based on scientific knowledge which should be quite familiar to the general practitioner. On such an occasion a word fitly spoken is like apples of gold in pictures of silver.

Doctors in general practice can further help their health departments by reporting early all cases of patients with communicable diseases; cases of confinement and all deaths, being careful to give the exact cause or causes of death. The list of reportable diseases is growing constantly. Influenza is now reportable in many municipalities. Sometimes reporting of this disease is neglected or overlooked by the doctor.

The family doctor would do well to follow the lead of the public health doctors, making periodic examinations of members of the households of his clientele, just as the others do of the school children. He can give physical examinations of all children. He can do baby welfare work, give prenatal care, give first aid in cases of slight injuries, rashes, sore throats, etc. In many communities the school-nurse is robbing the doctor of this work. He should be able to do ordinary tonsillectomies and adenectomies.

On the other hand, the health departments are assisting the rank and file of the profession. First in importance is the laboratory work they perform for them: examination of throat swabs, sputum, blood for Widal tests and Wassermann reactions and the like. Then follows the gratuitous distribution of antitoxin, and other medicaments. Many health boards will send one of their men to consult with the practitioner in doubtful cases of exanthemata.

It is the practice, too, to extend to the family doctors the privilege of attending their own patients in the Health Department's Isolation Hospitals a courtesy not yet extended by many of the general hospitals.

As time goes on, more and more will these two classes of servants of the public get together; and that for the benefit of each and for the people whom they serve.

and National Hygiene

Incorporating The Dominion Medical Monthly

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Selected Articles

THE DRUG HABIT*

W. E. DIXON, M.D., B.Sc., F.R.S., READER IN PHARMACOLOGY AND ASSESSOR TO THE REGIUS PROFESSOR of PHYSIC, UNIVERSITY OF CAMBRIDGE.

Our conscious life may be regarded as a collection and perception of sensory impulses. The ever-changing conscious personality is controlled in adult life by centres which develop only after the age of 10. These later developed centres, such as those of control, judgment, attention, and choice, govern the lower centres, such as those of emotion, so that natural emotions are rarely expressed in adult civilized and cultured life. The repression of sexual emotion is an example, and it is an everyday experience that with age our memory for proper names fails, not because of any loss of function of nerve tissue, but by a repression caused by the exaggerated activity of the higher centres. The subject is bound up with what we have come to term psychotherapy.

But repression, like other higher faculties of mind, is very different in different individuals. Some are so highly reflex, so easily responsive to external impressions, that the associations set loose by any ordinary stimulus cause such a complexity of cerebration that the ordinary affairs of life become a burden. Such people are not phlegmatic and uninteresting, but are rather those possessed of quick perception, acute sensibility, and other higher attributes of mind which go to make up high breeding and culture.

But such a complexity of cerebration cannot continue long; soon it gives place to fatigue, depression, and mental distress. Such people we term neurotics, and they form a class pecu liarly prone to succumb to narcotics.

Increased nervous sensibility appears to be a product of civilization and wealth, of indoor life, luxury, and perhaps

*Lecture delivered before the East York Division of the British Medical Association at Hull, February 9th, 1923.

excessive indulgence in the satisfaction of desires. It is diffi cult to form an estimate of this factor, but attempts have been made to guage relative sensibility in different nations by estimating the number of women who employed anodynes during normal parturition. The figures obtained were for the United States 70 per cent., Great Britain 50 per cent., and for Spain and Russia 5 per cent. The figures are interesting

in view of the prevalence of drug addiction in the States.

A tendency has shown itself in recent years to classify patients into two groups-those exhibiting an excess of vagotonia, like dogs, and those exhibiting an excess of sympatheticotonia, like cats. These two types of people, if they receive the same stimulus, respond differently. The members of the one group may grow pale and their pulse slow, while members of the other may flush and their pulse race. Dogs die in the early stage of chloroform narcosis by vagal inhibition and cats by ventricular fibrillation, probably induced by sympathetic stimulation.

These neurotics always belong to the sympathetic group; they easily weary of the strain and anxiety involved in the fight for existence, and anything that gives them relief from their cares and anxieties is seized with avidity. Now it is these higher faculties of mind which are most responsive to narcotic poisons; they are influenced long before those concerned with movement and ordinary sensation. So that such abnormal people, under the influence of narcotics, lose the exaggerated effect of their normal sensations, and become more like normal people; the everyday trifles and inconveniences of life are no longer exaggerted out of all proportion to their significance, and life, instead of being oppressive and anxious, becomes pleasant and free from worry. Sometimes the very acuity of their intellect is their undoing. Perhaps in a few special instances persons possessed of such vivid sensations may benefit by a narcotic which limits these conflicting impulses by allowing a freer play of the higher mental faculties; certainly the records of De Quincey and Coleridge suggest such a possibility.

I have no doubt that the drug addict is a psychopath before ever he becomes addicted, that the ordinary normal man or woman is as unlikely, even with every facility at hand, to become an addict of morphine or cocaine as he is to become a drunkard. A lady who for a short period worked in my laboratory injected herself daily with morphine until 2 grains