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The 
 
 Drug Habits and 
 
 Their Treatment 
 
 A Clinieal Summary of Some of the General 
 Facts Recorded in Practice. 
 
 By T. D. CROTHERS, M. D., 
 
 SUPERINTENDENT WALNUT LODGE HOSPITAL, HARTFORD, 
 
 CONN. ; PROFESSOR DISEASES OF THE BRAIN AND 
 
 NEKVOUS SYSTEM, NEW YORK SCHOOL 
 
 OF CLINICAL MEDICINE,N.Y. ETC. 
 
 CHICAGO: 
 
 G. P. ENGELHARD & COMPANY, 
 1902. 
 

 Copyright 1902 
 By G. P. ENGELHARD & COMPANY. 
 
>- 
 
 -J 
 
 o 
 
 PREFACE. 
 
 The Disease of Inebriety is now passing through 
 the empiric and squatter stage of development, 
 which meets every new truth of science. The 
 partial recognition of the Disease of Inebriety has 
 attracted the empirics, who, like squatters in a 
 new country, rush in and occupy the land with 
 great noise and pretension. They never build 
 towns or cities, or develop the country, but dis- 
 appear when permanent settlers arrive. This lit- 
 tle work comes in the capacity of a permanent 
 settler, and aims to point out some of the general 
 facts and conditions of Inebriety, and to indicate 
 the great possibilities awaiting further research 
 and more exact study. The curability of this form 
 of neurosis is established beyond question, from 
 the limted studies and experience of the present. 
 Evidently we are on the threshold of a new realm 
 of practical science, in the study and cure of the 
 Disease of Inebriety, and the results may exceed 
 any present expectation. 
 
 The Journal of Inebriety, which was established 
 in 1876 to promote the study of spirit and drug 
 neuroses, has published nearly all the literature on 
 the subject for the past quarter of a century. The 
 
6 DRUG HABITS AND THEIR TREATMENT. 
 
 student of tliis topic lias to do pioneer work with 
 little or no aid from others, and this Yolume comes 
 as an assistant to suggest lines of study and point 
 out the direction for future inquiries. 
 
 These neuroses are rapidly increasing, and their 
 study and treatment is hecoming more and more 
 imperative. The colleges will have to add to their 
 curriculum this new tield of study; alread}^ a ISTew 
 York college has taken up this subject and lectures 
 are given on the topic. This work is only a gen- 
 eral discussion of a topic which will be treated 
 by the author more exhaustivel}^ in a larger work 
 now preparing. If this work brings new interest 
 to the subject and increases the number of scien- 
 tic workers, its object will be accomplished. 
 
 T. D. CEOTHERS, M. D. 
 
CONTENTS. 
 
 CHAPTER I. PAOE 
 
 Habit and the Damages of Alcohol ... 9 
 
 CHAPTER II. 
 Dipsomania , . . . 29 
 
 CHAPTER III. 
 ^ Opium Inebriety 61 
 
 CHAPTER IV. 
 Cocain and other Drug Habits 75 
 
CHAPTER I. 
 
 HABIT, AND THE DAMAGES OF 
 ALCOHOL. 
 
 The popular and common meaning of the word 
 habit is some state or condition of the body, vol- 
 untarily acquired and continued at the will of the 
 person. Conduct and acts which can be changed 
 or checked by the will, and are apparently under 
 the control of the person, are called habits. In 
 its broader, scientific sense, there is a physiological 
 and psychological tendency to repeat the same acts 
 apparently outside of the control of the will. It 
 is this meaning of the word habit which will be 
 used in the present study. 
 
 Of all the drugs used either medicinally or as 
 beverages, alcohol seems to be the most destructive. 
 In recent times this fact is becoming more and 
 more apparent in science studies. All the recent 
 text-books on the practice of medicine recognize 
 the dangers from the use of alcohol, and its influ- 
 ence as a contributory cause in many of the organic 
 diseases of the body and brain. The modern 
 clinician inquires into the history of the use of 
 alcohol, either moderately or immoderately, and 
 this fact is important in a knowledge and treat- 
 ment of the cause. Next to syphilis, alcohol is one 
 of the most potent poisons in the causation of dis- 
 
10 DRUG HABITS AND THEIR TREATMENT. 
 
 ease. In the neuroses, alcohol is very prominent 
 as an active or contributory cause. The various 
 palsies, mental derangements, and disturbances of 
 nutrition, circulation and obscure organic af- 
 fections, are always better understood when all 
 alcoholic causation is eliminated. In pneumonia, 
 the prognosis is very different where there is no 
 history of the use of alcohol. In surgical treat- 
 ment the fact of the use of alcohol complicates 
 the results. While alcohol is still used as a medi- 
 cine in many instances, its influence as a cause of 
 disease, both active, predisposing and contributory, 
 is becoming more and more prominent. Eecent 
 researches show that alcohol has a peculiar, cor- 
 roding action on the cell and tissue. It is not only 
 a toxin but produces toxins which are chemical and 
 physical poisons. Every new advance in the chemic, 
 physiologic, pathologic and psychologic fields 
 brings out this fact of the danger of alcohol either 
 in moderation or in excess. The increasing num- 
 ber of cases which become disabled and degener- 
 ate in almost every community from the use of 
 alcohol suggests something more than moral lapses 
 and sinful weakness. 
 
 HISTORY AND ASSOCIATIO^ST WITH OTHER DISEASE. 
 
 A clinical study of accurately grouped histories 
 of a large number of cases brings ample confirma- 
 tion of the fact that inebriety or alcoholism is a 
 disease. A closer study of these causes indicates a 
 
HABIT, AND THE DAMAGES OF ALCOHOL, 
 
 11 
 
 distinct and clearly traceable causation, also a 
 uniform development and progress, and a uniform 
 symptomatology and termination. The physical 
 conditions apparently resulting from the poison- 
 ings of alcohol on the nerve centers and organic 
 activities appear to follow a definite, organized 
 line of degeneration whose progress and termina- 
 tion can be traced with much certainty. 
 
 The idea of disease is very old, and dates back 
 to the early ages of the world. The fathers of 
 medicine asserted that drunkenness was a disease, 
 and curable as other diseases. Hippocrates, Galen, 
 and many of the old worthies gave strong opin- 
 ions on this subject but these facts were not formu- 
 lated into theories until the beginning of this cen- 
 tury when Dr. Eush in this country, and Salvator 
 of Russia, and Cabanis of France, formulated 
 and put into active service these facts. The disease 
 of inebriety and its pathology and treatment has 
 been studied more accurately in America than else- 
 where. The first inebriate asylum organized in 
 1864, took up this subject as a medical one in 
 advance of all others. From that time the growth 
 of the subject has extended all over the world, 
 and researches and literature have been very 
 largely the result of the efforts of Americans. The 
 Journal of Inebriety, the organ of this new study, 
 has been published since 1876, giving researches 
 and facts along this line exclusively. 
 
12 DRUG HABITS AND THEIR TREATMENT. 
 
 When the drink symptoms of alcohol are ex- 
 amined with more care, they are found to be 
 closely related to a great variety of neurotic dis- 
 eases. In many cases they appear to be phases or 
 types of epilepsy, hysteria, neuralgia, also closely 
 allied to consumption, and intimately connected 
 with heart disease. Many of the degenerations 
 of the nerve centers, such as the palsies, the paretic 
 states, have alcoholic stages and symptoms. ISTeu- 
 rasthenia in all its types and forms is often man- 
 ifest in this way. jSTerve storms, such as head- 
 ache, neuralgias of the stomach, and various parts 
 of the body often precede and follow alcoholic ex- 
 cess. The vaj-ious organic and functional affec- 
 tions of the heart often exhibit tliis drinlc symp- 
 tom. Tuberculosis alternates with drinlc excesses. 
 At one time acute symptoms of breaking down of 
 nerve structure is checked by the advent of a drink 
 craze. When this subsides, the acute symptoms 
 reappear. Not unfrequently they are associated, 
 and it is difficult to decide which is cause and 
 which is effect. The epilepsies seem to have drink 
 symptoms more commonly than other diseases, the 
 drink craze taking the form of paroxysm and sub- 
 siding after a time in ranch the same way as the 
 epilepsies. The periodical drinkers are very largely 
 of the class of explosive epilepsies in which nerve 
 energy gathers and bursts at stated intervals. The 
 frequent use of alcohol in these neurotic cases 
 
HABIT, AND THE DAMAGES OF ALCOHOL. 13 
 
 suggests the disease character and the action of phy- 
 siological laws which are at present largely unknown. 
 
 FORMS OF INEBRIETY AND DRINK HABITS. 
 
 The various forms of alcoholic drinking may 
 be grouped into three classes, namely, the contin- 
 uous, the periodical, and the regular. Beyond this 
 there is a class which may be called the contagious 
 or neurotic cases which seem not to drink except 
 from peculiarly exciting conditions. These various 
 classes are well-known and often merge into each 
 other. 
 
 The continuous drinker seems to possess the 
 poAver of using alcohol in uniform doses at short 
 intervals without exhibiting any marked derange- 
 ments of character and conduct. He belongs to 
 those who pride themselves on being able to drink 
 without any serious damage. They are the mod- 
 erate drinkers in every community whose masked 
 condition is misleading to all except to physicians. 
 They die suddenly from congestion of the brain, 
 hemorrhage or pneumonia. Often they are found 
 dead in bed or die from heat or sun-stroke. Some 
 of these persons become insane, usually of the 
 type of dementia. Others have palsies from which 
 they never recover. Such persons suffer first in 
 the community from the presence of epidemic 
 diseases, and seem to have no resisting power to 
 concussions, injuries or shocks. The spirit and 
 beer-drinking longshoremen at Liverpool have a 
 
14 DRUG HABITS AND THEIR TREATMENT. 
 
 frightful mortality. Yet they are types of physical 
 strength and vigor and seldom appear to suffer 
 from intoxication. They are unable to resist the 
 slightest attack of disease, and die from the sim- 
 plest injuries. In this country few moderate drink- 
 ers attain the average longevity of the race unless 
 they are muscle workers and live in the open air. 
 As brain workers, living indoors, their length of 
 life is greatly diminished. 
 
 Most of the drinkers after a variable time merge 
 into periodical or impulsive drunkards, and drink 
 to stupor or maniacal conditions. It rarely hap- 
 pens that men can drink in moderation in this 
 country where the condition of mental strain is in- 
 tense and exhaustive. The periodical drinker is 
 always a neurotic. The excessive use of spirits 
 after a free interval is of the nature of a nerve 
 storm. The morbid gathering of the energies of 
 the system explodes in this impulsive, unreasoning 
 demand for relief which alcohol most quickly 
 overcomes. There will be perfect freedom from 
 desire, and even distrust for spirits up to a cer- 
 tain point ; then an overpowering impulse to drink 
 will follow. Nothing short of complete satura- 
 tion from alcohol and profound and repeated nar- 
 cotism, which seems to exhaust the nerve energies, 
 will satisfy this morbid demand. The abrupt be- 
 ginning and sudden termination of the drink 
 paroxysm indicates its neurotic nature. 
 
HABIT, AND THE DAMAGES OR ALCOHOL. 15 
 
 Then follows a long free interval. In some 
 instances the return of the drink paroxysm is uni- 
 form as to time, rarely varying more than an hour. 
 This periodicity is so absolute and positive that 
 it can be traced, and even anticipated. In other 
 cases it is irregular, and depends upon unknown 
 conditions or on some special exciting cause, which 
 when removed, is followed by a cessation of the 
 paroxysms. Many of these eases are literally epi- 
 leptoid, and frequently merge into convulsive 
 spasms which are called alcoholic epilepsy. The 
 palsies after the cessation of the drink craze and 
 the convulsive activity of the muscles indicate 
 central brain lesions of grave character. The 
 symptomatology of these cases is a very inter- 
 esting study, and while each case differs widely 
 there is often a uniform movement which can be 
 readily traced. 
 
 SYMPTOMATOLOGY AND CLASSES OF DRINKING MEN. 
 
 Many of these cases appear among the active 
 brain workers of the country, and their addiction 
 is concealed. The sudden disappearance of ener- 
 getic, active men, and their return in a week or 
 two a little paler are the general indications of 
 these alcoholic attacks. Some of these cases use 
 spirits only at midnight and alone. Others never 
 drink except at the club and in certain company; 
 and then only at stated intervals. Many of these 
 
16 DRUG HABITS AND THEIR TREATMENT. 
 
 persons frankly confess that they go off to indulge 
 in this alcoholic narcotism, that it is an irresist- 
 ible charm which they are powerless to control. 
 Others conceal these attacks or explain them aa 
 due to other causes. 
 
 Not unfrequently these attacks end in acute 
 mania from which recovery is very slow, and in 
 many cases does not follow. After the subsidence 
 of the drink storm, the mind often retains its 
 exalted and delusional state, and permanent men- 
 tal troubles begin. Some of the most dangerous 
 homicidal cases have followed the drink excess of 
 periodical drinkers. General paralysis is often 
 a sequel of this form of drinking. Paranoia, and 
 many of the obscure mental disorders come from^ 
 this cause. 
 
 The third class of irregular or impulsive drink- 
 ers are very numerous, and drinlc or abstain from 
 causes and conditions very obscure. Sometimes a 
 period of abstinence extending over years will 
 occur, then they will drink to excess and continue 
 at irregular intervals for an indefinite time. Such 
 persons drink when excited or from overwork or 
 underwork or any other causes which seem to 
 break up the uniformity of their life and surround- 
 ings. Many of these persons explain the drink 
 craze by the most trifling, childish theories. Often 
 they appear in temperance meetings, and describe 
 with great minuteness their sin of drinking, giving 
 
HABIT, AND THE DAMAGES OF ALCOHOL. 17 
 
 great prominence to the struggles which, they claim 
 to have undergone in the effort to abstain trom 
 drink. They are also prominent at prayer-meet- 
 ings, and pose as types of the power of conversion. 
 There is in this class a mixture of imbecility and 
 delusional cunning which is not well understood. 
 At times they appear like dipsomaniacs over- 
 whelmed with a mad craze for spirits but unlike 
 this class, when forced by adverse circumstances 
 and with apparent objects to gain, they show 
 remarkable power of abstinence. Others of this 
 class drink in favorablp circumstances only, and 
 abstain when their interests are in peril. The 
 drinking seems to be of a mental as well as a 
 physical type. The mind recurring to alcohol as a 
 help when the conditions are favorable. They alter- 
 nate between extreme condemnation of persons 
 who use it, and childish theories and explanations 
 of their own addiction. They are filled with buo)'-- 
 ant and most extravagant theories of the methods 
 of relief and means of escape, and are the most 
 devoted advocates of all new remedies and means 
 of treatment. Among these persons the mental 
 element will often develop into fixed delusions 
 of the necessity of alcohol as a medicine, and 
 many of the most devoted advocates of the tonic 
 and stimulant powers of alcohol belong to this 
 class. Some of these persons use wines continu- 
 ously, and only resort to alcohols at long inter- 
 
18 DRUG HABITS AND THEIR TREATMENT. 
 
 vals. Such, cases become elemented after a time, 
 and are noted as cranks, paranoiacs and persons 
 with twisted brains. The}^ belong to the eccen- 
 tric class, and those who are "uncertain, unreliable, 
 unstable, and likel}^ to develop into more pro- 
 nounced forms of mental disease. 
 
 A stud}' of the causes of these different classes 
 reveals varied and complex conditions. When the 
 histories of a large number are carefully gathered 
 and compiled, it is found that over sixty per cent 
 have inherited from their parents a predisposition 
 to seek for some relief for states of depression 
 and ill-feeling. 
 
 HEEEDITT AXD FORMS OF PEEDISPOSITION". 
 
 These causes are divided into two classes, one 
 called direct and the other indirect. The direct 
 heredities are those where the parents have been 
 moderate or excessive drinkers. The indirect 
 heredities are cases where grandparents drank or 
 used drugs. 
 
 In the first class, there is often a direct trans- 
 mission from parent to child of the drink impulse 
 appearing at about the same time as in the par- 
 ent, following a uniform course, and ending in 
 the same way. 
 
 Example. One family for three generations 
 had several sons in each branch who began to 
 drink at pubert}^, and either died or became total 
 
HABIT, AND THE DAMAGES OF ALCOHOL. 19 
 
 abstainers at about thirty years. The daughters 
 in these families were drug-takers and alcoholics, 
 hysterical, and epileptoid. Some of them died in 
 early life but all showed marked defects of brain 
 and nervous system. 
 
 The rule is that where alcohol takers have 
 large families, the tendency is to an early extinc- 
 tion. The defects transmitted seriously impair 
 longevity under the most favorable conditions. 
 Many children of drinking parents are total ab- 
 stainers until some serious change or physical rev- 
 olution takes place in their organism; then, if 
 alcohol is used, they become impulsive drinkers 
 of the most imbecile type, drinking usually to 
 death. Other descendants of alcoholic ancestors 
 are delusional fanatics in their conceptions of the 
 drink disease and their theories of its remedies. 
 
 It may be stated as a rule that the children of al- 
 coholic parents are defectives, and will often use 
 alcohol with or without any particular exposure. 
 The exceptions to this only indicates a change in 
 the type of degeneration. For instance, daughters 
 of alcoholized parents show great feebleness of 
 moral faculties and become prostitutes, hysterics 
 and degenerates. If they fortunately escape this, 
 they may develop in later life some of the manias 
 ■\\'hich indicate their unsoundness. 
 
 In the third generation from the alcoholized 
 parents extreme types of weakness with mental in- 
 
30 DRUG HABITS AND THEIR TREATMENT. 
 
 capacity and physical defects appear. Statistics 
 of the criminal and degenerate classes show a 
 large percentage of alcoholized parents. Morel, 
 of France, has made a table of this decline which 
 can be stated with great certainty as showing the 
 line of degeneration. First generation, alcoholic 
 excesses with immoralities and degradation. Sec- 
 ond generation, early drunkenness, manias, and 
 general palsies, with criminality and pauperism. 
 Third generation, sobriet}'-, hypochondria, great 
 feebleness and paralysis. Fourth generation, men- 
 tal feebleness, idiocy and extinction. 
 
 In the examination of a large number of cases, 
 these direct heredities of persons in this country 
 seem not to pass beyond the second generation. 
 The vitality becomes exhausted and early death 
 from acute and chronic disease follows. 
 
 The general principles that obtain in these cases 
 may be stated as follows : All children of inebri- 
 ate parents inherit a defective vitality with feeble 
 power of resistance and inability to adjust them- 
 selves to the surroundings. These conditions of 
 weakness and degeneration diminish the power of 
 resistance to all inflammatory disease and make 
 narcotism from alcohol fascinating because it 
 brings with it a feeling of strength and relief 
 from physical and mental pain. 
 
 Often the higher moral faculties of the person 
 are undeveloped, and the children of alcoholized 
 
HABIT, AND THE DAMAGES OF ALCOHOL. 31 
 
 persons are born criminals without consciousness 
 of right and wrong, and with a feeble sense of 
 duty and obligation. 
 
 Another curious fact is that the children of 
 alcoholized persons often show great fecundity and 
 have large families, suggesting the oft-noted fact 
 that just before the extinction of the race Nature 
 makes a supreme effort to perpetuate the seed 
 and to save it from obliteration. While these in- 
 ebriates' families are often large, they rarely live 
 through childhood, and carry into maturity defects 
 which soon cause their extinction. Families of 
 this kind are by no means uncommon. The gen- 
 eral history clearly indicates degeneration, both in 
 appearance and conduct. Tuberculosis, hysteria, 
 eccentricity, rheumatism, and an almost endless 
 variety of neuroses appear. Occasionally some 
 member of these dying families will be brilliant 
 and precocious, and start far away above his age 
 and generation in intellectual development and 
 achievement but die suddenly. The vast major- 
 ity comprise the dying masses or as it is popularly 
 termed "the driven-out, or crowded-out remnants 
 of the race." 
 
 The indirect heredities are equally sta.rtling. 
 Why one generation of sober people should inter- 
 vene, and only in the third generation the defects 
 of the grandparent appear is difficult to under- 
 stand. In the figures we have mentioned the 
 
23 DRUG HABITS AND THEIR TREATMENT. 
 
 indirect heredities will be from a third to a half 
 of the sixty or seventy per cent of cases. In all 
 probability some form of defects has laid dormant 
 through one generation and breaks out in the third 
 from the application of some exciting causes or 
 possibly in the second generation there was an 
 absence of these causes. Nearly all these persons 
 who develop alcoholism in the third generation 
 also exhibit various neurotic troubles, both of ner- 
 vous system and nutrition, also a tendency to rapid 
 exhaustion. 
 
 The following is an example: An inebriate an- 
 cestor had four children who were temperate and 
 well. Of their children, eight out of eleven drank at 
 different times, four of them dying from this 
 cause, the others becoming demented or dying 
 from intercurrent diseases. Other members of the 
 family were neurotics and died of consumption or 
 broke down in early life and were invalids. 
 
 In three cases under my care, there was no in- 
 ebriety in the ancestors but in the grandparents 
 on both sides there had been excessive drinking. 
 Each of these cases had a very careful training 
 and the inebriety did not break out until middle 
 life. The conditions in which it developed pointed 
 out clearly the neurotic inheritance. There is no 
 more mystery in this than the transmission of 
 physical defects from one generation to another or 
 the skipping of one generation and the develop- 
 
HABIT, AND THE DAMAGES OF ALCOHOL. 23 
 
 ment of the same peculiarity in the second or third 
 generation. 
 
 In these drug diseases there is probably trans- 
 mitted some special tendency to seek relief in 
 some way from psychical and physical pain. Al- 
 cohol gives the most positive relief of all other 
 drugs. There is also transmitted a low degree of 
 vitality with feeble resisting powers to pain, and 
 defective control. The person suffering from 
 nerve or mental pain is unable to bear discomfort 
 and becomes possessed with the impulse to secure 
 relief at all peril. There is also, no doubt, trans- 
 mitted some latent predisposition to hyperaesthe- 
 sia and exhaustion of the nerve centers which pro- 
 voke morbid impulses to overcome them. 
 
 NEUEASTHENIA AND OTHER CAUSES. 
 
 !N'ext to heredity as an active cause in inebriety, 
 states of exhaustion and neurasthenia are most 
 prominent. The use of drugs, particularly alco- 
 hol, is far more impulsive and precipitate in this 
 country than elsewhere. No doubt this is due to 
 the intensity of living, the continuous excitement 
 and rapid change in life and living occupying 
 nearly every moment of the time, drawing con- 
 stantly on the energies of the brain and body 
 without healthy periods of rest. To this is added 
 the consequent neglect of the healthy normal func- 
 tions of the body. As a result neurasthenia, cere- 
 
24 DRUG HABITS AND THEIR TREATMENT. 
 
 brasthenia, and other profound neuroses lower the 
 vitality of the body and produce a condition of 
 mental pain and suffering for which narcotic drugs 
 are most grateful. Often these conditions of ex- 
 haustion begin in early life and are intensified by 
 educational training and bad conditions of living. 
 The overworked and those who have a large burden 
 of cares and exacting duties, and who neglect to 
 live in accord with the requirements of their life, 
 soon exhaust their vitalities and become early vic- 
 tims. They become drug-takers, finding most 
 ready relief in 'T)itters" and remedies containing 
 alcohols, and soon abandon these for the various 
 compounds of strong liquors. 
 
 There are others who become neurotic from bad 
 surroundings, suffer from shocks, both physical 
 and mental, and have stages of extreme depression 
 in which alcohol is a grateful remedy. 
 
 The perturbations and changes of puberty are 
 often fatal periods for the development of this 
 predisposition. The disasters and storms of later 
 life have the same effect. 
 
 The failures of nutrition, conditions of starva- 
 tion, with anemia and insomnia, are all active 
 causes. 
 
 There are a number of persons in every com- 
 munity who are constitutionally sensitive to their 
 surroundings. They seem to refiect the company 
 they are associated with as well as the hygienic 
 
HABIT, AND THE DAMAGES OF ALCOHOL. 25 
 
 conditions they live in, and are subject to every 
 fluctuation of both, mental and physical condi- 
 tions of life. Such persons are intemperate or 
 temperate according to the presence of temptation 
 or absence of it. 
 
 Inebriates of this class are called contagious 
 inebriates. 
 
 Where the causations are clearly physical, they 
 early become chronic and develop serious disease. 
 Such persons are usually neurotics of the hyper- 
 esthetic, emotional class. They often possess 
 genius but are impulsive, unreasoning and credu- 
 lous, accepting the conclusions of the present with- 
 out doubt or question, and also seem to be gov- 
 erned entirely by present impressions. In com- 
 pany with drinking men they imitate them. With 
 abstainers, they are abstinent, and never seem to 
 realize that they cannot do as others do without 
 suffering. Many of this class are wanting in cul- 
 ture and training. Often they come from indul- 
 gent family circles where every wish has been 
 gratified. In other circles where they have been 
 isolated, and seldom come in contact with new 
 persons and conditions of life, they become mere 
 imitators, and do not seem to be able to adapt 
 themselves to any new conditions but are molded 
 by the surroundings entirely. Such persons are 
 often described as "sowing wild oats" at this time. 
 
36 DRUG HABITS AND THEIR TREATMENT. 
 
 and from bitter experience acquire certain predis- 
 positions which are fatal through all after life. 
 
 Parents and guardians are more responsible for 
 this condition than the victims themselves. Young 
 men and women with this pliable contagious men- 
 tality require more than school and home train- 
 ing. They need to be under the control and direc- 
 tion of robust and controlling minds for a long 
 time. 
 
 As inebriates such persons early become de- 
 mented and fall into pauperism and petty crimes, 
 rarely becoming criminals except of the lowest 
 type. 
 
 As patients, nothing but a revolution of sur- 
 roundings and conditions of living will be of any 
 advantage. They are subject to every new method 
 of treatment, and bec^ome restored and pose as ex- 
 amples of cure from every condition and method 
 of treatment. Then they relapse as quickly, and 
 seem so thoroughly identified with the surround- 
 ings that it is difficult to classify them. 
 
 Types of the two classes are apparent in the 
 following examples: 
 
 A , the only son of an excellent clergyman, 
 
 was brought up without the slightest control, and 
 every whim was gratified. In college he fell in 
 with drinking companions, and drank to great ex- 
 cess. Later, as a merchant, he drank in company, 
 and wherever he went seemed to follow the habits 
 
HABIT, AND THE DAMAGES OF ALCOHOL. 27 
 
 and practices of those he was associated with. 
 He was converted frequently, signed the pledge on 
 many occasions, went to several asylums, came 
 away restored — only to relapse when brought in 
 contact with drinking company. Finally, at thirty 
 years of age, he was sentenced to prison as an 
 accessory to murder. He is there at present, and is 
 a most reputable prisoner, allowed great liberties, 
 and is an active man in his place. 
 
 The exact surroundings and prison discipline 
 have brought him to a higher standard of living 
 than he has had before. When his sentence is fin- 
 ished he will be employed in the prison, and prob- 
 ably will live a useful, temperate life. 
 
 Example ISTo. 2 is that of a farmer's son, brought 
 up in the interior, isolated, and seldom coming 
 in contact with other persons. At twenty he pro- 
 cured a situation in a large city, and soon became 
 an inebriate, and drifted from place to place, hav- 
 ing no individuality — simply following every influ- 
 ence which is brought to bear on him. Finally, 
 ten years later, he became a servant of a vigorous 
 man who realized his flaccid character, and treated 
 him with great severity, forcing him to live in 
 correct surroundings and away from bad company. 
 He remained here many years and was a temper- 
 ate, valuable man. Then his employer died, and in 
 another situation he became a drinker and soon 
 relapsed and died. 
 
«o DRUG HABITS AND THEIR TREATMENT. 
 
 Both of these eases are types of a class of per- 
 sons who in certain surroundings could be made 
 useful citizens, and, acting under the control and 
 dictation of others, might be free from all use of 
 drink. 
 
DIPSOMANIA. 39 
 
 CHAPTER II. 
 
 DIPSOMANIA. 
 
 Dipsomania^ as its name implies, is an insane 
 thirst or craze for alcohol. This disease is not 
 very common, and frequently appears without 
 premonition. Such persons have used spirits in 
 moderation or at intervals, rarely to stupor, and 
 are considered temperate. Suddenly, without ap- 
 parent cause, they will be possessed of an insane 
 desire to procure spirits and drink to stupor. On 
 recovery after an interval the mania comes on 
 again, and another period of narcotism follows. 
 This continues several days until complete ex- 
 haustion, gastritis, and delirium supervenes. 
 Then a long, irregular period of rigid abstinence 
 follows. 
 
 This differs widely from the periodical drinker 
 in coming on suddenly and possessing the body 
 like a veritable mania in which no other thought 
 or motive exists except to procure spirits. 
 
 It is an insanity of the impulsive t5rpe, and has 
 a distinct beginning, progress, and termination; 
 and is certain to end in recovery. Such persons 
 are dangerous when opposed but harmless when 
 permitted to use spirits. Delirium tremens is not 
 often associated with this although some cases 
 
30 DRUG HABITS AND THEIR TREATMENT. 
 
 have been called delirium tremens. The impetn- 
 osity of the impulse and its overmastery of the 
 mind and body is illustrated in many striking 
 cases. 
 
 In one instance a man chopped off his hand for 
 the purpose of procuring spirits as a medicine for 
 the shock. 
 
 During the Civil AYar. a sutlers vragon with a 
 barrel of Tvhiskey was broken down between the 
 lines within easy range of the sharpshooters on 
 both sides. The certainty of instant death did not 
 deter men on both sides from attempting to reach 
 the barrel to procure spirits. After a number of 
 men had been killed a cannon was brought up to 
 destroy the barrel. 
 
 Men have been known to deed away their prop- 
 erty for spirits under this impulse. Some famous 
 trials have followed from acts committed during 
 this period. A noted statesman had dipsomaniac 
 impulses which were controlled by placing him in 
 a cell for forty-eight hours. Others have been 
 given spirits to stupor until the impulse died away. 
 Many of these cases become opium-eaters or have 
 died from the effects of narcotic drugs given to 
 check the impulse. "When the craze subsides a 
 period of extreme exhaustion follows, without delu- 
 sions or hallucinations: the mind seems to be clear 
 again. Some authors think that this condition is 
 more common among women than men. In my 
 
DIPSOMANIA. 31 
 
 experience it is of shorter duration and more easily 
 checked in women. In some of these cases where 
 the impulse is forcibly restrained by drugs it 
 breaks out again with greater force than ever. 
 Active treatment should be continued for some 
 time after the subsidence of the impulse. There 
 is associated with this, loss of appetite, excessive 
 perspiration, increased heart's action and slightly 
 raised temperature of the body. Insomnia and in- 
 tense muscular and mental activity are also com- 
 mon symptoms. 
 
 These attacks usually follow each other at irreg- 
 ular intervals, depending upon unknown causes, 
 but no doubt due to some central irritation and 
 exhaustion. All periodic drinkers are not dipso- 
 maniacs, and very few inebriates can be classed 
 under this head. Many of these persons go to 
 the insane asylums before the paroxysm subsides, 
 and afterward are very clamorous to be released, 
 claiming that they have been unjustly confined. 
 The following is an example : A lawyer supposed 
 to be temperate, though he had occasionally used 
 spirits in company and at banquets, suddenly 
 developed this impulse following a period of in- 
 tense excitement. He wandered about the streets, 
 drinking at all times and places in the most mani- 
 acal way, giving no reason for his conduct, simply 
 saying that he must drink. He was forcibly re- 
 strained, and developed maniacal violence, and was 
 
32 DRUG HABITS AND THEIR TREATMENT. 
 
 taken to an insane asylum. He recovered, was dis- 
 charged, and commenced action for false impris- 
 onment. Two 5''ears after, following a political 
 campaign during which he was abstinent, the same 
 impulse came on, lasting about a week, during 
 which time he was continuallj^ stupid or wildly 
 delirious, having no other thought on his mind 
 but drink continuously. He eventually became 
 insane, and died in an asylum. Physicians who 
 treat cases in prisons notice the outbreak of this 
 impulse among the inmates, often manifest in a 
 dazed, delirious condition, with continuous talk 
 of drink and effort to procure it in some form. 
 
 Such cases have done themselves injury for the 
 purpose of getting into the hospital, hoping to 
 procure spirits as a medicine. They are often 
 confined in a strait- jacket during these 
 periods, and it is often a difficult question to de- 
 cide whether to restrain them or to permit this 
 impulse to be gratified. 
 
 DELIEIUil TREMENS. 
 
 Much confusion exists concerning delirium tre- 
 mens. In reality the term should be applied to 
 persons who have delirium associated 'ndth mus- 
 cular trembling, and hallucinations and delusions. 
 Many cases of delusions without muscular dis- 
 turbance are cases of alcoholic delirium of short 
 duration ; and when not overtreated, recover with- 
 
DIPSOMAMA. 33 
 
 out serious sequelas. In delirium tremens there 
 appears to be profound exhaustion and irritation 
 of all the nerve centers^ affecting both the sensor}' 
 and motor centers of the body. It is always asso- 
 ciated with neurites of the nerves of the extremi- 
 ties, and seems to be a complex poison case ijj 
 which both the poisons of alcohol and the toxins 
 formed in the system are combined. It usually 
 follows a prolonged period of excessive use of 
 spirits, particularly where the person has neglected 
 the nutrition of the body and has been subjected to 
 great strain, both mental and physical, with ex- 
 haustion. The onset is marked by hallucinations 
 and delusions with failure of muscular co-ordina- 
 tion. Sometimes symptoms of acute neuritis pre- 
 cede the attack, marked by shooting pains, numb- 
 ness, prickling sensations and formication. The 
 muscular control of the hands and extremities will 
 be enfeebled, and more spirits will be taken to 
 counteract these effects, which are often ascribed 
 to other than the real causes. Then insomnia, ex- 
 altation and profuse perspiration will come on. 
 For all these physical conditions more spirits wiU 
 be taken. Sounds 'wiR be heard and double ob- 
 jects will appear to the vision. These will soon 
 develop into hallucinations and delusions which 
 become more and more fixed. The muscular agi- 
 tation will increase, and the mind will become 
 alarmed at the apparent reality of the horror of 
 
34 DRUG HABITS AND THEIR TREATMENT. 
 
 the situation. These cases are usually self -limited, 
 and when treated with eliminatives and controlled, 
 will recover in ten days or two weeks. The hallu- 
 cinations and delusions gradually pass away, the 
 muscular trembling and agitation going first. The 
 serious danger in these cases is over-medication, 
 both from overfeeding and excessive use of drugs. 
 
 Alcoholic delirium begins Avith slight defects 
 of reason and sensory changes growing gradually 
 into certain fixed conditions, without muscular 
 disturbance or much digestive changes. It usually 
 comes on from prolonged use of spirits, associated 
 with excitement. It often occurs among persons 
 who are overfed, gourmands and idlers, and in 
 underfed, anemic persons. Frequently the con- 
 tinuous use of wines brings on this condition, par- 
 ticularly champagne, the brain being seemingly 
 unable to recover from the continuous irritation 
 and depression which follows. It may be stated in 
 a general way that beer and wine are more active 
 in the causation of alcoholic delirium than whiskey 
 or brandy. 
 
 There are difEerent forms of delirium in which 
 delusions seem to be prominent, the senses often 
 remaining partially intact, the delusions having 
 reference to outside matters and possessing the 
 brain to the exclusion of all other thoughts. There 
 are milder stages of the same condition which are 
 amenable to treatment, and are self-limited. The 
 
DIPSOMANIA. 35 
 
 delusions may remain a very long time, even after 
 recovery and long abstinence. They indicate, 
 without doubt, some lesion of the brain which is 
 not restored by the removal of the active cause. 
 
 Many of these cases become paranoiacs and show 
 mental disturbances for the remainder of their 
 active lives. Others recover and seem but little 
 changed. 
 
 Experience shows that the presence of de- 
 lirium, either in pronounced delirium tremens or 
 the lighter forms, is most serious in its effects on 
 the brain, recovery rarely taking place without 
 leaving entailments and defects that are noticeable 
 in all after life. Even slight attacks of delirium 
 have been followed by changes of character and 
 conduct that grew to serious proportions later. 
 
 There can be no doubt that the tendency to a 
 recurrence of these conditions is greatly increased 
 after the first attack. Hallucinations and delu- 
 sions are more likely to occur than before. Some- 
 times an old delusion entertained in a former at- 
 tack reappears again with greater intensity. Hal- 
 lucinations also come on again of the same char- 
 acter as before. 
 
 The pathological condition is one of poisoning 
 and local degeneration of cells and perversion of 
 cell force, and often indicates profound changes 
 both functional and organic. It is always well to 
 take into consideration the possibility of the com- 
 
36 DRUG HABITS AND THEIR TREATMENT. 
 
 plication of syphilis in these cases. It undoubtedly 
 modifies the form and duration of the delirium. 
 In all cases the damage which accrues from these 
 two poisons should never be minimized. In med- 
 ico-legal cases it is safe to assume that the fact 
 of having had delirium from alcohol is positive 
 evidence of mental impairment. 
 
 No case presents a uniform class of symptoms 
 except in some very general particulars. Wide 
 variations will constantly appear. In some in- 
 stances defects of sight will be most prominent; 
 all the other symptoms will be negative. In others, 
 hallucinations of hearing will be the leading symp- 
 tom. SjDecial delusions of snakes and grotesque 
 objects are not always present and may be only 
 transient. Scm^e persons have grandiose delusions. 
 Others suffer from fears of unseen disasters. One 
 man was alarmed lest the house should fall upon 
 him. Another, that an earthquake would swallow 
 him up. A third, that he would be struck by 
 lightning or destroyed in a hurricane. Sometimes 
 the delusions refer to business matters or to so- 
 cial events, to family and friends or to politics or 
 religion. They are usually transient but some- 
 times take on permanent forms which influence 
 the mind ever after. 
 
 It is difficult to differentiate many of these 
 eases from well-known forms of insanity, and it is 
 justifiable for the physician to treat them as such. 
 
DIPSOMANIA. 
 
 37 
 
 using practically the same means and measures, 
 only recognizing the poison causes as most prom- 
 inent. Some of these cases have convulsions after a 
 prolonged period of intoxication which resemhle 
 epilepsy, and are called alcoholic epilepsy. They 
 have many of the features of a true epilepsy, only 
 the duration is shorter, and rarely any stupor fol- 
 lows. Local paralyses are very common after these 
 conditions, and gi-eat depression of spirits amount- 
 ing in some cases to melancholia. 
 
 The suicidal cases of alcoholism undouhtedly 
 occur after these convulsive attacks. In many 
 instances homicides have occurred where the pa- 
 tient was opposed or where some delusion of in- 
 jury existed and a feeling of revenge followed. 
 The melancholia which follows these convulsive 
 attacks is often associated with intense activity of 
 certain ideas or delusional conceptions. It is in 
 this condition that crime may be committed. Some 
 wrong or supposed injury of the past will suddenly 
 break out into great activity or perhaps a suicidal 
 impulse which has occurred long ago will become 
 prominent again. 
 
 Hallucinations of the senses rarely occur. The 
 disturbances are mostly confined to delusions. 
 Many of these impulses and false beliefs pass away 
 by active treatment, and seemingly depend upon 
 some disordered state of digestion or condition of 
 exhaustion. 
 
38 DRUG HABITS AND THEIR TREATMENT. 
 
 Convulsions following excess of alcohol always 
 leave a serious entailment on the brain and ner- 
 vous S3''stein which is manifest in various physical 
 and mental defects. In some cases these convul- 
 sions increase and become veritable epilepsies of 
 the classic type. If it can be ascertained that it 
 was purely of alcoholic origin, the prognosis and 
 treatment will vary from that of traumatic epi- 
 lepsy. A few cases have been reported of convul- 
 sions following the use of opium, but in all prob- 
 ability some latent condition of the system favor- 
 ing this state had existed before the drug was 
 taken. Absinthe and "bitters" composed of strong 
 alcoholic extracts when taken in excess have pro- 
 duced convulsive conditions wliich differ from 
 the ordinary alcoholic epilepsies. There is more 
 delirium present and intense physical and mental 
 depression, ending in maniacal states; hence the 
 use of these forms of spirits is more dangerous. 
 
 Magnan found in 100 cases of mania 40 which 
 had used these alcoholic liqueurs. He described a 
 form of mania due to this cause. In this coun- 
 try this is rare, and when absinthe is taken the 
 symptoms are more of the melancholic type. 
 
 OTHER CAUSES. 
 
 The general impression is that bad surround- 
 ings and company are the most frequent causes of 
 the drug habits. This is not sustained by a study 
 
DIPSOMANIA. 39 
 
 of cases. It is found that most cases have a range 
 of causes farther back, and that surroundings 
 and company are only incidental and associate con- 
 ditions. Persons who use spirits suffer from pal- 
 sies of the moral brain, and are not disturbed by 
 low company and bad surroundings. The action 
 of spirits creates a tolerance and liking for bad 
 company and surroundings. This gives the im- 
 pression of being the real cause — in reality it is 
 only the effect. It may be the first cause among 
 those predisposed and with feeble personality; it 
 then acts as an exciting influence, but in most cases 
 it is secondary. 
 
 In a large proportion of cases certain predispos- 
 ing and favoring conditions are present. Of these 
 heredity explains the largest number. In a study 
 of many thousand cases over 60 per cent are 
 found to have inebriate ancestors. In 40 per cent 
 of these, both parents have used spirits. In 15 or 
 20 per cent the grandparents on both sides were 
 spirit takers. In the remaining number are cases 
 in which one of the parents or grandparents have 
 drank. 
 
 Injury and disease are found to be the 
 next largest factors in the causation. Then comes 
 dietetic disturbances and exhaustion, both mus- 
 cular and mental as early causes. Beyond this 
 there is a certain unknown field of causes which 
 includes almost every condition of obscure strain 
 
40 DRUG HABITS AND THEIR TREATMENT. 
 
 and drain. Of the liereditaiy causes the facts are 
 apparent in any general observation. What prob- 
 ably is transmitted is a predisposition to seek relief 
 from some condition of exhaustion or defective 
 vitality. Also there is no doubt a low degree of 
 vital force with feeble power of restoration often 
 manifest at puberty^ wliich calls for spirits. 
 Later in life under any conditions of strain the 
 same sense-fatigue appears calling for help. In 
 some instances this predisposition is manifest 
 in taste enjoyment. Both the odors and flavors 
 of spirits are agreeable and sought for. Many 
 persons have this inheritance^ which is not de- 
 veloped into spirit-taking. 
 
 Often inherited cases show general marks of 
 defect^ both mentally and physically, which are 
 apparent from general observation. Atavism or 
 the skipping of one or two generations of this in- 
 heritance is not uncommon. Such cases usually 
 break out suddenly without any tangible or prom- 
 inent causes, and become so precipitate and pro- 
 nounced as to suggest a far-off iuheritance. They 
 are usually incurable, developing other neuroses 
 or dying early from some concurrent disease. 
 
 These cases of heredity are all noted for the pro- 
 found degeneracy which follows from the use of 
 alcohol even in small quantities. Dr. Kerr be- 
 lieved that there was more mental derangement, 
 a stronger tendency to delirium and delusional 
 
DIPSOMANIA. 41 
 
 states in inherited eases than in others. This has 
 been confirmed by French observers. Magnan 
 wrote that the inlierited cases suffered from con- 
 vnlsions and conralsive disturbances. This is sus- 
 tained by observations in this country. 
 
 I have found inherited cases more liable to take 
 intercurrent diseases and to suffer from ordinary 
 inflammations and to have a greater mortality. 
 It is evident that such cases are more serious and 
 require longer treatment and are more likely to 
 have complications. 
 
 INJUEIES AS CAUSES. 
 
 The next general group of causes which seem 
 to follow from diseases and injuries are less prom- 
 inent and seldom observed. Of these, physical in- 
 juries will be found prominent, such as concus- 
 sions of the brain and cord, blows on the head or 
 sudden physical shocks overwhelming the nervous 
 system, followed by profound reaction. Altera- 
 tions of nutrition frequently follow these states 
 and also profound exhaustion for which spirits 
 give relief. Blows on the head have frequently 
 been followed by dipsomania and periodical in- 
 ebriety. Shocks and mental perturbations seem 
 to develop delusional states after spirits have been 
 used. Some of these cases have become noted in 
 literature. A prominent physician was thrown 
 from a carriage, striking on his head, receiving 
 
43 DRUG HABITS AND THEIR TREATMENT. 
 
 a simple scalp wound. Soon after he developed 
 inebriety of a dipsomaniac character, which ended 
 in his death in an asylum. A chaplain in the 
 Civil War was injured by a shell and soon after 
 became a continuous drunlcard, dying later, having 
 caused a great deal of distress among liis friends. 
 In both these cases the causes were unknown, and 
 the injury was not supposed to have any influence 
 in the drunkenness which followed. Peripheral 
 irritation has been noted as a cause in 
 some cases. Tapeworms have excited inebriety. 
 Their removal was followed by total abstinence. 
 The irritation from j)rolonged lactation or in dys- 
 menorrhoea, amenorrhoea, and disturbances of the 
 genital organs has been followed by the drink 
 craze. 
 
 PREVIOUS DISEASES AS CAUSES. 
 
 Previous diseases are active causes. Some con- 
 ditions of exhaustion follow, or defects of the ner- 
 vous system which call for relief. Probably states 
 of neurasthenia and cerebrasthenia are pres- 
 ent. Intermittent and malarious fevers frequently 
 precede excessive use of spirits. Attacks of acute 
 rheumatism, diseases of the skin, and renal dis- 
 turbances precede the drink craze. Dietetic dis- 
 eases are often associated as causes owing to the 
 intimate association between the nutritive func- 
 tions and the nervous system. Practically any dis- 
 ease influencing the nutritive functions is fol- 
 
DIPSOMANIA. 43 
 
 lowed by exhaustion of which inebriety is the nat- 
 ural sequence. Irregularity of life and living is 
 followed by the same condition. Sudden excite- 
 ment and exhaustion;, intense mental activity from 
 violent emotions, are all pregnant causes. These 
 and other general conditions of debility are to be 
 sought for in a study of the early causes. It is 
 not so clear how surroundings unhealthy and ab- 
 normal act in this way, but undoubtedly they have 
 a strong influence by lowering the vital forces and 
 creating an abnormal impulse for relief. 
 
 Some very interesting studies have been made 
 on the effects of winds and the elevations above 
 the sea-level. Cases have been noted where per- 
 sons living at the sea-level could not resist the 
 temptation of drink, but going to the mountains 
 several thousand feet above the sea-level they 
 were total abstainers without efl'ort. Persons liv- 
 ing in these high levels and drinking excessively 
 have been able to abstain by going down to the sea- 
 level. High, dry winds and moist, damp winds, 
 apparently have the same influence, either excit- 
 ing the drink craze or depressing it. 
 
 Certain sections of the country, particularly 
 river bottoms, are noted for their large number of 
 drinking people, while adjoining towns on higher 
 levels show but very few people of this class. It is 
 difiicult to account for these conditions, but prob- 
 ably some state of exhaustion is encouraged in 
 
44 DRUG HABITS AND THEIR TREATMENT. 
 
 these different conditions of living which is mani- 
 fest in the drink craze. 
 
 It is a disputed question how far adversity is an 
 exciting cause of the drink habit. A number of 
 cases are- reported where inebriety seemed to 
 follow directly from conditions of adversity. In 
 all probability in most of these cases some pre- 
 disposing conditions existed which were roused 
 into activity by the depression of adversity and 
 other states. 
 
 Sun and heat strokes are very often early causes 
 of this condition. Common instances are those 
 overcome by the heat who are given spirits by some 
 officious friend, and become comatose. They are 
 then taken to the station as intoxicated, and later 
 are found dead, the sunstroke not having been 
 recognized. Many of these cases become delirious 
 after a glass or more of spirits, and are called 
 "'crazy drunlv." They resist arrest and are fre- 
 quently hit on the head by a policeman's club, and 
 later are found dead in the cell, and the examina- 
 tion reveals cerebral hemorrhage. The history of 
 the case is that of simply insolation and delirium 
 from the brandy given, and the hemorrhage is 
 the direct result of the blow by the policeman's 
 club. The real cause is not ascertained. 
 
 It is always dangerous to administer spirits to 
 one found comatose on the street. Heat 
 apoplexies are very intimately associated as causes. 
 
DIPSOMANIA. 
 
 45 
 
 and are followed by inebriety. Beyond this there 
 are innumerable exciting and predisposing con- 
 ditions, not only incident to our civilization but to 
 the tremendous activities and strains common to 
 every active life. 
 
 PATHOLOGY. 
 
 The general pathology of these conditions is 
 that of cell-poisoning and nerve esliaustion. These 
 conditions, with infinite variations and complica- 
 tions affecting every organ of the body, are present 
 in all cases. Eecent examinations have shown 
 degenerations of nerve tissue and fibrinous pro- 
 liferation with thickening^, of the walls of the heart 
 and arteries. 
 
 Both the liver and kidneys suff'er from fatty 
 degenerations. 
 
 Local hemorrhages in the brain are more or 
 less common, followed by cutting off of certain 
 areas from activity, and resulting in local palsies. 
 
 The direct eft'ect of alcohol has been summed 
 up by Dr. Taxy in the following statements: 
 
 First, it impoverishes the blood by diminished 
 oxidization and retarded circulation. 
 
 Second, it destroys the blood corpuscles and 
 lessens their oxygen-carrying properties. 
 
 Third, it produces vaso-motor paralysis and im- 
 paired reflex action. 
 
 J^umerous experiments of the action of alcohol 
 
46 DRUG HABITS AND THEIR TREATMENT. 
 
 on animals have brought out many curious facts 
 of the forms of degeneration which follow, and 
 the statement has been made by eminent author- 
 ities that alcohol in the system is one of the 
 most dangerous, corroding substances known. 
 
 TEEATMENT. 
 
 The treatment of inebriety will depend very 
 largely on the causes, both predisposing and con- 
 tributing. When these are ascertained accurately, 
 the indications of what to do will be clear. Thus, 
 if it is apparent that inebriety depends on irrita- 
 tion from reflex action, the removal of this cause 
 is the first essential. If it is the result of shock 
 or injury favorable conditions must be sought for 
 to lessen the effects of these. If dietetic and nu- 
 . tritional diseases and sexual irritations are present 
 and have preceded the drink craze, they will re- 
 quire attention. If the drink craze is only a symp- 
 tom of organic disease or another phase of some 
 form of insanity, the treatment will also be differ- 
 ent. If contagion of company and surroundings are 
 active causes or states of exhaustion 'vith excessive 
 drains and strains, all these require special, appro- 
 priate remedies. 
 
 Only general principles can be laid down in 
 the matter of treatment as each case must be 
 a law to itself. In one, the effects of alcohol are 
 very prominent; in the other, alcohol has simply 
 
DIPSOMANIA. 47 
 
 developed some states of degeneration. Thus, 
 excessive use of spirits is a symptom of general 
 paralysis, and not the disease itself. In another 
 case, the craze for liquor is a symptom of mania 
 or delusional melancholia; in another epileptoid 
 conditions manifest themselves in impulsive drink 
 crazes; in a third senile dementia develops the 
 drink craze. 
 
 The removal of spirits can always be done at 
 once with safety. There is no danger of any ex- 
 haustion from sudden withdrawal. 
 
 Frequently this is followed by other symptoms 
 not noticed before and marked by the use of alco- 
 hol. The most common example is that of tubercu- 
 losis, which appears and goes on with great activity 
 when the alcohol is removed. The acute symp- 
 toms seemingly have been masked while the spirits 
 were taken. These are the cases which develop 
 acute pneumonia and die in a few hours. A post- 
 mortem shows extensive cavities and tuberculous 
 'deposits which have not been noticed. The sup- 
 posed shock from the removal of alcohol is largely 
 a mental condition fostered by the fears of the 
 person. No successful treatment can be carried 
 out while the spirits are being used. ISTo specific 
 drugs can overcome the effects of alcohol when 
 given with it. 
 
 Many combinations can be used to produce a 
 disgust for spirits, simply producing another spe- 
 
48 
 
 DRUG HABITS AND THEIR TREATMENT. 
 
 cies of intoxication which is followed by nausea 
 and discomfort. Opinm and many of the narcotics 
 will effectually control the drink craze by render- 
 ing the patient comfortable and indifferent to all 
 other means of relief. The desire for a more 
 perfect state of feeling and removal of physical 
 and psychical pain is controlled by these drugs, 
 and alcohol is abandoned. 
 
 The modern quack treatment is very largely a 
 recognition of this principle of substitution, giving 
 drugs and using measures which chemically and 
 physiologically remove the desire for spirits. This 
 is not curative in any sense; it is simply drug 
 restraint, and masking of symptoms which break 
 out with greater force Avhen the restraint is re- 
 moved. 
 
 The most important treatment is a change of 
 surroundings and conditions of living. This en- 
 ables the patient to adapt himself to new states 
 with greater ease. Going away to a sanitarium 
 or asylum with a distinct purpose and having 
 changed surroundings, diet, and methods of liv- 
 ing, prepares the way for the removal of spirits 
 and restoration. This cannot be done at home ex- 
 cept in special instances where the conditions and 
 mental occupation can be concentrated along new 
 lines of life and living. 
 
 The first consideration is the withdrawal of 
 alcohol and an effort to eliminate its effects upon 
 
DIPSOMANIA. 49 
 
 the system. There is always associated with this, 
 states of exhaustion and irritation which call for 
 appropriate remedies. 
 
 If the case is a periodical drinker, the drink 
 attack will require special treatment. This can 
 often he overcome by saturated infusions of 
 quassia hark in doses of two ounces given every 
 one or two hours until the drink impulse sub- 
 sides. Then free evacuation of the bowels by sul- 
 phate of magnesia or any other salt which is most 
 convenient, and a warm bath. Following this, 
 rest in bed with hot nutrients, of which milk is 
 the most valuable. 
 
 On the return of the paroxysm, the same treat- 
 ment with the addition of fifty grains of bromide 
 of sodium will generally suffice. The paroxysm 
 subsiding, a period of tonic treatment must follow. 
 The tonics to be used here will vary largely with 
 the patient. Usually some form of arsenic given 
 continuously for a long time is the best and most 
 effectual remedy. 
 
 If the paroxysm returns at stated intervals its 
 approach can be anticipated and often prevented 
 by large doses of nitrate of strychnia given a short 
 time before its return or on the first intimation of 
 this appearance. This remedy can be given alone 
 or combined with phosphoric acid. 
 
 If the drink period is uncertain in duration and 
 liable to return at unexpected times, great care 
 
50 DRUG HABITS AND THEIR TREATMENT. 
 
 should be given to the diet and regularity of living. 
 Turkish baths at intervals, followed by prolonged 
 rest, are very useful. 
 
 On the advent of the states of excitement which 
 have preceded the drink craze some mild nar- 
 cotics, such as valerian, asafetida, hops, and others 
 of this class, are very useful. 
 
 If there is a malarious history, some form of 
 cinchona or quinine may be given until the physi- 
 ological effects are noted. Sometimes quinine can 
 be given for a long time with excellent effects, and 
 without its poison action. 
 
 Where there is a history of any specific trouble, 
 arsenic and potassium iodid are the chief rem- 
 edies, which may be supplemented by mercury 
 according to the conditions present. It is always 
 safe to give mercury. The iodid may be given in 
 tonic doses for a long time. 
 
 Bitter barks and iron preparations, while very 
 useful and valuable medicines, cannot be given for 
 any length of time with advantage. The usual 
 effects of these drugs are to stimulate the appetite, 
 producing indigestion and nutrient disturbances 
 which seriously diminish the results sought for. 
 
 The next most important remedy is baths. 
 These will depend very largely on the patient, 
 his habits, and present condition. If a gourmand 
 suffering from dyspepsia, a Turkish bath and mas- 
 sage may be given with profit every day for the 
 
DIPSOMANIA. 51 
 
 first two weeks, then lengthened out to one every 
 two or three days. If such a bath is not con- 
 venient, an ordinary tub bath with warm water 
 and free rubbing will take the place. Under all 
 circumstances massage and sponging should be 
 given every day, if nothing more can be had. Sa- 
 line cathartics, both carbonated and otherwise, are 
 very valuable, particularly for their action on the 
 skin and kidneys. 
 
 The use of narcotics will vary largely with the 
 conditions present. Opium is a very effectual 
 remedy but dangerous in the possibility of creat- 
 ing an addiction. Under all circumstances the 
 patient should not know the name or character 
 of the drugs given. If narcotics are used they 
 should be given early in the evening so that their 
 effects may encourage natural sleep and thus ob- 
 viate the necessity of large doses. Experience 
 shows th^t one grain of opium in the forenoon is 
 required to produce steadiness of the nervous 
 system, whereas at night one-half a grain will 
 produce more prominent effects. 
 
 Many cases have delusions of drug-reliance, be- 
 lieving they cannot recover unless using drugs 
 very often. This class must be treated with 
 placebos and exact methods of administration and 
 strict accountability as to time and place when 
 taken. This serves to impress the mental value^ 
 of the drug, which is always essential. 
 
52 DRUG HABITS AND THEIR TREATMENT. 
 
 Patients undergoing treatment should be en- 
 couraged to rest as much as possible in bed or 
 reclining on a cot or chair. The system requires 
 continuous rest and quietness. This can best be 
 secured by having a fixed time each day to go to 
 their rooms to rest. Baths can be taken at night 
 with the best results. In the morning they are 
 also good but should rarely be given in the middle 
 of the day. 
 
 It is not helpful to discuss symj)toms or talk 
 with the patient to any length about his drink 
 experience. There is always a tendency, which is 
 morbid, to revert to these scenes and to recall 
 the pleasurable and exciting conditio]is which were 
 present. They should be taught to forget these 
 states and to regard them with disgust and regret, 
 and all recurrence to them should be associated 
 with more positive declarations never to repeat or 
 to live them over again. 
 
 One effect of apomorphia, ipecac, antimony, and 
 other emetics by producing intense nausea, is to 
 break up the recollection of the past and to impress 
 the memory of spirits with disgust. This is very 
 efEectual in some cases, and often can be applied 
 with good effect. Thus, in one case, a man who 
 had abstained, constantly recurred to the pleasur- 
 able incidents of his drink period, and while as- 
 serting that he would never drink again, retained 
 the most pleasing recollections of the effects of 
 
DIPSOMANIA. 53 
 
 alcohol. He was persuaded to drink again; given 
 apomorpliia^ which was followed by intense nausea 
 and vomiting with profound relaxation; the result 
 of which was the entire disappearance of all pleas- 
 ing thoughts of the action of spirits. This was 
 followed by the insistence of the statement that 
 he could not drink again. Later another experi- 
 ment was tried to prove it with the same result. 
 The idea of inability to drink became fixed from 
 this point, and he remained temperate many years 
 to his death. This treatment is not of general 
 application, and is full of danger. 
 
 The revulsive effects of an emetic not unfre- 
 quently produce a shock to the nervous system, 
 and may be the starting point for very serious 
 diseases. The use of alcohol and the conditions 
 of debility which preceded it may have formed 
 unknown states of disease and degeneration which 
 may easily be excited and concentrated into some 
 organized form by the revulsive effects of emetics. 
 Some of the disastrous consequences following the 
 quack methods used indiscriminately are no doubt 
 due to this cause. 
 
 In the history of 100 cases which had taken 
 the Keeley and other methods of cure, 10 died 
 from general paresis, 21 from imbecility and de- 
 mentia, 30 died from acute pneumonia, and the 
 remainder died from various diseases associated 
 with palsy, mania and profound exhaustion. It 
 
54 DRUG HABITS AND THEIR TREATMENT. 
 
 would be dangerous to give emetic remedies to one 
 suffering from a fatty heart or atheromatous ar- 
 teries or to persons suffering from prolonged dys- 
 pepsia and nutrient disturbances. 
 
 Combinations of strychnia given indiscrim- 
 inately are also of danger. The stimulant action 
 in some cases is so pronounced as to cause irrita- 
 tion with extreme exhaustion. The danger comes 
 largely from the fact that the actual condition 
 present is unknown, and the possibility of increas- 
 ing some trouble is certain in many cases. 
 
 That strychnin has a specific effect other than 
 in a general way is by no means certain. If used 
 in mild cases of the drug habit which have come 
 from ordinary exhaustion and neglect of the hy- 
 gienic rules of living, its effects are very marked, 
 but in other cases where the causes are farther 
 back, and the drinking is only a symptom, its 
 value is questionable. In periodic and convulsive 
 cases it is sometimes a marked sedative and takes 
 the place of spirits most effectually but its effects 
 seem to be lost after two or three weeks, and its 
 value depends upon its alternate use. 
 
 The treatment of the continuous drinker in- 
 volves the same principles, only a different appli- 
 cation of them. In one who is accustomed to 
 use spirits daily some substitute is required after 
 their removal. This may be found in strychnin, 
 phosphate of sodium, quinin, and preparations of 
 
DIPSOMANIA. 55 
 
 cincliona bark. To these may be added some of 
 the milder narcotics, of which the bromids and 
 the vegetable narcotics are the most valuable. 
 Occasionally opium or its alkaloids will be found 
 valuable for sleep at night. Care should be taken 
 not to continue them long or to allow the patient 
 to know what he is taking. Some of the coal-tar 
 derivatives can be used with good effect, and 
 these with vigorous massage and bathing com- 
 prise the most practical measures. 
 
 Tinctures should be avoided because of the alco- 
 hol which they contain. Very slight quantities of 
 alcohol, although concealed by bitter drugs, are 
 often very effectual substitutes for spirits, hence 
 specific remedies for the cure are composed of 
 alcohol. While using these specifics, they leave no 
 desire for spirits; in reality they are taking spirits, 
 only concealed. It is safe to say that all the 
 remedies on the market promising to cure such 
 cases in a brief time • contain either alcohol or 
 opium. Many of the most popular tonics of the 
 day, so highly praised and largely sold, depend 
 for their virtue on one or both of these drugs. , 
 
 It is possible to treat these cases at home in 
 the early stages but only with the fullest co-oper- 
 ation of the patient and his most earnest effort to 
 follow out the directions of his physician. Later, 
 after a long period of addiction, it is doubtful if 
 
56 DRUG HABITS AND THEIR TREATMENT. 
 
 any good results- will follow except from a total 
 change of surroundings and conditions of living. 
 Many patients need coercion at first and alDsolute 
 restraint, making it impossible to do otherwise 
 than to follow the dictum of the physician. This 
 can he done in asylums by actual force in locked 
 rooms or in private homes with the services of a 
 skilled attendant. In all cases there should he a 
 distinct, clear recognition of the objects to be 
 sought and the condition present. To coerce and 
 confine a periodic inebriate during the free inter- 
 val of his drinking paroxysm is a mistake and 
 increases the sources of irritation. When the 
 attack comes on it is a tonic and of value. 
 
 In the constant drinker alternate confinement 
 and liberty is most helpful. The effort should be 
 to constantly appeal to the will to make an effort 
 to avoid dangers and put some restraint upon him- 
 self, and at the same time to diminish all tempta- 
 tion as far as possible. To give a patient a nar- 
 cotic which will restrain his drink impulses, and 
 then give him liberty and urge him to show his 
 sitrength is not a safe or commendable plan to 
 inspire confidence and rouse up a feeling of hope- 
 fulness that he can succeed. The question of 
 restraint and liberty is like other problems in 
 medicine, to be applied according to the condition 
 of the patient. To give equal liberty to all or to 
 
DIPSOMANIA. 57 
 
 keep all under strict surveillance are two extremes 
 whicli are not followed by good results. 
 
 In a large institution where personal discrim- 
 ination cannot he easily made, certain general 
 rules can be applied requiring of each one strict 
 obedience to certain regulations which are bene- 
 ficial to all. In the treatment, all methods of the 
 adminstration of medicines, with diets, and habits 
 of military exactness should be required; all irreg- 
 ularities should be avoided. 
 
 In private treatment the same is essential. 
 Medicines should be given at the exact moment 
 every day. Exercise and baths at the exact time. 
 This creates obligation^ and is stimulating to the 
 mind. 
 
 It is clearly impossible to expect any results 
 from two or four weeks^ treatment by any con- 
 ceivable method or plan. The degenerations and 
 injuries following and associated with the use of 
 spirits cannot be repaired in that time. No treat- 
 ment should be for less than from six months to 
 a year. Patients do not need to remain in an 
 asylum during this time but should have the con- 
 trol and care of the medical attendant. 
 
 A certain number of periodic drinkers are able 
 to work during the free, sober interval, and on 
 the return of the paroxysm should go under treat- 
 ment in an asylum or with the family physician. 
 
58 DRUG HABITS AND THEIR TREATMENT. 
 
 Others after a few months' residence in an asy- 
 lum go under the care of the family physician at 
 home or in some favorable conditions in the coun- 
 try. These cases often do well. 
 
 PEOGNOSIS. 
 
 The prognosis of these cases is generally favor- 
 able. A large number .are restored; some of them 
 permanently, as experience of years proves. Oth- 
 ers relapse when exposed to temptation and are 
 worn out by exliaustion and strains. The perma- 
 nent cure of these cases no doubt depends on 
 some physiological change in the brain and ner- 
 vous system, which may come on spontaneously 
 or be cultivated and brought about by exact con- 
 ditions of hygienic living with medical care and 
 training. 
 
 All cases can be benefited by asylum treatment 
 and the treatment by specialists along lines of 
 exact medication, but the permanency of the restor- 
 ation depends on many complex and largely un- 
 known factors-. A great deal can be done in the 
 early stages in personal private treatment by the 
 use of tonics and saline drugs and other means 
 adapted to the peculiarities of the case. More 
 can be accomplished in special asylums with spe- 
 cial surroimdings and appliances, where brain and 
 nerve rest and mental and physical training 
 
DIPSOMANIA. 59 
 
 towards the ideal standard of health may be car- 
 ried on. 
 
 Public asylums to support and to care for the 
 large class of chronic cases are a necessity which 
 will be practically recognized in the very near 
 future. 
 
 A large proportion of these cases could be made 
 self-sustaining in workhouse hospitals in the coun- 
 try, and would be able to do a good work under 
 the espionage and care of others. Some of this 
 class would be permanently restored and go back 
 to active life. Others would need hospital care all 
 their life. All these cases require medical treat- 
 ment, not so much drugs or specific plans of treat- 
 ment but the scientific adaptation of means to 
 control and direct their disordered impulses. 
 
 The private treatment of these cases at home in 
 the early stages is thoroughly practical, and very 
 often successful as in any other disease. The 
 early recognition of the drink impulse as a symp- 
 tom as well as a cause of disease will suggest the 
 means and measures for its practical treatment. 
 When this condition is recognized and acted upon 
 there will be fewer chronic cases and prevention 
 will take the place of curative treatment. 
 
 It may be safely said that all use of spirits to 
 states of intoxication or continuously to stupor 
 indicates disease and diseased conditions for which 
 
60 DRUG HABITS AND THEIR TREATMENT. 
 
 medical measures are demanded. The patient's 
 judgment of himself is wortliless. His conduct 
 should govern the measures used. The failure of 
 legal and moral methods point out the necessity 
 for a new medical study and application for both 
 prevention and cure. 
 
OPIUM INEBRIETY. 61 
 
 CHAPTER m. 
 OPIUM INEBRIETY. 
 
 Witliin a comparatively recent period the use of 
 opium and its alkaloids come into great promi- 
 nence. There is now a well ascertained disease 
 called "opium inebriety" which has an origin, 
 development and termination distinctly defined. 
 There are many reasons for believing that this dis- 
 ease is rapidly increasing, especially in large cities 
 and in circles where there is great mental activity. 
 This is confirmed by the quantity of opium and 
 morphin called for beyond the legitimate wants 
 of medicine. Careful estimates indicate that fully 
 fifty per cent of the morphin and opium is con- 
 sumed in some unknown way. This will be un- 
 derstood when it is known that a large number 
 of such cases use opium secretly. 
 
 Comparative estimates make the number of 
 opium cases in this country to be over a hundred 
 thousand. While it is very difficult to determine 
 the exact number, there can be no doubt that this 
 is not an exaggerated statement. Many of these 
 eases die from other diseases, and the fact of 
 opium-taking is only discovered after death. Up 
 to the present time very few studies of these cases 
 have appeared. 
 
62 DRUG HABITS AND THEIR TREATMENT. 
 
 Usually the symptoms have all dated from some 
 definite point after the opium addiction began, and 
 the history of the case from this point is more 
 or less obscure until chronic stages appear. Hence 
 great uncertainty and doubt exists concerning the 
 exact condition and pathology of such cases. 
 
 A careful clinical study and grouping of the 
 history of many opium cases points out a neurotic 
 diathesis or condition of brain and nerve defect 
 which predisposes to the development of this dis- 
 ease. There is an opium diathesis or special in- 
 herited tendency to use opium or other narcotics. 
 Such persons exhibit an unstable brain condition 
 which calls for relief from every condition of de- 
 bility and fatigue. If opium is given^^the effects 
 are so fascinating that its use is ever after in- 
 dulged in. 
 
 This particular tendency may be latent and may 
 depend on certain conditions of life and surround- 
 ings or the application of some peculiar exciting 
 causes. The opium-user has often this neurotic 
 element in his history. His ancestors may have 
 suffered from severe nerve injuries, c£ll starvation, 
 faulty nutrition, auto-intoxications, brain strains, 
 with excessive drains or nerve force. The children 
 following will have decided nerve defects which 
 may find in opium the most pleasing nepenthe, 
 and its use will ever afterward be followed. Kext 
 to the inherited diathesis comes the acquired de- 
 
OPIUM INEBRIETY. 63 
 
 fects. These may begin with diseases in early 
 childliood which leave retarded growth and per- 
 verted nerve activities. States of defective nutri- 
 tion and bad surroundings leave similar defects. 
 Following these are a great variety of complex 
 strains and drains which leave the nervous system 
 defective. States of brain and nerve instability 
 with low vitality and tendency to exhaustion and 
 hypersensitiveness to pain from every degree of 
 disturbance with feeble powers of restoration^ are 
 all characteristic early symptoms of the opium 
 disease. 
 
 The narcotism from opium is very grateful to 
 most of these neurotics, and is tolerated in large 
 doses from the beginning. A dose of morphin, 
 calming the excitement and giving complete rest, 
 is a physiological revelation which profoundly im- 
 presses the organism. This hypersensitiveness to 
 pain and delusional impulse to avoid it at all 
 hazards is the basis of all opium disease. After 
 opium has been used a few times this increases 
 rapidly, particularly to avoid pain, and a species 
 of mania follows possessing the mind thoroughly 
 and demanding relief from all discomfort. Along 
 with this comes the delusion that this is only a 
 temporary condition which can be stopped at will 
 at any time. This continues to the very last, not- 
 withstanding all the failures and repeated efforts 
 to abstain from opium the idea is dominant that it 
 
64 
 
 DRUG HABITS AND THEIR TREATMENT. 
 
 can be done by the will of the person. This morbid 
 impulse for opium is a veritable mania, and soon 
 becomes a symptom of some brain degeneration 
 which increases, involving one by one the higher 
 brain centers until imbecility and idiocy is reached. 
 
 The opium-taker is on the road to imbecility. 
 Low states of delusional mania may appear, but 
 the gradual weakening and profound dissolution 
 of all the liigher functions is inevitable. In some 
 cases the march is rapid and progressive along well- 
 defined tracts; in others it is slow, with halts 
 and intervals and apparent retrograde movement. 
 Periods of abstinence may occiir followed by re- 
 lapses and more precipitate decline. Delusions of 
 strength and of power of concealment and cunning 
 to deceive and cover up liis real condition are al- 
 ways prominent. Consciousness of right and wrong 
 and veracity in matters pertaining to himself dis- 
 appear early, and the only motive which remains 
 with any persistency is to procure opium and to 
 avoid pain. Many of these cases are very com- 
 plex. The degeneration often seems to be local 
 while other faculties remain the same. 
 
 Some of these cases exhibit a degree of unim- 
 paired vigor along certain accustomed lines, while 
 others show profound deterioration. Many of 
 these cases show hypersensitiveness to their own 
 condition, but seem to be impotent to change it. 
 They are in a continual conflict with the desire to 
 
DIPSOMANIA 65 
 
 abandon the drug, and failures to take the first 
 step, particularly where it is followed with the 
 least suffering. They show great anxiety to re- 
 cover, but will not make any effort. These defects 
 of will are all significant of psychical change and 
 degeneration. Dr. Kerr calls these cases narco- 
 maniacs in whom the morbid impulse for relief 
 is ever present. These cases are always serious, 
 and are always associated with psychopathic condi- 
 tions and states of life and living which require the 
 clearest wisdom to overcome. 
 
 In the treatment the central fact of removing 
 the drug is of small importance compared with 
 the removal of the causes and the conditions which 
 have favored this impulse. As in the alcoholic, 
 the removal of the active, exciting cause, spirits, 
 is only a small part of the real treatment. The 
 conditions which preceded the use of opium must 
 be studied, and the defects which have followed 
 from its use must be ascertained. Then the ques- 
 tion of treatment can be determined. 
 
 In the removal of the drug many clinicians have 
 laid down elaborate plans and defended them with 
 earnestness on the supposition that they were 
 finally curative. This is not sustained by more 
 careful studies. Some of the general facts which 
 must be recognized may be grouped as follows: 
 Where an opium diathesis or predisposition to ob- 
 tain relief from all states of pain and exhaustion 
 
66 DRUG HABITS AND THEIR TREATMENT. 
 
 has come down from the past generation, the with- 
 drawal of opium should be gradual, and the treat- 
 ment should have reference to constitutional 
 changes. In such cases the surroundings should 
 be regulated with care and exactness. The patient 
 should commence a military regime of life and liv- 
 ing and the opium should be withdrawn, covering 
 a period of many days and weeks, depending upon 
 the sensitiveness of the person. With this should 
 be associated careful diet, regular baths, and exer- 
 cise, and mental diversion. When the amount has 
 been reduced to a minimum other mild narcotics 
 may be given and the opium withdrawn. Of these 
 narcotics, a great variety may be chosen from — 
 such as valerian, hyoscyamus, lupulin, bull-nettle, 
 and others of this class, using the one which seems 
 to be the most positive in its effects. Baths should 
 be increased and massage should be taken every 
 day. Often hot liquid foods, as hot milk, beef 
 extracts, and some malted food preparations, can 
 be used with advantage. Mineral waters, particu- 
 larly soda waters, are of great advantage to neu- 
 tralize the acidity of the stomach. 
 
 The withdrawal symptoms, of which diarrhea 
 is the most prominent, can be easily overcome by 
 baths, slight astringents and rest on the back. Hot 
 fomentations over the bowels give local relief from 
 the tenesmus. The gastric irritation is most quick- 
 ly relieved by soda preparations, and long periods 
 
DIPSOMANIA. 67 
 
 of rest. The withdrawal symptoms of exhaustion, 
 irritation and general relaxation are nsnally of 
 short duration, and not at all severe in these cases 
 where the opium has been gradually withdrawn. 
 After the acuteness of the symptoms has subsided 
 a tonic of strychnia is very serviceable. Beginning 
 with one-thirtieth of a grain four times a day and 
 increasing this up to every two or three hours if it 
 can be borne by the patient without toxic symp- 
 toms, then decrease the frequency of the dose to 
 two or three times a day for several weeks. In 
 addition to this, preparations of cinchona bark and 
 iron can be used with advantage. Phosphate of 
 sodium is also a favorite remedy given in ten-grain 
 doses four times a day for several weeks. 
 
 The after treatment will vary largely with the 
 person and his surroundings, but should always in- 
 clude baths, carefully selected nutritious food com- 
 bined with exercise and all possible conditions 
 favoring nerve and brain rest. In cases where 
 opium-taking has come from brain strains and 
 drains in a previously healthy person, the treat- 
 ment will vary. The opium should be removed 
 rapidly, and other drugs substituted at once. The 
 narcotism from opium must be broken up and its 
 peculiarly fascinating effects overcome. 
 
 Dr. Parrish found the best results to follow 
 from the use of ipecac in those cases where the 
 person had taken opium for some form of pain 
 
68 DRUG HABITS AND THEIR TREATMENT. 
 
 the result of injury or nutritional disturbance. 
 He was accustomed to reduce the opium rapidly and 
 to associate its use witi. nauseating doses of ipecac. 
 The revulsive action and relaxation which followed 
 soon broke up the fascination from the narcotism 
 of opium. This was followed by large doses of 
 quinin and tincture of lupulin or other mild nar- 
 cotics. The withdrawal symptoms were very great- 
 ly lessened by the mental disgust and dread of 
 opium. Baths were used daily and soda prepara- 
 tions in the form of carbonated waters were given. 
 
 Dr. Mattison treated all these cases, from what- 
 ever cause, with bromide of sodium, giving in- 
 creasing doses and withdrawing the opium within 
 a day or two. Bromism followed in these cases 
 and was considered of less importance and more 
 easily overcome than the relaxation from opium 
 withdrawal. In these cases pain would be absent 
 and the patient would recover after an uncertain 
 period of stupor and somnolence suffering only 
 from profound mental and physical exhaustion. 
 This plan of treatment has not been found val- 
 uable only in exceptional cases. 
 
 Innumerable plans have been devised and car- 
 ried out, and a great variety of drugs have been 
 urged as specifics, but none of them have stood the 
 test of experience as applicable to all cases. 
 
 In my experience the condition of the patient 
 and his inherited psychosis determines the course 
 
DIPSOMANIA. 
 
 of treatment. The question most commonly dis- 
 cussed by both physician and patient is the sudden 
 or gradual withdrawal of the opium. To the 
 patient the sudden withdrawal presents horrors 
 which he wishes to avoid. To the physician the 
 gradual withdrawal means complications and com- 
 plexities of methods and plans which are to be 
 avoided if possible. The lengthening out of the 
 withdrawal symptoms to weeks, and even months, 
 is not followed by good results. Each case should 
 be a law to itself. For example, a person coming 
 from a degenerate family, who has had an early 
 period of alcoholic addiction, followed by the use 
 of opium, has still farther broken up the nutrition 
 of the body and perverted all healthy mental and 
 physical functional activities, and is now taking 
 large quantities of opium and alternating it with 
 spirits at irregular intervals, requires a special and 
 peculiar treatment. 
 
 First, his surroundings and conditions of living 
 must be methodical and exact. Spirits must be 
 abandoned at once, and the opium withdrawn grad- 
 ually for the first week, dropping down to a mini- 
 mum dose and keeping him on this amount until 
 his system becomes accustomed to this change. 
 Sometimes this requires two or three weeks, giv- 
 ing uniform doses every day without change ; then 
 a diminution for several days and another long 
 halt in which the same amount is given regularly. 
 
70 DRUG HABITS AND THEIR TREATMENT. 
 
 When the amount has been reduced to a grain of 
 opimn or a quarter of a grain of morphia in twen- 
 ty-four hours substitution may begin. Large doses 
 of bromide of sodium may be given eyerj two hours 
 until two hundred grains are taken, then stop. If 
 this is not well borne, some vegetable narcotic 
 may be given in large doses. If the withdrawal 
 sj-^mptoms are prominent, tincture of opium may 
 be substituted, not to exceed one or two doses. 
 The patient in the meantime must be kept in a 
 reclining position and given hot baths and mas- 
 sage. Strychnia may be given in large doses either 
 by the mouth or hj'podermically. 
 
 The after-treatment will consist of tonics, sa- 
 lines, baths and long-continued rest. Such per- 
 sons should continue treatment for months, and 
 possibly 5"ears in changed surroundings and differ- 
 ent conditions of living. Where the needle has 
 been used, a new complication arises, and to over- 
 come this the ingenuity of the physician will be 
 taxed seriously. Sometimes a continuation of the 
 needle with water injections serves a very good 
 purpose, and permits the abandonment of the drug 
 with very slight after symptoms. In other cases 
 the substitution of apormorphia, with its peculiar 
 depressing and nauseating effect, soon breaks up 
 the needle addiction. In a second example, where 
 the morphia addiction is uncomplicated with spir- 
 its, and seems to have grown up from some state 
 
DIPSOMANIA. 71 
 
 of exhaustion and neuralgia or disturbance of the 
 nerve and sense centers^ the treatment must diJffier. 
 There is often in this a large mental element which 
 must be considered and treated. The patient must 
 not only be in exact surroundings but mental di- 
 version must be provided, the mind must be di- 
 verted as far as possible, and sometimes 
 concentrated on elaborate plans of treatmeat. 
 Placeboes every hour, military exactness of rest 
 and times of eating, massage and baths must be 
 required. The morphia should be cut down at 
 once, and if the withdrawal symptoms are ^t all 
 severe, mild narcotics may be substituted. 
 
 Every measure should appeal to the mind to 
 rouse up confidence and to create new hope. Fre- 
 quently the morphia can be withdrawn in a few 
 days and the usual tonics of strychnia, quinin, 
 iron and arsenic can be given in varying forms, 
 associated with placeboes and mental medicines. 
 The ingenuity of the physician will be taxed to 
 the utmost to vary these drugs and keep the confi- 
 dence of the patient. Oftentimes exercise even up 
 to the point of occupation is valuable. The diet 
 and digestion should be considered with great care, 
 and no withdrawal symptoms should be allowed to 
 progress very far, even at the expense of recurring 
 again to the drug for a single dose. If the morphia 
 is taken by the needle, the mental symptoms can 
 
73 DRUG HABITS AND THEIR TREATMENT. 
 
 be treated for a long time with success. In these 
 cases the appearance of unknown local disturbances 
 which have been masked by the drug are to be 
 anticipated and treated. The success of such a 
 case depends largely upon psychical treatment, the 
 efficiency of nursing and the exactness of surround- 
 ings. In a third example where morphia has been 
 used to lessen the pain of organic diseases or to 
 relieve the infirmities of age, the treatment should 
 also vary. 
 
 It will be a disputed question whether the re- 
 moval of morphia can be practically and success- 
 fully carried out in cases of paresis, locomotor 
 ataxia, carcinoma or organic diseases of the kid- 
 neys and liver. If it is found advisable to do 
 this, the treatment in the removal of morphia 
 should be gradual and tentative, depending upon 
 the condition present, and the irritation which 
 seems to follow. Great care should be used in 
 substitYiting other drugs, particularly when their 
 addiction is likely to be followed with more se- 
 rious results. ITot unfrequently the removal of 
 morphia is ver}^ easily accomplished in these cases. 
 The irritation and relaxation following may be 
 slight, but the possibility of relapse is almost cer- 
 tain. Alterative tonics should be used from the 
 start, of which mercury and arsenic and the various 
 forms of phosphorous are most excellent. In old 
 
DIPSOMANIA. 73 
 
 age the removal of morphia can be quickly accom- 
 plished by substituting some of the milder vege- 
 table narcotics. Here constitutional treatment 
 is essential, with great attention to the hygienic 
 conditions of diet and surroundings. These three 
 examples include a large number of opium and 
 morphia takers. 
 
 Eecently a class of professional and brain work- 
 ers has come into prominence where morphia is 
 taken for its stimulant effect as well as to quiet 
 nerve and brain fatigue. These cases should be 
 treated heroically; the opium should be removed 
 by the use of substitutes, and active medication 
 follow. States of neurasthenia and cerebrasthenia 
 always present should be treated on general princi- 
 ples. All such persons should have asylum or sani- 
 tarium care for months, followed by rest in the 
 country for an equally long time. Many of them 
 must give up all brain labor and abandon all oc- 
 cupation associated with mental strain. The gen- 
 eral treatment is the same — baths for elimination, 
 food and tonics for building up, rest and diversion 
 for training them out of their old life and living. 
 The opium disease is curable in a large number of 
 instances, but never by specific drugs or mechanical 
 plans of treatment, and never by simply withdraw- 
 ing the drug, no matter how painless or perfect. 
 The brain and nervous system has suffered some 
 
74 DRUG HABITS AND THEIR TREATMENT. 
 
 profound shock and change which cannot be over- 
 come except by long care and medicinal measures. 
 
DDIPSOMANIA. 
 
 75 
 
 CHAPTER IV. 
 
 COCAIN AND OTHER DRUG 
 ADDICTIONS. 
 
 The cocain addiction has been called the third 
 great scourge of the world, — alcohol and opium 
 addictions being the first and second. The most 
 remarkable fact is that only a small part of the 
 cocain imported and used is known to go into 
 legitimate channels. An inquiry in Philadelphia 
 showed that sixty per cent of the cocain was sold 
 and used in unknown ways. It is extremely diffi- 
 cult to know how far its addiction has extended. 
 The frequency of the cases is becoming more and 
 more apparent, particularly in the large centers. 
 Usually the cocain taker has had a previous experi- 
 ence with morphin and spirits, and finds the cocain 
 a great improvement over the two. From this drug 
 he gets mental exhilaration and physical satisfac- 
 tion without any of the depressions which follow 
 the use of the other drugs. It is noted that ema- 
 ciation and rapid decline of both the physical and 
 mental activities are very marked in the opium 
 case which becomes a cocain-taker. A pleasing 
 state of mental exaltation and volubility follows 
 its use. The mind seems to run on with great 
 
76 DRUG HABITS AND THEIR TREATMENT. 
 
 rapidity, the thoughts flow with confused medley 
 without point of conclusion, interlaced and com- 
 bined with all sorts of ideas, fears and credulities. 
 This mental condition seems to be without con- 
 ception of time or present condition, passing from 
 all grades of hallucinations and delusions of 
 suspicion, credulity and good humor to states of 
 imbecility and sleep. In some instances great 
 assertiveness with indecisiveness of thought follow 
 in a confusing medley. 
 
 The principal delusion characteristic in most 
 cases is that of parasitic infection principally of 
 insects crawling over the skin, marked by itching 
 and uncomfortable feelings. Delusions of perse- 
 cution, not only to himself but to others, often 
 rouse indignation and efforts to correct them. 
 Oftentimes it is self-accusation, and is followed 
 by crime, generally suicide to escape from his pur- 
 suers. During all this time there is a reasoning 
 mania with the pleasing imagination that invests 
 objects near and far away with personal interests. 
 In some instances intense depression follows 
 alternated with transient exaltation. His voice 
 and manner give evidence of his mental condition. 
 The soft, persuasive tones, and the smiling, affable 
 appearance and supreme consciousness of his great 
 vigor and perfect strength is characteristic. He 
 believes his condition is exaggerated by his friends 
 and that he does not need to make any exertion 
 
COCAIN AND OTHER DRUG ADDICTIONS. 77 
 
 himself, that the effects of the drag are not dan- 
 gerous but rather helpful, enabling him to do what 
 would be impossible to do otherwise. His personal 
 appearance is greatly changed; anemia, glassy 
 staring eye; nervous, trembling walk, which be- 
 comes more feeble as the effects of the drug wear 
 off. His digestion is impaired, and often convul- 
 sions and partial unconsciousness of short dura- 
 tion follow. Attacks of sudden melancholia may 
 end in suicide or some violent act. The effect of 
 cocain on the mind is remarkable in destroying 
 the moral sense first. All consciousness of right 
 and wrong, of duty and obligation and pride of 
 personal appearance disappear earty. He may 
 seem physically to be very little different except 
 anemia and general nervousness. Mentally he 
 will be optimistic and extremely voluble but 
 morally he vnll be utterly depraved, irresponsible 
 and unreliable to the last degree. These condi- 
 tions rapidly merge into imbecilitj', suicide or 
 acute mania. The delusions take on an imagina- 
 tive character often very interesting psychologi- 
 cally as indicating the dominance of certain brain 
 sections and functions. 
 
 In one case under my care literary delusions 
 manifest in continuous writing of poetry occupied 
 nearly all the time of the patient while awake. 
 In another, plans of military campaigns were the 
 absorbing topic of liis thoughts. In a third. 
 
78 DRUG HABITS AND THEIR TREATMENT 
 
 schemes for breaking up the poverty of the masses 
 were his constant dream. 
 
 These cases will vary largely according to the 
 condition which has preceded the opium addiction. 
 If they have been alcoholics, more manias and 
 deliriums will follow. If they have been opium- 
 takers, less mental activity and more of functional 
 delusions will appear. If the)^ have taken up 
 cocain for some local condition and irritation and 
 have been neurasthenics before the addiction, the 
 mental perversion will be very prominent. A 
 large number of cases have found the use of cocain 
 at first medicinal for the relief of catarrhal and 
 local inflammations. From this point they have 
 continued it for its general effects. 
 
 Two conditions follow in all these cases — one, 
 that of exaltation of the intellectual faculties — the 
 other lowering of the senses and functional activ- 
 it}^ Both may occur together, but in one the 
 senses and functional activities may be more 
 seriously affected at first. In the other the intel- 
 lectual faculties show abnormities from the begin- 
 ning. 
 
 The effects of cocain-taking usually end in death 
 or serious mental disturbances within one or two 
 years. Often the use of cocain is abandoned for 
 morphin, then taken up years afterward. The 
 prognosis is always grave when the addiction is 
 continued any length of time. It is not difficult 
 
COCAIN AND OTHER DRUG ADDICTIONS. 79 
 
 to remove the drug and secure temporary restora- 
 tion, but unless this is followed by the most radical 
 change of life and living with the avoidance of 
 every source of exhaustion and every possible peril 
 and danger, relapse is to be expected. 
 
 The general treatment must begin with isola- 
 tion and removal of all exciting causes in a sani- 
 tarium or asylum where the surroundings are 
 military and exact. In every case special localized 
 means are essential to meet the various conditions 
 present. The drug can be removed at once. Some- 
 times narcotics may be used for substitutes for a 
 day or more but usually they are of little value. 
 Sharp elimination through the skin, kidneys, and 
 bowels is the first indication. The continuous 
 activity of the skin by hot air, warm and medi- 
 cated baths, are required daily for a long time. 
 Anemia, h}^eremia, and insomnia, each requires 
 sjjecial medication, of which foods and tonics are 
 usually sufficient. Preparations of iron and bark 
 are valuable for a short time. Arsenic appears 
 to be the best of all the mineral tonics, and should 
 be given many weeks. Acids are also very excel- 
 lent. The phosphates and preparations of soda 
 and magnesia are equally valuable. Strychnia does 
 not seem to be well borne and cannot be used in 
 some instances, nux vomica being preferable, and 
 its use may be continued for a long time. Of 
 foods, meats should be used sparingly at first; 
 
80 DRUG HABITS AND THEIR TREATMENT. 
 
 later, their use can be increased. A diet of eggs, 
 milk and fruit is the best. The patient should 
 remain in bed during the first week of active treat- 
 ment. Massage may be given for an hour every 
 day during this time. Later he may be taken out 
 to walk a few moments every day in the open air. 
 Exercise and massage depend for their value 
 largely upon the adaptability to the condition of 
 the case at the time. In a brain-worker, less exer- 
 cise is required than in a muscle-worker or one 
 who is in the open air much of the time. In an 
 over-fed, plethoric person, exercise is better borne 
 and followed by greater relief than in thin, spare 
 persons. 
 
 Often the patient should remain in bed two or 
 three weeks, particularly where the reaction symp- 
 toms are those of depression and great prostration. 
 Daily baths should be continued for many weeks 
 together with a rigid living and diet, which shoulc. 
 be insisted upon for a much longer period. 
 
 Many of these cases require an entire change 
 of surroundings and removal of local exciting 
 causes. The tendency to drug-taking should be 
 overcome by reliance on hygienic measures and 
 physical training, together with careful diet. The 
 restoration of the disordered mind is to be expected 
 only from prolonged rest and diversion of all 
 functional activities. 
 
 The cocain-taker can rarely be treated at home 
 
COCAIN AND OTHER DRUG ADDICTIONS. 81 
 
 with success. Like other cases of drug addiction, 
 a careful study must be made of the causes, both 
 exciting and predisposing, which lead up to this 
 condition. To this add a careful history of the 
 present addiction and the injuries which have re- 
 sulted from the use of the drug, then the therapeu- 
 tic indications will be clear. Whenever cocain is 
 used for its medicinal effects care should be taken 
 to watch its effects and to conceal its character 
 from the patient. But few cases are on record 
 Inhere it has been given in surgical operations that 
 it was followed by an addiction. Most commonly it 
 is found in catarrhal remedies, and often is the 
 basis of the successful proprietary drug. It is 
 also given by unprincipled and thoughtless persons 
 for the relief of opium and alcohol addictions, 
 with the result of producing more serious difficul- 
 ties than it seeks to remove. 
 
 It is doubtful if the fascination of the drug is 
 ever fully dispelled. The patient may abstain for 
 years from its use and from the slightest exciting 
 cause the impression of its relief will come back 
 again. Sometimes this is overcome by the good 
 jud'pnent of the person, but where the opportunity 
 is present and the judgment is weak it is taken 
 again with readiness. Some cases have fully recov- 
 ered, but the disability which follows its use has 
 continued in varying degree the rest of the life. 
 
83 DRUG HABITS AND THEIR TREATMENT. 
 
 CHLOROFOEM 
 
 The use of cliloroform as a drug addiction is 
 not common. Xearly all cases follow the use of 
 alcohol or opium. The delirium and insomnia 
 from the above drugs are relieved by the inhala- 
 tion of chloroform. Frequently chloroform is 
 taken to break up a drink craze, and later the 
 effects are so pleasant that it is used in the 
 place of alcohol or opium. In many cases chloro- 
 form is given for some acute pain or distressing 
 condition of insomnia or some state of exhaustion 
 and irritation. The relief is so prompt and com- 
 plete that it is repeated. The odor is also attrac- 
 tive, and the dreamy oblivion which follows is 
 very pleasing. 
 
 All chloroform cases are periodical at first, and 
 rarely become continuous, and yet in some in- 
 stances it has been used from the first every night. 
 This does not last long, as mania and stages of 
 melancholy soon follow. 
 
 In one case a man would provide a large bottle 
 of chloroform, arrange all his business in ad- 
 vance, and at a certain time commence using it 
 continuously until the chloroform was gone. Then 
 he would recover and abstain for a long period; 
 then anticipate and provide for another attack. 
 He seemed to have power to abstain for a certain 
 
COCAIN AND OTHER DRUG ADDICTIONS. 83 
 
 length of time;, then gave way to the impulse 
 abjectly. Chloroform-takers are secretive and 
 rarely acknowledge the addiction. After a time 
 they suffer from gastric troubles, bad circulation, 
 emaciation, trembling, extreme paleness, and great 
 susceptibility to chills with depression. ISTeuritis 
 is also common, and chronic cases frequently die 
 from tetanic conditions. Sudden syncope is also 
 common and fatal. The fascination for this drug 
 and its effects is an insane impulse which is al- 
 most insurmountable. This impulse for chloro- 
 form comes on often without premonition. A 
 favorable opportunity to procure it secretly or 
 the odor of the drug seems to provoke the desire 
 at once. After the impulse dies out, the efforts 
 for recovery are equally earnest and energetic. 
 No one can be more earnest and seem to use means 
 to prevent relapse, and yet the slightest oppor- 
 tunity to procure chloroform and conceal it is al- 
 ways taken advantage of. 
 
 In the treatment this element of insanity must 
 be considered as well as the extreme liability to 
 relapse at the most unexpected moment. Death 
 may come suddenly at any time. It is possible 
 to overcome this impulse by morphia and to 
 change the case to a morphinomania, but the fas- 
 cination of chloroform is never forgotten. 
 
 In the treatment the complete removal of the 
 drug is necessary, with military care and control 
 
84 DRUG HABITS AND THEIR TREATMENT. 
 
 Physical exercise and baths, tonics, alteratives and 
 concentrated food are the general measures useful. 
 When the person is not accustomed to other nar- 
 cotics many premonitory symptoms of the insane 
 impulse appear. Usually irritative melancholias, 
 with restlessness and depression which is not 
 affected by advice or surroundings. Strychnin 
 seems to increase these morbid sensations in some 
 instances; in others it is very useful, particu- 
 larly when given in small doses and often. Chloral 
 is not a good remedy. The stimulation which it 
 produces is followed by greater depression. 
 
 Bromids in large doses may break up the im- 
 pulse, but leave greater depression after the first 
 effects are passed. Opium is an excellent remedy, 
 but must be concealed to prevent the patient from 
 continuing its use. After hot baths and massage, 
 ten drops of deodorized tincture of opium in syrup 
 of wild cherry or wintergreen may be given every 
 two hours until sleep follows. After the patient 
 wakes, an active mineral cathartic will aid in re- 
 lieving the nervous condition. Hot acid drinks 
 are soothing, and may be given very often in some 
 cases. Eecovery from the paroxysm of stupor may 
 be accelerated by hot salt baths and sponging and 
 the internal use of some mineral acid. Coffee 
 infusion can be given with great advantage. After 
 the paroxysm has passed lupulin and quinin can 
 be used vsdth excellent results. Arsenate of iron 
 
COCAIN AND OTHER DRUG ADDICTIONS. 85 
 
 should "be given as a general tonic. Iodide of 
 potassium with the fluid extract of conium is also 
 very valuable as a continuous remedy. 
 
 The chloroform-taker should be under the con- 
 stant care of the physician in an asylum; if at 
 home, faithful attendance, with constant watch- 
 ing and careful regulation of all the surroundings 
 and modes of living. 
 
 In some cases the irritative depression which 
 seemingly provokes the desire for cholorform is 
 traceable to chemical changes of nutrition. 
 
 The good results following from active catharsis 
 and elimination by the bowels seem to point to 
 ptomaine compounds in the body acting as ex- 
 citing causes. The value of an eliminative treat- 
 ment brings additional confirmation of the the- 
 ory that some state of auto-intoxication may both 
 precede and follow the cholorform impulse. 
 Chloroform-takers can never restrict themselves 
 any length of time to the moderate use of the 
 drug. The inhalation may be irregular as to 
 time and free interval, but the desire for relief is 
 increased with each repetition. 
 
 Often with this chronicity appears increased 
 secretiveness and greater efforts to conceal it. 
 In a few cases radical changes of life and living 
 with active constitutional remedies have been fol- 
 lowed by restoration. The use of alcohol seems 
 to be dangerous, increasing the degeneration and 
 
86 DRUG HABITS AND THEIR TREATMENT. 
 
 rousing up mental symptoms not noticed before. 
 
 Chloroform should rarely be used in cases of 
 hysteria or of any convulsive neurosis, particu- 
 larly where it is not followed by any unpleasant 
 effects. When it occurs in middle or later life the 
 degenerations are very serious, and the cases are 
 early fatal. 
 
 In early life the problem is less difficult. In 
 all the cases there are serious defects of both the 
 physical and moral brain which require prolonged 
 treatment and the skillful use of means applied 
 with military exactness. 
 
 OHLOEALISM 
 
 Cliloralism is a form of drug addiction which 
 appears to be more common among women. As in 
 all other forms of drug addiction some previous 
 neurosis will be found to precede the first use of 
 chloral. The sleep which it produces is so pro- 
 found and followed by no unpleasant sensations 
 that it is repeated as often as occasion calls for it. 
 
 Chloral can be taken secretly for a long time 
 without any suspicion of its use. After a time the 
 effect of its use appears in disordered digestion, 
 the irregular heart's action, and the increase of 
 nervousness and muscular unsteadiness. In per- 
 sons past middle life a form of cardial asthma 
 with a tendency to delirium appears. These and 
 many other obscure symptoms finally merge into 
 
COCAIN AND OTHER DRUG ADDICTIONS. 87 
 
 delirmm and death. Kot unfrequently cases of 
 delirium tremens have been found in which the 
 drug taken was chloral and not spirits. The usnal 
 trembling and delusions of persecution and hal- 
 lucinations of sight and loathsome animals are 
 present. Some observers have noticed that chloral- 
 takers have peculiar blueness of the extremities 
 with venous congestion; also marked listlessness 
 and lack of energy as prominent symptoms of 
 this addiction. Choralism is confined largely io 
 the more prosperous classes of society. This drug 
 can be disguised in many ways and used as a 
 fascinating sleep producer. The amount varies 
 from twenty to two hundred grains a day. Often 
 considerable time will elapse before toxic symp- 
 toms appear; then, suddenly extreme prostration 
 with delirium comes on, ending fatally. Sudden 
 palsies, with vaso-motor disturbances, heart fail- 
 ure, and low stages of delirium, should suggest 
 chloralism, particularly if alcohol, opium, cocain 
 and chloroform can be excluded. The statement 
 of the patient concerning his condition is of no 
 value. Where the history indicated extreme 
 neuralgia and insomnia and a sudden passing 
 away of these conditions, the assumption that 
 chloral is used is possible. When it is established 
 that chloral addiction is present, the patient 
 should be isolated at once and placed under posi- 
 tive restraint and the drug withdrawn. Alcohol, 
 
OO DRUG HABITS AND THEIR TREATMENT. 
 
 opium, chloroform, ether and cocain are all con- 
 traindicated as substitutes. Vegetable narcotics, 
 such as hyoscyamus, valerian, lupulin, bull nettle, 
 and others of this class may be given as substitutes 
 and withdrawn at the earliest moment. Then 
 comes the usual tonic treatment of nux vomica, 
 strychnin and arsenic. The latter seems to be the 
 best borne, and can be given a very long time. 
 Cinchona and iron are also excellent drugs. The 
 insomnia and neuralgia with deranged nutrition 
 which follow the withdrawal should be treated 
 with baths, foods, and careful hygienic manage- 
 ment of all the functional activities of the body. 
 When chloral is used in connection with other 
 drugs, profound exhaustion often follows its 
 abandonment. Sudden, unexpected death occur- 
 ring during the use of the drug is common. Many 
 secret remedies for neurotic troubles contain 
 chloral, and decided symptoms of chloralism often 
 appear. Chloralism has been mistaken for gen- 
 eral paralysis, neurasthenia, and hyperemia, as 
 well as several affections of the cord. Many opium 
 and alcohol cases are found io be complicated 
 with chloral addiction, and their recovery is more 
 difficult. 
 
 ETHEE 
 
 The use of ether as a beverage has so far only 
 been noted in certain distinct sections of the 
 country. In the north of Ireland it has attained 
 
COCAIN AND OTHER DRUG ADDICTIONS. 89 
 
 such prominence as to become the subject of legis- 
 lation and medical study. In certain sections of 
 Wisconsin and Pennsylvania the sale of cheap 
 snlphuric ether has assumed some prominence. 
 Many persons use it regularly. The effect of the 
 ether is rapid exhilaration, with tnmnltuous satis- 
 faction and joy; then a variable period of stupor 
 and sleep, and recovery. When this is used often 
 digestion suffers and conditions of hyperesthesia 
 and anesthesia follow. Sometimes the excited 
 stage is a form of acute mania with violent symp- 
 toms. On recovery depression and melancholia 
 follow. Fortunately no general addiction has been 
 so far noted. The few cases which have appeared 
 have had alcohol or opium addiction before, and 
 the use of ether was a more pleasant addiction 
 than the other. The mind in all such cases is 
 more or less impaired and recovery will depend 
 upon the use of the various means found useful in 
 other cases of addiction. 
 
 TEA HABIT 
 
 Tea inebriety is one of the milder addictions 
 that only occasionally comes under medical no- 
 tice. It is a well-recognized fact clinically that a 
 number of persons seriously injure themselves by 
 the excessive use of tea, the symptoms of which 
 are usually gastric derangement, neuralgias, 
 muscular twitchings and trembling, great irri- 
 
90 DRUG HABITS AND THEIR TREATMENT. 
 
 lability, with hyperexcitability. In some instances 
 delusions of fear and hallucinations of voices at 
 night, bad dreams, painful insomnia, are com- 
 mon. Many single women, past middle life are 
 clearly tea inebriates. Often some form of deliri- 
 um breaks out or some obscure neuralgic pain 
 which is attributed to many very serious diseases 
 appears. Many of these eases are unconscious of 
 the effects of excessive tea-drinking, and attribute 
 the symptoms to other causes. The general symp- 
 toms may be described by the terms neurasthenia, 
 cerebrasthenia, and anemia. The removal of the 
 tea and active hygienic treatment is usually suffi- 
 cient. Mineral tonics and bitter barks and acid 
 drinks are the usual remedies. Some of these 
 cases end fatally from acute exhaustion and heart 
 failure ; others seem to suffer from profound star- 
 vation, food not being assimilated and poisons 
 gathering in the. system become sources of acute 
 inflammation. Many obscure neurotic cases will 
 be found to follow the action of the active prin- 
 ciple of tea, affecting the cerebral centers. 
 
 COFFEE ADDICTIOJf 
 
 Coffee addiction belongs to the same class of 
 irritant narcotics, and when taken in excess pro- 
 duces semi-delirium and great prostration. Coffee- 
 drinkers sometimes under great excitement de- 
 velop delusional states, usually of the grandiose 
 
COCAIN AND OTHER DRUG ADDICTIONS. 91 
 
 character, and rarely violent or destructive. Sus- 
 picions of wrong and injustice may occur. These 
 alternate with extravagant credulit}'. In the treat- 
 ment arsenic and strychnia are valuable tonics. 
 Elimination by baths and catharsis and nerve and 
 brain rest are especially valuable. Both tea and 
 coffee can become dangerous addictions where used 
 by neurotics, and often require medical aid and 
 counsel to be relieved. Frequently they precede 
 the use of opium and alcohol, and are very sig- 
 nificant addictions. 
 
 AESE^^C 
 
 The use of arsenic as a stimulant has been noted 
 in many sections of the country. In the reported 
 cases its effects were those of a pleasing tonic. 
 The skin soon becomes pearly and white, the e3"es 
 take on a brilliant hue, and the face becomes 
 plump and a general air of indifference is mani- 
 fested. There is a certain tolerance to this drug 
 in such cases, and apparent exhilaration which fol- 
 low from its use. In the cases which have been 
 observed fifteen to twenty-five grain a day were 
 used, and after a year or so death followed sud- 
 denly from apparent heart failure. In others 
 slight degrees of dementia preceded the fatal issue. 
 In all cases the perspiration gave out a strong 
 metallic odor. Fortunately these cases are un- 
 
92 DRUG HABITS AND THEIR TREATMENT. 
 
 common, and seem so far to be confined to women 
 and neurotics of the better classes. 
 
 EAU DE COLOGNE 
 
 Another form of addiction has been noticed and 
 described at some length, that of the use of Co- 
 logne water. In these cases the narcotic action is 
 simply that of alcohol, often of an inferior kind, 
 concealed by the odor of the perfume. It is prob- 
 able that the odor is quite as much of a fascination 
 as the spirit itself. The conditions which follow 
 are substantially those of delirium and melan- 
 cholia, with obscure and complex nerve disorders, 
 which readily disappear on the removal of the 
 cause. These cases are all alcoholics, and are 
 likely to develop delirium and serious nutrient 
 degenerations. The external use of these odorif- 
 erous spirits by drug neurotics is always unsafe, 
 and open to suspicion. When taken internally its 
 treatment and care are along such lines as those 
 of alcohol. 
 
 GINGER 
 
 Jamaica ginger is another one of those alcoholic 
 preparations which have become popular in cer- 
 tain sections. They are all forms of cheap alco- 
 hol concealed with solutions of ginger, the latter 
 being only a mild stimulant and irritant, the 
 former having the same effect as other spirits. 
 Several cases have occurred where its use was 
 
COCAIN AND OTHER DRUG ADDICTIONS. 93 
 
 decided to be harmless and in no way responsible 
 for the mental disturbance and irregular conduct 
 following. This is incorrect. The use of Jamaica 
 ginger usually containing from ten to forty per 
 cent, of alcohol is precisely like that of other 
 alcohols, and should be treated in the same way, 
 and is certainly followed by the same symptoms, 
 only less prominently. 
 
 PAEALDEHYD 
 
 Paraldehyd has been used by neurotics to some 
 extent, and may properly be called one of the 
 addictions. Excessive prostration and delirium 
 are the common symptoms which follow. The 
 removal of the drug and the causes which impel 
 its use are the obvious means required for the 
 
 treatment. 
 
 gelse:miu:m 
 
 Gelsemium is another drug which has been used 
 as a tonic and narcotic. The common symptoms 
 are stupor, emaciation, listlessness, delusions and 
 hallucinations, followed by an early death. This 
 drag is used first for the relief of pain, and its 
 effects are so pleasing that its use is continued. 
 
 These are only the more common of the drugs 
 whose poisonous use has attracted medical attention. 
 They may be called drug addictions for the reason 
 that they often begin with and without the pre- 
 scription of a physician, and are taken secretly. 
 
94 DRUG HABITS AND THEIR TREATMENT. 
 
 When the derangement which follows from their 
 use becomes prominent the medical man is called. 
 Unfortunately many of these cases have reached 
 chronic stages before this period, and the result 
 is that the treatment is diflBcult and uncertain. 
 Many of them require asylum treatment; others 
 may be treated at home, but all need exact means 
 and measures for restoration and relief. The de- 
 lusion that these unfortunates have full posses- 
 sion of their will to abstain or continue is fast 
 passing away. We are now able to recognize in 
 most of these cases well-defined diseases that begin 
 and follow a progressive line on to death or resto- 
 ration. While the treatment is much more posi- 
 tive through the cooperation of the patient, it is 
 only by the use of physical means and measures 
 that any permanent results can be expected. 
 
INDEX. 
 
 Alcohol, the study of, 9 
 
 Cofifee addiction, mental 
 
 its influence as contrib- 
 
 conditions, 90 
 
 utory, to disease, 9 
 
 treatment of, 91 
 
 in neuroses, 10 
 
 in relation to other 
 
 in medical and surgical 
 
 drug habits, 91 
 
 diseases, 10 
 
 Cologne water, habit, 92 
 
 as a medicine, 10 
 
 physical results, 92 
 
 as a toxin producer, 10 
 
 Cocain addiction, with 
 
 inebriety a disease, 10 
 
 opium, 75 
 
 drinkers, 19 . 
 
 mental confusion, yS 
 
 the removal of, 48 
 
 phy sical changes 
 
 Alcoholism, the progress 
 
 caused, 77 
 
 of, II 
 
 prognosis, 78 
 
 symptoms of, 12 
 Alcoholic parents, chil- 
 , dren of, 21 
 
 treatment, 78 
 diet and moral treat- 
 ment, 79-81 
 Drunkenness, curability 
 
 Arsenic, 91 
 
 of, II 
 
 Baths, 50 
 
 Drink habit, forms of, 13 
 
 Convulsions, 38 
 
 Drinkers, periodical, 14 
 
 following use of opium, 
 
 continuous, 13 
 
 38 
 
 contagious, 13 
 
 Chloroform, abuse of, 82 
 
 concealed addiction of. 
 
 mental state in abuse 
 
 of, 82 
 example of abuse, 83 
 
 IS 
 
 impulsive, 16 
 impulsive character of, 
 
 17 
 impulsive causes of, 18 
 
 Cabanis; of France, 11 
 
 Chloralism, physical and 
 
 eccentric class, 18 
 
 mental states, 87 
 
 heredity of, 18 
 
 treatment, 88 
 
 heredity of, direct and 
 
 prognosis, 88 
 
 indirect, 18-40 
 
II. 
 
 INDEX. 
 
 heredity of, producing 
 
 criminals, 21 
 heredity of, examples 
 and forms of predis- 
 positions, 18 
 Drugs, disease impulse, 
 23 
 disease, liability to men- 
 tal change and physi- 
 cal disease, 24 
 Delirium tremens, how in- 
 duced, 33 
 how manifested, 33 
 prognosis, 34 
 treatment, 34 
 other diseases caused 
 by, 36-37 
 Dipsomania, differs from 
 inebriety, 30 
 how manifested, 31 
 prognosis, 34 
 treatment, 34 
 Ether addiction, mental 
 
 state in, 89 
 Galen, 11 
 Ginger tincture (Jamaica 
 
 ginger), 92 
 Gelsemium, its abuse, 93- 
 
 94 
 Habit, the popular defini- 
 tion, 9 
 Hippocrates, 11 
 Inebriety, the study of in 
 America, 11 
 
 the quarterly Journal 
 
 of, II 
 epileptoid types, 15 
 produces permanent 
 
 mental disorders, 16 
 examples and forms of 
 
 predisposition, 18-22 
 conditions conducive to, 
 
 25-47 
 contagious, examples 
 
 of, 25 
 types of, 26 
 
 change of character, 35 
 contributing causes, 41, 
 
 42, 43, 44 
 pathology, 45 
 symptoms, 46-47 
 treatment, 48 to 58 
 prognosis, 58, 59, 60 
 Inebriate asylum, the first 
 
 in America, 11 
 Magnan, 38-41 
 Mattison, 68 
 Morel, of France, 20 
 Opium inebriety, users in 
 this country, 61 
 diathesis favored by the 
 following conditions, 
 63-64 
 treatment of, 64 to 73 
 Parish, 67 
 Paraldehyde, 93 
 Rush, II 
 Salvator, of Russia, 11 
 
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