moral insanity. Alcoholism cannot be cured until the inhalation habit is disposed of, and this habit cannot be disposed of without objective authorization by the patient. If there be mental reservation on this point, the smoking will be resumed and a relapse will be practically certain.

The government has begun a most meritorious campaign against drug-taking in the enforcement of the Harrison law. But it has left unnoticed two habits that are doing infinitely more damage to the brains and physical constitutions of the people of the United States than all the drugs put many times together-viz., the drink and cigarette habits. Three times the amount of our national debt (about $3,000,000,000) is spent annually in the country on alcoholic drinks and tobacco.1 Twenty billion cigarettes, it is estimated, are smoked every year. Boys and girls, men and women, are permitted, without protest from high quarters, to destroy their mental faculties and moral propensities by this practice.

Physicians have come to realize that those who abandon themselves to the double indulgence in tobacco and alcohol are practically committing suicide on the instalment plan. They can never

1 One million dollars represents the estimated amount expended daily in the city of New York for alcoholic drinks.

be at their best, and a cigarette-smoker represents as hazardous a risk from the viewpoint of life insurance as a consumer of liquor.

In closing this chapter the author must insist that the ill-success of a given suggestionist in the treatment of an alcoholic or drug addict does not imply that such a subject is incurable through psychodynamic influence. The sufferer should make trial of another personality. Especially is this to be considered in the failures of "Emmanuelism" (so noble in its conception and so successful in the hands of its founder), where cures are attempted by unqualified clergymen who are ignorant of the mental states in which receptivity is at its height, and who employ extremely crude methods of diagnosis and treatment. The same criticism applies to the quixotic efforts of theotherapy and the tedious procedures of psychanalysis.

THE PHYSIOPSYCHIC TREATMENT OF NARCOTIC

ADDICTION

We have seen drug addicts during or after fruitless efforts at treatment, their tortures and poor physical condition overcoming their resolutions, until they plead for an attempt to obtain more of their drug. We have seen them exhausted, starved, with locked-up elimination, toxic from self-made poisons of faulty metabolism, worn with the struggle of concealment and hopeless resistance, semi-irresponsible beings, soon to be inmates of institutions affording custodial care.

Our literature pictures them as weak-minded deteriorated wretches, mental and moral derelicts, pandering to morbid sensuality; taking a drug to soothe them into dream states and give them languorous delight; held by us all in despite and disgust, and regarded as so depraved that their rescue is impossible.

Dr. ERNEST S. BISHOP, New York.

Probably the gravest alterations-distorted judgment, emotional deterioration, character changes, etc.-occur in the mental sphere. These perverted mental habits present, ordinarily, the greatest difficulty in establishing ultimate cure; yet it is to these changes that least attention is usually paid. The mathematical schedule of therapy is addressed to the physical side, and after such administration those in attendance often feel that they have done their whole duty, and the patient is likely to be dismissed with a complacent, "Now you're off your drug; it's your own fault if you go back." As a matter of fact, many cases of addiction are found to be an expression of a definite neurosis or psychoneurosis. To expect to cure such, or bad environment, by means solely of intensive purgation and belladonna or scopolomin medication is simple folly. Such cases can be reached adequately only by psychanalysis (better, the analytic psychotherapy that gives the patient self-knowledge not only of the existence and influence, but also of the causes of his craving, with the power to overcome them, through the luminous methods of dynamogenic suggestion). C. C. WHOLEY, M.D., Physician in Charge of Drug Addictions, St. Francis Hospital, Pittsburgh.