proportion of cases in which the temperature is high and in itself dangerous because of its height, by the use of the plunge we get effects which are most desirable; but there are conditions of mind and body which are capable of contraindicating the bath, just as there may be conditions contraindicating the use of quinine in malaria. Are we then to ignore the contraindication, or are we to allow the patient to suffer for want of these beneficent effects? We are to do neither, but to devise another plan for producing them without the factors contraindicated. This can be done by a modification of the cold bath in such a way as to preserve some of its good and excluding its evil effects, and we find its type in the profusely applied cold sponging. I believe this should be used as follows to produce the effects needed, and just as the bath will prove futile if badly given, so will the sponging: The patient should be placed on a blanket on his own bed, stripped, and the nurse should then apply rapidly over his surface a sponge dipped in water varying in temperature with his reactive power and persistency of temperature. It is my custom in the presence of moderate fever, say of 102.5 degrees, to order sponging with water at 70 degrees; if the temperature does not fall readily under this, to use water at 60 degrees, 50 degrees, or with ice in it. At the same time that the cold water is applied, the patient is thoroughly and actively rubbed by another until reaction takes place and the surface of his body is bright red. By this treatment the vascular tone can be as well if not better maintained than if the patient is put in a tub, and no cyanosis and severe shivering occurs. Further, it is possible to properly rub and sponge the great muscles of the back, in which region stasis and bed-sores often form, and it is worthy of note that these parts are not rubbed when the patient is in the tub. The rubbing, or massage, is a very important part of the bath, and if it is not performed both the tub bath and sponge bath are nearly futile. In these cases, when the fever is not marked-that is, as high as 102 degrees-sponging with alcohol and rubbing may be used to maintain capillary circulation and improve the nutrition of the connective tissues. We are told by the full bath advocates in this country to tub all cases unless they have hemorrhages or performation or are far advanced in the disease. It seems very much more rational to suit the needs of each case by modifying the bath, provided we are sure to obtain reaction and overcome stasis and improve nervous tone. Let me urge upon your attention the wisdom of giving a more generous diet during the course of this exhausting malady. Surely a pure milk diet is needlessly scant and loads the stomach with large quantities of liquid. Eggs up to three or four a day, soft custards, arrowroot and thin cornstarch may often be given with advantage, and even meat broths may be used, although they sometimes cause diarrhoea and may act as culture media for the bacillus. If Graves' epitaph was to be "he fed fevers," surely typhoid fever is one of them. The use of antipyretic drugs is seldom if ever needed in enteric fever. Personally, I never use them for any fever, because they decrease the oxygen-carrying powers of the blood, they give the eliminating organs the work of eliminating them, and in all probability decrease the power of the body to withstand infectious disease. Further, the most that they do is to remove the fever; no one has claimed for them the power to modify the disease, and the fever in itself is usually by no means a dangerous symptom. On the contrary, fever is, in some instances at least, a protective process capable of no harm. Only when it is excessive does this symptom need treatment. It would seem as if fever in a disease like typhoid fever is simply a part of the symptom group, a part which may be taken as an index of the severity of the attack, but not the most important part of the malady, any more than the quickened pulse rate, the diarrhoea or the spots make the disease in themselves. But if it be true that fever is not a symptom of particularly evil import, why attack it by the use of the cold bath. As a matter of fact, the cold bath is not directed so much to the fever as to the combatting of the toxæmia and the arousing of the nervous centers stupefied by the poison. A word about stimulants and supportant treatment. The more I see of current medical treatment the more inclined am I to believe that drugs are given too often and too much. I have been said to be a therapeutic nihilist while teaching therapeutics because I have expressed this view. Nothing can be further from the facts in the case. A therapeutist Is one who knows not only when to give drugs, but when not to give them. Because a man is a good shot with the rifle he is not expected to shoot at everything he sees. Neither is a good doctor expected to drug every patient who comes to him. The skill of the physician consists in knowing when to shoot. In no respect are drugs so abused as is the class known as stimulants. Our knowledge of most of the true circulatory stimulants derived from the vegetable kingdom shows that they are not particularly well suited to febrile states. Alcohol is, however, well suited, but how often do we give it when it really is not needed? A patient lying quietly in bed is not supposed to have a very strong pulse, yet I have often, when tempted to give a patient some alcohol, felt my own pulse and found it weaker than that of the patient, proving that the seemingly feeble pulse of the patient was not so at all. Too often are we led in our anxiety to aid the patient to overlook the fact that disagreeable symptoms must be met with in the natural history or course of the malady, and to attempt to meddle with it instead of letting it pursue its course, which it will do in many instances without evil effects. On the other hand, there are times when very active interference is necessary, and here the maxim "be sure you are right then go ahead" is to be followed fearlessly. In this connection let me speak of the use of camphor as a general diffusible stimulant in exhausting diseases, and for the same purposes in medicine as we commonly employ strychnine at this time. Graves, of Dublin, regarded it as one of the best remedies we possess for the prevention or relief of collapse, and yet the profession has, in its search for new things, given it far less attention than it deserves. It has been found of great value, both when given internally and hypodermically, in such severe maladies as Asiatic cholera and many other ailments. A large amount of literature might be gathered concern DENVER MEDICAL TIMES. 11 ing its value, but I need only quote Alexander, who has used it successfully in the exhaustion of phthisis, and Schilling, who has found its value to be very great in nearly all the severe infectious maladies. While it quiets nervous excitement, it seems at the same time to support the circulatory and nervous systems. In advanced typhoid fever I have found it very valuable. The doses I have employed have been fifteen to thirty minims of a 1-to-15 olive oil solution of the drug, given hypodermically, and my resident physicians having seen its beneficial results have used it without my orders in a number of urgent cases when I could not be consulted, so effective have they found its action to be. In the toxæmia of severe typhoid fever and in combatting hemorrhage in this disease, let me call attention to hypodermoclysis. This method deserves much confidence and its wide scope of usefulness makes it a valuable aid. SOME QUESTIONS OF THE LEGAL RESPONSIBILITY OF INEBRIATES. By T. D. CROTHERS, M.D., Superintendent Walnut Lodge Hospital, A serious crime is committed by a person intoxicated in the general sense, or at least, absolutely under the influence of alcohol; a will is written while the person is using spirits to excess; an important contract is made and signed in this same condition; a course of criminal conduct is followed, and the actor is using spirits constantly to excess. Such cases come into court. The counsel turn to the physician for help. There is some abnormality in each instance. The acts are without the pale of reason, and the continuous use of spirits clearly disturb the natural common sense line of conduct of the person. The lawyer turns to the rulings of judges in similar or allied cases, and the physician to text books of medicine and medical jurisprudence. Both fail; while the lawyer finds rulings that apparently apply to such cases, he is conscious that they do not comprehend or recognize the real facts in issue. The more closely he studies these facts, the wider the discrepancy between them and the theories of the law. The judge recognizes this inconsistency, but is forced to follow lines of previous rulings, and only along certain narrow limits dare he venture to express opinions at variance with others. The legal theories of these cases are the outgrowth of the moral teachings of past centuries. Teachings that inebriety is moral depravity innate in every life, always ready to grow and develop, and particularly from wilful neglect and gratification of the lower animal instincts. Also that inebriety is always a phase of savagery, or inborn tendency to lawlessness, to giving up restraint and control; indulging all 12 DENVER MEDICAL TIMES. the passions regardless of society or the interests of others. The remedy is punishment, suffering, pain, and in this way building up the moral to control the lower animal. Lord Coke's rulings three centuries ago, that inebriety always aggravated the offense, and should be followed by increased punishment, has been accepted and acted upon as the central truth in all these cases. The physician who is called into court to assist in reaching equitable decisions in such cases, finds little or no help from the text books. Dogmatic statements and theories, that are obviously unsound and in conflict with the facts, comprise the largest part of so-called authorities on this subject. The physician turns to a study of the cases, and seeks to find out the facts as they are presented in real life. Here a new world of truth confronts him. The inebriety of the prisoner, or the case in question is found to be a physical condition that is both inherited and acquired. This physical condition is literally a disease, and is prac tically an obscure or pronounced form of insanity. In some cases the drink craze is a symptom of insanity, and vice versa. When the symptoms of a large number of cases are studied and compared, they are found to follow a uniform line of origin, progress and development. Taking up the story of alcohol on the system, it becomes clear that the continuous use of alcohol, or spirits taken to excess at intervals, is always followed by degrees of brain and nerve palsy, paralysis, congestion and impaired and diminished activities. Alcohol in the system to excess is always followed by incapacity of the senses and judgment, with lessened power of control. The degree will vary widely with the amount taken and the state of health, but impairment and disability is a physiological consequence, that is absolute, to which the exceptions only prove the rule. The legal theory on which the present administration of the law is carried out, assume sanity and sufficient mental soundness to both recognize and act differently, the remedy for which is more severe punishment and accountability. Practically this theory presupposes a degree of psychological knowledge and capacity to distinguish lines of health and disease, that is far beyond any present attainments of science. The conclusions from a medical study of these cases is that every case is one of physical degeneration and progressive march downwards. A dissolution that follows a continuous line of cause and effect that can be seen and recognized. These cases are not metaphysical theoretical states of the mysterious mind and will power. They are actual tangible conditions that follow with absolute certainty causes that may be known and conditions that are traceable. The real medical jurisprudence of inebriety is first a question of the facts in each case, and their meaning. Facts of heredity, of growth, of culture and health; facts of disease, of injuries, of degenerations, local and general, of the influence of surroundings, of occupation and climate, and all the history, physiological, pathological and psychological. From these facts only can any clear intelligent conception be formed of the act and its motives. When this is settled then the legal question of what shall be done, and what disposition will more accurately serve the cause of justice will appear. The medical jurisprudence of inebriety theoretically aims to check and prevent illegal acts by inebriates. But practically and literally the very opposite effects follow. Experience of all courts in this country and Europe agree that capital punishment for murder committed by inebriates never deters other inebriates from committing similar crime. Yet notwithstanding this fact, inebriates are tried and executed daily all over the country. Fines and imprisonment for illegal and criminal acts are not only absolutely worthless as deterrents, but increase the very condition which it proposes to check. The physiological fact in these cases is that legal penalties which are supposed to appeal to the higher moral brain make no impression, for the reason that the higher brain is so impaired and palsied that it can not recognize or respond to these influences. The question of the legal responsibility in any given case where spirits has been used before and during the act in question, must be decided from a study of the mental health of the man. If there is a reasonable doubt of the mental soundness at the time the act was committed, the degree of responsibility will be changed. If there is evidence of delusions, or strange, unusual beliefs which influence his conduct and warps his judgment; or if his mind acts in an impulsive, unreasoning way, apparently under an irresistible impulse, that is beyond his control, incapacity should be expected. The question of capacity to distinguish between right and wrong in all these cases is difficult and confusing. The immediate effect of alcohol is to obscure and break up this power of discrimination between right and wrong. The use of alcohol is always followed by an increase in the heart's action, and later a corresponding diminution of the flow of blood. This increased heart's action is followed by unsteadiness of brain force and activity. The increase of the heart's action extends to all parts of the body, giving the appearance of greater power, then after a time lessened power and energy until stupor comes on. In all men who use alcohol occurs this alternation of exhilaration and depression, and when this is repeated for years positive damage follows. First of all, the senses become impaired, and this always darkens knowledge and misleads the judgment. This follows from the fact that accurate perceptions are wholly dependent upon definite and normal sensations. When the senses are disturbed and impaired, perceptions are correspondingly disturbed; they are unable to present the facts to the mind as they are or as they really exist in the surroundings. The fine shadows, the uncertainties and doubts which attend all human transactions escape the notice of the inebriate, hence he imagines they do not exist. Hence, the more alcohol he uses the more positive things appear; they have the quality and energy of absolute demonstration. He never doubts or hesitates. Such a man is a dangerous witness in criminal courts, because his defective knowledge has a morbid positiveness that often carries conviction. In reality an inebriate witness testifying to events observed while sober is more reliable than a sober witness testifying as to events observed while intoxicated. The inebriate is literally in a state of anæsthesia, manifested by the rude |