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of the cerebellum, but likewise in the anterior horn cells of the spinal cord and in the ganglionic layer of the retina. Furthermore, the frontal cortex and the pyramidal tracts, which are myelinated late, are as badly affected as the visual cortex which is myelinated early, probably in the ninth fætal month. In all these cases also, as detailed in the family histories, there is a strong neurotic and psychopathic background.

An organic or functional inferiority of the nervous system in certain individuals of Jewish birth or descent, probably explains the affective make-up of the Jew with his exaggerated emotional reactions. This elucidates his liability to the functional psychoses and the psychoneuroses, particularly those disturbances of the sympathetic nervous system so often designated as Jewish neurasthenia or Hebraic debility. As a result of this inferior sympathetic nervous system, he becomes abnormally sensative to emotions, leading to palpitation of the heart, flushing, gastro-intestinal disturbances, trembling, sweating and fatigue, in other words the typical picture of Jewish neurasthenia dependent on emotional stimulation of the ductless glands, probably the adrenal system. Cannon's statement may be applied to this group of cases:

It is possible that disturbances in the realm of the sympathetic, although initiated by nervous discharge, are automatically augmented and prolonged through chemical effects of adrenal secretion."

Since from a therapeutic standpoint, amaurotic idiocy is a hopeless disease and always has a fatal outcome, usually from an intercurrent disorder occuring during the terminal marasmus, we ought, if possible, to direct our efforts to prevention of the disease. But here again, prevention of the disease presents just as hopeless and pessimistic a problem as the therapeutic attempts. We do not know when a case of this disease may suddenly appear in a family of healthy children and even if the disease is recognized in its early stages, any attempt to retard its development is just as hopeless in this stage as in a later period of the disorder.

Referring again to the family histories, it will be noted that in none of the families, did the first-born child or the first few children have amaurotic idiocy. There was only one exception



15 W. B. Cannon: Bodily Changes in Pain, Hunger, Fear and Rage, 1915. to the rule, namely, in Family VII. In this case the mother had three healthy children by her first husband, but only one child with her second husband. This child was an amaurotic idiot, which would suggest that the cause of the disease lay in the father rather than in the mother. It seems also from an analysis of our material that the disease appears suddenly after a group of otherwise healthy children, but its appearance cannot be predicted and once the disease appears, it tends to repeat itself in the children that follow, as two or even as three successive cases of the disease. In only one family were healthy children born after the disease had once appeared.

We may safely assume then, that the sudden appearance of the disease is in the nature of a recessive mutation, which follows a sequence of normal children. The disease appears, not because of repeated pregnancies in the mother, since the same repeated pregnancies may occur in non-Jewish families where the disease is absent, but because the child is born with an inferior central nervous system. It is this inferior nervous system which undergoes the rapid degeneration which leads to this serious and fatal disease. Not only are the pyramidal tracts affected, as shown by the spasticity and the hyperacuisis, but the frontal lobes as evidenced by the dementia and finally the peripheral and central visual neurones, leading to the optic atrophy, the macular degeneration and the consequent blindness.

For this organic inferiority as the basis of amaurotic idiocy, there is no attempt at compensation, since a compensation or repair would be impossible in the presence of the rapid and fatal degenerative processes in the central nervous system.


THE RELATION OF ALCOHOL TO MENTAL STATES.* BY MAJOR SIR ROBERT ARMSTRONG-JONES, M. D., R. A. M. C., Consulting Physician in Mental Diseases to the London Military Command,

and Lecturer on Mental Diseases to St. Bartholomew's Hospital. I have been requested by your secretary to deliver a short address upon the subject of alcohol in relation to various mental conditions, in order to stimulate a discussion upon this point, and, as may be known to some of my hearers, I have been engaged during the greater part of my professional life in the study and care and treatment of mental departures from health, much of which was due directly to the excessive use of alcohol, although probably more was indirectly due, or in close relationship to, its employment as a common beverage. From the point of view of personal experience therefore, it may be appropriate and pertinent that I should endeavor to stimulate a debate and thus to elicit the views and the opinions of others among my audience whose experience may well supplement my own. I propose to deal with the subject in a controversial rather than in an authoritative manner, and to divide my theme into two sections: Firstly, the evident meaning attached to my title, viz., the different forms of mental abnormality resulting from excessive drinking in the individual, and secondly, the different mental states exhibited, or the different points of view adopted by the community responsible for the methods of its sale and use, and as a consequence for the maintenance of public order. In dealing with the latter section I shall pass in review the different legal measures that have been adopted to control its sale and the various steps that have been taken to safeguard the health of the people in connection with it.

The question of the effects of alcohol upon the human organism is an important medical point as well as being an interesting economic and sociological one; for it has a concern with the vitality and with the output of work of the individual, as also with his relation to the state which protects him and of which he forms a component part. As to the use of alcohol in health, all experiments are in accord, and it would be useless to occupy space with a repe

* Read before The Society for the Study of Inebriety in England, January 8, 1918.

tition of the results obtained. Broadly, they are, that alcohol stimulates the heart and circulation; in other words, it increases the force and frequency of the pulse and the functional activity of the nervous system; but it tends also to lower the temperature of the body, because it checks tissue changes. It is evident, therefore, that we have in alcohol a drug which can afford temporary relief in certain abnormal bodily states, but the very relief afforded in one particular direction, viz., as a cerebral stimulant, doubles the temptation to its frequent use, and as the body becomes habituated to its action and the dose has to be increased more and more, the habit of frequent stimulation grows almost of necessity into drunkenness. For this reason I am of opinion that no physician is ever justified in prescribing alcohol for its purely soothing, stimulating or narcotic effects, and I have never used it nor advocated its use for the mental conditions described as painful emotional states, because I consider its legitimate use to be for those extremely serious nutritional disturbances such as threaten to be the last moments of life, and in these states I have known it to prolong the life struggle. Personally I have no sympathy under ordinary circumstances with the daily use of alcohol by healthy persons who are not beyond middle life, and even such use in health has moral and politico-moral issues which cannot be discussed here; but under conditions of unaccustomed exposure to wet and cold, when the extremities are numbed and have lost or are losing their proper feeling, I have been informed by both officers and men from the trenches that the “rum ration" has enabled these men to withstand the continuous exposure to intense cold and wet. This fact is not in contradiction of the physiological experience already quoted, that alcohol lowers the body temperature and has no heating power. It only means that the chill of sudden exposure, the stiffness from benumbed extremities and the bronchitis that may follow are the result of cold, which drives the blood from the skin and the general surface of the body to the extremities; that as a consequence of long exposure the circulation fails in the skin, the functions of which are suspended, with the result that the skin ceases to excrete the body waste normally carried out with perspiration, and that these waste products are thrown upon the internal organs, which are already in a state of passive congestion. The relief obtained is properly explained by

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