Direct efforts for the prevention of alcoholism, drug addictions, and syphilis, independently of the measures for-combating bad heredity, are by no means to be neglected.

Abstinence

The most trustworthy experimental data seem to show that even moderate indulgence in alcohol, though producing in the subject a sense of well-being and of increased physical and mental ability, in reality causes impairment of muscular power and coordination and of mental efficiency.2 In persons of neurotic constitution comparatively slight indulgence often causes severe mental disturbance.

1 A. J. Rosanoff. Intellectual Efficiency in Relation to Insanity. Amer. Journ. of Insanity, July, 1916.

2 L. Schneider. Alkohol und Muskelkraft. Pflugers Arch. f. d. ges. Physiol., Vol. xciii, p. 451. - M. Mayer. Ueber die Beeinflussung der Schrift durch den Alkohol. Kraepelins Psychol. Arb., Vol. Ill, p. 535. - G. Aschaffenburg. Praktische Arbeit unter Alkoholwirkung. Kraepelins Psychol. Arb., Vol. I, p. 608. - A. Smith. Ueber die Beeinflussung einfacher psychischer Vorgdnge durch chronische Alkoholvergif-tung. Br. lib. d. V. intern. Kongr. z. Bekampf. d. Missbr. geist. Getranke. Basel, 1896, p. 341. - E. Kurz and E. Kraepelin. Ueber die Beeinflussung psychischer Vorgdnge durch regelmdssigen Alkoholismus. Kraepelins Psychol. Arb., Vol. Ill, p. 417.

Those who favor temperance rather than abstinence do so mainly on the basis of the usefulness of alcohol as a food and as a sedative contributing to the recuperative effect of rest by promoting complete relaxation. It is not to be disputed that alcohol does possess these beneficial qualities, but it is for many not possible to derive the benefit and yet escape the harm from using it. Moreover, moderate indulgence, if regular, leads but too often to the development of uncontrollable craving, increase of dosage, and ultimately to chronic alcoholism. It need hardly be added that alcohol either as a food or as a sedative is not a physiological necessity.

Therefore the advice of the physician to his patient must usually be: total abstinence without compromise.

Of measures that may be employed by society the most important is dissemination of the knowledge of the true effect of alcohol, which should constitute a part of the program of all public schools. It is necessary before all to dispel the prevailing notions that alcohol is harmful only when taken in excess and that, taken in moderation, it is beneficial and even necessary to the laborer or artisan.

The next in importance are legislative measures. As having been actually proved to be in some degree effective may be mentioned: (1) The Gothenburg system, (2) prohibition, and (3) local option.

The Gothenburg system was first instituted in Sweden, and has since been adopted by Norway and Finland. The Swedish Law of 1855 gives to each municipality the right of prohibiting within its jurisdiction the sale of liquor over the bar or in stores in quantities under forty liters. Retail licenses in limited number - according to population - are awarded by the municipal authorities at public sale to the highest bidder, provided he be a person of good reputation. The law provides further that retail licenses may be awarded to societies, thus making it possible for public-spirited citizens to form organizations for the purpose of securing the licenses which are at the disposal of the municipal authorities and thus assuming control of the entire retail liquor trade. Thus was founded for the first time in the city of Gothenburg "The Gothenburg Retail Liquor Stock Company." This and other similar companies derive, of course, no profit from the trade, the profits going in part (60-80%) into the city treasury and in part (20-40%) into the state treasury.

The aim of such companies, in contrast with that of private liquor dealers, is to reduce the consumption of liquors; for that purpose they have established popular price restaurants, reading rooms, etc., for working people.

The results of this legislation may be judged from the following statistics.1

Prior to 1855 liquor could be purchased in Sweden in any hamlet. In 1869 there was only one barroom or liquor store to 8,028 inhabitants; in 1880 only one to 13,450 inhabitants.

There are 2400 separate municipalities in Sweden; of these 1800 have entirely abolished barrooms and retail liquor stores.

The consumption of liquor in Sweden in 1824 was 46 liters per capita, in 1851 it was 22 liters, and in 1896 it had become reduced to 7.2 liters.

Prior to enactment of the laws of 1855 from 25% to 30% of all male cases admitted to hospitals for the insane were due to intemperance. Following the enactment of those laws this percentage gradually became less, and from 1865 until 1899 it varied between 5.2% and 7.19%.

Prohibition has been tried in several states. In some of these states the prohibition laws have been repealed (Connecticut, Vermont, Massachusetts); in others they have been but recently enacted (Alabama, Georgia, Oklahoma); in still others they have been in force for many years (in Maine since 1851, in Kansas since 1880, in North Dakota since 1889), so that they may be assumed to have been given a thorough practical trial.

1 A. Baer and B. Laquer. Die Trunksucht und ihre Abwehr. Berlin and Vienna, 1907.

Practical difficulties of enforcing state prohibition laws reduce materially the possible effectiveness of such laws.

Nevertheless it has been amply shown that crime and pauperism have been reduced wherever prohibition laws have been enacted.1

The effect of no license under local option is similar to that of prohibition; that is to say, drunkenness, crime, and pauperism are undoubtedly reduced, but the incidence of insanity is but slightly, if at all, affected.

The following table shows the reduction of drunkenness which resulted from no license under local option in several cities in Massachusetts.

Table 8

Cities.

Arrests for Drunkenness.

License.

No License.

Year.

Number of Arrests.

Year.

Number of Arrests.

Brockton................

1898

1627

1899

455

Waltham................

1900

634

1901

179

Taunton................

1901

1202

1900

482

Chelsea....

1902

1246

1901

398

Newburyport...

1901

673

1902

150

Lowell...

1902

4077

1903

2304

Salem...................

1903

1432

1904

503

Woburn....

1903

842

1904

204

Fitchburg...............

1905

1160

1906

359

It would be too early as yet to size up the effects of the more recently enacted national prohibition.

1 Year Book of the Anti-Saloon League, 1908. - Twenty-sixth Annual Report of the Massachusetts Bureau of Labor. Boston, 1896. - Twenty-seventh Annual Report of the Massachusetts State Board of Charities, 1907.

As regards drug addictions, the solution of the problem would seem to be simple in comparison with the problem of alcoholism. No considerable opposition would be encountered to legislation which would make the importation, manufacture, distribution, and sale of habit-forming drugs a monopoly of the federal government and which would at the same time prohibit any unauthorized traffic in them.

It seems strange that in the world campaigns against syphilis there should have been until recently complete neglect of measures which have been so successful in the prevention of other communicable diseases, namely, the compulsory reporting of all cases, regardless of the manner or source of infection, and their hospitalization, if necessary, during the period of greatest infectiousness.

Local inunction with calomel ointment applied within an hour or even within several hours of exposure to the infection may prevent the development of syphilis.1

For the prevention of hereditary syphilis Fournier gives the following rule: "When a woman is pregnant with a child threatened, by paternal antecedents, with syphilitic heredity, syphilitic treatment of the mother, although healthy, constitutes for this child a real and powerful safeguard for which there is a precise and formal indication." 2

Finally there can be no doubt that in cases of syphilitic infection promptness and thoroughness of treatment, until the Wassermann reaction and cerebro-spinal fluid findings become and remain negative, is capable of greatly reducing or even eliminating the danger of involvement of the nervous system.