted at the first appearance of the. natural cessation or failure of these functions, and often the

    valuable seconds, which may make the difference between: the life or death of the patient, are wasted by watching to. see if breathing has returned, or is likely to return, by dash.. ing cold water on the face and other efforts, which, though

    indirectly of some service perhaps, cannot cope with thereal danger. Engaged in considerable ophthalmic andgeneral surgical practice, I must have administered or caused

    ; to be administered, some form of anaesthetics (chiefly chlo-, reform) several thousands of times within the last fifteen

    years, and it affords me great pleasure to say that I havenever witnessed a death from any of these agents. I havenotes of five cases in which death seemed imminent, but wasaverted. The plan which I always adopt is to commence atthe first appearance of danger Silvesters method of artificialrespiration, and continue it until natural respiration is com-pletely established. If plenty of assistants are at hand theymay apply other adjuvants, such as cold applications, gal-vanism, enemata, &c., but the person who has commencedartificial respiration should continue uninterruptedly, andwithout a moments cessation, his efforts, nor should theybe discontinued, under any pretext whatever, until lifereturns, or the patient is unmistakably beyond the reach ofmedical aid.

    I am, Sir, yours, &c.,CHRISTOPHER S. JEAFFRESON, F.R.C.S,

    Newcastle-on-Tyne, Feb. 16th, 1880.CHRISTOPHER S. JEAFFRESON, F.R.C.S.


    To the Editor of THE LANCET.SiR,Since you favoured me by publishing my article

    under the above heading (THE LANCET, Jan. 24th, p. 127),many cases in the practice of other surgeons, as well as inmy own, have proved the perfect comfort, and great thera-peutic value, of the absorbent cotton-wool and gauze pads,with and without antiseptic and styptic medication.

    I beg leave through your columns to express regret forsending such scanty specimens to those gentlemen who haveapplied to me for the materials. The fact is, such has beenthe demand that it has been impossible to meet it. Thisdifficulty cannot recur, as the matter has been taken inhand by the well-known manufacturing chemists of thistown, Messrs. Southall Brothers and Barclay.Amongst many other cases, I have lately employed the

    pads after two operations for strangulated hernia. In thefirst (aged seventy-five, five days strangulation, femoral, sacopened), cicatrix solid, and the patient left her bed theeleventh day, after three dressings. In another (agedthirty-four, large bubonocele, acute strangulation, sac

  • 309

    opened), the temperature was normal, the cicatrix firm, andthe man out of bed the eighth day.The suggestion to use the pads in childbed, instead of

    napkins, has been acted on by several accoucheurs, whospeak of their comfort and purity with approval.

    I am, Sir, faithfully yours,Birmingham, Feb. 15tb, 1880. SAMPSON GAMGEE.SAMPSON GAMGEE.


    SIR,-Will you kindly grant me a small space to correctan error into which Dr. Sinclair has fallen in referringto some cases of rheumatism published by me a year ortwo ago ?

    Dr. Sinclair says: " The results show...... three fatalcases in a total of sixteen." " Sir, the total number of caseswas not sixteen; those were only the selected cases out ofsome sixty or seventy, amongst which I naturally recordedall the fatal ones. We have had, as may be supposed,many more cases since, but without another death fromany cause.

    I care not whether this or that drug is beneficial in rheu-matism, but in judging of their respective merits, let usgive each one fair play.

    I am, Sir, your obedient servant,Harley-street, W., Feb. 17th, 1880. JULIUS POLLOCK.JULIUS POLLOCK.


    SlR,The replies to "Beta" in to-days issue fully setat rest the question whether the sex of the child is deter-mined by the ovary from which it is generated. In mypatient the right ovary was removed. Dr. T. J. Walker,who