Tobacco, insanity and nervousness

Biomed,
Lib.
HV
5733
B751t
1892

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THE LIBRARY

OF

THE UNIVERSITY

OF CALIFORNIA

LOS ANGELES

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TOBACCO,

INSANITY .™ NERVOUSNESS.

-BY-

DR. L. BREMER,

LATE PHYSICIAN TO THE ST. VINCENT'S INSTITUTION FOR
THE INSANE, OF ST. LOUIS, MO.

PRICE, FIFTKEX CE^^VTS,

PUBLISHED BY THE

MEYER BROTHERS DRUGGIST.

ST. LOUIS, MO.

1892.

le Contents of this Pamphlet are based on an
?le read before the St. Louis Medical Society in
ber, 1891. At the request of friends and per-
interested in the subject the author has agi
large and modify the article, and to publis
? present form.

L. Bremer, M. D
Louis, December 22, 1891.

ONES PRINTING CO.. 2< I PINE ST., ST. LOUIS.

T t

TOBACCO, INSANITY and NERVOUSNESS

BY

DR. L. BREMER,

OF ST. LOUIS.

There is no narcotic, either in modern or ancient times,
which has been and still is, so universally in use, as tobacco,
And. there- is none about whose action on the human body
there is so much difference of opinion among the laity and
the profession.

Whereas, by some, it is looked upon as an im mitigated
' evil, it is claimed by others, that its use is not without
advantage. Hence, it has been condemned and corn-
amended in turns. Its friends have, so far, carried the
' day; its triumphal march over nearly the whole civilized
feand uncivilized orlobe has been continuous.

Without entering into preliminaries and details, I will
I state at the outset, that 1 side with those who, looking at

> the injurious effects collectively, consider it more harmful
i than alcohol, from the simple fact that its use is more
t general, its effects more gradual and less obvious, and

that, from a moral point of view, it is in better standing.
, The breath of tobacco is held permissible and will be
[Condoned by all classes ; that of alcohol is looked upon

as odious and exposes its bearer in some quarters to social

> ostracism.

It is this connivance, on the part of public opinion, at
this land of luxus-consumption, as it is euphoniously styled

A A ># r* *~k .-

4 TOBACCO, INSANITY AND NERVOUSNESS.

by modern physiologists, that fosters its spread, especially
amongst those who can least afford to offer any insult to
their nervous systems. And unfortunately it is just this
class of persons who delude themselves into the belief, that
tobacco is indispensable to them. With advancing civili-
zation it is considered necessary by many to use a sedative
or a stimulant of some sort as a kind of a safety-valve for
the growing nervousness of our age.

Thus, by many smokers it is thought that after bodily
or mental exertion an equilibrium of all the functions is
re-established by the pipe, cigar, or plug. Its action,,
therefore, is somewhat like that of coca * in its pleasant
effects,

This is the case in the healthy smoker as long as he keeps
within certain limits. But it is quite different with the
vast and ever-increasing army of neurasthenics and psycho-
paths of our days.

Our ancestors were evidently not so deleteriously
affected either by alcohol or tobacco, as modern man is,,
with the strain of the requirements of a more complicated
life weighting upon him, and handicapped, as he frequently
is, in his nervous and psychical make-up.

It is specially of the effect of tobacco on this latter class
that I wish to speak in the following remarks, and to start
with, I venture the broad assertion, that, whereas the

* The pernicious influence of this drug is also spreading at an alarm-
ing pace among the well-to-do. The various proprietary preparations
which go by the name of '« Wine of Coca " and which, to the detriment
of many, have been indorsed by physicians in good standing, are con-
stantly working havoc among neurotic persons who believe they can take
this kind of wine with the same impunity as they can alcohol in some
form. Only too late they find that one tablespoonful of the stuff calls
for another and that a constant vague, half-conscious feeling of misery
pushes them with the relentlessness of fate to the baneful bottle. Why
do not the physicians, if coca is indicated, use the reliable fluid extract
and have it taken in Madeira wine instead of v^iUg and abetting a nefa-
rious traffic, which they do by prescribing rietary wines of coca?

TOBACCO, INSANITY AND NERVOUSNESS. 0

and healthy, especially if he lead an active outdoor

b,* may use jbacco in its various forms with apparent

ity, t. e without experiencing any demonstrable

*o holy or mind, the neurasthenic and the

^ath ha^e no business either to smoke or chew.t

it is just persons of this category (who are often not

I aware of their morbid condition) that become such

1 i owerless slaves to the habit. They fall

.rly in life as a rule. Whilst the healthy

1 revolts against the drug as intensely as

a cat, and has to gradually accustom itself

ove e unpleasant sensations accompanying the

■at attempts i using it, the born neurasthenic often takes

it as the yoi lg duck does to water. Only in this manner

i] the pecu xr phenomenon of infant-smokers be

e does not prefer to look upon such per-

ite as a species of precocious moral insanity

herited from parents who are generally not only excessive

-users, I ut evidently mentally defective.

. I do n >t believe that, with approaching maturer

I am one f those who eye through pessimistic specta-

risins; deration, but I simply repeat the every-day

ch I have never seen doubted or cont ra-

te eliminate nicotine so quickly as muscular ex-
:

X It is strange am would be amusing to the observer, were it not such

ter, to see the delusion on the part of many young neuras-

;s who imagine that they have a great deal of nerve force. It is

. 3 ung man that he has a deranged stomach. or kidney,

oms are present; but a statement that his nerves

ad brain are Helow par, and that tobacco is rank poison to him, is

jceived with more r less incredulity. Thus, a young man, a patient of

line, knew that on various occasions, after excesses in smoking, he had

_>f a grave and pronounced character. Yet he consid-

>ng, because he was energetic; after periods of

bstinence •■ woul. iudulg

Lways with the ^ame result.

b TOBACCO, INSANITY AND NERVOUSNESS.

dieted, that there is an alarming increase of juvenile smok-
ers; and, basing my assertion on the experience, gathered
in my private practice and at the St. Vincent's Institution
of this city, I will broadly state that the boy who smokes

AT SEVEN, WILL DRINK WHISKEY AT FOURTEEN, TAKE TO
MORPHINE AT 20 OR 25, AND WIND UP WITH COCAINE AND
THE REST OF THE NARCOTICS, AT 30 AND LATER ON.

It is like a pathologico-moral version of Hogarth's " The
Rake's Progress."

It may look like overstating and exaggerating things >
but I know whereof I speak, when I say that tobacco when
habitually used by the young leads -to a species of imbecil-
ity ; that the juvenile smoker will lie, cheat and steal,,
which he would not, had he let tobacco alone. This kind
of insanity I have observed in quite a number of cases at the
St. Vincent's. The patients presented all the characteristics
of young incorrigibles. They had exhausted the indul-
gence of their parents, who saw no other way to protect
them from their insane pranks, than to commit them to
the institution. Had they been less favorably situated
financially, they would have landed at the House of~Cbrrec-
tion or the Workhouse.

I do not know whether a lasting improvement was
effected in any of them. There was not one amongst them
that was able to comprehend that tobacco was injuring him ;
they were constantly on the lookout for obtaining it, by
begging, stealing or bribing, and regarded the deprivation
of the drug as a punishment. The sense of propriety, the
faculty of distinguishing between right and wrong, was lost.
The father of one of thenf who looked upon Iris son only
as an aggravated case of bad boy, told me that he.. himself
had been smoking. -ever' since his 10th year and it never had
affected him. Iiureality, being only 45 years old, he was
a wreck, physically and mentally, though he came of
healthy stock, tie could not or would not comprehend

, 4

TOBACCO, INSANITY AND NERVOUSNESS. 7

that tobacco was gradually undermining his own mind
and body, although his wife and his friends knew and
saw it.

But it is not only in the young, that the use of tobacco is
followed with such disastrous effects. Smoking or chew-
ing, when commenced in the period of manhood, and even
at the time it generally does least harm, after middle age,
will tell on the mind if excessively indulged in. Is it to be
wondered at, that a drug which, until tolerance is estab-
lished, has such potent and palpable effects as to produce
loss of co-ordination and unspeakable malaise, and after the
organism has become used to it, is capable of setting up
the well-known heart disturbances, amblyopia and even
amaurosis — which, in short, possesses the characteristic
qualities of a powerful nerve poison, is it a wonder if such
drug, when, in spite'of the warnings on the part of various
organs, excessively and persistently used, finally produces
one or the other form of insanity? A drug that can, as
has been demonstrated, cause organic changes of the optic
nerve, wThich, I hardly need mention it, is, in reality, not
a nerve, but a protrusion of elongation of the brain itself
must certainly be capable of injuriously influencing
other and functionally higher, parts of the organ of the
mind.

Dr. Kjelberg read before the section of Neurology and
Psychiatry of the last International Congress, a paper in
which he described a nicotine-psychosis, well marked by def-
inite symptoms and stages. I have never seen the clinical
picture as drawn by this observer, but it always seemed
to me that whenever tobacco entered at all as a factor in a
case of insanity, it was the immediate cause, vivifying,
uniting and condensing, as it were, the dormant morbid
elements which predisposed the individual to mental dis-
turbance. Thus I have seen melancholia, more often
mania, and very frequently general paresis hastened and

8 TOBACCO, INSANITY AND NERVOUSNESS.

precipitated by excessive use of tobacco. I know, however,
of instances where the last named disease, or " softening
of the brain," as it is called by the lay-public, could not be
referred to any other cause but tobacco.

That the majority of the insane smoke or chew is too
well known to deserve special mention. Some alienists
have been of the opinion that this habit ought not to be
discouraged, that it has a calming and pacifying effect
especially on the chronic insane. I believe this to be the
case in some of the secondary dements, but ordinarily,
though calming at first, it has an exciting effect later on.
True, if the temporary contentment resulting from the
gratification of the craving of the patient is looked upon as
the action of tobacco, I agree that its effects are calming.
But this quieting down, in my opinion, takes place on the
same principle that a child gets quiet and stops crying when
its wish, even though most unreasonable, is gratified. The
rule is, that smoking causes or prolongs excitement in the
insane. Many become absolutely unmanageable as soon as
they touch tobacco. They get quarrelsome, tease and
molest their fellow-patients and render themselves obnox-
ious generally.

That tobacco really does cause insanity is evidenced by
the magic effect seen in some cases after the discontinu-
ance of the drug, when the patient's condition is still
such that he is not wholly inaccessible to reason and has
will power enough to abandon the habit. Thus I have
seen that beginning melancholia with suicidal impulses,
hallucinations of various kinds, forced actions, besides, the
precursory symptoms of insanity, such as insomnia, crying
spells, praecordial anxiety, fears of impending evil, " that
something is going to happen," impotency, vertigo, begin-
ning impairment of memory and judging power, and even
the lowering of the moral tone, all of which, and a host of
other symptoms were attributable to chronic tobacco-

TOBACCO, INSANITY AND NERVOUSNESS. V

intoxication, disappeared after freedom from the habit was
established.*

But whenever a case has gotten so far, that commitment
to an institution has become necessary, the prospects are
not so good, because such persons, as a rule, cannot be
convinced that tobacco is, or has been, the cause of their
mental trouble. Their argument is that almost everybody
smokes, that all their friends and acquaintances chew or
vSmoke, without showing any symptoms of insanity. I The

* One of my patients experienced among other morbid symptoms an
almost uncontrollable desire to throw himself out of the window, when-
ever he had to go to the upper stories of the house in which he was
employed; this impulse was so overpowering that he did not dare to
approach the windows and was in mortal fear of high places. He was
a smoker and a neurasthenic. The discontinuance of the drug termin-
ated his morbid impulses and fear.

X This is an argument which it is hard to invalidate, because the smoker
does not appreciate the law of difference and variability of the resist-
ing power on the part of the organism, although this law is a matter of
every-day observation. While some persons seem to be proof against
almost any injurious agencies, others will yield on the slightest occasion,
to much less powerful influences, mechanical, toxic, or morbific in the
stricter sense. Again, the susceptibility to injury varies in the same
individual. What is true of individuals applies with equal force to
nations. Thus, the Germans have been called a nation of thinkers and
smokers, and, seemingly, their smoking habits have not interfered with
their power for logic, nor, for that matter, [except a generally pfevaling
short-sightedness] with their physical constitution. This has, for a long
time, puzzled the French, who have tried to account for the dire effects of
tobacco on their own countrymen in various ways. Some investigators
think this difference in effect is due to the difference in the manner of
raising tobacco in the two countries, and the different percentage of
nicotine thus obtained. The Germans, on the other hand, are dumb-
founded at the amouut of alcohol which the Russian consumes appar-
ently without injury.

This discrepancy, in effect, is certainly not a matter of difference in
quality. As remarked before, all this is a question of resisting power
produced and governed by racial, social, climatic, industrial and a num-
ber of other more or less occult influences. Now, all observers agree
that in our country many conditions conspire to make us a nervous peo-
ple, to produce what has even been styled, ." American nervousness."

10 TOBACCO, INSANITY AND NERVOUSNESS.

alcoholic insane when leaving the institution to enter active
life again, generally knows and admits that alcohol has
been the cause of his mental break-down, the nicotine-vic-
tim does not admit anything.

There has been a movement on foot in the medical press,
and to some extent in the daily papers, which latter
chronicle the few cases that come to public knowledge
under the head: " Gone insane from cigarette-smoking, "*
etc., to counteract the spread of this fatal habit, fatal to
the individual himself and pernicious to the coming genera-
tion ; but so far, apparently without any appreciable
result.

French medical observers are of the opinion that one of

This " nervousness " in other words means a weakness, an instability, a
vulnerability of the nervous system. Add to this the unquestionably
stroug quality of the tobacco which the taste of the American public
exacts from the manufacturer, and it becomes plain that there exist two
cogent reasons why we should be on our guard vis-a-vis the indiscrimi-
nate use of the article.

* Whether there is a constituent in the cigarette endowed with special
properties as a nerve and brain-poison, I have not been able to ascertain.
My friend, Dr. J. C. Mulhall, of this city, in a paper read before the
Medico-Chirurgical Society several years ago, claimed that it was the
cheapness and easy acquisition of the article and consequently its un-
bounded consumption, that rendered it so pernicious, especially to the
young, and that its contents differed in no way from other tobacco. I
have no doubt that pecuniary considerations and the temptation to fill
the little scraps of time with smoking contribute largely to the lamentable
effects of cigarette consumption : but the result of my inquiries among
former victims of the cigarette habit leads me to believe that the action
of cigarette smoke' on the nervous system is totally different from that
of the cigar. I hope for the sake of humanity that the charge so often
made that opium is used in cigarette manufacturing cannot be substan-
tiated. If true, it would constitute the lowest depth of commercial
infamy. However this may be, one thing seems to be generally con-
ceded, that is the well-nigh universal habit of cigarette smokers to
"inhale" and thus to multiply the chances of nicotine-absorption.
Possibly it is on this account that moral and intellectual blight befalls so
oft,en the juvenile habitue and that the adult victim in time becomes
fidgety and cranky, sometimes barely able to move along the narrow strip
of the borderland of insanity.

TOBACCO, INSANITY AND NERVOUSNESS. 11

the factors causing the depopulation of France is the ex-
cessive use of tobacco by its inhabitants; for the offspring
of inveterate tobacco consumers is notoriously puny and
Stunted in stature and lacks the normal power of resist-
ance, especially on the part of the nervous system ; again,
in our country it is a significant fact that an astounding
percentage of the candidates for admission to \Ve*t Point
and other military schools are rejected on account of
tobacco-hearts ; from all countries and from all classes of
society come reports in increasing numbers of the baneful
effects of the tobacco-habit.

But the consumption goes on and will do so, until an exam-
ple is set by those who, above all others, can estimate the
disastrous effect of the habit.

If teachers, preachers and physicians would pronounce
the anathema on tobacco and abstain from it themselves,
others would follow. But here is the difficulty. It is only
exceptionally that a smoking pedagogue, clergyman or
physician can be convinced that he would be a better man
physically, intellectually and morally, if he would give up
tobacco, and that he has no idea what capabilities of well-
being he possesses, if he only could muster up moral cour-
age enough to abandon the use of a drug which in nine
cases out of ten produces, to say the least, a vague sensa-
tion of uneasiness and restlessness, which only too often
calls for a remedy that will do away with these effects, and
that is alcohol. Some are aware that tobacco alone is
responsible for a continual malaise or misery, especially
when their attention is called to it by others, but like the
cocainist, who asserts that the effects of cocaine are horrible,
and still goes on, using the poison, so the tobacco-slave is
bound, as by fate, to again indulge in a drug which he
knows causes him to suffer.*

* It must be a strangely potent fascination indeed, which tobacco exer-
cises over the bulk of its victims, when we consider that some are aware

12 TOBACCO, INSANITY AND NERVOUSNESS.

Some, however, labor under the delusion that it increases
their working power, that the flow of thought becomes
easier, and that without tobacco they are unable to do any
mental work. Instances are cited by them of great men,
inveterate and excessive tobacco consumers, who left their
mark in the history of civilization as savants, artists, etc.
They do not consider the possibility that these men accom-
plished what they did in spite, but not in consequence of,
or aided by, their habit.

Students of chronic nicotine-intoxication are convinced
that the great men among the tobacco slaves would have
been still greater, had they never used the drug. Thus,
Kant, the most eminent of German philosophers, is said to
have written such an obscure and unintelligible style, be-
cause he smoked and snuffed to excess. I myself know
of a medical man who wrote a great book, which labors
under the same defect as Kant's works, because of his
slavery to tobacco.

But these things are trifles when compared with the de-
structive and degenerative influences the drug exerts on
the broad masses.

that tobacco is at the bottom of all their ailments. The question
naturally arises in this connection: why do people smoke, when they
know that as soon as they touch tobacco, they experience immediately its
toxic effects? Many a smoker rises in the morning bright and energetic :
the nicotine absorbed during the previous day has been eliminated from
his tissues — thanks to his well-meaning and powerful excretory organs.
He smokes his first cigar after breakfast, becomes at once restless, dis-
satisfied, peevish and disagreeable; the cigar stamps its siguatureon his
mind for the rest of the day. This is the experience of many a neurotic
smoker, and yet he will resume the practice clay after day, making his
own life a burden and rendering everybody around him miserable. It is
easily intelligible why some persons take alcohol: this is primarily a stimu-
lant and secondarily a paralyzant, but tobacco paralyzes at once : it
lowers all the faculties except those of fancy, and tobacco-phantoms are
not of much value. The downfall and general backwardness in civiliza-
tion so characteristic in the Oriental people is largely due to their
dreamy disposition engendered by abuse of tobacco.

TOBACCO, INSANITY AND NERVOUSNESS. 13

There is only one way to lessen the evil — it is the dis-
semination of knowledge of the baleful effects of tobacco
among the rising generation, initiated and sustained by the
three professions mentioned above. Of course they ought
practice first, what they are going to preach.

But is there much prospect of such a movement at pres-
ent? I think not. I know of schools conducted by the
clergy, in which smoking is not only permitted to fourteen
years old — and even younger boys — but more or less
encouraged. I believe that its well known anaphrodisiac
effect, on account of which it was very popular among the
monks of Italy, several centuries ago, is possibly a reason
for the favor in which it is held at the present day in some
quarters.

Again, I know of physicians who not only smoke to ex-
cess themselves or still worse, indulge to a morbid extent
in the unmannerly habit of chewing, but permit and even
encourage their own children to smoke. One of them was
in the habit of awarding his 13-year-old son by extra-good,
i. e!9 extra-strong cigars for high numbers in school. It is
hardly necessary to add what became of this boy. He is
now a periodical inmate at various sanitariums for a com-
bination of bad habits.

And the teachers? They are not lagging behind in con-
tributing to the army of tobacco slaves ; there are few that
raise their voices against the habit, for the very valid
reason that they are not fully cognizant of its evil effects
and smoke as much themselves as men in other vocations.

In view of such discouraging facts I hardly expect much
good from this contribution and testimonial to the perni-
cious effects of tobacco, because the truth has not dawned
upon the multitude yet. As in the body politic, evils will
run their course, until there is a general uprising of com-
mon sense which disposes of them, so with the irrational
and excessive use of tobacco, which will probably go on

14 TOBACCO, INSANITY AND NERVOUSNESS.

increasingly, until a limit of endurance is reached, and the
disastrous results of the abuse become patent enough to
impress even the dullest mind.

But under existing conditions the habit will not want for
new generations of victims, as long as the cigar is looked
upon as a symbol of manliness by the young, and the pipe
as that of peace and comfort by the adult, and as long as
tobacco is praised in word and picture. To what extent
the habit is fostered among boys on the theory of forbidden
fruit, it is not my province to discuss.

This paper was designed to bring before this Society
and the profession at large my views on a subject with
which unusual opportunities have made me familiar. Im-
perceptibly I have drifted from the role of the author of a
paper into that of a moralist and exhorter, and yet I know
what an unpopulur figure the man cuts that has the slightest
suspicion of a reformer about him. My consolation is that
I foresee the results of these remarks on my readers. One
will say with a pitying smile: All true, but exaggerated.

Another one who reads this will be convinced of the cor-
rectness of some points as applying to his own case. He
will fling his freshly-lit cigar away with the firm resolve of
quitting the weed forever. The effect is immediate. In a
few days he feels that his mental and physical energies are
wonderfully strengthened ; there is a buoyancy of spirits,
a return of healthy animal life, which he has not expe-
rienced for many a year and, one fine day, when he feels
particularly bright and happy over so wonderful a change,
he celebrates the event and — lights another cigar. The
Angel of Constancy veils his face, and the same train of
the old familiar symptoms of neurasthenia and mental
depression, of irritability and don't-know-what's-the-mat-
ter-feeling take a renewed and firmer hold of him.

So I fear I shall share the fate of the preacher in the
desert.

TOBACCO, INSANITY AND NERVOUSNESS. 15

But may be, that one or the other tobacco-user comes to
the conclusion that he shows some of the symptoms
detailed above himself, and that he resolves to quit ; is
there, in this case, any danger in the abrupt discontin-
uance of the drug, as there is in quitting the habitual use
of alcohol or morphine, for instance?

My experience is that there is none. By " tapering off "
the combat would be unnecessarily prolonged.

It is not well to make a compromise for him, who has
already begun to suffer from outspoken toxic effects of nico-
tine, and to simply decrease the daily allowance of tobacco.
Many a smoker is astonished to hear from his physician
that even the two or three cigars he is smoking now, keep
him in the wretched state he complains of, when a dozen
and more in former years did not affect him.

The explanation of this paradox is very simple. Through
chronic poisoning, or a long series of acute and sub-acute
attacks of nicotine intoxication he has lost all resisting
power and, like the broken-down alcoholic, who used to
drink a quart or more of whisky a day, and, when his nerves
are shattered by the abuse gets pathologically drunk and
fuddled on one ounce, so the nicotine-invalid is completely
unnerved by one or two cigars.

A stumbling-block to good resolutions proves often the
following mistake which is quite prevalent: Many smokers
who are told that tobacco is at the bottom of their ailment
and who finally believe it and act on this belief, expect that
with abolishing the cause, the effect will cease immediately,
that they will jump with both feet into perfect health on
quitting tobacco. They do not consider that the mischief
done by a chronic disease of any kind to the organism, it
takes months, nay, years, to undo by strict hygienic living.
Tobacco-cachexia in its various forms, is no exception to
the rule.

Lastly: Are there means by which the abandoning of

4-1 1 RCH

16 TOBACCO, INSANITY AND NERVOUSNESS.

the drug may be facilitated ? Yes. But of paramount im-
portance is the firm resolution to quit. This being settled,
a combination of the bromides, Indian hemp and bitter
tonics will easily tide the patient over the gnawing sensa-
tion and general uneasiness of the tobacco-hunger.

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