106 PRESIDENTIAL ADDRESS SECTIOX F. 



1 shall first deal with a few psychoses, which clearly belong 

 to the intoxication group. 



It is not necessary to say much of these forms of mental 

 derangement which occur duiing the course of physical illnesses 

 and which are only caused by the toxins of these illnesses. 

 Take, as example, the delirium which is occasionally seen in 

 patients suffering from enteric fever or from sepsis. Without 

 the primary sickness no mental symptoms would have occurred. 

 As soon as the original affection improves, the mental picture 

 clears up, in the vast majority of cases. Therefore, the pro- 

 phylaxis of these psychoses is simply that of the underlying 

 physical condition. Now and again it happens that an infectious 

 disease, if it is of prolonged duration, has an exhausting effect, 

 and that, especially if the patient goes back to hard work before 

 he is fully recovered, a mental affliction becomes manifest. The 

 prophylaxis thereof is obvious, although in many instances it is 

 much easier to give the advice than to follow it. 



Amongst the intoxication psychoses, those caused by alcohol 

 occupy the foremost place. In almost any form of insanity we 

 find cases where alcoholism has to be regarded as one of the pre- 

 cipitating factors. But besides these there is a whole group of 

 mental disorders (in which alienists distinguish some eight or 

 nine different kinds), where alcoholism is undoubtedy the 

 principal factor if not the only factor; which, in other words, 

 would never have occurred if the patient had never touched 

 liquor. The degree of alcoholisation required to cause definite 

 mental changes varies greatly in different individuals : one man 

 may become the inmate of a mental hospital through the con- 

 sumption of less alcohol than many others can take with apparent 

 impunity. The most frequent alcoholic psychoses are : delirium 

 tremens and hallucinosis. The prognosis of each individual 

 attack is fairly good, but unless the patient has learnt his lesson 

 thoroughly and leaves alcohol severely alone afterwards, there is 

 great danger of recurrences I have frequently seen patients who 

 had recovered and who had sworn great oaths never to touch a 

 drop of the poison again, admitted two, three and four times 

 within a few years, with a mental picture, photographically the 

 same on each occasion. During every attack, however, the 

 patient runs a certain risk of dying from exhaustion or from a 

 complication, like pneumonia. Of the chronic forms I may men- 

 tion Korsakow's disease and the various degrees of alcoholic 

 dementia, from which there is no recovei'y and which make the 

 sufferer generally fully a social outcast and dependent on care 

 by others. This is not the place to discuss the general merits of 

 total prohibition. A strong argument in favour of it is this 

 o-'currence of alcoholic psychoses which would never have 

 developed if the individual had left liquor alone. Accordins- to 

 statistics of certain big cities, the incidence has been from 20 to 

 40 per cent, of all psychoses admitted to institutions. In South 

 Africa this percentage of the admissions for the years 1919 and 

 1920 was 11 per cent. The actual number is much larger, of 



