The etiology is still unsettled; and conflicting claims have been made as to the nature of the infective agent. Workers all over the world have had great difficulty in transmitting the disease from human cases of encephalitis to laboratory animals, and a successful transmission has been claimed in about six human cases only. McIntosh, Levaditi, Doerr, and others claim to have produced in rabbits and monkeys brain lesions indistinguishable from those characteristic of human encephalitis lethargica by inoculating a virus obtained from human cases. Other workers have shown that a virus obtained from herpes febrilis (not herpes zoster) used in the same way produces similar lesions. Levaditi has obtained a transmissible virus from a case of lethargic encephalitis, and by cross-immunity experiments showed it to be identical with the virus of herpes febrilis. This work has been confirmed by other writers. Levaditi, therefore, claims that encephalitis lethargica is the result of an extension of the virus of herpes from the naso-pharynx to the central nervous system as the result of an increased virulence due to some unknown cause at times of epidemic. On the other hand Flexner has reported the occurrence of a virus identical with that of herpes in an affection of the central nervous system in which there were no signs of encephalitis lethargica. Kling, Thalminer and a number of American workers have described an entirely different form of virus as the cause of the disease. The most recent work seems to show that this virus is probably derived from the spontaneous encephalitis of rabbits, originally described by Wright

and Craighead, and due probably to a minute protozoan. Finally Rosenow, Bastai and others have obtained various bacterial forms growing easily on ordinary media, and not passing through filters so fine as those traversed by the viruses mentioned above. The whole question of experimental transmission is clouded by the fact of a spontaneous encephalitis of rabbits. Nevertheless the similarity between the clinical symptoms and pathology of human encephalitis lethargica and those of experimental encephalitis in rabbits produced by the herpetic virus suggests some relationship between the two viruses, and it is along this line that much experimental work is being carried out at the present time in England and on the Continent.

There is no specific treatment. In England, as soon as the disease is recognized, the patients isolated from the other members of the household, or placed in a separate hospital ward, or on a "barrier" system. The services of a trained nurse are regarded as essential, and day and night attendance in all severe cases. During violent delirium the patient is nursed on a mattress on the floor. Hypnotics, morphia or other preparation of opium are not considered advisable. If urotropin is given, it is used in small doses with caution, and the urine tested daily for blood and albumin. Transient or permanent relief, with diminution of stupor has been noted in many cases to follow the withdrawal of cerebrospinal fluid by lumbar puncture. When this improvement results, it may be repeated, with due precautions, at intervals, according to the condition of the patient.

Encephalitis lethargica was made

compulsorily notifiable throughout England and Wales from the first of January, 1919. Medical Officers of Health are instructed to collect all facts of the associated conditions that may give them any light on the epidemiology of the disease, to search for mild and abortive cases, to aid in securing hospital treatment, to carry out precautions against the transmission of the disease, to secure cerebrospinal fluid for examination, and to take any action which they consider useful and practicable to secure postmortems and pathological examinations by skilled workers who are investigating the disease. Further, they are instructed to "follow up" and record the after-history of patients, in particular as to the occurrence of any mental after-effects which may be observed. Inquiry is also to be made into the previous history of children who begin to exhibit changes in behaviour or unusual accentuation of undesirable qualities, as such symptoms not infrequently point to an over-looked attack of epidemic encephalitis at some previous date. The occupants of a house are to be assured that the disease is one

of low infectivity, and that, while very slight risk is run by association with the patient, it is desirable that such association should be limited to what is necessary for proper care and nursing and the patient should be well isolated in a separate room. School children in the affected household may be kept from school, as a precautionary measure, for three weeks after the isolation of the patient. It is not necessary to place restriction on the movements of other occupants provided they are frequently examined and remain well. Those in contact with the case are advised to use antiseptic nasal sprays or douches, and to gargle the throat with such solutions as a 1 per cent solution of hydrogen peroxide, a 0.5 per cent of liquor sodae chlorinatae, or a 1:5000 solution of permanganate of potash in 0.8 per cent solution of sodium chloride. Any persons in the affected household developing sore throat or other symptoms suggesting a mild or abortive attack should be isolated as far as possible, and treated from this point of view until they have recovered. After recovery the sick room should be thoroughly cleaned and disinfected.

THE ACTION OF ALCOHOL ON THE HUMAN ORGANISM

A second edition of the published "Report of the Advisory Scientific Committee upon the Physiological Action of Alcohol," first issued in 1918, appeared early during the present year as a revision by the Alcohol Investigation Committee of the Medical Research Council of Great Britain for 1923. In addition to other interesting new matter it includes a new chapter on "Alcohol as a Medicine" which is worthy of consideration by all medical men. The statements in this report are not concerned with the social evils arising from alcoholism, nor is it concerned with ethics, administration or national economy. It is an attempt to deal solely with physiologic facts in so far as our present knowledge goes. Alcohol in its various preparations has from antiquity played a part in the treatment of many diseases; but in recent times its usefulness in medicine has come to be seriously questioned, and its use in many hospitals has been much reduced without injury to the patients, and in some clinics it has been abandoned altogether. There can be no doubt that a greatly exaggerated importance was laid on the value of alcohol in illness formerly, and the question at issue is whether its prescription has reached the proper limits or should be still further curtailed. In discussing the therapeutic value of alcohol we are not concerned with the poisonous effects of alcohol resulting from its use as a beverage, but have to consider only its value for the patient as a food and as a drug. Alcohol has no specific curative action on any disease. Whatever therapeutic value it may have must be through some one of those physiologic actions of alcohol for which clear evidence has been foundits narcotic action on the brain and nervous system; its dilating action on the cutaneous blood-vessels; its carminative action on the movements of the alimentary

canal reducing the tendency to painful and irregular contraction; and its action as a readily available food. Of these, the narcotic action is probably the most important from the therapeutic point of view. It may have a definite therapeutic value when the recovery of a patient is delayed or his condition aggravated by anxiety and worry, by allaying these and promoting rest and confidence. The fact that a patient may be made to feel less anxious and more confident may tell in his favor, although the alcohol has no effect upon the course of the disease. In such cases it should be prescribed with care and judgment as any other narcotic, and not administered at the discretion of the patient or his friends. On the other hand its action upon the mind in mitigating anxiety and discomfort may be dangerous to a neurotic patient. While alcohol cannot be regarded as having any food value for a healthy man, it may have a limited food value when the main object of the treatment is to control the restlessness and morbid anxiety of the patient, but little importance can be attached to its food value during convalescence or chronic illness. Indeed, if its administration leads the patient to take less of other more normal foods its use would be disadvantageous. The popular use of alcohol for griping pains and for abdominal discomfort generally, is probably related to the carminative action which it shares with other substances acting as mild irritants to the gastrointestinal mucous membrane, such as various essential oils, peppermint, cloves, etc. The action on the brain may also make the patient less keenly aware of the discomfort. From the medical point of view it can only be said that there are many alternatives equally effective, and that the recourse to alcohol to allay the minor discomforts of life, whether physical or mental, is probably the starting point for many cases of habitual intemperance, especially in women. Finally, the flushing of the body

surface caused by alcohol may have therapeutic value as an adjuvant action to the application of external warmth in the case of the victim of severe exposure to cold, as by immersion, or in the "chill" stage of a catarrhal infection. The Report summarizes the known therapeutic uses of alcohol as follows:

1. Its main value is due to its narcotic action, by which it allays excitement and distress, and induces rest and comfort, and thereby often ameliorates other symptoms indirectly.

2. Its limited food value may become important in association with its narcotic action under conditions in which ordinary nourishment cannot be taken.

3. By diverting blood from the internal organs to the surface it has an adjuvant action to the application of external warmth in warding off or abating the effects of the common catarrhal infection known as a "chill."

So much for the positive value of alcohol in therapeutics, and it is open to argument as to whether all of these therapeutic actions cannot be brought about by other agents. At any rate the therapeutic value of alcohol, as based upon scientific facts, lies in a very much restricted field, and is infinitely smaller than the popular belief would have it. Further, whatever real utility it may possess is liable to be obscured by the unthinking attribution to it of various qualities which it does not possess, and by the popular custom of recourse to it in almost every kind of emergency. The report further emphasizes the dangerous futility of certain popular illusions concerning the action of alcohol. In the first place the popular belief in alcohol as a remedy is largely based on the illusion that it has an important stimulant action on the heart, respiration and vital activities in general. Rational medicine has long since abandoned this belief, but it still lingers in popular practice. The popular supposition that alcohol stimulates the action of a failing heart has no basis in ascertained fact.

When a person suddenly becomes unconscious from any cause whatever, the first impulse of the sympathetic bystander ist usually to force liquor between the teeth of the victim. The indiscriminate administration of alcohol to a person found unconscious from an unknown cause is to be deprecated; it is unlikely to do good, and it may well do harm.

Another popular illusion is that which credits alcohol with a specific stimulant action on assimilation so that its habitual use is supposed to impart a physical robustness unattainable without it. With this may be classed the even more dangerous belief that the use of alcohol exerts a protective action against infection. There is good evidence, on the contrary, to show that the use of alcohol, in excess of the strictest moderation, definitely weakens the power of resistance to such infections as influenza and pneumonia. The prognosis in pneumonia for the user of alcohol is always bad, his habit has weakened his natural powers of resistance and cuts him off from any therapeutic benefit which an abstainer might obtain from the unaccustomed action of the drug at a critical period of the disease.

The Alcohol Investigation Committee of the Medical Research Council was made up of the following well-known experts: A. R. Cushny, Professor of Pharmacology in the University of Edinburgh; H. H. Dale, Director of the Department of Bio-Chemistry and Pharmacology in the National Institute for Medical Research; M. Greenwood, Medical Officer, Ministry of Health; E. Mellanby, Professor of Pharmacology in the University of Sheffield; Sir Frederick W. Mott, Director of Research at Hollymoor Mental Hospital; C. S. Myers, Director of the National Institute of Industrial Psychology; Sir Charles S. Sherrington, Waynflete Professor of Physiology in the University of Oxford; W. C. Sullivan, Medical Superintendent of the Broadmoor Criminal Lunatic Asylum.

ANNALS OF CLINICAL MEDICINE, VOL. III, No. 6

Rhus Dermatitis from Rhus Toxicodendron, Radicans and Diversiloba (Poison Ivy), Its Pathology and Chemotherapy. By JAMES B. MCNAIR, University of Chicago, Chicago, Illinois. 298 pages, 15 illustrations and 3 plates. University of Chicago Press, Chicago, Illinois. Cloth. This monograph on poison ivy dermatitis will be of great value to the internist, particularly to one connected with a rural practice, since this form of dermatitis is of such frequent occurrence throughout the greater part of the United States. The history and distribution, and botanical characters of poison ivy are fully discussed, as is also the origin and occurrence of the poison in the plant, and the relation of the poison to the morphology of the plant, and to its growth. The chemistry of the poisonous principle, its mode of transmission from plant to person, the pathology of rhus dermatitis, its differential diagnosis, internal poisoning from rhus, the questions. of natural and acquired immunity, and the treatment of rhus dermatitis are all given adequate chapters. A very full bibliography is appended. The book contains much valuable information on this subject.

The Nature of Love. By EMMAnuel Berl. Authorized translation by Fred Rothwell. 278 pages. The Macmillan Company, New York, 1924. Cloth. Price $2.00. One always approaches a book having a title of this kind with a certain amount of suspicion as to what degree of Freudism, eroticism, or degeneracy he may find contained within. This book is an exception. Biological explanations of the nature of love are rejected, as are also the sociologic explanations of the origin of this emotion. A philosophical argument is presented leading to the final conclusion that love is essentially an ecstasy similar in origin and kind to the religious ecstasy, originating in God and leading back to God. Numerous philosophical and poetical references are referred to throughout the book. While primarily a volume for the psychologist and philosopher, it is of interest to all physicians who keep in touch with the larger aspects of life, and to whom the study of psychology is of importance in the attempt to arrive at some understanding of the causes and motives underlying human actions and emotions.