individual and the race. It is a controversy not-like so many controversies-between ignorance and knowledge, but between sincere convictions and genuine tru -seekers. There are those who hold that the most temperate use of alcohol is invariably hurtful to all persons and at all times; while, at the other extreme, there are those who regard alcohol, if not as a necessity of life, as a valuable food, tonic, stimulant, and medicine. Of all phases of this problem, the most obscure is the influence of alcohol upon racial fitness, wellbeing, and consequent survival.

Vital statistics show that abstainers have a better life-prospect than non-abstainers; but this fact, important as it is, throws little or no light upon the effects of the temperate use of alcohol upon the individual. The average of the non-abstaining column is lowered by the inclusion of a certain proportion of inebriates.

The racial and genetic influence of alcohol is still a most obscure problem. Certain facts are clear enough. Races are resistant to alcohol in proportion to the length and severity of their past experience of it. Strong liquors when introduced to such races as the negroes and the Red Indians of America, previously unaccustomed to their use, prove the most devastating of plagues. Classes in any given country are temperate in proportion to their past command of alcohol. The inhabitants of wine-producing countries are in general temperate if the industry is of long standing, but less temperate if the industry, as in some of our colonies, is of recent introduction. The most robust and virile races are in general consumers of alcohol, often in large amount. That many of the most robust and intellectual of men make a somewhat free use of alcohol is a matter of daily experience. A distinction would require to be drawn between free drinking and actual inebriety. The latter is disease, a form of neurosis, and is found in stocks in association with other varieties of neurosis, such as epilepsy, hysteria, and insanity. That the offspring of such tainted stocks. should be above the general average of physical vigor and intellect is highly improbable, but the facts are very complex.

It is impossible to say what would be the racial result of the banishment of alcohol from human society. Other evils would probably develop, and the millennium be indefinitely postponed.

The hope of the future lies in a heightened sense of social obligation and an increased capacity or self-control.

FROM T. CLAYE SHAW, B.A., M.D., F.R.C.P.

Emeritus Professor of Psychological Medicine, St. Bartholomew's Hospital.

Personally I agree with Major Darwin; I think that the ardent total abstainers who hide their faces in the sand when the question of the moderate use of alcohol is introduced are making a mistake, and are injuring their own position, because they give the impression that their despotic treatment and their disinclination to listen to opinions of those who think differently are really founded on weakness and upon contemptuous disregard for logic. The abolitionists should remember that they have never yet proved that the moderate use of alcohol is baneful to everybody, whilst if they choose they can see for themselves that teetotalers often produce a weak offspring, both physically and mentally, with pronounced addiction to alcohol and drugs; and yet no one could be so foolish as to attribute this to total abstinence, because many factors besides alcohol and teetotalism may be responsible for the presence of these defects.

A country which consumes only a moderate quantity of alcohol is more likely to be successful and tolerate than is one which—if such a country exists-plumes itself on total abstinence. But, then, all depends upon the word "moderation." There are many who call themselves "moderate," but who, as is euphemistically said, "do themselves well," swallow too much as a rule; and there are others who, under the pallium of moderation, are really drunkards. To neither class can the word "moderate" be properly applied, and there is no doubt that they are dangerous to the social integrity of the community.

ALCOHOL AND INSANITY

By James Hendric Lloyd, M. D., Neurologist to the Philadelphia Hospital

(Read at the meeting of the Philadelphia County Medical Society, April 14, 1915)

It is seldom that physicians of prominence take the war path against the humbug of temperance reformers. Dr. Lloyd, from whose paper the extracts herein are taken, is one of the men who speak out in meeting; and he seems to have followed carefully "the activities of the reformer and the amateur law-maker, in whom missionary zeal is not always tempered with scientific knowledge."

Before turning his attention to the question of alcohol as a product of insanity, he states his views of the temperance crusader in this country in the following words:

"These crusades are worked by enthusiasts; they make a great deal of noise; they do some good and more harm; then they finally exhaust themselves with their own fury, and the country settles down again and takes its beer and whiskey. They are the occasion of much fanaticism and they produce an infinite variety of cranks. As a field for psychological study of epidemic morality they are unsurpassed; and they are not unlike the popular furores that used to appear in the middle ages, attended by all sorts of pandemic hysteria on the subject of witchcraft. In our more enlightened age, intemperance indeed may be said to be a substitute for witchcraft. The populace seems to demand these periodical moral upheavals; and if witches are not to be found, a substitute for them is found in the saloons. I can recollect one of these temperance outbreaks when I was a boy, just after the close of the Civil War, when the popular mind was in an emotional state, just as it is now in Europe; and I can distinctly recall a nice, whitehaired old man who cut down a fine apple orchard, lest the tree should bear fruit, which would yield cider, which would become hard, and peradventure some one would drink thereof and get tipsy.

This old man, if he were living to-day, would probably be sent to the legislature."

Of course, Dr. Lloyd takes a serious view of the drink question he speaks freely of the brutal feature about our modern. drink habits and says that "the evil effects are on the nervous system." Having analyzed thoroughly the variety of mental disorders caused by alcohol, he continues:

I desire now to make an equally plain statement about some of the fallacies which are promulgated on the subject by too ardent reformers. One of these fallacies is the statement that our insane asylums are largely populated by the victims of alcohol. I do not hesitate to repel this as a libel on the insane. Statistics, properly compiled, do not prove it; and I am willing to submit the question to the asylums themselves. For thirty years I have been associated with the Pennsylvania Hospital for the Insane-known as Kirkbride's-in the capacity of examiner. During that period I have examined and certified for that large and representative asylum an average of about 20 new cases every year; that is, a total of at least 600 cases. I have, to be sure, kept no accurate records, but I believe my memory is correct when I say that a very small proportion of those cases were cases of alcoholic insanity. Among the women especially I can recall only two well-marked cases. The cases examined by me, however, do not include by any means all the admissions. I therefore asked Dr. Copp to give me the exact figures for the year just closed, which may be taken as representative. These figures are as follows: For the Female Department the total admissions were 114. Of these only three were to be attributed to alcohol—that is, about 2 per cent. Of these three patients, one had a plus Wassermann with suspicious pupillary phenomena, and may really have been a case of syphilitic paresis; and another of the three took large amounts of paregoric, and so may really have been a victim of opium instead of alcohol. This leaves only one case of undoubted alcoholic insanity. For the Male Department there were 85 admissions, of which six were to be ascribed to alcohol-about 7 per cent. The State Asylum for Chronic Insane at Wernersville reported for the year 1907 a total number of 81 admissions, of which seven were ascribed to alcohol-about 9 per cent. Some years ago Dr. Reed, of Cincinnati, examined

critically 200 consecutive cases of insanity, and found that 54 per cent of them were total abstainers, while of the remaining 46 per cent the great majority had merely a history of being occasional drinkers (just as with a large proportion of the healthy population), and alcohol could not be traced as a cause. As every alienist knows, the great bulk of the population of our insane hospitals is made up of cases of manic-depressive insanity, simple and involutional melancholia, dementia præcox, senile dementia, paranoia, confusional insanity, and terminal dementia and epilepsy-in most of which classes alcohol is really an insignificant cause, and in some of them is almost entirely absent. Even in the psychopathic wards at Blockley, where we undoubtedly see a good deal of alcoholism, these patients by no means make up the majority or anywhere near it. In 1914 there were 384 admitted to the insane wards at Blockley, of which 22 were cases of alcoholic psychoses, or 5.72 per

cent.

"I grant that it is difficult to estimate the question of alcohol in some cases of insanity-but that is no excuse for making sweeping and unfounded statements. It should rather suggest caution and conservatism. The same is true especially of hereditary defects due to alcohol. You can prove almost anything by heredity, whereas, in fact, it is the most obscure and insolvable problem in psychiatry. There are but few patients in the asylums whose heredity can be traced with anything like scientific accuracy. To jump to the conclusion that alcohol is an important factor in heredity is simply begging the question. The fact that an insane patient had a drunken father does not prove anything. The father may have formed the alcohol habit entirely after the birth of his child.

"If Weismann is correct, acquired characteristics are not transmissible. How then can such an acquired habit as alcoholism be transmitted? According to Conklin, the germ plasm may be poisoned by alcohol, and the effect be shown in the offspring, as has been seen in guinea pigs, but it is doubtful whether this acquired characteristic can be transmitted beyond one generation.

"The statistics of many hospitals are notoriously inexact. Thus the incidence of alcohol as a cause of insanity is variously estimated at from 10 to 30 per cent. This wide variation shows clearly how unreliable most of them are. As an instance of the wide range of