Omitting Vermont and Bridgewater, we find pretty uniform ratios in the others investigated, as shown in Table IV.

Middletown

Diefendorf (2000 cases).

11.90

In Italy, out of 1814 patients admitted to the Naples Asylum in 1901-5, 314 were definitely ascertained to be alcoholics-a percentage of 17.30+. Bianchi thinks there is perhaps an unconscious effort to make up for deficiency of food by taking alcoholic beverages, or to counteract the mental depression that is produced by the existing intellectual, physical, and social conditions. It is probable that in southern Italy much, not only of the epilepsy, crime, and idiocy that occur in that region, but also of the corpulence, indolence, indifference, rarity of noble impulse, excitability, irascibility, and impulsiveness displayed by the population may be due to the excessive use of wine. He expects better remedial results from education than from legislation, and maintains that the doctor must take the leading part.

In France the large percentage of cases of alcoholism has aroused not only the medical men, but the state. The U. S. consular report quotes the results of a careful and systematic investigation made by Mr. Mirman, director of the Department of Public Assistance and Hygiene, to determine the exact relation in France of alcoholic excess to mental alienation. His report divides the patients in the various public asylums into three groupes: viz., (1) those affected by simple alcoholism; (2) cases of alcoholism complicated more or less with degeneracy or mental debility, and (3) all cases of mania, intermittent insanity, systematic delirium, etc., in which the abuse of alcoholic drinks has been a definite contributing cause.

Group one includes 2287 men and 721 women, a total of 3008. Group two comprises 2237 men and 1048 women, a total of 3285. Group three included 2538 men and 1101 women, a total of 3639. The grand total was 9932. At the same time the whole number of the insane from all causes in French asylums was 71,547. Hence the percentage of alcoholics of all kinds was 13.60.

Review Neurology and Psychiatry, February, 1907.

This report also shows the important rôle in the drama of degradation played by absinthe, which has been fitly called "the curse of the youth of France." Four thousand, eight hundred and eighty-two, or nearly one-half of the above 9932 cases, owe their degradation to absinthe or the two or three other so-called "aperitifs" which in France form the customery tipple at cafes and drinking bars. The serious element in Mirman's statistics is the revelation of an increase during the decade from 1897 to 1907 of 57 per cent in the number of insane in thirty-six departments of France. The national league against the abuse of alcohol is now organized and actively pursuing a crusade against intemperance and the sale of absinthe and other noxious liquors.

While statistics are not available to the writer, it is my impression that the increase of alcoholic psychoses has been noted in many other countries; notably in Russia, England and Germany. In fact, alcohol has become not merely a local or state peril, but a national and even a world plague, the more dangerous because the results of its continued ingestion are often so insidiously manifested. The nations are beginning to notice and act.

In the report of the Connecticut Hospital for Insane for 1906 the trustees say:

Alcoholic patients are committed by the courts, many of them for definite terms. Many of them, after a short period in the hospital, are not insane in the true sense of the word, even if a very liberal interpretation of the term had declared them to be so at the time of the commitment. Still they must be retained until their sentence expires. What disposition to make of these unfortunate people is a very serious question affecting many families and homes.

Not only are hospitals beginning to ask if some special institutions should not be established wherein a large proportion of alcoholics should be treated, and not be required to mingle with the ordinary insane; not only are town and national governments discussing the problem of alcoholism in all its phases-medical, social, economic and therapeutic-but we find the business world also not only studying the question, but taking stringent action to protect its interests from the injuries inflicted on it by alcohol. For a dozen years or more every big railroad system in the country (U. S.) has enforced a rule against drinking by their employees, especially those in the operating departments. More

than one million men are included in this rule. On most of the roads the employe found entering or coming from a saloon while on duty is immediately discharged, unless he can prove that he did not visit the place to take a drink or to loaf. The United States Department of Labor found that 72 per cent of agriculturists, 79 per cent of tradesmen and 90 per cent of railroad officials discriminate against men who drink. So far as I can learn, no hospital, either general or special, in the civilized world, will knowingly keep in its employ any nurse who is known to drink. It seems ironical, but it is true, that no "respectable" saloon will employ a bartender who drinks.

In Great Britain, during the past seven years, there has been a reduction of nearly 14 per cent in the consumption of beer and of over 22 per cent in the consumption of distilled spirits. Sir Victor Horsley states that there has been a marked decrease in the use of alcohol in English hospitals since 1872, and in more recent years in its use in the special treatment of fevers, and his data seem to indicate, so far as they go, a changing medical view of the medicinal value of this agent.*

"In many of the great public hospitals of Berlin not a drop of alcohol ever enters the doors, efficient substitutes having been found." The last German National Socialist Convention voted almost unanimously gainst the use of alcohol during working hours, and inveighed against the pernicious custom of drinking four or five quarts of beer while at work-a procedure long regarded as sacred by many German laboring men. There is only room for an allusion to the great temperance movement, which starting in South Carolina and sweeping through the entire South, is now reaching out over the entire country. At this date over one-third of the entire population live in communities where the law forbids the sale of alcoholic beverages. In Connecticut a drastic law was enacted by the last legislature, decreasing the number of saloons. While no one (except fanatics) believes that prohibition laws will abolish all drinking, it is evident that the question of how to abate the evils of alcoholism is a vital one-a

Report British Association for Advancement of Science.

New York Herald.

6

Ibid.

condition and not a theory-and an educational process is going on which will bring forth some good.

The probation laws in force in many States are helps. In Chicago recently Judge Cleland severely reprimanded a physician because he prescribed brandy for a parole man, and threatened him with a jail sentence if he ever did it again. "This man loses control over himself when in liquor, and as a result of this dose went on a prolonged debauch-the first in many months. . . . . It's men like you that overturn the work of a good many friends of a man. You ought to find out all about a man before you advise him to take liquor. This applies to all other physicians as well."'

We have shown that to-day there is a very large number of cases of the alcoholic psychoses committed to our hospitals for the insane. As many of these cases tend to become, or are already chronic, the percentage of those present in any year will naturally increase. We have also shown in part that similar conditions prevail in other countries.

It seems to me that if alcoholics are to continue to be committed to these hospitals, there should be some legislative provision whereby every alcoholic, so far as his physical condition will allow, should be made to work, not only because occupation is now recognized as one of our most valuable therapeutic resources, but also for the economic gain. Most of this class will not work unless obliged. Further, courts should give long sentences. In my opinion, one year should be the minimum. In cases where patients are committed several times, disfranchisement might act as a deterrent. It would also be well to punish by imprisonment and fine any person selling or giving liquor to any alcoholic who had been an inmate of a hospital for the insane.

On the whole, I am more and more inclined to the opinion that the interests of the individual, the town and the State would be best subserved by creating in each State institutions devoted exclusively to the care of all alcoholic habitues, sane or insane. As this course is now generally recognized as proper for epileptics, most of whom display some mental deterioration, why not for alcoholics?

'Chicago paper.

NEUROPATHIC WARDS IN GENERAL HOSPITALS.*

BY CAMPBELL MEYERS, M. D., TORONTo, Canada.

Mr. President: As functional nervous diseases have of late occupied a prominent place in the advance of medicine, I thought a few remarks on the practical result of their treatment for the past two years in the special department of a general hospital, might be of interest to this Association.

I may first say that I advocated the formation of neuropathic wards in general hospitals primarily, in the belief that a practical means would thus be found for the prevention of the most serious disease which, not only the physician but the State has to contend with, viz., insanity.

I would here state that by the word "insanity," as used in this paper, I would refer only to the acute insanities, the psychoneuroses of Kafft-Ebing; and by functional nervous disease; to those forms especially of so called neurasthenia, in which psychical symptoms predominate, or as it might be termed, acute psychasthenia. The chronic insanities, such as dementia præcox, etc., are not included.

With the many other beneficial results, which arise from the treatment of those functional nervous diseases, in a special department of a general hospital, which do not tend immediately towards insanity in their onward course, I will not detain you.

I would like first to direct your attention to the question of the prophylaxis of insanity from a neurological point of view, viz., by beginning at the earliest stage of the development of nervous disease, and proceeding thence to the more advanced stage, when the boundary-line of insanity is reached.

The question of the prevention of insanity has been discussed chiefly by the alienist, who, in spite of every effort to promote this good work, has been greatly handicapped by the existing condition of affairs, since the patient only comes under his care when

* Read at the sixty-fourth annual meeting of the American MedicoPsychological Association, Cincinnati, May 12, 1908.