Kraepelin, of Heidelberg, as alcoholic delusional insanity, in which the clinical picture is as clear as that in delirium tremens. With a sudden or sub-acute onset and no obscuration of consciousness, the most marked and characteristic symptoms of the psychosis are delusions of persecution based on hallucinations of hearing. Why, under the same casual conditions, alcoholic delusional insanity should develop in one individual and delirium tremens in another, or why, in the same individual alcoholic delusional insanity should develop at one time, and delirium tremens at another, has not been explained. Unlike delirium tremens, in alcoholic delusional insanity, consciousness is not clouded. Loss of sleep, headache, dizziness and irritability may for a brief period precede the actual attack. Sleep is disturbed by strange sounds which suddenly arouse the patient from his slumbers. Later, these sounds take shape, are clearer, are heard in the daytime, as well as at night, and are finally resolved into voices. At first, a single word, an oath, or it may be the patient's name is heard, and finally sentences which have direct reference to the patient. The voices seem to be those of nearby shopmates, acquaintances, etc., and may seem to come from the wall, from an adjacent room, or it may be over the telephone. The patient hears himself accused of crimes, reminded of past misdeeds, is called thief, liar, murderer, traitor; he is to be hung, shot, burned; he hears that his children have been drowned, that his wife is unfaithful. All that he hears is derogatory to himself, defamatory, to all of which he is a powerless and unwilling listener. Delusions of reference are especially prominent in all cases of this psychosis. Everything going on in the patient's vicinity has reference to himself; all his thoughts and actions are commented upon. He is watched, jeered at, shot at, and pursued for imaginary crimes. Reacting to his delusions he becomes alert, suspicious, distrustful, fearful and often antagonistic. In his desperation he

may commit suicide, or in response to hallucinations, having been called a vile name, he may suddenly strike the supposed aggressor.

The patient's actions, especially in the beginning of the psychosis may be well directed; he often performs his accustomed employment for days before his psychosis attracts attention.

Physically impaired appetite, loss of weight, insomnia, tremor of hands and tongue, occasionally exaggerated reflexes.

The course of the psychosis, like its onset, is acute or sub-acute. Usually in two or three weeks the symptoms rapidly disappear, sometimes very suddenly--occasionally they persist from one to eight months, gradually passing away.

The alcoholic history, acute onset, delusions of persecution based on hallucinations of hearing, with clear consciousness, form a symptom group by which it may be readily diagnosed.

The prognosis is usually favorable. It is rendered less so by marked physical changes of chronic alcoholism (arterio-sclerosis) and by a defective constitutional basis, according to statistics at the Connecticut Hospital for Insane.

Frequency: 7% of all alcoholic psychoses.

Treatment consists in careful watching to prevent suicide and in the promotion of sleep.

The epidemic of insanity among our soldiers in the Philippines in the late war, and which was chronicled in the newspapers at the time, was probably one or other of the two last named psychoses, caused by the excessive indulgence of our men, in a warm climate, in some aleoholic drink mixed with the juice of a native plant containing a narcotic principle.

I have shown that sixteen per cent. of the male admissions to the Connecticut Hospital for Insane for the years 1899 and 1900 were alcoholic psychoses. These

care.

were severe and protracted cases, demanding special While it does not necessarily follow, yet the above figures would naturally lead to the conclusion that the lighter forms of alcoholism must be common in the State. The milder cases of inebriety, in which there are no organic changes due to alcohol, and, in which there is simply an uncontrollable thirst for drink, are cared for at the home or in private sanitaria. It would be manifestly unfair to make a comparison between cases ordinarily admitted to a "cure," sanitarium or similar institutions and those met with in an insane asylum. Many cases of acquired alcoholism, taken in their inception, are curable, under good hygienic conditions; change of environment, suggestion, and abstinence from alcoholics. According to good authority the use of double chloride of gold and sodium, reinforced by nitrate of strychnia has been productive of good results. A cer tain percentage of cases so treated make quicker recoveries, with less danger of the development of delirium tremens, than those treated with strychnia alone.

Of eighty-seven cases of alcoholism under treatment in the Connecticut Hospital for Insane, taken in the ortheir admission, twenty-five were diagnosed as delirium tremens, thirty-one as alcoholic delusional insanity, thirty-two as chronic alcoholism, and the remainder as pseudo-paresis and alcoholic paranoia. As a large percentage of these cases are recoverable, the question of the advisability of committing the alcoholic to a hos pital for the insane arises. Should not some other provision be made for his care and cure, thus avoiding the inevitable stigma which must attach to one adjudged to be of unsound mind and legally committed to an asylum for the insane? One who has been so committed, after his cure and release, often labors under a disadvantage in obtaining employment and otherwise, to say nothing of the unenviable heritage to his descendants.

The indirect and remote effects of alcohol are most damaging and difficult to calculate. Probably the worst effects of intemperance in the use of alcoholic liquors, are least known and least noticed. It is in the silent destruction of the nervous system, the slow poisoning of the great centers of thought, that it exerts its most injurious and far-reaching effects, and in the transmission by inheritance of the evil from parent to child, from generation to generation.

DANGERS FROM THE INDISCRIMINATE USE OF

MORPHIA.

BY T. D. CROTHERS, M.D.,

HARTFORD.

Morphinism and other narcomanias are rapidly increasing in this country. Some of the more apparent causes are nerve and brain exhaustions, so common in all circles of life. Next are the toxic conditions, following failures of nutrition with auto-intoxications from lowered vitality and general debility. From these and other sources, the brain centers lose their vigor and power of endurance, and become highly sensitive to pain. The absence of proper rest to the brain centers is followed by irritation and instability which are transmitted to the next generation, and is apparent in the neurotic and hyper-sensitive states. The increasing number of neurotic and psychopaths in every community is an unmistakable sign of brain and nerve failure. In such persons, morphinism, alcoholism and narcomania generally are symptoms of low vitality, starvation and poison states. It is these conditions that prepare the way and make ready the soil for the growth of nervous diseases, of which morphinism and other narcomanias are common instances. There are reasons for believing that physicians are responsible for many of these conditions which a larger and more accurate knowledge would have prevented. One class of physicians who are more or less responsible are the thoughtless, unreasoning doctors who believe that the highest achievement of art is to relieve pain and suffering, irrespective of all consequences. These physicians have never been taught that morphia therapeutically was dangerous, except in the size of the doses and in certain conditions. The professors of