encouraged, the watchword must be festina lente. However excellent the motives, however firm the zeal and unwavering the devotion, progress cannot be forced, and it cannot be pushed far in advance of public opinion. I know, in regard to the control of the liquor traffic, that both feeling and sentiment have run high and with regrettable consequences. It is necessary in regard to this aspect of the question to take cognizance of the state of feeling in all classes of the people, and at the moment there seems to be an irresistible popular feeling against the complete prohibition of alcoholic drink, which that great and useful movement, the "Wartime Prohibition" or the "Strength of Britain movement," has already had to experience; nevertheless, it has achieved much useful success in its educational campaign, for it has drawn special attention to a social problem that has been too largely ignored. In discussing this problem, various aspects of the drink question come under review, and the hygienic, medical, sociological and ethical aspects all come up for consideration.

In this paper I propose to deal exclusively with the mental symptoms, viz., those that result from the influence of alcohol upon the nervous system, and in discussing this aspect it may be appropriate to state that there is evidence that every psychological state has a corresponding physical state in the brain, for to every physical process there are special physical and chemical changes in the nervous substance corresponding to them, hence the maxim, "To every psychosis there is an appropriate neurosis," which means that every mental act has its appropriate physical correlation. This parallel relationship has been proved both by observation and experiment; it is a joint conclusion of psychology and physiology, and can be definitely supported by clinical and pathological research. Different parts of the brain, as we know, subserve different physiological functions; thus, one part is concerned with vision, one with sensation, and another with bodily movements and speech; yet the whole brain acts together, so that when these various parts are affected by alcohol there occur visual and sensory illusions upon which are based delusions. In consequence of affections of touch there arise mistaken ideas and complaints about electricity, machinery, hot irons, or the gnawing lacerations of wild animals. It is these sensory disturbances which so often originate delusions of persecution and the violent and impulsive

retaliations so often associated with drink. There is no better ascertained fact in medicine than that alcohol has a peculiar affinity for that part of the brain which is connected with the "muscular It destroys the co-ordination of the fine sense which interprets the equilibrium of the upright position and that of the limbs, and as we see in drunkenness it may bring about motor paralysis. Even before ordinary sensation is affected, the muscular sense may be attacked; so that engineers, delicate instrument makers, mechanics, typewriters, pianists, draughtsmen and those who do fine work need to be especially on guard if their educated and delicate muscular sense is to be preserved to them. It is our fine perceptions that give us the experience upon which we act, and two of our perceptions especially, viz., sight and touch, have been very fully studied experimentally, and these are the ones mostly affected by alcohol. In regard to touch, a composite sensation, we know there are four distinct external receiving organs in the skin: Firstly, that giving the measure of pure touch ascertained by the pressure on the skin of fine hairs mounted in wooden handles and attached to a balance; secondly, the pain spots indicated by pressing with metallic points; thirdly, heat spots, and fourthly, cold spots indicated by hot or cold blunt rods. In every instance is the response to these varied by alcohol; the first to go is pain, the next heat and cold and the last pure touch. These are facts that can be demonstrated by experiment and are the same as occur when the nerve to the skin is divided. In speaking of the mind as related to the brain, we realize that its study implies a close investigation of the various senses which are the avenues leading into the mind. Formerly the study of the mind was limited to the field of introspection only; but of late years investigation has been carried into mental phenomena by means of experiments, and these have enabled us to examine our sense perceptions with much more accuracy and precision both under normal conditions and under the influence of graduated doses of alcohol. It is usual to speak of the mind as composed of three types of conscious activities, viz., cognition, or the state of knowing, of feeling and sensation, and lastly of the will, the two latter being now grouped in the subdivision of interest; but the will is the highest and essentially the most human characteristic of the mind. Of the powers of the mind, the memory is one of the most fundamental as well as the

most important, for without memory we should be unable to coordinate the different states of consciousness and we should also lose our personality, results which we see occurring after the excessive use of alcohol. The facts which come into the mind to be grouped together by association-like to like and unlike contrasted with unlike-remain endorsed upon it through memory, and the main facts in education are to form time-saving and correct associations. Discipline is a matter of association—a body of welltrained troops only needs to hear the first of a series of orders to carry out the whole train, as one is linked to the next by association. The power of constructing and carrying out trains of thought by association is described as the power of apperception, which is the focussing power of the mind, and it is the attention which is the first to be impaired by alcohol. It may be temporarily suspended or it may be permanently destroyed.

There has been much confusion as to the use of terms in dealing with the effects of alcohol, and the term alcoholism has received widely different meanings. Mr. Leif Jones (president of the United Kingdom Alliance), in an address to the International Congress at the Hague in 1911, used it as signifying the total consumption of alcohol by a people; whereas others use it to imply the measure of the mortality from strong drink indicated by mental and physical symptoms leading to fatal results and recorded in the registrar-general's statistics. The most common effect of the excessive use of alcohol is drunkenness, and the symptoms of this are too well-known to need description. But there are three very different types of drunkenness: Firstly, there is the periodic drinker or the dipsomaniac who imbibes freely and deeply, but at intervals only, and during these intervals he may abstain completely; secondly, there is the person who literally sops in alcohol, who is hardly ever sober and is the person described as the "habitual drunkard," who swells the police court lists until, eventually, owing to the progressive lesions and their lasting effects, his death is recorded in the registrar-general's statistics as a case of alcoholism; and thirdly, there is the ordinary drunkard who drinks from pure conviviality and only needs the congenial pals to spend all or most of his money whenever he gets it, and thus to lower his productive efficiency. He is the typical Saturday-night and Sunday drinker, and he almost invariably gets into the hands of the police

and figures in their statistics. It is this person who is the average worker upon whom the state depends. Broadly speaking, neither of these terms signifies the amount of alcohol consumed, although the statistics of drunkenness may be the most reliable index. As we know, there may be a considerable consumption of alcohol with a comparative absence of drunkenness, and for this reason it would be more convenient to regard alcoholism as a social disease of which drunkenness-whether of the periodic, the chronic or the occasional kind—is one of its forms. If drunkenness may be taken as an index of the amount of drink consumed, the number of deaths from cirrhosis, delirium tremens, dropsy or Bright's disease may be taken as an index of the incidence of the social disease. It has been asserted by some critics that a diminution in the number of cases of drunkenness may imply even more rather than less drinking, because those persons who, under the present restrictions have a difficulty in obtaining alcohol, may drink privately and secretly in their own homes; but this is denied by all social workers and is contrary to the observed experience and the recorded inferences of all those who know the homes of the people. Whatever importance or value we give to these terms, it must be the question of immunity or the insusceptibility or the vulnerability of the different organs of the body which is the determining factor as to whether a person comes under the definition of drunkenness or habitual drunkard or of alcoholism. We employ the latter term to signify all the pathological changes which result from alcohol and to include all the varying symptoms, whether mental or physical, and whether these occur in hospitals, asylums, police courts or the private home of the individual. Alcoholism must be the total effects of the use of alcohol, of which drunkenness is probably the most convenient if superficial indication, and it is drunkenness in one of its many forms-sensory, motor, mental or moral-which is the most common indication of excess.

Of the various forms of mental impairment caused by alcohol, the most dangerous because the most violent and impulsive is delirium tremens, which occurs in consequence of continuous alcoholic intoxication in those persons who are liable to mental and sensory hyperæsthesia, and is associated with extreme agitation, tremors, night hallucinations and insomnia. The symptoms are too familiar to be further detailed, but probably thousands of

these occur annually. Another form of mental affection not uncommon among the civil population, although fortunately rare among the military, is that of multiple neuritis associated with mental symptoms and commonly called Korsakoff's psychosis. It is characterized by a loss of memory of a peculiar kind. There are gaps in the recollection of past events, which the person fills up with events that have never happened; these being suggested by some trifling incident in the environment at the moment, and for this reason he is said to lie shame facedly, but this is only because the memory is a blank and he is unable to retain impressions of his own statements, causing a peculiar forgetfulness as to time and place and a loss of orientation. There is an impairment of that special adhesive quality of the nerve cells by which the healthy brain is able to retain the images of past sensations and by means of which thoughts are retained in a clear, regular and logical order. This form of loss of memory is described as paramnesia and is most indicative of alcoholic indulgence. A third form of mental affection through drink is one closely related to epilepsy and this is greatly favored by a head injury or some predisposition to mental disease. It is accompanied with sudden frenzy and fury and is not infrequently associated with unconsciousness, and possibly also epileptic convulsions; but if these are absent there is a marked "automatism" and a complete forgetfulness of what has previously occurred. In these attacks the person may commit acts of serious violence, even suicide or homicide, and there is an imagined hostility to his environment which calls for resistance or retaliation; but this condition ceases entirely with abstention from alcohol, although an immediate relapse may occur when excessive drinking is again resumed, and it may be noted that this excess may be a very small amount of alcohol, as in these persons there is a marked susceptibility to its effects. I have met these cases repeatedly in civil practice and also in the case of young officers who have suffered from head injuries. A fourth form of mental affection is an unrestrained excitement caused by the presence of vivid hallucinations, and again it is the susceptible brain that suffers rather than the normal person, for very little alcohol may produce these delusions which are vivid and terrifying. The hallucinations may induce a chronic delusional state from which there is no recovery, and this condition much resembles that of