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THE 
 
 DISEASE OF INEBRIETY 
 
 FROM 
 
 ALCOHOL, OPIUM AND OTHER NARCOTIC 
 
 DRUGS, 
 
 ITS ETIOLOGY, PATHOLOGY, TREATMENT 
 
 AND 
 
 MEDICO-LEGAL RELATIONS. 
 
 ARRANGED AND COMPILED BY THE AMERICAN 
 
 ASSOCIATION FOR THE STUDY AND 
 
 CURE OF INEBRIETY. 
 
 NEW YORK: 
 
 E. B. TREAT & COMPANY, 
 
 241-24^ WEST 23D STREET. 
 1899. 
 
 $2.00, n«t. 
 
CC)PYR]GHT, 1893, 
 
 By the American Association 
 
 FOR THE 
 
 Study and Cure of Inebriety- 
 
 
o 
 
 Cir: 
 
 DEDICATED 
 
 TO THE MEMORY OF 
 
 DR. J. EDWARD TURNER, 
 
 THE PROJECTOR AND FOUNDER OF THE FIRST 
 
 INEBRIATE ASYLUM IN THE WORLD, AT 
 
 BINGHAMPTON, NEW YORK. 
 
 ALSO TO THE MEMORY 
 OF THOSE PIONEERS, NOW PASSED AWAY, WHO 
 FAR IN ADVANCE OF THEIR TIMES 
 ORGANIZED THE FIRST SCIEN- 
 TIFIC SOCIETY FOR THE 
 STUDY AND CURE OF 
 INEBRIETY : 
 
 DRS. JOSEPH PARRISH. THEODORE L. MASON, WIL- 
 LARD PARKER, DANIEL DODGE, JOHN WILLETTS, 
 
 AND OTHERS. 
 
 THIS VOLUME IS OFFERED AS A SLIGHT TRIBUTE 
 TO THEIR SUPERIOR DISCERNMENT, AND PRAC- 
 TICAL RECOGNITION OF THE GREAT ONCOM- 
 ING TRUTHS OF INEBRIETY. 
 
INTRODUCTION. 
 
 In 1870 the American Association for the Study and cure 
 of Inebriety was organized in New York City. Its members 
 were composed of physicians connected with asylums for 
 Inebriates and others interested in the scientific study of the 
 drink problem. 
 
 The following statements were adopted as representing 
 the principles and purposes of the Association : 
 
 1. Inebriety is a disease. 
 
 2. It is curable as other diseases are. 
 
 3. The constitutional tendency to this disease may be 
 either inherited or acquired ; but the disease is often in- 
 duced by the habitual use of alcohol or other narcotic sub- 
 stances. 
 
 4. Alcohol has its place in the arts and sciences, but as a 
 medicine it is classed among the poisons, and its internal 
 use is always more or less dangerous, and should be pre- 
 scribed with great caution. 
 
 5. All methods hitherto employed for the treatment of 
 inebriety that have not recognized the disordered physical 
 condition caused by alcohol, opium, or other narcotics, have 
 proved inadequate in its cure ; hence the establishment of 
 Hospitals for the special treatment of inebriety, in wliicli 
 such conditions are recognized, becomes a positive need of 
 the age. 
 
 6. In view of these facts, and the increased success of the 
 
VI INTRODUCTION. 
 
 treatment in inebriate asylums, this Association urges that 
 every large city should have its local and temporary hospital 
 for both the reception and care of inebriates ; and that 
 every State should have hospitals for their more permanent 
 detention and treatment. 
 
 7. Facts and experience indicate clearly that it is the 
 duty of the civil authorities to recognize inebriety as a dis- 
 ease, and to provide means in hospitals and asylums for its 
 scientific treatment, in place of the penal methods by fines 
 and imprisonment hitherto in use, with all its attendant evils. 
 
 8. Finally, the officers of such hospitals and asylums 
 should have ample legal power of control over their patients, 
 and authority to retain them a sufficient length of time for 
 their permanent cure. 
 
 For twenty-two years this association has held annual 
 and semi-annual meetings in which a large number of 
 papers have been presented, read and discussed. 
 
 In the first seven years, six volumes of transactions 
 were issued, then a society journal was established as the 
 official organ of the association. This was called the 
 Quarterly Journal of Inebriety, which has been published 
 since 1877; the special work of this journal has been to 
 gather and group the scientific literature of this subject 
 and make it available for future study. 
 
 In addition to this literature, many members of this 
 association have published volumes on this subject. Of 
 these may be mentioned : " Alcoholic Inebriety" by the late 
 Dr. Joseph Parrish, President of the Association ; ** Metho- 
 mania" by Dr. Albert Day, the present President ; ^^ Inebri- 
 is>n,*' by Dr. T. L. Wright, a member of the Association ; 
 "Inebriety," by Dr. Norman Kerr, of London, an honorary 
 member ; " Alcoholism," by M. Magnan, an honorary member, 
 of France ; " The Manifestations of Alcoholism," by Dr. Lentz, 
 of Brussels, an honorary member ; " Alcoholism as a Malady^* 
 by Dr. A. Baer, of Berlin, also an honorary member. 
 
INTEODUCTION. Vll 
 
 III both this country and Europe, a large number of 
 valuable papers and monographs on this topic, have 
 appeared. 
 
 Among the most prominent who have written on this 
 subject may be mentioned Drs. Mason, Crothers, Mattison, 
 Mann, Hughes, Searcy, Wright, Davis, Shepard, Morris, Day 
 and many others. Abroad, Drs. Peddie, Kerr, Clouston, 
 Carpenter, Ridge, Richardson and many of the most 
 eminent physicians and medical teachers of Europe. 
 
 A large part of these writings have been published in 
 \.\ic Journal of Inebriety, together with the discussions and 
 criticisms which have grown out of them. 
 
 This literature has been copied into medical and other 
 journals and become the subject of lectures, sermons and 
 works on temperance ; but in many cases the original ideas 
 have been changed and modified to such an extent as to be 
 unrecognized. As a result, the most confusing uncertainty 
 and conflict of opinion exists concerning the scientific 
 study of inebriety and its maladies. 
 
 Recently, this subject has attracted renewed attention, 
 growing out of the empiric assumptions of specific reme- 
 dies for its cure. Following this, an increasing demand has 
 appeared for some authoritative grouping of the studies of 
 scientific men in this field, and suggested the value of a 
 volume comprising some of the best papers which have 
 been published in the journal. 
 
 In accordance with this, the following resolution was 
 unanimously adopted at the November meeting of the Asso- 
 ciation for the Study and Cure of Inebriety. 
 
 " Whereas, In view of the fact that the demand for copies 
 of the Journal of Inebriety containing special studies, mono- 
 graphs and papers on distinct phases of inebriety is steadily 
 increasing, together with constant inquiry from physicians 
 for facts, statistics and conclusions relating to the disease of 
 inebriety; 
 
Vlll INTEODUCTION. 
 
 " Therefore^ resolved^ that the secretary be authorized 
 to prepare a volume, wliich shall contain the most reliable 
 conclusions and studies of eminent authorities on all phases 
 of the disease of inebriety up to the present time ;" 
 
 ^^ Resolved, that the secretary, with the publication com- 
 mittee, make all arrangements for the printing and issuing 
 of said volume at the earliest possible moment. 
 
 This volume is in conformity with this resolution, and 
 simply aims to give the reader many of the best and most 
 suggestive studies of this subject which have appeared. 
 
 More prominence has been given to heredity, treatment 
 and medico-legal relations, because these phases are dis- 
 puted and the subject of confusing controversy. The fact 
 of disease in inebriety has passed beyond question and is 
 practically settled, hence all moral theories or discussions 
 are of little or no value from a scientific point of view. 
 These various studies are not presented as exhaustive, but 
 rather as outlines suggesting wide stretches of the unknown, 
 inviting the reader to take up this subject and extend its 
 frontiers far in advance of the present. 
 
 It will be apparent to all that the scientific study of in- 
 ebriety is yet in its infancy, and no student or volume can 
 do more than give a general view of the most probable 
 facts which appear to be sustained by the strongest evidence 
 available up to this time. 
 
 This volume is intended to represent the work of the 
 Association for the Study and Cure of Inebriety and the 
 cliaracter of the papers and discussions which have 
 appeared in its journal. 
 
 For over a quarter of a century, this association has 
 studied exclusively the scientific side oi inebriety, and 
 although it has not attracted much attention and is practi- 
 cally unknown, it has been a great silent power, crystalliz- 
 ing and marshalling the many facts constantly appearing 
 from a knowledge of these cases. 
 
INTRODUCTION. IX 
 
 The drink malady, its causes, cure and prevention, are 
 practically an unoccupied field of medicine, and this work 
 is offered as a guide and stimulus to farther study in this 
 direction. 
 
 These selections have been gathered from over five 
 thousand pages of printed matter, published in the journal 
 iiiid transactions, and are from papers which have not 
 appeared elsewhere and hence will be new to most pliysi- 
 cians. It will be evident to tlie reader that while the facts 
 are very numerous and startling, and fully sustain the 
 principles of the association, tliey are not yet sufficiently 
 studied and generalized to be accepted as absolute truths. 
 
 Tills volume brings the subject up to the frontier lines, 
 and suggests that the possibility of restoring the inebriate 
 and stamping out inebriety, is onlylimited by our want of 
 knowledge of the laws and means to accomplish this end. 
 It also suggests that a solution of this great problem of the 
 forces and sources which develop the armies of the inebri- 
 ates or halt and disband them, must be along the line of 
 accurately observed facts and their meaning. 
 
 The purpose of this work will be accomplished, if, in any 
 way, it shall help on this pioneer work. 
 
 T. D. Crothers, 
 
 Secretary. 
 Hartford, Conn. 
 
 March, 1893. 
 
CONTENTS. 
 
 CHAPTER I. 
 
 PAGE 
 
 Early history of the Theory of Disease in Inebriety. — 
 Opinions and Statements of authors and writers in 
 Europe and America 17 
 
 CHAPTER n. 
 History of disease theory in modern times, — Dr. Turner, 
 New York State Inebriate Asylum. — American 
 Association for the Study and Cure of Inebriety. — 
 Journal of Inebriety ^ etc 22 
 
 CHAPTER III. 
 Different forms of Inebriety. — Classes of Inebriates.... 27 
 
 CHAPTER IV. 
 Dipsomania and its varieties and manifestations 29 
 
 CHAPTER V. 
 Some phases of the philosophy and etiology of Inebri- 
 ety. — The higher ranges of causes 39 
 
 CHAPTER VI. 
 Inebriate diathesis, its conditions and relations 47 
 
 CHAPTER VII. 
 General and predisposing causes described 55 
 
X'l CONTENTS. 
 
 CHAPTER VIII. 
 
 PAGE 
 
 Special exciting causes. — Traumatism nnd injury 66 
 
 CHAPTER IX. 
 Special causes continued, Adversity, Sunstroke, Heat, 
 
 and other causes 79 
 
 CHAPTER X. 
 Inebriety in America. — Some of its peculiarities, etc. .. 90 
 
 CHAPTER XI. 
 Prevalence and mortality of Inebriety. — Fatality in epi- 
 demics, etc 100 
 
 CHAPTER XII. 
 Relation between Inebriety and Consumption, etc., 
 
 etc 103 
 
 CHAPTER XIII. 
 Effects of alcohol and beer on mental functions, etc. .. 113 
 
 CHAPTER XIV. 
 Climatic periods and diagnosis of Inebriety. — Study of 
 
 social statistics 118 
 
 CHAPTER XV. 
 Delirium tremens and associated conditions 131 
 
 CHAPTER XVI. 
 General facts of heredity and predisposing conditions. 145 
 
 CHAPTER XVII. 
 Heredity continued, views of foreign authors 155 
 
 CHAPTER XVIII. 
 Statistics of heredity and other considerations 161 
 
CONTENTS. XI U 
 
 CHAPTER XIX. 
 
 PAGE 
 
 Pathology and general considerations of the nature of 
 
 Inebriety 173 
 
 CHAPTER XX. 
 Some of the pathological changes common to all cases 
 
 of Inebriety 185 
 
 CHAPTER XXI 
 Treatment, some general considerations of the nature 
 
 and plan 197 
 
 CHAPTER XXII. 
 Inebriate Asylums and their nature and work 215 
 
 CHAPTER XXIII. 
 Hygiene. — Hot air and other methods of treatment. . . 227 
 
 CHAPTER XXIV. 
 Duty of the State in the care and treatment of Inebri- 
 ates 239 
 
 CHAPTER XXV. 
 
 Special care of Pauper Inebriates in cities and towns.. 251 
 
 CHAPTER XXVI. 
 Some medico-legal considerations concerning Inebriety. 265 
 
 CHAPTER XXVII. 
 Medico-legal questions continued, rulings of judges and 
 
 the law 277 
 
 CHAPTER XXVIII. 
 General questions of irresponsibility in Inebriety 285 
 
XIV CONTENTS. 
 
 CHAPTER XXIX. 
 
 PAGE 
 
 Some special forms of irresponsibility, trance, etc 297 
 
 CHAPTER XXX. 
 Practical relations of inebriety, coma, and brain dis- 
 ease 309 
 
 CHAPTER XXXI. 
 Opium Inebriety . — Its nature and character 317 
 
 CHAPTER XXXII. 
 Opium inebriety continued. — Its special treatment..,. 329 
 
 CHAPTER XXXIII. 
 Ether Inebriety. — Its origin and consequence 347 
 
 CHAPTER XXXIV. 
 Cocaine Inebriety 357 
 
 CHAPTER XXXV. 
 Chloroform Inebriety 363 
 
 CHAPTER XXXVI. 
 Inebriety from coffee and tea, and its effects 369 
 
 CHAPTER XXXVII 
 On the psychosis caused by nicotine 377 
 
 CHAPTER XXXVIII. 
 Eau de Cologne drinking. — Arsenic and ginger inebri- 
 ety 3^3 
 
DISEASES OF INEBRIETY. 
 
 CHAPTER I. 
 
 EARLY HISTORY OF DISEASE THEORY. 
 
 It is a curious fact that inebriety was recognized as a 
 disease long before insanity was thought to be othet* than 
 spiritual madness and a possession of the devil. The fact 
 has escaped the attention of persons who assert that inebriety 
 is always a vice, and the disease theory is only an extrava- 
 grant view of enthusiasts, peculiar to our times. For over 
 a century, the disease of insanity was denied and contested. 
 Inebriety is passing the same ordeal of ignorant opposition 
 and criticism, notwithstanding it has been recognized by a 
 majority of the leading physicians of the world to-day. 
 
 The following outlines of the early history of inebri- 
 ety will show that this is not a mere theory of our times, 
 but a great truth, outlined and foreshadowed by many of 
 tlie leading physicians and philosophers of the past. 
 
 This disease was hinted at in an early age of the world, 
 and is by no means a modern idea. On an old papyrus 
 found in one of the tombs of Egypt> dating back to a very 
 ancient period, was the following significant passage, 
 referring to an inebriate who had failed to keep sober . 
 
 17 
 
18 DISEASES OF INEBRIETY. 
 
 " Thou art like an oar started from its place, which is 
 unmanageable every way ; thou art like a shrine without its 
 God, like a house without provisions, whose walls are found 
 shaky." 
 
 Many of the sculptures of Thebes and Egypt exhibit 
 inebriates in the act of receiving physical treatment from 
 their slaves, such as purgatives, rubbings or applications to 
 the head and spine, Heroditus, five centuries before the 
 Christian era, wrote, " that drunkenness showed that both 
 the body and soul were sick." Diodorus and Plutarch 
 assert " that drink madness is an affection of the body 
 which hath destroyed many kings and noble people." 
 Many of tlie Greek philosophers recognized the physical 
 character of inebriety and the hereditary influence or tend- 
 encies which were transmitted to the next generation. 
 
 Laws were enacted forbidding women to use wine, and 
 young boys were restricted. 
 
 Frequent reference is made to the madness which 
 souglit solace in wine and spirits. Such cases are called 
 and urged to give more diligent care to their bodies, a 
 distinct hint of the physical origin of inebriety. 
 
 In the first century of the Christian era, St. John 
 Clirysostom urged that inebriety was a disease like dys- 
 pepsia, and illustrated his meaning by many quaint reason- 
 ings. This was the first clear, distinctive recognization of 
 the disease, which had been hinted at long before. 
 
 In the next century, Ulpian, the Roman jurist, referred 
 to the irresponsible character of inebriates, and the 
 necessity of treating them as sick men. His views were 
 embodied in some laws, which referred more distinctly to 
 the physical nature and treatment of inebriety. 
 
 Many of the early and later writers of Roman civiliza- 
 tion contain references to drunkenness as a bodily disorder, 
 not controllable beyond a certain point, which resulted in 
 veritable madness. Nothing more was heard of this theory 
 until the thirteenth century, when one of the Kings of 
 
EAELT HISTORY OF DISEASE THEOKY. 19 
 
 Spain enacted laws fully recognizing inebriety as a disease, 
 lessening the punishment of crime committed when under 
 the influence of spirits. One of the laws provided, that 
 when murder was committed during intoxication, the death 
 penalty should be remitted, and the prisoner be banished 
 to some island for a period of not less than six years. 
 
 In the sixteenth century the penal codes of France and 
 many of the German States contained enactments which 
 recognized the disease character of inebriety. 
 
 All punishment for crime committed during this State 
 varied according to the conditions of the prisoner at the 
 time. 
 
 Drunkenness, continued beyond a certain point, was 
 regarded as a condition of insanity and irresponsibility. 
 In many of the medical writings of these ages, drunken- 
 ness and madness were mentioned as synonyms, and curious 
 reflections on the nature and treatment of the evil are 
 detailed. 
 
 In 1747, Condillac, a French philosopher, wrote express- 
 ing clear views of the disease of inebriety, also that the 
 State should recognize and provide means for its treatment. 
 He asserted that the impulse to drink was like insanity, 
 an affection of the brain, which could not be reached by law 
 or religion. 
 
 Dr. Benjamin Rush, of Philadelphia, in 1790, set forth 
 the same theory, supported by a long train of reasoning. 
 To him belongs the honor of first elaborating this sub- 
 ject and outlining what has been accepted half a century 
 after. 
 
 In two essays, entitled, " The influences of physical causes 
 upon moral faculties," and "An inquiry into the effects of 
 ardent spirits upon the human body and mind," he described 
 the disease of inebriety, dividing it into acute and chronic 
 forms, giving many of the causes, of which heredity was 
 prominent, also urging that special measures be taken in 
 the treatment, which should be in a hospital for this pur- 
 
20 DISEASES OF INEBRIETY. 
 
 pose. Up to tliis time these views were clear and distinct- 
 ive, althougli not published until 1809. They were entirely 
 independent of all previous observations. 
 
 In 1802, Dr. Cabanis, of Paris, wrote fully indorsing the 
 views of Condillac, that inebriety, like insanity, was a disease 
 which should be studied, and that it was a distinct form of 
 mental disorder, needing medical care and treatment. Pro- 
 fessor Plainer, of Leipsig, published a paper in 1809 (the 
 same year Rush's writings appeared), affirming that ine- 
 briety was like an insane impulse and a form of insanity 
 which should receive medical care and be studied by the 
 aid of science. 
 
 In 1817, Salvator, of Moscow, a physician of some emin- 
 ence, published a pamphlet called " Ebriosity, its pathology 
 and treatment." He divided drunkenness into two forms, 
 intermittent and remittent, and urged that they be treated 
 by physical means. 
 
 Esquirol, in 1818, described a condition of the nervous 
 system in which inebriety was sure to follow. In 1822, Buhl 
 Cramner, a distinguished physician of Berlin, wrote a small 
 book defining inebriety as a state of irritation of the brain 
 and nervous system, to be cured by physical means because 
 it was purely of physical origin. 
 
 In Europe the writings of these four men, Platner, Sal- 
 vator, Esquirol and Cramner, placed the subject on a scien- 
 tific basis, paving the way for a wider and more thorough 
 study. Although Dr. Rush had written on the general 
 subject more definitely than the others, his writings were 
 practically unknown. 
 
 In 1830, a committee of the Connecticut State Medical 
 Society, appointed the year before to report on the necessity 
 of an asylum for the medical care and treatment of inebri- 
 ates, recommended in an elaborate essay that it was expedi- 
 ent to establish an asylum for the cure of inebriates. 
 
 This report, written by Dr. Todd, the superintendent of 
 
EARLY HISTOKY OF DISEASE THEORY. 21 
 
 the insane asylum, strongly urged the recognition of the 
 disease of inebriety and its curability by physical means. 
 
 Tliis report, wliich may be found in the Transactions of 
 the Conn. State Medical Society, was a remarkable concep- 
 tion of the subject, far beyond the current opinions of that 
 time, only now beginning to be recognized. 
 
 In 1833, Dr. Woodard, of Worcester, Mass., urged that 
 inebriety was a disease, and curable as other diseases in 
 asylums for this purpose. This attracted attention and 
 was endorsed by many. In 1839, Dr. Roesch, of Tubingen, 
 in a volume on spirituous liquors, urged that inebriety be 
 considered a disease. He elaborated the idea and pointed 
 out the errors of other authors at some length. 
 
 Dr. Nasse, of Bonn, followed, urging the same view. 
 
 From this date, the literature has grown rapidly, especi- 
 ally in this country. The opinions and writings of Ameri- 
 can physicians on this subject are now widely sought for in 
 Europe. The English Lunacy Commission, in 1844, urged 
 that inebriates should be regarded as insane, sent to asylums 
 for treatment, and not punished as before. 
 
 Many other writers timidly followed these advanced 
 theories and, when stoutly opposed, compromised by admit- 
 ting a state of half disease and half vice. 
 
CHAPTER IT. 
 
 HISTORY OF DISEASE THEORY IN MODERN TIMES. 
 
 The Washingtonian temperance revival, of 1840, seemed 
 to have cleared away man}'- of the old theories and prejudices, 
 and gave clearer conceptions of the real nature and charac- 
 ter of inebriety. The sudden and intense projection of the 
 moral side of inebriety reacted when this reform wave 
 died away, but it had served to fuse and mobilize the tide 
 of oncoming truth, outlined for a long time in frequent 
 statements of the disease of inebriety. The first practical 
 demonstration of this began in a lodging-house for in- 
 ebriates, opened in 1845, at Boston, Mass., called the Wash- 
 ingtonian Hall. This recognized, in a crude way, the phys- 
 ical disabilities of inebriates, and souglit to remove them 
 by physical means. This was tiie first embrio asylum of the 
 world, which has grown into the Washingtonian Home of 
 the present da3\ 
 
 While physicians and writers were repeating the theories 
 of the possibility of disease of inebriety, Dr. J. Edward 
 Turner, a Maine physician, came forward as the great pion- 
 eer to vitalize and show the practical value of the truth that 
 inebriety was a disease, and curable. 
 
 In 1846, Dr. Turner became interested in this work from 
 an ineffectual effort to save an early friend who was an 
 inebriate. He recognized the nature of the disease of 
 inebriety and the need of hospital treatment, and began an 
 enthusiastic agitation of the subject. After eight years of 
 most persistent effort, in the face of great opposition, he 
 succeeded in enlisting the attention of many eminent medi- 
 
 23 
 
HISTORY OF DISEASE THEORY IN MODERN TIMES 23 
 
 cal men, and in forming a company to build an Inebriate 
 Hospital, witli the late famous surgeon, Dr. Valentine Mott, 
 as president. Laws were passed to give power to hold 
 inmates, a charter was granted, and nearly fifty thousand 
 dollars subscribed for tlie grounds and building. Ten 
 years later, in 1864, a magnificent building was completed 
 and opened for patients, at Binghampton, N. Y., the pioneer 
 hospital of the world. Later, a fire destroyed part of the 
 building, which was soon after rebuilt. Then the board of 
 trustees became involved in a controversy with the founder, 
 Dr. Turner, resulting in his retirement, and placing the 
 hospital in the care of the State. Passing into the manage- 
 ment of politicians, its history was a series of misfortunes, 
 until finally it was changed into a chronic insane asylum. 
 Thus Dr. Turner, the founder, who had conceived and built 
 this hospital, giving over a quarter of a century of time and 
 effort, and his own personal fortune, shared the fate of all 
 reformers and benefactors of the world, in the obloquy and 
 disgrace of being driven away from the creation of his own 
 genius. 
 
 The New York State Inebriate Asylum was the first 
 institution of the kind ever organized. After fourteen 
 years of a most extraordinary history, it was closed and 
 converted into an insane asylum. The same old battle has 
 been waged around and about this institution with which 
 every new truth of science has had to contend. Bitter 
 skeptics and foolish enthusiasts have rushed to conclusions 
 in regard to his work, which could only be determined by 
 a century of accurate study and observation. Literally, this 
 pioneer asylum has been the great " On to Richmond" 
 movement, checked by a Bull Run disaster. During the 
 fourteen years of its existence, two thousand three hundred 
 and forty-four inebriates weie under treatment. A vast 
 majority of these were the most chronic cases. 
 
 The enthusiasm wliich at first centered about Binghamp- 
 ton Hospital reacted, and the moralists and temperance 
 
24 DISEASES OF INEBRIETY. 
 
 advocates, who from tlie first liad opposed tliis movement 
 as an " infidel work " to diminish human responsibility, 
 used every means to spread the idea of failure and condemn 
 other efforts in this direction. But a great fact had been 
 recognized, and its practical character had taken deep root 
 in the public mind. The birth of the Binghampton Hospital 
 was followed by the organization of over a dozen different 
 hospitals for this work in different parts of tlie country, 
 some of which are still in existence, doing grand work. 
 
 Notwithstanding the misfortunes of the first hospital 
 and its founder, a large number of similar places have been 
 organized and managed with success. As in all new enter- 
 prises, many of these hospitals must suffer from non-expert 
 management, and be organized on some theory of the 
 nature and treatment of inebriety not founded in correct 
 study and experience. After a time they are abandoned 
 or changed to homes for nervous and insane cases. Over 
 fifty different hospitals for inebriates have been established 
 in America. More tlian thirty of this number are in suc- 
 cessful operation ; the others have changed into insane 
 asylums, water-cures, etc. Tiiree large buildings or insti- 
 tutions are practically " faith cures," wiiere all physical 
 remedies and means are ignored. Several asylums are 
 called homes for nervous people, to conceal the real cause, 
 and thus protect the patients from the supposed stigma of 
 inebriety. Others are literally lodging-liouses, where the 
 inmates can remain a few days and recover from the effects 
 of spirits. Several places make a specialty of opium cases ; 
 in some the treatment is often empirical. In only a few of 
 these hospitals is inebriety studied and treated on a scien- 
 tific basis. The others are passing through the ordeal of 
 "elimination and survival of the fittest," incident to every 
 new advance of science. In many of the States large pub- 
 lic hospitals are projected, and are awaiting pecuniary aid 
 from the State or from other sources. 
 
 Most of the inebriate hospitals in America are private 
 
HISTORY OF DISEASE THEORY IN MODERN TIMES. 25 
 
 and corporate organizations, wliich receive, from time to 
 time, State aid. Some of them have endowments, such as 
 free beds, or incomes from estates, or are given so much of 
 tlie license money. Others depend upon the income from 
 patients, private donation, and charities generally. Very 
 few paupers or indigent poor are received in any of these 
 hospitals. This class appear in the "lodging" and " faith- 
 cure " places. The State of Connecticut has projected a 
 workhouse hospital for the criminal class of these cases, 
 where the commitment is for three years, but want of State 
 aid has prevented practical work so far. In three other 
 States similar projects for the pauper inebriates have been 
 organized, but for various reasons have not gone into oper- 
 ation. 
 
 In Europe, over sixty hospitals for the physical care and 
 treatment of inebriates are in active operation to-day. There 
 are two in Australia, one in China, two in India, one in 
 Ceylon, three in Africa, and one in Mexico. While these 
 institutions vary widely in plan and methods, the central idea 
 is the physical treatment of the inebriate and his malady. 
 
 The literature of this subject has grown to enormous 
 proportions, principally in papers, lectures and pamphlets. 
 
 The exact scientific study of inebriety has revealed facts 
 and conclusions which have aroused bitter controversy from 
 those who should have been first to welcome its truths. 
 
 A large number of so-called reformers have been from 
 the first denouncers of the disease theory, but unwittingly 
 they have greatly helped on the work by controversy and 
 agitation. In 1870, an association was formed of persons who 
 were connected with inebriate asylums, or interested in the 
 subject, called' the American Association for the Study and 
 Cure of Inebriates. This Association has since met yearly and 
 semi-yearly ; its papers and transactions comprise the first 
 permanent literature on this subject. In 1877, the Journal 
 of Inebriety was issued as the organ of this association, and 
 from that time has been the medium through which most 
 
26 DISEASES OF INEBRIETY. 
 
 of the literature of the subject from America has been pre- 
 sented. Inebriety, and its curability in special hospitals, 
 has been the cardinal principle of this Association, which it 
 has demonstrated and maintained with increasing vigor. 
 Discussing exclusively the physical side of this subject, 
 amid difficulties which only pioneers in a new field have to 
 contend with, tlie foundation of a scientific literature has 
 been laid which will be historic to future students of this 
 subject. This Association and its journal are great silent 
 powers, crystallizing and marshaling the many facts con- 
 stantl}'^ appearing from a study of tliese cases. Already sev- 
 eral members of this Association liave publislied works on 
 inebriety that mark the beginning of a " new era," and have 
 given great impetus to its scientific study. 
 
 In 1884, a similar society was formed in England, called 
 the Society for the study and cure of Inebriety. Similar 
 societies have been formed in France, Switzerland, Germany 
 and Sweden. 
 
 In 1887, an International Congress was held in London 
 for the discussion of the disease of inebriety. Delegates 
 from all the world were present. 
 
 Numerous committees, scientific and legislative, have 
 made elaborative reports on the disease of inebriety and 
 the means and measures for its prevention and treatment. 
 
CHAPTER III. 
 
 INEBRIETY : ITS CLASSIFICATION AND FORMS. 
 
 This term more accurate!}' represents the general 
 phenomena called diunkenness tlian any other. There are 
 two great classes, which may be designated Inebriates and 
 Dipsomaniacs. 
 
 The first class, when studied collectively, seem to divide 
 into several classes from different causes witli different 
 symptoms and termination. One of these classes are the 
 accidental idebriates, persons whose use of spirits are depend- 
 ent entirely on external conditions and environment. 
 They seem to possess a high degree of brain and nerve 
 instability, and have small resisting power, or capacity to 
 adapt themselves to new surroundings and conditions of 
 life, and retain any fixed individuality. Such persons drink 
 or abstain according to the company they are associated 
 with. They are enthusiastic temperance reformers, or 
 abject drunkards, from the mere contagion of surround- 
 ings. In a prohibition community, they are models of 
 sobriety, or types of the lowest drinkers where spirits are 
 free. Their progress and future turn altogether on 
 environment. 
 
 A second class of these accidental inebriates are con- 
 trolled solely by functional disturbances of the body. 
 Spirits are never used except when some derangement of 
 tlie organism occurs. Attacks of indigestion, chills, over- 
 work, and all forms of minor strains or drains, lead up 
 quickly to the use of spirits, without reason or premedita- 
 tion. After the sedative action of alcohol has taken place a 
 
 27 
 
28 DISEASES OF INEBRIETY. 
 
 few times, the internal resisting force is permanently 
 broken up and tlie person drinks ever after. 
 
 A second group may be called emotional inebriates. They 
 belong to that class who are always on the borders of 
 hysteria, with feeble and unstable will. Wayward, selfish, 
 fitful, uncertain, out of harmony with every relation of 
 life ; all the time suffering from a constitutional unrest, 
 and emotional struggles to attain the impossible. Spirits 
 afford relief for this physical state, and are alternately 
 used and abandoned until death or insanity comes on. 
 
 Another class, called solitaiy inebriates, use spirits only at 
 night or alone, and seem morbidly sensitive to conceal this 
 fact. They always deny all use of spirits, and display great 
 cunning and tact to cover up this condition. Tiieir drink- 
 ing seems often to be under control of the morbid reason, 
 and is checked at certain times, and is limited b)' con- 
 ditions and circumstances. These are the most interesting 
 of all cases, and often appear in persons who occupy 
 responsible positions, and involve very important ques- 
 tions of business and science. 
 
 . A large class of inebriates, appearing in lower levels of 
 life, are found to be literally constitutional paupers, who 
 through heredity and environment are switched off on the 
 side-track of dissolution. They may be termed the 
 pauper inebriates, and are persons with special unfitness for 
 healthy life, who are by the higher processes of nature 
 crowded out in the race struggle. Inebriety is simply 
 another symptom of this condition. The subsidence of 
 the drink craze is followed by other degrees of degener- 
 ation. Criminality, pauperism, prostitution, are all allied 
 conditions. Many other sub-classes of inebriety are found, 
 but they all date from some condition of brain and nerve 
 degeneration, and although the symptoms may vary, the 
 line of progress and growth are practically the same. 
 
CHAPTER IV. 
 
 DIPSOMANIA : ITS HISTORY AND RELATION. 
 
 Dipsomania is a term used to designate a large class of 
 inebriates, in which the drink impulse comes on suddenly 
 and after a time dies out, and is succeeded by a free inter- 
 val. This has been truly termed a neurosis, which is prac- 
 tically another branch of the same family of epileptics, 
 insane hysterias and paranoic. 
 
 There are three principal forms : First, the acute, which 
 is not very common, wliere the drink craze comes on sud- 
 denly from hemorrhage sunstroke ; and also convalescence 
 from fevers, excessive strains, as continuous overwork, with 
 mental care and excitement, and also severe drains of the 
 nerve energy, exhaustion and other causes. 
 
 This variety seems to resemble an attack of mania in its 
 violence and uncontrollability, and good evidence of dipso- 
 mania being an insanity and requiring careful watching and 
 treatment. 
 
 Th^ periodic is a more common variety. By some authors 
 it is considered the most common form, but in our expe- 
 rience the chronic is more frequent. In this variety are 
 classed those patients who have periodic attacks of drinking 
 lasting for a long or sliort period. In some patients the 
 attack comes on suddenly. That is to say, they take 
 to drinking laige quantities of alcoholic fluids without 
 any premonitory symptom. But more often there is 
 noticed an alteration in character and temper that fore- 
 warns those who have anything to do with the patient. In 
 the case of a married man, the wife can almost always tell 
 
 29 
 
30 DISEASES OF INEBRIETY. 
 
 when an attack is coming on. The length of these attacks 
 vary greatly, more especially according to the duration 
 of the disease in the patient. In the early history of tlie 
 disease, the drinking bouts often last from one to three 
 weeks, and during that time the patient is constantly 
 drinking. When he cannot get the quantities of liquor 
 that he requiries outside, he takes to diinking in his own 
 rooms or house. Nothing will stop him. If his friends or 
 servants try to get him to leave off, he storms and rages, 
 and terrifies tliem into submission to his ways and wants. 
 His excuse for drinking is always that he is excessively 
 weak and nervous and requires support, and that it is abso- 
 lutely necessary for his life that he should have stimulants. 
 His appetite soon disappears, and he only makes vain 
 efforts to partake of any food tliat is brought to him. 
 Great sleeplessness and restlessness comes on, and in fact, 
 the patient is often on the verge of delirium tremens when 
 the disease abates either gradually or suddenly, and he gets 
 fairly well. When it ends suddenly, it is from an attack of 
 acute or subacute gastritis, for which he requires and seeks 
 medical aid. The craving for drink having also disap- 
 peared, he willingly submits to medical direction, and under 
 judicious treatment, recovers. When the attacks go off 
 gradually there are less severe gastric symptoms, and the 
 craving having become less, tliere is a diminution in the 
 gastric and nervous troubles. 
 
 After patients have lived for several years with these 
 periodical attacks, the duration of attack diminishes in 
 length, and they increase in frequency ; the cause of this 
 being chiefly due to the effects on the gastric system. The 
 stomach much sooner resents the large quantities of alcohol 
 put into it, and consequently the drinking fits are cut short 
 by attacks of gastritis, and often also enteritis. But from 
 the attack being shoiler, the interval of diminution in drink- 
 ing also becomes shorter, so that tlie patient gradually goes 
 on from bad to worse. Once the drinking fit passes ofi, the 
 
DIPSOMANIA : ITS HISTORY AND RELATION. 31 
 
 patient generally expresses great horror and grief at his 
 propensity and the effects it produces, and will make all 
 sorts of promises to abstain altogether from alcholic drinks. 
 If the case is not a severe one, and the moral surroundings 
 of the patient are good, he will often keep his resolution 
 for a long period. But eventually, from some cause, either 
 of social temptation or mental worry, he again breaks 
 out and becomes wholly ungovernable. We have known 
 cases where a man having recovered from a periodic attack 
 would go for a period of from four to eigiit months without 
 drinking any alcoholic liquor, but the first taste of liquor 
 after that abstinence would bring on an attack. 
 
 A great many cases are called periodic which are really 
 chronic, but with temporary exacerbations, and we will dis- 
 cuss these under the chronic variety. We only include 
 under the periodic those cases where there are complete 
 periods of a natural condition of mind and body ; and in 
 almost all these the patients are either total abstainers or 
 extremely careful and temperate in their habits in the 
 intervals between the drinking fits. The higher tlie moral 
 nature of the patient, the longer are those tranquil intervals, 
 but the lower the moral nature the shorter are those periods. 
 The reason being that a man of high moral nature, either 
 from culture or inherent preception, gets more control over 
 himself and will battle long against the craving when it is 
 coming on, although eventually he gives way not from any 
 fault of his own, but on account of his being the subject of 
 a mental disease entirely beyond his control. On the other 
 hand, a man of low moral standing will never try to keep 
 himself from the temptations that he knows are dangerous 
 for him, and never makes any attempt to stave off the crav- 
 ing, but yields at once. These last are a much more hope- 
 less set of cases to deal with, and are almost always incur- 
 able, and eventually die from accidents or diseases induced 
 by their habits. 
 
 Dipsomania that comes on from injury to the head is 
 
32 DISEASES OF INEBRIETY. 
 
 generally of the periodic variety. Blows or falls on the 
 head are followed at a long or short period afterward by 
 periodic attacks of drinking mania. In surgical and medical 
 practice it is well known that similar blows on tlie head are 
 not infrequently followed by epileptic fits, and both these 
 classes of cases, viz., the accession of periodic attacks of 
 dipsomania after injuries, and the periodic attacks of which 
 we have been treating at length above, tend to point to a 
 relation between epilepsy and dipsomania. Just as an injury 
 to the head by producing some alteration in the nerve- 
 centers brings on epilepsy, so do they at other times bring 
 on dipsomania by no doubt causing also some alteration in 
 the nervous tissues. Again, where there is insanity in a 
 family, in the progeny there is a great liability to a repetition 
 of that same condition of the nerve-centers which produces 
 insanity, or else some modification of it, such as epilepsy or 
 dipsomania, for in almost every case of periodic dipso- 
 mania is there to be found a history of nervous affections. 
 There are cases on record of transitions between these two 
 affections. Either an attack of drinking passing off by an 
 epileptic fit, or patients at one time having an attack of 
 epilepsy and at another time an attack of craving for drink. 
 In fact, the two affections are very much alike in many 
 ways. Judging from cases under observation, the periodic 
 variety seems hardly ever to be induced by acquired habits 
 of drinking alcohol, it being almost always the result of 
 strong hereditary tendency to neurosis of some kind. Our 
 object in laying such stress upon the real insanity of dipso- 
 mania is to get its recognition as such by the legislature. 
 
 We stated just now the difference in effect upon the 
 course of dipsomania caused by the presence of more or 
 less high moral nature in the patient. All those who have 
 studied insanity have come to the conclusion that very 
 often there is a complete absence of the moral nature — 
 patients not having the slightest conception of any moral 
 obligations due to their fellow beings or themselves. 
 
DIPSOMANIA : ITS HISTORl AND RELATION. 33 
 
 Very frequenth'^, among dipsomanics, is there this complete 
 absence of any morality. 
 
 It is not often recognized. Friends and acquaintances 
 of the patient accuse him or her of immorality unjustly. 
 For a man cannot be immoral who has no ideas of morality 
 to start with. Many will think such a state of tilings 
 incredible, but it is really not so. Patients suffering from 
 dipsomania often behave very well for a time, but it is only 
 from the effects of habit from the way they have been 
 brought up. They may do what is right, and often appear 
 to go out of their way to do what is right, but if one could 
 get at the root of their actions, it would be found that they 
 were not guided by any moral feeling or sense whatever. 
 
 Dipsomaniacs show this perversion, or rather, absence 
 of morals, in almost all their dealings with tlieir friends 
 and relations, and it is on this account that the disease is 
 such a scourge to the friends and relatives. The patient 
 will give the most solemn promises not to take any stimu- 
 lant, but the backs of those to whom he has made the 
 promise are no sooner turned than he violates it, either by 
 obtaining the liquor himself or not refusing the first or any 
 temptation that is set before him. They always have a 
 plausible excuse when taxed with their violation of promise. 
 They will also prevaricate most cunningly until the ques- 
 tion is put directly to them. It is curious that in spite of 
 the absence of moral nature they will rarely tell a deliber- 
 ate lie. Some people might think this was due to a vestige 
 of morality, but it is, we think, due simply to a knowledge 
 of their weakness, and to the power exercised by a stronger 
 mind over theirs. This habit of prevarication, of never 
 giving the lie direct, they are cunning enough to bring for- 
 ward as a plea for tlieir being trusted occasionally. But in 
 our opinion, a dipsomaniac can never be trusted. It is not 
 right that he should be led to suppose so, for that would do 
 iiim inevitable harm, as we shall see presently in discussing 
 moral treatment for dipsomania, but at the same time 
 
34 DISEASES OF INEBRIETY. 
 
 one would never rely on the promises given by a dipso- 
 maniac, more especially if it is in regard to taking any pre- 
 cautions for guarding against his propensity. 
 
 As regards the recurrence of these periodic attacks, 
 they do not seem to have any regular intervals. In some 
 patients there is a cessation of the drinking propensity for 
 many montlis, in others, only for a few weeks. In the 
 chronic variety we shall have to mention that where periodic 
 exacerbations occur, they often do so at regular intervals, 
 and the length of time is generally a month. 
 
 In women, where generative functions are periodic, dip- 
 somania, like other varieties of insanity in women, is apt to 
 recur at intervals corresponding to the menstrual periods. 
 
 The progress, tlien, of periodic dipsomania is generally 
 an increasing frequency of the recurrence of the attacks 
 which may verge into the chronic variety, but as often as 
 not kills the patient before tiiat stage is reached. 
 
 Among this class, however, are found some who do 
 appear to be cured by careful and judicious treatment 
 during the intervals. The treatment consisting in eleva- 
 ting the moral nature by every possible means, improv- 
 ing the patient's general health, and getting him to employ 
 his mind and body actively. Tiiere is one drug which 
 ought to have extensive trial for treating the periodic 
 attacks. Bromide of potassium is well known to be of 
 great service in reducing the frequency and force of epi- 
 leptic attacks, and seeing the close relationship of dip- 
 somania to epileps}'', it ought to be of use. We have not 
 had the chance of giving it much trial in the periodic 
 varieties, but in the chronic it is of immense service. 
 
 In those cases where the moral nature is evidently low, 
 weak, or absent, no hope can be held out for cure, and 
 the patients will be an endless source of misery to them- 
 selves and relatives till they die. It is for these cases that 
 a proper law is so much required. During tiie attacks 
 nothing but restraint can keep them from liquor. 
 
dipsomania: its history and relation. 35 
 
 Men who suffer from periodic attacks live a little longer 
 than those whose attacks are chronic in their nature. 
 Among women the periodic is more common during the 
 whole of the time of the existence of the generative func- 
 tions. Chronic dipsomania in women more often comes 
 on later in life. 
 
 Chronic Dipsomania. — We are certain that this is the most 
 common form. Those suffering from it generally commence 
 drinking at an early age, usually 17 or 18, and by 30 years 
 of age most of them have died. They die either from 
 the direct effects of the drink they are continually consum- 
 ing, or else from diseases induced by it, such as absolute 
 insanity or diseases of liver artd kidneys. The disease is 
 not generally recognized in the first few years of its course, 
 as the patient's friends and relatives merely suppose him to 
 be living a little too fast, and that he will pull up soon. 
 However, after a few years it is found that he is never really 
 free from the effects of liquor. He is hardly ever really 
 drunk, but is never sober. As we have said before, cham- 
 pagne is the usual drink during the first years of a dipso- 
 maniac's career. When he takes more than enough, it shows 
 its effects by making him very sleepy, and he will lie down 
 at the most unusual times and places, and fall off into an 
 apparent dead sleep, from which it is very difficult to awake 
 him, and if one does so, he usually manifests a disgusting 
 temper, and will curse and swear at his best friends. This 
 sleep does not rest the brain at all, as when they do wake up 
 voluntarily they are by no means refreshed, and immediately 
 have recourse to another stimulant, which generally freshens 
 them up for a short time, but they very soon require 
 re-stimulating. 
 
 In the early days of their career, these men often go 
 through a large amount of fatigue, and consequently for a 
 time ward off the mental effects of their drinking. They 
 will hunt vigorously and slioot, walking long distances, but 
 the excitement of horse exercise is what they most delight 
 
36 DISEASES OF INEBRIETY. 
 
 in, as the fatigue enables them to drink large quantities of 
 stimulants without much apparent effect. But after several 
 years the muscular as well as mental system begins to fail. 
 They cannot go through the fatigue they were formerly 
 capable of. Their will also fails. Overnight they will make 
 engagements and promises for the morrow, but the morrow 
 finds them unable to perform their promises, nor have they 
 the will to carry their project out. 
 
 Every now and then the patient acknowledges that he 
 is drinking himself to death, and he will slacken in and 
 reduce his quantities of stimulants, but never leave off 
 entirely. He very soon, however, resumes his usual large 
 potations. Occasionally he can be induced to go to a 
 home or inebriate asylum for a time, but he never stays 
 very long, and is no sooner out than he resumes his former 
 habits. It is a fearful existence, the constant craving for 
 fluid, and that fluid must have some taste. All dipsoma- 
 niacs have a complete antipathy to water. They will drink 
 anything but water. If they cannot get stimulants they 
 will drink soda-water, lemonade, or ginger-beer, in enor- 
 mous quantities, so much so indeed that the mere quantity 
 of these apparently harmless fluids which they drink is 
 quite sufficient in itself to ruin their digestive powers. 
 Many people think that it is only necessary to substitute 
 these supposed harmless fluids for alcoholic drinks to pro- 
 duce a cure. The idea is entirely fallacious, as large 
 quantities of those fluids are as likely as not to induce 
 dipsomania itself. There are two classes of dipsomaniacs 
 that are very different from each other in their habits of 
 eating. One set has the most voracious appetite, eating 
 enormous quantities of meat, cooked in all forms. These 
 patients are generally wine-drinkers, and very often claret- 
 drinkers. Another set of patients eat very little, their 
 stomachs being unable to retain or digest the food. In the 
 first class the large quantities of food taken is not properly 
 digested, as is evidenced by their constant call to get rid 
 
DIPSOMANIA : ITS HISTORY AND RELATION. 37 
 
 of their excrement. In fact some of these patients seem to 
 occupy a great part of their time by evacuating their 
 bladders and rectums of the large quantities of food and 
 drink they ingest. The diet of those who only eat a small 
 quantity is generally a meat one. 
 
 Tlieir usual routine of life consists in getting up early 
 or late in the afternoon, rarely in the forenoon. But dur- 
 ing the morning they have been taking continual small 
 doses of beer, champagne, hock, or claret, generally diluted 
 with soda or seltzer, and have short snatches of a boozy 
 sleep. Having come out by the afternoon they attempt a 
 dinner in the evening, and with a fair amount of liquor in 
 them, they bring themselves up to the scratcli to play bil- 
 liards or cards, but they soon get tired, as tliey call it, and 
 lie down and go off to sleep. By about one or two in the 
 morning they wake up, and from then till eight or nine is 
 their miserable time. They cannot sleep. The effect of the 
 liquor is passing off and they get frightfully nervous. 
 They often wander about the house, and if tliey cannot 
 obtain any liquor before the general hour of rising of 
 others, they are usually reduced to a state verging on deli- 
 rium tremens. Directly they get some liquor, however, they 
 go and undress and go to bed, and so on till the afternoon, 
 when the repetition of the niglit before takes place. 
 
 In the early history of dipsomaniacs they have usually 
 had one or more attacks of delirium tremens, but after 
 recovering in a way from them they are never able to drink 
 the large quantities of stimulants they used to do formerly, 
 as they get so mucli sooner prostrated and intoxicated that 
 they never get real delirium tremens again. We have seen 
 patients in whom the disease is of long standing so altered 
 that one or two glasses of beer would make them quite 
 boozy. Also, after the attacks of delirium tremens, they 
 never seem to recover tlieir muscular tone and power, and 
 consequently cannot go tlirough the same amount of exer- 
 cise. The reason of this is of course that they go on drinking. 
 
38 DISEASES OF INEBRIETY. 
 
 If tlieir liquor was stopped, pliysically they would get quite 
 well. A characteristic sign of the clironic dipsomaniac is a 
 diffuse roseate hue of face and neck and a watery aspect of 
 eye. They are generally full-bodied, but they are always 
 weak on their legs, and late in the disease get into almost a 
 state like locomotor ataxy. Besides the roseate hue of face 
 there is another symptom indicating the determination of 
 blood to the head, and that is a constant recurrence of slight 
 hemorrhages from the nose. The pocket-handkercliiefs of 
 dipsomaniacs always contain secretion mixed with blood. 
 This is only found in old standing cases, and is often alone 
 due to the congestion of the liver, which is constantly pres- 
 ent. The urine in the morning is generally very high col- 
 ored. The pulse in the morning is also always weak, soft, 
 and small. We have already stated our belief in the absence 
 of any moral feeling in these patients. It is hard often to 
 decide whether the drink may not have removed their moral 
 sense by its effects on the brain. For a man may have pos- 
 sibly started in life with a fair proportion of the moral sense, 
 but the physical action of alcohol on his cerebrum may have 
 destroyed his moral appreciations. No doubt this occurs in 
 truly acquired dipsomania. But in these latter, the disease 
 comes on later in life. Where the disease is hereditary, and 
 is an insanity, and begins earlier in life, one generally finds 
 that even in their boyhood they evidently were devoid of 
 moral sensibility. The cunning of these patients in using 
 every artifice to get drink, when they know efforts are being 
 made to keep them from it, is really wonderful. They will 
 hide bottles of spirits among their clothes. They will, in 
 the earlier stage, walk long distances so as not to be seen 
 drinking, will use persuasions and threats to those attend- 
 ing on them, and will eventually beg anybody for drink to 
 satisfy their craving. 
 
 The symptomology of inebriety is far more familiar to 
 the reader than its philosophy and causation, hence it is 
 omitted for want of room. 
 
CHAPTER V. 
 
 SOME CONSIDERATIONS OF THE PHILOSOPHY AND HIGHER 
 RANGES OF CAUSES. 
 
 Men in the world can be very readily graded, as they 
 ascend from tlie lowest to the highest types, by two very 
 essential qualifications — the one, their degree of intellectual 
 sense ; the other, their degree of moral sense. 
 
 By the lowest type of men we mean one both ignorant 
 and immoral ; by the highest type, we mean one both intelli- 
 gent and moral These two qualifications can, to a consid- 
 erable extent, be separated : we often speak of the 7netttal 
 and w^ra/ qualities as distinct; and we recognize the fact 
 that in tlie same individual, frequentl}', the levels of these 
 two qualities do not correspond. For instance, we can have 
 one person, who will grade higher in his morality than in his 
 intelligence, and another, lozver in his morality than his in- 
 telligence. Tlie rule, however, is, — the ability to think is 
 accompanied by an equal ethical ability. 
 
 In the gradual advance of a race from savagery to civil- 
 ization, their progress is occasioned by and marked by grad- 
 ual improvement in both these particulars. 
 
 In any man, his intelligence and his ethical ability are 
 raised to a level corresponding with his previous practice in 
 performing these kinds of action. The savage, compared 
 with the more advanced man, is inherently less able to per- 
 form these kinds of thouglit, and as he progresses upwards 
 towards civilization, through generations, there is a gradual 
 improvement in his ability, until as a most advanced man he 
 finally has most capacity to think and to do right. 
 
 39 
 
40 DISEASES OF INEBRIETY. 
 
 The first essential in an advancing man, or advancing 
 race, is activity. An indolent, idle man or race never ad- 
 vances. It is the activity or exercise of the brain that increases 
 its ability. Accomplishments and excellences are acquired 
 only by practice and exercise. 
 
 The rapid competitions of active society, therefore, ne- 
 cessitate activity on the part of the individual to avoid sup- 
 pression and elimination. Hence, improvement of individ- 
 uals is most rapid in active society. The continuous brain- 
 w^ork, which under such circumstances becomes a necessity, 
 improves the thinking ability of the rising man. 
 
 In the rising man, because it is a necessity, his intellect- 
 ual (competive) ability antedates to some extent his ethical 
 sense. In a society which is advancing from a savage to a 
 civilized grade, competitive ability is acquired before ^^w^xsX 
 communal interests require the harmonizing of the com- 
 petitions. The safety and the welfare of society soon 
 demand that the competitions of its membership shall be 
 harmonized. This gives rise gradually to the evolution of 
 higher and higher rules of conduct. Public opinion and 
 moral sense, with laws and government to enforce them, 
 thus become of a higher and higher grade, until the highest 
 type is reached. 
 
 In this gradual improvement of society, the advancing 
 man is more and more practiced in ethical observances, 
 until, as an accompaniment to his improving ability to com- 
 pete, there also grows in him a better ethical sense of the 
 rights of others. A high ethical sense may well be called 
 the capsto7ie of human improvement. 
 
 In the best communities to-day we find some individuals 
 — in most communities they are few, in no community do 
 they reach a majority — who have a high order of ethical 
 sense inherent in them. These persons are always inherently 
 intelligent, for it takes the highest order of intelligence to 
 so understand the complexities of civilized competitions 
 as to be able to formulate and maintain high rules of con- 
 
PHILOSOPHY AND HIGHER RANGES OF CAUSES. 41 
 
 duct to suit them. Such a high order of man — highly intel- 
 ligent and highly ethical — is only the result of a long line 
 of generations of this kind of practice. 
 
 We spake of civilized countries, and of civilized societies 
 as though their membership were uniform. This is not so. 
 Every community, even that graded highest, will furnish 
 examples ranging all the way down from the highest type, 
 just described, to the lowest. In any community, in a so- 
 called civilized country, we can find persons who inherently 
 grade very low in thinking ability and in ethical sense. 
 They are at the savage level. A great many have the sav- 
 age level of moral sense, while they hold a higher level in 
 intellectual sense. This, in my opinion, is particularly the 
 case with deteriorating or degenerating individuals, they 
 have lost their ethical sense in advance of their intellectual, 
 — the latest evolved and most delicate goes off first. 
 
 We have not yet invented a cerebral dynamometer, by 
 which we can test and record a man's intellectual capacity 
 or his moral strength, but in our associations with others 
 we instinctively recognize such information to be very 
 valuable. It is interesting to note how much we are 
 engaged in this very kind of work. We are continually 
 making estimates of this character, and it is astonishing, in 
 a crude way, how expert we become at it. 
 
 In making our estimates in society, the position a per- 
 son holds is one to which he has arisen from a lower level 
 or one to whicli he has lapsed from a higher one. Human 
 brain ability is not by any means a constant quality — there 
 is no standstill level. The index rises and falls in the 
 course of the life of the person, and also it varies in the 
 course of the line of descent. In so-called civilized society 
 the lapses probably constitute the large majority of the 
 incompetent. 
 
 Ability, at whatever height it occurs in an advancing 
 man, is raised to tliat level solely by previous brain practice. 
 The practice is either personal or ancestral. The person 
 
42 DISEASES OP INEBRIETY. 
 
 receives his ability at a certain level from his ancestry and 
 raises it or lowers it by his habits of thouglit. By far the 
 best and most stable ability is that which is the result of 
 practice reaching through a long ancestral line. 
 
 While it is true there is only one way of improving brain 
 ability, namely, by activity, there are several ways of lower- 
 ing it. There are several ways in which the /tz/x^^ members 
 of society have reached their levels. 
 
 Brain inactivity, I have already stated, is ihe^ physiological 
 method of lapsing. There are a number of pathological 
 methods. 
 
 Our pathology is always injured or impaired physiology, 
 so I have dwelt this long upon the physiology of cerebration, 
 in order more properly to approach its pathology. 
 
 Whatever injures the structure of the brain impairs its 
 functional action. Tliis impairment is exhibited in altered 
 conduct, in a loss of ability, both intellectual and ethical. 
 
 We can go tiirough the wards of our insane asylums 
 and find numbers of men, who once ranked higii in intelli- 
 gence and in morals, now lowered in both. Defect, injury, 
 or disease now renders the brain of each of them less able 
 to perform at as high a level as it formerly did. 
 
 Insanity, indeed, is only a name we give to a certain 
 degree of brain incapacity. As generally defined, it simply 
 means there is such a degree of incapacity as renders the 
 person an tinjit member of society. For this reason, for his 
 own or his neighbor's safety, he has to be placed under for- 
 cible restraint ; his brain is so lowered in intellectual ability 
 that he is unable to compete for his living, so a support has 
 to be given him ; and it is so lowered in ethical ability that 
 he is a nuisance or a danger to others, so he has to be 
 restrained. 
 
 In society, short of the degree called insane, we have 
 innumerable varieties and kinds of disability, exhibited by 
 the peculiar, the cranky, and the delirious. 
 
 Besides the long list of diseases, traumatisms, and 
 
PHILOSOPHY AND HIGHER RANGES OF CAUSES. 43 
 
 defects of the brain, which impair its functional capacity, 
 we also have a long list of drugs, wiiicli, taken into tlie circu- 
 lation, bring down tlie brain's capacity to a lower level. 
 
 I need not go over the long list, nor point out the pecu- 
 liarities of their actions, but at once mention alcohol ns one 
 of them. This agent, from its general use, brings down 
 more brain capacity in the world — and it certainly does a 
 great deal to produce the lapsed me?nbers of civilized society. 
 
 If it were not for the fact that alcohol has in the system 
 a special effect upon nerve centers, particularly high brain 
 structure, men would never have used it as a beverage. In 
 seeking and taking it the alcohol drinker is after its brain 
 effect. 
 
 The brain is the organ of thought and all conscious ac- 
 tion. The partially hardened condition of its delicate struc- 
 ture that alcoiiol produces, renders it less capable of cellular 
 motion or action. Its conscious sensitiveness is lessened 
 thereby. It is less able to feel. The alcoholized man there- 
 fore says he " feels better" or " feels good," and acknowl- 
 edges that this kind of lowered sensitiveness is what he 
 likes. He " feels better" if his brain feels less any discom- 
 fort or pain he may have. Even in health, if he have no 
 special discomfort, the benumbed condition is a more com- 
 fortable one. The well man therefore says he " feels good.** 
 Tiie luxury of alcohol drinking consists in this condition of 
 the brain. 
 
 I wish to draw attention to the fact, that in order to 
 obtain the pleasant, comfortable condition of lowered sensi- 
 tiveness, the alcohol drinker does not avoid or fail to 
 have.the alcohol effects on his brain — there is a general 
 lowering of function. When the brain's ability to feel is 
 lowered, its ability to think and to adjust conduct ethically 
 are also lowered. The keenness of a high ethical sense is 
 probably ihG first thing blunted. 
 
 The disability of the alcohol drinker will vary accord- 
 ing to the amount taken; according to the inherent strengt/i 
 
44 DISEASES OE INEBRIETY. 
 
 of brain structure ; and according to the length of time the 
 brain-abuse is continued. 
 
 For instance, first, according to the amoutit taken, con- 
 scious sensitiveness lets down from a slightly benumbed, 
 comfortable condition, to that of complete anaesthesia ; 
 intellectual ability varies from being " a little off " to the 
 condition of a temporary dement ; the ethical sense varies 
 from slight indecorum to full viciousness or madness. 
 Secondly, the degree of brain disability under alcohol will 
 vary according to the inherent brain strength of the drinker. 
 Weak brains will be lowered in ability more than strong 
 ones, and low grade savage brains, or defective ones, will 
 exhibit their incapacities in the lines of their deficiencies. 
 Thirdly, the disability will also vary in proportion to the 
 /(?«^/// t*/ //;;;^ the drain-drug abuse is continued. A single 
 debauch can be fully recovered from, but long-continued 
 use produces such an injury the full function is never 
 restored. 
 
 Sometimes all three of these conditions obtain in the 
 same person ; when this is the case, the degeneracy of brain 
 function is extreme. The inebriates constitute this extreme 
 class, always degenerated to a very low level in intellectual 
 sense and ethical sense. Of course there is a tendency to 
 return to previous capacity when the brain-drug abuse is 
 left off^, but I question whether an inebriate's brain is ever 
 fully restored to its previous capacity, or ever reaches the 
 level it would have occupied without the injury. 
 
 As society advances from a savage to a civilized level 
 success depends more and more on brain strength. The 
 most advanced society pays the highest premium for brain 
 ability. In active civilized society, the safety and success 
 of the individual depend almost altogether upon this qualifi- 
 cation. In savage society, the muscle strength suppresses 
 the weak, in advanced society it is the brain strength of 
 the more competent that suppresses the incompetent. 
 
 The drinkine man lets down in business and loses his 
 
PHILOSOPHY AND HIGHER RANGES OF CAUSES. 45 
 
 money because his thinking capacity is lowered by his habit 
 — his ability is weakened. The drinking man also lets down 
 in mor-dls, /al/s into vicious habits, because liis ethical sense 
 is weakened. 
 
 In modern society, brain idleness probably puts most 
 men into the eliminating level ; next to idleness comes alco- 
 hol. These two agencies rapidly rid crowded society of 
 their unfit membership. Nothing is so rapid an elimi?iator 
 as alcohol. The least fit, both in the idle wealthy ranks, 
 and in the idle poor ranks, are most given to its use. 
 Under the light of advancing science, the use of alcohol is 
 becoming more and more confined to the class of the weak- 
 brained and the vicious. The intelligent, for the sake of 
 maintaining this intelligence and superior fitness, are 
 learning to leave it off. 
 
 Society is much interested in the intellectual level of its 
 members, but it is most interested in tiieir ethical level. 
 The safety and survival of tlie individual are most depen- 
 dent upon his intellectual ability ; society, though, is prin- 
 cipally interested in his ethical ability. The safety and 
 welfare of society depend upon the moral status of its 
 people. The good of society demands this. 
 
 Communities, races and nations, like individuals, are 
 engaged in competitive life. The most successful is the 
 one which has the high intellectual, progressive capacities 
 of its people welded into a harmonious, united whole by a 
 high ethical sense. 
 
 There is a very satisfactory scientific explanation there- 
 fore to the fact, that the most altruistic persons, those most 
 interested in public good, have always been opposed to 
 alcohol drinking. They recognized the fact that it lowered 
 the intellectual and moral abilities of the people and 
 tended to weaken and disintegrate society. Probably one 
 reason they have never succeeded better in enforcing their 
 opinions upon the attention of the alcohol users, is because 
 they have not had the advantage of recent scientific knowl- 
 
46 DISEASES OF INEBRIETY. 
 
 edge to back their instructions — the brain has been left out 
 of their philosophy altogetiier. 
 
 I have often been make impatient in listening to the lec- 
 turer presenting the " scientific aspects of tlie alcohol ques- 
 tion" to an audience, to see him illustrate extensively with 
 charts and spend hours to show the effects of alcohol upon 
 the coats of the stomach, and upon the structure of the 
 liver, the lungs, and the kidneys, and never allude once to 
 the brain, when the fact is, alcohol's principal effect is upon 
 this organ ; and the functions of this organ so far transcend 
 the functions of all the others, that, I might say, there is no 
 comparison. 
 
 When the individual in society is taught the fact, which 
 he seldom knows, that alcohol incapacitates this very organ 
 upon which his safety and success in the competitive world 
 depend, he will be very much less inclined to use it. And 
 when society recognizes that with alcohol a low-grade, vic- 
 ious man can be made chemically out of its excellent 
 man, and that tliis process is continually going on among 
 all its ranks, it will be more alive to spread scientific 
 instruction upon the subject. 
 
CHAPTER VI. 
 
 INEBRIATE DIATHESIS AND ITS CONDITIONS AND 
 
 RELATIONS. 
 
 By the inebriate diathesis is meant that constitutional pro- 
 clivit}^ or neurosis, which impels to the inordinate use of 
 narcotics. 
 
 This includes the hurtful consumption of opium, chloral, 
 cocaine, etc., as well as of alcohol. The latter, however, 
 will be more particularly the subject of the present inquiry. 
 
 The peculiar bent of the constitution herein referred to 
 has been classed as a specific mania ; and has been called 
 by Dr. Norman Kerr and otliers tiarcomania. 
 
 In the interest of brevity, I will begin what I wish to 
 advance on this subject with a homely illustration. We are 
 assured by anatomists that the bones of the skeleton — it 
 matters not what shapes they assume — are, as to form, 
 modifications of a single fixed type. This type is repre- 
 sented by the separate and distinct bones of the spinal 
 column. 
 
 When we attentively consider the group of nervous 
 maladies known as the neuroses, we perceive that they bear 
 a close relationsliip with one another. We learn that 
 either member of this family may assume the character- 
 istics and features of some other member. We become 
 aware of the fact that, seemingly, one of them may be 
 transformed into the semblance of some kindred neurosis. 
 We see that this transmutation may be effected through the 
 operation of heredity — a neurotic form in ancestry appear- 
 ing as a different form in posterity. We are also impressed 
 
 47 
 
48 DISEASES OF INEBRIETY. 
 
 that this interchange may even take place in the same per- 
 son ; as when epilepsy, or dipsomania, gives way to 
 amnesia, or some other neurosis. 
 
 While it is reasonable and necessary to study the bones 
 of the skeleton separately and individually, in order to 
 arrive at right conclusions respecting the body as a whole, 
 it is also philosophical, and, indeed, essential to a correct 
 apprehension of the subject, to study with care the distinct 
 type of which these bones may be modifications. It is 
 desirable to examine the spinal bones, so that a proper 
 estimate may be made of the nature of the modifications 
 assumed by various parts of the skeleton — and the reasons 
 of them. 
 
 The true and perfect type of which the entire assemblage 
 of neurotic maladies is representative, is, it appears to me, 
 simply epilepsy. The varying aspects which this disease 
 assumes, its several grades of intensity, as well as its origin, 
 — so far as that is known — seem to point it out as the great 
 central source of the several neurotic besetments. If this 
 be true, even in a general sense, it follows that in seeking the 
 origin of the inebriate diathesis an examination of the causes 
 and phenomena of epilepsy will be a necessar}' work. 
 
 Epilepsy has been classified as either centric or excentric. 
 That is to say, it arises sometimes from causes situated 
 within the brain ; and at other times, from causes exterior 
 to the brain, but influencing tlie condition of that organ. 
 These causes, while often attended by pain, may operate 
 without exciting actual pain. In epilepsy there is a con- 
 stant, unrelenting irritation, nagging the great nervous 
 center. This irritation may be simply a morbid impres- 
 sion acting through organic sensibility, or it may be 
 attended by actual pain and distress. 
 
 Hence teething, indigestion, and worms excite convul- 
 sions in children, which are epileptoid. So, too, tape- 
 worms, affections of the liver, or stomach, or kidneys and 
 the like, may excite true epilepsy in the adult. It is 
 
INEBRIATE DIATHESIS AND ITS CONDITIONS. 49 
 
 obvious that epilepsy from such causes is more or less 
 amenable to treatment. But the treatment of centric epi- 
 lepsy — frequently hereditary, with its proximate cause within 
 the brain — is more difificult ; and usually the most that can 
 be expected is a certain toning up of the general constitu- 
 tion, by which means the effects of the original evil may be 
 better endured. Through such measures some hope may be 
 entertained, perhaps, that the violence of the epileptic 
 seizure may be abated. In short, some slight possibility 
 may appear, that, instead of true and complete epilepsy, 
 there may be substituted amnesia, or neuralgia, or some 
 other and milder one of the neurotic forms. 
 
 An educated and refined gentleman — now a retired 
 clergyman — once suffered with repeated and severe attacks 
 of epilepsy. The coma continued many hours. The epilep- 
 tic form disappeared under treatment ; but it was followed 
 by seasons of absent-mindedness (amnesia), lasting for 
 days. No recollection of the life of this neurotic trance 
 was or is retained. The same individual suffered after- 
 wards for nearly two years with excruciating pains. They 
 were referred at first to the stomach, cancer being feared. 
 Subsequently they were located in the pleura. Finally the 
 trouble was attributed to biliary calculi. The "cure" was 
 complete, sudden, and unexpected. No calculi ever put in 
 an appearance. Tlie physician in attendance upon the case 
 in its neuralgic form had no accurate knowledge of the 
 previous history of his patient. 
 
 Central or centric epilepsy is often hereditary. But that 
 fact does not militate against the idea that irritation is the 
 primum. mobile of the disease. The misshapen head, the 
 undeveloped brain, may readily be supposed to act as 
 sources of unceasing irritation. Injuries to the head pro- 
 ducing epilepsy are too common to call for remark. Know- 
 ing, then, that irritation is an efficient cause of epilepsy in 
 all cases where its cause has been satisfactorily determined, 
 we are justified in assuming that in those cases where the 
 
50 DISEASES OF INEBKIETY. 
 
 source of the malady does not plainly appear, the high 
 probabilities are that some undiscovered or masked point 
 of irritation is nevertheless operative as the proximate 
 cause of the disease. 
 
 I sa.y proximate cause — for it is evident from the fact that 
 irritation does not always produce epilepsy, that, after all, 
 there must be some peculiar predisposing constitutional 
 susceptibility in epileptics that is not found in people gen- 
 erally. And here is the key which unlocks at least some 
 of the secrets of heredity. It is the peculiar impressibility 
 of the epileptic constitution, which, being hereditary, 
 makes possible the heredity of the disease itself — circum- 
 stances favoring its full development being presented. It 
 also makes possible the heredity of those neurotic forms 
 recognized as kindred with epilepsy. This constitutional 
 susceptibility therefore explains the heredity of inebriety, 
 hysteria, chorea — epilepsy itself. It explains the heredity 
 of dipsomania, and all the features of the inebriate 
 diathesis. 
 
 When there is present a peculiar constitutional tendency 
 allied to the epileptic diathesis, then any irritation of 
 nerve — if severe and unremitting — will be likely to develop 
 some form of neurotic disease ; and this will correspond, 
 not with the nature of the irritation itself, but with the 
 nature of the constitutional trend. Dr. Cheyne refers to a 
 case of epilepsy " which was caused by a cartilaginous 
 tumor of the size of a large pea, which was situated on a 
 nerve. Upon excision of the tumor the fits ceased." Why 
 may not inebriety — narcomania — be developed by causes as 
 small and apparently as trivial ? 
 
 We are admonished to look for the pathological condi- 
 tion provocative of inebriety. Wliy not insist upon some 
 invariable pathological condition in explanation of epi- 
 lepsy ? Very often, indeed, this morbific cause cannot be 
 determined ; but when it does appear, it is always found 
 to consist of some point, or points, of unflagging and 
 
INEBRIATE DIATHESIS AND ITS CONDITIONS. 51 
 
 remorseless irritation. It may be repletion, or it may be 
 famine and weakness. It may be too much blood, or too 
 little blood. It may be observed in the center of the cir- 
 culation — the heart — or it may reveal itself in irregularities 
 and disturbances of the equilibrium among the arteries, 
 veins, and capillaries. But virhatever else it is, or wherever 
 located, it is irritation worrying and exhausting the nervous 
 powers. 
 
 Now certain constitutions bear up through the changes 
 of life fairly well, until some serious injury overtakes the 
 physical organization, such, for example, as a blow upon 
 the head, a wound in battle, or even a long and trying ill- 
 ness. Irritation at once begins to do its work. The ordi- 
 nary and natural constitution gives way. It is weak, 
 exhausted, weary. It has become unequal to the require- 
 ments even of ordinary life. It reaches out for aid, or rather 
 for rest and repose. Tlie inebriate diathesis is established, 
 and the anaesthetic — the lethal influence of narcotics, and 
 especially of alcohol — is invoked. The call is not feeble 
 and uncertain, but earnest and reckless. 
 
 An habitual drunkard "shot a bar-keeper and set fire to 
 a saloon, without the occurrence of any quarrel or dispute. 
 A homicide was hung. A post-mortem revealed a splinter 
 of bone that had pressed upon the brain for ten years, the 
 result of a blow upon the head." The drinkinghabit began 
 shortly after tlie infliction of the injury, 
 
 A daily paper of Cleveland, Ohio, dated October 13, 
 1886, contains a pitiless notice of the downfall of the Rev. 
 
 , a clergyman living in the city, " In the gutter again," 
 
 was part of the heading. The account says the reverend 
 gentleman was sent to the workhouse, and also contains a 
 notice of the dismissal of the deliquent from his position in 
 the church, with a warning to the Christian public to beware 
 of him. On the 6th of October, 1891, after the lapse of 
 about five years, the same daily journal contains a sympa- 
 thetic account of a. post-mortem held upon the body of the 
 
52 DISEASES OF INEBRIETY. 
 
 reverend gentleman. This was had in an insane hospital in 
 which the unliappy man had been placed. T\\\% post-mortem 
 disclosed the fact that the man was carrying in his lungs a 
 bullet weighing over one ounce, received w!ii!e bravely 
 fighting the battles of his country in the war of the rebellion. 
 
 It is evident that the treatment proper for inebriety must 
 occupy a very wide field, as its proximate causes are so 
 varied. It is filled with innumerable facts, requiring the 
 utmost skill, both in observation and discrimination. In its 
 very simplest view, three considerations must be kept before 
 the mind : 
 
 ist. The causes of inebriety. 
 
 2d. The nature of the drunken state. 
 
 3d. The functional disturbances and physical degenera- 
 tions that are sure to follow long-continued habits of 
 intemperance. 
 
 The Diathesis and Cachexia of this affection has never 
 been carefully studied, but, standing on the border, we 
 catch intimations of its vast possibilities, awaiting the 
 future investigator. 
 
 A diathesis implies a special predisposition to certain 
 kinds of diseased action. A. cachexia is a developed dia- 
 thesis, a real condition of disease of the blood and tissue. 
 A diathesis is a more or less remote cause, but a cachexia 
 is a present part of disease, an influence on the organism. 
 Using these terms together, certain well defined conditions 
 appear to be traced, from which inebriety can be studied 
 and prognosed witii much certainty. The first and most 
 common form seen may be classified as the nervous diathe- 
 sis and cachexia. They may be noted by their spare 
 bodies, light hair, changeable countenances and restless 
 animation. Easily agitated, intense functional activity, so 
 sensitive as to show signs of mental disorder when excited. 
 Mentally their views of life are unreal, visionary and 
 exceedingly changeable ; seldom calm and deliberate, but 
 abrupt, jerking, and when exhausted, prostrate. When 
 
INEBRIATE DIATHESIS AND ITS CONDITIONS. 53 
 
 this is inherited it is often accompanied by a vain, weak 
 mind, witli boundless self-esteem, always on the verge of 
 eccentricity. 
 
 The mind dashes from one extreme of emotion to an- 
 other, either showing excitement that is morbid, or degrees 
 of feebleness that are abject. Women are often of this 
 class, and persons from the wealtliier circles of social life. 
 Luxurious habits, indulgence of wliims and fancies in 
 childhood, are active causes of such a diathesis. This is a 
 distinct type of mental defect from which inebriety and 
 insanity are an almost constant sequence. An early diag- 
 nosis and prognosis, with treatment, would furnish the 
 only practical means of escape from this diathesis. An- 
 other condition may be noted, called Strumous Diathesis 
 and Cachexia. Here the patient has diminished vital en- 
 ergy, imperfect nutrition, with mental weakness and perver- 
 sions, unnatural special developments, which have a con- 
 stant tendency to exhaust themselves, as, for instance, in 
 case of extraordinary mental or physical genius, where the 
 body is out of all proportion. Many of the so-called great 
 men of the world belong to this class. They are nearly 
 always anaemic, complain of frequent headaches and have 
 often a tuberculous history, accompanied by a species of 
 degeneration which has a constant tendency to concentrate 
 in some particular organ. Any exposure to cold takes on 
 an aggravated type of symptoms, or injury to any organ 
 assumes the most alarming phase. 
 
 The nerve centres are always more or less involved, and 
 siiocks or injuries are acutely felt. Inebriety appears as a 
 part of the natural history of this diathesis. Paroxysmal 
 drunkards belong to this class, and of all others they are 
 the most thoroughly demented during the attack. In 
 many cases an Arthritic Diathesis and Cachexia are 
 well marked. Here a chronic state of imperfect nutri- 
 tion, with mental exaltation, or depression existed. In 
 many cases a history of rheumatism and deposits about 
 
54 DISEASES OF INEBRIETY. 
 
 the heart, with calculi of gall duct and bladder were 
 given. The circulation was weak, and the intellect un- 
 stead\\ A capricious, irregular appetite accompanying 
 these conditions often forecasts inebriety, and generally 
 precedes violent attacks. A 
 
 Syphilitic Diathesis and Cachexia 
 
 are known by temporary headaches, amaurosis and flying 
 pains, with mental and moral defects of various grades ; 
 anaemia and affections of the heart are often present. This, 
 with a clear syphilitic history, are evidences beyond ques- 
 tion. In this, diathesis inebriety or insanity develops from 
 the least exciting causes. There is a He77iorrhagic Diathesis 
 and Cachexia^ which is characterized by anaemia, blood 
 deficient in fibrin, suffering from persistent neuralgias, and 
 a constant tendency to copious hemorrhage from the slight- 
 est causes. Inebriety often follows from this condition. 
 Two cases have fallen under my notice where this diathesis 
 ended in uncontrollable drunkenness and death, A Fibri- 
 nous Diathesis and cachexia may be the active cause of ine- 
 briety by the constant tendency of the blood to exudations 
 of unhealthy plasma, and general hypertrophy and indura- 
 tion of the cerebral system, all the functions being lan- 
 guidly performed. In all these cases the normal equili- 
 brium of the nutritive functions is destroyed, and inebriety 
 follows as the first stage of degeneration. These are some 
 of the many conditions of the body coming down from in- 
 heritance, well marked, and so often preceding this affec- 
 tion, as to be called active and predisposing causes. These 
 conditions are not always distinct, but blend into each 
 other, multiplying and diverging. 
 
CHAPTER Vir. 
 
 GENERAL PREDISPOSING CAUSES. 
 
 A Study and grouping of the general causes will afford 
 data, from which we can understand inebriety in its first 
 manifestations. The first group, called General Causes, 
 are those which frequently produce inebriety in common 
 with other insanities. Of these vicchanical injuries seem 
 prominent, such as injuries or concussion of the brain and 
 spinal cord, and consequent alterations of nutrition. Blows 
 on the head are not uiifrequently followed by violent 
 paroxysmal drunkenness ; railroad accidents, where the 
 concussion and surprise are sudden and overwhelming, 
 causing intense re-action on the nervous system (produc- 
 ing at first insignificant physical lesions), often develop 
 inebriety and mania, A chaplain in the late war, injured 
 in the leg by a shell, although but a simple flesh 
 wound, was several months in the hospital before recovery. 
 From this time he became an incontrollable drunkard, and 
 eventually died. A prominent physician was precipitated 
 from his carriage on the head, and received flesh wounds 
 of a minor character. Very soon after inebriety was devel- 
 oped, and he ended his life a raving maniac in an asylum. 
 The rule in many cases indicates that injuries of the brain, 
 spinal cord, or any part involving numerous nerve trunks 
 may end in cerebral disturbance, of which drunkenness is a 
 very common stage of the lesic^n, the injury being small 
 in comparison to the mental disturbance which follows. 
 Peripheral irritation or reflex excitability has been noticed 
 as a common cause in many cases. In a letter to the 
 
 55 
 
56 DISEASES OF INEBKIETT. 
 
 Psychological Joicrnal, a physician describes two cases 
 where tape-worms excited inebriety and mental liallucina- 
 tions, which disappeared on tlieir expulsion. Several 
 instances are on recoid where the use of pessaries in pro- 
 lapsus uteri and the prolapsus alone, has been the cause 
 of mental disturbances of which drunkenness was the most 
 prominent symptom. The irritation from prolonged 
 lactation, or in dysmenorrhaea, ammenorrhea, nymphomania 
 and functional disturbances of the genital organs, are 
 frequently the beginnings, and in many cases the active 
 causes of this disease. 
 
 A case of chronic masturbation, which ran into inebriety, 
 came under my notice lately. Numerous cases of puer- 
 peral insanity, preceded or followed by inebriety, are 
 recorded in the English obstetrical journals. Cases of 
 drunkenness during pregnancy, ending at delivery, are not 
 uncommon. A remarkable case was noted at the Dublin 
 Lying-in Hospital, some years ago, of a woman, who during 
 the period of lactation, drank gin to excess. This craving 
 for stimulus began when the child was born and continued 
 until the death or weaning of the child, the former being the 
 most common termination. When lactation ceased the desire 
 died away. Another case of equal interest is reported in a 
 western journal. A soldier, wounded at Pittsburgh Land- 
 ing, previously temperate, became a paroxysmal drunkard. 
 A portion of the shaft of the femor was injured, and con- 
 tinued to exfoliate dead bone until 1873, when it was 
 removed by an operation. From the healing of the wound 
 his drunkenness disappeared, and he is now one of the most 
 enthusiastic of temperance men. 
 
 Previous diseases are also active causes. Dipsomania, 
 erotomania or monomania often are associated with epilepsy 
 in some of its obscure forms, as natural stages in its progress. 
 Epilepsy, with its disordered fancies, auras and impulses, 
 ending in apparent recovery, only to be followed after time 
 by a repetition, closely simulates the impulsive drunkard. 
 
GEJSTEEAI. PREDISPOSING CAUSES. 57 
 
 The connection between inebriety and epilepsy is far more 
 intimate than we are aware. Affections of the heart, either 
 organic or nervous, and low chronic hepatitis, predisposing 
 to hypocliondria and melancholy, very often precede this 
 affection. Neuralgia often ends in this way, by disturbing 
 the mind centres and its equilibrium. Gout suppressed has 
 brought on inebriety, but when it returned, drunkenness 
 declined. Intermittent and malarious fevers have been fol- 
 lowed by this disorder, and the medical attendant has been 
 blamed for causing it, by prescribing stimulants. Persons 
 suffering from acute rheumatism, after the severe symptoms 
 have subsided, have exhibited the same affection. Diseases 
 of the skin and renal disturbances have been noted as pre- 
 ceding drunkenness. 
 
 Diseases of an intermittent character (a hint of nerve 
 complication) may be the primary cause of drunkenness, 
 through the perversion of functions, beginning so obscurely 
 as not to be noticed. 
 
 Dietetic diseases seem more frequently associated as 
 causes owing to the intimate association between the nu- 
 tritive functions and the nervous system. Dyspepsia, with 
 all its train of perverted sensations and tastes, have often 
 common sequence in this disorder. Excessive hunger and 
 thirst are followed conditions vyiiich are often active causes. 
 Indigestion, inflammation of the stomach and liver often 
 leave a train of predisposing causes. Practically, any 
 disease influencing or breaking up the nutritive functions 
 of the body, has its first effect in perversions and cerebral dis- 
 turbances, of wliicii inebriety is a frequent result. Indi- 
 vidual iiistories of neglect of hygienic care, followed by 
 indigestion, dyspepsia, hypochondria, drunkenness and 
 death, can be traced in every community. 
 
 Exhaustive intellectual and physical exertion, by break- 
 ing up healthy cerebral action, may develop insane longings. 
 Over stimulation of the brain ends in structural changes 
 and perverted tastes for alcohol or narcotics of some kind. 
 
68 DISEASES OF INEBRIETY 
 
 Scholars, and tliose who use the mind to excess, and laborers, 
 who only exert the physical system, when exliausted from 
 over work, have unnatural longings for something to restore 
 the lost balance of mind and body. A prominent senator 
 spent thirty hours continuously in tiie preparation and 
 delivery of a speech, and became an inebriate from that time. 
 The proprietor of an ice-house offered some men large 
 wages to continue the work of filling the iiouse ; being 
 expert workmen they continued without much rest for 
 fifty hours. Two out of five became drunkards, and dated 
 it from this time. 
 
 Instances of similar character are not uncommon. Sud- 
 den excitement and exhaustion acts in the same way, one 
 physiological effect is rapid contraction of the arteries, 
 apparent in the pallor and consequent anaemia of the brain. 
 The shock imparted to the senses through the mind, 
 extends to the brain cells, producing similar commotion, 
 often breaking up their normal action forever. The sudden 
 loss of property, disappoiniment, trouble, unrequited 
 affection, may so depress the vital powers and disturb 
 the circulation, that drunkenness or insanity, or both 
 will follow. Ambition to lead, wliere it becomes a domin- 
 ant passion, filling up every moment of tliought, lowers 
 the nutritive functions and leads directly to perver- 
 sions of taste. Religious activity, where the mind over- 
 flows with sentiment and emotion, may react into violent 
 gluttonness or^inebriety. No class of men are so thoroughly 
 dyspeptic as clergymen and lawyers ; simply the reaction 
 of the mind to restore the equilibrium broken up b}'^ irregu- 
 lar exhaustive labor. In every community large numbers 
 of this class are on the verge of inebriety. The capricious 
 appetites, and the excessive thirst for tea, coffee, cider, soda, 
 lemonade, etc., etc., and the bitters and patent medicines 
 consumed to cure ills that are imaginary, are all early 
 stages of this affection ; a change of surroundings, and they 
 become inebriates in the fullest sense. 
 
GENERAL PREDISPOSING CAUSES. 59 
 
 Maudsley thinks tliat tlie depraved l:>nging's of inebriates 
 are greater in the morning, particularly if following exhaus- 
 tion and anaemia, owing to tlie contracted blood vessels dur- 
 ing sleep, which have not had time to recover. Confirming 
 this, a case under my care has strong cravings for liquor in 
 the morning, whicii, if broken up, does not return until the 
 next day. This craving for unnutritious fluids, or substances, 
 generally indicates impending brain disorder. Excentrici- 
 ties of character are frequently associated with inebriety. 
 The poets, artists, and scholars, and warriors of the world, 
 who were inebriates, are examples. Their minds, dashing 
 beyond the bounds of normal, mental and physical life, 
 reacts in nutritive excesses. Of this class we might men- 
 tion Alexander, Philip and Nero, among the warriors ; 
 Shakespeare, Byron, Burns and Poe, of the poets ; and John- 
 son, Addison, Pitt, Sheridan, etc., etc., among the scholars. 
 
 An unbalanced mind resulting from a misdirected educa- 
 tion is the common cause of inebriety. Where the laws of 
 growth and elementary power are untaught, and the child 
 grows up without any purpose or object in life, the facul- 
 ties undisciplined, the appetites and tastes indulged, no 
 system, only the gratification of the physical wants, no par- 
 ticular knowledge, the love of excitement constantly stimu- 
 lated, and self-esteem encouraged, add to all this, predomin- 
 ant passions, extravagant and capricious desires, and drunk- 
 enness is almost sure to follow. The present system of 
 cramming and over-stimulating children, in the study of 
 imperfect text books, in worse surroundings, lays the 
 foundation for both physical and mental dyspepsia, hypo- 
 chondria and dipsomania. Two-thirds of our graduates 
 leave the schools with unnatural and perverted tastes, feeble 
 will-power, and ignorant eccentricities, strongly predispos- 
 ing them to inebriety; all they need is the exciting cause, 
 the fertile field is prepared to receive it. The perpetuity of 
 the race depends upon the education received, from both 
 school and parents. It the child grows up surrounded witli 
 
60 DISEASES OF INEBRIETY. 
 
 unnatural, morbid, influences and ignorant indulgences, and 
 worse school education, its ruin is inevitable. Under the 
 third group are included all those conditions and circum- 
 ■■* stances which seem to particularly favor the development 
 of inebriety. Of these, age has a controlling influence. It 
 is well understood that the body has various stages of 
 development and decline. These are really physiological 
 eras in the organization, whicii have prominent pathological 
 relations, influencing the nervous system, and markedly 
 controlling its disorders. Statistics of the time of life 
 when inebriety begins, or when the predisposing causes are 
 most active, are wanting. From an examination of a large 
 number of inebriates at the Albany Penitentiary and a 
 comparison of records elsewhere, the following facts seem 
 to be indicated. Inebriety occurs in manhood, or midway 
 between the weakness of infancy and the decline of old age, 
 at a time when the brain has reached its period of fullest 
 activity. The development of the mind and nervous system, 
 from simple conditions to complex stages, is followed by an 
 increase of the range of its susceptibilities and diffusion of 
 its powers, and also greater exposure to morbid influences. 
 In adult life the struggle is at its height, all the faculties 
 are intensely occupied, the fullest capacity of mental and 
 physical energies are exercised. The ambitions, disappoint- 
 ments, and changes are sudden and far-reaching. The 
 over-weaning confidence in the physical and mental powers 
 of recovery, cause recklessness of effects. Inebriety appear- 
 ing in adult life, may be the result of perversions of devel- 
 opment, beginning in infanc)^ Such cases are generally 
 associated with some form of mental disease. The brain 
 power of infancy and youth, cannot bear much irritation 
 without peril, its circulation is more rapid and susceptible 
 to sudden fluctuations, which are intense in their influence. 
 This is apparent in the cases of permanent injury, which 
 follows from fear, anger or sudden emotions that profoundly 
 impress the organism. At this time of life organic changes 
 
GENERAL PREDISPOSING CAUSES. 61 
 
 take place, which have a correlative mental transformation, 
 the active degree of enervation existing makes the entire 
 body extremely susceptible to commotions, in both the or- 
 ganic and mental developments. I believe tliat future ob- 
 servations will indicate tliat inebriety begins here, although 
 its development may be delayed for years. 
 
 Sex evidently brings certain influences which bear on 
 the causes of this affection, although the data are wanting 
 a few outline facts indicate an intimate relation. More men 
 are inebriates tlian women, but a large number of the latter 
 are concealed by their friends; also this affection merges into 
 otiier diseases more rapidly than in man. 
 
 The number of women who have mental perversions is 
 very large, always in excess of men. Generally women 
 suffer more keenly from inebriety than men, because they 
 have feebler organizations, and suffer more from functional 
 disorders and organic degenerations. Men are more ex- 
 posed to the wear and tear of active life, involving accidents, 
 excesses, wasting degenerations, witii larger passions and 
 capacities, and stronger nervous and mental organization. 
 Women, vvitli a less vigorous system, change oftener, and the 
 evolution is earlier ; the absorbent system and circulation 
 are more rapid. 
 
 In mental diseases women recover rapidly if the sur- 
 roundings are good, but when functional and organic dis- 
 turbances affect tlie organism, the return to health is 
 slower. Both sexes at puberty, pass a period of liigh 
 functional activity, a crisis in the organic and mental 
 growth of the body, wliich is often the beginning of condi- 
 tions resulting in inebriety. At the menapause another 
 revolution comes over women, which predisposes to ner- 
 vous defects. The close sympathy existing between the 
 sexual organs and the encephalic ciiculation, predisposes 
 both sexes to disorders of mental and functional character, 
 of wiiich inebriety is prominent. 
 
 Social condition has been recognized as an active cause 
 
62 DISEASES OF INEBRIETY. 
 
 in inebriety ; celibacy predisposes to unnatural and per- 
 verted impulses, which rapidly develop functional diseases. 
 Married people lead more natural and regular lives, and 
 their habits and pursuits are usually fixed and methodical. 
 Home-life furnishes sympathy and outlets for affections 
 which no otlier conditions can give. Inebriates often 
 attempt marriage as a remedy to save themselves ; generally, 
 inebriety, beginning either before or after marriage, predis- 
 poses to celibacy. As a rule inebriates do not marry, nor 
 are they true to their vows after marriage. Statistics 
 indicate a preponderance of married men as inebriates, but 
 a closer examination indicates a large proportion of them 
 leading single lives. Domestic troubles, breaking up the 
 normal quietness of life, and sudden changes of conditions, 
 from affluence to poverty, or vice versa, often bring on this 
 affection by destroying the equilibrium or co-ordinating 
 power. Social changes frequently drive men into un- 
 healthy conditions, whicli bring on perversions ending this 
 way. Fashions and customs develop unhealthy mentality, 
 which lead towards the same affection. In many instances 
 we can exclude every other cause but the latter, but fre- 
 quently social conditions only develop and excite latent 
 tendencies to this affection. Future studies will show that 
 the seasons and weather are agents, influencing more or 
 less inebriety and inebriates. 
 
 The changes in the organism from these causes are 
 followed by corresponding changes of the mental condi- 
 tions. The increased functional activity of the body in 
 the spring, is supposed to favor the production of mental 
 diseases ; but from the records of police courts, penitenti- 
 aiies and asylums, inebriety appears most common and 
 acute in the season of autumn. This has been explained 
 as coming from moral and physical causes. The former 
 arising from general failures, with blank prospects, loss of 
 opportunities, and depression which follows. The latter 
 from physiological changes, su'ch as thickening of the 
 
GENERAL PREDISPOSING CAUSES. 63 
 
 arachnoid, shriveling of the convolutions, serous effusions, 
 with general atrophy, and wasting of the functions. 
 Another fact well recognized is that prolonged cold and 
 rapid changes from one extreme to the other particularly 
 predispose to degeneration and morbid mental and func- 
 tional activity. The effect of cold, driving the blood from 
 the surface, preventing proper contraction by congestion of 
 the cerebral capillaries from reflex action explains this. 
 Barometrical changes act in the same way. Sailors, sol- 
 diers, woodmen, teamsters, etc., exposed to these conditions, 
 are generally inebriates, evidently due to similar causes. 
 
 All unhealthy mental, physical and social surroundings, 
 continuous excitement, and dark, damp, low places of resi- 
 dence are noted for the inebriety which springs from 
 them. Whatever climate or season, combined with external 
 causes, checks or perverts the normal development of 
 mental or physical life, becomes the exciting cause of 
 inebriet}'^, insanity and imbecility. There are many rea- 
 sons for believing that future studies will indicate that 
 certain climates and seasons are more favorable for the 
 treatment of inebriety. 
 
 The temperature and condition of surroundings are evi- 
 dently active causes. High degrees of heat and cold may 
 so far impair the nutrition of the nerves, or produce paresis 
 of the vaso-motor centres, as to result in inebriety. Sun- 
 stroke, inflammations, congestions and similar disorders of 
 the brain-cells, coming from extremes of heat and cold, are 
 often followed by drunkenness. A fireman while overheated, 
 took a bath which resulted in severe headache, indigestion, 
 and finally acute drunkenness. Here the sudden abstrac- 
 tion of heat so damaged the nerve-centres, as to bring on 
 this affection. The Captain of a South American steamer 
 informed me that the firemen and most of the men em- 
 ployed (for any length of time) in this service, became 
 drunkards ; this he attributed to tlie extremes of climate 
 and heat which they were constantly exposed to. Leaving 
 
64 DISEASES OF INEBRIETY. 
 
 New York in mid-winter, within a few days they are in a 
 tropical temperature, then bade again, from the literal sum- 
 mer of the Equator to the frequent Polar temperature of 
 New York, Inquiry among the furnace-men of Albany and 
 Troy indicates the same fact ; men exposed to a high heat 
 after a time (to a large extent) became inebriates. 
 
 The purity of surroundings, particular!}: sleeping-rooms 
 and places of business, (without doubt) influence tlie devel- 
 ment of inebriety. Unsanitary conditions of every descrip- 
 tion react first on the nutritive functions, then on the will- 
 power. I believe further study will show tliat the nutritive 
 perversions of inebriates frequently begin in imperfect oxi- 
 dation of the blood, and the inhalation of noxious impurities. 
 In this respect our reformatories, asylums and prisons are 
 criminally wanting. To attempt reformation or treatment 
 in damp cellars, or rooms badly ventilated, is to ignore the 
 predisposing causes, and fix and intensify the derangement. 
 Cases are on record of men confined for a few montiis in a 
 prison, previously temperate, who, on coming out, became 
 furious drunkards. The New York State Prison Association 
 mentions this fact, and the explanation is evident in tlie 
 poor quality of food and bad unhealtliy surroundings, 
 strongly favoring this termination. The Almsliouses and 
 Poorhouses of the country furnish confirmatory evidence. 
 Children and young people who have by any misfortune 
 been confined in them, may be said to have as a rule 
 decided tendencies to drunkenness. Older people, past the 
 middle of life, who come to these places, go away with the 
 same perversions. Cellar occupants and those of tenement- 
 houses (where nearly all the conditions of health are want- 
 ing), are inebriates as a rule ; separate them from these 
 baneful influences, and reform or recovery follows naturally 
 in many cases. Working rooms, such as factories and shops, 
 are often nuclei for the same causes. Sleeping and living 
 rooms may present conditions which bring on disturbed 
 nutrition, and then the train of causes are put to work. 
 
GENERAL PBEDISPOSING CAUSES. 65 
 
 The sympatliy between the stomach and brain is so intimate, 
 and tiie changes which take place so obscnie, tliat inebriety 
 may brealv out as tlie result of long and continuous abuses 
 of the surroundings. 
 
 Mental diseases are found to be largely controlled bv 
 cosmical influences, such as Electrical piienomena, Lunar 
 attractions, velocities and directions of winds, Geoloo-ical 
 formations, elevations above the sea level, etc., etc. A 
 professional man of great intelligence, who is an inebriate, 
 becomes restless, depressed, and has headache and irreo'u- 
 larity of temper when the wind blows from the South, and 
 a storm is impending ; also before a thunder-storm. If he 
 can resist the cravings for liquor until the storm is over 
 he is safe, but if the moon be at a change, and the storm is 
 delayed, he loses all control and lias a paroxysm of drink- 
 ing. At the Albany penitentiary it has been observed, 
 that chronic inebriates, recently confined, show a decided 
 difference in work and temper on the approach of a storm. 
 
 A clergyman, who was an inebriate in early life, cannot 
 go near the seashore, without feeling an almost irresistible 
 desire to drink again. On two occasions he, was obliged to 
 go back suddenly to the interior to save himself — a few 
 miles back the desire leaves him. These cases indicate a wide 
 field of causes entirely unknown. There are influences 
 wliich control the wants of tiie body which no one has yet 
 solved ; conditions of exaltation and depression, which we 
 all experience, of undefinable longings and tastes, a pres- 
 sure of unknown surroundings, which may perhaps be 
 influenced by cosmical forces. Certain districts of the far 
 West, particularly river-bottoms, seem to present combina- 
 tions of circumstances which end in this affection. The 
 same may be said of certain kinds of labor. The State 
 Board of Charity of New York have in their inquiries 
 found certain rural districts where pauperism and inebriety 
 seemed to flourish as indigenous. Who can predict what a 
 farther study will disclose in this direction ? 
 
CHAPTER VIII. 
 
 TRAUMATISM IN THE CAUSATION OF INEBRIETY. 
 
 From a clinical study it will be found that the use of 
 alcohol in inebriety is in many cases only as a symptom, or 
 one of the matu^ causes that develop positive disease. It is 
 proposed in the following study to show that physical 
 traumatism is often an active cause of inebriety, which in 
 most cases is not recognized. The early history of drink- 
 ing is often a period of great obscurity, and the patient 
 himself will have no clear idea of the conditions and causes 
 whicli impel him to use spirits. His opinions are often 
 misleading and never reliable unless confirmed by other 
 evidence. If he has been taught to consider inebriety a 
 vice and sin, his ideas of the early causes will be governed 
 by this impression. If he has no fixed theories on this 
 point, he will usually have some notion of misfortune and 
 trouble, and consequent despair, associated with the early 
 periods of drinking. From a clinical study the views of 
 the patient may be of value as intimations of his present 
 mental state, and the possible mental conditions which 
 have obtained in the past. In all cases the tendency to 
 exaggerate and prevaricate, without any ascertainable 
 reason, must be considered in the problem of diagnosis. 
 There are two distinct periods in all cases of inebriety. 
 The first, beginning somewhere in the past, unknown and 
 not noticeable to ordinary observers, and terminating with 
 the first excessive use of acohol. The second, starting from 
 this point and noted by the occasional or continuous 
 66 _ . . 
 
TRAUMATISM IN THE CAUSATION OF INEBRIETY. 67 
 
 excessive use of spirits, terminating only in death or recov- 
 ery. This period comes under the observation of friends 
 and relatives, and can be accurately studied, and is 
 supposed to include the entire field of observation. Inebri- 
 ety begins in the first period, and breaks out in the latter. 
 This first period is not studied, it is in the outer circle, the 
 penumbra, or neurotic stage. 
 
 The second period is the umbra, and inebriate stage. 
 In this first or neurotic stage, the causes and conditions 
 are as varied and complex as that which produces insanity. 
 Notwithstanding their obscurity, they often present distinct 
 intimations of inebriety far in advance. Every case will be 
 found to come from some special condition of change or 
 departure, from healthy activity in the organism, in which 
 both the function and structure are involved. Even in this 
 early stage, a certain progressive march may be noted, 
 often broken by long obscure halts, or precipitous strides, 
 changing into varied forms and manifestations of disease. 
 This neurotic stage will be marked in most cases by nerve 
 exhaustion, instability of nerve force, and nutrient per- 
 versions and disturbances. Not unfrequently delusions 
 and hallucinations about foods and drinks are unmistakable 
 symptoms. Often persons who have never used spirits, 
 and become fanatical in their efforts to reform inebriates, 
 are in tliis stage, and sooner or later glide into the next 
 one. Tliese are the general indications, associated with 
 innumerable minor hints and symptoms, that follow from 
 all the degrees of inheritance, occupation, surroundings, 
 and all conditions which make up physical and mental 
 health. Traumatism may bring the patient into the first 
 stage, or into the second at once. Or it may leave him 
 susceptible to every piiysical state and surroundings. 
 Psychical traumatism, or injury from mental agitation or 
 powerful emotions, as a cause of inebriety, may be con- 
 sidered from two points of view. First, as a direct cause of 
 inebriety, and second, as an indirect cause, by developing 
 
68 DISEASES OF INEBRIETY. 
 
 conditions which rapidly merge into tliis disorder. As a 
 direct cause tlie following case is a good illustration : 
 
 A merchant, previously healthy and temperate, forty-five 
 years old, with no neurotic inheritance, was returning from 
 New York City (wliere he had been on business), on an 
 evening train, on tiie Hudson river railroad. Wiiile moving 
 at great speed the cars jumped the track, and ran along on 
 the sleepers for some distance before they were stopped. 
 The sudden alarm, crashing of the windows, and profound 
 agitation from fear of death, produced functional paraly- 
 sis, and he had to be lifted out of the car. He was taken 
 to a farm-house, and after a few days was able to go home, 
 but complained of exhaustion and neuralgic pains all over 
 the body. He began to use alcohol to intoxication and 
 could give no reason why he drank. This continued for 
 three years, until death from pneumonia brought on by 
 exposure while intoxicated. Notwithstanding all the efforts 
 of himself, relatives and family, he drank precipitately to 
 the latest moment of life. He began to drink soon after 
 the injury, calling for it with g'-eat urgency. At first it 
 was freely given, until he was so often under the influence 
 that it had to be removed. 
 
 The second case of this character was that of a clergy- 
 man who was in good health, a man of strong temperance 
 scruples, and very correct in all his habits. The sudden 
 death of his wife from a railroad accident, threw him into a 
 nervous fever, that lasted for two weeks, after which he 
 began to use spirits in large quantities. He claimed that 
 he needed it for exhaustion as a tonic, and justified his 
 use of it to intoxication. From this period he drank at 
 all times and places, giving no cause or reason for its use 
 except that of a medicine. He was soon discharged from 
 the church, and became an outcast and inebriate of the 
 lowest grade. He is now serving out a sentence for assault 
 in state's prison. His inebriety began directly from the 
 shock following or caused by intense sorrow and grief. 
 
TRAinviATrsM: in the causation of inebriety. 69 
 
 In both of these cases there was a degree of mental and 
 physical vigor, that gave no indications of tliis sequel, or 
 any neurotic disease. There was no heredity in either case 
 that was prominent, and the inebriety was purely from psy- 
 chical traumatism. 
 
 There is another class of cases which not only have a 
 general neurotic inheritance, but have hints of defective 
 nerve force long before traumatism brings on inebriety. 
 The following cases bring out these facts clearly : 
 
 A lawyer, age forty-four, who was a temperate hard- 
 working man, was made unconscious by a stroke of liglit- 
 ning, and from recovery began to use large quantities of 
 spirits at night. He became an inebriate and died three 
 years after from delirium tremens. His grandfather on his 
 mother's side died from inebriety, and two uncles were 
 inebriates. His mother used spirits freely as a medicine 
 for many years. Here it was clear that an inebriate 
 diathesis existed, and was only developed or exploded by 
 the traumatism. 
 
 A farmer, who was temperate, had suffered some years 
 from nervousness and general liypochondria, was greatly 
 excited at the burning of his barns, supposed to be the 
 work of an enemy. He was laid up in bed for two days, 
 then began to drink brandy, and was intoxicated from this 
 time to death nearly every day. Tiiere was no clear history 
 of heredity, but iiis nervousness and hypochondria seemed 
 to follow from some disorder which began at puberty. 
 Some nerve defect liad lessenea tlie vigor and integrity of 
 the organism, and tlie traumatism followed, bringing out 
 inebriety. 
 
 Another case has lately cd^ne under my care of a mer- 
 chant, who had been well and temperate up to his business 
 failure. This came upon him unexpectedly, and caused 
 great mental anguish, follow by impulsive inebriety. He 
 could give no reason for his drinking, and simply said it 
 was impossible to abstain. His history, for some years 
 
70 DISEASES OF INEBRIETY. 
 
 befoie the failure, indicated chronic dyspepsia and general 
 perversion of nutrition, altliough he had conscientiously 
 refrained fi'om all use of spirits, yet liis capricious nutritive 
 impulses exploded readily into inebriet}' from tlie action of 
 traumatism. 
 
 There are many reasons for supposing that all cases of 
 this character, where dyspepsia and nutrient disturbances 
 exist for some time, are peculiarly susceptible to traumatism, 
 particularly of psychical character. The same may be said 
 of a large class who have inherited unstable brain and 
 nerve forces, either from inebriety, insanity, or any other 
 organic disease. They are all more susceptible to trauma- 
 tism and his results. 
 
 All these cases proceeded directly from psychical 
 traumatism. Whether the traumatism broke up the co-or- 
 dinating nerve centers, which are supposed to govern the 
 sensation of thirst, or produced some general exhaustion 
 of these and other centers, which found in alcohol a seda- 
 tive, cannot at present be determined. The desire for 
 alcohol in all these cases is only a symptom of some general 
 nerve degeneration, which has been produced by trauma- 
 tism. In the second class of cases, where psychical trauma- 
 tism is the cause of inebriety indirectly, the histor}'' and 
 symptoms are alwavs more or less obscure, and require 
 careful study. Yet these cases are undoubtedly numerous, 
 and will in the future attract much attention. The follow- 
 ing cases are fair illustrations : 
 
 A banker, in middle life, in good health and strictly 
 temperate, W'as greatly shocked at the death of his father 
 from heart disease while at the table. For several weeks 
 lie suffered from insomnia, tind could not concentrate his 
 mind on anything, was nervous and complained of dull 
 headache. He was under treatment for a long time with- 
 out any positive results. Nearly a 5'^ear after he suddenly 
 drank to intoxication, and from this time went rapidly 
 down to hopeless inebriety. There was no heredity and no 
 
TRAUMATISM IN THE CAUSATION OF INEBRIETY. Tl 
 
 ill-health up to this time. Some shoclc liad been sustained 
 by tlie nerve centers which, from tlie application of 
 unknown causes, burst out into inebriet3\ 
 
 A lawyer whose fatlier had suffered from general paraly- 
 sis, suddenly became an inebiiate at twenty-four years of 
 age, under circumstances and surroundings that were tlie 
 most adverse. After a long study it was ascertained tliat 
 he had been profoundly agitated from tlie refusal of 
 marriage with a lady, who soon after married a rival. 
 Tliat for a long time he was treated by a physician for 
 threatened brain fever, and that he never recovered liis 
 former vigor and cheerfulness. Three years after he 
 married into a fine family, and had every agreeable sur- 
 rounding possible, when suddenly he rushed into a low 
 saloon and drank to intoxication for the first time. He 
 seemed to try and help himself, but every day sank lower 
 and lower, and was finally divorced from his wife and cast 
 adrift a hopeless incurable. The same psychical causes 
 were at work beginning in the shock from disappointment, 
 and slowly slumbering along until inebriety developed. 
 
 A farmer with no heredity of nerve disease, temperate 
 from principle and a hale, vigorous man, was greatly pros- 
 trated by grief, while on a visit to tlie army, to find that his son 
 had been killed in battle. For five years after he complained 
 that he did not feel well, could not sleep soundly, was more 
 easily exhausted than ever before, and suffered from neural- 
 gia and changing sensations. One day, in tlie harvest field, 
 he left his work and drove off to a distant city, drinking to 
 intoxication. Ever after he drank all the time, with every 
 opportunity and occasion. His excuse was that he had a 
 tape worm, which had been taken into the system when he 
 was in the army. Like the other cases the effect of grief 
 and consequent shock produced some permanent alteration 
 of both structure and function ending in inebriety. The 
 cases were also noted by the absence of any stage of 
 moderate drinking, and the sudden onset of the excessive 
 
72 DISEASES OF INEBRIETY. 
 
 use of alcohol. Quite a large class after some form of 
 psychical traumatism have a stage of moderate drinking, 
 which very commonly ends in impulsive inebriety, that 
 comes on unexpectedly. The following are some cases, 
 whose origin and history are very clear in many instances : 
 
 A strong temperance advocate and lawyer of culture, in 
 vigorous health, was involved in a stock company that 
 ruined his reputation, by an accident in which he was not 
 in any way guilty. He suffered so keenly that he was 
 treated for fever, which lasted some weeks, then he resumed 
 business. Later, he began to use bee*" in moderation for 
 debility, and this in a year or more merged into stronger 
 drinks at night. Another year, and he suddenly began to 
 drink to intoxication every day, soon losing his business 
 and becoming a hopeless incurable. From the time of 
 failure of tlie company and his reputation, a steady decline 
 of mind and body was apparent. No special symptoms 
 could be recognized that pointed to other than general 
 failure of his former vigor and pride of character. Some 
 change had taken place, and something was wanting to 
 make up health and integrity of organism. 
 
 A second case was an engineer, with no history of hered- 
 ity, and a man of fine health and thoroughly temperate. 
 While at his work in the field, a gun in his hands w^as 
 accidently discharged, killing an intimate friend and 
 brother engineer. He was greatly depressed and melan- 
 choly for months, at times would burst out into tears, and 
 be unable to work ; then he began to use spirits at night to 
 bring on sleep, and a few montiis after he drank to excess 
 and was obliged to give up his business. He died a year 
 later from excessive use of spirits. 
 
 A third case, equally free from all entailment of disease, 
 and well up to the time of great exposure and excitement 
 from the loss of his mill by a freshet, began to use spirits 
 for exhaustion and debility, and a few months later was a 
 pronounced inebriate, drinking all the time. It may be 
 
TRAUMATISM IN THE CAUSATION OF INEBRIETY. 73 
 
 asked if these cases gave indications of inebriety following 
 the traumatism ? The answer is that the period of moder- 
 ate drinking showed this tendency clearl3\ It could not be 
 an accident, for all of these cases were men that were fully 
 aware of the danger of such a course, and would not enter 
 upon it unless impelled by a diseased impulse which they 
 could not control. 
 
 It is exceedingly difificult for tliose not practically 
 acquainted with business life to understand the constant 
 strain and excitement which follows all business and pro- 
 fessional activity. From the poorest laborer to the million- 
 aire and professional man of the widest influence, there is 
 a hurry and excitement, and a want of rest, that is steadily 
 preparing the soil for all forms of nervous diseases. Tiie 
 rivalry and intensity of school life follows the child to the 
 grave. In business, in a profession or farming, it is the 
 same struggle for prizes ; gathering up all the energies of 
 body and mind and concentrating them in one effort ; if 
 they fail, turning to some other field with the same intensity 
 and courage. A prominent professor in a leading medical 
 college and author of note, has been a teacher of languages, 
 a mercliant, an inventor, a mining engineer, all within a 
 career of less than half a century. These extreme changes 
 of life and occupation strongly predispose the person to 
 states of exhaustion, or as the late Dr. Beard wrote : " We 
 are a nation of neurestlienics out of which many and com- 
 plicated nervous diseases are constantly springing." 
 
 Psycliical traumatism will appear oftener as a promin- 
 ent factor in tiie causation of inebriety here than elsewhere. 
 The following cases are typical of a class that represents 
 one extreme of American life, tlie speculators and brokers : 
 A broker, witli no history of heredity, healthy and temper- 
 ate, who liad made and lost two fortunes, and was rich 
 again, entered into a pool and sunk every dollar. His wife 
 was taken ill, and he was forced to leave his old home, and 
 have her taken to the hospital, wiiere she died soon after. 
 
74 DISEASES OF* INEBRIETY. 
 
 He began to use spirits to gi-eat excess at once and is now 
 a chronic inebriate. The shock from tlie last misfortune 
 brouglit on inebriety, and although he made many efforts 
 to recover he always drops lower from the struggle. 
 
 A banker who had made a large fortune, became a 
 speculator and went into Wall street. He was very correct 
 in all his habits of living and was careful of his body. For 
 ten years he both made and lost large sums of money, and 
 was under the usual strain of men who embark their for- 
 tunes in one venture. His son, who was expected to follow 
 in the same business, proved a defaulter, and was sent to 
 state's prison. The father began to drink to great excess at 
 once, and died after three months of extreme drinking. In 
 cases of this character there must be a condition of great 
 exhaustion and general debility which gives way under the 
 last shock of traumatism. 
 
 The following cases represent another extreme of life in 
 this country. A farmer who had for twenty years worked 
 early and late, eaten poor food, depriving himself of many 
 necessities and comforts of life, that he might own his 
 farm, was plunged into the deepest distress on finding tiiat 
 the title was wrong, and all his labors had been lost. He 
 drank at once to excess, and a year 'after was taken to an 
 insane asylum. He was discharged in a few montiis, but 
 continued to drink. 
 
 A bookkeeper worked night and day in an absorbing 
 passion for wealth, neglecting to rest and taking but little 
 outdoor exercise. His position and investments were all 
 swept away by a financial storm, and he became an inebii- 
 ate at once. Later he was a bar-keeper, then was sent to 
 prison for some crime. The usual explanation would be 
 that these cases drank from despair and discouragement, 
 but a general study will show a state of psychical pain and 
 agony for whicli alcohol alone acts as a sedative. It very 
 commonly appears in a study of cases of inebriety, that the 
 [latient will refer to some event of life, or disease, from 
 
TEATTMATISM IN THE CATTSATION OP INEBKIETT. 75 
 
 which he lost some power or force whicli lie lias never re- 
 gained. Such facts are not given as reasons for his diink- 
 ing, but as explanations of his vigor or power of endurance. 
 One man gives a history of overwork under conditions of 
 great mental excitement from which he has never recovered 
 his former vigor. Years after he becomes an inebriate, but 
 he never traces the connection between tlie former overwork 
 and the inebriety. A careful inquiry will show many hints 
 along this interval (which may be years), that refer directly 
 to this event, showing that inebriety is but the result of 
 degenerations whicli begun there. In another case a man 
 suffers from some profound grief and sorrow, which at the 
 time breaks up his health, and for a long time after is felt 
 in general debility and weakness. Years go by, and sud- 
 denly he drinks to intoxication, and is an inebriate at once. 
 No good reason can be given for drinking, and possibly no 
 stage of moderate use of spirits precedes the inebriety. To 
 himself and friends a degree of ill health has been recog- 
 nized from the time of his great grief, and to the physician 
 who can study closely this interval, there will be found 
 nutrient perversions, neuralgia, eccentricities, and nameless 
 indications of a coming storm. 
 
 A very large class of cases have in the past suffered 
 from some form of disease from which they have recovered 
 with an entailment of debility, and a want of something 
 that cannot be defined. They are fully conscious of dimin- 
 ished power, of change of vigor and force. It may be they 
 do not sleep as naturally, and do not get the usual rest ; or 
 they do not recover so quickly when exhausted, cannot 
 digest food as thoroughly, have dyspepsia from sliglit 
 causes. They are more sensitive than before, emotional 
 and excitable witli every event that is irritating. 
 
 In one case a man has a severe pneumonia with a tedious, 
 long convalescence. After recovery, a change of disposi- 
 tion and character is noticed, and a year or so after he 
 
^S DISEASES OE USTEBRIETY. 
 
 begins to drink spirits and soon becomes an inebriate. Or 
 another case where a man recovers from typhoid fever, and 
 for a long time exliil)its marked alterations of liabits and 
 ciiaracter, then suddenly or gradually becomes an inebiiate. 
 There can be no doubt that inebriety originated in the 
 traumatism following the diseases in these cases. Some 
 special exciting cause favored its development, or possibly 
 the injury done to the nerve-centers would only manifest 
 itself in tliis way. The first causes are traumatic, following 
 the diseases or lesions which take place, particularly notable 
 in the complex range of psychical symptoms that are seen. 
 The integrity of tlie organism and function has been 
 impaired, and from this point disease and diseased ten- 
 dencies are developed. 
 
 These cases are found in every community, and of 
 course do not all become inebriates, but like a large class 
 of eccentrics are on the border line, or inner-circle shading 
 into inebriety or insanity. A large number of persons 
 engaged in the late civil war, who suffered hardship and 
 mal-nutrition, became inebriates years after, following the 
 psychical and physical traumatism received at that lime. 
 The effects of commercial disasters, of bankruptcies, and 
 panics in Wall street, can be seen in inebriate or insane 
 asylums. 
 
 In the asylum at Binghamton, New York, for inebriates, 
 at one time were eighteen cases, whose inebriety could be 
 clearly traced to a great money panic in Wall street, known 
 as the " Black Friday." Many of these cases were purely 
 from psychical traumatism, others were already in the dark 
 circle close to inebriety, and needed but a slight cause to 
 precipitate them over. Political failures are also fertile 
 fields for the growth of inebriety and the action of 
 psychical influences. Annually a large class after the close 
 of a campaign find themselves literally inebriates, and if 
 they have money go to water-cui-es, inebriate asylums, or 
 to the far west and begin life again. The inebriety is 
 
TRAUMATISM IN THE CAUSATION OF INEBRIETY. 77 
 
 often of a paroxysmal or dipsomanical type, with free 
 intervals of sobriety, that give renewed energy to the 
 delusive hope tliac recovery will follow the bidding of the 
 will. A class of moderate or occasional drinkers are 
 always more susceptible to these influences than abstainers. 
 This was marked in an instance where three men, two 
 moderate drinkers and one abstainer, partners in business, 
 witli equal capital, lost it all in one night. The abstainer 
 recovered and resumed again, the moderate drinkers both 
 drank to excess after, and died inebriates. It may be 
 stated as a rule tliat moderate drinkers suffer more fre- 
 quently from psychical shocks of every form, and are more 
 likely to become inebriates from such causes. The 
 inebriety that follovvs directly or indirectly from psychical 
 traumatism, differs in natural progress and history from 
 other cases. The physical degenerations are more pro- 
 nounced, the heart and liver take on organic disease 
 quickly, and the mental symptoms are prominent. In 
 some cases the course of the disease is paroxysmal, and 
 the mental degenerations are suspicious of what is called 
 moral insanity. As in the following : A commercial 
 traveler in good health, and a man of character, became an 
 inebriate dating from a steamboat accident in whicli he 
 was greatly alarmed, and barely escaped being both burned 
 and drowned. When not drinking he planned and exe- 
 cuted deceptions, cheated his employers, and engaged in a 
 course of crime and villainy that was without shrewdness, 
 and entirely foreign to all his past history. He was sent 
 to prison and died from consumption. In another case, a 
 merchant, after the onset of inebriety from the same 
 psychical influences, suddenly became a gambler, and 
 frequented the lowest places of this class. 
 
 In the treatment of these cases, where the previous 
 history has been concealed or not ascertained, the impulsive 
 boasting and foolish prevarications, and efforts to cover up 
 and live a double life by pretending to use all means for 
 
78 DISEASES OF INEBRIETY. 
 
 recovery, and steadily thwarting them, are often clear hints 
 of psychical traumatism, which a more accurate history 
 confirms. Want of space prevents us from illustrating this 
 subject further. Any general study of inebriety will point 
 out this factor of traumatism as prominent in many cases 
 that are now unknown. The following conclusions may 
 serve as a guide to other studies in this field, or as hints of 
 the rich mines for clinical and psychological investigation 
 awaiting future discovery. 
 
 1. The injury to the nerve-centers from psychical 
 traumatism is the literal switch or point of departure from 
 the main line, from which all subsequent disease and 
 symptoms of change and perversion can be traced and 
 studied. 
 
 2. The most prominent early symptom is exhaustion or 
 neuraesthenia, which goes on progressively manifest in 
 more complex deviations from health, and general func- 
 tional disturbances. 
 
 3. This may explode into inebriety at once, or appear in 
 moderate drinking, which will always end in inebriety. 
 The type of this ci'aving will differ from others in the 
 extreme mental degeneration which follows. 
 
 4. The prognosis and treatment will differ materially, 
 depending on a knowledge of these facts, and will present 
 indications that are absolutely necessary to know in the 
 proper management of the case. 
 
CHAPTER IX. 
 
 CAUSES CONTINUED. ADVERSITY, ETC., ETC. 
 
 The disease of inebriety has in many cases a distinct 
 prodromic stage of moderate drinking. In a certain num- 
 ber of instances the disease never goes beyond this stage. 
 Death follows from some intercurrent affection, always 
 influenced by the state caused by alcohol. Moderate use of 
 alcohol in a healthy man is always injurious, and is the 
 initial stage of inebriety, whether it goes on to full devel- 
 opment or not. All cases of inebriety are either preceded 
 by tills early stage of moderate drinking, or appear sud- 
 denly as the result of certain conditions more or less 
 unknown. In the latter case injuries of all kinds are the 
 most frequent causes. But in the former, the soil favorable 
 for inebriety is already prepared, and slight exciting causes 
 are sufficient to bring on full development. 
 
 Adversity witli its mental depression and tendency to mel- 
 ancholy, also general lowered mental and physical activity, 
 are among the active causes which precipitate the moderate 
 drinker into full inebriety. Clinical experience brings abun- 
 dant proof of this statement. On physiological grounds it 
 is clear that moderate drinkers have less resisting power to 
 disease or change, which involves exhaustion of the nerve- 
 centers, and changes of brain force. The use of alcohol 
 has intensified the very state of debility which it is sup- 
 posed to remedy, always masking and covering up the real 
 condition. When a special demand is made on the system, 
 this mask is thi"own off and inebriety appeal's. 
 
 Clinically, a class of moderate drinkers who are intently 
 
 79 
 
80 DISEASES OF INEBRIETY. 
 
 absorbed in some pursuit or ambition, in which great 
 interests are involved, become inebriates as a rule from 
 adversity. They are neuraesthenic both from the use of 
 alcohol and general perversions of tlie nervous system con- 
 sequent upon over-work and mental anxiety. Hence, when 
 the increased strain from the changed conditions of adver- 
 sity comes on, alcohol is taken as a narcotic and gives 
 relief. 
 
 Another class of persons are noted clinically by their 
 weak, exhausted nerve condition, and general instability of 
 mind and body. Adversity frequently precipitates this 
 class into inebriety. They are always predisposed to this 
 affection, and tlie use of alcohol as a stimulant is so com- 
 mon, and its effects are misleading, that they quickly fall 
 into chronic stages of inebriety. The nerve-centers are in 
 a condition of starvation from over-work and defective 
 nutrition. Alcohol constantly increases tliis state, and 
 hushes the agonized cries of nature for relief. 
 
 In the observation of every one are found cases who 
 have been moderate drinkers up to some great trouble or 
 adversity, then become inebriates. Anotlier class are 
 noticed of intensely nervous persons, who are not known as 
 moderate drinkers, up to some period of profound shock 
 or adversity, which changes and alters the entire mental or 
 physical life. From this time inebriety springs up suddenly 
 and generally progresses with great intensity. In the 
 former case, adversity was the active exciting cause, kindling 
 into energy conditions whicli may have been gathering for 
 a long time. In the latter, it explodes a state of nerve 
 exhaustion, in the direction of inebriety. Adversity, while 
 depressing some men, destroying all energy and faith in any 
 further exertion, has the opposite effect on others, rousing 
 them to greater endeavors, which if buoyed up on alcohol, 
 must fail in the future. Tiie ph3'sician's frequent prescrip- 
 tion of alcohol in cases of debilit}'' following mental trouble 
 and sorrow, is always full of peril to the patient. At this 
 
CAUSES CONTINUED, ADVERSITY, ETC. 81 
 
 time the danger of inebriety is very great, and cannot be 
 over-estimated. Those who liave previously used spirits in 
 moderation, should never have it as a medicine for any 
 general disorder marked by nerve depression. 
 
 Those who liave been temperate, and suffer from great 
 physical and psychical disorder consequent on changes of 
 external conditions, following adversity, cannot take alcohol 
 without great danger of inebriety. 
 
 Adversity has been recognized for a long time as preced- 
 ing inebriety. The general fact has been often noted, that 
 long-continued adversity in any community will produce 
 more or less insanity. 
 
 The same condition of adversity is followed more fre- 
 quently by inebriety, which fact can be shown in the history 
 of every community. 
 
 Inebriety is a common sequel gnd physiological out- 
 growth of adversity. All moderate drinkers are practically 
 inebriates in the early stages, and liable any moment to 
 develop extreme symptoms or stages of this disease. 
 
 It may be said tliat the use of alcohol in all cases of 
 nerve and brain debility, either from mental or physical 
 depression, is dangerous and likely to bring on inebriety. 
 
 Neurasthenia is rather the comparatively permanent 
 exhaustion which is the result of prolonged over-strain, 
 mental or physical, or botli, too little rest, insufficient or 
 defective nourishment, long continued, until the substance 
 of the nervous system, and often of the blood which 
 nourishes it, is wasted or worn away far below healthy 
 limits, entailing as a necessary consequence a correspond- 
 ing /c^j'i" ^y /z^rz/^/t'Zf'^r and in most cases morbid exaltation of 
 the seftsibility, not to speak at present of other important 
 though auxiliary elements of such cases. Neurasthenia may 
 be exhibited in the sphere of the mind as in weakness of 
 thought, but especially weakness and vacillation of will, 
 or in other words, loss of control and lack of decision ; in 
 unduly excitable and unhealthy emotions, generally of a 
 
82 DISEASES OF INEBRIETY. 
 
 distressing or depressing character ; or in the sphere of the 
 simple physiological activities, especially in feebleness and 
 irregularity of muscular action ; exaltation of physiological 
 sensibilities of any or all kinds, but especially reflex excita- 
 bility ; the circulation of tiie blood is also, as a rule, 
 unsteady and fluctuating, the action of the heart and small 
 muscular vessels being easily disturbed by multitudinous 
 causes, mental and physical. Then, again, it may be %^w- 
 eial, extending to the whole nervous system, or it may be 
 strictly localized, involving only limited parts of the nervous 
 system, while other parts do not participate to the same 
 extent or at all. Again, it may be hereditary or congenital, 
 especially the former. People are born into the world 
 daily, to begin, live, and end life, neuresthenic, or at least 
 to be brought early into that state ; persons who have from 
 the beginning weak, tricky nervous systems, either as a 
 whole, or in some of its parts. On the other hand, 
 there are persons to be met with, at all periods in life, 
 and of both sexes, who are naturally healthy, as the 
 phrase goes, who from prolonged over-exertion, mental or 
 physical, or from being under a load of care or distress, 
 or from prolonged loss of sleep or loss of appetite, or 
 from insufficient food, or on the contrar}^ excessive waste, 
 as in hemorrhages or diarrhoeas, or on account of some 
 wasting disease, etc., and suffer a loss of balance in their 
 nutrition, so that waste for a long time predominates over 
 repair, to the exhaustion of the nervous energies, and a 
 great gain in mobility, or " shakiness " of the nervous sys- 
 tem, especially the nervous centers. 
 
 It may form a disease (as it must be called) by itself, 
 or it may and it does form a more or less conspicuous 
 element in a great variety of diseased states, one which 
 behooves you all to learn and detect and estimate. It is 
 often overlooked or under-estimated, and often is the 
 obscure and all-important element in cases that are widely 
 different in appearance. It is the undertone in the picture 
 
CAUSES CONTINIJED, ADVERSITY, ETC. 83 
 
 in a vast number of cases of " heart disease," " brain dis- 
 ease," even ** softening" of the brain, of hysteria, epilepsy, 
 melancholia, neuralgia, paresis, mental weakness, feeble 
 circulation, insomnia, etc. It prevails in all periods of life, 
 and in both sexes. Instead of becoming less common, it is 
 becoming more so, as time passes, and as people as a whole 
 become more sedentary in habits, more intellectual in activ- 
 ities, more engaged by occupation or by culture, so as to 
 augment the sensibilities at the expense of the forces or 
 power of the nervous system. 
 
 I regard the refusal to take proper physical rest, when 
 tired from labor, as one of the most important and power- 
 ful in inducing a love for, and an indulgence in, the use of 
 ardent spirits. Men work till they get so tired that they 
 cannot wait to feel sensibly rested by processes of change 
 going on in their systems from suspension of labor. They 
 either want to work more hours than they are able to do ; 
 or when they have done as much as they feel themselves at 
 liberty to do, they are so tired that they cannot rest. They 
 get rest, therefore, in artificial ways, by resorting to eating 
 and drinking. Some get rested by drinking tea, others by 
 drinking coffee, otliers by chewing and smoking tobacco ; 
 but the great majority of tired people in this country — and 
 the larger share of our people are tired — drink ardent spirits 
 in some or oilier of its forms or preparations. They fall 
 back on stimulants instead of the intrinsic vitalities of their 
 bodies. They therefore are lifted up into false conditions. 
 Accepting these as true, they keep on working till they be- 
 come so functionally impaired as to induce positive inability 
 to work longer, or they become so constitutionally depreci- 
 ated as to be smitten with incurable disease. 
 
 The hot waves wliich follow each other during the sum- 
 mer months, register their duration and intensity in the 
 police courts, station-houses, and hospitals of all large cities 
 by the sudden increased number of inebriates who come 
 under observation, A sudden rise of the thermometer 
 
84 DISEASES OF INEBRIETY. 
 
 brings more drunken men to the station-house, and more 
 acute intoxication is noticed on the streets. Why this is so 
 is not clear. Why sliould the nerve and brain debility of 
 inebriates seem more easily affected by extreme heat ? Why 
 should alcohol have more rapid action, causing pronounced 
 narcotic effect? Why should the inebriate use spirits more 
 freely at such times ? These and many more inquiries await 
 an answer from the scientists and future investigation. 
 
 One view of the subject should be practically recognized 
 everywhere. First, the great danger of confining intoxicated 
 persons arrested on the street in hot weather, inclose, badly 
 ventilated cells; such cases are in great danger of heatstroke. 
 Narcotized with alcohol, and thrust into close, stifling air — 
 all the favoring conditions are present, and the person is 
 found dead next morning in the cell, or in a state of deep 
 stupor from which he dies later. The real cause was not 
 the intoxication, but the heatstroke from the close air of 
 the cell. Close, hot cells should never be used for the pur- 
 pose of confining intoxicated men in hot w^eather. 
 
 Second, in a number of cases, drinking-men suffer from 
 partial sunstroke in the street or saloons, and are taken to 
 station-houses, as simply drunken men. They are placed 
 in cells, receive no care, and die. They may be temperate, 
 and, feeling bad, take a glass of brandy for relief, fall into 
 a state of coma, the real cause being the sun or heat-rays ; 
 but from the alcoholic breath they are judged to be intox- 
 icated and taken to the cell, only to have an increase of their 
 injury and die. 
 
 Another class of cases, far more common than is sup- 
 posed, are those who, after a partial sunstroke, take a single 
 glass of spirits, become delirious, and are called ** crazy 
 drunk." They are roughly taken to the station, and, per- 
 haps, hit on the head, with no other idea than that of will- 
 fulness, and next morning are dead, or are taken to the 
 hospital, and supposed to have meningitis, from which they 
 
CAUSES CONTINUED, ADVEKSITT, ETC. 85 
 
 die. The real cause was the policeman's club, and hemorr- 
 hage from traumatism. 
 
 Another class drink ice-water, or soda compounds, to 
 excess, then, to relieve the distress from tiiese drinks, take 
 brandy or whisky and become delirious. They are arrested, 
 and thrust into a cell like the others, and if they do not 
 have a heatstroke suffer from injury in their delirium by 
 striking their heads against the walls. Policemen have no 
 other standard except the alcoholic breath for determining 
 the state of the person. 
 
 An instance came under my observation, of a man, 
 poorly dressed, who was overcome by heat and exhaustion, 
 and was given a glass of whisky by a kind-hearted store- 
 keeper. He became delirious, was taken to the station, 
 and from thence to the hospital, where he died a few 
 days later. The autopsy revealed a fractured skull and a 
 ruptured artery, which came from the struggles in the 
 arrest or self-inflicted injury in the cell. 
 
 T/ii'rd, jndges who administer so-called justice to these 
 poor victims, often assume that this sudden increase of 
 inebriates demands increased severity of punishment ; and 
 the wrong of arresting every one indiscriminately and 
 sending them to station-houses is still further increased. 
 Justice is outraged, and the burdens of the tax-payer 
 increased, and the danger to life and property made greater 
 by recruits to the dangerous classes — classes diseased and 
 incapable beyond recovery, yet treated as law-abiding 
 citizens and held responsible. 
 
 Tlie medical men in every town should insist that all 
 men arrested during hot periods for supposed intoxica- 
 tion should come under medical care, and be examined 
 carefully before they are thrust into cells. The community 
 sliould be tauglit that the increased number of acute inebri- 
 ates in hot weather points to ranges of physical causes that 
 require study, and cannot be treated by policemen or police 
 judges. Hot cells, in the ordinary station-houses, are 
 
86 DISEASES OF INEBRIETY. 
 
 sources of danger that should be avoided. The delirious 
 or comatose inebriate who is placed in such cells over night, 
 is practically murdered. The chances of escape from heat- 
 stroke and traumatism are far less than the hope of recov- 
 er^^ The skill to correctly determine the condiiion of 
 these acute inebriates who are arrested in hot weathei", is 
 far greater than in ordinary insanity, and should not be 
 trusted to policemen and non-experts. Here is a field for 
 tiie ambitious pliysician who would discover new ranges of 
 physical causes, and point out methods of prevention of 
 tlie greatest practical importance. 
 
 Those who use alcohol in any form, either moderately 
 or in excess, suffer more frequently from sunstroke and 
 heat apoplexies. The fatality of these cases are greater 
 than in those who are abstainers. The brain disturbances 
 following are more serious and prolonged, and in many 
 cases acute manias, various palsies, and dipsomaniac 
 impulses are very prominent. 
 
 Many of these cases occur in persons who are not 
 thought to be other than moderate drinkers, particularly 
 as they are seldom seen intoxicated, and, although at the 
 time of the sunstroke may have the odor of alcohol about 
 them, yet are not considered to be injured by spirits in any 
 particular way. Tiiese cases suffer from sunstroke in two 
 ways : either from the direct rays of the sun, or from the 
 heat of close rooms or areas. In the latter case it occurs 
 most frequently after sunset and before midnight. Very 
 serious mistakes are frequently made in the diagnosis by 
 physicians. A man will be found in the street in a state of 
 coma, with an alcoholic breath, which, to a superficial 
 observer, points to spirits as a cause. The real cause, sun- 
 stroke, is not recognized, and death follows in a cell at the 
 station-house, or in some other place, and nothing has been 
 done to avert this event. In any case of coma found in the 
 street in hot weather, the diagnosis of apoplexy from heat 
 should be considered, irrespective of all alcoholic odors in 
 
CAUSES CONTIlSrUED, ADVERSITY, ETC. 87 
 
 the breath. A moderate and only an occasional user of 
 spirits, feeling bad, took a glass of brandy, and soon after 
 suffered from sunstroke and was taken to the station-house, 
 where he had been ordered by a pliysician who made a diag- 
 nosis on the odor of his breath alone. A clergyman who 
 drank only wine at meals, and was' a red-faced man, was 
 struck down by the sun soon after drinking some wine, and 
 was taken to the station as a drunken man, the diagnosis 
 being made on the same grounds. The physician should 
 not forget tliat the odor of spirits, with a tendency to apo- 
 plexy, excited by sunstroke or any other cause, and the 
 circumstance of being found insensible in tiie hot sun, is 
 sufficient to warrant a diagnosis of sunstroke, rather than 
 that of coma from alcohol. 
 
 In the second class, more difficulty follows. Thus, a 
 man who has drank in moderation, or not at all, will be 
 stricken down in a close room, and if the odor of alcohol is 
 present he is supposed to be intoxicated. Cases of this 
 kind are frequent in bar-rooms, and close, crowded tene- 
 ment-houses in hot nights. The real diagnosis, heat 
 apoplexy, is often overlooked. A man comes home from a 
 hard day's work, takes a glass of spirits, and goes to some 
 close room where the air does not circulate and radiation 
 is imperfect, and soon after has an attack of heat apoplexy ; 
 or, he may go to some close bar-room, and late in the 
 evening be stricken down. 
 
 These cases occur most frequently in large cities, and 
 close, narrow streets, but will be found in all sections of the 
 country where the conditions of heat and surroundings are 
 favorable. The advice given in India to the English resi- 
 dents and troops is very sensible and correct. First, to 
 abstain from all alcoholic drinks during the hot season ; 
 and, second, to drink large quantities of water, especially 
 in hot days. With this are many directions about the care 
 of the body, namely : to avoid over-work, pressure of 
 
88 DISEASES OF INEBRIETY. 
 
 clothes, bad food, and so on. Partial sunstrokes are more 
 common where the person has a faint, attended with dizzi- 
 ness, momentary loss of consciousness, followed by severe 
 headache and great prostration. These. attacks have a very 
 serious influence on moderate or excessive drinkers. Often 
 it is the beginning of profound degenerations, which go on 
 rapidly to death. Heat apoplexies are very intimately 
 associated as causes of inebriety, and when occurring in 
 inebriates, lead to the gravest results. 
 
 The use of spirits in any form undoubtedly favors and 
 predisposes to sunstroke ; and whatever the explanation 
 may be, it is certain that he who uses alcohol has less vigor 
 and resisting power to high degrees of heat. 
 
 In the comparison of the histories of many cases of 
 inebriety, certain ranges of fact appear in a regular order. 
 Continuous chains of cause and effect run through all the 
 events. What appears to be the free will of the victim is 
 but a narrow channel along which he is forced by condi- 
 tions which he cannot escape. Appeals to his feelings and 
 reason are useless, for these faculties are unable to direct or 
 control the progress of disease. Often the victim is uncon- 
 scious that he has lost his power of control, unconscious of 
 the march of events ; the steady disintegration of brain 
 vigor and health, and never realizes it. Delusions of health 
 and self-control become fixed as the disease goes on. The 
 range of his mental powers steadily narrow and approach 
 the animal in comparison, and are finally lost in a general 
 dissolution. 
 
 The agents exciting the emotions, and exhausting tlie 
 nerve forces, and so causing inebriety, are everywhere 
 present in the tremendous activities of our American 
 civilization. 
 
 The atmosphere is full of psychological germs, calcula- 
 ted to infect the nervous system and produce disease. 
 " Hopes and fears, appealing to the deepest motives of our 
 nature ; political excitement, producing tumults of passion 
 
CAUSES CONTINTTED, ADVEKSITY, ETC. 89 
 
 and bitter feeling ; commercial waves of good and bad 
 fortune, causing alternately intense joy and as intense disr 
 appointment and chagrin ;" these are some of tlie dangers 
 breaking up the healthy mental equilibrium and increasing 
 the perils of every life. It is in this atmosphere that 
 inebriety begins and goes to full development, standing out 
 in lurid relief with our boasted civilization. 
 
CHAPTER X. 
 
 INEBRIETY IN AMERICA AND ITS PECULIARITIES, ETC. 
 
 Inebriety in America is more impulsive and precipitate 
 than in other countries, the period of moderate drinking is 
 less marked, and the average life of the inebriate is shorter. 
 Among the many reasons for this are the tremendous 
 activity and competition in the ordinary vi^ork of life, the 
 intensity of living, the constant excitement and changes, 
 filling every moment of time, calling out every energy, put- 
 ting them in a constant strain, followed by want of rest, 
 neglect of the healthy functions of the body, etc., etc. Add 
 to this the constant practice of using the stron'gest alcohols 
 at all times and occasions, and it will be seen that the 
 average American must of necessity possess less resting 
 power, and will fall a victim more readily to the action of 
 alcohol. 
 
 The effects of these influences are marked psychologic^ 
 ally in the character of the inebriety seen in America. 
 When under the influence of alcohol the average American 
 is full of delusions of speculation for wealtli, power, and 
 political achievement ; his ideas flow in a channel of great 
 events, and great schemes for the welfare of the nation and 
 ilie race ; he is rarely a wife-beater or avenger of personal 
 worngs, but may be prominent in a mob to destroy some 
 great evil, or foremost to break up some old order of events 
 which are supposed to be blocking the wheels of progress. 
 The inebriate American will always be found in the van of 
 every new project in politics, social science, religion, and 
 
 90 
 
INEBEIETY IN AMERICA. 91 
 
 business, and, like Colonel Sellers, is buoyed up with the 
 stimulating hope of " There's millions in it." The records 
 of courts rarely exhibit brutal crime among inebriates who 
 are Americans, but great schemes of companies, frauds, 
 and stupendous swindles, for money or notoriety, etc., 
 etc., are common among this class. The increased con- 
 sumption of all forms of alcoholic drinks, beyond the 
 average gain of population, give indications of the in- 
 crease of inebriety. This is confirmed by the court 
 records of drunkenness in all the large cities and towns, 
 and also from comparative evidence of the mortuary sta- 
 tistics which point to a rapid increase of those diseases 
 which are most common in inebriates : namely, insanit}', 
 paralysis and acute affections of the heart, kidneys and 
 lungs. It may be said, beyond all doubt, that inebriety in 
 America terminates most frequently in acute organic 
 affections of the body. Another fact of great interest is 
 apparent to the psychological student, namely, that ine- 
 briety in America moves in waves and currents, with a decided 
 epidemic and endemic influence. This can be traced to 
 the rapid increase of drunkenness in towns and cities, and 
 after a time a reaction sets in, and a marked decline follows ; 
 the latter is seen following the temperance agitation and 
 revivals. In some cases this is traced to special causes, 
 such as financial depression, great social changes, etc. ; at 
 such times moderate drinkers become pronounced inebriates 
 and weak, nervous organizations fall into inebriety. This 
 increases up to a certain point, then from some unknown 
 psychical force declines, and a revival of temperance efforts 
 follows, with a decline of inebriety to a minimum. These 
 waves and inebriate storms that sweep over large circles of 
 country are always followed by intense revivals of temper- 
 ance interest, and are fields of the most fascinating psycho- 
 logical interest yet to be studied. 
 
 Alcholic inebriety among American women is undoubt- 
 edly becoming less every year. Although it is more 
 
92 DISEASES OF INEBRIETY. 
 
 covered up tlian in oilier countries, yet its presence is 
 apparent in the demand for narcotics, and the sale of beer 
 and wine by grocers, also in the divisions of saloons into 
 general and family entrances, with separate rooms for each. 
 Among the better classes of women wine and spirits are less 
 openly used, and social drinking more rare. The same is 
 true of all classes, except those of foreign birth, who still 
 cling to the old custom of public drinking. The same gen- 
 eral causes govern women that are noticed among men, only 
 varying in degree ; hence, while women do not use alcoholic 
 spirits as men do, undoubtedly they consume all forms of 
 narcotics in excess of other classes. Their peculiar sensitive 
 organization demands narcotics as a relief from the strain 
 and exhaustion to vyhich they are constantly subjected, and 
 this is a source of great peril to the future of the American 
 race. 
 
 In this brief outline of the nature and character of 
 inebriety, it may be said that American inebriety is more 
 often a pronounced form of brain and nerve degeneration, 
 and that it comes from well marked physical conditions, 
 largely controlled by social and psychical states peculiar to 
 America. Its symptomology more nearly resembles that of 
 insanity and general paralysis ; its course is in waves and 
 currents ; its progress is shorter ; and among women the 
 use of narcotics is more prevalent than of other forms of 
 alcohol. 
 
 At the recent international congress, held in London 
 under the auspices of the Society for the Study of Inebri- 
 ety, brief reference was made to certain factors which con- 
 tribute to make the study of inebriety in America specially 
 serious and urgent. 
 
 Although there are abiding factors the world over, in 
 America we have elements to study which are peculiar and 
 unique. Bs' America is meant the American Republic, the 
 States and Territories bounded by the seas, the lakes and 
 the gulf. Here sixty millions of people are placed under 
 
mEBRIETT IN AMERICA. 93 
 
 those physical, ps3xhic, political and social conditions which 
 combine to make life more vividly intense atid exacting than 
 anywhere else on tliis planet, and therefore are more sus- 
 ceptible to the malady of inebriism. 
 
 This region luis been called " the intemperate belt." 
 " Inebriety may be said to have been born in America and 
 has developed sooner and far more rapidly than elsewhere ; 
 and like otiier nerve maladies is especially frequent here. 
 It is for this reason, mainly, that asylums for inebriates were 
 first organized here." Here also the total abstinence soci- 
 eties of modern days began. Why ? because of the abnor- 
 mal nerve sensibility which the feverish rush of life here has 
 developed, a physiological condition, that will not tolerate 
 stimulants. 
 
 Dr. Beard says that it is a greater sight than Niagara, 
 which is presented to a European coming to this land, to 
 behold an immense body of intelligent citizens, voluntaril}'- 
 and habitually abstaining from alcoholic beverages. " There 
 is perhaps no single fact in sociology more instructive and 
 far reaching than this ; and this is but a fraction of the 
 general and sweeping fact that the heightened sensitiveness 
 of Americans forces them to abstain entirely, or to use in 
 incredible and amusing moderation, not only the stronger 
 alcoholic liquors, but the milder wines, ales, and beers, and 
 even tea and coffee. Half my nervous patients give up 
 coffee before I see them, and very many abandon tea. Less 
 than a century ago, a man who could not carry many bottles 
 of wine, was thought effeminate. Fifty years ago opium 
 produced sleep, now the same dose keeps us awake, like 
 coffee and tea. Susceptibility to this drug is revolutionized." 
 Dr. Beard makes the ability to bear stimulants a measure 
 of nerves, and asserts that the English are of "more bottle- 
 power than the Americans ;" that it is worth an ocean-voy- 
 age to see how they can drink. A steamer seat-mate poured 
 down, almost at a swallow, a half tumblerful of whiskey 
 with some water added. He was a prominent minister in 
 
94: DISEASES OF INEBRIETY. 
 
 the Established Church, advanced in years, yet robust. He 
 replied to the query, " How can you stand tiiat ?" that he had 
 been a drinker all his life and felt no harm. 
 
 Tlie same relative sensitiveness is shown in regard to 
 opium, tobacco, and other narcotic poisons. The stolid 
 Turk begins to smoke in early childhood, when seven or 
 eight ; everybody smokes, men, women, and little ones, yet 
 the chief oculist in Constantinople says that cases of amau- 
 rosis are very few. A surgeon whom I have known. Dr. 
 Sewny, of Aintab, after 3''ears of extensive practice in Asia 
 Minor, has yet to see the first case of amaurosis or ambly- 
 opia due solely to tobacco. But Americans cannot imitate 
 Turk, Hollander, and Chinese. Heart and brain, eyes, 
 teeth, muscle, and nerve are ruined by these vices, yet the 
 frightful fact remains that laterally the importation of 
 opium has increased 500 per cent.! The "tobacco heart" 
 and other fatal effects of cigarette smoking are attracting 
 the attention of legislators as well as physicians, and the 
 giving or selling this diminutive demon to youth is made 
 in some places a punishable offense. 
 
 Physical, psychic, political, and social conditions com- 
 bine in the evolution of this phenomenal susceptibility. 
 Nowhere, for instance, are such extremes in thermal changes. 
 I have seen in New England a range of 125", from 25° 
 below to 100^ above, in the shade. The year's record at 
 Minnesota has read from 39° below to 99'^ above, a range 
 of 138". Even within twenty-four hours, and in balmy 
 regions like Florida, the glass has shown a leap from torrid 
 heat to frosty chill. 
 
 No wonder then the greatest fear of some is the atmos- 
 phere ! They dreadeS to go out to face Arctic rigor or 
 tropic fire, and so get in the way of staying indoors even 
 in exquisite weather of June and October. They make 
 rooms small, put on double windows, with list on the doors, 
 and build a roaring furnace fire in the cellar, adding 
 another of bright anthracite in the grate. The difference 
 
INEBRIETY IN AMERICA. 95 
 
 befween tliis liot, dry, baked air within, and the wintry air 
 without, is sometimes 80°. It is estimated that the differ- 
 ence of temperature inside and outside an English home 
 averages 20", and tliat within and without an American 
 dwelling is 60°. The relation of this to the nervousness of 
 the people is apparent. 
 
 The uniform brightness of American skies favors evapo- 
 ration. The Yankee is not plump and ruddy like his moist, 
 solid British brother, but lean, angular, wiry, with a dry, 
 electrical skin. He lights the gas with his fingers, and fore- 
 tells, with certainly, the coming storm by his neuralgic 
 bones. Hourl}'^ observations were conducted for five years 
 with Captain Catlin, U. S. A., a sufferer from traumatic 
 neuralgia in care of Dr. Mitchell. The relation of these 
 prognostic pains to barometric depression and the earth's 
 magnetism was certified beyond doubt, and was reported 
 to the National Academy of Science, April, 1879. Even 
 animals in the Sacramento valley and on the Pacific coast 
 are unwontedly irritable while the north desert winds are 
 blowing, and electricity seeking equilibrium, going to and 
 from the earth. Fruits, foliage, and grass, towards the 
 wind, shrivel. Jets of lightning appear on the rocks and 
 sometimes on one's walking stick. 
 
 "^wl psycJiic and social factors cannot be ignored. Some- 
 one has said that insanity is the price we pay for civilization. 
 Barbarians are not nervous. They may say with the Duch- 
 ess of Marlborough that they were born before nerves were 
 invented. They take no thought of the morrow. Market 
 returns and stock quotations are unknown ; telephones and 
 telegraphs ; daily newspapers, with all their crowded col- 
 umns of horror and crimes, are not thrust upon them ; and 
 the shriek of the steam engine does not disturb their mid- 
 day or their midnight sleep. Once a day they may look at 
 the sun, but they never carry watches. This bad habit of 
 carrying watches is rebuked by a distinguished alienist, 
 who says that a look at one's watch, when an appointment 
 
96 DISEASES OF INEBRIETY. 
 
 is near, sensibly accelerates the heart's action and is correl- 
 ated to a definite loss of nervous energy. Every advance of 
 refinement brings conflict and conquest that are to be paid 
 for in blood and nerve and life. 
 
 Now, it is true, that watches are occasional!}' seen in 
 England. Sun-dials are not in common use in Germany 
 and Switzerland. But the "American Watch " is an institu- 
 tion. Not the Elgin, the Waterbury, or any particular 
 watch, but the worry and haste and incessant strain to 
 accomplish much in a little time — all this symbolized in the 
 pocket time-piece, is peculiarly American. It was an Amer- 
 ican who, at Buffalo, I think, wanted to wire on to Washing- 
 ton. When told it would take ten minutes, he turned away 
 and said, "I can't wait." He now uses the Edison telephone, 
 and talks mouth to mouth with his friend. Dr. Talmage 
 says, "We were born in a hurry, live in a hurry, die in a 
 hurry, and are driven to Greenwood on a tro.t !" The little 
 child, instead of quietly saying to its playmate "Come," ner- 
 vously shouts, "Hurry up !" You cannot approach the 
 door of a street car, or railway carriage, but what you hear 
 the same fidgety cry, " Step lively !" 
 
 Said a New Yorker to me, " I am growing old five years 
 every year." Can such physical bankrupts, whose brains 
 are on the brink of collapse, bear the added excitement of 
 drink? The gifted Bayard Taylor was but one of thousands 
 who burned a noble brain to ashes in a too eager race of 
 life. Reviewing sixteen months he notes the erection of a 
 dwelling-house, with all its multitudinous cares, the issuing 
 of two volumes of his writings, the preparation of forty-eight 
 articles for periodicals, the delivery of 250 lectures, one 
 every other day, and 30,000 miles travel. The same story 
 might be told of other brain-workers who never accepted 
 the "gospel of rest." 
 
 The emulous rivalries of busitiess life and the speculative 
 character of its venture cannot be paralleled elsewhere. The 
 incessant strain they impose increases mental instability. 
 
INEBRIETY IN AMERICA. 97 
 
 Bulls and bears, pools, corners, margins, syndicates, and 
 other" words that are dark, and tricks that are vain," rep- 
 resent the omnivorous passion for gambling. Millions may 
 be made or lost in a day. No one is surprised if a Wall 
 Street panic is followed by suicides. 
 
 Legitimate business may, by its methods, exert a per- 
 nicious influence on the nervous system in still oilier ways, 
 as for example, in tlie depressing influence from specializa- 
 tion of nerve function, as indicated by D!\ Jevy'ell, where 
 one keeps doing one petty thing monotonously year after 
 year and so sterilizes mind and muscle in every other 
 direction. 
 
 Turning to educational systems in America, we see how 
 unphysiological they are, and calculated to exhaust the ner- 
 vous energy of youth, many of whom have inherited a morbid 
 neurotic diathesis. Of twenty-seven cases of chorea reported 
 by Dr. Hamimond of Bellevue Hospital, eight were " induced 
 by intense study at school." Dr. Treichler's investigations 
 as to " Habitual Headache in Children," cover a wide field 
 and show that continental communities suffer from similar 
 neglect of natural laws. Here it is more notorious. 
 
 Not to dwell on these points, we may say that the 
 stimulus of liberty is a productive cause of neurasthenia in 
 America. It is stated that insanity has increased in Italy 
 since there has been civil and religious liberty guaranteed. 
 Kpost hoc is not always Sl propter hoc. But it is obvious that 
 the sense of responsibility which citizenship brings ; the 
 ambitions awakened by the prospect of office, position, 
 power, and influence ; the friction and disquiet, bickerings 
 and wranglings, disappointment and chagrin that attend the 
 struggles and agitations of political life, do exhaust men, 
 and more in a land where opportunities for advancement 
 are abundant as in America. While writing these words, 
 news is received of the sudden death of a prominent New 
 York politician, comparatively young, directly traceable to 
 disappointment in carrying out a scheme on which his lieart 
 
98 DISEASES OF INEBRIETY. 
 
 was set. Chagrin acted like a virulent poison on a system 
 already unstrung by the severe political struggle in which 
 he was defeated. 
 
 Multitudes contract the full malady of inebriism under 
 the continued pressure of these political campaigns. The 
 patient of a friend of mine had, for two years, been kept in 
 working order. He was living, however, on a small reserve 
 of nerve force. A few days before election, he was drawn 
 into a five minutes eager discussion, and became entirely 
 prostrated, more exhausted tlian by months of steady work. 
 
 Other nations have their measure of liberty and aspira- 
 tions for social and political eminence to gratify. But 
 nowhere have men the exliilarating possibilities of position, 
 wealth, and influence, that this republican community offers. 
 The history of the last half century, as related to this fact, 
 reads like a romance. But liberty, like beauty, is a perilous 
 possession, and it lias been truly said " the experiment 
 attempted on this continent of making every man, every 
 child, every woman an expert in politics and theology is one 
 of the costliest of experiments with living human beings, 
 and has been drawing on our surplus energies for one hun- 
 dred years." 
 
 Final Iv, American life is cosjnopolitati. A curious observer 
 noted nine nationalities in a single street car in New York, 
 one day. I repeated the fact to a few of my students who 
 were riding with me througli those same streets. Looking 
 over the ten or dozen passengers on board, one of them at 
 once replied, " Well, here are five nationalities represented 
 here." 
 
 In one aspect, these importations, particularly English, 
 German, and Scandinavian, are compensative and antidotal. 
 We may hope, with the author before quoted, that " the 
 typical American of the highest type will, in the near future, 
 be a union of the coarse and .fine organizations ; the solidity 
 of the German, the fire of the Saxon, the delicacy of the 
 American, flowing together as one; sensitive, impressible, 
 
INEBRIETY IN AMERICA. 99 
 
 readily affected through all the avenues of influence, but 
 trained and held by a will of steel ; original, idiosyncratic ; 
 with more wiiiness than excess of strength, and achieving 
 his purpose not so much through the amount of his force 
 as in the wisdom and economy of its use." 
 
 This hope may be realized in the future and in the 
 highest type of American manhood. It is a bright, optim- 
 istic view of things, but we have to do with the present 
 and the evils of society as they exist. We have to face the 
 fact that our civic life is growing at the expense of the 
 rural ; that our cities are massing people by the hundreds 
 of thousands, among whom, on the grounds of contiguity, 
 association, and psychic sympathy, evil influences become 
 more potent to undermine the welfare of society ; that 
 we have to encounter in America the drink traffic in its 
 belligerant aspects, as nowhere else, not only politically and 
 financially organized most thoroughly, but ready it would 
 seem to use fraud, violence, or assassination if other means 
 fail, and that we have anarchism stirring up discontent and 
 firing the passions of the desperate classes, who understand 
 liberty to mean license, equality to be the abolition of all 
 the diversities of position and property which intelligence, 
 temperance, and industry have made, and will make, to 
 the end of time. 
 
 We have had a practically unrestricted importation of 
 the refuse population of Europe. Of every 250 emigrants 
 one is insane, while but one of 662 natives is insane. Add 
 to all these facts the conditions of American life already 
 enumerated as related to the development of neuroses, par- 
 ticularly inebriety, and we have material which makes the 
 study, as was stated at the start, serious and urgent. 
 
CHAPTER XI. 
 
 PREVALENCE OF INEBRIETY AND ITS MORTALITY, ETC. 
 
 Notwithstanding all the advances of civilization and 
 intelligence, and the increasing temperance agitation and 
 effort, the drink evil, or inebriety, is one of the most threat- 
 ening, ominous perils to all social progress and development 
 of to-day. 
 
 Some idea of its extent may be obtained from the fol- 
 lowing satistics. In 1891 over five hundred tliousand per- 
 sons were arrested in this country charged with being 
 drunk and disorderly, crazed from the effects of alcohol. 
 Nearly twenty per cent, had committed crime of petty 
 character while under influence of spirits. 
 
 These facts furnish some approximate estimate of the 
 extent of inebriety in this country. It is reasonable to infer 
 that if this number of inebriates have come under police 
 surveillance in one year, at least a third more using 
 alcohol to excess, have escaped legal notice. 
 
 The statement that there are fully a million persons in 
 this country who are, continuously or at intervals, using 
 alcohol and opium to excess and poisoning tlieniselves, is 
 not an extravagant or improbable one. 
 
 Of course the mortality from this, both directly and 
 indirectly, is excessive, and the oft repeated assertion of 
 sixty and a hundred thousand deaths a year from alcohol is, 
 after all, only a minimum statement. 
 
 The physical and mental degeneration, the unsanitary 
 conditions of living and surroundings, predisposing to pau- 
 perism and exhaustion, all strongly favor disease, accident 
 and early death. Dr. Kerr, of London, after a very exhaust- 
 100 
 
PEEVALENCE OF INEBRIETY. 101 
 
 ive Study of the mortality reports of the United Kingdom, 
 concluded that the annual mortality from inebriety could 
 not be less than one hundred and twenty thousand. 
 
 This statement was confirmed by Mr. Wakel}'', a well 
 known coroner, who found in fifteen hundred inquests held 
 in one year, nine hundred of them were from inebriety. 
 The conclusions of the late Mr. Neilson, tlie eminent actuary, 
 are equally striking. He found that while ten temperate 
 persons from 15 to 20 years of age die, eighteen inebriates of 
 the same age die. Between 21 and 23 years (inclusively) 
 51 of the intemperate of inebriates die for every 10 of the 
 temperate. Between 31 and 40 about 40 die. In the first 
 group the fatality is raised 80 percent., in the second over 
 500 per cent., and in the third 400 per cent. Mr. Neilson 
 calculated the cliances of life as follows : A temperate 
 adults chances of life is at 20 over 44 years, an intem- 
 perate 15/^ years ; at 30 a temperate 36/^, an inebriate 13.8 
 years ; at 40 a temperate's 28.8 years and an inebriates 11.6. 
 
 In the mortality of Great Britain only between 1400 and 
 1500 deaths are noted as arising from alcohol annually. 
 But it is well known that these figures are no criterion of 
 the actual number of deaths from inebriety. The present 
 system of death certificates makes it easy to evade the real 
 cause of death, and put down some intercurrent affection 
 or condition that occurs just before death takes place. 
 This is done to save the feelings of friends and relatives, 
 and cover up some state which would only add new pangs 
 of sorrow by exposure. 
 
 A new system of registration is demanded to ascertain 
 accurately many of such mortality facts. 
 
 Tiie Harvian Society of London have studied this topic 
 and reached similar conclusions, sustaining Dr. Kerr's esti- 
 mate of one hundred and twenty thousand deaths yearly in 
 the United Kingdom from inebriety. In this country the 
 late Dr. Parker showed from some comparative facts that 
 inebriates had an average of ten years, after the full devel- 
 
102 DISEASES OF INEBRIETY. 
 
 opment of the drink curse. Dr. Harris indicated that twenty 
 per cent, of all deaths in large cities were due to inebriety. 
 
 All the life insurance companies find the mortality which 
 dates from heart and kidney disease associated with the 
 use of alcoholics, and many of them refuse to take risks on 
 any one but total abstainers. It is computed that for every 
 death from inebriety there are at least fifty cases of illness. 
 Associated with this are premature deaths, starvation, acci- 
 dents, violence, neglect, until tiie loss and suffering becomes 
 appalling in magnitude and severity. 
 
 Tlie recent outbreak of cholera, with its extreme fatality, 
 recalls the mortality amonginebriates which has character- 
 ized the march of this and other epidemics in modern times. 
 
 We select illustrative statistics of the ciiolera epidemic 
 of 1832. In St. Petersburg, out of 10,000 deaths only 145 
 were known to be temperate ; in Moscow, only 2 out of 6,000 
 cases were temperate. This fact so alarmed the citizens that 
 nearly all the population ceased to use alcohol ; of 30,000 
 victims in Paris, nearly every one used alcohol, in some form, 
 to excess ; nine-tenths of those who died in Poland, were of 
 this class. In some towns every inebriate was swept away. 
 In Tififlis, every drunkard died. In the Park Hospital of 
 New York city, only 4 persons were temperate in 200 fatal 
 cases. In Albany, there were only 7 out of 326 fatal cases 
 who were not inebriates. In the late epidemic of yellow- 
 fever in the South, the percentage of victims among inebri- 
 ates was nearly as large. Tiiese are not extraordinary 
 facts, but follow, naturally, tlie degeneration produced by 
 alcohol, and are readily explained by the low vitality and 
 lessened power of resistance to toxic forces and agents 
 present in every inebriate. Most unfortunately, this con- 
 dition is not realized by either the patient or friends until 
 it is too late. The continued use of alcohol keeps up the 
 delusion of strength and vigor ; but with the onset of dis- 
 ease all is thrown off, and only the physician and surgeon 
 can realize their hopeless condition. 
 
CHAPTER XII. 
 
 INEBRIETY AND CONSUMPTION :,, ITS RELATION AND 
 CONNECTION. 
 
 Any one who studiously watches the evolution and dis- 
 solution of families, some of whose members are addicted 
 to alcoholic excess, must be struck with the frequent 
 occurrence of pulmonary phthisis among tiiem. So on the 
 other hand, it is no less astonishing to find the latter 
 disease suddenly appearing in families who are absolutel}'' 
 free from a phthisical history, and who seemingly live 
 amidst the most healthful surroundings. Why these two 
 conditions should be so closely associated, if in consonance 
 with the current belief, the one is a nervous, and the 
 other a strictly pulmonary disease, is not very clear. The 
 following is an attempt to an elucidation of this intric- 
 ate problem, in which I shall endeavor to show that 
 these two apparently isolated phenomena are naturally 
 interchangeable with each other, and that like two diversi- 
 fied islands cropping out above the surface of the ocean 
 without exposing their connection beneath, they find their 
 common bond of union in a disordered state of the nervous 
 system. 
 
 In order to make this subject as practical and as intel- 
 ligible as possible, I shall at the very outset endeavor to 
 prove the intimate association between alcoholism and 
 phthisis, how one link may change place with the other in 
 the chain of vital persistence, by citing a number of living, 
 illustrative examples. The first ten of these cases liave 
 been culled from the extensive experience of Dr. Crotlieis, 
 
 103 
 
104 DISEASES OF INEBRIETY. 
 
 and have been placed at my disposal through his kindness ; 
 while the remainder have been obtained from various other 
 sources. 
 
 Case I. J. B., aged 42 years, began the excessive use of 
 spirits after the death of his wife. He was a merchant, 
 temperate, prosperous, and a man of character. He became 
 a steady drinker, and was practically intoxicated all the 
 time. After an attack of delirium tremens he was placed 
 under my care. During the four months while under 
 treatment, he was alternately depressed and elated. He 
 complained of wandering pains, and changeable appetite, 
 as well as of spasmodic periods of coughing. A few 
 months after he left me, he relapsed and continued to 
 drink until he died a year later. 
 
 His mother and two sisters died of consumption. His 
 father died from injury, but his grandfather was asthmatic, 
 and used spirits to excess for years. One uncle on his 
 father's side died from excess of drink, and another one 
 died of consumption. One uncle died from phthisis after 
 many years of drink excess. 
 
 His grandfather on his mother's side drank more or less 
 all his life, and died from some rheumatic trouble. 
 
 Case II. B. A., aged 35, a mechanic, began to use spirits for 
 insomnia and general debility, and finally became a periodi- 
 cal inebriate. He was under treatment for six months, and 
 recovered. His father, grandfather, and two uncles, died 
 of consumption. His mother was liysterical, and his grand- 
 mother on his mother's side died of some lung trouble. One 
 brother died from chronic alcoholism, and a sister is a drug- 
 taker. 
 
 Case III. C. H., age 48, an army officer, began to drink 
 during the late war. He is now a dipsomaniac, with dis- 
 tinct free intervals of three months. His mother died of 
 consumption two months after his birth, and his two sisters 
 died of the same disease. His father's family is temperate, 
 but several members have died of consumption. His grand- 
 
IKEBEIETf AND CONSUMPTION. lOS 
 
 father on his mother's side was a sailor, and drank to 
 excess at times. 
 
 Case JV. D. P., age 38, a farmer. His drinking seems 
 to date from a nervous shock following the burning of 
 a barn by lightning. His two brothers are chronic inebri- 
 ates, one sister is a morphine taker, and the other uses both 
 spirits and drugs to excess for all kinds of imaginary evils. 
 On his mother's side, a grandfather and three aunts and 
 one uncle died of consumption. His mother is still living. 
 His father died of pneumonia, and his grandmother on his 
 father's side died of consumption. 
 
 Case V. E. J., age 31, a clerk of inferior mental and 
 physical development, began to drink at puberty. Con- 
 sumption has been the common family disease of both 
 parents. On his mother's side both consumption and 
 inebriety have been common. On his father's side con- 
 sumption alone has prevailed. 
 
 Case VI. P. O,, age 28, is withont business, and drank 
 from infancy. He is now a chronic inebriate and has had 
 delirium tremens. His father and two uncles died of con- 
 sumption. His mother is a woman of wealth and fashion, 
 and she lost her mother and one sister from consumption. 
 
 Case VII. M. B., a lawyer, 54 years old, who began to 
 drink at fifty from no apparent cause. His father and 
 grandfather died of consumption at fifty years of age. 
 
 Case VIII. D. T., age 38, a conductor, began to drink 
 after an injury to the spine. A brother, who was injured at 
 the same time, died of consumption. The mother and a 
 sister, the grandfather, and grandmother, on his father's 
 side, all died of consumption. 
 
 Case IX. D. B., 24 years old, and without business, 
 began to drink at puberty, and is now a chronic inebriate. 
 Both parents died of consumption. His grandfather on his 
 father's side, and two uncles on his mother's side, died of 
 the same disease. 
 
 Case X. A. H., 34 years old, a physician, took morphia 
 
106 DISEASES OF INEBRIETY. 
 
 for malarial poisoning, and then used alcohol to great 
 excess. His mother and tiiree uncles on his father's side 
 died of consumption. His older brother became an inebri- 
 ate at about thirty years of age, and one sister is in Colo- 
 rado to prevent consumption. 
 
 Case XI. {Quarterly Journal of Inebriety, Oct., 1888, p. 390.) 
 "George Ulmercame from England in 1798 and settled at 
 New Haven, Conn. He was a harness-maker, a beer- 
 drinker, and after middle life drank rum to excess, until 
 death at sixty-one years of age. His wife was a healthy 
 woman, and lived to eighty years of age. Eight sons grew 
 to manhood and married. Six of them died of consumption 
 under forty-five years of age. One v^^as killed by an 
 accident, and one died from excessive use of spirits. Two 
 daughters grew up and married ; one died of consumption, 
 the other in childbirth. They left four children ; two were 
 inebriates, and the others were eccentric and died of con- 
 sumption. Of the children of the eight sons only ten grew 
 up to manhood. Four of these drank to excess and died. 
 Three of the six remaining died of consumption, and two 
 others were nervous invalids, until death in middle life. 
 The last one, a physician of eminence, has become an 
 inebriate and is under care at present. He is the only sur- 
 viving member of all this family. The male members of 
 this family were farmers, tradesmen, and men of more than 
 average vigor in appearance. They married women (so far 
 as can be ascertained) without any special liereditary his- 
 tory of consumption or inebriety." 
 
 Case XII. Father was an inebriate until after he w;is 
 forty years old, at which time a cardiac affection developed 
 itself from which he ultimately died, but which had the 
 power of restraining him from exercising his morbid appe- 
 tite. His brother was a drunkard too. Tliree of his sons 
 became confirmed alcoholics, one daughter died of phthisis, 
 and another son died of general paralysis. 
 
 Case XIII. Father violent, an alcoholic, and a libertine. 
 
INEBKIETY AND CONSUMPTION. 107 
 
 Mother is very nervous, and died of cancer of the uterus. 
 Many of patient's relations are drunkards. Her brotlierand 
 sister died of chest disease, and another brotlier is always 
 ill, and coughs a great deal. She was admitted May 3, 1879. 
 One month previously she had a chill, rigors, and feverish- 
 ness, which confined her to bed for four days ; then she 
 began to cough, and had two copious haemoptyses. She 
 sweats profusely at night, is losing flesh, and in a word has 
 all the symptoms of pulmonary phthisis. Physical examin- 
 ation shows evidence of tuberculosis of both apices. 
 
 The histories of these cases give the most unmistakable 
 proof that alcoholism and phtliisis are not mere coinci- 
 dences, but that they have a relationship so intimate that 
 one may be converted into the other. The problem arises, 
 however, as to the channel through which alcohol produces 
 phthisis ; for if these two conditions are interchangeable, it 
 is obvious that they must possess a common physiological 
 basis, and this I believe resides in the nervous system. I 
 have elsewhere (to which I beg to refer the reader) given 
 good reason for believing that pulmonary phthisis is prin- 
 cipally nervous in character, and by considering it as such, 
 tlie natural association between the two diseases is at once 
 established. For whatever else may be said of the action of 
 alcohol, it is pretty generally understood that it possesses a 
 special affinity for the nervous system, and that it produces 
 its principal ravages in the body by operating on this, and 
 by preference on the peripheral nervous tissue. Dr. James 
 Jackson, in this country, and Dr. Wilks, in England, were I 
 believe the first to point out this form of disease, and they 
 called it alcoholic paralysis. It has since then received the 
 more appropriate name of alcoholic neuritis, and it is charac- 
 terized in its early stages by numbness, tingling, hyperses- 
 thesia in the extremities, and later on by anoesthesia, par- 
 alysis of motion, loss of knee jerk, quickened pulse, short- 
 ness of breath, and frequently by pulmonary embarrass^ 
 ment. The brain and spinal cord remain comparatively 
 
108 DISEASES OF INEBRIETY. 
 
 normal. The morbid changes occurring in the peripheral 
 nerves under the influence of alcohol are parenchymatous 
 and interstitial, or in other words they are confined to the 
 nerve substance itself, or to its investing membrane. As a 
 rule these changes occur together, tiie latter in many 
 instances depending on the former, but frequently one 
 exists exclusively of the other ; especially is this true of the 
 degeneration of the nerve fibre itself. 
 
 It being established, then, that alcohol has the power of 
 producing degeneration of the nerve fibres, it does not 
 require a reckless fiiglit of fancy to see how, by operating 
 on the same tissue, it may bring about that peculiar 
 destruction of lung substance known as pulmonary con- 
 sumption. Degeneration of a nerve implies degeneration 
 of the organ which it supplies witii sensation and motion. 
 Thus, degeneration of the sciatic nerve is followed by 
 impairment of sensation and motion in the muscles and 
 other textures of the leg — a condition which is almost con- 
 stantly present in chronic alcoholism, and degeneration of 
 the pneumogastric nerves is just as naturally followed by 
 disease of the lungs, heart, stomacli, and all the other 
 organs supplied by them. This is no more than we may 
 legitimately anticipate ; for it has been amply proven that 
 division of, and protracted pressure of tumors, aneurisms, 
 etc., on the pneumogastric nerves are capable of calling 
 forth all the destructive lesions of pulmonary phthisis. 
 
 The following cases will serve to illustrate the close 
 anatomical and physiological association of chronic alco- 
 holism and phthisis, as well as other destructive pulmonary 
 charges with degeneration of the vagii, and of the respira- 
 tory center (the latter of which practically amounts to the 
 same thing), and with that of the peripheral nerves. The 
 ditficulty encountered in this research has not been so much 
 in obtaining an abundance of material in which phthisis 
 was evidently the direct result of alcoholic abuse, as it has 
 been in finding the records of cases possessing all the points 
 
INEBRIETY AND CONSUMPTION. 109 
 
 which I desire to emphasize in this paper, viz.: the coexist- 
 ence of pulmonary disintegration, alcoliolism, and nerve 
 degeneration, well brought out by a tliorough post mortem 
 demonstration. 
 
 Case XIV. Drs. Oppenheim and Siemerling. Male, 
 addicted to alcoholic excess, was received in hospital Jan. 
 26, 1886. He was weak and stiff, but had no pain. At the 
 end of the same month he became delirious, and also paretic 
 in both legs and arms. Death occurred in March of the 
 same year. On section it was shown that the heart was 
 normal, and that he had pneumonia ; microscopically it was 
 proven that the radial, peroneus, and saphenous nerve had 
 undergone degeneration. Not stated whether the vagii 
 were examined or not. 
 
 Case XV. Drs, Oppenheim and Siemerling. A female, 
 ^gs 45 years, suffering from chronic alcoholism, was 
 received Dec. 26th, and died on the 28tli of the same month, 
 in the year 1885. On section there was found chronic exud- 
 ative pleurisy on right side, as well as a caseous broncho- 
 pneumonia and tracheitis. The great saphenous and super- 
 ficial peroneus nerves liad undergone parenchymatous 
 degeneration of a medium degree. No otlier nerves were 
 examined. 
 
 Case XVI. Dr. T, Dejerine. Female, age 46, a hard 
 drinker, suffered from paralysis of both upper and lower 
 extremities. Had a pulse of 150-160, and her heart sounds 
 were normal. Her death was caused by pneumonia. Sec- 
 tion showed parenchymatous neuritis of the cutaneous and 
 muscular nerves, as well as of both vagii in the cervical 
 region. 
 
 Case XVII. Prof. Schultze. Male, 39 years old, devel- 
 oped diabetes insipidus in 1882, but had been feeble since 
 childhood. He used alcohol greatly to excess in his younger 
 days. Some time after the year 1882, he began to suffer 
 from nystagmus, trembling in the arms, perversion of sen- 
 sation (paraesthesia) in the legs, and from thoracic constric- 
 
110 DISEASES OF INEBRIETY. 
 
 tion. In 1886 he became subject to marked attacks of 
 dyspnoea, and death was caused by paralysis of respiration. 
 Section : Degeneration of medulla oblongata and spinal 
 cord, as well as that of tlie root of the vagus and hypo- 
 glossus. No account of the post mortem appearances of the 
 lungs is given, but it is evident that these organs were 
 implicated in the morbid processes, since death was pro- 
 duced through pulmonar}"" paresis. 
 
 Case XVIII. Striimpbell. Male, aged 47 year, a potator, 
 was received November 25, 1881. His frame is large and 
 powerful. Both of his arms hang helplessly by his side ; 
 hands cedematous, skin and tendon reflexes wanting ; legs 
 weak and powerless ; pulse, 124 ; temp. 38.2° ; deglutition 
 and power of speech impaired ; after a while oedema of 
 lower extremities, cough, diarrhoea, dyspnoea ; bronchial 
 rSles, paralysis of diaphragm, and death, Feb. 13, 1882. 
 Section: Marked tubercular phthisis of both lungs. The 
 radial median, crural, and sciatic nerves were degenerated 
 very decidedly, and Dr. Striimpbell believes that the phrenic 
 and vagii were also involved, but he failed to examine 
 them closely. 
 
 Case XIX. Drs. Oppenheim and Siemer.ling. Male, 26 
 years old, a potator, was received in the Charity Hospital 
 Jan. 17, 1881, on account of delirium tremens. He com- 
 plained of headache, giddiness, and formication in the legs. 
 He improved and was dismissed, but was received again on 
 July 28, 1883, on account of marked disturbances in the 
 nervous system. He now suffered from complete impo- 
 tence, lancinating pains and rectal tenesmus. In August, 
 he became subject to polydipsia and polyuria; on the 12th 
 of December, there ivas dullness in left supra clavicular 
 fossa, and infiltration of both apices and tubercle bacilli 
 were found in the sputum. He gradually sank and died in 
 August. Microscopic examination showed degeneration of 
 the medulla oblongata, and of all the peripheral nerves 
 which were examined. 
 
INEBKIETT AND CONSUMPTION. Ill 
 
 Case XX. Dr. Oswald Vierordt. Male, 30 years old, 
 much addicted to alcoliol, and without a syphilitic history, 
 suffered since Marcli, 1884, witli piercing, lightning pains in 
 the lower extremities, as well as with weakness, unsteadi- 
 ness, and formication in the same. He also developed 
 tubercular phthisis and died the following March. Section : 
 extended tuberculosis of the lungs and degeneration of the 
 columns of Goll, medulla oblongata, and the cervical and 
 dorsal portions of the spinal cord. 
 
 Case XXI. Mr. Siiarkey {^British Medical Journal, 1888, 
 April 21, and Journal of Inebriety., Jan., 1889, p. 67) related 
 a case of alcoholic paralysis of the phrenic, pneumogastric 
 and other peripheral nerves before, and presented specimens 
 of the same to the Pathological Society of London. The 
 patient was a female and addicted to the excessive use of 
 alcohol. She suffered from weakness in her legs, numbness 
 and cramps, and was incoherent in speech. Respiratory 
 sounds were harsh, and in a few days after admission had 
 a rigor, which was followed by a temperature of 102.8^, 
 severe attacks of dyspnoea, paralysis of the diaphragm, and 
 difficulty in swallowing. Respiration 40 per minute, and 
 average pulse rate 140. Spitting of blood supervened, the 
 lung apices began to break down, and she died after having 
 been under observation nearly one montii. Section : tuber- 
 culosis of botli apices and inflammatory changes in the 
 piirenic, pneumogastric, and popliteal nerves. 
 
 In these examples we have proof that pulmonary phthisis 
 can be produced through the toxic action of alcohol on the 
 nervous system. This is unquestionable in four of the 
 cases, and in so far as demonstrating the mode of tlie action 
 of alcohol on the human lungs is concerned, it is equally 
 true of the other cases ; for I think it is pretty well estab- 
 lished that phthisis is but the legitimate offspring of any 
 persistent catarrhal state of the lungs, and that clironic 
 bronchitis and catarrhal and broncho-pneumonia, are bat 
 
112 DISEASES OF INEBRIETY. 
 
 the milestones marking the pathway along which the dis- 
 ease travels to its final destination. 
 
 Such then being the relation between alcoholism and pul- 
 monary phthisis it is very readily understood why these two 
 diseases should so frequently change places in different 
 members or generations of the same family, and why they 
 are so often associated with various other nervous dis- 
 orders. Moreover, alcohol having the potency to produce 
 phthisis de novo in the human subject, either directly or 
 through hereditary influence, or both, as we have seen, it 
 must, in view of its past and present widespread abuse in 
 civilized countries, be a tremendous factor in maintaining 
 the ranks of the hundreds of thousands of those who are 
 annually slain by this terrible malady. To this and to no 
 other conclusion do the premises of this paper point, and 
 if one had the inclination to moralize on this subject it 
 would be very interesting to inquire why the North Ameri- 
 can Indian, and other savages, were practically free from 
 pulmonary consumption until they came in contact with 
 tlie white race ! When we connect the facts that alcohol 
 and syphilis are the greatest curses which the Indian has 
 acquired from his white civilizer, with the evidence which 
 has been brought forward in this as well as in another 
 paper on Syphilitic Phthisis, I think it must be obvious that 
 these two causes are largely responsible for sowing the 
 seeds of pulmonary phthisis among these people. 
 
CHAPTER XIII. 
 
 EFFECTS OF ALCOHOL AND BEER ON MENTAL FUNCTIONS 
 AND THE BRAIN. 
 
 The effects of a single dose of alcohol differ widely in 
 different individuals, and this lies at the root of all scientific 
 inquiries into the matter. The variety of the effects on the 
 mental faculties of different brains is also extreme. This 
 indicates such different qualities and susceptibilities in dif- 
 ferent brains as regards this agent, that it makes the whole 
 question of the effects of alcohol a most complicated one, 
 not to be explained by a few unqualified assertions. In 
 reply to the question, What are the normal effects of alcohol 
 on the mental forces of the brain ? the scientific man must 
 reply. What k4nd of brain do you mean ? and it is only by a 
 careful study of the qualities, the tendencies, and potential- 
 ities of different brains, that we can answer the first question 
 properly. We need to study the mental qualities of the 
 brain at different periods of life, in the two sexes, in differ- 
 ent temperaments and constitutions, in different races, in 
 different states of healtii and vigor, and with reference to 
 the hereditary tendencies of the organ ; for all these things 
 influence the effects of one single small dose of alcohol. So 
 we find, looking from the point of view of the amount of the 
 doses, the effect is very different. There is, I believe, no 
 other agent known which differs so greatly in different in- 
 stances in the dose needed to produce the same effect on 
 the mental powers as a dose of alcohol, and herein again we 
 find that there must be the greatest difference in the power 
 of resisting the effects of alcohol in different brains. Tak- 
 
114 DISEASES OF INEBRIETY. 
 
 ing tlie lower animals, that difference is exceedingly small, 
 an ounce of alcoliol given to a dozen dogs of tlie same size 
 will practically have the same effect on them ail ; but an 
 ounce given each to a dozen men has not only the most dif- 
 ferent effects in the mental faculties it stimulates, as we 
 have seen, but in the amount of the effect it causes. Some 
 brains are exceedingly sensitive to very small quantities ; 
 other brains have the power of resisting or tolerating alco- 
 hol in a wondrous degree, this being an innate quality quite 
 apart from the effect of the use and custom. These differ- 
 ences are so great as to compel us to conclude that there 
 are enormous inherent disparities in human beings in this 
 respect, and this is no doubt one of the very great dangers 
 in the use of alcoliol. 
 
 So we also find at the various periods of life, ordinary 
 small doses of alcohol have very different effects. In a 
 child the effect is extremely great, in a boy or girl 
 it is also great, but it is not so great in a growing adoles- 
 cent. In the two sexes there are also considerable differ- 
 ences, the female having less resisting power, her brain 
 being unusually much more susceptible to 'the influence 
 of this agent. Looking at different races, the differ- 
 ence of effect of the same dose is also extremely great 
 There are some savage races that are so subject to its influ- 
 ence that a very small dose indeed — half an ounce — will 
 have greater effect on them, than two or three ounces will 
 have on an ordinary European. The psychological, the 
 mental effects of small doses of alcohol are therefore exceed- 
 ingly various, and we have not yet discovered the precise 
 qualities of brain which caused these differences. We can 
 not tell beforehand which brain will be susceptible to its 
 effects, and which will not. Looking at the matter next 
 from a point of view of the effects of a much larger dose, 
 these will be found much more uniform. The effect, 
 instead of being stimulating, is then narcotic, and we have 
 a deadening, paralyzing and temporary arrestment of the 
 
EFFECTS OF ALCOHOL ON MENTAL FUNCTIONS. 115 
 
 mental functions of the brain in every individual if a suffi- 
 cient quantity is taken. But here we find much variety in 
 the way tlie result is arrived at, when carefully studied. 
 
 In one person we have this paralysis, this deadening 
 taking place first on the intellectual faculties, in another on 
 the emotional, in another on the propensities, and in 
 another on the power of motion. We see a certain kind of 
 mental degeneration of a slight type, which results in those 
 who habitually take an amount of alcohol that is to them 
 excessive. This slow but quite marked type of mental 
 degeneration a doctor of experience soon comes to observe 
 in his patients ; and others a certain change mentally, 
 morally, and bodily, in the man who is taking more than 
 is good for him. The expression of his face and eyes — 
 those mirrors of the mind — you see has changed, and for 
 the worst. The mental condition of the man is lowered all 
 round, and especially one effect is noticed, that his higher 
 power of control is lessened, I am safe in saying that no 
 man indulges for ten years in more alcohol than is really 
 good for him, without this kind of degeneration being 
 observed, and that although during these ten years he was 
 never once drunk, we find him psychologically changed for 
 the worse in his independence of mind, in his spontaneity. 
 After a man has passed forty, such changes are very apt to 
 be faster, and more decided. We see such a man's work 
 and his fortune suffering, but we dare not call him either 
 a drunkard or dissipated, because, as a matter of fact he has 
 never been drunk, and never intends to be drunk. Whether 
 this degeneration takes place soon or late depends upon 
 inherent resistive capacities of his brain cells. In some 
 individuals the resistive capacity against alcohol is so great 
 that for years they may indulge in its excessive use without 
 this degeneration taking place to any great extent, but in 
 other instances we have it very i-apidly developed indeed. 
 
 Some men pass into a premature old age and become old 
 at fifty, when they ought to have lived on and been young 
 
116 DISEASES OF INEBRIETY. 
 
 men up to sixty, and this merely owing to tlie excessive use 
 of alcohol. Memory and the power of thinking are affected, 
 but you see the lowering most in the finer faculties, the 
 tastes, the more delicate perceptions of things, and the force 
 of character. This is an effect which, I believe, is especi- 
 ally to be observed in men who have used their intellectual 
 powers constantly and vigorously. We often see this effect 
 on the brains of men in our profession, of medicine, at the 
 bar, and even among the clerical profession, in a very marked 
 degree, without their owners having been once drunk. In 
 such persons, their mental powers having been greater to 
 begin with, and with a finer edge on them, you notice in a 
 more marked way this degeneration in its progress. This, 
 I may say, is the least marked mental effect of alcohol 
 taken, not so as to produce drunkenness, but taken in 
 greater quantity than the physical constitution of the brain 
 can stand over a long period. In some brains a very small 
 quantity indeed, taken daily, will produce this degen- 
 eration. 
 
 For some years past a decided inclination has been 
 apparent all over this country, to give up the use of whisky 
 and other strong alcohols, using as a substitute, beer 
 and bitters and other compounds. This is evidently 
 founded on the idea that beer is not harmful and contains 
 a large amount of nutriment ; also that bitters may have 
 some medicinal quality, which will neutralize the alcohol it 
 conceals, etc. These theories are without confirmation in 
 the observations of physicians and chemists where either has 
 been used for any length of time. The constant use of beer 
 is found to produce a species of degeneration of all the 
 organism, profound and deceptive. Fatt}'^ deposits, dimin- 
 ished circulation, conditions of congestion, and perversion 
 of functional activities, local inflammations of both the liver 
 and kidneys, are constantly present. Intellectually, a stupor 
 amounting almost to paralysis arrests the reason, pre- 
 cipitating all the higher faculties into a mere animalism ; 
 
EFFECTS OF ALCOHOL ON MENTAL FUNCTIONS. 117 
 
 sensual, selfish, sluggish, varied only with paroxysms of 
 anger, that are senseless and brutal ; in appearance the 
 beer-drinker may be the picture of health, but in reality he 
 is most incapable of resisting disease. A slight injury, 
 severe cold, or shock to the body or mind, will commonly 
 provoke acute disease, ending fatally. Compared with 
 inebriates, who use different forms of alcohol, he is more 
 incurable, and more generally diseased. The constant use 
 of beer every day gives the system no time for recupera- 
 tion, but steadily lowers the vital forces ; it is our observa- 
 tion that beer-drinking in this country produces the very 
 lowest forms of inebriety, closely allied to criminal insanity. 
 The most dangerous class of tramps and ruffians in our 
 large cities are beer-drinkers. It is asserted by competent 
 authority that the evils of heredity are more positive in this 
 class than from alcoholics. If these facts are well founded, 
 the recourse to beer as a substitute for alcohol, merely 
 increases the danger and fatality following. 
 
 In bitters we have a drink whicii can never become gen- 
 eral ; but its chief danger will be in strengtliening the dis- 
 ordered cravings, which later will develop a positive disease. 
 Public sentiment and legislation should comprehend that 
 all forms of alcohol are more or less dangerous, when used 
 steadily ; and all persons who use them in this way, should 
 come under sanitary and legislative control. 
 
CHAPTER XIV. 
 
 CLIMATIC PERIOD — DIAGNOSIS OF INEBRIETY AND STUDY 
 OF SOCIAL STATISTICS. 
 
 " There is a natural tendency in our very life to find a 
 settled cliannel in which its forces may flow. So conscious 
 are we in the earlier periods of our adult life of the exist- 
 ence of strong and opposing passions and tendencies, that 
 we are apt to accept as an axiom the common expression 
 that ' character is not formed until forty.' Physical factors 
 are all the time at work to develop and mature what is in, 
 and of us, and it is not until maturity is reached that 
 a definite and uniform channel is wrought out and 
 established. This age of maturity is not and cannot be 
 determined according to a uniform rule, but just as the 
 sexual instinct has its time of beginning and ending, so 
 other elements have a similar history." 
 
 Again, " There comes a time in the course of one's life 
 when the forces that have been engaged in structural repair 
 and waste come as to a stand-still, and consult together as 
 to which shall be dominant in the future. Some of the 
 organs may be said to rest entirely after a certain age ; 
 rest by a cessation of function, and become atrophied also ; 
 some, that do not rest absolutely, undergo a modification of 
 functional activity. It is at this slack-water period — at the 
 middle of life — when the molecular deposits in the organic 
 structure are different in quality than formerly, that we 
 look for a different product." 
 
 The craving for drink is not a craving of childhood, it 
 does not usually declare itself until the demands on the 
 nervous system begin to be exorbitant, and its terminal 
 ii8 
 
CLIMATIC PERIOD. 119 
 
 period comes with as much certainty as does its initial stage. 
 That terminal period is the climacteric period. 
 
 Many years ago Dr. Parrish called attention to this 
 thought, and urged those who had opportunity to observe 
 to note the period of life when the largest number of reform- 
 ations or cures of inebriety were accomplished, and stated 
 that he believed they would be found between the ages of 
 forty and fifty. Subsequent observation has confirmed his 
 view. ''^Between these ages especially do recoveries that are spon- 
 taneous occur, and statistics show that by far the greater 
 number of persons first exhibit the alcoholic proclivity 
 between the ages of fifteen and twenty-five, and though 
 unable to verify the statement by figures, he was convinced 
 that the allowance of twenty-five years of use will, in most 
 cases, close the drinking career, either by exhaustion of the 
 desire, or by the fatal teimination of the individual life. He 
 thought it will be found also, that when inebriates have 
 lived beyond the middle period of life, so as to attain the 
 three or four-score limit, the commencement of the drink- 
 ing career was considerably later in life than the average 
 period named." 
 
 Dr. Mason from a careful study of six hundred cases in 
 this country and one hundred and fifty-two treated in Eng- 
 land, found the greatest liability to be from 30 to 40, and 
 after 45 or 50 the decline in the drink curse was very rapid. 
 Dr. Kerr found that this period was from 55 to 60. Other 
 observers agree that a time occurs in each case where the 
 possibility of the subsidence of the drink curse is favored 
 by such a period. 
 
 In the early stage of inebriety the diagnosis of the dis- 
 ease is extremely difficult. There are no physical signs 
 upon vvhicli the examiner can rely. He must draw all the 
 facts on wliich to form his opinion from the applicant him- 
 self or his friends, neither of whom are likely to conscien- 
 tiously confess tlie truth. Tlie applicant himself, as a gen- 
 eral rule, is ignorant of tlie fact of disease, and will account 
 
120 DISEASES OF INEBRIETY. 
 
 for his personal habits in some other way. Fortunately, if 
 he is not tlioroughly posted in regard to tlie symptoms of 
 the disease, he will unwittingly betray the trutli by the 
 revelation he will make of his habits. 
 
 First of all, it must be borne in mind that the inebriate 
 is a chronic deceiver, and cannot be depended upon to tell 
 the truth. 
 
 His testimony is not to be relied on even under oath 
 when there is a motive to deceive, unless there are corrobo- 
 rating circumstances to sustain it. Impairment of the moral 
 perceptions is one of the first symptoms of the disease, and 
 is also an obstacle to a correct diagnosis. 
 
 An inebriate never sees himself as others see him. If he 
 did there would be more hope in his case. 
 
 The heredity of the applicant should be carefully inquired 
 into. No man is a good risk if he uses alcohol in any form, 
 or to any extent ; if he has an inheritance of inebriety, 
 insanity, epilepsy, or any other form of neurasthenia, no 
 matter what a man's present habits of indulgence may be, 
 he will not be able to adhere to a temperate use for any 
 great length of time. It is a recognized fact that three-fifths 
 of all the persons who use alchoholic liquors between twenty 
 and thirty become inebriates ; and the inference that per- 
 sons of such a heredity who indulge in alcoholic stimulants 
 will become inebriates, amounts to almost a certainty. 
 Careful inquiry will elicit the fact that such persons use 
 alcoholic drinks because they like them, because the effect, 
 if not the taste, is agreeable, A man may like claret because 
 it relieves his thirst, or he may like beer because it gives 
 him an appetite ; or he may indulge, in a company of friends, 
 for the sake of sociability or hospitality, and it may not be 
 considered a symptom of inebriety. But when it is evident 
 that the man drinks because the specific effects of alcohol 
 are especially agreeable to him, he must become a total 
 abstainer, or it will be only a question of time when he will 
 become a confirmed inebriate. 
 
CLIMATIC PERIOD. 121 
 
 A positive dislike or aversion to the use of alcoholic 
 drinks at certain intervals, and a strong desire for them at 
 other periods, is often a characteristic of the inebriate 
 diathesis. Wlien an admission is made of an occasional 
 indulgence to excess, it is very important to know why it is 
 occasional, or what tlie occasion is. If it is periodic, or at 
 somewhat regular intervals, it must be regarded as evidence 
 of disease. 
 
 An abnormal desire for alcoholic drinks, however mani- 
 fested, is an evidence of disease. If the diseased condition 
 has once been establislied, it is always liable to return ; and 
 tlie percentage of exceptions in favor of permanent cure is 
 so very small that a period of abstinence for one or more 
 years does not make the applicant a safe risk. Men who 
 have had alcoholism, dipsomania, or delirium tremens, and 
 have reformed to such an extent as to be total abstainers, 
 for any considerable period, go down very rapidly if they 
 return to their old liabits. 
 
 Under such circumstances their prospect of life is very 
 low ; not more than four or five years at most in the majority 
 of cases. 
 
 All cases of inebriety may be classed as persons of unde- 
 veloped, degenerate, and disordered minds. Tlie first class, the 
 undeveloped, represents all grades of defective, retarded 
 growths, sometimes seen in external conformations of head 
 and body. Grades of ancestral defects and brain failures, 
 seen in faulty acts and thoughts. The second class, of 
 degenerate brains, are those who are retrograding both in 
 mind and body. Such cases frequently date from illness, 
 injuries, shock, diseases of all kinds, and diseases of old 
 age, and of the nerve centers. The third class, the disor- 
 dered brains, are those who from ill-health, bad conditions 
 of living and surroundings, have developed inebriety. 
 Such cases cannot bear the strains, drains, or any extreme 
 circumstances, which tax the energies and vigor of the 
 body. In all these cases, inebriety starts from unknown 
 
122 DISEASES OF INEBRIETY. 
 
 States and exciting causes, and these marked physical 
 conditions are both primary and secondary. Inebriety is 
 always disease and degeneration, and the fact often disputed 
 is, can this disease be traced in any uniformity of symptoms 
 or progress? Dr. Jackson has clearly pointed out, that all 
 disease follows a regular retrograde march, which can be 
 outlined and studied as clearly as growth and development. 
 Inebriety is no exception to the rule. 
 
 The frequent instances where inebriates in apparent 
 possession of good judgment, go away and drink to great 
 excess, displaying a degree of forethought and premeditation 
 fully characteristic of all the ordinary events of life, are often 
 very confusing to the ordinary observer. When the drink 
 paroxysm comes all unexpectedly upon the victim, in some 
 unforeseen state and circumstance, and he falls, it is dimly 
 apparent that he is suffering from some unstable or diseased 
 brain state, which has burst out from the application of some 
 exciting cause. But when the paroxysm is anticipated and 
 prepared for, and all the surroundings are made subservient 
 to this end, when every facility to procure spirits are 
 increased, when money is secured and business arrange- 
 ments are made in view of this coming paroxysm, the con- 
 clusion most commonly reached by all non-expert observers 
 is that it is deliberate vice and wickedness. When the his- 
 tories of a number of these cases are studied and compared, 
 they are found to be well-marked cases of reasoning insan- 
 ity, with drink paroxysm. These paroxysms are the acute 
 attacks — the deliriums wliich expend thejnselves like storms 
 that gather and burst — and are preceded by long periods 
 of rest. A typical case is that of a banker, who is a man of 
 excellent judgment in all business and social matters. He 
 will prepare for a week or ten days in advance for a drink 
 paroxysm. He is a temperance advocate, yet he will 
 display great cunning to conceal the approach of this 
 "spell." He will become very active in his temperance 
 efforts. His friends realize his danger, and try by every 
 
CLIMATIC PERIOD. 123 
 
 means to help him, but find tliat all their efforts are turned 
 to aid him in concealing it. He will not begin unless he 
 can find some way to conceal his presence while the parox- 
 ysm is on him. When his friends were vigilant, he has been 
 kept sober for a week or more, but witii the first opportu- 
 nity he disappears, and all tiieir work has been thwarted by 
 his cunning. In another case, the most deliberate reason- 
 ing and planning will mark the paroxysm. In another 
 case, all at once he will rush away and diink in the most 
 suicidal and insane way, only giving as an excuse some real 
 or fancied injury or trouble. This deliberation and cunning 
 is a symptom of mental unsoundness, and is most obviously 
 reasoning insanity, and will be recognized when these cases 
 are better understood. Dipsomaniac and periodical inebri- 
 ety very soon became reasoning maniacs, dangerous bC' 
 cause they are unknown and misunderstood. 
 
 In a study of social statistics, nativity^ sex, age, tempera^ 
 ment^ climate, occupation, custom, and social conditions, are import- 
 ant factors in the etiology of alcoholic inebriety, outside ot 
 the well-known causes preceding or accompanying dis- 
 ease or injury and heredity, and also, to a certain extent, 
 are to be taken into consideration in the treatment of all 
 cases of inebriety. 
 
 Nativity of tiie 4,663 cases under care at Fort Hamilton, 
 N. Y., was as follows : United States, 3,186 ; Ireland, 826 ; 
 England, 203 ; Scotland, 77 ; British Possessions, 73 ; Ger- 
 many, 109; other nationalities, 44 ; not recorded, 145. The 
 United States naturally compose a large majority, as we 
 find in asylums of other countries inhabitants of those 
 countries as inmates will be in excess of all others ; but 
 we must acknowledge that the nervo-sanguine tempera- 
 ment of the American is peculiarly susceptible to the evil 
 effects of alcohol, and that, other things being equal, the 
 average American would sooner succumb to inebriety than 
 his transatlantic brother. Ireland takes the lead among 
 foreign nationalities. Next in order we have England, 
 
124 DISEASES OF INEBRIETY. 
 
 Germany, and Scotland ; tlie lesser nationalities occur in in- 
 significant proportions, and do not call for special comment. 
 
 As a matter of racial importance I cannot recall a single 
 instance of acute or chronic alcoholic mania in the negro 
 among the several thousand inebriates who have passed 
 under my notice during a period of nearly twenty-four 
 years. 
 
 In reply to a series of questions, Dr. Edwards, of Rich- 
 mond, informs me " that the negro is rarely the subject of 
 chronic mental or nervous disease arising from alcohol, 
 although it is rare to find a negro, male or female, who 
 does not drink. Alcoholic liquors are preferred, and yet 
 the laboring negro, as a rule, is not a drunkard." He 
 attributes this to the out-door life, simple habits, and low 
 grade of nervous organization of the negro. 
 
 Climate. — As to the influence of climate on inebriety, 
 we have not any special statistics to show, but it is a popu- 
 lar impression that the inhabitants of low levels, especially 
 near the sea-coast, are more apt to be intemperate tlian the 
 dwellers on the higher plateaus, table-lands, and mountain- 
 ous districts. The influence of certain barometric condi- 
 tions, dependent upon atmospheric changes, in influencing 
 and producing certain conditions of the nervous system, is 
 familiar to all who have made this subject a special study. 
 It is also a well-known fact that in malarious districts the 
 depressing effects of the malarial cachexia are counteracted 
 by the free, habitual use of quinine, strychnine, coffee, and 
 other nerve stimulants, among which alcohol predominates. 
 No one will dispute the fact that an unhealthy, enervating 
 climate is more apt to produce intemperance and conse- 
 quent inebriety, than a climate having just the opposite 
 characteristics. Climate, undoubtedly, is one of the factors 
 in the production of inebriety, as it is of other diseases. 
 
 Sex. — There were 4,084 males and 579 females. The 
 Fort Hamilton Asylum is intended more especially for 
 males, hence the small proportion of females. It has no 
 
CLIMATIC PEKIOD. 125 
 
 provision for females of the better class ; the female 
 inmates were from the middle and lower classes of society, 
 but the inference must not be drawn that inebriety does 
 not prevail among females of all classes, or that the above 
 is a fair relative proportion of the inebriates of botli sexes. 
 In this countiy, undoubtedly, the male inebriate far exceeds 
 in numbers female inebriates. But this is not universally 
 the case. In England and Wales the habitual inebriate 
 females already convicted to the habitual inebriate males 
 already convicted are as three to one. In England, espe- 
 cially among the higher classes of society, inebriety pre- 
 vails to a greater extent among females than in the same 
 class and sex in the United States. 
 
 Social Conditions. — The married male inebriate exceeds 
 in numbers the unmarried male inebriate. There were 2,098 
 married, 1,744 single, male inebriates ; and especially does 
 the married female inebriate in far greater proportion 
 exceed the unmarried female inebriate. There were 401 mar- 
 ried female inebriates and only 48 single female inebriates. 
 Must we conclude that, other things being equal, the married 
 life predisposes to inebriety > It would seem so, in the case of 
 females at least. The married female has a much greater 
 strain upon both her mental and physical constitution than 
 the unmarried. A fact substantiated in the reports of our 
 Asylum further shows, that unmarried males are more fre- 
 quently subjects for re-admission than the married ; that is, 
 that they are more apt to relapse. The reverse is true in 
 regard to females. Married females are more apt to relapse 
 than unmarried females. The latter are not apt to relapse ; 
 if they do, it is the exception to the rule. The spinster 
 then, is the most temperate member of society. There were 
 242 widowers and 130 widows also recorded. 
 
 Approximation of Ages. — The ages of the majority of the 
 cases treated were from 20 to 60, the greater proportion 
 from 30 to 50, and of these considerably over one-half were 
 between 30 and 40 years of age. Below the age of 20 and 
 
126 DISEASES OF INEBRIETY. 
 
 above the age of 60, comparatively few. The oldest patient 
 w^as 73 years of age, and the youngest 18 years. We must 
 conclude that the great majority are of that period of life 
 which is the most effective for usefulness and attainment 
 under normal conditions. In other words, alcohol cripples 
 and handicaps the majority of inebriates at the most useful 
 period of life. Another fact is, that inebriates may excep- 
 tionally, but do not as a rule, attain to a long life. About 
 one in 385 of inebriates, whom we treated, reached the age 
 of 70 years. 
 
 Occupatio7t. — Let us now consider the relation of in- 
 ebriety to occupation. Imagine a community of 4,663 adult 
 inebriates, embracing every trade, employment or profes- 
 sion. Excluding 234 males who had no occupation and 
 562 females, 275 of whom were unemployed, and the 
 balance either domestics or housekeepers, we liave about 
 3,867 males who were variously occupied, representing 
 two hundred trades, professions, commercial, mercantile, or 
 agricultural occupations. 
 
 We find directly engaged in the liqtior business 71 bar- 
 tenders and 51 liquor dealers. The indoor trades exceeded 
 the outdoor trades. Among those engaged in the outdoor 
 occupations, inebriety seemed to affect most those whose 
 business especially exposed them to irregular hours and 
 inclement weather, — teamsters, cartmen, coachmen, carmen, 
 conductors, drivers. One hundred such are recorded. Tiie 
 next in frequency were butchers (45) ; next stone-cutters 
 (28) ; next plasterers (26) ; next coopers (19). The other 
 occupations being at or below the latter figure, and run- 
 ning at or about the same average or percentage. Among 
 in-door occupations we find painters (121) in the majority. 
 The painter handles alcohol, turpentine, etc. ; his occupa- 
 tion is not a healthful one ; he is apt to contract diseases 
 incident to it, as turpentine poisoning, lead colic, and ner- 
 vous diseases arising from lead poisoning, as wrist drop, or 
 paralysis of the extensor muscles, etc. 
 
CLIMATIC PERIOD. 127 
 
 Next in order come printers (58) and pressmen (58). 
 Long hours, extra work, night work, and an employment 
 that demands great rapidity, and probably more mental 
 and physical strain than the average occupation, may 
 account for the fact that the printer and the pressman take 
 the second place. 
 
 The other trades are in the following order : Shoemakers 
 (45), plumbers (39), tailors (38), hatters (34), tinsmiths (31), 
 waiters (28), photographers (27), carpet-weavers (22), glass- 
 blowers (21) — the remainder of the in-door trades were at 
 or below 20, 
 
 The greater part of the various occupations were from 
 mercantile or commercial life. At least 1,200 or 1,300, or 
 about one-third of the entire number belonging to one or 
 the other of the above classes in the following order : 
 Clerks (565), merchants (283), bookkeepers (100), salesmen 
 (152), agents (78), brokers (44), the balance being made up 
 of canvassers, contractors, railroad officials, bankers, pub- 
 lishers and superintendents, etc. 
 
 In agricultural occupations we note, farmers (34), and 
 gardeners (15). 
 
 Professions. — Four hundred and seventy-seven, or about 
 one-eiglith of the whole number, belonged to the profes- 
 sions, as follows : Physicians (115), lawyers (m), engineers 
 (58), druggists (43), journalists (39), artists ('32), students 
 (21), reporters (19), clergymen (10), actors (9), the balance 
 being in small proportion, architects, accountants, actuaries, 
 notaries public, chemists, assayers, army officers, dentists, 
 editors, etc. 
 
 Why physicians are in excess of other professions is due 
 to the fact that they lead very arduous lives, both physical- 
 ly and mentally, with irregularity as to sleep and diet, rest 
 and recreation ; but there is another fact also, the physician 
 would be more likely to appreciate and avail himself of 
 asylum privileges for the treatment of his inebriety than 
 any of the professions. 
 
128 DISEASES OF INEBRIETY. 
 
 In considering the various avocations the usual average 
 relation of the occupation or profession to a normal con- 
 dition of society must be considered. In this way only can 
 we get at the fact as to wliether any one calling exceeds 
 the other in a tendency to lead to inebriety. 
 
 Results of Treatment, etc. — Total cases, 4,663 ; still under 
 treatment, 1,283 I total cases discharged and to be accounted 
 for, 3,380 ; doing well, 1,465, 43 per cent. ; lost sight of, 
 662, i9>^per cent. ; unimproved, 555, i63^ per cent. ; re-ad- 
 mitted, 556, idYz per cent. ; died, 81, 2>^ per cent. ; trans- 
 ferred to otiier institutions, 61, 2 per cent. 
 
 Doing well. — By this we mean the patient is restored to 
 society, to his business and social relations. Exclusive of 
 death and transfer, the percentage will be nearer 45 per cent. 
 It must also be considered that the inebriate on an average 
 is not brought to us for treatment until after his Inebriety has 
 existed ten years, his system broken down, and oftentime the 
 subject of incurable disease, the result of his inebriety or 
 some disease or injury with which his inebriety is compli- 
 cated, and which may have preceded and been the cause of 
 it. Again, not only do inebriates apply at a late period for 
 treatment, but onl}'' about one-quarter of those who do 
 apply remain over six months, while three-fourths remain 
 at periods varying from one to four months, and the large 
 majority less than the legal limit of three months, so thai 
 if we were to apply the same rule that is applied to other 
 diseases which are submitted to us to be cured, that is, hav- 
 ing the patient brought to us at a reasonable period after 
 the disease tendency has manifested itself, and having also 
 the patient remain under our care a reasonable length of time 
 for treatment as each case may demand, it would be easy 
 to see that our ratio of cures would be 75 or 80 per cent., 
 instead of 43 per cent, as they now are, which is neverthe- 
 less a good showing considering the disadvantages we have 
 had to contend with. We are confident that in the future, 
 
CLIMATIC PEKIOD. 129 
 
 under proper conditions, at least three-fourtlis of the in- 
 ebriates treated in our asylums will be cured. 
 
 Thirty-six per cent, were lost sight of, or unimproved, but 
 this does not mean they will not be heard of again ; a cer- 
 tain proportion will return to our institution, and of tliese a 
 number will be cured. Some of our most successful cases 
 are those wliich have been in the asylum at different periods 
 under treatment. Of the balance, some will die, others will 
 move away, otiiers go to similar institutions elsewhere 
 located. We shall not make any comments as to deaths 
 except to call attention to \.\\^ remarkably small percentage, 
 which is about equally divided between those who died 
 outside of the asylum and those who died in the asylum. 
 Some 6i were transferred to other insitutions — 30 to the 
 lunatic asylum. We observe the tendency of inebriety 
 toward insanity. The great majority of inebriates caVry 
 unevenly-balanced minds ; they are on the verge of insanity 
 all the time, and not unfrequently pass over the line. In 
 any inebriate asylum it would be safe to assert the large 
 majority of inebriates, at least for the first few weeks after 
 their entrance into the asylum, are in a mental condition 
 that, to say the least, is not normal. The above 30 trans- 
 fers were marked cases of lunacy, acute or chronic mania, 
 which were not suitable for an asylum of our character. 
 The moral effect and the law of association forbid that the 
 inebriate of weakened mind and body should be associated 
 with insane persons. The tendency of every inebriate is 
 that way, and such association would only precipitate the 
 event. This is the principal argument against the incarcera- 
 tion of insane persons and inebriates in the same institu- 
 tion, although there are other arguments equally effective, 
 A certain proportion of persons were brought to the asylum 
 suffering from various diseases or infirmities that rendered 
 them unfit subiects for our asylum. Of these, some 31 were 
 transferred to hospitals or other institutions. 
 
 We have thus given a few general observations, result- 
 
130 DISEASES OF INEBRIETY. 
 
 ing from a study of these special statistics. We have not 
 by any means exhausted tlie subject, but we trust we liave 
 added some points of interest and importance, not only to 
 the etiology of inebriety, but also some indications for its 
 more successful treatment. 
 
CHAPTER XV. 
 
 ALCOHOLIC DELIRIUM AND ASSOCIATED CONDITIONS. 
 
 The existence of certain specially dangerous and hyper- 
 acute forms of delirium tremens has been known and recog- 
 nized by many writers since the days of Magnus Huss, but 
 the first distinct description of this class of cases in which 
 an attempt at their differentiation from the ordinary type 
 was made, seems to have been that of Delasiauve, of his 
 so-called superacute form in 1852. In his cases, however, the 
 distinctive symptom of fever was absent, and it was left for 
 Magnan, in 1873 and 1874, to describe as a distinct variety, 
 his cases of febrile delirium tremens. 
 
 Although the cases which I am about to report do not 
 agree in all respects with those related by him, I have ven- 
 tured to make use of the title of febrile delirium tremens 
 for them also. One of the predominant symptoms, perhaps 
 we may even say their most striking cliaracteristic, was the 
 presence of fever, and in many points they closely resemble 
 the cases of Magnan. Moreover, there can be little doubt 
 that the different varieties of delirium tremens shade imper- 
 ceptibly into each other and that they are all acute mani- 
 festations of chronic alcoholism modified in their symptoms 
 by the constitution of the patient, his condition at the time, 
 the existing complications and various other attending cir- 
 cumstances. 
 
 The presence, however, of so important a symptom as 
 fever, affords, in our opinion, a sufficient ground for placing 
 those cases in which it exists to any marked degree, in a 
 separate category from the ordinary simple febrile cases. 
 
 131 
 
132 DISEASES OF INEBRIETY. 
 
 Since, after as thorough an examination as possible of tlie 
 voluminous literature of delirium tremens, we have found 
 no carefully reported cases of this character, since those of 
 Magnan, we feel justified in bringing these to tlie notice of 
 tlie profession more especially as we believe tliat there are 
 certain considerations connected with them of considerable 
 importance both to the specialist and perhaps even more to 
 the general practitioner. 
 
 A full description of the case is given, of which the fol- 
 lowing is a summary : 
 
 In this case we have a man of thirty-two, with a distinct 
 predisposition to mental disease, and addicted for a consid- 
 erable period to the excessive use of alcohol. Having con- 
 tinued the abuse of the stimulant after, at least, two attacks 
 of delirium tremens, he finally, four weeks before entering 
 the hospital, and probably much earlier, is perceived to act 
 in a strange manner, to have temporary lapses of memory, 
 and hallucinations of sight and hearing. On entrance, he is 
 found to be much in the condition of a patient recovering 
 from a severe attack of delirium tremens — weak, with 
 decided tremor of face and hands, and mentally affected, 
 unable to realize his surroundings. Very shortly , /ever was 
 detected, and, instead of improving, he grew rapidly worse. 
 The general weakness increased, and was accompanied by 
 v-ery marked and constant subsultus tendinum, and by con- 
 tinual plucking at the bed-clothes. The tongue was cracked, 
 dry, and parched, and the general condition suggested that 
 of typhoid fever. Mentally, he likewise became worse, hav- 
 ing constant, rapidly changing hallucinations, many of them 
 terrifying and horrible, but many also, and the proportion 
 of these increased as the disease progressed, of a not unpleas- 
 ant character. He constantly imagined that he saw friends 
 and acquaintances, who spoke and chatted with him. He 
 talked aloud much of the time, often starting up suddenly 
 and answering some subjective question. This condition of 
 things continued for a montli, being varied by periods of 
 
ALCOHOLIC DELIRIUM. 133 
 
 semi-coma, when he could with difficulty be roused to 
 answer questions. The fever ceased at one time, to recur 
 later. At the end of a month his strength had improved, 
 and there were no acute symptoms remaining. From this 
 time his mental condition improved until he left the hospital, 
 only to grow worse afterwards, and to necessitate a still 
 longer treatment before final recovery. 
 
 In this case, there is little doubt that there existed in the 
 beginning that condition of chronic alcoholic poisoning so 
 carefully described by Lentz, under the title of chronic 
 hallucinatory alcoholism. This, possibly due to the with- 
 drawal of stimulants, passed soon into an acute febrile con- 
 dition, recurrent, and lasting about a month, to be followed 
 in its turn by the ordinary hallucinatory alcoholic insanity. 
 
 The second case was that of a liquor-dealer, thirty-two 
 years of age, a native and resident of Boston. 
 
 One of the patient's uncles was insane for a time, and at 
 the Worcester Asylum for six months. No record of any 
 other mental or nervous affection in the family obtained. 
 
 Patient had been healthy, except as follows : He has 
 been a constant drinker for two or three years, and at times 
 has drunk very heavily. Last autumn, he had several epi- 
 leptic fits, and he has fallen down stairs several times. Two 
 weeks before entrance, he stopped the use of alcohol 
 entirely for five days, but then resumed. He was at this 
 time placed under the care of a physician, as he had begun 
 to have hallucinations of sight, and was rapidly growing 
 worse. Finally, being inclined to be violent, he was brought 
 to the hospital. 
 
 This case was similar to the others. 
 
 In both the preceding cases we have to deal with patients 
 in whom, we may presume, a certain tendency to mental 
 disease exists. One had already himself been in an asylum; 
 the other had had a near relative in one. In both, the 
 existing affection was undoubtedly induced by addiction to 
 the excessive use of alcohol. The more prominent and 
 
134 DISEASES OF INEBKIETY. 
 
 noteworthy symptoms in these cases may be resumed as 
 follows : (i) Tlie duration of the disease, followed in both 
 cases by recovery, in connection with (2) the peculiar tem- 
 perature, rising at times to 102^ or more ; (3) the great 
 weakness of the patient, especially in the earlier stages ; 
 (4) the typhoidal appearance ; (5) the constant subsultus 
 tendinum, and the plucking at the bed-clothes ; and (6) 
 which is less uncommon, the long duration of the pecu- 
 liar form of delirium vvh'ich in the beginning, precisely 
 resembled that of delirium tremens, but continued for 
 weeks, with a gradual change to less terrifying hallucin- 
 ations. 
 
 I will not enter here into the question of the differentiation 
 of these cases from typhoid fever and other diseases, but 
 will merely say that in the cases related tliere did not exist 
 any of the more diagnostic symptoms generally seen in 
 typhoid fever, except the general typhoid-like condition of 
 the patient, and that in both cases the course of tlie temper- 
 ature was unlike that usual in typhoid. 
 
 The medico-legal importance of such cases as these 
 seems to me considerable. The question to decide is 
 whether the patients were actually insane, and likely to 
 remain so for a considerable period of time, or whether the 
 condition was a more or less temporary one, and the patient 
 had a fair chance of recovery. In the first case, the actual 
 question to be decided was whether the patient should at 
 once be committed to an asylum, or whether it weie advis- 
 able to wait ; in the second, whether the patient was likely 
 to remain in his actual condition so long that it was right 
 and advisable that his property should be put in trust. In 
 both cases the decision was in the negative, and rightly so. 
 
 I cannot help feeling, for these reasons, that it is very 
 important that this class of cases should be early recognized, 
 not only by specialists, many of whom have, undoubtedly, 
 opportunities for observing them more or less often, but 
 also by the general practitioner, into whose hands they, in 
 
ALCOHOLIC DKLIEIUM. 135 
 
 the beginning, almost always fall. All the cases of this 
 character that I have seen, or have been able to find accounts 
 of up to the present time, have either been fatal within a few 
 days, or have ended in recovery. At any rate, if death does 
 not occur within ten days, the prognosis is more favorable 
 than one would be led to suppose by simple consideration 
 of the duration and character of the symptoms. 
 
 In regard to the pathology of these cases, although 
 data sufficient to justify a decided opinion are wanting, 
 certain facts bearing on this subject may be mentioned. 
 Without entering into detail in regard to the pathological 
 changes of the nervous centers and their envelopes in 
 alcoholism, we may refer to a few general results. Four- 
 nier states that autopsies after aaite alcoholism in man show 
 most commonly the following lesions: " cerebral conges- 
 tion, more or less intense ; meninges injected, veins and 
 vessels of the pia mater gorged with blood, cerebral sub- 
 stance dotted with points, roughened (sable), and, on 
 section, permitting the escape of fine drops of blood ; 
 sometimes, also effusion of serum into the meninges." 
 
 In chronic alcoholism we find two classes of lesions in 
 these organs ; the one, which may fairly be classed as 
 acute, though the result of clironic changes, comprising, 
 for example, hemorrhages, and perhaps some effusions ; 
 the other class, the subacute and chronic. Audhoui, writ- 
 ing in 1868, says : "There is no need, I think, of insisting 
 on the form that the nutritive trouble affects in the nervous 
 centers, thickening of the meninges, the production of false 
 membranes on the cranial dura mater, adherence of the 
 pia mater to the cerebral cortex, hypergenesis of the 
 neuroglia, fatty degeneration of the nerve-cells, of the 
 capillaries, etc. ; all this is perfectly well-known." 
 
 In regard to tlie superacute form of delirium tremens we 
 may mention two varieties, the " forme suraigne " of Dela- 
 siauve, and the delirium tremens febrile of Magnan. 
 
 Delasiauve's form is described by Lentz as follows ; 
 
136 DISEASES OF INEBKTETY. 
 
 *' The forme suraigne of Delasiauve is remarkable par- 
 ticularly for its violence, its agitation, the intensity of the 
 delirium and the gravity of the general condition. The 
 nervous activity is prodigious ; the patient has neither 
 respite nor repose, no part of his body is free from move- 
 ment ; liis face bloated, red, even violet, is contorted through 
 the quivering of the muscles ; his eyes roll in their orbits ; 
 his skin is hot and burning, is moist with a profuse and 
 sticky sweat, whicli sometimes emits an alcoholic odor. 
 The tongue may preserve its natural moistness ; more often 
 it is dry along the edges, and its surface as well as the edges 
 are covered with fuliginous crusts. Usually the thirst is 
 excessive, unquenchable ; the respiration more or less 
 labored ; the alteration of the features indicates a profound 
 prostration. As to the pulse, sometimes rapid and feeble, 
 at other times it contrasts by its almost normal rhythm 
 with the other symptoms. The mind is assailed by hallu- 
 cinations whose rapid succession causes an incessant change. 
 The words crowd each other so in the patient's mouth, that 
 several demand utterance sim.ultaneously and escape with 
 difficulty in jerky, interrupted, often unintellibible sen- 
 tences. In constant agitation (jactitation), the head and 
 hands are moved abruptly in all directions whejice the 
 imaginary impressions seem to arise." 
 
 Magnan's form differs but little. Its principal distinctive 
 feature is the rise of temperature which is apt to run high 
 and reach 40° C. {104'' F.), or even 42° C. (107.6° F.). This 
 lasts without remission for two or three days or perhaps 
 longer, and if not followed, as is usual, by a fatal result, 
 gradually descends to the normal limit. This form also is 
 marked by the constant presence of muscular movements, 
 subsultus tendinum, jerkings and contractions of the muscles 
 all over the body, and by the extreme muscular weakness 
 which eventually results from this incessant activity. Lentz 
 considers that the only symptom by which this form can be 
 differentiated from that of Delasiauve is the possibility of 
 
ALCOHOLIC DELIEIUM. 137 
 
 prolonged remissions in which the consciousness may for a 
 time become quite clear. 
 
 The presence of a high and continued fever during an 
 attack of delirium tremens, is always a symptom of most 
 serious import. It denotes either the presence of some 
 severe and dangerous complication, as pneumonia or menin- 
 gitis, or it implies, as is thought to be the case at times, by 
 certain authorities, an affection of the cerebral heat-centers, 
 and thereby a wide-spread and dangerous condition of the 
 cerebrum. In ordinary cases of delirium tremens, there is 
 no rise of temperature whatsoever. 
 
 Nacke says : " In a series of examinations of a small 
 number of cases (eleven), a slight feverishness could be deter- 
 mined in one-third of them. The maximum was 38.8° C, 
 loi^ F. Any temperature above this pointed to some inter- 
 nal inflammation, more especially pneumonia. In our cases 
 a slight fever appeared in the evening only, as a slight rise 
 of the physiological evening exacerbation of the tempera- 
 ture, never in the prodromal stage, commonly only on the 
 first, rarely on the second day of the true delirium. Pulse 
 and respiration were commonly only slightly increased in 
 rate." 
 
 The cause of the fever in febrile delirium tremens is still 
 doubtful. Magnan gives the results of five autopsies in 
 which little definite was found beyond the injection and 
 oedema of the cerebral meninges and a similar condition of 
 the meninges of the spinal cord with injection of the gray 
 substance of the latter. He himself says, that besides the 
 hyperaemia, which sometimes ends in hemorrhage and thus 
 attests the very violent irritation of the nervous centers, we 
 scarcely find at the autopsy anything except the more or 
 less advanced alterations of ciironic alcoholism. 
 
 That delirium tremens may be complicated by menin- 
 gitis, is, of course, well-known, and many instances have 
 been published, of which, however, I will only refer to the 
 cases of Bonnemaison. 
 
138 DISEASES OF INEBRIETY. 
 
 Wliether such complication exists in any special case, 
 can, of course, only be decided after a careful consideration 
 of all the symptoms. 
 
 Whether in the febrile cases ending in recovery, the 
 fever is due to complications meningitic or otherwise, or 
 whether it is simply due to the violence of the cerebral 
 irritation and the affection of the cerebral heat-centers has 
 not yet been proved. The evidence in favor of tlie latter 
 condition is up to the present time wliolly negative. Con- 
 sidering the existence of heat-centers, as shown by Dr. Ott 
 and others, proved, since no other cause of the liigli tem- 
 perature is apparent, and since cerebral irritation evidently 
 exists, it is assumed that the fever is due to the irritation of 
 these centers. It must be remembered, however, that this is 
 only a theory with some plausibility in its favor. 
 
 Nacke is in favor of this view. As in Magnan's cases 
 the temperature cannot be simply dependent on increased 
 muscular action " since now at the autopsy of such patients, 
 beyond the more or less marked hyperaemia of the central 
 nervous apparatus, and tlie clianges produced in the system 
 by chronic alcoholism, notiiing was found which could 
 explain the violent fever, we must in tliese cases regard tlie 
 fever as directl}' dependent on the action of the lately intro- 
 duced masses of alcohol upon the heat regulators." 
 
 We, however, do not believe that this question can yet 
 be decided without further evidence. 
 
 Anotlier form of delirium tremens has been noticed as 
 coming from traumatism. 
 
 This nervous affection, characterized by muscular tremor 
 and a peculiar restless delirium, not infrequently follows 
 the receipt of injuries in those accustomed to alcoholic 
 stimulation. 
 
 Some writers describe, under the terms traumatic delir- 
 ium and nervous delirium, a condition frequently very 
 similar to delirium tremens, wliich is said to occur in 
 patients free from the alcohol habit, and to depend upon 
 
ALCOHOLIC DELIRIUM. 139 
 
 nervous prostration, often associated with shock and hem- 
 orrhage. It is possible that failure to investigate previous 
 habits with judicial acumen has allowed to arise a confusion 
 between delirium dependent simply upon traumatism and 
 delirium induced by traumatism in alcohol drinkers. The 
 muttering delirium and muscular twitching that supervene 
 in asthenia, from surgical as from medical causes, and the 
 noisy delirium after injury that is exhibited by quick, rapid, 
 and full pulse, and by febrile reaction, are two very differ- 
 ent conditions to which the name traumatic delirium might 
 with propriety be applied. These forms of mental disturb- 
 ance, in my opinion, better called asthenic and inflamma- 
 tory delirium respectively, arise without reference to per- 
 sonal habits. 
 
 The group of symptoms which I propose describing as 
 traumatic delirium tremens, however, is found especially, if 
 not exclusively, indeed, in those whose nervous systems 
 have undergone, prior to injury, the deterioration due to 
 absorption of alcohol, I have not been convinced by my 
 experience, nor by my reading, that such a concatenation 
 of symptoms can occur after traumatism in the absolutely 
 abstemious. The amount of drinking requisite to induce 
 the predisposition vai'ies with the individual. The repeated 
 ingestion of quite small quantities of alcohol may give 
 rise to the delirious susceptibility. It is possible that 
 a similar deterioration of constitution, and a consequent 
 liability to trembling delirium, may be caused by the 
 opium, chloral, and tobacco habits ; but it is difficult to 
 differentiate these because of their frequent association 
 with alcoholic excess. 
 
 Traumatic delirium tremens may follow even slight in- 
 juries, but compound fractures and burns seem to have a 
 special tendency to develop this serious complication. Its 
 occurrence should not be ascribed to the restraint imposed 
 upon the patient's habits by the injury, but to a traumatic 
 disturbance of a previously unstable nervous equilibrium. 
 
14:0 DISEASES OF INEBEIETY. 
 
 Medical authorities vary in tlieir appreciation of the causa- 
 tive influence exerted by sudden deprivation of accustomed 
 stimulants in exciting attacks of ordinary delirium tremens. 
 It is probable, however, that in a vast majority of such 
 cases tlie directly exciting causes are tlie deficient assimila- 
 tion of food, the anxiety, and the nervous strain which go 
 hand in hand with a period of debauch, and which persist 
 after the ingestion of alcohol is stopped. Neither is the 
 occurrence of the malady to be imputed to the directly 
 poisonous effect of a large amount of consumed alcohol, 
 since acute alcohol poisoning, in persons unaccustomed to 
 the use of alcoiiol, gives rise to stupor and death, but not to 
 delirium. 
 
 Traumatic delirium tremens occurs because chronic 
 changes in the nervous tissue or blood, or perhaps in both, 
 have rendered the alcohol drinker susceptible to such an 
 outbreak upon the application of any disturbing influence. 
 The receipt of injury is a sufficient perturbing force, especi- 
 ally if tlie patient be on the verge of an idiopathic attack. 
 It has been thought that the use of beverages containing 
 amylic alcohol (fusel oil) especially predisposes to delirium 
 tremens. 
 
 The alteration in nerve structure or blood, which is the 
 essential pathological factor of delirium tremens, is unknown 
 to us. At autopsies, an abnormal amount of serum is usually 
 found in the substance, and within the ventricles of the 
 brain ; meningeal congestion and hemorrhage are often 
 seen ; the cells of the gray matter, the cerebral connective 
 tissue, the lymph spaces and the vessels may show sclerotic 
 or fatty changes ; and the liver, kidneys, and digestive tract 
 may exiiibit the characteristic lesions found in chronic 
 alcoholism ; but there is nothing to which we can point as 
 the distinctive lesion of delirium tremens. 
 
 The initiatory symptoms of traumatic delirium tremens 
 are sleeplessness at night, and slight tremor, which is readily 
 noticed by ordering the patient to hold out the hand with 
 
ALCOHOLIC DELIRIUM. 141 
 
 widely-separated fingers. Subsequently, restlessness, insom- 
 nia, and tremor increase, and delirium is. shown. 
 
 The delirium, wliicli is often first exhibited at night, is 
 peculiar. Tlie patient sees numerous small animals or 
 insects creeping over the bed and about liis person, or is 
 pursued by some hideous spectre. Hence, he is constantly 
 endeavoring to eject the vermin from his clothing, or trying 
 to escape the persecutions of his tormentor. I have now 
 under my care a patient with traumatic delirium tremens, 
 after an open fracture of the leg, who imagines tliat ele- 
 phants are moving over his bed and tramping on his legs. 
 He may, in his efforts to get rid of these disgusting and dis- 
 tressing annoyances, leave his bed and fall from a window 
 or down a flight of steps. The mental condition is one of 
 depression, trepidation, and great activity. He is exceed- 
 ingly restless, and is constantly chattering in a low tone, 
 but, thougli he may cry out because of fear, he shows little 
 or no maniacal excitement. He is good-natured, not prone 
 to violence, and can often be aroused, by emphatically 
 spoken words, to an understanding of his surroundings: 
 but he soon relapses into the previous incessant chattering 
 and motion. Very often a single idea recurs again and 
 again to his delirious fancy, and not infrequently the delirium 
 has a comical or tragedo-comical aspect. The muscular 
 tremor is not like the twitching of tendons seen in asthenic 
 conditions, but resembles the sliakiness, from want of coor- 
 dination, seen in cerebro-spinal sclerosis. Often there is 
 hurry in movement, and the limbs or tongue will then be 
 thrust forward with a jerk. The tremor of delirium tremens 
 reminds me much of the movements that would be expected 
 in an association of chorea with sclerosis of the nervous 
 centres. 
 
 During these symptoms, the patient is unable to sleep, 
 is incessantly in motion, and has a bright eye with dilated 
 pupils, and an unsteady, restless look. He exhibits a 
 moist, flabby, tremulous tongue with a whitish fur, desires 
 
142 DISEASES OP INEBRIETY. 
 
 no food, has constipated bowels, and passes a scanty, high- 
 colored urine. In idiopathic delirium tremens of moderate 
 severity there is no great acceleration of tlie pulse, and the 
 temperature does not rise much above ioo°, except during 
 active muscular exertion. In tliose graver cases, vi'liich 
 Magnan calls febrile delirium tremens, the bodily heat is 
 apt to remain in the neigliborhood of i02"-i25°, though 
 there is no inter-current affection to keep up the temper- 
 ature, and the pulse rate is also increased. In traumatic 
 delirium tremens the constitutional disturbance, due to the 
 wound, affects the pulse and temperature. The patient 
 will often remove the dressings from his wound, or subject 
 the injured limb to violent motion without appearing to 
 experience pain. 
 
 Traumatic delirium tremens arises, as a rule, within two 
 or three days after the receipt of injury, and lasts usually 
 not more than five or six days. The illusions are apt to 
 continue during the night, even after the patient has 
 become convalescent and quite rational in the daytime. 
 
 The peculiarity of the tremor and delirium renders the 
 diagnosis easy. If my view of its causation be correct, the 
 existence of the characteristic symptoms is evidence of 
 previous liabits of stimulation ; but it is not always well to 
 mention this suspicion, nor to call the disease delirium 
 tremens, since the patient's friends may be unaware of the 
 existence of such habits. 
 
 Death may occur from exhaustion, coma, or some inter- 
 current affection, and is sometimes inexplicably sudden. 
 Tlie character of the traumatism may determine the mode of 
 death. Pneumonia is frequently associated with idiopathic 
 delirium tremens. It is often, in fact, the exciting cause of 
 the delirious outbreak, and, of course, in traumatic cases 
 greatly diminisiies the chances of recovery. When the tem- 
 perature shows a tendency to remain high without a suffic- 
 ient traumatic cause, and especially when the tremor affects 
 all the muscles of the trunk, as well as those of the head and 
 
ALCOHOLIC DELIKIUM. 14:3 
 
 extremities, and is not arrested during sleep, the prognosis 
 is bad. A history of previous attacks of the disease renders 
 the outlook more grave. 
 
 In considering treatment, it is important to bear in mind 
 that delirium tremens is an asthenic condition. There is 
 action, but it is the activity of weakness, not of power. 
 Depressants are therefore injurious. Five or ten grains of 
 calomel, or one or two seidlitz powders, may be administered 
 in the beginning of the disease, or when its occurrence is 
 feared, because of the anorexia and gastric derangement. 
 Concentrated liquid food, bitter tonics, and capsicum add 
 to the patient's strength, and tend to give tone to the im- 
 paired digestive organs. Bathing and mild diuretics may 
 be employed, in the endeavor to eliminate the alcohol that 
 has entered the system. Ciiloral hydrate (gr. x-xx) with 
 potassium bromide (gr. xxx-xl) should be given every two 
 or three hours, as soon as sleeplessness and slight tremor are 
 noticeable ; no visitors should be allowed in the room. 
 If the development of the attack is not prevented, the same 
 treatment is continued, but the doses may be increased. 
 The object is to quiet the nervous system and induce sleep. 
 In this endeavor an occasional dose of morphia (gr. 1-4 to 
 1-3,) may be combined with the chloral and potassium bro- 
 mide. The excessive use of opiates is undesirable, for it 
 is not narcotism that is desired, but sleep; cerebral conges- 
 tion is induced by overdosing witli morphia. 
 
 If fatty heart exists, opiates should be pushed, perhaps 
 rather than the chloral and potassium bromide. Tiie com- 
 bination treatment with the three hypnotics allows the sur- 
 geon to diminish or increase each element according to 
 indications. Tincture of digitalis (m. x-xxx) every two or 
 three hours, is valuable in cases of weak but not fatly 
 heart, where there is pallor and cyanosis with probable 
 anaemia of the brain. Strychnia also has been recom- 
 mended in delirium tremens. Meclianical restraint, with 
 the straps and the straight jacket, is only to be adopted 
 
144 DISEASES OF INEBRIETY. 
 
 when efficient watching and soothing by attendants is 
 impracticable. All such apparatus excites the patient and 
 is very liable to interfere with respiration. The best appli- 
 ance is a loose but strong garment, consisting of trowsers 
 and shirt, in one piece, with loops attached for fastening 
 the patient in bed. Fractures should be dressed with 
 plaster of Paris bandages, because ordinary splints will 
 probably be displaced by the patient. If failure of vital 
 powers is to be feared, alcoholic stimulants in small amounts, 
 administered only when food is given, are judicious, because 
 in chronic drinkers digestion will sometimes not go on 
 sufficiently without the aid of alcohol. Such failure of 
 assimilation in delirium tremens may turn the scale against 
 the patient. Whiskey or brandy (F. i§-F. iv§ during the 
 twenty-four hours) in the form of milk punch or egg-nog, 
 is probably the best form of administration. Many pStients 
 will not require any stimulants. Vomiting occurring in 
 delirium tremens, is to be treated by milk and lime-water, 
 cracked ice, effervescing drinks, bismuth sub-nitrate, pep- 
 ain and carbolic acid mixtures. 
 
CHAPTER XVI. 
 
 GENERAL FACTS OF HEREDITY AND PREDISPOSING CON- 
 DITIONS. 
 
 Alcoholic Heredity, or the transmission of a special ten- 
 dency to use spirits, or any narcotic, to excess, is much 
 more common than is supposed. In the study of a large 
 number of cases, several distinct groups will be apparent. 
 
 First will appear the direct heredities. Those inebri- 
 ates whose parents and grandparents used spirits to excess. 
 The line of tiie inheritance will be from father to daughter, 
 and motlier to son ; that is, if tlie father is a drinking man, 
 the daughter will inherit his disease more frequently than 
 the son. While the daughter may not, from absence of 
 some special exciting causes, be an inebriate, her sons will 
 in a large proportion of cases fall from the most insignificant 
 exciting causes. About one in every three cases can be 
 traced to inebriate ancestors. Quite a large proportion of 
 these parents are moderate or only occasional excessive 
 users of spirits. If the father is a moderate drinker, and 
 the mother a nervous, consumptive woman, or one with a 
 weak, nervous organization, inebriety very often follows in 
 the children. If both parents use wine or beer on the table 
 continuously, temperate, sober children will be the excep- 
 tion to the rule. If the motiier uses various forms of alco- 
 holic drinks, as medicines, or narcotic drugs for real or 
 imaginary purposes, the inebriety of the children is very 
 common. Many cases have been noted of mothers using 
 wine, beer, or some form of alcoholic drinks, for lung 
 
146 DISEASES OF INEBRIETY. 
 
 trouble or other affections, and the children born during 
 this period have been inebriates, while others born before 
 and after this drink period have been temperate. 
 
 The second group of these alcoholic heredities are called 
 the indirect. They are cases wljere the inebriety of some 
 ancestor has left a stream of diseases, such as minor forms 
 of insanity, consumption, and various nerve defects, whicii 
 may have run through one or two generations, tlien suddenly 
 develop into inebriety, with or without any special exciting 
 cause. In such cases the moderate or excessive drinking 
 parents will be followed by nervous feeble-minded, consump- 
 tive, or very precocious children, or eccentric and odd people 
 who are born extremists in every relation of life. They are 
 persons who die early, and leave a large progeny, who suffer 
 from nerve and nutrient troubles, and neuralgia, and find 
 in alcohol and opium a most seductive relief from all their 
 troubles. About one-fourth of all cases of inebriety are 
 examples of this form of indirect heredity. 
 
 A third group of heredities in these cases of inebriety, are the 
 complex border-land cases. They are persons whose ancestors 
 have been insane, epileptic, consumptives, criminals, pau- 
 pers, and had other forms of degeneration. Victims driven 
 along by a tide of degenerate heredity, which burst out in 
 varied forms and phases of diseases. This class are seen 
 among the very wealthy and the very poor. Fully one- 
 fourth of all inebriates are of this class, and their inebriety 
 is only another stage of profound degeneration in the march 
 to dissolution. In these cases there seems to be in certain 
 families a regular cycle of degenerative diseases. Thus in 
 one generation great eccentricity, genius, and a high order 
 of emotional development. Extreme religious zeal, or un- 
 reasonable skepticism, pioneers or martyrs for an idea, and 
 extremists in all matters. In the next generation, insanity, 
 inebriety, feeble-minded, or idiots. In the third generation, 
 paupers, criminals, tramps, epileptics, idiots, insanity, con- 
 sumption, and inebriety. In the fourth generation, they die 
 
GENERAL FACTS OF HEREDITY. 147 
 
 out, or may swing back to great genius, pioneers, and heroes, 
 or leaders of extreme movements. 
 
 In the study of a large number of cases of inebriates, a 
 physical and mental heredity will appear. Thus the children 
 of inebriates for one or two generations will be found to 
 have, as a rule, physical defects and deformities. Bad 
 shaped heads and bodies, an inharmonious development, 
 retarded or excessive growths, club feet, cleft palate, defec- 
 tive eyesight, great grossness of organization, or extreme 
 frailty of development. This can be seen in the observation 
 of almost anyone, and indicates the defective nutrition and 
 cell growth caused by injuries from alcohol transmitted to 
 the children. The mental heredity from inebriate parents 
 is equally clear and apparent to any close observation. 
 Mental instability, and mental feebleness are common signs. 
 Impulsive, excitable, emotional persons, who are on the two 
 extremes, either buoyed with great faith and hope, or 
 depressed to the verge of despair. Extravagant self-esteem, 
 boundless faith in the most absurd schemes of politics, 
 religion, and science. 
 
 Men and women who are called " border-liners," mean- 
 ing those whose good judgment and reason alternate back 
 and forth over the line where sanity and insanity join. 
 They are found in the great army of the irregulars, the 
 intellectual and moral quacks, the badly-balanced, and 
 weak, unstable mentality. Genius and precocity often 
 appear in these persons. They frequently come into 
 prominence like blazing comets, dazzling for a time, then 
 disappear in some cloud of insanity, inebriety, or other 
 disease. This mental heredity will be often seen in the per- 
 verted nutrient tastes of children, the impulsive appetites, 
 and dominant animal desires. With the very wealthy and 
 very poor, these signs of alcoholic heritage are prominent. 
 One of the reasons is the excessive nutrient stimulation 
 from excess of quality and quantity of food, among the 
 
148 DISEASES OF INEBRIETY. 
 
 wealthy, and the opposite among the poor ; also the under- 
 work and overwork of those classes. 
 
 These are only hints and intimations along the shore of 
 a great continent of facts, which some future explorer will 
 reveal. It will be of interest to point out some of the 
 results which follow from alcoholic heredity. First, the 
 longevity is di?ninished. It is impossible for a generation 
 with' this entailment to have the same vigor to resist disease 
 and death. Exhaustive physical and intellectual exertion 
 is not repaired and overcome so readily, and death from 
 slight causes are more common. Thus exposure merges 
 into pneumonia, and other fatal conditions, more quickly 
 than in others without this entailment. 
 
 In epidemics of fevers and other diseases these children 
 of alcoholic parents, and inebriates themselves, die first. 
 The}^ die from injury, shock, strain, worry, and care. In 
 brief, this alcoholic legacy from ancestors means a short- 
 ened life, an early death, from varied insignificant causes 
 and general incapacity to bear the strains and drains of 
 the ordinary activities of life. Second, by a wise limita- 
 tion of nature the race with this heritage must die out. 
 Only by a prudent ingrafting and marriage with a healthier 
 stock can it be continued into the future. A family with 
 this heritage is on the road to extinction, it is switched 
 on a side track, and is moving on a down-grade of rap- 
 idly increasing degeneration. Nature seems to often make 
 an effort to put on the brakes and check the speed in 
 some remarkable fecundity. 
 
 Thus in these degenerate families you will often see 
 a great number of children who, as a rule, exhibit many of 
 the defects of the parents, and are short lived. 
 
 The large families of children in inebriate parents may 
 be taken as a hint of the approach of extinction for that 
 race. In the same way, great genius in certain directions, 
 as for instance a poet, an orator, an inventor, or a reformer, 
 starting far away above the levels of his ancestors and sur- 
 
GENERAL FACTS OF HEREDITY. 149 
 
 roundings, are often the last members of families far down 
 towards tlie rapids that precede the final plunge into obliv- 
 ion, like the flicker of a lamp bursting into full blaze before 
 extinction. Third^ where this alcoholic heredity is re- 
 tarded or accelerated by the union with different currents 
 of heredity, very strange compounds are the result. Thus, 
 if to this alcoholic heredity are united a heritage of insanity 
 idiocy, or any other pronounced defective influence, all 
 grades of criminals, paupers, and mixed insanities follow. 
 While most of these defects are apparent to ordinary obser- 
 vation, yet there is a class of defectives springing from tliis 
 soil which may be termed moral paralytics, which will be 
 the subject of bitter controversy in psychological circles in 
 the near future. Along this frontier line the great questions 
 of free will and moral responsibility must be settled. The 
 injury from alcohol first numbs, then finally paralyzes the 
 higher brain forces, which includes all the moral elements. 
 This paralysis goes down into the next generation as a con- 
 genital deformity, a retarded growth, in the same way tliiit 
 in some families cross-eyes, hare-lip, defective hands or 
 legs, are seen in every generation. This form of heredity 
 produces criminals of tlie most dangerous type ; men and 
 women born without any consciousness of duty, of right 
 and wrong, of obligation to live a moral, consistent life. 
 From these mixed heredities some central brain region has 
 become malformed and degenerate, and tlie victim is with- 
 out power to change or comprehend the normal relations 
 of mental or moral life. Many of these persons occupy 
 places of wealth and influence in societ\\ holding positions 
 of honor and respect, by force of surroundings and absence 
 of opportunity to reveal their incapacity to follow lives of 
 truth and justice. . . . 
 
 If this subject is seen liigher up, other and more start- 
 ling conclusions appear. First, this heredity from alco- 
 hol is intensijied and increased by the misapplication of the 
 educational forces of to-day. The highest culture of the best 
 
150 DISEASES OF INEBKIETT. 
 
 colleges, applied without regard to the natural capacity of 
 the individual, and along unphysioiogical lines, must clear- 
 ly unfits and destroys him. Often this higiier culture is 
 abnormal stimulation and growth, particularly for the 
 entailments of past generations. 
 
 First of all, the educational systems do not alwciys 
 build up healthy brain and nerve force. Seco?id, they ignore 
 all heredity, and influences of food, climate, surround- 
 ings, and natural capacity and the result is that abnor- 
 mal impulses are intensified in certain directions, and 
 the power of control is diminished in a positive substratum 
 of exhaustion from which chere is no relief. The highest 
 modern culture applied indiscriminately to children of 
 inebriates, will result in tlieir ruin as positively as any 
 degree of ignorance. This is seen in the inordinate self- 
 esteem, feeble common sense, unstable will power, extrava- 
 gant idealities, and general mental dyspepsia of many col- 
 lege graduates. In actual life the college graduate who 
 has an alcoholic heredity, and is an inebriate, is more incur- 
 able than his brother who has never had a college culture. 
 It has been truly said that ignorance will give more promise 
 of longevity, and a final triumph over this heredity than the 
 highest indiscriminate culture of to-day. 
 
 Another view reveals the fact that the present legal methods to 
 restrain inebriety, and the result of alcoholic heredity, pro- 
 duce results exactly opposite. Thus the army of inebriates 
 and irregulars of this family group are held accountable as 
 healthy, responsible beings, and confined in most dangerous 
 mental and physical surroundings, actually intensifying 
 their defects and removing them farther from all hope of 
 recovery. The police courts and jails are to inebriates 
 literal training stations, for mustering in armies that never 
 desert or leave the ranks until crushed out forever. A 
 Chinese law, enacted a thousand years ago, and in force 
 to-day, contains a flash of truth. When a criminal comes 
 before the courts, careful inquiry is made into his ancestry. 
 
GENERAL FACTS OF HEREDITY. 151 
 
 If they are found to have any of the traits common to the 
 prisoner he is killed and they are punished. His death ends 
 all possibility of transmitted crime, and their punishment 
 and recorded history puts a clieck on any farther propaga- 
 tion of the evil. Common law and public opinion are far 
 behind the march of science in a practical knowledge of this 
 evil and the means to correct it. Not far away in the future 
 this terrible shadow will vanish before a larger, clearer intel- 
 ligence, and all our blind efforts of to-day will be found to 
 be but a repetition of history — the stage of empiricism, 
 quackery, and superstition, which precedes every great 
 advance of humanity. From a highet' ;point of view, civiliza- 
 tion and the increasing complexities and changing conditions 
 increase this heritage. Thus every new^ invention which 
 changes the direction of human activities, brings greater 
 strain on the brain and nerve force, demanding new ener- 
 gies, which the alcoholic heredity victim cannot give. He 
 is unfitted and crippled for these new conditions of life by 
 his forefathers, left dismantled and without strength for the 
 race, and by that great law of our being is crushed out, 
 driven out, and crowded out in the struggle and survival of 
 the fittest. 
 
 One great fact comes out prominently in this outline re- 
 view, namely, that alcoholic heredity or a predisposition to 
 inebriety, and many other nerve and brain degenerations, 
 will certainly follow in the next generation from the moder- 
 ate or excessive use of spirits. Parents who do not recog- 
 nize this fact, practicall}', are committing unpardonable 
 sins, by crippling the coming generations and switching 
 them on the side-tracks, away from the main line of devel- 
 opment. 
 
 Another fact appears : education and marriage should 
 be governed by a knowledge of heredity. Education should 
 be detemined by the family physician, aud have for its ob- 
 ject to control and antagonize all the predisposition of he- 
 redity. Marriage sliould be under control of law, and from 
 
152 DISEASES OP INEBRIETY. 
 
 the judgment of the family pliysician. The time is coming 
 when every family will have its scientific medical advisers, 
 and these vital questions of heredity and practical life will 
 be determined from a scientific basis. Still another fact 
 comes up prominently. The great armies of the insane, 
 inebriates, criminals, and paupers are largely the doomed 
 victims of the sins of our forefathers. Our duty to them is 
 to house them, to protect them from perpetuating their 
 defects and injuring others. Science tells us that this 
 army of hereditary defectives are wards of the State, and 
 should be housed, quarantined, made self-supporting, and 
 forced into conditions of healthy living. The present indis- 
 criminate freedom of this class is a sad reflection on the 
 intelligence of this century. The study of alcohol heredity 
 furnislies not only the strongest reasons for total abstinence 
 in each person, but reveals the laws and forces which gov- 
 ern its march in each individual, revealing a wider range of 
 the subject. Along this line of heredity will be found the 
 practical solution of many of the mysteries and remedie-s of 
 this great drink problem. 
 
 In regard to the transmissibility of inebriety from 
 parents to offspring through different branches and gener- 
 ations, and its correlation with insanity, epilepsy, and other 
 nervous diseases, there is far less known, in spite of all that 
 has been written on the subject, than is needed to be 
 known. It is not the disease, it is the tendency to the dis- 
 ease that is inherited ; and this tendency is not transmitted 
 to all the children, but is liable to be transmitted to some 
 of them, and one form of nervous disease, as inebriety, in 
 one or both parents, may, in some of the cliildren or more 
 remote descendants, re-appear as epilepsy or insanity, or 
 hypochondriasis. There is a general tendency to disease 
 of the nervous system developed and fostered under our 
 modern civilization and institutions, which I call the nervous 
 diathesis, and which subdivides itself into various phases of 
 nervous disease, such as neuralgia, sick headache, spinal 
 
GENERAL FACTS OF HEREDITY. 153 
 
 and cerebral irritation, hysteria, and hypochondriasis, as 
 the hand brandies out into a tiiumb and fingers. 
 
 A pliilosophic study of the transmissibility of inebriety 
 requires tliat these otlier and allied disorders be studied in 
 connection with it, and studied in this way it would be 
 proved that in nearly all cases of inebriety, as in nearly all 
 cases of other and allied forms of nervous disease, there 
 was an inheritance of the nervous diathesis on one or 
 on both sides, and usually also an inheritance, through near 
 and remote relatives of some one of the various forms of 
 nervous disease that spring out of the nervous diathesis. 
 
 A similarly thorough investigation of nervous diseases 
 of an allied character would show if not as marked, yet a 
 very decided hereditary tendency in them all, and a con- 
 stant tendency likewise to interchange, reversion, and cor- 
 relation of the different manifestations of the nervous 
 diathesis. Thus hay fever in a parent may appear as 
 sick headache in one child, as epilepsy in another, as 
 insanity in another ; in a grandchild as inebriety, in a 
 nephew or niece as simple nervous exhaustion. 
 
CHAPTER XVII. 
 
 FURTHER CONSIDERATIONS OF HEREDITY. 
 
 Alcohol does not alone affect those who abuse it, but 
 afflicts more or less grave disorders upon their children. 
 Many books have been written on this topic, but heredity 
 in nervous diseases resembles so closely the symptoms of 
 alcoholic heredity, that the latter cannot always be distin- 
 guished. Another cause of obscurity is owing to tiie fact 
 that alcoholic excess does not necessarily come from alco- 
 holism, and that alcoholism can exist apart from alcoholic 
 excess. Alcoholism by itself in the ancestors does not neces- 
 sarily predicate heredity in the descendants. This requires 
 a whole group of symptoms. Many families in which 
 excess have happened escape alcoholism, for the reason 
 that a sufficient number of predispositions did not exist to 
 take on a morbid form. 
 
 Historically, alcoholic heredity was known since the 
 days of mythology. We are told that Vulcan lame was 
 conceived by Jupiter drunk. Diogenes, addressing a stupid 
 child, said : "Thy father was drunk when thy mother con- 
 ceived thee." Aristotle declared " that a drunken motlier 
 would produce drunken offspring." The legislation of Ly- 
 curgus promoted drunkenness in vanquished nations, that 
 it might extinguish patriotism. 
 
 The Carthagenian law prohibited any drink but water 
 on the day of cohabitation with one's wife. Numerous 
 ancient and modern authorities have repeatedly called atten- 
 tion to the serious and varied effects of parental drunken- 
 
156 DISEASES OF INEBRIETY. 
 
 ness in the offspring. The first serious study was by the 
 celebrated alienist Morel. He first defined the foundations 
 of alcoholic heredity. His successors have done no more 
 than develop what he had discovered. 
 
 There are admitted to be two general forms : First, the 
 homologous hereditary, or that of similitude. Second, 
 heredity of transformation, or eccentric heredity. In the 
 first form the progenitor gives to the descendant his ten- 
 den, y to alcohol, or symptoms of his alcoholism. In the 
 second form the alcoholized mental state of the progenitor 
 becomes transformed into the varied nervous disorders of 
 wiiich the body may develop. No alienist of to-day denies 
 this direct heredity. The examples are too frequent and 
 striking; but it must be remembered that heredity will 
 appear under the most varied forms. There is but little 
 agreement among authors about the frequency of its trans- 
 mission. Dr. Dodge claims that fifty per cent, of all inebri- 
 ates were hereditary. Dr. Bare believes that twenty-five 
 per cent, are inherited. Dr. Kerr thinks over fifty percent. 
 Dr. Magnan claims eighty per cent. Dr. Parrish eighty 
 per cent. Dr. Crothers eighty per cent. Dr. Day seventy 
 per cent. Dr. Mason sixty per cent. 
 
 The mere appetite for drink transmitted from the par- 
 ent to child presents so many varied aspects that it is diffi- 
 cult to define any exact law for its manifestation. It is not 
 rare to see it reproduced in the child with the same charac- 
 teristics as exhibited in the parents. As a general law, it 
 may be stated that hereditary alcoholism begins early, aug- 
 menting, reaching its climax, and showing its greatest 
 activity at manhood and at the menopause. Notwithstand- 
 ing what we have said, heredity does not always reveal 
 itself by this disordered appetite for drink. 
 
 Heredity not unfrequently shows itself by irritability 
 instability, and a vicious moral disposition, which seems to 
 place the sufferer under some burden to find an excitement 
 which will relieve him from his suffering. The laws of 
 
FUETHEK CONSIDERATIONS OF HEREDITY. 157 
 
 nerve and psycliopathic heredity govern heredity drunken- 
 ness. For this reason it may be mediate or immediate, 
 coming direct from parents or skipping several generations 
 in their descent. 
 
 Apart from the question whetlier strong drink produces 
 alcoholism or alciiolism produces a desire for strong drink, 
 it is certain that a variety of mental and nervous disorders 
 engenders a desire for strong drink. Unfortunately the 
 control of these cases is wholly unknown to us. Tiiis con- 
 stitutes the first variety of heredity of similitude, which is 
 the simple transmission of the defect from parent to child. 
 A second variety of the same form is more discussed. This 
 exhibits in the descendant symptoms of chronic alcoholism 
 witliout any accompanying alcoholic excess. It is well 
 ascertained that the drinker does not transmit the vice of 
 drinking, but tlie disease of alcoholism. Sensibility is di- 
 minislied in their descendants, and they have varied and 
 complex symptoms of complex nervous disorder. 
 
 The author cites two cases of the homiietic type, in 
 which various nervous symptoms were present, but does not 
 deem them marked typical cases. The heterotype form is 
 more easily defined. Numerous observations render it cer- 
 tain that epilepsy occurs under a reflex excitability produced 
 by alcoholic heredity. The same mother with a sober man 
 gives birth to healtliy children, and with a drunken man to 
 epileptic cliildren. Statistics prove tlie presence of epilepsy 
 in the children of drinking parents. Of eighty-tliree epilep- 
 tics, sixty have been traced to drinking parents. Youthful 
 convulsions are not less infrequent than epilepsy. In the 
 families of sixty alcoholics, there were one hnndred and 
 sixty-nine survivors, forty-eight of which experienced con- 
 vulsions in childhood. In the case of twenty-three non-al- 
 coholic families, having seventy-nine survivors, only ten had 
 convulsions in youth. 
 
 Another form of the heterotype order is seen in the hys- 
 teria and sensitive states of women. In men, under the 
 
158 DISEASES OF INEBRIETY. 
 
 name of nervosisme, it offers an infinite variety of symptoms. 
 A certain number of tliese nervous symptoms leave no 
 doubt of their alcoliolic origin. The digestive function is 
 especially the seat of these disorders, prominent of wliicli is 
 nervous dyspepsia, vomiting, hyperaesthesia, insomnia, 
 dreams, enfeebled muscular force, capricious character, and 
 so on. 
 
 The following clinical observations make this class more 
 clear : A laborer, witii alcoholic father, mother, and sister, 
 died of lung disease. He had convulsions in youth, is neu- 
 ralgic, has headaches, stomach troubles, and is weakly. 
 His character is unrestrained, imperious, and he has fears of 
 becoming insane. He drinks but little wine, because it dis- 
 agrees with him. B, a woman with an alcoholic father. 
 She has vomitings every few days, although her menses are 
 regular. For several years tliis dyspepsia is more pro- 
 nounced at the menstrual period. Goes often without eat- 
 ing, and has cramps of the stomach. Laughs and cries, and 
 is very emotional at times. Has a nervous laugh, and 
 neuralgia and analgesia all over the body. Sensibility to 
 heat and cold is gone, and the sense of taste and smell 
 greatly diminished. 
 
 These cases give only some symptoms of the varied nerve 
 troubles which follow from an alcoholic origin. Tliese 
 states represent a continual progression from a simple neuro- 
 pathic temperament to the most pronounced nervosisme. 
 With women this nervosity is revealed by more or less pro- 
 nounced symptoms of hysteria, unaccompanied by convul- 
 sive attacks. A third manifestation of alcoholic heredity is 
 impulsive madness, more rare than others. These are not 
 explained apart from hereditary taint. Often it is the 
 expression of an extended neuro-psychopathic condition. 
 The moral perversions and atrocious crimes often seen can 
 only be accounted for by the alcoliolic inheritance. In 
 addition to this and opposed to it is another form of mania, 
 consisting of a delirious obsession, which completely con- 
 
FURTHER CONSIDERATIONS OF HEREDITY. 159 
 
 trols the idea of the person, despite all his efforts to prevent 
 it. Its approach is known to the sufferer, but he cannot 
 deliver himself from it. It has only recently been described, 
 and should be considered a consequence of alcoholic ances- 
 try. 
 
 Krafft-Ebing describes two cases of this kind, both of 
 which had alcoholized fathers. One of these cases was a 
 work-woman. She was hysterical from youth ; once had 
 slight loss of consciousness ; the obsession approached 
 gradually and consisted of melancholy and religious terror, 
 with perplexities about dogmas. These culminated in a 
 conviction to abstain from all food and drink. From simple 
 mental weakness to absolute idiocy there are grades of 
 degeneration which can be ascribed to hereditary alcoholism. 
 These affections may be congenital and primitive, or con- 
 secutive, in the sense that the slightest cerebral derange- 
 ment will result in irreparable mental weakness. Lunier 
 thinks fifty per cent, of tiiose who exhibit moral imper- 
 fections are traceable to alcoholic forefathers. Beyond 
 the definite cerebral and psychical derangements which we 
 are acquainted with, there are many moral and intellectual 
 perversions which alcoholic ancestry fully explains. These 
 persons are the prey of moral degeneration inherited direct 
 from their parents. From youth they exhibit the worst 
 instincts, are cruel, vindictive, and quarrelsome. Their 
 delights are in witnessing suffering and tormenting others. 
 Later they are lazy, undisciplined, and vagabonds. Usually 
 it is impossible or very difficult to educate tliem, and the 
 period of puberty is the sign for throwing off all restraint. 
 Idleness, indecision, vagabondage, moral perversion, rest- 
 lessness, drink, and venereal impulses are their principal 
 characteristics. 
 
 These persons exhibit a wonderful precocity in develop- 
 ing the drink habit, resulting in alcoholism more danger- 
 ous from the fact of previous disposition to degeneration. 
 They end by falling into the instinctive moral manias, the 
 
160 DISEASES OF INEBRIETY. 
 
 existence among criminals, which has been so much dis- 
 cussed. These subjects usually pass through many jails 
 and prisons before ending in asylums. 
 
 Alcohol is even worse in its inflictions on the physical 
 nature than on the moral. Children of alcoholized parents 
 are nearly always timid, feeble, pale, bad nutrition, and 
 lessened vitality, making them an easy prey to attacks of 
 sickness. The muscular sytem is but little developed, and 
 they suffer from general imperfect growth in all directions. 
 One of the consequences of alcoholic heredity is the partial 
 and unequal development of the brain, amounting to gen- 
 eral or partial atrophy, unilateral, and accompanied by 
 cranial malformations. With the microcephalus the organic 
 development is incomplete, the cranium and superior region 
 of the head is asymetrical, the body hemiatrophical. 
 
 Another consequence of alcoholic degeneration is hydro- 
 cephalic, and also infantile paralysis. In another order of 
 observation it is found that alcohol heredity diminishes 
 fecundity and birth. Lippich has demonstrated that alco- 
 holized marriages produce two-tliirds less children than 
 among those who were temperate. There can be no doubt 
 that alcoholism affects the generative function of both sexes. 
 The testicles undergo degeneration in alcoholized persons. 
 The spermatic fluid shows this in the well-marked changes 
 it exhibits, robbing it of the vitality indispensable to con- 
 ception. The alcoholic cachexia, after it has attained suffi- 
 cient intensity, will produce this, although the organs may 
 not be themselves diseased. 
 
 Many examples of women are noted who have had chil- 
 dren by their first marriage, whose subsequent union was 
 barren with an alcoholized husband, and also the reverse. 
 Women may become sterile by alterations of the ovaries and 
 matrix, and abort before maturity. From this point of 
 view alcoholism in the mother is a more serious trouble 
 than in the father. 
 
CHAPTER XVIII. 
 
 STATISTICS OF HEREDITY AND OTHER CONSIDERATIONS. 
 
 Dr. Matthews gives the following statistics of heredity : 
 " The passion for alcoholic stimulants, if not reproduced 
 in the immediate descendants, may show itself in the suc- 
 cessive generations, and in all cases is the most prominent 
 factor in insanity, epilepsy, idiocy, hypochondria, hysteria, 
 neuralgia, nervous degeneration, and its kindred ailments — 
 often manifesting these maladies in a vicious circle — with 
 the effect of exhibiting insanity in one, epilepsy in another, 
 intemperance in a third, idiocy in a fourth, hypoq^iondria 
 in a fifth, hysteria in a sixth, and so on until the circle is 
 completed, each generation increasing in numbers, and 
 contributing in a direct ratio to the filling of our jails, pen- 
 itentiaries, inebriate asylums, insane retreats and poor- 
 houses. That this is not a conjectural statement the fol- 
 lowing facts will abundantly prove : In a Swedish asylum 
 it was found that 50 per cent, of the patients had been 
 addicted to the use of alcoholic beverages. After the 
 removal of the heavy tax on alcoholic drinks in Norway, 
 the percentage of increase during eleven years was : In 
 mania, 41 per cent. ; melancholia, 69 per cent. ; dementia, 
 25 per cent. ; and idiocy, 150 per cent. Of the last, 60 per 
 cent, were the children of drunken fathers and mothers. 
 In the insane hospital at Vienna, Austria, probably one of 
 the largest in the world, the superintendent informed me, 
 personally, that from 50 to 60 per cent, of the insanity was 
 due to spirituous liquors. This percentage in a country 
 
 161 
 
162 DISEASES OF INEBRIETY. 
 
 where it is claimed alcoholic drinks do no harm, is well 
 worth noticing. 
 
 In our own State insane asylum, of the now present in- 
 mates, numbering 364, 75 per cent, can be ascribed to habits 
 of intoxication, either on their part or that of their ancestors. 
 
 1 am also authorized in making the statement that fully 
 two-thirds of those persons requiring aid from city and Slate 
 are descendants of inebriate parents. In one of our promi- 
 nent lunatic asylums 637 cases were traced to intemperance 
 as the assignable cause of their insanity. The statistical 
 accounts of the State of New York give the following facts : 
 In the poor-house of Ontario county there were 113 inmates. 
 These, together witli their ancestors for three generations, 
 living and dead, represented 90 families, and in these fam- 
 ilies there were 168 dependents, 26 insane, 12 idiots, 103 
 inebriates. In Columbia county, 118 inmates, representing 
 114 families, had 143 dependents, 12 insane, 32 idiots, 127 
 inebriates. In Yates county, 32 inmates represented 26 
 families, of whom 59 had been dependent, 4 insane, 2 idiots, 
 and 31 inebriates. In Kings county, 1,876 inmates repre- 
 sented 1,668 families, 2,039 dependent, 755 insane, i-3 idiots, 
 and 973 inebriates. Herkimer county had 77 inmates, rep- 
 resenting 67 families, 128 dependents, 21 insane, 12 idiots, 
 and 64 inebriates. The total in the alm.s-houses of the State 
 was 12,614 inmates, who represented 10,161 families, whose 
 members for three generations, living and dead, had among 
 them 14,901 dependents, 4,968 insane, 844 idiots, and 8,863 
 inebriates. In round numbers, here are 10,000 families who 
 have produced 15,000 paupers, or 3 paupers for every 2 
 families — of insane, about i for every 2 families ; of insane, 
 inebriates, and idiots combined, about 15,000 or 3 to every 
 
 2 families." 
 
 Dr. Wright asks : Is there a form of inebriety allied to 
 those neuroses which mark a constitutional defect in nerve 
 balance, a defect, the conditions of which are transmissible 
 by heredity ? Some noted gentlemen deny the reality of 
 
STATISTICS OF HEREDITY. 163 
 
 the dipsomanical diathesis, and especially deny that such a 
 constitutional proclivity can be handed down from ancestry. 
 The real importance of the subject causes one to inquire 
 with a good deal of interest: "What do the highest 
 authorities say on these points ? The testimony of such 
 eminent physicians as Hughes, Parrish, Crothers, Mann, 
 Mason, and others in this country ; and Clouston, Mitchell, 
 Kerr, Peddie, Cameron, Carpenter, and a host of others in 
 Great Britain, any one of whom is fully competent to 
 decide on the merits of the question, and who have con- 
 scientiously studied inebriety for some years, will not be 
 taken. Their great interest in the subject might expose 
 them to the imputation of prejudice in viewing the facts. 
 Authorities who are supposed to contemplate scientific 
 principles through an atmosphere pure and uncolored by 
 sympathy, are the only ones who will be questioned. The 
 attempt will be made to show that if epilepsy, spasmodic 
 asthma, prolonged neuralgia, hysteria, suicidal melancholia 
 and the like, are constitutional diseases, then dipsomania, 
 or as it is called by some, inebriety, is also a constitutional 
 disease. 
 
 Morel, when speaking of the degeneration and final 
 extinction of a neurotic family strain, gives a history from 
 his own personal observation thus : " First generation — 
 immorality, depravity, alcoholic excess, and great moral 
 degradation in great-grandfather who was killed in a tavern 
 brawl. Second generation — hereditary drunkenness, mania- 
 cal attacks ending in general paralysis in grandfather. 
 Third generation — Sobriety, delusions of persecution, and 
 homicidal tendencies in father. Fourth generation — defective 
 intelligence, mania at sixteen ; transition to idiocy ; gener- 
 ative functions feeble ; sisters imbecile ; wife had a bastard 
 child of good constitution." When treating of heredity, 
 Maudsley divides the subject into three branches : ist, 
 heredity of the same form ; 2d, of allied form ; 3d, with 
 transformation of neurosis, as when the ancestral defect was 
 
164 DISEASES OF INEBRIETY. 
 
 simply a nervous disease. Of heredity of tlie same form, 
 this author says : " That is, when a person suffers from the 
 same kind of mental derangement as a parent, whicli he sel- 
 dom does, except in cases of suicide or dipsomania."' Dr. M. 
 says in another place : " This mingling and transformation 
 of neurosis which is observed sometimes in the individual, 
 is more plainly manifest when the history of the course of 
 nervous disease is traced through generations." The book 
 of inebriety is open everywhere and to everybod}'. But to 
 study its pages aright, particularly in respect to its habits 
 of descent through individuals and generations, the observer 
 himself must abide for a long series of years amongst one 
 and the same community of people. It is obvious that in 
 this way only can he study the facts respecting the influence 
 of alcohol upon individuals and upon families. 
 
 In the work already cited it is written : "With respect 
 to an individual's legacy from his parents, he inherits not 
 only their family nature . . . but something from their 
 individual characters, as these have been modified by their 
 sufferings and doings, their errors and achievements, their 
 development or their degradation." 
 
 Dr. Blandford {Insanity and its Treatjnenf, p. 139), speaks 
 as follows : "As I have said, the particular cliaracter of 
 the mania or melancholia depends on the constitution of 
 the individual, , . . and the same person may at one time 
 be maniacal and at another melancholic. It is true, we fre- 
 quently see the same form in successive generations, e. g., 
 suicidal melanchol}^ and hereditary drunkenness. He 
 teaches that- there is a vast number of cases whei'e the 
 descending form is different from its parent ; and that the 
 same form may, or may not, appear in posterity. The idea 
 that the hereditary transmission of different but inter- 
 changeable neurotic form is an indication of the insane 
 temperament is universal amongst alienists. Tliat "alco- 
 holism is more liable to produce epilepsy, or idiocy, than to 
 repeat itself," places alcoholism (or inebriety) at once 
 
STATISTICS OF HEREDITY. 165 
 
 amongst the hereditary and insane neuroses. " Hence, I 
 believe springs the ever renewed insanity inebriety of our 
 lower classes . , . My opinion is, that amongst the lower 
 classes of our countrymen, insanity is on the increase. . . . 
 There is a degree of drunkenness among the lower classes 
 of this country that is not found in the higher. . . . The 
 amount of drunkenness is enormous, and is almost confined 
 to the lower orders — below the shopkeeper class." 
 
 This is placing habitual drunkenness, or rather the 
 neurotic mood which craves intoxication, very closely in 
 alliance with those neurotic states which immediately inter- 
 change with true insanity, it does indeed classify them 
 together as one family. The intense desire for intoxication 
 which is distinctive of the dipsomaniac, appears to issue 
 from some unstable or abnormal state of the brain, as other 
 lawless and unmanageable nervous symptoms frequently 
 do, speaking of the influence of parentage in impressing a 
 morbid diathesis upon posterity, uses this language : "The 
 causes of insanity may come into operation at the period of 
 conception. We should expect this a priori, and experience 
 appears to prove it. We allude more especially to the case 
 of a parent begetting children when drunk." 
 
 " When mental disease is transmitted, does the form of 
 insanity descend ? Very frequently this appears to be the 
 case," says Dr. Tuke. The doctor then proceeds to give 
 examples from various authorities of the direct descent, 
 from ancestry to posterity, of hallucinations, monomania, 
 melancholia, mania, general paralysis, and idiocy ; and 
 then he adds upon his own authority : " Of dipsomania, 
 the cases are so common that it is not necessary to detail 
 any examples." Dr. Tuke gives a table " Exhibiting the 
 proportion of hereditary cases /;/ the different forms of 
 insanity, observed in the Cricliton Institution, as reported 
 by Dr. Stewart." Mania descends as such in 51 per cent, 
 of cases ; melaneholia, 57 per cent. ; monomania, 49 per 
 cent. ; moral insanity, 50 per cent. ; idiocy and imbecility, 
 
166 DISEASES OF INEBRIETY. 
 
 36 per cent. ; dipsomtuiia, 63 per cent. ; general paralysis, 
 47 per cent. ; dementia and fatuity, 39 per cent. 
 
 Dr. Wynter says : "Among the more special forms of 
 moral perversity, or as the alienist physician would say, 
 insanity, which are transmitted by an insane parent, may 
 be mentioned dipsomania." Again, tiie same author 
 speaks of " the known fact that persistent drunkards plant 
 the seeds of insanity and the other allied diseases in the 
 offspring. Once planted there, the fruits may be diverse ; 
 in one, there may be persistent neuralgia ; in another, the 
 ancestral drunkenness may assume the form of dipsomania ; 
 while another may be affiliated with partial paralysis or 
 with epilepsy." 
 
 Dr. Forbes Winslow declares : " I maintain, and facts 
 clearly demonstrate my position, tiiat there is a vast 
 amount of crime committed by persons who occupy a kind 
 of neutral ground between positive mental derangement 
 and mental sanity. I do not support the dangerous 
 opinion that all crime is referable more or less to aber- 
 ration of mind, but I do affirm that in estimating the ^w^i^/z/ 
 of puJiishment to be awarded, it is the dut}'^ of the judge, not 
 only to look at the act itself, but to consider the physical 
 condition of the culprit, his education, moral advantages, 
 prior social condition, his early training, the temptations to 
 which he has been exposed, and, above all, whether he has 
 not sprung from intemperate, insane, idiotic, and criminal 
 parents." 
 
 Dipsomania is declared by authorities to be one of the 
 hereditary transmissible neuroses, wliich is interchangeable 
 with other neuroses that are undisputably allied to insanity. 
 Dipsomania is an aptitude for intoxication, but it is an apti- 
 tude that is not subject to rules or laws. It is pathological 
 for it is insatiable, unmanageable, in fact, an outlaw. 
 
 Dr. Elam asserted : " The offspring of the confirmed 
 drunkard will inherit either the original vice or some of its count- 
 less protean transformations^ 
 
STATISTICS OF HEREDITY. 167 
 
 Dr. Anstie affirms : " In the course of a large experi- 
 ence of alcoliolism among hospital out-patients, I have 
 been greatly struck witli the number of drinkers who have 
 informed me that their relatives eitlier on the paternal or 
 maternal side have been given to drink ; my own experi- 
 ence has led me to a firm conviction that particular causes of 
 nervous degeneration affecting individuals, do very fre- 
 quently lead to the transmission to the offspring of those 
 persons of an enfeebled nervous organization which ren- 
 ders them peculiarly liable to the severer neurosis and 
 which also makes them facile victims of tlie temptations to 
 seek oblivion for their mental and bodily pains in narcotic 
 indulgence. I believe that things often work in a vicious 
 circle to this end, and that the nervous enfeeblement pro- 
 duced in an ancestor by great excesses in drink, is repro- 
 duced in his various descendants with tlie effect of produc- 
 ing insanity in one, epilepsy in another, neuralgia in a 
 third, alcoholic excesses in a fourtli, and so on. Among the 
 higher classes, where it is easier than in the case of the poor 
 to obtain tolerably complete family histories extending 
 over two or three generations, careful inquiry elicit facts of 
 this kind with surprising frequency. So strong is the im- 
 pression left on my mind by what I have observed in this 
 direction, that I am inclined to believe that the great ma- 
 jority of most inveterate and hopeless cases of alcoholic 
 excesses among the higher classes are produced by two 
 factors, of which the least important is the circumstance of 
 external momentary temptation, in which the person has 
 been placed where the more momentous and mighty canse is 
 derived from an inherited nervous weakness, which renders 
 all kinds of bodily and mental trouble specially hard to be 
 borne. 
 
 Dr. Wright says : " Observation teaches no lesson more 
 clearly, unmistakably and universally, than tlie absolute 
 certainty of heredity. Nothing escapes it — neither the 
 slightest physical formation or movement, nor the faintest 
 
168 DISEASES OF INEBRIETY. 
 
 hint of a mental or moral impulse. Race propagation is 
 simply the handing down of the salient features of one gen- 
 eration to succeeding ones. There is no necessary progres- 
 sion, deterioration, or change. But heredit}^, in its highest 
 sense, is particularly concerned and exact in transmitting 
 an immense number of personal cliaract^eristics derived 
 from the innumerable associations, good, bad and indiflfer- 
 ent, that have been connected viMth individual existence. 
 
 " The main features of humanity are one and unvarying ; 
 but the acquired " peculiarities " of families, and especially 
 of individuals, are the reflections of the possibilities of 
 human life. They measure the capabilities and the defects 
 of man's nature, as they are susceptible of development by 
 personal contact with the ever-changing situations, and the 
 endless accidents of time. To the descent by heredity of 
 the acquired characterics of individuals in varying forms, 
 and by unnumbered vicarious substitutions, we owe the 
 strength as well as the weakness of the race. The poten- 
 tialities of humanity, exhibited in the beauty of one, the 
 eloquence of another, the artistic genius of another, the 
 fortitude and patriotism and unselfishness of others, illus- 
 trate and also demonstrate the existence in the human race 
 of qualities far greater and more glorious than the highest 
 achievements of minds merely symmetrical can possibly 
 evince. These potentialities are the outcome of personal 
 traits formulated in individuals by contact with the experi- 
 ences of life, and transmitted in endless variety of combina- 
 tion and form by the power of heredity." 
 
 Dr. Kerr : " This heredity may be regarded as two-fold. 
 There is the direct alcoholic inheritance. That drunkards 
 beget drunkards is an axiom dating from very early times. 
 There are also large numbers of children born with an 
 inherited and extremely delicate susceptibility to the 
 narcotizing action of alcoholic intoxicants, whose parents 
 were not in the habit of getting drunk, but drank regularly 
 
STATISTICS OF HEKEDITr. 169 
 
 and freely, physiologically intemperate, though considered 
 by the world to be models of sobriety. 
 
 " There is also the indirect inheritance of alcohol. Under 
 this category are ranged individuals who have no special 
 proclivity to excess, who have no direct though latent 
 proneness to inebriety, but who are weighted from their 
 birth by a controlling power too feeble to stay the advances 
 of alcohol within their very being. Alcohol, if it gain an 
 entrance into such constitutions by however tiny an inlet, 
 slowly yet steadily widens the aperture by increasing in 
 volume, as the dykes built to resist the encroaches of the 
 ocean, till all the defenses are swept away by the over- 
 powering and overwhelming flood. In no inconsiderable 
 proportion of cases this defective power of control is the 
 product of alcoholic indulgence on the part of one or both 
 parents. 
 
 " I have seen the alcoholic habit in the parent bear diverse 
 fruit in the persons of the offspring, one sister being ner- 
 vous, excitable, and inebriate, a second consumptive, a 
 third insane ; one brother an epileptic and a periodic 
 inebriate, the second in an asylum, the third a victim to 
 chronic inebriety. In another instance, where all the four 
 children have become habitual drunkards, the grandfather 
 had also been addicted to excess. 
 
 " The heredity is sometimes crossed. The daughters of a 
 drinking father, and the sons of a drinking mother may be 
 the only children affected with the inebriate taint, 
 
 " The heredity may be either insane or inebriate. As 
 inebriate parents not unseldom beget insane offspring, so 
 from insane parentage we sometimes get inebriate children. 
 The heredity may be of some other type. Any transmitted 
 disease or effect of disease which increases nervous sus- 
 ceptibility, unduly exhausts nerve strength, and weakens 
 control, may bear a nervine crop, in the form of asthma in 
 one child, hysteria in another, epilepsy in another, idiocy in 
 another, and inebriety in another," 
 
170 DISEASES OF INEBRIETY. 
 
 Dr. Dacaiene concludes an exliaustive study as follows: 
 
 " ist. Under tlie name liereditary alcoholism is included 
 the totality of tlie pathological manifestations transmitted 
 to a child by one or the other of his parents who are drink- 
 ers, and sometimes both. 
 
 " 2d. The inheritor of this taint, as well as the drinker 
 himself, can hand down not only his own vice, but a special 
 morbid tendency, a particular neuropathic state, which can 
 always be charged to inebriety. 
 
 "3d. The alcoholic inheritance may at first be dormant. 
 When it exists it shows itself in infancy, or later, or in 
 another generation. It shows itself as congenital paralysis, 
 convulsions, epilepsy, hypochondriasis, idiocy, etc. 
 
 * 4th. The increase in the number of the insane, of the 
 number of suicides, of crimes and misdemeanors, such are 
 the results of hereditary alcoholism. 
 
 "5th. It is in hereditary alcoholism that can be found 
 the explanation of certain monsters who come from time to 
 time to horrify society and scandalize the courts of law. 
 
 " 6th. These degenerate beings are smitten with sexual 
 impotence. T!ie female inebriate is apt to abort, and lastly 
 the mortality of the newly-born among drinkers reaches a 
 figure truly frightful. 
 
 " 7th. It has often been proved that in the case of drink- 
 ers, there is a loss in stature and physical force. 
 
 " 8th. To sum up hereditary alcoholism as well as the 
 acquired, determines an enfeeblement of the species, the 
 destruction of the family, and the degeneration and abase- 
 ment of the race. 
 
 "9th. From amedio-Iegal point of view, the hereditary 
 inebriate, in particular the dypsomaniac, should be regard- 
 ed most of the time as irresponsible, or at least his respon- 
 sibility should be regarded as very limited. He is a sick 
 man, who should be cared for, remembering that he presents 
 an undeniable propensity to sickness, that he possesses a 
 defective intellectual organization, in a word that he is a 
 
STATISTICS OF INEBEIETY. 171 
 
 degenerate. If the moral sense has not completely disap- 
 peared in his case, at least its use is not accurately regula- 
 ted. The judge then ought to take into account this moral 
 state in appreciating Iiis acts. 
 
 Dr. Lykke, Copenhagen, has shown clearly that heredity 
 is a powerful factor in the origin of dipsomania. He 
 indicated that psychical abnormities in the parents are 
 developed in the next generation, and that if an improve- 
 ment of the morbid condition is not attained by inter- 
 marriage, the result will be complete degeneration. One 
 of the prominent symptoms of such degeneration is a lack 
 of moral capacity, and the preponderance of ungovernable 
 instincts and dipsomaniac tendencies. Hence he supposes 
 dipsomania to be a symptom of hereditary degeneration or 
 insanity. 
 
 Briihl Cramer, from a long examination of this subject, 
 concludes that drunken parents are seldom prolific, and 
 when so, the children are stupid, malicious, and full of 
 mental defects. Skae and Thompson have both made deep 
 researches into the hereditary disposition. The cases which 
 they examined were largely of the mixed form of dipso- 
 mania, and all sliowed decided tendencies to insanity. 
 Skae found in eighty-two, thirty-two cases of inherited 
 dipsomania. In the parents of the cliildren of the collateral 
 branches, he found drunkenness, dipsomania, suicide, and 
 other mental diseases. Thompson found in twenty cases, 
 nineteen in which inebriety was clearly inherited. Many of 
 these families containing two, four, and eight members, 
 were all either drunken, epileptic or insane. In three 
 families which I have studied, where both parents were 
 drunken and insane, every single member following suf- 
 fered from mental defects, of which epilepsy, dipsomania, 
 and suicide were most common. 
 
 All authors agree tiiat heredity is the prominent cause 
 in the etiology of dipsomania ; but they disagree as to the 
 place it should occupy in the nosology, and whether it 
 
172 DISEASES OP INEBRIETY. 
 
 should be considered as a principal disease or only as a 
 symptom. It is clear that insanity and nervous diseases 
 develop into dipsomania in the next generation, and vice- 
 versa. The intimate relation between these diseases is evi- 
 dent. 
 
CHAPTER XIX. 
 
 GENERAL CONSIDERATIONS OF THE PATHOLOGY OF 
 INEBRIETY. 
 
 When a considerable portion of alcohol is consumed at 
 one time by a person perfectly sober, certain characteristic 
 appearances will usually be observed to follow immediately. 
 There is a decided shock throughout the whole system. 
 The face will often be very pale. This will be more notice- 
 able in nervous and sensitive persons. The muscles of the 
 face will be drawn, and fixed in position. The eyes will be 
 bright and glittering, while their movements will be quick 
 and constrained. The mouth will be firmly shut ; but when 
 an effort is made to speak, the lips will be spasmodically 
 affected. The breath will be short and panting, the pulse 
 accelerated, and the articulation interrupted and difficult. 
 The entire body will be affected by a trembling movement 
 and a sensation of shivering. In fact, there will be a brief 
 nervous chill. All these features appear at one and the 
 same time. The period of their duration is very short, how- 
 ever. After the lapse of five or ten minutes at most, the 
 second stage, characteristic of heavy drinking, will come into 
 view. Movements will appear unnatural, and very quickly 
 will seem absolutely distorted and staggering. Intellectual 
 activity, also, will speedily appear both irregular and 
 unsteady. The voice very likely will be elevated, and an 
 incessant chatter of speech, laden with absurd boasting, 
 will din the ear. The brim of the hat will perhaps be 
 
 173 
 
174 DISEASES OF INEBRIETY. 
 
 thrown upward, or the hat itself placed upon the side of 
 the head, or thrown backward, revealing the noble forehead. 
 Indeed, the conditions are now all present for a full display 
 of aggressive vulgarity and foolishness. 
 
 The ruffianly instincts being aroused by alcohol, the 
 garb of the ruffian is put on. For truly it is a fact, that 
 when a man, being sober himself, arranges his attire like 
 that of a rowdy, as thrusting his pantaloons inside his boot 
 tops, turning upward the brim of his hat both in front and 
 behind, and tying a handkerchief loosely about his neck — 
 he will begin to feel like a rowdy, and to act like one. He 
 will, perchance, stick his fists down deep into his pockets, 
 while, possibly, he pours forth profanity and tobacco-juice 
 in equal volumes. 
 
 This description, of course, is not of universal applica- 
 tion. In different persons there are considerable modifica- 
 tions in these particulars, owing partly to peculiarities of 
 individual constitutions, and partly to the kind of alcohol 
 contained in the liquor that has been taken. But, let the 
 constitutional disposition be what it may, the full drink of 
 alcoholic liquor will induce displays in movement, mind, 
 and morals, that are unwortiiy of the individual : and, the 
 liquor being the same, these displays will, in a given indi- 
 vidual, always be practically the same. 
 
 Differences in the kind of alcohol will doubtless occasion 
 considerable difference in the conduct of those who indulge 
 in the alcoholic habit. Dr. Norman Kerr, in his very able 
 work on Inebriety, says : "All alcohols are poisonous. 
 The least poisonous are the alcohols of wine. More poison- 
 ous are the alcohols of beet-root. Still more deadly are 
 the alcohols of corn (all kinds of grain) ; and the most 
 potent and pestiferous are the alcohols from potatoes. 
 Cider inebriates are usually more heavy and stupid than 
 alert and offensive. Amylic alcohol is nearly four times as 
 poisonous as ethylic." Amylic alcohol quickly brings on 
 muscular tremors and delirium tremens — whereas the 
 
PATHOLOGY OF INEBRIETY. 175 
 
 ethylic does not readily produce such effects, if it does at 
 all. It is therefore perceived that while there is a sameness 
 in the physiognomy of conduct under the influence of alco- 
 hol, tliere is likewise a certain difference in details, in 
 accordance with the particular kind of alcohol that is taken, 
 A drunken man will not be of so unruly and satanic tem- 
 per after partaking of wine, or of stronger drink derivetl 
 from wine, as he will after partaking of beet or potato 
 whiske}' ; and he will come out of his drunken state more 
 quickly, and witli less distress in the former than in the 
 latter contingency. 
 
 There are many persons who drink alcoholic liquors with- 
 out any driving impulse to intoxication. It is a common 
 belief tiiat alcohol adds to the natural powers of the organ- 
 ism ; and hence, alcohol is frequently taken in order that, 
 tiirough an intensified capacity, ends may be secured that 
 would otherwise be impossible. In this respect, the occa- 
 sional drunkard is to be distinguished from the spasmodic 
 or impulsive drunkard, whose whole aim is to secure intox- 
 ication for its own sake, and also to secure it quickly and 
 completely. 
 
 Drinking fro7n association. — There are many persons who 
 drink alcoholic liquors only as accidental contingencies and 
 opportunities offer. They do not purposely seek the means 
 of intoxication. The motives which actuate them in drink- 
 ing are wholly derived from circumstances external to 
 themselves and which are truly fortuitous. Yet the occa- 
 ssional drinker cannot be said to be devoid of even strong 
 motives for his indulgence. Sometimes a man will drink 
 alcoholic liquor simply because he happens to be in com- 
 pany with others who are drinking. The natural, but occa- 
 sionally idle sympathy, which is so apt to bind men together 
 in a common course of conduct, is sufficiently powerful to 
 lead to a community of action, even in the matter of drink- 
 ing liquors. Such cause for drinking may be operative on 
 public days, or in companies that are engaged in enterprises 
 
176 DISEASES OF INEBRIETY. 
 
 wherein there is unity of feeling and purpose — and, of 
 course, good fellowship — as, at log-rollings, barn-raisings, 
 and the like. 
 
 Drinking from this cause is not apt to lead to very seri- 
 ous consequences. It is true, however, that if there is any 
 considerable constitutional irritability of nerve in an indi- 
 vidual, even an accidental indulgence may ignite a flame 
 tliat can never be extinguished ; and in this way the occa- 
 sional drinker ma}'^ become an habitual drunkard. 
 
 The pleasurable sensations of early drunkenness are not 
 so pronounced in the occasional drinker as they are apt to 
 be in tlie spasmodic inebriate. This migiit be expected 
 when it is remembered that an exquisite sense of mental 
 and physical delight is one of the ruling inducements to 
 frequent intoxication — that is, to intoxication for its own 
 sake. In a stolid mind, rage and hate are not unlikely to 
 be aroused by alcohol, instead of generosity and good 
 temper. 
 
 Misfortunes^ either domestic or in business, often lead to 
 drinking. The benumbing influence of tlie alcoholic potion 
 renders callous the distressed mind and quivering nerve. 
 It is not always for excitement that alcohol is taken into 
 the system. It is sometimes taken to secure repose ; and 
 tliis repose is simply paralysis, more or less complete. In 
 the paralysis of sensation, pain is abated ; in the paralysis 
 of the co-ordinating nerve centers, moral and sympathetic 
 afflictions no longer harass the mind. Alcohol is a com- 
 plete remedy ; for the paralysis of alcohol extends through- 
 out the whole body. It is seen in the motor system 
 through the staggering gait, the imperfect articulations, the 
 distorted countenance. It is perceived in the organs of 
 sensation through the general numbness and the absence 
 of the sense of feeling. The intellectual powers exhibit 
 the paralyzing properties of alcohol, through confusion of 
 mind, distortions in ideas, and in the irregular operations 
 of the imagination. The same paralysis is seen in the 
 
PATHOLOGY OF INEBRIETY. 177 
 
 moral sense through the loss of that sense, and the inflow 
 of untruthfulness, deceit, and prevarication. 
 
 A deatli in the family is followed sometimes by deep 
 potations on the part of the survivors, with the object of 
 inducing a forgetfulness or partial unconsciousness of 
 trouble. Yet the time thus consumed is expended in vain. 
 It cannot serve to shorten the period which truly is requisite 
 to assuage the intensity of sorrow. In truth, when this 
 drunkenness has passed away, the poisoned nerves are in a 
 pitiable state of excitement and tremor, much greater than 
 oppressed them in the first place. With renewed distress 
 and intensified grief, the mind is compelled to await all the 
 longer for consolation and repose. It is in this condition 
 of mind and nerve — after drinking is abated — when some- 
 times suicide is invoked to vanquish once for all the com- 
 bined horrors of grief and intemperance. 
 
 Alcohol iniwked to increase the power of physical endurance. — ■ 
 The casual drinker takes alcoholic liquors oftentimes with 
 the view of increasing the powers of bodily endurance. The 
 acuteness of the feelings being subdued by the nervous tor- 
 por superinduced by alcohol, the sensations of cold and heat 
 are not keenly presented to the mind. Yet this fact does 
 not give the physical organism any immunity from the 
 extreme effects of changes in the temperature. Experience 
 has shown that persons exposed to cold, wet, and fatigue, 
 sustain themselves much better without alcohol than with 
 it. The truth is, that alcohol reduces the temperature of 
 the human body, as the thermometer fully demonstrates. 
 Therefore, the drunken man perishes from cold more readily 
 than the sober man. For, not only does alcohol abstract 
 oxygen, the source of heat, from the blood, and thus reduce 
 the fires of ordinary physiological combustion, but it 
 benumbs and paralyzes certain nerve centers, whose office it 
 is to preside over the regulation of animal heat. As a 
 remedy in violent fevers, alcohol is extensively used for 
 reducing the dangerous heat of the blood. As a trickster 
 
178 DISEASES OF INEBRIETY. 
 
 and fraud, nothing can exceed alcohol, if indeed, it can be 
 equaled. He who relies upon alcohol to warm him when 
 cold is cheated and deceived. 
 
 Alcohol as sustaining muscular efficiency. — Men frequently 
 take ardent spirits with the notion that it will increase the 
 bodily strength. The professional athlete, however, who 
 understands the subject, will carefully avoid alcohol when 
 upon the verge of action. There are several sound reasons 
 for this, (a) The benumbing effect of alcohol upon the 
 nervous powers is universal. It includes the muscular sys- 
 tem in common with all others. The readiness of muscular 
 contraction — its exact concord of action throughout the 
 whole of its substance, and the completeness of its move- 
 ment, all depend upon the natural strength, quickness, and 
 sharpness of the nervous influence whicii is brought into 
 play. But this influence is dwarfed and minimized by the 
 paralyzing impression of alcohol, (b) The heart in intoxi- 
 cation is thrown into increased action to the extent that the 
 additional duties which very great muscular effort would 
 impose upon it, are too great for its capacity, (c) The 
 lungs refuse the breath requisite to extraordinary muscular 
 effort when a man is drunk ; for in drunkenness they have 
 a double duty to perform. They are busy, not only in 
 exhaling the alcoholic poison, but also in disposing of 
 the deleterious material ordinarily thrown out by them. 
 Consequently, when uncommon muscular effort throws 
 upon them an excessive volume of blood, they are unable 
 properly to dispose of it. The man speedily gets out of 
 breath, and is compelled to moderate his efforts. 
 
 The base ball player is sadly deficient when under the 
 influence of liquor. He cannot judge correctly with respect 
 to distance, nor tell the true direction or velocity of a fly- 
 ing ball. He can neither catch nor throw with his usual 
 accuracv. His eyes are wanting in alertness of action, if 
 not in correctness of vision. His movements and his judg- 
 ment are equally at fault. The disabling powers of the 
 
PATHOLOGY OF INEBRIETY. 179 
 
 alcoholic potion are plainly displayed in the destruction of 
 the normal relationship whicli should exist between the 
 great divisions of human nature — mind and body. The 
 perceptive faculties, as observed through the operations of 
 common sensation and the sense of sight, are benumbed, 
 while the muscular alacrity answering the calls of volition 
 and judgment is absent. In brief, the atlilete has not vol- 
 untary control of his muscular powers when under the 
 dominion of alcohol, for paralysis, in whatever degree it 
 exists, withdraws function in a corresponding degree from 
 volition. Yet alcohol is wonderfully complicated as well 
 as positive in its activities — volition itself being dull and 
 paralyzed as well as the muscular system. 
 
 Similar considerations are applicable to almost all ath- 
 letic or muscular exercises. The swordsman and the 
 pugilist must possess not only a steady but a correct nerve. 
 It is indispensable to success that the eye and the hand be 
 untrammeled and alert, but they should also be in exact 
 harmony with each other in quickness of perception and 
 movement. The details should be right, and the great 
 movements of the system, which combine the details, should 
 be unimpeded. The prize fighter knows the fact that the 
 universal dullness of nerve wrought upon the organism by 
 alcohol is fatal to his efforts for victory. It is amazing to 
 see the absolute confidence with which a person under 
 alcoholic influence views his powers, when the knowledge 
 of the disabilities imposed by it are not recognized. In 
 him, all the nagging asperities of nervous activity have dis- 
 appeared. Nothing seems impossible to the transcendent 
 egoism of a drunken man. The very suggestion of unfit- 
 ness or mistake is scouted by him. Equally unable to fore- 
 see, or appreciate difficulties, he has no faith in their 
 existence. 
 
 One A , a physician of ability, while considerably 
 
 intoxicated, was handling a pistol, and accidentally dis- 
 charged it. The ball flew near his wife's head, and shat- 
 
180 DISEASES OF INEBRIETY. 
 
 tered a looking-glass behind her. He was astonished 
 exceedingly, and, with respect to this matter, he remains so 
 to this day. His confidence in the absolute infallibility of 
 his care and caution was simply impregnable — as it is, 
 indeed, in every man who is drunk. Yet in this very thing 
 he was terribly deceived and beguiled by alcohol. The 
 sense of feeling in his hand was benumbed. He grasped 
 the pistol with more force, and pressed upon the trigger 
 more firmly, than he had any idea of, by reason of his 
 impaired sense of feeling. The truth is, the confident 
 approach of a drunken man is always amazing. His sense 
 of feeling is dulled, and he seizes the person of another 
 in a rude manner. His grasp is painful because it is vio- 
 lent. The inebriate unconsciously exerts considerable force 
 in his movements, in order to feel that he is really in con- 
 tact with tilings or persons exterior to him. In the case of 
 A , in whose liands the pistol was discharged, the har- 
 mony of action between the eye and hand was deranged, 
 through deadening of the nervous sensibility. The con- 
 sequence was that, what he supposed was a normal com- 
 munity of action between distant, but auxiliary parts, was 
 an unnatural and inharmonious relationship. It was in 
 obedience to that unrecognized condition, affecting alike 
 mind and sensation, that the explosion took place, and not 
 from a condition thoroughly regular and under the control 
 of volition. 
 
 How often has a drunken man had cause to bless his 
 "good luck," when a gun went off without dealing death, 
 while in his hands ; and how often again, has regret and 
 remorse followed him through life, because some weapon 
 has been accidentally fired by his awkward and trembling 
 movements — maiming, or possibly killing some friend or 
 companion. 
 
 A young man, Samuel L , recently shot a female 
 
 companion through the head, killing her instantly. They 
 were both partially intoxicated. The pistol was of cheap 
 
PATHOLOGY OF INEBRIETY. 181 
 
 pattern, and was very unreliable about the trigger. The 
 shooting was claimed to be an accident. The young man 
 was no doubt in a state of more or less muscular incapacity. 
 Testimony was given that in handling a pistol by a person 
 drunk, it would more likely to be accidentally discharged 
 than it would be in the hands of the same person when 
 sober. Although in this case other facts pointed to mur- 
 der, yet such a plea in defense might have been perfectly 
 good and proper. 
 
 A drunken man cannot dance. It does not require a 
 very considerable degree of intoxication to disable a person 
 for dancing. Anything which requires a community of 
 action amongst a number of muscles — an3'tliing which is in 
 the line of auxiliary aid, or help in muscular actions, is an 
 utter impossibility for the individual who is intoxicated. 
 Yet, if there is a person in the world who thinks he can 
 exhibit the consummation of grace, ease, and eclat in danc- 
 ing, it is the man who is drunk. 
 
 In consequence of the inequality of alcoliolic paralysis, 
 even on the muscular system itself, the really drunken indi- 
 vidual moves as though he was about to fall in pieces. The 
 inebriate dancer would probably miOve off in sections or 
 separate parts, were it not that his physical body is securely 
 fastened togetiier in spite of himself. The want of l)armony 
 between mind and body, often present, also, no doubt, dis- 
 ables the drunken dancer. Sometimes the muscles act 
 tolerably well in the intoxicated individual, while his mind 
 and will may be in a state of sad confusion. At other times 
 hi5 mind may be fairly clear, while he is limp and helpless 
 on his legs. 
 
 The musician and the actor likewise fail in the exercise 
 of their callings when intoxicated. The actor is totally 
 unable to depict character by facial expression. The 
 muscles of his countenance are withdrawn from voluntary 
 control. The feature he wants to supply will not come at 
 his bidding — it is something else, something quite different, 
 
182 DISEASES OF INEBRIETY. 
 
 and yet he is not conscious of the fact. He is deceived by 
 the power of alcohol, and resents the obtuseness and unfair- 
 ness of his critics. 
 
 The effects of alcohol upon the body of even the casual 
 drinker are always those of a traitor — they always betray. 
 The steadiness and tone of nerve which seem to follow from 
 its use aie only indications of paralysis and insensibility 
 which, deceiving the mind, lure the unwary drinker into 
 danger and disgrace. 
 
 The late Dr. Jewell gives the following description, 
 which applies in many cases of inebriety : " There is a real, 
 pervasive nutritive lesion of nerve structure in neurasthenia. 
 Waste has morbidly preponderated over repair. The nerv- 
 ous system becomes lean. This involves, necessarily, loss of 
 power and undue sensitiveness or "shakiness " of the nerv- 
 ous system. It is more easily excited than when healthy, 
 and the excitement when once produced radiates farther, 
 and endures longer, than in health. This state or physical 
 condition of the nerve structures differs in degree in various 
 cases or at different times in the same case, from a very 
 slight exhaustion to that which is the most profound. It 
 may extend to the whole nervous system or to only a small 
 part of it, or, if to all parts, unequally so to different parts. 
 It may be in part hereditary, or it maybe acquired. It may 
 affect chiefly the bodily functions, or it may affect chiefly 
 the mental functions, as in some cases of melancholia, or it 
 may involve both at the same time in varying ways and pro- 
 portions, as often happens. 
 
 There is another condition of neurasthenia which I wish 
 tp place distinctly before you. It consists in a morbidly 
 fluctuating blood-supply to tlie affected parts of the nervous 
 system. The nutritive lesion described seems always to 
 involve an unsteady circulation of blood in the part which 
 has suffered. Especially is the blood-supply likely to 
 fluctuate rapidly, from a too free and tumultuous supply for 
 healthy nutrition, down to a partial anaemia. Nutrition in 
 
PATHOLOGY OF INEBRIETY. 183 
 
 the part in question is therefore irregular and unreliable. 
 Hence nervous action is unsteady and unreliable. The 
 condition of the walls of the blood-vessels themselves, and 
 of the local vaso-motor mechanisms which control them, in 
 the diseased nervous centres, is much the same as that of 
 the worn nerve elements in the midst of which they are. 
 The local vaso-motor apparatus become worn and ex- 
 hausted, and the muscular walls of ttie vessels in the seat 
 of disease lose their tonus in a measure, and give way 
 before any increase in the blood-pressure with abnormal 
 ease, and this is one of the cliief conditions of a fluctuating 
 circulation of blood in the diseased nervous centres. When 
 it is known how sensitive are the higher nervous centres to 
 changes in the pressure and quantity of the blood circulating 
 in them, it will not be difficult to understand how rapid and 
 extreme fluctuations in blood-suppl}' may give rise to many 
 symptoms, varying according to the function of the part 
 which is the seat of the disorder. 
 
CHAPTER XX. 
 
 PATHOLOGICAL CHANGES IN ALCOHOLIC INEBRIETY. 
 
 If we consider the serum of the blood in the habitual 
 drunkard as an alcoholized fluid, and that alcohol existing 
 in a certain percentage in the serum acts not only upon the 
 serum of the blood but also upon its anatomical elements, 
 we have a condition that modifies nutrition, producing met- 
 amorphosis and degeneration of tissue. If, in connection 
 with this, we add the fact that alcohol, J>er se, is anarcothie 
 irritant, producing modification as well as degeneration of 
 tissue independent of blood changes, we have an additional 
 reason to regard alcohol as a disease-producing agent. 
 
 We have, then, to study the pathological effects produced 
 by alcohol on the blood from two standpoints : 
 
 First. — As to its effect on the blood itself. 
 
 Second. — The direct effect of the alcohol in the alcohol- 
 ized blood or serum upon the tissues of the body. 
 
 It would be of interest to determine to what extent the 
 serum of the blood can take up alcohol. That it does so, 
 in common with the other fluids of the body, there can be 
 no doubt. Blood taken from an habitual drunkard, and 
 exposed to heat, will give off the fumes of alcohol. At 
 autopsies on drunkards, the fluid in the ventricles of the 
 brain has been ignited with a match. 
 
 There is good reason to warrant the conclusion that not 
 only the serum of the blood, but also the fluid of the ventri- 
 cles and the cerebro-spinal fluid, in the case of habitual 
 drunkards, contain alcohol to a greater or less extent, in 
 some cases probably as much as is compatible with life. A 
 
 185 
 
186 DISEASES OF INEBRIETY. 
 
 series of chemical analyses, to determine the average per- 
 centage of alcohol in the blood of habitual drunkards, 
 would be of extreme interest. The blood in such a con- 
 dition has not only its nutritive qualities very much impaired 
 and its oxygenation and circulation retarded, but as a build- 
 er up of tissue it must be very inferior to normal blood ; 
 in fact, it is a disintegrator of tissue. The urine of the habit- 
 ual drunkard contains a certain percentage of alcohol. The 
 application of heat or the proper chemical tests for alcohol, 
 if applied, prove this. Indeed, if we test tlie urine of an 
 abstainer within a reasonable time after he has taken alco- 
 hol, the chromic acid test will show the characteristic reac- 
 tion. The effort to prove that the milk of nursing mothers 
 using beer or other alcoholic beverages did not contain 
 alcohol, has resulted in failure. The toxic effect on the 
 infant is shown in the moderate alcohol coma it experiences 
 after nursing, and where the mother was intoxicated, the 
 convulsions that ensued. 
 
 The experience of M. Lallemand, Duroy, and Perrin 
 seemed to demonstrate that alcohol received into the body 
 was eliminated by the lungs, the kidneys, and the skin, com- 
 pletely and as alcohol, and that if it was retained in the 
 tissues it was not transformed. The experiments of Anstie, 
 on the other hand, disprove this. "While a certain propor- 
 tion of the alcohol injested is excreted by the lungs, 
 kidneys, and skin, a certain proportion is broken up in the 
 blood and transformed into some otlier substance, prob- 
 ably aldehyde," just as aldehyde shortly after its adminis- 
 tration is transformed in the blood into acetic acid. But 
 this does not weaken the practical fact that alcohol is 
 present in all the fluids of the body, passes through all 
 the excretory organs, acts directly upon the nervous 
 system and other tissues of the body, producing its delete- 
 rious effects either as alcohol or some transformation of it 
 equally pernicious. The degeneration and alteration of 
 tissue in chronic alcoholism is due to the following causes : 
 
PATHOLOGICAL CHANGES IN ALCOHOLIC INEBRIETY. 187 
 
 First. An impoverished, alcoliolized blood, imperfect 
 in its oxygenation and retarded in its circulation, and, con- 
 sequently, producing mal-nutrition. 
 
 Second. The direct irritating effects of alcohol contained 
 in said blood. 
 
 Third. Tlie degenerating effects of alcohol on the nerv- 
 ous centers, producing vaso-motor paralysis and impaired 
 reflex action. 
 
 The latter is regarded by some writers as the primal 
 and most potent cause of general alcoholic degeneration. 
 The principal tissue changes in chronic alcoholism are falty, 
 fibroid, and atrophic. 
 
 The most marked examples of alcoholic fibrosis are 
 found in the lungs, kidney, and liver. 
 
 In the lungs, as alcoholic phthisis, a chronic interstitial 
 pneumonia ; in the liver is cirrhosed, gin, or hobnail liver ; 
 in the kidney as cirrhotic, hard, or contracted kidney. 
 These fibroid changes are slow, may take years to form, 
 but they are rapid in the latter stage. In syphilis we may 
 resolve a gumma or modify the lesions of the tertiary stage. 
 In pulmonary tuberculosis we may be fortunate enough to 
 secure cicatrization of cavities, or hold the disease in check; 
 but the lesions of chronic alcoholism are progressive, and, 
 when once fully established, irremediable, whether in the 
 lungs, kidney, or liver. 
 
 The effect of chronic alcoholism on the generative func- 
 tions in both sexes is instructive and interesting. 
 
 " Lippich has demonstrated that alcoholized marriages 
 1 roduce two-thirds less children than among those who 
 were lemperate. There can be no doubt that alcoholism 
 affects the generative function of both sexes. The testicles 
 undergo degeneration in alcoholized persons. The sper- 
 matic fluid shows this in the well marked changes it 
 exhibits, robbing of the vitality indispensible to concep- 
 tion." 
 
 "The alcoholic cachexia after it has attained sufficient 
 
188 DISEASES OP INEBRIETY. 
 
 intensity, will produce this, although the organs themselves 
 may not be diseased. Many examples of women are noted 
 who have had children by their first marriage whose subse- 
 quent union was barren with an alcoholized husband, and 
 also the reverse. Women may become sterile by altera- 
 tions of the ovaries and matrix, and abort before maternity. 
 From this point of view alcoliolism is a more serious 
 trouble in the mother than in the father." 
 
 Drs. Mairet and Combernal recently presented some 
 experiments on the hereditary influence of alcohol before 
 the Academy of Sciences of Paris. 
 
 A healthy bitch was made a chronic alcoholic, and gave 
 birth to twelve puppies ; two were still-born, three died b}'^ 
 accident, and the remaining seven died of epileptic attacks, 
 enteritis, pulmonary and peritoneal tuberculosis. The 
 lesions found at the post-mortems were thickening of the 
 bones, fatty degeneration of the liver, adhesion of the dura- 
 mater, and other marked alcoholic changes. 
 
 A strong bitch was kept intoxicated on absinthe the last 
 three weeks of gestation. Six puppies were born ; three 
 died at birth ; two were of defective intelligence ; one grew 
 up, but was defective in intelligence and nervous organiza- 
 tion. This one was coupled with a healthy dog ; of this 
 union three puppies were born ; one died of marasmus, 
 the other two were congenitally defective, having atrophy 
 of hind legs. One of the conclusions drawn was that the 
 degeneration from alcohol was more prominent in the 
 second generation than the first ; also that alcohol used by 
 the mother always produced defective offspring. 
 
 A point of interest in this connection is the etiology of 
 dipsomania. The best authorities now agree that, while 
 exceptionally dipsomania may arise from traumatism or 
 alcoholism, the great majority of cases are traced to an 
 insane or intemperate parent or parents. It is a hereditary, 
 not an acquired neurosis. 
 
 It will be of interest to record further the results of 
 
PATHOLOGICAL CHANGES IN ALCOHOLIC INEBKIETT. 189 
 
 chronic alcoholism in the lower animals, produced by 
 experimenters with the view of determining the pathologi- 
 cal lesions of alcohol. And none have been more zealous 
 than the French in this direction ; and of these investigators 
 none more prominent or painstaking than M, Magnan, 
 
 " M. Tardieu has found meningeal haemorrhages in per- 
 sons dying in a state of intoxication. These are less fre- 
 quent in animals, and this is the reason why pachymenin- 
 gitis due to the prolonged action of alcohol is rarer in ani- 
 mals than in man." 
 
 Magnan. — "That in dogs, even at the end of two months 
 of alcoholic poisoning, the liver undergoes fatty degenera- 
 tion. A microscopic section shows the cells have lost form, 
 are swollen, round, infiltrated with granules and drops of 
 fat." 
 
 M. Pupier notes the effect on a fowl to which absinthe 
 had been given as a drink ten months. " The liver is hard, 
 resistant, lessened in volume, has irregularities on its two 
 surfaces, numerous whitish depressions, the intermediate 
 parts of a reddish brown color. The microscope shows 
 dilatation of vessels at periphery of lobules, filled with gran- 
 ules ; extreme compression and degeneration of hepatic 
 cells." 
 
 In another experiment a fowl was subjected to the 
 action of red wine for ten months. " The liver is of a clear 
 yellow color, soft, pasty, and oils the blade of the scalpel. 
 Microscope shows cells enlarged and rounder than normal, 
 filled with granules resembling those in parencliymatous 
 inflammation at its beginning ; here and there large fat 
 drops." 
 
 A fowl was given white wine under similar conditions. 
 "The liver is of good color, but is shriveled on its lower 
 surface and borders. Microscope shows dilatatiorfi of vessels, 
 which appear three or four times the normal size when 
 compared vvitli the cells which have undergone atrophic 
 degeneration. A rabbit was subjected to alcohol. The 
 
190 DISEASES OF INEBRIETY. 
 
 liver shows nothing as regards capillary net-work ; the cells 
 are altered and contain two or three nuclei ; around bile 
 ducts there is an increase of connective-tissue nuclei. M. 
 Pupier concludes that absinthe affects primarily the stroma 
 without producing new connective tissue or sclerosis of 
 walls of vessels. This marked new growth has not been con- 
 firmed. As for red and white wine and alcohol, their 
 injurious effect is seen rather in the plasma and hepatic 
 parenchyma," 
 
 Alcohol would seem to produce hepatic steatosis, but 
 not to the exclusion of sclerosis. 
 
 A prolonged period of alcoholic intoxication, and conse- 
 quent irritation, might provoke sclerosis. In the same ani- 
 mal, with fatty degeneration of liver, are found irritative 
 lesions, such as pachymeningitis, sclerosis of posterior col- 
 umns of spinal cord, thickening and opacity of arachnoid 
 and pia mater, milky patches in pericardium — all these at 
 the same time. 
 
 "The kidneys, like the liver, undergo beginning fatty 
 degeneration. The surface is smooth and even ; the 
 cortical substance and prolongation between the pyramids 
 of Malphigi show a well-marked yellowish tint, with small 
 striations of a deeper color. The microscope shows tubuli, 
 slightly swollen, cloudy, filled with granular and fatty 
 epithelium." 
 
 M. Ruge mentions adhesion of capsule to renal substance 
 in four cases ; in three cases fatty degeneration of the heart. 
 Magnan has seen traces of pericarditis : " The coats of the 
 stomach in dogs who take alcohol mixed with food are not 
 ^ensibly thickened ; but the mucous membrane is injected, 
 rarely ulcerated." 
 
 When alcohol is taken without food, and directly injected 
 by oesophageal tube or by fistula, traces of violent gastritis 
 are seen ; in one case the stomach was shriveled and thick- 
 ened, and the surface of the reddish-brown mucous mem- 
 brane was H-ned with a layer of thick, sticky, glairy mucus, 
 
PATHOLOGICAL CHANGES IN ALCOHOLIC INEBRIETY, 191 
 
 Streaked with blood. On cleansing with a stream of water, 
 small ulcerations with irregular borders were seen ; in some 
 places cicatrices appeared as irregular grayish plates. In 
 the mucus were found infiltrations of blood, some in layers, 
 others in small spots. In the same dog, the cord is not in- 
 jected and appears normal ; a grayish tint is seen on the 
 posterior columns, more marked on lower third, where it 
 has the form of a triangle with the base directed backwards 
 on each side of the posterior median fissure ; in the same 
 locality a slight grayish tint in the anterior columns on 
 each side of commissure ; Magan lias noted the same con- 
 dition in a man where chronic alcoholism terminated in 
 general paralysis. 
 
 Kremiansky, in dogs who were given alcohol four weeks, 
 noticed pachymeningitis. 
 
 M. Neumann observed the same fact, but also that it 
 did not exist sometimes in a more prolonged use of alcohol. 
 Magnan found slight infiltration and slight thickening of 
 arachnoid and pia matei', but no false membranes of dura 
 mater. Others, slight dilatation of vessels of dura or 
 simple injection or oedema of pia. 
 
 This diversity is explained by Magnan as due in some 
 cases to a meningeal haemorrhage during drunkenness, a 
 haemorrhagic pachymeningitis ; but while this accounts for 
 the existence of new membranes in some dogs, Magnan 
 asserts " that pachymeningitis may come on without pre- 
 existing haemorrhage in certain nervous affections and 
 chronic alcoholism." 
 
 We have thus quoted extensively from these French 
 experimenters that others may be encouraged to follow 
 similar researches with regard to the " pathological effects 
 of alcohol " in animals, with the advantage of improved 
 pathological knowledge and modern appliances ; for these 
 investigations demonstrate not only that researches as to 
 the effects of alcohol can be satisfactorily conducted in the 
 lower animals, but they also corroborate what has been 
 
192 DISEASES OF INEBRIETY. 
 
 demonstrated to be the effects of clironic alcoholism on pro- 
 creation in the human species, as well as its other patholog- 
 ical effects. 
 
 Alcohol acts not only indirectly through the blood as an 
 irritant, provoking fibrosis or other tissue changes, "but on 
 tlie alimentary canal, particularly the stomach. The local 
 effects of habitual doses of concentrated alcohol are seen in 
 the permanent congestion of the blood vessels, exaggerated 
 or vitiated secretions from tiie gastric glands, and ulti- 
 mately a degenerative change in the structure of the sub- 
 mucous tissues, which consists in the disappearance of 
 characteristic secreting structures and hypertrophic exagger- 
 ation of fibrous tissues." 
 
 The effect of alcohol upon muscular or other tissue, pro- 
 ducing fatty degeneration, is similar in this respect to the 
 action of phosphorus, arsenic, or other poison. Fatty de- 
 generations of the pancreas from alcoholism shows " the 
 glandular parenchyma has partially or entirely disappeared ; 
 _it may be replaced by adipose tissue, which is developed in 
 the fibrous stroma of the organ around its vessels and 
 glandular ducts." In some instances the acini or charac- 
 teristic gland structure is lost entirely and replaced with 
 fatty tissue. 
 
 But the most marked evidence of the deteriorating 
 effects of alcohol is seen in its action on the nervous system. 
 "It is clear that the nervous centers, independently of the 
 ill effects on their nutrition of the blood changes, have a 
 certain chemical attraction for alcohol, which accordingly 
 is found in their tissue. 
 
 "The characteristic changes which have been observed 
 in the brain, medulla oblongata, etc., of confirmed drinkers, 
 consists essentially of a peculiar atrophic modification by 
 which the true elements of nervous tissue are partially re- 
 moved ; the total mass of nervous matter wastes, serous 
 fluid is effused into the ventricles and the arachnoid, while 
 simultaneously there is a marked development of fibrous 
 
PATHOLOGICAL CHANGES IN ALCOHOLIC INEBRIETY. 103 
 
 tissue, granular fat, and other elements which belong to a 
 low order of vitalized products." 
 
 From these conditions arise vaso-motor paralysis, with 
 all the results that follow a defective supply of blood and 
 an impaired circulation, tending to local stasis. Moreover, 
 if we exclude traumatism, there is not any disease of the 
 nervous system resulting from other causes than alcoholism, 
 at least with few exceptions, that alcohol cannot produce — 
 alcoholic neuritis, alcoholic anaesthesia, general paralysis, 
 serous apoplexy, etc., and those cerebral conditions from 
 which arise the acute and chronic forms of mental derange- 
 ment. The nerves of special sense are not exempt. " The 
 abuse of alcoholic stimulants has been said to be the cause 
 of amaurosis, and, as a proof of this, tlie fact has been 
 adduced that the affection has been arrested, or even cured, 
 by completely giving up the habit of drinking. Tliis much 
 is certain, that amblyopia occurs in great misproportiun 
 among habitual drinkers. It is generally first seen as night- 
 blindness, but soon becomes constant, and gray atrophy of 
 the nerve is recognized by the ophthalmoscope." (Pagen- 
 stecher.) 
 
 " One point of interest in this connection, relating to the 
 action of alcohol on the nervous system, is the theory 
 advanced by writers on this subject, and it is a very plaus- 
 ible one : that the degeneration of all tissue in cases of 
 alcoholism is due primarily to the action of alcohol on the 
 nervous centers, and through these, by vaso-motor disturb- 
 ance or impaired reflex action, upon the organs or tissues 
 which these nerve centers, or vessels influenced by them, 
 supply." But it would seem, while regarding this as the 
 prime cause of alcoholic degeneration, we could not ignore 
 the fact that the blood itself was a chronic alcoholism much 
 deteriorated as to its quality and retarded as to its circula- 
 tion, and, moreovei-, tiiat it contained a chemical irritant. 
 The limits of this paper will not permit us to consider in 
 detail all the pathological changes due to alcohol. It affects 
 
194 DISEASES OF INEBRIETY. 
 
 all the tissues of the body ; even the bones are not 
 exempt. 
 
 We have therefore generalized our statements and taken 
 a view over the whole field, rather than endeavored to carry 
 out and elaborate any special line of thought. Our object 
 has been to demonstrate that there is abundant material for 
 the pathologist and the microscopist to investigate, and a 
 neglected but nevertheless a rich field for medical research. 
 How little progress has been made in the study of the path- 
 ology of chronic alcoholism and the diseases incident to alco- 
 holism. 
 
 A general principle may be laid down that, whatever 
 tends to innutrition aims directly at that strength and bal- 
 ance of its forces, that coordination, so to speak, between its 
 peripheral and central portions, that it is needful for the 
 equable discharge of its multitudinous functions. Innutri- 
 tion, by lowering the vitality of the brain-cells, and dimin- 
 ishing the store of power held by the central ganglia from 
 the steady and well-timed responses to all the demands 
 upon them, into spasmodic, irregular, and insufficient sup- 
 plies of the force which it is tiieir province to furnish. But 
 alcohol especially promotes innutrition, and the very stimu- 
 lation which it produces is the surest evidence of its drain 
 upon those reserve forces, that exubei-ance of tlie central 
 nervous fund, that wealth of power which is indispensable to 
 the maintenance of the full vigor, of the constitution during 
 those brief and rare occasions when unforeseen circum- 
 stances shall make unusual demands upon them. 
 
 Nor is this exhaustion and innutrition all the evil which 
 alcohol works in the constitution. The blood and secre- 
 tions are vitiated and loaded with material foreign to their 
 normal constitution, and there is a universal departure 
 from that almost infinite delicacy of balance, resiliency of 
 the organization, which in the natural healthy state charac- 
 terizes its various portions, to say nothing of that depri- 
 vation of the higher spiritual nature which is the inevitable 
 
PATHOLOGICAL CHANGES IN ALCOHOLIC INEBRIETY. 195 
 
 concomitant of the habitual deviation from natural 
 metliocls which is forced upon it. Nor is this all of the 
 evil. How unreasonable it is to suppose that children 
 begotten of a parent during such exhaustion of the gangli- 
 onic force — during such prolonged vitiation of the blood 
 and secretions and the perversion of the intellectual and 
 moral forces — should not carry in their physical and spirit- 
 ual natures evidence of the outrage done to natural laws ! 
 
CHAPTER XXI. 
 
 GENERAL CONSIDERATIONS OF TREATMENT, PPfOGNOSES, 
 RESULTS, ETC. 
 
 Four conditions of cure must be observed. The first 
 condition of cure and reformation is abstinence. The 
 patient is being poisoned and the poisoning must be stopped. 
 Were it an arsenic instead of an alcohol no one would dis- 
 pute this ; so long as the drinking of intoxicants is indulged 
 in, so long will the bodily, mental, and moral mischief be 
 intensified and made permanent. Abstinence must be 
 absolute, and on no plea of fashion, of physic, or of religion, 
 ought the smallest quantity of an intoxicant be put to the 
 lips of the alcoholic slave. Alcohol is a material chemical 
 narcotic poison, and a mere slip fias, even in the most sol- 
 emn circumstances, been known to relight in the fiercest 
 intensity the drink crave which for a long period of years 
 had been dormant and unfelt. The second condition of 
 cure is to ascertain the predisposing and exciting causes of 
 inebriety, and to endeavor to remove these causes, which 
 may lie in some remote or deep-seated physical ailment. 
 The third condition of cure is to restore the physical and 
 mental tone. This can be done by appropriate medical 
 treatment, by fresh air and exercise, by nourishing and 
 digestible food given to reconstruct healthy bodily tissue 
 and brain cell, aided by intellectual, educational, and other 
 influences. Nowhere can these conditions of cure be so 
 effectually carried out as in an asylum where the unfortun- 
 ate victim of drink is placed in quarantine, treated with 
 suitable remedies until the alcohol is removed from his sys- 
 
 197 
 
198 DISEASES OF INEBRIETY. 
 
 tem, then surrounded by elevating influences, fed with a 
 nourishing and suitable diet, and supplied with skillful 
 medical treatment. His brain and nervous system will 
 then be gradually restored to its normal condition, and, 
 after a period of from six to twelve months in most cases, 
 he will be so far recovered as to be able to return to his 
 usual avocation and successfully resist his craving for 
 drink. 
 
 In the cttre of inebriety there is probably more agitation 
 and interest than ever before. The efforts of societies and 
 parties, of the pulpit and rostrum, with the increasing books 
 and papers from the press, have never been more active than 
 to-day. Yet reports show that inebriety is increasing, and 
 that more spirits are made and consumed every year. 
 
 All the temperance efforts and legal means for the cure 
 and prevention of inebriety are based on the theory that it is 
 a moral disorder which the victim can control at will, or a 
 wicked habit that he can continue or put away at his own 
 pleasure. This theory of inebriety is theoretical, and 
 embodies the same error which follows every new advance 
 of thought, namely, explaining all human action from some 
 moral or theological standpoint. Thus the phenomenon of 
 insanity was explained as a possession of tiie Devil, and the 
 victims were supposed to enter into a compact with evil 
 spirits, voluntarily. The remedy was severe punishment. 
 Public attention was occupied for ages in persecuting and 
 punishing the insane and epileptics on this tiieory of the 
 causation. Law, religion, government, and public senti- 
 ment, all failed in the cure and prevention by this means, 
 and these diseases went on unchecked, simply because the 
 real causes were unknown. 
 
 Inebriety is regarded in the same way as wickedness, and 
 the same means are urged as a remedy. Over five liun- 
 dred thousand inebriates were sent to jail in iSgi.and pun- 
 ished as willful and voluntary drunkards. Armies of 
 moralists and temperance people are pledging and praying 
 
GENERAL CONSIDERATIONS OF TREATMENT. 199 
 
 the inebriate to stop drinking, and exercise his will, and be 
 temperate and well again. 
 
 Yet all such efforts fail, and often tend to increase the 
 very condition which they seek to remedy. They fail 
 because they are based on a false assumption of the causes, 
 and not on any accurate study of tlie history or real con- 
 dition of the patient. A new era is dawning for the inebri- 
 ate. His diseased condition, and the need of special 
 medical care in special surroundings, is a truth that is 
 spreadingslowly and surely in all directions. Not faraway 
 in the future inebriety will be regarded as small-pox cases 
 are now in every community. The inebriate will be forced 
 to go into quarantine and be treated for his malady until 
 he recovers. The delusion that he can stop at will, because 
 he says so, will pass away. Public sentiment will not per- 
 mit the victim to grow into chronic stages ; the arhiy of 
 moderate and periodic drinkers will be forced to disappear, 
 and the saloons which they have supported will close in 
 obedience to a higher law than any prohibition sentiment. 
 
 Public sentiment will realize that every inebriate is not 
 only diseased, but dangerous to society, to himself, and all 
 his surroundings, and demand legal guardianship and re- 
 striction of personal liberty until he recovers. When these 
 poor victims realize that society will not tolerate their 
 presence or allow them personal liberty in this state, they 
 will seek help and aid before they reacli extreme stages. 
 
 This is the teaching of all modern science, — to check the 
 disease at the beginning, to seize the poor waif on the street 
 and the rich man's son, who are just at the beginning of 
 inebriety, and force them into conditions of health and sobri- 
 ety, to save the one from becoming a prey on society and a 
 burden to the producer and tax-payer, and the other from 
 destroying society and himself and leaving a tide of misery 
 and sorrow that will continue long after. When society 
 shall realize and act on these facts, the great centers of pau- 
 perism and criminality will be broken up. This will be 
 
200 DISEASES OF INEBRIETY. 
 
 accomplished by the establishment of work-house hospitals, 
 where the inebriate can be treated and restrained. Such 
 places must be located in the country, removed from large 
 cities and towns, and conducted on a military basis. They 
 must have all the best appliances and remedial means to 
 build up and restore the debilitated victim. They should 
 be military training hospitals, where all the surroundings 
 are under the exact care of the physician, and every condi- 
 tion of life is regulated with steady uniformity. 
 
 Besides the medicinal and hygienic treatment, there 
 should be educational and industrial training, and each one 
 should be 'employed, both in body and mind, every day. 
 He should be placed in a condition for the best culture and 
 building up of the entire man. Every defect of body and 
 mind should be antagonized and remedied as far as possible. 
 Each case sliould be an object of study to ascertain the real 
 state and the means to strengthen and improve it. These 
 hospitals should be built and conducted entirely from the 
 license fund or the taxes on the sale of spirits. They should, 
 in a large measure, be self-supporting from the labor of the 
 inmates, and independent of the tax-payers. These places 
 would most naturally divide into three distinct grades. The 
 first class of hospitals should be for recent cases, where the 
 inmates can be committed by the courts, or voluntarily com- 
 mit themselves for one or two years. The second class 
 should receive chronic cases for longer terms of treatment 
 — from one to three years. The third class should be for 
 the incurables, or those who give no reasonable promise of 
 restoration. The time should be from five to ten years and 
 life. 
 
 The latter class should be thoroughly organized into 
 military habits of life and work, and kept in the best con- 
 ditions of forced healthy living. Employment and mental 
 occupation should be carried out literally as a stimulus to 
 strengthen the body and mind. Where it was possible the 
 rewards of his labor, beyond a sum to pay for care, should 
 
GENERAL CONSIDEEATIONS OE TREATMENT. 201 
 
 be turned over to his family and friends or held in trust 
 for him. He should be encouraged to healthy work and 
 living by all possible means and surroundings. The semi- 
 chronic cases should be treated substantially the same way, 
 only occupation and training of the mind and body should 
 be more suited to the wants of each case. The amusements 
 should also be of a sanitary character. 
 
 The recent cases should have the same exact discipline, 
 filling the mind with new duties and new thoughts, and 
 suited to build up the exhausted, overworked man, as 
 well as the gormand and under-worked idler. All persons 
 should pay for their care if possible, and be required to 
 render some service which would be credited on their bills. 
 These hospitals should be literally quarantine stations, 
 where the inebriate can be housed and protected and 
 society saved from the losses following his career. 
 
 If ten thousand poor chronic inebriates could be taken 
 from New York and placed in such hospitals, and made self- 
 supporting, who could estimate the gain to society, to 
 morals, to the tax-payer, and to civilization ? This can and 
 will be done in the near future. If ten thousand semi-chronic 
 cases of inebriety could be taken from New York and 
 quarantined two or five years in such military hospitals, 
 and made to pay for their care by labor, who could estimate 
 how many would be returned to health and temperate liv- 
 ing again ? — who could estimate the relief from sorrow, 
 misery, wretchedness, and losses ? This will also be a 
 reality a little fartlier on. If ten thousand recent cases of 
 inebriety could be taken out of their surroundings in New 
 York and placed in these hospitals, where forced conditions 
 of the highest degree of health and vigor are maintained, 
 a large percentage would recover. The gain to society and 
 the world would be beyond all computation. Now each 
 one of these propositions and the practical working of a 
 military hospital is a reality, based on evidence constantly 
 accumulating. Every prison, penitentiary, or hospital, every 
 
202 DISEASES OF INEBEIETT. 
 
 asylum or home where inebriates come under care and 
 restraint bring such evidence. They show that such a 
 method of treatment, combining the varied experiences of 
 all these institutions can be made practical and is the only 
 scientific way of solving this problem. 
 
 To banish the still and saloon does not prevent inebriety 
 or cure the inebriate ; it only changes the direction of the 
 drink current. But quarantine the inebriate in a hospital, 
 as one suffering from contagious disease, and the victim is 
 cured, the spread of the disease is prevented, and a knowl- 
 edge of the causes ascertained, from wiiich the remedies 
 can be known and applied. To punish the inebriate as a 
 criminal cannot cure his inebriety, but it always unfits him 
 for living a temperate, healthy life hereafter. To attempt 
 a cure by faith and prayer is to depend on false hopes, the 
 failure of which is followed by increased degeneration. 
 To attempt any form of treatment without knowing any 
 other fact except that the victim drinks to excess is always 
 to blunder and fail. 
 
 The time has come to recognize the physical conditions 
 which enter into all cases of inebriety, and to apply exact 
 remedies along the line of nature's laws and forces. 
 
 The late Dr. Bellows, in an address delivered in 1858, 
 said : " Inebriates, like criminals and insane, will all be 
 eventually restrained in hospitals, and treated with medical 
 and psychological skill the moment their liberty becomes 
 dangerous to society. The terms of their confinement will 
 be limited only by the possibilities of cure and tiie con- 
 ditions of their disorder. Society gains nothing by holding 
 prisoner for an hour any man who is fit to be at large. 
 Liberty and human rights gain nothing by allowing anv 
 man to be at large for a moment who is destroying himself, 
 his family and his neighbors. What we need is what we 
 are fast gaining, namely, a possession of the tests and 
 gauges of the fitness and unfitness, and we shall be able to 
 
GENERAL CONSIDERATIONS OF TREATMENT. 203 
 
 treat the inebriate successfully the same as in other dis- 
 eases." 
 
 Sorne general idea of the details of treatment will be of 
 interest. In a hospital conducted on scientific common- 
 sense principles the patients are received for periods of not 
 less than three or six months. The patient signs a commit- 
 ment paper, and is examined by the physician, and all the 
 facts of his present and past condition noted. If intoxi- 
 cated he is placed in charge of a nurse and baths and 
 remedies given for his special condition. If sober he is 
 given a pleasant room and placed upon a regular diet, exact 
 conditions of living, and required to take such medicines, 
 baths, exercise, and general treatment as may be needed in 
 his case. Mental occupation, amusement, change of thought 
 and life in every particular are sought for. He is treated 
 as one u'ho has a profound disease of the brain and nervous 
 system, requiring rest, care, and removal from every source 
 of irritation and excitement. The question of responsibility 
 to aid the efforts of the hospital in his behalf is urged as a 
 S5'mptom of his capacity or incapacity to recover. The 
 asylum is a quarantine where he can recover, and his 
 liberty or restraint is governed by his condition. Wherever 
 congenial work can be added to the amusement it is done 
 as a medical aid. Every condition of life is controlled and 
 regulated, and every surrounding arranged to aid recovery. 
 Daily religious exercises, rides, walks, Turkish baths, and 
 exact methodical living, most naturally result in a degree 
 of strength and vigor that is very promising for the future. 
 To accomplish this the asylum must be pleasantly located, 
 the building must be cheerful and sunny, and adapted to 
 the work. The surroundings must be free from all sources 
 of irritation and unpleasantness, such as noise, excitement ; 
 and the management must seek to apply remedies to meet 
 the wants of every case. Thus, in some instances, sharp 
 restraint is a tonic remedy of value ; in others it is depress- 
 ing. In some cases nerve rest and regularity of living is of 
 
204 DISEASES OF INEBRIETY. 
 
 more value than all other things. The physician finds 
 from a study of each case a most bewildering complexity 
 of causes, beginning with heredity and including every- 
 thing which produces distinct strain or drain on the nerves 
 and brain. 
 
 The great object of all inebriate asylums is to practi- 
 cally quarantine the inebriate, where all the exciting causes 
 are removed, and every predisposing cause is antagonized, 
 and where the most favorable conditions for rest and build- 
 ing up can be secured. The remedies to aid in this 
 work are indicated by the special condition present, and 
 include all the nerve and brain tonics, the common property 
 of the profession. The physical remedies, are diet, baths, 
 exercise ; and the mental remedies, including mental occu- 
 pation, amusement, change of thougiit and mind, growth 
 out of the past, are all essential and equally valuable. 
 Restraint and freedom, rewards and punishment, appealing 
 to the will and ignoring it, etc. Rules and regulations for 
 every act of life ; few rules, which the patient applies him- 
 self, and so on, using the most diverse means which would 
 apply to the special need of each case. 
 
 The condition or disease to be treated is a profound 
 physical disordei", and the toxic use of alcohol is always a 
 symptom as well as a cause. The best efforts of science is 
 to break up this cause, and change the symptoms. The 
 defects continue, the man is permanently impaired. He may 
 go back to active life and do well, but ever after, as a rule, 
 the same range of causes will produce the results. 
 
 In a certain number of cases the drink impulse or 
 symptom seems to be permanently exiiausted after a time 
 like the exhaustion of the germ soil of some diseases, 
 and no exciting causes will develop the drink symptoms 
 again. Other defects may appear, but he never again uses 
 spirits. The germ soil has gone, it may be forever, or after 
 lapse of years it will return. 
 
 A period of six or twelve months in an asylum will re- 
 
GENERAL CONSIDERATIONS OF TREATMENT. 205 
 
 move the states of delirium which have kept up the use of 
 alcohol, and reveal an exhausted brain and nerve soil that 
 will not tolerate alcohol in any form after. The person sud- 
 denly realizes that alcohol is both poisonous and repelling 
 to his system. This may be so intense that should he take 
 any form of spirits by mistake it will produce intense nau- 
 sea and depression. In other cases the drink exhaustion 
 dies out after long years of abstinence, and should the pa- 
 tient relapse late in life, death follows soon after. A care- 
 ful study in an asylum often reveals these cases, and the 
 expert can safely predict a total or partial cure of the drink 
 symptoms and disorder, or its temporary suppression, only 
 to break out again. Another fact, not generally known, 
 appears to the asylum physician, namely the great uniform- 
 ity of the symptomology and progress of these cases. Be- 
 ginning at a certain point, or from certain range of causes, 
 they follow a uniform line of progress, which can often be 
 seen, traced, and predicted with certainty. 
 
 In an asylum the stage of progress can frequently be 
 seen, and means for its prevention or diversion can be 
 applied. In an asylum all tlie conditions of life can be reg- 
 ulated ; the food, the surroundings, the pei'iod of rest and 
 activity ; the mental states can be antagonized or prevent- 
 ed ; the local condition from which irritation is produced 
 can be removed ; the physical irritation which keeps up the 
 drink impulse is changed. The asylum treatment, like the 
 quarantine for contagious disease, isolates the victims from 
 all exciting and predisposing causes, and thus places him in 
 the best possible condition for returning health. Asylum 
 and medical treatment for the inebriate are most impera- 
 tively demanded, not only to save the victim, but to enable 
 us to understand some of the great underlying causes which 
 are active in precipitating so many men into this terrible 
 disease. 
 
 Primarily in the treatment we have shattered constitu- 
 tions, and broken-down nervous systems to deal with. We 
 
206 DISEASES OF INEBEIETY. 
 
 have a disease eminently marlced by weal^ening of the will- 
 power, and seclusion from society, rest, judicious restraint, 
 and enforced abstinence from ail alcohol stimuli are car- 
 dinal points of treatment. I always let patients, applying 
 to me for treatment, distinctly understand that a permanent 
 recovery depends largely on allowing sufficient time for 
 restoration of nerve-power, mental tone, and physical vigor, 
 and I think, in most cases, six months is the least time nec- 
 essary for a complete recuperation of the will-power. Dip- 
 somania is a disease that requires the most perfect disci- 
 pline, both moral and physical, if we expect a cure. Peri- 
 odical insanities are notably difficult to cure so that there 
 is no chance of a relapse, but we may reasonably expect an 
 ultimate cure if there is but little structural change in the 
 brain which has resulted from the course of inebriety. 
 
 The heart's action in dipsomaniacs is weak, often irreg- 
 ular, accompanied by palpitation. There is a loss of tone 
 in character, blunting of moral perceptions, impairment of 
 intellectual discrimination, and generally impairment of all 
 the mental faculties. There is very often an utter inability 
 to fix the mind on any one subject, or to follow up a train 
 of thought consecutively. We see periods of abnormal 
 cerebration ; an instantaneous abeyance of reason and 
 judgment ; a condition resembling an epileptic state, dur- 
 ing which period the inebriate may be actuated by mad, 
 ungovernable, or eccentric impulses ; a condition in which 
 disease has deprived him of the power of choice, and during 
 which states, in my opinion, the inebriate is as little respon- 
 sible for his actions as is a person suffering from any other 
 phase of mental disease. I knew a gentleman of high 
 social standing in this city who has these mental blanks, 
 during which time he rides up and down New York in a 
 horse-car, aimlessly, and has no recollection afterward of 
 having done this at all. 
 
 These are very interesting cases from a medico-legal 
 point of view. In these cases the healthy coordination of 
 
GENERAL CONSIDERATIONS OF TREATMENT. 207 
 
 ideas is destroyed for the time, and tlie patient need not be 
 alcoholized to liave such states occur. In cases of inebriety 
 or dipsomania we liave to deal with the results of a toxic 
 poison, and we may have various complications proceeding 
 from the abuse of alcoliol, such as cirrhosis of the liver, 
 gastritis, epilepsy, various forms of dyspepsia, and in some 
 cases with Bright's disease. We may also find a simple 
 hypertrophy of the left ventricle of the heart, and degen- 
 erated arteries. Our patient must have cheerful, tranquil, 
 and pleasant surroundings ; all cerebral excitement must be 
 repressed ; sleep must be procured ; plenty of nourishing, 
 easily digested food administered at sliort intervals, and an 
 abundance of fresh air and exercise. I am not in favor of 
 much meat in tlie diet list. Certainly none at all, except at 
 dinner, and I think a strict diet list, so that the work of the 
 liver and kidneys is diminished by lessening the amount of 
 highly nitrogenized food and of the hydro-carbons, gives 
 decidedly the best result. Fish, oysters, and fruits that con- 
 tain sugar, the green vegetables, bread, wheaten meal, and 
 oatmeal are all permissible. Potatoes should be eaten 
 somewhat sparingly, and eggs also. Poultry and the white 
 meats are well borne. Beef and mutton are not so well 
 borne, and are contra-indicated, except at dinner. 
 
 Exercise in the open air is indispensable. The action of 
 the skin must be stimulated, and systematic skin friction 
 w^ith cold sponge or shower baths do much good. Also 
 the Turkish bath is useful. The natural saline mineral 
 waters are the best to stimulate excretory action by the 
 abdominal organs. The Hunyadi-Janos, Friedrichshall 
 vi^ater, and Saratoga Congress water are the best, while foi' 
 diuretic waters, Saratoga Vichy and Apollinaris water arc 
 the best. 
 
 We have a worn, irritable condition of the nervous 
 system in inebriates, an unstable condition as regards its 
 nutrition, its solidity, and its perfection of structure. We 
 must supply the greatest amount of nutritive material to the 
 
208 DISEASES OF INEBRIETY. 
 
 brain and nervous system to repair the existing nutritive 
 lesion. We must supply the phosphates in some way, the 
 many eligible preparations containing them being familiar 
 to you all. All abnormal nervous excitability must be 
 quieted, and our patient kept calm and tranquil. A pro- 
 longed warm bath at night, followed by the administration 
 of one teaspoonful of the ammoniated tincture of lupuline, 
 or of a pill of camphor, ext. hyoscyamus, and pulv. digitalis 
 will often quiet the nervous excitability. 
 
 Care must be given to the excretory functions of the 
 skin, kidneys, and bowels. If there is headache and drow- 
 siness, such diuretics as the liq. ammoniac acetat., w'ith spt. 
 nitric ether are indicated. Indian hemp has proved itself 
 in my hands a valuable adjunct, in doses of X gr. of the 
 extract, as required. A very valuable sedative mixture is 
 one composed of 30 grains of bromide of sodium and 30 
 minims of tinct. of cannabis indica prepared with water, at 
 the time required. It induces calmness and tranquility, and 
 can be repeated thrice daily, if required, without the loss 
 either of flesh or appetite. One of our most valuable remedial 
 agents in inebriety is phosphorous, which I always give in 
 i-ioo to 1-25 gr. doses in cod liver oil after meals. Cod 
 liver oil is one of the best nutritive remedies, as fat must 
 be applied to the nutrition of the nervous system if this is 
 to be maintained in its organic integrity. The general 
 effects of phosphorous are those of a stimulant, but it pos- 
 sesses a special power over the exhausted nervous system. 
 It is perhaps evanescent in its effects, but is never followed 
 by a stage of depression wdiich is noticable. It should 
 never be ordered upon an empty stomach. A pill of iron, 
 phosphorous, zinc, and strychnia is also very useful, and 
 combinations are often more beneficial than the medicines 
 when taken singly, 
 
 A large percentage of all cases of inebriety, before 
 admission into our institutions for the cure of inebriety, 
 have passed through the primary and acute stages, and liav^ 
 
GENERAL CONSIDERATIONS OF TREATMENT. 209 
 
 probably been subjected to medical treatment. This fact 
 must never be lost sight of in forming our opinion, not only 
 of the nature of the disease itself, but of the medical treat- 
 ment necessary for its cure. We often discover that the 
 dipsomania has been allowed to exist and slowly progress 
 for a considerable period, no treatment, either medical or 
 moral, having been adopted for its removal. 
 
 The most simple classification of inebriety, the one best 
 adapted for useful and practical purposes, is its division into 
 the acute, periodic, and chronic forms. The acute form is the 
 rarest, and is ushered in by exhausting diseases, or excessive 
 sexual excess. The periodic form is much more frequent, 
 and it is to this form of inebriety that I would recommend 
 the term dipsomania to be restricted. It is frequently 
 hereditary, like all insanities, and strictly periodic in its 
 paroxysms. These patients — dipsomaniacs — may abstain 
 for weeks or months, and may during this interval positively 
 dislike stimulants. 
 
 The last or chronic form of inebriety is very incurable, 
 as the patients are incessantly under the desire for alcoholic 
 stimulants, and will get them if any opportunity occurs, 
 whereas the dipsomaniac have only the irresistible craving 
 for stimulants periodically. It is in these cases of chronic 
 inebriety that we find hallucinations of sight and hearing, 
 very painful moral impressions, confusion of thought, 
 suicidal tendencies, tremors of the facial muscles and 
 tongue, and very often paralytic symptoms, ending in gen- 
 eral paralysis. It is here, in chronic inebriety, that disease 
 of tlie brain may destroy all apparent consciousness of pain, 
 and keep in abeyance the outward and appreciable mani- 
 festations of the important indications of organic mischief. 
 Extensive disease of the stomach, lungs, kidneys, bowels, 
 uterus and heart have been known to have progressed to a 
 fearful extent without any obvious recognizable indication 
 of the existence of such affections. 
 
 The most essential preliminary matters for inquiry 
 
210 DISEASES OF INEBRIETY. 
 
 relating to the treatment of inebriety, have relation to the 
 age, temperament, previous occupation and condition in 
 life of the patient. It will be necessary to ascertain the 
 character and duration of the attack, to ascertain whether 
 it has resulted from moral or physical causes ; if of sudden, 
 insidious, or slow growth ; whether it has an hereditary 
 action, or is the effect of a mental shock or of mechanical 
 injury ; whether it is the first attack, and if not, in what 
 features it differs from previous paroxysms. It will also be 
 our duty to inquire whether it is complicated with epilepsy, 
 insanity, suicidal or homicidal impulses. If any prior treat- 
 ment has been adopted we must learn its nature ; whether 
 the patient has suffered from gout, heart disease, rheuma- 
 tism, skin disease, or syphilis. It is important in cases of 
 females to obtain accurate information in relation to the 
 condition of the uterine functions. We should also inquire 
 whether the patient has been suspected of habits of self- 
 abuse. 
 
 Having obtained accurate information upon these essen- 
 tial points, our own personal observation will aid us in 
 ascertaining the character of the inebriety. The configura- 
 tion of the head, chest, and abdomen ; the gait of the pa- 
 tient ; the degree of sensibility and volitional power mani- 
 fest ; the state of the retina, the pulse, the temperature of 
 the head and body ; the condition of the skin and chylopoie- 
 tic viscera ; the action of the heart, lungs, and nature of any 
 existing disease of the uterus should be noticed. Onv prog- 
 nosis in cases of inebriety will mainly depend upon the dura- 
 tion of the attack, its character and origin, and the diathe- 
 sis of the patient. The prognosis is unfavorable if the 
 disease is hereditary. Age materially guides us in forming 
 a correct prognosis. The greater proportion recover be- 
 tween the ages of twenty and thirty-five. When a patient 
 has youth and a good constitution, and remedial measures 
 are promptly applied to the patient while he is secluded 
 
GENERAL CONSIDERATIONS OF TREATMENT. 211 
 
 from all occasion of temptation, the prognosis is favorable. 
 I have seen patients after forty and fifty recover. 
 
 The prognosis is unfavorable when inebriety is associ- 
 ated with organic disease of the heart or lungs, or when 
 great impairment of mind, associated with paralysis, is pres- 
 ent. Prolonged hot baths are of the utmost service in the 
 treatment of inebriety. Among the therepeutic effects of 
 these baths I would mention a diminution of the circulation 
 and respiration, relaxation of the skin, alleviation of thirst, 
 the introduction of a good deal of water into the system, an 
 abundant discharge of limpid urine, a tendency to sleep, 
 and a state of repose. It is most useful in acute and chronic 
 inebriety. The preparations of hyoscyamus, conium, stra- 
 monium, camphor, hops, aconite, ether, chloroform, and 
 Indian hemp are all of great service if given with judgment. 
 The best plan in practice would seem to be to judiciously 
 combine various kinds of sedatives. Milk heated almost to 
 boiling is very valuable. It allays irritability of the stomach 
 and craving for stimuli, and two glasses at night have a 
 very sedative effect. 
 
 If there are decided signs of cerebral congestion the 
 occasional application of a leech behind the ear is good 
 practice. If symptoms of softening of the brain appear 
 they will often yield to the persevering use of the prepara- 
 tions of iron, phosphorous, zinc, and strychnia, with gener- 
 ous living. Strychnia antidotes, it appears to me, slight 
 impairment of the mind, loss of memory, defective power of 
 attention in inebriety very perfectly, and may be combined 
 with two gr. doses of quinia thrice daily. If inebriety is 
 associated with suicidal tendencies it will be important to 
 ascertain whether any cerebral congestion exists, and if so, 
 a few leeches applied to the head, followed by an active 
 cathartic, will relieve the local irritation. In the absence 
 of any positive active cerebral symptoms, the prolonged 
 warm bath and the continued exhibition of morphia will be 
 the best treatment until the suicidal idea disappears. 
 
212 DISEASES OF INEBRIETY. 
 
 We need both State and national hospitals for the 
 cure of inebriety, places of detention or asylums, under the 
 care of medical officers well trained by preliminary educa- 
 tion for their vocation, and acquainted thoroughly with 
 inebriety. 
 
 One of the best remedial agents whicli can be employed 
 in inebriety is electricity. Both the constant and induced 
 currents, or galvanic and Faradic electricity, may be used. 
 Electricity is a true nerve tonic, and it is an agent which 
 furnishes us with the means of modifying the nutritive con- 
 dition of parts deeply situated, and of modifying the circula- 
 tion to a greater extent, I think, than by any known agent. 
 By the judicious employment of the constant and induced 
 currents we have it in our power to hasten the processes of 
 nerve growth and nerve repair, and thereby hasten the 
 acquisition of nerve power. 
 
 The use of electrictity does not, I think, act by contribut- 
 ing anything directly to the growth or repair of nerve 
 tissue. Its action is to stimulate and quicken those pro- 
 cesses on which the material and functional integrity of the 
 nervous system depends. The use of electricity in inebriates 
 is always followed by an increase of strength and nerve 
 force, and the results gained are gradual and permanent. 
 Dipsomania or periodical inebriety is characterized by 
 abnormal nervous excitability, conjoined with cerebral 
 exhaustion, and the two indications which are urgent 
 are, primarily, for increased rapidity and effective- 
 ness as regards the process of nerve nutrition, and second- 
 arily, to secure freedom from excitement, and diminution of 
 nerve activity, and thereby to check the waste of nerve 
 structure and of power. These indications we can fulfill by 
 the judicious use of electricity and nerve tonics more cer- 
 tainly than by any other means, there being no other such 
 combined sedative, restorative, and refreshant to the central 
 nervous system. To give the brain the direct nutriment it 
 
GENERAL CONSIDERATIONS OF TREATMENT. 213 
 
 needs in inebriety, I Iiave before stated, can be accomplished 
 by rest, cod liver oil, phosphorus, the phospliates, etc. 
 
 Every intelligent person who has observed the march of 
 human thought into the recently explored realms of Psycho- 
 logical medicine and the treatment of mental diseases, 
 will get new views as to modes of treatment, more especi- 
 ally of that class for whom institutions were organized. 
 The favorable results of each succeeding year, only confirm 
 and demonstrate the truth of the humane and wise idea 
 that led to the organization of institutions, viz. : that 
 intemperance in all its stages may be not only checked and 
 mitigated, but in many instances permanently cured, and 
 the subject fully restored to his normal condition of health 
 and sobriety. 
 
 Such results may not be reached by the final and utter 
 extinction of the morbid desire for alcohol, so much as by 
 a development and cultivation of opposite and ennobling 
 qualities, which by their vital action, hold the depraved 
 mental tendencies of the subject in constant and absolute 
 subjection, so that they become as inoperative as if they 
 did not exist. 
 
 This is as near an absolute cure as we can hope to 
 reacli, as the testimony of all inebriates concurs in the fact 
 that the appetite for intoxicating drink never dies, though 
 it may be put to a life-long sleep. 
 
 It cannot be expected that the final and complete results 
 of the treatment of our patients, so variously circumstanced 
 and conditioned, can be fully known. From this common 
 center of reform, hundreds have struck out in new and 
 divergent paths, and are lost to our view in the general 
 whirl of business and laudable enterprise. Whenever any 
 one does fall into his previous habits, we are certain to be 
 informed of the fact, as few things travel so fast and so 
 sure as ill-tidings of man's vices and misfortunes. 
 
 We can congratulate ourselves on the fact that thousands 
 who have been under hospital care are now in active life 
 
214- DISEASES OF INEBRIETY. 
 
 all over the country, of wliose doings we are cognizant, and 
 it is a source of pleasure to us to know that their correct 
 and consistent conduct is productive of liappiness to them- 
 selves, and does iionor to the institutions and the humane 
 work which it has in hand. 
 
CHAPTER XXII. 
 
 ASYLUMS AND THEIR WORK IN THE TREATMENT OF 
 INEBRIETY. 
 
 Asylums and hospitals for the treatment and cure of 
 inebriates are only modern applications of truths asserted 
 centuries ago. Ulpian, tlie Roman jurist, in the second cen- 
 tury of the Cliristian era, urged the necessity of treating 
 inebriates as sick and diseased, in special surroundings, with 
 special means. Other authorities indorsed these views, and 
 asserted that the State sliould recognize the veritable mad- 
 ness of drunkards and treat tliem as such. 
 
 In 1747 Condillac, of France, wrote that the State should 
 provide special hospitals for drink maniacs, and urged a 
 change of law and public sentiment to this end. Dr. Rush 
 of Philadelphia, in 1790 ; Dr. Cabanis of Paris, in 1802 ; 
 Prof. Platner of Leipsic, in 1809 ; Salvator of Moscow, in 
 1817 ; Esquirol of France, in 1818 ; Buhl Cramner of Berlin, 
 in 1822, all urged the need of physical restraint and treat- 
 ment of the inebriate as sick and diseased, in places espec- 
 ially provided for this class. In 1830 the Connecticut 
 Medical Society appointed a committee to report on the 
 need of an asylum for the medical treatment of inebriates. 
 In 1833 Dr. Woodward, of tlie Worcester Insane Asylum, 
 in Massachusetts, urged that inebriety be recognized as a 
 disease, and special hospitals be provided for its treatment. 
 In 1844 the English Lunacy Commission urged that inebri- 
 ates be regarded as insane, and sent to asylums for special 
 treatment. These are only a few of the more prominent 
 references to inebriate asylums, although many other 
 
 215 
 
216 DISEASES OF INEBRIETY. 
 
 writers urged the same views in different ways. The men- 
 tion of tlie disease of inebriety roused a bitter opposition, 
 and the question of asylums was put aside until the former 
 could be settled. 
 
 In 1846 Dr. Turner began an entliusiastic agitation, 
 which culminated in the first asylum at Binghamton, New 
 York. 
 
 The opposition to this work was very intense, and came 
 from moralists, who urged that it was a purely " infidel 
 work " to diminish human responsibility. Tlie asylum at 
 Binghamton began on the most advanced principles, of 
 receiving no one for less than one year, and having abso- 
 lute restraint over them during this time. It asked no 
 pledges or promises from the patient ; it aimed to give 
 each one positive protection and medical treatment. The 
 patients were locked in at night, and only allowed out 
 under the strict care of attendants. Each case was consid- 
 ered a suicidal case of insanity, requiring long medical care 
 and restraint. 
 
 These methods were far in advance of that time, and even 
 to-day are just beginning to be recognized as the latest 
 teacliings of science. The patients themselves, after the 
 immediate recovery from the effects of spirits, protested 
 against the confinement and doctrine of disease, and sought 
 in every way through their friends to break up the methods 
 of treatment. The points of difference were these : The 
 asylum and management insisted that each case was more 
 or less diseased, and should be under absolute control and 
 restraint for long enough time to effect a permaraent cure. 
 The patients and their friends insisted that, while the case 
 might be diseased, his recovery depended largely upon his 
 liberty and promise to get well ; that restraint was irrita- 
 tion and injury; and that appeals to his honor and man- 
 hood were the real agents for final cure. In brief, one plan 
 proposed long restrain ; the other, no restraint except nom- 
 inal care at first, then persuasion and advice. 
 
ASYLUMS AND THEIR WORK. 217' 
 
 The board of management changed, and the central 
 object was to make the asylum popular with the patient. 
 Political controversy followed, and the State changed the 
 asylum to an insane hospital, and a political governor, in 
 justification of the act, called the inebriate asylum a failure. 
 , The asylums in this country for the treatment of inebri- 
 ates may be divided into three classes. 
 
 ist. Those hospitals which have been established by cor- 
 porations receiving State aid, or by private enterprise, and 
 incorporated, having the advantage of the laws, where the 
 inebriate is regarded as diseased, and treated on broad sci- 
 entific principles. 
 
 2d. Hospitals, both corporate and private, wnere the 
 inebriate is admitted with other cases of mental disease ; 
 mild maniacs, and eccentrics of all degrees of debility, of 
 both mind and body. Here the inebriate is treated from 
 some mixed theory or half disease and half vice ; when he 
 has recovered from the acute symptoms, is held as fully sane 
 and responsible. 
 
 The third class of hospitals ignore all question of disease 
 except that which comes from the direct use of alcohol, 
 which from their theory can be quickly remedied. The 
 treatment of the case is by the pledge, prayer and promise. 
 
 The first class of hospitals endeavor to apply real scien- 
 tific means of treatment and study of these cases, much the 
 same as in other cases of insanity. 
 
 The second class combine and treat these cases with 
 other mental diseases, without any special study or recogni- 
 tion of tiieir nature or character. 
 
 The first persons who come to these asylums are the in- 
 curables. They clamor most importunately for help. They 
 are the credulous, emotional incurables, who have signed 
 pledges, joined churches, and tried every means known, 
 and now expect from the asylum some miraculous power of 
 restoration. In a few weeks they believe themselves fully 
 recovered, and go away only to relapse again and become 
 
218 DISEASES OF INEBRIETY. 
 
 bitter enemies of the institution. This class appear every- 
 where as examples of the failure of the liospitals. An- 
 other class of incurables come from the better ranks of 
 society, often for the purpose of accomplishing some object, 
 consent to go anywhere and do anything that promises 
 relief or restoration. These moral paralytic inebriates 
 rouse the highest expectation and greatest enthusiasm in 
 the grand work of asylum-cure among their friends, and 
 pose as examples of " brands rescued from the burning," 
 then suddenly relapse and condemn the asylum and man- 
 agement as the cause. The humbug of the asylum, its 
 frauds and deceptions, are themes of great relish and pleas- 
 ure to them, 
 
 A second class of persons are coming in greater numbers 
 every year to these asylums. They are the cuiable cases, — 
 the nerve and brain-exhausted men and women, the large 
 and ever-increasing class of business and professional men, 
 who have broken down from overwork, worry, and irregu- 
 larity of life and living, and who find alcohol a narcotic of 
 most seductive nature. The still laiger class seen in every 
 city of the land, who from brain strains and drains incident 
 to the rushing, grinding civilization of to-day, also to the 
 struggle for position, wealth and power, and tiie effort to 
 adapt themselves to the new conditions of life, to the new 
 demands, thus prepare the soil by exhaustion, and encourage 
 the growth of inebriety and its allied diseases. This class 
 often represents the highest talent and genius, and, as a 
 rule, are the active brain-workers of the times. An ine- 
 briate hospital to this class is almost an " el dorado." It 
 brings rest, restraint, seclusion, building-up, and is literally 
 a place for repairs and restoration. 
 
 In this class the use of alcohol, opium, or any other nar- 
 cotic is often more of a symptom of exhaustion and debility, 
 for which rest and medical care are essential. There are 
 many thousands of this class who could be saved and perma- 
 nently restored to temperate life and living if they could 
 
ASYLUMS AND THEIE WORK. 219 
 
 be placed in inebriate hospitals and treated early. Later, 
 they become clironic and incurable, and are ever after a 
 burden and heavy loss to the world. To-day they cannot 
 go to an insane asylum, and tlie public hospital is unfit for 
 them, and no place is open adapted to reach tiieir wants. 
 
 A large army of tliese curable cases are scattered in 
 ever)^ community, and in almost every home; and are the 
 skeletons which haunt and peril the peace of many house- 
 holds. They are tlie secret and moderate drinkers. They 
 are those who have secret or open drink paroxysms, and 
 who recover only to relapse again whh steady increasing 
 frequency. Both men and women in all circles of life are 
 found in this army of dissolution. Moral remedies fail, 
 religion fails, they go steadily down and soon all fears of 
 publicity are thrown aside, and the march to death is rapid 
 and distinct. Not far away in the future, asylums and 
 hospitals will be opened to save these cases, and public 
 sentiment will demand that they be placed under treatment 
 early in the progress of the case. Of this class a very 
 large number are curable, and all are benefited by hospital 
 residence. 
 
 A third class comprises the erratic border liners, or per- 
 sons who alternate up and down the line of sanity and 
 insanity, whose genius attracts by its glitter, and bewilders 
 by its weakness. They sound the praises of the asylum far 
 and near, exaggerate its power, and claim the most extra- 
 ordinary results, then rush to tiie other extreme on relaps- 
 ing, exliibiting a malice and pleasure in destroying what 
 they so lately praised. 
 
 Others who are less incurable appear, but always wish 
 to decide the lengtii of tiieir treatment, then go away only 
 to relapse and attribute the failure to the asylum. In 
 addition to all this, public sentiment often gives credit to 
 these statements of incurables, and hence withholds the 
 sympathy and aid wiiich should be given. In many cases 
 the State refuses to give only limited authority to the man- 
 
220 DISEASES OF INEBRIETY. 
 
 agers to hold patients. And in other cases the clergy and 
 temperance reformers insist tliat prayer, conversion, and 
 the pledge shall be made prominent in the treatment. 
 
 Thus tlie most extraordinary misrepresentations, extrav- 
 agant credulity, and ignorant criticism follows every 
 movement of the institution. The superintendent and the 
 managers are never able to carry out their plans fully, or 
 bring out the real object and methods of obtaining it with 
 these cases. 
 
 The results of treatment in a few scientific hospitals for 
 inebriates are most encouraging. The first statistical study 
 was made at Binghamton Asylum in 1874. The object was 
 to find out how many persons who had been under treat- 
 ment continued temperate years after. Accordingly, over 
 a thousand circular letters were addressed to friends of 
 patients who had been under treatment five years before, 
 asking the present condition of the patient. The answers 
 indicated sixty-two and a-half per cent, as yet temperate 
 and total abstainers. This result, after an interval of five 
 years, was clear evidence that a large per cent, would remain 
 cured during the remainder of life. 
 
 Dr. Day, of Washingtonian Home, made a similar study 
 of eight thousand cases who had been under treatment ten 
 to eighteen years before, and found over thirty-eight per 
 cent, yet sober and temperate. Dr. Mason, of King's County 
 Home, examined two thousand cases who had been away 
 from the asylum for ten years, and found thirty-six per 
 cent, of all cases yet cured. Other observers have made 
 studies of a smaller number of cases with similar results. 
 
 Not less than two thousand inebriates are under treat- 
 ment in hospitals in America. Over a thousand of this 
 number are in special hospitals. They represent most 
 largely the incurable cases ; persons who have tried every 
 means found in the pledge, prayer, and by moral suasion, 
 and exhausted every resource of home and friends, and 
 come as a last resort, expecting extraordinary change and 
 
ASYLUMS AND THEIR WOKK. 221 
 
 cure. Tliey have been victims of this disease from five to 
 thirty years, and present tlie most complex and varied de- 
 grees of physical and mental degeneration. Yet, notwith- 
 standing this fact, the experience of the few scientific hos- 
 pitals in the results of treatment is exceedingly promising. 
 Statistics of over three tliousand cases, wliich have been 
 under treatment at different hospitals, indicate nearly forty 
 per cent, restored and temperate after a period of six to 
 eight years from the time of discharge from the hospital. 
 The best authorities unite in considering thirty-five per 
 cent, of all who remain under treatment one year or more 
 as permanently restored. In view of the chronic character 
 of these cases, and the imperfect means of treatment, these 
 statistics are encouraging, and indicate great possibilities in 
 the future from a better knowledge and control of these 
 cases. 
 
 Legal Control of Inebriates. — The legal control of the ine- 
 briates in America, and legislation, are very imperfect. In 
 Connecticut the best laws are in force, giving power over 
 inebriates to voluntarily commit themselves, or be com- 
 mitted by tiieir friends, without the formality of appearing 
 before a judge or court. In other States they are com- 
 mitted to asylums in about tlie same way as the insane 
 are. In the hospitals they are controlled legally the same 
 as the insane, only with more difficulty, and the constant 
 intrusion of disputed questions of authority which cannot 
 be settled. Nearly all the leading hospitals have special 
 powers of control, which they exercise with caution in most 
 cases. But generally both legislation and legal authority 
 are not far ahead of public sentiment, and hospital managers 
 are unwilling to go beyond this. Most of the hospitals 
 have power to control patients a certain specified time, 
 agreed upon when admitted to the hospital. 
 
 But apart from the view tiiat special retreats are neces- 
 sary for the sake of inebriate patients, I would urge their 
 estabiisiiment in order to relieve the families of such 
 
222 DISEASES OF INEBRIETY. 
 
 patients of the burden of maintaining them. I know of 
 many instances where tlie wife could provide for herself 
 and children, but an attack of inebriety in the husband 
 tlirows all back. He must be watched day and night while 
 tlie attack lasts, medical attendance and medicines must be 
 procured, the siiop or the sewing which would otherwise 
 bring in enough to keep them is necessarily neglected, and 
 slie is obliged again and again to appeal to friends, who 
 begin to get weary of giving assistance. The poor wife 
 says: " Something must be done; he must be put some- 
 where ;" but the prospect of prison or of the lunatic asylum 
 deters her from taking any action, and she says : "Well, I 
 will give him another trial." Tiiese poor women have bitter 
 lives, and many of them make noble sacrifices for the sake 
 of their families. The State ought to afford them a ready 
 means of relief from the consequences of a physical and 
 mental disease in their husbands for which they are in no 
 way responsible. 
 
 I would then propose the establishment of hospitals for 
 the care and cure of inebriates, such hospitals to be either 
 supported by the State, or else under State inspection and 
 control. That persons suffering from inebriate disease 
 should, if the outbreak of the disease be recent, on the rep- 
 resentation of their friends to a magistrate, and after due 
 examination by medical men and proper certificates being 
 signed by them, be committed to one of the hospitals for 
 nervous diseases for a j'ear. That the period of detention 
 in such hospital might be lessened on the recommendation 
 of the medical ofiiceis. That during the patient's residence 
 in such institution he should be obliged to do sufficient 
 work to pay the expenses of his living, and the surplus to be 
 lianded to iiis friends for his support on his discharge. The 
 object of the work would not be merely to pay expenses, 
 but to give healtiiy mental and bodily occupation ; to sub- 
 stitute healthy nerve-work for unhealthy impulses, and thus 
 to act curatively. In cases where such seclusion and abstin- 
 
ASYLUMS AND THEIR WORK. 223 
 
 ence from alcohol for a year had been tried without effect 
 — that is, in cases of presumed incorrigible drink-mania — 
 the patient should, on each outbreak, if not under proper 
 care and control, be admitted for treatment until the attack 
 should be over, and he should be detained as long as the 
 medical officers thought fit with regard to his safety. 
 
 I have explained what proper care and control means, 
 but will do so again. It means such care as will prevent 
 the patient getting alcohol during the attack — an exceed- 
 ingly difficult measure to carry out in private houses. I 
 would avoid the use of the word " asylum," and name 
 an institution for the treatment of inebriates " Hospital for 
 Disease of the Nervous System." It could easily by speci- 
 fied in the rules of the hospital for which particular nervous 
 disease it was intended. Such a name would be less repug- 
 nant to the patient than the word " asylum," and would 
 serve to educate public opinion. The establishment of such 
 State hospitals might be objected to on the score of cost, 
 but it must be evident that the community pays far more 
 heavily by the present system, or want of system, than it 
 would do if special hospitals were established. We should 
 then be saved the expense of maintaining such patients in 
 prison ; and such special hospitals could be made self-sup- 
 porting to a very great extent, rendering the estates of those 
 who were able to pay liable for their maintenance, while the 
 others should work for their support. Inebriates who might 
 be allowed to live out of the retreat on parole, could, if they 
 broke their parole, be treated in the nearest public hospital 
 and discharged when the fit was over ; but if they again 
 broke out they could be committed to the retreat for the 
 full time on the recommendation of the medical officers, 
 without option of leaving until their time should have 
 expired. 
 
 Dr. Day, of Washingtonian Home, makes the following 
 clear and positive statement of results. Twenty-two years 
 of experience in this work has demonstrated that the task 
 
224 DISEASES OF INEBRIETY. 
 
 is neither hopeless nor thankless ; nor would it be if the 
 measure of success had been lessened one-half from the 
 known rate of percentage of cures. I know of no hospital, 
 infirmary, or reformatory institution in the country — and I 
 may as well say, in the world — in which the proportion of 
 cures to the number of patients treated is greater than it 
 has been annually in this Institution, from the date of its 
 origin down to tiie present time. 
 
 A variety of circumstances beyond our control prevents 
 us from making a fair and just exhibit of our success to the 
 world. A man will go to the hospital or infirmary with a 
 disease or a broken limb, and when healed, or made whole, 
 there is no hesitancy or delicacy on his part, or with his 
 friends and relatives, in making the fact generally known ; 
 sometimes, especialh'^ when the patient is of sufficient conse- 
 quence, the community will acquire this information from 
 the public prints. But it is different with the recovered ine- 
 briate, who, for his own or family reasons, shrinks from a 
 confession of his case, and while he rejoices, and is thankful 
 and grateful for his cure, has a natural repugnance to ac- 
 knowledge tliat he actually needed the treatment he 
 received. Hence it is, that numbers of men are reformed at 
 the " Home" who return to their families and to their busi- 
 ness, giving joy to friends and neighbors, not one in ten of 
 whom know how or where the sudden change was wrought. 
 
 As a rule, failures occur with persons who are willing to 
 be cured if it can be done without making any sacrifice or 
 concession themselves towards effecting such a consumma- 
 tion. However honest their desires may be to live soberly, 
 they have not strength of will sufficient to resist strong and 
 repeated temptation. Is not this the case with transgres- 
 sors of every physical, moral, and Christian law ? . , . 
 
 But even such cases are not without hope. Proper 
 medical and dietary treatment may do much to build and 
 strengthen their physical system, but what they need most 
 is medicine for a diseased and weakened mind, and that is a 
 
ASYLTJMS AND THEIR WORK. 225 
 
 curative agent not to be found in a drug store or a physi- 
 cian's medical case. 
 
 In most cases a longer lapse of time is required to efTect 
 a cure than the patient thinks he can spare from liis busi- 
 ness, or afford to pay for. The deaf, the hime, the blind, 
 and the sick, who satisfy themselves with one or two visits 
 from tiie piiysician, when their several cases require a 
 patient and lengthened treatment, have just the same right 
 to declaim against the efficacy of medicine and surgery, as 
 the public have to charge us with failure in cases where we 
 liave been permitted to treat only for days, when we should 
 have had weeks, and weeks when months were fairly re- 
 quired. 
 
CHAPTER XXIII. 
 
 HYGIENIC AND HOT AIR TREATMENT OF INEBRIETY. 
 
 There are two classes of drunkards to be found in the 
 United States — one class are drunkards because of their 
 training and education ; the other class is born with a ten- 
 dency to drunkenness. Let me call attention first to begot- 
 ten drunkards. These are peculiar. At the time of their 
 conception the father and mother were habituated either in 
 their foods or drinks to the use of some form of stimulants ; 
 not necessarily were these alcoholic or fluid in their nature. 
 Stimulants are substances which contain in their constituent 
 elements properties that when taken into the human stom- 
 ach by eating or drinking have a specific effect on the nerv- 
 ous system, exciting the heart to undue action, and through 
 it the whole circulatory system, insomuch that the person 
 thus affected takeS on an unnatural condition of the vital 
 organs, by which he is subjected to extraordinary activity 
 of such organs. 
 
 This condition, continued long enough, becomes habit- 
 ual, and under it no person can go into the procreative act 
 without carrying over to the offspring a constitutional dia- 
 thesis or habit of body, or, in other words, a tendency or 
 predisposition to the use of stimulants. 
 
 The child thus made up has in him a need for stimu- 
 lation in order that the vital organs may perform their 
 work to the best advantage, and there will be failure in 
 their action unless this need be supplied. The child maj 
 linger along, being feeble ; but, if his habits are such as are 
 common to the children of our country, he will die unless 
 help is given him through stimulation. A physician, if 
 
 227 
 
228 DISEASES OF INEBRIETY. 
 
 called to such a child, would almost surely discern the need 
 of extrinsic aid being furnished, in order that the vital 
 organs might perform their functions with sufficient direct- 
 ness and vigor to result in good iiealth and continued life. 
 
 Under such circumstances, how is a person to be kept 
 from becoming a drunkard ? That is a problem which 
 science and morality, separate and together, have been 
 unable to solve hitherto, and will be unable so long as 
 persons permit themselves, wliile under habitual stimula- 
 tion, to beget and give birth to children. It is not at all 
 necessary, in order that a child's organization shall have 
 such idiosyncrasy as to call for and require stimulants, that 
 either of the parents shall be drinkers of alcoholic liquors. 
 It is enough that through food eaten or medicines taken, 
 stimulants are constantly introduced into their circulation. 
 Nature, in her great organic processes, knows nothing of, nor 
 cares anything about, the particular substances a person 
 uses whereby his whole system is extraordinarily excited. 
 It answers all evil purpose that this excitement of the nerv- 
 ous svstem is created and constantly kept up. A married 
 pair can give birth to children in whom shall inhere a 
 tendency to demand stimulation to that degree that a 
 clamor for it is set up in the very center of their bodies, 
 just as surely by the eating of stimulating food as by the 
 drinking of stimulating drinks. 
 
 Of begotten drunkards the numbers in this country are 
 larger by far than are the numbers of trained and educated 
 drunkards. There are but very few children now-a-days 
 who have not in them a natural desire for stimulants. 
 Denied these in every form, they put forth but feeble 
 growth, and in many ways show inefficiency in the perform- 
 ance of those bodily functions which must be fully and 
 fairly exercised in order to the production of good health. 
 
 Here, then, is an evil of great magnitude which is not 
 touched at all by any temperance movement yet inaugurated, 
 and herein lies the secret of the imperfect success of all 
 
HYGIENIC AND HOT AIR TREATMENT. 229 
 
 such movements. Little or nothing is gained as respects 
 the arrest and overthrow of intemperance while the cliildren 
 who come into the world have not only a natural liking for 
 liquor, but have also what may be called a natural need for 
 it. Every generation repeats the story of its predecessor. 
 As the child grows up his liking for stimulants takes on the 
 form of a need for them. When puberty is reached, the 
 boy, whose activities are tlien drawn upon more largely and 
 decidedly than at any previous period, finds that to answer 
 to the simple nutrient wants of his system, so far as muscu- 
 larity is concerned, does not meet his necessities. He may 
 be in good muscle and so of good size of body, but there is 
 a defect in him not to be overcome by force of will when he 
 is called upon to show large, well-directed, and successful 
 energy. He lacks just at this point the agency by which 
 energy alone can be developed, and if he cannot have aid 
 he fails. 
 
 It is this cry in his body for stimulation, for something 
 to innervate him and make him feel strong, that sets him to 
 drinking ; and this clamor is just as likely to be manifested 
 if his father and motlier are total abstainers from all intoxi- 
 cating drinks as though they indulged habitually in them. 
 Total abstainers from these drinks, who do not abstain from 
 other stimulants, may use them to a degree and in a measure 
 that will produce quite as deleterious effects on the nervous 
 system as would be produced by drinking alcoholic bever- 
 ages. So the cliild born of parents who are pledged to the 
 entire disuse of intoxicating liquors, may have a natural 
 desire or need for alcoholic stimulants, as truly as the child 
 born of parents whose nervous systems have been habitually 
 excited by alcohol. 
 
 The object tlien to be sought must be, not the exchange 
 of stimulants, but tlie abandonment of them altogether. 
 Then cliildren will be brought to birth with no tendency in 
 them to the use of stimulants, and then they can be trained 
 up and reared along a line of sobriety and abstinence from 
 
230 DISEASES OF INEBRIETY. 
 
 all Stimulants, which will make it quite out of the question 
 that they should ever use intoxicants in any form. 
 
 There is a process by which a child with an inborn need 
 for stimulants, in order to make his organs perform their 
 natural functions, can be reconstitutionalized. That pro- 
 cess involves freedom from taxation of tlie nervous system 
 for years after his birth. The child lias to be cared for and 
 looked after like a young animal. The developments that 
 need to be made in him are such as affect tlie nutritive 
 nervous system. He should be kept free from all cerebral 
 excitement. He needs to be cared for by judicious and 
 wise nurses. He cannot be permitted to eat or drink, nor 
 do or be, as children usually are. 
 
 If he were thus related to life he would die ; but if he 
 can be kept free from all unnecessary excitement of brain 
 and be handled with close watclifulness for the first three 
 or four years of his life, his relations to vital development 
 will become greatly changed, and from that point on, the 
 reconstructive processes, so well begun, will proceed to com- 
 pleteness. He will ultimately reach a condition of his 
 nervous organization where he will no longer need stimula- 
 tion. 
 
 Till that is accomplished, attention must be given to him 
 or, with no stimulants administered in his food or drink, he 
 will fade away and die. It is most unfortunate that a child 
 should be made up in a state of dependency upon factitious 
 aids, but where such dependency exists, reconstructive meas- 
 ures can be instituted and made effectual. This I have 
 proved on tiiis Hillside to the satisfaction and joy ofagieat 
 many parents. The better way, however, is to forestall such 
 an issue as this, and not have children begotten when the 
 parents are under a bodily habitude of subjection to stimu- 
 lation. 
 
 For a long time I have been convinced that the present 
 temperance reformation is radically inefificient. Theunphilo- 
 sophical aspect of it will have to give way before a broader 
 
HYGIENIC AND HOT AIR TREATMENT. 231 
 
 and more effective effort, or we shall liave to keep it up for- 
 ever, having in each succeeding generation as many or more 
 persons becoming drunkards as in generations preceding. 
 
 The second class of drunkards — those who are made so 
 by education and training — are persons not born with a 
 constitutional necessity for the use of stimulants. As chil- 
 dren they do not in our country constitute a very large class. 
 They never need be drunkards. Tiie temptation to drink is 
 not in their bodily constitution. It lies in society in some 
 or other of its forms of associations. Thrown into good 
 and upright relations from childhood, they will not become 
 drunkards. They will not even drink liquors moderately. 
 As they develop into intelligence and moral sense, they will 
 see that the use of stimulants for purposes of exiiilaration, 
 or of innervation of the nervous system, is not good for 
 them. They will be ready to join the total abstinence 
 ranks, and when they have joined them, they will stand 
 true. 
 
 But out of this class there is a certain number who do 
 become drunkards. These lack the early training and right 
 association and proper surroundings. They eat highly 
 stimulated foods and drink stimulo-narcotic drinks, like tea 
 and coffee, until they have created in them an abnormal 
 desire for things that are exciting. No person can habitu- 
 ally eat largely of the indiscriminate foods used in most 
 families, and drink such beverages as are there daily 
 imbibed, without after awhile coming to have a longing for 
 stimulation. Young persons come to have a want for some- 
 thing stronger than tea or coffee, and many of them have 
 opportunity at the home table to indulge in the milder 
 forms of alcoholic drinks. So they go on from bad to 
 worse and from worse to worst. Out of this class a certain 
 proportion become drunkards and once they are habitually 
 inebriated, their restoration to permanent sobriety is as dif- 
 ficult as though they belonged to the first class. 
 
 This cure does not lie with certainty in any movement 
 
232 DISEASES OF INEBRIETY. 
 
 which simply makes its appeal to the moral sense. A 
 drunkard may be said to have no moral sense. He has a 
 physical sense and he has a social sense. His physical sense 
 tends directly to keep him a drunkard. His social sense 
 may work for his recovery. He may be so situated that 
 social influences shall operate to induce him to sign a pledge 
 that he will not drink any more, and here and there may be 
 found one out of a great many who will keep such a pledge, 
 not by reason of any inherent strength which he himself has 
 whereby to keep it, but by reason of the outside influences 
 which affect him and the watch-care which is had over him. 
 
 If thinking men and women will take pains to investigate 
 this matter as thoroughly as I have done, they will see that 
 a very large proporiion of the whole number of drunkards in 
 this country is made out of the class which is born with a 
 liking for, with a tendency to, and with a need of, the use of 
 stimulants. 
 
 It is now coming to be recognized that inebriety is a 
 disease, but its treatment has heretofore been too much 
 relegated to the moralist instead of the physician to whom 
 it properly belongs. The moralist has given us theories as 
 to its cause and cure, but the theories have brought us no 
 advancement ; the disease still remains to vex their patient 
 souls. The medical profession, however, place this subject 
 in its true ligiit, and give aliope to the world that in a short 
 time there will be a better way to handle this whole matter. 
 Dr. Wright most forcibly says : "Drunkenness is in every 
 essential particular a condition of civil death, and it would 
 seem best that it should be so construed by the law of the 
 land." Society should be protected from the habitual 
 drunkard, and especially should he be protected from him- 
 self. To my mind the bane of the age is excessive alimen- 
 tation, leading up to a desire for stimulants, which is 
 ' naught but a morbid craving, and in ignorant hands stim- 
 ulation is supposed to ward off its consequences. 
 
 On the contrary, and in reality, the use of stimulants at 
 
HYGIENIC AND HOT AIR TREATMENT. 233 
 
 such times induces a condition of internal inflammation 
 that increases the desire for further stimulation, and also 
 the inability to properly dispose of whatever aliment may 
 be present, thus effectually rendering a bad matter worse. 
 We well know that nothing will so speedily subdue the 
 nervous storm as the ever convenient and alluring alcohol. 
 It is sought to give insensibility to nerve agony, and secures 
 for a time, rest and repose, but the wear and tear of this 
 oft repeated nerve strain is frequently shown in paralysis 
 and sometimes insanity. Perliaps the most serious effect of 
 alcohol is its direct tendency to interfere with nutrition, 
 and by promoting growth of cellular tissue to compromise 
 the integrity of the brain tissue where the poison is not 
 readily thrown off, and where it soon destroys not only its 
 co-ordinating power, but degenerates the brain substance. 
 Inasmuch as the mental and moral character of the individ- 
 ual depends upon the action of the brain itself, we cannot 
 look for good results when there is any impairment of its 
 substance ; on the contrary, we often see the worst results 
 from such a condition. 
 
 The impairment of consciousness is only one of the many 
 forms by which the influence of alcohol is felt, and suggests 
 the question whether we have any process whereby its 
 elimination may be successfully secured. We also know 
 that with tlie inebriate thei-e is a lack of fine moral sense, 
 not infrequently amounting to obtuseness, and that this 
 condition is far reaching, affecting even the progeny, thus 
 making it hereditary. If there is a process whereby the 
 blood itself can be purified, we may, witli every reason, 
 expect tlie brain tissues to participate in the advantages 
 derived tlierefrom, and consequently we will have greater 
 clearness of perception, followed by a quickened moral sense. 
 The irresistible impulse of our modern civilization, from 
 infancy to old age, is push, and the mental and physical 
 powers alike suffer in tlie long run. The free use of alcohol 
 is accountable for a large measure of this condition. Can 
 
234 DISEASES OF INEBRIETY". 
 
 we not teach the people to give more time to rest and 
 recuperation and less to stimulation ? If it is wished to 
 place tiie inebriate in the condition most favorable for cure, 
 it is important that there should be institutions created for 
 that purpose. 
 
 Granting that inebriety is a disease, our efforts should 
 be to eradicate that disease, and in order to do so, there 
 must necessarily be desirable sunoundings as well as con- 
 trol over the patient. The model institution is yet to be 
 built, wherein the hot-air bath shall hold a pre-eminent po- 
 sition, where narcotics shall be entirely disallowed, even 
 though it may be an improvement on inebriism to have one's 
 system saturated and senses blinded by narcotism, and when 
 there shall be enough control to prevent any dallying with 
 the tempters. The theory of the action of the hot-air bath 
 is very simple. Like the action of the sun's rays upon 
 Bunker Flill Monument when shining upon one side and 
 causing it to lean toward the other, so does this agent act 
 gently and yet powerfully. The primary action of heat, 
 which is the one essential thing of the Turkish bath, is to 
 relax the tissues of the body and thus invite a more perfect 
 circulation to every part of the system ; by a more active 
 circulation every sense is quickened — the secretions are 
 more thorough, the excretions more perfect, the blood is 
 better supplied with oxygen — the skin assumes its natural 
 roseate complexion, indicative of the improved condition, 
 and each and every function, whether it be that of the lungs 
 liver, spleen, or bowels, comes in for its share of the general 
 benefit — in a word, it opens every pore of the skin, and hence, 
 the most perfect sewage to the body The secondary action 
 is tiiat of profuse sweating — where water from the blood 
 and debris or used-up tissue and poison held in solution are 
 rapidly thrown out of the body. 
 
 According to recorded observation, "the quantity of 
 blood in the body is lessened by tlie free excretion which 
 takes place through the skin and lungs ; the body weight is 
 
HYGIENIC AND HOT AIR TREATMENT. 235 
 
 reduced, and the work of tlie heart in this way liglitened, at 
 tlie same time that its substance is better nourislied by the 
 improved quality of tlie blood supplied to it. The peripheral 
 arterioles of the body, too, become dilated and filled with 
 blood, thus affecting a corresponding emptying of the blood 
 vessels of the internal organs. Lastly, as a result of the 
 alternate warm and cold douching, the vaso motor energy 
 of the vessels is increased, thus rendering them more capable 
 of resisting any strain thrown upon them." Thus it will 
 readily be seen how quickl}'^ congestion, wherever it may be 
 located, is broken up and the offending material thrown out 
 through the pores of the skin. Under such conditions 
 absorption and elimination have their most perfect oppor- 
 tunity and equalization crowns the work. It must be 
 apparent that alcohol is soon eradicated from the system 
 under such favorable conditions, and that torpidity gives 
 place to activity. Furthermore, no living tissue or vitality 
 can be abstracted by the process — nothing is thrown off but 
 what the system is better without. One bath has been fre- 
 quently known to relieve an intermittent pulse, giving a 
 smooth, regular action to the heart, indicating a well bal- 
 anced circulation. What known drug can do this in the 
 space of half an iiour? And another great advantage in 
 favor of this treatment is, that there is no poison left in the 
 system to work its way out, as is sometimes the case when 
 drugs are administered; per contra, the individual is left 
 in a calm and quiet frame of body, which necessarily reacts 
 upon the mind. It could not be maintained that the hot- 
 air bath would renew brain or other tissue where there has 
 been actual lesion, but it will place under most favorable 
 condition for repair what is left, and then adjacent or collat- 
 eral parts will do their best to carry on the work of the 
 injured part. 
 
 By placing the patient in an institution of the kind men- 
 tioned, we at once completely remove the cause of the 
 disease, and then with the bath we have only the effects to 
 
236 DISEASES OF INEBRIETY. 
 
 treat. In the instance of insanity the hot-air batli has in a 
 large number of cases brought relief to deranged conditions 
 and given harmony to disturbed mental functions, and this 
 where tiie cause was present, for we know that this disease 
 obliterates the patient intellectually, and leaves the physi- 
 cian in the dark in reference to the cause or the effect of 
 the malady. It must, therefore, be evident to every medi- 
 cal mind, that the remedy which will effect every organ and 
 create in it an action to throw off diseased conditions, is the 
 only one to meet sucii cases. With how much more reason 
 must we expect even better results in cases of inebriety, 
 where the cause of the disease is eliminated and the advan- 
 tages of treatment are more perfect. The mucous surfaces 
 of the inebriate, and, in a minor degree, tliose of the mod- 
 erate drinker, are in a chronic state of inflammation. The 
 effect of the hot-air treatment is to reduce that inflamma- 
 tion by purifying the blood, thereby relieving that immod- 
 erate craving for stimulants, tliat only perpetuates and 
 increases the disease instead of giving relief. During my 
 long experience in the administration of the Turkish bath, 
 many persons who had been more or less under the influ- 
 ence of alcohol, have expressed to me in most unqualified 
 terms the benefits that they had derived from its use, par- 
 ticularly those who came after a debaucli. In fact, this 
 has been thoroughly demonstrated, as tiie experience of all 
 bath establishments will testify. Place man or boy in a 
 clean suit of clothes throughout, and he will not only take 
 good care of the clothes, but also of himself, and behave 
 more discreetly than before. 
 
 In like manner, if you thoroughly purify a man, as is 
 done by one of these baths, he at once realizes that he is a 
 cleaner man and on a higher plane, his senses are more 
 acute, he is in his best condition, he respects himself so much 
 the more, and is less liable to return to his base practices. It 
 is stated as a fact that in no country has inebriety been 
 found co-existent with the bath. Temperance and clean- 
 
HYGIENIC AND HOT AIE TREATMENT. 237 
 
 Hness are its handmaids. This treatment lias had but a 
 limited trial in this countr\% though it has been successfully- 
 used in a multitude of cases in Great Britain, particularly 
 at Dr. Barter's establishment, near Cork, in Ireland. The 
 only demonstration in this country was at Binghaniton, 
 during tlie first three years of it administration, in which 
 time not a death occurred among the patients. Dr. Lees, 
 says: "In the case of persons having latent cravings for 
 drink, we know of few things more efificacious than a short 
 course of that peculiar method of cleansing, which, bor- 
 rowed from the Orientals, has been recently introduced 
 into many cities — we mean the Turkish bath. Who, suffer- 
 ing from morbid accumulations incident to town life, that 
 has ever tried these processes, has not felt a wonderful 
 increase in the vital elasticity of his frame ! It is as though 
 a heavy weight had been lifted from the bent spring of life, 
 permitting fuller and freer play to the vital machinery and 
 creating a feeling of sympathetic purity in the soul." 
 
 The true physician stands before the community in the 
 light of a teacher as well as a healer, and his opportunities 
 for usefulness are large and often far reaching. Probably 
 no class do more charitable work than the men of this pro- 
 fession. In no way can they do more good than in encour- 
 aging both by example and precept, those institutions that 
 have for their object the welfare of the community, and no 
 institution of modern times promises so much to the mass 
 of the people as the genuine hot-air bath. Sanitary science 
 is of incalculable value to each and every one of the com- 
 munity, for it deals with that which is vital to the well- 
 being of the whole, but the hot-air bath is sanitary science, 
 refined and brought to the individual ; indeed it is the per- 
 fection of sanitary science. As a prophylactic, it stands at 
 the head of all remedies. As a disinfectant, none with it 
 can compare. The more it is popularized, the nearer 
 it will come within the reach of everybody, and the more 
 widespread, necessarily, will be its blessings. 
 
CHAPTER XXIV. 
 
 DUTY OF THE STATE IN THE CARE AND TREATMENT OF 
 INEBRIATES. 
 
 The State assumes the right to license reputable men to 
 seii alcoliolic liquors to those who are in tiie habit of using 
 them, to those who would like to experience their effects, 
 and to those who wish to treat their friends to sometliing 
 uncommonly good. This the State does in accord with 
 tlie laws made to suit public opinion. 
 
 If tliis " opinion of the public" would demand it, the 
 State could very properly assume the right to license opium 
 dens, or saloons of euthanasia, wiiere a fellow could shuffle 
 off this mortal coil according to the most approved 
 methods. 
 
 In other words, public opinion forms laws, whether just 
 or unjust, and it is the duty of all good citizens to acquiesce 
 in a state of affairs brought about b}'^ the decision of the 
 majority. 
 
 In a study of this topic I enquire, Firsts Has a man the 
 right to become a drunkard, and after he is a drunkard has 
 he the right to be one ? 
 
 The laws of the State permit the drunkard to be made, 
 because tlie State licenses reputable men to sell alcoliolic 
 liquors ; and the laws of the State concede the right to be- 
 come a drunkard to every citizen, because the State says 
 that personal liberty sliould not be interfered with. On the 
 other hand, tlie laws of the State direct tiiat the drunkard 
 be fined and imprisoned for being what his personal liberty 
 entitles him to be. It is, therefore, logical to say, tiiat 
 
 239 
 
2J:0 DISEASES OF INEBRIETY. 
 
 according to the laws of the State, a man has a perfect 
 right to become a drunkard, but that after lie is a drunkard 
 he has no right at all to be one. 
 
 Science claims that the inebriate does not exercise his 
 free will to remain or to be a drunkard, for the simple 
 reason that he no longer has a free will to exercise, but that 
 lie is the involuntary slave of an uncontrollable desire. 
 Science also claims that the drunkard may have never exer- 
 cised his free will in the matter. He may not be a drunk- 
 ard from choice, but he may have inlierited a predisposition 
 to become a drunkard, and necessity, opportunity, and 
 circumstances may have made him what he is, an habitual 
 drunkard. 
 
 Science further claims that it has demonstrated that ine- 
 briety is a disease ; that the State licenses the making of 
 this disease, and that the State does not judiciously recog- 
 nize inebriety as a disease. 
 
 Science further claims that no man has a right to become 
 a drunkard, because, as a rule, every man has a choice in 
 the matter, and he ought to choose what is best for the 
 individual and for society. 
 
 Science further claims that " Punishment is no cure for 
 the Disease of Inebriety." 
 
 The State and science, therefore, differ in their ideas 
 about "becoming" and "being "a drunkard. The State 
 considers "becoming a drunkard" a personal riglit, and 
 " being a drunkard " a crime. Science holds " becoming a 
 drunkard " to be a sin, and "being a drunkard " a disease. 
 
 Second. Is drunkenness a disease? 
 
 The laws of the State sanction moderate and temperate 
 drinking. The men who made the laws did it in accord 
 with the wish of the public. And the public, no doubt, is 
 satisfied tliat the State cannot legislate its people into tem- 
 perate habits. The people must be educated to be temper- 
 ate through the press, the pulpit, the school, and the 
 lecture. 
 
DUTY OF THE STATE. 241 
 
 There are men who are said to get drunk by accident. 
 These are indiscreet and sliould not be judged harslily. 
 They ouglit to beware of accidents lest they become habitual 
 drunkards. 
 
 Tlie habitual drunkard, however, suffers from a disease 
 called dipsomania. 
 
 Habitual drunkenness or dipsomania maybe inherited or 
 it may be acquired. 
 
 "Dipsomania is a mental alienation due to a morbid con- 
 dition of the nervous structures, generally hereditary. The 
 strictly periodical form of this type of dipsomania, the ten- 
 dency to gradually shorten the intervals as the years pass, 
 and the peculiar mental condition preceding the debauch, 
 are a proof that dipsomania is a disease of the cerebral ner- 
 vous centers analogous to recurring neurosis, such as epi- 
 lepsy, etc. 
 
 This disease is nothing but an attack of uncontrollable 
 drunkenness, always kept up until the stomach refuses 
 longer to tolerate the alcoholic drinks. Then the attack 
 stops as suddenly as it came, the sufferer recovers his usual 
 health and spirits and enters into his business in a way as 
 if nothing had happened. As a general thing these attacks 
 recur at intervals of from one to six months, and the end is, 
 some disease of the renal, hepatic, or gastric organ carries 
 off the patient. 
 
 Earnest resolutions or pledges do no good to ward off 
 the attack. When the time comes the patient succumbs. 
 An indescribable feeling of weakness of the nervous system 
 is generally the first sign of an attack. This may be brought 
 on by over-work, over-study, anxiety, worry, trouble, anger, 
 etc., and the patient thinking himself proof against a 
 debauch by his long interval of sobriety, yields to the temp- 
 tation, and then nothing can head him off. Friends, 
 family, duty, rank, morality, resolution, and pledge are all 
 forgotten, and the patient will drink as long as his stomach 
 will bear it. So strong is this desire for drink, while the 
 
242 DISEASES OF INEBRIETY. 
 
 attacks last, that the patient will drink as long as he has 
 money, or rather as long as he can get the liquor, though 
 he may have to beg, borrow, or steal it. 
 
 Such people are the despair of their friends, the tor- 
 ment or ruin of their families, the scandal of their com- 
 munity. Seventy times seven they fall and are lovingly 
 raised up. They express contrition, they make firm prom- 
 ises of amendment, but they always fall. 
 
 From the researches of many authors it appears that 
 inebriety is a nervous disease closely allied to insanity, 
 which manifests itself either periodically or constantly. It 
 may commence suddenly as a consequence of some severe 
 shock to the brain. The disease may also have its origin 
 in the social habits of the patient, who from a simple con- 
 vivial drunkard may become transformed into a regular 
 inebriate. It may be produced by the action of other 
 poisons besides alcohol, so that there may be as many 
 varieties of inebriety as of narcotics. There must, how- 
 ever, be a predisposition to inebriety in order to effect its 
 evolution. Healthy men without neurotic predispositions 
 may drink voluntarily in moderation without thus breaking 
 down ; but an inter-current disease may turn the tide even 
 against such individuals, and if they do not themselves 
 suffer the penalty of indulgence, their children will be found 
 far on the road that leads to inebriety. Hereditary influ- 
 ences are among the most potent that determine this dis- 
 ease and they follow the usual course. Thus, in mixed 
 families, the male children of an inebriate mother, or the 
 female children of an inebriate father, may alone exhibit 
 the morbid tendency. 
 
 There is another type of drunkenness which goes under 
 the name of ebriosity, and by which is understood the con- 
 dition of continual half-way intoxication. This, necessarily, 
 occurs only among saloon-keepers and those engaged in the 
 liquor traffic, having access at all times to alcholic drinks. 
 This is a very fatal form of drunkenness, and may be called 
 
DTTTT OF THE STATE. 243 
 
 incurable. It is the form of drinking which life insurance 
 companies especially fear. 
 
 Habitual drunkenness is, therefore, a disease brought 
 on by the excessive use of alcoholic drinks, though this use 
 may or may not have been continual, and the victim is an 
 involuntary slave of an insane propensity. He knows what 
 is right, but cannot choose it ; and he knows what is wrong, 
 but cannot shun it. There is no loss of the power to judge 
 of right and wrong nor any disturbance as to facts, but the 
 mind is powerless to control conduct according to knowl- 
 edge. This state which the drunkard is in may be called 
 criminal irresponsibility. 
 
 Third. Can the drunkard cure himself or be cured under 
 the existing circumstances ? 
 
 In the early stages of dipsomania, inherited or acquired, 
 something can be done for the patient, but the cures are 
 the exception. 
 
 As to chronic cases of drunkenness a reformation is 
 improbable and very nearly impossible under the existing 
 circumstances. The temptations are too great and the 
 opportunities are too many, and though the drunkard may 
 have a desire to reform or to cure himself, his will-power is 
 enfeebled and he cannot resist the demands of his habits 
 unless he be removed from temptation and it be made 
 absolutely impossible for him to get a drink. The drunk- 
 ard is an object of contempt and disgust as a drunkard, and 
 an object of pity and danger as a man, as a father, as a son, 
 and as a brother. He is pitied by all good men, but they 
 are powerless to help him. He cannot help himself. 
 
 He cannot reform while he is in the midst of tempta- 
 tion. The licensed liquor houses are easy of access, and 
 indiscreet friends are not wanting to tempt him to go into 
 such places and to take but one drink, which is the spark 
 that lights the attack. 
 
 Dr. Kerr says, " The struggle of the intemperate for free- 
 
244 DISEASES OF INEBRIETY. 
 
 dom is a combat more terrible tlian any other figlit on 
 earth." It is a hopeless figlit, I add, if unassisted. 
 
 Dr. Parrish sa3^s, "The temptation with which they are 
 tempted is within. It is subjective. It circles in the stream 
 that gives them life. It may be likened to a battery that is 
 hidden somewhere in the cerebral substance — connected by 
 continuous fiery wires, with a coil in every ganglion, from 
 whence they continue to extend — attenuating and distribu- 
 ting as they go, reaching after the minutest nerve fibrils, 
 which need only a throb from the inborn impulse to trans- 
 mit a force that quivers in every muscle and burns in every 
 nerve till the victim is suddenly driven to debauchery." 
 
 Tell me now, is not the condition of the drunkard a 
 deplorable one ? In fact, is it not a blot on civilization ? 
 Should not something be done to prevent the increase of 
 drunkenness and to diminish what there is of it.-* 
 
 Fourth. If the drunkard cannot cure himself, has he a 
 right to be protected against himself and against those who 
 are licensed by the State to sell him the wherewithal to 
 remain a drunkard ? 
 
 It is true that there are a great many private institutions 
 throughout the country for the cure of inebriates, and they 
 do a great deal of good, but the charges for treatment in 
 these institutions cannot be met by the majority of drunk- 
 ards. Taking into consideration that less than a year's 
 treatment will do no good, it is quite plain that the majority 
 of these unfortunates have, under tlie circumstances, no 
 chance whatever offered to them to become cured of their 
 malady. This is a serious matter to those afiflicted with the 
 drinking habit, and it is in their behalf that I make this 
 appeal to the citizens of Indiana, relying on their feelings 
 of justice, charity, mercy, and humanity that my efforts in 
 behalf of the habitual drunkard will not be without success, 
 I ask for these unfortunates nothing but what is just. 
 There is no hope for these poor creatures until they are 
 withdrawn from temptation and placed under restraint. 
 
DUTY OF THE STATE. 245 
 
 Fifth. After a man becomes a drunkard is he a danger- 
 ous man to society ? and, if so, has society a right to be 
 protected against the drunkard ? 
 
 The State protects society against the drunkard in the 
 following manner : 
 
 1. The law assumes that he who, while sane, puts 
 himself voluntarily into a condition in which he knows he 
 cannot control his actions, must take the consequence of 
 his acts, and that his intentions may be inferred. 
 
 2. That he who tlius voluntarily places himself in such 
 a position, and is sufficiently sane to conceive the perpetra- 
 tion of the crime, must be assumed to have contemplated 
 its perpetration. 
 
 3. That as malice in most cases must be shown or 
 established to complete the evidence of crime, it may be 
 inferred from the nature of the act, how done, the provoca- 
 tion or its absence, and all the circumstances of the case. 
 
 4. The law has not yet judicially recognized inebriety 
 as a disease. 
 
 The State does in every way trj' to prevent the making 
 of robbers, thieves, burghirs, and murderers, and criminals 
 in general, but it licenses men to make the drunkard. The 
 State protects society against the murderer and the robber 
 by imprisoning him, but it allows the drunkard to con- 
 stantly menace the well-being of society. 
 
 Would you say that the poor wife, who supports herself 
 and her children by sewing and washing, has no right to be 
 protected against the evil habits of her husband ? Would 
 you siy that tlie drunkard's children have no right to be 
 protected against the evil influence, the bad example, and 
 the burden of drunkenness of their father, which threatens 
 to blight their whole lives ? Would you say tliat the friends 
 of the drunkard have no right to have an asylum provided, 
 wherein they may place their unfortunate son or brother or 
 sister or father or mother or friend, in order that they may 
 
246 DISEASES OF INEBRIETY. 
 
 be cured of their malad3% which is a curse to ail coming in 
 daily contact with tiie habitual drunkard ? 
 
 These are questions that can have but one answer. Yes ; 
 society should be protected against the drunkard, who is 
 made by consent of the State in accord with public opinion. 
 
 Sixth. If society has a riglit to be protected against the 
 drunkard, if the drunkard has a right to be protected against 
 himself, and if the drunkard has a riglit to be protected 
 against those who are licensed by the State to sell him the 
 wherewithal to remain a drunkard, does it not follow that 
 the State should afford the protection ? 
 
 In answer to this question I read you several extracts : 
 " From the very nature of the malady it is scarcely to be 
 expected that the inveterate drunkard will voluntarily sub- 
 mit to control, or continue under it for a sufficient length of 
 time to receive lasting benefit ; and therefore it seems 
 essential, as in the case of other insanities, that legal power, 
 with, indeed, the neglect of law^ to provide such a check and 
 remedy, seems inconsistent, unjust, and inhumane when we 
 consider that while it permits the insensate drunkard to 
 endanger his life, to waste his property, and deprive liis 
 family of that which they are justly entitled to expect from 
 his hands during life, or to fall to them at his death, it holds 
 him responsible for any criminal act he may commit. No 
 doubt the law assumes that he drinks voluntarily, and with 
 his eyes open to all the consequences, and that his practices 
 therefore form an aggravation of his guilt ; but such is not 
 the case, for he drinks involuntarily, and he is unable to 
 exercise his reason aright or govern his will." 
 
 " All experience has shown that little progress or none 
 can be made toward the permanent recovery of a dipso- 
 maniac so long as his business places him in more or less 
 contact with alcoholic drinks, or in frequent association 
 with drinking comrades. Consequently, both physician 
 and friends should combine their influence to separate as 
 far as possible the patient from such associations. And if 
 
DUTY OF THE STATE. 247 
 
 it cannot be done in any other way, let him be induced to 
 take a residence for six or twelve months in a well-regu- 
 lated asylum for inebriates until the paroxysmal tendencies 
 have been broken. Enforced seclusion in a proper asylum, 
 with no possibility of obtaining any kind of alcoholic drink, 
 but where good air, good food, kind treatment, and some 
 suitable employment can be furnished, on the same prin- 
 ciple that applies to the treatment of insane persons, will 
 save them from early destruction." 
 
 "For the permament cure of inebriety, however, nothing 
 avails but special treatment in hospitals provided for this 
 class of patients. Of these the number is increasing as the 
 public becomes informed regarding the nature of the dis- 
 ease and the appropriate means of combating its ravages." 
 
 Dr. Carpenter says : " However responsible he may have 
 been for bringing the disease on himself, his responsibility 
 ceases as soon as he comes under the influence of the malady. 
 The disease, however, may not be brought on by the act of 
 the individual, and then it is clear at once that neither 
 directly nor indirectly can he be deemed responsible. But, 
 suppose that it were the result of his previous conduct, I 
 repeat that, however culpable he may have been for that, he 
 is not a responsible being while afflicted with the malady ; 
 for I can see no distinction between this form of the disease 
 and any other which has been induced by the habits or acts 
 of the individual. 
 
 " The only chance of a cure or alleviation is from atten- 
 tion to the health and abstinence from intoxicating liquors. 
 Neither can he be cured so long as the patient is at large, 
 and no amendment can be depended on, unless he has 
 undergone a long course of discipline and probation. Con- 
 sidering, then, that the individual is irresponsible and 
 dangerous to himself and others, and that his disease can 
 be treated only in an asylum, it is not only merciful to him 
 and to liis relatives, but necessary for the security of the 
 public, that he be deprived of the liberty which he abuses 
 
248 DISEASES OF INEBRIETY. 
 
 and perverts, and that he should be prevented from com- 
 mitting crimes instead of being punished — or, I should 
 rather say, being the object of vindictive infliction — after 
 he has perpetrated them. 
 
 " Of the chronic form I have seen only one case com- 
 pletely cured, and that after a seclusion of two years' dura- 
 tion. In general, it is not cured. Paradoxical though the 
 statement may appear to be, such individuals are sane only 
 when confined in an asylum." 
 
 The insane asylums cannot and ouglit not to be used as 
 a home for inebriates. Only those in the last stages of alco- 
 holism, that is, only those who are actually insane, are sent 
 there. Special attention cannot be paid to cases of inebriety 
 in the insane asylums ; besides, no one would voluntarily 
 apply for admission into an insane asylum, and if he were 
 to do so, it were questionable whether he would be admitted. 
 Therefore, the insane asylums offer no aid to the inebriate. 
 
 Seventh. If the State should afford the drunkard a chance 
 to be cured of his malady, how can it be done ? 
 
 The only way in which the State, under the existing cir- 
 cumstances, can provide a protection for the drunkard, so 
 that he may be cured of his malady, is by erecting and 
 maintaining homes for inebriates. The sending of confirmed 
 drunkards to these homes should be made compulsory by 
 laws in the same manner as the insane are sent to the asylums. 
 Voluntary entering into the homes by confirmed drunkards 
 should be encouraged, but only allowed after a proper 
 examination by two physicians, who should certify as to 
 the condition of tlie patient. A complete history of the 
 case would also help the medical superintendent and his 
 medical assistants in treating the patient. 
 
 The inebriate must remain at the home at least a year, 
 when the medical superintendent, under the advisement of 
 the board of trustees, may let the patient out on trial until he 
 has proven himself able to govern his will. The friends 
 should not be allowed any control over the patient after he 
 
DUTY OF THE STATE. 249 
 
 becomes an inmate of the home to which, according to cir- 
 cumstances, lie is assigned. 
 
 It is not my object to direct just how these homes should 
 be built and afterwards carried on ; all this is subject to 
 the decision of those who make the laws ; but I feel that 
 in order to make this paper of sufificient worth to merit 
 attention, I must give a general outline of what can be done 
 for the inebriate. With this object in view, I will suggest 
 that the money derived from the licenses issued and from 
 the fines collected from those who are not yet confirmed 
 drunkards, and from those who transgress the law by selling 
 to minors, by selling on Sundays, by selling without a 
 license, etc., be used for erecting a home for inebriates of 
 the male sex, and another for the female sex, and for the 
 sustainment of these homes. 
 
 The homes, after they were once in good working order, 
 could be made self-sustaining under efficient management. 
 Indeed, the inmates should be employed in labor, in order 
 to learn discipline and improve their bodily health. They 
 should also be afforded recreation and amusement to pre- 
 vent discontentment with the situation in which the}' are 
 placed, and to convince them that there are other ways of 
 enjoying life besides sitting in a saloon and becoming 
 drunk. 
 
 These homes should be erected in the country, away 
 from temptation. Proper rules and regulations should gov- 
 ern the inmates as well as those in attendance. The super- 
 intendents should be medical men, who ouglit to be under 
 the control and advisement of a board of directors or trus- 
 tees, one of whom should be the President of the State 
 Board of Health. The salaries of the officers should be 
 regulated by law, and they ouglit to give a bond. Politics 
 would necessarily have something to do with tlie appointing 
 of these men, which, undoubtedly, would be for the best. 
 
 The drunkard who is out on trial should be considered 
 as belonging to the institution until he has kept sober for 
 
250 
 
 DISEASES OF INEBRIETY. 
 
 the time of one year. Should he show signs of return of 
 his malady before the year is up, he should immediately be 
 brought back to the home. It is presumed that the person 
 who can keep sober one year is no longer to be considered 
 an habitual drunkard. 
 
CHAPTER XXV. 
 
 CARE AND CONTROL OF PAUPER INEBRIATES IN TOWNS 
 AND CITIES. 
 
 A certain proportion of the population of towns and cities 
 are composed of what are called the " Criminal Classes " — 
 those that require the constant espionage of the police, and 
 the adjudication of justice. Intermingled with these in no 
 small proportion is tlie pauper inebriate — friendless, home- 
 less, — appearing in varions roles on the public stage as 
 drunkard, tramp, or vagrant, many times entered on the blot- 
 ter of the police station as an " habitual drunkard," or 
 "rounder," — appearing at the various hospitals and dispen- 
 saries with disease or injury incident to his habits — finally we 
 find him in the wards of the charity hospital or among the 
 chronic insane of the insane asylum, if perchance sudden 
 death from natural causes or suicide has not intervened — 
 and whether his career terminates on the street or in the 
 hospital, or the cell or asylum, the trench in " Potter's 
 Field " receives him, and thus the story ends. 
 
 During the year 1887 the department of police and 
 excise of the city of Brooklyn report 23,912 arrests ; of 
 these arrests 13,862 were for intoxication ; of these, 108 are 
 stated as habitual — we presume this to mean that they were 
 known to the police as "habitual "drunkards, but it will at 
 once be seen that this is entirely out of proportion to the 
 number arrested. It would be no risk to say that of the 
 13,754 intoxicated persons arrested, many, if not the larger 
 proportion, were habitual or periodical users of alcoholic 
 stimulants, and that to intoxication. 
 
 251 
 
252 DISEASES OF INEBRIETY. 
 
 The English testimony as to the relation which alcohol 
 bears to the so-called criminal classes is very conclusive. 
 In the "testimony of chief constables and superintendents 
 of police," taken before " The Committee on Intemperance 
 for the Convocation of York," in 1874, in reply to this ques- 
 tion — " What proportion of those who have come under 
 your cognizance as criminals have been the victims of 
 drinking habits and associates." 
 
 A. " If by the term criminal is meant persons convicted 
 of any offence against the law, sixty-five or seventy per 
 cent." 
 
 B. " Nearly all." 
 
 C. " Fully nine-tenths." 
 
 D. " Quite nine-tenths." 
 
 E. "Twenty per cent, of the summary convictions of 
 one year are absolutely for drunkenness — exclusive of a 
 large proportion of the residue attributable to drunkenness." 
 
 F. " Nearly half the entries," 
 
 G. "About three-fourths." 
 
 H. " During the past twelve months in this division there 
 has been 283 persons apprehended for serious offences. I 
 can safely state that 200 apprehensions were directly caused 
 from the effects of drink." 
 
 Question — " What proportion of those taken into custody 
 are under influence of liquor ?" 
 
 A. " 25 per cent, in country, 70 per cent, in town." 
 
 B. "Those directly arrested and those summoned, all 
 cases, 90 per cent." 
 
 C. " 70 out of every 100 persons when arrested are drunk." 
 
 D. " 161 persons arrested in this district in one year, 75 
 were under influence of liquor." 
 
 E. "50 per cent, are apprehended as drunks and disor- 
 derly independent of any other offence." 
 
 F. " The majority of persons arrested and charged with 
 drunkenness. I should say 70 out of every 100." 
 
 We then have the testimony of chief constables, superin- 
 
CAEE AND CONTROL IN TOWNS AND CITIES. 253 
 
 tendents of police, governors of goals, and chaplains, that at 
 least two-thirds if not three-fourths of all arrests made by 
 the police, the persons were addicted to the use of alcohol, 
 and that a large proportion of these were intoxicated when 
 arrested. 
 
 If we were to consult the police and criminal records of 
 any of our large cities, New York, Philadelphia, or Boston, 
 we might not equal but we should certainly approximate 
 such testimony as that given before the " Convocation at 
 York," We cannot then shut our eyes to the fact that in 
 every city and town a certain proportion of the population 
 are more or less continually under the influence of alcohol, 
 and that to a degree often dangerous to the community at 
 large. Intoxication, with or without overt criminal acts, 
 continually occurs, rendering it necessary to arrest and 
 imprison this class. 
 
 The question now before us is whether the present 
 method of dealing with the inebriate is the best, and if not, 
 what are its disadvantages. Those who have given thought 
 to the subject confidently assert, that the present method 
 of arrests, fines, and short term imprisonment (or occasional 
 six months) is not the proper and scientific way of dealing 
 with the inebriate. By this method, on regaining his 
 liberty the individual simply repeats his act of intoxication 
 and is again subject to arrest, fine, or imprisonment ; after 
 this has been repeated several times, he is known as the 
 " repeater," or " rounder." Instances are on record where 
 one person was subjected to arrest for intoxication over one 
 hundred times, a period, of course, extending over some 
 years, 
 
 A female is reported as having been convicted forty- 
 eigiit times for various offences, at all times committed 
 through drink. She paid ^200, or $1,000, as fines for drunk- 
 enness. The large majority in English prisons of re-com- 
 mittals are due to intemperance. If crime be associated 
 with the intoxication, as assault, grand larceny, tlien the 
 
254 DISEASES OF INEBRIETY. 
 
 clironic inebriate, strange to assert, will get the best treat- 
 ment ; tlie law will give him the full benefit of his criminal 
 act. Restraint, and a long continued period of total abstin- 
 ence will be enforced during his term of imprisonment, 
 and when his sentence expires, he will often leave greatly 
 benefited, and practically a sober man. Instances aie on 
 record where the inebriate has requested that he might be 
 placed in prison and thus secure restraint, seclusion, and 
 the discipline of prison-life, and thus attain habits of sobri- 
 ety. 
 
 The testimony from English prisons is singularly unan- 
 imous on this point as well as conclusive. 
 
 Question — " Do you consider the health of patients would 
 be affected by total abstinence from intoxicating drink ?" 
 Governors of jails testified " prisoners are universally bene- 
 fitted ; there are cases where it might be occasionally used, 
 as in feeble and broken-down prisoners — but these occasions 
 were rare." As a rule, men who have served long periods 
 of imprisonment, and who have been habitual drinkers, go 
 out heavier and better in health than they came in. Their 
 general improvement in health is due to cleanly habits, 
 warm bath, good ventilation, regular rest, systematic exer- 
 cise, connected with prison discipline, and total abstinence 
 from liquor of all kinds. 
 
 This result incidently points out clearly, we think, the 
 general plan and method by which we ought to control and 
 treat the pauper inebriate. He ought to have all the 
 advantages that prison discipline may secure to him with- 
 out the necessity of a criminal proceeding on his part. 
 
 Undoubtedly, the law, in dealing with the inebriate, 
 simply as an inebriate, is faulty or only partial in its effect 
 upon him. "It practically does this, it arrests him, and 
 fines or imprisons him for a short period — too short for any 
 benefit to be derived from it," — and then lets him go. The 
 law is like an incompetent physician : it first makes a wrong 
 diagnosis, and then prescribes an inert and therefore inef- 
 
CAKE AND CONTROL IN TOWNS AND CITIES. 255 
 
 fectual remedy. It reprimands the inebriate, it does not 
 treat his case at all. It looks upon the inebriate as an indi- 
 vidual who has the knowledge of right and wrong, and full 
 power of volition ; it regards the act of inebriation as 
 deliberate and voluntary, and therefore it proceeds by fines 
 and imprisonment to lash back into moral decency and 
 rectitude the offender. 
 
 But do we not recognize the value of restraint ? Would 
 we permit the brawling drunkard to make night hideous, or 
 the insane drunkard to scatter ruin right and left ? Cer- 
 tainly not. 
 
 What plan would then have all the advantages of the 
 present system of dealing with the inebriate, and none of its 
 disadvantages ? 
 
 In the first place, as to arrest and restrahtt. The inebri- 
 ate should be arrested if found intoxicated upon the 
 street or any public place, or upon a warrant issued on due 
 complaint of his family, or in case they failed to do their 
 duty, by a committee of reputable citizens of the ward in 
 which the inebriate was a resident, or the officers of said 
 ward. A warrant should be issued on complaint from any of 
 said parties, by the proper justice, and the inebriate arrested. 
 
 Proper testimony sliould then be secured as to facts 
 concerning his inebriety from reputable medical and other 
 sources. He should then be sent to an inebriate reformatory, 
 hospital, or work-house, for the institution should include all 
 these features ; we are dealing with a diseased person, not 
 a criminal, but as a pauper inebriate, without friends, or if 
 he has friends, without means. 
 
 There are abundant provisions for the wealthy inebriate. 
 Private asylums are numerous, and the appointments are 
 very complete for his treatment both here and abroad. It 
 is the pauper, his more unfortunate brother, whom we are 
 considering. 
 
 The pauper inebriate is now duly arrested ; he must be 
 restrained and controlled for some definite time in some 
 
256 DISEASES OF INEBRIETY. 
 
 institution. The period should be not less than one year, 
 made longer if necessary by recommittal. The institution 
 to which he is committed should be placed in the suburbs 
 of the city or town, with convenient access to it. Abundant 
 grounds should surround the building, or, better still, a 
 farm should be the site of its location. Out-door occupa- 
 tion, so beneficial in the treatment of the chronic insane, 
 would be no less so in the case of the inebriate. A compe- 
 tent medical superintendent, with suitable assistants, could 
 readily conduct such an institution. Its inmates would be 
 chronic inebriates ; all insane persons, or those incurable 
 from other diseases, should be sent to their proper asylums 
 or hospitals. Such an institution, with properly appointed 
 work-shops, a farm under cultivation, well-stocked and 
 planted, with a practical farmer at the head to regulate the 
 labor of the inmates, would be almost self-sustaining, for 
 the inmates would not be like those in an insane asylum, 
 mentally inefificient, or those in a charity hospital, physi- 
 cally helpless, but many would be skilled workmen who 
 outside would command good wages. Then, also, a system 
 of payment for extra work might be made, so that when 
 they left the reformatory something would be due them, 
 and they would not be turned out paupers. If this plan 
 were adopted, a large body of chronic inebriates that now 
 drift about in the community would not only be restrained 
 but made to a certain extent self-supporting, and in a cer- 
 tain proportion of cases cured. 
 
 The inebriate Home at Fort Hamilton is based on some 
 such plan, and demonstrates on a moderate scale what 
 might be accomplished on a larger one. 
 
 Every large town and city should have such an institu- 
 tion of sufficient size to meet its wants, containing a farm, 
 a work-house, and suitable medical care. It should be 
 readily accessible, although the price of land would regulate 
 somewhat the site of its location. 
 
 The locality should be healthy, and the internal and sur- 
 
CARE AND CONTROL IN TOWNS AND CITIES. 257 
 
 rounding sanitary conditions good. The dietary should be 
 generous, of good quality, and the food well-cooked. This 
 is essential. Specialists in lunacy have found that a certain 
 way to precipitate acute or sub-acute lunacy into the ciironic 
 forms is to put the patient on low and innuiritious diet. 
 Out-door exercise and occupation, as well as those measures 
 that will eventually appeal to his better nature, lead him 
 back to thoughts of home and family, develop his higher 
 tendencies, prompt his aspirations, and raise him above the 
 mere animal life he has led so long. To deprive such a one 
 of religious privileges, or the intellectual enjoyment he may 
 crave, is a refined species of cruelty that no true form of 
 philanthropy would be guilty of or tolerate. 
 
 This is no sentiment, it is practical fact and truth, for 
 among these pauper inebriates are found lawyers, editors, 
 physicians, clergymen, writers, artists, and skilled artizans, 
 men who have fallen from high estate. It is natural, then, 
 with returning and improved physical and moral perception 
 they should begin to crave that which feeds the intellect 
 and administers to the improved moral tone. 
 
 So much, then, for the Reformatory, the work-house, the 
 hospital, where we would place the chronic inebriate with- 
 out friends and without means. 
 
 But while the above institution will care for the chronic 
 inebriate, it does not, and cannot, fill a want severely felt and 
 long needed — how shall we deal with intoxicated persons 
 arrested on the streets by the police? 
 
 The usual metiiod is to arrest them, take them to the 
 nearest police station, prefer a charge of intoxication, with or 
 without disorderly conduct, record the case on the blotter, 
 and commit the accused to a cell, to await the sentence of 
 the justice. The following morning he is brought before 
 the police court — if a first offence, and not paiticularly ag- 
 gravating, sentence may be suspended — usually a fine is in- 
 flicted — and if this cannot be paid, ten days in jail is the 
 penalty. If the prisoner is an " old offender" and *' incorri- 
 
258 DISEASES OF INEBRIETY. 
 
 gible who has appeared before the justice probably several 
 times, lie or she is sent to the "penitentiary" or the " Island " 
 for a period not exceeding six months. To this method of 
 dealing with intoxicated persons arrested on the street or 
 other public place there are several objections ; in the first 
 place, the average policeman is not a good diagnostician. 
 Every case where the person is found stupid, dazed, or un- 
 conscious, is to him a " drunk," and must be " run in." 
 Hence, persons suffering from stupor, partial or complete, 
 arising from certain cerebral conditions resultant from head 
 injury, uraemic disease, or narcotics of any kind, unless these 
 conditions are accompanied by marked evidence of assault, 
 or other severe injuries, are apt to be mistaken for alcoholic 
 intoxication. This is not the fault of the police — they are 
 not diagnosticians, neither, indeed, can be — these cases 
 oftentimes puzzle the experienced physician. The system 
 that allows such a state of affairs to exist is at fault, not the 
 policeman who fails to make a proper diagnosis. 
 
 Certainly, to place such cases in a cell, and allow hours 
 to elapse before the true condition of affairs is apprehended, 
 is a grave and serious error. 
 
 But even if the stupor is alcoholic, and the ar»-est there- 
 fore legitimate, we maintain that the cell is an unfit place 
 for such a person seriously intoxicated. 
 
 Richardson, in his " Cantor Lectures," thus writes : 
 " Whenever we see a person disposed to meet the effects of 
 cold by strong drink it is our duty to check that effort, and 
 whenever we see an unfortunate person under the influence 
 of alcohol, it is our duty to suggest warmth as the best 
 means for his recovery. 
 
 " These facts prompt many other useful ideas of detail in 
 our common life. If, for instance, our police were taught 
 the simple art of taking the animal temperature of persons 
 they have removed from the streets in a state of insensi- 
 bility, the results would be most beneficial. The operation 
 is one that hundreds of nurses now carry out daily, and 
 
CARE AND CONTROL IN TOWNS AND CITIES. 259 
 
 applied to our police-officers at their stations, it would 
 enable them not only to suspect the difference between a 
 man in an apoplectic fit and a man intoxicated, but would 
 suggest naturally the instant abolition of the practice of 
 thrusting the really intoxicated into a cold and damp cell, 
 which to sucli a one is actually an ante-room to the grave." 
 
 In view of this, in the " London Metropolitan District " 
 the cells in whicli intoxicated persons are received are 
 properly warmed in cool weather. 
 
 In addition to this we maintain that every case of alco- 
 holic coma or stupor should come under medical supervis- 
 ion, that the police surgeon should make the diagnosis, — 
 not the policeman who made the arrest — and appoint the 
 proper remedial agencies. Too often the cell door has 
 been shut and the prisoner allowed to " sleep off " his 
 intoxication, and "the sleep that knows no waking" has 
 come to him before morning. 
 
 It has been suggested that in every large city there be 
 established a central hospital, convenient of access, where all 
 seriously intoxicated persons, or persons found dazed or 
 stupid upon the streets from other causes, can be taken and 
 receive prompt medical aid, and from thence, after they are 
 sufficiently recovered, sent to their own homes, or if friend- 
 less and homeless, assigned to the insane asylum, the ine- 
 briate asylum, the charity hospital, or such institution as 
 seems to be most appropriate for their condition. 
 
 There is still another class, not directly coming under 
 police supervision, to whom such central reception hospital 
 would be a great boon — those who through alcoholic ex- 
 cesses develop delirium tremens or acute alcoholic delirium, 
 those living in boarding-houses whose means are limited, 
 who cannot command nursing and medical attention. The 
 regular city hospitals refuse such cases, except special 
 arrangements are made and high rates are charged ; then 
 only cases of acute alcoholism are taken — of course, chronic 
 alcoholics are peremptorily refused. There is good reason 
 
260 DISEASES OF INEBRIETY. 
 
 for this; general hospitals have no special provision for 
 cases of contagious disease, insane persons, or cases of 
 alcoholism ; no padded rooms, no extra attendance, none 
 of the appointments necessary for the care of such cases. 
 
 The suburban inebriate hospital outside of the city is 
 already tested to its full capacity with chronic cases of 
 inebriety. It is at some distance from the city, and to enter 
 a patient in its wards requires certain legal formalities, and 
 therefore, time. 
 
 Such a central hospital in the city, accessible at all 
 times, especially to this class of cases under consideration, 
 for which no provision is made at the general hospitals, 
 would provide at least temporar}' care and treatment for 
 insane or intoxicated persons found upon the street. It 
 would be a channel through whicli the inebriate asylum, 
 the insane asylum, or the general hospital, would receive its 
 proper class and quota of patients. It would, as a " bureau 
 of distribution," save much trouble now experienced in 
 assigning insane persons to inebriate asylums, and alcoholic 
 to insane asylums, as well as persons to either of these who 
 might need the care of a general hospital. 
 
 While not directly established for this work, it would in- 
 directly do considerable of it. 
 
 Besides this, the establishment of sucii a special hospi- 
 tal mainlv for the treatment of such cases, would afford 
 excellent opportunities to study alcoholism in its more 
 acute forms. The capacity of such a hospital need not 
 exceed fifty beds, as from it would be constantly sent out 
 all cases not appropriate to it, and all cases assuming a 
 chronic character. 
 
 It would not be altogether dependent on the city for its 
 support, as the friends of many would gladly pay for the 
 privilege of having cases treated in its wards ratiier than in 
 their own homes. Acute cases of alcoholism, after recovery 
 from the immediate attack, should their cases warrant it, 
 
CARE AND CONTROL IN TOWNS AND CITIES. 261 
 
 could be assigned or committed to the inebriate asylum for 
 *' chronic inebriates." 
 
 Fortunately, we are not without precedent in this matter. 
 The establishment of a special city hospital devoted to the 
 care of "acute cases of alcoholic delirium," to which the 
 police are directed at all times to bring persons found upon 
 the streets seriously intoxicated or stupid from other cause, 
 and all others who may desire to have their friends treated 
 for acute alcoholism. " The Bureau d'Admission," of the 
 department of the Seine, at St. Anne Asylum in Paris, of 
 whicli Dr. Magnan is one of the two physicians, is an insti- 
 tution to which no exact parallel exists in England or in this 
 country. To it are brought all the cases of insanity pre- 
 vious to their admission to the various public asylums, and 
 all cases of acute delirium or mania whicii fall under the 
 care of the police in Paris. It is here that they are exam- 
 ined, and their admission or rejection decided upon. If 
 admitted, they are drafted to the one or other of the asylums 
 which is most suited to the class of the patient, or the form 
 of his malady. 
 
 The Bureau d'Admission is quite distinct from the St. 
 Anne Asylum itself, and under altogether different admin- 
 istration. In order to provide accommodation for the tempo- 
 rary lodgment of patients on their way to other asylums, 
 and also for the reception of the more acute cases, it is pro- 
 vided with about fifty beds, and is fitted up in every way as 
 a small asylum. Here there are brought all the cases of 
 delirium tremens and "simple alcoholic delirium " which 
 fall under the notice of the police, and a large number from 
 the lower and middle classes, and here they are treated 
 until tiieir recovery. Hence, it comes to pass that a very 
 large proportion of all the cases of delirium tremens occur- 
 ring in Paris and its vicinity come under observation here, 
 and this not only in one attack, but again and again, and 
 when at last by repeated attacks they have become mentally 
 
262 DISEASES OF INEBRIETY. 
 
 deranged or greatly weakened, they again come under 
 notice for transference to asylums. 
 
 The results of such opportunities of observation could 
 scarcely fail to be productive of an increase of our knowl- 
 edge, and their value is necessarily augmented by the fact 
 of their being utilized by experienced alienists, and seen 
 side by side with other forms of acute delirium. In addi- 
 tion to the hospital wards there is an out-door department, 
 where discliarged patients and others return for treatment 
 of the various nervous disorders induced by their habits. 
 
 This hospital does excellent work, but there should be a 
 large suburban hospital for the control of the more chronic 
 forms of inebriety, and persons treated for an acute attack 
 "should not be allowed to return again and again, until 
 their minds were weakened and they became thus fit sub- 
 jects for the insane asylum." 
 
 Such asylums, for long periods of commitment of chronic 
 inebriates, exist in America, in England, in Australia, in 
 New Zealand, and in Germany. 
 
 Much interest is now manifested by the public and the 
 legislatures of States on this all-important topic. It is nec- 
 essary, therefore, that legislative effort be directed in the 
 proper channels, and the inebriate, who constitutes so large 
 a proportion of our population, should be laid hold of and 
 dealt with systematically and scientifically — not as criminals, 
 but as those deprived of their reason and their volition — 
 those automatic in their actions, vicious in their propensities 
 — a curse to the community in which they dwell. Restrain, 
 control this class, and you reduce prodigality, want, disease, 
 to a minimum, and produce the best sort of political economy, 
 based on science and common sense. Allow this class their 
 liberty, and you foster these evils, and encourage and prop- 
 agate their results. 
 
 Imprisonment, punishment — all punitive laws — have 
 failed to abate or even mitigate the evil. Any effort 
 directly based on fear of punishment or moral persua- 
 
CAKE AND CONTROL IN TOWNS AND CITIES. 263 
 
 sion will fail. We must place the evil on its true basis, 
 — that of DISEASE, — and treat it accordingly. Yellow 
 fever, cholera, small-pox we quarantine. We investigate 
 the causes of epidemics, and we endeavor to remove that 
 cause ; so with alcohol and its attendant evils. Punitive 
 and restrictive laws should be directed against the manu- 
 facture and sale of alcohol, not against its victim, the 
 inebriate. How we shall care for the homeless, friendless, 
 pauper inebriate, as he is presented to us in the acute and 
 chronic forms of his malady, it has been the province of 
 this paper to point out. 
 
CHAPTER XXVI. 
 
 SAME MEDICO-LEGAL CONSIDERATIONS. 
 
 It has become a maxim in law that drunkenness is no 
 excuse for crime. The interpretations of phenomena by 
 theology and medicine are undergoing modifications in con- 
 sonance with the advancement in science and discovery, 
 which distinguishes the age in which we live. Similar in- 
 terpretations- by the law, however, are not so impressible. 
 The movements of the law are necessarily cautious and de- 
 liberate. The legal principle which denies to drunkenness 
 any liberty with respect to crime, must have its reason in 
 some presumed expediency, in the absence of exact knowl- 
 edge. For the true principles which underlie the several 
 and distinct varieties in motive and intent, inciting the 
 inebriate in the gratification of his unnatural appetite, are 
 even now undergoing study and analysis. The law has 
 been unable, hitherto, to offer a comprehensive and satis- 
 factory explanation and definition of drunkenness ; and its 
 dictum, therefore, that inebriation is no excuse for crime, 
 must be open to suspicion. 
 
 It is certain that a man indubitably drunk is not in his 
 right mind, and that he can not, by any power within him- 
 self, either mental or physical, conduct himself as he would 
 do when not intoxicated. 
 
 It is also certain that his departures from the lines of 
 right reason are fundamental and not frivolous. But 
 drunkenness is a state of mind and body usually of brief 
 duration. The sober mind has means within itself of study- 
 ing the nature of drunkenness between spells, as well as 
 
 265 
 
266 DISEASES OF INEBRIETY. 
 
 observing it in others. It is capable of perceiving that the 
 use of alcoholic liquors will induce a condition of the men- 
 tal faculties wherein motives and intent? are unusual and 
 unsound, as well as beyond volitional control. But the 
 questions arise : Are there not radical differences in the 
 motives which impel to drunkenness ? Is not intoxication, 
 very frequently indeed, the result of the demands of a disease 
 or of an urgency in the feelings which an attending imbe- 
 cility of mind is unable to control or overcome ? If these 
 interrogatories really fore-shadow actual facts, then it must 
 be that there are important exceptions to the proposition 
 that drunkenness is no excuse for crime ; for the inebriate 
 may then be not merely irresponsible, abstractly, when 
 drunk, but he may be irresponsible for the imbecility of 
 will which so readily yields to the demands of the neu- 
 rotic constitution. 
 
 In the neurotic constitution even slight intoxication is 
 often succeeded by an utter blank in the memory. This 
 withdrawal of the mind from the direct line and knowl- 
 edge of conscious life implies radical disabilities in the 
 assumption of responsibility for conduct. Drobisch ex- 
 plained clearly the general nature of the law of association 
 in psychology in the language following : Psychology shows 
 that not only memory and imagination, but judgment, 
 reasoning, conscience itself, and, in general, all higher 
 activity and all development of the mind rest upon the 
 association and reproduction of states of consciousness ; 
 that this explains also the different variations of feeling, 
 emotion, desire, passion, and rational will. But these 
 explications are supported by generalities that have always 
 an indeterminate character. This arises from their lack of 
 quantitative determination. Whatever, therefore, is con- 
 ceded or permitted to a congenital infirmity of mind in its 
 relations with the world at large, must also be accorded to 
 constitutional incapacity in any special direction. The 
 well-defined neurotic or spasmodic drunkard is an imbecile 
 
SOME MEDICO-LEGAL CONSIDEKATIONS. 267 
 
 in respect to his desire for intoxication ; for, in the con- 
 genital inebriate, the association and reproduction of states 
 of consciousness neitlier are, nor can they become, witli 
 respect to his special besetment, eitlier normal or manage- 
 able. 
 
 In general terms it may be said that inebriety is origin- 
 ally — that is, anterior to its hereditary descent in varying 
 forms — the outcome of very serious bodily injury, but more 
 especially injury to the head. The history of the late civil 
 war abounds in exemplifications of this fact. Certain physi- 
 cal wounds affect directly portions of the brain, or they may 
 withdraw from normal correspondence and relationship with 
 the brain to important parts of the body elsewhere. The 
 means, and measure, and quality of consciousness, through 
 many channels of sensation and association, are thus perma- 
 nantly destroyed. Thus there are produced radical defects 
 in consciousness, which in respect to inebriety prevent those 
 conservative mental operations and associations upon which 
 all higher activity and all development of mind rest. I have 
 said neurotic inebriety is primarily occasioned by some 
 physical injury, possibly in remote ancestry. This includes, 
 of course, such injuries to nervous integrity as may arise 
 from any adequate cause, perhaps not technically, yet in 
 reality physical, as prolonged grief, great nervous shock, 
 excessive study, protracted and profound disease, malaria, 
 and many other recognized sources of that peculiar state of 
 nervous instability and inadequacy which goes under the 
 general designation of the neurotic constitution. Absence 
 of function begets incapacity to act through sheer debility 
 of nerve, or even through atrophy of substance. 
 
 Dr. Livingston, after years of absence amongst the black 
 tribes of Africa, says that upon coming into the presence of 
 his countrymen he was at home in everything except his 
 own mother tongue. He seemed to know the language 
 perfectly ; but the words he wanted would not come at his 
 call. It is difficult to divest the mind of the idea that the 
 
268 DISEASES OF INEBRIETY. 
 
 inebriate is really capable of mastering his morbid proclivity 
 at will. And that there may be — in view of the lack of 
 quantitative determination in the character of the nervous 
 disability in the neurotic inebriate — certain instances 
 wherein the defect is not overmastering, seems probable. 
 Yet this very qualification may doubtless include innumer- 
 able instances in which voluntary restraint is impossible. No 
 man by taking thought can add one cubit unto his stature. 
 Neither can a man by any process of reasoning, or any 
 effort of will, change the functions appertaining to physical 
 defect or pathological deterioration into the ways of normal 
 and physiological life. 
 
 It is impossible to discuss the exact time when the brain 
 becomes diseased by alcohol and its victim loses self-con- 
 trol, or what quantity of that stimulant a person can use 
 before becoming a dipsomaniac. This point of time can be 
 no more satisfactorily arrived at than the true time required 
 for the production of yellow fever by the application of its 
 exciting cause. Some constitutions would be affected in 
 five minutes. In others it would require weeks or perhaps 
 months of exposure to miasmata before the individual 
 would discover the premonitory S3'mptoms of the disease. 
 So it is with different individuals who are in constant use 
 of alcoholic stimulants. 
 
 It is impossible for the physician to state when the con- 
 stitution is first affected by disease. The dividing line 
 between health and disease has never been determined. 
 Nor can it ever be defined. The physiologist has never 
 been able to draw the dividing line between sanity and 
 insanity, or to determine how much of the exciting cause it 
 requires to produce a morbid condition of the brain. 
 
 These nice distinctions in regard to the pathology of dis- 
 ease do not enter into the discussion in reference to the im- 
 portance of asylums for the control and medical treatment 
 of dipsomaniacs. 
 
 Neither can we point out the dividing line where the 
 
SOME MEDICO-LEGAL CONSIDERATIONS. 269 
 
 moral responsibility ceases, and the irresponsibility begins 
 in the use of alcoholic stimulants. 
 
 The time, when an institution can reach the dipsomaniac 
 is when he has lost self-control, and the law regards him as 
 a dangerous citizen, or when he can be induced to enter 
 the asylum voluntarily. 
 
 We contend that when the brain is diseased from defect- 
 ive nutrition, by any animal or vegetable poison, by any 
 great shock on the nervous system impairing the nervous 
 fluids of the body, there will be a corresponding disease of 
 mind, which disease will develop all tlie peculiar types, 
 stages, and phases of insanity, from the most inoffensive to 
 the most furious and dangerous. It matters not how this 
 disease may have been induced, wliether by stimulants pre- 
 scribed in sickness, or by the influence of social friends ; 
 whether under extenuating circumstances, or in full view of 
 the terrible penalty which this malady inflicts on its victim ; 
 the State is equally bound to protect society against the in- 
 sane acts of this dipsomaniac. He should be committed to 
 an asylum for restraint and treatment adapted to his 
 physical and mental condition. 
 
 All the laws and penalties which a State can enact 
 against crime committed by the dipsomaniac will never 
 prevent him, while at large, from committing murder, arson, 
 or theft, or from taking his own life. Why, then, should 
 our State allow its citizens to go at large, when they have 
 lost self-control, and when daily experience shows that it is 
 not compatible with private and public safety for them to 
 remain at liberty ? 
 
 Does the State bring to life the murdered family by 
 simply going through the accustomed forms of judicial 
 procedure, in order to punish the man for what he cannot 
 be responsible, or place him as a criminal at the bar, when 
 his testimony would not be received in the witness box, or 
 find out, too late, that he really is a maniac, and send him 
 at last to an asylum as a criminal lunatic. 
 
270 DISEASES OF INEBEIETT. 
 
 The only true and enlightened policy for the State is to 
 provide asylums for tliis class of insane. 
 
 What IS it ? is the question of the hour. To find the 
 answer, let it first be determined what or who are inebriates. 
 That there are thousands of persons who consume intoxi- 
 cants habitually and constantly, who are never visibly 
 intoxicated, is a very obvious truth. It is nevertheless true, 
 that there are many who, by nature and constitutional bias, 
 are inebriates, who have never taken an inebriating draught, 
 but who, knowing theijiselves, and their morbid tendency, 
 avoid the danger of excess by absolute and perpetual abstin- 
 ence. 
 
 Not a few such persons may be found among intelligent 
 and careful people, with whom each day is a day of conflict 
 — of conflict with themselves and their environment. Tliey 
 are a multitude of heroes, whose battles with self will never 
 be known, and the record of whose conquests will never be 
 made. Such cases have their analogues in various forms of 
 morbid inheritance, only two of which need now be men- 
 tioned, insanity and pulmonary consumption. 
 
 The natural history of insanity and inebriety is so simi- 
 liar that it is sometimes difficult to draw the line cf separa- 
 tion. Indeed, they are so near to each other as to admit 
 in some cases of an equal place in nosology, as, for example, 
 in the use of the terms '* insane drunkenness " and "drunken 
 insanity," both representing kindred pathological conditions. 
 The relationship is so patent even to the unprofessional 
 observer, that I need dwell no longeron this point than to 
 allude to a striking inconsistency in the law, as viewed from 
 a medical standpoint. If I understand its meaning, the law 
 discriminates between common drunkenness and dipso- 
 mania, but fails to recognize the likeness between dipso- 
 mania and insanity, or, in other words, it does not see a 
 similarity between insanity from drink and insanity from 
 other causes, though the manifestations may be similar. It 
 assumes that the dipsomaniac is a voluntary demon or 
 
SOME MEDICO-LEGAL CONSIDERATIONS. 271 
 
 drunkard, and if he will, he may avoid the paroxysms that 
 characterize the disease. 
 
 Science, however, declares a dipsomaniac, or an inebriate 
 in the medical sense, to be what he is from an impaired or 
 defective will, that is unable to resist the " nerve storm" 
 which assails him at intervals, that he cannot always antici- 
 pate, as is the case in hysteria, epilepsy, etc. In consequence 
 of this error, the law provides in the same statute for habit- 
 ual drunkenness and insanity, making a criminal act com- 
 mitted by an insane person so far different irr its results 
 from the same act committed by an inebriate, as to warrant 
 the commitment of the former to an asylnm, while the pen- 
 alty inflicted upon the latter may be imprisonment for life 
 in a penitentary, or it may be hanging by the neck till he is 
 dead. 
 
 The analogy presented by pulmonary consumption may 
 not, in the view of some, be so decided, and hence I invite 
 attention to the early symptomatology and hereditary signs 
 of tiie two disorders. Thousands are being born with a 
 decided and well-marked consumptive diathesis, but who, 
 knowing tliemselves and their family history, adapt them- 
 selves to such hygienic and climatic methods of living as 
 tend to counteract the progress of the disease, and thus 
 avoid its fatal ravages. Such persons, however, are con- 
 sumptives by natural descent, who would go steadily on to 
 a consumptive's lingering death, but for the knowledge of 
 their tendency to it, and their ability to avail themselves of 
 means to resist its approaches. While it is interesting to 
 observe these analogues, and while the very fact of likeness 
 serves as confirmatory evidence of disease, there is ample 
 testimony from distinguished sources to fix the fact of dis- 
 ease independent of any likeness to other morbid condi- 
 tions. Dr. Quain defines disease to be " any deviation 
 from the standard of health, in any of the functions or com- 
 ponent materials of the body." 
 
 Dr. Norman Kerr says in his recent work on inebriety, 
 
272 DISEASES OF INEBRIETY. 
 
 "In drunkenness of all degrees, and every variety, the 
 Churcli sees only sin ; the world, only vice j the State, only 
 crime. On the other hand, whatever else any intelligent 
 medical practitioner beholds in such cases, he generally dis- 
 covers a condition of disease," In our own country, the 
 current medical opinion favors the same view, and I am 
 convinced that it is gaining a firmer hold on the public mind 
 in all departments of our social and civil life. It remains 
 for the legal and the judicial sentiment of the land so to 
 classify alcoholic intoxication as to remove it from the do- 
 main of morals, not even regarding it as a species of moral 
 mania, but to accord to it its legitimate place as a physical 
 disease. 
 
 For our present purpose, at least, it is assumed that we 
 are agreed as to the abstract question of disease as applied 
 to inebriety, but it becomes us to extend our inquiries a 
 little further, that we may ascertain to what class of disor- 
 ders it belongs. By common consent it is assigned to the 
 realm of neurotic disorders. It affects most immediately 
 and seriously the nervous system. Here, again, we may 
 pause a moment to notice a fact concerning the complicated 
 nervous system, which I think is not fully appreciated out- 
 side the medical profession. I refer to the sympathetic 
 system of nerves as distinct and largely independent of the 
 motor system. In order to apprehend the ravages of alco- 
 hol upon the sensitive nature of man, it is essential that we 
 understand the functions of the vital, as distinct from the 
 mechanical or automatic forces and movements of the body. 
 I take it to be an admitted principle of law that to consti- 
 tute a criminal act, the will must consent to the perform- 
 ance of the act, and in the study in which we are now 
 engaged it is highly important that we discriminate as I 
 have suggested ; that we appreciate the difference between 
 the nervous system, which has to do with vital forces and 
 functions, and the other nervous system, which does not 
 control or influence vital forces or functions. 
 
SOME MEDICO-LEGAL CONSIDERATIONS. 273 
 
 The inhibitory, restraining power resides in the series of 
 nerves which is specifically assailed by alcohol, when taken 
 into the body, and this is the prime fact in the whole matter 
 of responsibility, to which the law of the land does not seem 
 to attach importance. I read in my Blackstone that "all 
 the several pleas and excuses which protect the committer 
 of a forbidden act from the punishment which is otherwise 
 annexed thereto, may be reduced to this single consideration 
 — the want or defect of will. Indeed, to make a complete 
 crime cognizable by human law, there must be both a will 
 and an act." In the time when this wholesome doctrine 
 was proclaimed, the dogma of disease, as applied to in- 
 ebriety, was not considered. Intoxication was taken to 
 be a voluntary act, and hence it was said of an inebriate 
 that " what hurt or ill soever he doeth, his drunkenness doth 
 aggravate it." 
 
 This doctrine may be to-day orthodox in law, but in med- 
 icine it is not, and herein lies the difference between law and 
 medicine. Occasions or opportunities like the present are 
 meant to reconcile the two professions to the acceptance of 
 this wiser doctrine and a more humane practice. 
 
 But the question arises here, and is submitted from the 
 legal side. If inebriety is not to be punished, how will 
 society be protected from the assaults of the drunkard ? 
 Judge Davis says : " No disease excuses any man for the 
 commission of crime. A man in the last stages of consump- 
 tion is to be hanged for a murder as surely as though he 
 was in perfect health, and no disease by reason of its own 
 existence can, under any circumstances, excuse any man for 
 the commirsion of crime. Hence, to establish that it is a 
 disease is only to put it on the exact footing on which all 
 other diseases stand in respect of violation of law and their 
 punishment." If, then, insanity being considered a disease, 
 and inebriety be taken by law to be also a disease as well 
 defined and understood, we should gain all that we ask for. 
 Then I sliould hail this utterence from such a distinguished 
 
274 DISEASES OP INEBRIETY. 
 
 source as the keynote of a new doctrine, which should be 
 taken up by the courts of law and sounded with accumulat- 
 ing force and rhythm till the jurisprudence of the whole 
 range of disease and crime in their joint relation shall be 
 infused by its healthy tone. 
 
 While it proposes that society shall be protected from 
 the voluntary and deliberate criminal by punishment, be it 
 hanging or what else, it will protect society from the invol- 
 untary and unconscious criminal by isolation in a hospital 
 or asylum provided by the State for its unfortunate citizens 
 who have come into this world with an organization that is 
 out of harmony with the ethical and civil relations which 
 the law sanctions and provides for. When the philosophy 
 of law and the science of medicine shall join hands together 
 to create a jurisprudence founded on such a basis, it will be 
 a step toward a state of society that is much to be desired, 
 and will be doing more in the direction of relief from the 
 blight of intoxication than can, in the very nature of things, 
 be done by the methods so ineffectually put forth at this 
 time. 
 
 When alcohol enters into the human body in excess, its 
 affinity for nerve structure is manifest in its grasp upon the 
 inhibitory forces as among its very early influences. The 
 will is the citadel of the soul, by which life and conduct are 
 guarded and guided, but when it is seized and made captive, 
 to obey only the behests of this destructive force, the victim 
 is lost to himself, and acknowledges that he is enslaved. 
 The relation of the human will to the nervous system is 
 sadly misjudged. The wonderful network of nerves known 
 as the sympathetic system acts independently of the will. 
 It presides over vital functions. It has to do with the forces 
 of life with which the will has nothing to do. The heart 
 beats, the stomach digests, all the vital organs fulfill their 
 respective offices without any reference to the will. It 
 works while we sleep, and the vital functions are performed 
 
SOME MEDICO-LEGAL CONSIDERATIONS. . 275 
 
 in our unconscious rest. By its side the will is powerless. 
 If it presides over appetite, its behests are absolute. 
 
 The inebriate, with inherited or acquired passion for 
 stimulants, or for their hypnotic effect, cannot control his 
 longing when it asserts itself. The hungry man who is 
 starving for bread cannot, at his will, bid his hunger 
 depart. The true inebriate, when his restless nerves and 
 sinking spirits and burning desire demand repose and satis- 
 faction, must obey the call. He obeys though his will, his 
 conscience, his judgment, his past experiences, his moral 
 sense, all join in earnest protest. 
 
 Is it depravity of his nature or infirmity of his will ? A 
 wide distinction exists between depravity and pravity of 
 will. 
 
 Depravity signifies a state of natural debasement, with- 
 out any cause. The idea of a cause is precluded. It is 
 natural. 
 
 Pravity signifies a departure from a right purpose, for 
 which a cause is implied which is generally subjective. 
 Indeed, an impaired, feeble will is frequently the first symp- 
 tom of an approaching debauch. 
 
CHAPTER XXVII. 
 
 MEDICO-LEGAL QUESTIONS (CONTINUED) — LAW AND RUL- 
 INGS OF JUDGES. 
 
 In a discussion in which the question is to be considered 
 by such able medical men from the medical side or stand- 
 point, it has seemed to me that it would be of interest to 
 both professions, as well as to laymen, to have the inquiry 
 made as to those relations which attach by law to inebriety, 
 as well in the civil and domestic relations of the inebriate, 
 as in regard to crimes committed by persons while acting 
 under the influence of intoxicants, or while in a state of 
 intoxication. 
 
 What, then, is the present legal status of the question ? 
 
 I shall briefly state (but have neither opportunity nor 
 space to discuss) wliat I believe to be the law upon the sub- 
 ject ; citing and grouping authorities — the civil side first, 
 and the question of criminal responsibility second. 
 
 I. Civil Relations, i. Intoxication was regarded by 
 the common law, when complete and characterized by un- 
 consciousness, as a species of insanity. Lord Coke's fourth 
 manner of " 7ion compos mentis " was " 4. By his own act as 
 a drunkard." 
 
 Deliriutn tremens, which results directly from habits of 
 intoxication, is in law considered to be a form of insanity, 
 and this has been repeatedly held by the courts. 
 
 It has always been a well-settled rule of law that no per- 
 son can make a contract binding upon himself while he is 
 wholly deprived of his reason by intoxication. This would 
 
 277 
 
278 DISEASES OF INEBRIETY. 
 
 be true as to deeds, wills, all instruments and obligations of 
 every kind. 
 
 This rule is not changed where the intoxication was not 
 procured by the other party to the contract, but is voluntary 
 on the part of the drunkard. 
 
 By tlie common law, as well as by the New York stat- 
 ute, a testator must, at the time of the execution of a will, 
 bj of ^^ sou?id niind and memory," and it is as requisite to have 
 the presence of a '''disposing memory," as a *' sound mind." 
 
 {b) By common law and by statute law an intoxicated 
 person is thereby rendered incompetent as a witness. The 
 statute law usually classifies sucli intoxicated persons as 
 lunatics, and the provisions frequently apply similarly to 
 each, and' to both. 
 
 (<:) In the marriage contract, which in some is treated 
 on different grounds from all other contracts, from the neces- 
 sity of the case and consequences upon consummation, the 
 sound general rule has been, that if the party was so far 
 intoxicated as not to understand the nature and consequences 
 of the act, this would invalidate the contract. 
 
 2. The analogy between lunacy and total intoxication, 
 or even habitual drunkenness, is doubtless most marked in 
 the statutes of the various States, regarding the care and 
 custody of the person and estates of lunatics, idiots, and 
 habitual drunkards. 
 
 (a) By English law the Lord Chancellor, as the direct 
 representative of the Crown, has always exercised the right 
 of assuming the custody and control of the persons and 
 estates or all those who, by reason of imbecility or want of 
 understanding, are incapable of taking care of themselves. 
 
 Writs de lunatico inquirendo were issued in cases to inquire 
 whether the party was incapable of conducting his affairs 
 on account of habitual drunkenness. 
 
 The Supreme Court of every American State would 
 doubtless have the right which the Court of Chancery 
 exercised under the law of England in the absence of any 
 
LAW AND KULINGS OF JUDGES. 279 
 
 Statute law. This must be so in the nature of things in 
 American States ; the principle has been exercised and 
 adjudicated on in Kentucky, in Maryland, Illinois, Indiana, 
 and North Carolina. 
 
 The Legislatures of the various States have vested this 
 power by statutory enactments in various tribunals, for 
 example in New York, by the old law in the chancellor ; in 
 New Jersey, in the Orphans' Court ; in South Carolina, 
 equally in the law and equity side of the courts, and now 
 in New York, where the distinction between law and equity 
 has been abolished, in the Supreme Court, which exer- 
 cises it. 
 
 It will be observed that in many of the American States 
 the habitual drunkard, even, is classified and treated under 
 the same provisions, and in the same manner as the lunatic 
 and the idiot, notably in Pennsylvania, New Jersey, Mary- 
 land, Illinois, New York, and many other States. 
 
 Taking New York as a fair illustration of the principle, 
 it has been held by the courts, that all contracts made by 
 habitual drunkards who have been so adjudged in proceed- 
 ings de lunatico inquirendo are actually void. And that the 
 disability of the habitual drunkard continues after the 
 committee has been appointed, even when he is perfectly 
 sober and fully aware of the nature and consequences of 
 his acts. 
 
 It has also been held that habitual drunkenness being 
 established, it x'?, prima facie evidence of the subject's inca- 
 pacity to manage his affairs. 
 
 We may then assume, in considering the medical juris- 
 prudence of inebriety, that the law has always regarded 
 and treated intoxication as a species of mental derangement, 
 and has considered and treated the habitual or other 
 drunkard as entitled to the special care and protection of 
 Courts of Equity, in all matters relating to his civil rights, 
 his domestic concerns, his ability to make contracts, his 
 
280 DISEASES OF INEBRIETY. 
 
 intermarrying and disposing of his property, by deed, gift, 
 or devise. 
 
 The law has gone farther, for it has thrown round him 
 its protecting arm and shield, when it is satisfied that he 
 has become so addicted to drink as to seriously interfere 
 with the care of his estate, and the courts have then come 
 in and taken absolute control of both person and estate of 
 drunkards, in their own interest and for their presumed 
 good. 
 
 Medical men should keep in mind the distinction run- 
 ning all through the law between insanity and irresponsi- 
 bility. The medical view, that irresponsibility should follow 
 where insanity exists, has nowliere been conceded by the 
 law, and this distinction must be borne in mind in the sub- 
 ject here under consideration. 
 
 II. Criminal Relations. This brings us to the second 
 question : The relation of the inebriate to the criminal law 
 for illegal acts, committed while intoxicated, which seems 
 more harsh in its practical effect than the principles which 
 govern him in his civil and social relations to society and 
 the State. 
 
 This seeming hardship, however, is due to the capacity 
 of the drunkard, considered objectively, for wrong-doing. 
 In the one case his position as a civil agent is that of a unit 
 of society merely — one who is, as it were, to be "saved from 
 himself"; in the other case, the criminal aspect of the 
 drunkard, it is the weal of society which is to be conserved 
 and protected. 
 
 I. That form of intoxication which results in the total 
 or partial suspension of, or interference with, the normal 
 exercise of brain function, is regarded, at law, as mental 
 unsoundness, and sometimes amounts to a species of in- 
 sanity. It has been held at law to be a voluntary madness, 
 caused by the willful act of the drunkard, and the decisions 
 have been uniform, that where reason has been thus sus- 
 pended, by the voluntary intoxication of a person otlierwise 
 
LAW AND KULINGS OF JUDGES. 281 
 
 sane, this condition does not relieve him from the conse- 
 quences of his criminal acts, or, more carefully stating it^ 
 from acts committed by him in violation of law, while in 
 that state. 
 
 (a) There are decisions which go to the length of hold- 
 ing that the law will not consider the degree of intoxica- 
 tion, whether partial, excessive, or complete, and even tiiat 
 if the party was unconscious at the time the act was com- 
 mitted, such condition would not excuse his act ; and, in 
 some cases, judges have gone so far as to instruct juries 
 that intoxication is actually an aggravation of the unlawful 
 act rather than an excuse. 
 
 But the better rule of law now undoubtedly is, that if 
 the person, at the moment of the commission of the act, was 
 unconscious, and incapable of reflection or memory, from 
 intoxication, he could not be convicted. 
 
 There must be motive and intention to constitute crime, 
 and in such a case the accused would be incapable from 
 intoxication of acting from motive. 
 
 [d) The reasons upon which the rule of law rests, may, 
 with great propriety, be considered, and should be carefully 
 studied, before any attempt at criticism is made. 
 
 1. The law assumes that he who, wliile sane, puts him- 
 self voluntarily into a condition, in which he knows he 
 cannot control his actions, must take the consequences of 
 his acts, and that his intentions may be inferred, 
 
 2. That he who thus voluntarily places himself in such 
 a position, and is sufficiently sane to conceive the perpetra- 
 tion of the crime, must be assumed to have contemplated 
 its perpetration, 
 
 3. That as malice in most cases must be shown or 
 established to complete the evidence of crime, it may be 
 inferred, from the nature of the act, how done, the provoca- 
 tion or its absence, and all the circumstances of the case. 
 
 In cases where the law recognizes different degrees of a 
 given crime, and provides that willful and deliberate inten- 
 
282 DISEASES OF INEBRIETY. 
 
 tion, malice, and premeditation must be actually proved to 
 convict in the first degree, it is a proper subject of inquiry 
 whether the accused was in a condition of mind to be 
 capable of premeditation. 
 
 Sometimes it becomes necessary to inquire whether the 
 act was done in heat of passion, or after mature premedita- 
 tion and deliberation, in which tlie actual condition of the 
 accused and all the circumstances attending his intoxica- 
 tion, would be important as bearing upon the question of 
 previous intent and malice. 
 
 (<r) The New York Penal Code lays down with precision 
 the provision of law governing the question of responsibility 
 in that State as follows : 
 
 "§ 22. Intoxicated persons. — No act committed by a per- 
 son, while in a state of intoxication, shall be deemed less 
 criminal by reason of his having been in such condition. 
 But whenever the actual existence, of any particular pur- 
 pose, motive, or intent is a necessary element to constitute 
 a particular species or degree of crime, tiie jury may take 
 into consideration the fact that the accused was intoxicated 
 at the time, in determining the purpose, motive, or intent, 
 with which he committed the act." 
 
 (^) Voluntary intoxication, though amounting to a 
 frenzy, has been held not to be a defense when a homicide 
 was committed without provocation. 
 
 [e) Delirium tremens, liowever, — a condition which is the 
 result of drink and is remotely due to the voluntary act of 
 the drunkard, — has been held to be a defense to acts com- 
 mitted while in the frenzy, similar to the defense of 
 insanity. 
 
 (/) It has been held that, when inebriety develops into 
 a fixed and well-defined mental disease, this relieves from 
 responsibility in criminal cases, and such cases will be 
 regarded and treated as cases of insanity. 
 
 (^) It may now be regarded as a settled rule that evi- 
 
LAW AND KULINGS OF JUDGES. 283 
 
 dence of intoxication is always admissible to explain the 
 conduct and intent of the accused in cases of homicide. 
 
 {h) In crimes less than liomicide, and especially wlieie 
 the intent is not a necessary element to constitute a degree 
 or phase of the crime, this rule does not apply. 
 
 The practical result, however, in such cases, and in those 
 States where the latter provision of tlie New York Penal 
 Code has not been adopted, is to leave this whole subject 
 to the judges who fix the details of punishment. This is a 
 great public wrong, because each judge acts on his own 
 idea, and one is merciful and the other harsh. If it is 
 placed by law in the breast of the judges, it should be well- 
 defined and regulated by statute. Lord MacKenzie well 
 says : " The discretion of a judge is the law of tyrants." 
 
 3d. It will be observed that the law has not yet judicially 
 recognized inebriety as a disease, except in the cases of 
 delirium tremens — above cited — and hardly even in that 
 case. 
 
 It is for publicists, judges, and lawmakers to consider 
 the claim now made, that science has demonstrated inebriety 
 to be a disease. 
 
 If this is conceded, what changes are needed to modify 
 the law, as it at present stands, so as to fully preserve the 
 rights of society, in its relation to the unlawful acts of ine- 
 briates, with a proper and just sense of the rights of the 
 inebriate himself ? 
 
 The theoretical superstition that more severe punish- 
 ment of inebriates will deter them from drink and crime 
 has revived again in many sections. 
 
 A little practical investigation will show that every ine- 
 briate has a delusion that he is not a literal drunkard, but 
 is an exception to others, and he can always stop at will 
 when he chooses. He never realizes that any application 
 of the law to more severe punishment will have any refer- 
 ence to him. He never believes that he will drink to excess 
 or violate any law — he is not foolish enough for that. He 
 
284 DISEASES OF INEBRIETY. 
 
 always deludes himself with the idea that there is no disease 
 in his case, and all his use of spirits is the result of acci- 
 dents which he coulci at all times control. Hence all 
 example and fear of the law are powerless. As a lawmaker 
 and judge of other inebriates he is unjustly severe, but in 
 his own case he is always an exception, and will never come 
 under the general rule. Confinement or even capital pun- 
 ishment of inebriates has never a personal application or is 
 an example in the minds of inebriates who do not suffer. 
 Inebriates who are sent to jail regularly every year for 
 intoxication always delude themselves that it is unjust and 
 the result of accident or personal revenge, and not of 
 violated law. 
 
 The inebriate who is punished for crime always consoles 
 himself with the faith that he is a victim of plots and con- 
 ditions that should have been otherwise. 
 
 All appreciation of themselves when intoxicated is con- 
 fused and cloudy, and hence he never can realize that he 
 will do as others have done in tliis condition. Tlie theory 
 of deterring these men by increased punishment has no 
 support practically or scientifically. No single incident has 
 been produced to show that such an effect ever follows the 
 practical working of any law which assumes the inebriate 
 lias the power to stop drinking, and can be forced to exer- 
 cise it by intimidation and fear. 
 
CHAPTER XXVIII. 
 
 GENERAL QUESTIONS OF IRRESPONSIBILITY. 
 
 The Importance of the difficult and delicate subject of 
 the criminal responsibility of inebriates has been consider- 
 ably enhanced of recent years. The public conscience has 
 been shocked by the severe punishment which has been 
 inflicted on persons, for offenses committed without any 
 criminal intention, of whicli offenses the doer had no 
 remembrance when he awoke from his drunken paroxysm, 
 and of the commission of which he was in some instances 
 quite unconscious, in other instances impelled by a domin- 
 ating narcomaniacal impulse, against which nothing short 
 of physical restraint could have prevailed. 
 
 The marked advance made by this special question has 
 been evidenced by the interest which has been evoked by 
 the publication of the papers read to the Medico-Legal 
 Society of New York, in an attractive volume, by the accom- 
 plished president, Mr. Clark Bell. The value of this book 
 is the greater from Mr. Bell's historical account of the 
 various papers presented to that influential and useful 
 society (on legal relations of the inebriate in business, in 
 social affairs, and in his responsibility before the law), dur- 
 ing the last two decades. This interest has been increased 
 by a thoughtful and suggestive brochure on the impropriety 
 of inflicting capital punishment on inebriate criminals, by 
 Dr. T. D. Crothers. There has been no general rule of 
 law, all along the ages, as to responsibility for offenses 
 complicated with intoxication. Roman law made some 
 
 285 
 
286 DISEASES OF INEBRIETY. 
 
 allowance for drunkenness, but no sucli consideration was 
 exhibited in Grecian jurisprudence. Indeed, in Mitylene, 
 under Pittacus, tliere was a double punisliment for crimes 
 committed wiiile the accused was intoxicated. 
 
 In the United States, thougli the law recognizes no plea 
 of responsibility on the ground of drinking, there is often 
 manifested a practical recognition of a clironic as a diseased 
 drunkard ; and in capital cases, the higher penalty of the 
 law is sometimes avoided by a verdict of murder of the 
 second degree. New York State, some fifty years ago, 
 classed confirmed drunkards with " lunatics, idiots, and 
 persons of unsound mind," so far as related to care of per- 
 son and property. A somewhat similar classification is 
 made in Manitoba. 
 
 In Germany and Switzerland there is a difference in the 
 penalties for crimes committed in culpable and inculpable 
 intoxication. By Austrian law, the accused is punished for 
 the drunkenness only, provided he has not become intoxi- 
 cated for the purpose of committing the offense. In France, 
 the indicted inebriate is shorn of civil rights, tiiough there 
 is no qualification of punishment on the plea of drunken- 
 ness. In Sweden, a husband can be divorced for inebriety, 
 and there is no mitigation of penalty from alcoholic com- 
 plications. The new penal code of Italy enacts that in 
 remission of punishment on account of intoxication at the 
 time when the alleged criminal act is done, one-tiiird of the 
 sentence in money or in time is taken off, 
 
 English jurisprudence on this point is an excellent 
 exemplification of " the glorious uncertainty of law." In 
 the sixteenth century it was held that capital punishment 
 must be exacted though the accused was drunk and igno- 
 rant of the fatal violence. This was re-affirmed by Lord 
 Mansfield in the eighteenth century, he holding that drunk- 
 enness was a crime, and that one crime could not be 
 excused by another. Coke ruled that drunkenness is an 
 aggravation, and being an artificially contracted madness, 
 
GENERAL QUESTIONS OF IRRESPONSIBILITY. 287 
 
 the intoxicated madman is a volutitarius dcetnon and there- 
 fore responsible. 
 
 In later times judges have again and again held that 
 drunkenness is no excuse for crime, and that a criminal act 
 committed in a fit of intoxication is as rightly punishable 
 as a similar act done when the accused is quite sober. For 
 example, a man while he was drunk killed his friend who 
 was also drunk, imagining that the latter was assaulting 
 him violently. This prisoner was found guilty of man- 
 slaughter on the ground that he had voluntarily become 
 intoxicated (Reg v. Patterson, Norfolk Lent Assizes, 
 1840). 
 
 This exaction of full responsibility from a drunken ac- 
 cused on the ground tiiat drunkenness is a voluntary mad- 
 ness, does not operate fairly or justly in many cases. 
 
 If drunkenness were always a voluntary act there might 
 be something in such a contention ; but this state, in whicli 
 confessedly there is often a temporary loss of reason and 
 consciousness, is not invariably avoidable. 
 
 There are individuals who are borne involuntarily on a 
 whirlwind of intoxication, just as at times other persons are 
 swept off their equilibrium by a maniacal access. In the 
 latter case, as in epileptic mania, if it can be established that 
 the seizure is unavoidable, and the consequent actions un- 
 controllable, complete responsibility is not exacted. In some 
 criminal cases, complicated with drinking, the intemperate 
 outburst during which the crime has been committed has 
 simply been as utterly beyond the control of the person as 
 an epileptic maniacal attack. The drunkenness has simply 
 been a symptom of mental unsoundness. In these cases 
 there should be no room for difference of opinion. 
 
 In other cases, though there has been no insane diathe- 
 sis or previous insane or inebriate paroxysm, there has been 
 a temporarily disordered nervous and mental condition 
 which lias produced a temporarily uncontrollable impulse 
 or crave for narcotic indulgence. These morbid phenom- 
 
288 DISEASES OF INEBRIETY. 
 
 ena may be the issue of a variety of unavoidable predis- 
 posing or exciting causes. For example, there is nerve 
 exhaustion and brain disturbance, produced in some persons 
 by excessive and continuous watching of a very exacting 
 invalid, A longer or shorter period of constant nursing 
 without sleep may so affect the cerebro-spinal centers that 
 the nurse may, for the time, be hurled into a drunken fit on 
 the m.ere sipping of an intoxicant, of which, under ordinary 
 healthful conditions, she could partake in limited quan- 
 tities. 
 
 In the disease of narcomania (a mania for any kind of 
 narcotism), inherited, as in narcomania of the neurotic dia- 
 thesis, there is apt to be a like risk of extreme susceptibil- 
 ity to the narcotic action of alcohol and other anaesthetic 
 intoxicants. Is it equitable that no allowance should be 
 made for crime committed under such circumstances ? 
 
 But over and above this inability to partake of an alco- 
 holic or other intoxicant in limited quantity, if the smallest 
 sip has been tasted, there remains a still more important 
 phenomenon. There are many persons, who, from various 
 causes, operating physically and sometimes even in spite of 
 efforts at resistance, are impelled by an inward irresistible 
 impulse to rush headlong into a drunken bout. In this 
 transient stage of inebriate exascerbation violence may be 
 attempted. All admit that while drunk and beside them- 
 selves these accused are unconscious of evil intention, for the 
 simple reason that consciousness is for the moment practi- 
 cally obliterated. If such affected persons can be locked up 
 apart from intoxicants for a given number of hours or days 
 they are safe for a spell ; but unless restrained by superior 
 force they cannot resist the drink-impulse. Is it just that 
 such involuntary criminals should be punished as are vol- 
 untary evil-doers ? 
 
 Yet, again : To constitute many crimes there must be 
 an illegal intention. How can this be present when a man 
 or woman is so drunk as to be incapacitated to reason or to 
 
GENERAL QUESTIONS OF IRRESPONSIBILITY. 289 
 
 remember, or even to be conscious of what he or she does ? 
 In a recent case, where there was a sentence of twenty 
 years imprisonment, — equivalent in the circumstances to 
 imprisonment for life, — two men had been drinking together 
 for hours at various bars. While at dinner in the evening, 
 and still intoxicated, one of tlie drunkards shot the other. 
 Though the judge, in his summing up, could assign no 
 motive for the deed, the survivor of this fatal alcoholic duet 
 was found guilty and sentenced to this iieavy punishment. 
 
 Murder is sometimes done by persons who are laboring 
 under some delusion or hallucination begotten of the nar- 
 cotic brain-poisoning under which tliey are laboring. In 
 one case an educated man was hung for a deliberately 
 executed murder. Though the fact was not brought out 
 at the trial, this victim of the law had been suffering from 
 delusions similar to those which I have seen other persons 
 laboring under while under the influence of chloral. But 
 in these latter instances the patients were prevented from 
 doing any violence by the watcliful care of friends. In this 
 class of cases human beings may suffer the higliest penalty 
 of the law for capital offenses of which they had no per- 
 sonal knowledge at the time, and of which they had no 
 remembrance on emerging from the narcotic influence. 
 
 Reviewing these and many other considerations based 
 on physical departures from health which operate to impair 
 and for the moment destroy the moral control, and which 
 (temporarily, it may be) so dull the consciousness that the 
 doer of a violent deed may be either unaware of the act 
 itself, or, if he is aware of it, his reason may be so con- 
 fused that he is unable to understand the consequences or 
 the nature of the act. Or, again, if conscious and able to 
 understand the character and effects of the act, his will may 
 be so paralyzed as to be powerless to resist the morbid 
 impulse. Passing all this under review, it is most gratifying 
 to scientific students of medical jurisprudence, to find a 
 gradually increasing disposition in judge and jury to allow 
 
290 DISEASES OF INEBRIETY. 
 
 scientific discoveries to influence their judgments. Mr. 
 Justice Day, for excimple, recently ruled that " whatever 
 the cause of the unconsciousness, a person not knowing the 
 nature and quality of his acts, is irresponsible for them " 
 (Reg. V. Barnes, Lancaster Assizes, January, 1886). If this 
 ruling were acquiesced in by other judges, and if juries 
 acted on this ruling, then a considerable proportion of 
 cases in which criminal offences have been committed while 
 the doer was in a state of drunken unconsciousness and 
 was tl'.erefore innocent of a criminal design, or of any actual 
 present knowledge of the deed, would at once be removed 
 from the category in wliich they have hitherto been almost 
 always placed, that of complete responsibilitv, involving full 
 penalties, and treated as irresponsible. Indeed, the general 
 following of such an enlightened ruling would amount to a 
 revolution in our present criminal procedure. 
 
 As remarkable a judicial deliverance was that of Chief 
 Baron Tolles (Reg. v. M. R., Galway Summer Assizes, 1887). 
 The defendant, a female nurse, was accused of killing a 
 male patient who was under her care for typhus fever. The 
 evidence showed that for over seven days she had nursed 
 the invalid day and night, that one night half a glass of 
 whiskey was given to her, and the bottle with five glasses 
 remaining in it was left on the kitchen dresser. The dying 
 man was in charge of his mother and the nurse during the 
 night, when all else in the house had retired to rest. The 
 mother, who was quite worn out, slept in another room, 
 and was awoke early in the morning by the nurse screaming. 
 She found her son's dead body on the kitchen floor, sur- 
 rounded by fire. The nurse was screaming and dancing 
 about, with a brush in one hand and a pair of tongs in the 
 other. The nurse was very excited and appeared either 
 mad or drunk. From other witnesses it was elicited that 
 the nurse cried out, " she'd soon have the devil burnt and 
 M. D. back again." 
 
 The judge charged that drunkenness being a voluntary 
 
GENERAL QUESTIONS OF IRRESPONSIBILITY. 291 
 
 act, the law held persons responsible for acts done in a state 
 voluntarily produced, though they did not know the nature 
 and quality of their acts. But that, if a person, from any 
 cause, say long watching, want of sleep, or deprivation of 
 blood, was reduced to such a condition that a smaller 
 quantity of stimulant would make him drunk than would 
 produce such a state if he were in health, then neither law 
 nor common sense would hold him responsible for his acts 
 inasmuch as they were not voluntary hut produced by disease. 
 It appeared from the evidence that the nurse was under the 
 delusion that her patient had been turned into a devil, that 
 the proper course was to burn the devil and thus bring 
 back the patient. Was that delusion the result of drunken- 
 ness or of disease of the mind ? The jury found the 
 prisoner guilty of manslaughter, but insane at the time of 
 committing it, and she was ordered to be confined in a 
 lunatic asylum during the Lord Lieutenant's pleasure. 
 
 Here again is a decision affecting a wide circle of crim- 
 inal accusations. In former times the accused has suffered 
 severe penalties in such cases, but Baron Tolles' recognition 
 of a diseased condition and of, so to speak, an accidental 
 involuntary intoxication as entitling to criminal irresponsi- 
 bility is a remarkable event in our criminal annals. 
 
 Let me just call your attention to one more evidence of 
 the growing influence of the discoveries of modern patho- 
 logical scientific research on the judicial mind. This case is 
 an excellent illustration of the extraordinary advance in 
 medical jurisprudence, recognizing as it does the influence 
 oi heredity \n modifying criminal responsibility. 
 
 An unmarried man, aged thirty-four, was charged with 
 killing his mother, with prolonged violence, in the presence 
 of a terror-stricken servant, whom he had locked up in the 
 room witii them all night. About five years previously the 
 prisoner had an attack of delirium tremens, and for a year 
 past had been subject to excited fits and delusional fears as 
 to his life having been threatened. He persisted in declar- 
 
292 DISEASES OF INEBRIETY. 
 
 iiig tliat the victim was not his mother. One medical witness 
 testified that the accused was laboring under a seizure of 
 delirium tremens when the murder was done. Another 
 testified that he believed the form of the prisoner's illness 
 was mania-a-potu. Evidence was adduced in proof of an 
 insane heredity. 
 
 Baron Tollock, in his charge, said that though no man 
 could be excused on the mere plea that he had reduced 
 himself to want of reason by drinking, there were other 
 circumstances in the present case. One was that through 
 hereditary influence the accused's infirmity and mental 
 deterioration possibly did largely account for the violent 
 act. Another circumstance was whether, apart from drink- 
 ing, the man was the subject of delusional insanity. The 
 judge most judiciously answered the objection that if the 
 prisoner had been an abstainer from alcoholic drink he 
 would not have been guilty of killing his mother ; that, as 
 a certain amount of alcohol with his predisposition made 
 him a murderer, the accused should not have taken ilie little 
 drop that upset his reason. Baron Tollock replied that the 
 last man to know his own weakness is he who has a weak 
 mind, that such an one cannot argue as doctors can argue 
 for him, but believes that as regards strength of mind he is 
 on a par with all around him. The learned judge charged 
 that if at the time when the murder was committed (though 
 the accused had been a drunkard and had suffered from 
 delirium tremens) he had drank only such a quantity of 
 intoxicant liquor as an ordinary man could take without 
 upsetting his reason, and that the insane predisposition was 
 tlie main factor, although the drinking of a small quantity 
 of alcohol was a contributary cause,' the plea of irresponsi- 
 bility on the ground of insanity was good. Happily the 
 jury returned a verdict of acquittal in accordance with 
 the judge's charge. 
 
 To these encouraging deliverances ought to be added 
 others of an earlier date, though those were referable to a 
 
GENERAL QUESTIONS OF IRRESPONSIBILITY. 293 
 
 special alcoholic disease as freeing from responsibility. 
 Though in some cases a plea based on delirium tremens has 
 not been allowed, in other cases, such as the following, this 
 plea has been pronounced valid. In Reg. v. Burns (Liver- 
 pool Summer Assizes, 1865), the accused had killed his wife, 
 and immediately thereafter appeared to be quite calm, 
 coolly stating that he knew what he had done, and giving 
 as his reason for the deed that she was in league with men 
 concealed in the walls. The jury acquitted the prisoner on 
 the ground laid down by Baron Bramwell that, though the 
 accused might have known that the act was killing and was 
 wrong, he was laboring under a delusion which led him to 
 suppose that the delusion, if true, would have justified the 
 action. 
 
 Another person was acquitted of feloniously wounding 
 two individuals, on the plea that he was under the impres- 
 sion, from delirium tremens, that his house was being 
 broken into. 
 
 At the Liverpool Assizes, May, 1888, the jury found a 
 verdict of " not guilty " in the case of a lady of independent 
 fortune, on the ground that she had recently suffered from 
 delirium tremens, had not quite recovered therefrom, and 
 was incapable of knowing what she was doing. The alleged 
 offence was theft of a purse, a knife, a diamond ring, and 
 three shillings in cash. 
 
 Turn we now to our police-courts. Our present practice 
 of dealing with drunkards there is as misciiievous as it is 
 unjust. I am informed by Dr. J. Francis Sutherland, that 
 in my native city, Glasgow, there are some 10,000 annual 
 commitments of intemperate women for drunkenness and 
 offences connected therewith, for an average period of seven 
 days. On an average each female is imprisoned three times 
 in a year. Some forty per cent, of these prisoners have had 
 from eleven to 800 previous convictions. What does this 
 really mean ? Simply tliat, so far from curing or reforming, 
 these short sentences actually only suffice to allow the incar- 
 
294 DISEASES OF INEBRIETY. 
 
 cerated to recover from the effects of a" drinking bout," and 
 send them forth once more witli renewed vigor to resume 
 their drunken excesses. 
 
 Our police-court procedure in such cases is a mere mock- 
 ery of justice, a huge system for the governmental training 
 of inebriates. All this is most unfair. When a fine is ex- 
 acted the real sufferers are the children of the prisoner, who 
 often deny themselves necessary food to gather together the 
 amount of their parent's fine. When there is a term of 
 imprisonment, the famil)'' are again the punished, for their 
 means of subsistence is taken from them by tiie internment 
 of the bread-winner. The latter is practically not punished, 
 prison being but a " club " wliere he is provided with whole- 
 some food, free apartments, and healthful discipline, to say 
 nothing of gratuitous medical attendance. 
 
 Looking at our existing general criminal treatment of 
 inebriety, there can be little doubt that it is altogether an 
 error, and founded on a wrong conception of what drunken- 
 ness usually is. Science is day by day showing more clearly 
 that intemperance is generally the effect of disease, the inev- 
 itable outcrop of an unhealthy condition of body or brain 
 or both. To exact full criminal accountability from a culprit 
 "tvhose temporary unconsciousness. and lack of control have 
 been in the main due to certain physical perversions, tem- 
 porarily or permanently affecting his reason, is as prejudicial 
 to the individual as it is costly and demoralizing to the com- 
 munity, and as futile as it is unrighteous. 
 
 The legislature, by licensing the common sale of intoxi- 
 cating drinks, tempts to their destruction human beings too 
 scantily endowed with resisting-power to withstand such 
 tremendous temptations, and having trained them in ine- 
 briety, exacts from them full responsibilit}^ for all criminal 
 acts thus committed and developed under the iFgis of the 
 law. Is tliis intelligent, honorable, or fair ? I trow not ; 
 and I look forward with confidence, a confidence heightened 
 by a recollection of the remarkable tributes of the judicial 
 
GENERAL QUESTIONS OF IRRESPONSIBILITY. 295 
 
 bench to science, to which I have just referred, to the not far 
 distant future, when every diseased inebriate accused of a 
 criminal offence shall receive that fair consideration at the 
 hands of our legal tribunals, which a rigliteous administra- 
 tion of justice owes to even the least deserving and the 
 meanest panel at the bar. 
 
CHAPTER XXIX. 
 
 SOME FORMS OF IRRESPONSIBILITY — ALCOHOLIC 
 TRANCE. 
 
 The frequent statement of prisoners in court that they 
 did not remember anything about the crime they are accused 
 of, appears from scientific study to be a psychological fact. 
 How far tiiis is true in all cases has not been determined, 
 but there can be no question that crime is often committed 
 without a conscious knowledge or memory of the act at the 
 time. 
 
 It is well known to students of mental science, that in 
 certain unknown brain states memory is palsied, and fails 
 to note the events of life and surroundings. Like the som- 
 nambulist, tlie person may seem to realize his surroundings 
 and be conscious of his acts, and later be unable to recall 
 anything which has happened. These blanks of memory 
 occur in many disordered states of the brain and body, but 
 are usually of such short duration as not to attract attention. 
 Sometimes events that occur in this state may be recalled 
 afterwards, but usually they are total blanks. The most 
 marked blanks of memory have been noted in cases of epi- 
 lepsy and inebriety. When they occur in the latter they 
 are called Alcoholic Trances^ and are always associated with 
 excessive use of spirits. 
 
 Such cases are noted in persons who use spirits continu- 
 ously, and who go about acting and talking sanely although 
 giving some evidence of brain failure, yet seem to realize 
 their condition and surroundings. Some time after, they 
 wake up and deny all recollection of acts or events for a 
 
 297 
 
298 DISEASES OF INEBRIETY. 
 
 certain period in the past. This period to them begins at 
 a certain point and ends iiours or days after, the interval of 
 which is a total blank, like that of unconscious sleep. 
 Memory and certain brain functions are suspended at this 
 time, while the other brain activities go on as usual. 
 
 In all probability the continued paralysis from alcohol 
 not only lowers the nutrition and functional activities of the 
 brain, but produces a local palsy, followed by a temporary 
 failure of consciousness and memory, which after a time 
 passes away. 
 
 When a criminal claims to have had no memory or 
 recollection of the crime for which he is accused, if his 
 statement is true, one of two conditions is probably present, 
 either epilepsy or alcoholism. Such a trance state might 
 exist and the person be free from epilepsy and alcoholism, 
 but from our present knowledge of this condition it would 
 be difficult to determine this fact. If epilepsy can be traced 
 in the histor}' of the case, the trance state has a patho- 
 logical basis for its presence. If the prisoner is an in- 
 ebriate, the same favoring conditions are present. If the 
 prisoner has been insane, and suffered from sun or heat 
 stroke, and the use of spirits are the symptoms of brain 
 degeneration, the trance state may occur any time. 
 
 The fact of the actual existence of the trance state is a 
 matter for stud}^ to be determined from a history of the 
 person and his conduct ; a grouping of evidence that the 
 person can not simulate or falsify ; evidence that turns not 
 on any one fact, but on an assemblage of facts that point 
 to the same conclusion. 
 
 The following cases are given to illustrate some of these 
 facts, which support the assertion of no memory of the act 
 by the prisoner in court : 
 
 The first case is that of A., who was repeatedly arrested 
 for horse stealing, and always claimed to be unconscious of 
 the act. This defense was regarded with ridicule by the 
 court and jury, and more severe sentences were imposed, 
 
SOME FOEMS OF IRRESPONSIBILITY. 299 
 
 until, finally, he died in prison. The evidence offered in 
 different trials in defense was, tliat his fatlier was weak- 
 minded and died of consumption, and liis motiier was insane 
 for many years, and died in an asylum. His early life was 
 one of hardship, irregular living, and no training. At 
 sixteen he entered tlie army, and suffered from exposure, 
 disease, and sunstrol<e, and began to drink spirits to excess 
 at tliis time. At twenty lie was employed as a hack-driver, 
 and ten years later became owner of a livery stable. He 
 drank to excess at intervals, yet during this time attended 
 to business, acting sanely and apparently conscious of all 
 his acts, but often complained he could not recollect what 
 he had done while drinking. When about thirty-four years 
 of age he would, while drinking, drive strange horses to his 
 stable, and claim that he had bought them. The next day 
 he had no recollection of these events, and made efforts to 
 find the owners of these horses and return them. It 
 appeared that while under the influence of spirits the sight 
 of a good horse hitched up by the roadside alone, created 
 an intense desire to possess and drive it. If driving his own 
 horse, he would stop and place it in a stable, then go and 
 take the new horse, and after a short drive put it up in his 
 own stable, then go and get his own horse. 
 
 The next day all this would be a blank, which he could 
 never recall. On several occasions he displayed reasoning 
 cunning. In not taking a horse when the owners or drivers 
 were in sight. This desire to possess the horse seemed 
 under control, but when no one was in sight all caution 
 left him, and he displayed great boldness in driving about 
 in the most public way. If the owner should appear and 
 demand his property he would give it up in a confused, 
 abstract way. No scolding or severe language made any 
 impression on him. Often, if the horse seemed weary, he 
 would place it in the nearest stable, with strict orders to 
 give it special care. On one occasion he joined in a search 
 of a stolen horse, and found it in a stable where he had 
 
300 DISEASES OF INEBRIETY. 
 
 placed it many days before. Of this he had no recollection. 
 In another instance he sold a horse which he had taken, 
 but did not take any money, making a condition that the 
 buyer should return the horse if he did not like it. His 
 horse stealing was all of this general character. No motive 
 was apparent, or effort at concealment, and on recovering 
 from his alcoliolic excess, he made every effort to restore 
 the property, expressing great regrets and paying freely for 
 all losses. Tlie facts of these events fully sustained his 
 assertion of unconsciousness, yet his apparent sanity was 
 made the standard of his mental condition. The facts of 
 his heredity, drinking, crime, and conduct all sustained 
 his assertion of unconsciousness of these events. This was 
 an alcoholic trance state, with kleptomaniac impulses. 
 
 The next case, that of B., was executed for the murder 
 of his wife. He asserted positively that he had no memory 
 or consciousness of the act, or any event before or after. 
 The evidence indicated that he was an inebriate often years 
 duration, dating from a sunstroke. He drank periodically, 
 for a week or ten days at a time, and during this period was 
 intensely excitable and active. He seemed always sane and 
 conscious of his acts and surroundings, although intensely 
 suspicious, exacting, and very irritable to all his associates. 
 When sober he was kind, generous and confiding, and never 
 angry or irritable. He denied all memory of his acts during 
 this period. While his temper, emotions, and conduct were 
 greatly changed during this time, his intellect seemed more 
 acute and sensitive to all his acts and surroundings. His 
 business was conducted with usual skill, but he seemed un- 
 able to carry out any oral promises, claiming he could not 
 recollect them. His business associates always put all bar- 
 gains and agreements in writing when he was drinking, for 
 the reason he denied tliem when sober. But when not 
 drinking his word and promise was always literally carried 
 out. He broke up the furniture of his parlor when in this 
 State, and injured a trusted friend, and in many ways showed 
 
SOME FOEMS OF lEEESPONSIBILITY. 301 
 
 violence from no cause or reason, and afterwards claimed 
 no memory of it. 
 
 After these attacks were over, he expressed great alarm 
 and sought in every way to repair tlie injury. Finally he 
 struck his wife witli a chair and killed her, and awoke the 
 next day in jail, and manifested the most profound sorrow. 
 While he disclaimed all knowledge of the crime, he was 
 anxious to die and welcome his execution. This case was a 
 periodical inebriate with maniacal and homicidal tenden- 
 cies. His changed conduct, and unreasoning, motiveless 
 acts, pointed to a condition of trance. His assertion of no 
 memory was sustained by his conduct after and efforts to 
 find out what he had done and repair the injury. 
 
 The third case, that of C, was a man of wealth and 
 character, who forged a large note, drew the money and 
 went to a distant city on a visit. He was tried and sen- 
 tenced to State prison. Tlie defense was no memory or 
 consciousness of the act, by reason of excessive use of alco- 
 hol. This was treated with ridicule. Although he had 
 drank to excess at the time and before the crime, he 
 seemed rational and acted in no way as if he did not under- 
 stand what he was doing. Both his parents were neurotics, 
 and he began to drink in early life, and for years was a 
 moderate drinker. He was a successful manufacturer, and 
 only drank to excess at times for the past five years. He 
 complained of no memory during these drink paroxysms, 
 and questioned business transactions and bargains he made 
 at this time. On one occasion he went to New York and 
 made foolish purchases which he could not recall. On 
 several occasions he discharged valuable workmen, and 
 when he became sober took them back, unable to account 
 for such acts. 
 
 These and other very strange acts continued to increase 
 with every drink excess. At such times he was reticent and 
 seemed to be sensible and conscious, and did these strange 
 acts in a sudden, impulsive way. The forged note was 
 
302 DISEASES OF INEBRIETY. 
 
 offered boldly, and no effort was made to conceal his pres- 
 ence or destination. When arrested, he was alarmed and 
 could not believe that he had done so foolish an act. This 
 was a clear case of alcoholic trance, in whicli all the facts 
 sustained his assertion of no conscious memory of the crime. 
 In these three cases the correctness of tlie prisoner's asser- 
 tions of no memory was verified by all the facts and circum- 
 stances of the crime. The mere statement of a person 
 accused of crime, that he had no memory of the act, should 
 lead to a careful examination and be only accepted as a 
 fact when it is supported by other evidence. 
 
 The following case illustrates the difficulty of support- 
 ing a prisoner's statement of no memory when it is used for 
 purposes of deception : 
 
 Case E. An inebriate killed a man in a fight, and was 
 sentenced to prison for life. He claimed no memory or 
 recollection of the act. I found that when drinking he 
 seemed conscious of all his surroundings, and was always 
 anxious to conceal his real condition, and if anything had 
 happened wliile in this state he was very active to repair 
 and hush it up. He was at times quite delirious when 
 under tlie influence of spirits, but would stop at once if any 
 one came along that he respected. He would, after acting 
 wildly, seem to grow sober at once, and do everything to 
 restore the disorder he had created. The crime was an 
 accident, and at once he attempted concealment, ran away, 
 changed his clothing, and tried to disguise his identity ; 
 when arrested, claimed no memory or consciousness of the 
 act. This claim was clearly not true, and contradicted by 
 the facts. 
 
 In a recent case, F. shot his partner in business while both 
 were intoxicated, and displayed great cunning to conceal 
 the crime and person ; then, after elaborate preparations, 
 went away. He made the same claim of defense, whicli was 
 unsupported by any other evidence or facts in his previous 
 life. He was executed. Of course it is possible for th^ 
 
SOME FOKMS OF IRRESPONSIBILITY. 303 
 
 trance state to come on suddenly, and crime be committed 
 at tliis time ; still, so far, all the cases studied show that 
 this condition existed before, and was the product of a 
 growth beginning in brief blanks of a few moments and 
 extending to hours and days duration. Unless the facts 
 indicated the trance state before the crime was committed, 
 it would be difficult to establish this condition for the first 
 time, followed and associated with the crime. 
 
 I think in most of these cases, where this defense is set 
 up, there will be found certain groups of cases that have 
 common physical conditions of degeneration. These groups 
 of cases I have divided from a clinical standpoint, the value 
 of which will be more as an outline for future studies. 
 
 Probably the largest number of criminal inebriates who 
 claim loss of memory as a defense for their acts, are the alco- 
 holic dements. This class are the chronic inebriates of long 
 duration ; persons who have naturally physical and mental 
 defects, and who have used spirits to excess for years. 
 This, with bad training in early life, bad surroundings, and 
 bad nutrition, have made them of necessity unsound, and 
 liable to have many and complex brain defects. Such per- 
 sons are always more or less without consciousness or 
 realization of their acts. They act automatically only, 
 governed by the lowest and most transient impulses. 
 Crimes of all kinds are generally accidents growing out of 
 the surroundings, without premeditation or plan. They 
 are incapable of sane reasoning or appreciation of the results 
 of their conduct. The crime is unreasoning, and general 
 indifference marks all their acts afterwards. The crime is 
 always along lines of previous conduct, and never strange 
 or unusual. The claim of no memory in such cases has 
 always a reasonable basis of truth in the physical conditions 
 of the person. Mania is very rarely present, but delusions 
 and morbid impulses of a melancholic type always exist. 
 The mind, like tlie body, is exliausted, depressed, and acts 
 along lines of least resistance. 
 
304 DISEASES OF INEBRIETY. 
 
 The second group of criminals who cUiim no memory 
 are those where the crime is unusual, extraordinar}^ and 
 unforeseen. Persons who are inebriates suddenly commit 
 murder, steal, or do some criminal act that is foreign to all 
 previous conduct. In such cases the trance condition may 
 have been present for some time before and escaped any 
 special notice, except the mere statement of the person that 
 he could not recollect his acts. The unusual nature of the 
 crime, committed by persons who never before by act or 
 thought gave any indication of it, is always a factor sus- 
 taining the claim of no memory. The explosive, unreason- 
 ing cliaiacter of crime always points to mental unsoundness 
 and incapacity of control. 
 
 A third group of criminals urge this statement of no 
 memory, who, unlike the first group, are not imbeciles, 
 generally. They are positive inebriates, drinking to excess, 
 but not to stupor, who suddenly commit crime with the 
 most idiotic coolness and indifference, never manifesting 
 the slightest appreciation of the act as wrong, or likel}'^ to 
 be followed by punishment. Crime committed by this class 
 is never concealed, and the criminal's after conduct and 
 appearance gives no intimation that he is aware of what he 
 has done. These cases have been termed moral paralytics, 
 and the claim of the trance state may be very likely true. 
 
 A fourth group of cases, where memory is claimed to be 
 absent, occurs in dipsomaniacs and periodical inebriates, 
 who have distinct free intervals of sobriety. This class 
 begin to drink to great excess at once, then drink less for a 
 day or more, and begin as violently as ever again. In this 
 short interval of moderate drinking some crime is committed 
 which they claim not to have any recollection. 
 
 Other cases have been noted where a condition of mental 
 irritation or depression preceded the drink explosion, and 
 the crime was committed during this premonitory period and 
 before they drank to excess. The strong probability of trance 
 at this period is sustained by the epileptic character of such 
 
SOME FORMS OF IRRESPONSIBILITY. 305 
 
 conduct afterwards. The trance may be justly termed a 
 species oi aura, or bva.in paralysis, which precedes the explo- 
 sion. 
 
 In some instances, before the drink storm comes on, the 
 person's mind would be filled with the most intense suspic- 
 ions, fears, delusions, and exhibit a degree of irritation and 
 perturbation unusual and unaccountable. Intense excite- 
 ment for depression, from no apparent cause, prevails, and 
 during this period some crime may be committed ; then 
 comes the drink paroxysm, and later all the past is a blank. 
 Trance is very likely to be present at this time. 
 
 In these groups the crime is generally automatic, or 
 committed in a manner different from other similar crimes. 
 Some governing center has suspended, and all sorts of 
 impulses may merge into acts any moment. The conscious- 
 ness of acts and their consequences are broken up. The 
 strong probability is tliat these trance blanks begin in short 
 periods of unconsciousness, which lengthen with the degener- 
 ation and mental feebleness of the person. The obscurity 
 of these conditions, and the incapacity of the victims to 
 realize their import, also the absence of any special study, 
 greatly increases the difficult}'. It will be evident from 
 inquiry that trance states among inebriates are common, 
 but seldom attract attention, unless they come into legal 
 notice. 
 
 The practical question to be determined in a given case 
 in court is the actual mental condition of the prisoner, who 
 claims to have no recollection of the crime. This is a class 
 of evidence that must be determined by circumstantial and 
 collateral facts, which require scientific expertness to gather 
 and group. The court can decide from the general facts of 
 the crime and the prisoner whether his claim of no memory 
 may possibly be true, and order an expert examination to 
 ascertain the facts. Tliis should be done in all cases where 
 the prisoner is without means, in the same way that a 
 lunacy commission is appointed to decide upon insanity. 
 
306 DISEASES OF INEBRIETY. 
 
 The result of this expert study may show a large prepon- 
 derance of evidence sustaining the claim of no memory, or 
 the opposite. If the former, the measure of the responsi- 
 bility must be modified, and the degree of punishment 
 changed. While such cases are practically insane at the 
 time, and incapable of realizing or controlling their acts, 
 they should be kept under legal and medical surveillance 
 for a lifetime, if necessary. Such men are dangerous, and 
 sliould be carefully wratched and deprived of their liberty 
 for a length of time depending on recovery and capacity to 
 act rationally and normally. They are dangerous diseased 
 men, and, like victims of contagious disease, must be housed 
 and treated. 
 
 The future of such cases depends on the removal of the 
 causes w^hich made them what they are. The possibility of 
 permanent restoration is very promising in most cases. How 
 far alcoholic trance exists in criminal cases is unknown, but 
 the time has come when such a claim by criminals cannot 
 be ignored, and must be the subject of serious inquiry. Such 
 a claim cannot be treated as a mere subterfuge to avoid 
 punishment, but should receive the same attention that a 
 claim of insanity or self-defense would. This is only an 
 outline view of a very wide and most practical field of 
 medico-legal research, largely unknown, which can be seen 
 in every court-room of the land. These cases appeal to us 
 for help and recognition, and the highest dictates of 
 humanity and justice demand of us an accurate study and 
 comprehension of their nature and character. 
 
 The following summary of the leading facts in this 
 trance condition will be a standpoint for other and more 
 minute investigations : 
 
 ist. The trance state in inebriety is a distinct brain con- 
 dition, that exists beyond all question or doubt. 
 
 2d. This brain state is one in which all memory and 
 consciousness of acts or words are suspended, the person 
 
SOME FOKMS OF IKKESPONSIBILITT. 307 
 
 going about automatically, giving little or no evidence of 
 his real condition. 
 
 3d. The higher brain centers controlling consciousness 
 are suspended, as in the somnambulistic or hypnotic state. 
 The duration of this state may be from a few moments to 
 several days, and the person at this time may appear con- 
 scious and act naturally, and along the line of his ordinary 
 life. 
 
 4th, During this trance period crime against person or 
 property may be committed without any motive or appar- 
 ent plan, usually unforseen and unexpected. When accu- 
 rately studied such a crime will lack in the details and 
 methods of execution, and also show want of consciousness 
 of the nature and results of such acts. 
 
 5th. When this condition passes away the acts and con- 
 duct of the person show that he did not remember what he 
 had done before. Hence his denial of all recollection of 
 past events and his changed manner confirm or deny his 
 statements. 
 
 6th. When such cases come under judicial inquiry the 
 statement of the prisoner requires a scientific study before 
 it can he accepted as a probable fact. It cannot be simu- 
 lated, but is susceptible of proof beyond the comprehension 
 of the prisoner. 
 
 7th. In such a state crime and criminal impulses are 
 the result of unknown and unforeseen influences, and the 
 person in this condition is dangerous and an irresponsible 
 madman. 
 
 8th. This condition should be fully recognized by court 
 and jury, and the measure of responsibility and punishment 
 suited to each case. They should not be punished as crim- 
 inals, nor should they be liberated as sane men. They 
 should be housed and confined in hospitals. 
 
CHAPTER XXX. 
 
 PRACTICAL DIFFERENTIATION OF INEBRIETY FROM 
 COMA, ETC., ETC. 
 
 The frequent occurrence of blunders in mistaking brain- 
 diseases for drunkenness, and the serious reproach they 
 bring on medical men, render it necessary that more earnest 
 attention siiould be paid to the subject than heretofore, and 
 that a higher knowledge should be obtained of the charac- 
 ter of the dangers incident to these accidents. Unfortu- 
 nately, drunkenness has not, save in a few instances, been 
 studied as a disease, and consequently the manifestations 
 pertaining to it are very little understood. The ignorance 
 is particularly unfortunate when it is necessary to distin- 
 guish between it and brain-troubles. 
 
 In starting out in this discussion, our first duty will be 
 to enumerate the different conditions which may be mistaken 
 for drunkenness, and the symptoms of which it is necessary 
 to bear in mind in forming a diagnosis. 
 
 These are : 
 
 1. Fracture of the skull. 
 
 2. Concussion of the brain. 
 
 3. Cerebral hemorrhage. 
 
 4. Embolism and thrombosis. 
 
 5. Uraemia, from Bright's disease. 
 
 6. Epilepsy. 
 
 7. Narcotic poisoning. 
 
 8. Heat apoplexy. 
 
 We will take up these lesions one by one. 
 
 In cases of fracture of the skull, or where severe or stun- 
 
 309 
 
310 DISEASES OF INEBRIETY. 
 
 ning blows have been dealt, the greatest difficulty is met 
 with in the diagnosis in the absence of any history of the 
 case, for the reason that the coma in these instances is 
 frequently profound, and simulates that of drunkenness. 
 The smell of the breath should never be relied on as a test, 
 for many industrious and useful workmen are in the habit 
 of taking a certain amount of liquor during the day. 
 
 The temperature, the condition of the pupils, the breath- 
 ing, should all be carefully observed, but the true rule is to 
 keep the patient under close and constant watch, until a 
 fixed diagnosis is obtained. It is also important, in these 
 cases, to look closely for wounds and marks of violence. 
 
 Mr. Lavvson, of Middlesex Hospital, relates an interest- 
 ing case bearing on this point. " The patient was taken to 
 the police-cell as drunk. He was medically examined, and 
 recovered sufficiently from his apparent drunken semi-con- 
 sciousness to be able to converse with those about him. 
 After a few hours, however, severe cerebral symptoms came 
 on, and he was transferred to the hospital, where he died on 
 the thirteenth day from severe lacerations of the brain-sub- 
 stances, associated with extensive hemorrhage, and with 
 fracture into the lamboidal suture, A remarkable point in 
 this case was the absence of paralytic symptoms, considering 
 the severe laceration of the brain. With the exception of the 
 loss of power over the sphincters, there was no paralysis 
 whatever," 
 
 Cerebral hemorrhage is more frequently mistaken for 
 drunkenness than any other trouble, for the reason that the 
 symptoms are similar in several stages of the two diseases. 
 There is a stage of noisy violence and uproar in both, and 
 also a condition of complete coma. In ordinary cases of 
 apoplexy we look for paralysis of one side or the other, but 
 this does not always obtain, if the hemorrhage be into the 
 pons, or lateral ventricle. We may have convulsions in both 
 diseases, but usually they are more severe on one side of the 
 body in apoplexy. 
 
INEBKIETY FROM COMA. 311 
 
 The State of the pupils cannot always be relied on as a 
 differential test, although squinting as well as conjugate 
 deviation of the eyes is a distinctive mark of apoplexy. 
 Doctor MacEwen, of Glasgow, says the ordinary opinion that 
 dilation of tiie pupils is found in alcoholic coma is incorrect, 
 but that contraction is the rule. He accidentally discov- 
 ered, however, that if a patient was sliaken or disturbed, the 
 pupils dilated, but very soon contracted again. He there- 
 fore lays down the rule that an insensible person who, 
 being left undisturbed for from ten to thirty minutes, has 
 contracted pupils, which dilate on his being shaken, without 
 any return of consciousness, and then contract again, can 
 be laboring under no other state than alcoholic coma. 
 Strange to say. Dr. Reynolds has witnessed the same phe- 
 nomena in patients suffering from acute softening. He says 
 in his system of medicine, that he has often raised the lids 
 of patients in this condition, and exposed the contracted 
 pupils to the light without arousing them ; that there is no 
 dilation or change to be observed, but if they be addressed 
 loudly by name, or their toes pinched so that they awake, the 
 pupils instantly dilate. 
 
 The truth is, that in cerebral hemorrhage the pupils pre- 
 sent no fixed peculiarity. There may be a clot on one side 
 of the brain, and yet the pupils appear normal. Their con- 
 dition may even vary in different cases of the same lesion. 
 Cases of ingravescent apoplexy generally commence with 
 delirium or convulsion, and the coma comes on slowly and 
 gradually. These are the cases that are frequently mis- 
 taken for drunkenness, provided the smell of alcohol be dis- 
 covered on the breath of the patient. 
 
 Cases of embolism and thrombosis should not be con- 
 founded witli drunkenness. In embolism, the coma is sud- 
 den and transient, and in thrombosis, the paralytic symp- 
 toms are so marked that an error can scarcely occur. Fatal 
 cases of sudden coma and paralysis, with partial recovery 
 
312 DISEASES OF INEBRIETY. 
 
 of consciousness and power, are met with, independent of 
 drunkenness or brain trouble. 
 
 A remarkable case of this character is reported in the 
 Lancet^ in which the only lesion found after death was 
 liydatids of the pineal gland, liver and peritoneum. The 
 patient died in thirteen hours from the commencement of 
 the attack. In cases of coma from uraemia, the diagnosis is 
 not so difficult, inasmuch as we have some well-marked 
 points for our guidance. This form of coma is generally 
 preceded by convulsions. The breath has a peculiar un- 
 mistakable fetor, and the urine upon examination will be 
 found to contain a large quantity of albumen as well as 
 other deposits, indicating kidney disease. Occasionally, 
 however, cerebral hemorrhage is present along with uraemic 
 poisoning, and this complicates to some extent the diagnosis. 
 
 Another difficulty in diagnosis in that the urine may 
 become temporarily albumenous from the inordinate use of 
 alcohol. Dr. George Johnson mentions a case of this char- 
 acter, which occurred in the practice of his friend Dr. Baxter. 
 ** A man between twenty and thirty years of age was brought 
 in one night by the police. He was unconscious and breath- 
 ing stertorously. He appeared to be drunk, aud a large 
 quantity of vinous liquid was pumped out of his stomach. 
 The unconsciousness continued, and it was then suspected 
 tliat he might be suffering from uraemic poisoning. This 
 suspicion was confirmed by the fact that his urine, drawn 
 off by a catheter, was loaded with albumen. He was then 
 put to bed, cupped over the loins, and a purgative was given. 
 When Dr. Baxter visited the ward next morning, he found 
 the man up and dressed, and clamoring for his discharge. 
 He said he had been very drunk over night, but now he 
 had nothing the matter with him ; and he passed some 
 Urine, which was found to be in every respect quite normal. 
 The temporary albuminuria was the result of renal conges- 
 tion, caused by the excretion of an excess of alcohol through 
 the kidneys." 
 
INEBRIETY FROM COMA. 313 
 
 Epilepsy can generally be diagnosed without much 
 difficulty, though if the patient is not seen during the 
 attack, but only during the profound and prolonged coma 
 which sometimes follows the paroxysm, the case may be 
 mistaken for one of drunkenness. Epileptic coma, how- 
 ever, is usually of short duration, and if the tongue is bitten 
 or bleeding, or if hemorrhagic spots be discovered beneath 
 the conjunction or skin, all uncertainty with regard to the 
 case will be cleared up. 
 
 The coma resulting from the poisoning by opium is very 
 similar to that produced by the administration of large 
 quantities of alcohol. At one time it was believed that 
 extreme contraction of the pupils was a distinguishing mark 
 of coma resulting from opium, but this, it is known, cannot 
 be relied on, inasmuch as the pupils are often found con- 
 tracted, as I have before mentioned, in alcoholism, and also, 
 as mentioned by Dr, Wilks, in apoplexy seated in the pons 
 varolii. In cases of opium poison that I have seen, I have 
 always thought that the breathing was much slower than in 
 the coma produced by drunkenness, but in this I may be 
 mistaken. The smell of opium is frequently to be dis- 
 covered on the breath, particularly if laudanum has been 
 taken, and this becomes an important feature, provided no 
 history of the case can be obtained. 
 
 There are many symptoms in severe cases of heat apo- 
 plexy which might mislead an inexperienced practitioner, 
 and cause him to believe his patient is suffering from the 
 effects of drunkenness. Coma is very often the result of 
 sunstroke, and great mental disturbance and outward vio- 
 lence are not unfrequent results of aggravated cases. I can 
 remember several instances in which I was in doubt for a 
 time in regard to the origin of the symptoms present in 
 cases which afterwards proved to be heat apoplexy. There 
 is one very simple diagnostic mark in sunstroke which is 
 never absent, and which will greatly aid us in forming a 
 judgment : it is intense heat of the head — a heat which is 
 
314 DISEASES OF INEBRIETY. 
 
 to be found in no other disease, save yellow fever. In the 
 coma of drunkenness this extreme heat is never found — at 
 least, I have not met it in my own experience. 
 
 I have seen many cases of hysteria in women which at 
 first puzzled me, inasmuch as the symptoms were similar to 
 those induced by the action of alcohol. These cases are 
 not so much characterized by coma as by a state of excite- 
 ment and violent demonstration. The phases of hysteria 
 are so varied, and the abnormal manifestations of this 
 trouble so curious, that the ordinary practitioner may read- 
 ily mistake neurotic trouble for the effects of alcohol ; as, on 
 the contrary, he may and does frequently mistake drunken- 
 ness for hysteria. The puzzling cases I have met with are 
 those in which there was a combination of whiskey and 
 hysteria, a condition which, I may add, is of the most 
 delightful character, and affording a train of the most 
 original and beautiful manifestations. The methods of 
 examination in coma may be summarized as follows : 
 
 First. An examination of the head and body for frac- 
 ture of the skull and external injuries. 
 
 Second. Examination for hemiplegia, squinting, conju- 
 gate deviation or facial paralysis. 
 
 Third. Examination of the mouth and tongue. 
 
 Fourth, The legs and eyelids should be examined to 
 see if oedema had previously existed. 
 
 Fifth. An examination of the urine both for albumen 
 and alcohol. 
 
 Sixth. A stomach pump may be used in many cases 
 with great advantage. 
 
 Seventh. A history of the attack and its general features 
 should be inquired into, if possible. 
 
 Eighth. The pupils and breath should both be examined 
 and the temperature taken, thougli undue importance, as 
 before stated, should not be attached to the evidences 
 afforded by such an examination. 
 
 In conclusion, let me particularly dwell on the import- 
 
INEBRIETY FROM COMA. 315 
 
 ance of close attention and watchfulness in all cases of 
 coma supposed to be due to drunkenness. The system 
 heretofore pursued has been most barbarous, both in this 
 country and Europe, and is a reproach to our civilization. 
 Dwelling on this subject, Dr. John Curnow pointedly says : 
 " I must enter a protest against the routine treatment of 
 drunkenness too generally followed, viz.: emetics or the 
 stomach pump, cold effusion, flecking the skin with a wet 
 towel, and then the interrupted galvanic current. A patient 
 having grumbled out a name, and perhaps an address, is 
 turned over to a policeman, who speedily consigns him to a 
 cold cell to sleep off his symptoms. It cannot too often be 
 insisted upon that a drunken man is suffering from acute 
 poison, and cannot be too closely watched." 
 
 All police stations should have a regularly appointed 
 medical officer in charge, and every case of sickness, or 
 aggravated case of drunkenness, should be put under his 
 care. Certain instruments and appliances should be con- 
 stantly at hand, and supplied at public expense, such as a 
 stomach pump, galvanic battery, hypodermic syringe, test 
 tubes, cupping apparatus, as well as mustard, apomorphia, 
 etc. When these precautions are taken, and when inebriety 
 is added to the list of diseases, and its treatment taught in 
 our schools, many lives will be saved and much unhappiness 
 be spared to the community. 
 
CHAPTER XXXI. 
 
 GENERAL CONSIDERATIONS OF OPIUM INEBRIETY. 
 
 Opium neurosis is not an intoxication from the drug, 
 but a central neurotic change, brought about by the long 
 persisting perversion of function and impairment of cen- 
 tral nervous nutrition, from its persisting presence in the 
 nutrient pabulum of the circulation. 
 
 The psychosis of opium is a blended intoxication and 
 chronic poisoning of the psychical centers of the brain ; 
 other symptoms of acute opium poisoning are essentially 
 different, being mainly a profound paralysis of sensation 
 and of the centers of involuntary motion especially having 
 their origin in the medulla and upper part of the spinal 
 cord — profound narcosis, lowered respiratory movements, 
 etc., while chronic opium poisoning, or meconeuropathia, is 
 characterized by repeated nerve excitations, in which the 
 nerve centers, not being completely overcome, a kind of 
 tolerance is established, with progressively developing 
 abnormal molecular neural changes, which are as repeat- 
 edly covered up and masked by the renewed doses, till 
 some sudden deprivation of the drug or failure to appropri- 
 ate it, reveals, in full force, the neural mischief which has 
 been gradually done. Opium, like a bank defaulter, both 
 makes and masks the mischief done, which may be kept 
 concealed so long as he stays in the institution. 
 
 Beyond all question, the toxic use of opium and its alka- 
 loids is rapidly increasing. Only about 50 per cent, of 
 opium and morphine manufactured is required by the legit- 
 imate demands of medicine and pharmacy. The enormous 
 
 317 
 
318 DISEASES OP INEBRIETY. 
 
 balance is consumed in some unknown way. Comparative 
 estimates make the number of opium cases in this country 
 over a hundred tliousand. Wlietlier tliis is correct or not, 
 it is evident that the number is very great and largely con- 
 cealed, and many of them are very hopeless and difficult to 
 treat. The natural history of such cases indicates a steady, 
 progressive degeneration on to death. Recovery is rarely 
 spontaneous and without tlie aid of applied science. 
 
 The central tracts involved are the cerebro-spinal and 
 sympathetic systems. Deviations from health noted are 
 due to departure from the normal tone of one or both of 
 these centers. Organic lesions are rare, possibly some 
 instances of renal or brain disease, the usual ultimate result 
 being a state of marasmus, impaired nutrition and profaned 
 nerve depression ending in death. 
 
 From a careful clinical study and grouping of the his- 
 tory of a number of opium cases, it is evident that a large 
 proportion have a distinct neurotic diathesis, or, more literally, 
 have inherited from their parents some condition of brain 
 and nerve defect which favors and predisposes to the devel- 
 opment of neurotic diseases. A more careful study of these 
 records shows that in some cases an opium diathesis is present, 
 or a special inherited tendency to use opium. Here are 
 two conditions which influence and favor this disease. It 
 is a well-known fact that a large proportion of all nerve 
 and brain diseases appears in children of neurotic and 
 defective parents. Such children have received some special 
 tendency and predisposition favoring the growth of nerve 
 diseases, springing into activity from the slightest causes. 
 
 The latency or activity of this diathesis will depend on 
 certain conditions of life and surroundings, which in many 
 cases can be traced. In some instances the diseases of 
 parents reappear in the children, in others in allied diseases, 
 and not infrequently these defects pass over and reappear 
 in the third generation. Often such defects are dormant, 
 and onl}' break out from the application of some peculiar 
 
GENERAL CONSIDERATIONS OF OPIUM INEBRIETY. 319 
 
 exciting cause. Thus a hysteric mother and paranoic 
 father were followed by three children. One was an alco- 
 holic, the second was a wild, impulsive temperance reformer, 
 the third was a sad, depressed, melancholic man. In the 
 third generation opium and alcoholic inebriety, insanity, 
 pauperism, also feebleness of mind and body, appeared. 
 These varied forms of nerve diseases all had a neurotic 
 diathesis as a basis, and the different phases were the direct 
 result of different exciting causes. These facts are numer- 
 ous and well attested, and so uniform in their operation that 
 it is entirely within the realm of possibility to predict that, 
 from a knowledge of the diseases of the parents and the 
 environment of the child, certain forms of degeneration and 
 diseases w^ill appear with almost astronomical precision. 
 This term, " neurotic diathesis," covers a vast unknown field 
 of causes which extend back many generations. 
 
 The evolution of brain and nei/^ defects can often be 
 traced through the realms of environment, nutrition, growth, 
 and development. Medical text-books and teaching which 
 fail to recognize this, give very narrow conceptions and 
 strange exaggeration of the influence and force of many 
 insignificant and secondary factors in the production of dis- 
 ease. The opium-taker has often this neurotic element in 
 his history. It may be traced back to his ancestors, or it 
 may be associated with brain or nerve injuries, cell-starvation, 
 faulty nutrition, auto-intoxications, brain strains, or exces- 
 sive drains of nerve force. A train of predisposing causes 
 may have been gathering for an indefinite time back. Then 
 comes the match which kindles or fires the train oi gathering 
 forces. This same train of exciting causes may not explode, 
 because the germ soil is absent. Opium in all forms is 
 given daily, and yet only a comparatively small number of 
 cases become addicted to its use. Why should an increas- 
 ing number of persons take opium continuously for the tran- 
 sient relief it gives ? Why should the effects of this drug 
 become so pleasing as to demand its increased use, irrespect- 
 
320 DISEASES OF INEBRIETY. 
 
 ive of all consequences ? The only explanation is the pres- 
 ence of a neurotic diathesis, either inherited or acquired. 
 
 There is a large class of opium cases in which a complex 
 diathesis exists — particularly following inebriety and var- 
 ious forms of brain exhaustion Often alcoholics will use 
 opium irregularly and transmit to their descendants a 
 diathesis which very commonly favors the use of this drug. 
 Thus the alcohol diathesis frequently becomes the opium 
 craze, with but slight exposure. Both of these disorders 
 are rapidly interchangeable. The children of opium takers 
 may turn to alcohol for relief, and vice versa. It is clear 
 that the moderate use of alcohol produces a degree of 
 degeneration that frequently appears in the next generation 
 as predisposing causes to the opium or allied diseases. 
 Clinical study of cases brings ample confirmation of this. 
 The children of both alcohol and opium inebriates display 
 many forms of brain degeneration. Tlie paranoics, criminals, 
 prostitutes, paupers, and the army of defects, all build up a 
 diathesis and favoring soil for the opium craze. Descend- 
 ants from such parents will always be markedly defective. 
 They are noted b)'' brain and nerve instability, hyperaesthesia, 
 and tendency to exhaustion ; also extreme pain from every 
 degree of functional disturbance, with low powers of restor- 
 ation, inability to bear pain, and suffering from mental 
 changeability, impulsiveness and drug credulity, etc. 
 
 Tiiese characteristics are prominent, and mark a neuro- 
 sis that quickly merges into the opium disease. Yet a min- 
 ority of these cases show a sensitiveness in the effects of 
 opium that prevents them from using it. I have seen a 
 neurotic patient become dangerously narcotized by the use 
 of half a grain of solid opium. Some of the alcoholics and 
 other narcomaniacs have exhibited an incompatibility to 
 opium that is often startling. The emesis and prostration, 
 and the brain stimulation which approaches and becomes 
 hyperaemia from one or more doses, are familiar to all. 
 This intolerance precludes the use of the drug, and is recog- 
 
GENERAL CONSIDEKATIONS OF OPIUM INEBRIETY. 321 
 
 nized with alarm by the patient. On the other hand, when 
 the effects are rapid and marked, relieving pain or restoring 
 the disturbance of the functions, with no other than a pleas- 
 ing sense of rest and cure, a dangerous diathesis should be 
 suspected. While the physician recognizes the constitu- 
 tional incompatibility in one case, he ought not to overlook 
 the abnormal attractiveness of the drug in the other. The 
 dose of morphine which gives the first complete rest, or 
 calms the delirious excitement, or relieves the neuralgic 
 pain or the digestive disturbance, soon calls for its repeti- 
 tion, and many physicians will unconsciously sanction and 
 advise its use. Thus, far more fatal conditions are culti- 
 vated and roused into activity. 
 
 In all neurotic cases, the use of opium in any form when 
 given, should be concealed and watched with care. If a 
 special predilection for this drug appears, equal care and 
 skill should be exercised to divert and change it. Opium 
 should only be used from a knowledge of the nature and 
 cliaracter of the case. I have seen the most disastrous 
 results from the reckless use of morphine with the needle. 
 Recently, a man to whom morphine was intolerant was cut 
 and stunned by a falling plank in the street. The surgeon 
 gave him a hypodermic of morphine and ordered him to the 
 hospital. He died in a short time from opium neuroses. 
 Police surgeons often make this mistake, giving morpliine 
 that from some unknown reason becomes fatal. 
 
 There is another class of opium takers in which abnor- 
 mal nutrition seems to be the most active factor in the cau- 
 sation. The neurotic or opium diathesis is not apparently 
 present, and opium-taking dates from some nutrient disturb- 
 ance. Such cases are very commonly sufferers from dyspep- 
 sia, derangement of the liver and bowels. They have a 
 deranged appetite, headaches, cramps, thirst, and fever at 
 times, with nausea. Tiiey are anaemic and hypersesthetic 
 and complain of varied pains and neuralgia. These cases 
 are evidently ill-nourished, and, in all probability, suffer from 
 
322 DISEASES OF INEBRIETY. 
 
 imperfect digestion, assimilation, and elimination of food- 
 products and waste material. Poisonous compounds and 
 auto-intoxications form sources of serious trouble. The 
 brain suffers from fatigue and pain, the cells are imperfectly 
 nourished, and congestions, complex neuralgias, nerve irri- 
 tation and instability follow. For this condition opium is 
 almost a specific paralyzant. These cases are found among 
 the over-fed, the under-fed, and those who neglect common 
 hygienic rules of living. 
 
 Cases of the over-fed are usually epicures, gormands, 
 and persons living sedentary lives, and eating at all times 
 and places. Dyspepsia and derangement of the bowels and 
 kidneys make tiiem drug-takers; then follows opium in some 
 form. Defective elimination and auto-intoxications are 
 always present. Tiie under-fed are usually misers, or persons 
 very poor and very neglectful of themselves, or paranoics 
 who have some food delusion. They are practically suffer- 
 ing from cell and tissue starvation and nutrient debility. 
 The same dyspepsia and bowel derangements follow. Then 
 follows drug-taking or special foods, and soon opium is dis- 
 covered and adopted as a remedy. The same poisonous 
 waste products appear from deranged assimilation; also, 
 elimination and the nerve centers are deranged by these 
 new and dangerous chemical compounds. The class of 
 persons who, from simple neglect, become diseased, are often 
 the very poor and ignorant, or some division of the great 
 army of border-liners, who live both mentally and physically 
 on the very frontiers of sanity and insanity. Such persons 
 clearly suffer from many and various forms of auto-intoxi- 
 cations, and this is proven inductively by the result of 
 eliminative treatment. 
 
 In all of these cases of nutrient neglect, many favoring 
 conditions encourage the use of opium. These cases are 
 numerous and comprise a large part of the invalids, 
 hypochondriacs, and chronic drug-takers, who are seen in 
 our offices and at the dispensaries. They are all practically 
 
GENERAL CONSIDERATIONS OF OPIUM INEBRIETY. 323 
 
 suffering from faulty assimilations, and faulty eliminations 
 and the irritation of retained poisonous compounds. Opium 
 is. a remedy of positive force in covering up the protests of 
 the defective cells and irritable nerves. Often these cases 
 are concealed, and are partly the result of previous disorder, 
 and partially acquired from tiie effects of opium. 
 
 Next to this class of nutrient sufferers who become opium- 
 takers, are those who have some entailment of disease or 
 injury. In their history it will appear that some stage of 
 invalidism was present, dating from brain, nerve, or bodily 
 injury. Fevers, heat, or sun-strokes, brain shocks from any 
 source, which are followed by unconsciousness or marked 
 mental perturbations, with exhaustion, and also a profound 
 lowering of all the vital forces. These and other events have 
 left damaged functional and organic activities, manifest in 
 various neuralgias and physical disturbances. 
 
 The use of opium conceals and covers up this trouble. 
 Many veterans of the late war have become opium maniacs 
 for the relief of their pains and sufferings, and this is often 
 concealed where it might possibly peril the procuring of a. 
 pension. The pension bureau should recognize the use of 
 opium as a natural sequence and entailment following the 
 disease and injury in the service. In Prussia, both alcohol 
 and opium inebriety are treated as diseases when occurring 
 in the army or civil service. The suffering and hardships 
 growing out of the war has been the exciting cause of a 
 great many opium cases. Many persons who have no spec- 
 ial nerve diathesis in their history, after some severe illness, 
 injury, or mental strain, exhibit a degree of nerve instability 
 and feebleness that is significant of serious organic change. 
 Such persons manifest perversions of taste, with delusions 
 of food and medicines, and are on the border-lines of nar- 
 comania, ready to use any food or drugs which will bring 
 even transient relief. 
 
 The use of opium is always perilous. Why all these and 
 
324 DISEASES OF INEBRIETY. 
 
 similar cases do not become opium-takers is owing to the 
 absence of some diathesis inherited or acquired. 
 
 We can see some of the many complex causes favoring 
 brain and nerve strain, with rapid exhaustion and degener- 
 ation, and the interchangeability of nerve diseases, in which 
 tlie use of opium is only another form of the same disease. 
 But we cannot yet trace the early causes and cell-conditions 
 which develop the opium craze. This morbid impulse, like 
 the delirious thirst for water on a desert plain completely 
 dominates all reason and so-called will-power, and every 
 consideration of life and surroundings. It is more than an 
 accident, more than a failure to reason and act wisely ; it is 
 a disease, an organized march of dissolution. The demand 
 for opium is only a symptom ; the removal of opium is not 
 the cure. Some central brain degeneration has begun and 
 is going on. Narcomania, a morbid thirst for any solids or 
 fluids that will produce neuroses, is the general name, and 
 opium mania is only one member of this family. 
 
 In this study the fact is emphasized that the opium 
 disease appears most frequently in persons who have a 
 neurotic and opium diathesis, and also in persons who are 
 suffering from nutrient disturbances, and those who are 
 invalids or have some entailment of previous disease and 
 injury ; also that certain diseases and symptoms seem to 
 furnish favoring soils for its growth and development. 
 While these are but faint outlines of many unknown facts, 
 they are urged as starting points from which to base other 
 and more accurate studies. The medical treatment from 
 this point of view is very suggestive. Obviously the removal 
 of the opium is not the cure. The various methods of 
 removal, detailed with great exactness, as if they would 
 apply to each case, are unfortunate reflections of the fail- 
 ure of the writers, and are based on tlie assumption that all 
 cases are the same, and the removal of opium is the great 
 essential in the treatment. 
 
 Basing the treatment on the clinical study of the case, it 
 
GENERAL CONSIDERATIONS OF OPIUM INEBRIETY. 325 
 
 will be evident that where an opium diathesis exists, the 
 withdrawal of opium should be very gradual. The treat- 
 ment and surroundings should be arranged with great care 
 and exactness. Such persons should live in an institution 
 for a long time, or be under constant medical care. The 
 danger of relapse and the future of such cases will depend 
 entirely on the conditions of life and surroundings. Rapid 
 reduction and any heroic treatment is never permanent, 
 even with the consent of the patient. Specific, faith cures, 
 or any measures that promise speedy cure, are failures 
 from the beginning. The road back to approximate health 
 is straight and narrow, and only along lines of applied 
 science. Where the history of a neurotic diathesis is present, 
 the withdrawal of tiie opium should be equally slow. 
 
 More attention must be paid to the brain and nerve 
 nutrition. The removal of opium may be followed by the 
 appearance of very serious disorders, such as epilepsy, 
 hysteria, complex neuralgias and paranoics phases, alcohol- 
 ism, and various other neuroses. The slow withdrawal of 
 opium enables one to discover and anticipate these neurotic 
 troubles which have been masked before. In one case, 
 suicidal melancholy ; in another, hyperemia of the brain, 
 with delusions ; in the third, irritation and delirium ; in 
 the fourth, hysterical spasms appeared when the opium was 
 removed. I have seen two cases of general paralysis sud- 
 denly spring into great activity after the opium was taken 
 away. This condition was not suspected before. Alcohol- 
 ism is a very common sequel after the removal of the 
 opium. Cocaine, chloral, and almost every drug that has 
 narcotic properties, are also very common entailments. 
 
 While these are extreme cases, the)' are likely to appear 
 at any time. Great care should be exercised in using 
 other narcotics to lessen tlie irritation from the withdrawal 
 of this drug. Foods and tonics should be given. These 
 cases require the same general treatment as neurasthenia 
 and other states of brain exhaustion. They are drug-takers 
 
326 DISEASES OF INEBRIETY. 
 
 and will resort to anything for relief. They are secretive, 
 and require more care and more mental remedies, with long, 
 exact hygienic surroundings. 
 
 Where tlie opium addiction has apparently come from 
 bad nutrition and faulty elimination, with auto-intoxication, 
 the treatment is very hopeful. A long preliminary course 
 of baths, mineral waters, and tonics should precede the 
 removal of opium. Then the opium may be removed slowly 
 and without the knowledge of the patient. In proper sur- 
 roundings, with frequent baths, little danger of relapse or 
 suffering will follow. Careful study and treatment of nutri- 
 tion and digestion will fully restoie the case, and relapse 
 seldom occurs except from failure or neglect of the sur- 
 roundings. 
 
 In the last class, where opium is taken and apparently 
 follows from the entailment of some injury or disease, or 
 the exhaustion of old age, a preliminary period of treatment 
 seems to be required. Often the opium can be abandoned 
 at once for sorrie milder narcotic, and from this, by grada- 
 tions, discontinued entirely. Full knowledge of the diseased 
 states present Will always suggest the lines of treatment. 
 In some cases the opium should not be removed ; its dimi- 
 nution and concealment is required. In others, its rapid 
 removal is essential. Many varied and difficult questions 
 will appear in these cases. The more accurately the diseased 
 states, also predisposing and exciting causes, the diathesis, 
 and varied influences which have caused opium to be used, 
 are studied, the more accurate the treatment. As in many 
 other diseases, the causes may be anticipated, also neutral- 
 ized and prevented. Opium-taking should be seen as a 
 symptom ; remove or break up the cause, and this symptom 
 disappears. 
 
 Routine treatment, either by slow or rapid reduction of 
 the opium, is not wise. The substitution of other narcotics 
 is equally unwise. In a certain number of cases the with- 
 drawal of opium only unmasks more serious diseases, and 
 
GENERAL CONSIDERATIONS OF OPIUM INEBRIETY. 827 
 
 is often wrong. A case of general paresis is now under 
 treatment for the opium addiction. Before this opium 
 addiction began, the patient caused great distress by his 
 delusions and extravagantly strange conduct. This treat- 
 ment is wrong, A rheumatic woman of seventy is going 
 through the same course to be free from opium, which has 
 made life tolerable for ten years past. The treatment of 
 opium mania is something more than the application of 
 means and remedies for withdrawal of the drug with the 
 least suffering. The symptomatology and organic lesions 
 often date back to other causes more complex than opium. 
 The treatment must begin by their removal. The general 
 or special diathesis must be treated ; the nutritive disorders, 
 intoxications, and starvations must be recognized and re- 
 moved. The influence of pathological states from previous 
 disease and injury must be ascertained and treated. The 
 power of environment, climate, occupation, and idiosyn- 
 crasies are also powerful factors to be considered. 
 
 These are the essential facts and conditions which must 
 enter into the practical treatment. Among the many im- 
 portant problems, that of prevention promises the greatest 
 possibilities. A recognition of the neurotic diathesis and 
 other predisposing causes would enable the physician to 
 successfully guard against its approach. 
 
CHAPTER XXXII. 
 
 OPIUM INEBRIETY (CONTINUED). 
 
 In the special treatment : i. We have to deal with an 
 individual whose will-power is subverted. To him the 
 enslaving drug has become as much a necessity of existence 
 as his food and drink. Any treatment which depends upon 
 his own volition must fail. For his own must be substituted 
 the control of another sound will. As a rule, removal from 
 home is essential to secure this control. As in insanity and 
 hysteria, strangers have far more control than relatives or 
 friends. It has the further advantage of breaking up the 
 accustomed train of associations, whicli is always a great 
 aid in overcoming a confirmed habit. Special asylums have 
 their advantages (if under proper management) and their 
 disadvantages. I shall not discuss this point. 
 
 The choice of attendant is of great importance, as upon 
 his or her trustworthiness and efficiency the result may 
 often depend. In the case reported, the firmness and tact of 
 the nurse, her readiness with massage, bath, medicine, or 
 nourishment, etc., enabled the reduction to be made rapidly, 
 and assisted greatly in mitigating the prostration and suf- 
 fering of the patient. With inflexible will she combined a 
 patience and sympathy which made the patient feel she was 
 a strong friend to help, not a jailor or detective, and was 
 thus a model of what is needed in the attendant. 
 
 2. Control of the patient having been secured, how shall 
 the drug be taken from him ? Three methods have their 
 advocates : {a) immediate and entire withdrawal ; {l>) 
 gradual reduction ; {c) rapid reduction. 
 
 329 
 
330 DISEASES OF INEBRIETY. 
 
 Under the first the sufferings are intolerable, the pros- 
 tration great and dangerous and it does not offer any great 
 security against relapse. 
 
 In the majority of instances tlie rapid reduction is the 
 wiser means between the two extremes. The rapidity 
 should vary with the case, and should be such as not to 
 involve extreme suffering or great prostration. 
 
 3. We have to deal in all cases of long standing with 
 an emaciated body and starving nerve centers. At the 
 same time we have complete anorexia and feeble digestion, 
 perhaps nausea and vomiting. The feeding of the patient 
 becomes, therefore, one of the most important, and perhaps 
 most difficult parts of the treatment. 
 
 Often it is well to begin with exclusive milk diet (pep- 
 tonized, if necessary). Systematic feeding of small quanti- 
 ties at frequent intervals is usually best. Confinement to 
 bed during early part of treatment will promote the nutri- 
 tion. At the same time it reduces to the minimum the tax 
 upon the shattered nervous system. For the same reason, 
 as well as for the sake of preventing the clandestine supply 
 of the drug, seclusion is best until convalescence is well estab- 
 lished. 
 
 The good results of the "rest treatment," as advocated 
 by Mitchell, /. e., seclusion, confinement to bed, forced feed- 
 ing, massage, and electricity, with gradual (usually rapid) 
 reduction of the drug, are permanent. 
 
 4. The use of various mechanical agencies for the relief 
 of pain, quieting" tlie nervous system, inducing sleep and pro- 
 moting nutrition — massage, electricity (both faradism and 
 galvanism), hot baths, Turkish baths, tlie cold shower-bath. 
 Dr. Jennings recommends the hammock for the restlessness 
 and desire for constant motion, so often a distressing symp- 
 tom. 
 
 5. Medicinal agents to meet the various indications of 
 each case. 
 
 The observations of Drs. Jennings and Ball, of Paris, 
 
OPIUM INEBKIETT (cONTINDEd). 331 
 
 upon the sph3'gmographic tracings of the pulse of habitues 
 we believe, have laid the physiological basis for a rational 
 system of medication. 
 
 These observations, which have been confirmed by others, 
 show, " that the pulse of a morphine habitue in a state of 
 privation .... caused by want of cardiac impulsion, 
 together with a resistance to the passage of the blood in the 
 vessels. A hypodermic or morphia given at this moment 
 
 restores the normal state of the circulation The 
 
 study of these tracings suggested the use of cardiac tonics 
 and stimulants as substitutes for the morphia during the 
 progressive reduction." The drugs chosen were : " Spar- 
 teine, on account of the facilities it offers for hypodermic 
 injection, and producing thus a rapid and evident effect ; 
 and trinitin, because of its congestive effect on the head and 
 its calorific effect upon the body generally." 
 
 D«'. Jennings uses these remedies in the gradual suppres- 
 sion of the drug when the reduction has reached such a 
 degree as to bring on the symptoms of deprivation. It is 
 not to be understood that these drugs take the place of 
 morphia, i. e., that it can be at once omitted without the 
 usual suffering ; tliey are but aids in mitigating that suffer- 
 ing by counteracting some of the circulatory disturbances 
 upon which it largely depends. 
 
 The evidence of clinical experience is largely in favor of 
 heart tonics and stimulants rather than of sedatives. In 
 the case reported, no sedatives were given, yet after the 
 first few nights, sleep was good. The glonoin had certainly 
 a good effect, being given at the time when the symptoms 
 of the craving came on. Quinia was used as a stimulant 
 to the heart and the cerebral circulation. Strychnia was 
 given as a heart tonic after complete withdrawal of 
 morphia. 
 
 When nervousness is great, or insomnia does not yield 
 to other means, drugs may be necessary. In these instances, 
 cannabis indica in large doses {}i to i drachm of fl. ext.)^ 
 
332 DISEASES OF INEBEIETT. 
 
 sulfonal, chloralamid or bromides will often render good 
 service. Chloral is used by Erlenmeyer, condemned by 
 Aurleck and others. Dr, Jennings seems latterly to have 
 usually substituted digitalis /^r^.y forspartein hypodermati- 
 cally, Quinia has seemed to me in many cases of distinct 
 value. Strychnia is one of the best heart tonics in the 
 pharmacopoeia. 
 
 Obersteiner is almost the only w^riter of note who now 
 speaks well of cocaine. If used at all, it should never, of 
 course, be placed in the hands of the patient himself. The 
 f^uid extract of coca has been highly spoken of by several 
 writers to relieve restlessness and depression. Valerianate 
 of ammonia has been a common favorite since the time of 
 De Quincy. 
 
 This method, which, so far as we are aware, is original 
 with and peculiar to Dr. Mathison, is merely a new applica- 
 tion of a well-established principle, for the power of the bro- 
 mides to subdue abnormal reflex irritability is so constant 
 that it may be looked upon as an invariable sequel of such 
 medication. Dr. Ed. H. Clarke, in his valuable treatise on 
 the bromides, says : " Diminished reflex sensibility, however 
 different physiologists may explain the fact, is cne of the 
 most frequent piienomena of bromidal medication that has 
 been clinically observed, and is, therapeutically, one of the 
 most important." The testimony of other distinguished 
 observers is to the same effect — Gubler, Guttman, Laborde, 
 Voison, Damourette, Eulenberg, Claude Bernard, Brown- 
 Sequard, Echeverria, and Hammond all giving evidence as 
 to the power of these agents to impair the control of the 
 spinal cord over reflex manifestations, and, at the same 
 time, exert a marked influence over the general nervous 
 system. Admitting that the symptomatology of opiate 
 abandonment pertains almost exclusively to the functions 
 over which the bromides exert so decided a control, we 
 have in the treatment of opium inebriety a new field pre- 
 sented for the exercise of this valuable property, and the 
 
OPmM INEBRIETY (cONTINTJEd). 333 
 
 fact, proven conclusively by our experience, that it ^(^^j- exert 
 this happy effect, fully supports the idea advanced as to 
 pathology of this disease. 
 
 In speaking of the bromide of sodium, let it be under- 
 stood that we refer entirely to the influence of the continued 
 dose, by which we mean its administration three times in 
 the twenty-four hours, at regular intervals, so as to keep 
 the blood constantly charged with the drug. A most 
 important difference, physiological and therapeutical, exists 
 between the effect of this mode of exhibition and that of 
 the single dose, or two or three doses so nearly together as 
 to form practically one. for in the former case the system is 
 constantly under the bromide influence, while in the other, 
 the drug being largely eliminated in a few hours, the blood 
 is nearly free from it a large portion of tlie time. Results 
 obtainable from the continued use cannot be gotten from 
 the single dose, and, as a consequence, its value is far 
 greater in the disease under consideration. 
 
 Again, the action of the continued dose being somewhat 
 remote, three to five days usually elapsing before there is 
 decided evidence in this direction, much more desirable 
 results are secured by its employment for several days/r/^r 
 to an entire opium abandonment, meanwhile gradually 
 reducing the opiate, than if the withdrawal be complete and 
 then reliance placed on the bromide to control the result- 
 ant irritability ; for, in one instance, the maximum sedative 
 effect is reached at the period of maximum disturbance 
 from the opium removal, and its counteracting and con- 
 trolling effect is far in excess of that to be had from its 
 employment subsequent to the lighting up of the nervous 
 irritation. What, then, we style preliminary sedation forms 
 a peculiar and most valuable feature in our administration 
 of the bromide, and it is this particular point we commend 
 to you, our experience having convinced us we have in it 
 an unequaled means of obviating the suffering incident to 
 the treatment of this disorder. v 
 
334 DISEASES OF INEBRIETY. 
 
 The value of the various bromides depends'on their pro- 
 portion of bromine. Bromide of potassium contains 66 per 
 cent., sodium 78, and lithium 92 per cent. We should, 
 therefore, expect a more powerful influence from the latter 
 agent, and, according to Wier Mitchell, it has a more rapid 
 and intense effect. Bromide of sodium being richer in bro- 
 mine, and pleasanter to the taste, we prefer it to potas- 
 sium. 
 
 Either of the bromides, in powder or concentrated solu- 
 tion, is somewhat irritant, sometimes provoking emesis, and, 
 in any event, delaying its absorption. A practical point, 
 then, is that it be given largely diluted. Dr. Clarke says, 
 " There should be at least a drachm of water to each grain 
 of the salt." We give each dose of the sodium in six or 
 eight ounces of cold water, and have never known it to 
 cause vomiting. 
 
 Another important feature relates to the time of its 
 employment. We usually administer it at 10 a. m., 4 and 10 
 p. M., or half an hour before each meal. Given thus, largely 
 diluted, it is probably absorbed in half an hour, and the 
 effect of tlie continued dose rapidly secured. 
 
 To produce the requisite degree of sedation within a 
 limited period, it is essential that the bromide be given in 
 full doses. I am convinced that failure in its use, in any 
 neurosis, is very often due to a non-observance of this 
 point. Our initial dose of the sodium is 30 grains, twice 
 daily, time and mode as stated, increasing the daily 
 amount 30 grains each day, i. e., 40, 50, 60 grains and 
 continuing it eight days, reaching a maximum dose of 
 100 grains twice times in the twenty-four hours. It is then 
 discontinued, but its sedative effect persists and somewhat 
 increases for two or three days following, and then begins 
 to decline. This period may last a week or more depend- 
 ing on some state of the blood and power of elimination. 
 During this week of bromidal medication, the usual 
 opiate is gradually reduced, so tliat oa the seventh or 
 
OPIUM INEBRIETY (oONTINDEd). 335 
 
 eighth day it is entirely abandoned. A decrease of one- 
 third or one-half the accustomed daily quantity is made at 
 the outset, experience having shown that habitues are 
 almost always using an amount in excess of their actual 
 need, and this decided reduction occasions little or no in- 
 convenience. Subsequently, the opiate withdrawal is more 
 or less rapid according to the increasing sedation, llie object 
 being to meet and overcome the rising nervous disturbance 
 by the growing effect of the sedative — in other words, 
 maximum sedation at time of maximum irritation. 
 
 Having secured the sedative effect desired, the object is 
 to eliminate the bromide as rapidly as possible, and as the 
 skin and kidneys form the only outlets, recourse is had at 
 once to diaphoretics and diuretics. Of the former, hot and 
 steam baths are to be relied upon. And, of the latter, digi- 
 talis, in infusion, or, if bulk be objectionable, Squibb's fluid 
 extract combined with potass, acet. and spirits aether nitrosi. 
 The bromide itself increases renal secretion, and, aided by 
 the others, it passes from the system in a few days. The 
 bromide and opiate having been discontinued, restlessness, 
 more or less prominent, from 20 to 56 hours, invariably sur 
 pervenes. It is controlled by codeine, i to 3 grains sub- 
 cutaneously, or by mouth, every 2 to 4 hours, and this is 
 continued, decreasing the dose or increasing the interval 
 till no longer needed, but is greatly relieved by hot — not 
 warm — baths, temperature 110° to 112°, 15 to 30 minutes 
 duration, repeated as required. They are often signally 
 effective. We have known a patient fall asleep, snoring 
 vigorously, while in a bath. 
 
 Sleeplessness is always more or less prominent after 
 opium abandonment. During the first six nights, sulfonal 
 or trional in 30 or 40 grain doses is given. Afterward, such 
 hypnotic as seems best suited to the case ; cliloral is most 
 effective, in 20 or 30 grain doses at bedtime. Often smaller 
 doses may be given at intervals of two hours until sleep 
 follows, with good results. 
 
336 DISEASES OF INEBRIETY. 
 
 A peculiarity of this insomnia is, that it is most marked 
 in the early morning. Slumber comes readily enough 
 at niglit, but patient awakes at two, three, or four oclock, 
 and finds further sleep impossible. Often it is well to 
 defer the sleeping draught until this time. This wak- 
 ing tendency gradually diminishes, and ultimately dis- 
 appears. 
 
 Chloral, given during the early opium abstinence, has, 
 with us, not acted kindly as a hypnotic, but produced a 
 peculiar intoxication, though we have never noted the wild, 
 maniacal delirium mentioned by Dr. Levenstien as occur- 
 ring during this period in his cases. As soon as possible it 
 should be discontinued, and sleep secured by a fatiguing 
 walk, a half hour's warm bath, a light lunch, or glass of 
 milk — one or all, before retiring. 
 
 For three or four days following the opiate withdrawal, 
 the diet should be exclusively of milk combined with lime- 
 water — one or two ounces, with one or two drachms respect- 
 ively — every hour or two. It is very seldom rejected, and is 
 preferable to beef tea, or anything else. Afterwards, a full, 
 solid diet may be resumed, soon as practicable. 
 
 While diarrlicea is the decided exception under this plan 
 of treatment, we still deem it best to keep the bowels in 
 good condition, and administer the first night, a mercurial 
 cathartic sufficient for several full evacuations, followed, 
 during the bromide giving, by daily laxative enemas, or 
 doses of Hunyadi water. 
 
 Debility, of varying d egree, due to the opium abstinence, 
 and bromide relaxation, is among the sequelae. It decreases 
 with the increasing bromine elimination, aided most effect- 
 ively by general faradization, twenty minutes morning 
 seances daily, after the restlessness subsides, and strychnia 
 I-20 gr. thrice daily, combined with iron, quinine, phospho- 
 rus, digitalis, or cod liver oil, as most required. 
 
 The following formulae are valuable : 
 
OPIUM INEBRIETY (CONTINUED). 337 
 
 Be. Strychnine, two grains ; Muriated Tinct. Iron, five ounces ; 
 Tinct. Digitalis, and Glycerine, of each, two and one-half ounces. 
 M. Dose — One to two drachms, three times daily. 
 
 5. Strychnine, four grains ; Dialized iron, five ounces. M. 
 Dose, one-half drachm, ter in die. 
 
 R. Strychnine, two grains ; Dilute Phosphoric acid, and Syrup 
 of Ginger, of each, two and one-half ounces. M. Does — One 
 drachm thrice daily. 
 
 R. Pyrophosphate of Iron, 5 to 10 grs., Quinme, 2 grs. at a 
 dose. M. Pill, or solution, three times a day, if the appetite be 
 slow in returning. 
 
 'Be. Comp. Tinct. Quassia, one drachm ; Tinct. Capsicum, ten 
 drops. M. For one dose, diluted, 20 minutes before each meal. 
 
 Strychnia is not advisable during the bromide adminis- 
 tration. Being decidedly antagonistic — one causing relax- 
 ation and deficient reflex excitability, the other, just the 
 reverse — the desired sedative effect may be materially 
 delayed if they be given together. Subsequently, it is the 
 most valued general tonic at command, and may be con- 
 tinued in varied combination for weeks. With the strictly 
 medicinal course are to be employed a full nutritious diet, 
 out-of-door exercise, especially walking, and varied social 
 enjoyments — in fact, anything that can exert a roborant 
 effect on mind or body. 
 
 Surprise may be expressed, and objection made regard- 
 ing the extent of the bromide doses, but the fact must never 
 be overlooked that we are not to be governed in the giving 
 of any remedy by the mere numerical amount of drops or 
 grains, but by the effect produced. Again, I am led to think 
 that one effect of opium addiction is a peculiar non-suscep- 
 tibility to the action of various nervines, necessitating their 
 more robust exhibition to secure a decided result. More, 
 and most important of all, under the influence of certain 
 
338 DISEASES OF INEBKIETY. 
 
 abnormal conditions, doses which ordinarily are toxic be- 
 come simply therapeutic. The annals of medical literature 
 abound with illustrations in support of this statement, and 
 among the most striking may be noted the following : Dr. 
 Southey read before the Clinical Society of London notes of 
 a case of idiopathic tetanus, which occurred in a boy ten 
 years old. The first symptoms of trismus were observed 
 two days after a severe fright and drenching due to the up- 
 set of a water-butt. They steadily increased up to the date 
 of liis admission to St. Bartholomew's hospital, upon the 
 eighth day of his illness, when the paroxysms of general 
 opisthotonos seized him at intervals of nearly every three 
 minutes. Each attack lasted from fifteen to thirty seconds* 
 and although between the seizures the muscles of the trunk 
 became less rigid, those of the neck and jaw were maintained 
 in constant tonic cramp. The patient was treated at first 
 with chloral, ten grains, and bromide of potassium twenty 
 grains, every two hours, and, afterwards, with the bromide 
 alone in sixty grain doses every hour and a-half. When 
 about two ounces were taken in the twenty-four hours, the 
 attacks became less frequent, but at first each separate seiz- 
 ure was rather more severe, and upon the evening of the 
 eleventh day, he was able to open his mouth better. 
 
 On the thirteenth day the bromide was decreased to 
 twenty grains every three hours, and on the fourteenth day, 
 was discontinued altogether. When the bromide had been 
 omitted for twenty-four hours, the attacks returned at inter- 
 vals of an hour, and the permanent rigidity of the muscles 
 of the neck was re-established. His condition now steadily 
 became worse, so that on the eighteenth day of his illness 
 it became necessary to resort to the previous large doses — 
 one drachm — every hour and a-half. After three such doses, 
 the expression became more natural, and he was able to 
 open his mouth again ; but it was not till the twenty-fifth 
 day of the disease that it was possible to discontinue the 
 remedy. The patient remained in a state of remarkable 
 
OPIUM iNEBRiETy (continued). 339 
 
 prostration and drowsiness, sleeping the twenty-four hours 
 round, and only waking up to take his nourishment for 
 eight days, and passed all his evacuations under him. He 
 subsequently steadily and rapidly convalesced. The bro- 
 mide produced no acne or other disagreeable symptoms, 
 and certainly appeared to exert marked inhibitory influence 
 upon the tetanus. 
 
 Surely, under ordinary circumstances, no one would 
 think of giving such extensive doses of the bromide, but 
 liere, under the antagonizing influence of the intense reflex 
 irritability, their effect was vastly beneficial, conducing, 
 unquestionably, to the patient's cure. 
 
 Given, as we recommend, no effect is usually produced 
 by the bromide before the third day. From the third to the 
 fifth, an unpleasant taste is complained of ; the bromic 
 breath begins ; the patient is disposed to drowse, and there 
 is a growing indisposition to muscular exertion. From the 
 fifth to the seventh, these symptoms increase — the tongue 
 begins to furr ; the odorous breath is marked ; the drowsi- 
 ness deepens into sound sleep, more or less prolonged, and 
 the inaptitude for physical exercise becomes so decided, that 
 patients generally take to bed on the last day. The follow- 
 ing two or three days — during the period of maximum dis- 
 turbance from the opium withdrawal — are characterized by 
 a persistence of the symptoms alluded to. Patient remains, 
 more or less restlessly, in bed; general relaxation is decided; 
 the pulse is less frequent — usually about 60 : the voice 
 somewhat weakened ; pupils dilated ; the renal secretion 
 augmented — though, sometimes, diminished ; the saliva 
 increased and rather viscid, and mild hallucinations of sight 
 and sound — almost always of sight — occur, occasionally, for 
 tliree or four days, accompanied with a peculiar aphasic 
 tendency, as shown by substituting one word for another — 
 Mediterranean for Mississippi; Brown, instead of Iowa, etc. 
 This curious symptom may occur at increasing intervals for 
 several days. 
 
340 DISEASES OF INEBRIETY. 
 
 Dr. Clarke refers to such instances. He says: "They 
 are hints of a distinct organ of hmguage, and suggest the 
 notion that, inasmuch as the drug we are considering para- 
 lyzes reflex, before it does general sensibility, language 
 may be the expression or correlation of a peculiar reflex 
 power." 
 
 After the ninth or tenth day, the bromidial manifesta- 
 tions gradually disappear, so that within two weeks from 
 beginning of treatment, patient is generally up and the 
 only prominent symptoms remaining are the debility and 
 insomnia. Tonics, hypnotics, and vis medicatrix naturae 
 effect speedy convalescence, and — where treatment is begun 
 on entrance — patients are usually dismissed, cured, within 
 a month. 
 
 More than one week's employment of the sodium is not 
 advisable lest the hallucinations become unpleasantly pei"- 
 sistent ; and cases will present in which a minor degree of 
 administration — five or six days — will suffice. 
 
 Marked general debility contra-indicates the bromide, 
 and a tonic course should precede it. 
 
 Granted a case suitable for treatment, tliis method may- 
 be summarized as follows : Opiate reduced, at once, to 
 one-half or two-thirds usual quantity. Subsequent grad- 
 ual decrease and entire withdrawal in seven or eight 
 days. Mercurial cathartic, first night, followed by daily 
 laxative enemas, or Hunyadi water. Bromide of sodium, 
 30 grain doses, increased 30 grains daily, in six or eight 
 ounces water, on empty stomach, continued 5 to 7 days. 
 Restlessness following opium abandonment met by hot 
 baths, 100'' to 110°, ten to thirty minutes each, often as 
 required. Bromide eliminated by diuretics — digitalis and 
 nitre, and diaphoretics — hot and steam baths. Insomnia 
 relieved by chloral, combined, if need be, with Indian 
 hemp or hyoscyamus. Diet exclusively milk and lime- 
 water first three days of opium abstinence. Full diet 
 resumed soon as possible. Debility removed by generous 
 
OPIUM INEBRIETY (cONTINTJEd). 341 
 
 living, general faradization, strychnine, iron, quinine, etc., 
 with out-of-door exercise and varied social enjo3'ment. 
 
 For relief of neuralgic pain varied measures suffice. 
 Leading the list are electricity and the local use of ether. 
 As to the value of the galvanic current in migraine and 
 other neuralgias, so common in opium habitues, and the 
 manner of using it, tlie reader is referred to papers by the 
 writer. The same agent is effective in relieving limb and 
 lumbar pains, tliough here a much stronger current is 
 required than can be used with safety about the head. 
 Sometimes a faradic current acts well, and when one fails, 
 trial should always be made with the other. Local hot 
 baths are often of great service. 
 
 Regarding the ether, those who have never used it will, 
 we think, be surprised at its pain-easing power. In 
 either way applied — spray, drop, or lavement — it is potent 
 for good. 
 
 These three — electricity, ether, hot water, are valued 
 anodynes, and one special point in their favor is entire free- 
 dom from unpleasant gastric, or other result. 
 
 Other remedies relieve, at times, of the coal-tar salts, 
 phenacetine, or phenocoll, lo to 15 gr. doses are best. It 
 has often a hypnotic effect. A valued external anodyne is 
 menthol, i part ; chloroform, 10 parts ; ether, 15 parts ; used 
 as spray. 
 
 Under this plan of treatment marked disorder of stomach 
 or bowels is rare. Our rule is to give a mercurial or other 
 cathartic at the outset, if there be alvine torpor, and then 
 secure regular action by such laxative as seems best. If 
 restraint be needed, large enemas of hot water may be used. 
 Tills failing, i to 3 grs. sulpho-carbolate of zinc, 10 to 20 
 minim doses of fluid extract of coto, in capsules, or 40 to 
 60 grains of subnitrate of bismuth every four hours. If, 
 however, it persists, the best thing is a full opiate — tinct, 
 opii, per mouth or rectum, at bedtime, preferred. This 
 promptly controls, gives a full night's sleep, and the trouble 
 
342 DISEASES OF INEBRIETY. 
 
 seldom returns. Fear of a bad effect on convalescence is 
 unfounded. 
 
 Diet is not restricted, unless tlie condition of stomach or 
 bowels demands. We have again and again seen patients 
 recover who did not vomit once, or wlio liad only two, three 
 or four movements daily, Tlie excessive vomiting men- 
 tioned by Levinstein and Obersteiner — abrupt disuse — we 
 have never noted. Tiie former thought tlie collapse — which 
 we have never seen — in several of his cases was due to 
 vomiting and purging. More likely the largest factor in 
 causing it was tlie exhausting mental and physical suffer- 
 ing which his metliod entails. If the stomach rebels, 
 entire rest for a time, or milk and lime-water, ale and beef, 
 malted milk or bovinine, in small amount, may act well. If 
 not, sinapisms, ether, faradism, or chloroform, alcohol and 
 ice are of value. All failing, a full opiate hypodermic will 
 promptly suffice. 
 
 Twenty-four hours after the opiate-quitting, patients are 
 directed to bed, and kept there two to four days, for we 
 are convinced that rest is an aid of great value. Erlen- 
 meyer says, "The best remedy is rest in bed. The import- 
 ance of quiet, rest in bed, and warmth in promoting 
 restoration during the abstinence struggle, cannot be 
 overestimated. I order every patient to bed at the start, 
 and can state with confidence that those who submit to this 
 till I allow a change will get along more easily and satis- 
 factorily during the treatment than others who do not obey, 
 but who insist on moving about or having the run of the 
 premises." 
 
 Having thus crossed the opiate Rubicon, treatment per- 
 tains, mainly, to the debility and insomnia. For the 
 former, coca leads the list. Of fluid extract, 2 to 4 drachms, 
 or cocaine, i to 2 grains, with other tonics, 3 or 4 times 
 daily, decreasing as need lessons. As a rule, its use is 
 ended in a fortniglit. To remove the mental and physical 
 depression, the minor neuralgias, and the desire for stimu- 
 
OPIUM INEBKIETT (cONTINUEd). 343 
 
 lants sometimes noted nothing equals it, and full doses of 
 tincture of capsicum often add to its value. 
 
 Another agent of much service is general faradization, 
 twenty minute stances daily. This imparts a feeling of 
 exhilarating comfort, but care must be taken not to overdo, 
 for a current too strong or long makes mischief, overstimu- 
 lating and exhausting to the extent, it may be, of several 
 days' discomfort, which nothing but time will remove. 
 
 Faradism also acts kindly in easing the peculiar unrest 
 — " fidgets " — and the nagging aches in legs during con- 
 valescence. It may be applied in the usual way, or througli 
 the special electrodes we have devised. 
 
 Galvanism is another general tonic of value. Our 
 method is positive pole to nape of neck and negative to 
 epigastrium for five minutes, then the former behind tiie 
 angle of each jaw for a minute or two, making entire 
 stances seven to nine minutes. 
 
 Another valued tonic is the cold shower-bath. With 
 many it is a great invigorator, and patients who dread it, 
 at first, came to appreciate it highly. 
 
 Internal tonics have a place in the roborant regime. 
 Most habitues are below par, and it is our custom to give 
 such, from the start — phosphorus, strychnine, arsenic and 
 quinine, combined. After the opiate-quitting, coca, in 
 some form, can be added. If anaemic, ferri tincture, or 
 Blancard's pills. Caffein is of value. It is stimulant, tonic 
 and diuretic. We sometimes give it with codeine and 
 cocaine. Digitalis is often useful. In some cases, cod- 
 liver oil is of service — with pepsine and quinine, with malt, 
 with phosphates, or plain — and may be given for months. 
 
 Some anorexia is usually present, yet it may not prevent 
 the regular meal, and need never occasion anxiety, for it 
 will likely give place to a vigorous appetite, whicli may be 
 encouraged to fullest feeding siiort of digestive disaster. 
 If it be slow in returning, half grain doses of cannabis, an 
 hour before meals, often have a marked action. 
 
344: DISEASES OF INEBRIETY. 
 
 Regarding the insomnia, Levinstein said : " Sleepless- 
 ness, which is generally protracted up into the fourth week, 
 is very distressing." Our record differs. Wakefulness is 
 an invariable sequel, but usually not so marked nor pro- 
 longed, and in ordinary cases recovery can generally be 
 promised, without the loss of a single entire night's sleep. 
 We have known a patient able to dispense with hypnotics 
 in five, others in eight, and the average, in a series of cases, 
 was eleven nights. 
 
 The insomnia is of two kinds. Most patients secure 
 sleep on retiring, but waken early — 3 or 4 o'clock — and fail 
 to get more. Others remain awake nearly all night before 
 slumber comes, and these usually require soporifics the 
 longer. For relief of this, cannabis indica will often suffice. 
 The hemp is given in 40- to 60-minim doses, in capsules, or 
 mixed with glycerin, or ginger syrup, two hours before bed- 
 time. There may be noted, in some, laughing and talking 
 during the first hour, tending to sleep in the second. 
 Many require nothing else. At the end of a week it is less- 
 ened, and usually, ended in ten or twelve days. 
 
 Other hypnotics — chloral, chloralamid, trional, sulfonal, 
 paraldehyde, hypnal — in full doses, often work well. 
 
 Chloral, during the first 5 or 6 nights of opium abstin- 
 ence, fails as a soporific, often causing a peculiar excite- 
 ment or intoxication — patients talking, getting out of bed 
 and wandering about the room — followed after several 
 hours, by partial sleep. Later, in full doses — we prefer 
 40 grains at once, rather than two 20 grain doses — alone, or 
 with a bromide, it can be relied on. 
 
 If, as rarely happens, the sleepless state is so pronounced 
 or prolonged as to distress patient, we never hesitate to 
 give a full opiate, by mouth, and with good result. Erlen- 
 meyer says: "In such cases there remains nothing to do 
 but to resort to morphine. I give, then, the alkaloid inter- 
 nally on two consecutive evenings ; a certain cumulative 
 effect takes place. The first night in the dose of Yi grain, 
 
OPIUM INEBRIETY (cONTINUEd). 345 
 
 there is usually no sleep ; but on the second night, after 
 giving the same dose, a sound sleep of six hours' will 
 ensue. I have not observed any special danger from these 
 resumed doses of morphine, although I feared it ; but after 
 I was constrained in several bad cases, when every other 
 medicine had failed, to resort to this, I was convinced that 
 my fear was groundless." 
 
 In all cases drugs should be dropped as soon as pos- 
 sible, and sleep secured by a walk or other exercise — an 
 electric seance, a Turkish or half-hour's warm bath, a light 
 meal, a glass or two of hot milk, one or more of these before 
 retiring. Patients, whose slumber ends early, often note a 
 peculiar depression on waking, and if so, a lunch, hot 
 milk, cocoa, coffee, beef, or bovinine should be at com- 
 mand. 
 
 It may be well in passing to refer to certain minor 
 sequelae and their treatment. If dyspnoea or palpitation, a 
 stimulant — coca with capsicum or Hoffman's anodyne 
 with aromatic spirits of ammonia — will promptly control. 
 
 If aching pains in the calves, strong galvanic or faradic 
 currents, hot water, massages, or ether will relieve. If a 
 peculiar burning in soles, mustardized foot-baths. If 
 marked hysteria, ether inhalations. 
 
 Belly pain may be eased by hot fomentations, or full 
 doses of ether in hot water, or camphor with capsicum. 
 The latter, with atropine injection, act happily in ovarian 
 irritation. 
 
 Very seldom unrest and insomnia compel hyoscine. If 
 so, hydrobromate i-ioo to 1-20 grain, hypodermically, or, 
 double, by mouth. 
 
CHAPTER XXXIII. 
 
 ETHER INEBRIETY — ITS HISTORY AND PROGRESS. 
 
 Ireland has in the nineteentli century presented to the 
 world two interesting and remarkable series of inobrio- 
 psycliological piienomena. In 1838, a simple-minded 
 Roman Catliolic priest, Fatiier Matliew, adopted and be- 
 gan to advocate the practice of abstinence from all intoxi- 
 cating drinks. So amazing was the impression made by 
 him that, in three years, the roll of the teetotal pledges 
 which he had administered exceeded 5,000,000, in Ireland, 
 in aiddition to large numbers in England, Scotland and 
 America. The reality of this epidemic of temperance 
 was attested by the statement of the Chief Secretary, in 
 1840, that "the duties of the military and police in Ireland 
 are now almost entirely confined to keeping the ground 
 clear for the operation of Father Mathew." 
 
 Though this great wave of sobriety has gradually 
 receded, till now the extent of drinking in Erin is simply 
 terrible, I am every now and again meeting professionally 
 with sons and daughters of Hibernia, who glory in their 
 steadfastness to the pledge which they so long ago took at 
 the hands of the Irish apostle of temperance. An accurate 
 study of this unique crusade would, in psychological 
 results, amply repay the labors of any earnest student of 
 mental science. 
 
 Curious to relate, the other series of inebrio-psychologi- 
 cal phenomena is an experience in an opposite direction — an 
 experiment, so to speak, not, as in the former case, in tem- 
 perance, but in intemperance. 
 
 347 
 
348 DISEASES OF INEBRIETY. 
 
 The disease of inebriety or narcomania (a mania for 
 intoxication by any kind of narcotic or anaesthetic), may 
 besides other phases, assume a form correspondent to the 
 particular inebriating substance. It may, therefore, be 
 interesting to glance at the origin and growth of this new 
 mode of inebriate indulgence, as this is the first opportu- 
 nity afforded to us of observing the rise and progress of 
 such a process in a community. 
 
 The centre from which etlier drinking spread was the 
 town of Draperstown (with a population of some 300), in the 
 southern part of the County of Londonderry. Before Father 
 Mathew's abstinence propaganda, etiier drinking was there 
 unknown. Between 1842 and 1845 a local medical practi- 
 tioner, in response to a request from a few newly-pledged 
 abstaining converts for something tlie taking of which would 
 not violate their vow, gave them a drachm of ether in water. 
 So far as I can ascertain, this was the /o/is et origo viali. A 
 desire for more frequent doses grew upon the ether drink- 
 ers, and the practice spread in and around Draperstown till 
 there was a shop for the sale of ether, in one town, to every 
 twenty-three of the population. In the session of 1855-6, an 
 Act was passed by the British Legislature allowing spirits 
 of wine to be used dutv-free in arts and manufactures 
 provided it was made nasty as a drink (which the Govern- 
 ment, in their innocence, supposed would prevent people 
 from drinking it) by the addition of a minimum 1-9 of methy- 
 lated spirit. As ether prepared in this way is much cheaper 
 than ordinary sulphuric ether, this cheap production of 
 "methylated ether " caused the consumption to increase 
 ** by leaps and bounds." 
 
 The present ether area was, from its mountainous fea- 
 tures, a central locality for the illicit distillation of whiskey. 
 Owing to the activity of the police and the making of roads, 
 this illicit traffic was effectually stamped out. The disap- 
 pointed cheap whiskey drinkers found a cheap unintoxicant 
 in ether. Mr. H. N. Draper first called attention to Irish 
 
ETHER INEBRIETY. 349 
 
 ether drinking in 1877, followed by Dr. B, W. Richardson, 
 about 1879, and by Mr. Ernest Hart in 1890. 
 
 Ether drinking was in a year or so gradually introduced 
 from Draperstown into the neighboring town of Mtighera, 
 and soon extended its sway till it occupied an area of some- 
 where about 295 square miles, with a population of nearly 
 79,000 souls. This area may, in general terms, be said to 
 comprise the mountainous districts, especially of Derry and 
 Tyrone, and to some extent, of Armagh and Antrim. 
 Cases of ether intoxication have occurred in Dublin and 
 ottier parts of Ireland, in Glasgow (Scotland), in Lincoln- 
 shire in England, and I have seen several in London. 
 
 All the cases which I have seen in England have been 
 persons of education and refinement, who had first been al- 
 cholic inebriates and gradually developed into devotees of 
 these twin poisons. Nearly all of these English cases have 
 been females, the only males having been members of the 
 medical profession. In Ireland, women assert the equality 
 of the sexes by taking their fair share of this form of intem- 
 perance. Small farmers and agricultural laborers make up 
 the bulk of the Irish ether tipplers. Workmen, too, are 
 well to the front. But the practice is by no means confined 
 to these classes. Members of the learned professions have 
 their representatives. Etherists are to be found at almost 
 all ages from puberty onwards. Sturdy Irish lads and 
 beautiful Irish lasses, brimful of Hibernian wit, as well as 
 "60-year olds" of both sexes, are slaves to ether drunken- 
 ness. The mother may be seen with her daughters, and 
 maybe a neighboring Irishwoman or two, at a friendly ether 
 " bee." The habit has become so general that small shop- 
 keepers treat the children who have been sent to purchase 
 some article, with a small dose of ether, and schoolmasters 
 have detected ether on the breaths of children from 10 to 
 14 (or even younger), on their arrival at school. 
 
 Some critics have endeavored to lay the blame of this 
 new development of inebriety on the Roman Catholic 
 
350 DISEASES OF INEBRIETY. 
 
 religion. Nothing could be more unwarrantable and 
 unfair. The disease has spread principally among Roman 
 Catholics, simply because this is the creed of the greater 
 part of the population. One Protestant village, Tobermore 
 is as bad as any other place. All my cases have been Prot- 
 estants. 
 
 The amount swallowed at a draught varies mainly with 
 the stage of education in ether consumption. A novice 
 will find a drachm (a teaspoonful) sufficient. Gradually 
 the wished-for effect demands an increased dose, till X of 
 an oz. may in time become the ordinary "peg" of an 
 accomplished drinker, to use the phraseology of Anglo- 
 Indians. These are average quantities of a so-call5d 
 "moderate" drinker. More ''seasoned casks" have a 
 higher capacity, many toping off a half a wineglassful as 
 unconcernedly as an average Englishman would drink a 
 glass of claret, or an average American a glass of cham- 
 pagne. 
 
 The amount of ether consumed in a day is often remark- 
 able. A confirmed ether inebriate will take a much larger 
 dose than any I have just enumerated, and repeat the dose 
 three, four, five, or even six times in the twenty-four hours, 
 when " on the spree." Indeed, in some cases, half a pint 
 has been the regular daily allowance of constant (or habit- 
 ual) inebriates. In England I have known an ether inebri- 
 ate use a pint of ether by inhalation every day. In Ireland, 
 many persons keep themselves intoxicated pretty well dur- 
 ing the day for the sum of sixpence — taking two penny- 
 worth at lo o'clock, I o'clock and 4 o'clock. What a para- 
 dise for drunkards ! Drunk three times a day for 13 
 cents ! 
 
 In England, in my own practice, the majority of ether 
 drinkers have inhaled the poison. In Ireland the universal 
 method is drinking. By the latter mode the ether is taken 
 "neat." Owing to an idea that ether, like whiskey or 
 brandy, should be drunk diluted with water to sheathe the 
 
ETHEK INEBRIETY. 351 
 
 virulence of the poison, the uninitiated and ignorant Eng- 
 lisliman, when in Ireland, sometimes mixes his ether " peg" 
 with water, "just to try the stuff, you know." Ludicrous 
 failure awaits him, for, unlike ardent spirits, ether is but 
 sparingly soluble in water. The pungency of ether, except 
 to those who have "finished their education," generally calls 
 for an "overture" to the "act" of ether swallowing. 
 Scene I. — The mouth is washed out with cold water. 
 Scene II. — A draught of cold water is drunk. Scene III. — 
 The ether is swallowed " neat." Scene IV. — The perform- 
 ance closes with a second and final drink of cold water. 
 
 The preliminary draughts of water are to cool the 
 mouth and throat, and the post-ether draught is " to keep 
 the ether from rising." The washing of the mouth is soon 
 omitted. By-and-by the preliminary draught of water 
 follows the same fate, the ether dose and the succeeding 
 draught of water being the commonest method. As his 
 education advances, the etherist dispenses with water alto- 
 gether. He may for a while, especially when drinking an 
 unusually large dose, hold his nose with one hand, but 
 probably ends by despising all precautionary safeguards, 
 and by simply drinking his mouthful of ether at a gulp. 
 
 Ether purus of the British Pharmacopoeia was at one 
 time affected by my inebriate patients. This pure ether 
 (02^15)20, which is free from alcohol and water, has been in 
 my hands the only ether preparation which has proved tO' 
 be without complicatory drawbacks when used as an 
 anaesthetic (Brit. Pharmacopoeia, 720 ; U. S., 725). Ether 
 of the B. P. (sulphuric ether) was, however, the article gen- 
 erally used for purposes of intoxication. It contains 8 per 
 cent, of alcohol and water with 92 per cent, of ether purus ^ 
 and is soluble in all proportions with rectified spirit, but in 
 only I in 10 with water. The specific gravity should be 
 (B. P.) .735 ; (U. S.) .750. It is a swift, potent, diffusible 
 stimulant, narcotic, anaesthetic and antispasmodic, of great 
 
352 DISEASES OF INEBRIETY. 
 
 value in medicine. It has a strong, penetrating odor, is 
 sweetish, hot, burning and pungent to the palate. 
 
 To America the whole world owes a deep debt of grati- 
 tude for ^he introduction of ether as an anaesthetic by Dr. 
 Morton, in Boston, in 1846, and any saddening misuse of 
 this grand mode of alleviatiug human suffering ought not 
 to lessen our appreciation of tliis splendid boon to humanity. 
 
 By the Act 18 and 19 Vict., the use of spirit of wine, free 
 of duty, was permitted in the arts and manufactures, on the 
 addition of a minimum of 1-9 of wood-naphtha (methylic 
 alcohol or spirit from the destructive distillation of wood, 
 after rectification ; specific gravity .803 B. P.) with a view 
 to prevent this fouled liquid from being drunk as a bever- 
 age. Ether prepared from this fouled duty-free spirit is, of 
 course, much cheaper than ether prepared from spirit of 
 wine on which duty has to be paid. Tlie intention, how- 
 ever, was defeated, inasmuch as in the process of manufac- 
 ture of ether from the fouled spirit, the fouling ingredients 
 (/. e., the methyl products) are destroyed. Thus, contrary 
 to tlie general belief in what is commonly called "methyl- 
 ated ether" being as nasty as the methylated spirit which 
 is used for lamps and for polishing purposes, " methylated 
 ether" is to the taste hardly discernible from pure sulphuric 
 ether. This so-called " methylated ether " is practically 
 undistinguishable from ether (B. P.) at the specific gravity 
 of .717, /. ^., when purified. At any other specific gravit}'^, an 
 odor is given off after evaporation. Practically, one cannot 
 discriminate between the ethylic and methylic productions. 
 
 Price. — The ether thus prepared from the duty-free spirit 
 (sp. vin. rect. cum methylic alcohol), can be produced at as 
 low as one-seventh of the cost of ether prepared from the 
 duty-paid spirit, the latter being bought wholesale at $1.25 
 per lb., and the former at as low as 16 cents. 
 
 Ether is imported mostly from England, partly from 
 Scotland, by larger chemists and druggists in the principal 
 towns of Cookstown, Magherafelt, and Maghera. The 
 
ETHER INEBKIETY. 353 
 
 large dealers supply small shopkeepers, and also cottagers, 
 who sell in "drauglits " (rather less than 2 teaspooiifuls) for 
 one penny. Tlie small shopkeepers also supply the hawkers 
 (who are very often women), who attend fairs and other 
 festive gatherings to dispense the "draughts" of the liquid 
 poison. These "draughts" are also to be had from the 
 surgeries of some medical practitioners, and in cottages or 
 ether shebeen, where the cottager keeps a pig or two, and 
 sells ether, the country people frequently giving potatoes, 
 meal, or other produce in exchange. Tlie hawkers carry 
 about a bottle of ether, and do not scruple at selling to any 
 one, however young, bartering a little for one or two eggs. 
 In this way the children may procure the ether on their 
 way to scliool. 
 
 Intoxication by ether presents one distinguishing feature 
 as compared with alcoholic intoxication. Tlie phenomena 
 are practically alike, but in rapidity of manifestation, alcoiiol 
 is " nowhere." Indeed, in this respect, ether beats the 
 record. There is the exhilarative stage of morbid exalta- 
 tion, when the fun and exuberant merriment, the latent and 
 ineradicable impulse of one " spoiling for a fight " of the 
 genuine Irishman stands revealed in the twinkle of the 
 eye, and the flourish of the shillelagh. The pleasing but 
 quickly vanishing whirl of enjoyment is followed by an 
 evanescent episode of brain disturbance and mental riot, 
 with muscular paralysis and incoordination. To these 
 succeeds the concluding comatose stage, when the patient 
 is said to be " dead drunk." The shortest period in which 
 I have seen this inebriate panorama move on till it swung 
 round to recovered sobriety has, with alcohol, been six 
 hours. With ether, I have witnessed the entire revolution 
 in less than two hours. 
 
 In my observation an alcoholic inebriate career, from 
 start to a fatal finish, has in America been, on an average, 
 one-third of the duration of a corresponding career in 
 Britain. So, curious to say, has the length of an ether 
 
354 DISEASES OF INEBRIETY. 
 
 intoxicative paroxysm been one-third the length of an 
 alcoholic intoxicative paroxysm. Thus the etherist can 
 have three thorough "drunks "for one of the alcoholist. 
 Herein, in addition to the greater cheapness, lies the supe- 
 rior claim of ether to the " greedy for intoxication," the true 
 " narcomaniac." 
 
 Intoxication by ether may be described as "hysterical," 
 and intoxication by ether ^«;;/ alcohol as "maniacal." A 
 man arrested while drunk on ether alone, would probably 
 be quite sober by the time the constable had him at the 
 police station, which might be very awkward for the con- 
 stable, though the arrest had been made when the man was 
 in a frenzy of boisterous excitement. Several deaths from 
 ether, and ether cunt alcohol, have occurred. 
 
 Little is known of the pathology of ether. The habit 
 has been too young to afford opportunities of much post- 
 mortem examination of ether inebriates. Premature old age, 
 an antedated shriveling up of the living frame, attests the 
 poisonous influence of the destroying agent. Gastritis 
 (acute and chronic), debility, dyspeptic distress, epigastric 
 pain, pallors, tremors, timidity, moroseness, suspicion, nerv- 
 ous prostration, chilliness, a cyanosed or lemon skin, and 
 an intermitting heart-beat, with exaggerated reflexes, are 
 prominent symptoms. I have one such victim in my mind's 
 eye now. Fawning, cunning, terror-stricken, this wretched 
 medical colleague is the incarnation of utter misery. Not 
 yet 40 years of age, he shuffles about like a worn-out old 
 man of 90 after a wasted and mis-spent life. It has been 
 urged by some medical authorities that ether is guiltless of 
 producing any pathological lesion, from the almost light- 
 ning rapidity with which its inebriating manifestations 
 appear and fade away, and from no serious morbid after- 
 death appearances having been observed. 
 
 This conclusion is, in my judgment, premature. Judg- 
 ing from the symptoms from which I have seen ether 
 inebriates suffer, I have not the slightest doubt that ether 
 
ETHEK INEBRIETY. 355 
 
 has a pathological influence on various organs and tissues, 
 and that, if ether drinking could boast of as venerable an 
 antiquity as alcohol drinking, unmistakable lesions would 
 have been but too manifest. Wliat are the forty years of 
 ether consumption by a hundred thousand persons, to the 
 thousands of years of alcohol consumption by at least as 
 many millions of human beings ? 
 
 Happily, this new form of inebriation is but in its 
 infancy, so there is some hope that its growth may be 
 " nipped in the bud." As, in the conversion of methylated 
 spirit into ether, the nauseous methyl products are 
 destroyed, something might be done towards making the 
 liquor loathsome to the palate by the compulsory addition 
 of the wood spirit after the completion of the etherification 
 before the sale of the liquid. This, however, would be but 
 a palliative, for I have had patients under my care who 
 drank methylated spirit (some even from jars with anatom- 
 ical preparations) and in Edinburgh and Glasgow, Sun- 
 day drinking of tiiis nasty beverage recently flourished 
 apace. In a certain locality in the north of Ireland, the 
 drinking of methylated spirit was introduced seven or 
 eight years ago. At first confined to the very poor in a 
 hilly district, it has spread rapidly, till now farm laborers 
 and farmers are daily indulging in it, 
 
 Tliere are many inebriates who hate and abhor the taste 
 of the intoxicant which, in their narcomaniac madness, they 
 would barter their salvation to procure. 
 
 Another remedy would be the abolition of the retail 
 sale. This would help by putting difficulties in the way of 
 the drinker, but would only mitigate the mischief. Still 
 more effectual would be the scheduling of ether as a poison, 
 the sale of which is restricted to druggists under certain 
 safeguards. This course was so readily adopted for Ireland 
 by the British government in January last, that I have j'et 
 hope the dav will come when the more deadly allied poi- 
 son — alcohol — will be placed in the same category, and so 
 
356 DISEASES OF INEBRIETY. 
 
 dangerous a drug vviVl be relegated to the shelf of the 
 apothecar}'', its sale hedged in with as stringent precautions 
 as is now the sale of arsenic or prussic acid. But tliis hal- 
 cyon era of prohibition will only be attained after a pro- 
 longed struggle, amid the howls and groans of an enraged 
 liquordom, whose indignation is concentrated on all who 
 attempt to " rob a poor man of his beer."' 
 
 It is too soon yet to foretell the ultimate result of the 
 bold step taken by our Government in scheduling ether as 
 a poison, but it has made the procuring of ether for drink- 
 ing purposes so difficult that for the present the sale lias 
 diminished by at least 75 per cent. I fear, however, that 
 the cupidity of some wlioiesale dealers will incite them to 
 risk the penalties of the law by surreptitious sales, which 
 will speedily be ferreted out by the marvelous cunning of 
 the diseased and demoralized inebriate. 
 
 The lines of sound treatment of ether inebriety, and of 
 its prevention by law, must alike be based on an intelligent 
 appreciation of the true character and etiology of ether 
 drunkenness. This is, in reality, but a new manifestation of 
 an underlying morbid condition which renders certain of 
 the sons and daughters of men peculiarly liable to plunge 
 into intoxication. We can never hope to succeed in the 
 cure and prevention of any disease, until we first recognize 
 the presence of tiie disease itself. The malady of narcoma- 
 nia, as subtle as it is far-reaching in its influence on body, 
 brain and mind, and morals, is a legitimate outcome of 
 natural law, and we will not be adequately equipped for 
 the fight till we are thoroughly conversant with the laws 
 under which every form of the disease of inebriety is 
 developed and propagated. 
 
CHAPTER XXXIV. 
 
 COCAINE INEBRIETY. 
 
 The dangers to be apprehended from the abuse of 
 cocaine are probably hardly yet quite realized, at least in this 
 country. A great deal of harm has undoubtedly been done 
 of recent years by the use of cocaine as a help to break off 
 the morphia habit. An exaggerated estimate of the assist- 
 ance to be obtained from the former drug has been formed 
 by such writers as Freund, and although Elwin and Erlen- 
 meyer have warned us not to fly from Scylla to Charybdis, 
 still it is to be feared that the notion lingers that cocaine 
 may be used advantageously and safely for this purpose. 
 Nothing can be more mistaken. Cocaine is more seductive 
 than morphia. It fastens upon its victim more rapidly, 
 and its hold is, at least, as tight. Cocaine solutions are 
 probably somewhat too freely prescribed in cases of diseases 
 of the nose and naso-pharynx. Patients who use the drug 
 in this way become very soon acquainted with its agreeable 
 effects. Several cases have been recorded by American 
 authors of cocaine habit arising thus. That cocaine has 
 not been even more extensively misused is probably due to 
 its being still a comparatively new drug, and also in part to 
 its costliness. Up to the present time the largest number 
 of its victims appear, unfortunately, to have been medical 
 men. 
 
 Cocaine owes its special dangers to three causes. First, 
 it is particularly treacherous. Secondly, it produces early 
 mental breakdown both in the moral and intellectual spheres. 
 Thirdly, it is intensely toxic, bringing about destructive tis- 
 
 357 
 
358 DISEASES OF INEBRIETY. 
 
 sue clianges after a comparatively short period of abuse. 
 Taking the last first, we know tliat aicoliolic poisoning is 
 usually a slow process, while morphia may be taken even in 
 very large quantities for years without producing any serious 
 structural changes in the nerves. In fact,' we recognize no 
 distinct pathological results of morphia poisoning. On the 
 other hand, the marasmus of chronic cocaine poisoning, 
 appearing early and developing with extreme rapidity, is 
 but one indication of the serious organic changes that are 
 produced. Convulsions similar, as Richet points out, to 
 those of cortical epilepsy, have been noted in a great number 
 of cases. In at least one recorded case, death occurred in 
 an epileptiform attack. In animals, poisoned with cocaine, 
 remarkable rise of temperature has been observed by Mosso 
 Reichert and otiiers. Acute poisoning in animals kills by 
 asphyxia ; clironic poisoning, as Zanclievski shows, is accom- 
 panied by albuminous degeneration of the ganglionic cells 
 in the medulla oblongata and spinal cord, as well as of the 
 nerve cells of the heart ganglia and of the liver cells. In 
 other more advanced cases this author has found atrophic 
 changes with vacuolation in the cells of the medulla and 
 cord, fatty degeneration of the muscular fibres of the heart, 
 and atrophy of the liver cells. Degenerative changes also 
 occurred in the arterial coats, particularly in the spinal cord 
 Perhaps organic changes similar, but less in degree, account 
 for the slowness and difficulty in recovering from the cocaine 
 habit, and the liability to dangerous collapse which exists 
 during the process of withdrawing the drug. 
 
 The treacherous and insidious character of cocaine 
 results from the fact that when taken in small doses it pro- 
 duces at first apparently nothing but a slight degree of ex- 
 altation, a sense of well being, a feeling of mutual and bodily 
 activity, of general satisfaction and of good humor that is 
 most agreeable. There is no mental confusion which the 
 consumer of cocaine is conscious of, and the only overt 
 symptoms he betrays at this stage is more than natural 
 
COCAINE INEBRIETY. 359 
 
 talkativeness. The hypnotic effects, when they appear, are 
 not overwhelming, and there is no headache, no nausea, no 
 confusion next day. This cocaine is probably the most 
 agreeable of all narcotics, therefore the most dangerous and 
 alluring. It is to be feared that these peculiar qualities may, 
 indeed, conduce to raise this drug in the future to the bad 
 eminence of being as Erlenmeyer says, the third great 
 scourge of the human race (alcohol and opium being the 
 first and second). Like several other observers, I have sat- 
 isfied myself by experiments on healthy persons, that the 
 agreeable results described actually follow the ingestion of 
 small doses of cocaine, and this fact impresses one strongly 
 with the feeling of how seductive this drug would be to the 
 neurotic or debilitated. Of course, as is the case with all 
 narcotics, small doses soon lose their effect, and hence a 
 rapid increase is necessary. 
 
 The rapidity with which mental symptoms of a grave 
 character appear is remarkable in cases in which increasing 
 quantities of cocaine are taken. Within three months 
 marked indications of degeneration, loss of memory, hallu- 
 cinations, and suspicion deepening into persecutory delusions 
 have been found. 
 
 The following is a characteristic clinical picture : on the 
 one side in the cachexia or bodily ruin, on the other side in 
 the moral impairment and pronounced mental affection. 
 Patients who use cocaine alone — and those who have endeav- 
 ored to wean themselves from morphine by its aid, and so 
 added cocainism to the morphine habit — appear marasmatic. 
 The skin is of a pale yellowish, almost cadaveric tint and 
 withered feel ; the extremities are cool and covered with 
 cold sweat. The eyes are deeply sunken, glistening, and 
 surrounded by a dark ring ; the pupils widely dilated. 
 Appetite is lost ; digestion disturbed. Salivation with dry- 
 ness of throat may be complained of, and further, partial 
 sensory disturbances or total analgesia. From the paralyz- 
 ing action of cocaine upon the blood-vessels, patients com- 
 
360 DISEASES OF INEBKIETY. 
 
 plain of palpitation and breathlessness, troublesome sweat- 
 ing and noises in the ears, and also syncopal attacks and 
 dyspnoea. The pulse is more frequent and easily compres- 
 sible. They suffer from a want which must be satisfied ; 
 they become nervous, trembling, and fall into a wretched 
 condition of neurasthenia. 
 
 Speech is disconnected and can scarcely be understood ; 
 impotence and incontinence of urine may appear. Sleep- 
 lessness sets in early. One of the most characteristic effects 
 of this habit is the occurrence of muscular twitching, tonic 
 and clonic convulsions, and finally epileptic attacks in 
 which the patient may die. The mental symptoms may 
 take the form of hallucinations, usually of general sensa- 
 tion, but not infrequently of sight as well. General mental 
 weakness may set in rather early, to be observed in a loss of 
 memory and unusual prolixity in conversation and corres- 
 pondence. When the drug is withdrawn, besides the vaso- 
 motor symptoms there may be seen depression, impairment 
 of will-power, weeping, etc. The chronic form does not 
 protect from acute intoxication. 
 
 The treatment of a cocaine inebriate is practically the 
 same as that of opium and alcohol cases. There is a degree 
 of brain-degeneration apparent in the morbid impulses 
 and strange, uncertain mental action of these cases that 
 approaches very near to insanity. Abrupt withdrawal of the 
 drug is the safest plan, and reliance is to be placed on 
 bromides, foods, and baths to relieve the irritation and 
 depression which follow. In the method of gradual with- 
 drawal it has been found that small doses may result in 
 collapse. In one case, in which lo grains a day had been 
 previously taken, and by gradual withdrawal the amount 
 had reached 3 grains, symptoms of heart failure and paral- 
 ysis suddenly came on. The dose was increased and the 
 patient recovered. In another case, complicated with 
 alcoholism, the daily allowance of 7 grains was reduced to 
 4, when a violent collapse set in, which was cliecked by giv- 
 
COCAINE INEBRIETY. 361 
 
 ing the usual dose. The case finally became an alcoholic, 
 but eventually recovered. The treatment of these mixed 
 cases requires great care and watching, as they are 
 especially liable to fatal collapse or to develop some form 
 of acute brain disease. 
 
 Strychnine and the mineral acids are useful. Because 
 of its rapid stimulant action strychnine, given hypodermi- 
 cally, 1-40 grain every three hours, will often prevent col- 
 lapse when the cocaine is withdrawn. Mineral acids, chiefly 
 phosphoric, may be given in i drachm doses three times a 
 day as a general tonic, unless contraindicated by an acid 
 stomach. In these cases mental conditions approaching 
 delirium are present. The functional disturbance of the heart 
 and the emotional changes that are so prominent in the 
 latest stages, and the uncertain co-ordination of both the 
 higiier and lower brain and nerve-centres, all indicate the 
 most serious disturbance. Some of the forms of iron, 
 quinine, and strychnine may be very useful at the beginning 
 of the treatment. Water containing bromide of sodium, 40 
 grains to the ounce, and charged with gas, can be given 
 freely for some time with good results. 
 
 The therapeutics must be governed by the conditions of 
 the case. AH cases should be treated in an asylum, wliere 
 the physician can have the full control of the conditions 
 and surroundings of the patient. Home treatment is dififi- 
 cultand unsatisfactory. The patient is always hypersensitive 
 to pain and suffering, and will use deception and intrigue 
 t© avoid it. The will-power is of no assistance, and the 
 success of treatment will depend on accurate study and 
 observation of the case. Drugs are of little value ; foods 
 and hygienic care, including baths, will give the best results. 
 
 In all chronic drug-maniacs the pliysician should be on 
 the lookout for cocainism. When cocainism is present a 
 sudden addiction to opium, alcohol, chloral, or chloroform 
 may arise, and in all cases the piiysician should be prepared 
 for a sudden fatal termination of the case at anv time. 
 
CHAPTER XXXV. 
 
 CHLOROFORM INEBRIETY. 
 
 The following history of a case is so graphic and full of 
 suggestions as to give the reader a good idea of sucli cases. 
 He says : "With me the chloroform infatuation was a 
 case of love at first sight. I had been always temperate, 
 almost a total abstainer from stimulants of all kinds. Once 
 or twice I had smelled chloroform, and thougiit its odor 
 pleasant. I was a young man just finishing my education, 
 and fond of study. I had had some curiosity to know what 
 it was like to be put to sleep with chloroform, and one night 
 I happened to see a one-ounce bottle of chloroform wiiich 
 was bought for the toothaciie. I took the bottle home with 
 me, and when I went to bed put a little of the chloroform 
 on a handkerchief, and for the first time felt the deligiitful 
 sensation of being wafted through an enchanted land into 
 Nirvana. Those wiio know nothing of intoxication, except 
 in the vulgar form produced by whiskey, have yet to learn 
 what power there can be in a poison to create in a moment 
 an Elysium of deligiit. It is a heaven of chaste pleasures. 
 What I most remember is the vivid pictures that would 
 seem to pass before my eyes — creations of marvelous beauty 
 — every image distinct in outline, perfect in symmetry, and 
 brilliant in coloring. The enjoyment is purely passive ; you 
 have only to watch vision after vision ; but why each vision 
 seems more wonderful and charming than the last you can- 
 not tell, and you do not stop to question. 
 
 "I suppose that it was an unfortunate circumstance for 
 me that I had never been drunk before in my life, and I 
 
 363 
 
364: DISEASES OF INEBRIETY. 
 
 never thought of comparing my blissful condition with that 
 of the wretches I had sometimes seen staggering through 
 the streets. I liad made a great discovery. I iiad found a 
 golden gate into dreamland — dangerous indeed to approach, 
 I knew that, but who would heed any danger where the 
 prize to be obtained was so great ? — and guarding jealously 
 my secret, I took care night after night to have by me the 
 key to tliat golden gate. Probably I inhaled from half a 
 drachm to a drachm or two each time. Generally I did 
 not waken again until morning, and my sleep seemed to be 
 just as refreshing as usual, only now and then I would 
 wake with a trifling headache and feel disposed to lie a 
 little longer in bed than common. My bodily condition 
 did not seem to sufier in the least, and my faculties all 
 seemed as keen as ever. I felt no craving for my pet 
 intoxicant during the day — did not give it a thought often 
 until bed-time came, and then it would occur to me for a 
 moment to try and see how it would seem to go to sleep in 
 the ordinary way, the conclusion always being that — 
 to-morrow night I would make the experiment. So, before 
 I knew it, I was a slave. I would say to myself, ' It does 
 not hurt me ; it seems to have no more effect than the cigar 
 my friend smokes after dinner. Really I believe it is a 
 positive benefit. It seems to keep my bowels regular, and 
 it certainly makes me sleep soundly all night.' 
 
 "But after a while I found that I was using a larger 
 quantity of chloroform than at first. I would take a two 
 ounce bottle half-full of the stuff to bed with me, and inhal- 
 ing directly from the bottle would forget at last to cork it, 
 and in the morning it would be empty. Sometimes I would 
 wake after midnight, or partially wake, to take another 
 dose. I found that there was a bad taste in my mouth all 
 the time, keeping me in mind of chloroform. I was often 
 nauseated in the morning, and sometimes at intervals dur- 
 ing the day. I began to feel a longing for chloroform 
 whenever I had a little headache, or was dispirited from 
 
CHLOEOFOKM INEBEIETT. 365' 
 
 any cause, and I sometimes yielded to what I already knew 
 was a morbid craving. I began to be indifferent to the 
 things that personally had interested me, avoided society, 
 and became depressed in spirits. My complexion became 
 sallow, whites of the eyes yellow, the bowels sometimes 
 windy and unnaturally loose, skin dry and seemingly 
 bloodless, and injuries of the skin did not heal rapidly. 
 In winter there was a tendency to chapping, that had not 
 before been noticed, 
 
 " Meanwhile I had ceased to have visions, or they came 
 rarely. I began to realize that my pet habit was becoming 
 my tyrannical master. I had no special cares to drown, but 
 it became my insane pleasure to draw over my senses the 
 veil of oblivion. I loved the valley of the shadow of death. 
 I knew there was danger that some night I should pass over 
 the line, into a sleep from which there would be no waking ; 
 but death had no terrors for me. Nay, to bring all my 
 faculties and powers and ambitions into tlie sweet oblivion 
 of transient death was the one pleasure for which I cared to 
 live. I was conscious of a profound moral deterioration ; I 
 became materialist ; I had no soul ; immortality was a 
 dream of the ignorant ; I, who had a thousand times anni- 
 hilated my own soul with my senses, knew that the dream 
 had no corresponding reality. 
 
 ** Yet all this time I continued faithful in my daily duties, 
 and resisted successfully the temptation to hurry through 
 my evening so as to get the sooner to my chloroform, I 
 did not admit to myself that I was a slave to the habit, or 
 even that the habit was an injury to me, as yet ; but I 
 began to be afraid, and the more when I found, when I 
 resolved (as often I did), to omit my nightly indulgence, 
 just for a week, how impotent my will was in the matter, 
 
 "This was my condition at the end of two years. I was 
 still only using a moderate quantity of chloroform, about 
 three drachms daily, exceeding that quantity only by acci- 
 dent. An opportunity offered for a change of occupation 
 
366 DISEASES OF INEBRIETY. 
 
 and surroundings, which I eagerly seized in the hope that 
 it might enable me to break my fetters. For about three 
 months, under the new surroundings, I abstained from 
 chloroform, and found it really not difficult to do so. I 
 began to think that I had greatly over-rated the power of 
 the habit. At all events, after the first week I had no crav- 
 ing for the stimulant. But one day I came across a bottle 
 of chloroform. When I saw it I smiled to myself to think 
 that I had imagined myself a slave of any such thing. 
 Night came, and when I was ready for bed the devil of 
 appetite gave me his commands, and I obeyed. Just one 
 smell to see whether I really wanted it ; I would not take 
 the bottle to bed with me. So I inhaled, standing, directly 
 from the bottle — a full pound of chloroform — and with the 
 first breath of the vapor came back, with renewed force, all 
 the old appetite, keener than ever from long abstinence. 
 Once more I saw the old-time visions, as beautiful and as 
 vivid as at first. One peculiarity of these visions I may 
 speak of right here. Objects would appear with wonderful 
 sharpness of outline just as they would be seen with the 
 eyes, only reduced to micoscopic size like objects seen 
 through an inverted microscope. 
 
 "To go on with my story. What happened after I got 
 the bottle in my hands I do not know. The next morning 
 I found the bottle corked and in its place, but only half 
 full of chloroform, and I was told that I had been lying in 
 some kind of a fit ; some thought I was drunk — as indeed I 
 was. From this time I realized myself a slave, but not 
 now a willing one. I did not again commence at once the 
 use of the chloroform, but at intervals of from three to 
 eight weeks would indulge in a regular spree, lasting from 
 one to three days, during which I would keep myself as 
 nearly as possible dead drunk, and would consume from 
 four to eight ounces of chloroform. All this time I kept 
 my habit a secret, and continued to do my ordinary work 
 
CHLOKOFOKM INEBRIETY. 367 
 
 with the usual zest in the intervals between my sprees. At 
 last discover)^ came. You well remember how I was found 
 apparently lifeless, and how by the active use of restora- 
 tives you brought me to myself. How my moral percep- 
 tions were quickened the moment I saw myself througli the 
 eyes of another ! 
 
 " You know that it was not in a week or a year that I was 
 placed morally on a firm foothold again. Indeed, you did 
 not know how often, after I had given you and myself my 
 word and pledge to abstain wholly from chloroform, I 
 relapsed, taken unawares by the tempter. For more than 
 two years I kept up the conflict, too often thinking the final 
 victory won, only to find there was one imperative command 
 it was useless for me to attempt to disobey, and that com- 
 mand came to me whenever the least whiff of chloroform 
 entered my nostrils. Once or twice I tried tlie expedient of 
 returning to my first practice of a regular moderate use of 
 the stimulant, but I found that moderation was now almost 
 impossible, if I went to sleep under the influence I would 
 awake again, and find myself then unable to sleep, distress- 
 ingly wide awake and nervous, until I courted again my 
 'dearest foe.' Symptoms like those of delirium tremens 
 several times developed. I saw ' things,' not now beautiful 
 visions, but shadowy images, that filled me with nameless, 
 irrational horror. Appetite was capricious. I was fre- 
 quently nauseated, but food seemed to relieve this condi- 
 tion ; vitality was low, the blood ran sluggishly in my veins, 
 and seemed especially to desert the surface of the body. I 
 suffered particularly in cold weather, and it was during cold 
 weather in winter, especially, that I found it almost impos- 
 s-ible to resist my besetting temptation. 
 
 "At last I prevailed by sheer force of will. I had recov- 
 ered enough faith in the soul to assert my freedom, and I 
 now look back upon those years of conflict with a kind of 
 self-pity, to think I could have been so weak. But I do not 
 to-day court temptation. I am not conscious of a lurking 
 
368 DISEASES OF INEBRIETY. 
 
 appetite, but I dare not put my virtue to any severe test. -I 
 am sure, however, that the chloroform habit is one that can 
 be broken by steady determination. I have no faith in any 
 process of tapering off. It is just as easy to quit once for 
 all as to prolong the agony, and the suffering is often purely 
 imaginary. It took many months for me to recover. If 
 doctors only knew the fascination of this drug, they would 
 seldom or never prescribe it. The danger of the wine cup 
 is nothing to that of the chloroform bottle." 
 
CHAPTER XXXVI. 
 
 COFFEE AND TEA INEBRIETY AND THEIR EFFECTS. 
 
 Most physicians are doubtless able to recall numerous 
 instances in which coffee has induced more or less serious 
 symptoms. It seems that personal idiosyncrasies often 
 determine the extent of the evil. The evils upon the eyes 
 and ears of people are more frequent from coffee than from 
 tobacco or alcohol. It does not absolutely destroy vision or 
 hearing, but it induces functional troubles very annoying to 
 their possessors. That coffee is the efficient agent appears 
 from the fact that upon the entire discontinuance of the use 
 of coffee, the symptoms complained of disappear. 
 
 Dr. Guelliot has published twenty-three cases of chronic 
 caffeism. Of these cases seventeen were women. 
 
 The following are the principal symptoms : 
 
 Anorexia, disturbance of sleep, trembling of the lips and 
 tongue, attacks of gastralgia, different kinds of neuralgia, 
 dyspepsia, and leucorrhoea, often profuse. In the twenty- 
 three cases, he found in eighteen, anorexia ; in sixteen, 
 disturbance of sleep ; in sixteen, trembling of the lips and 
 tongue ; in twelve, leucorrhoea ; in eleven, gastralgia ; in 
 ten, dyspepsia ; in ten, neuralgia of various forms ; in eight, 
 cephalalgia ; in four, vertigo and convulsive attacks ; in 
 four, obstinate constipation ; and in three, constipation and 
 diarrhoea alternating. 
 
 The patients had pinched, pale, wrinkled faces, a weak, 
 rapid pulse, and the sleep was disturbed by anxious dreams. 
 The following is the account of a typical case : A woman 
 
 369 
 
370 DISEASES OF INEBRIETY. 
 
 in middle life kept her pocket full of coffee, which she ate 
 constantly. Her skin was of an earthy tint, constipation 
 was obstinate, sleep very irregular, and her mind restless, 
 anxious, and full of forebodings. She wasmucli emaciated, 
 and both the nervous system and digestion suffered severely 
 at times. The lips and tongue were tremulous, dry, red, 
 and cracked. The appetite was very irregular, and vertigo, 
 prolonged headache, and epigastric pain were present most 
 of the time. She was placed under treatment and became 
 delirious. Beef-tea, milk, baths, and a mild galvanic current 
 were used for several weeks, and these were followed by 
 bark tonics. She was discharged restored six months 
 later. 
 
 The evil effects of coffee are especially observable in 
 children. Tlie coffee drunkard is described as thin, pinched 
 features, pale, wrinkled face, and a grayish yellow complex- 
 ion. The pulse is weak, frequent, and compressible. The 
 sleep is troubled with anxious dreams. 
 
 Although coffee does on the whole far more good than 
 evil, it is important to bear in mind the evils that it is able 
 to produce under favoring circumstances. In a general way 
 it may be said that indoor brain workers do not bear coffee 
 as well as outdoor muscle workers. Persons of nervous 
 temperament bear coffee badly. 
 
 The effects of coffee when pushed to an excess may be 
 to some extent confused by the alcohol and tobacco which 
 often accompany it, but they can be studied more accurately 
 in women, especially in those who do not drink coffee, but 
 eat it. 
 
 As a rule both nervous system and digestion suffer in 
 these cases. The appetite fails, there are attacks of sliarp 
 epigastric pain, much vertigo, and prolonged headache. 
 There is less insomnia than might be supposed by those 
 who know the weakening power of a single cup, but much 
 dreaming and restlessness of a non-aphrodisiae type. The 
 pulse is weak and quick, there is often an anaemic mur- 
 
COFFEE AND TEA INEBRIETY. 371 
 
 mur. The muscles waste quickly. The coffee inebriate 
 is always thin. He may be a mere skeleton ; his eyes 
 are bright and quick in movement, their pupils large ; and 
 may be mistaken for a tea-drinker. In the insomnia wliich 
 follows, when the coffee is removed, the only remedy is the 
 old poison. 
 
 As with tea-drinking, coffee addiction is followed by the 
 employment of spirits and other drugs. Many inebriates 
 and opium-takers have a history of excessive use of coffee 
 before the other drugs were taken. The recognition of 
 addiction to coffee is important in many cases of neurotics, 
 especially in children and young persons, and unless 
 promptly checked will be followed by serious results. The 
 excessive use of coffee in all cases is a very significant hint 
 of nerve-exhaustion and disorder of the motor nerves. 
 
 In the late war many cases of delirium from coffee were 
 noted where the food-supply was scant and coffee was 
 abundant. Some of these cases came under special treat- 
 ment, and yielded readily to baths, mineral waters, and 
 strong foods. When coffee seems first to have been used 
 for insomnia, the treatment must depend on a careful study 
 of tlie etiology, and from the removal of the causes the cure 
 may be expected. I have also noted a number of cases in 
 young children of inebriate and neurotic parents who 
 developed a morbid impulse for coffee. Such cases require 
 active treatment, and milk, mineral waters, and baths are 
 prominent remedies. Neurotic disturbances and diseases 
 from coffee are but little known. 
 
 Dr. Mendel, of Berlin, has lately published a clinical 
 study of this neurosis, which is growing rapidly in this 
 country. His observations were confined to the women of 
 the w(;rking population in and about Essen. He found 
 large numbers of women consumed over a pound a week, 
 and some men drank considerable more, besides beer and 
 wine. The leading symptoms were profound depression of 
 spirits, and frequent headaches, with insomnia. A strong 
 
372 DISEASES OF INEBRIETY. 
 
 dose of coffee would relieve this, for a time, then it would 
 return. The muscles would become weak and trembling, 
 and the hands would tremble when at rest. An increasing 
 aversion to labor and any steady work was noticeable. The 
 heart's action was rapid, irregular, and palpitations and a 
 heavy feeling in the precordical region were present. Dys- 
 pepsia of an extreme nervous type was also present. Acute 
 rosacea was common in these cases. These symptoms con- 
 stantly grow worse, and are only relieved by the large quan- 
 tities of coffee, generally of the infusion. In some cases 
 the tincture was used. The victims suffer so seriously that 
 they dare not abandon it for fear of death. 
 
 Where brandy is taken only temporary relief follows. 
 The face becomes sallow, and the hands and feet cold, and 
 an expression of dread and agony settles over the counten- 
 ance, only relieved by using strong doses of coffee. In all 
 these cases, acute inflammations are likely to appear any 
 time. An injury of any part of the body is the starting 
 point for inflammations of an erysipelatous character. 
 Melancholy and hysteria are present in all cases. In this 
 country the coffee-drinker after a time turns to alcohol and 
 becomes a constant drinker. In otlier cases opium is taken 
 as a substitute. Coffee inebriates are more common among 
 the neurasthenics, and are more concealed, because the 
 effects of excessive doses of coffee are obscure and largely 
 unknown. Man}'^ opium and alcoholic cases have an early 
 history of excessive use of coffee, and are always more 
 degenerate and difficult to treat. A very wide field for 
 future study opens up in this direction. 
 
 Dr. Slayter describes a case of delirium in a girl who 
 chewed large quantities of tea. It appeared that masses of 
 tea leaves had lodged in the bowels, and the delirium was 
 in some measure dependent on the irritation and reflex 
 actiofi which followed. Trembling delirium, and delusions 
 of injury from others, gave it a strong resemblance to 
 delirium tremens. The amount of tea chewed daily was 
 
TEA AND COFFEE INEBRIETY. 
 
 378 
 
 over one pound. The patient recovered by the use of free 
 cathartics and the witlidrawal of the tea. In 1881 I saw a 
 boy wlio had delirium and trembling that had existed at 
 intervals for two months. The fact that his father had died 
 an inebriate seemed to be a sufficient reason for his symp- 
 toms in the minds of his friends. It was ascertained that 
 he had for years drank large quantities of tea. Having 
 been employed in a tea-store, he had chewed it freely. He 
 was literally a tea inebriate. He had inherited an inebriate 
 diathesis, and the early and excessive use of tea was a 
 symptom of it. He had all the symptoms of one who was 
 using alcohol to excess. He recovered, and a year later 
 used coffee to great excess, until he became unfit for work ; 
 then was under medical care for a time, recovered, and 
 finally became an opium-taker. 
 
 Another case came under my observation in the person 
 of a little girl, twelve years old, the daughter of a patient 
 under my care for inebriety. She had gradually and stead- 
 ily become excessively nervous. Could not sleep, had mus- 
 cular twitchings and delusions of fear ; would burst into 
 tears, and complain that she was going to be turned out 
 into the streets. She heard voices at night, and could not 
 keep still. She also imagined that her fatlier was being 
 burned. It was finally found that she was a tea inebriate, 
 and botli drank and chewed it at all times and without any 
 restraint. A physician consulted me about a singular stage 
 of trembling and mild delusions which had appeared in a 
 family of three old maids living alone in the country. It 
 was found to come from excessive use of tea, and to be tea 
 inebriety. When this was stopped they recovered. My 
 observation leads me to think that these cases are not un- 
 common among the neurotics. They are of such a mild 
 character at first as to escape special observiition, and 
 hence are supposed to be due to other causes. Such cases, 
 after beginning on tea, take other drugs, and become aico- 
 
374: 
 
 DISEASES OF INEBRIETY. 
 
 hol, opium, or chloral takers, or develop some form of neu- 
 rosis, which covers the real and first causes. 
 
 Theine is the active principle of the leaves of Cliinese 
 tea, and is generally reputed to be identical with caffeine, 
 both in chemical composition and in physiological action. 
 My experiments show that it differs very markedly in physi- 
 ological action from that of caffeine. Caffeine principally 
 affects the motor nerves, while theine chiefly influences the 
 sensory nftrves, and clinically proves itself a most valuable 
 analgesic, surpassing morphia in promptness and permanency 
 in relieving pain in some affections, without producing any, 
 or at least very little, disturbance of the general nervous 
 system. It paralyzes sensation before motion ; it impairs 
 sensibility from the centre to the periphery and not, like 
 brucineand cocaine, from the periphery to the centre ; it 
 produces convulsions which are spinal and not cerebral ; it 
 has a more powerful action on the sensory nerves, and less 
 on the motor nerves than caffeine. 
 
 From the results of theine in these cases it will be 
 seen that it is a powerful anodyne without producing any 
 intoxication of the higher nerve centres, which is so common 
 with morphia and all other agents belonging to this class. 
 Its influence is both quick and persistent, and it manifests 
 an almost exclusive affinity for the sensory nerves. It 
 relieves pain by acting from the centre toward the periphery 
 and showing its effects but very seldom above the seat of 
 injection. In i-io, 1-5, and even lA, grain doses it is entirely 
 free from dangerous consequences — the only inconvenience 
 which it causes is a slight, but transient burning at the 
 point of introduction. I use a one percent, watery solution 
 of Merck's preparation — ten minims of which equal one- 
 fifth of a grain of theine. Larger doses are required in 
 some individuals in order to bring out its characteristic 
 action. 
 
TEA AND COFFEE INEBEIETT. 375 
 
 EFFECTS OF TEA DRINKING ON THE NUTRITION OF THE 
 
 EYEBALLS. 
 
 Dr. Wolfe has described the first effect as one of soften- 
 ing of the vitreous humor, which became filled with floating 
 particles of pigment. It had come under his notice in per- 
 sons who at first sight seemed to have very little in common. 
 He had found it among — i. The mining population, who 
 pass a deal of time underground. 2. Washerwomen. 3, 
 Middle-aged laborers, masons, and out-door workers. 4. 
 Siiop and factory girls. 5. Not a few belonging to the 
 upper classes. His attention was specially directed to the 
 affection by its frequent occurrence among Australians who 
 came to consult him. He could discover no assignable 
 cause for the disease, either in the tissues themselves or in 
 the history of the patient ; and it was only on directing his 
 inquiries to their diet, and finding that ikey all agreed in 
 consuming large quantities of tea, that he came to suspect 
 its agency. A comparison of the numerous cases of opacity 
 of the vitreous humor occurring among tea-drinking popula- 
 tions, with its less frequency in France, Germany, and 
 America, and its rarity among the Turks, tended to confirm 
 his suspicions. Physiology did not suggest an explanation, 
 but chemistry pointed to theine and tannic acid as most 
 likely to cause disease. Theine might be left out of con- 
 sideration, being identical with caffeine, which was innocu- 
 ous ; so there only remained tannic acid. This precipitated 
 albuminoids from their solutions ; hence it probably acted 
 injuriously by precipitating some of the most important 
 constituents of the food, and also by affecting the mucous 
 membrane of the stomach and alimentary canal, and thus 
 preventing digestion and assimilation. 
 
 Some observations had been made as to the effects of 
 tea-drinking on the healing of wounds and ulcers, by a 
 Glasgow surgeon, wlio had noticed that, in persons addicted 
 
376 DISEASES OF INEBRIETY. 
 
 to this habit, they took on a sort of scorbutic character. 
 Pliysicians also ascribed numerous cases of rebellious dys- 
 pepsia to the use of tea. The disease of the vitreous humor 
 above alluded to, could hardly be an isolated pathological 
 fact, but must be associated with deleterious changes in 
 other parts of the economy, and probably only made its 
 appearance in organs which had a predisposition to be so 
 affected. Without venturing upon any theory as to the 
 action of tea on the vitreous humor, he would point out 
 that the first expression of acute irritation of the fifth nerve 
 in sympathetic ophthalmia was opacity of the vitreous 
 humor and detachment of pigment from the whole uvular 
 tract. So it was possible that chronic irritation of the same 
 nerve might give rise to such changes in the nutrition of 
 the eyeball as to brings about the condition under con- 
 sideration. He commended this subject to the notice of 
 general practitioners, who had better opportunities of judg- 
 ing of it than he had. 
 
CHAPTER XXXVII. 
 
 ON PSYCHOSIS CAUSED BY NICOTINE.- 
 
 Nicotine is the most important chemical substance con- 
 tained in tlie West Indian plant, nicotiana tabaciim ; when 
 pure, it is a colorless, easily soluble fluid, of strong tobacco 
 odor and very acrid, burning taste, is easily dissolved in 
 water, alcohol, and ether, its reaction being strongly alka- 
 line, and it forms simple crystallizing salts. It is said that 
 Virginia tobacco contains the largest quantity of nicotine. 
 Nicotine acts on the human organism as one of the most 
 powerful poisons ; the action of tobacco differs only in 
 degree. 
 
 From experiments instituted in Professor Schroff's 
 laboratory it results that the effects of nicotine on the 
 healthy organism are as follows : Taken in doses of i to 3 
 milligrams, the alkaloid produced first an acrid burning 
 sensation on tlie tongue and in the throat, with increased 
 salivation, and a sensation of heat in the stomach, in the 
 extremities, and in the whole body. Soon after this the 
 phenomena are headache, vertigo, drowsiness, impaired 
 vision and audition, accelerated and oppressed respira- 
 tion. They were succeeded within half or three-quarters 
 of an hour after ingestion of the poison by an extraordinary 
 feeling of relaxation and weakness, the face became pallid 
 artd the whole body as cold as ice ; fainting fits and vomit- 
 ing made their appearance. The symptoms increased to 
 tumultuous and chronic spasms of the respiratory muscles. 
 After three hours the symptoms commenced decreasing, but 
 secondary effects continued for several days. 
 
 377 
 
378 DISEASES OP INEBKIETY. 
 
 Subsequent experiments demonstrated tliat tlie first 
 action of the poison is excitation, the ulterior action is 
 depression and paralyzation. In the beginning the func- 
 tions of the brain and of tlie spinal cord are enhanced, but 
 this excitation is followed by relaxation and debility. The 
 whole voluntary muscular system is subjected to tiiis influ- 
 ence, which gradually extends to the heart, and finally to the 
 vasomotor system. Such are tlie effects of this redoubt- 
 able poison on the healthy organism, when taken in small 
 doses of I to 3 milligrams. Wiiat may be the effects of the 
 1,200,000 kilograms of the same alkaloid, constituting the 
 present amount produced on the whole surface of the globe.? 
 It is impossible to ascertain in an exact manner the num- 
 ber of men using tobacco, but it is asserted tliat approxi- 
 mately they number 800,000,000. Each of them consumes 
 on an average 1% grams nicotine ever}' year, or 4 milligrams 
 every day, some of them less, others considerably more. 
 The fact that large doses of this amount are supported by 
 man proves once more the adaptability of the human nerv- 
 ous system to injurious habits. 
 
 The first contact with the tobacco poison is always felt 
 by the cerebral nervous system as painful and hostile, and 
 its repetition requires a certain violence against nature. By 
 not heeding this warning of the attacked nervous cell, and 
 by repeating the essays with tlie necessary perseverance, 
 the repulsive sensation gradually vanishes and the excita- 
 tion remains as a stimulus, which soon becomes indispen- 
 sable. At last the irritation and debilitation of the cerebral 
 nervous system reaches a degree in which privation is deemed 
 a real suffering, and the same longing for renewed enjoy- 
 ment of the poison manifests itself as is noted in alcoholists 
 and morphinists. 
 
 The action of nicotine differs considerably, not only ac- 
 cording to the different classes of tobacco, but also accord- 
 ing to its different applications. Smoking only allows the 
 products of decomposition connected with it to exercise an 
 
ON PSYCHOSIS CA.USED BY NICOTINE. 379 
 
 influence, although several cases are known, not only of nerv- 
 ous erethism, but even of perfect psycliosis, caused by 
 excessive tobacco smoking. Kjellberg had several oppor- 
 tunities of convincing himself that even a too abundant use 
 of tobacco for snuflfing may originate psychic phenomena. 
 
 But the greatest danger lies in the use of tobacco for 
 chewing. The ordinary sliape for this application is to- 
 bacco in rolls. It is true that small doses of it may be taken 
 without causing psychic injuries. But as soon as the daily 
 use exceeds lo to 12 grams of genuine and good tobacco, 
 the field of pathologic phenomena is approached, and the 
 sensation becomes an abnormal one. This transition is 
 effected more rapidly in case pulverized snuff is used for 
 chewing. In the last decades the use of snuff for cliewing 
 has considerably increased in various northern countries, 
 especially among mariners, manufacturing laborers, etc. 
 
 From a number of cases observed by him, and in which 
 a continued daily use of from 20-27 grams of tobacco in 
 rolls, or in snuff, had been ascertained, Kjellberg has 
 reached the conclusion that the similarity of symptoms 
 points to a specific psychosis caused by the use of tobacco, 
 ^^ nicotinosis mentalis," a real primary mental disease with its 
 own peculiar symptoms, wliich are clinically distinguish- 
 able, and which give it a place among mental intoxications. 
 "■ Nicotinosis mentalis" is described by Kjellberg as follows : 
 
 Among general symptoms a painful sensation of weak- 
 ness and impotence is to be noted, accompanied very soon 
 by hallucinations, maniacal ideas and suicidal inclination. 
 Tlie disease has a prodromic stage and three distinct stages 
 differing from each other. 
 
 Prodromic stage — The patient has felt unwell for some 
 lime, his general disposition changes, he shows an unusual 
 uneasiness whicli may pass to a transient state of anguish. 
 He sleeps little, and the ordinary occupations are repugnant 
 to him. He is disposed to indulge in somber reflections, is 
 tormented by palpitations of the heart and unusual anxiety. 
 
380 DISEASES OF INEBRIETY. 
 
 This condition continues for one and one-half and three 
 months, when psychosis sets in. 
 
 First stage. — The patient's attention is seized by lively 
 hallucinations, and he is entirely occupied witli these new 
 and surprising perceptions. He hears voices, visions 
 appear to him, he lias a sensation as though something dif- 
 ferent from himself was inside his body, and strange notions 
 take hold of his conscience, from which he can't free him- 
 self. False, fixed ideas often combine suicidal tendencies ; 
 his mood is always gloomy ; the patient feels tired and 
 exhausted, inclined to loneliness and rest ; at times he has 
 short fits of fright. Otherwise he is quiet and obedient, 
 talks little, and never without being previously requested to 
 do so, but then what he says is logical and shows good per- 
 ception. He complains of painful sensation in the heart, of 
 wearisome insomnia and of voices that give him no peace. 
 Nutrition is not impoverished, for the patient usually eats 
 plenty, although he often speaks of bad appetite and spoiled 
 food. After six or seven months the disease enters anew 
 stage. 
 
 Second stage. — The mental disposition improves, and we 
 find the patient talks hilariously of his perceptions. He 
 relates the visit of angels, he has seen heaven, but also hell 
 and the evil spirits. He sings and talks to himself without 
 interruption in a low voice ; motions become more vigorous, 
 and he moves about with a certain agitation. The halluci- 
 nations of brain and vision are on the increase, and the 
 patient is constrained to execute involuntary motions. This 
 condition is periodic, the periods usually lasting from two 
 to four weeks with intervals of indefinite length. In such 
 times the patient lays down prostrated and lazy, his mood is 
 gloomy and discontented, his attention diminished, his per- 
 ception very slow, his language distinct and logical, but 
 hesitating. This stage may continue for a long time, but 
 unless convalescence sets in, it passes gradually into a last 
 stage. 
 
ON PSYCHOSIS CAUSED BT NICOTINE. 381 
 
 Third stage. — The intervals pass each other and periods 
 of raised disposition disappear by degrees ; the mental dis- 
 position remains quiet, perception is very limited. Hallu- 
 cinations continue, and the patient gradually sinks into a 
 state of general psvcliic debilit}^ while his physical condi- 
 tion improves, and lie may even be partially serviceable 
 for ordinary occupations. 
 
 With regard to prognosis, it is not entirely bad during the 
 first and second stages. But in the third stage recovery is not 
 to be expected any more. Therapeutic treatment requires, 
 first of all, absolute deprivation of tobacco, with the under- 
 standing that it should be enforced by degrees, the patient 
 being otherwise subjected to very painful sensations and 
 much suffering. With this, substantial diet, motion in the 
 open air, and use of mineral waters are to be recom- 
 mended. 
 
CHAPTER XXXViri. 
 
 EAU DE COLOGNE DRINKING AND ARSENIC TAKING. 
 
 The use of cologne as a substitute for spirits is very 
 common among inebriates ; generally when no other form 
 of spirits can be procured. Recently attention has been 
 turned to the rapidly increased consumption of cologne, 
 both in large cities of Europe and this countr}^ and the 
 conclusion reached by several authorities is that cologne is 
 becoming a drink in many circles in preference to other 
 forms of spirits. To many persons this odoriferous com- 
 pound is very attractive, and especially when the cologne is 
 made with methylated spirits its spirit strength is equal 
 and exceeds many of the stronger alcoholic drinks in 
 market. 
 
 The factories for its manufacture in Cologne use the 
 following general recipe : Twelve drops of the essential oils 
 neroli, citron, bergamot, orange and rosemary ; one drachm 
 of malabar cardamons to one gallon of rectified spirits. In 
 this country cheap wood spirits are used, which gives 
 greater alcohol strength at half the expense. 
 
 In England many women and men in the better walks 
 of life begin by taking a few drops of this perfume on sugar 
 in the morning for some debility. This increases until they 
 come to depend upon it the same as any other spirit com- 
 pound. It can always be purchased with ease and without 
 exciting suspicion, and can be used with great secrecy. 
 American cologne is most often made from wood spirits, 
 and is a very fiery, nauseous mixture, which cannot be taken 
 in water, but used on loaf sugar or lozenges is endurable. 
 
 383 
 
384 DISRASKS OF INEBRIETY. 
 
 In one instance a wine glass of cologne was taken tliree or 
 four times a day for a long time ; tiie patient finally died 
 from delirium tremens. It appears tiiat the effects of tiiis 
 drink vary but little from ordinary strong spirits, except, 
 perhaps, tliere maybe more profound nutrient disturbances, 
 insomnia, and tendency to delirium. If the cologne is made 
 from wood spirits, the brain and nerve degeneration is both 
 intense and profound, and delirium is very sure to follow. 
 
 It has been asserted that melancholia and insomnia in a 
 case suspected of using spirits in secret is an indication of 
 the use of cologne. Usually the cologne-drinker will have 
 a strong odor of this perfume about his body and breath 
 which cannot be mistaken. Such cases usually use this per- 
 fume externally in excess to divert suspicion from its 
 internal use. Undoubtedly there are, in this country, an 
 increasing number of cases where cologne is used secretly 
 and exclusively. These cases, no doubt, become morphia, 
 chloral, and cocaine inebriates after a time, and in some 
 instances from a physician's prescription which contains 
 these drugs, that are often fascinating substitutes. The 
 alcohol and opium inebriates turn readily to cologne, and 
 use it freely and with great satisfaction. 
 
 The American inebriate, if a man, is not likely to use 
 this perfume very long as a drink, but if a woman, it may 
 be taken for years in secret. Obscure and complex 
 nervous disorders in a woman that uses cologne externally 
 should always suggest the possibility of its internal use. 
 Inebriates who use it externally and recover rapidly, or 
 make sudden changes of habits and living may be sus- 
 pected of substituting it for other spirits. Cologne, both 
 German and American brands, contains a large and vari- 
 able per cent, of alcohol, and are always dangerous for use 
 among neurotics, even externally. Its internal use is very 
 likely to follow if the person has a great liking for this per- 
 fume. In hospitals for the treatment of alcohol and opium 
 cases cologne is found to be as dangerous as alcohol and is 
 
ARSENIC INEBRIATES. 385 
 
 Hot allowed. In private practice among neurotics the pos- 
 sibility of this danger should always be considered. It is 
 asserted tiiat the sale of cologne has increased enormously 
 in certain sections of this country. Statistics on this point 
 would be very interesting. We trust the coming census 
 will throw some light on this, and the extent of the use of 
 bitters in this country. 
 
 ARSENIC INEBRIATES. 
 
 In the highlands of Styria the prevalence of inebriety is 
 limited, if not directly counteracted, by the strange habit 
 of arsenic eating. Beginning with a minimum quantity, 
 the devotees of the baneful drug gradually accustom their 
 organism to a dose that would prove promptly fatal to any 
 non-habitue, and persist in excusing their practice by all 
 sorts of sophisms. Arsenic counteracts the raw air of the 
 bleak uplands, it enables travelers to resist the fatigues of 
 mountain-climbing, it stimulates digestion, etc., etc. 
 
 " South of this city " (Gratz), writes an Austrian physi- 
 cian, " arsenic eaters are found in nearly every village; 
 there are families where the drug is used by every male 
 adult, and often by white-haired patriarchs of seventy or 
 eighty years, for it must be conceded that the habit is not 
 incompatible with longevity. As a rule, I have been able to 
 recognize a poison-eater by a certain moody appearance, 
 contrasting strangely with the jovial disposition of the high- 
 landers in general. A sallow, though clear and wax-like, 
 complexion, is another characteristic symptom, and, in large 
 doses, the use of the drug often involves serious digestive 
 dii^rders. 
 
 "It must be admitted, however, that arsenic never pro- 
 duces anytliing like intoxication in the uglier sense of the 
 word. The poison-eat^' directly after a large dose, feels 
 elated ; his habitual moodiness gives way to a more 
 buoyant disposition, but he does not become quarrelsome 
 
386 DISEASES OF INEBRIETY. 
 
 or maudlin-sentimental ; he can keep his temper in a lively 
 controversy and the clearness of his intellect is not visibly 
 affected. Nor are his financial circumstances apt to be 
 imperiled by the habit. At retail rates, half a florin 
 (twenty-five cents) worth of wliite arsenic will keep a whole 
 family in stimulants for a couple of months. Very few 
 inveterate poison-eaters can use up a florin's worth in tlie 
 course of a year, while brandy drinkers often waste the 
 wages of a week's hard work in the mad revels of a single 
 night. And while one such night incapacitates or indis- 
 poses the toper for work during the next forty-eight hours, 
 an arsenic eater, under tlie full influence of his tonic, and 
 for hours after, can follow his usual occupation as if noth- 
 ing had happened." 
 
 INEBBIETY FROM GINGER DRINKING. 
 
 The increasing demand for ginger extracts and drinks is 
 a very significant hint of a new phase of the morbid drink 
 impulses of the age. Several large proprietary establish- 
 ments are devoted exclusively to the preparation of ginger 
 extracts, essences, and drinks, which are extensively adver- 
 tised as medicines and preventive drinks for the diseases of 
 the different seasons. It is a well-known fact that all these 
 preparations are made with the poorest, cheapest spirits, 
 and contain from thirty up to eighty per cent, of alcohol. 
 In some instance wood spirits are used on account of the 
 clieapness, and the intoxicating qualities of this mixture are 
 far worse than any alcoholic drinks of commerce. The 
 demand for these ginger drinks is due to the alcohol they 
 contain, the ginger in itself having but little influence on 
 tlie body, altliough some entliusiastic writers assert that 
 ginger taken in large quantities produces a distinct form of 
 inebriety, marked b}' stupor and melancholy. 
 
 In two cases which have been reported where extract of 
 ginger was taken in large quantities, profound nutrient 
 
GINGER INEBEIETT. 387 
 
 disturbances, and inanition were present. The intoxication 
 was less maniacal, and attended with profound depression. 
 This would undoubtedly depend on the alcohol more than 
 the ginger. From inquiries it appears that there are a large 
 number of persons who buy extract of ginger regularly, 
 apparently using it as a common drink. The probability is 
 that after a few months or years they abandon this drink 
 for some stronger alcoholic drinks, or narcotics. 
 
 A New York druggist writes : "That the sale of ginger 
 extracts to women are rapidly increasing ; that he has over 
 a dozen regular customers, who buy from two quarts to one 
 gallon of ginger a week." 
 
 The sale of ginger in Maine was so great, that it was 
 declared by the courts to be an intoxicant, and placed among 
 the alcoholic drinks prohibited. 
 
 From a variety of evidence there can be no doubt that 
 ginger drinking in this country has reached a dangerous 
 magnitude, and those who use it any length of time are 
 almost certain to become alcoholic or opium inebriates. 
 
 The extracts of ginger on the market are without excep- 
 tion dangerous, because of the dangerous alcohols they con- 
 tain. Neuraesthenics and neurotics should avoid them as 
 poison, and inebriates of every form will always find them 
 treacherous remedies for every condition. For all the vari- 
 ous functional disturbances they are supposed to relieve, 
 pure alcohol is far safer, and less injurious. 
 
 The following item is of interest : 
 
 An officer of a church accused the pastor of being a 
 ginger inebriate. A trial followed and Dr. Day was called 
 as an expert. The peculiar conduct of the clergyman, with 
 the great number of extra ginger bottles found in his pri- 
 vate study, with other evidence, pointed to the conclusion 
 that he was a secret ginger inebriate. Dr. Day said that for 
 a long time he was convinced that the use of alcohol, plain 
 and simple, was being superceded by a preference for new- 
 fangled nerve tonics that possessed substantially the essen- 
 
388 DISEASES OF INEBRIETY. 
 
 tial properties of alcohol, without the disagreeable repu- 
 tation, and to discover what peculiar forms this new 
 manifestation was taking. 
 
 For thirty-one years he had been treating nearly one 
 hundred cases yearly that displayed all the symptoms of 
 alcoholic delirium when the cause of disease was not, 
 strictly speaking, alcoholic indulgence. 
 
 Besides chloral and cocaine inebriates, of which we 
 always have more or less, I had a man who used to get 
 furiously drunk on quinine. He'd stagger about and yell 
 like a regular whiskey drunk, and he'd go tiirough all the 
 successive stages of a common intoxication. He'd get jovial 
 and pleasant first, and then cross and savage, and finally 
 maudlin. He was a very interesting case. I have seen 
 some cases suffering from the effects of the use of patent 
 medicines ; for instance. Many of these nerve-tonics and 
 so-called patent foods are cultivators of an intemperate 
 habit that results in mental and physical manifestations 
 very similar to the indications of excessive alcoholic indul- 
 gence. A well-known proprietary food was nothing better 
 than an alcoholic stimulant. 
 
 In regard to Jamaica ginger: " It takes tlie strongest 
 kind of alcoliol to preserve Jamaica ginger, and the tinc- 
 ture of this substance is extremely inebriating when used 
 even in small quantities. I knew a patient who used to 
 get drunk on a spoonful or two of this stuff, and there isn't 
 any doubt that a great many people use it as an intoxicant. 
 Anything almost acting as a stimulant to the nerves may he" 
 used as an intoxicating agent. I knew a man who gol 
 quite drunk on a strong cigar, and I've had several case? 
 of physical derangement of pronounced alcoholic appear, 
 ance from excessive smoking. Tobacco and alcohol seem 
 to have a very close identity. Many a drunkard will rest 
 comparatively content when deprived of his liquor, if a 
 good supply of tobacco is fuinished him, and many an 
 inveterate tobacco user falls into drink when he is deprived 
 
GINGEK INEBKIETY. 389 
 
 of the favorite weed. I knew a confirmed tea-drinker who 
 was badly sliattered from tlie excessive indulgence in what 
 the poet calls " the cup that cheers, but not inebriates," and 
 there are instances of mild intoxication resulting from too 
 much tea-drinking. 
 
 " The tendency of these days seems to be toward new 
 forms of inebriety, and the effect of alcoholic indulgence 
 now is much more injurious, because the practice of adul- 
 teration has become so extensive. Then the odium which 
 attaches to the use of alcohol has led many people in high 
 places to cultivate a habit of secret tippling, and such 
 people frequently devise an original method of securing the 
 effect of inebriety without subjecting themselves to the 
 charge of using alcohol. Consequently the use of out- 
 landish and sometimes deadly drugs is clearly on the in- 
 crease." 
 
APPENDIX. 
 
 DRUNKENNESS AS A DEFENSE. 
 
 BY CLARK BELL, ESQ. 
 
 The law as now settled in England and the American 
 States ma}"^ be stated as follows : 
 
 While drunkenness is not per se a defense upon a charge 
 of crime, yet mental unsoundness, superinduced by exces- 
 sive intoxication and continuing after it has subsided, may 
 excuse ; or where the mind is destroyed by a long-continued 
 habit of drunkenness ; or where the long-continued drunk- 
 enness has caused an habitual madness, which existed when 
 the offense was committed, the victim would not be respon- 
 sible. For if the reason be perverted or destroyed by a 
 fixed disease, although brought on by his own vices, the law 
 holds him not accountable : Rex v. Meakin, 7 Car. & P., 
 297 ; Reume's Case, i Lewin, 76 ; Reniger v. Fogassa, 
 Plow., I ; I Russ. on Crimes (9th ed.), 12 ; i Bishop Cr. L. 
 (6tii ed.), 406 ; i Wharton Cr. L. (8th ed.) sec. 48 ; McDon- 
 ald C. L. of Scott., 16 ; I Hale, 4 ; Black. Com., 26 ; Beasley 
 V. State, 50 Ala., 149 ; Peo. v. Odill, i Dak. Ter., 197 ; Estes 
 V. State, 55 Ga., 30 ; Baily v. State, 26 Ind., 422 ; Roberts 
 V. People, 10 Mich., 401 ; s. c, 19 Mete, 402 ; State v. 
 Hundley, 46 Mo., 414 ; State v. Thompson, 12 Nev., 140 ; 
 
 391 
 
392 APPENDIX. 
 
 Lanergan v. People, 50 Barb. (N. Y.), 266 ; Maconnehey 7>. 
 State, 5 Ohio, 77 ; Com. v. Green, Ashm. (Pa.), 289 : U. S. 
 V. Forbes, Crabbe (D. C), 558 ; Stuart v. State, 57 Tenn., 
 178 ; Carter v. State, 12 Texas, 500 ; Bell's Med. Jurisp. of 
 Inebriet}^ p. 10, and cases there cited). 
 
 The rule of law is well settled that evidence of intoxica- 
 tion is always admissible to explain the conduct and intent 
 of the accused in cases of homicide, although the rule does 
 not apply in lesser crimes, where tlie intent is not a neces- 
 sary element to constitute a degree or phase of the crime. 
 Bell's Med. Jur. of Inebriety, p. 10, and cases there cited. 
 
 In cases where the law recognizes different degrees of a 
 given crime, and provides that willful and deliberate inten- 
 tion, malice, and premeditation must be actually proved to 
 convict in the first degree, it is a proper subject of inquiry 
 wiiether the accused was in a condition of mind to be 
 capable of premeditation : Gray. J., in Hopt v. People, 104 
 U. S., 631 ; Buswell on Insanity, § 450 ; Penn v. McFall, 
 Addison, 255 ; Keenan v. Commonwealth, 44 Pa. St., 55 ; 
 Jones V. Com., 75 Pa. St., 403 ; State v. Johnson, 40 Conn., 
 136 ; Pirttle zk The State, 9 Humph., 663 ; Haile v. State, 11 
 Humphrey, 154 ; Smith v. Duval (Ky.), 224 ; Bosswell v. 
 Com., 20 Gratt., 860 ; Willis v. Com., 32 Gratt., 929 ; People 
 ZK Belencia, 21 Cal, 544; People v. King, 27 Cal., 507; 
 People V. Lewis, ;^6 Cal., 531 ; People v. Williams, 43 Cal., 
 344 ; Farrell e;. State, 43 Texas, 508 ; Colbath v. State, 2 
 Tex. App. 391 ; State v. White, 14 Kan., 538 ; Schlacken v. 
 State, 9 Neb., 241 ; 104 U. S. 
 
 The reason of this rule of law rests upon the fact that 
 intoxication is a circumstance to be weighed in connection 
 with the other circumstances surrounding the commission 
 of the act in determining whether it was inspired by deliber- 
 ate and malicious intent, and whether immediately before 
 and at the time of his act the intoxication of the accused 
 was so great as to render him incapable of forming a design 
 or intent, which the jury must find from the facts in the 
 
APPENDIX. 393 
 
 case, without regard to the opinions of others: Buswell on 
 Insanity, § 452 ; Marshall's Case, i Lew. Cr. Cas., 76 • 
 Thacher, J., in Kelly v. State, 3 S. & M., 518 ; Armor v. 
 State, 63 Ala., 173 ; People v. Belencia, 21 Cal., 54. 
 
 And because, since he who voluntarily becomes intoxi- 
 cated is subject to the same rules of law as the sober man, 
 it follows : that where a provocation has been received 
 whicii, if acted upon instantly, would mitigate the offense if 
 committed by a sober man, the question in the case of a 
 drunken man sometime is, whether such provocation was in 
 fact acted upon, and evidence of intoxication may be con- 
 sidered in deciding that question : Buswell on Insanity, § 
 423 ; State v. McCants, i Speer, 384. 
 
 The New York Penal Code defines precisely this ques- 
 tion of responsibility in that State in such cases as follows : 
 "§ 22. Intoxicated persons. — No act committed by a per- 
 son while in a state of intoxication shall be deemed less 
 criminal by reason of his having been in such condition. 
 But whenever the actual existence of any particular pur- 
 pose, motive, or intent, is a necessary element to constitute 
 a particular species or degree of crime, the jury may take 
 into consideration the fact that tiie accused was intoxicated 
 at the time, in determining the purpose, motive, or intent, 
 with which he committed the act." 
 
 DELIRIUM TREMENS AND THE LAW. 
 
 The rule of law is well established both in Engand and 
 the United States, that insanity produced by delirium tre- 
 mens is a good defense to a ci'iminal charge. Even if 
 induced by intoxication, the victim is no more punishable 
 for ills acts than if the delirium had resulted from causes 
 not under his control : Regina v. Davis, 14 Cox C. C, 563 ; 
 Bell on Med. Juris, of Inebriety, 9, and cases there cited ; 
 J. Crisp Poole, Med. Leg. Jour., vol. 8, p. 44 ; U. S. V. 
 
394: APPENDIX. 
 
 McGIue, I Curt., i ; Wharton's Crim. Law (8th ed.), sec. 48 ^ 
 People V. Williams, 43 Cal., 344 ; U. S. v. Clarke, 2 Cr. C. C, 
 758 ; Lanergan v. People, 50 Barb. (N. Y.), 266 ; s. c, 6 
 Parker, Cr. R. (N.Y.), 209 ; O'Biien v. People, 48 Barb., 274 ; 
 State V. Dillahunt, 3 Harr. (Del ), 551 ; State v. McGonigal, 
 5 Harr. (Del.), 510 ; Cluck v. State, 40 Ind., 563 ; Bradley 
 V. State, 26 Ind., 423 ; O'Herrin v. State, 14 Ind., 420 ; 
 Dawson v. State, 16 Ind., 428 ; Fisher v. State, 64 Ind., 435 ; 
 Smith V. Com., i Day (Ky.), 224 ; Roberts v. People, 10 
 Mich., 401 ; State v. Hundley, 46 Mo., 414 ; State v. Sewell, 
 3 Jones (N. C), L., 245 ; Corn well v. State, Mart & Y. 
 (Tenn.), 147 ; Carter v. State, 12 Tex., 500 ; Boswell v. 
 Com., 30 Gratt. (Va.), 860 ; U. S= v. Drew, 5 Mason C. C.» 
 283. 
 
INDEX. 
 
 Page 
 
 Accidental Inebriates 27 
 
 Adversity in Inebriety 80 
 
 Alcoholic Delirium and its 
 associated conditions. .. . 131 
 
 Alcoholic Heredity 145 
 
 Alcohol as a Paralizant. . . 181 
 American Association for 
 the Study and Cure of 
 
 Inebriety 5, 25 
 
 Anstie, Dr 167 
 
 Arsenic Inebriety 383 
 
 Asylums, History of 22, 215 
 
 Asylums in America 24 
 
 Alchol and Beer on the brain 113 
 
 Beard, Dr. G. M 73-93 
 
 Beer Drinking in this 
 
 Country 116 
 
 Bellows, Dr 202 
 
 Bell, Clark 277,285 
 
 Blandford, Dr 164 
 
 Binghampton Asylum, 
 
 24, 76, 216 
 
 Carpenture, Dr 247 
 
 Cholera in Inebriety 102 
 
 Page 
 
 Chronic Dipsomania, 35 
 
 Chloroform Inebriety 363 
 
 Clouston, Dr 113 
 
 Climatic period in Ine- 
 briety 119 
 
 Classification of Inebriety. . 27 
 Climate in Inebriety. .65, 93, 124 
 
 Coma in Inebriety 306 
 
 Cocaine Inebriety 357 
 
 Consumption in Inebriety. . 103 
 Conditions favoring Ine- 
 briety 39 
 
 Connor, Dr 363 
 
 Cofifee Inebriety 369 
 
 Cologne Inebriety 383 
 
 Connecticut State Medical 
 
 Society 21 
 
 Crothers, T. D., 
 
 17, 55, 66, 116, 145, 316, 297 
 
 Criminal Inebriates 289 
 
 Cure of Inebriety 198 
 
 Day, Dr. Albert, 
 
 213,223, 374, 387 
 Dacaiene, Dr 170 
 
398 
 
 INDEX. 
 
 Page 
 Delirium Tremens, Febrile. 137 
 Delirium Tremens Trauma- 
 tics 142 
 
 Details of Treatment 203 
 
 DeZouche, Dr. 239 
 
 Disease theory, History of 17 
 Disease theory in Modern 
 
 Times 22 
 
 Dipsomania, its History and 
 
 Relation 29 
 
 Disability of Alcoholized 
 
 Cases "]"] 
 
 Diathesis Inebriate 52 
 
 Dietetic diseases in Ine- 
 briety 57 
 
 Diagnosis of Inebriety 118 
 
 Differentiation of Inebriety. 309 
 Drinking from Association 175 
 Duty of State in Treatment 
 
 of Inebriates 239 
 
 Dyspepsia 57 
 
 Early history of Dipsomania 3 1 
 
 Education in Inebriety 59 
 
 Emotional Inebriates 28 
 
 Elliott, Dr 209 
 
 Epilepsy, its relation to 
 
 Inebriety 48 
 
 Ether Inebriety 347 
 
 Exhaustion in Inebriety... 70, 80 
 
 Fort Hamilton Inebriate 
 Home 123, 256 
 
 Head Injuries in Inebriety. . 31 
 
 Heredity, Opium 319 
 
 Heredity, Alcoholic 145 
 
 Heredity, Psychical 147 
 
 Page 
 
 Heredity, History of 155 
 
 Heredity, its Extent and.. 
 
 Statistics 156 
 
 Hughes, Dr. C. H 317 
 
 Hospitals in Europe 25 
 
 Inebriety and Coma 309 
 
 Inebriety from Opium 317 
 
 Inebriety from Ether 347 
 
 Inebriety from Cocaine.... 357 
 Inebriety from Chloroform 363 
 Inebriety from Coffee and 
 
 Tea 369 
 
 Inebriety from Tobacco. . . . 377 
 Inebriety from Cologne. .. . 383 
 
 Inebriety from Arsenic 385 
 
 Inebriety from Ginger 386 
 
 Inebriate Asylums. .24, 203, 217 
 International Congress for 
 the Study of Inebriety. 26, 92 
 
 Insanity of Inebriates 242 
 
 Inebriety, Predisposing 
 
 Causes 55 
 
 Inebriety among Women.. 61 
 
 I nebriety from Heat 63 
 
 Inebriety and Sun-stroke. .86, 87 
 Inebriety among many 
 
 American Women 92 
 
 Inebriety in Epidemics.... 102 
 Inebriety and Consump- 
 tion 103 
 
 Insanity and Inebriety. .242, 271 
 Inebriate Asylums, History 
 
 of 22, 217 
 
 Inebriates in Asylums 246 
 
 Inebriate, Legal Control of, 
 
 221, 253 
 
 Inebriates, Criminal 302 
 
 Inebriate's Responsibility.. 283 
 
IHDEX. 
 
 899 
 
 Page 
 Inebriety, Law and Rulings 
 
 of 276 
 
 Irresponsibility of Inebriates 297 
 
 Jackson, Dr..... 83,227 
 
 Jewell, Dr. J. G 182 
 
 Journal of Inebriety. .... .vi., 25 
 
 Kemp, Dr. E.J 187 
 
 Kerr, Dr. Norman, 
 
 168, 174, 243,271, 277, 347 
 
 Law and rulings of Judges 
 
 in Inebriety 277 
 
 Lett, Dr. Stephen 222 
 
 Lentz, Dr. F 260 
 
 Legal care of Inebriates. 221, 253 
 Lykke, Dr 29, 171 
 
 Maudsley Dr 59 
 
 Mays, Dr. Thos. J 103 
 
 Mason, Dr. L. D., 
 
 118, 123, 220, 251 
 
 Mann, Dr. E. C 206 
 
 Mattison, Dr. J. B. .232, 329, 340 
 
 Marriage and Heredity 152 
 
 Matthews, Dr 161 
 
 Mendel, Dr 360 
 
 Mental Heredities I47 
 
 Military Hospitals 200 
 
 Morris, Dr. John 309 
 
 Morel, Dr 163 
 
 Mortality of Inebriety 100 
 
 New York State Inebriate 
 
 Asylum 23 
 
 Neursesthenia in Inebriety, 
 
 81, 1S2 
 Nicotine 377 
 
 Page 
 Occupation of Inebriates. . . 123 
 
 Opium Inebriety 317 
 
 Opium Neuroses 313 
 
 Opium Diathesis 321 
 
 Opium Classes 319 
 
 Opium allied diseases 317 
 
 Opium Special Treatment. . 329 
 
 Opium Heredity 331 
 
 Opium Medical Treatment. 329 
 
 Parrish, Dr. J 119, 244 
 
 Pathology of Brain Feeble- 
 ness 39 
 
 Pauper Inebriates 28, 251 
 
 Pathology of Inebriety. 173, 185 
 
 Periodic Dypsomania 29 
 
 Politics in Inebriety 76, 98 
 
 Philosophy of Inebriety 41 
 
 Predisposing Causes of Ine- 
 briety 55 
 
 Premeditation in Inebriety, 
 
 TJ, 122, 146 
 Prognosis of Inebriety. . 197, 209 
 Psychical Traumatism in 
 
 Inebriety 73 
 
 Psychological Forces in Ine- 
 briety 90 
 
 Punishment does not deter 
 Inebriates 198 
 
 Quimby, Dr. I. N 241 
 
 Rest in Inebriety 182 
 
 Results of Treatment.. .128, 183 
 Responsibility of Inebriates. 2S3 
 
 Richardson. Dr. B. W 258 
 
 Roberts, Dr. John B 139 
 
 Rush, Dr 19 
 
400 
 
 INDEX. 
 
 Page 
 
 Searcey, Dr. J. T 39 
 
 Shepard, Dr. C. H 234 
 
 Slayter, Dr 372 
 
 Solitary Inebriates 28 
 
 Special Hospitals for Inebri- 
 ates 220 
 
 Statistics of Heredity. ..156, 161 
 State Hospitals for Inebri- 
 ates 248, 260 
 
 Syphilitic Diathesis 54, 377 
 
 Temperature in Inebriety. . 84 
 Tea Drinking on the eyes. . 375 
 
 Tea Inebriety 376 
 
 Thwing, Dr. E. P 90 
 
 Theane Inebriety 372 
 
 Tobacco Inebriety 377 
 
 Treatment, General Princi- 
 ples 197 
 
 Transmissibility of Inebriety 168 
 
 Tuke, Dr 165 
 
 Treatment by Hot-air 234 
 
 Treatment by the State 239 
 
 Trance in Inebriety 297 
 
 Treatment, Failure of, 
 
 85, 150, 240 
 
 Page 
 Treatment, Duration of, 
 
 306, 248, 256 
 
 Treatment, Form of 215 
 
 Treatment by Restraint 255 
 
 Treatment by Medicines. 206, 21 1 
 Treatment, Results of. . 128, 197 
 
 Treatment, Hygienic 227 
 
 Traumatic Delirium Tre- 
 mens 142 
 
 Treatment of Delirium Tre- 
 mens 143 
 
 Treatment of cases of 
 
 Heredity 150 
 
 Traumatism in Inebriety.. 66 
 
 Turner, Dr. J. Edw 22. 216 
 
 Types of Inebriates 29 
 
 Washingtonian Movement. 22 
 
 Washingtonian Home 22 
 
 Women Inebriates 61 
 
 Wolf, Dr 375 
 
 Winslow, Dr. Forbes 166 
 
 Woodard, Dr 21,215 
 
 Wright, Dr. T. L., 
 
 47, 162, 173, 179. 270 
 Wynter, Dr i66 
 
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