grasp of the hand, a loud voice and a certain exaggeration of manner, as if to assure himself of the reality of his senses. The sense of touch, of sight, of hearing, of smell and the muscular sense, all show disturbance, and point to a degree of paralysis, which manifests itself in illusions, hallucinations and perversions, impeded articulation, staggering gait and diminished functional and organic activity. This is literally paralysis in a degree, and extends to the control of volition. No effort of will can remove or lessen these incapacities from alcohol. Weakness, prostration and debility respond in some measure to the calls of volition, but paralysis from alcohol never. Hence the responsibility of the inebriate is lessened and differs from that of all other narcotic states in direction and degree. It can be readily seen how impossible it is for the mind to receive accurate knowledge of events and persons exterior to it when the senses are obscured and imperfect; also when this degree of paralysis extends to the higher operations of reason and coördination, where both the facts and the conception of them are faulty and perverted. The coördinating brain centers are enfeebled and can not analyze the impressions of the senses, and this extends to those higher operations of the brain called morals. The paralysis of the lower ranges of brain activity quickly dulls and breaks up those fine distinctions of duty and the consciousness of right and wrong. It is a physiological law of growth and development that the highest elements of brain activity and power are formed last. This is called the character, the "moral" of the man, and from the use of alcohol it appears to be the first to suffer and be destroyed. The inebriate, like the man intoxicated, exhibits confused, halting ideas and beliefs of morals, and his duties to his fellow man. His ethical sensibilities and conceptions of duty and obligations undergo a progressive degeneration, while the coarser organic operations of the mind and body seem but little disturbed. Hence the acts and thoughts that are supposed to be malicious and brutish indicate merely a suppression of the higher coördinating centers. This is seen practically in many cases where persons of refinement in thought and act, after the use of alcohol, have become coarse in language and manner, also brutal in conduct. Often the inebriate is amazed when told what he has said and done while under the influence of alcohol, showing how far he has been dominated by the alcoholic paralysis. But if the drinking has been continuous, he is unable to review his thoughts and acts, and both the mind and body undergo debasement that is fixed. Morally, mentally, and physically, he slowly or rapidly grows crippled and deformed. The inebriate is literally a moral paralytic, his intellect is disordered, and among the insane none are more dangerous, for the reason that he has no fixed mentality or conception of himself and his relations to others. He may before the use of alcohol have formed habits and conceptions of life that cling to him automatically, and thus be able to appear and act along the ordinary grooves of normal life. He may as a professional man or as an artisan or farmer pursue his avocation with reasonable success; but let some supreme crisis intervene, let some emergency throw him out of his automatic range of life, and his true state will be revealed. DENVER MEDICAL TIMES. 15 His damaged brain will be seen in the crimes and the insane confusion of all his thoughts and acts. From alcohol alone this conclusion is sustained beyond all question, viz., that its effects on the brain and nervous system are anæsthetic and paralyzant. The heart, the senses, and then the higher brain centers slowly succumb to paralysis, while the victim's capacity to realize his true condition and adjust himself to it grows less and less. His conception of right and wrong, of duty, of obligation and responsibility grows more and more confused. Often this is masked by automatism, and the victim may perform his daily routine in accordance with his surroundings, but he is a mere mental waif, drifting at the mercy of his surroundings and the uncertain conditions of life. The mental incapacity of inebriates to reason clearly about their acts and the consequences of them is fully sustained by the facts of heredity. All statistics agree that over 80 per cent. of all inebriates are born with defective brains and nervous system. Their ancestors are inebriates, insane, epileptic, idiots, feeble-minded, neurotics, consumptives, and others, who are diseased, and who transmit to their children either special disease tendencies or general constitutional defects. These classes are wanting in brain, health and vigor; they are unable to bear the strains and drains of life, or adjust themselves to its changing conditions. If they do not inherit a special tendency to alcoholic disease, they have a defective brain soil, from which disease springs upon the slightest exposure. As shown by their defective external appearance, the brain and nervous system are imperfectly formed, dwarfed, and incapable of acting normally. The effect of alcohol on such an organism must of necessity reduce it below the plane of healthy activity and responsibility. These are general principles that are beyond question in the field of scientific inquiry. The fact I wish to make prominent is not the irresponsibility legally of these cases, but to show that the present legal standard of judgment is wrong and contrary to all teachings of science. The superstition that insists on full measure of accountability in all cases where spirits are used, and assumes that the use of alcohol is a voluntary act of a brain both conscious and capable of control, is a sad reflection on the intelligence of the present. The interpretation of the law that boundary lines of responsibility and irresponsibility can be marked out in these disputed cases of inebriety is a delusion. The effort to find a dividing line where sanity and insanity join, or where the brain could or could not have controlled its acts or realized their nature, is an impossibility. The strange theory which seems to be fixed in the legal conceptions of inebriety, that alcohol can be used to excess at times, or continuously, and the person retain the full possession of his faculties and have the same power of control as in health; also, that no history of excessive use of spirits before or during the commission of the act, has any bearing on the case, unless associated with marked symptoms of insanity, are all errors that make justice impossible in these cases. To-day a large per cent. of all medico-legal cases are associated with inebriety and the use of spirits, and the legal responsibility by which they are judged are from theories urged centuries ago. The legal responsibility and accountability of these cases is very different from that seen in courts of justice. The teachings of modern science open up a new world of facts, that indicate clearly the physiological nature of all brain activities. Facts that show the influence of heredity, of injuries, of diseases, of strains, of drains, of failures, of diet, of surroundings, of culture, of ignorance, and all the vast ranges of influences and forces, which enter into the acts and character of each one. Facts that show a march downward, and progressive degeneration, or development and evolution. It is from this evidence that the questions of responsibility and capacity to act sanely at any time and under any circumstances can be solved. No legal responsibility in inebriety can be solved from any other point of view, or from any theories. It is a pure question of facts, not theories of the law, or rulings of judges. What is the history of the man and the act in question? Ascertain these clearly and the problem is solved; fail to do this and confusion, injustice and wrongs follow. The legal responsibility of inebriety as administered by courts to-day is a farce. A new jurisprudence is demanded, a new scientific study and recognition of these cases and their disabilities is called for. This demand is felt in every court of justice by clear, thoughtful men. INFLUENCE OF ALTITUDE UPON THE BLOOD. By G. H. STOVER, M.D., Assistant in Medicine and Lecturer in Electro-Therapeutics, Gross Medical College; Denver, Colo. The administration of iron to patients suffering from the various forms of anæmia has been a routine procedure for many years, sometimes with satisfactory results, but just as often with no favorable change. Indeed, it is difficult, in these days of therapeutic nihilism, to find a well-posted clinician who will assert postively that iron is of any benefit at all except indirectly and in a slight degree; that there is a great doubt in the mind of the profession is shown by the many conflicting statements of the therapeutists when they are fighting the battle of organic versus inorganic iron preparations. Here in Colorado, however, we can offer to the anæmic or depleted invalid nature's own hæmatinic, in the marvelous effect of altitude in increasing the number of red corpuscles and their hæmoglobin content. Within a very few days of arrival at a point of high altitude, the process of blood regeneration is observed in an increase in the number of red corpuscles, accompanied by an increase in hæmoglobin, the latter DENVER MEDICAL TIMES. 17 being somewhat slower than the former. The process seems to increase with the altitude, as shown in the following table: Place. (Published by Köppe in Munch. Med. Woch., 1890, No. 41.) Christiana Gottingen Lübingen Zürich Auerbach Reiboldsgrün Arosa The Cordilleras It is said by Köppe that the corpuscles are small, thus making no increase in the total volume of corpuscles, but this is not mentioned by other observers, I believe. While I do not wish to range myself as an authority against Köppe, I will say that my impressions, formed from a good many examinations, do not bear out Köppe's statement. It is also said that upon a return to the low altitude, the number of red corpuscles goes down to the original count. This may be so in some instances, but there are many reasons for doubting its general truth, especially where an anæmic patient has remained a reasonable length of time at the high altitude, so as to have passed beyond the time of temporary effects, remaining long enough for a positive impression to have been made upon physiologic processes. I might mention that I, who have lived in Colorado almost all my life, after a stay of five months at sea level, yet had a red corpuscle count of 7,000,000 something over a year ago. The point to which I desire to call the attention of eastern readers of the Times is, that in our altitude here we have an unfailing means of building up depleted blood, certainly a boon to the anæmics, chlorotics and other blood-poor invalids of lower regions who have failed to receive benefit from iron and other hæmatinic drugs. PROGRESS IN NEUROLOGY.* BY PROF. C. H. HUGHES, M.D., St. Louis, Mo. Since last we met neurology continues its onward march, both in special discovery and in new and better precepts and principles to guide the practice of our art. More and more as the years go by, medicine in general, with its many departments of practice, looks to the neurological sky for light, even more than, or at least quite as much as, it looks elsewhere about the firmament of the sciences for further illumination. *Chairman's Address before the Section on Neurology and Medical Jurisprudence of the American Medical Association at Denver, Colo., June 10th, 1898. 18 DENVER MEDICAL TIMES. The dictum of Cullen more than a century old, promulgated in a century of theory, has become an embodied fact of clinical medicine, notwithstanding the justly recognized influence of the blood microbes, bacilli, bacteria, etc., in the play of health and of the morbid motions of the economy, and in the development of phagocytosis in the destruction of disease. The nervous system, omnipresent in every problem of disease, of life or death, is now prominently considered by all thoughtful and well informed men of medicine, and neuriatry and psychiatry have become familiar phrases in, as they are common phases of, symptomatic expression and descriptive thought. "Quantem ergo quidem video motus morbosi fere omnes a motibus in systemate nervorum ita pendent, ut morbi fere omnes quadammodo nervosi dici queant.” It seems strange that we can in mental vision vault across an intervening century and see a British observer, before even Marshall Hall had differentiated the sensory from the motor nervous system of the cord, promulgating a doctrine from the meager data of his time which all the rich revelations of neurology and neuriatry since his day, of psychology or psycho-physiology and cerebrology, including psychiatry, have planted on an immutable foundation of truth. It would be interesting but not germane, to dwell a while on the work of this early neurologist and his American contemporary, Benjamin Rush, as we did in regard to the latter in last year's report on the century's neurological progress, for comparison, but the record of the year's work in our field will more than exhaust the lawful time limit of our task to-day. During the past year the neurological view of heart disturbance finds further confirmation from physiological sources in the following recent editorial reference to the subject in the Deutsche Wochenschrift: "A series of experiments at Buda Pest, producing artificial valvular insufficiency and dividing the vagi, seems to demonstrate that alterations in the nervous system play an important part in preventing compensation in cases of valvular insufficiency. The vagus is the intermediary between the heart and the extracardiac nerve centers. After both vagi were severed in these experiments, the spinal nerve mechanism of the heart was insufficient to carry on the work of the organ unaided for a certain length of time, but this period was much shortened if, in addition to the severed vagi, there was also valvular insufficiency. Likewise, the heart carried on its work in spite of valvular insufficiency when the innervation was undisturbed and even one vagus was left. The same result was obtained alike with cats, rabbits and dogs, leading to the inference that the cause of lack of compensation in a person with valvular insufficiency is in some functional or anatomic disturbance in the cardiac innervation, rather than in the cardiac musculature. Numerous clinic symptoms confirm this assumption; arythmia, etc., and Ott's statement that he found the nerve cells degenerated in cases of 'incompensation.'" The direct neural and reflex nervous disorders of the heart constitute our chief concern in clinical medicine and damage to the vagus and upper abdominal viscera constitute the chief concern in the management of most cardiac affections, as the neurologist, the alienist and even the general practitioner encounter them in practice. |