MENTAL DEGRADATION THE RESULT OF ALCOHOL.

BY ROBERT JONES, M. D.,

Resident Physician and Superintendent London County Asylum, Claybury, England; Lecturer on Mental Diseases, Westminster Hospital Medical School, London.

Short of actual death in the family, insanity is probably the condition which causes the greatest amount of consternation and terror, if not actual misery. It is of all diseases the most farreaching in its effects and has been truly described in most cases as a living death. It is capable of turning the most joyous and happy homes into abodes of deep despair. It disfranchises the sufferer, curtails his liberty, separates him from home and friends, disqualifies him from all social functions, indeed it not only deprives him of his civil, social, financial, political, and domestic rights, but also in most cases compels his associating with others of the same class in houses or institutions in which he is compulsorily detained against his will, and which reveal to him scenes of suffering and distress of which hitherto he had never even dreamt and to which he often feels he can never become accustomed.

On January 1, 1905, there were 119,829 insane persons in England and Wales, of whom 55,169 were males and 64,660 females, being a proportion of one insane person to every 285 of the population. Of this number 109,277 persons (50,180 males and 59,097 females) were of the poorer classes.

It is no easy matter to determine with exactness the cause of any disease, but in respect to mental disease this becomes a task of extreme difficulty, as no definite facts of causation are vouchsafed, the information usually obtained being some antecedents in the history of the patient which are considered by his friends to bear some relation to the attack of insanity, and those which stand in more immediate relation to it being given the greatest prominence as factors of causation.

Underlying the causes ascertained is often some inherited or acquired frailty of the brain tissue which renders the individual more prone to be affected by noxious circumstances or conditions

which in the healthy would have less influence. Although several antecedents may take a share in the ultimate production of insanity one of the causes of the impaired resistance in the nervous system may also be the agent immediately responsible for the fully developed disease.

It is interesting to note when statistics as to the causation of insanity are taken over a period of years that the number of cases appearing as caused under the different headings show but little variation from year to year.

It is computed with some certainty that alcoholic intemperance may be attributed as an assigned cause of insanity in 22.7 per cent of all the male admissions into asylums and in 9.4 per cent of the females: the proportion for private patients being 16.7 per cent for males, and 8.6 per cent for females, and for pauper patients 23.6 for males, and 9.6 for females, showing the lesser resistance to temptation among the poorer classes.

It is fair to state, however, that intemperance is often an effect, as well as a cause, of brain weakness or disease, and the intermingling of these antecedents renders it impossible to arrive at precise conclusions as to causation, but the Lunacy Commissioners in their last report, dated 1905, to the Lord Chancellor-issued as a Blue Book-acknowledge that "alcohol is a brain poison." It is interesting to note as pointed out in this report that certain counties with a comparatively low rate of insanity show a high proportion of cases admitted with a history of intemperance; that counties with a high rate of insanity have a low proportion of cases from alcoholic intemperance and that areas in which the association of intemperance and insanity exists correspond with those areas in which intemperance and crime also prevail.

Dr. Bevan Lewis recently referred to the geographical incidence of alcoholism, and pointed out that the industrial people in coast counties were the most intemperate, but had the lowest ratios of pauperism and insanity; whilst inland agricultural people were the least inebriate, but had the highest ratio of pauperism and insanity. This apparent dissociation between alcoholism and insanity is a complex question, for pauperism, want, anxiety, and other moral factors are essentially related to both insanity and drink.

I am convinced that the great question of the effects of alcohol

upon the human organism is primarily one for the medical profession, for intemperance has in numerous instances been initiated through misapprehension of medical advice in regard to the use of stimulants; and secondly, the question of the use of alcohol is a sociological one. The causes of drinking are so many and so infinitely varied that great caution is required before accurate conclusions in regard to them can be arrived at.

We hear a great deal about lowered vitality, about the craving for luxuries and excitement, and about alcohol in any shape and form being a poison that many facts are distorted by fanatical enthusiasts who are too apt to indulge in hasty generalizations and in severe condemnation of those temperate people who themselves are endeavoring to the best of their ability to prevent the spread of excessive drinking and to educate the public in regard to the evils which must follow and how these may be mitigated.

The profession of which I am a member, has, I venture to think, within recent years, done more than any other to fix attention upon the evil effects of intemperance, and a proof of this statement is the petition presented a little over a year ago to the Board of Education, signed by 15,000 medical men, asking for fuller and more correct information about the physiological effects of alcohol to be taught to children in our public elementary schools.

There is no question of public interest that is in greater need of being studied by sober-minded individuals than this question of drink, and in a country in which every attempt is now being made to educate the masses it should not be forgotten that the elevation of the individual out of the sphere into which he was born may impose a tax upon his nervous system which may eventually expose him to serious temptations. The frequency with which neuroses and psychoses-diseases of the nervous system and affections of the mind-are met with in families in which there has been a sudden and rapid change in the environment-for example, the removal from a country to a city life, or from comparative straits to comparative affluence-is a factor of great importance and it has not received the consideration it needs. Addiction to alcohol is an indication of a functionally unstable nervous system, and under the stress of the conditions created by modern civilization, many individuals whilst attempt

ing, as they suppose, to better their condition in the social organization are thrown out of sympathy with their surroundings and become subject to excessive nervous strain-drinking being the phase presented of this general and mental instability.

Now it is a fundamental law in evolution and dissolution that the last, most complicated and highest developed function is the first to go in disease. The highest faculties of man are the attention, intellectual discrimination, and judgment. Upon these alcohol exerts a degrading and degenerating influence. It is upon the highest mental faculties upon beliefs, ideals, ambitions, and desires that conduct depends, and there is no fear of exaggeration when the statement is made that the greater part of delinquency or crime and numerous other social calamities-sins of omission as well as of commission-result from excessive alcoholic indulgence. Indeed the gradual non-observance of the three C's "Ceremony, Courtesy, and Convention," and their replacement by the three P's "Persiflage, Paradox, and Pruriency" demonstrate the effects of alcohol upon conduct which through its effects gradually deteriorates until the most complete ethic degeneration eventually results. Not only in delinquency but also in innate criminality does alcohol exercise a genetic power. Crimes due to alcohol have in Germany reached the figure of 41.7 per cent of the total crimes. In France delinquency has also risen to 45 per cent where the consumption of alcohol has increased, a corresponding diminution having occurred during those years in which the vine crops were very bad. In Hungary delinquency through alcohol has reached to 35 per cent of total crimes, in Norway to 44.4, and in the districts surrounding St. Petersburg to 47 per cent. In our own country 50 per cent of crime is attributed to the abuse of alcohol.

The question "what is the recognized effect of drink on crime" is closely related to our present subject, and it was asked at the International Penitentiary Congress at Brussels in 1900 and was subsequently reconsidered at the Congress at Buda-Pesth in September of last year. At this Congress 28 States were represented by 82 official delegates and the number of adherents was 335. The subjects treated by the Congress embraced the problems of penal policy, especially the deprivation of liberty with reference to the prevention of crime. Punishment comprehends the whole