for by the failure to discover the existing hereditary taint. The difference is so great, however, as to make one think that perhaps too much stress has been put upon heredity.

Besides manic depressive and dementia præcox, several other groups showed considerable hereditary influence. In alcoholic insanity the large percentage of alcoholic family history is the striking feature.

General paresis apparently showed a large percentage, but the influence of heredity is probably not as great as the figures might imply.

Epilepsy gave a heredity of both psychoses and alcoholism.

Psychoses, peculiarities and habits among relatives were common in narcotic inebriety.

Imbecility likewise showed considerable hereditary influence. The frequency of alcoholic family history in certain psychoses is quite marked. As might be expected, the largest percentage of alcoholic heredity was shown in alcoholic insanity. In the manic depressive group and dementia præcox also, alcoholism in the relatives was far from being unusual.

While it may not be possible from the present evidence to conclude with absolute certainty as to the kind of psychosis in the relatives of manic depressive and dementia præcox cases, yet a few general statements are possible.

The prevalence of psychoses in the manic depressive group as compared with the percentage of the peculiar or eccentric type in dementia præcox is noticeable. In the manic depressive cases, although there is frequently doubt as to the character of the psychosis, the evidence seems strong as to the existence of some kind of a psychosis. On the other hand, in dementia præcox the relative is often described as queer, eccentric, or by some similar term.

The evidence seems to be against the theory as an absolute rule that cases of manic depressive and dementia præcox do not occur in the same family. At least one well-marked manic depressive woman was shown to have an undoubted dementia præcox brother and there were several other possibly similar cases, the diagnosis, however, not being so certain.

On the other hand, there are a number of instances of the same psychosis in the relatives both in dementia præcox and manic depressive.

ACUTE ALCOHOLIC HALLUCINOSIS (ACUTE

ALCOHOLIC PARANOIA).*

BY WILLIAM C. GARVIN, M. D.,

Assistant Physician, Manhattan State Hospital, New York City. The characteristic clinical features which form the symptom complex of this group of alcoholic psychoses appear, as yet, to be imperfectly understood by physicians engaged in insane work. An examination of the yearly reports of the various insane hospitals throughout the country will bear out this statement. The literature in English on the subject is very meagre. This is rather surprising, as the psychosis is a fairly common one in all insane institutions. I have thought then that a review of the German literature, together with our observations at the Manhattan State Hospital, might prove of general interest.

To Wernicke belongs the chief credit for his extensive and exhaustive studies in delirium tremens. Korsakoff performed brilliant work in isolating that particular form of mental and physical disorder which bears his name. Ziehen, Wernicke and Krapelin have contributed to our knowledge of acute alcoholic hallucinosis; but it remained, however, for Bonhoeffer of Breslau to make the most detailed and accurate study of this type of alcoholic mental disorder.

The symptom complex under discussion presents the following characteristic features:

The sudden onset in an alcoholic individual of hallucinations of hearing of a persecutory character, with anxious fear reaction or silent brooding, without loss of orientation or memory.

The disorder, as Bonhoeffer states, exhibits many features which bear a strong resemblance to delirium tremens and, for a thorough understanding of their relation, an exact knowledge of the cardinal features of this psychosis is necessary.

This observer mentions a systematized form of delirium tremens with transition to acute hallucinosis. We receive a number of such cases from the alcoholic ward at Bellevue Hospital, but as no detailed records are kept in that ward, we are unable to give

* Read at the sixty-fifth annual meeting of the American Medico-Psychological Association, Atlantic City, June 1-4, 1909.