THE TESTS FOR DRUNKENNESS.

446 let no flicker of bright promise die out for lack of protection. Nobody can press a switch and turn a flood of light into the dark caves of medical ignorance. The function of the Medical Research Council, which they fulfil with fine discrimination tempered with most kindly tolerance, is to see that no one who has flint lacks steel, and that where even a tiny spark is produced tinder sliall not be wanting.

THE TESTS FOR DRUNKENNESS. October, 1925, a Committee was appointed by

IN the Council of the British Medical Association to consider and report on the present tests for drunkenness, and to make recommendations as to their improvement. The Committee included the President of the Association, the chairman of its Council and of its Representative Body, and its treasurer ; several divisional surgeons of the Metropolitan Police Force, two Metropolitan magistrates, and certain well-known clinicians and scientists like Dr. FARQUHAR BUZZARD, Mr. J. T. J. MORRISON, Mr. E. B. TURNER, and Sir WILLIAM WILLCOX, the chairman being .Alajor-General Sir WILLIAM MACPHERSON, A.M.S. The institution of the inquiry was immediately due to the notoriety given by the press to certain cases where persons had been convicted of drunkenness when in charge of motor-cars. There were here two pronounced waves of feeling : first, that the public must be protected from the gross risks brought about through the reckless driving of motor vehicles, and, second, that the acuteness .of this apprehension had led to the sentencing, as drunken, persons whose condition had not been properly tested-in short, there was a view that, in order to ensure the non-escape of the guilty, the innocent had been more than occasionally penalised. The Committee show by the report that they have considered closely the procedure usually adopted in police-courts for dealing with cases of alleged drunkenness, for they print in an appendix a resume of what happens in London and in most of the larger towns, and for purposes of comparison describe also the procedure in the Navy and Army, and that in certain foreign countries such as Denmark, France, and the United States of America. A further appendix consists of a memorandum on the particular otlences where drunkenness plays a part, a list being thus presented of the circumstances in respect of which a doctor may be asked to express an opinion as to the existence of drunkenness in a particular individual. In the body of the report the Committee suggest that the word " drunk " should always be taken to mean that the person concerned was " so much under the influence of alcohol as to have lost control of his faculties to such an extent as to render him unable to execute safely the occupation on which he was engaged at the material time." Medical practitioners will agree that the adoption of this as a definition would clear away some of the difficulties in certain classes of case. The usuai deliberations for establishing the fact that an individual is under the influence of alcohol having been reviewed, the general conclusion is come to that no single test taken by itself justifies a medical practitioner in deciding that the amount of alcohol consumed had caused a person to lose control of his faculties "to such an extent as to render him unable to execute safely the occupation on which he was engaged at A correct verdict, it is held, the material time." can only be arrived at by the consideration of a combination of several tests and observations such as "general demeanour; state of the clothing ;

appearance of conjunctiva ; state of the tongue ; smell of the breath ; and character of the speech." These manifestations are to be noted in connexion with the manner of walking, turning sharply, sitting down and rising, and making small coordinated movements, while memory of incidents within the previous few hours and estimation of time intervals should be inquired into. It is the sum of the con. clusions arrived at after such varied inquiries that may justify or negative the diagnosis of drunkenness. The pathological conditions are set out which may simulate alcoholic intoxication and so lead to obviously unfair conditions where an inquiry Li conducted in a perfunctory manner. Here a warning is given which should hardly be needed by medical men, but which has an extreme importance in law courts especially for the information of juries. The report finds that every single symptom due to the consumption of alcoholic liquor may also be assigned to some other pathological condition. ir JAMES PURVES-STEWART pointed out in a famous address on acute drunkenness delivered two years ago before the Society for the Study of Inebrietyl that many of the commoner clinical phenomena employed on tests in the recognition of drunkenness are not in themselves tests for alcoholic poisoning, but rather for cerebral, cerebellar, or ponto-bulbar disorders. And everyone knows how the presence of mental or nervous disorder, and the effects of drugs, of chemicals, or of shock may cause symptoms indistinguishable save by scientific investigation from those of

drunkenness. ____________

VORONOFF’S METHOD OF REJUVENATION. Dr. Serge Voronoff is an enthusiast whose literary output keeps pace with his surgical work, and " Etude sur la Vieillesse " (1926) is followed by an English publication entitled " The Study of Old Age and 31y Method of Rejuvenation,"2 translated by Dr. F. F. The introductory chapters deal with Imianitoff. the immortality of unicellular organisms, and the mortality of more highly organised creatures-a mortality which Voronoff attributes, pa.rtly, at anv rate, to degenerative processes in the endocrine glands during old age. He points out that the testis more than any other gland gives evidence of diminished function, for whereas the thyroid of an old man still continues to secrete, the testicles-at least so far as spermatogenesis is concerned-cease to function. The diminution in the activity of the sexual glands, according to Voronoff, occurs pari passu with the onset of the signs and symptoms of old age, and the similarity between symptoms of senility and those of testicular

insufficiency were, of course, emphasised by Brown-Sequard as long ago as 1869. The arguments employed by Voronoff in favour of the use of testicular grafts are, indeed, strongly reminiscsent of those formerly put forward by the advocates of treatment by injection of testicular extract. But unfortunately the problem is less simple than Brown-Séquard and Voronoff would lead us to believe. The changes in the testes during old age are part of a widespread process affecting the whole body, and there is no reason to regard testicular atrophy and senility as standing in the relationship of cause and effect. The

real value of Voronoff’s book lies not in its " scientinc " preamble, but in its account of the practical results obtained from grafts ; the value of his work must be determined by clinical results rather than theoretical arguments. No longer can it be suggested that his deductions are based on insufficient material. He has carried out the operation of grafting in over 1000 animals, and, if the work of other surgeons who have applied his methods is included, in over 600 men. 1 THE

LANCET, 1925, i., 111.

2 London : The Gill Publishing Co., Ltd. 10s. 6d.

1926.

Pp. 155.