Norwich bulletin., 1916-02-14

showing the effects, thus demonstrat- ing, to his own satisfaction at least, the harml lessnesS of the habit. Such a person fails to realize that just as the morphine habitue establishes a tolerance for his particular poison, so the constant drinker establishes a tol- erance for his alcoholic poison. Just as the morphine habitue can take fatal to a normal person, so the all coholic can drink without becoming intoxicated, many times the amount of alcohol necessary to intoxicate an athlete in training. He boasts unwit- tingly of the poisoning to which his system has been subjected.
 Just as the word insanity has now lost its meaning, in view of the num- erouS forms of mental disease the term represents, so the, diagnosis of alcoholic insanity means little to the alienist. There are various forms of mental disease directly dependent up on alcohol, some of which offer good prospects for recovery. and some of which offer no chance of recovery.
 The most common mental disease dependent upon alcohol Is delimium tremens, and as many cases recover in few days upon the withdrawal of all cohol, such persons are rarely sent to state hospitals. and hence few such cases are included in hospital statis- titS. When, however, the alcoholic is continued, and second and third at tacks of delirium tremens occur, per- manent insanity may result.
 In another form of alcoholic insan- ity delusions of persecution and hal fluctuations, usually of hearing, are prominent features, while also prom inent Is the emotional reaction of fear and apprehension. Such patients imagine they are vilely slandered, their lives are threatened, and some times in their agitated terror they at tempt suicide or make. dangerous as- saults upon those about them, identi- flying their associates as enemies.
 Neuritis an Accompanying Feature.
 In a third variety of aIcohilic insan- ity, neuritiS is an accompanying fea- ture, with paralysis of the limbs. There is great mental confusion and almost complete loss of memory. A patient in a hospital many months will assert that he was admitted but an hour or two before. Such patients fill in enormous memory gaps by so- called fabrications, but they lack any appreciation of the true character of their impossible and absurd stories. While occasionally some improvement may occur, permanent mental deteri- oration or dementia usually results.
 A partially dangerous type of al coholic insanity is seen in those in- diViduals who develop delusional sys- tems, in which ideas of jealousy are most prominent. Many families have been disrupted because of the un- founded suspicious formed in the minds of unrecognized insane alco- hoIcs, but the great danger lies in the fact that these persons are apt to make murderous assaults upon an in- nocent wife or husband.
 In addition to the more frank forms of mental disease dependent upon al- cohol, there also occurs peculiar mental enfeeblement, which while ser ious often fails to bring the sufferer into conflict with his environment, at least to such an extent as to cause commitment to hospital for the in- sane. Hence these constitute another group of insane alcoholics, who are but poorly represented in hospital statis- ties. Nevertheless they show 0 mark ed mental change They become care less in personal habits, are unreliable, irritable and often abusive. Losing all sense of responsibility, they become indifferent and idle. parasitic burdens upon their families or upon the com munity.
 In addition to all the cases of men tai disease directly dependent upon alcohol, it should not be forgotton that alcohol is often a contributory factor in the production of ment1 disease when other factors are more promin- ent. No authorities give less, and many give more than five per cent as being the proportion of epileptic cases in which alcohol is a causative factor. Although less directly responsible for the fatal disease of paresis than was formerly thought, alcohol is often a contributory factor in dementia prae- cox, that form of mental disease, from which suffer the great bulk of chronic insane in our hospitals A Large Percentage.
 While the presentation of statistic rarely excites interest, it should be stated that from ten to twenty per cent of all insane patients admitted to