[Footnote 4: One cannot help but add a word here as to the cause of the disease, because clergymen can by their advice do something to remedy the evil which lies at the root of the infliction. Hydrophobia is due to stray dogs. In practically every case the fatal bite is inflicted by some animal that no one in the neighbourhood claims. Bites by pet dogs are rarely fatal. If clergymen would use their influence to suppress the dog nuisance we would soon have an end of hydrophobia.] Alcoholic subjects are very liable to unexpected death from a good many causes. Patients suffering from delirium tremens, for instance, may die suddenly in the midst of a paroxysm of excitement. Such a termination is not frequent, but it has occurred often enough to make it the custom, at asylums for inebriates, to warn friends who bring patients of the liability of such an accident. It is not so apt to happen during a first attack of delirium tremens as during subsequent attacks. It is most frequent among those whose addiction to alcohol for years has caused repeated paroxysms of delirium tremens. The cause of the sudden death is usually heart failure. This term means nothing in itself, but it expresses the fact that a degenerated heart finally refuses to act. Alcoholic poison in the circulation has led to fibroid degeneration of the muscular elements of the heart and made them incapable of proper function, or at least has greatly hampered their action, and the heart ceases to beat. It must be borne in mind that chronic alcoholism makes a number of serious organic diseases run a latent course. The patient is apt to attribute his symptoms to the after effects of the abuse of alcohol. Unless the doctor who is called in makes a very careful examination, serious kidney disease or even advanced pneumonia may not be discovered. Alcoholic subjects bear pneumonia very badly, and the preliminary {163} symptoms of the disease are often completely concealed by the symptoms due to the patient's alcoholism. Other infectious diseases, as typhoid fever, tuberculosis, and even various forms of meningitis, may run a very insidious course and give but very slight warning of their presence. The result is that these diseases are very frequently fatal in alcoholic subjects. Old inebriates bear operations badly, and the mortality after any operation in such subjects is distinctly higher than in normal individuals. One reason for this is that considerably more ether or chloroform is required to produce narcosis in alcoholic subjects than in ordinary individuals. Ether and chloroform are very irritant to the kidneys. The kidneys are prone to be affected more or less in old alcoholic subjects. Death from oedema of the lungs or from some form of pneumonia is not infrequent in these post-operative cases, and gives as a rule but little warning of its approach.