Google
Uber dieses Buch
Dies ist ein digitales Exemplar eines Buches, das seit Generationen in den Regalen der Bibliotheken aufbewahrt wurde, bevor es von Google im
Rahmen eines Projekts, mit dem die Bucher dieser Welt online verffigbar gemacht werden sollen, sorgfaltig gescannt wurde.
Das Buch hat das Urheberrecht fiberdauert und kann nun offentlich zuganglich gemacht werden. Ein offentlich zugangliches Buch ist ein Buch,
das niemals Urheberrechten unterlag oder bei dem die Schutzfrist des Urheberrechts abgelaufen ist. Ob ein Buch offentlich zuganglich ist, kann
von Land zu Land unterschiedlich sein. Offentlich zugangliche Bucher sind unser Tor zur Vergangenheit und stellen ein geschichtliches, kulturelles
und wissenschaftliches Vermogen dar, das haufig nur schwierig zu entdecken ist.
Gebrauchsspuren, Anmerkungen und andere Randbemerkungen, die im Originalband enthalten sind, finden sich auch in dieser Datei - eine Erin-
nerung an die lange Reise, die das Buch vom Verleger zu einer Bibliothek und weiter zu Ihnen hinter sich gebracht hat.
Nutzungsrichtlinien
Google ist stolz, mit Bibliotheken in partnerschaftlicher Zusammenarbeit offentlich zugangliches Material zu digitalisieren und einer breiten Masse
zuganglich zu machen. Offentlich zugangliche Bucher gehoren der Offentlichkeit, und wir sind nur ihre Hiiter. Nichtsdestotrotz ist diese
Arbeit kostspielig. Um diese Ressource weiterhin zur Verffigung stellen zu konnen, haben wir Schritte unternommen, um den Missbrauch durch
kommerzielle Parteien zu verhindern. Dazu gehoren technische Einschrankungen fur automatisierte Abfragen.
Wir bitten Sie um Einhaltung folgender Richtlinien:
+ Nutzung der Dateien zu nichtkommerziellen Zwecken Wir haben Google Buchsuche flir Endanwender konzipiert und mochten, dass Sie diese
Dateien nur fur personliche, nichtkommerzielle Zwecke verwenden.
+ Keine automatisierten Abfragen Senden Sie keine automatisierten Abfragen irgendwelcher Art an das Google-System. Wenn Sie Recherchen
liber maschinelle Ubersetzung, optische Zeichenerkennung oder andere Bereiche durchffihren, in denen der Zugang zu Text in groBen Mengen
nfitzlich ist, wenden Sie sich bitte an uns. Wir fordern die Nutzung des offentlich zuganglichen Materials fur diese Zwecke und konnen Ihnen
unter Umstanden helfen.
+ Beibehaltung von Google-Markenelementen Das "Wasserzeichen" von Google, das Sie in jeder Datei finden, ist wichtig zur Information fiber
dieses Projekt und hilft den Anwendern weiteres Material fiber Google Buchsuche zu finden. Bitte entfemen Sie das Wasserzeichen nicht.
+ Bewegen Sie sich innerhalb der Legalitdt Unabhangig von Ihrem Verwendungszweck mfissen Sie sich Ihrer Verantwortung bewusst sein,
sicherzustellen, dass Ihre Nutzung legal ist. Gehen Sie nicht davon aus, dass ein Buch, das nach unserem Daffirhalten ffir Nutzer in den USA
offentlich zuganglich ist, auch ffir Nutzer in anderen Landem offentlich zuganglich ist. Ob ein Buch noch dem Urheberrecht unterliegt, ist
von Land zu Land verschieden. Wir konnen keine Beratung leisten, ob eine bestimmte Nutzung eines bestimmten Buches gesetzlich zulassig
ist. Gehen Sie nicht davon aus, dass das Erscheinen eines Buchs in Google Buchsuche bedeutet, dass es in jeder Form und fiberall auf der
Welt verwendet werden kann. Eine Urheberrechtsverletzung kann schwerwiegende Folgen haben.
Uber Google Buchsuche
Das Ziel von Google besteht darin, die weltweiten Informationen zu organisieren und allgemein nutzbar und zuganglich zu machen. Google
Buchsuche hilft Lesern dabei, die Bficher dieser We lt zu entdecken, und unterstfitzt Au toren und Verleger dabei, neue Zielgruppen zu erreichen.
Den gesamten Buchtext konnen Sie im Internet unter http : //books . google . com durchsuchen.
This is a reproduction of a library book that was digitized
by Google as part of an ongoing effort to preserve the
information in books and make it universally accessible.
Google” books
https://books.google.com
Digitized by
Google
os
University of Chicago Library
GIVEN BY
Ckrrv \. Caaax- ^ .V^JLi)ruViJCfl>>
Besides the maif. topic
Subject No. On page
this book treats of
Subject No. On Page
Digitized by ^ooQie
Digitized by
GoogI
Digitized by
INEBRIETY
Published under the Auspices of the American Association
for the Study and Cure of Inebriates .
T. D. CROTHERS, M. D., Editor,
56 Fairfield Avenue,
Hartford, Conn.
Vol. XVII, 1805.
HARTFORD, CONN.:
The Case, Lockwood & Brainard Company, Printers.
EUROPEAN AGENCY: Bailliere, Tindall & Cox,
ao King William Street, on the Strand, London, W. C.
Digitized by ^ooQie
• •• •
Digitized by ^ooQie
172141
INDEX TO VOLUME XVII.
A.
Alcohol and Other Anaesthetics, .
Alcoholism in the Street, .
Alcoholic Cirrhosis of the Liver, .
Abbott, Prof. Austin,
Alcohol and Nicotine,
Auto-toxaemia in Drug Habits,
Alcohol in Diseases,
Alcohol and Pneumonia,
Alcohol, Intolerance of,
Alcohol and Happiness,
Alcoholic Question in Germany, .
Arrested Development in Inebriety,
Alcoholic Coma, ....
Antolntoxication in Mental Disorders, .
Alcoholism, with suggestions as to treatment,
Alcohol and Chastity,
Ancient Punishment for Drunkenness,
Arthur, Dr. D. H., . .
Alcohol by Synthesis,
Buck, Dr. E. O.,
B.
34
S 3
55
102
III
*52
*75
232
2 53
262
267
287
289
294
345
360
373
354
386
248
C.
Crook, Dr. James K., .......
Crothers, Dr. T. D., 39, 43, 68 to 76, 171, 188 to 198, 281 to 291, 380 to
Chloral Poisoning, ........
Coyle, Jane, Case of, . v
Cure of the Alcoholic Disease,
Cure of Inebriety, ........
Cocaine Inebriety, ........
Coal Tar in Inebriety, .......
Cocaine Intoxication, .......
Cigarette Habit, ........
Clevenger, Dr. S. V.,
22
386
58
74
89
* 5 *
272
2 93
295
333
3*6
D,
Davis, Dr. N. S., .
Duty of the Profession in Inebriety,
34
128
14534
Digitized by ^ooQie
IV
Index .
Delusional Inebriates,
Drink Traffic, ....
Dipsomania State Cure,
Diagnosing Opium Habitues by Snap-shot,
Dipsomania and Hypnotism,
Dill, Dr. J. G.
Dunham, Dr. S. A., ...
PACK.
188
264
297
340
30 i
3 °*
345
E.
Enfield, Dr. A.,
F.
Freeman, Dr. A. B.,
89
28
G.
Gold Cure Legislation,
Gold Cures,
Green, Mr. C. T., .
73
284
307
H.
Heredity in Reference to Inebriety,
Hamburger, Prof L. M., .
Home for Inebriates, San Francisco,
Happel, Dr. T. J., .
Home for Inebriates in Switzerland,
Hypnotic Suggestion for Alcoholism,
Heredity Problems,
Holbrook, Dr. M. L.,
15
197
237
257
261
265
360
I.
Inebriety and Imbecility, ......
Inebriety among Railroad Men, .....
Inebriety and Crime in New York, ....
Inebriety and Life Insurance, .....
Inebriates, An Inquiry^into, .....
Inebriate Hospital, Mass.,......
Instruction in Inebriety, ......
Inebriate Hospitals in England, .....
Inebriety and Alcoholism among Children,
Inebriety in Women, .
Insane Delusions, ......
Influence of Alcohol on Urinary Toxicity,
Importance of Accurate Diagnosis in Inebriety and Mental Diseases,
Inebriate Tramps, ......
43
69
P
77
133
162
171
176
222
254
269
325
354
384
Digitized by ^ooQie
Index. v
J.
PAGB.
Jones, Dr. H. M., ........ 201
K.
Kerr, Dr. Norman, ..... ... 77
Kellogg, Dr. J. H., . . . 325
L.
Ledeux, Prof. A. R., . .111
Legislation for Inebriates in Austria, ..... 373
M.
Morton, Dr. Thomas, ....... 1
Mason, Dr. Theodore L., . . .39
Maltine with Coca Wine, ....... 97
Moyer, Dr. H. N., ........ 128
Morphine Inebriety, ....... 180
Morphine Dangers in Practice, ...... 201
Mulhall, Dr. J. C., . . 333
N.
New Year, . . • . . . .68
Neurotic Inebriates, ....... 282
Nutrition in Inebriety, ....... 383
o.
Opium and Morphine Poisoning, Value of Stomach Washing, . 15
Opium in Gynecology, . . . .251
Opium Delusions, ... ..... 190
Opium Curse and its Prevention, ...... 237
Opium Commission, ....... 296
P.
Price, Dr. Joseph, ........ 125
Psychical History of the Drink Problem, ..... 192
Pohlman, Dr. Julius, ....... 232
Pathology of Delirium, ....... 292
Potter, Dr. W. W.,.340
R.
Remarkable Case of Theaism, ..... . 3 «
Restoration of Inebriate Women, ...... 366
Digitized by ^ooQie
VI
Index.
S.
PAGE.
Statistics of Inebriates, ....... 76
Strychnine Delirium, ....... 196
Strychnine in the Treatment of Inebriety, .... 248
T.
Tobacco Inebriety, its Effects on the Heart, . .21
Tuberculosis and Alcoholism, Predisposition to, ... 28
Tea Inebriety, ........ 95
Temperance Legislation, ....... 102
Tea and Its Effects, . . . .134
Treatment of Inebriates in the District of Columbia, . . 221
Tours, Dr. M. De, . . . . 222
Tobacco and Blindness, ....... 247
Trional as a Hypnotic, . . 263
Tobacco Smoking in Disease, ...... 295
Treatment by Suggestion, ....... 307
Training Essential in the Study of Inebriety, .... 381
u.
Use of Cocaine on the Race Track,
W.
Wood, Dr. James, ........ 134
Walsh, Dr. David, ........ 144
Workshops and Drink, .144
Waugh, Dr. Wm. T., ....... 152
Walnut Lodge Report, . .156
Wilson, Dr. Andrew, ....... 254
Digitized by ^ooQie
r
Digitized by t^-ooQLe
Digitized by
THE
Quarterly Journal of Inebriety.
Subscription, $2.00 per year.
Vol. XVII. JANUARY, 1895. No. 1.
This Journal will not be responsible for the opinions of contributors, unless
indorsed by the Association.
THE PROBLEM OF HEREDITY IN REFERENCE
TO INEBRIETY*
By Thomas Morton, M.D., M.R.C.S.
The problem of heredity, by which I mean the transmis¬
sion of parental and ancestral characters to each new genera¬
tion of organic beings, is one of transcendent interest in
biology at the present time, not only because it seems to hold
the key to a large part of evolution, but on account of its
relations to many social, moral, and even political and re¬
ligious questions.
If I am right in assuming a general belief or impression
among temperance men that a tendency to inebriety may be
inherited —and I believe few of us doubt it — we cannot be
indifferent to the controversy which is raging on the subject
of heredity in general. The laws of heredity, whatever they
may ultimately prove to be, must necessarily govern the
transmission of inebriety, and the facts of inebriety must oc¬
cupy a place in the body of phenomena, by induction from
which those laws will be formulated.
* Read Oct. 4, 1894, before the English Society for the Study of Inebriety
at London*
Digitized by i^-ooQie
2 The Problem of Heredity in Inebriety .
We know that every individual, even the most complex,
takes its rise from the division and subdivision of a single
cell or its nucleus, constituting the essential part of a bud or
a fertilized ovum, in which latter case the nucleus itself re¬
sults from the union or conjugation of a male and a female
pronucleus, derived respectively from each parent. But how
is it that this extremely minute particle of matter can convey
to the new being, into which it is destined to develop, the
precise configuration of the parent form, nay, the very pecu¬
liarities, temperaments, and predispositions, not only of an
individual, but of a family or breed.
The older and still popular idea was that the reproductive
elements were, in a vague way, a sort of quintessential distil¬
lation of the parent body ; as Buffon puts it, “ un extrait de
toutes les parties du corps ” ; and, related to this, but elabora¬
ted to a high degree, and based in the true scientific spirit on
the widest induction from masses of facts relative to repro¬
duction in its various forms, development, reversion, and in¬
heritance, both of ancestral and acquired characters, is Dar¬
win’s splendid, but confessedly provisional, hypothesis of
“ Pangenesis,” which, to use his own words, “ implies that the
whole organization, in the sense of every separate atom or
unit, reproduces itself. Hence ovules and pollen grains —
the fertilized seed or egg, as well as buds — include and con¬
sist of a multitude of germs thrown off from each separate
atom of the organization ; ” or, in another passage, 41 that all
organic units, besides having the power, as is generally ad¬
mitted, of growing by self-division, throw off free and minute
atoms of their contents, that is, gemmules. These multiply
and aggregate themselves into buds and the sexual elements,
their development depends on their union with other nascent
cells or units, and they are capable of transmission in a dor¬
mant state to successive generations.”
Wholly different in its fundamental conception, and
sharply contrasted with this, is Weismann’s theory of the
“ Continuity of the Germ Plasm,” so called, which now, it
may be said, holds the field, and which teaches that "the
Digitized by ^ooQie
The Problem of Heredity in Inebriety .
3
germ cells are not derived at all, as far as their essential and
characteristic substance is concerned, from the body of the
parent, but directly from the parent germ cell, from which
the individual has also arisen ; so that heredity is brought
about by the transference from one generation to another of
a substance with a definite chemical and, above all, molecu¬
lar constitution/’ and, “ from this identical starting point an
identical product necessarily arises.”
Perhaps this further quotation will bring out his meaning
rather more clearly, “ in each ontogeny (or generation of a
new individual) a part of the specific germ plasm contained
in the parent egg cell is not used up in the construction of
the body of the offspring, but is reserved unchanged for the
formation of the germ cells of the following generation ; ”
and it is interesting to compare this with the words of Mr.
Francis Galton, who, in 1872, anticipated Weismann by say¬
ing that “ each individual may properly be conceived as con¬
sisting of two parts, one of which is latent and only known to
us by its effects on his posterity, while the other is patent
and constitutes the person manifest to our senses.” This
idea of the soma or body as, so to speak, a sort of appanage
of the germ plasm, runs through all Weismann’s work, and
he even, in metaphor, compares the germ plasm to a creep¬
ing underground root stock which throws up leaf shoots at
intervals.
It is obvious that, on such a conception as this, the latent
qualities of the germ plasm must entirely control and domi¬
nate the sensible characters of the body, which expresses
them, but can have little or no reciprocal influence on the
germ plasm. And accordingly we find that Weismann and
his school almost wholly disbelieve in, and take great pains
to dispute, the hitherto received idea of the transmissibility
of acquired characters, which Darwin himself and most Eng¬
lish biologists have assumed to play a considerable, though
subordinate, part in the process of evolution.
And, with reference to this question, he draws a distinc¬
tion, which is certainly valuable and tends to clearness, be-
Digitized by ^ooQie
4
The Problem of Heredity in Inebriety .
tween characters acquired or supposed to be acquired in the
ordinary sense by the effects of the use or disuse of organs,
by habits of life, or the reaction of the organism under the
various influences of the environment, and those which are
acquired in the course of evolution by spontaneous variations
controlled by natural or artificial selection. A moment's
thought will satisfy us that these latter are really potentially
present in, and depend upon, molecular changes in the germ
plasm, before they make their appearance in the soma or
body, and he proposes to call them blastogenic , in contradis¬
tinction to the former, which he terms somatogenic.
It must be at once evident that an inebriate tendency aris¬
ing from the intemperance of a parent must fall under the
somatogenic category, and consequently be disallowed by
Weismann and his school, so that if his theories are to be ac¬
cepted in their entirety we must say good bye to a belief in
inebriate inheritance as ordinarily understood.
But are they to be accepted in their entirety ? When I
spoke just now of the theory of the Continuity of the Germ
Plasm as holding the field, I did not, of course, mean to im¬
ply that it might now be regarded as established, but merely
that it occupies such a position that round it the battle
chiefly rages, and upon its proof or disproof the issue of the
controversy must mainly turn.
It has the support of great English authorities, among
whom I may name Alfred Russell Wallace and Ray Lancas¬
ter, but it is of course incompatible with the teaching of
Herbert Spencer, who, as is well known, attaches the great¬
est importance to the influence of the environment, not only
on the individual but the race, and it traverses that of Dar¬
win himself, who, in repeated passages, down to a late period
of his life, admitted that “ a great value must be given to the
inherited effects of use and disuse, some also to the modifica¬
tions in the direct and prolonged action of changed condi¬
tions of life.” Prof. Vines has, also, published a searching
criticism of Weismann's views ; and Prof. Turner describes
himself as “ unable to accept the proposition that somatogenic
Digitized by LjOOQie
The Problem of Heredity in Inebriety .
5
characters are not transmitted/' and adds, “ I cannot but
think that they form an important factor in the production
of hereditary characters.” Even Francis Gal ton who, as I
have mentioned, himself anticipated the theory, makes a sim¬
ilar admission ; though he says, “ the effects of use and dis¬
use of limbs and those of habit are transmitted to posterity
in only a very slight degree.”
I cannot help thinking that here is the weak point in
Weismann’s teaching, and that he will not succeed in making
good the absolute seclusion of the germ plasm from all soma¬
tic influences, upon which he insists with the warmth of a
partisan and with excessive ingenuity. But his teaching is
probably in the main true, and at any rate it has to be reck¬
oned with by those who wish to retain that most powerful
argument for abstinence which is based upon the assumed
transmission of the physical results of intemperance to gen¬
erations yet unborn.
How, then, do we stand who not only wish this but are
convinced, from what we have ourselves seen of inebriety,
that there is truth in the assumption on which the argument
is based.
It seems to me, that the time has come for reconsidering
the assumptions on this subject which pass current among
us, defining them more carefully, and attempting a positive
demonstration of so much of them as can be proved; and
this, not only in the interests of truth, and for our own satis¬
faction and encouragement in our warfare with drink, but in
order to compel the attention of that enormous public, of all
grades of intelligence, who will not take the trouble to listen
to or understand us, and who more or less consciously justify
themselves by regarding us as prejudiced enthusiasts. If
what we have believed and taught on this particular subject
cannot be maintained in all its fullness we ought to know it,
and modify our teaching accordingly; and if it can the biolo¬
gists ought to know it, and it is sure of a hearing, as it bears
directly upon the vexed question of the transmission of ac¬
quired characters.
Digitized by t^-ooQie
6
The Problem of Heredity in Inebriety .
The object of my paper is not to attempt any such demon¬
stration as I have suggested, but after pointing out, as I have
done, the importance of its being given at the present
juncture in the course of scientific thought and of temper¬
ance advocacy, to indicate the chief difficulties which beset
the task, and the lines upon which I think it should be
attempted.
1. In existing statistics on the subject it does not seem
to be sufficiently recognized that it is one thing to establish
the fact that the children of intemperate parents are apt to
be afflicted with degeneracy and various neuroses, and
another to prove that they inherit a special proneness to ine¬
briety. The class of observations available for the latter
purpose is much narrower and more difficult to verify than
for the former. Both are available for temperance advo¬
cacy, but the latter is what the scientific world wants and will
listen to.
2. It is not sufficient to show that a large number of de¬
generates and inebriates have intemperate parents, or, con¬
versely, that intemperate parents produce a large number of
degenerates and inebriates, without knowing, as a standard
of comparison, what proportion of the general public have
intemperate parents, or, conversely, what proportion of de¬
generates or inebriates average parents produce. The late
Prof. Demme, of Stuttgart, evidently recognized this, and
based upon it some excellent work in the comparison of the
direct descendants of ten families of drunkards, and ten with
temperate parents. The results were very striking as to de¬
generacy, but less so as to inebriety.
3. It must be remembered that mere degeneracy or in¬
sane neurosis involving defective control, not necessarily de¬
pending on alcoholic abuse in the parents may show itself in
the form of alcoholic excess if circumstances favor that
particular form of excess instead of some other. Many typi¬
cal inebriates have an insane parentage, and such cases go
to prove inebriety to be a neurosis, but do not prove the
transmissibility of an acquired taste for alcohol.
Digitized by t^-ooQie
The Problem of Heredity in Inebriety\
7
4. It seems to have been taken for granted that, when
the link of parentage exists between two inebriates, the link
of heredity may safely be assumed ; but we know well that
drinking habits will of themselves establish a condition of
inebriety in a person of sober parentage, and the children of
drunkards are more likely than others to acquire an inebriate
constitution in this way, from early familiarity with alcohol.
This is an objection peculiarly difficult to meet, even in those
strong cases where two or three brothers or sisters are simi¬
larly affected; as the only cases which would afford a stand¬
ard of comparison would be those of the children of temper¬
ate parents brought up by intemperate relatives. A
somewhat similar objection might be urged as regards
degeneracy. The mortality among the children of drunkards
is known to be enormous, from the poverty, disorder, and
misery in which they are commonly brought up, and many
of those who survive may naturally be expected to be puny
and feeble in body and mind, independently of any congeni¬
tal defects they may bring into the world with them.
So much for the objections which, I conceive, fairly lie
against assuming as a matter of course that acquired in¬
ebriety may be transmitted to descendants. I think that if
they are to be fairly met it will be necessary to sift and re¬
arrange the data which we already possess, with constant
reference both to some such standards of comparison as
I have suggested, and to the distinction between general
degeneracy and the special inebriate condition. And they
should be supplemented by further observations upon
Demme’s excellent plan. After all, the proof of such a
proposition must necessarily be of a cumulative kind, and
rest upon the convergence of several lines of argument,
neither of which is absolutely conclusive in itself. And
there is one special set of cases which afford perhaps the
strongest argument of any. I mean those of remarkably
precocious inebriety, if, as I believe, they are never met with
except in the families of intemperate persons. Observations
on this point are much needed and would be of great value.
Vol. XVII.—2
Digitized by
Google
8
The Problem of Heredity in Inebriety .
Let us now, quitting fact for theory, turn again to the
biological aspect of the question, and, admitting almost com¬
pletely Weismann’s contention that the characters im¬
pressed on the germ are, so to speak, antecedent to and
independent of those which its bearer’s life history may
impress on his or her soma , and that there does not exist any
mechanism by which these latter can be impressed upon or
registered in the germ, let us enquire whether there does not
nevertheless exist a mode in which the bearer’s drinking
habits may, and indeed must, affect it or the being into
which it is destined to develop. “ The blood is the life,”
and even the exclusive and independent germ plasm must
share in the life of its bearer so far as to be nourished and
kept alive by the same blood stream. And if this blood
stream is constantly poisoned at its source by a large infu¬
sion of a soluble substance inimical to healthy cell life, and
especially to that which is youngest and that which is most
complex, should we not confidently expect the tremendous
but exquisitely delicate potentialities of the germ cell to
suffer some disorder ? And, if this be admitted of the quies¬
cent unimpregnated germ, which has simply to maintain and
multiply its life like some unicellular organism, what shall
we say of the impregnated germ, which has entered upon its
career of development, and is drawing to itself large and
hourly increasing supplies of nourishment, for many months,
out of the maternal blood, which ex hypothesi contains
alcohol in pathological percentage.
Do we not have here an ample and abundant explanation
of the greater potency of inheritance through the mother,
which seems to be acknowledged by all observers of alcoholic
degeneracy, and which ought to be kept clearly in view in the
future collection of statistics ?
And we may even go further, and see with the mind’s
eye the genesis, not only of degeneracy, but of inebriety.
We know that one of the characteristic properties of alcohol
is to establish a tolerance of itself in tissues where its pres¬
ence was at first resented as a disturber, and before long to
Digitized by
Google
The Problem of Heredity in Inebriety . 9
become apparently so indispensable to their smooth working
that its temporary absence is felt to be intolerable. Where
alcohol is a constant constituent of the nutritive fluid, it
is easily conceivable that the nine months of intra-uterine
life may suffice to establish in the tissues of the embryo such
a tolerance of alcohol, or intolerance of its absence, as may
be readily revived again from time to time during childhood,
by the taking of alcohol, and finally re-established in later
life. The tissues seem to have a sort of memory of their
own, in virtue of which they, as it were, recognize and
respond to familiar stimuli when again brought into their
presence after an interval.
Mr. President, I am painfully conscious that I occupy
to-day the unpopular position of advocatus diaboli. But, as
the result of that functionary’s labors is usually to establish
more firmly and indisputably the sanctity of the person
whose claims to canonization he opposes, so I trust that my
criticisms will lead in the end to the clearing up of all doubt
and confusion on the subject of hereditary inebriety, and to
the placing of it beyond all cavil or question.
DISCUSSION.
The president, Dr. Kerr, after expressing his high opin¬
ion of the philosophical and scientific merits of the paper,
and concurring in the suggestion of a re-arrangement of all
the facts that could be collected as to cases illustrating
transmission of inebriety, submitted that Weismann’s
theory of the non-transmissibility of acquired characters was
untenable from even the comparatively few facts as yet
ascertained. It* was extremely improbable that the germ
plasm could remain through generations uninfluenced and
unmodified by the human envelopes in which it was for
a time encased. The theory was merely a hypothesis, but
he was afraid it was incapable of disproof as it was of proof.
The conditions of both appeared to him impossible. They
could not experiment in breeding with human animals. He
had seen cases of abnormal family trees which he thought
Digitized by ^ooQie
10
The Problem of Heredity in Inebriety .
negatived Weismann’s proposed law. The Jukes genealogy
in America and the Phultain in Britain were illustrations.
The great desideratum appeared to the president to be the
accumulation of facts. Probably to our successors must
belong the deduction of general laws from a sufficiently wide
induction of facts.
Dr. H. Rayner complimented Dr. Morton on his paper,
which aimed at getting a clear scientific basis for our views
on inebriety in a scientific manner.
Dr. Rayner agreed with the president in antagonism to
Weismann’s theory, and in considering it incapable of
proof, but held that disproof was possible.
Recent microscopical investigations had by means of
chemical reagents shown distinct changes in nerve struct¬
ures as minute as those of the germ cells, in persons dying
under the influence of alcohol, and an extension of the
observations to the germinal cells would probably give simi¬
lar results. Should this be the case, Weismann’s theory
would appear to be untenable.
Dr. A. M. Holmes, Denver, Colorado: —
Mr. President, Ladies and Gentlemen :
It is a rare pleasure to be present with you to-day, and
hear the valuable paper that has been read. I would much
prefer not to enter into the discussion of this difficult sub¬
ject, since my opinions on many of these points are very
imperfectly formed. I may say, however, that for some time
past I have been much interested in the problems of hered¬
ity, and believe that so long as there are honest differences
of opinion among students of biology, just so long should
those who are interested in the mention of these problems
avail themselves of every opportunity to study them. If the
suggestions that have been so ably presented in the paper
to-day are adopted, they will hasten the day when many of
these problems will be less complicated.
In The Contemporary Review for October, in an able
article entitled “Weismannism Once More,” Mr. Herbert
Spencer reviews the discussion between himself as maintain-
Digitized by
Google
The Problem of Heredity in Inebriety .
II
ing that acquired characters are inherited, and Professor
Weisraann, who believes in the “ All-sufficiency of Natural
Selection,” and repeats the statement which he has often
made before, that “ the question whether acquired characters
are inherited is the most important question before the sci¬
entific world.”
Those who oppose the theory of the “transmission of
acquired characters,” agree with those who favor it, that
there are certain characters that are transmitted, but that
these are potentially present in the germ plasm — stable
qualities or so-called “ fixed characters ” of the plasm.
Those who accept the theory of evolution must grant
that at some remote period the so-called “ fixed characters ”
were acquired. Consequently I am unable to reconcile a
belief in the theory of evolution with disbelief in the theory
of the “ transmission of acquired characters.”
Can there be any other alternative than that these “fixed
characters ” either always existed, or that they have been ac¬
quired ?
If they have always existed in what Professor Weismann
terms the “ Continuity of the Germ Plasm,” what function,
then, shall we ascribe to evolution ?
Or if they have been the result of the slow process of
development — the effect of use, the influence of well-
selected environment, together with natural selection — then
we must not discard the theory of the “ transmission of ac¬
quired characters ” altogether.
After a rather careful observation of the phenomena of
life, I am very frank to acknowledge that unless I accept the
theory of the “ transmission of acquired characters,” I am
unable to account for the marked resemblance between
certain characters which are often observed in parents and
their offspring, which, to all appearances, have been acquired
by the one and certainly are possessed by the other.
When we adopt a more systematic method of collecting
accurate data concerning the influence of heredity, I have
little doubt that its anatomical, physiological, psychological,
Digitized by t^-ooQLe
12 The Problem of Heredity in Inebriety.
as well as its pathological aspect will be much more readily
traced from parent to offspring.
Mr. President, I should like to state before closing — if
you will indulge me a moment longer — that I have been
greatly pleased to note the magnitude of the work that your
society is accomplishing, especially its efforts in tracing the
hereditary effects resulting from the habitual use of alcohol.
One of the most genuine pleasures that I have experi¬
enced since I have been in your city, has come from reading
the very excellent work on 14 Inebriety ” by your dis¬
tinguished President. His effort in tracing the influences
of heredity into the realms of pathology, is destined to
change many of the opinions formerly held concerning the
liquor question, and the dreaded disease— Inebriety.
Mr. President, allow me to thank you for the courtesies
of this society.
Mr. President: — You are aware that for the last thirty
years I have been connected with an establishment for the
cure of inebriety, and am therefore in a position to speak
upon the hereditary taint to which the majority of these
cases owe their origin. But I will give you four particular
cases, each of which is marked with its own peculiarities.
The first case came under my notice some twenty-five
years ago. A lady, the wife of a professional man in
London, was placed under treatment, remained a full year,
and returned home cured. For twelve years she did not
touch stimulants ; but, at the end of that time, being ill, she
was ordered to the seaside, a medical man there being
in attendance on her. Not being aware of the previous his¬
tory of the case, he ordered her stimulants, and in a few
months time the drinking mania was again developed, and
she was, for the second time, placed under treatment. Her
friends, however, would not allow her to remain for more
than two months, and therefore, when she returned home,
she relapsed and died.
The next case brought under my notice is a peculiar one ;
for the whole of the female branch of the family, with one
Digitized by ^ooQie
The Problem of Heredity in Inebriety . 13
exception, had the taint of inebriety well marked, but the
male portion entirely escaped. The family consisted of five
daughters and three sons. Two of the daughters died from
the results of their habits, the third’s brain has partly given
way, and the fourth was placed under treatment twelve
years ago, and was perfectly cured. But she has informed
me recently that she has never entirely lost the desire for
stimulants, and if a strange medical man is called in and
orders her wine, she always tells him of her hereditary
tendency, and, in that way, protects herself from the disas¬
trous consequences which would result from her carrying out
his instructions.
The third case is that of a lady who informed me that
when she and her brother, the two eldest children, were
born, the father was very fond of taking large quantities
of stimulants. But after that he became a total abstainer,
and five other children were born. The two eldest, that is,
she and her brother, were confirmed inebriates all their
lives, while the five younger ones were all total abstainers.
The fourth case is that of two children of a confirmed-
inebriate mother, a boy and a girl. Their father was obliged
to separate himself from his wife on account of her habits,
and the two children were brought up total abstainers, and
the daughter remained so up to the time of her marriage,
when her husband, who was a merchant, wished her to take
wine. After she had been taking it about two years, she
became a confirmed inebriate like her mother, and was
placed under treatment. The brother informed me that he
was always careful himself not to take stimulants, fearing
that it might lead to the same disastrous results as in the
case of his sister.
I think, Mr. President, these four cases, selected from
hundreds of well-marked cases of hereditary inebriety which
have been brought under my notice, go to prove that there
is a strong hereditary tendency in the majority of cases
placed under treatment; and it also shows, that, where the
hereditary tendency does exist, it does not die out. It may
Digitized by LiOOQle
14 The Problem of Heredity in Inebriety .
remain dormant, as I have shown in three of the cases
quoted, but it can be brought again into activity by the
taking of stimulants. Therefore, the only safety is for the
patients to acknowledge that they have this hereditary tend¬
ency, and never touch stimulants for the remainder of their
lives.
Dr. Murray looked upon the eagerness with which infants
and little children looked for liquor from their mothers when
in public houses, as a proof of heredity.
Mr. Raper had been considerably comforted by the fact
stated by the President and supported by other medical men,
that sometimes children of drunken parents, shocked at the
example set them at home, become resolute abstainers, as he
had been formerly discouraged by the fear that alcoholic he¬
redity would be too strong to be overcome by many of the
young.
Dr. Morton, in reply, on the general question of Weis¬
mannism, pointed out how difficult it is to prove that any
transmitted character has had its origin in habit or reaction
to environment, and not in so-called spontaneous variation
consequent on the .continual blending of different stocks in
sexual generation. It had been said that Weismannism was
incapable of demonstration, but the same might have been
said of Darwinism.
As to inherited inebriety, all the cases cited confirmed
him in the conviction that the evidence, though ample,
required re-arrangement. It was true that drunkards* chil¬
dren were often strict abstainers. Such cases might be
cited against inebriate inheritance, but they proved nothing,
as such persons might be incapable of moderation in drink.
They were, however, a great encouragement against pes¬
simism on this subject.
Digitized by t^-ooQie
Opium or Morphine Poisoning.
IS
ON THE VALUE OF REPEATEDLY WASHING
OUT THE STOMACH AT SHORT INTERVALS
IN CASES OF OPIUM OR MORPHINE
POISONING.
By Prof. L. P. Hamburger,
Pharmacological Laboratory of John Hopkins University .
Among the many researches that have been made
on the physiological, therapeutical, and toxicological proper¬
ties of morphine since its isolation by Serttirner in 1817,
those of Marm6,* Leineweber,f Alt,J and Tauber,§ demon¬
strating its elimination by the gastric mucous membrane,
take a leading place. The medical profession in general
does not seem, however, to be familiar with the practical
applications that may be made of this discovery, and it is
worth while to record the following case of opium-poisoning
in which a chemical examination was made of the urine and
of successive stomach washings, especially since the results
agree with those found by the above-mentioned investigators
in their experiments on animals.
On the evening of May 2, 1894, 660 cc. of a sherry-red
fluid was sent from the hospital to the pharmacological labor¬
atory, the liquid being part of the washings of the stomach of
a Chinaman, Lee Hee, who had attempted suicide. '
A report was requested as to the kind of poison that had
been taken. The fluid was clear, with a few bits of orange
pulp floating in it, and it smelled faintly of crude opium; it
was filtered and gave the characteristic meconic acid reaction,
* Untersuchungen zur acuten u. chronischen Morphinvergiftung. Deutsche
Med. Wochneschr., 1883, nr. 14.
fUeber Elimination subcutan applicirter Arzneimittel durch die Magen-
schleimhaut. Inaug. Dissert., Gottingen, 1883.
\ Untersuchungen iiber die Ausscheidung des subcutan injicirten Morphins
durch den Magen. Berl. Klin. Wochenschr., 1889, nr. 25.
§ Arch. 5. exp. Path. u. Pharmakol., Bd. 27, S. 336.
Vol. XVII.— 3
Digitized by C^ooQie
16 Opium or Morphine Poisoning.
namely, the red color with ferric chloride or ferrous sulphate
which persisted on the addition of hydrochloric acid and also
when boiled. A second portion of the filtered fluid was
made alkaline with sodium hydrate, shaken up with ether,
the ether removed and evaporated, the yellowish-white residue
from the ether dissolved in a little acidulated water and this
solution examined for alkaloids. It responded perfectly to
the following reagents: platinic choloride, iodine in potassium
iodide solution, sodium molybdate sulphuric acid (Frohde),
potassium-bismuth iodide and potassium-mercuric iodide.
The presence of meconic acid and of alkaloids being demon¬
strated, it became evident that we were dealing with poisoning
by opium.
Lee Hee is supposed to have taken the opium at about
10 A. m., and the quantity taken we estimated to be at least
ten grams, judging from the amount that still remained in
the little jar which was known to have been full when the
suicide was attempted.
About half-past five Lee Hee was brought into one of
Prof. Osier’s wards in a comatose condition, and it was evi¬
dent from the state of his respiration and circulation that he
was hot likely to recover. At this time the stomach was first
washed out and the process was repeated until the physicians
in charge had reason to think that there was no longer any
opium in the stomach. A second lavage was made at 8 p. m.
and a third at half-past eleven, a quarter of an hour before
death. The fluid secured in these last two washings was
colorless, and from this fact it may be concluded that all the
crude opium had been removed by the first washing, though
unfortunately this conclusion could not receive positive proof,
since the last portion of the first washing was not kept sepa¬
rate from the rest and chemically examined. All three wash¬
ings were examined for opium and morphine and the results,
which will presently be given, at least demonstrate the
practical value of repeated stomach washings, even after all
ordinary signs of opium, such as color and odor, are no longer
found.
Digitized by L^OOQie
Opium or Morphine Poisoning,
1 7
At 6 p. m., 75 cc. of urine was removed by the catheter
and submitted to a chemical examination by Landsberg’s
method for the detection of morphine in the urine.* The
residue finally obtained was a mixture of urea and morphine.
No difficulty was experienced in identifying the former; it
appeared in the characteristic four-sided prisms with pyrami¬
dal ends. In addition to these crystals of urea there were
seen numerous very small rhombic prisms. Whether the
latter were certainly crystals of morphine was not determined;
nevertheless, the chemical tests demonstrated the presence of
morphine in considerable amount. This difficulty in separ¬
ating morphine from urea is not peculiar to this case,f but is
due to the fact that both behave toward solvents in much the
same way. Control tests showed that urea does not interfere
with the following morphine reactions. A minute quantity of
the residue dissolved in water and treated on a porcelain dish
with a drop of ammonium molybdate, gave a yellow precipitate,
and the addition of a drop or two of concentrated sulphuric acid
caused that beautiful play of colors, violet, blue, and green,
which solution of morphine give under the same conditions
(Frohde). A fragment of iodic acid added to the diluted
residue was reduced and the free iodine recognized by shak¬
ing with chloroform. In this way the presence of morphine
in the urine was demonstrated. In the present case, therefore,
there was no difficulty in proving the elimination of at least a
part of the ingested alkaloid through the urine. Yet there is
probably no point in the physiological history of morphine
which has given rise to more controversy than its presence
or absence in this excretion. The controversy involves not
only the immediate experimental result but the more gen¬
eral problem of the fate of morphine in the body. Thus,
some observers, after demonstrating that the alkaloid was
present in the urine, claimed that it passed through the
body unchanged; others, failing to find it, argued that it
suffered a destructive oxidation and could not be demonstrated
♦Pfliiger’s Archiv, Bd. 23, S. 425 (1880).
t Neubauer u. Vogel, Analyse des Hams, Th. i, S. 359.
Digitized by LjOOQie
18 Opium or Morphine Poisoning.
as morphine in the urine. But it is now generally admitted
that after large doses of the alkaloid a small quantity appears
in the urine.
It is in the stomach, however, that the elimination of
morphine proceeds most actively. The practical importance
of this gastric excretion will be evident upon considering the
results of the stomach washings in the present case.
Of these there were three, as already mentioned. The
first was the sherry-red fluid, giving meconic acid reactions,
and upon treatment by the method of Stas, alkaloidal re¬
actions. This fluid was treated like the urine and a similar
brown residue was obtained. This residue was dissolved in
water, acidulated with hydrochloric acid and again evaporated.
During this evaporation a white precipitate separated out,
which upon examination was found to be calcium phosphate,
one of the inorganic constituents of opium. Having removed
this salt, the residue was dissolved in warm absolute alcohol
and allowed to evaporate spontaneously. Morphine crystals
of a definite type were not obtained, but the solution gave
beautiful morphine reactions, reducing iodic acid, responding
to Frohde’s reagent, and giving a pink color with sulphuric
and nitric acids (Husemann).
As already stated, it was believed that all the opium was
removed during the first washing, and the fact that the
second washing came out colorless seems to confirm this view.
Nevertheless, the latter liquid. gave fine alkaloidal reactions,
but did not respond to the tests for meconic acid. In other
words, at the first washing the ingested but unabsorbed
opium was removed; between this first lavage and the second
the alkaloids had accumulated again. How ? It could only
have been through an excretion by the gastric mucous mem¬
brane. Nor did the elimination of the poison stop at this
period; for the third washing, made several hours later, color¬
less also, still gave good reactions.
The meaning of these results must be clear. They point
to the excretion of the alkaloids of opium by the mucous
membrane of the stomach and suggest a practical application
Digitized by t^-ooQie
Opium or Morphine Poisoning .
19
of this fact. If, as has been shown, these alkaloids, and mor¬
phine in particular, are excreted into the stomach, then wash¬
ing this viscus repeatedly and at very short intervals to
remove the alkaloids as fast as they are eliminated, must cer¬
tainly be a life-saving process, whether the poison has been
taken by mouth or hypodermically. Poisoning by the latter
method has not, as far as can be ascertained, been treated in
this manner, in spite of Alt’s demonstration of the presence
of morphine in the stomach washings of men who had re¬
ceived 3 eg. of the hydrochlorate subcutaneously. The
quantity of the alkaloid capable of being removed by repeated
washings has been estimated at almost one-half. Tauber also
recovered 41.3 per cent, from the faeces of dogs to whom
morphine was administered subcutaneously but where the
stomach had not been washed out. Alt has ascertained that
for dogs, doses of more than 10-12 eg. morphine pro kilo
maybe considered lethal; 17 eg. pro kilo almost invariably
caused death. On the other hand, if, immediately after the
injection, the stomach was washed and the lavage continued
for forty-five minutes, then 10-12 eg. pro kilo never produced
serious symptoms, and indeed with 17 eg. and even 20 eg.
pro kilo the symptoms of poisoning were not so severe as
when 12 eg. were administered without repeated washing.
Two dogs were saved after the injection of so large a quan¬
tity as 24 eg. pro kilo. This evidence goes to prove that
the excreted morphine is reabsorbed and that it still has toxic
properties; and may not the frequent relapses following ap¬
parent recoveries from overdoses of morphine* also furnish
proof of such reabsorption? By a continuous lavage the ex¬
change that goes on between the gastro-intestinal mucous
membrane and the general system would be interrupted, and
in proportion as the alkaloids excreted by the mucous mem¬
brane are removed the effects of their reabsorption would be
avoided. Conformably to the results of Alt’s experiments,
♦See, for example, Souchon: “On relapses following recoveries from
overdoses of injections of morphine,” N. Orl. M. & S J., XIV, pp. 437-39,
1886-87 ; Taylor: “Lancet,” Vol. 1, p. 937 (1884).
Digitized by CjOOQie
20
Opium or Morphine Poisoning.
the lavage should be repeated at short intervals, and the
sooner this can be done after the opium or morphine has
been taken the better. In the case cited in this paper no
successful outcome could be anticipated, because too long a
time elapsed between the taking of the opium and the be¬
ginning of the treatment.
In connection with this subject it may be well to repeat
Kobert’sf suggestion, that a chemical examination of the
faeces should be made in cases where the morphine habit is
suspected but is denied by the patient and where for various
reasons it is difficult to secure conclusive evidence of the
fact in other ways.
This incident is sent to us by a railroad surgeon and
vouched for as correct. An engineer who had been on the
road twenty years was laid up with influenza two years ago,
and since then has drank spirits to excess at intervals,
especially at night. The superintendent paid no attention to
this and permitted him to go on his usual daily runs. One
day he came in to the end of his route very much intoxicated,
ran up to the yard, and left his engine in the proper place,
then staggered back towards the depot muttering. The
train he brought in went on, when suddenly he sprang on
a waiting engine and started down the road after the train.
The yardmaster conceived this to be a drunken freak, and
wired to turn the switch off from the main line at a distant
station. This was done just in time to avert dashing into
the rear of the passenger train. The engine was ditched
and the engineer escaped unhurt and was taken to an asylum
with acute mania, where he is still confined. A very serious
accident was narrowly averted and the stupidity of per¬
mitting an inebriate engineer to run a train was literally
criminality of the most flagrant type.
t Lehrbuch der Intoxikationen, p. 561.
Digitized by t^-ooQie
Tobacco Inebriety , and its Effects on the Heart.
21
TOBACCO INEBRIETY, AND ITS EFFECTS ON
THE HEART*
By James K. Crook, A.M., M.D.,
Instructor in Clinical Medicine and Physical Diagnosis , New York Post-Gradu¬
ate Medical School and Hospital,
As far as we can learn the use of tobacco was adopted by
the Spaniards from the North American Indians early in the
sixteenth century. In the year 1560, it was introduced into
France by the Ambassador of that country at the Portuguese
court, Jean Nic^, whose surname is perpetuated in the gen¬
eric title of the plant. It is believed that Sir Walter
Raleigh, who learned the qualities of tobacco from the Vir¬
ginia Indians, introduced smoking into England. The alluring
weed met with a warm response in the affections of male hu¬
manity, and it soon became one of the ruling passions. In
the various habits of chewing, smoking, and snuffing it is now
largely consumed in every country on the globe. In return
for this somewhat dubious blessing European civilization
taught the noble red man the potent virtues of firewater —
not an uneven exchange. The limitation of the habit to males
is, no doubt, to a large extent, due to the difficulty which the
fair sex find in overcoming the first repugnance to its odor
and taste, and probably also to a natural higher moral status.
That tobacco, in some cases, produces a deleterious impres¬
sion on the human economy has been recognized by medical
men of all ages since it came into use. There can be no
doubt that these bad effects have become greatly augmented
by the recent enormous increase in the cigarette habit. On
consulting medical literature, however, we are struck by the
paucity of contributions of real value on the subject, most
that has been written being from the pens of moralists and
clergymen, or medical men with some theory to advance or
defend. Among the notable exceptions to this rule may be
* Read before the Clinical Society, March 17, 1894.
Digitized by ^ooQie
22 Tobacco Inebriety , and its Effects on the Heart .
mentioned the classical Fiske Prize Fund essay of 1885 by
Dr. Hobart A. Hare, which practically exhausted the subject
of tobacco in many of its aspects up to that date. Almost
all the text-books and systems of medicine refer to the injuri¬
ous consequences of the excessive use of tobacco, but usually
in the most general terms, and leave the reader with but lit¬
tle practical knowledge regarding these effects. Let us
pause for a moment and consider the chemical nature of to¬
bacco. The following analysis by Possett and Reinmann,
although somewhat antiquated, is with certain modifications
about the most trustworthy extant at the present day.
Nicotine (in 100 parts), .
Volatile oil, ....
Bitter extractive matter,
Gum and malate of lime,
Chlorophyl, ....
Albumen and gluten,
Malic acid, ....
Salts of potassium, calcium, and ammonium,
Silica, .....
Water, .....
0.060
0.010
2.870
1.740
0.267
1.308
0.510
°’o^8
88.280
It will be seen that the acrid, volatile principle, called
nicotianine, subsequently supposed to have been discovered,
has no place in this analysis. This substance has long since
been proved to have no existence as a separate entity,
although the mistake of enumerating it among the chemical
ingredients of tobacco has been perpetuated in the last (1894)
edition of the National Dispensatory. The proportion of
nicotine in the analysis (less than one-sixteenth of one per
cent.) is undoubtedly too small, as subsequent investigators
have ascertained it to be present in proportions varying from
two per cent, in Havana tobacco to more than eight per cent,
in French tobacco. In an analysis of tobacco smoke in
1871, Vohl and Eulenberg found pyridine, lutidine, collidine,
picoline, and other bases of the same series, besides ammo¬
nia and traces of ethylamine. In passing* the vapor through
potassa solution, hydrocyanic, hydrosulphuric, acetic, butyric,
valerianic, carbolic, and probably other acids were retained.
These chemists found no nicotine in smoke, but all subse¬
quent observers state that it is invariably present in greater
or less quantities. Dr. Krause, of Annaberg, besides nicotine,
Digitized by {jOOQle
Tobacco Inebriety , and its Effects on the Heart. 23
sulphuretted hydrogen and cyanogen, found a considerable
proportion of carbon dioxide, and he believes that much of
the poisonous effects in young smokers is due to this gas.
From twelve experiments made by Dr. Krause, it appears
that the quantity of carbon dioxide varies from 5.2 to 13.8
per cent, in the smoke, the average being 9.3. These inves¬
tigations of Krause have been subsequently fully verified by
the chemical experiments of Dr. W. L. Dudley, of the Vander¬
bilt University. As the consumer of the weed never gives
out all the smoke he takes in, it follows that a certain amount
of carbonic oxide poison is inevitable. Most authorities,
however, agree that the alkaloid nicotine represents the chief
poisonous ingredient of tobacco smoke, and it is to that sub¬
stance we must look when dealing with this subject. This
principle, discovered by Vauquelin, but first isolated by Pos-
selt and Reinmann about 1828, is a colorless, or nearly col¬
orless, fluid, having a specific gravity of 1.048. It has an ex¬
ceedingly acrid, burning taste, even when much diluted ; is
very volatile, inflammable, and possesses an odor recalling
that of tobacco. It is strongly alkaline in reaction, and is
capable of forming crystallizable salts with acids. In suffi¬
cient doses nicotine is an intense depressant poison, and is
said to stand second only to prussic acid in the rapidity of its
fatal effects. One-fifteenth of a grain by weight has caused
death in a human being, and one thirty-second of a grain is
fatal to cats and dogs. In a case mentioned by Taylor, in
which an unknown quantity of nicotine was taken with sui¬
cidal intent, the victim dropped instantly to the floor insensi¬
ble, gave a deep sigh, and was dead in about three minutes.
The symptoms produced by small doses of nicotine represent
fairly well those of the plant generally. Few tobacco
habitues will forget the horrible nausea, giddiness, vomiting,
and feeling of general wretchedness which characterized
the inaugural chew or smoke. These effects may be repro¬
duced at any time by the exhibition of nicotine in sufficient
quantities. If the amount taken be large, to these symptoms
are added burning pain in the stomach, purging, free urina-
Vol. XVII.—4
Digitized by t^-ooQie
24 Tobacco Inebriety , and its Effects on the Heart .
tion, extreme giddiness, passing into delirium, a rapid, feeble,
and finally imperceptible pulse. Cramps in the limbs, abso¬
lute loss of muscular strength, a cold, clammy skin, and
finally complete collapse, terminating in death. Basing his
calculations on the amount of tobacco produced in the United
States, and the amounts exported and imported, Hare esti¬
mates that each consumer of the weed in this country uses,
on an average, 505 grains of tobacco daily. Taking four per
cent, as the average proportion of nicotine, we find that the
ordinary smoker is daily exposed to rather more than twenty
grains of one of the deadliest poisons known to science. To
be sure, only a small percentage of this poison finds its way
into the patient’s system. As nicotine is very volatile, some
of it is lost by heat in smoking, some is caught by the fibres
of the pipe (in pipe smoking), while a great part is lost in the
smoke and by expectoration. That a certain quantity of
nicotine does enter the circulation, both in chewing and
smoking, is readily shown by its speedy and marked effects
in those not habituated to the use of tobacco.
Having thus ascertained that this plant contains a viru¬
lent poison in large quantities, and its vapor at least one ad¬
ditional, highly noxious agent in carbonic oxide, the question
arises, Does the daily introduction of these agents into the
human system give rise to injurious effects, and what are
these effects ? It is well known that the race from which we
acquired the use of tobacco was composed of hardy and ac¬
tive men, and even the most zealous anti-tobacco writer has
been unable to show that European races have degenerated
either in physical or intellectual vigor since the advent of the
habit. The experiments of Dr. William A. Hammond,* upon
his own person, almost forty years ago, showed that in mod¬
erate quantities to a healthy adult, tobacco produces no ap¬
preciable injurious consequences, but, on the contrary, that
it seems to possess certain sustaining properties, and enables
one better to withstand a deprivation of the normal food sup¬
ply. Further than this, we see daily, on every hand, men
* Am. Jour. Med. Sci., 1856.
Digitized by t^-ooQie
Tobacco Inebriety , and its Effects on the Heart. 25
who have sufferred no apparent physical deterioration after
years of constant smoking or chewing. The fact, however,
that these habits are in many cases productive of harm to
the human system has been recognized by medical men
almost from the date of their introduction. The sentiment
against tobacco has been so strong as to lead to restrictive
legislation in many countries, and even to-day in France,
Germany, and many parts of the United States, its sale is
forbidden to minors. Among the numerous diseases, dis¬
orders, and conditions for which the use of the plant has been
held responsible, we may mention general debility, stunting
of physical development, color-blindness, amblyopia, amauro¬
sis, ophthalmia, indigestion, cardiac diseases, catarrh of the
nasal passages, cancer of the lips and tongue, premature
gray hairs, baldness, nervous irritability, blunting of the moral
sense, mental aberrations, and even insanity. It is said, also,
to promote sexual decline, and as early as 1622 the Sultan
Monarch prohibited its sale in his dominions on account of
its anaphrodysiac effects. Furthermore, the use of tobacco
is said to produce a dryness of the mouth which water alone
fails to quench, the partially paralyzed nerve terminals of the
buccal mucous membrane and tongue requiring something
more stimulating. It thus originates or increases the desire
for alcoholic indulgence. “ Show me a drunkard who does
not use tobacco and I will show you a white blackbird,” said
Horace Greeley. The scope of the present paper does not
comprehend a discussion of these various conditions, but
simply of the influence of the tobacco habit upon the heart,
with particular reference to its pathological relations. The
physiological action of nicotine upon the circulatory appa¬
ratus has been studied by a number of competent observers
(Brodie, Traube, Tugenbald, Rosenthal, Benham, Hare, and
others), but the exact rationale of its influence is not yet
fully understood. Upon the myocardium the poison appears
to possess but little influence. Immediately after death from
the alkaloid the heart is found pulsating, and according to the
experiments of Dr. W. P. Benham the poison painted on the
cut out heart of a rabbit, or injected into its cavities do not
Digitized by ^ooQie
26 Tobacco Inebriety , * 7 .r Effects on the Heart .
arrest its movements, but, on the contrary, a heart which has
ceased movement is stimulated to renewed action by the ap¬
plication of the drug. These researches of Benham confirm
the somewhat older investigations of Brodie, viz., that
tobacco acts on the heart through its nervous system. Pri¬
marily, nicotine lessens the pulse rate, but how it does this is
still unsettled. The later increase in the pulse rate appears
to be due to paralysis of the peripheral inhibitory apparatus.
The exact cause of the rise and fall of arterial pressure is
likewise not satisfactorily accounted for. In the present
state of our knowledge concerning the effects of tobacco upon
the circulation, we are, therefore, forced to take refuge be¬
hind the still undetermined vaso-motor influence of the drug.
Now we come to a consideration of the symptoms and signs
which indicate the pathological influence of tobacco on the
circulation. What is the so-called “ tobacco heart ” ? An
exact answer to this question is not to be found in medical
literature, nor does the author believe it to admit of a cate¬
gorical reply, unless we say it is a form of heart trouble due to
the effects of tobacco. According to the author’s experience
there is no complex of symptoms which typify the effects of
tobacco. We find in tobacco habitues all grades and condi¬
tions of nervous, painful, or oppressed cardiac action depend¬
ing upon the age of the patient, the amount of tobacco con¬
sumed, the continuance of the abuse, etc. Most new cases,
however, are observed among recent smokers or chewers.
The subject is apt to be a youth, ranging in age from twelve
to twenty years. He probably has a pale face, an anxious
cast of countenance, perhaps tremulous muscles, and is apt
to suffer from heartburn, acid eructations, and other symp¬
toms of indigestion. Most patients of this class readily ad¬
mit the excessive use of tobacco, and some even manifest a
certain degree of pride in the confession. As above stated,
the heart symptoms vary greatly. In mild cases there is
simply a little occasional palpitation, a flutter, or a dart,
which gives rise to but little annoyance. There are no phys¬
ical signs whatever, and the diagnosis of tobacco heart is
made by exclusion. In other cases the symptoms are more
Digitized by t^-ooQie
Tobacco Inebriety , and its Effects on the Heart. 27
pronounced and cause the patient considerable distress and
uneasiness, and there may be some quickening or irregular¬
ity of the heart’s action. In still other cases, and these are
apt to be in older habitues, the cardiac pain amounts to an
actual severe pang, requiring the patient to sit or lie down,
and to abstain absolutely from all muscular effort for the
time being. In a recent case of this kind occurring in the
author’s office, while the patient was under examination, the
face became ghastly pale, a cold perspiration bedewed the
surface, the hands were clasped over the heart, and the pa¬
tient complained of a horrible sense of tightening and oppres¬
sion in the chest. The symptoms fairly represented a well-
marked case of angina pectoris. There was in this case a de¬
cided irregularity, and an occasional intermittence of the
heart’s contractions. These physical signs are not uncom¬
monly found in severe cases of nicotine toxaemia. Ausculta¬
tion, however, is generally entirely negative, or only confirms
what we find by palpitation ; cardiac murmurs, as a rule,
have no place in tobacco heart, except, perhaps, as a se¬
quence of long-continued abuse of the habit. The exact
pathology of tobacco heart is unknown. It probably involves
lesions of the pneumo-gastric nerve which are beyond the
reach of our present methods of investigation. Osier states
that in young lads excessive indulgence may lead to cardiac
hypertrophy, dilatation, and even valvular lesions. Patients,
probably, do not often die directly from the action of tobacco
on the heart, but life is often made miserable, and the victim
useless, by its effects.
The treatment of tobacco toxaemia in recent cases is very
simple, a withdrawal of the cause generally resulting in a
speedy disappearance of the symptoms. There should be no
compromising in this matter, however ; a complete and rigid
abstinence should be invariably insisted upon. In more ad¬
vanced or severe cases some form of internal medication
must supplement the withdrawal of the habit. Any of the
nervines, antispasmodics, or diffusible stimulants used in
functional cardiac disorders due to other causes may be given
a trial.
Digitized by t^-ooQie
28
Predisposition to Tubercular and
PREDISPOSITION TO TUBERCULAR AND ALCO¬
HOLIC DISEASE, AND ITS REMEDY.
By A. B. Freeman, M.D., Joplin, Mo.
Read before the Southwest Missouri Medical Society in Springfield, Mo.,
October, 1894.
No truism ever furnished more numerous and forcible
demonstrations of its truth than that “like produces like/*
In fact, it is one of the most rigidly enforced laws of nature,
amd dependent upon its fixedness is the assurance of the
continuity of the species, otherwise all progeny would abound
in confusion.
Huxley said : “ It is the first great law of reproduction
that the offspring tend to resemble its parent or parents
more closely than anything else.”
That “like produces like” is no truer of man in a physio¬
logical than in pathological state. If he has attained a
diseased condition of his body, he may transmit it to his off¬
spring just as he would endow it with a likeness of any
bodily feature. If his body is contaminated with the tuber¬
culous bacilli he may transmit a similar condition to his
progeny.
Quoting from Ziemson: “ There is, perhaps, no fact of
experience which is regarded as so incontrovertible as the
heredity of tuberculosis.”
Ransom of London says : “ Few medical men who have
been long in practice will doubt the existence of family pre¬
disposition to tubercular diseases. Thus most of us have
seen instances of families of which almost every member has
died of the disease, and others in which members of the
same family, living in different and sometimes far-distant
places, have most of them ultimately succumbed to it.”
Lugol states “that more than half the subjects of
scrofula have consumptive parents.”
Digitized by t^-ooQie
Alcoholic Disease , and its Remedy .
29
The tuberculous transmit to their children constitutional
conditions peculiarly adapted to attack by the bacillus.
There seems to exist within them a suitable pabulum for its
sustenance and reproduction. You will find this condition
early in life manifesting itself through the lymphatic glandu¬
lar system, and known as scrofula, or later in life, in the
form of phthisis or lupus, or in the decline of life as cancer.
But the tuberculous condition by no means stands alone in
transmitting disease and predisposition to disease in children,
and in those with whom infected subjects come in contact.
Alcoholism also plays a very important part by way of
transmitting from parent to offspring not only a longing for
the use of alcoholic liquors, but various neurotic conditions
as well. I call to mind at this time two cases in which chil¬
dren, begotten while the father was in a state of intoxication,
were not only idiotic, but had the same actions and ways, so
far as it was possible to imitate him, as the father had when
he was in a state of intoxication.”
Down, in a paper on “ Mental Affection of Childhood and
Youth,” said: “With fathers phthisical and irascible, with
mothers feeble in judgment and so emotional that everything
is a cause of fright, one is astonished that they should have
procreated any sane children at all, and, indeed, in some
cases the whole progeny of these parents is puny and feeble.”
He says further: “ I feel quite sure that drunkenness must
be placed among the factors in the production of idiocy. I
have had under my observation several families in which the
majority were mentally weak, and the whole more or less
fatuous, whose fathers were never very drunk, yet never per¬
fectly sober, and in these cases the chronic alcoholism had
produced a condition of mental hebetude from the slow
poisoning to which they were subjected.”
Dr. Ruez has observed that idiocy was very common
among the miners of Westphalia, who lived apart from their
wives, only came home, and generally got drunk, on their
holidays.
Demany assured himself that out of thirty-six epileptic
Digitized by CjOOQie
30 Predisposition to Tubercular and
patients he had under his observation for twelve years, and
whose history he was able to trace, five were conceived in
drunkenness. He observed two children in the same
family suffering from congenital paraplegia, whose concep¬
tion also took place under alcoholic conditions in the parents.
Grenier, in his thesis of 1887, in the discussion of the
progeny of alcoholismics, shows, by numerous instances, that
weak-minded subjects are very much inclined to abuse strong
drink, and that from being at first hereditary alcoholismics
they become inebriates in process of development by the
same sequence as their procreators. “ We see alcoholics
not only generating feeble offspring, but implanting in them
also the taint of alcoholism. Hard drinkers procreate hard
drinkers in a notable proportion of cases — approximately
one-half.”
Legrain, in his thesis of 1886, in summing up the
opinions of Magnan and his school, says: “ If there be any
two propositions we have the right to formulate at the pres¬
ent day the following are the two: First, cerebral inferiority,
the direct cause of excesses in strong drink, has its origin
most frequently in heredity, that is, excessive drinkers are
degenerates. Second, alcoholism is one of the most power¬
ful causes of mental degeneration, that is, the sons of ineb¬
riates are degenerates. The relations between alcoholism
and mental degeneracy are comprised within this terrible,
vicious circle, which is irrefutably traced out and confirmed
by innumerable most eminent medical observations." And
further, he remarks: “ There are but few cases of degenerates
in the careful study of which we may not discover, some¬
where, evidences of excessive addiction to strong drink. On
the other hand, it is notorious that in the category of con¬
firmed inebriates we find their progeny to include cases of
idiocy, imbecility, weak-mindedness, and various neuropath¬
ies, of which the most frequent is epilepsy." We find the
weight of medical authority in England, France, Germany
and Belgium in favor of the theory of the transmission from
parent to child of not only the alcohol habit but of many
Digitized by t^-ooQie
3i
Alcoholic Disease , and its Remedy .
neurotic diseases, and American authors are, if possible,
more inclined to the theory than those of any other country.
Crothers, in Medical Journal of Nervous and Mental
Diseases , says: “ That there is no other disease which is
more intimately connected with the prevalent physical and
mental conditions of the human race.” “ Inebriety/’ he says,
“is most positively transmitted from one generation to
another, and this diathesis or predisposition may be observed
to extend through two or three generations.”
It is useless to go further quoting medical statistics and
reports in proof of the heredity of disease and crime, when
every medical man knows that medical literature richly
abounds in reports from the very best medical authority of
the world in proof of the theory; the evidence is so over¬
whelming that no man can doubt it.
There is no class of men in so favorable a position to
understand and realize the importance of the situation as the
physician. He is daily and hourly coming in contact with
disease, and is of necessity led to look for its origin. He is
supposed to stand between the people and disease. They
look to him to care for them in their bodily afflictions, and
to act as general supervisor over matters pertaining to
hygiene and prevention of disease, and he has voluntarily
assumed these grave responsibilities, and it is through his
efforts that this much-needed reformation, touching so vitally
the welfare of the nation, must be wrought.
Those most concerned, and in whom reform must be
worked, if ever, know little or nothing of the matter, and
have least opportunity and inclination to learn.
Our suggestions are almost wholly along the line of
prophylaxis, as practiced by every intelligent physician in
his daily practice, and this course would naturally necessitate
the enactment of laws providing against the production of
disease and crime.
Government is organized with the power of preservmg
the rights of its subjects , and can divest itself of the power
to provide for them,
Vol. XVII.—s
Digitized by t^-ooQle
32
Predisposition to Tubercular and
As a people we have a right to legislate against the pro¬
creation of the diseased and vicious because it would result
in the greatest amount of good\ to the greatest number of
people. We have a right to demand of our lawmakers such
enactments as will finally stamp out disease and crime.
Candidates for matrimony should be compelled to go be¬
fore a competent medical board of examiners and subject
themselves to a rigid examination, under oath, as to their
moral and physical condition, present the written examina¬
tion to the county clerk, with the stipulated fee paying for
the examinations, which papers sent to a general medical
examiner, who, being a State officer, should be located in the
State capitol, where the report of examination should be put
upon record. The general medical examiner, after a careful
examination of the papers, should respond to the man wish¬
ing to be married, notifying him whether or not he was
granted the right to marry, when he can then go to the
county clerk's office, and not till then should he be granted
a license to wed. This would require the appointment of a
board in each county, and the election by the people of a
general medical examiner.
Laws for the prevention of crime and vice should have
the precedence over those for the punishment of the same.
If it is prevented there will be no need of laws providing for
its punishment.
If the hereditary effects of syphilis, tuberculosis, scrofula,
cancer, alcoholism, morphiaism, absintheism, with the bane¬
ful use of other drugs, and of criminal tendencies were
eliminated from our progeny, disease and crime, in a few
generations, would be almost unknown. In our most san¬
guine imagination and speculations as to the result on our
future generations, we would hardly overstep the limits of
reason. There is no reason why the average time of exist¬
ence should not be doubled, the physique increased in size,
strength, and beauty, the intellect rendered more acute and
powerful, and the soul more in accord with God. Truly, man
might be restored to his creative condition, when it was said
Digitized by t^-ooQie
Alcoholic Disease , and its Remedy . 33
of him that he was created a little lower than the angels.
He has retrograded in body and soul, till in many instances
he is little above the brute creation, though his capabilities
are vast and much varied, ranging through gradations from
the deepest degradation to the most superior exaltation. It
may be possible for man to again attain his Adamic physical
and moral condition. What man has been he may again be,
as the result of proper culture, through a sufficient period
of time, and it is doubly true of the people of America,
whose environment is better than that of any other people
on the globe ; we have every essential in the way of environ¬
ment to the production of the perfect physical and moral
man.
The key-note to an exalted manhood lies in the enact¬
ment and enforcement of laws governing matrimony, to
which most holy and sacred ordinance there is absolutely no
requirements except the price of a license. Men are allowed
under existing conditions to go with a putrid and diseased
body and a criminal mind before a justice of the peace,
maudlin drunk, and mock this most holy ordinance, dese¬
crate its sanctity and purity with their degradation and un¬
holy desires, and are then sent out to bring into the world
their kind, degenerates in body and criminals in mind, a
generation of corruption.
There is no social or commercial position to which a man
may aspire without certain qualifications except to the
marital, where the only requirements are to be so many
years old, and the price of a license.
Shame on a nation that will allow disease and crime to
run riot, absolutely free and unbridled, with no preventive
laws directed to its source!
Gentlemen, the time has come when we must resort to
radical and effective means and measures of cure. We have
sat still in a state of stupidity long enough concerning this
matter. It is our duty to see, if possible, that the conditions
are met, and if it is our duty, why do we longer wait ?
Digitized by ^ooQie
34 Facts Relating to Alcohol and other Ancesthetics .
ESTABLISHED FACTS RELATING TO ALCOHOL
AND OTHER ANAESTHETICS.
By N. S. Davis, M.D., LL.D., Chicago, III.
1. The three well-known anaesthetics in common use —
ether, chloroform, and alcohol, each and all, when received
into the blood, either by inhalation, hypodermic injection, or
by the stomach, first suspend the sensibility of the cerebral
hemispheres (unconsciousness or anaesthesia), and next they
suspend in succession or simultaneously the functions of the
respiratory, vasomotor, and cardiac nerve centers or ganglia,
thereby suspending life. It is hardly necessary to adduce
proof of this proposition, as it is familiar to every practi¬
tioner of medicine and surgery.
2. Each of these three anaesthetics act on the nervous
centers in the same direction, and consequently each inten¬
sifies the action of the others, whether given together by in¬
halation as in the A. C. E. mixture, or separately by different
methods, provided they are present in the blood at the same
time. The correctness of this proposition is demonstrated
by the experiments of Dubois in 1883, and still more fully
by those of H. C. Wood as detailed in his “Address on An¬
aesthesia ” to the Tenth International Medical Congress,
Berlin, 1890, and by many carefully observed clinical facts.
3. The action of these three anaesthetics — alcohol,
chloroform, and ether, on the cerebral, respiratory, vasomo¬
tor, and cardiac nerve centers, is not only in the same direc¬
tion, but that direction is one of diminished sensibility or
paralyzant in direct proportion to the quantity used. This
has been so perfectly demonstrated by the well-known ex¬
periments of Sidney Ringer and Sainsbury; Professors
Martin and H. C. Wood ; David Cernay, J. H. Kellogg, and
others, particularly in regard to the action of alcohol, that it
must be admitted as an established fact, or we must deny
the value of all experimental therapeutics.
Digitized by C^ooQie
Facts Relating to Alcohol ’ and other Anesthetics . 35
4. These anaesthetics not only directly diminish nerve
sensibility and force, but their presence in the blood so
modifies the action of the hemoglobin, corpuscular elements,
and albumen, as to diminish the reception and internal
distribution of oxygen and to lessen the activity of the
cell nuclein and leucocytes ; and consequently they lessen
all metabolic and natural excretory processes. The correct¬
ness of this proposition is sustained by an amount of both
experimental research and clinical observation sufficient to
fill a fair-sized octavo volume. So far as relates to the action
of alcohol, the reader will find these proofs alluded to more in
detail in a paper prepared by me for the World's Temper¬
ance Congress in Chicago, 1893, and published in the second
volume of “Temperance in all Nations," 58 Reade Street,
New York, and also in an interesting volume “ On the
Effects of Alcohol," by Dr. J. E. Usher, London.
5. When alcohol, or either of the anaesthetics named, is
retained in the blood but a few hours, as is usually the case
when administered for strictly anaesthetic purposes, the
effects mentioned in the four preceding propositions soon
disappear. But when the dose is repeated sufficiently often
to keep it pretty constantly present in the blood and tissues
for weeks, or months, or even years, as when alcohol is
administered liberally from the beginning to the end of
many of the acute general fevers and some chronic affec¬
tions, or drank in the form of beer, wine, or distilled spirits
as a beverage, the consequent impairment of nerve sensibil¬
ity and force and the coincident impairment of oxidation
processes necessary for healthy tissue metabolism and ex¬
cretion, directly encourage fatty or atheromatous degenera¬
tions in almost every tissue in the body,' and especially in the
stomach, liver, lungs, heart, and kidneys, as may be seen
illustrated in every case of chronic alcoholism. It is this
effect of alcohol in diminishing the internal distribution of
oxygen and also the activity of the nuclein and leucocytes of
the blood, that mades the individual using it more liable to
attacks of almost every variety of acute disease, whether
Digitized by L^OOQie
36 Facts Relating to Alcohol and other Ancesthetics.
epidemic or endemic, and lessens his vital resistance when
attacked. So true is this, that every modern writer of note
on practical medicine tells us that even habitual moderate
drinkers of alcoholic liquor give a much higher ratio of
mortality when attacked with cholera, continued fever,
pneumonia, influenza, or almost any other acute disease,
than the total abstainers. Even the more intelligent part
of the non-professional public have come to quite generally
recognize this inherent and inevitable power of alcohol to
impair man’s physical power and activity, and hence they
prohibit its use in all circumstances requiring the highest
degree of activity and endurance, whether mental or physi¬
cal. Having stated as plainly as possible the five foregoing
propositions, and believing their correctness to be capable of
abundant proof, I will ask a few questions of very great prac¬
tical importance both to the profession and the public :
1. If alcohol when taken into the living body directly
diminishes nerve sensibility, muscular force, and so alters
the constituents of the blood as to retard both the internal
distribution of oxygen and natural tissue metabolism in
direct proportion to the quantity taken, why do we continue
to speak or write concerning it, or to use it, as a stimulant
heart tonic , or restorative agent ? Is not such a designation
untrue, and directly calculated to perpetuate errors of the
most destructive character, both as regards its use as a medi¬
cine and as a beverage ? Why not give it its true designa¬
tion, i. e. f an anaesthetic and organic sedative; and to be
used only as such ?
2. If the presence of alcohol in the blood directly dimin¬
ishes respiratory, vasomotor, and cardiac nerve force, and
retards the reception and internal distribution of oxygen,
what possible indication can there be for its use in such dis¬
eases as pneumonia, diphtheria, typhoid fever, etc., in which
all the functions just named are already below the natural
standard ? Would not its presence not only still further
depress the respiratory and vasomotor functions, but also by
retarding the internal oxidation and metabolic processes,
Digitized by i^-ooQie
Facts Relating to Alcohol and other Anesthetics. 37
help to retain in the system both the specific toxic agents
and the natural products of tissue changes, and thereby
increase both the duration of the disease and the danger of
final exhaustion ?
3. Does not an accurate study of the history of thera¬
peutics show that, the greater the amount of alcohol or other
anaesthetics used in the treatment of the general acute dis¬
eases, especially those named under the preceding head, the
higher has been the average ratio of mortality ?
4. If alcohol and other anaesthetics actually diminish
cerebral, respiratory, and vasomotor functions in proportion
to the quantity used, why administer them to any patient
coincidently with strychnin, digitalis, strophanthus, conval-
laria, cactus, or other direct cerebro-spinal, respiratory, and
vasomotor tonics ? As both direct experiment and clinical
observation have proved that strychnin, digitalis, etc., most
reliably antagonize the effects of alcohol and chloroform, is
it not the climax of therapeutic inconsistency to give a
patient a hypodermic injection of strychnin and at the same
time fill his stomach or rectum with whisky or brandy ?
5. How is it possible to determine the real value of the
antitoxin serum in the treatment of diphtheria, if the patient
is given at the same time liberal doses of a toxic bacterial
product in the form of wine, whisky, or brandy ? And if
these latter are omitted or their quantity greatly reduced,
how shall we know whether the increased ratio of recoveries
is owing to the virtues of the antitoxin serum or to the omis¬
sion of the toxin, alcohol ? Having carefully noted the pub¬
lished results of the treatment of diphtheria by antitoxin
serum, as given in the best medical periodicals, I find a very
large proportion of the cases so imperfectly described as to
render them of no value in determining practical results.
In many cases, nothing is said about any coincident use
of other remedies ; in other cases\it is simply said that stim¬
ulants and nourishment were given, but what kind or
amount is not stated ; in still other cases the administration
of quinin, iron, etc., is mentioned in addition to stimulants
and nourishment; and in one case reported in The British
Digitized by i^-ooQie
38 Facts Relating to Alcohol and other Ancesthetics .
Medical Journal , the child, 6 i years old, presenting symp¬
toms of an average case of diphtheria without laryngeal
obstruction, was treated with antitoxin and was represented
as progressing very favorably until the fifth or sixth day,
when a moderate antitoxin injection was given and six
ounces of brandy ordered to be given the succeeding twenty-
four hours. The next day the child was cyanosed and soon
died. Can any one be quite certain whether this last case
died from the toxin of diphtheria, the antitoxin, or the torula
cervisae toxin in the six ounces of brandy ?
Is it not practicable to have three or four hospitals ad¬
mitting diphtheria patients supplied with a sufficient quan¬
tity of some one of the reliable antitoxin preparations and
then make a fair test of its efficacy by treating in parallel
beds with good air, rigid cleanliness, and good milk for
nourishment, but no alcoholic stimulants, two series of cases
as nearly alike in severity as possible. To one series of
cases, let the antitoxin or antitoxin serum be given in strict
accordance with the most approved rules, and no other inter¬
nal remedies. To the other series, let just enough calomel
be given during the first or second day of the attack to
procure one or two intestinal evacuations, and let this be
followed by small but frequently repeated doses of a solution
of bichlorid of mercury and belladonna until the diphtheritic
membrane begins to break up, which is generally between
the fourth and sixth days, then substitute suitable doses
of tincture of chlorid of iron and quinin until the case is ter¬
minated. Let the most complete record possible be made
in both series of cases, and then we shall have data that are
parallel or comparable, and from which the most reliable
practical conclusions can be deduced. If, in cases in either
series, the disease invades the larynx sufficiently to demand
it, intubation or tracheotomy should be performed as in
other cases. The results orf the two series of parallel cases
thus managed would not only be comparable with each
other, but both would be comparable with the results of the
liberal alcoholic and all other methods of treatment in
vogue.
Digitized by L^OOQie
The late Dr. Theodore L. Mason.
39
THE LATE DR. THEODORE L. MASON.
By T. D. Crothers, M.D.
J Dr. T. L. Mason was one of the active founders of our
association organized in 1870, and in 1876 he was made pres¬
ident, and continued in this office until his death, February
12, 1882. At "the next annual meeting of the association, in
May of the same year, Dr. Day, the vice-president, paid an
eloquent tribute to Dr. Mason and his memory, which he
promised to write out for the Journal, but never did, owing
to absence of data and a wish of Dr. Parrish to write a
sketch. For various reasons, including invalidism, Dr. Par¬
rish failed, and we take pleasure in presenting the first ex¬
tended sketch which has appeared in the Journal, of one of
the most prominent, earnest pioneer workers who has been
associated with this great movement. Dr. Mason was born
in Cooperstown, N. Y., in 1803, and graduated at the College
of Physicians and Surgeons in New York city in 1825, and
after a few years of practice in Wilton, Conn., moved to
Brooklyn, N. Y., where he spent the rest of his life. He de¬
scended from a military and legal family dating back to early
colonial times, and inherited a particular mental and moral
robustness of character, which gave him prominence all his
life. In 1858 he became president of the first college hospi¬
tal, called the Long Island Hospital, where medical instruc¬
tion was given in the hospital exclusively. In 1865 he
organized and was president until his death, of the King's
County Inebriate Home, at Fort Hamilton. From this time
he became actively identified as a writer and pioneer worker
of the inebriate asylum movement, and the scientific study of
inebriates. He was for many years vice-president of the
American Colonization Society, and active member and offi¬
cer of numerous societies, both medical, historical, and theo¬
logical, in all of which his wise counsel and clear conceptions
You XVII.—6
Digitized by t^-ooQie
40
The late Dr. Theodore L . Mason .
were highly prized. In 1870 he assisted in the organization
of the Association for the Study and Cure of Inebriates, and,
in some remarks made at that time, predicted that this asso¬
ciation would mark the beginning of a great revolution in
public sentiment concerning the inebriate, which would be
felt all over the civilized world. Twenty-four years has
passed since that event, when fourteen earnest men met in
the parlors of the Young Men’s Association in New York
city, in November, 1870, and organized this association to
centralize and proclaim the great oncoming truths of ine¬
briety. To-day eleven of the great nations of the world
have similar societies, and Dr. Mason’s prediction proved to
be a veritable prophecy. He saw clearly that the questions
of alcohol and inebriety were vital topics that civilization
would recognize and study not far in the future. Among
the many prominent papers which he wrote on this subject
was an address in 1876, “ On the Disease of Inebriety.” This
was very widely read, and was a calm, dispassionate study,
very clear and convincing in its statements, and had a wide
influence, that is noted even to-day. Other papers and ad¬
dresses on this topic were very influential in their clear ear¬
nest tone, and strong legal method of presentation. Dr.
Mason was always intensely practical, and the present theory
or conclusion that could not be used at once and harnessed
into the world’s working forces did not attract him. As
president of our association he urged a steady, persistent ad¬
herence to the facts, no matter what the conclusions might
be. In the bitter attacks which were made on this journal in
its early days, he gave the same advice and counsel, never
to stop to fight theories, or notice wild dogmatists; also if
this association and its journal were founded on truths, per¬
secution and opposition would only give it more permanent
growth. Dr. Mason was cautious and conservative in form¬
ing new views, and reaching conclusions on new topics.
When he was fully convinced of the correctness of the facts
or methods, he never hesitated or wavered. No opposition
or difficulties deterred him. He took up the work of ine-
Digitized by i^-ooQie
The late Dr. Theodore L. Mason.
4i
briety, helped to found an asylum and association, because
they were practical facts that would help on the solution of
a problem of the greatest importance. He studied and
worked for this subject in the same lofty spirit and high
moral purpose that helped found a college, a historical
society, or the colonization of poor colored men in far distant
lands. His mental vision was higher, and his spirit of phi¬
lanthropy to raise his fellow man, and do something to help on
the race, was broader and wider than his cotemporaries. As
a pioneer student and practical worker in the field of inebri¬
ety, Dr. Mason will be long remembered. As the organizer
and first president of the Kings County Inebriates’ Home, he
gave a permanent impress and direction to its work, that
will be seen and felt for long years to come.
'"As an active founder and officer of our association, his
counsel and labors constituted a very large part of the influ¬
ence and success of the movement. Dr. Mason was thor¬
oughly a man of faith as well as courage. He knew when
others doubted, his energies increased when others faltered,
and he saw the movement of events higher up and farther
down into the future. We can notice only a small part
of Dr. Mason’s life work, and that along the line of the
inebriate asylum movement. Beyond this a wide circle of
friends and a devoted family both saw and felt the genial in¬
fluence of his life, scattering the clouds and gloom and in¬
sensibly lifting and raising all who came in contact with him.
It is a source of great pleasure to say that the mantle of his
genius has fallen on his son, the well-known Dr. L. D. Mason.
Taking up his father’s work he has gone on along the same
practical lines of study, as the many excellent contributions
in this Journal will attest.
He is now the only surviving member of the fourteen who
formed the Association for the Study and Cure of Inebriety in
1870. This late tribute to the memory of Dr. Mason has a
greater significance to-day than ever. Each year brings new
interest to the life and work of one who is already known to
all students of inebriety, and especially to members of our
Digitized by
Google
42
The late Dr. Theodore L . Mason .
association. Such men have impressed themselves by their
work on their day and generation to a far greater extent than
any present study can determine. They live on in a con¬
stantly widening circle. The truths which they have taught
go on as a permanent addition to the development and pro¬
gress of the world.
STIMULATION.
Dr. McDowell of Dublin in a recent lecture remarked on
stimulation as follows: “ The second point I would allude to
is the fallacy in the application of the word ‘stimulant* to
alcohol. If alcohol was a stimulant its consumption ought to
tend to more and more work being done, and the danger
would be from the strain of overwork; but action is different.
We get a chain of events made up of three links: Action,
increased action, paralysis. The increased action is really a
connecting link between ordinary action and paralysis. This
is because a great many functions of the body are arranged
so that when increased action is required more power need not
be directly put forth: there is always more than enough power,
and a check, or inhibiting action, keeps it to the required
amount. If the check is lessened the action becomes more
rapid, but this is from narcotising the controlling agent, not
from stimulating the action. The common illustration is
that if you take the pendulum off a clock, the weights (which
are the existing force) are not increased, but yet the action
is hurried, because the control is weakened. If a person
gets a sudden start, the heart beats much quicker; the start
is not a stimulant, it really paralyzes the controlling nerves,
whose action is for the time relaxed. So the cause of the heart’s
quicker action is not stimulation but relaxation. In illness
no one would try to stimulate the heart by repeated frights—it
would beat quicker but fail faster. The action of alcohol is
similar, it does not stimulate but reduces control, and experi¬
ments have shown that each special sense is blunted even
by small doses. As a matter of fact, those who have most
studied its action least use it as a medicine.*'
Digitized by
Google
Inebriety and Imbecility\
43
INEBRIETY AND IMBECILITY—A MEDICO¬
LEGAL STUDY.
By T. D. Crothers, M.D., Hartford, Conn.
The following records of two cases brings into promi¬
nence again the old conception of inebriety, and the recent
modem view accepted by the more intelligent courts and
jurors.
In March, 1894, John Cronin was tried and convicted for
the murder of Albert Skinner. The facts relating to his
crime are these : He was a farm laborer, thirty-seven years
old, living about Hartford. He has been a periodic drinker
since early life, and when sober is a quiet, peaceable man ;
when drinking is excitable, irritable, abusive, and often quar¬
relsome. He has been arrested and confined in jail twice for
intoxication. His drink periods have been growing longer,
and the sober intervals shorter for the past few years. He
has been growing more irritable and stupid when drunk
lately.
For at least two weeks before the crime was committed
he was idle and drank continuously. He was intoxicated on
the night before the murder. A few weeks before this time
he had a drunken altercation with the man he shot, and at
that time made a threat to shoot him. Amicable relations
were re-established, and he seemed to be on good terms again
with this man with whom he had formerly boarded and been
very intimate.
On the morning of Oct. 6, 1893, he went to the house of
this man, Albert Skinner, and without a word of provocation
shot him at the breakfast table. He was pushed and thrown
out of the house twice in a few minutes, and stood round on
the street near the house with a revolver in his pocket mak¬
ing no attempt to shoot again, and coolly boasting of what he
had done ; submitting to restraint and expressing a wish to
Digitized by
Google
44
Inebriety and Imbecility .
shoot others also, justifying himself and affirming that he was
ready to accept the consequences and be hung, and if he was
permitted would kill others. These expressions of regret that
he had not shot more persons were repeated several times.
He was recognized as having been drinking by his breath
and strange actions, but several witnesses thought he was
fully conscious of his acts and their consequences.
For the next two days all the witnesses seem to agree
that he was in a semi-dazed condition of mind, indifferent
to all surroundings and would not talk. After this his man¬
ner changed, and he responded to inquiries and conversed,
claiming not to recollect any of the past occurrences and
the crime. He said that Skinner, the murdered man, was
the best friend he ever had.
This crime was characterized by two very unusual lines
of conduct.
1. Shooting the man in open day in his own home, with¬
out a word of provocation, boldly and under the possible ob¬
servation of many persons; firing only one shot and stand¬
ing round to see the result, being pushed out of the door by
the wife of the murdered man, and going back into the house
again, was thrown out by the son ; also making no attempt
to shoot other persons or run away.
2 . Offering no resistance when the pistol was taken from
him, submitting to arrest, acknowledging the crime, and in
violent language expressing a desire to repeat the act on the
murdered man and others, and take the consequences. His
cool indifference and violent expressions unaccompanied by
acts or delirious excitement, seemed to those about him not
to indicate drunkenness, although his breath was strong with
the odor of spirits and his manner was strange and unusual.
Thirteen months after the commission of the crime I ex¬
amined him in the State prison. During all these months he
has been free from spirits, and it would be natural to expect
that his condition of body and mind would be very near
normal.
His appearance was that of a stout, short-built man, with
Digitized by ^ooQie
Inebriety and Imbecility .
45
a small, irregular-shaped head, retreating forehead, sunken,
tremulous eyes, large stigmatic ears, and high palate arch.
He walks with a shuffling, unsteady gait, and when seated
supports his head on his hands, and seldom looks up. He
answers questions slowly and with hesitation, and seems in
doubt unless the questions are direct and repeated. The an¬
swers begin in a natural tone of voice and drop down to a
whisper at the close of the sentence. This hesitation and
doubt differ widely from the cunning reserve of one who
would conceal his mental operations in the apparent feeble¬
ness and effort to give some answer and overcome an evasion
and incapacity for sustained reason or explanation of any
event. The impression he gives is that of a naturally defec¬
tive brain, already approaching and evidently in the penum¬
bra region of imbecility.
He appears in fair health, and without delusions, and pro¬
foundly indifferent to any past, present, or future conditions.
As a result of persistent questioning the following facts were
brought out, most of which have been confirmed from other
sources, hence they are generally correct. He was intoxica¬
ted at about fifteen years of age, and has used spirits contin¬
uously, and at times to great excess up to the present. He
both drinks alone and in company, and when intoxicated has
little or no recollection of what he does or says. His mem¬
ory has never been good. At times he can recall events
when drinking, at others they are a blank. Concerning the
homicide he has no recollection of it; the blank of memory
extends from the night before the crime to some time after
being placed in jail.
He cannot understand why he should have shot Skinner,
as he was his best friend. He gave the history of a fall on
his head with a period of unconsciousness, and a scar show¬
ing a scalp wound was exhibited as evidence of it.
Three years ago he was made unconscious by a fall from
a train and laid up with injuries of the back and knee for
two months. He has been struck on the head several times
when drinking and made unconscious. For the past few
Digitized by CjOOQie
46
Inebriety and Imbecility\
years when drinking he has been more irritable and quarrel¬
some, and been told that he was crazy at those times. He
makes no complaint against any one, and expresses no sor¬
row or indignation at anything concerning the crime or trial.
He is strangely indifferent concerning his life, and would not
escape if he could, but is ready to die at any time. It makes
no difference to him what the result may be.
Concerning the future he has been told that by repent¬
ance one can go to heaven; if this is a mistake he will ac- v
cept the situation. His wishes are of no account, “ as the Lord
and the law will have their own way.” No questions of his
moral responsibility and guilt in this crime excite &ny emo¬
tion or nervousness or apparent realization of his condition.
He expresses himself coolly and with utter unconcern. At
times a half imbecile smile would appear when he could not
answer the question, and did not know what to say. There
was no irritation or excitement or depression or annoyance
from questions which were pressed, and if different answers
were suggested he would select the briefest one.
When the same question was put in a different form, he
seemed not to realize it but answered in monosyllables, irre¬
spective of any previous answer. In all this there was no
criminal cunning or attempt to conceal or to appear crazy,
but clearly the natural working of a feeble and imbecile
mind. He seemed to have a remarkably abnormal brain, in
which all the higher functions were paralyzed, and the nor¬
mal consciousness of duty and responsibility were absent.
A study of the heredity of this case was startling. His
near relatives on both his father's and mother's side were
hard drinkers, and on his mother's side insanity and epilepsy
appear frequently. None of his relatives exhibited anything
more than a very low order of intelligence.
His maternal grandparents were Willliam and Mary Cal¬
lahan of County Antrim, Ireland. William died in middle
life, and Mary lived to be sixty years old, and was insane for
some years before her death. Catherine, the oldest daughter,
and aunt of John Cronin, became insane from the death of
Digitized by C^ooQie
Inebriety and Imbecility.
47
her child and the desertion of her husband, recovering in part
and coming to this country, where she died in middle life.
Michael, the second child, was early addicted to drinking in¬
toxicants, and his mother tried to kill the appetite by mixing
snuff with his drinks He enlisted in the English army, was
discharged insane, and wandered about in the woods and
finally died of exposure. Thomas Callahan, the second son,
lives in Hartford, and is a respectable man. He drank until
he was fifty years of age ; since which time he abandoned
the habit. He testified as to the facts of his nephew’s ances¬
try before the board of pardons, and appeared to be a quiet
man, “thick” in his memory, and in the appreciation of
what the counsel was trying to bring out.
Margaret Callahan, the youngest child of William and
Mary, and the mother of John Cronin, was a nervous, excita¬
ble girl, who went to Wales with her older sister, Catharine.
There she married Peter Cronin, a Welsh miner, of a boister¬
ous nature and a man who drank to excess. His wife drank
with him daily, and they lived in- a state of perpetual trouble.
At last Peter was murdered in a drunken row, and Margaret
became insane for a time. Her sister Catherine took her
home and adopted John Cronin, who was one year old at the
time. He lived with his aunt until he was eight years old,
when he was put out to work.
His mother, Margaret, came to this country and married
a man named Moran, who is now dead. There were three
children by this marriage, one dying in early life, and two
daughters surviving. One of these, Mrs. George Somers, is
subject to epileptic fits, is a hard drinker, and has attempted
suicide. She has been in the county jail in this city for
drunkenness.
Margaret Moran, the mother of John Cronin, is well
known to the authorities of Hartford. She has been a drink¬
ing, troublesome woman during her long residence in and
about Hartford, and was surrendered to the authorities by her
brother, Thomas Callahan, after he had endured her boister¬
ous and wild ways, while under the influence of drink, as long
Vol. XVII.—7
Digitized by ^ooQie
48
Inebriety and Imbecility .
as he could. She is now an inmate of the almshouse in this
town, where she has been for nearly five years.
This brief sketch of Cronin's ancestry shows that his
father and mother were both inebriates, an uncle and aunt
were insane, and a half sister is a drinking, epileptic degen¬
erate. Of the direct stock of his father, John Cronin was
the last, and of his mother the worst.
In these facts a very clear history can be traced of what
is well known as alcoholic insanity of the imbecile and epi¬
leptic class, the prominent symptoms of which are a marked
degenerating heredity, usually from an alcoholic insane or
idiotic ancestry: or practically from a dying family, where
the race stock is exhausted, enfeebled, and approaching ex¬
tinction. Alcoholism in such a family is a symptom of pro¬
gressive degeneration. The drinking is always followed by
insane, epileptic, and impulsive conduct. When not drink¬
ing apparent sanity and normal conduct may be the rule, but
the strain of alcohol on a defective brain will bring on homi¬
cide, suicide, or epileptic explosions. The use of alcohol is
always followed by delirious conditions, delusions, and strange,
unusual acts.
Failures of memory are common symptoms, and may be
total or partial. After a time a progressive palsy of the
higher brain functions appears. In most of these hereditary
defects this moral palsy and loss of consciousness of right
and wrong, of duty and obligation, is an inheritance which the
use of alcohol develops. All such cases show this strange
indifference and unconsciousness of their acts and the con¬
sequences. The man's talk and conduct in a criminal act is
only a link in the chain ; by itself it may display a cunning,
deliberation, mature judgment, and recognition of all the con¬
sequences, and yet when the other links in the history are
known, it will be found to be the act of a clearly insane
man.
The act of shooting Skinner with foolish boasts and gen¬
eral conduct, noted by great coolness and indifference, is a
good illustration. What he did and said at this time and the
impression he created on the minds of persons about him, is
Digitized by t^-ooQie
Inebriety and Imbecility .
49
a small part of his history, and when judged alone may be
very misleading, but taken in connection with all the facts of
his life, points out the real condition of health or disease. It
is evident that Cronin’s mental condition at the time of this
homicide must be judged from the facts of his inheritance,
from the facts of his surroundings and manner of life, also
from his conduct and acts when sober and drinking, and
from all the circumstances and conditions which have been
influential in his history.
The State assumed that Cronin had a low criminal brain,
capable of deliberation and premeditation, and with power of
control. That he could reason clearly concerning his acts
and their consequences. That in the crime he displayed
malice and revenge and full consciousness of the nature of
this act, and the legal penalties.
That he was not only conscious of his conduct, but had
the power of control and concealment, to take advantage of
favoring conditions. That he has been and is of sufficient
mental capacity to distinguish between right and wrong in
the abstract, and at the time of the crime was of sound mind.
That his claim of no memory of the act and cool indiffer¬
ence are mere subterfuges for concealment.
The fact of his periodical intoxication and drinking the
day before the crime were assumed to be aggravations and
additional evidence of his responsibility.
I urged that Cronin could not have a sound brain ; that
his twenty years of drinking had so fixed and intensified the
inherited defects that he could not reason or discriminate
soundly; that in some respects his conduct would be auto¬
matic, where the motives and conditions of living were the
same, but change these and his disease would be seen. Also,
he had a defective brain, showing great disturbance from the
use of alcohol, would always be swayed by morbid impulses
of any form, and crime, suicide, and other abnormal acts
would be the rule and not the exception.
Many authorities have pointed out the evident unsound¬
ness of degenerative neurotics, who were alcoholics of long
standing. The acts of such persons are always open to sus-
Digitized by t^-ooQie
50
Inebriety and Imbecility .
picion, and where crime is committed there is always a
doubt. Unusual strange conduct can only be explained on
the theory of brain degeneration and disease. While it may
lack many of the symptoms of so-called insanity, it will
nevertheless show degrees of palsy and brain disorder that
cannot be mistaken.
This case was finally decided by the Board of Pardons,
and Cronin was hung Dec. 19, 1894. He maintained the
same stolid indifference to the last, sleeping soundly up to a
short time before the execution.
The second case was tried at Norwich, Conn., in May,
1894, and was that of Michael Donovan, who shot and killed
John Bell, some months before. Donovan was a laborer, in
charge of a stationary engine, forty-five years of age, and a
man of quiet, peaceable character. He was married and had
a grown-up family, and was a retiring, hard-working man.
For five years he had used spirits to excess at irregular times
and intervals, and was always silent and stupid when drink¬
ing, never quarrelsome or violent. During the year 1893
Donovan had drank more than usual, and been stupid nearly
every night. In December of that year Bell, a colored man,
called him insulting names and was very abusive for some
supposed slight. At this time Donovan paid no attention
to this, saying he was not worth noticing, and appeared to be
in no way disturbed by Bell’s insults. Two days after he
took an old revolver to a shop to be repaired and loaded, and
told several persons he was going to shoot Bell. He drank
several times and showed the revolver, and affirmed that he
was going to find Bell and kill him. This he did in a short
time, and without any words or apparent excitement, he shot
at Bell, and finding that he staggered and fell, fired his pistol
in the water and replaced it in his pocket. Quietly walking
back he stopped to drink at two saloons, telling the bar¬
keepers that he had shot Bell, then went home, changed his
clothes, and walked over to the station-house, giving himself
up
That night and next day he suffered from delirium and
delusions, and was treated as suffering from a mild attack of
Digitized by ^ooQie
Inebriety and Imbecility .
51
delirium tremens. He soon after recovered and denied all
recollection of the circumstances of the crime. From this
time on to the time of trial he was quiet, indifferent, and
seemed not to be interested in any thing, and only manifested
emotion when visited by his family. When examined in
jail he seemed to be dull, and, although in fair physical health,
was strangely indifferent to the results of the trial; ex¬
pressed sorrow for having killed Bell, and did not remember
the facts of the crime, and seemed to be unconcerned. He
could not give a connected account of the difficulties which
led up to the crime, and the suspected motive for shooting
Bell, who had threatened to have him turned away. His mind
seemed confused as to events and his own conduct for some
time past. In the history of his family an uncle, on his
mother’s side, became insane in middle life, and was confined
in an asylum until death. Donovan had been a moderate
drinker up to about forty years of age, when he began to
have distinct drink paroxysms. These increased in fre¬
quency and duration, until finally he drank steadily every
day. The past six months he drank almost every hour, and
was many times unfit for work. He complained of his head
feeling bad, and said he was “ not right ” from the time of an
injury from a fall from a wagon. In a conversation with the
medical expert for the State two days later, he described the
act of killing, denying that he had said he was going to kill Bell,
and in a disjointed way, explaining why he had shot Bell.
His statements were opposed to the testimony of other wit¬
nesses, and seemed to be based on the history of the crime
repeated by others.
Two experts swore that he was sane at the time of
the crime, and was conscious of his acts and their conse¬
quences. Two experts for the defense affirmed that it was
a clear case of alcoholic imbecility and unconsciousness of
the crime, and at present he was of a low order of intelli¬
gence, with unsound, degenerative brain. They further
urged, that the cool preparation for the crime, and telling
others what he was going to do, and the act in broad day¬
light, where he was seen by others, was clearly insane. Such
Digitized by i^-ooQie
52
Inebriety and Imbecility .
conduct, following excesses in the use of drink, could not
come from a mind sane and conscious of the acts committed.
The counsel for the defense, Messrs. Hull of New Lon¬
don and Thayer of Norwich, urged that there was more
than reasonable doubt of the soundness of the prisoner’s
mind at the time of the commission of the crime. Also,
that his excessive drinking before the crime would of neces¬
sity so far impair his reason and judgment that any unusual
acts would be more or less insane, and be committed without
conscious reason. They urged that this crime in its boldness
and strange premeditation and execution, and his delirious
condition after, was strong proof of insanity. The experts
for the defense argued that the man at the time the crime
was committed, was suffering from alcoholic dementia, and
when confined had an attack of delirium tremens, from which
he recovered with an enfeebled demented brain, and at pres¬
ent is in a low paretic condition. The verdict was man¬
slaughter and imprisonment for life. This was a rational,
modern disposition of the case. In New York State such a
case would be sent to the asylum for insane convicts. In
Connecticut he would be under observation at the State
prison, and when pronounced symptoms of insanity appeared,
would be sent to the insane asylum. Both of these cases
were alike in the well-marked evidence of imbecility, due di¬
rectly to alcohol. In the Cronin case, the heredity intensi¬
fied and made the degree of degeneration very clear, and
placed the assumption of insanity and unconsciousness with¬
out power of control beyond all possible doubt. In the later
case, Donovan’s conduct before and during the commission
of the crime, and after, clearly indicated the impossibility of
mental soundness. Neither of these cases were able to rea¬
son rationally, or to form motives, and to act upon them with
consciousness of their import and consequences. The hang¬
ing of Cronin ignored all modern facts concerning the brain
and its disorders, and was a reversion to the theories that pre¬
vailed two centuries ago. Donovan’s sentence recognized
the dawn of a new era in jurisprudence and progress along
the lines of development, with clearer conceptions of the re¬
lations and limits of responsibility.
Digitized by CjOOQie
Abstracts and Reviews.
S3
ki\d f{eview$.
REPORT OF COMMITTEE ON ALCOHOLISM IN
THE STREET.
To the Medical Society of the County of Kings :
Gentlemen,— In making its final report, your committee
would emphasize all that it presented in its preliminary re¬
port, and more especially that —
1. All persons found upon the street or elsewhere by
the police or others, and being in a comatose or semi-coma¬
tose condition should be at once removed to the nearest
hospital.
2. No hospital should refuse admittance to such cases
on the ground that alcoholic cases, or cases in which alco¬
holism is a prominent feature, are not proper subjects for
treatment in such hospitals. This plea should not hold
in hospitals that receive aid from the city. If they are not
prepared to receive such cases, they should at once make
such provision as is necessary. In the opinion of your com¬
mittee it is as much the duty of hospitals receiving city aid
to render medical assistance in such cases as it would be if
the patients were the subjects of an accident. Indeed, many
of the so-called accident cases are the result of alcoholism,
and it would be just as logical to exclude such cases from
hospitals as to exclude those who are unconscious from the
same cause. Whatever differences of opinion may exist as
to the duty of taking care of alcoholic cases, your commit¬
tee believes that inasmuch as a diagnosis cannot be always
made at once, every unconscious person should have the ben¬
efit of the doubt, and receive prompt medical attention.
3. Your committee believes that ambulance-surgeons
should qualify themselves so as to be able to differentiate
alcoholic coma from other forms of coma so far as that is
Digitized by i^-ooQie
54
Abstracts and Reviews .
possible, and that the examination of these surgeons should
include questions bearing directly on this subject.
4. In the preliminary report your committee referred to
a special hospital for the treatment of alcoholism. To such
an institution, centrally located, all cases of delirium tre¬
mens which are now treated at the general hospitals at con¬
siderable expense and inconvenience to the hospital authori¬
ties, could in the special hospital receive skilled treatment
by specially trained physicians. Your committee hopes that
in the near future the city will see the wisdom and human¬
ity of establishing such a hospital; in the meantime such
facilities as exist must be relied upon. Finally, your com¬
mittee notices already a moral effect which the discussion of
this subject by the society has produced. It has attracted
attention, not only in this country but also in Europe, and
copious extracts have been made by foreign journals from a
paper published by the secretary of the committee, in which
the work of the committee is alluded to. The medical so¬
ciety of the County of Kings is the first organized body of
medical men to move in this matter, and it is not too much
to prophesy that the effect of this agitation of a most im¬
portant subject will spread from Brooklyn to every other
civilized center.
The county society is not such a body as that it can
enact laws and compel their enforcement, but it can by
moral suasion influence police and hospital authorities, and
do much to bring about an improvement in the matter un¬
der discussion. Your committee would therefore suggest
that a circular be prepared, calling attention to the subject,
and that a sufficient number of copies be made to be sent to
the managers of the various hospitals, to the medical jour¬
nals, and to such other organizations as is thought wise.
Respectfully submitted,
J. H. Raymond,
L. D. Mason,
John C. Shaw.
Digitized by i^-ooQie
Abstracts and Reviews .
SS
GENERAL CONSIDERATIONS ON ALCOHOLIC
CIRRHOSIS OF THE LIVER.
Hanot, who has contributed much to the elucidation of
hypertrophic cirrhosis of the liver, has recently written a
monograph on atropic cirrhosis; and as the result of an ex¬
haustive study based on very many clinical observations, he
regards “ arthritism ” as a necessary predisposing factor in
this disease. By arthritism he understands “a constitutional
state, characterized by a vitiation, ordinarily congenital and
hereditary, of the nutrition of the connective tissues and of
their derivatives, which become tissues of less resistance. ,,
He refers in illustration to the congenital debility of the
cardio-vascular system in chlorotic girls, of the nervous
system in the hysterical and degenerate, of the lungs in
persons predisposed to tuberculosis. “ From a functional and
anatomo-pathological point of view,” he says, “ arthritism is
characterized by the exaggerated vulnerability of the connect¬
ive tissue with tendency to hyperplasia, to fibrous transfor¬
mation and retraction.”
Hanot insists that clinical cases without number confirm
his view, the “stigmata” of arthritism being everywhere
apparent in the cirrhotic. We will enumerate the principal
“stigmata,” remarking that the French make quite as much
of that monster arthritism as we Americans do of its conge¬
ner, neurasthenia: “ pseudo-lipomata, acne, obesity, varicose
veins, hemorrhoids, enlargements of the second phalanges,
early baldness, dry cracklings in the joints, rheumatic pains in
loins and limbs, asthma and atheroma.”
Among the signs of cirrhosis in process of evolution,
Hanot enumerates dyspeptic troubles, meteorism, constipa¬
tion, urobilinuria, urobilinic tint of the integument, sometimes a
bronze tint from pigmentary deposit, glycosuria after inges¬
tion of carbohydrates, pruritus, epistaxis, gingival hemor¬
rhages, hemorrhoids, localized edemas, attacks of diarrhea.
“As for the dyspeptic troubles, it is,” says Hanot, “diffi¬
cult to define the part which the hepatic disease has in their
Vol. XVII.—8
Digitized by L^OOQie
56
Abstracts and Reviews .
production: the stomach is likely to be modified directly by
the alcoholism, or by the arthritism. Hepatic patients have a
strong dislike for fats and for meat. Hyperchlorhydria is a
frequent condition of the stomach in the dyspepsia of hyper¬
trophic cirrhosis, and hypopepsia or apepsia with lactic
reaction in atrophic cirrhosis.”
The constipation is generally ascribed to absence of bile
in the intestines, and the meteorism indicates the same lack,
the bile being antagonistic to putrescence. Meteorism is an
early symptom, coming before the ascites, in accordance with
Portal’s jeu d } esprit y “ Les vents pr6c£dent la pluie.”
Hanot has described, under the name of “ pigmentary
acholia,” an alteration of the bile which is secreted without
the ordinary coloring pigments. This gives rise to the
decoloration of the feces, and is observed in almost all the
diseases of the liver. In most cases of cirrhosis, the spectro¬
scope shows the presence of urobiline in the urine, and thereby
indicates in a general way the suffering of the hepatic organ
and the disorder of the biliary secretion. The bronze tint of
the skin is also due to a trouble in the formation of the biliary
pigments, and is seen at its maximum in “ bronzed diabetes”
associated with hypertrophic cirrhosis. The alimentary
glycosuria is an early and persistent symptom. The pruritus
is a troublesome affection, may exist apart from any eruption,
and is not peculiar to cirrhosis, being observed in other
hepatic affections with or without jaundice. It is one of the
earliest symptoms. Hanot does not believe that impregnation
of the skin by the coloring matter of the bile is the cause;
this is not well understood. In a certain number of cases
there will be frequent attacks of diarrhea alternating with
constipation, which are explained by the hyper-tension in the
portal system, as the hemorrhages and localized edema attest
the profound disturbances in the circulatory system elsewhere.
Hanot thinks that the epistaxes, the gingival hemorrhages,
the purpura “ testify to the cell alteration, and the perver¬
sion of its hematopoietic r 61 e.”
In the pre-cirrhotic period and at an early stage of the
Digitized by
Google
Abstracts and Reviews.
57
stationary period, the liver is enlarged, “ owing to congestive
processes which usher in the sclerosis and the final atrophy of
the organ.” Many cases of cirrhosis, however, according to
Hanot, are atrophic from the onset. He believes also that
there is a rare form (which he was the first to describe)
which is alcoholic and hypertrophic throughout its entire
course. Among the later symptoms are the ascites with
increased development of the abdominal veins, a dry pleurisy
at the base of the right lung, anorexia, a brick-red tint of the
skin, emaciation and cachexia.
The complications belong to the group of infectious dis¬
eases. The liver in its state of physiological integrity is an
“advance-guard of protection against infection;” when
smitten in its vitality and its function, it leaves the way open
to infections. Among these, grave icterus is “ the last act
in the period of infection and atrophic degeneration.”
Among the inter-current infections which frequently carry
off the patient, are erysipelas, pneumonia or broncho-pneu¬
monia, infectious endocarditis, suppurative peritonitis, sup¬
purative cholecystitis, abscess of the liver, acute infectious
nephritis, and phlebitis. The patient sometimes dies of a
“veritable cholera”—abundant watery diarrhea, algidity,
coma. Hanot refers these choleriform attacks to an infection
due to the colon bacillus. Cirrhosis -sometimes prepares the
way for tuberculosis, the latter grafting itself on the
cirrhosis.
When the patient escapes or resists any of these inter¬
current affections, he is very likely to die of grave icterus,
which is in fact the natural and final term of the disease.
These grave kinds of jaundice are classified according to
the microbe that causes them; the symptomatology is some¬
what different according as the icterus is the product of this
or that microbe. There are grave icteri with hyperpyrexia;
there are others with hypothermia. The infection in icterus
with sub-normal temperature is believed to be the coli-com-
munis; at least, this is in accordance with some very exact
observations.
Digitized by ^ooQie
58
Abstracts and Reviews .
The liver is the great arrester and destroyer of poisons —
microbic and others—according to the modern physiological
school. Therefore, when its functions are invaded the organ¬
ism easily falls a prey to septic agents; and hence, in Hanot’s
estimation, the grand therapeutic indication becomes plain,
to diminish the causes of infection by intestinal antiseptics,
and thus to oppose by this indirect way the progress of the
disease. Here he is in accord with Bouchard and his school,
who teach that more good is accomplished in this disease by
intestinal antiseptics judiciously administered than by any
other means.
As an effort to throw new light upon hepatic cirrhosis
through that popular and universal illuminator, bacteriology,
this attempt of our French confrere is worthy of attention.
The part played by his “ arthritism,” and the inevitable
“ stigmata ” by which its presence may invariably be recog¬
nized, is rather vague and misty theorizing to the Anglo-Saxon
mind. Observation continues to convince, however, that ex¬
cessive alcohol injures the hepatic cells; that the less resistant
the organism the earlier the effect: that when the normal
hepatic secretions are interfered with, intestinal digestion is
deranged, and the general system falls a prey to poisons which
are otherwise unformed or excluded .—Boston Med. and Surg¬
icalJournal.
POISONING BY ONE OUNCE OF CHLORAL
HYDRATE: RECOVERY.
Dr. R. J. Colenso described this case. The patient, a
lady, aged 34, deliberately took, on December 12, 1893,
1 ounce of chloral hydrate in solution at 8 a.m. At 4 p.m.
she was discovered in her bed unconscious. No ordinary
rousing measures were of any avail. Medical aid was not
procured till 5.30 p.m. The patient was found to be comatose
with abolition of all reflexes. The breathing was shallow and
stertorous, pupils both small and very sluggish, pulse 130,
small and rather firm ; temperature 100,5°. The nature of
Digitized by L^ooQie
Abstracts and Reviews.
59
the poison taken was not discovered for about three hours
subsequently. Atropine was given hypodermically, and the
stomach washed out with much difficulty; the washings re¬
vealed nothing as to the poison taken. Strychnine with
ether was next injected under the skin ; the pulse began to
fail and the coma increased. Nitrite of amyl by inhalation
had some good effect on the pulse; deglutition was very im¬
perfect. Sir Dyce Duckworth saw the case at io p.m., and
at this time a lady friend disclosed the fact that she had on
the previous day bought two ounces of chloral for the patient
to send to a friend in India. This could nowhere be found.
Enemata of strong coffee were now given, and sinapisms ap¬
plied to the thighs and legs. The patient was vigorously
rubbed and slapped with towels. At midnight the tempera¬
ture reached 103°, the pulse continued to flag, and the out¬
look became very bad. Enemata of coffee, milk, Valentin's
beef essence, and brandy, were continued, but not till 12.30
a.m. on December 13th were any signs of animation mani¬
fested. Twitchings of the face and movements of the limbs
were then observed. Groaning and restlessness began about
2 a.m., and the hypodermic use of strychnine was stopped.
The patient cried out to be left alone and allowed to sleep,
but friction and rousing measures were continued until 3
a.m. Short intermissions were allowed, and sleep for ten
minutes at a time, and then the patient was taken from bed
and made to walk about. The urine was drawn off by cath¬
eter early in the evening, and was of dark color. From 8 a.m.
on December 13th the patient slept thirteen hours and a half
in the twenty-four. Recovery ensued, and the patient left
the room on January 7, 1894. Muscular tone was much im¬
paired for some time subsequently, as was the digestion.
Periods of excitement, alternating with great depression, en¬
sued for six weeks subsequently. The patient was a very
powerful woman of large build and of good condition. Nine-
tenths of a grain of strychnine was employed. The amount
of chloral was accurately determined afterwards, the bottle
being found, and a full confession of her conduct was made
Digitized by ^ooQie
6o
Abstracts and Reviews .
by the patient. An ounce of chloral hydrate dissolved in
two fluid ounces of water was the exact dose.
The President has seen a similar case. Artificial respi¬
ration was employed, the stomach pump used, and enemata
of hot coffee given. Eventually the patient, a woman, made
a good recovery. She had probably taken 320 grains of
chloral hydrate, and the stomach pump had been used with¬
in an hour of its being taken.— British Medical Journal\
THE ETIOLOGY OF OSSEOUS DEFORMITIES OF
THE HEAD, FACE, JAWS, AND TEETH. By
E. S. Talbot, M.D., D.D.S., Professor of Dental Sur¬
gery in Women’s Medical College and Rush Medical
College, etc. Third Edition. Chicago, Ill.: W. S.
Keener Company. 1894.
The author has grouped in this work of five hundred
pages a most exhaustive study of degenerations of the head
and face. His facts are drawn from a wide range of reading
and clinical study, fully illustrated by cuts, tables, and
charts. To the general reader the chapters on Changes
of Climate, Intermixture of Races, Hereditary Influences,
Development, Neurosis, Crime, Prostitution, Sexual Degen¬
eracy, Moral Insanity, Pauperism and Inebriety, Intellectual
Degeneracy, Neurotics, Genius, Idiocy, Nutritive Degenera¬
tions, Maternal Impressions, City and Country Life, etc.,
etc., etc., are full of the most startling facts. These topics
in themselves comprise some of the most important themes
of modern civilization, and give the work a value to all
scholars and students that is not easily measurable. The
other chapters on Neuroses of Development of the Bones of
the Face and Head, also the Irregularities of the Teeth and
Jaws, enter exhaustively into a field of study not treated in
the usual text-books of medicine. We give the following
extracts from the last chapter on the conclusions, which
give a good idea of the value of the work :
“The various influences which have been brought to
Digitized by L^OOQie
Abstracts and Reviews .
61
bear upon the present races of the earth, resulting in neuro¬
sis of degeneracy, noted in excessive or arrested develop¬
ment of the osseous system, has been discussed in this work.
A neurotic brain may be transmitted, which presides over
the development of the osseous system ; and this will
cause an arrested or excessive development of the osseous
system. Persons of this character have a tendency to seek
each other’s company. As a result they marry, and the
children may possess genius and egoism, or they may
become idiotic, deaf, dumb, or blind ; or in middle or later
life become insane, criminal, or inebriates. Such mar¬
riages always result in defective osseous growths with
mental instability, and these stigmata are handed down
for a number of generations. These deformities of the
head and jaws often extend to other bones, and the re¬
sulting unbalanced bony framework is an unstable blood
supply and defective nerve function. Consequently all
forms of abnormalities appear, and refer back to physical
changes and degenerations. This refers back to the ques¬
tion why criminals, inebriates, and other defectives should
possess so uniformly stigmata of degeneration.”
The great teaching of this work is the necessity of a
more thorough study of these defects, both as acquired and
inherited, and a full recognition of the tendencies which are
present in the constitution. From these facts certain hy¬
gienic lines of acts and living are necessary to prolong life
and prevent an early failure and death.
This work should be read by all students of science, and
we congratulate the author on this great pioneer study in a
new land of unexplored facts.
PRACTICAL URANALYSIS AND URINARY DIAG¬
NOSIS : A Manual for the Use of Physicians, Surgeons,
and Students. By Charles W. Purdy, M.D., Queen’s
University ; Fellow of the Royal College of Physicians
and Surgeons, Kingston ; Professor of Urology and
Urinary Diagnosis at the Chicago Post-Graduate Medi-
Digitized by CjOOQie
62
Abstracts and Reviews .
cal School. Author of “ Bright's Disease and Allied
Affections of the Kidneys”; also of “ Diabetes : Its
Causes, Symptoms, and Treatment.” With Numerous
Illustrations, including Photo-Engravings and Colored
Plates. In one crown octavo volume, 360 pages, in
extra cloth, $2.50 net. Philadelphia: The F. A. Davis
Company, Publishers, 1914 and 1916 Cherry Street.
Every physician has his own favorite methods of making
uranalysis ; “ short cuts ” practiced now, which he would
studiously have avoided when albuminuria, cystitis, and cal-
culary deposits were to his cases of bronchitis, anaemia,
pleurisy, eczema, etc., in the proportion of one to ten. Dr.
Purdy's book on “Practical Uranalysis and Urinary Diagno¬
sis ” deals not only with the aids to accurate diagnosis of
diseases which manifest themselves by abnormal constitu¬
ents in the urine, through chemical processes, but also
its effects in physiological and pathological phenomena.
This valuable compilation is especially practical for students
and the young physician, while older practitioners, who have
grown used to certain methods followed by themselves for a
long time, would do well to study its text, and thus keep up
with the strides chemistry, physiology, and mechanics are
ever making, in all branches of medicine. This work is
literally the most valuable compendium of uranalysis ever
issued. Part I is devoted to an analysis of urine, in which
are discussed the theories of secretion and excretion of
urine, composition of normal urine, abnormal urine, proteids,
carbohydrates, urinary sediments, anatomical sediments,
gravel, and calculus. The second division of the work,
under the head of “ Diseases of the Urinary Organs and the
Urine in Other Diseases,” aims at a concise description of
the special features of the urine that indicate the presence
of special pathological processes in progress in the economy,
whether they be local or general, medical or surgical, to¬
gether with a brief enumeration of the leading clinical symp¬
toms of each disease, and in most cases an epitome of their
nature and etiology.
Digitized by t^-ooQie
Abstracts and Reviews .
63
A HANDBOOK OF MEDICAL MICROSCOPY FOR
STUDENTS AND GENERAL PRACTITIONERS,
including Chapters on Bacteriology, Neoplasms, and
Urinary Examinations. By James E. Reeves, M.D.,
Member of the Association of American Physicians ;
Ex-President of the American Public Health Associa¬
tion, etc. Philadelphia: P. Blakiston, Son & Co. 1894.
The author of this excellent little manual states in his
preface that his object in writing the book was to take away
from the practising physician all excuse for his neglect of
the microscope in his daily work. He says, and very justly,
that the time has now come when all progressive physicians
and surgeons, general practitioners and specialists alike,
must either themselves possess sufficient skill in microscopic
technique for the faithful and proper discharge of the high
obligation which rests upon them in the diagnosis and treat¬
ment of diseases, or else be able to command the ready
service of some accomplished microscopist and pathologist
to do such necessary work for them. The writer himself is
a general practitioner belonging to the former class, knowing
by actual experience the needs of those situated like himself,
and has the rare gift of being able to impart his self-acquired
knowledge to others. The work is not elementary for the
professional microscopist, but it is admirably adapted to
meet the work of the general practitioner, for whom it was
written.
We reprint the above criticism to give it our warm
endorsement and add that this is one of the most valuable
and practical works that can be placed in the library of
every physician.
TEXT-BOOK OF HYGIENE: A Comprehensive
Treatise on the Principles and Practice of Pre¬
ventive Medicine from an American Standpoint.
By George H. Rohe, M.D., Professor of Therapeutics,
Hygiene, and Mental Diseases in the College of Physi¬
cians and Surgeons, Baltimore; Superintendent of the
Vol. XVII.—9
Digitized by i^-ooQie
6 4
Abstracts and Reviews.
Maryland Hospital for the Insane ; Member of the Ameri¬
can Public Health Association ; Foreign Associate of the
Societe Franchise d’Hygi^ne, etc. Third Edition, Thor¬
oughly Revised and Largely Rewritten, with Many Illus¬
trations and Valuable Tables. Royal Octavo, 553 pages.
Cloth, $3.00 net. Philadelphia. The F. A. Davis Co.,
Publishers, 1914 and 1916 Cherry Street.
This work comes to us in large clear type, well illustrated,
and each chapter ends in a series of questions, which give it
special value as a text-book in colleges. The various topics
are presented clearly and brought up to the present time.
The object is to present the leading facts in a suggestive,
rather than an exhaustive way; to this is supplemented many
valuable tables. It is essential that every physician should
have a clear general conception of the progress of science in
this field. This volume answers this purpose admirably and
we commend it to all our readers as the best single work
published on this subject.
A PRACTICAL MANUAL IN MENTAL MEDICINE.
By Dr. E. Regis, Professor Mental Diseases. Bordeaux,
etc. A Prize Work, 1886. Second Edition. Translated
by H. M. Bannister, A.M., M.D., with an Introduction by
the Author. Press of the American Journal of Insanity.
Utica, New York. 1894.
This work was awarded the Chateauvillard prize by the
Paris Faculty of Medicine in 1886. It is translated by the emi¬
nent expert, Dr. Bannister, and is practically one of the most
thorough manuals that has appeared in this country. The
work opens with an elaborate review of the history of insanity
down to date. Under the head of general pathology are
given the definitions of the various forms of mental aliena¬
tion, and the etiology, progress, and termination. In the
second chapter the functional elements and the constitutional
elements, and the lesions of disorganization are very clearly
brought out. After describing the various forms of mania, a
Digitized by v^qpgie
Abstracts and Reviews.
65
chapter is devoted to the degeneracies of evolution and the
degeneracies of involution. Toxic insanities comprise a very
interesting chapter. The second part, the practical applica¬
tions of mental pathology, is not so original or suggestive as
other parts of the works. The last chapter, on the medico¬
legal side of insanity, is suggestive and clear. Taken
together as a manual from which a general view of the entire
field of psychiatry may be had, it is the best work published.
The general reader will find very clear teachings on all the
general forms of mental diseases, and some of the divisions
of these disorders will clear up the obscurity which has con¬
fused many persons. To the mental expert this work will
bring many new points to view, and suggest a new study of
some topics supposed to be settled. The chapter on toxic
insanities, including pseudo-general paralysis, and morphin¬
ism, absintheism, etherism, chloroformism, chloralism, hasch-
ischism, cocainism, and oxy-carbonism are of great interest
to all our readers, and gives outlines of new fields of study in
the future. This is the first French work which has been
translated in this country, and the first work of the kind ever
printed in an insane asylum by the inmates. We predict a
large sale and great popularity for the work.
ANNUAL OF THE UNIVERSAL MEDICAL
SCIENCES. Edited by Charles E. Sajous and Seventy
Associate Editors. Philadelphia: The F. A. Davis Co.,
1894.
The present work marks^the seventh annual publication
of what has come to be an indispensable possession for those
who desire to keep fully abreast with the medical literature
of the day. The principal feature of this work is the clear,
concise grouping of the new facts which have been presented
during the past year. Several of the special reviews of dif¬
ferent fields of medicine are of great excellence in their clear
scientific presentation, showing skill and experience in the
treatment of these subjects. The division of inebriety and
allied neurosis, under Dr. Kerr's care, is thoroughly well
done, and will attract many readers. This work is now so
Digitized by
Google
66
Abstracts and Reviews .
well established, and the editor and his associates have be¬
come so familiar with the labor and skill of gathering and
condensing from all over the field of medicine, that this work
may be said to be the most complete encyclopaedia of medi¬
cine ever published. From no other source can the physi¬
cian obtain a wider and more complete view of the progress
of scientific medicine in the world to-day. An important
feature of the work is the excellent index, which at once re¬
fers the reader to any given disease, to treatment, or to the
authors of publications upon any medical subject.
The Literary Digest , published by Funk & Wagnalls of
New York city, is one of the most practical weeklies pub¬
lished, giving the reader an excellent picture of every event
in all fields of history, art, and science, religion, and travels,
covering all the world. Send for a copy and become a
subscriber.
The Review of Reviews is one of the best magazines that
can be sent to the busy man and physician. It contains a
picture of the march of events from month to month, and at
the end of the year is a splendid history of the times. No
more acceptable present could be made. Send to the pub¬
lishers, Astor Place, New York city.
P. Blakiston Son & Co's Visiting List for 1895 is one
of the noted annuals that for forty-four years has been pub¬
lished consecutively. Besides being an account book of great
value, it contains a great deal of most valuable information
that is very practical and useful to every medical man. This
is the oldest and best of all the many lists now on the
market.
Our frequent notices of the Popular Science Monthly is
always a matter of pleasure. No other journal brings so
large a variety of scientific facts by the most eminent experts.
It is a great relief for the physician to turn to other fields of
science and watch the growth of new truths. This journal
Digitized by t^-ooQie
Abstracts and Reviews .
67
brings every month a view of the ever onward movement of
science, that widens and enlarges our mental horizon. We
urge all our readers to become subscribers.
The Homiletic Review published by Funk & Wagnalls,
brings the story of the march of religious truth, and the
progress along the higher lines of life to each reader. This
journal is stimulating, vigorous, and helpful to all readers.
The Dixon Crayon pencil is one of the most valuable
for all general work. All pencils of this company are
superior in uniformity and pureness of lead. These pencils
are sold in assorted packages to professional men. Address
Dixon Co., Jersey City, N. J.
Catarrh Remedies Said to Contain Cocaine. — Dr. R.
G. Eccles of Brooklyn has contributed to the Druggists
Circular some observations as to the dangers arising from the
nostrums advertised for the cure of catarrah, due to their con¬
tained cocaine. He remarks that “ the sober second thought
has been commended by wise people through all time. When
the Birney Catarrhal Powder Company took their second
thought they deemed it wise to let their patrons know that
they were using cocaine every time they blew Catarrhal Pow¬
ders in their noses, and began to state this fact on their labels.
They certainly could not have done a more discreet thing
for themselves nor better for their patrons. This writer has
certainly no desire to oppose those who with open eyes
walk into medical danger, but he deems it a duty to the
public to point out such danger and then allow each person
to act as he desires.” As to the danger, Dr. Eccles writes:
“ Persistent use will most likely establish a habit as bad or
worse than drunkenness; to become a slave to cocaine is
something terrible. The writer has seen several such wrecks,
and they are truly objects of pity.”
Digitized by C^ooQie
68
Editorial.
S^ditorikl.
THE NEW YEAR.
It is always a pleasure at the beginning of the year to
look back over the road we have passed ; to study the move¬
ment and direction of events, to find some indications or in¬
timations of the future progress. Twenty-four years have
passed since the first meeting of our association at New
York city, in November, 1870. Eighteen years ago, in De¬
cember, 1876, the first number of The Journal of Ine¬
briety appeared. Only one person is living of that group
of physicians who organized the association. The Journal
still continues under the same management. During all
these years the great central facts which this association and
its journal were organized to proclaim have been slowly
working their way into the public mind. That inebriety is a
disease, and is curable, is fully recognized. The frontiers of
truth concerning inebriety have widened, and each pioneer,
from his advanced studies, points to wider and more ex¬
tended realms of facts that have not been examined. While
the year that has passed has echoed the turbulent shouts of
the gold cure empirics and their frantic rivalry and dying
groans, a great, restless movement has been apparent all
over the world on a far different level. The evils and obsta¬
cles to all civilization from inebriety, and the possibility of
their prevention and cure, are convictions that are rapidly
centralizing both in this country and Europe. Wild schemes
of reform and wilder remedies, involving the most serious
complications and antagonisms are proposed. Legislation,
law, theology, and the boldest charlatanism are fighting to
have their theories tried and accepted. The many questions
of inebriety and alcoholism are coming into prominence in so¬
ciety meetings, into discussions of social problems, in the re-
Digitized by i^-ooQie
Editorial.
69
view and magazine, in the press and pulpit. Opinions are
formed and defended with eagerness and boldness unknown
before. The cure of a few hundred inebriates in asylums
will be lost in the larger questions of prevention. This is
the direction of scientific advance. How can we halt these
armies of inebriates ? How can we prevent and break up
the recruiting stations ? How can we isolate and lessen their
destructive influence on society and on individuals ? How
can we prevent their culture and growth in our midst ? Our
association and journal have, during all these long years,
urged that the inebriate was diseased, and controlled by laws
of dissolution that moved with uniformity, and could be
traced and understood. That all the confusion of theories
and dogmas which are associated with these armies of in¬
ebriates, and the alcoholic problem practically will vanish in
the light of scientific investigation. Every year our work
raises in importance, and it is more and more evident that
we are leading the advance and directing lines of research
that promise a great revolution in the present study and
treatment of this subject. Each year develops and solidi¬
fies the work of the past, and each year brings new assur¬
ances for the future. To all our friends and co-workers are
due thanks and congratulations. The past is full of cheering
promises for the future.
INEBRIETY AMONG RAILROAD MEN.
The drink problem on American railroads is a ques¬
tion of business and without any sentiment. If the man
who uses spirits in moderation or excess shows any incom¬
petency he is discharged at once. An engine was sent to
the shop for repairs more frequently than usual; an inquiry
showed that the engineer was a beer-drinker. The infer¬
ence was that beer had disturbed his judgment and made
him more reckless, and he was discharged. Practical men
are afraid to use spirits on the road for fear they will neg¬
lect some duty, and not act wisely in an emergency. Re-
Digitized by t^-ooQie
7o
Editorial\
cently, a great railroad corporation gathered all the facts
concerning the men, and the conditions of every accident
which had occurred on their lines for five years. When tab¬
ulated it appeared that forty per cent, of all accidents were
due altogether, or in part, to the failures of men who were
drinking. That in eighteen per cent, there was strong sus¬
picion of similar causes, yet no clear proof. In one year
over a million dollars' worth of property was destroyed by
the failures of beer-drinking engineers and switchmen. The
companies' rules requiring temperate men for all positions
are more and more rigorously enforced. Engineers find that
practically they are unable to do good work while using
spirits, even in small doses. The coolness and presence of
mind so essential in their work is broken up by alcohol in
any form.
Trainmen, men exposed to the weather, reach the same
conclusion, if they are practical men. The startling mortal¬
ity of brakemen is referable in many cases to the use of
alcohol to drive out the cold, or keep awake in long hours
of service. Each year the duties and responsibilities of rail¬
road men increase, and men more temperate, accurate,
prompt, and careful in their work are required. Only abso¬
lutely temperate men can do this work for any length of
time ; all others fail and are dangerous in their weakness.
A western road permitted an inebriate, who was really
an able man, to continue as a claim agent adjusting accounts
against the company. His drinking was supposed to be an
aid in the settlement of claims with other drinking men.
After his death a temperate man who filled his place saved
several thousand dollars a year by doing the same work, re¬
peating the common experience that inebriates are always
more or less incompetent. The great railroad strike of last
year began among inebriates, and was sustained by drink¬
ing men and saloon loungers everywhere. While the large,
well-managed companies are steadily driving out all moder¬
ate or excessive users of spirits, as business wisdom, and a
measure of safety and security to the road, many of them
Digitized by i^-ooQie
Editorial\
7 1
make the mistake of permitting open saloons in their build¬
ings at stations. The poor workmen are thus exposed at a
time when they are least able to resist. It is inconsistent to
rigorously forbid all use of spirits to the employes, and pro¬
vide it for the traveling public. Notwithstanding the fact
that nearly two-thirds of all trouble and accidents to passen¬
gers are confined to inebriates and persons intoxicated,
several roads have recognized and avoided this mistake. It
may be said with pleasure that inebriety among railroad
men is rapidly decreasing, especially among men in active
service. The time is approaching when railroad men will
be composed of the most superior mechanics and workmen
of the world. Of the railroad men who are inebriates and
discharged, they are probably the most incurable. The
strains and drains essential and a part of the work, espe¬
cially of trainmen, are followed by a form of exhaustion and
central nerve degeneration from which recovery is difficult.
Railroads are rapidly teaching the true solution of the great
drink-problem, viz.: That alcohol is an anesthetic and paralyz¬
ant, and that inebriety is a disease, and the victim unfit and
incompetent to act and reason soundly. They are also
teaching the incompetency of men who use spirits to do any
form of work requiring care and exactness. When this is
accepted as a fact, inebriety will be judged in its true light,
and the inebriate thrown out as unfit and unable to do the
world’s work.
INEBRIETY AND CRIME UNDER THE NEW
YORK CODE.
The common law was emphatic in stating that drunken¬
ness was no excuse for crime, but in certain cases evidence
of intoxication was admissible, and could be considered as an
extenuation. The statement that a man who made himself
voluntarily drunk should take the responsibility for any crime
committed is repeated as if it was a truism. If the assault
was unprovoked the fact of intoxication would not be allowed
to affect the legal character of the crime. The jury should
Vol. XVII .—10
Digitized by ^ooQie
72
Editorial.
not consider this fact of intoxication where the question of
premeditation was raised. From this the New York penal
code has varied, and provides that a crime committed while
intoxicated shall be equally criminal, but whenever a purpose
or motive or intent is apparent constituting a particular
species of crime, the jury may consider the fact of intoxica¬
tion in determining the purpose of the crime. It is affirmed
that the fact of intoxication might show either premeditation
and deliberation, or the absence of it; this the jury should
consider, and the judge should leave it to them exclusively.
Recently the Court of Appeals have decided “ that it does
not think that under this statute the intoxication need be
to such an extent as to necessarily and actually preclude the
defendant from an intent or from being actuated by a motive
before the jury would have a right to regard it as having any
legal effect upon the character of his act. Any intoxication
may be considered by the jury, and the decision as to its
effect rests with them. But that a man may be grossly in¬
toxicated and yet be capable of forming an intent to kill or
to do any other criminal act is indisputable; and if while so
intoxicated he forms an intent to kill and carries it out with
premeditation and deliberation, he is without doubt guilty of
murder in the first degree.
“If, however, by reason of intoxication, the jury should
be of the opinion that the deliberation and premeditation
necessary to constitute murder in the first degree did not
exist, the crime is reduced to a lower grade of murder, or in
the absence of any intent to kill, then to manslaughter in
some of its grades. The intoxication need not be. to the ex¬
tent of depriving the accused of all power of volition or of
all ability to form an intent.”
This is a marked advance from previous rulings of judges
and shows that the facts are slowly being recognized. The
statement “ that inebriates can be grossly intoxicated and
capable of forming an intent to commit crime or kill is indis¬
putable,” is only true in theory. The crime committed in
this state is always impulsive, unreasoning, and accidental.
Digitized by ^ooQie
Editorial\
73
The next statement of being able to premeditate and deliber¬
ate when grossly intoxicated is never seen in reality. While
men intoxicated may display some cunning and persistency
of purpose, they never deliberate or premeditate when intox¬
icated. This is impossible for a brain anaesthetized by spirits.
In some cases men who have drank a little become possessed
of delusions, and may develop insane cunning in conduct for
a time, but this is so clearly defective as not to be classed as
sane. The question of motive and intent in a drinking man
cannot be determined ; there are no facts or means of com¬
paring his mental operations with that of a sane man. The
brain is in a semi-paralyzed condition, and cannot act nor¬
mally or sanely ; also he may have a defective brain when not
under the influence of spirits ; he may be incapable of forming
a conscious motive and intent for any act. The delusion
that intoxicated men can act with the same capacity and
consciousness as when sane, still clings to the legal theories
of crime. Happily, a change is going on in public sentiment,
and the law will recognize it in the near future.
GOLD CURE LEGISLATION.
According to gold cure authorities, the State of Colorado
has enacted a law, now in active operation, which has some
unique features. The first section permits anyone to petition
to the board of county commissioners to place a drunkard in
a reputable gold cure institution at the expense of the county.
The inebriate must show his anxiety and willingness to take
such a treatment and be properly vouched for. Then the
board shall send him to the institution which will receive him
at the lowest figures, provided the best interests of all seem
to be promoted by this course, and the county shall pay the
bills. This cure and treatment shall be according to the
wishes of the board, who may change or stop the treatment
or send him to another institute, as they may consider
proper. No county shall send the same man twice to the
same institute. The inebriate agrees to attend the institute
Digitized by
Google
74
Editorial.
for treatment, and asserts his excessive addiction and inabil¬
ity to abstain alone by will power.
The second law seems to be in operation in Maryland.
This provides that the friends of the inebriate may petition
the judge of the court to send the case to some institution at
public expense. This institution shall show by a sworn cer¬
tificate that it has had the largest number of cures during
the past twelve months and the smallest per cent, of relapses.
Such certificates are to be deposited with the secretary of
state. This institution shall not charge a sum greater than
one hundred dollars for treatment. No case shall be bound
to be sent to an institution who will charge less than one
hundred dollars unless the judge thinks the best interests
will be accomplished.
A law has been passed in Louisiana of the same purport,
and limiting the cost of treatment to one hundred dollars.
A law has been introduced in Wisconsin to commit inebriates
to some institute where the remedies have been in use for
five years, and are supposed to be sound and useful. The
cost is not to exceed one dollar a day, and the length of
treatment be determined by the physician in charge. This
has not become a law yet. Great emphasis is laid on the in¬
stitute who has demonstrated a thorough method of treat¬
ment.
Evidently the day is far spent and the night is coming on,
and, unless the State comes to the rescue, many poor ine¬
briates will go down before the gold cure ark comes along.
CASE OF JANE COYLE.
This woman was married, without children, and had lived
a quiet life, attending to all her household duties. Her
husband was a prosperous groceryman, devoted and kind
to his wife. Her ancestors had been beer-drinking Eng¬
lish people of the middle classes, and she had occasion¬
ally used beer, when feeling badly, for many years.
When about forty-four years of age, after a mild attack
Digitized by CjOOQie
Editorial\
75
of fever, she began to use spirits to stupor. This grew
worse until at fifty she was a chronic inebriate. At this
time she drank brandy every day, and was intoxicated
each night, and had become incapacitated for all duty.
In the morning, when not so bad, she would beg her hus¬
band to help her, and to find some remedies or physicians
who would cure her. Several medical men prescribed for
her, and a three months’ visit to a private sanitarium was
followed by a relapse, and the same excessive drinking. One
day, after a period of more than usual excess, when the
family physician was called and prescribed some temporary
medicine, his opinion was asked by the distressed husband.
In a loud, emphatic voice, so she could hear him in the next
room, he declared she was incurable. He said she ought to
die as soon as possible, that she was determined to kill her¬
self and go to hades, notwithstanding everything that could
be done. He urged her husband to procure a barrel of the
cheapest brandy, and place it in an adjoining room, and give
her every facility to drink as much as she could. Adding
that in a short time she would die, and all would be glad to
get rid of her. After hearing this and similar advice from
the physician, she relapsed into a semi-stupid state, and re¬
fused to take spirits. The next day a barrel of brandy was
placed in an adjoining room, and both husband and nurse
were urgent in their advice to have her drink of it. She
continued to refuse, using milk and coffee in the place of
it. Finally, she became very angry, and ordered the barrel
taken away, and begged them never to mention the name of
spirits again in her presence. From this time she recov¬
ered, never using alcohol again, and when able to walk
about had all spirits removed from the house. She contin¬
ued temperate and well four years, up to death from acute
pneumonia. This was a case of psychical shock, in which
some unknown physiological change took place in the brain,
and the drink-craze died away at once. The impression of
an idea was so overwhelming that it dominated all diseased
impulses, and enabled her to live temperately until death.
Digitized by t^-ooQLe
76
Editorial.
STATISTICS OF INEBRIATES.
I stated two years ago that there was approximately one
million six hundred thousand persons who use spirits to ex¬
cess in the United States. By excess I meant all persons
who drank to intoxication continuously or at long intervals.
This would include many persons who are temperate most of
the time, then have drink paroxysms. It would also include
persons who use strong spirits daily, seldom manifesting the
usual symptoms of intoxication, but at all times more or less
under the influence of spirits. These figures were reached
from, a study of the statistics of persons arrested for intoxi¬
cation in the lower courts, also the general opinion of per¬
sons with a wide acquaintance among business men, who as¬
sert that less than two per cent, of all drinking men come
under legal notice. The comparative statistics of a town of
five thousand people in Massachusetts, Kentucky, and Texas
might differ widely in the number of spirit-drinkers, and yet
the same general facts would prove true in all of them. In
some communities a very large per cent, of all the males are
spirit-drinkers, and many females use spirits as a medicine
most of the time. Of course, wide differences of opinion will
prevail until some accurate statistics are made. Two at¬
tempts to make a census of drinking men in Eastern towns
revealed many difficulties, and the intensely morbid desire to
conceal the drinking customs of people. Both of these cen¬
suses indicated one drinking man to every eight persons, and
a strong conviction that this was a very low proportion.
There are many reasons for believing that the estimate of a
million six hundred thousand persons who use spirits to ex¬
cess in this country is a minimum rather than a maximum
statement. If the persons who so frantically deny this state¬
ment will make a little study in their own neighborhood,
they will probably find facts that will materially change their
views of the extent of spirit-drinking in this country.
Digitized by t^-ooQLe
Clinical Notes and Comments.
77
dliqidkl Jsfote^ Coir\n\er\t^.
INEBRIETY AND INSURANCE.*
By Dr. Norman Kerr, London.
Dealing first with the subject of insurance against acci¬
dent, Dr. Kerr said that associations insuring against acci¬
dent, or death by accident, usually had a proviso to the effect
that no claim could be allowed if the insurer was intoxicated
at the time when the accident occurred. Two special legal
points were here involved. To successfully resist a claim on
the ground of the insured’s drunkenness at the moment
when the accident took place, it must be established that he
was drunk at the time. It must also be proved that the
accident was the cause of his inability to follow his occupa¬
tion, or of his death. With reference to the first point, the
lecturer pointed out that the contradictory testimony of
witnesses was sometimes most perplexing, due to the fact
that there were varying opinions as to what constituted
drunkenness.
After quoting cases in which companies had been suc¬
cessful in resisting claims, where proof had been forthcoming
that death was due to alcoholic disease, the lecturer pro¬
ceeded to deal with life assurance apart from accident, and
quoted cases to show that resistance to claims for payment
had been successful on the ground of concealment of intem¬
perance. In all cases, however, the refusal of the payment
of the amount for which the deceased’s life had been insured,
on the ground of concealment of intemperance, had not
*A synopsis of a second lecture before the Society for the Study of
Inebriety.
Digitized by i^-ooQie
78
Clinical Notes and Comments .
been sustained. On the point of concealment of intemper¬
ance, it was not always easy to establish that the deceased
was intemperate either before or after insurance had been
effected. Having touched upon the question of opium, the
lecturer said that in addition to the purely medico-legal
relations of insurance actions to inebriety, there remained a
wider and important field for research in the commercial
relation of life insurance itself to narcomaniacal indulgence.
Insurance companies were generally understood to be de¬
sirous of avoiding the risks of intemperate lives altogether,
but there could be no doubt as to the fact that a consider¬
able proportion of the many inebriates who abound in our
midst were insured. What the exact proportion might be,
it was difficult to estimate with even an approach to accu¬
racy. Among the drunken poor only a very small number
of individuals had life policies, but as we ascended in the
social scale the ratio increased. Of inebriate artisans and
skilled workmen, probably more than one-half had their lives
insured. Coming to the middle and upper classes, so called,
in all probability at least one-third of men had taken out
policies on their lives. Inebriates who were insured might
be divided into two groups — those who effected their in¬
surance before and those who effected their insurance after
becoming addicted to drinking. With regard to the first
class of insurers, the lecturer said that no provision except
the forfeiture of the policy on the substantiation of the fact
of intoxication at any previous period in life could possibly
meet the difficulty. Such an insurance revolution, however,
would be too radical, such a procedure too drastic, to be
practical. If enforced it would probably act as a strong de¬
terrent from insurance altogether. Yet the loss to insurance
associations from this source was undoubtedly grievous and
amounted to a very much larger sum than almost any one
could imagine. Some time ago a leading official to a well-
known life assurance company in the United States es¬
timated the annual loss arising on inebriate lives insured
with his office at several millions of dollars. With regard to
Digitized by
Google
Clinical Notes and Comments .
79
the second class of inebriates, those who were addicted to
intemperance for a longer or shorter period prior to apply¬
ing for a policy and who concealed their previous mode of
life from the office, that was a still more numerous class than
the other, and the loss accruing therefrom was very grave
indeed. As he had before pointed out, there was a remedy
at law for the companies against this species of fraud—for
fraud it often unquestionably was ; although in many cases
the concealment was not purposely designed. Of course
the various life offices had to bear the brunt of the heavy
financial loss arising from the insurance of both these
classes of inebriate lives—or rather the burden of loss
on these additional and uncertain risks had to be shared
by the policy-holders, the offices being compelled in self¬
protection of themselves and their assured to weigh the scale
of all premiums sufficiently to cover such risks. The result
was that the rates of premiums were higher than they would
be if the inebriate risks could be substantially reduced.
Thus the abstaining life had to bear the loading necessitated
by the abnormal risks of inebriate policy-holders. Having
pointed out that such a system acted unfairly against and
was unjust to the abstaining policy-holder, the lecturer com¬
mended the example of such offices as the United Kingdom
Temperance and General Provident Institution, the British
Empire Mutual, and the Sceptre, who had separate classes
for abstainers and non-abstainers. It ought not to be for¬
gotten that the acceptance of so-called “ moderate ” or “ tem¬
perate ” lives involved not a little risk of the offices being
saddled unawares with a considerable sprinkling of unde¬
sirable, because doubtful, lives. That risk, however, was
practically unavoidable for many reasons, for there were so
many interpretations of intemperance, for a given quantity
of alcohol had a different effect (i. e. t in degree, not in
kind, all intoxicants being of a poisonous character) on
different individuals, and even on the same individual at
different times. It remained, therefore, to locate the stand¬
ard in the specific life, in the individual idiosyncracy, and
Vol. XVII.—ii
Digitized by i^-ooQie
8o
Clinical Notes and Comments .
make the standard itself the real (not the apparent) effect
which any beyond an arbitrary physiological minimum
might, from their modern knowledge of the action of alcohol
and its narcotic allies, be reasonably believed to have on the
life in question as compared with the known effect on an av¬
erage life. The effects of such habits might not show them¬
selves immediately; but the insurance office required to
be informed of their existence or non-existence, and not
of the period when they were likely to affect health visibly
or to engender a fatal disease. To assert that a man could
be addicted to excessive drinking without impairing his
health was contrary to experience. There was no such com¬
pensation or balance of habits as was supposed to exist
in such cases. Habit might accustom a man to intemper¬
ance, it might enable him to drink a large quantity of alco¬
holic liquor without apparently being injuriously influenced
by it at the .time. But a deranged state of the system
would sooner or later follow, and delirium tremens or dropsy
would probably intervene. A good constitution might en¬
able a man to resist the pernicious effects for a certain time,
but ultimately they would show themselves in some form of
disease, and the result of his intemperance was made appar¬
ent by early death. As to what constitued intemperance,
the lecturer quoted Dr. Tidy, who had said, “ It is difficult to
say in words what constitutes intemperance. An occasional
‘drinking bout 1 does not make a man, in strict phrase,
‘ intemperate/ Again, a habit of indulgence which would
constitute intemperance in one man may not constitute
intemperance in another. Hence, for insurance purposes,
the true question is, not What constitutes intemperance gen¬
erally ? but Is there reason to believe that the applicant
takes more alcohol than his constitution will bear ? In this
matter, the general circumstances of a man’s life must be
considered. Much beer and much exercise is a totally differ¬
ent combination to much beer and sedentary habits. Hence
it is evident that, in insurance cases, physicians and jury
must consider the word ‘intemperate' as a habit prejudicial
Digitized by ^ooQie
Clinical Notes and Comments\
81
to the life of the special individual and not in any broad and
general sense.” Continuing, Dr. Kerr said that the most
skilled and painstaking physical examination would fail to
disclose the initial morbid states of gradually but surely
advancing inebriety, in many cases. Only when the disease
had attained a certain height could any appreciable sign
of its existence be so diagnosed. Hence the need for sotne
more scientific method of dealing with proposals from ine¬
briates who were not recognized to be inebriates by public
estimation. Little as we know with certainty about this
malady and the action of inebriants on the human frame, we
know enough to form an approximate idea of the compara¬
tive values of temperate and intemperate lives. By “ tem¬
perate” lives they might mean insurable persons who, if
they drank at all, drank too little and too seldom either
appreciably to disturb normal functions, or to keep the
system continuously under the influence of the intoxicant.
There was a scale which might fairly be applied in the
elucidation of this valuation. We know that one prominent
effect of alcoholic poisoning, whether spread over a longer
or shorter series of years, was premature aging. If there
was one fact concerning alcohol better established than
another, it was that it operated in antedating the day of our
death. Based on an exhaustive comparison of a wide induc¬
tion of insurance death returns and distribution of profits
to abstainers and non-abstainers, the medical examiner
ought to be able to load the premiums of any inebriate,
whose life was not rejected, with additional years of pre¬
mium corresponding to the increased risk. That scale
might be extended in application to the lives of “moderate ”
drinkers. As the vital statistics of those companies which
insured non-abstainers and abstainers in different sections
showed a higher rate of mortality, with a smaller proportion¬
ate return of profits among the non-abstainers than among
the abstainers, a thoroughly scientific revision of rates
would take the abstaining life — free, of course, from or¬
ganic disease, as the normal starting point. That would be
Digitized by t^-ooQie
82
Clinical Notes and Comments .
a typically healthy life, calling for no loading of premium.
Each non-abstaining life which might be deemed fit to
be accepted (of course some of this class of lives would
involve too heavy a risk and would have to be refused)
would be weighted with an addition to the premium on
abstaining first-class lives, proportional to the extra risks in¬
volved. That would be fair to all parties. The non-alco¬
holic insurer would reap the full benefit of his healthful
habits; the “moderate” or “immoderate” or “free”
drinker would have to pay a premium commensurate with
the actual risk on his life to the office insuring him.
Having given it as his opinion that regular “moderate”
drinking tended to shorten life, he said that practical confirm¬
ation of the noxious influence of what was generally held
to be “ moderate” drinking and of the accuracy of the scien¬
tific classification of alcohol as a poison, was afforded by
the only available practical test — experience. The records
of associations for insurance against sickness and death,
with different sections for abstainers and non-abstainers,
supplied the opportunity of applying that crucial test.
Take a quarter of a century's returns of the United King¬
dom Temperance and General Provident Institution. The
expected and actual claims for insurance against death
during twenty-five years had been, in the General Section,
7,277 and 7,043; in the Temperance Section, 4,856 and
3,423. That was to say, there was a mortality in the Gen¬
eral Section of 96.66 per cent, and in the Temperance Sec¬
tion of 71.49 per cent., a difference in favor of the latter of
26.17 per cent. In other words, reckoned by a common life
table, there were 243 fewer deaths in the General Section,
against no less than 1,433 fewer among the abstainers. If
all those insured had been non-abstainers, the total deaths
would have been 11,727. If all had been abstainers, the
deaths would have been 8,553, a difference of 3,174 deaths,
which last total number gave ’the nearest approach to accur¬
acy as to the preventable loss by death to a considerable
group of selected lives. Any objection to the unmistakable
Digitized by
Google
Clinical Notes and Comments .
83
meaning and force of those figures on the score of the Gen¬
eral Section including some inebriates, was counterbalanced
by the fact that the lives in that section had been below the
expectancy, supplemented by the additional fact that some
of the abstaining section had been reclaimed drunkards, and
had succumbed to cirrhovic and other fatal lesions dating
from their pre-abstinence days. The transfer of insurers
from one section to the other, both ways, had not appreci¬
ably affected the comparative death rate. The only precise
information which he had as to transfers had been with
regard to the Sceptre office, Mr. Bingham having supplied
him with the total number of deaths in the transferred
during the seven years, which had amounted to seven. The
fact was that the transfers had been found to occur from the
omission of the insured to fill up and send the declaration of
continued abstention which had to be done at stated times.
The claims by death expected during 1891 in the Sceptre
(calculated by the Institute of Actuaries* Hm table) as com¬
pared with those which actually occurred, were as follows :
Expected Claims.
115
Expected Claims.
6l
General Section .
Actual Claims.
93
Temperance Section .
Actual Claims.
30
Rate per cent.
80.86
Rate per cent.
49* 1 8
The returns of the office for eight years showed a difference
in favor of abstaining lives of 22.5 per cent. Having quoted
other figures to show the advantage of total abstinence, Dr.
Kerr said the figures he had given proved that even the
strictly limited dietetic use of intoxicating beverages was
prejudicial to health, inimical to longevity, and considerably
increased liability to disease. Even if the regular limited,
or moderate, drinker never drank to excess, other things
being equal, he would yet have less vitality, greater liability
to disordered health, with inferior recuperative powers to
stand up against the onset and weakening effects of disease
and accident. Another very important point, especially in
these later days of more active philanthropic effort at the res-
Digitized by t^-ooQie
8 4
Clinical Notes and Comments .
cue, and of intelligent medical treatment, of the victims of
strong drink, resulting in the greatly increasing numbers of re¬
formed and cured inebriates, was the answer which insurance
companies had to make to applications for policies on the lives
of inebriates who had entirely abandoned the use of intoxi¬
cants and all other inebriating substances. In their “ Hand¬
book of Assurance,” Dr. J. E. Pollock and Mr. James Chisholm
had written these remarkable words : “ We scarcely believe
in the existence of a reclaimed drunkard, so rarely is he met
with in medical practice, and after many years of active pro¬
fessional work we have scarcely seen two such cases which
could be verified.” And they added : “ We cannot, there¬
fore, advise the acceptance of a total abstainer who is known
to have been habitually intemperate. They almost always
break out again.” Mattison, in “ Opium Addiction as Re¬
lated to Life Insurance” (New York), said: “All companies,
very properly, exclude alcoholics ; but ex-rum users, if all
other conditions be good, are taken by most life assurance
companies on short-term policies after three to fifteen years,
provided the steady taking ended before the age of thirty-
five.”
It must be borne in mind, continued the lecturer, that
even if an inebriate totally discarded his cups and never
drank any quantity of any intoxicant, nor consumed in any
form any other inebriant, he could not expect in his strict
teetotal days to escape “scot free” from the injurious phys¬
ical consequences of his previous term of intemperance.
Especially with alcoholic intoxicants did an inebriate course
of five, ten, fifteen, twenty, or more years leave its mark on
the frame which had been so long assaulted with heroic
doses of so potent a poison as alcohol. In many different
ways and on many vital organs, by tissue destruction, by
structural degradation, by cell degeneration, by permanent
lesions of stomach, liver, kidneys, lungs, heart, brain, and
nerve substance, as well as by the deterioration caused
by functional disturbance and depravity. Alcohol branded
as with a red-hot rod of iron the whole man, leaving the
Digitized by L^OOQie
Clinical Notes and Comments .
85
scars to attest, long after its abandonment, its once blighting
influence on the human body. There were, therefore, addi¬
tional risks in insuring an erewhile though now abstinent
inebriate, but those risks were not nearly so great as Pollock
and Chisholm's sweeping pronouncement would seem to
indicate. The onward route of the marvelous series of phe¬
nomena of the nineteenth century known as the temperance
movement, or abstinence crusade, had been thickly dotted
with an enormous company of drunkards transformed by its
beneficent influence into sober and industrious citizens,
a chaplet studded with pearls of great price, each of which
was worth a king’s ransom. Reclaimed inebriates were
everywhere around us, entrusted with responsibilities of no
ordinary value. In all ranks, professions, and callings they
were to be found fulfilling the duties of life as faithfully as
the abstainer from birth. After nearly thirty years of study
and experience of the case of habitual drunkards, he had no
hesitation in declaring his belief that, on an average, at least
one-third of such as have been under skilled treatment and
in seclusion for a sufficient time have remained staunch
water drinkers all through their after life. Even of drunk¬
ards brought under moral and abstinence influences alone,
without medical cure (though most religious and moral mis¬
sions of this kind now recognized a diseased condition in the
greater number of drink victims), his observation had been
that from io to 20 per cent, had kept steadfast in the prac¬
tice of the only safe rule of life for them — entire abstinence
from all intoxicants. The aggregate of the saved from
alcoholic excess was thus by no means contemptible. He
estimated that in Britain there were at least 200,000 ex¬
drunkards now consistent nephalists, a goodly proportion of
whom had a record of from ten to thirty and more years'
freedom from alcoholic inhibition, and there were at least as
many more in the United States of America. Taking into
account the similarity, rescues in our colonies, on the conti¬
nent of Europe (where special sanatoria and the temperance
propaganda had cared for a very large number of individ-
Digitized by i^-ooQie
86
Clinical Notes and Comments.
uals), and in other quarters of the globe, he felt that he was
far within the truth in computing the present number of
permanently restored inebriates in the world at no less than
600,000. He was therefore of opinion that all lives of re¬
claimed drunkards should not be rejected by life assurance
companies. A certain proportion of such lives were so bad,
the proposers had so permanently and seriously damaged
their constitutions by their former indulgence, that they
were practically uninsurable ; and justice to the already
insured demanded that such utterly bad lives should be
refused. Where, however, there was no evidence on exam¬
ination of organic disease, and where the abstaining period
had been long enough to warrant a reasonable prospect of
abiding abstention, such lives ought to be deemed insurable
at an additional risk, representing an enhanced premium.
What the loading should be could be arrived at by actuarial
calculation on the wide induction of facts and figures in the
possession of insurance societies. In this connection, two
points had to be determined — first, What term of abstinence
should be regarded as a minimum requirement ? There
could be no absolute term fixed, as the necessary nephalian
term would depend largely on the present state of the
proposer’s health, on the duration of the drinking habit prior
to abstinence, and on his heredity — inebriate, neurotic, and
general. But it appeared to him (the lecturer) that, taking
into consideration the deceptive character of alcoholic action
on the constitution, a minimum abstinent term of five years
should be held to be the shortest abstaining career qualifying
for the consideration of a proposal from a reformed or cured
inebriate — in a case of not more than five years’ standing.
Beyond five years there should be half a year of probation
added for every additional year of former intemperate career.
With opiumists, the minimum term of freedom from the
drug might be rather less. Though opiumania and mor-
phinomania were more difficult of cure than alcoholomania,
pathological science had not as yet revealed any post mortem
appearances indicative of the grave organic degeneration
Digitized by t^-ooQie
Clinical Notes and Comments .
8 7
and permanent structural alterations seen in the bodies
of intemperate alcohol takers. The well-known case of the
executors of the Earl of Mar vs. Edinburgh Life Assurance
company, tried at Edinburgh in 1830, did not yield any facts
in support of the contention that opium-eating was antago¬
nistic to long life, which was one of the pleas relied on
by the company for resisting payment of the policy. There
could hardly be any doubt, however, that in the opinion of
the overwhelming majority of medical observers, that con¬
tinuous, excessive opium consumption was subversive of
good health, and therefore likely to induce premature decay.
On the whole, giving due consideration to all the probabili¬
ties and risks, he agreed with Dr. Mattison’s suggestion that
three years* entire abstention from the drug in any form,
after not more than five years, ought to qualify for the
acceptance of a life in other respects eligible for insurance.
He (Dr. Kerr) would add the additional condition that the
applicant be not above forty-five years of age on this proba¬
tion. If the practice had been extended over five years, he
would extend the period of probation six months for every
additional addiction term of two years. In the case of ine¬
briates addicted to chloral and chlorodyne, he would insist
on the same minimum probationary term as with opium;
but in the case of chloroform and ether inebriates, on the
longer term required for abstaining alcoholic inebriates.
The other point for consideration was the amount of loading
which the premium of an insuring cured alcohol inebriate of
at least five years’ good standing ought to bear to meet the ad¬
ditional risks on the individual life. Reviewing the results of
the various series of vital statistics which he had adduced,
before the exact risk was determined by actuaries from a
collection of records extended enough to warrant fairly accu¬
rate deductions, they might form a rough idea for present
purposes. In the case of alcohol drunkards, if the period of
alcoholic addiction had been not over five years, he would
suggest a loading which would bring the premium up to the
Vol.XVII.—12
Digitized by
Google
88
Clinical Notes and Comments .
premium payable at the ordinary risk on a life being insured
five years later in life. For every additional year of the
alcoholic indulgence, he would add half a year’s extra pre¬
mium. In the case of opium consumers who had given up
the poison for at least three years, he would age the
premium by weighting it so as to bring it to the premium,
at ordinary risks, payable if making the proposal four years
older. The lives of once inebriate, but now abstinent, per¬
sons would thus be eligible for insurance at an increased
charge for premium somewhat commensurate with the added
risks ; and a solid encouragement would be held out to
drunkards to reform. There were many circumstances pe¬
culiar to an individual life to be weighed — for example, the
risk would be very much greater in the case of a person who
had been predisposed or excited to inebriety by permanent
structural brain lesion, as in syphilis affecting that organ,
than inebriety developed through evanescent functional dis¬
turbance. In the same way the risk would be smaller in an
ex-inebriate with no family history of inebriety or insanity,
than in one with a clear heredity of either of those diseases.
In conclusion, Dr. Kerr said that Dr. Mattison had pro¬
posed that the lives of reformed drunkards might be insured
on the condition if they relapsed into inebriate excess the
policy would lapse. In the event of such a course being
adopted, there ought to be adequate provision for the repay¬
ment by the company of the surrender value if re-addiction
should unfortunately take place. There would appear to be
some doubt in the minds of insurance officials as to whether
the enforcements of such a condition could be sustained
in law, or whether in a suit against the insurer for the pay¬
ment of the policy on the life of a reformed inebriate who
had returned to his potations, the verdict would be against
the insured. A legal opinion, however, had been obtained
to the effect that such policies might be issued and that
there was no legal objection.
Digitized by i^-ooQie
Clinical Notes and Comments .
89
THE CURE OF THE ALCOHOL DISEASE FROM
A PHYSIOLOGICAL POINT OF VIEW.
By A. Enfield, M.D., Bedford Springs Sanitarium, Pa.
The day of medical theories which do not have the basis of
established facts to justify them belongs to the past. It has
taken ages of observation and investigation, by the greatest
intellects of the profession, to elevate the science of medicine
to the high position it now occupies. We live in an age of
light and knowledge, an age in which old isms, theories, and
fallacies are fast disappearing before the sweeping progress
of this century.
The past decade has given us the beginning of a new
epoch in the science of life. Medical science is now called
upon to defend our bodies from the parasites which prey
upon us from without, and physiological and chemical re¬
search have taught us the therapeutic application of drugs in
the cure of dipsomania and kindred diseases.
The power of self-regeneration is one of great distinctive
properties belonging to all organized living bodies, but the
moment we commence to live we begin to die. Molecular
change may be increased or retarded by various foods and
drugs taken into the system at stated periods. We apply
the term “ hunger ” to that peculiar want felt by the human
system for food, a sensation (when not too prolonged) by no
means disagreeable, and one which is often excited by the
sight or smell of a savory dish.
It is true the taking of food is influenced in some degree
by exercise and habit, as well as by the sense of hunger, and
if our systems are not supplied at regular intervals by this
nourishment the sensation becomes so great that we suffer
great pain and distress.
All the elements necessary to nutrition (except oxygen
and light) can be taken into the system by the mouth ; and
if it were not that there comes a time in the history of every
Digitized by t^-ooQie
90
Clinical Notes and Comments .
organized body when tha tissues fail to appropriate sufficient
new material to repair the waste we would continue to live
forever. Death is, consequently, a physiological necessity.
Therefore, there is no such thing as true euthanasia. But it
is the duty of the physician to secure for man such good
health as shall beaF him in activity and happiness onward in
his course to the goal. Good health and happiness can be se¬
cured by living in obedience to the laws of health. When
the medical profession succeeds in teaching the world how
to live in a proximate, physiological, and normal condition,
then physicians will have reached the consummation of their
calling.
Fifty years ago there was not a medical college in Europe
or America that had a special chair of neurology, whereas,
to-day there is not a school that has not at least one such
chair, and some schools have two or even three professors
who are giving their whole time and attention to discoveries
and advancements in this important branch of medical
science. It is, therefore, gratifying to the American student
of scientific medicine to note the amazing progress that has
been made in the discovery and cure of nervous diseases, es¬
pecially by American neurologists.
It was our own beloved Rush who, a century ago, stood
as the great pioneer (in advance of all the world) to describe
and clearly demonstrate the future of this branch of medical
science. It was through men like Rush, Pinel, Brown-S6-
quard, and others who taught us that insanity is a disease,
and not the devil, in man, as was generally supposed prior to
their time. So that to-day, while medicine is advancing all
along the line, in no other department has there been such
an advancement as in the discovery and treatment of nervous
diseases. Advancement has been so rapid in this special de¬
partment of medicine that some writers claim that all dis¬
eased manifestations are but the result of nervous shock.
Vesalius took his own life in his hands when he was
brave enough to sharpen his scalpel for his first dissection of
the human body. Galen taught us that the arteries con-
Digitized by ^ooQle
Clinical Notes and Comments .
9 i
tained blood and not air, and Harvey showed us how that
blood circulated. Jenner, Pasteur, and Koch have been bold
enough to transfuse the very elements of chemistry into our
blood, in order to kill the myriads of germs that infest our
organisms, and produce disease and death. By the aid of
physiology and chemistry, we have used the elements around
us to cure disease and prolong life. The great labors of the
past are but now beginining to bear their fruits. Alcoholic
neuritis is no longer considered a habit, but a disease ; as
much so, indeed, as insanity.
It is an insult to medical science to say that all the brave
and good men who have killed themselves with alcohol and
opium did so just from habit. Tell me that all the men of
genius whose lives have been wrecked and ruined by these
drugs were led to their use by mere accident ? Impossible !
These men fought like heroes against their diseases, and
for these diseases they are not responsible. The day has
come in the fullness of tim.e when we can say that this dis¬
ease which has destroyed so many shall destroy no more.
Thousands of human beings are being rescued from the de-
stoying influence of these diseases, and thousands and tens
of thousands are yet to be saved from an untimely death.
Every new advancement in science is met with a storm
of opposition. Dipsomania must be recognized as a disease
and not as a habit. Until recently the medical profession
has neglected to examine this subject carefully from a phys¬
ical point of view. We must examine this subject the same
as we examine any other ailment if we wish to reach a satis¬
factory conclusion.
It is not the intention of this article to begin a contro¬
versy with those who honestly believe that inebriety is the
result of habit alone. Inebriety is no more due to habit,
vice, and sin than is insanity. If inebriety is a disease, then
its cure rests with the physician ; if it is wholly a sin, and
man is entirely responsible for his appetite, then his treat¬
ment and salvation must come from those who claim that it
is a habit.
Digitized by i^-ooQie
92
Clinical Notes and Comments .
A Christian will be a better, a brighter, and a happier
Christian if we can remove this appetite for stimulants and
give him a healthy stomach. An ounce of cure is worth a
pound of prevention, if applied at the proper time. Thou¬
sands have been crying for help from this dreadful disease,
while theorists have been talking, and preaching, and splitting
hairs as to whether it is a moral or a physical evil.
The word habit, as is the word malaria, is a convenient
word with which to explain something we know nothing
about. Conversion, change of heart, and the grace of God
are the great moral helps, but they cannot cure a diseased
system nor a depraved stomach. The moral side of intem¬
perance has been proclaimed for ages, and yet statistics show
that inebriety is on the increase.
On this subject the medical profession has remained
silent entirely too long, and it has allowed the moralists to
advance their own views in the matter, without any scientific
examination of its cause, its nature, its character, or its cura¬
bility. We must admit that the moral agitation of the sub¬
ject has done much good, but still there is something want¬
ing. The removal of alcohol does not remove the craving
for its use, but rather increases the appetite for it.
If we cannot cure the inebriate by the application of
drugs scientifically applied, we shall never be able to cure
him by forced abstinence. Public opinion may deny this
and opposition may come from every superstitious person in
the land, but that will not frighten the conscientious and pro¬
gressive physician who has science, experience, and results
to support him. He must go patiently on, and look beyond
the present opposition of the incredulous and skeptical pub¬
lic, until he has worked out the physiological and pathologi¬
cal condition of the inebriate and restored him to health.
Man is a complex animal, full of variations, and easily
influenced by any change in his nerve-centers. His call for
stimulants arises from a loss of nutrition to some part of the
central system, just as the call for food arises from the same
cause. Therefore, it is impossible to cure this morbid crav-
Digitized by t^-ooQie
Clinical Notes and Comments.
93
ing, which has its seat in the brain, without first removing
the cause by appropriate medication.
The inebriate may be anxious to quit the use of the stim¬
ulant, but the moment he makes the attempt his diseased
stomach and brain give notice that they must have some¬
thing to nourish them.
It is not within the scope of this short article to analyze
and examine the many predisposing causes of this disease,—
such as heredity and non-heredity, occupation, etc., — or we
might present many facts and data that would help to deter¬
mine this question, outside of any social feelings or opinions
we may entertain.
There is no subject in medicine that should receive more
interest or more attention from the profession than this sub¬
ject of inebriety, and yet, in the past, we have allowed the
laity to do all the thinking, writing, and legislating on the
subject. It is time we call a halt. The physician is certainly
better qualified to investigate the subject, and to pass his
judgment on it than those who have never examined it from
a scientific point of view.
The same general principles apply in the treatment of
this disease that apply in all chronic nervous diseases.
Physical laws and forces are the same in all individuals.
The system broken down by long years of dissipation cannot
be relieved by any one drug or combinations of drugs alone,
but by building up the whole body by special diet, baths, exer¬
cise, electricity, and good hygienic surroundings.
In my hands a combination of drugs has proved most
beneficial. Each and every case must have special treat¬
ment, according to the symptoms manifested.
No doubt chloride of gold may possess alterative proper¬
ties, and, when properly and systematically given, in combi¬
nation with strychnine, atrophine, coca, quinine, sulphonal,
and codeine, has a tendency to change the habits of the sys¬
tem, remove the diseased condition of the nerve-centers, and
allow nature to return to a normal condition.
These powerful drugs, when given for a long time, so pro-
Digitized by t^-ooQie
94
Clinical Notes and Comments .
foundly influence and build up the nervous system that the
inebriate feels strong and well, and gradually acquires as
much repugnance for stimulants as he before had an appetite
for them. The treatment breaks or removes the cause of
the disease, and the inebriate starts in a new career of life.
Of course, he may relapse ; so he may from any other nerv¬
ous disease. Anything that tends to exhaust the brain or
lower the vital forces predisposes to a return of the disease.
The individual should live a life free from excitement,
annoyance, and worry ; eat wholesome and substantial food,
and be constantly under, the observation of a physician.
Physicians who are familiar with i the modern treatment of
inebriety, do not condemn that treatment; but they rightly
refuse to indorse nostrums of which they know nothing.
The general practitioner has not the time to devote to the
treatment of these cases. He might as well attempt to treat
all his cases of insanity.
Specialists have explored the grounds, investigated the
disease, and formulated the treatment, and are, therefore,
more competent to handle such cases successfully. Nor is it
advisable for the patient to treat himself. Most drugs that
are of any value in this disease would prove dangerous in his
hands.
My reason for dwelling upon the neurological and physi¬
ological aspect of this disease is, to call the attention of
those outside of the medical profession to the great ad¬
vancements that have been made in this special department
of the healing art. The world is too apt to look with dis¬
favor upon any new discovery that is invisible and incompre¬
hensible to the common mind.
People grow wild over the graphophone, the telephone,
or the electric car, but fail to realize the subtle and invisible
agents that science is using to cure man. In conclusion, we
may then state with perfect confidence that inebriety is a dis¬
ease and not a habit, and, being a disease, is, therefore, cura¬
ble ; and, in order to intelligently treat it, we must study the
nature and character of the disease as it manifests itself in
Digitized by t^-ooQie
Clinical Notes and Comments . 95
different individuals. We must approach the subject from
the physical and not from the moral side of the case. We
must discard any preconceived notions and theories not
based upon facts.
TEA INEBRIETY.
Dr. Wood of Brooklyn, N. Y., in the American Therapist
calls attention to the consumption of tea and coffee at the
Pennsylvania Insane Hospital at Philadelphia. He finds
from the statistics of the past year that the women drank
one ton and a half of tea, and nearly four and a half tons of
coffee. The men drank a half ton of tea and three tons
of coffee in one year.
He comments as follows :
“The writer has already reported 125 cases of tea-inebria¬
tion. In the study of these cases it was found that 72 per
cent, were what is generally known as nervous persons ; 20
per cent, had frequent spells of faintness ; 50 per cent, were
troubled with gastric or intestinal indigestion with all of the
attending ailments ; 3 per cent, had seriously contemplated
suicide ; 45 per cent, were sufferers from persistent head¬
ache or capital neuralgia; 10 per cent, had spells of great
depression ; 20 per cent, were despondent ; 50 per cent,
were excited; 19 per cent, were troubled with conscious
palpitation of the heart; 20 per cent, had insomnia, and
when it was not complete, what little sleep they were able
to get was greatly troubled by the most harrowing night¬
mares and dreams, so that they by far preferred to remain
awake. In 12 per cent, there was noticed increasing
muscular tremors. There were found among quite a number
well-marked hallucinations, especially those of impending
death and robbery. Such a picture as this presented to the
thoughtful physician is most deplorable in every respect.
These poor individuals often confess to a degree of tea¬
drinking which without question makes the habit an actual
dypsomania.
Vol. XVII.—13
Digitized by t^-ooQie
96
Clinical Notes and Comments.
“The writer is at present studying the place of tea as
a causative agent in insanity in this country. Before me lie
reports from all the institutions for the insane in Ireland,
and in these tea-tippling is given a most prominent place.
Those in charge of these institutions do not hesitate to say
that it is a direct cause. This fact, in connection with the
table showing that out of the 10,562 patients 1,246 were of
Irish birth, lends weight to my assertion.
“ The writer has traced many cases of insanity to the
immoderate use of tea. Every intelligent physician knows
that coffee interposes serious obstacles in the treatment
of occult diseases associated with or dependent upon hepatic
torpor. Yet, here we have men (inmates) consuming coffee
at the rate of 30 lbs. a year per capita, and women (inmates)
consuming 37 lbs. of coffee and 13 lbs. of tea each, or
in round numbers 50 lbs. of tea and coffee annually. Even
when used moderately, this would be ten times as much as
sane people ought to have.
“ No wonder that the record of recoveries is so low as 31
and 32 among the male and female inmates, respectively.”
FUNDAMENTAL PROBLEMS. By Dr. Paul Carus,
Editor Open Court, etc., etc. Open Court Publishing
Co., Chicago, Ill., 1894:
This is the second edition of a series of essays which
have appeared in the Open Court Publishing Co. “ On
Forms of Thought” ; Problems of Law and Nature ; Ques¬
tions of Cause and Effect; Agnosticism, Mysticism, Rea¬
son, Ethics, Matter, etc., etc. These and many other allied
topics are presented clearly, and from the broad standpoint
of modern science. The following sentence in the preface
suggests the range of the book : " The philosophy of the age
depends on the health of our religious, our scientific, our in¬
dustrial, our mercantile, our political, and our social devel¬
opment.” Such works are very stimulating and helpful, and
every thinking man should be familiar with them.
Digitized by CjOOQie
Clinical Notes and Comments.
97
MALTINE WITH COCA WINE.
During the withdrawal of opium a great variety of neurotic
symptoms appear which are not only very distressing, but
difficult to treat. The milder narcotics are aggravating in
the transient relief which they bring, and spirits are often
unpleasant to the taste, and, only when large doses are used,
bring relief. The question often occurs, Is alcohol, in any
form, a practical narcotic for these psychical disturbances ?
This is variously answered, but usually in the negative. Yet,
practically, some of the forms of tinctures in which alcohol
is the most prominent factor are found to be excellent in
certain cases. The tinct. of oats and red bark, and other
tonics, have been highly praised, and, in a few cases, seem
almost specifics ; but much depends on the method and way
of administration. The maltine preparations are all excellent
tonics, in both alcoholic and opium cases, and can be used
with great satisfaction whenever great debility and anaemia
are present. The new combination of coca wine with maltine
seems to meet many conditions present in the stage of with¬
drawal of both opium and alcohol that have not been observed
before. In two cases of opium ediction, this drug, given in
two-ounce doses every three hours, markedly relieved the
distress following the rapid reduction of opium. Both cases
recovered with less suffering from the use of this drug, and
a week after the withdrawal of the opium, changed from
maltine and coca wine to maltine and hypophosphites. These
results were very satisfactory, and has encouraged us to
make a more thorough trial in the future. In four cases of
inebriety, the abrupt withdrawal of spirits and the substitu¬
tion of maltine and coca wine, had equally satisfactory results.
The usual nervousness and precordial distress was absent in
nearly all these cases, and only noted at the beginning of the
treatment. It appeared that this form of spirits, associated
with coca and maltine, has some special tonic action
that is eminently suited for such cases. We take pleasure
in saying that this form of maltine appears to be of unusual
Digitized by i^-ooQie
98
Clinical Notes and Comments .
value, and deserves a careful trial and clinical study, particu¬
larly in the opium and alcoholic cases.
This prescription is very valuable in many cases, and
should be tried :
CHRONIC ALCOHOLISM.
R.-Tinct. Capsid, ..... i ounce.
Tinct. Zingiberis, ..... i ounce.
Tinct. Valerinae Ammon, .... 2 ounces.
Celerina, ...... 2 ounces.
M. Sig. : Teaspoonful in teacupful of hot tea three or four times
daily. — St. Louis Clinique .
The Antikamnia Pocket Case is exceedingly practical
and a useful aid to physicians. This firm has distributed
them very freely to physicians who appreciate this in many
ways.
The Antikamnia Chemical Co . are hereafter to put this
drug in a tablet form, of definite proportions. This places
an excellent drug in the most available form for ready use.
No remedy has become more popular as a safe and reliable
sedative than Antikamnia.
F. A. Davis Co. t the well-known medical book publishers
of Philadelphia will issue a companion book to Dr. R. von
Krafft-Ebing’s famous treatise, “ Psychopathia Sexualis,” en¬
titled “ Suggestive Therapeutics in Psychopatia Sexualis/' it
being a translation of the original by Dr. A. Schrenck-Not-
sing, of Munich, collaborator with Krafft-Ebing. This book
will contain about 325 pages and be sold by subscription
only, at $2.50 per volume, in cloth. It will be of the great¬
est importance as an authoritative work on suggestion as
a therapeutic agent in the hands of the intelligent practi¬
tioner.
Dr ’. R. Cantalupiy writing from Naples, Italy, under date
of July 24, 1893, says : “ Bromidia has produced successful
results in all the most varied forms of insomnia. Among
others who have been benefited by its use is Professor Ces-
Digitized by i^-ooQie
Clinical Notes and Comments .
99
are Olivieri, well known as a most distinguished surgeon in
this city, and who, after undergoing tracheotomy for neo¬
plasm in the larynx, suffered terribly from insomnia, which
the usual hypnotics all failed to relieve. Hearing of this,
from a mutual friend, I advised the use of Bromidia, which
promptly produced the desired result.
Kola Cordial has come into prominence as a powerful
stimulant of the nervous system, and particularly of cardiac
feebleness, neuralgias, and other disturbances arising from
degenerations caused by alcohol and opium. Park Davis
& Co. have placed a very reliable preparation of this new
drug on the market. Send to this firm for the literature of
this new drug.
The E. C. Morris & Co. Fire-Proof Burglar Safes made
at Boston, Mass., are the best and most reliable on the
market. Send for a circular.
Snlfonal and Trional have become the most valuable
hypnotics in use. In cases of alcohol and opium inebriety
they are invaluable, and in many cases are practically spe¬
cifics, without any rivals. The well-known firm of Schief-
felin & Co., of New York, are American agents.
Syrup Hypophosphites by Fellows has achieved a very
wide-spread reputation for its peculiar tonic and nutritive
properties. Its effect on the appetite and digestion is very
marked and satisfactory. In all mental and nervous dis¬
eases it has become a standard remedy.
Wheeler s Tissue Phosphates contains calcium phos¬
phate, sodium phosphate, ferrous’s phosphate, trihydrogen
phosphate, and the active principles of calisaya and wild
cherry. It will be seen from this, that its value as a remedy
is very great.
The Arethusa Spring Water of Seymour, Conn., has re¬
cently come into prominence, as an exceedingly fine table
water. It is alkaline, and has a marked tonic action, and
may be truly said to be the great American Apolinaris Wa¬
ter which will outrank or equal all other waters in purity and
Digitized by
Google
IOO
Clinical Notes and Comments .
freedom from germs. The following is the analysis of this
water by Professor Chittenden of Yale College:
Grains per
U. S. Gallons.
Silica, ....... 0.607
Calcium Carbonate, ..... 0.431
Sodium Chloride, ...... 0.247
Magnesium Carbonate, . . .0.128
Potassium Sulphate, ..... 0.095
Sodium Sulphate, ...... 0.203
Sodium Carbonate, ..... 0.015
Ferric Oxide and Alumina, .... 0.009
Total.1.735
The water is clear, colorless and alkaline, and as the analysis shows is an
exceedingly pure and soft water.
Respectfully yours,
(Signed), R. H. CHITTENDEN.
Horsford Acid Phosphate has in our practice proved, on
several occasions, to possess both tonic and antiseptic pow¬
ers that was unexpected. In a case of severe erysipelas in¬
flammation from the use of a hypodermic needle, the acid
phosphate was used by mistake in large doses every three
hours. Two days later when the mistake was discovered
the case had improved so rapidly that the acid was contin¬
ued, and full recovery followed. Later, a case of extreme
debility with abscesses was treated exclusively with the
acid phosphate, and recovered. In these cases it appeared
when the system became saturated with the phosphates
healthy granulations followed and tissue degenerations was
checked. This experience has been repeated in various
ways, with the same results, and it seems reasonable to state
this conclusion, as sustained by many facts. In cases of
tissue degeneration following drug poisoning and exhaus¬
tion, and when a strong tendency exists to formation of ab¬
scesses and elimination of poisons and dead cells in this
way, the acid phosphate may be given very freely, as both
an antiseptic and neutral tonic. In certain of these cases
its action is that of very nearly a specific, and in all cases it
has more or less benefit. In all forms of general exhaustion
associated with anaemia and low vitality, the acid phos¬
phate should be used either alone or associated with some
bitter tonic. A favorite form is to combine it with fluid
extract of cinchonia, and to give it in small doses frequently
repeated.
Digitized by i^-ooQie
THE
Quarterly Journal of Inebriety.
Subscription, $2.00 per year.
Vol. XVII. APRIL, 1895. No. 2.
This Journal will not bo responsible for the opinions of contributors, unless
indorsed by the Association.
THE RELATION OF THE MEDICAL PROFES¬
SION TO TEMPERANCE LEGISLATION.*
By Prof. Austin Abbott, LL.D., Dean of Columbia
Law School, N. Y. City.
One of the most interesting subjects affecting the medi¬
cal and legal professions just now presented by that field in
which the duties of the one concur or co-operate with the
duties of the other. Consider the field of these professions
respectively as separate circles lying side by side. There
was a time when they were wholly independent, not touch¬
ing each other. The constant enlargement of the field of
each profession during the last two hundred years has re¬
sulted in the overlapping of these circles so that now there
is a territory which is in a sense the common domain of
both. This domain is the field of medical jurisprudence in
the widest sense of that term. The subjects within this
field cannot be intelligently understood or efficiently dealt
with by medicine alone or by law alone, they require the
concurrence of these functions. This concurrence is not
always harmonious ; it is sometimes necessary for the law to
* Read before the New York Medical Jurisprudence Society, March n, 1895
Digitized by L^OOQie
102 Relation of the Medical Profession to
be instructed by the medical profession, and changes in the
law which the medical profession dictate must sooner or later
be conceded by the legal profession, and, on the other hand,
the law frequently needs to regulate matters whose general
direction is in charge of the medical profession, and to mod¬
ify to some extent in view of public interest and safety what
medical science might, or for abstract reasons, direct differ¬
ently.
When we look at what the members of these professions
are actually doing in society upon this common domain, we
see two principal modes of co-operation or concurrent labor
or mutual modification. In the course of justice the law, in
investigating questions which involve scientific knowledge,
calls on the medical profession for information and instruc¬
tion, medical knowledge and medical reasoning; and the
knowledge and reasoning which is the peculiar gift of the
medical profession upon scientific subjects generally here is
brought into the service of the law; and while, on the one
hand, the law directs what inquiries may be made and in
what maimer and how far they shall be prosecuted, and
what legal consequences shall be affixed to the conclusion
which science presents, it is scientific aid and assistance
which the law within these limits seeks for, and the instruc¬
tion and knowledge which the medical profession give are of
increasing service in the administration of justice. This is
the department of forensic medicine or medical jurisprudence
in the stricter sense of that term.
But we see another class or mode of co-operation between
the professions in which medical men, discerning what is
necessary for the welfare of the community and observing
the habitual indifference of the community upon the subject,
call upon the law to provide by legislation the rule of con¬
duct and enforce it by the administration of justice. It is in
this method that sanitary legislation has been so admirably
developed within the present generation. This department
is what we usually designate by the term state medicine.
These two fields, state medicine and forensic medicine make
Digitized by ^ooQie
Temperance Legislation .
103
up the area in which the domains of the two professions
overlap each other. In the first, forensic medicine — law¬
yers take the initiative, the law calling the physician to the
aid of its administration; in the second, physicians take the
initiative and the principles of sanitation in the hands of the
medical profession pall the lawyers to their aid for enforce¬
ment.
When we compare the relative progress of these two great
movements we are struck by an interesting contrast. The
law is conservative and it pursues substantially the same
method now which it has from the beginning of medical ju¬
risprudence in its use of expert testimony. Whatever ad¬
vance has been made in this field has been in a great multi¬
plication of the classes of cases in which medical testimony
is called for and great increase in the number and ability of
experts, and, I believe, on the whole, an increase in the
respect accorded to experts who appear upon the stand to be
both intelligent and impartial.
On the other hand, the department of state medicine is
progressive. It is not merely doing an increasing business
within the same old conservative lines. It is moving forward,
extending to new subjects, discerning new needs, formulat¬
ing new methods of provision or remedy, and thus giving a
wholesome ascendency over many subjects with which for¬
merly it had no direct relation.
This notable increase of the branches of sanitary legisla¬
tion will be obvious to every one upon the mere mention of
quarantine and compulsory vaccination, of sewerage and
drainage laws, ventilation and those parts of the building
laws which have been dictated by medical opinion, and the
lunacy laws, the sanction for the segregation of persons of
unsound mind, and the superintendence of asylums and
homes, health boards with all their various subjects of inspec¬
tion and regulation, the sanitary inspection of schools, the
great department of vital statistics, the growing functions of
the inspectors of food products, and the prevention of adul¬
teration, and the condemnation of that which is unfit, and
Digitized by t^-ooQie
104 Relation of the Medical Profession to
even the legal investigation of the diseases of cattle. Others
present could readily name additional topics necessary to a
complete view of the extent to which the medical profession
are now taking the lead in originating and to some extent
formulating the legislation of the state in matters affecting
the general health.
It is difficult to estimate how much society owes to the
influence of the medical profession caused by these and sim¬
ilar measures of compulsory sanitation.
In all such matters, it is important to observe that it is
the judgment of the medical profession which points the
way and leads. The law waits for a reasonable consensus of
medical opinion. Whenever that is reached and it is made
clear to the community, the law follows with legislation
attempting as far as may justly be done, to give effect in the
life of the community to the principles of safety and welfare
upon which medical men have agreed.
This being the case, I desire to invite your attention to
the relation of the medical profession to the subject of legis¬
lation respecting inebriety. I believe the time has now
arrived when the community are ready to consider with can¬
dor and acquiescence what ought to be done considering
inebriety as a disease. It is true that a number of the com¬
munity do not believe that it is a disease, and some will per¬
sistently oppose any such view to the last; nor do I know
that medical men would agree that it is always a disease.
The proposition which I wish to put forward is, that the
community are ready to acknowledge that to some extent,
at least, inebriety may be usefully considered as a disease.
It is for the medical profession to instruct the community
if anything can and ought to be done by the community
through its legislature, towards diminishing its prevalence. I
do not affirm that the community are ready to admit that
inebriety is always a disease, but I believe that it may with
confidence be affirmed that the community are ready to fol¬
low medical men in some important steps in which they may
be advised that it ought to be considered as a disease and
Digitized by LjOOQie
Temperance Legislation .
105
treated as a disease. We should all agree that other ele¬
ments besides pathology enter into the problem. If it be a
disease, is it engendered by self-indulgence and by igno¬
rance ? Is it promoted by the profits of the traffic ? Is it
extended by the allurement of social attractions ? Is it
closely connected with other self-indulgences that are profit¬
able to those who cater to them ? It is not strange that it
has thus far been treated by the law in the calendar of vol¬
untary criminal offenses and not as a disease.
I do not suppose that the proposition to consider it as a
disease would very soon, and perhaps not ultimately, termi¬
nate our treatment of it in some part as an offense, but is it
not time to introduce the other element as an actual basis of
the law in dealing with the subject ?
The steps which appear to me to be worthy of discussion
in this direction are:
First, the entire administration of the law. touching ine¬
briety as an element in those disorders which require police
administration should be committed to direct medical care.
Men arrested for intoxication should no longer be sent at
once to prison, but in the first instance they should be com¬
mitted to medical custody, and afterward go to prison, if at
all, by medical consent. If such a simple change as this were
made, how quickly would the medical knowledge of inebriety
and the scientific methods of dealing with it become dissem¬
inated in the community and rendered practical and effica¬
cious.
Second, the traffic in intoxicants should be subject to
medical supervision to the end that adulterations and falsifi¬
cations of all kinds should be stopped, and what may be more
important, the foisting of intoxicants and narcotics upon peo¬
ple in search of health, by selling them in the guise of patent
or proprietary medicines, without medical direction and with¬
out disclosure of the true nature of the preparation, should
be stopped.
Third, the education of the community in a way to pro¬
mote the intelligent self government of individuals in respect
Digitized by t^-ooQie
io6 Relation of the Medical Profession to
to the use of intoxicants, should be accomplished by instruc¬
tion under medical supervision systematically provided for
by the State in all that it has to do with education.
Some important steps have been taken in this direction
as well as in regard to the prevention of adulterations ; but I
believe the community has scarcely begun to avail itself of
the medical guidance which it needs in thos 4 respects.
Fourth, it appears to me that the open discussion as to
which method for regulation of the traffic is the best, license
or taxation, should receive careful consideration from medical
men, and that legislation on the question should be aided by
whatever light they can give.
If I do not mistake the signs of the times, the subject of
inebriety is now opening, or ready to open, as a great field
for the services of medical science. Hitherto it has been
treated chiefly as a private and individual question. The
victim has been regarded rather as indulging in a personal
vice than as suffering from an aberration and bringing phys¬
ical suffering upon others. It is now seen to be a social
question ; and the community, as I have said, are beginning
to admit that there may be some truth in the medical view
which classifies it with disease. Moral suasion has been
tried and though it may have prevented much and cured
some individual cases, it fails to accomplish the service
which the community needs. Legal suasion or compulsion
has been tried with similar inefficiency. Is it not time now
that scientific suasion should be tried ? It is for medical
men to say what ought to be done in reference to inebriety.
It is also for them to say how much of what ought to be
done is practicable to do in the present situation.
I do not think that in considering such measures we
should hesitate to count on the material self interests of
individuals and of the community. I believe there are large
and wholesome interests in the community which would tend
to support a concerted movement such as I have suggested.
In the first place it is for the interest of all tax-payers to put
some reasonable regulation upon the increase of inebriety.
Digitized by L^OOQie
Temperance Legislation .
107
It is not necessary to enter into figures here, but we all
know that a considerable portion of the burdens of taxation
caused by crime, pauperism, and insanity are attributed by
medical men to inebriety as the original cause.
We know, however, that the records of institutions,
founded entirely on such admissions or acknowledgments as
inmates may make in regard to the habits of themselves and
their ancestors are not a satisfactory basis for definite con¬
clusions in this respect.
One question which I should like to hear medical men
discuss is, whether it would be practicable for competent
medical examiners by personal inspection of each case to
determine (with a reasonable degree of certainty in respect
to any considerable proportion of cases) that inebriety was
in fact a cause of the resulting condition. The statements
of those who have considered this matter most fully, appear
to confirm the impression that it would be practicable to
show to tax-payers that a definite and considerable propor¬
tion of their burdens come from this source.
Again, in considering the subject in a practical way we
should not overlook the interest of producers, and dealers in
intoxicants, to stop adulterations and falsifications. We
must of course assume that the traffic will go on, but it is a
legitimate question how far adulterations and falsifications,
which probably are now practiced on a very large scale, are a
cause of degeneracy and mortality which the medical profes¬
sion should greatly diminish if they were provided with
suitable legislation. I am aware that there is a difference of
opinion as to whether the common adulterations are detri¬
mental to health, but I suppose there is a general agreement
as to the injurious effects of intoxicants sold as patent
medicines.
Again, I believe it could be shown that it is for the
interest of organized labor, which is becoming so large a
feature in the social question, to promote moderation in the
use of intoxicants. If I am not misinformed, one difficulty
with which the leaders in labor movements have to deal
Vol. XVII.—15
Digitized by ^ooQie
io8 Relation of the Medical Profession to
arises from the tendency to excess so common among wage
earners as well as among others.
It would certainly be also in the interest of the medical
profession if the charge of the administrative law in reference
to inebriety upon the basis of the public treatment of it as a
disease should be devolved upon medical men. The advan¬
tages of scientific investigation thus rendered practical may
readily be appreciated.
The importance of this subject appears to me greater
than the mere question of inebriety. The law is now neces¬
sarily treating crime as well as inebriety almost wholly on
the basis of punitive measures applied only after the evil has
been done. Medical science alone can instruct the com¬
munity how to deal with either by measures directed toward
diminishing the sources. It would be futile in the present
state of public opinion to propose measures for prophylactic
treatment of crime, but is it premature to propose such
measures in a practical form in respect to dealing with
inebriety and would not the demonstration of the wisdom
and propriety of such measures in that regard lead the way
as fast and as far as may appear desirable to similar meas¬
ures.
There appears to be good foundation for the opinion that
sooner or later both crime and inebriety will be considered
hnd tried in the light of medical science as well as of puni¬
tive justice. Now it is only a few cases comparatively in
which the law calls in the medical profession, sooner or later
the presumption and burden of proof must be shifted when¬
ever it shall be made the duty of the medical profession to
take charge of all accused and determine what, if anything,
may be done for them or properly attempted considering the
criminal as diseased, and turning over to the punitive author¬
ities of the law those cases for which scientific treatment has
no advice to give. Then and not until then will our penology
be put upon its true and ultimate basis.
Let me add a few words as to the position which the legis¬
lative question as to liquor legislation now seems to occupy
Digitized by L^OOQie
log
Temperance Legislation .
in the community under our statute. In a country consist¬
ing, as ours does, of a number of States which regulate their
own internal affairs in their own way, the legislature of each
State becomes a sort of experiment station legislation. Ohio
tries one plan, Maine tries another, New York a third, and
South Carolina a fourth, and others consider plans, and
adopt those which are modifications and adaptations of those
mentioned.
The four leading plans which in one or another form seem
to be the only ones necessary to consider, are:
First, licensing as in this State;
Second, making the business free to all comers but impos¬
ing a tax in addition to ordinary taxation ;
Third, prohibition, with or without local option as to its
adoption;
Fourth, government monopoly of the traffic.
The question now uppermost in the minds of the most
intelligent and most influential men in shaping the policy of
this State, I believe, suggests a consideration of these plans
in the following order:
First, local option, in each town or ward and possibly
in each election district, as to whether the business shall be
allowed there, and if allowed, whether Sunday sales shall be
permitted;
Second, if and where the business is allowed, is a license
to be granted to selected applicants on payment of a fee, or
should a tax be levied upon all who enter the business ? *
Which is the preferable method of making the business con¬
tribute to relieve the burdens of taxation ?
Third, is government monopoly an experiment worth try¬
ing in our present condition ?
I believe it is within the power of the medical profession,
by considering these and kindred questions in the light
which comes from regarding inebriety as a disease, and by
giving the community the benefit of their views in that
aspect, to introduce a new and most wholesome element into
the discussion, take the subject out of the control of polit-
Digitized by t^-ooQie
110 Relation of the Medical Profession t etc.
ical interests and the depressing influence resulting from the
present association of inebriety with crime, and lead the way
to the dissemination of a better knowledge of the real uses
of intoxicants in the community and to the formulation of
such legislation as may be necessary, and practically en-
forcible, to protect the community against those excesses
which now afflict so many lives and homes and which form
so serious an obstacle to the prosperity and welfare of our
people. Individual medical men may be wedded to
peculiar opinions, but a consensus of medical judgment as
to what by general agreement is reasonably necessary and
practicable would, I believe, and ought, I am sure, to control
and direct the course of legislation in a way in which, without
trenching on individual liberty, the best interests of indi¬
viduals and of society at large would be promoted.
Do not let me be understood as advocating an extension
of interference by the law in reference to the drinking habits
of society. On the contrary, I believe that medical opinion
would guard efficiently against that. My proposition is
simply this, that so far as the law does undertake or pro¬
pose to interfere with questions of inebriety, the manner
and the extent should be subject to medical opinion.
The first step, perhaps, in applying the principles I have
suggested would be to establish within convenient access of
every police precinct a correctional hospital, and to provide that
whenever under existing law a person is taken into custody
as intoxicated or disorderly, that is to say, without any
specific charge of crime other than disturbing the peace or
intoxication, he should be sent in the first instance to the
correctional hospital, and there it should be determined by
medical authority whether he should be turned over to the
ordinary punitive justice.
All inebriates suffer from poisoning, auto-intoxications,
starvation, and exhaustion. A large proportion of inebriates
have mal-formed defective nerve centers, and suffer from
exhaustion and debility before spirits are taken.
Digitized by i^-ooQie
Popular Fallacies as to Alcohol and Nicotme . ill
POPULAR FALLACIES AS TO ALCOHOL AND
NICOTINE.*
By Albert k. Ledoux, M.S., Ph.D.
Mr. President and Gentlemen: There is probably no
subject connected with human habits and appetite that has
been so much discussed as the use or abuse of tobacco and
alcohol. The controversies which have raged over these two
substances have been continuous, although on ever-shifting
grounds. I desire to state at the outset of this brief paper
that the members of the Society of Medical Jurisprudence
need have no apprehension that they are about to be com¬
pelled to listen to an appeal for prohibition, on the one hand,
or that I shall seek to enlist the society in the movement for
freer saloons or unrestricted license.
It is my purpose to consider the problems surrounding
the alcohol and tobacco questions from the standpoint of an
analytical chemist, rather than that of either a temperance
reformer or advocate of license; a devotee of the “weed”
or an anti-tobacco man.
I may dismiss the moral and ethical consideration with a
few words, leaving this to be discussed by others, and this
paper may perhaps in some measure clear the way for that
distinguished jurist, Dr. Austin Abbott, who will at our next
meeting consider the relations of alcohol to crime.
The few words with which I will dismiss the moral and
ethical side of the question will be: “ There is something to
be said on both sides.” * Probably no one has better stated
the relative merits and demerits of tobacco than Burton,
who, in his “Anatomy of Melancholy,” says: “Tobacco,
divine, rare, super-excellent tobacco, which goes far beyond
all the panaceas, potable gold, and philosopher’s stones ; a
sovereign remedy in all diseases. A good vomit, I confess,
* An address delivered at the February meeting of the Society of Medi¬
cal Jurisprudence, 1895.
Digitized by t^-ooQie
1 12 Popular Fallacies as to Alcohol and Nicotine .
a virtuous herb if it be well qualified, opportunely taken and
medicinally used ; but, as it is commonly abused by most
men, which take it as tinkers do ale, ’tis a plague, a mischief,
a violent purge of goods, lands, health — hellish, devilish, and
damned, the ruin and overthrow of body and soul.” This is
certainly “saying something on both sides” with a vengeance!
As far as the physiological effects of alcohol* are con¬
cerned, that its use as a vehicle for beneficent drugs is of in¬
calculable value will hardly be denied, nor its value as a
stimulant at times, nor will the sad effects of over-indulgence
— temporary or habitual — be controverted ; there is some¬
thing on both sides here also.
The danger which I apprehend, and the fallacy noted on
all sides to-day, is that the public, always ready to follow
selfish and ill-considered advice, anxious to be led by quacks,
and advised in harmony with their appetites and weaknesses,
are now being persuaded that there are no deleterious effects
from the use of wines, whiskies, beer, etc., provided these
articles are “pure”; and that they may smoke tobacco with
impunity, provided they do not smoke cigarettes.
Some vendors of whiskies and other alcoholic beverages
have been most active in this country and in other countries
in seeking legislation to punish adulteration, and, while join¬
ing the prohibitionists in pointing out the alleged horrors in
adulterated goods, boast of the extreme purity and harmless¬
ness of the article in which they especially deal. How com¬
mon it is to see the advertisement in the street cars:
“ Don’t drink; but if you do, then drink only pure whisky.
Blank’s whisky is absolutely pure.” Temperance reformers
and others interested in the welfare of their fellow-men have
unconsciously assisted in the spreading of this idea, until
from many platforms we hear more of the horrible adultera¬
tions of drink than we do about the physiological effects of
the legitimate ingredients in all of them. Staid boards of
health, public analysts, and others have also dwelt very
largely upon this side of the question, until there is abun¬
dant evidence that the public is misled, and a strong proba-
* Common or ethyl alcohol is everywhere intended in this paper.
Digitized by v^.ooQLe
Popular Fallacies as to Alcohol and Nicotine, 113
bility that many a man upon whom the alcoholic habit is
fastening itself is encouraging himself with the belief that
he will suffer no injurious effects if he only imbibes the
product of some particular manufacturer.
Perhaps this is a convenient place to state my premise,
and proceed to discuss it more in detail. As to alcohol: if
the use of intoxicating drinks is, on the whole, an evil to be
combatted, the medical profession, as well as all temperance
reformers, should never cease to make it plain that the evil
lies in the alcohol in the liquors, and not in the adultera¬
tions ; that the unfortunate votary should not be allowed to
deceive himself with the idea that if he drinks some particu¬
lar brand, or abstains from another, he can derive benefit, or
at least escape injury. If he is injured at all he is injured
by the alcohol; if he is benefited at all he is benefited by
the alcohol.
It is really remarkable, when one thinks of it, how very
slight is the difference between all classes of alcoholic
liquors as a matter of fact, however different they may be in
taste, color, etc. We know that they consist essentially of
water and alcohol, with only from 2 to 7 per cent, of all other
ingredients, unless artificially sweetened. In wines, for in¬
stance, the difference in flavor is almost entirely due to the
volatile acids and ethers, and in no wines are these present
in greater amounts than ^ of 1 per cent. The alcohol by
weight in standard wines will vary from 7 to 18 per cent,
the water 80 to 90 per cent., and the solid residue, which
includes all the coloring matter and sugar, varies from 1 to 4
per cent., for all excepting artificially sweetened wines, like
champagne.
The natural coloring ingredient of these substances in
no case exceeds 1 per cent, of the material, the salts in
solution in no case exceed ^ of 1 per cent, when all the
phosphoric acid, alkaline sulphates, chlorides, and carbonates
are added in. In fact, the total mineral matter (ash) after
burning off all the organic matter, varies, in Battershall’s
Table of Standard Wines, from 0.17 per cent, to 0.48 per
Digitized by t^-ooQie
114 Popular Fallacies as to Alcohol and Nicotine .
cent. We may therefore leave, as proven, the statement
that there is nothing in natural wines that is injurious, unless
it be the alcohol.
When we consider the question of whiskies, brandies,
rum, and other distilled liquors we meet with another set of
conditions, but to which the same facts may be applied.
According to Blyth, the constituents of brandy show : alco¬
hol from 48 to 60 per cent.; water from 37 percent, to 48 per
cent., total solid matter from 1 to per cent., mineral mat¬
ter or ash, from 0.04 to 0.20 per cent.; acids, from 0.01 to
0.05 per cent.; sugar, from 0.0 to 0.40 per cent. Twenty-
five samples selected by the Metropolitan Board of Health
for analysis showed alcohol by weight from 25.39 to 42.96
per cent.; solid matter from 0.02 to 1.79 per cent.; these
samples being abnormal chiefly from the fact of their palpa¬
ble dilution with Water, reducing the alcohol from an average
according to our above table, of 54 per cent., to an average
of 34 per cent. The Board of Health of the State of New
York in 1881 analyzed a great many samples of American
whisky, finding the alcohol by weight to vary from 23 to 52
per cent., and the solid residue from o. I to 0.7 per cent.
Rum and gin are also, as is well known, simply mixtures
of water and alcohol obtained by fermentation, distillation,
different from one another and from whisky and brandy
only in the average proportions of these two chief ingredi¬
ents, and in the natural or artificial flavors imparted to them.
Of course, as in the case of wines, popular demand, as well
as the ingenuity of dealers, causes artificial flavoring of these
substances with any and every ingredient likely to produce
the desired result, and we find in the list of substances rec¬
ommended, many which, considered by themselves, harrow
the imagination; such as oil of turpentine, recommended to
give a distinctive flavor to gin, in place of juniper berries,
cayenne pepper, etc., etc., but the above outlined analyses
show in what infinitesimal proportions these substances
are added, and consequently, even when present, how slight
must be their effect on the system as compared with the alco¬
hol
Digitized by ^ooQie
Popular Fallacies as to Alcohol and Nicotine . 115
Numerous recipes are given for imitating genuine distilled
spirits, but the worst of them show but exceedingly trifling
amounts of injurious adulterations ; for instance, a well-known
receipt for imitating brandy calls for 40 gallons of proof
spirits, 1,000 parts of alcohol (95#), 600 parts of water, one
part of essence of brandy, 1 \ parts of burnt sugar, i oz. of
tannin, and £ of an oz. of oil of cognac. The latter ingredi¬
ent is chiefly amylic alcohol, but in this proportion of liquid
its physiological effect is inappreciable compared to the
alcohol.
Another formula for making 50 gallons of rye whisky,
artificially, calls for 50 gallons of alcohol, 10 drops of oil of
wintergreen, 4 ozs. of acetic ether, 4 drops of oil of cloves.
Receipts for making Scotch and Irish whiskies call for
the following :
Scotch Whisky .
46 gallons 95# alcohol,
8 gallons of real Scotch whisky,
18 gallons of water,
3 pounds of honey,
5 drops of creosote,
2 oz. of acetic acid,
1 gallon of ale,
1 ounce of pelargonic ether.
Irish Whisky .
30 gallons of alcohol (proof),
5 gallons real Irish whisky,
£ gallon old ale,
4 drops creosote dissolved in acetic acid,
1 ounce pelargonic ether.
The difference seems to be that there is no water added
to the Irish article. The “ pelargonic ether ” is a flavor made
up of a mixture of Jamaica rum, vanilla essence, raisin juice,
and one or two other harmless ingredients, with caprylic,
caproic, and other organic acids. This is probably the worst
that can be said of the distilled liquors, excepting as to the
fusel oil, which is another name for amyl alcohol, and even in
fresh potato spirits it is never present in greater quantity
than one part in 500.
Vol. XVII.—16
Digitized by i^-ooQie
n6 Popular Fallacies as to Alcohol and Nicotine .
It is, perhaps, a natural desire on the part of Boards of
Health, temperance advocates, and other reformers to make
out as strong a case as possible against intoxicants, but they
overdo it when they dwell on the adulterations they are
supposed to contain. Granting that wines have been found
to contain tumeric, glucose, borax, gum-kino, and even
arsenic, to say nothing of aniline red and other colors, and
that these substances are poisonous to greater or less degree,
it is, nevertheless, true that they are so rarely present in any
wine or liquor, and then in such very small quantity, that in¬
jury from their presence must be exceedingly rare ; arsenic,
for instance, having been discovered once, in Spanish wines,
and aniline dyes very seldom, if ever, in this country. There
is such a thing as pushing entirely too far arguments based
on the mere presence of poisons.
Whisky and other fermented liquors are, according to
all authorities, seldom, if ever, adulterated in the United
States. Blyth says : “ In the United States, whisky is prob¬
ably less subjected to serious sophistication than any other
spirituous drink, and there is very little ground for the belief
that it is subjected to noxious admixture to any great
extent.”
Some time ago the editor of a well-known weekly paper
published in this city, himself an earnest advocate of temper¬
ance reform, desired to ascertain and publish what were the
facts concerning alleged adulterations of, and injurious qual¬
ities in, the wines and liquors sold to the poorer classes in
New York. My firm were retained to collect the samples
and make analyses. The samples were purchased at various
saloons and groceries on the east and west sides from Harlem
to the Battery, and, I may say in passing, that some of the
things observed by my agents in securing these samples
were themselves eloquent sermons on behalf of the control of
the liquor traffic. In one saloon on West street, for instance,
my man had to wait for his flask of brandy until a previous
customer was served. This customer was a little girl, her
head barely reaching to the level of the bar. She laid down
Digitized by t^-ooQie
Popular Fallacies as to Alcohol and Nicotine . 117
her ten cents and handed up an empty whisky flask, which
she had been sent from home to have filled. The bar-tender
filled it, and set it down without corking it, winking to my
representative, indicating that he should watch the child.
The little thing tipped the flask up, took a drink, and re¬
placed it on the bar. The bar-tender refilled it without a
word, put in the cork, and the child went away with it.
Upon my man expressing his horror at the sight, the bar¬
tender said : “ What can I do ? That is her commission.
They all demand it, and if I do not give it to her she will go
somewhere else.”
But we are at present interested in the results of these
analyses, not with the method of securing samples; and
these results, not to weary you with details, I will sum up in
the words of my report to the editor.
“ The whiskies were in no respect adulterated, the color¬
ing matters and flavoring being caramel and raisins respect¬
ively, both harmless.
“Twenty-five samples of brandy, varying in price from
fifty cents to #1.75 per quart, contained no fusel oil, no
coloring matter except caramel, and no extract of pepper.
All but one contained zinc and lead and had copper in minute
proportions. These were undoubtedly due to metallic stills
or pipes, and were no more prevalent than in soda-water led
through lead pipes with syrups dispensed from metal cans in
some soda-water fountains of this city and Brooklyn, to my
personal knowledge.
“ The alcohol in the brandies varied from 25 per cent, to
50 per cent. Two of them contained more alcohol than is
natural—it had been added — while the balance of them
had been diluted.
“The sherry wines contained no metallic poisons and no
poisonous coloring matter. The alcohol varied from 9 to 23
per cent., most of them having been diluted with water.
But one sample of the sherries had been fortified with alco¬
hol, the balance being diluted.
“The port wines contained no metallic poisons and np
Digitized by ^ooQie
Ii8 Popular Fallacies as to Alcohol and Nicotine .
logwood or other poisonous coloring matter. Burnt sugar in
most and cochineal in one were the only artificial colors.
“ As a general thing, the cheapest liquors were the least
injurious, as they contained, from their dilution, the least
alcohol.”
I next take up the subject of beer, which, perhaps, owing
to the extent of its use, is the most important. Chemists of
Germany have found in beer all sorts of substances, harmful
or otherwise, but the chief of these may be considered harm¬
less, viz.: burnt sugar, liquorice, molasses, quassia, coriander
seed, glycerine, and glucose. The harmful ingredients are
only relatively so, salycilic acid being the chief of these
The reports of the United States government experts
and those of the various State Boards of Health are all
against the prevalence of poisonous adulteration of beer,
admitting that it is the exception, and not the rule, to find
deleterious substances present.
I trust that the Society does not conclude that I am
asserting that there are never harmful substances in our
alcoholic liquors. I simply take the ground that as com¬
pared with the alcohol their injurious effect is absolutely
insignificant; and this is true of the salycilic acid infre¬
quently found in beer. At great length, professional chem¬
ists and sanitary experts have experimented with this drug,
and there is plenty of evidence that in continued or large
doses it is injurious, yet the dose for an adult is from ten to
forty grains, and in no beer or ale is it necessary, to produce
the effect desired, to have it present in anything like that
proportion. To-day there are few, if any, of the ales and
beers on our market to which it is added, as is demonstrated
by the analyses and tests constantly published.
As has been intimated, the difference in flavor between
two kinds of wine, between sauterne and claret, port and
sherry, for instance, is so delicate that it requires but an in¬
finitesimal amount of the natural or artificial ether or organic
acid to affect it. This can be readily seen when we consider
the difference in taste between two varieties of grapes.
Digitized by ^ooQie
Popular Fallacies as to Alcohol and Nicotine . 119
Instinctively the tongue recognizes the difference between
a Catawba and a Niagara grape, for instance, but no chemi¬
cal analysis, however subtle, could isolate, or, if isolated,
determine the relative proportion or identity of the delicate
ethers which cause this difference in aroma or taste.
I will conclude this part of my paper by stating some
comparative figures showing the difference between wines,
beers, and distilled liquors in composition, emphasizing once
more how slight this is.
Rhine wine.
Claret.
Whisky.
Brandy.
Beer.
Per cent
Per cent.
Per cent.
Per cent.
Per cent.
Alcohol by weight,
9-00
12.00
38.OO
50.00
3-oo
Water,
88.00
85.OO
60.00
4800
91.00
All other ingredients,
3-00
3.OO
2.00
2.00
6.00
100.00
100.00
100.00
100.00
100.00
I have not touched upon the question of the benefit or
injury of the alcohol. Abundant experiments will bear me
out in the statement that the benefit in typhoid fever, pneu¬
monia, etc., derived from liquors can be exactly duplicated
by plain alcohol and water; and the intoxication from plain
alcohol is just as pronounced as from the worst “Jersey
lightning/* The color, flavor, and “ smoothness ” of liquors
depend on age—or sometimes manipulation; their effect
depends on their alcohol.
We are now brought to the second division of this in¬
formal paper — that relating to tobacco — and my premise
is : If the use of tobacco is ever an evil to be combated, the
medical profession, as well as all reformers, should not cease
to make it plain that the evil lies in the nicotine — that is,
in the tobacco itself, not in its adulterations — and that this
injury does not depend upon the form in which the tobacco
is used. I employ the term nicotine in its broadest sense,
including all the alkaloids associated in tobacco.
A few years ago I found myself in that interesting corner
of the world where the States of North Carolina, Virginia,
aud Tennessee come together. My driver and guide was a
youth of about nineteen. We stopped at a store, and he
called out the proprietor. Upon his appearing, the youth
Digitized by i^-ooQie
120 Popular Fallacies as to Alcohol and Nicotine .
handed me ten cents, and requested the storekeeper to sell
me a package of cigarettes. I handed the money over, and
then asked my driver foir an explanation of this financial
transaction. He said: “Why, you know it is against the
law of this State to sell cigarettes to minors—I am not of
age. The storekeepers here are strict In this county I
have to buy smoking tobacco and make my own cigarettes,
or smoke cigars. Over the State line I can buy cigarette
papers, but not cigarette tobacco, and some of the dealers
make me show my pipe.” He added: “ I don’t smoke a
pipe, but if I simply show it I can buy all the smoking
tobacco I want and make my own cigarettes. It is handier,
though, to get somebody who is of age to buy the cigarettes
all ready made for me.”
The legislation against the smoking of cigarettes has
been to me one of the most interesting phenomena of these
times, especially as I happen to know something of its incep¬
tion. It is now some ten or twelve years since I was
approached by a gentleman representing one of the largest
combinations of tobacco interests. He desired to retain me
for the purpose of making a series of investigations of cigar¬
ette papers and all that pertains to this article. The gentle¬
man stated to me, without hesitation, that the cigar and
chopped tobacco men began to find their trade seriously
interfered with by the growing popularity of the American
cigarette, and that they had determined to offset it in every
possible way. They desired to show through the public
press that, first, extremely dangerous products resulted from
the burning of the cigarette-paper-creosote, etc., and, second,
after they had worked this scare to its utmost market value,
to show that opium and other deleterious drugs were used in
the manufacture of cigarettes, and that the public using
them ran great danger. I undertook the investigation as a
matter of business, examined no end of cigarette-papers for
lead, arsenic, and other deleterious substances, but with
entirely negative results; in fact, the rice paper usually
employed was the purest form of cellulose that had been
Digitized by i^-ooQie
Popular Fallacies as to Alcohol and Nicotine . 121
brought to my attention, and the products of its combustion
all told were infinitesimal in amount and effect as compared
with the combustion of the tobacco-leaf itself. There is
more cellulose in one cigar than in 100 cigarette-papers.
I next addressed myself to an analysis of the cigarettes
upon the market, and reported that these contained various
substances with which to flavor them, and to prevent their
drying up, among which were angelica root, tonka bean, rum,
licorice, glycerine, glucose, and nitro-benzole, but no opium,
and I reported that these substances were comparatively
harmless when burned in full or in part, and only the harm¬
less ingredients were present in any amount. I found, how¬
ever, that other chemists were being employed for this pur¬
pose in different parts of the country, and very soon arose
the chorus throughout the press first against cigarette-papers,
then the cigarette itself, which has resulted in anti-cigarette
legislation and anti-cigarette leagues throughout these
United States.
I desire to state right here, and in the most positive man¬
ner, that there is one objection to cigarettes which is not at
all fictitious, and that is the handy form in which they are
presented ; and the fact that dealers will sell them in broken
packages render them extremely alluring to the tender
youth, who undoubtedly smokes oftener, and more easily
acquires the habit, than would be the case if he had to
acquire it from the use of a cigar or a pipe ; and again, their
very adulteration with artificial flavors renders them mild,
and tempts to inhalation of the smoke. But I trust that I
shall be able to prove the fact that, after all, if the youth is
injured , or, for that matter, the adult, by smoking cigarettes,
he is injured by the nicotine in the tobacco, and not by the
paper or flavoring, or other adventitious ingredients.
The adulteration of tobacco has received great attention
for many years, though not to the extent as has the adulter¬
ation of wines and liquors. Long before there were such
things as chemical analyses there were stringent laws against
the adulteration of wines, and there are in Europe laws
Digitized by L^ooQie
122 Popular Fallacies as to Alcohol and Nicotine.
against the adulteration of tobacco. It is related that in the
reign of Henry VI, in the year 1432, a petition was pre¬
sented to this monarch which stated that the Lombardes
were corrupting their sweet wines, and, by command of the
king, “ the mayor of London, John Ranwell, seized casks in
divers places of the citie ; the butts were broken open in the
streets to the number of fifty, so that the liquor running
forth passed through the citie like a stream of raine water in
the sight of all men, from whence there issued a most loath¬
some savour.”
I will not deny that a “most loathsome savour” fre¬
quently emanates from some cigarettes, and I am not an
advocate of the flavoring mania of the present day, nor am I
prepared to commend the cigarette on the grounds of taste or
morals, but really it is a popular fallacy to suppose that it is
adulterated injuriously to any greater extent than tobacco in
any other form.
The worst adulterated tobacco is that which is sold in the
form of snuff, and the long list of substances going into the
composition of this article in Europe makes one hunt care¬
fully before he finds the word “ tobacco.” The leaves are
dyed with various suitable browns, among which are men¬
tioned as articles common for this purpose, printers* ink,
Frankfort black, and logwood. The microscope has revealed
in snuff ground wood, ground oats, turf, moss, weeds, chic¬
ory, umber, ochre, quicklime, and even powdered glass, to
say nothing of cayenne pepper. But, after all, says the En¬
cyclopedia Britannica, in summing up an article on snuff:
“ Its properties are dependent on the presence of free nic¬
otine and the peculiar aromatic principle developed in fer¬
mentation.”
One of Dickens’ characters is an analytical chemist,
which individual makes himself obnoxious at every feast by
saying: “Oh, if you only knew what dreadful things you are
eating you would abstain,” or words to that effect. I do not
propose to come before this society in this role and get my¬
self disliked, nor to harrow your feelings with detailed
Digitized by ^ooQie
Popular Fallacies as to Alcohol and Nicotine . 123
descriptions of the substances which are said to enter into
some of the cigars of commerce. But before this audience I
may speak freely of chewing tobacco without hurting any¬
body's feelings, which sometimes cannot contain a large per
cent, of tobacco in its composition, after we have deducted
molasses, sugar, aloes, licorice, gum catechu, lamp-black,
alum, bi-chromate of potash, tannic acid, iron, logwood, rhu¬
barb, cabbage, burdock, and other leaves, all of which have
been found in chewing tobaccos. Still, many of these sub¬
stances are entirely harmless, and, in fact, the English laws,
which are very stringent against adulteration, specifically
allow some of them, like licorice, to be added to chewing
tobacco.
The purest tobacco is undoubtedly that which is pre¬
pared for pipe smoking, purer, in my opinion, than that
found in the average cigar, yet the nearer it comes to the
absolutely pure leaf the higher the per cent, of nicotine; but
neither in the cigar, nor cigarette, nor chopped or cut
tobacco, is there at this day, among all the adulterations,
anything approaching in potency this nicotine which they
contain.
Whether we are smokers or non-smokers, whether we are
moderate or immoderate drinkers, or total abstainers, let us
fearlessly and honestly and intelligently instruct the rising
generation that alcohol and tobacco are substances to be
avoided by youth, no matter in what form or under what
name they may be sold; and let the intelligent physician,
who meets in his practice the too slavish devotee of the
tobacco habit or the votary of alcohol, inform his patient in
all candor and fearlessness that it is the alcohol and the nic¬
otine which he must let alone, and not endeavor to shift him
from port to sherry or from cigar to pipe, under the vain
delusion that if one harms the other will benefit.
A few years ago, before the days of the cigarette, warfare
raged around the cigar, which began to supplant the pipe.
That was the day when our grandfathers were all told to
drink port ad libitum . In our youth, here in New York, we
Vol. XVII.—17
Digitized by i^.ooQle
124 Popular Fallacies as to Alcohol and Nicotine .
were told nullum vinum nisi hungaricum , and to-day we are
warned against wines by our medical friends, and told to
drink only Scotch whisky. Let us be honest.
Mr. President, the card I received reminding me of this
meeting to-night states : “ A collation will be served after the
meeting.” I had not noticed this on the cards announcing
other recent meetings, and I wanted to see if it had any con¬
nection with my subject, so I looked it up in the Century
dictionary. I found many meanings for the word “ colla¬
tion,” and give them in their order:
1. “ A comparison of manuscripts.”
2. “A collection of the lives of the fathers of the
Church.”
3. “ The act of reading or conversing on the lives of the
saints.”
4. “A conference.”
5. “ A contribution from several participators.”
6. “A sort of theological lecture, laying down propo¬
sitions without necessarily proving them!' (This sounds
like the General Assembly!)
7. “A reasoning : drawing conclusions.”
8. “ A repast; a meal originally partaken of by monks
after reading the lives of the saints.”
I read no farther, for the illustration of this meaning was
a quotation from Whiston, the English theologian of 1700.
He had been invited to a conference, and says: “ I found
such a collation of wine and sweetmeats" as little corre¬
sponded to the terms of the invitation.” (He was subse¬
quently declared a heretic.)
A collation, then, may include wine, and perhaps cigars;
so I will prudently close my paper before I say too much.
Dr. Franklin of Indianapolis reports a case of a child
born asphyxiated in a difficult labor, who was given hyper-
dermatically one-fourth of a grain of morphia every two
hours until one grain of morphia was taken. The child re¬
covered, but died two weeks later. The morphia was given
qy mistake, supposing it to be nitro-glycerine.
Digitized by L^ooQie
Opium in Gynecology .
125
OPIUM IN GYNECOLOGY.
By Joseph Price, M.D., Philadelphia, Pa.
The medical profession has always been responsible for
the opium habit of patients or the laity. The reckless and
indiscriminate use of anodynes and narcotics, generally used
for the treatment of symptoms — rarely does the routine
practitioner make a precise diagnosis, before giving opium
if pain is present. Opiates are commonly used without a
clear recognition of an indication except that of pain. The
opium habit is rarely acquired, except it be antedated by pain
or an illness for which some doctor has given morphine or
some preparation of opium. There is scarcely a remedy in
the Pharmacopaia used so recklessly and ignorantly and none
doing more general mischief— it has always done thrice more
harm than good. In the general practice of medicine some
of the preparations of opium are to be found in about every
prescription. The hypodermic syringe has made thousands
of morphine habituates, either with the syringe or without
it with the powder. The abuse of the drug is much more
common in some States than in others. The influence or
impress of certain teachers of therapeutics has been wide
in certain sections. The very common remark of teachers,
“ Gentlemen, it is your mission to relieve pain and suffering,”
has done a world of mischief. Many of them spend days
talking over the numerous preparations of opium without an
allusion to the importance of an accurate knowledge of
pathology and diagnosis. The growth of the poppy in
North Carolina is to be lamented; it will do just what it has
done for China — decimated a great people.
While a student of medicine we were taught the use of
opium throughout the treatment of about every disease. In
many of the hospitals Dover's powders were dubbed “dozing
powders,” and begged for nightly. Many patients purchased
Digitized by C^ooQie
126
Opium in Gynecology .
hypodermics immediately on their discharge from the
hospital. The abuse of morphine with the hypodermic has
resulted in two great evils, an habituate, and the mercenary
use of the drug ; the unfortunate patient the prey. Now,
daily at eight o'clock, I see a physician drive to a house to
give a hypodermic ; the visit is made twice or thrice daily at
fixed hours, to repeat the injections, not for malignancy. It
is a common thing for physicians to visit patients regularly
for the specific purpose of giving a hypodermic. Again
without an effort to determine the nature of the trouble, or
cure the patient with well-applied treatment. It is in sur¬
gery and nervous disturbances that opium and patients have
been most abused. But few physicians re-educate them¬
selves ; the few that have successfully tried it, realize the
great importance of deviating from the routine methods of
practice still commonly taught. It is to be hoped that the
more scientific schools of the day will recognize the great
evil.
The comfort of patients throughout their convalescence
in abdominal surgery has been so gratifying and pleasing
without the use of opiates in any form that I constantly take
pleasure in exhibiting patients to visitors and pupils, and
directing their attention to the total absence of all the un¬
comfortable symptoms following its use.
The management of all surgical cases is easy and the
convalescence more satisfactory and speedy when opium
preparations are not used. I am satisfied that the use of
opium in some form, either by injection, suppository, or
solution, has been largely responsible for much of the high
mortality in abdominal surgery. I rejoice I have never used
it in abdominal work except where cancer existed. I have
watched the work of others and compared the mortality of
the operators who use it with that of those who reject it —
all that condemn it head the list with a low mortality. It is
simply cruel and unkind to use opium in abdominal surgery.
The use and abuse of it before painful troubles are removed
obscures symptoms, impairs nutrition, and greatly compli-
Digitized by Google
Opium in Gynecology .
127
cates the management of the patient. Without opiates the
patient co-operates, the pain lasts only a few hours in all
abdominal and pelvic operations.
The numerous uncomfortable conditions favored by
opium are wholly absent without it.
The surgical profession should make an earnest effort to
withhold opiates before discussing this subject.
We can justly speak of the opium or morphine habit as
that of the profession, not of the patient.
The following report of four instructive cases will illus¬
trate most beautifully the successful management of four
typical cases of acute, angry, and general peritonitis, a pain¬
ful trouble, one always treated by opiates and rarely success¬
ful ; quite universally admitted a fatal disease.
Case I October 13, 1894. Mrs. A. F., aged twenty-
five years — acute general peritonitis, persistent nausea,
distention, general adhesions, bloody serum, lymph and
muddy fluid throughout the peritoneal cavity. Freeing of
all adhesions, irrigation and glass drainage, followed by
speedy recovery.
Case II. October 13, 1894. Mrs. M. B., aged twenty-
three — acute double pyosalpinx, with acute general per¬
itonitis. Section irrigation, glass drainage; speedy recovery.
Case III October 17, 1894. Mrs. J. C., aged twenty-
one years — acute double pyosalpinx, with general peritonitis.
Section removal of suppurating tubes and ovaries, irrigation
and drainage, freeing of all adhesions ; recovery.
Case IV October 25, 1894. Miss J. R., aged twenty
years — acute pyosalpinx, general adhesion and peritonitis.
Removal of suppurating tubes and ovaries, unraveling of all
adhesions, thorough flushing, glass drainage; recovery.
This was a very angry and ill group of patients. The
treatment was rather simple, rapid and thorough. Section,
irrigation, drainage, and rest, quiet and position, without
opium. All varities of peritonitis have been uniformly and
successfully managed by the simple treatment suggested.
Digitized by ^ooQie
128
Duty of the Profession in Inebriety.
DUTY OF THE PROFESSION IN INEBRIETY*
Bv Harold N. Moyer, M.D., Chicago,
Professor Mental Diseases, Rush Medical College , Fellow of 'the Chicago Acad¬
emy of Medicine.
Is inebriety a vice or a disease ? To the philosophical
mind it would seem as if the above question was useless, as
our answer will depend almost wholly on the definition that
we attach to the terms “vice" and “disease.” The term
disease as used by medical writers has come to have a narrow
and restricted meaning. That was not true of the old
French word cUsaise from which the word is derived, and
which simply meant a want of ease, or discomfort, and
might be applied to an immense variety of conditions and
objects. This broader use of the word was common with
the early English writers. Spenser says :
“ Labored long in that deep ford with long disease.”
Of late the term has become more and more restricted
until it is now largely used by medical writers to designate
certain morbid conditions of the body or its organs, usually
accompanied by a disturbance of function or appreciable
alterations in the tissues. Later writers, particularly those
indoctrinated with the evolutionary views of Darwin, Spen¬
cer, and Huxley, would again enlarge the scope of this term,
and now define disease as “a want of harmony between the
individual and its environment.” In this broad sense all vice
and criminality are but diseases, which is substantially the
view adopted by Lombroso, Maudsley, and others interested
in criminal anthropology.
In this, as in many other discussions, an exact apprecia¬
tion of the scope, and agreement as to the meaning, of the
terms employed would at once settle the main points of con¬
tention.
* Chicago Pathological Society Transactions.
Digitized by i^-ooQie
Duty of the Profession in Inebriety . 129
It is apparent that in the narrow, restricted sense ine¬
briety should not be considered a disease, certainly not in
the same sense that pneumonia is. Of course,-the secondary
effects of alcohol, the changes of brain, stomach, and liver
that are produced by it, are diseases. The question, how¬
ever, does not relate to these, but to the drink-habit per se.
At first it would seem that inebriety must surely be a vice,
that to drink alcohol or to refrain from doing so is something
peculiarly within the domain of the volition of the individual,
and if we adopt the theological conception of free-will we
must place inebriety among the vices ; but it is at this point
that evolution steps forward and denies the freedom of the will
in its broad sense. We are, therefore, on the horns of a
dilemma. We must accept one theory or the other. Which
shall it be ? Before answering this question let us consider
the question of utility, for theories must, to a large extent,
govern practice, not only in medicine, but in human affairs.
The world once burned its witches, because on the then
theory of witchcraft they believed it would be dangerous to
allow witches to live and be at large. The revolving stool,
baths of surprise, and chains were part of the necessary
outfit for the treatment of insanity. It was not that the peo¬
ple of those times wished to be cruel, but the treatment was
an outgrowth of a mistaken theory of insanity. This theory
was based on the metaphysical conception of free-will. The
doctors interrogated their own minds and found that they
had the power to control their wayward fancies and co-ordi¬
nate their conduct. They believed that lunatics had the
same power if they were only furnished a sufficiently power¬
ful motive, hence the stripes and chains with which lunatics
were treated, and according to their theory of the diseases
the treatment was certainly appropriate. They could not
conceive of the mind being diseased, hence insanity marked
but an imperfection in the will. The same question is now
raised concerning inebriety, and we must ask ourselves
whether the chronic drinker will not or can not abstain from
liquor. If the liquor habit marks but an imperfection of the
Digitized by t^-ooQie
130 Dnty of the Profession in Inebriety .
will its natural treatment will by be prayers, exorcisms, and
moral suasion, as well as fines and imprisonment. The
world has been following this prescription for many years,
and with, so far, but imperfect results. The agitation against
liquor has greatly lessened its use as a beverage, and has
quite banished it from the tables of the better classes of the
community', but at the same time we doubt if there has been
a material decrease in inebriety, certainly not if we count
the various drug habits that in a measure have taken the
place of alcohol. The chief argument that is used in sup¬
port of the vicious theory of drunkenness is, that to admit
for a moment that the inebriate is a diseased person removes
at once all incentive to moral regeneration, that he will sink
supinely into the condition of an interesting invalid and will
give up all hope of reformation. We do not think that this
view is well taken or that it is borne out by the experience of
those skilled in the treatment of inebriety. If we tell a
gouty person that his disease is the result of an indiscretion
in diet, and that he must be more abstemious in the future,
do we thereby lessen his inhibitory power ? Would it be
better to say that there is nothing the matter with him, and
that the pain in his toe marks but an imperfection in morals ?
If we assume that inebriety is a disease, we place an
additional restraint upon the use of alcoholic liquors. If the
consequences of over-indulgence are once clearly pointed out,
and that the chronic ingestion of alcohol not only produces
a disease, but in a measure renders an individual irrespon¬
sible, not only will there be an additional incentive to refrain
from its use, but the community will deal much more justly
and rigorously with the inebriate. The chief enemy of these
unfortunates is their immense egotism. It is rare to meet
one who does not say that he can give up the habit any time.
Or, after a brief period of abstinence, he will say that he
could wade through a lake of liquor as deep as his chin and
not drink a drop. Such remarks as these are usually pre¬
cedent to a most disastrous relapse. The only way to over¬
come this egotism and the too great confidence of friends is
Digitized by ^ooQie
Duty of the Profession in Inebriety . 131
to teach that inebriety is to a great extent beyond control of
the person’s will, that the mind and body are diseased and
that it is necessary for the person to place himself under
medical advice for the bodily ailments and the best circum¬
stances for aiding the feeble will.
Another matter that has served to obscure the discussion
and proper understanding of this subject is that there is no
well marked line of division between liquor taking and
inebriety. One swallow does not make a summer, and one
drink does not make an inebriate. In fact, some individuals
do and may take liquor in moderate quantities for many
years, without becoming inebriates. It is impossible to lay
down any hard line on one side of which a man shall be said to
be an inebriate and on the other that he has the drink
habit. It would be desirable for our theories if nature would
follow our classifications and make clean-cut distinctions.
We can divide the whole world into inebriates and sober
people, but we shall find all gradations, from the individual
who takes three or four drinks a year, to the victim of the
drink disease who is as hopeless and helpless in the presence
of his malady as is the sufferer from epilepsy or hydrophobia.
This want of division is not peculiar to inebriety, it is
characteristic of insanity, and one of the chief difficulties in
dealing with the legal control of the lunatic arises from this
want of a dividing line between sanity and insanity, a difficulty
that our judges have been attempting to overcome for two
hundred years. It is impossible to lay down any definite
rule, but in a general way, where there is a distinct craving
for alcohol, which is only partially restrained, or where we
have unrestrained indulgence with the more constant
phenomena of acute or chronic intoxication, or where we
have the secondary effects of alcohol upon the tissues, we
may make a diagnosis of inebriety. It is well understood
that such division is but arbitrary, and the effects of alcohol
in the milder cases is one of degree and not of kind. Still
a division must be made somewhere, and it would seem best
Vol. XVII.—18
Digitized by v^ooQie
132 Duty of the Profession in Inebriety .
to place it near the point where alcohol affects self-control
and civic relations.
The profession at large owe a great debt to the inebriate
and one that they have appreciated too lightly in the past.
It is rare that a patient presents himself directly for the
alcohol habit; it is usually for some intercurrent affection or
for the secondary results of the alcohol. As a rule the
symptoms are prescribed for, a few inquiries are made
regarding habits and the patient is told to moderate, or stop
his use of alcohol, and dismissed with a few added injunc¬
tions as to diet. In these cases the physician regards as a
cause that which is in reality the disease (inebriety). It is
the duty of the physician in every such case to make a care¬
ful inquiry into the family and previous history of the patient,
the date of beginning of the alcohol habit, its cause if ascer¬
tainable, and finally the quantity, time, and kind of alcoholic
drinks taken. These, with an estimate of the condition of
the nervous system and an examination of the internal or¬
gans, will furnish a guide for prognosis and the general in¬
dications for treatment.
I do not believe there is any specific treatment for ine¬
briety, nor that there is any drug or combination of drugs
that will relieve the craving for liquor, except they are them¬
selves intoxicants, or are like strychnine, atropine, or other
alkaloids, that when exhibited in very large doses produce a
marked toxic effect. Not that these drugs are devoid of
value when exhibited in proper doses, and under proper
directions. They are most excellent tonics and restoratives,
but when given in extraordinary quantities and particularly
beneath the skin, they may produce very profound disturb¬
ances in the nutrition of the nerve centers that may lead to
insanity or the production of the more grave degenerations.
Such drugs as ext. cocoa and the general nerve tonics are
indicated, but they are not to be given in doses that shall
in any way make them substitutes for the alcohol that has
been taken. Hot baths are useful, especially the Turkish
bath, where available. They tranquilize the nervous system
Digitized by LjOOQie
Duty of the Profession in Inebriety . 133
and aid elimination. Chloral, the bromides, and other seda¬
tives are useful to procure sleep. These patients ought to
be kept busy as much as possible with their treatment.
Medicines should be given often, in small doses, and the
baths frequently repeated. It is astonishing sometimes what
a wonderful effect a small bottle of a comparatively innocent
drug will have in allaying the thirst for liquor, providing the
patient is told with sufficient earnestness that it is given for
that purpose. In a general way, the home treatment of in¬
ebriety, like that of insanity, is unsatisfactory. In the milder
cases good results may be achieved. In the more advanced
cases, where the peculiar mental changes of chronic alcohol¬
ism have come on, it is better to send the patient to some
institution. In this way old habits and associations are inter¬
rupted, and a more profound impression is made upon the
mind of the patient than can ever be reached by the
physician at home, be he ever so skillful.
In bringing this article to a close, I am profoundly im¬
pressed with its fragmentary nature. I have made no attempt
to go into the extensive and valuable literature with which,
indeed, I am but imperfectly acquainted. I have simply en¬
deavored to set down a few suggestions that have been the
outgrowth of my experience with this class of cases. If it
shall but stimulate the profession to a livelier sense of their
responsibility in dealing with these unfortunates it will ful¬
fill the object for which it was written.— 132 LaSalle St .,
Chicago .
Departmental Inquiry on Inebriates. — The Scot¬
tish Departmental Committee on vagrants and inebriates,
concluded the reception of evidence at several sittings n
London last week. Among the medical witnesses examined
were Sir James Crichton Browne, Dr. Hoffman, Dr. Nicolson
of Broadmoor, and Dr. Norman Kerr. Sir Charles Cameron,
Bart,. M.P., presided as chairman of the committee; Dr.
Farquharson, M.P.,and the secretary (Dr. J. F. Sutherland)
were also present. The committee expects to meet in Lon¬
don in March or April to prepare their report.— British
Medical Journal , February 9th.
Digitized by i^-ooQie
134
Tea and its Effects.
TEA AND ITS EFFECTS.
By James Wood, M.D.,
Visiting Physician to the Brooklyn Central Dispensary .
Excessive tea drinking is fast becoming a greater evil
in this country than it ever has been in England and Ire¬
land, the countries most noted for this indulgence. People
so easily fall into the habit of using this form of stimulant
that they are surprised when the physician calls their atten¬
tion to the fact that they are drinking too freely. It is gen¬
erally thought to be so harmless that it has become almost a
household drink in many families, and in consequence the
use is steadily increasing. It is, indeed, a very frequent
occurrence to find one member of the profession advising
patients to use tea and another immediately prohibiting its
use. This procedure testifies most strongly to a want of
some definite knowledge of the subject, and consequently
there is no principle for guiding the course to be taken.
What result this condition of affairs has had upon the limita¬
tion of the use of tea is well illustrated in the increasing de¬
mand and consumption in this country.
In 1890 there were imported into the United States
83,494,956 pounds of tea, an appreciable increase over the
previous decade, and giving an allowance of i£ pounds to
each individual — truly a surprising quantity.
Some there are who deny that “ theinism ” is a common
condition. In reply, the statement is made that since Janu¬
ary I, 1894, of 1,000 patients applying for treatment, 100
gave such symptoms in the general examination as to point
directly to tea inebriation. How many suffered from a simi¬
lar condition, but applying for treatment for such diseases
that did not necessitate going into a history of their daily
customs, were addicted to the same habit, it is hard to state.
The estimate is made that at least 50 per cent, drank the in-
Digitized by t^-ooQie
Tea and its Effects .
135
fusion to a greater or less extent. Here, then, we have
clinical data of a cause of io per cent, of the ordinary de¬
rangements which one meets in general practice, especially
in our large cities. Surely the importance of the question
merits a careful study of tea and its effects upon the system.
There seems to be a very wide divergence in the results
of different authorities in the analytic examination of the tea
leaf or of an infusion of the same. Probably the best repre¬
sentative analysis is as follows :
Theine,
Albuminoid principles,
Carbohydrate elements,
Tannic acid,
Essential oil,
Cellulose,
Water,
2.8 per cent.*
3.5 per cent.t
9.0 per cent.J
14 2 per cent.§
0.75 per cent.
23.0 per cent,
o per cent.
These are considered the principal constituents of the
tea-leaf, but besides the ones already mentioned, we have
others, such as wax, resin, extractives of different kinds, salts,
xanthine, hypoxanthine, boheic acid, and apo-theine. From
this extensive list of constituents we might with justice con¬
sider the tea-leaf a very complex body. However, there are
but few of value either from a dietetic or scientific stand¬
point. Those which we shall consider are theine, tannic
acid, and the essential oil.
Tea is usually used in the form of an infusion,— very
often it is a pure decoction, made from the leaves, and the
action which it has on the human organism is as the sum of
the effects of the three important constituents named above.
The theine affects directly the nervous system primarily and
the organic system secondarily ; the tannic acid affects the
digestive apparatus and such organs as are intimately con¬
nected with it; while the essential oil gives us the peculiar
♦Kozai says 3.3 per cent.; Muller, .65 per cent.; Peligot, 3 per cent.; Sten-
house, 2 per cent.; Bauer, 1.3 per cent.; Parkes, 1.8 per cent.
t Kozai says 5.9 per cent.; Muller, 3 per cent.; Bauer, 9.4 per cent.; Parkes,
2.6 per cent.
$ Parkes, 10 per cent.
§ White, 7.17 per cent.; Parkes, 15 per cent.; Kozai, 10 per cent.
Digitized by t^-ooQLe
136
Tea and its Effects .
intoxication so typical of tea dipsomania. The natural order
of study of this commodity and the effects of its use would
be to consider at this point the infusion of tea. Tea is
usually taken in this form by the people at large. The
length of time of the infusion will greatly change, not only
its composition, but influence almost entirely its action upon
the system imbibing the same. A good example of this is
found in the following table of the difference in the amount
of tannin taken up in a three and fifteen-minute infusion :
Finest Assam.
Finest China.
Common Congou
Infusion for 3 minutes yielded
“ «« I5 «
11.30 per cent.
17.73 P er cent.
6.77 per cent.
7.97 per cent
9.37 per cent.
11.15 per cent.
It will be seen from
this table that in an
infusion of
fifteen minutes of the finest Assaiji (Indian) tea, the yield
of tannin is nearly two and a half times as much as the
finest China. In all of the different teas, we find the length
of time of the infusion affecting greatly the composition,
with possibly an exception in the case of the better qualities
of China tea. About six-sevenths of the entire soluble
matter — 33 per cent.*—of the tea-leaf can be incorporated
in the first infusion. Again the authorities differ f greatly,
but the above percentage will be found to be that most often
met with in teas in common use in this country. Of the
total amount of nitrogenous substances, 47 per centj is
soluble and is present in the infusion. The amount of
tannin will range from 7 to 11 per cent., differing in the
kind of tea. The amount of essential oil is about .75 per
cent., and is present in larger quantities in the first infusion
than in subsequent ones, and if the tea is not drunk immedi¬
ately, it is soon lost. This is well illustrated in the frequent
headaches complained of by professional tea-tasters, who use
* Pavy, Bauer, and Peligot.
f Soc. of Pub. Analysts of Eng. says 30 per cent.; Muller, 45 per cent.; J.
Lehman, 15 per cent.
$ Parkes.
Digitized by CjOOQie
Tea and its Effects. 137
the infusion immediately after it is made. Thus much for
the constituents of the infusion.
The amount of tea which can be drunk every twenty-
four hours with impunity differs with the individual. Some
people are profoundly intoxicated by indulging in two cups
of strong tea per day, while cases have come under my ob¬
servation where fifteen pints of the strongest were taken
every day with very little damaging effects. Usually we
find that an ounce of tea-leaves used daily will soon produce
poisonous symptoms. This amount would contain from six
to ten grains of theine.
The question might very properly be asked: What are
the functions of the body disturbed by drinking tea, and
what prominent symptoms are most often present.
From the first 100 cases which presented themselves for
treatment and advice the following analysis has been pre¬
pared :
ANALYSIS OF SYMPTOMS IN IOO CASES OF THEINISM.
Sex, 69 per cent, female ; 31 per cent. male. Quantity:
2 pints or less, 54 per cent.; 4 pints or less, 37 per cent.; 10
pints or less, 9 per cent. Strength: 77 per cent., strong;
15 per cent., ordinary; 8 per cent., not known. Number
nervous : 72 per cent. Bowels : 40 per cent., constipation ;
2 per cent., diarrhoea; 15 per cent., irregular. Pains: 16
per cent., general; 10 per cent., heart; 9 per cent., back ; 6
per cent., side ; 7 per cent., chest. Dizziness : 20 per cent.;
faintness: 8 per cent.; gastric and intestinal indigestion : 19
per cent.; intestinal catarrh: 8 per cent.; dreams: 5 per
cent.; “ nightmare ”: 5 per cent.; depression: 10 per cent.;
despondent: 20 per cent.; excited: 5 per cent.; suicide: 3
per cent.; headache: 45 per cent.; rheumatism : 5 per cent.;
irregular menses: 12 per cent.; palpitation: 19 per cent.;
muscular tremor: 12 per cent.; insomnia: 15 per cent.;
anaemia: 6 per cent.; dyspnoea: 5 per cent.
In subsequent cases careful study is being made of the
irregular cardiac action, hallucinations,.nightmares, success-
Digitized by i^-ooQie
138
Tea and its Effects .
ive dreams, obstinate neuralgia, anxiety, a persistent, sinking
sensation in the epigastrium, prostration and general weak¬
ness, excitement, and mental depression. These are more
or less present in nearly all cases of tea intoxication, and
are often the symptoms for the relief of which the patient
seeks medical advice. Certainly comment on the table is
hardly necessary; it bears silent but impressive witness.
In the abuse of this drink we have the aetiological factor,
either direct or indirect, for nearly 50 per cent, of the head¬
aches, one-fifth of the cases of dizziness, and the same per¬
centage of despondency and palpitation of the heart. Truly
an agent capable of so strongly affecting the human organ¬
ism is worthy of more than passing attention.
The effects of tea drinking on the digestive organs is
very pronounced. In a large number of cases it is the active
agent in the production of constipation, in others’an alternat¬
ing constipation and diarrhoea, and in some an intestinal
catarrh. Some patients after drinking tea give a history of
severe abdominal pains accompanied with nausea, and the
action of the bowels greatly diminished.
These or any of the effects which tea has on the digestive
system are largely due to the estringent action of the tannin.
Schwann has shown that tannin will throw down a pre¬
cipitate from artificial digestive fluids and render them inert.
What else can we expect but deranged digestive action,
when people will indulge in copious draughts of strong tea
before, during, and after each meal, and often nearly every
hour in the day ?
Let us now consider the principal constituents of the
infusion of tea separately that we may better appreciate the
latent power which they contain. The theine is probably
the most important of them all, and yet what changes this
nitrogenous body undergoes in the system is still uncertain.
We know that the end products, like those found after the
metamorphosis of any nitrogenous body, are undoubtedly
urea, uric acid, creatinine, water, and carbonic acid, but
what intermediate changes have occurred before the final
Digitized by i^-ooQie
Tea and its Effects .
139
results are reached, is unknown. If it is oxidized artificially,
we have as the result methylamine (CH 3 H 2 N), hydrocyanic
acid (HCN), and amalic acid (C 12 H 12 N 4 0 7 ).
Theine lessens the tissue metamorphosis to a considerable
extent,* as we find a decrease in the amount of carbon di¬
oxide expired. If theine is pushed until we get its full
physiological effects, we have a general excitement of the
circulation, with rapid pulse, muscular tremor, and a very
urgent wish to empty the bladder. The imaginative faculties
are more acute, or the mind may wander, hallucinations and
visions make their appearance, and a peculiar form of intoxi¬
cation supervenes. These symptoms end, after a long period
of wakefulness, in a deep sleep from exhaustion. Theine
seems to affect chiefly the sensory system, but, in large
doses, it may cause spasms and convulsions. The peculiar
rhythmical contraction, which we find in the voluntary mus¬
cular fibers and lasting for a considerable period, often
several hours, acts transversely across the fiber, because we
find that it is elongated at each contraction. Hypodermatic
injections of theine acting on the sensory system produce
local anaesthesia at the point where the needle was inserted,
and for some distance below, thus having an efferent action
along the nerve trunk. It is not narcotic.
Of the 47 per cent, of nitrogenous substances, little of
value can be said. Traces of xanthine and hypoxanthine
were found by Baginsky, and these bear the same relation to
similar if not identical bodies which we find in the extract
made from muscular tissue, and they undoubtedly occur as
the result of a like process, namely, a retrograde metamor¬
phosis of nitrogenous elements.
The amount of nitrogenous elements which is available
for nutrition is manifestly too small to be of any value, and
additionally it exerts little if any influence in the chemico-
physiologic changes by virtue of which vital force is now pro¬
duced. The arguments which certain individuals bring forth
*Dr. Edward Smith, Phil. Trans.
VOL. XVII.—19
Digitized by ^ooQie
140
Tea and its Effects.
to substantiate its high-sounding claim as a valuable addition
to our list of food stuffs are truly amphigoric.
The next most important constituent of tea is the essen¬
tial oil. This oil gives the aroma to the tea in a properly
prepared infusion. Johnson is skeptical about its existence
before the roasting and drying process has been completed,
and thinks it is produced during this procedure. It is found
more plentifully in the green tea, and seems to be lost during
the greater oxidizing process through which the leaves are
put in order to produce the black variety. Physiologically it
exerts a stimulating and intoxicating effect which is so power¬
ful that the natives do not use tea until it is at least a year
old. This alone is the narcotic agent found in the tea leaf
and infusion. The amount usually found will average about
i per cent.
Mention has been made of a difference existing between
the black and green varieties of tea. The green tea is richer
than the black in theine essential oil and tannin, and all the
constituents soluble in water by fully five per cent. The
influence which the green tea has on the nervous system,
and for which it is largely noted, is due to one of the above
named constituents — the essential oil. Among the better
class of people who drink tea, and can afford the better
varieties, the black is given the preference, because it is less
astringent and exerts less influence on the nerves. The
poorer classes, in Ireland especially, use the Indian (Assam)
and cheaper varieties and cannot avoid the deleterious effects
which the better class escape.
Next to the effects of tea on the nervous system the
digestive organs are most often deranged functionally. In
so many cases the so-called infusion of tea is nothing more
or less than a very strong decoction that its contact with
secreting and excreting surfaces must result in harm. If tea
is imbibed too soon after a meal is taken, the digestive action
will be seriously disturbed and hindered. The condition is
not to be wondered at when we are aware of the ease with
which the active agents of the digestive juices are precipitated
Digitized by i^-ooQie
Tea and its Effects.
141
and rendered inert by the tannin, or tannic acid, always
present in the infusion or decoction. A very persisting gas¬
tric disturbance is often excited and maintained, which is
positively non-responsive to any medicinal remedy and is
only relieved by a total abstinence from the use of tea. In
a large percentage of tea inebriates, as can be seen from the
analysis given, the action of the bowels is greatly diminished,
nausea is common, and very distressing abdominal pains are
present. The nerve ganglia of the solar plexus are in an
irritable condition, and a sinking feeling in the epigastrium
is much complained of.
This description of the effects of tea on the nervous
system and digestive apparatus is necessarily brief. To
elaborate the different effects noted in thpse who indulge too
freely, would be to narrate most of the common complaints
suffered by humanity. In reports just received from insti¬
tutions for the insane in Ireland great prominence is given
to the immoderate use of tea as a causative factor in insanity.
The use of tea by the two sexes is a very interesting
study. In the table of the 100 cases reported, 69 females
were inebriates, while only 31 were of the male sex. This
difference is often greater, especially among the poorer
classes in our cities. Why this difference between the
sexes exists is probably explained by the greater use of to¬
bacco by men and the consequent satisfaction for a stimulant.
Women assuage the importunities of the system for a stimu¬
lant by tea.
Undoubtedly the primal cause of the use of stimulants
is poor health. Excessive labor, insufficient and unhygienic
sleep, improper and inadequate amount of nutrition extend¬
ing over a long period, possibly years, creates the best
possible condition which calls for stimulants.
It is hardly within the province of this article to discuss
the relation of tea-drinking to poverty, general perverseness,
and other economic factors; these are reserved for future
narration.
The relative position of theine among other stimu-
Digitized by i^-ooQie
142
Tea and its Effects.
lants is interesting, as we may thereby the more readily
appreciate the power which this drug — for we may with
justice so class it — is capable of exerting.
Theine and digitalis exert certain physiological actions in
common. In toxic doses reflex action is lowered, especially
of the nasal mucous membrane, by exciting Setschenow’s in¬
hibitory center. Both cause prostration, muscular tremor,
and often convulsions. They are mildly diuretic and di¬
minish urea and uric acid. They cause nausea, vertigo, and
abdominal pains. They are antagonized by opium.
The contrast between theine and caffeine is of still
greater interest, because a large amount of so-called caffeine
is made from old tea leaves, and is nothing more than theine.
Is it, then, to be wopdered at that some of the caffeine found
in our shops proves of so little value ?
Attention is called to the following table of the compara¬
tive actions of the two drugs :
THEINE.
Effects sensory system.
Produces neuralgia.
Causes spasms.
Causes convulsions.
Impairs or abolishes nasal reflex.
Diminishes temperature.
Is astringent.
Dilates capillaries of splanchnic
arcade.
Mildly diuretic.
Causes irregular and feeble cardiac
action.
Causes sinking sensation in epigas¬
trium.
Causes sick headache.
Opposes active nutrition.
CAFFEINE.
Motor.
Does not.
Does so late, if at all.
Does so late, if at all.
Does so late, if at all.
Increases.
Is relaxing.
Contracts the same.
Is powerfully so.
Causes strong and regular.
Relieves the same.
Relieves the same.
Increases nutrition and tone of system.
While theine and caffeine are diametrically opposite in
the above actions on the system, they are similar in produc¬
ing cerebral excitement, wakefulness, hallucinations, and a
soporific state following the exhaustion of insomnia. It is
very apparent from our study of tea and its principal con¬
stituents, that we have an agent of great power,— one
Digitized by t^-ooQie
Tea and its Effects . 143
capable of producing the most detrimental effects on the
system.
A fact has been noted among those tea inebriates who
also drink coffee which is in support of the above statement.
There are a considerable number of people who indulge very
freely in both coffee and tea, and it is often difficult to de¬
termine which is producing the poisonous effects.
When we endeavor to make a diagnosis by exclusions
aided by the table already given, the difficulty is even greater.
Caffeine and theine do undoubtedly antagonize each other,
or rather, the symptoms which each are likely to produce
alone are not present when the two are used in conjunction
with each other. This was- first noticed in some few patients
who could drink large quantities of both tea and coffee and
be but slightly affected thereby. They, however, complained
the most of insomnia and cerebral excitement and of almost
no other symptom. The study of the action of these two
drugs in the system at the same time, was one of the most
interesting phases of our investigation of tea intoxication
and gave the idea for the employment of caffeine in the
treatment of this condition — a procedure which has given
the best results.
It is a question whether theine represents any physio¬
logical action worthy of a place as a therapeutic agent. It
has been used hypodermatically in a few cases of sciatica,
but with uncertain results. That its constant administration
either in the uncombined form or in conjunction with other
bodies, as for instance in the infusion or decoction of tea, is
followed by undesirable effects on the system is undeniable.
The pernicious influence on the organism which our study of
tea has brought to light, and with its increasing use, should
not be lightly treated, but an effort made to educate the
people as to the danger of using it. Tea is one of the
principal articles given to the poor by the charitable societies
of some churches, and is a factor, therefore, of some import¬
ance in producing the increase of sickness among these un¬
fortunates.— Brooklyn , N Y, 162 St.John's Place.
Digitized by i^.ooQle
144
Unwholesome Workshops and Drink.
UNWHOLESOME WORKSHOPS AND DRINK
By David Walsh, M.B.,
Assistant Physuian , Western Skin Hospital , London.
Your president, Dr. Norman Kerr, has asked me to
contribute a short paper for discussion at your Society. In
complying with that request I shall not attempt to deal with
any of the deeper scientific issues involved in the study of
inebriety, but shall endeavor to present you with some sug¬
gestions upon what appears to me a matter of some import¬
ance, namely, the relation of unwholesome workshops to in¬
temperance.
The study of inebriety is now rapidly assuming the posi¬
tion of an exact science. Investigators recognize that alco¬
holism does not merely mark a failure in individual morality,
but that it is to a large extent the outcome of heredity and
environment. So that instead of bemoaning the personal
wickedness of the drunkard the tendency nowadays is to
unearth, as far as we may, the causes underlying his un¬
happy condition. To put the matter in other words, we no
longer waste our time in treating symptoms, but do our best
to get at the root of the disease. This attitude is the more
hopeful inasmuch as we have in alcoholism to deal with a
morbid condition which is in all cases much easier to pre¬
vent than to cure.
I venture to think that this logical way of approaching
the question constitutes a great step towards the solution of
a complex and difficult problem. It has always seemed to
me that the temperance party has lost a great deal of sup¬
port owing to the unattractiveness of its methods. Beyond a
doubt the advocates of total abstinence have won great tri¬
umphs in the teeth of persistent opposition and abuse. Still,
from a scientific point of view, their work is open to the ob¬
jection that it has been carried out on a narrow basis, and
Digitized by t^-ooQie
Unwholesome Workshops and Drink . 145
has appealed to emotions rather than to reason. Folks
of sound understanding require something more than the
hymns and the “horrible examples’* of the teetotal platform
to convince them of the dangers of alcoholic excess. They
are more likely to pay attention to a broad philosophical
treatment of the whole question, with a systematic examina¬
tion of causes, symptoms, and results.
Such a task, however inviting, would be far outside the
limits of this short paper. For present purposes I will as¬
sume that the evils of excessive drinking are granted. I
will draw no lurid picture of how the demon drink plays
havoc with the homes and the lives of all classes of society ;
of how it brings disease and suffering and death in its train.
Nor will I attempt to discuss the broad question of why
men drink. At the same time I may perhaps be allowed to
classify what are in my opinion the chief causes of intemper¬
ance. They are briefly as follows :
1. Fashion, a powerful lever. Habits of excessive drink¬
ing have ceased to be fashionable among the wealthier
classes, and are now in vogue chiefly among the poor.
2. Weakness of body, hereditary or acquired, leading to
a natural desire for stimulus for heart and brain.
3. Weakness of brain, also hereditary or acquired; close¬
ly connected with bodily weakness, and shown by want of
control.
4. Temptation, which abounds on every hand, owing to
the absurdly disproportionate number of places licensed by
government for the sale of drink.
5. Acquired habit; as the"health is undermined and self-
respect destroyed, drinking becomes a fixed habit.
6. Individual environment, such as starvation, poverty,
overwork, idleness, unwholesome dwellings and workshops,
leading to weakness of mind and body, and so predisposing
to alcoholism.
My part of the subject is to show how the environment
of an unwholesome workshop may drive a man to drink.
First of all, apart from mere unreasoning custom, I im-
Digitized by ^ooQie
146
Unwholesome Workshops and Drink .
agine that the desire for drink, in the earlier stage at any
rate, is purely physiological. In other words, a man drinks
for the two reasons that he is thirsty and exhausted. For
instance, if engaged in a hot and laborious calling, such as
iron smelting or baking, he finds temporary comfort and aid
in alcoholic beverages. His thirst is quenched and his
flagging heart stimulated in a quick and speedy way by a
draught of ale or porter.
Besides heat and hard work, however, the workman is
often exposed to other injurious influences. In a workshop
where the ventilation is defective, for example, he is exposed
to the injurious effects of carbonic acid gas, given off in res¬
piration, by gas jets, and by furnaces. It must be remem¬
bered, moreover, that a man when working hard throws off
much more carbonic acid than when at rest, and therefore
needs a greater air supply. The following table furnishes a
fair idea of these varying conditions of waste and demand:
CO 2 given off per hour
in cubic feet.
Adult male at rest, . . 0.72
“ in light work, . 0.95
“ in very hard work, 1.96
Fresh air needed hourly per
head in cubic feet.
. 3,600
• 4.750
. 9,800
That is to say, an adult gives off more than twice the or¬
dinary amount of carbonic acid when at hard work, and re¬
quires nearly three times more air than when at rest. From
these figures it is clear that a workshop demands a specially
abundant supply of fresh air. What are the actual facts of
the case ?- I imagine those who are acquainted with the aver¬
age condition of workshops in this country, sanitary inspec¬
tors and others, will tell you that not only is ventilation in the
majority of instances totally inadequate, but also that over¬
crowding is the rule rather than the exception. With regard
to overcrowding it is no doubt difficult to fix a standard of
cubic space that should be exacted for each workman. In
barracks the minimum allowance is 600, and in prisons 800
cubic feet for each occupant, but in each case it must be
noted that free ventilation is insisted upon. Would it not
Digitized by i^-ooQie
Unwholesome Workshops and Drink . 147
be feasible to impose a general minimum average for all
trades of 300 cubic feet for each workman, permitting that
minimum only when accompanied by proper ventilation ? It
is obvious that some trades require a larger amount of air
space for workers than others. Thus in bakeries, to which
my friend Dr. Waldo and I have given special attention, we
are of the opinion that at least 500 cubic feet of air space
should be allowed for each occupant.
A familiar instance of the ill effect of carbonic acid is
seen when a person faints in a crowded church or theatre,
and then the popular, and indeed, the physiologically correct
remedy is fresh air and a dose of alcohol. The workman in
a badly-ventilated workshop suffers from a form of chronic
carbonic acid poisoning, which gives rise to headaches, anae¬
mia, rheumatism, lung and heart affections and general de¬
bility. In point of fact, this is just the condition in which
a man goes to the nearest public-house for a stimulant as
naturally as a duck would make for the nearest pool of
water.
Besides carbonic acid there are of course many other in¬
jurious agencies hurtful to health in an unwholesome work¬
shop. Among them may be mentioned, darkness, damp,
and poisonous sewer gas from imperfect drainage. Special
trades, again, have their own peculiar dangers, such as lead
and other metallic poisoning, the irritation of dust, and the
deadly action of various kinds of chemical fumes.
After a close investigation of the subject Dr. Waldo and
I have come to the conclusion that the badly constructed
and unhealthy bakehouse is to a great extent answerable for
the drinking habits that unfortunately prevail among the
journeymen bakers. We take that class because it has
come especially under our notice, but in many other trades
there is no doubt as great or a far greater amount of intem¬
perance.
If we compare mortality according to occupation and
classify certain specified causes of death we obtain some in¬
teresting results as to the diseases and trades closely asso-
Vol. XVII.—20
Digitized by v^ooQie
148 Unwholesome Workshops and Drink.
ciated with alcoholism. It is extremely difficult, however,
to steer clear of fallacies in dealing with statistics of this
sort. Dr. Whitelegge, however, has laid down a general
statement that statistics tend to establish the relation be¬
tween intemperance and diseases of the heart, liver, kidneys,
and nervous system, and also phthisis, gout, and suicide.
Broadly speaking, it may be assumed that men who
spend the greater part of their time at indoor work are likely
to be of impaired vitality. The difference is shown by the
enormous disparity of the rates of mortality between the
town and the country laborers. The longer life of the
countryman is probably due to the fact that he spends most
of his time in the open air, and has little opportunity for
indulgence in alcohol. Otherwise he shares many of the
unfavorable conditions that apply to the town brethren,
such as bad housing, scanty food, poor pay, and long hours
of labor. The London general laborer has a mortality
three times as great as that of a corresponding class in the
country.
Enough has been said to show that the question of occu¬
pation and environment in relation to mortality is both wide
and complex. If, however, it can be shown that an un¬
wholesome workshop is one of the causes that lead men to
crave for a physiological stimulant, we have at once the key
to a preventive measure capable of wide application. Place
the workman under proper conditions in his workshop and
he will be less likely to crave for drink. The definition of
“ proper conditions ” is by no means an easy one to make.
It, is clear that the matter cannot be disposed of simply by
handing it over to the medical officer of health. There are
other important economic factors that must be taken into
consideration. Hours of work, for instance, will have to be
shortened to a reasonable length, in order that the work¬
man's bodily strength may not be unduly taxed. He should
have a fitting time and place provided for his meals. He
should also be able to command a fair living wage, so as to
procure for himself good food, clothing, and housing.
Digitized by L^OOQie
Unwholesome Workshops and Drink . 149
Here, then, is a sufficiently wide field for the energies of
the temperance reformer. An old proverb reminds us that
it is ill talking to a starving man. In my opinion it is just
as useless to.preach temperance to a man who is daily and
hourly weakened in mind and body by exposure to long
hours of labor in an unwholesome workshop.
Finally, I may say that I have found even this small sec¬
tion of the subject of inebriety to be beset with difficulties.
In our present state of knowledge it seems hopeless to at¬
tempt any formal proof of the views I have advanced. My
remarks have been necessarily for the most part of a general
character, and I feel that their possible value may lie in a
certain suggestiveness. At the same time I have endeav¬
ored to avoid the faintest approach to dogmatism.
The conclusions I draw are:
1. Anything that weakens the health of the individual
predisposes him to resort to alcohol.
2. That an unwholesome workshop, by undermining the
bodily and mental health of its occupant, leads him to seek
physiological relief in alcohol.
3. That the temperance reformer should also be an ear¬
nest health reformer.
DISCUSSION,
Dr. Waldo, medical officer of health for Southwark,
thoroughly endorsed what had been advanced by Dr. Walsh.
With reference to the true mortality of alcohol, he said, “ In
my report for 1892, I remarked that the deaths attributed
directly to chronic alcoholism and to delirium tremens did
little to indicate the actual loss of life due to the abuse of
alcohol. I further pointed out that the natural wish to spare
the feelings of surviving relatives prevented the returns from
mentioning the real cause of death. Hence the offensive
term “ alcoholism ” was often replaced by one of its second¬
ary results, such as disease of the liver, brain, kidneys, or
stomach.”
With this fact in view the following suggestion was
made:
Digitized by ^ooQie
150 Unwholesome Workshops and Drink .
“ That a nearer approach to truth as regards alcoholism
and certain other diseases could, I think, be arrived at were
it made obligatory, in future, for medical practitioners to for¬
ward all death certificates, in confidence, direct to the regis¬
trars, instead of handing them to relatives, which is at pres¬
ent the usual procedure.
Since the above was written the select committee ap¬
pointed by the House of Commons to report on death cer¬
tification, has recommended “ that medical practitioners
should be required to send certificates of death to the reg¬
istrar, instead of handing them to the representatives of the
deceased.”
The following is a list of those children suffocated while
lying in bed with their parent or parents during the year
1893, together with the particular day of the week on which
they died:
Sunday, ....... 1
Monday, ....... 2
Tuesday, ....... o
Wednesday, ....... 2
Thursday, ....... 1
Friday, ....... 2
Saturday, ....... 5
Comment on this list is needless.
Mr. H. H. Collins, surveyor for the city of London, and
Vice-chairman Paddington Sanitary Committee, looked more
to education of the people in sanitary knowledge than to new
Acts of Parliament. The law, if carried out, would be very
beneficial. Insanitary conditions led to drinking, and in the
interests of sobriety the people’s surroundings should be
made happy.
Dr. Allen, medical officer of health for the Strand dis¬
trict, concurred as to the unhealthy condition of workrooms
creating a tendency to force people to drink. With the pol¬
luted air so often to be found no wonder that a craving was
engendered which found speedy relief in drink. He held
that in every domestic workshop there should be 400 cubit
feet for each worker.
Digitized by i^-ooQie
Unwholesome Workshops and Drink . 151
Dr. Longhurst thought too much stress had been laid on
insanitary conditions as driving people to alcohol. He had
seen great overcrowding in India in bakehouses, etc., and
natives literally forced to rush out to drink and assuage
their thirst, but the drink was water. Heredity and other
causes operated more strongly.
Mr. Raper pointed to omnibus and cab-drivers as free
from polluted air, but as being considerably intemperate.
Insurance statistics showed that the alcohol itself was the
destroying agent.
Mr. Gandy held that while bad sanitary conditions should
be remedied, temptation ought to be diminished.
The president said that there was no true antagonism
between temperance reform and sanitary reform, both re¬
forms running on the same lines. Indeed, abstinence from
intoxicants was real sanitation applied to the individual,
being simply the avoidance of the introduction of lowering
poisons into the human system. Vitiated air and a foetid
atmosphere predisposed to drunkenness by their depressant
influence, and this predisposing cause, with a variety of
other physical predisposing causes, should never be lost
sight of.
The Cure of Inebriety. — The drunkard is curable in
at least one-third of the cases. The basis of cure is forced
and prolonged total abstinence, which should be instituted
at once. Delirium tremens does not result from suddenly
stopping the alcohol; its only results are headache, malaise,
and sweating. The treatment should be undertaken only
where the patient may have calm surroundings and a military
discipline ; some drink, which will quench the patient’s thirst
and give him pleasure, should be substituted for the
alcohol. Treatment should last at least for one year, and before
it is terminated the force of the patient’s resistance should
be tried. When the treatment is concluded some moderate
surveillance should still be exercised. If a certain trade or pro¬
fession has been a causative factor it should be abandoned.—
Marandon de Monytel in Annal . Med. Psych .
Digitized by t^-ooQie
152
Auto- Toxczmia in Drug Habits.
AUTO-TOXAEMIA IN DRUG HABITS.
By William F. Waugh, A.M., M.D.,
Professor of Practice, Chicago Summer School of Medicine; Professor of Medi¬
cine, Chicago Post Graduate Medical College, etc .
Without having occasion to withdraw anything I have
written concerning the drug habits, I am inclined to regret
that I ever published an article upon them. I would like to
hunt up those papers and add to each as a postscript that
the remarks applied to the cases on which they were based
exclusively, and not to narcomania in general. For the
cases vary so much that they defy classification, and the
symptoms, causes, and treatment in one case may be pre¬
cisely contradicted in the next. Even physostigmine, the
best of the remedies, has its limitations. In many cases it
is of great value; in others it has proved useless, in some
even injurious.
In the management of narcomania there is no royal road
to success. Each case must be individually studied and be
treated as its special symptoms require. Physostigmine has
proved best suited to cases with capillary stasis, constipation,
fever, and delirium following trifling excitants, when the
disease has been of long standing, with many relapses, and
when alcohol has been used freely, as well as morphine. But
in one such case, where cocaine and tobacco had also been
used to excess, and the heart’s power was materially weak¬
ened, the physostigmine in doses of gr. produced toxic
effects at once. When this alkaloid has proved unsuitable,
one of its congeners sometimes succeeds, such as muscarine,
solanine, pilocarpine, caffein, etc. On the other hand the
antagonistic groups, the atropines, picrotoxin, strychnine,
brucine, cruraine, etc., prove so decidedly useful in other
cases, that one is perplexed to account for these observations.
Possibly the explanation is to be found in the study of
Digitized by ^ooQie
Auto-Toxcemia in Drug Habits .
153
the phenomena attending the prolonged use of toxic agents.
When asked why persons who would be fatally affected by a
grain or two of morphine, after using it a long time are able
to consume a drachm daily with impunity, we answer that
they have become accustomed to it. But this is only a
re-statement of the fact, and not an explanation of their
immunity. Why are they immune ?
* My observations in treating many cases of various drug
habits, suggested the following hypothesis: When any toxic
agent is taken into the system, there is developed in the body
an antidote — a counter poison. If the dose of the 1 drug
taken be increased slowly, pari passu with the power of the
system to elaborate a corresponding dose of the antidote, the
toxic effect is prevented. If the taking of the poison become
habitual, the production of the counter poison becomes also
habitual. If, then, the taking of the drug be suddenly stop¬
ped, the elaboration of the antidote does not necessarily
cease at the same time, because its production has become a
habit. Hence, what we term the withdrawal symptoms,
following the disuse of a drug habit, are really symptoms of
poisoning by the systemic poison, which, no longer needed
to antidote the drug taken, exerts its toxic action upon the
body producing it. If this hypothesis be correct, we will
see, when the habitual drug is withheld, the symptoms due
to the leucomaine; and the treatment of this stage will
consist in endeavoring to prevent the formation of this
organic alkaloid, and in antidoting its effects. Certainly the
most direct antidote will be the drug habitually taken, and
hence the gradual withdrawal is better, so far as relieving
pain is concerned, than the sudden stoppage. But our expe¬
rience has been that it is still better to substitute for the
habit-drug some other antagonist of the toxic leucomaine.
The study of the phenomena of intestinal sepsis has
shown that in the intestinal canal are produced two toxic
bodies, known as the atropine alkaloid and the muscarine
alkaloid. Whether it is in the intestinal canal or elsewhere
that the toxines in narcomania are produced, I know not;
but as the trend of professional opinion is setting strongly
Digitized by CjOOQie
154
Auto-Toxcemia in Drug Habits .
toward considering the intestinal canal the laboratory in
which are elaborated the toxic principles of uraemia, diabetes,
and many other affections, it is at least possible, even prob¬
able,' that the toxin in these cases of morphinism, alcoholism,
etc., are also prepared in the bowels. If this be the case,
the treatment of the narcotic habitues should be improved
by the use of agents that render the intestinal canal aseptic.
The following case is the only one I have as yet treated
on this principle, but its history is in some degree confirma¬
tory of the hypothesis proposed.
A physician, aged forty years, began the use of morphine
to relieve asthmatic attacks, and soon became a habitual
consumer. He took the drug hypodermatically, up to eight
grains a day, in four doses, with a small dose of strychnine
nitrate. This use of strychnine was peculiar. In all cases
where I have given strychnine to morphinists, the hyperaes-
thesia has been aggravated and the suffering increased. The
night following his admission to my private hospital he had a
very severe asthmatic paroxysm, not relieved by aspidosper-
mine or by trinitrin. The next day he took a purgative dose
of calomel and magnesia, and the bowels were emptied by a
large enema, passed high up through a long tube. This was
repeated a number of times during the following week, bring¬
ing away large masses of dark, hardened feces, until finally
the stools became natural. Calomel and sulphate of mag¬
nesia were still given in small doses daily, and an antiseptic
drink containing eucalyptol and zinc sulfocarbolate. To
prevent the asthmatic seizures a full dose of quinine sulphate
was given at bedtime; fifteen grains at first, gradually
lessened to seven. I will say here also, that quinine has not
as yet proved of any special value in the treatment of mor¬
phinism, the hyperaesthesia being unaffected by it, and the
tendency to hallucinations increased.
The morphine was reduced rapidly for four days and then
discontinued; the strychnine was continued until the fif¬
teenth day and then stopped. No substitute was given, or
other medicine except as a placebo. Cold baths were em¬
ployed from the end of the first week. He did not lose a
Digitized by t^-ooQie
Auto-Toxcemia in Drug Habits . 155
night’s rest nor a meal, did not keep to his room nor absent
himself from the table for a meal ; in fact, the amount of
suffering from discontinuing the drug was too trifling to be
worth mention. The first day he did without the strychnine
he sat about the house “ feeling rocky,” he said; but he
bathed, ate, smoked, etc., and played cards as usual; and
this trial, trifling as it was, was greater than that which
followed the deprivation of the morphine. During the whole
time, care was taken to keep all the emunctories, the skin,
kidneys and liver in active operation. There is generally
with narcomaniacs a decided tendency to sluggish or defi¬
cient action of the excretory organs; and also a deficiency
in the supply of the digestive ferments.
Before this patient had discontinued his strychnine he
wanted to return to his business, feeling perfectly well and
eager for his work. I detained him for another week on
account of his asthma, as I desired to see if it would recur
when the quinine had been discontinued ; but as far as the
morphinism was concerned, he was a well man in two weeks
from the day he began treatment.
Men who have taken the drug in but small doses for a
short time, and who are as yet of good physique, have broken
the habit and returned to their work in two weeks, after
an ordeal that tried their utmost powers of endurance. The
case I have just described is the first I have known who got
well in so short a time with but little suffering. He was a
man of good nerve, but deficient in physique ; his muscular
system undeveloped, and his digestion weak. I can only
attribute the favorable result to the care taken in keeping
the alimentary canal in an aseptic condition. I would be
much more confident of the permanency of the cure if he
were to go to a gymnasium for six months; get up a little
home gymnasium, with Indian clubs and a pulling apparatus,
and remove to a locality where he would be free from asthma.
For a sound, equably developed body is a good thing to
have, and perfect health needs no drugs.
103 State Street, Chicago.
Vol. XVII.—21
Digitized by C^ooQie
156 Report of Walnut Lodge Hospital , Hartford , Conn .
ANNUAL REPORT OF WALNUT LODGE HOS¬
PITAL, HARTFORD,* CONN.
During the year 1894 fifty patients have been admitted
to this hospital. This, with the eight cases under treatment
at the beginning of the year, makes fifty-eight persons
treated. Fifty-two of these cases were discharged, and one
died the second day after admission. The following table
represents the class and character of these cases. Many of
them were mixed and complex in the causes, symptoms, and
progress.
Periodical Inebriates, . . . ..
Constant Inebriates,.
Dipsomaniacs,.
Opium Inebriety,.
Opium and Alcoholic Inebriety, . ..
Cocaine Inebriety,.
Chloral, Ether, Ginger, and other Inebriates,.
Complex Inebriates, using any narcotic that was most convenient, .
Spirits used medicinally for insomnia and debility, .
20
12
2
4
5
3
4
6
2
In all these cases except the last two, there was the
characteristic morbid impulse or mania to obtain relief from
and by the use of spirits and drugs, under all circumstances.
Periodicity is not common, except in alcoholic cases. Other
inebriates have no free intervals, but continue the use
of the drug constantly. Complex inebriates are cases who
at one time use opium to excess, then turn to alcohol,
chloral, ether, chloroform, cocaine, and any drug which gives
relief. These cases are usually incurables, and go the rounds
of asylums, and are recorded as cured of some particular ad¬
diction at each place. One such case has been treated in
four different asylums, for alcohol, opium, cocaine, and
chloral inebriety, and will no doubt continue as an inmate of
different asylums as long as he lives. In two cases, spirits
had been advised by the physician, one for general debility
Digitized by ^ooQie
Report of Walnut Lodge Hospital , Hartford , Conn . 157
with threatened lung trouble, the other for insomnia and
nervous prostration. In both the use of spirits had increased
to such proportions that they were brought for treatment.
The withdrawal of spirits was followed by recovery. Two
of the cases of cocaine inebriety began to use cocaine first
for nasal catarrh. All three cases were physicians, and two
were in special practice; the third was a general practitioner,
who began to use cocaine as a tonic when exhausted. In a
study of the causes, more attention has been given to ex¬
haustive family histories, and the term heredity has been
seperated into three divisions. The first, direct heredity, is
the appearance in the children of the same diseases and
defects as seen in the parents. Second, the indirect heredity,
is where the inebriety of a remote ancestor appeared in the
grand or great-grandchildren, the members of the families
intervening manifesting neurotic defects and degenerations.
The collateral heredities are cases where inebriety, epilepsy,
hysteria, paranoia, consumption, and other nerve and brain
defects have appeared in each generation, apparently alter¬
nating and depending on some special favoring causes.
The following is the table :
Heredity, Direct, . . . . 16 I Traumatism, .... 8
Heredity, Remote, . . . 13 I Exhaustion,.4
Heredity, Collateral, . . . 14 ] Environment and Contagion, . 3
The term traumatism describes a class of causes that
date from shocks and injuriei and sudden, severe mental
strains, associated with unconsciousness. Some of these
cases began to use spirits on recovery from acute inflamma¬
tion, others commenced after psychical and complex physical
shocks. Cases included under the term exhaustion began
to use spirits after profound debility and conditions of
acute anaemia, also cell and tissue starvation. Environment
as a particular and only exciting cause is rare; in the three
cases observed it was the most prominent factor. As an
exciting cause developing latent tendencies it is common in
many cases of heredity. A more exhaustive study of these
Digitized by CjOOQie
158 Report of Walnut Lodge Hospital , Hartford\ Conn .
cases might have revealed some other causes. It is a fact
not recognized, that in a certain number of cases the first
symptom is a desire to associate with low people in very bad
surroundings, and the use of spirits comes on gradually.
The impression is that environments are the causes; in
reality, some unknown palsy of the higher brain has begun,
and the desire to be with low people in bad surroundings is
only a symptom. The inebriety is also a symptom, and im¬
becility and paralysis are the common sequels.
Of the ages and general conditions of the persons treated,
the following tables are presented:
AGE OF PERSONS UNDER TREATMENT.
From 20 to 30 years of age, . ill From 50 to 60 years of age, . 6
From 30 to 40 years of age, . 25 1 From 60 to 65 years of age, . 1
From 40 to 50 years of age, . 15!
SOCIAL CONDITION.
Married and living with wife, . 22 I Widowers,.5
Married and separated from wife, n I Single,.20
OCCUPATIONS.
Physicians, .
• 9
Judge, ....
1
Lawyers,
• 4
Engineer,
. . 1
Farmers,
• 3
Hotel-keeper,
. . 1
Bankers,
• 3
Importers, .
. 2
Clerks, .
. 6
Liverymen, .
2
Veterinary Surgeon,.
. 1
Drummers, .
• 3
Manufacturers,
2
Gardener,
1
Teachers,
• 4 1
Undertaker, . . .
. . 1
Builders,
2
No occupation,
. . 2
Lumberman,
1
Women:—
Speculators,.
2
Housewives,
. . 2
Druggist,
1
Teacher,
. . 1
Merchants, .
2
No occupation,
1
Less than 5 years,
DURATION OF
. 6
rHE INEBRIETY.
From 15 to 20 years, .
• • 5
From 5 to 10 years,
.
• 19
Over 20 years,
• 4
From 10 to 15 years,
Collegiate, .
. 24
EDUC
• 17
A.TION.
I Academic, '.
. 24
University, .
•
• 5
1 Common School, .
. . 12
Digitized by t^-ooQie
Report of Walnut Lodge Hospital , Hartford , Conn . 159
NATIVITY.
Connecticut,
. . . 10
Nebraska,
New York, .
. 16
Missouri,
New Jersey, .
. s
Wisconsin, .
Rhode Island,
* • • 2
Illinois,
Massachusetts, .
• 3
Canada,
Pennsylvania,
. . . 4
Texas, .
Vermont,
• • • 2 1
Ireland,
Ohio, .
. 4 1
Maryland,
California, .
. . . 1 !
District of Columbia,
FORMER TREATMENT IN OTHER HOSPITALS.
Received treatment at Keeley Institutes, ....
Treated by other Gold-Cure Specifics, ....
Treated at other Hospitals,.
Never treated before,.
1
2
1
1
2
1
1
1
26
11
6
X S
The number of relapsed cases from the various specific
gold cures is increasing, and the possibility of their recovery
seems more difficult than in other cases. Delirium and ex¬
treme prostration are common symptoms, and spring up
from the slightest exciting causes. Defects of vision and
visual hallucinations are also common. The relapses of
these cases resemble acute insanity in symptoms and
duration.
Of the results of treatment, the following is the approxi¬
mate record :
Recovered, .
Improved,
Unimproved,
18 Benefited,.12
23 Died,.1
5
Those who are discharged and go back to active life with
excellent promise, and who are known to be doing well, are
recorded as recovered. In this class are those cases in
which local and hygienic causes are prominent. It is be¬
lieved that the removal of such causes and the restoration to
health constitutes, to a large degree, the measure of their
curability. The second class, marked improved, are the
paroxysmal cases, whose drinking is a distinct neurosis, and
who may possibly relapse, after long or short free intervals
of sobriety, from causes that are unknown and unantici-
Digitized by t^-ooQie
160 Report of Walnut Lodge Hospital , Hartford y Conn.
pated. Of the third class, unimproved, two were opium ine¬
briates and one a cocaine-taker. After a short period of
treatment, they refused to give up the drug and were dis¬
charged. The others were inebriates who went away in a
few days without any results from treatment. The third class
were termed benefited, but remained so brief a period that,
while improved for the time, no positive results could be
expected. One died from cerebral hemorrhage the second
day after admission.
All institutions for the cure of inebriates are unable to
keep the patients long enough to secure a degree of restora¬
tion that gives reasonable promise of permanency. The
law gives us full power to hold cases four months, while in
most cases twelve or eighteen months is far too short a
time. All institutions suffer seriously from the difficulty of
securing records of restored cases. Persons who recover
make unusual efforts to conceal the fact of having been
under treatment, and even deny it as an act of disgrace.
On the other hand, incurables and relapsed cases become
the most bitter detractors and prominent critics and de-
famers of the institutions. Hence public opinion of the real
work in an asylum is often unfair and misleading.
The physiological studies of the past year have been
continued with the additional aid of the spygmograph, and
special studies of the action of the heart. Muscular impair¬
ments have been studied with a dynometer, and various tests
of the disability of the muscles and senses have been made.
The special studies of heredity have been continued with in¬
creased interest, and it is expected to publish at an early
day some very interesting conclusions. Inquiries of the
present condition of cases under treatment before 1885 have
been made during the year. The results, so far, of the re¬
ported histories of sixty-six cases, show that sixteen are
living temperate and well, not having relapsed, and are con¬
sidered cured ; twenty-one died, all relapsed, and death was
more or less the result of the relapses ; four became insane,
and are confined in asylums; ten have become hopeless
Digitized by ^ooQie
Report of Walnut Lodge Hospital , Hartford, Conn . 161
inebriates, and fifteen are still drinking at irregular intervals.
Most of this number have tried gold-cure and other asylums,
with only temporary relief. These figures are reported as
very suggestive and encouraging.
The special work of this institution, to combine all the
best scientific measures known with the comforts and seclu¬
sions of a home and special personal care of each individual
case, has been very warmly commended during the past
year. The London Hospital Journal for December, 1894,
and many other medical journals of this country, have pub¬
lished very flattering descriptions of the work of this Hos¬
pital. The increased use and value of baths continue to
become more prominent every year, and this, with other
appliances, brings increased confidence in the permanent
restoration of an ever-increasing number of persons, as the
years roll around.
Alcohol has the power of degenerating nerve-fibres.
It is especially an irritant to the pneumogastric nerve and
has an especial destructive affinity for that nerve. The
children of parents who suffer from alcoholism are, in a
tremendous percentage of cases, the victims of consumption.
In fact, the children of parents who are even moderately
hard drinkers always prove the easy victims of consumption.
Furthermore, the records show that hard drinkers them¬
selves are particularly susceptible to consumption, and that
alcoholism in a very great percentage of cases leads to con¬
sumption These facts are due to reflex action over the
pneumogastric nerves.
A Father Mathew Chair. — The Catholic Total Ab¬
stinence Union has established a professorship in the Cath¬
olic University at Washington, known as the “ Father
Mathew Chair.” The Rev. Thomas Conaty, D.D., has
delivered the first of a series of annual lectures on temper¬
ance thus secured to the university.
Digitized by i^-ooQie
162 Report of the Massachusetts Inebriate Asylum ,
REPORT OF THE MASSACHUSETTS INEBRIATE
HOSPITAL AT FOXBORO, MASS.
This is the only asylum in the world where the problem
of the pauper inebriate is being practically solved. The
State of Massachusetts has erected fine hospital buildings
on a large farm in the country, and now sends the incorrigible
and indigent inebriate to this place for restraint and treat¬
ment.
The following extracts from the reports of the trustees
and physician are most suggestive of the obstacles and
struggles of this great pioneer work which will occupy a
large share of public attention in the coming years.
It is now about eighteen months since the hospital was
opened and the first patient received. In these first months
many difficulties have arisen, as was to be expected in trying
to start into existence a new institution. During the last
year patients have continued to be committed under a mis¬
taken idea of the laws governing the institution and the
purpose for which it was founded, though to a less extent
than a year ago.
Some are committed by their friends for “ punishment,”
and when, after a short stay in the hospital, they have been,
in the opinion of their friends, sufficiently punished, fault is
found with the institution because they are not released
upon their own request or that of those so committing them.
Others are sent there simply that they may be locked up,
where they can be kept from being a trouble and a nuisance
to their friends ; while the fact that the object of the hospi¬
tal is to treat inebriety, and, in such cases as it is possible
to do so, to cure the patient of the disease, is in these cases
and many others quite or entirely lost sight of by those
sending them, and much objection is raised when it is found
that they must submit to the laws governing the hospital
and the treatment instituted there.
Digitized by t^-ooQie
Foxboro , Mass .
163
The hospital is not a penal institution, and consequently
is not protected against escapes of the patients by walls or
guards about the grounds. There have been, therefore,
many escapes ; but they have decreased in number consider¬
ably during the year, while the number of voluntary returns
of patients who after their escape have found they needed
the protection and care of the hospital more than they had
realized, has steadily increased.
Such patients as the superintendent believes can be
trusted are paroled — that is, given the liberty of the grounds
from breakfast until supper, which not merely increases the
time that a patient can remain in the open air, and so helps
to build up his health and repair the injury done by liquor to
his physical system, but this reliance on his honor acts most
favorably on his moral and mental condition, and the self-
control thus gained assists him to resist the temptation to
drink when he is once more thrown upon the world on his
release from the hospital.
It is most important that the patients should be kept
constantly occupied, for the health of both mind and body
and for the establishment or restoration of the habit of in¬
dustry, which is commonly entirely lacking in them. It has
been difficult to devise means of keeping all the patients
busy. Some are employed as assistants in the various de¬
partments, kitchen, laundry, and so forth, of the hospital.
During the warmer months of the year others are employed
on the farm; but for the employment of many in the sum¬
mer, and of most in the winter, a workshop of some kind
was needed. The trustees began a year ago, as stated in the
last report, a small workshop, which has since been finished.
In this there is, on the lower floor, a carpenter shop, where
the repairing for the institution is done, and a paint shop;
on the second floor there is a broom shop. The making of
brooms has proved a marked success. The work is light,
easily learned, and in one part or another of the process em¬
ployment can be found for those mentally or physically
weak, as well as for the stronger and more able-bodied.
Vol. XVII.—22
Digitized by i^.ooQle
164 Report of the Massachusetts Inebriate Asylum ,
From the paint shop, as a basis, the walls of nearly all the
rooms and corridors in the buildings have been painted, and
the woodwork, both inside and out, done over by the patients.
As has been stated, it has been found difficult to devise
means of employing certain of the inmates. One source of
the difficulty has been the unwillingness of the patients to
do what is asked of them. There is a considerable number
of refractory patients, who will not work unless a parole is
given them, but who would escape as soon as paroled. This
class is being slowly diminished in number, as they learn to
realize that employment does improve their condition physi¬
cally, mentally, and morally, and helps materially to place
them finally in a condition when they may be released from
the institution.
A system of gymnastic exercise and baths was introduced
last June, and has proved most beneficial in every way to
such patients as have taken it, and gradually the number of
these has increased and is still increasing. This exercise is
under the direction of a well-trained and skilled gymnastic
teacher. One of the day rooms has been utilized as a gym¬
nasium, and a garden hose with water that can be graduated
to any temperature has to answer for the bathing establish¬
ment. These exercises make the mind more alert, train the
muscles and the will power over the muscles, and so over
the man. By the muscular exercise the effete matter and
poisonous accumulations in the body, the results of the pro¬
longed use of alcohol, are thrown off and replaced by new
tissues in the body and brain. The bath acts as a most
powerful stimulant, especially to the nervous system ; in¬
deed, some feel so directly stimulated by the bath that they
willingly take the muscular exercise for the sake of the bath
which follows. The results obtained from this physical
exercise and baths have been most satisfactory. It is hoped
that we may be able to have some time in the future a prop¬
erly constructed gymnasium and bathing establishment.
It should be borne in mind that many of the patients at
the hospital are of the worst type of inebriates. Some do
Digitized by t^-ooQie
Foxboro , Mass.
165
not care to be cured, while nearly all are sent there more or
less against their will, and so do not give their active assist¬
ance and co-operation in the treatment, which is most neces¬
sary in treating successfully all diseases of this class. Many
of the men have been already under treatment in other
institutions, both public and private, before their commit¬
ment to Foxborough, and, indeed, are finally sent to this
hospital merely that they may be under legal restraint, and,
as already stated, not with any idea on the part of their
friends, or of the physicians committing them, that they can
be cured.
The superintendent, with the help of the assistant super¬
intendent, has made, this summer, personal inquiries into
the condition of all those who have been discharged from
the hospital, traveling from one end of the State to the
other for this purpose. The results have been gratifying.
Of those cases regarding which we have been able to obtain
positive knowledge, it has been found that 42.14 per cent,
are “ doing well/' which means, as far as the investigation
could determine, that they have been entirely free from
inebriety since leaving the hospital; that some 14 per cent,
are “improved”; while 43.80 per cent, are left as “unim¬
proved/' — all of which is set forth in detail in the report of
the superintendent. Inasmuch as the time since the differ¬
ent patients had been released from the hospital varied from
two to fourteen months, cases which had been out less than
two months not having been considered, it is probable that
some of those, now reported to be “doing well,'* will yet
relapse.
Attempts to smuggle liquor into the hospital have been,
and are always liable to be, made. The trustees see no rea¬
son why the protection afforded by law to the penal institu¬
tions in this matter should not be extended to the hospital.
Although there are now in the hospital more patients
than at any previous time, the wards are not yet full, and it
will be impossible during the coming year to meet the ex¬
penses from the board of patients; hence the trustees re-
Digitized by LjOOQie
166 Report of the Massachusetts Inebriate Asylum ,
quest an appropriation for part of the current expenses in
1895.
In the superintendent’s report occurs the following : This
is the first full or complete year since the opening of the
hospital on February 6, 1893.
There were 108 persons in the hospital on October 1,
1893. Since that date there have been 163 admissions. Of
these, 153 were by order of commitment from the courts;
of the other 10, 4 were returned from leave of absence
granted during the previous year, and 6 from elopement
during the same year. There were then 271 cases under
care during the year. These 271 cases are represented by
265 persons. One person has' been committed twice by
order of court within the year, having received his second
commitment while out on leave of absence from his first.
Two were recommitted while out on leave of absence granted
during the present year. Three had been discharged from
the hospital during the present year by reason of the expira¬
tion of the two years fixed by the law as the maximum
period of detention.
As the hospital will not have been open two years until
February 6, 1895, no person has been a resident in it for the
maximum period. Those who have been discharged by ex¬
piration of the maximum or two-year limit are persons who
were originally committed to the hospitals for the insane,
and transferred to this hospital soon after its opening. In
their cases it was the judgment of your board to consider
the time spent in the hospitals for the insane as time spent
in this hospital, and to discharge them accordingly at the
expiration of the two years from the date of their commit¬
ment to the hospital for the insane.
During the year 25 were given final discharge, 3 by
death while in the hospital, 2 by death while out on leave of
absence, 1 by death while on visit to the Massachusetts Gen¬
eral Hospital for operation, 9 by transfer to a hospital for
the insane, 1 by time limit while out on leave of absence, 5
by time limit while in the hospital, 3 by recommitment, being
Digitized by t^-ooQie
Foxboro , Mass.
1 67
at the time out on leave of absence granted within the pres¬
ent year, and 1 by order of court as not being a dipsomaniac.
Of those who eloped or were granted leave of absence
during the year, 29 and 107 respectively remained away at
the close of the year, as absent, not finally discharged, their
maximum time not having expired.
Of the 41 reported Sept. 30, 1893, as absent, not finally
discharged, on Sept. 30, 1894, there were still absent, not
finally discharged, 8 by elopement and 11 on leave of absence.
Of the others, 4 had been returned from leave of absence, 6
from elopement, 2 by recommitment while on leave of ab¬
sence, 5 had been discharged by time limit while .on leave
of absence, and 5 while out on elopement.
The daily average of patients was ior.08 ; the average
weekly cost of support per patient was $8.41+.
There has been no special or epidemic sickness among
the patients or employes.
Three patients have died within the year, the causes of
death being pulmonary tuberculosis, alcoholic neuritis with
delirium tremens, valvular disease of the heart.
Employment has been provided in the usual ways in the
various departments, both in and out of doors. No more
wage-earners have been employed than are necessary for a
proper supervision and performance of the work, which
otherwise would fail easily through the frequent changes
among the patients, many of whom have no previous train¬
ing in or taste for the work to which they are assigned.
Apart from the laundry, kitchen, and dining-rooms, for some
of the more visible results of their work, your attention is
called to the painting of the interior walls of the various
rooms and halls of the three cottages and dining-rooip build¬
ing, which is now completed and has been done solely by the
labor of the patients. Great progress has been made in the
redressing and varnishing of the ash finish of the buildings.
Your attention is also called to the products of the farm,
as shown in an appended list, in which the valuations are
made at a wholesale or jobbing price. Except a portion of
Digitized by ^ooQie
168 Report of the Massachusetts Inebriate Asylum ,
the milk, all these products are consumed at the hospital.
Some progress is being made in grading the roads about the
buildings this fall.
During six or seven months of the year the broom shop
has been in operation, under the supervision of a skilled
broom-maker, affording occupation for from eighteen to
twenty-two men. There is sufficient variety in the various
steps of making the broom to afford occupation for the infirm
as well as the vigorous, and to preserve the interest of those
who are engaged. Thus far the work has proved self-sus¬
taining.
In June last, by action of your board, the services of a
skilled teacher of gymnastics were secured, and provision
made for the exercise of the patients in classes for physical
culture. At the outset only free movements were attempted,
later, chest weights were added, also the out-of-door games
of medicine ball and basket ball.' It is now proposed to add
to the variety of the exercises by the use of wands, dumb
bells, and horizontal bars. Under the direction of the
instructor the exercises and classes have been arranged in a
manner adapted to the needs and ability of the young and
the old. As an essential part of the exercise, each class at
its close is required to take a spray bath at a regulated tem¬
perature. About one-sixth part of the patients are unable
to take part in the exercise by reason of some serious infirm¬
ity or organic disease ; as many more refuse to take part for
no sufficient reason ; others cease taking it after a longer
or shorter trial ; while some have sufficient exercise by rea¬
son of the hours and nature of their work, so about one-
half of them take the exercise with regularity. That the
physical culture is of positive benefit in the renovation of
the diseased tissue is manifest in the cases of many of those
who persist. There is evident brightening of facial express¬
ion, increased promptness in the working of the mind, greater
elasticity of movement, with increased capacity for and inter¬
est in work.
Between the 6th of July and the ioth of August of the
Digitized by i^-ooQie
Fox boro } Mass .
169
present year, an effort was made to obtain reasonably accu¬
rate information concerning those who had been discharged
from the care of the hospital prior to May 6th, were still ab¬
sent from the hospital on July 6th, and had been exposed to
all the trials and temptations presented in daily life. As
indicated, the inquiry was directed towards those who had
been discharged from the hospital for two or more months.
The purpose of this inquiry was to ascertain how many indi¬
viduals were unimproved, or drinking as much as ever; how
many were improved or drinking less ; and how many were
doing well, or had been abstinent since leaving the hospital.
In conducting this inquiry little use was made of corre¬
spondence, it being thought better to make a personal
inquiry in the several towns and cities from which the men
had been committed. As it best could be, information was
obtained from the town authorities, certifying physicians,
police and probation officers, friends and relatives. In very
many instances the individual was seen.
Prior to May 6, 1894, from Feb. 6, 1893, the date of the
opening of the hospital, a period of fifteen months, there
were 248 admissions, of which number 6 were recommit- >
ments ; therefore, 242 persons were admitted prior to the
given date. Of these 242 persons, 88 were remaining in the
hospital on May 6, 1894, 63 by continuous residence, 10 by
return from leave of absence, i. e ., unimproved, and 15 by
return from elopement ; therefore, 154 persons had gone
from the hospital.
For the purpose of the inquiry, 43 of the 154 persons are
excluded for the following reasons : 3 had died while in the
hospital, 4 had died after leaving the hospital, 7 had been
discharged as being insane, 1 had been discharged by order
of the court as not being a dipsomaniac, 2 could not be traced,
and 26 had eloped. This leaves as subject to the inquiry,
in persons who had been discharged from treatment prior
to May 6, 1894, and were still absent from the hospital on
that date. Of these, 12 were returned to the hospital
between May 6th and July 6, 1894, as relapsed or unim-
Digitized by t^-ooQie
170 Report of the Massachusetts Inebriate Asylum, etc .
proved cases, while 99 continued absent on July 6, 1894, two
months after the date of discharge of the last person under
consideration. If to these hi persons are added the 10
relapsed and returned prior to May 6th, 121 is obtained as
the whole number under consideration.
Of these 121 persons, it was ascertained that on July 6,
1894, two months after the discharge of the last person
under consideration, 51 were regarded as doing well or absti¬
nent, 17 as improved or drinking less, and S 3 as unimproved
or drinking as much as ever. In percentages, 42.14-f- per
cent, as doing well, 14.04-f per cent, as improved and
43.80-f- as unimproved.
Incidentally it was learned that, of those who had gone
from the hospital prior to May 6, 1894, whether by elope¬
ment or regular discharge, 2 are N in the Massachusetts
Reformatory, 5 are or have been in the House of Industry
at Deer Island, and 7 are or have been in a house of correc¬
tion. Some were sentenced for crime, more for drunkenness.
I recommend for your consideration an enlargement of
the present workshop building. Several times the present
number of men could be under the direction of the broom-
maker, provided there was sufficient floor space. This addi¬
tional provision for workroom is particularly needed for the
winter, when the usual out-of-door employments cease.
Diminishing Convictions for Drunkenness in Eng¬
land. —For the third year in succession there is shown a very
notable diminution in the number of offenses in which
drunkenness is involved. The total of 1893 was 153,072; for
1892 it was 159,003; for 1891, 168,999; and for 1890, 173,-
036. The decrease in the number of convictions since 1890
is thus seen to be close upon 20,000, or about 11£ per cent,
of the total as it then stood. Moreover, in the meantime,
the estimated increase in the population amounted to nearly
3^ per cent., so that the reduction of drunkenness in proportion
to the population is even greater than that.
Digitized by LjOOQie
Medical Instruction of Inebriety in Colleges . 171
MEDICAL INSTRUCTION OF INEBRIETY IN
COLLEGES*
By T. D. Crothers, M.D., Hartford, Conn.
The diseases and injuries which are directly or indirectly
traceable to the use of spirits and narcotic drugs, if not
increasing, are clearly becoming more prominent every year.
Practical physicians, engaged either in general or special
practice, assert positively, that alcohol and narcotics are very
common causes and always serious complications in most of
the diseases they are called to treat. Medical men with hos¬
pital and large general practice have estimated that at least
twenty per cent, of all cases are suffering from the poison of
alcohol and other narcotics. Many of these cases are so-
called moderate drinkers, or use spirits at long intervals, or
take narcotics irregularly for various purposes. A certain
class of cases who drink excessively come for treatment, and
the disorders from which they suffer are clearly traceable to
the spirits used. Another class have complex disturbances,
not so clearly due to spirits, yet recover quickly from the
withdrawal of spirits and narcotics. A third class are well-
marked inebriates, who appeal constantly to the profession
for help, and receive the stereotyped advice to “ stop drink¬
ing.” There is probably not a living physician of any class
or school, who has not been called for counsel and help in
cases of moderate or excessive drinking.
This is increasing with every advance of scientific knowl¬
edge. The degenerations which follow from the use of
alcohol, and the disease of inebriety in which the craze for
spirits is a symptom, are becoming more and more a recog¬
nized fact in practical medicine. Busy physicians find clin¬
ically that alcohol is the very genius of degeneration when
* Read before the American Association for the Study and Cure of Inebri¬
ety, at New York city.
Vol. XVII.—23
Digitized by LjOOQie
172 Medical Instruction of Inebriety in Colleges\
used as a beverage and continuously. Also that the drink
paroxysm and morbid impulse to procure spirits at all haz¬
ards, is something more than a moral state or a weak will
power. In some vague uncertain way the possibility of dis¬
ease may be recognized, but how to study and what means to
use in the treatment are practically unknown. The text
books of medicine give little or no information, and the phy¬
sician is obliged to turn to moral and ethical lines of treat¬
ment He gives lectures, warnings, appeals, and threats,
and possibly placebos, or he may administer secretly reme¬
dies to cause nausea, or give narcotics to check the morbid
impulses. By these means, he expects to rouse up the weak
will, or produce disgust for spirits, and thus give new power
to abstain for the future; or by checking the drink impulse
by narcotics destroy it. These means fail, and not unfre-
quently the use of morphine beginning in a prescription ends
in its addiction. Chloral, cocaine, and other drugs begun in
this way, are equally disastrous. This failure of the family
physician to relieve or even to check the inebriety only for a
short time, opens the door for all sorts of quack remedies,
and charlatan schemes. The recent wild wave of gold cure
specifics, with its boastful pretensions, would never have
been possible had the physical nature of inebriety been rec¬
ognized by the family physician and proper treatment given.
Thousands of cases in despair of any better means for relief
have taken these secret remedies, and received temporary
relief, only to realize later that they were more incurable and
the drink craze more difficult to control. Thoughtful men
in the profession recognize a field of practical work in the
scientific study and treatment of the inebriate, but suppose it
confined to specialists. In reality, the inebriate is more
curable in the early stages, at home under the direction of
the family physician. The prevention of inebriety can only
be accomplished here, and as in other diseases when the case
is neglected until chronic stages come on, the possibility of
cure becomes more remote. The use of alcohol alone in a pre¬
viously healthy person is followed by poisoning with cell and
Digitized by v^-ooQle
Medical Instruction of Inebriety in Colleges . 173
nerve starvation and central exhaustion. The use of alcohol
in an unknown proportion of cases is from the beginning a
symptom of derangement and exhaustion, a predisposition, or
a demand for relief from some organic suffering. In all
these cases poisoning, starvation, and exhaustion are present.
Derangements of nutrition, growth, development, and envi¬
ronment, associated with inherited or acquired defects, appear
in every case. These are physical facts, the knowledge of
which is absolutely essential to the rational treatment.
The assertion has been made by reliable authorities that one-
tenth of the male population use spirits as a beverage, either
in moderation or excess. At least half of this number
appeal to medical men for help from disorders due directly
or indirectly to the use of spirits. The chronic cases from
the lower walks of life, who are inebriates, constitute a class
who are ever appealing for medical assistance. Another
class higher up and actively engaged in the world’s work, yet
suffering from the effects of spirits, mutely turn to the fam¬
ily physician for help, and both classes fail, the physician is
unable to give relief.
He is unacquainted with this malady; he cannot under¬
stand the condition of these poor victims who are whirled
rapidly down the road to dissolution by laws and forces that
are largely unknown. The physical study of inebriety has
reached a point where the facts are sufficiently clear and
established to make it possible to teach authoritatively the
conditions, causes, and natural progress of inebriety, and to
point out certain general therapeutic principles available and
practical in its successful treatment. From this study comes
the clearest evidence that a large proportion of all inebriates
are curable in the early stages, through the family phy¬
sician’s care and wise counsel. His knowledge of the envi¬
ronment and physiological conditions of the patient’s life and
living, enable him to use means and remedies for cure with
very great certainty. 1 The possibility of prevention and cure
in the early stages along these lines are fully equal to that of
any other disease, when used by the intelligent medical man.
Digitized by LjOOQie
174 Medical Instruction of Inebriety in Colleges .
The time has come for a public recognition of this need
by the medical colleges of the country. The students who
go out without some idea of inebriety from a medical point
of view, are unable to treat or counsel wisely the first cases
they are called on for help. While they may not be any
more incompetent than other neighboring physicians to treat
such cases, they are clearly without capacity and knowledge
to render assistance that would give them a permanent rep¬
utation for the future. The drinking man who sends for the
young physician because he is a stranger, hoping for some
relief which the family physician has failed to give, is disap¬
pointed. The new physician has less knowledge than the
elderly man, although he has recently graduated at the head
of his class. Had he been taught some general facts of
inebriety, it would have been the opening door for a success¬
ful practice in the future. There are vast numbers of men
and women who are literally supporting armies of quacks
and charlatans, simply because the medical men are unac¬
quainted and unable to treat their disorders. The progress
of medical science and wider range of instruction given in
colleges are slowly and steadily reducing the ranks of these
chronic cases. The inebriates constitute the largest class of
these defectives, and the few pioneer students who are point¬
ing out the physical side of these cases and the new realm of
practice, appeal to medical colleges to instruct its students
along this new line of cure and prevention. Every graduat¬
ing class should have four or five lectures on the general
facts which are prominent in the causation and progress of
inebriety. This will enable them to not only study these
cases, but act intelligently when called for counsel and
advice. It is such knowledge as this that will help solve the
drink problem and raise its present treatment from the realm
of quackery into the field of exact science.
An eminent man in a recent speech said, “ I despair of
any great progress in this drink question until medical men
shall take up this matter and teach us the facts and their
meaning.” To this I add that the time and literature and
magnitude of the subject call for instruction from our med-
Digitized by Google
Medical Instruction of Inebriety in Colleges . 175
ical colleges. There is a demand that young medical men
be equipped with some knowledge of the most numerous
cases they will be called on to treat in many circles of life.
The theories and delusions concerning inebriety, repeated in
every community with the assurance of being positive facts,
fail when tested at the bar of accurate inquiry. The sup¬
posed popular knowledge is ignorance, and the real facts
will appear only from careful examination by medical men.
It is from a knowledge of the phenomena of this drink prob¬
lem only that means for cure and relief can be ascertained.
Medical instruction of students along this new line is a need
becoming more apparent every day.
ALCOHOL IN DISEASES.
In writing to the Physician and Surgeon; Dr. Bryan of
Detroit writes thus on the use of alcohol in diphtheria:
“ It is my belief that it is in diphtheria that the most
dire results are to be observed. In that disease the vast
majority of cases die by asthenia, or else by sudden failure
of the heart. To what is this sudden cardiac paralysis due?
The elucidation is as follows: In the grave cases there
is almost invariably a subnormal temperature, together with
great muscular prostration. Also it is a physiological fact
that a decrease of the temperature slows nervous conduction.
As the system is made colder the nervous force flows slower
and slower. In diphtheria the heart muscle is very weak, the
temperature falls, the lessened nervous energy but feebly
animates the muscular fibres, and so actual paralysis ensues,
death closing the scene almost instantaneously. Now, in
such a state of imminent danger, brought about by such
causes, what could be worse than to administer an agent
which notably reduces temperature, and at the same time
enfeebles muscular power ? May I add, what would be the
remedy in such a condition ? and I answer, External heat
freely applied to the whole surface of the body . This will
prevent the cardiac paralysis whenever it is preventable.”
Digitized by i^-ooQie
176
Abstracts and Reviews.
kr\d f^eview$.
ENGLISH INEBRIATE HOSPITALS.
Our readers will remember that for fourteen years the
English Government has had an inspector who visits all
inebriate retreats and asylums and makes a yearly report.
We publish the summary of last year’s report.
The fourteenth Report of the Inspector of Retreats, under
the Inebriates’ Acts, 1879 and 1888, for the year 1893, states:
With regard to the general condition of these establish¬
ments, there is no fault to find, as a rule, and the health of
the patients has been very satisfactory, on the whole. No
death is recorded.
There has again been a slight increase in the total num¬
ber of patients admitted to the various retreats during the
year. In 1891 and 1892 the admissions were 115 and 124
respectively, but in 1893 the number rose to 129.
In answer to an invitation the licensees of a number of
retreats have furnished observations as to the working of the
Acts and the result of the treatment.
“ Fallowfield.— The Manchester Retreat for Inebriate
Women was opened July 24, 1890, in accordance with the
provisions of the Inebriates’ Acts of 1879-88. These Acts
encourage the opening of retreats either for male or female
inebriates, to be conducted only by licensed managers, and
subject to the approval and open always to the visits of an
inspector appointed by the Crown. In fact, the law regards
the treatment of habitual drunkards as somewhat analogous
to that of lunatics, viewing their malady as a physical disease.
And such it unquestionably is. But it is a moral disease also,
which needs moral as well as physical remedies, and the success¬
ful cure of inebriety will depend on the care and skill with
which these moral and spiritual remedies are applied by the
Digitized by i^-ooQie
Abstracts and Reviews .
177
managers and committees of retreats. The law, however,
concerning the detention of inebriates differs at present
from the lunacy laws in two important particulars. In the
first place, it makes no provision for the support of retreats,
except from the payment of inmates. The attempt, therefore,
to rescue poorer persons and wean them from inebriety, is
wholly left to private benevolence. Now this has from the
first been a prominent aim of the promoters of the Manches¬
ter Retreat. The Grove receives two classes of patients.
One class consists of women of a certain social position, who
pay readily for their maintenance. These live apart in the
better rooms, and are encouraged to occupy themselves in
their favorite pursuits, whether drawing, or painting, or the
art of the needle. But a larger number are working women,
who pay at lower rates, according to their means, or even
nothing ; they employ themselves in the necessary work of
the household. As far as possible the retreat is made self-
supporting by means of the work and the payments of the
inmates. But the admission of poorer women—sometimes
gratis, and at the suggestion of the magistrate before whom
they have been brought for trial, and as an alternative to the
gaol — makes the maintenance of the Grove dependent in
part upon the generosity of subscribers.
“ In the second place, the Inebriates’ Acts give no power
to anyone to commit a patient to a retreat without the pat-
tient’s own desire. They may be committed to gaol for
being drunk and disorderly, and are so committed for short
periods hundreds of times over, to the mockery of justice
and to the vast expense of the nation, but absolutely without
any good result. In entering a retreat, however, everything
is left to the inebriate. Upon being certified to be an inebri¬
ate by two witnesses (who must neither be managers of a
retreat nor immediate relations of the patient), he or she
may make application to two justices of the peace, and so
obtain admission. Once admitted, indeed, the patient is
compelled to remain for a whole year. But the mode of
obtaining admission is so cumbrous, and leaves so much to
Digitized by t^-ooQie
178
Abstracts and Reviews.
the perverse and capricious will of the drunkard, that in
practice we find very few applicants proceed so far as to gain
admission, and precisely the most distressing cases are those
for whom the law provides no help.
“ It is certain that the number of habitual drunkards of
both sexes in the kingdom is so large as to constitute not
only a grave scandal, but a serious burden upon the commu¬
nity, and, above all, a frightful source of misery to many
thousands of households. It is estimated that there are at
this moment 6,000 inebriate women in prison — not to speak
of men similarly detained, nor of the crowds of both sexes
whom drink has brought either to the workhouse or to the
asylum, and quite apart from the far larger number of hab¬
itual drunkards outside of such places, who are free to indulge
their fatal craving and to be the daily and hourly scourge of
their homes.
“ In the meantime, in spite of the difficulties caused by
the insufficiency of the Acts on the one hand and by the prev¬
alence of temptations on the other, the work of the Man¬
chester Retreat has gone steadily on. Of the eight retreats
at this moment licensed under the Act, the Grove is consider¬
ably the largest. It is certainly second to none in pleasant¬
ness of surroundings (an important element in the treatment
of inebriates) and in efficiency of management. It is licensed
for twenty-five patients. We are ready to confess that
nearly half of those who leave us apparently cured do relapse.
But amid such temptations as surround them this is scarcely
strange, nor can we forbear reflecting upon the criminal folly
of husbands, who, when they bring their wives to us, assure
us that they would do anything in the world for their re¬
covery, and then, when the wife goes back again a changed
woman, refuse to become abstainers themselves, or to assist
the wife's resolution by clearing the drink out of the house."
“ Rickmansworth.— There can be no doubt of the ad¬
visability of some more satisfactory method of dealing with
criminal inebriates. The present police-court procedure in
connection with this class has proved an utter failure from
Digitized by
Google
Abstracts and Reviews .
179
every standpoint Experience has shown abundantly that
little or no benefit accrues from a short punitive confinement
in prison, or from short periods of residence in insane asylums.
The desire for liquor is only increased by temporary seclu¬
sion, and the prisoners on release soon fall easy victims to
their previous habits. Of late the repeated expressions of
opinion from magistrates and parochial boards have added
force to the long-recognized fact of their inability to cope
with the condition, and of the urgent need for the establish¬
ment of suitable public retreats for the reception and care of
such cases. ,,
“Twickenham.— The number of patients taking advan¬
tage of the Act here is about one-tenth of the total admissions,
and this notwithstanding that we try when consulted to get
the patients to come under the Act. Doubtless this will not
be the case when the mode of signing before the justice is
simplified. Again, there are a very large number of inquiries
from patients and their friends, who eventually fail to enter
any retreat at all, and these cases will be met when measures
of compulsion under certain circumstances are in force, and
when retreats are established wherein patients with limited
means can be received. Of our admissions, half of them are
in the married state and half unmarried, and the majority are
hard workers, and not the lazy drones many people would
have us believe. The most important fact to which attention
should be called is the number of occasions in which the in¬
ebriate patient is the victim of chronic physical disease.
Fully 50 per cent, of our admissions are suffering from dis¬
ease other than and in addition to the liquor habit, cases of
serious exhausting disease — phthisis, rheumatism, locomotor
ataxia, neuritis, and other diseases are frequently met with,
and it is by no means easy to appraise precisely the position
of such affection in the causation of the patient’s condition.”
Vol. XVII.—24
Digitized by ^ooQie
i8o
Abstracts and Reviews.
UNUSUAL CASE OF MORPHINE INEBRIETY.
Dr. McGillivray of Ottawa, Canada, reports the following
case in the Massachusetts Medical yournal:
I was called to see a man in one of our hotels who had
symptoms of delirium tremens. He was thirty-seven years
of age, stout, muscular, and plethoric, and of intemperate
habits, had resided in New York city for the last six years,
where he practiced his profession as attorney-at-law. About
the commencement of January, 1885, he had an abscess in
the thigh from which he suffered severe and continuous
pain, and in order to allay his agonies and induce sleep, he
was given by his physician a drachm of laudanum each
night, beginning of course, in smaller doses and a similar
quantity during the day. He continued that prescription
for a period of three months, until every symptom of his
complaint had entirely disappeared ; he then discontinued it,
but much to his discomfort, becoming nervous, irritable, and
wakeful, and subject occasionally to intolerable tremors.
He was forced to resume his habit. He made repeated
efforts to master his desires, and stop the use of opium in
any form, but without avail, and finding it impossible to
do without it, he was obliged to resume his accustomed
draughts, gradually increasing the dose from time to time, as
nature seemed to suggest and require it, until he had the
daily habit of taking astonishingly enormous quantities. In
order to satiate and appease his abnormal appetite, he found
it necessary to take half a drachm of sulphate of morphia
daily, some days more and some days less.
He took as much as a drachm and a half in thirty hours,
and found no alarming effects to follow; he frequently took,
three ounces of laudanum at one gulp, and repeated the
same dose within twenty-four hours, with the only effect of
causing snatches of sleep lasting from one to four hours.
He had always had a good appetite for food, and enjoyed
comparatively good health. Abstinence from opiates was
latterly followed by troublesome diarrhoea, associated with
the other symptoms already named, and when sleep occurred
Digitized by i^-ooQie
Abstracts and Reviews .
181
it was disturbed by frightful dreams. He was an inveterate
smoker and a hard drinker, almost incessantly reveling in
debauchery and profligacy ; the more whisky he drank the
more morphia he required to take. Until about a year ago
he used laudanum almost exclusively, but to avoid the incon¬
venience arising from carrying about him such large quan¬
tities as he required to use, he betook himself to the use of
morphia, of which he kept abundance on hand, but he took
laudanum occasionally.
One evening after he had recovered from his illness at
about seven o’clock, while I was present with him in his
room, in order to assure me of the capability of his system to
resist the effects of opium, an experiment I was very reluct¬
ant to witness, he opened a parcel containing twelve small
bottles, each of which contained a drachm of sulphate of
morphia, he took up one of these bottles and emptied its
whole contents into a tumbler which he had half filled with
whisky, stirred the mixture well and swallowed the terrible
dose at one gulp (a quantity sufficient to destroy twenty or
more lives), and in the course of fifteen or twenty minutes
after drank down at one draught four ounces of laudanum,
which he had procured in a drug stofe close by.
An hour after performing the dangerous experiment he
went to spend the evening in the theatre, where he enjoyed
the drama with all due complacency. I visited him at his
rooms in the hotel at eleven o’clock the same evening, and
saw him take nearly a fourth of a drachm of morphia in a
glass of whisky, before retiring. Fearing that the experi¬
ment might have proved to much for him during the night I
called to see him at an early hour the following morning, and
to my utter astonishment found him wideawake, after having
passed a quiet night, and apparently suffering from no ill
effects of the poison. He asked for more whisky and mor¬
phia. I strongly remonstrated and cautioned him against the
results sure sooner or later to follow such enormous doses of
poison, and such flagrant abuse of his constitution. His
only reply was, “I am used to it and there is no danger.”
Digitized by ^ooQie
Abstracts and Reviews .
182
Satisfied and easy in his own mind that there was no danger,
and that the seeming immunity he enjoyed in the past, he
would still enjoy in the future, he was willing and determined
to pursue his dangerous habits. Two days after he went
home to his family in New York and was gone nearly four
months ; at the end of that time he returned to this city with
the intention of taking up his residence, and practicing his
profession ; when he arrived here he consulted me for
urethral stricture which caused him intense pain, and to
allay it he was obliged to use opiates in larger quantities.
He was now feeble and exhausted, worn and emaciated,
apparently fast sinking a victim to his evil habits, of the
dangers attending which he was now fully convinced. He
had been addicted to this destructive vice of opium-eating
for nearly three years, and it had gone on increasing from
day to day, until it had acquired its alarming and incredible
magnitude. With the perfect consciousness at last that he
was destroying himself, and with every desire to struggle
against the insatiable cravings of his diseased appetite, he
found it utterly impossible to offer the slightest opposition to
them. In vain did he try to resist the baneful temptation.
His love for ardent spirits was so strong, his appetite for
opium so uncontrollable, that he must still indulge in the
use of these insidious poisons which he knew were under¬
mining his system, slowly but surely, and as an inevitable
consequence nature yielded to their pernicious influence;
an attack of delirium tremens supervened, and death closed
his sad career.
The report of the N. H. Railroad commissioners shows
that 90 per cent, of the deaths caused by railroads last year
were due to intoxicating liquors. On ten of the twenty-four
persons killed were found bottles of liquor, while many of
the others bore marks of drinking and were likely intoxicated
at the time of death.
Digitized by i^-ooQie
Abstracts and Reviews .
i «3
DUNGLISON’S DICTIONARY OF MEDICAL
SCIENCE. Containing a full explanation of the various
subjects and terms of anatomy, physiology, medical
chemistry, pharmacy, pharmacology, therapeutics, medi¬
cine, hygiene, dietetics, pathology, surgery, ophthalmol¬
ogy, otology, laryngology, dermatology, gynecology, ob¬
stetrics, pediatrics, bacteriology, medical jurisprudence,
and dentistry, etc. By Robley Dunglison, M.D.,
LL.D., Late Professor of the Institutes of Medicine in
the Jefferson Medical College of Philadelphia. New
(21st) edition, thoroughly revised and greatly enlarged,
with the pronunciation, accentuation, and derivation of
the terms. By Richard J. Dunglison, A.M., M.D. In
one imperial octavo volume of 1,191 pages. Cloth,
$7.00; leather, $ 8 . 00. Lea Brothers & Co., Publishers,
706, 708, and 710 Sansom street, Philadelphia.
This work has been before the medical public over forty
years, and is yet the standard authority. In this time twenty-
one different editions have appeared, and each one has been a
larger, more complete work. Thus by the process of evolution
and growth it has become the great lexicon of medical science.
Some idea of the book is apparent from the fact that forty
thousand new terms, tables, and definitions are now pub¬
lished for the first time, and many of the definitions are en¬
cyclopedic, giving a concise review of the symptomalogy and
treatment of many diseases. The correct pronunciation and
derivation of all words will be of inestimable value to every
medical man. Such a work becomes an essential aid to all
practitioners, going beyond the journals and text-books, and
constituting the foundation of all accurate knowledge of
medicine. The new Dunglison's is fully up to the very front
ranks of the present, and is equally valuable and indispens¬
able to-day, as it was in our student days of long ago. Every
office and every library should have a new copy of our old
friend of long ago. The science of healing has gone on,
and the new Dunglison gives permanent record of this ad¬
vance, matured and perfected by the experience of nearly
Digitized by ^ooQie
Abstracts and Reviews.
184
half a century. It stands out alone, unrivaled as the great
work of every medical library.
THE NATIONAL DISPENSATORY. Containing the
natural history, chemistry, pharmacy, actions and uses of
medicines, including those recognized in the pharma¬
copoeias of the United States, Great Britain, and Ger¬
many, with numerous references to the French codex.
By Alfred Stille, M.D., LL.D., Professor of the
Theory and Practice of Medicine in the University of
Pennsylvania ; John M. Maisch, Phar.D., Professor of
Materia Medica and Botany in the Philadelphia College
of Pharmacy, Secretary to the American Pharmaceutical
Association ; Charles Caspari, Jr., Ph.G., Professor of
Pharmacy in the College of Pharmacy, Baltimore; and
Henry C. C. Maisch, Ph.G., Ph.D. New (fifth) edition,
thoroughly revised in accordance with the new United
States Pharmacopoeia (seventh decennial revision). In
one magnificent imperial octavo volume of 1,910 pages,
with 320 engravings. Cloth, #7.25 ; leather, $8.00. Lea
Brothers & Co., Publishers, 706, 708, and 710 Sansom
street, Philadelphia.
We take great pleasure in calling attention to this work
for its practical value in every medical library. It is not only
a guide, but a most reliable work of reference on all ques¬
tions of drugs and pharmacy. In small hospitals and
physicians’ offices back from large cities, such a work is of
the greatest practical value in preparing medicines and
giving facts of their uses not found in other works of materia
medica. The special value of this work is in its pharma¬
ceutical and chemical facts, and formulas, with tables,
and also records of many of the new synthetic reme¬
dies which are attracting so much attention ; also tables and
tests and methods of analysis. The action of drugs and
the treatment of special diseases are presented in a very
graphic way. Like a dictionary, it has a permanent value,
and is the constant source to which every practical physician
Digitized by L^ooQie
Abstracts and Reviews.
185
will turn daily for facts and instruction. Such works are
libraries in themselves, and working tools of the science of
medicine. This Dispensatory has become national in char¬
acter and popularity, and is heartily recommended by all
authorities for its accuracy and completeness.
THOUGHTS ON RELIGION. By George John Ro¬
manes. Edited by Charles Gore, M.A., Canon of
Westminster. Chicago: The Open Court Publishing
Company. 1895. Pages, 184. Price, #1.25.
Prof. George John Romanes left some unfinished notes
on religion which were handed, at his request, to Mr. Charles
Gore, the Canon of Westminster, a friend of the late scientist
and a representative of ecclesiastical dogmatism. Mr. Gore
decided to publish these notes together with his own editor¬
ial comments and two unpublished essays on “ The Influence
of Science upon Religion, 1 ” written by Romanes in 1889, and
they now lie before us bearing the title “ Thoughts on Re¬
ligion.”
The book will create a sensation, for it shows that the
late scientist was possessed of an eagerness to believe, but
was still unable to overcome the objections made by science.
He showed, nevertheless, an increasing tendency toward be¬
lief, and we are informed by the editor, Mr. Gore, that Pro¬
fessor Romanes “ returned to that full, deliberate communion
with the Church of Jesus Christ which he had for so many
years been conscientiously compelled to forego.”
Whatever opinion we may have, the book is an obvious
evidence of the importance of the religious problem. An
article on the late Professor Romanes’ thoughts on religion,
setting forth the lesson which they teach, will appear in
the April number of The Monist from the pen of its
editor, Dr. Paul Carus.
SLEEP AND DREAMS. By Dr. F. Schalz, Director of
the Bremen Insane Asylum, and Dr. H. M. Jewett, of
Danvers Insane Asylum. Funk & Wagnalls Company,
New York city. 1893.
Digitized by i^-ooQie
i86
Ads tracts and Reviews .
This little work is a popular scientific dissertation on
sleep and dreams, and the analogy of insanity to these phe¬
nomena. The causes of sleep are presented in one chapter,
and dreams, their meaning and significance, fill up the second
part of the work. Sleeplessness and its prevention is one of
the best chapters, and describes in a clear way the common-
sense rules to overcome insomnia. This very difficult sub¬
ject is presented in a very clear, graphic way, and the work
is an excellent contribution that will be read with interest
and satisfaction by all.
The Buffalo MedicalJournal has passed the half-century
milestone of existence, and is a typical example of the sur¬
vival of the fittest. With Dr. Potter at the helm, one can
safely predict another half century, free from rocks and
storms, and replete with strong helpful influences for science
and humanity.
The Voice has won a commanding place in the temper¬
ance world, and its utterances are listened to with careful
attention. Send to Funk & Wagnals of New York city for
a copy.
The Medico-Legal Society announces a medico-legal con¬
gress at New York city in August. A very extensive pro¬
gram embracing many important subjects is announced. A
sub-committee on the Legal Responsibility of the Inebriate,
under the care of Dr. Crothers as chairman, will present this
subject. A very general invitation is given to all persons
interested in this topic to send their names to Clark Bell,
Esq., Secretary, 57 Broadway, New York city.
No other journal brings a greater variety of clearly writ¬
ten scientific papers regularly to the reader than the Popu¬
lar Science Monthly . The issue for the past few months
has contained some excellent papers on mental diseases and
psychological studies. It has come to be an essential for
every thinking man to keep in touch with this journal.
Digitized by C^ooQie
Abstracts and Reviews .
187
We find the Scientific American , published by Munn &
Co. of New York city, a paper that is read thoroughly, and
whose coming is watched for with great interest. Its rec¬
ords of the march of science are more fascinating than fiction.
The Homiletic Review tells the story of theologic thought,
and the direction of the great themes of the world to come.
Funk & Wagnals are the publishers.
Dr. Lyman of the State Insane Asylum at Cleveland,
Ohio, writes this in his last report:
“I cannot refrain from saying a word regarding the
whisky and opium habits. Here are cases which deserve
something more than reprimand and censure. In many
cases drunkenness is a real result of real disease or diseased
condition. The patient is practically helpless, unless the
State, in its beneficence, reaches out and tenderly directs
him to a haven of safety. He is like the shipwrecked
mariner who has not a single spar to which he may cling.
Our good, philanthropic people pass him by and dismiss the
subject with the thought. We should have hospitals for the
treatment of this class of unfortunates, where the very best
medical skill could be procured, and the poor wretch treated
for his disease and not trampled upon and ostracized as a
willful criminal. Many cases are admitted into and treated
in our State hospitals for the insane because there seems to
be no other place for them; but it is not right that they
should be so placed, nor is it justice to the insane, for whom
every spare room is needed. We simply desire to call atten¬
tion to the fact that so far there has been no disposition
on the part of the State to take custodial and curative care
of these distressing cases, and we hope that some philan¬
thropist may in our next legislature take the initiative in
this commendable work.”
Vol. XVII.—25
Digitized by L^OOQie
Editorial.
188
Editorial.
DELUSIONAL INEBRIATES.
There is a certain class of men belonging to the middle
and upper circles of social and business life, who early in
their lives have found that alcohol in small doses produced
very pleasant effects. The exhilaration and apparent phys¬
ical and mental vigor following its use has made a profound
impression of its value. Later they use spirits regularly,
and claim that it brings a certain nerve rest, and power of
adaptability and enjoyment of the surroundings not possible
otherwise. Later in their history, the early exhilaration
grows shorter, and periods of heaviness ending in stupor
and sleep follow. The common depression and reaction
from the narcotism of alcohol is not prominent or noticeable,
and is never recognized as due to spirits, but is always re¬
ferred to other causes.
Excesses from the use of spirits are not followed by the
common symptoms, but appear in complex neuralgias and so-
called rheumatisms, and transient acute inflammations, to¬
gether with functional disturbances. The mental exaltation
turns into egotism and delusions of strength, and power of
control. The constant dulling of the senses by the use of
alcohol removes all warnings of danger, and increases the
delusion of capacity and of power and judgment, and
full realization of his condition of mind and body. The
value of spirits, and its usefulness in all conditions of life
are defended with enthusiasm and vigor. Literally, he has a
certain predisposition for the narcotics of alcohols, the effects
of which are accumulative and masked. He drinks regu¬
larly in moderation, and sometimes to excess, carries on
the active duties of life with moderate or average success,
and is a warm defender of alcohol, and a bitter critic of in-
Digitized by L^OOQie
Editorial.
189
ebriates and total abstainers. If he is a brain-worker, his
delusions of self-control will grow into suspicions and doubts
of others. Delusions of persecution, of intrigue, of dis¬
honesty, and deception and neglect will follow. His former
integrity and moral character changes, he is less honest and
more unstable in his conceptions of right and wrong.
These may be concealed and only known to his intimate
associates. Often acute brain disease terminates the case,
or some sudden collapse from heart failure, cerebral hem¬
orrhage, or acute inflammations of the lungs or other organs.
The muscle-workers of this class always suffer from rheu¬
matism, neuritis, and chronic degenerative neuroses, and are
always the first to die in epidemics. Both muscle and brain
workers in this class may live the average period of life, and
continue the daily use of spirits. But the large majority will
die early, and all will suffer from functional and psychical
paralysis. Alcohol has obscured and paralyzed the higher
brain and sensory activities, and the man has been cut off
from normal relationship to the world, and correct knowledge
of himself. Such men appear as defenders of the use of
alcohol as a beverage. Such men doubt the question of
disease, and believe in free will, and full power of control at
all times. Such men are always dangerous unsound theorists,
and literally paranoic delusional inebriates.
When such cases appear as patients in inebriate asylums
their moral paralysis is unmistakable. They are oblivious to
reason, sympathy, or any other rational motives or rules of
conduct. Nothing but force, fear, and appeals to the lowest
impulses have any influence. They are uncertain and reck¬
less of every consideration of normal life and living. The
psychical paralysis is strangely blended with intelligence
and many misleading traits of character, which are always a
source of wonderment. A large class of these cases are only
known as moderate drinkers, and their degeneracy and real
condition is seldom recognized. When such cases come into
places of trust and prominence, or have new duties and new
responsibilities put upon them, they manifest weakness and
Digitized by i^-ooQie
Editorial.
190
instability that is not understood. They also display very
faulty reason, with childishness or absence of all rational
motives, and very low grade of principle. In the future these
cases will be studied, and then we shall be able to explain the
strange conduct and crime, and unusual acts of men who are
only known as moderate drinkers.
OPIUM DELUSIONS.
Recently some very marked examples of delusions in
opium cases have been noted in the daily press. A promi¬
nent woman telephoned the police station that a murder was
committed in the house adjoining, and urged them to come
at once. The patrol wagon with officers reached the house
in a few moments, and found no one stirring; two servants
were working before an open window, and the lady of the
house was asleep. The accuser described, with great
minuteness of detail, two women fighting, and a man rush¬
ing in and stabbing one, then disappearing. This was seen
from her window. When told that she was mistaken, she
became very angry and positive of her impressions. The
two servants working before the open window formed the
basis of her delusion. Later it was found that she was
using opium daily.
A well-dressed man, with a bruised face and some head
wounds, appeared at the police station and gave a minute
detail of an assault by a leading merchant, who attempted to
kill him. The motive was supposed to be political, to pre¬
vent him from securing a nomination the other wished. All
the circumstances of meeting, and exchange of blows, and
violent language, and his escape by jumping over some rocks
near the roadside, were given with graphic exactness. An
examination proved that the merchant was in a distant city
at the time, and no assault had been committed by any one.
The supposed victim was an opium-taker, and had no doubt
jumped over a rocky ledge, bruising himself. He was on
good terms with the merchant, and never had quarreled in
any way.
Digitized by i^-ooQie
Editorial .
191
The following case was submitted to me for examination
and opinion. A widow of wealth, culture, and the highest
respectability, charged her physician, an eminent man, with
committing a criminal assault. The physician was aston¬
ished. This lady was supposed to be in excellent health,
and had not called on him professionally for years. He was
a friend of her husband, and only called at long intervals,
and usually on some mission of charity.
The alleged offense was affirmed to have been committed
at night, and the lady was so overwhelmed that she remained
in bed for two days. A week later she confided to her
clergyman, and he called in a lawyer, and a meeting was
held. The doctor was emphatic in his denial, and the lady
was positive in her convictions. It appeared that the doctor
had called that evening, about seven o’clock, and remained a
short time. He came to announce the death of a distant
relative of the lady in a foreign country, who was traveling
with his son. Later the doctor accompanied his wife to the
theater, and remained at home all that night. The lady's
statement was that the assault was committed late at night,
then she changed and said it was early in the evening, and
that she was so much confused that the exact time was not
clear. The very unusual feature was the apparent unim¬
peachable integrity of both parties. There had been a feel¬
ing of profound respect between them, and no intimacy or
familiarity. The physician seldom called except on some
errand, and the lady was apparently strong and actively en¬
gaged in charity and the management of her property.
In my interview with this lady, there was no appearance
of vindictive anger, only deep sorrow, and her statement was
clear and natural in all its details. The pupils of the eyes
had a suspicious contraction, and she spoke of some neural¬
gia, for which she had used McMunn’s elixir. She acknowl¬
edged having used this drug the day of the assault, and
in larger quantities for several days after. I found from the
druggist that she used large quantities of this drug at differ¬
ent times, although never seemingly stupid from the use of
Digitized by L^OOQie
192
Editofial.
it. I concluded that if this was an opium delusion, she
would have another attack, so the decision was postponed.
Ten weeks later, she asserted that the same physician had
visited her room at midnight and assaulted her the second
time. The physician at the time was on the ocean with his
wife, going to Bermuda, having sailed two days before the
alleged act was committed. This woman was declared an
opium-eater and went under treatment, from which she re¬
covered, and no return of this delusion followed.
Fortunately these delusions are not very common, and
are so often mixed up with circumstances that indicate their
real condition as not to be mistaken.
PSYCHICAL HISTORY OF THE DRINK PROB¬
LEM.
We have repeatedly called attention to a certain class of
facts, which seem to prove that inebriety and the consump¬
tion of alcohol have a peculiar wave-like movement, rising
and falling like the action of the tides, under the influence of
certain psychical laws unknown at present. The prevalence
of inebriety in small circles, where the history has been re¬
corded for some years, brings out this fact in many ways.
The following editorial from the Temperance Record indi¬
cates the same general fact in relation to the consumption of
various alcoholic and non-alcoholic beverages. Its signifi¬
cance and value in a study of this very remarkable field can¬
not be over estimated.
Sir Frederick Hunt, in a motion before the British Parlia¬
ment, “ showed the consumption from 1861 up to the latest
date, of tea, coffee, cocoa, and chicory, of alcoholic bever¬
ages, and of tobacco, compared with the increase of popula¬
tion,” has just been issued, and is a most interesting study.
The line on the diagrams showing the consumption of non¬
alcoholic beverages is almost uninterruptedly upward. In
1861 the consumption of non-alcoholic beverages (tea, coffee,
cocoa, and chicory) was 127,000,000 lbs. In 1862 it fell to
Digitized by t^-ooQie
Editorial.
193
1 19^000,000 lbs. From 1862 there is a regular ascent till
1867, when the consumption was 159,000,000 lbs. In the fol¬
lowing year there was a drop to 153,000,000 lbs., and thence
a regular ascent till in 1879 it was 217,000,000 lbs. Next year
it was 214,000,000 lbs., and then followed a gradual ascent
till 241,000,000 lbs. was reached in 1885. A temporary drop
of 4.000,000 lbs. was followed by a rise to 246,000,000 lbs. in
1888. A drop of 3,000,000 lbs. next year was followed by a
rise to 267,000,000 lbs. in 1892, and then came a drop of
1,000,000 lbs. in 1893, the last year included in the return.
Between the highest and lowest figures embraced in the
return, the increase is shown to be 224 per cent. Per head
of the population the increase is from 4.06 lbs. to 6.99 lbs.
On looking at the diagram which shows the consumption
of tea, coffee, and cocoa separately, it is seen that by far the
greatest increase has been in tea. In 1861 the tea consumed
per head of the population was 2f lbs.; in 1893 it was
about 5i lbs.— as nearly as possible double. In 1861 the
consumption of cocoa was less than 3 oz. per head; in 1893
it was 9 oz. Coffee, in 1861, was consumed at the rate of
ii lb. per head of the population; in 1893 it had fallen
to 11 oz.
Turning to the diagrams which show the consumption of
alcoholic liquors, let us look first at beer. In 1861 the con¬
sumption was 20,000,000 barrels, and in 1876 it had risen to
31,000,000 barrels. The lowest consumption after that was
in 1880, when 26,000,000 barrels were consumed ; and about
that figure the consumption continued till 1888, when a rise
commenced, which attained its greatest heighten 1891, when
the consumption was 32,000,000 barrels. In 1893 it was
only a little less. The diagram showing the consumption
per head of population tells us that in 1861 it was 24i gal¬
lons. In 1874 it had risen to 33J gallons; in 1886 it had
fallen to 26J gallons ; in 1891 it was 30 gallons ; and in 1893
it was 29^ gallons.
The diagram showing the consumption of British and
foreign spirits and wines tells us that in 1861 it amounted to
Digitized by CjOOQle
194
Editorial.
35,000,000 gallons, and there was an almost steady rise until
1876, when it amounted to 60,000,000 gallons. From that
year there was an almost equally steady decline, until in
1886 it had got to 47,000,000 gallons. Again there was a
rise, until in 1891 and 1892 it reached 54,000,000 gallons,
and in 1893 it had declined to 51,000,000 gallons. The con¬
sumption per head of the population in 1861 was 1.22 gal¬
lons, in 1876 it was 1.80 gallons, in 1886 it was 1.30 gallons,
in 1891 it was 1.42 gallons, and in 1893 it was 1.35 gallons.
Turning to the diagrams which indicate separately the
consumption of rum, brandy, and Geneva and other foreign
spirits, we find that in 1861 the consumption of rum was
3,500,000 gallons, or 0.18 gallons per head of the population.
In 1867 it had risen to 4,300,000 gallons, or 0.28 gallons per
head. In 1875, with fluctuations in the interval, it had risen
to 5,400,000 gallons, or 0.36 gallons per head of the popula¬
tion. From this year there was a pretty steady decline till
1886, when it was 3,800,000 gallons, or 0.23 gallons per
head ; and then came a rise until 1890, when it was 4,600,000
gallons, or 0.24 gallons per head. In 1893 it had fallen to
3,800,000 gallons, or 0.20 gallons per head.
The consumption of brandy followed pretty much the
same course as rum, rising from 1,500,000 gallons in 1861 to
4,500,000 gallons in 1876, and falling to 2,500,000 gallons in
1888, subsequently rising to 2,700,000 gallons in 1891, from
which there was a slight reduction in 1893. Geneva and
other foreign spirits (except rum and brandy) had a con¬
sumption of 250,000 gallons in 1861, and rose to 1,200,coo
gallons in 1868, and in 1875 to 2,000,000 gallons. In 1880
the consumption had dropped to 600,000 gallons, and in
1889 it had again risen to 2,000,000 gallons, and in 1893 it
was 1,500,000 gallons.
The diagram showing the consumption of wine gives
lines indicating the fluctuations in the consumption of
French, Spanish, and Portuguese wines, and then of wines
other than French, Spanish, and Portuguese. In 1861 the
consumption of French wines was 2,200,000 gallons, and it
Digitized by t^-ooQie
Editorial ’
*95
rose to 4,500,000 gallons in 1868, and to 6,800,000 in 1876.
From that time there have been fluctuations, mostly down¬
ward, and in 1893 the consumption was 5,500,000 gallons.
Spanish wines were consumed to the extent of 4.000,000
gallons in 1861, and the consumption rose to 7,000,000 gal¬
lons in 1873. From that year there has been a pretty steady
decline, and in 1893 the consumption was 3,100,000 gallons.
The wines of Portugal were consumed in 1861 to the extent
of 2,600,000 gallons, and in 1875 the consumption had risen
to 3,900,000 gallons. A decline followed that year, and for
several years the consumption was very steady at about
2,900,000 gallons. It rose again to 3,700,000 gallons in 1890
and 1892, and in 1893 was 3,500,000 gallons. The other
wines have been very steady during the thirty-three years
embraced in the return, ranging from 1,500,000 to 2,100,000
gallons.
The diagrams which show the consumption, per head, of
British and foreign spirits, separately from foreign wines,
show that in 1861 the consumption of spirits was nearly 7
pints per head, and it rose to io£ pints in 1875 ; fell in 1887
and 1888 to 7 \ pints; rose in 1891 and 1892 to nearly 8£
pints; and in 1893 was under 8 pints. In 1861 foreign
wines were consumed at the rate of 3 pints per head; in
[873 and 1876 the consumption was 4^ pints ; in 1886 and
1888 it was just under 3 pints, and so it stood in 1893.
The diagram referring to tobacco shows an almost steady
rise in consumption from 35,000,(300 lbs. in 1861 to 63,-
000,000 lbs. in 1893. These figures tell us that the con¬
sumption per head was igl oz. in 1861, and 26 oz. in 1893.
[A striking confirmatory fact has just been made public
in the Internal Revenue Report of this country, ending in
June, 1894. This shows a reduction in the amount of
spirits, wines, and malt liquors on which a revenue was paid
of over ten million five hundred and ninety-five thousand
dollars for the year of 1893. A reaction backward has
clearly begun.— Ed.]
Vol. XVII.—26
Digitized by t^-ooQie
196
Editorial
STRYCHNINE DELIRIUM.
Those members of the medical profession who have em¬
ployed caffeine very largely in the treatment of cardiac and
renal disease, have recognized that large doses of this drug,
continuously administered for a considerable period, devel¬
oped in certain individuals what has been popularly called
“caffeine craziness.” In other words, the full medicinal
doses required by the condition of the heart or kidneys
have also been sufficiently large not only to produce an in-
breased activity of the brain, such as is seen when coffee is
taken in large amounts, but also have gone farther than this,
and by the very cerebral stimulation produced temporary
insanity. Within the last few years the medical profession
has been employing in certain states what may be consid¬
ered as massive doses of strychnine in the treatment of
failing respiration or circulation, and has obtained therefrom
very good results. It having been found that these full
doses of strychnine acted favorably when given in an emer¬
gency, we have been tempted to continue their administra¬
tion where the symptoms were relieved but temporarily,
and, as a result, have oftentimes been pleased with their
effect. On the other hand, a sufficient number of cases have
been seen in which cerebral disturbance has followed these
large doses to put us continually on the lookout for such
untoward symptoms. As a rule, he who administers large
doses of strychnine in an emergency is on the qui vive for
some twitching of the muscles of the forearm or other por¬
tion of the body as an evidence of the physiological action
of the drug. While we believe that these symptoms are
commonly produced by a single administration of the rem¬
edy, we are also confident that its continued administration
in full doses frequently fails to produce these evidences of
heightened reflex activity, and in their place causes a more
or less active delirium, in which the patient frequently
refuses to take his medicine, or develops the delusion that
his attendants are conspiring to poison him or do him some
other injury.
The above editorial note in the Therapeutical Gazette
calls attention to a fact not often recognized. In cases of
inebriety who have been drugged freely, particularly in those
who have received strychnine, low deliriums and imbecilities
are common. Remove all drugs and pursue the eliminative
plan of treatment and these symptoms disappear.
Digitized by i^-ooQie
Editorial . 197
THE SAN FRANCISCO HOME FOR INEBRIATES.
This well-known asylum has recently been assailed by a
leading daily paper, the principal reason being the refusal of
the board of trustees to pay two hundred dollars for a
column of praise. It appears that various gold-cure estab¬
lishments had fallen victims to this paper scheme, and paid
liberally for an extravagant “ write-up ” they received. The
refusal of this institution to buy the commendation of the
public was followed by wild charges of abuses and wrongs,
and appeals to the grand jury to investigate them. After a
series of savage onslaughts and vindictive efforts to gather
evidence against them, the grand jury found no cause of
action, and the paper, of course, had the last word, and made
the usual unpleasant ending to the scene. The gold cure
schemers were clearly at the bottom of the trouble. While
the charges of the paper were childishly assumptive, and
showed very little knowledge of human nature and sad lack
of business sense, the managers of the asylum failed to take
advantage of this splendid opportunity to enlist the sym¬
pathies of the people. Attacks of this kind on strong,
reputable asylums are welcomed by sharp business mana¬
gers as magnificent advertisements that can be turned into
gold and golden influences at once.
This Home has been before the public thirty years, and
has been managed by very able men. The present Superin¬
tendent, Dr. Potter, is a well-known writer and teacher of
medicine, and his management of this Home has commanded
the respect of medical men all over the country. Asylums
like this should never pray to be delivered from their ene¬
mies, but for an occasional battle with them, so they can
keep right before the public and have a lively, healthy interest
all the time.
Many criminal inebriates suffer from sense delusions and
hallucinations. They act from misconceptions and errors of
the senses, which to them seem real. They are unable to
correct these false impressions, or to judge of their value,
but act at once as if they were real and true.
Aural hallucinations of voices, threatening and violent
words, have caused many fatal assaults that were sudden and
unprovoked. Visual hallucinations have provoked similar
assaults, committed in supposed self-defense, and other un¬
explained acts are often traced to the same disturbances of
the sense impressions.
Digitized by i^-ooQie
198
Editorial.
The Keeley gold-cure people are concentrating an im¬
mense amount of energy to secure laws in different States,
giving judges power to commit chronic pauper inebriates to
Keeley institutes at the expense of the tax-payers. The
other gold-cure discoverers, who claim that they have better
remedies than Keeley, oppose these bills. In many of
the public hearings before the legislative committees, the
question of which specific has cured the largest number of
inebriates is discussed with great freedom and positiveness.
From the statements on both sides, it is evident that Mun¬
chausen has been carefully studied, and his famous methods
of expression copied with exactness.
Notwithstanding these peculiarities, the general subject
of the public treatment of inebriates is receiving prominence
and eliciting discussion that will clear away the heavy fog-
banks of superstition which now invest it.
HABITUAL MISCARRIAGE.
R. Reece, M. R. C. S. Eng., 1851, L. S. A., 1832, Walton-
on-Thames, England, says : I used Aletris cordial in a case of
painful menstruation. It was most valuable. The wife of
a minister suffered much and had had three miscarriages.
Prescribed Aletris Cordial. She has, for the first time, gone
her full time, and was safely confined with a male child. I
also prescribed it to a relative, suffering with leucorrhea for
years. Great relief from pain, and the discharge much less.
In the first case related it was truly a God-send to her.
Dr. Charles Henry Brown of New York, editor of the
Journal of Nervous and Mental Disease , says: “ Mai tine
with coca wine has served me well in cases of neurasthenia
from any cause. It serves as a most excellent sustainer and
bracer. Besides these two essential qualities, we are forced
to believe in another element in this combination, and that
is the sedative quality, which makes it a most valuable thera¬
peutic desideratum. It does not seem to me that this action
depends entirely upon the coca, or the coca in combination
with wine. My conviction is, that the maltine plays a lead¬
ing part in this triple alliance ” — Medical and Surgical
Reporter , Dec. 22, 1894.
Digitized by i^-ooQie
Clinical Notes and Comments.
199
dliqidkl jsfote$ ki)d Comments.
Dr. Chauncey Stewart of Allegheny City, Pa., has used
Iodia very extensively in his practice, and regards it as the
“Ideal alterative — the sine qua non in the treatment of
syphilis, scrofula, and all diseases arising from syphilitic
contamination or a strumous diathesis. Iodia has this
advantage over mercurial treatment in syphilis; when the
patient does get well he is well. He is not tortured with
mercurial rheumatism nor made to blush through the syphi¬
litic blossoming of his face in after years. He is well. Un¬
like the long-continued use of other alteratives, Iodia does
not reduce and debilitate the constitution, but invigorates
and restores the vital power and enable the patient at all
times to continue in the discharge of his vocation.”
At this season of the year, when radical and sudden ther¬
mal changes are the rule, it becomes of vital interest to the
busy practitioner to have in compact, ready form, such
approved medicaments as meet the analgesic and antithermic
requirements of the bulk of his patients. As pertinent we
call attention to the following combination tablets : “ Anti-
kamnia and codeine,” each containing 4J gr. antikamnia and
J gr. codeine, “antikamnia and quinine,” each containing
2 \ gr. antikamnia and 2k gr. quinine, “antikamnia and
salol,” each containing 2 \ gr. antikamnia and 2 \ gr. salol,
and “antikamnia, quinine, and salol,” each containing 2 gr.
antikamnia, 2 gr. quinine, and 1 gr. salol. These together
with the well-known “antikamnia tablets,” of varied sizes,
and antikamnia powdered,” constitute indispensable factors
in the armamentarium of the physician, and are more than
ordinarily indicated in present climatic conditions.
Park , Davis & Co ., with their usual masterly enterprise,
have already on the market a supply of antitoxin. They
have established a bacteriological department, and begun
new investigations in this fascinating field.
Digitized by i^-ooQie
200
Clinical Notes and Comments .
The experience of every person confirms the value of
trional and phenacetine as narcotics of rare powers. The
literature of the subject is already quite large. W. H.
Schieffelin & Co. of New York city are the American agents
for this drug, and will forward papers to any address.
Wheelers Tissue Phosphates is a very strong combination
of lime, sodium, iron, phosphate, cherry bark, and calisaya.
Practically, it is almost a specific in many cases.
Horsford Acid Phosphate , like the song of the brook,
“ goes on forever.” Its value grows with the years, and its
uses widen, until the demand has now reached such propor¬
tions that a vast manufactory and an army of men are re¬
quired to supply it.
Celerina is a standard remedy in all cases of exhaustion
coming from alcohol and narcotic drugs. The Rio Chemi¬
cal Co. of St. Louis have done excellent service to the pro¬
fession by placing this remedy where it can be used and
tested. We urge a careful trial of it in these cases.
The Vernon House at Bronxville, N. Y., under the care
of Dr. Granger, is an admirable place for mental and alco¬
holic cases. Each case receives special personal care.
Fire-Proof Safes have become a necessity in every insti¬
tution and in every case where valuable papers are kept.
E. C. Morris & Co. of Boston, Mass., make a specialty of
safes of all kinds. Send for a circular.
Fellows' Syrup of Hypophosphites is a rare preparation for
building up the brain and nervous system, and one of the
few remedies that are usually prescribed very freely after
having been once used by the physician.
The Arethusa Spring Water of Seymour, Conn., is an
excellent water for nervous invalids, and grows in popularity
wherever it is used. Send for some circulars.
Horlick's Malted Milk is an excellent nutrient for debil¬
ity and exhaustion. It can be used on the table as a substi¬
tute for food with the most satisfactory results. It is milk
combined with malted barley and wheat, and rich in phos¬
phates. Send for a package.
Digitized by CjOOQie
THE
Quarterly Journal of Inebriety.
Subscription, $2.00 per year.
Vol. XVII. JULY, 1895. No. 3.
This Journal will not be responsible for the opinions of contributors, unless
indorsed by the Association.
THE DANGERS OF MORPHIA IN GYNAECOLOG¬
ICAL PRACTICE.*
By H. Macnaughton Jones, M.D., M.A.O.
There are reasons, which I hope to make apparent before
the close of this paper, why a discussion on the subject I
have selected for our consideration is as important as any
other that can occupy our time or attention. It has at least
this charm attaching to it — that it takes us away from the
constant iteration of purely surgical procedure, and attracts
us through the dual interest of the therapeutic tolerance mani¬
fested, and the ethical responsibility incurred, in the admin¬
istration of a powerful toxic agent. I say “ toxic agent,” for,
in dealing with the danger of morphia administration in
gynaecological practice generally, I have to consider rather
those physiological effects which are followed by pathological
and psychical manifestations in the person of her to whom
morphia may be either imprudently administered, or in
whom its usage is carelessly prolonged. Morphia, with such
poisons as ether, alcoholic spirits, hashicsh, and opium itself,
* Read before the British Gynaecological Society at the April meeting in
London, and published in Medical Press and Circular.
Digitized by L^OOQie
202 Dangers of Morphia in Gynecological Practice .
is used in excessive or toxic quantities, either with the object
of producing pleasure, and ministering to voluptuousness, or
for certain therapeutic and medicinal purposes; stimulating
and dietetic, as in the instance of the alcohols; stimulating,
supporting, sedative, and narcotic in that of opium or its
alkaloids.
It is not too much to say that in the reaction that followed
the teachings of Todd and Graves, when the pendulum
swung from its highest point of antiphlogistic treatment of
bleeding, blistering, and mercury* to the opposite one of ex¬
treme stimulation (though it must be remembered, in justice
to both these great teachers, that neither of them can be
held responsible for the abuses founded on their doctrines),
many died more of alcohol than of the diseases it was admin¬
istered to cure. Many in fever were sent, unintentionally
but rashly, more drunk than delirious from life. Morphia
also has been responsible for many deaths other than those
which have followed its use with a suicidal object; nor can
we forget the many who have been accidentally poisoned by
over-dosage. The desire to relieve pain, or cause sleep,
has either overridden or lulled caution, when the narcotic
and other effects of opium and morphia were distinctly con¬
tra-indicated. I, myself, had to thank an imprudent dose of
opium, given to me in the helplessness and delirium of typhus
fever, for an over-distended bladder, consequent catheteri¬
zation, and a recto-vesical abscess, which, fortunately for me,
discharged itself through the rectum.
I propose to consider the question of morphia adminis¬
tration in women from the following points of view: The in¬
fluence of temperament on its action and effects; our
knowledge of its physiological and psychical influences ; the
precautions to be observed in its exhibition.
With regard to temperament, I must ask your attention
for a few minutes to that large class of sufferers from affec¬
tions of the female generative organs, commonly spoken of
as “ nervous.” The neurotic woman, I take it, is to be re¬
garded in the light of a by-product of that unstable nervous
Digitized by ^ooQie
Dangers of Morphia in Gynecological Practice . 203
organization which we style the nervous temperament, and it
were well to confine our employment of this term “ neurotic”
to such abnormal and morbid exaggerations of it as are so
uncommonly found associated with pathological conditions of
the woman’s pelvic viscera. Thus we can frequently trace
the incipiency of the neurosis to the occurrence of some
accident or injury, which may have had a dual consequence
through the infliction of shock, or the inducement of some
displacement or affection of any one of these organs. Pre¬
vious to such accidental determinations the woman may have
been normal in her control of her will, feelings, and emotions.
Her energy and impulses have directed her actions, without
causing that sense of reaction and fatigue which is so con¬
stantly present after slight exertion, when her impulses are
diverted by unhealthy excitations, and her energy is dissipa¬
ted by morbid introspections. Such a nervous temperament
is frequently satisfied with little sleep. Under the influence
of excitement fatigue is quickly recovered from, and a latent
reserve force of nerve energy appears ever ready on demand
to carry its possessor over unsurmountable obstacles. All
this accumulated governmental control of will and nerve en¬
ergy are missing in the neurotic, but none the less is that
loss felt when the unequal struggle occurs between the sov¬
ereignty of an enfeebled indeterminate will and the rebellious
and more masterful emissaries, the woman’s “ lower passions
and lower pains.” While in health such individuals can pass
through great physical and mental exertion without stimu¬
lants, but when the natural call on their reserve energy finds
no response they apply the artificial spur of alcohol, or some
other excitant, such as morphia, to the flagging nerve cells.
Such individuals are quite cognizant of the abeyance of the
power to exercise free will. The desire to suppress
the expression of pain is present, but the usual control
is lost. Also, there is general hyperaesthesia of the
peripheral nerves, which find in the frequently ill-nourished
central cells a susceptibility to slight impulses and morbid
sensitiveness, with an exaggerated perception of compara-
Digitized by v^ooQie
204 Dangers of Morphia in Gyncecological Practice .
tively trifling stimulation. Here we are dealing with an
acqitired neurosis, for which possibly we may find no clue
through atavistic transmission. On the other hand, we can
often see in early childhood the traits of temperament which
clearly foretell the future neurotic woman. Capriciousness,
irritability, selfishness, restlessness, and excitability, are the
characteristics which stamp the moral prototype in the child
of the adult neurasthenic and hysterical woman, though it is
after puberty that we frequently find such distinctive features
of character develop themselves. When a woman of this
type marries, in the demands on her nervous system, if she
be not sterile, which the claims of children and domestic
duties involve her in, she generally escapes those neurotic
and hysterical manifestations that are found in the unmarried
and sterile. In the former we are more likely to meet with
those erotic thoughts, desires, and practices that still further
enervate her nervous system and enfeeble her central control.
She is, perhaps most of all, the back drawing-room or bou¬
doir woman who is apt to fall, to use Professor Clifford All¬
butt’s expression, “ into the net of the gynaecologist.”
Turn we now for a moment to the lymphatic antithesis of
this unfortunate victim to unbridled and morbid nervous and
sexual impulses.
There is a type of woman, familiar to us all, indolent,
lethargic, fanciful of ailments, with a superficiality bordering
on childishness in conversation, dull of comprehension, readily
open to flattery, even to her own self a bore, and often one
to her husband and children, if she be married ; fringed with
layers of pectoral and abdominal fat, the easy prey to quack
systems of dieting and to the “man of the world” physician.
Her defective metabolism and a sexual voluptousness, makes
this proprietary article the registered dual property of the
“ pure specialist ” for gout on the one hand, and the cotton
wool gynaecologist on the other. She is one of the principal
sources of revenue to the new Franc Tireurs of the outposts
of medicine — the ubiquitous masseurs or masseuses, as the
previously described sufferer is to the fashionable “ Weir
Digitized by C^ooQie
Dangers of Morphia in Gyncecological Practice. 205
Mitchell Home.” With her, every twinge is “ agonizing, ”
to walk is impossible, and, once let her evolve uterus and
ovary “on the brain,” whether these organs are diseased or
not, they are made responsible for every ill her peccant flesh
is heir to, not even excluding “ housemaid’s knee.” She is
not of the classical neurotic type previously described, though
her visceral neurosis may be legion. She may suffer from
congestive dysmenorrhoea and ovoralgia, her uterus may be as
flabby as her brain, and her ovary as fertile in aches as her
imagination in fanciful allusions. Her voluptuosity is not
limited to her appetites of palate, but is not infrequently
manifested in sexual abuse. She fancies that she sleeps for
many hours less than she actually does, and hence is often
seeking for some new, when she has already exhausted every
conceivable variety of reputed, hypnotic. While we find in
the unmarried more frequently examples of the first type of
temperament, married women furnish a larger proportion of
the latter. Both, however, are to be found constantly as
representatives of the habit of morphinism.
It cannot be denied that numbers have succumbed to
the desire for morphia, and have ultimately become morphin-
omaniacs, in whose instances it could not be attributed to
any temperamental tendency. Here pain, the result of dis¬
ease, more especially in the nervous system, has invited the
first use of the drug, and the recurrence or continuance of the
pain has suggested its reapplication. Unfortunately, many
have used it rather in anticipation, than for the present relief,
of suffering. This has led to its employment when its thera¬
peutical action has been expended on the nervous system,
when the relief afforded by its narcotic action could not be
experienced, yet the patient has been subjected to the exhil¬
arating and pleasurable sensations which are produced by
repeated doses of morphia.
Let us consider very briefly the facts which are now fully
established regarding the etiology and course of morphinism,
leading up to morphinomania. It is a curious fact that not
until 1864, when Nusbaum drew attention to the conse-
Digitized by ^ooQie
206 Dangers of Morphia in Gyncecological Practice .
quences following the abuse of injections of morphia, was
there any serious notice taken of its ill effects, and the first
English physician who seems to have written on the subject
was Dr. Clifford Allbutt, who wrote in the Practitioner of
1870, of the dangers following incessant injections of morphia,
and pointing out that while relieving the severe pains in
various neuralgias, the need for the use of morphia increased,
and that it created an artificial craving, the yielding to which
only resulted in a depression and irritability due to intoxi¬
cation by the drug. The writer then clearly recognized the
craving and intoxication of morphinism.
During the seventies Laher (1872), Fielding and Hirsch-
feld (1874), Michel (1876), Lewinstein (1875-77), Burkart
(1879), wrote monographs on morphinism, Lewinstein writ¬
ing a complete description of the affection to which he gave
the name of “ Morphiumsucht” (1879).
Clarke wrote on the sudden discontinuance of morphia
after its protracted use, in the Lancet , in 1879, and Griffith
on the abuse of the morphia habit, in the Guy’s Hospital
Reports, 1878.
Erlenmeyer insisted, about the same time, on the relapses
after treatment. Braithwaite also in England (1878), Matti-
son in America, Dealbanne, Zambaco, Landowski, and Pichon
in France contributed material to the literature of the subject.
During the next decade Burkart, Erlenmeyer, Leppmann,
Obersteiner, Samter, in Germany; Zambaco, Bourneville,
Grasset, Benjamin Ball, Jennings, in France; Loose, Mann,
Kane, in America, were the principal writers.
In 1890, Regnier published his brochure on chronic in¬
toxication by morphia, a valuable and comprehensive mono¬
graph. This latter, with the work of Dr. Albrecht
Erlenmeyer, " Die Morphiumsucht,” gives the fullest inform¬
ation with regard to the entire subject, on which so little
has been written in this country.
It is sufficient for me to emphasize certain points which
have been fully established by these and other observers.
We may follow Regnier in separating morphia-takers into
Digitized by L^OOQie
Dangers of Morphia in Gyncecological Practice . 207
two broad classes, morphinises and morphinomanes, accord¬
ing as the habit can be resisted, and is more or less under
control, or, as in the latter class, it passes beyond this stage,
and the craving is, or tends to become, irresistible. Zambaco
divides morphia patients into three classes — those suffering
from painful chronic diseases, who have daily recourse to
morphia; secondly, those who, having been cured of such
affections, still continue its use; and lastly, those who aban¬
don themselves to morphia abuse for the mere pleasure it
affords, as in the case of alcohol or absinthe. Eloy briefly
summarizes all morphiomaniacs under two headings — those
who have become such from a necessity, or from passion.
Lewinstein, again, classifies the morphia intoxicants into
two categories ; first, those who,, in spite of themselves, have
been driven by a painful and often incurable affection to the
use of morphia (the morphinises of Regnier) and secondly,
morphinomaniacs. The clear distinction to be drawn be¬
tween the two is that in the one case the morphia is taken
solely for the relief of suffering, and not for its exhilarating,
exciting, and agreeable effects.
Let us here notice some indisputable facts as regards the
effects of morphia. Pain accounts for a certain immunity
from the toxic action of the drug, even when contiifued over
a considerable period of time (14 years in one case, Hirsch-
berg). This is especially true of cancer, and in certain ma¬
niacal cases Voisin has given, in gradually increasing doses,
over a drachm of morphia in the 24 hours, and continued this
treatment for some time without, either during administration
or at its relinquishment, producing any symptoms of morphia
intoxication. It may be concluded that age, sex, condition
of health, and the intervals between administration, influence
the effects of the dose.
Morphia administered by the mouth is somewhat less
active in causing intoxication. The abscesses which at times
accompany the subcutaneous punctures have been variously
explained by Despres, Jacquet, Verneuil, and Charcot, and
may be attributed to one or more of the following causes:—
Vol. XVII.—28
Digitized by C^ooQie
208 Dangers of Morphia in Gynoecological Practice .
Misuse of the injecting syringe, suppurative tendency in the
subcutaneous tissues of the patient, and microbal infection.
Both the staphylococcus having been found in the pus of
these abscesses, points to the necessity for efficient steriliz¬
ation of the morphia injector.
It is important to note that so far statistics appear to
prove that men are more subject than women to the morphia
craving. Lewinstein and Burkart have assigned the relative
proportion at about 25 per cent., but Landowski considers
that the habit is more successfully concealed in the case of
women, who more completely abandon themselves to it, and
make no confession of the practice. Also the prevalence of
morphinomania amongst doctors, nurses, and pharmacists has
to be remembered, doctors representing by far the largest
number of all classes in which the craving has been recorded.
Out of 150 morphinomaniacs noted by Lewinstein and Burk¬
art, 86 were either doctors or persons connected with the
medical profession. Rochard considers that doctors furnish
more than half the number of male sufferers. This unfortu¬
nate prevalence of the propensity in the ranks of medicine may
be accounted for, says Regnier, first, by the facility with which
the drug is procured, and, secondly, by the arduous nature of
a calling*which oftentimes makes irresistible demands on a
frame already over-fatigued and suffering.
So far as the influence of age is concerned, it would ap¬
pear that the majority of morphinomaniacs will be found
between the ages of twenty-one and fifty, though in France
cases have been recorded in females from thirteen to eight¬
een years of age. Apart from the narcotic effect of morphia
in assuaging pain in a healthy individual, it is well to summa¬
rize its effects in the person of a truly hysterical or neurotic
woman. Following the injection there is a period of repose
during which the patient has a pleasurable sensation. She
loses her feeling of depression and sense of fatigue, becoming
more alive to all that goes on about her, takes a greater inter¬
est in conversation, and is rendered more capable of her
ordinary occupations. At the same time her pulse is stronger
and her breathing freer.
Digitized by ^ooQie
Dangers of Morphia in Gynecological Practice. 209
Lewinstein applies to this condition the term “ euphoric ”
(euphorische). Its duration is variable. It may last for
twenty-four hours, or even longer, but its length is diminished
as the number of injections is increased, and gradually this
pleasurable period is reduced, after some months of indulgence,
to a few hours, and, ultimately, minutes. Little by little, as the
number of injections and quantity of morphia is increased,
the periods of depression are intensified ; a sense of malaise
and a feeling of restlessness succeed, complete reaction to the
previous exhilaration follows, the cardiac rhythm may become
irregular, the skin is pale, a sensation of feebleness and loss
of nerve control ensues, and the prostrate and languid
sufferer craves again for the artificial stimulus of the morphia.
Should she also be subject to neuralgia, whether in her pelvic
organs or elsewhere, her pains return with redoubled force,
and find, in her paralyzed will and disordered imagination, a
house ready swept and garnished for every devil of hysteria
and hypochondria to enter in and play havoc with her moral
nature. To such we may apply these lines of Milton : —
Which way she flies is hell — herself is hell,
And in the lowest deep, a lower deep,
Still threatening to devour her, opens wide.
To which the hell she suffers seems a heaven.
I have not time to touch upon those incidental troubles
which are known to be associated with morphinism. I allude
more particularly to disorders of digestion and dyspepsia,
constipation, and occasional vesical irritation, with abnormal
changes in the urine, both in its quantity and quality, and
urethral pain; visual disturbances, amblyopia, diplopia, and
disorders of accommodation; lessened reflexes ; rotatory
oscillations of the arms, defects of memory and moral per¬
version, psychical apathy (due probably to a direct effect of
the morphia on the discharging energy of the brain cells), and
interference with the metabolic function of the liver through
its influence on its glycogenic function. With regard to the
last action, we are reminded that there is a certain cumulative
tendency in morphia, and that this is specially shown in the
Digitized by L^ooQie
210 Dangers of Morphia in Gyncecological Practice .
case of the liver. The experiments of Rogers and others
tend to show that there is an interaction between the hepatic
glycogen and the morphia, the glycogen having the property
of arresting the alkaloid, an interaction which Regnier and
others suppose has to say to the occurrence of glycosuria in
more advanced morphinomaniacs. Outside the afore-men¬
tioned complications there are the occasional cardiac changes
to be remembered, which have been noted by Lewinstein,
Schweininger, Hirschfeld, Ball, and others, in the form of
hypertrophy, sclerotic changes, and fatty degeneration. Such
effects on the heart have to be considered if morphia is fre¬
quently administered during pregnancy, when there is a
natural tendency to such complications.
What touches us more especially is the influence exerted
on the catamenial function through the morphia habit,
namely, frequent arrest of the same, constant irregularity or
complete suppression. Sterility is at times the consequence
of this arrest of uterine function. There is also the un¬
doubted effect of morphia on the embryo, and the fact that
the infants of morphia-takers suffer immediately after birth
from the consequences of the habit has to be recollected.
But the fact before all others that I am anxious to emphasize,
and which has been clearly proved by a number of observers,
is, that what we understand by hysteria occupies the fore¬
most place in the causation of morphinomania. Hysteria,
neurasthesia, neuralgia, cephalalgia, ovarian crises, dysmen-
orrhoea, spinal neuropathies, neuro-mimesis, are the correlated
conditions, often associated with sexual disturbances, which
stand in the forefront in the etiology of morphia abuse in
women. And they are, unfortunately, the very conditions
for which it is most frequently prescribed.
Recall, now, the temperament that I have endeavored to
depict as types of those most susceptible to the deleterious
effects of morphia. They are distinctly those which all ex¬
perience has proved are most likely to.be conquered by the
physiological action of the drug. Such persons are always
importunate for its employment, once they have experienced
Digitized by t^-ooQie
Dangers of Morphia in Gynoecological Practice . 211
its effects, and the weak-kneed physician is compelled to
yield to their importunity. A prescription is given, possibly
a nurse is entrusted with the administration, and very
frequently, when the nurse leaves, the patient, retaining the
prescription, not alone administers, but practically prescribes,
the medicament for herself. I have known a supply of morphia
solution of the British Pharmacopoeia to be obtained daily at
different chemists, and thus as much as 18 to 20 grains of
morphia has been taken subcutaneously within the 24 hours.
The original prescription was copied at different establish¬
ments, and no demur was made to compounding it even after
the lapse of two years from the date of the original pre¬
scription, nor was the physician who prescribed it made cog¬
nizant of the fact that it was so repeated. I cannot but look
upon such a practice as a grave and dangerous abuse of that
mutual trust which should exist between the physician and
the pharmacist. When morphia can thus be readily obtained
in large quantities, the tendency often arises for one woman
to recommend its use to another, and even to go so far as to
herself subcutaneously inject it into friends. Thus the habit
becomes contagious, and there is even a morbid delight felt
in the act of puncturing, not alone herself, but others.
We must also bear in mind what the condition of the
nervous system is during and after pregnancy, when morphia
is thus occasionally administered to relieve vomiting, or to
give sleep. Here we have an abnormal circulating current
and a temporarily altered condition of the entire vascular and
nervous systems. Mental irritability, capricious or depraved
appetites, emotional and hysterical states, periodical neuralgic
waves of pain in different parts are not uncommon. Thus
we have have associated with pregnancy those very physical
and psychical states in which we might expect to find morphia
excite a craving for its effects and repeated use. Its action
on the foetus through its tendency to cause abortion, and
lower the vitality of the embryo, I have already referred to.
I have said sufficient to indicate the caution it is neces¬
sary to observe in determining to resort to morphia for certain
Digitized by v^ooQie
212 Dangers of Morphia in Gynoecological Practice .
affections of women, which specially fall to the lot of the
gynaecologist to treat. Many of these are of a reflex nature,
arising out of disorders of the uterus and its appendages, and
are to be cured only by the restoration to health of the de
ranged pelvic organ. In the majority of such cases the
morphia syringe is the most mischievous remedy to resort to.
^It may bridge over a period of time, but often this gain is
achieved at the expense of the entire moral control of the
woman, and her latent power to endure even trifling pain.
I do not quote particulars of cases, but I can say that
numerous observations of women whom I have known to be
addicted to the morphia habit, owed their misfortune to what
I could not but regard as the indiscriminate and too careless
administration of the drug. In one case a lady of consider¬
able refinement and culture had found her way into a private
asylum, an eminent gynaecologist having permitted her to
take morphia by the mouth at her own discretion, until at
last she arrived at such quantities as would almost seem in¬
credible. On leaving the asylum, where she had been cured,
she still continued to fall back occasionally on the use of the
morphia, and some years afterwards, when I saw her for a
haemorrhoidal affection, she handed me up a small phial con¬
taining acetate of morphia in powder, confessing that she
occasionally took it in varying quantities and without
measurement. For some years she has been completely
cured of the habit.
One other point I will only make a passing allusion to,
and that is, the double-edged nature of this weapon, when
used by the surgeon after abdominal operations, in masking
symptoms of peritonitis, and possible interference with the
natural process of cure through arrest of the secretions. As
Greig Smith well says, “ The routine employment of morphia
is to be condemned. Complications are better met with a
system unimpregnated with morphia.”
The moral of this paper is that there is a responsibility
attached to the employment of morphia for the relief of pain
in the affections of women, not sufficiently recognized in
Digitized by t^-ooQle
Dangers of Morphia in Gynoecological Practice . 213
practice. This responsibility imposes on the physician the
duty of differentiating those cases in which morphia may al¬
most certainly be given with immunity from its toxic effects,
from those in which the risk of intoxication by its repeated
use is great. It is not too much to say that under no circum¬
stances whatever should a patient be permitted to inject her¬
self, and it is questionable, for many reasons, whether rela¬
tives or friends, save under very exceptional circumstances,
should accept the responsibility of doing so. Only small
quantities of a solution should be ordered at one time, and
such an amendment should be made in the Sale of Poisons
Act as to prevent the dispensing of prescriptions for morphia
injections or powders which do not bear the signature of a
physician of a date recent to that on which they are presented
to the chemist. The effects of morphia, especially when the
doses are repeated or increased, should be carefully watched,
and its employment suspended if these appear to contra-indi¬
cate its use. The need for sterilizing the morphia syringe,
which has been referred to, should be remembered. These
are some conclusions I would place before the Society, and
though I have absorbed a portion of its valuable time, I do not
feel that the subject is one which does not justify the ex¬
penditure of it.
In the discussion which followed Dr. Leith Napier spoke
as follows. Dealing with the author’s reference to the in¬
fluence of temperament on the action and effects of morphia,
he thought that too much stress had been laid on this point
in the paper. The quotations of woman's “ lower passions
and lower pains, 0 was neither accurate nor, it seemed to
him, applicable. He would suggest, as a better comparison,
“ Passion drives the man, passions the woman; him a
stream, her the winds.” He concurred with Dr. Macnaugh-
ton Jones in adopting Zambaco’s classification of morphia
patients — those suffering from painful chronic disease, who
have daily recourse to morphia ; those who have been cured
of such affections, but continue its use; and those who in¬
dulge in morphia for the mere pleasure it affords. He
Digitized by v^ooQie
214 Dangers of Morphia in Gynoecological Practice .
thought insufficient stress had been laid on some of the symp¬
toms of morphia that were sometimes met with. Thus, he
had known hypodermic injections cause so much sickness
that the relief of pain hardly seemed sufficient to justify con¬
tinuance of the drug. Various cutaneous rashes as well as
general pruritus were also sometimes seen. After briefly
reviewing the physiological and pharmacological action of the
drug, Dr. Napier dwelt on the influences that modified its
effect. Women were more susceptible to morphia than men,
reacting readily to its exciting as well as to its sedative
effects. The effect of habit was most marked, and very large
doses could in time be taken. He held strongly that while
morphia should be given for relief of pain, less potent drugs
should be used in cases of insomnia and in neurotic con¬
ditions. Yet it was not necessary for medical men to blame
themselves unduly if, as the result of the legitimate use of
morphia, patients came to take it themselves, and in excess;
so also patients were not to be unduly blamed for taking
morphia if their medical attendants did not warn them of the
possible dangers ; and lastly, it was not right to assume that
every woman who had given way to the habit had done so with
insufficient cause. The temptations resisted had to be taken
into account, as well as those yielded to. He came then to
the question, What drugs could be substituted for morphia in
dealing with insomnia, and with various psychoses ? Some of
the bromides and belladonna answered very well, if used
judiciously. He had had good results from lactophenin, in
doses of 7 to 15 grains, in cases of nervous insomnia; from
chloralamid, bromidia, and tincture of piscidia erythrina (in
doses of 1 to 1 i dr. daily). Sulphonal and paraldehyde,
though not so much spoken of lately, were well known
remedies. He deprecated the routine use of morphia after
abdominal sections, while recognizing that in some cases it
was necessary. After many vaginal operations also a
morphia suppository was advisable. At the same time he
believed that morphia frequently increased the tendency to
post-anaesthetic sickness. In conclusion, he suggested the
Digitized by t^-ooQie
Dangers of Morphia in Gyncecological Practice . 215
following questions for discussion : 1. For what conditions of
pelvic disease ought morphia to be administered ? 2. Was it
preferable in giving morphia hypodermically to employ it
alone, or with sulphate of atrophine ? 3. What were the best
substitutes for morphia in psychoses of women ? 4. What
was the best curative treatment for morphinism in women ?
Dr. C. A. Mercier expressed his indebtedness to Dr.
Macnaughton Jones and to the society for giving him the
opportunity of taking part in the discussion. It was worth
noting that not everyone who took morphia, even habitually
and in large quantities, was a morphinomaniac. There was
the classical case of De Quincey, who indulged at frequent in¬
tervals in an opium debauch, from 1804 to 1812. At no time
during these eight years was he a slave to the drug. In 1813
a severe and painful illness led him to the daily use of lauda¬
num, and it was only then that it obtained a complete mastery
over him. He describes himself in 1816 as sitting down
every night with a quart decanter of laudanum at his elbow,
and he drank it without measure and without stint. The
absolute dependence on morphia, and not the mere indul¬
gence in it, however frequent and prolonged, constitutes
morphinomania. It was a very noteworthy fact that De
Quincey was able to and did abandon the habit at the cost of
intense suffering, without, as far as they knew, any external
assistance or advice. But then De Quincey never used the
hypodermic syringe. He took opium by the mouth, and it
was a matter for serious consideration whether the tyranny of
morphia administered by the syringe was not far more dom¬
inating and exacting than when it was taken by the mouth.
Dr. Macnaughton Jones had pointed out that attention was
first called to the prevalence of the morphia habit in 1864,
and he believed that it was about that time that the syringe
became prevalent. It was perhaps a question whether the
invention of this instrument had been a boon or a bane to
humanity. Undoubtedly it had given them a power of actu¬
ally saving life in cases of great agony, such as renal and
biliary colic, in which it was threatened by the extremity of
Vol. XVII.—29
Digitized by QjOOQie
2 \ 6 Dangers of Morphia in Gynecological Practice .
the pain; but he would submit whether its use ought not to
be restricted to such cases. It was a remarkable fact that a
successful means of breaking morphia-takers of their habit
was based upon the much greater facility with which it could
be abandoned when taken by the mouth than when adminis¬
tered by the syringe. A large proportion of the daily ration
of morphia could be cut off without the production of severe
distress ; it was when a minimum ration of one or two grains
was reached that the difficulty arose. It could be solved
by abandoning at this stage the syringe and giving double or
treble the amount by the mouth, and this ration could then
be rapidly diminished, and at last altogether abolished with¬
out occasioning any very severe distress to the patient. The
conclusion that he ventured to put before the society was
that the syringe should be reserved for cases of great agony
requiring immediate relief; that a long course of opium,
when necessary, should be given in other ways ; and, finally,
that it was almost criminal to entrust a patient with a syringe
for the self-administration of morphia.
Dr. J. F. Woods (Hoxton House Asylum) said that his
experience of the use of morphia had been chiefly through
cases that had come under his care through its abuse. He
had met with six cases. In one the patient, a medical man,
was admitted under certificates. He was suffering from de¬
lusions, and had been taking a daily dose of about twenty
grains hypodermically. After an attempt at suicide he was
allowed his syringe with an attenuated solution, so that in¬
stead of two grains for a dose (as he thought) he had only
one-twentieth of a grain. He improved rapidly, and left
after two months. After a time he had a relapse and was
again cured, but later he committed suicide by taking an
overdose of chloroform. Another case was that of a lady,
aet. 49, who had begun morphia fourteen years before, having
had it given her by a doctor for some uterine trouble. On ad¬
mission she gave up four syringes and two bottles of morphia.
He stopped the drug, and she had the usual restless symptoms.
Finding her amenable to hypnotic suggestions, he employed
Digitized by i^-ooQie
Dangers of Morphia in Gyncecological Practice. 217
this method with marked success. ' Suggestions in the day¬
time under slight hypnotism for a few minutes enabled her
to sleep at night, and he gave her suggestions against mor¬
phia during sleep with the effect that she always awoke
much better, and the restlessness disappeared. She made
rapid progress, and gained about two stone in weight. He
heard from her last week, and she was keeping well. He
considered morphia one of the most satisfactory drugs that
they possessed, but it should be given with extreme caution,
and stopped immediately the effect required was produced.
It should be administered by the medical man only.
Dr. Fitzgerald (Folkestone) said he would confine his
remarks to the use of morphia in cases of painful and hope¬
less malignant disease. In these cases he thought that he
would be a bold and unwise man who should deny its use.
Medical men were too cautious and even timid in the use of
opium in hopeless cases, where there was absolutely no hope
of prolonging life. Surely it was the function of the pitiful
physician to alleviate pain and suffering where cure was im¬
possible, even if it shortened life, which in the case of opium
he denied. Euthanasia, the ensuring of a painless death,
was the absolute duty of the conscientious physician, but
was from timidity too often neglected.
Mr. W. D. Spanton (Hanley) was in accord with most of
what had been said by the writer of the paper, but hoped that
gynaecologists would not be held responsible for all the evils
of morphia, as he believed it to be more common among men
than was supposed. Under no circumstances, however,
ought a patient to be permitted to use a hypodermic syringe
herself.
Dr. Morton, while admitting the great value of morphia,
wished to put in a plea for caution in its use. In dysmenor-
rhoea and allied conditions it was very rarely needed; there
was a large field here for the recent antipyretic and analgesic
drugs. In cancer it was invaluable, but should not be used
too early, or the doses increased too rapidly. Much could be
done with £ or i a grain. He strongly protested against the
Digitized by t^-ooQie
218 Dangers of Morphia in Gyncecological Practice .
syringe being placed in the hands of a nurse. In peritonitis
the sheet-anchor to be relied on was not opium, but purgation.
Dr. T. Outterson Wood thought the profession had the
matter to a large extent in their own hands, but in private
practice there were at times great difficulties. As long as
the patient possessed judgment and will-power he was
master of the situation, and could refuse advice. In asylum
practice the chances of cure were greatest, but it was not
there that the majority of cases were met with. It was
rather among borderland neurotics, and when their mental
condition became reduced to one of certifiable disease re¬
covery was rare. i
Dr. Macnaughton Jones, in reply, said that a sad interest
was connected with the reading of this paper. The last
words the late Dr. Hack Tuke spoke to him, a few days be¬
fore his fatal illness, were much in the same language as that
used by Dr. Mercier, viz., “ If all the benefit which had re¬
sulted from the use of morphia were balanced against the mis¬
chief that had followed its abuse, he doubted if the latter
would not largely outweigh the former.” He was indebted
to Dr. Tuke for much of the literature which he had referred
to in the paper. He would remind the fellows that the ob¬
ject of the communication was to draw the attention of the
society to the dangers arising from the indiscriminate use of
morphia subcutaneously. The first point he emphasized was
the influence of temperament on the susceptibility to morphia
intoxication. Inasmuch as, in the case of women, morphia
was frequently given for those subjective pains associated
with pelvic disorders, and in which the nervous temperament
played so large a part, it followed that the greatest caution
and discrimination should be exercised in its use. All ex¬
perience proved that the hysterical temperament was the one
which was the most susceptible to the insidious toxic action
of the drug. This type of case was most frequently exhibited
in reflex pains, which had their source in some functional
disorder of the uterus and ovaries, as in certain forms of dys-
menorrhoea, ovoralgia, etc. He had distinctly pointed out
Digitized by i^-ooQie
Dangers of Morphia in Gynoecological Practice. 219
in the paper that pain arising out of a true pathological con¬
dition afforded a certain degree of immunity from the intoxi¬
cating effects of morphia. This was specially true of cancer.
Its use in this affection was not alone legitimate, but, ^t the
proper time, imperatively indicated. His remarks did
not contemplate the use of morphia in any other class of af¬
fections than those peculiar to the generative organs of
women. He did not refer to men. In an allusion to the com¬
parative frequency of morphinomania in the two sexes,
he had not either alluded to opium , but to the one particular
alkaloid of opium. Some speakers, in the words of Shake¬
speare, “ had drawn out the threads of their discourses rather
than the staples of their arguments.” To speak of opium and
the use of morphia in cancer and other affections was simply
drawing a red herring across the trail of the discussion. In
reply to the president, he affirmed that he had had several
cases within the last few years in which morphinomania and
morphia intoxication had resulted from want of cautious ad¬
ministration of the drug. He (Dr. Macnaughton Jones)
believed that the clandestine use of morphia was rather on
the increase, through the facts which he referred to in his
paper, viz., the giving of prescriptions for quantities of mor¬
phia solutions to patients, and by the abuse of these pre¬
scriptions by the patients themselves or their friends, the
habit became, as he had said, contagious. He had emphasized
the fact that it was the subcutaneous injection of the alkaloid
^ which was so specially dangerous. Of course, Dr. Span-
ton was not serious when he spoke of a subcutaneous injection
as a surgical operation. As to sterility, it was pointed out by
Lewinstein, Erlenmeyer, Regnier, and others as a con¬
sequence of morphinomania. He (Dr. Macnaughton Jones)
had seen this in the case of a married patient who became
pregnant after some years of absence of conception, when
she was cured of the morphia habit into which she had fallen.
He would categorically summarize the different methods of
healing the morphinomaniacs or morphinises: (a) Lewin-
stein’s method of “ abrupt suppression,” or sudden stoppage
Digitized by t^-ooQie
220 Dangers of Morphia in Gynecological Practice .
of the morphia — this had been found to be dangerous and
not to answer. ( b) The plan (Erlenmeyer) of gradual sup¬
pression or gradually reducing the dosage of the morphia and
extending this over some time, (c) The medium course of
moderate suppression, or stopping the morphia gradually in
the course of some 8 to 10 days. This plan may be con¬
tinued with the use of hypnotics. He had given various
hypnotics. In one case urethane answered well, (d) Alco¬
hol had been tried as a substitute for the morphia. This
had failed, (e) Chloral also had been tried and abandoned. (/)
Opium itself had been tried and other of its alkaloids, but it
had not answered. (£*) Nitroglycerine.and other drugs had
been given, but the treatment by suppression combined with
other judicious treatment in control, diet, and the use of hyp¬
notics, was the best plan to adopt. He pointed out the dan¬
ger attending the deception of the patient by the substitution
of water for the morphia. Once it was discovered it was apt
to lead to a sense of indignation on the part of the patient,
and a refusal to be again guided by her physician. The last
state became worse than the first. Suicide might follow, as
in the instance of a medical man whom he knew. He would
place these conclusions before the society:— I. The risk
attending on the use of morphia in the treatment of affections
of the pelvic organs in women is often not sufficiently recog¬
nized. 2. The influence of temperament had to be carefully
considered in its administration, the hysterical and so-called
neurotic temperaments being especially susceptible to the in- #
toxicating effects of the drug. 3. In such cases morphia
should be used only as a dernier resort , and rarely, if ever,
for the relief of what may be said to be subjective pain. This
is true of many cases of ovarian neuralgia and reflex ovarian
pains. Also in those reflex spinal pains arising out of real
or functional disorders of the generative organs of women,
or in the insomnia arising from the same cause. 4. Its use
is particularly dangerous at the climacteric. 5. The risk of
morphia intoxication should be safeguarded against as far as
possible — (a) By the medical man himself, save under very
Digitized by i^-ooQie
Dangers of Morphia in Gyncecological Practice . 221
exceptional circumstances, administering the injection, (b)
Only the quantity of solution requisite for a limited number
of injections should be prescribed at the time. The pre¬
scription, for safety's sake, might be marked 14 not to be com¬
pounded unless re-initialed and dated." (V) By not giving
into patient’s hands prescriptions for hypodermic injections
of morphia, (d) All patients and their friends should be
warned of the dangers attending the repeated administration
of morphia. Morphia should never be administered from
the mere importunity of a patient, unless there is a clear in¬
dication for its employment. Pain arising out of cancerous
conditions and pain arising out of acute inflammatory states
of the adnexa and peritoneum afford an immunity from the
intoxicating action of morphia, and are indications for its
judicious use. As a rule, after abdominal operations, patients
do better without morphia. Lastly, friends and relations
who are in the habit of injecting morphia should be made to
clearly understand that circumstances may arise which
might bring most disagreeable suspicions of either misad¬
venture or design on those administering it.
The Treatment of Inebriates in the District of
Columbia. — Mr. Meredith of Virginia has introduced a
bill for the treatment of inebriates in the District of Colum¬
bia. It authorizes the commissioners to establish a public
hospital for the care and cure of inebriates. Such persons
shall be admitted as are committed to the hospital by the
police court or criminal court of the district, and the judges
of these courts shall have power to commit, for not more
than ninety days, (1) any person convicted of the habitual
excessive use of alcoholic liquors who might be amenable to
commitment to the workhouse ; (2) such persons as may be
recommended for treatment by the commissioners ; (3) such
as may voluntarily apply for admission, and pay for treatment
not less than ten dollars a week. All moneys so received
are to be handed over for deposit in the United States
treasury.
Digitized by C^ooQie
222
Inebriety and Alcoholism among Children .
INEBRIETY AND ALCOHOLISM AMONG CHIL¬
DREN.*
By Dr. Moreau de Tours, of Paris, France.
With a number of writers of the greatest authority we
have often raised our voice with energy against the abuse
the press sometimes makes of its liberty by giving currency
to facts, the publication of which is a real danger to public
morals, because of the unsuspected excitement they cause in
minds which are, no doubt, not well-balanced, but which,
without the examples so presented, might perhaps have
escaped the evil contagion. It is nevertheless right to
acknowledge that amid the multitude of these diverse facts
there are to be found those which, when brought together
and grouped, attract attention and are studied ; but which,
without this publicity of the press, would probably have re¬
mained in the condition of simple observations, scattered
here and there in the collections of specialists. From the
accumulation of these facts one is led to draw precious
teaching, and to send forth a cry of alarm against the evil
that is without cessation invading us, and at length to take
the necessary preventive measures for struggling against the
scourge.,
It cannot be too much insisted upon that alcoholism is
one of the human miseries which can neither be despised nor
denied. This terrible passion ought to excite the attention
of our times, arouse our vigilance, stimulate our thoughts.
The plague is threatening, it increases unceasingly.
We have no intention of recommencing a study which
has already been so often and so deeply inquired into by the
most competent men, moralists, physicians, hygienists, etc.
Our object is narrower, but not on that account less impor-
* Read at February meeting of French Temperance Society, and translated
for Temperance Record of London.
Digitized by LjOOQie
Inebriety and Alcoholism among Children . 223
tant; and it is not without a deep feeling of sadness that we
open a special chapter on alcoholism among children.
It is not seldom we read among the facts chronicled by
the press stories of children picked up in the streets dead
drunk. And these facts are not confined to our country;
they are equally true of foreign countries. As an example,
we have a note from Vienna, which tells us that a school¬
master in the quarter of Leopoldstratt had to give up to his
parents one of his scholars, who had arrived at his class in a
complete state of drunkenness. The child confessed that in
coming along the road he had drunk in a cabaret a quart of
brandy. The journals on that occasion made the remark
that this was unhappily not an isolated case, and that from
time to time scholars were met in the street who were mani¬
festly in a condition of drunkenness.
If we compare these facts with the observations occasion¬
ally published in medical journals, we are really amazed to
see the important rdle , hardly recognized up to a certain
point, which alcohol plays amongst the young. The causes
which determine alcoholism among children are many and
their origin very different. But, like the other affections,
they may be ranged under two principal heads : Fixed
causes and occasional causes.
In the number of causes under the first head the most
important of all is heredity. This is not a new observation,
for in all times there has been noted the evil influence upon
children of alcoholism in their parents, and it is remarkable
that when alcoholism is hereditary it manifests itself at the
most tender age. Numerous cases we are able to give go to
prove the importance that ought to be attached to the influ¬
ence of heredity for the transmission of alcoholism.
But there is another form of hereditary alcoholism, if one
may employ the word in this connection, which is less
known. It is due to that which we shall call the observance
of the traditions of the country or of the family. It is thus
that we see a custom widely prevalent in the northern
countries, and especially in Scotland, of making children,
Vol. XVII.—30
Digitized by i^-ooQie
224 Inebriety and Alcoholism among Children .
in order to appease their cries, suck a plug soaked in
very strong liquor, very alcoholic, of whisky, for instance,
and to strengthen them, after weaning, by doses of the same
liquors, more or less strong. At Leybach, according to
Lippik, especially amongst the poor, it has passed into a
proverb that it is necessary to give wine to infants in order
to facilitate teething. At Vienna, in Austria, a recent in¬
quiry established the fact that parents often made their chil¬
dren drink brandy, and, in consequence, they arrived at the
school besotted with drink.
And in our days, in spite of all that we have been
able to do in striving against such a tendency in our coun¬
try, there are departments where alcohol reigns supreme.
Tourdot, in his work on “ Alcoholism in the Lower Seine/’
tells us that the domestic hearth is there, amongst others, a
school of drunkenness for the children. However young
they may be, they receive their ration of brandy on the
great fete days. And thus is developed among the little
Normans a gross taste for alcohol.
There are other authors who do not hesitate to put to
the account of the treatment (medically) by alcohol, of
which such a great abuse is made in our days, the predispo¬
sition to alcoholism observable in many children. We are
certainly disposed to reprove the abuse which in our days is
made of a treatment, of which, nevertheless, the efficacy is
incontestable. Alcohol may be administered, but it is neces¬
sary to know how to use it without abusing it. In the ad¬
ministration of alcohol it is the strict duty of the physician
to thoroughly examine his patient, to search into his antece¬
dents, and if he discovers there the least trace of alcoholism
he ought to abstain from treatment by alcohol. To give
alcohol under such circumstances is to risk the awakening
of a latent predisposition, a result that at any cost ought to
be avoided. The remedy in such a case would be worse to
fight than the disease. But it is necessary to regard it as a
dangerous medicine, difficult to manage, and to administer it
with precaution in order to obtain from it the good effects.
Digitized by i^-ooQie
Inebriety and Alcoholism among Children . 225
Under this condition, and this condition only, we repeat
that it ought not to be dangerous, but useful.
The occasional causes, we have said, are numerous. But
it is necessary not to lose sight of the fact that in the
majority of cases, if not in all, the children who allow them¬
selves to be borne along by wine are the hereditary, the pre¬
disposed. In the simplest and most frequent cases the
child is thirsty ; he is given wine or liquor, or he takes
it himself. After a first draught he finds and avows “ this
is good/* and he continues without mistrust. The facts
detailed on this subject are not rare, and all are in similar
terms. Here is an example: On the 19th of last May the
police constables met in the evening on the quay of St. Ber¬
nard, two children of twelve and thirteen years of age, com¬
pletely drunk. On being interrogated, these children con¬
fessed that they had broken into a keg of wine that was
lying on the quay in front of the market-place, and that they
had drunk, at first because th$y were thirsty, and afterwards
because they found the wine good, and they continued to
drink until they were completely drunk. Far from putting
a curb on the marked taste which a child shows for strong
liquors, there are certain parents, without conscience, with¬
out prudence, worthless, who on the contrary think it fun to
urge the child to drink and to get tipsy, and by his drunken¬
ness the unhappy child becomes the laughing-stock and the
plaything of the wretches who are not ashamed to impose on
his feebleness and inexperience.
It is sufficient to pass through certain quarters on a
Sunday or a fete day, and then one is astonished to see
at tables with their parents, at the doors of one of those low
wine-shops which swarm in the workmen’s districts, children
of four, five, seven, and ten years of age, with a glass of
wine before them. Does the child refuse to drink, there
are reprimands — sometimes even cuffs are given be¬
cause of his repugnance, and under the rule of terror
he takes the poison. Is he ill after ? Without being put
about, the father answers, as one said to me: “ This little
Digitized by t^-ooQie
226
Inebriety and Alcoholism among Children.
-is not able to take a glass of wine ; it will nevertheless
be necessary that he habituate himself to it.” And another
unconscionable one, whom I incidentally reproached for
giving drink to his son of scarcely seven years of age,
answered me: “ But, doctor, if you knew how gay and
cheerful the little one is when he has drink! And then,
truly, he is so droll, so amusing, that he makes everyone
laugh.”
In spite of all that I have been able to say, in spite of all
the eloquence I have put forth in order to convince the
father of the irretrievable danger to which he exposes his
child, in spite of the blackest picture I have been able to
paint of the miseries which he voluntarily reserves for his
son, I have never been able to make him listen to the voice
of reason. Such parents have treated me as a trouble, a
bird of evil omen, and they do not understand, or rather
they do not wish to understand, that a little wine from time
to time may have a grievous influence on the future of the
child. The father, working a farm, drinks daily, but is never
tipsy. “He bears up with the drink,” he says, “ and it is
impossible the drink should work evil in the child.” What
a sad destiny is reserved for this child ! Son of an alcoholic,
he will soon become one himself, and that more quickly
through the double influence of heredity and education.
Note that this is not an isolated case. There are legions of
parents who are so wanting in intelligence as not to under¬
stand all the danger there is in teaching their children
to drink. Without regard to her dignity, and forgetful of
her rble> it is sometimes the mother herself who forces her
child to drink. And there are unscrupulous shipmasters
who, in order to get a maximum of work out of their appren¬
tices and their cabin-boys, induce them, and themselves
urge them, to drink. We are preoccupied at this moment
with the traffic in spirituous liquors in the North Sea. The
traffic takes place on board what are veritable floating
taverns, and is becoming greater and more extended every
day.
Digitized by
Google
Inebriety and Alcoholism among Children . 227
The dipsomaniac, who must not and ought not to be
confounded with the alcoholic, may be and almost always is
one predisposed by heredity; but in any case he is not
a vicious person. He is partially delirious, the attacks inter¬
mittent; he is the prey of a veritable impulsive madness.
This delirium manifests itself by paroxysms, and that is an
essential characteristic. Dipsomania is not an appendage of
men only ; it is very frequently met with in women, and
amongst young girls as they arrive at womanhood.
The form which intoxication assumes among children
varies much. We may there encounter almost all the varie¬
ties that we see among adults. Nevertheless, there is one
form more frequent — constant, we might say— and that is
the form we may call massive. The child who has drunk to
excess generally falls dead drunk, struck down. With him
the first two phases of intoxication, that is to say, exaltation
of the affections and of the intellect, pass most frequently
unperceived, and without opposition he arrives at the state
of comatose apoplexy, from which nothing will draw him.
The form furious is equally observable ; it is a veritable fit
of acute mania. As to the form gay , it is but the first
degree of intoxication which we have already pointed out.
The pathological manifestations may be ranged into two
groups. In the first we place the diseases of the under¬
standing, the affections, the morals (aberrations of the
feelings, delirium tremens , etc.). In the second we place
the physical diseases (cirrhose). We have examples of
them, but it would be too long to enumerate them here.
A priori , the prognostic ought to be very reserved, for if
at times through care and precaution, by means of hygiene,
and above all by the aid of the parents, we can succeed in
moderating the habit of intoxication in the child, if we are
able thus to rein up his defects, it does not the less remain
a terrible inheritance. The evil, we may be certain, will not
lose its rights. It may be calmed for a time, but at the
moment when we expect it the least it will be seen to reap¬
pear, not under the primitive form, which shall have been
Digitized by ^ooQie
228 Inebriety and Alcoholism among Children .
cured, but under a new manifestation, affecting principally
the nervous system (nervous madness), or the respiratory
system (tuberculosis). It is in this way we discover those
cases of false cures we have studied in a previous paper.
How often, after a cure which has been believed to be
complete, an insignificant occasion has reawakened the evil
which was asleep, but not destroyed ! It is necessary never
to pledge ourselves that a cure has been effected when the
question is alcohol. “ Who has drunk will drink,” says the
proverb, and never has proverb been more fully justified.
Now, when the observation of every day shows us that
persons who can understand the voice of reason fall again
inevitably and fatally into their vice, we can understand how
dangerous it is to maintain that the child who has once
given himself over to drink will not recommence, one day or
another, in spite of all that we may be able to do to cor¬
rect him.
The cure of alcoholism in childhood ought to be looked
at from three points of view, according as we have to
struggle against the grievous tendency of heredity, the per¬
sonal disposition of the child to give himself up to drinking,
and the effects, acute or chronic, due to the absorption of
alcohol. The fact cannot be disguised that the preventive
treatment is the best of all, and the true preventive treat¬
ment in respect of childhood is the treatment of progenitors.
In suppressing alcoholism in the parents, you suppress the
terrible effects alcohol produces in the children. But this is
an Utopia. Since the world was the world, man has always
had recourse to spirituous liquors, and unhappily, alas! has
not limited himself to the use of them. Very soon he has
passed to the abuse of them. We cannot hope to be able
completely to cure this deplorable mania. Let us seek to
lessen it, to diminish it, and this will assuredly be a great
step.
But how is this desired result to be arrived at ? Who
can prevent drunkards having children ? It is often amidst
the fumes of vice that the alcoholics are the most strongly
Digitized by
Google
Inebriety and Alcoholism among Children. 229
drawn to the pleasures of sense. Do you say that reason
and good counsels will be effective ? A moving picture of
the fate he prepares for his children ? The alcoholic will
yield to your reasons ; he will agree with you ; he will
promise you all that you wish, and there is no reason to
doubt that he will do all this in good faith. But temptation
is stronger than his promises ; a glass is very quickly drunk,
and the best promises fly away with the first drops of the
treacherous drink. “ The struggle against drink cannot be
efficacious except upon the condition that society and the
public authorities comprehend the extent of the danger, and
recognize the pressing necessity of taking in common effi¬
cient measures against the all-powerful enemy.”
Certainly the preventive treatment is the most efficacious
for alcoholism in the young. But the evil having been
acquired, what remains for us to do ? What are the meas¬
ures we have at our disposal, and what ought we to attempt
in order to lessen the evil ?
Here hygiene plays the most important part. Attention
to hygiene by private individuals and attention to hygiene
by the public authorities are powerful factors in the struggle
against the scourge. Since it is common that men drink
wine, is it not a chief point not to give him injurious sub¬
stances which, even under the name of wine, brandy, liquors,
etc., are only disguised poisons, and on that account all the
more to be dreaded, since they conceal under an agreeable
taste their dangerous and terrible effects ? We agree com¬
pletely with the proposition of M. Brouardel, who demands
that only pure drink should be sold, without the addition of
any injurious substances.
Is it not also, and above all, to the social elevation of the
working classes that it is necessary to address ourselves ?
Certain it is that after a day of labor the workman, who re¬
turns fatigued and does not find his home a place where he
may rest himself, goes to the tavern and there learns to
drink. Is he blamable for this ? Once on this declivity he
does not stop, he cannot stop. He spends his wages on
Digitized by CjOOQie
230 Inebriety and Alcoholism among Children .
drink, black misery enters his dwelling, but little he cares
for that. He has taken his course. He drinks and drinks al¬
ways, expends in killing himself that which he has painfully
earned, and is indifferent to the sight of his children who
cry for bread. To succeed in ameliorating this condition of
things would not, it is true, destroy drunkenness, but it
would be a great step in advance.
It must not be forgotten that the evil reigns as master
among the upper classes, where are to be found all the
conditions of comfortable living. We see men of the world
giving themselves over to their disastrous passion with¬
out discredit, without shame. These are diseased, and we
find such equally in the working class. But how many
alcoholics have become such by frequenting taverns, who,
in other surroundings and in other family conditions, would
never have dreamed of following the example of their com¬
panions ? There is here a great social question, which it is
difficult to solve, it is true, but which is, nevertheless, not
insoluble. When public hygiene shall have become what it
ought to be, it is certain that alcoholism will be diminished.
When alcoholism is disclosed, and it is found to be an
acute case, it is necessary to have recourse to curative treat¬
ment. Among children we have most frequently to do with
cases of acute drunkenness. Monin has very well indicated
what it is necessary to do in these circumstances. In the
rarer cases of delirium tremens , the treatment is that which
is followed with adults, but modified, according to age, after
the admitted rules of therapeutics. In a word, the curative
treatment is that of the symptoms.
The law of 1873, for the repression of public drunkenness
and for struggling against the progress of alcoholism, enacts
many penalties against those who are found in a state of in¬
toxication. But they are applicable to adults and not to
children. And thus, as in the cases we have cited, the
child is not punished; he is discharged with a rebuke.
The punishment, however light it might be, would be felt by
the child, upon whom the apparatus of justice always pro-
Digitized by ^or)Qie
Inebriety and Alcoholism and Children .
231
duces a great effect. Who knows whether some punishment
would not be an effective means of repressing his tenden¬
cies ?
But should this action by punishment be taken against
the predisposed, the hereditary ? Evidently not; the fatal
blemish cannot be made to disappear; it is almost certain
that, sooner or later, the unhappy ones will succumb.
These are only in part amenable to the judicial tribunals ; it
is for them and them only that we can plead extenuating
circumstances. They should be placed under the physician
rather than the justice. They are the diseased to whom it
is necessary to apply the rules of a rigorous therapeutic.
But be this as it may, we should not neglect the chances of
safety, small as they may be; and although a punishment
justly inflicted does not eradicate the evil, except in some
cases, have we a right to neglect the chance of safety which
is offered to us? Ought we not to struggle energetically by
all possible means ? It is for the legislator to frame the
enactment we wish to see inscribed on the statute book for
the suppression of drunkenness ; and it is for him to furnish
an arm the more for the fight against the scourge which
every day invades us more and more.
To sum up:
Drunkenness exists among children, and is more fre¬
quent than people imagine.
It is observed amongst them in nearly all the forms in
which it is found among adults.
In the majority of cases it manifests itself among the
predisposed, the hereditary, the degenerate.
The prospect is most serious on account of heredity and
the uncertainty of treatment.
The treatment ought to be principally, and above all,
preventive, not neglecting, however, the treatment of symp¬
toms and complications.
Vol. XVII.— 31
Digitized by
Google
232
Alcohol and Pneumonia.
ALCOHOL AND PNEUMONIA.
By Julius Pohlman, M.D.,
Professor of Physiology in the University of Buffalo , N. Y.
The action of alcohol on the different organs of the
human body has been investigated so carefully and system¬
atically that it almost seems impossible to add anything new
on the subject. Looking over the literature we find abund¬
ant evidence of careful study of the question in its bearing
upon heart, brain, liver, kidneys, and the digestive tract; but,
strange to say, the lungs have apparently escaped attention,
although a few straggling notices hinting at the true relation
between alcohol and the respiratory organs have been pub¬
lished at different times and in different countries. As early
as 1855 Dr. B. Cohen ( Zeitschr\ fur klin. Medizin , Breslau,
1855, p. 401) maintained that the abuse of alcoholic drink is
a strong predisposing cause of death when the drinker is
attacked by pneumonia. Out of fifty-seven such cases treated
at the Breslau Hospital, twenty-four died. Another notice
confirming this statement is given by Dr. William Osier in a
report on pneumonia in the Pennsylvania Hospital. Accord¬
ing to this authority, pneumonia is, as a rule, fatal if a drinker
is attacked when under the influence of alcohol ; if cases of
chronic alcoholism are excluded, the death-rate for that dis¬
ease in the Pennsylvania Hospital, 29 per cent., would be
only 8 or 10 per cent. A few reports are on record of autop¬
sies made on children who died after drinking large quanti¬
ties of strong drink, stating that the lungs were dark and
congested, but no experimental evidence has been given as
to the action of alcohol in the production of pathologic con¬
ditions of the lung-tissue.
In order to determine this question I made a series of
experiments during the winters of 1890, 1891, 1892, and
1893, and the results are embodied in this report.
Digitized by i^-ooQie
Alcohol and Pneumonia.
233
The animals used were dogs, male and female, mongrels
of very mixed origin, picked up from the streets by the city
dog-catchers. They ranged in weight from fifteen to twenty-
five pounds, and were all apparently in good health, if vora¬
cious appetites and strong fighting propensities can be
accepted as indications of physical well-being. Twelve ani¬
mals were used during 1890-91, ten the following winter,
and nine during the winter of 1892-93.
The experiments were simple. The animal, carefully
etherized, received an injection of a quantity of commercial
alcohol, varying from one dram to one ounce, into the tra¬
chea just below the larynx, by means of a large hypodermic
syringe. After the narcosis had passed away the symptoms
were noted, from hour to hour first, from day to day later,
and post-mortem examinations made after a certain time,
varying from half an hour to four weeks, gave evidence of
the internal conditions of the respiratory organs.
The general symptoms were invariably the same, differ¬
ing in severity only according to the quantity of alcohol
given and the age, weight, and strength of the animal exper¬
imented upon. The terms age and Strength are used guard¬
edly, for the temptation is strong to say “ idiosyncrasy; ”
otherwise it is difficult to account for the different effects
produced by equal quantities of alcohol upon dogs of the
same weight. For instance, two dogs, each weighing twenty-
five pounds, were treated with a dose of two drams each, and
one died after one hour, and the other after six hours ; while
two other dogs of twenty-four pounds weight, and two more
weighing respectively fifteen and eighteen pounds, received
the same quantity, two drams each, and all four survived and
were as well as ever after four weeks. One dog, weighing
eighteen pounds, died in five minutes after receiving two
drams of alcohol, while another, of fifteen pounds weight,
took one ounce , and recovered.
So, where there is a similar idiosyncrasy in dogs as there
is in men, or whether the differing results were due to age
and strength of the animal, is an interesting question open to
discussion.
Digitized by ^ooQie
234
Alcohol and Pneumonia .
The symptoms in all dogs experimented upon were alike
and as follows: difficulty in breathing, increasing with the
advance of the inflammation set up in the respiratory pas¬
sages by the action of the alcohol, until it finally resembled a
wheezing noise and called into activity all the accessory
respiratory muscles ; stethoscopic examination gave evidence
not only of the difficulty which the air encountered in trying
to force an entrance into the bronchial tubes and air-vesicles,
but also of the tumultuous beating of the heart while attempt¬
ing to drive the blood through the capillaries of the lung.
Copious expectoration of a bloody, frothy mucus indicated
the progress of the disease.
As the animal weakened it usually pressed itself against
the wall of the room with the thorax as much as possible
resting on the floor, and displayed a constant desire for cold
water, probably due to the feverish condition induced by the
inflammation. No temperatures were taken, for after three
thermometers had been broken by the struggles of the ani¬
mals the attempt to gain correct information on that point
was abandoned.
Post-mortem examinations always showed the lungs dark
and congested, solid in some places, so solid indeed that
these parts sank when thrown into water.
Cutting into the lung, the air-passages were found to be
always filled with bloody, frothy mucus ; even the animal
that died five minutes after the injection, presented the same
symptoms. The lungs were dark and congested and full of
bloody mucus, showing the rapidity of the inflammatory pro¬
cesses and clearly demonstrating how acutely sensitive the
respiratory passages are to the action of alcohol.
There is probably no danger of meeting contradiction
when we define pneumonia as an inflammation of the lung-
tissue, whether of bacterial or traumatic origin, of lobar or
lobular form, need not concern us here, as long as we are
satisfied that these inflammatory processes produce the phe¬
nomena observed in the respiratory passages during an
attack of the disease.
Digitized by CjOOQie
Alcohol and Pneumonia,
235
Alcohol introduced into the lungs of dogs sets up a pneu¬
monia more or less severe. Whether we call it a traumatic
pneumonia, or a broncho-pneumonia, or coin a new name for
it, will not change the fact.
On microscopic examination of such lung-tissue the air- .
tubes and vesicles are found to be partially or completely
filled with immense numbers of red and white blood-corpus¬
cles and large quantities of mucus, and present the same pic¬
ture as that obtained from a slide made from the lungs of a
child that died from broncho-pneumonia, and although one
is from a human being, the other from a dog, the former
representing a well-known type of disease, the latter an arti¬
ficial form, the similarity between the two is certainly strik¬
ing enough to prove that the pathologic condition of the
lung-tissue is the same in both, and that the alcohol has
induced inflammatory processes very closely resembling, if
not absolutely like, those found in attacks of broncho-pneu¬
monia in human beings.
Admitting then that alcohol can produce all the grades
of inflammation of the lung-tissue from the mildest to the
fatal form, according to the quantity used, we can perhaps
understand to some extent why drunkards if attacked by
pneumonia will succumb more speedily than the patient of
temperate habits.
By virtue of the alcohol coursing with the blood through
the lung-capillaries on the one side, and the alcohol exhaled
with the breath, be it ever so little, filling the air-vesicles and
air-tubes on the other side, the lung-tissue itself, so sensitive
to alcohol, stands between two fires, so to speak, and must
be in a chronic state of semi-engorgement, of mild inflamma¬
tion, like the highly-colored nose of the drunkard or the
engorged mucous membrane of his stomach.
Certainly such a state of affairs will change the normal
condition of the cells of the lung-tissue and reduce their
vitality, and in proportion their power of resistance to
external influences ; and if now a severe, acute form of inflam¬
mation, such as pneumonia, is added to the pathologic condi-
Digitized by CjOOQie
236
Alcohol and Pneumonia.
tions already existing, the lungs find themselves powerless
against the attack of the disease, and the drunkard's death-
rate from pneumonia illustrates the time-honored law which
says that an organ or organism weakened by previous ills
cannot compete with normal organs in fighting the battles
against acute diseases in the struggle for existence, and the
man of temperate habits, with lungs free from alcoholic
inflammation, has from five to seven chances for recovery
from pneumonia when the drunkard has only one.
Twenty-eight per cent, of the inmates of the mad-houses
in Austria are drinkers. In the month of August, 1894,
twelve drinkers suddenly became insane in Vienna. He
further stated that drunkenness affects the increase of pop¬
ulation. Out of 57 children from 10 drunken families, only
9 were strong enough to live; whereas out of 61 children
from 10 families, where the parents were sober people, 50
remained healthy. Drunkenness increases crime. Fifty
per cent, of all criminals committed their crimes through
excess of drinking. In the years 1871 till 1875 the Viennese
police alone were obliged to arrest 25,000 people for drunk¬
enness. Dr. Roser says that what the country gains from
the tax in the manufacture of spirits, it loses in its lunatic
asylums, prisons, and its criminal courts.
Inebriety seems to be increasing as shown by the figures
of the Interstate Revenue Commissioner for 1893. This
report says that the sixty-five odd millions, comprising the
population of this country, consumed 88,777,187 gallons of
alcoholic spirits and 1,054,785,376 gallons of beer during the
year. These gallons would make more than 6,000,000,000
drinks of whisky and nearly 13,000,000,000 glasses of beer,
for which there was paid to the barkeeper $ 1,226,258,000.
The naked figures are sufficiently eloquent of the resultant
amounts of misery, disease, and premature death.— Food .
Digitized by t^-ooQie
The Opium Curse and its Prevention .
237
THE OPIUM CURSE AND ITS PREVENTION.
T. J. Happel, A.M., M.D., Trenton, Tenn.
In a paper written a few years ago, entitled, “ Morphin¬
ism in its Relation to the Sexual Functions and Appetite;
and its Effects on the Offspring of the Users of the Drug,”
I gave a detailed account of eight families in which the
mothers were addicted to the use of morphine. Since that
paper was completed and read, I have had occasion to note
the effect of the drug in a few other families, and the results
have served to confirm the views set forth in that paper, viz.:
That the children of mothers who are habitual users of the
drug, in the majority of cases die within a week of birth,
cyanosed from an incomplete development of the heart.
Second: That if they survive the first year, they are puny,
delicate, nervous children, lacking in everything going to
make up a well-equipped boy or girl, mentally and physically.
Third: Should any of the offspring of such mothers attain
to adult life, they become either morphine habitues, or drunk¬
ards. That the effect upon the mother is such as to trans¬
mit to her offspring the disease as a heredity, just as tuber¬
culosis—not that the disease itself is transmitted, but that
“ a condition, a soil, a nidus, or whatever you may please to
call it, is handed down to the child, and some fortuitous cir¬
cumstance develops the disease.”
If this be a true picture, and I am constrained to believe
that it is, a great responsibility rests upon some one to pro¬
claim the evil everywhere and to enforce every possible
means of preventing it. The most important branch of med¬
icine to-day is that of prophylaxis. Disease is easier to pre¬
vent than to cure. To cure this curse, the using of the drug
must be prevented. Once in its toils, to abandon the use of
it is one of the greatest undertakings. It has been truly and
aptly said, that to abandon its use is to suffer the tortures of
Digitized by ^ooQie
238 The Opium Curse and its Prevention.
the damned. Further, without the full and free consent of
the patient, and his or her hearty co-operation, to break the
morphine habit is well nigh impossible. I would say noth¬
ing to discourage any one, but my own observation teaches
me that it is far easier to abandon alcohol than opium. The
using of opium is increasing daily. Public sentiment cries
out more loudly to-day than ever before against the use of
alcoholic drinks. Public opinion is against it. The dram-
drinker is not countenanced in polite society. All business
enterprises and corporations discriminate against those who
use alcohol. The great railroad systems put as a first ques¬
tion to an applicant for a position in their employ: “ Do you
use alcoholic drinks of any kind ? If so, how much, and
what ? ” Not content with the answers of the applicant, his
character upon that point is closely investigated at home
where he is known. Should it appear that he uses intoxi¬
cants, he is at once refused a position. Further, an employe
is at once dismissed if found at all under the influence of
liquor. One drink is recognized as, to that extent, unfitting
a man for a trustworthy position in the employ of the com¬
pany.
One of the most important questions in all life insurance
applications is: “ Does the applicant use any stimulant in
the form of any alcoholic drink ? ” Should it be shown that
he is a regular drinker, he is at once rejected. The fraternal
orders are all blacklisting saloon-keepers and bartenders.
These things are cited to show the current of public
opinion. The retail sale of liquor is regarded by communi¬
ties as disreputable, but are we not “ straining at a gnat and
swallowing a camel ? ”
Forty years ago the United States imported 72,000
pounds of opium ; in 1880, 372,000 pounds ; and in 1893,
nearly 1,000,000 pounds. This increase is largely out of
proportion to the increase of population and the legitimate
demands of medicine. The medical and surgical world were
never more united upon any one measure than on the effort
to discourage the use of opiates in many diseases where it
was formerly thought and taught to be sine qua non .
Digitized by t^-ooQie
The Opium Curse and its Prevention . 239
Within the twenty years of my practice, I can see that
not more than one-fourth as much morphine is used now as
was used when I began work. The teaching of to-day is,
when in doubt as to the propriety of an opiate, do not give it.
The medical profession, then, is not to be censured for
the increase in the consumption o£ morphine. Its use is
continually discouraged by all reputable practitioners of
medicine.
Of course in the last stages of incurable diseases, such as
cancer and the like, a sufferer is excusable if he uses the
drug, but not otherwise. The physician is frequently un¬
justly blamed because Mrs. A., or B., or Mr. C., or D., uses
an opiate. In not one case in a thousand of this kind should
any blame attach to the physician, because had he or she
never taken a dose of an opiate except when it was pre¬
scribed by the physician there would have been no trouble ;
but once having found relief, the patient concludes that he
can free himself from pain and at the same time save the
cost of calling the physician, by bringing out the morphine
bottle or the opium pill that had been put by for an emer¬
gency. Relief once obtained in this way invites another
trial; soon the habit becomes fixed and the party becomes a
morphine habitu£, or an opium-eater or smoker.
Is the physician to blame in such a case ? Nay, verily !
He did right. The patient must shoulder the blame. The
severity of the pain when the physician was called demanded
relief, and a relaxation of the spasm of the muscles was nec¬
essary before the cause of suffering could be removed. For
this purpose the opiate was given. The physician had noth¬
ing to do with the subsequent doses. Had they not been
sold to the patient, he would not have been tempted and
would not have fallen. A dose of an opiate, excepting par¬
egoric or laudanum, should never be administered, save as
ordered by a physician.
On September 13, 1894, this fact was most forcibly
impressed upon my mind. I was called to see a two-year-
old child suffering enteritis. The patient had been well
Vol. XVII.—32
Digitized by t^ooQle
240 The Opium Curse and its Prevention.
treated by the attending physician, but with no improve¬
ment. On consulting in regard to the case, a course of treat¬
ment was readily agreed upon, and it was remarked by the
attending physician that he had not been able to quiet the
child with what he considered full doses of an opiate, repeated
every two or three hours. The mother, when called and
questioned in regard to the dose of paregoric given, stated
that she was administering a full half-teaspoonful every two
hours, but that it had no effect upon the child. To an
inquiry as to whether she had ever given the child any form
of an opiate, she answered that she occasionally gave it a
small dose of morphine; that she began using it for the relief
of crying spells, when younger. Asked to show how much
morphine she gave at a dose, she measured out a full third
of a grain, for a child about two years old—fully seven times
the usual dose. This at once revealed why no effect had
been obtained from the medicines already administered.
This dose of morphine was measured from a bottle produced
from the family medicine shelf. No physician had ever ad¬
vised morphine for the child.
Too often is it the case, the first investment made in a
family when a child is born, is a bottle of “ soothing syrup; ”
“ Bateman's Drops ; ” somebody's “ quick cure for colic," or
some such-like remedy. All of them are sold warranted to
contain no morphine or opium. The various consumption
cures and cough remedies, with high sounding titles—too
many, with the certificate of some business man, lawyer, or
preacher appended, attesting their virtues—put upon the
market at the present time and sold over the druggists'
counter, are to blame for many a ruined member of society,
cursed with the opium habit. This is not overstating the
matter—rather understating it. Ninety-nine out of every
hundred of these various preparations sold contain opium in
some form although they state upon their faces that they
contain no “ morphine." They may not contain simply mor¬
phine, but the foundation is some preparation of opium, and
they sell because they stop the cough and make the “ patient
Digitized by LjOOQie
The Opium Curse and its Prevention. 241
feel good.” A dose of paregoric, laudanum, opium, or mor¬
phine would do the same. Once having obtained relief, that
patient advises some one else of the wonderful relief and
benefit he, or she, obtained and the new victim tries it, and
soon another fully-fledged opium habitue results.
Should a dose of such stuff be given to the offspring of a
morphine-using mother, the smouldering fire at once begins
to burn. The thing necessary to develop the habit has been
given—the match has been applied to the rubbish pile, and
it at once blazes up and burns with a flame that can not be
subdued. Doctor Crothers, of Hartford, Conn., cites many
cases in proof of this statement. One will answer my pur¬
pose. “To parents, both neurotic and probably opium-users,
a child was born. They died, leaving the child nervous and
irritable. Morphine was accidentally given to quiet it, and
from that time forward it became delirious without a daily
dose of morphine. At five years of age, it died a confirmed
morphine-user.” The literature of the day abounds in such
cases. Was the physician to blame there ? Nay, verily!
I have, in my own experience, met with a similar case
where two sons, born to an opium-eating, morphine-using
father, shortly after budding into a promising young man¬
hood, began the use of whisky and morphine, and soon
became wrecks mentally, morally, and physically ; one dying
not long since ; the other being, in every sense of the term,
a wreck. Though living, he is worse than dead.
Dr. Jules Rochard, in Le Union Medicale , draws a gloomy
picture of the increase of the morphine habit in France and
elsewhere. The habit, he finds, becomes incurable at the
end of six months of indulgence. The fair sex and the doc¬
tors are, in his opinion, most deeply addicted to the use of
morphine. Women seek less to hide the vice than do men.
As a rule, men, and especially medical men, take the great¬
est pains to hide their vice—hence the number of those who
use the drug cannot be correctly estimated.
In many cases parties have used the drug for years with¬
out being suspected of such a habit. The current literature
Digitized by i^-ooQie
242 The Opium Curse and its Prevention .
abounds in many such cases. A few years ago I was treat¬
ing a medical friend in a case of pneumonia. I was much
worried by the irregular effect obtained from the medicines
administered, and, at the time, suspected that an opiate was
being used, but could get no positive proof of the matter.
A few days since, I learned beyond question that my quon¬
dam patient was a confirmed morphine-user. These are not
exceptional instances. Numbers of just such cases, not only
among medical men but also among the laity, are cited in
Hare's Practical Therapeutics . This ability to conceal the
habit is one of the distinctive points in the use of alcohol
and opium.
A native Chinese preacher, in comparing the two vices,
stated that he found this one striking difference between the
effects of the opium vice among his countrymen, and those
produced by alcoholic intemperance among Americans:
“ When the Chinese opium-smoker comes home at night, he
does not abuse his children and kick his wife ; his wife kicks
him.”
The use of opium in some of its forms is, in my opinion,
on the increase, and while the medical profession cannot be
blamed therefor, it should, however, be held to some extent
responsible for the state of affairs, because, standing as we
do or should upon the watch-towers, we do not proclaim
boldly to the families under our charge the dangers lurking
in the use of all such remedies. We do not make proper
inquiries about the progress of our little ones, and keep the
parent posted upon the various household remedies admin¬
istered. Many deaths have been reported of children a few
months old, from unknown causes, where a careful inquiry
would show beyond cavil that they were cases of opium poi¬
soning.
I need not pursue this branch of my subject any further.
Any one by a little investigation can establish the truth of it.
The druggist sells the medicine, which he buys, for the
money that is in it. He does not trouble himself about the
composition of it. He reads the label, notes what it claims
Digitized by CjOOQie
The Opium Curse and its Prevention . 243
to cure, and when a human being calls for a remedy to meet
a certain ailment, he recalls the fact that he has on his
shelves a bottle warranted to cure just such a case. He
takes it down, assures his victim of the efficacy of the mix¬
ture, and sells it to him, pocketing at the same time a hand¬
some profit. The remedy may do more harm than good, yet
the druggist is not responsible. He has the stuff for sale,
and the man wanted it and got it.
This could be prevented: First, by allowing no patent or
proprietary medicine to be sold over the counter, which does
not show on its label its true and exact composition. Any
falsification in such matter should be punishable by a heavy
fine. Second, no one should be allowed to sell drugs who is
not a qualified pharmacist. In other words the present phar¬
macy law should be improved and made to apply to the
whole State.
Were these ideas carried out and enforced as laws, all
“ soothing syrups,” “ consumption cures,” “ microbe killers,”
and such like would show upon their face their exact compo¬
sition ; and the mother would know with what deadly stuff
she was drenching her child; would realize how rapidly she
was laying the foundation upon which, in time, would develop
a fully-fledged opium-eater.
In the next place, the law regulating the sale of poisons
should be rigidly enforced. It reads as follows :
Milliken and Vertrees' Code. Art. E., Sec. 5635. “Any
person who sells or delivers any poisonous liquid or sub¬
stance, in addition to having the word poison printed or writ¬
ten on the label as now required by law, shall note, in a book
kept by such person for that purpose, the name of the person
to whom such poison was delivered, the date of delivery and
the kind and amount of such poison so delivered, and shall
keep such book open for public inspection.”
Sec. 5636. “ Any person violating the provisions of this
article shall on conviction be fined not less than $20, nor
more than $100. This article shall not apply to the pre¬
scriptions of regular practicing physicians.”
Digitized by ^ooQie
244 The Opium Curse and its Prevention .
Sec. 5637. “Any person, except a practicing physician
in prescribing for a patient, who sells and delivers any tartar
emetic, laudanum, morphine, or other drugs or medicines,
without having the common name thereof written or printed
on a label attached to vial, box, or parcel containing the same,
shall on conviction be punished as provided in the preced¬
ing section.”
Sec. 5638. “Any person who sells to any child under
ten (10) years of age, any poisonous liquid or drug, without
an order in writing from the parent, guardian, or other per¬
son having the legal care of such child, designating such
drug either by its name or effect, shall on conviction be pun¬
ished as provided in Section 5636, and may also be impris¬
oned in the county jail not more than three months.”
The provisions of the law are plain. Morphine, opium,
and laudanum are poisonous, and will kill with as much cer¬
tainty as will strychnine, arsenic, and such like poisons.
Not one druggist in one hundred complies with the law.
No register is kept in which to note the sale of poisons.
Any thing called for is sold, and no questions are asked,
except, “ Where is the money ? ” When that is produced,
the sale is completed and the drug is delivered. Often and
over, a child of less than ten years of age steps into a drug
store with a fifty-cent piece and a small scrap of paper,
inscribed with one word “ morphine.” No name is signed.
No questions are asked. The bottle of morphine is wrapped
up and passed to the child over the counter. A death may
follow on the sale, but the morphine cannot be traced. No
register is kept in which the sale is noted, and hence no
proof exists that A. or B. sold the poison, and no prosecution
follows. Druggists say that the amount of opiates sold is
beyond the comprehension of the average doctor, even ; that
they sell it day by day without knowing or even inquiring
for whom it is bought. Such should not be the case, but so
long as any irresponsible party, or child of tender years can
buy without let or hindrance, the awful traffic will grow.
If the laws were enforced to the letter, and the name of
Digitized by v^ooQie
The Opium Curse and its Prevention . 245
the purchaser of every grain of morphine entered in a public
ledger open to the inspection of friend or foe, where the
buyer did not present the prescription of a reputable physi¬
cian for the drug, a halt would promptly be called. Even a
chronic opium-user would draw back and* hesitate to allow
the public to know the quantity of the drug he or she con¬
sumes, for it is an incontrovertible fact, that open and noto¬
rious morphine habitues will always minimize the amount of
the drug used. Time and again, in answer to the question
as to how much the individual used, have I been given a
quantity of about one-third or one-fourth of the amount that
I knew was consumed. The opium-eater does not want the
public to know how much he consumes. The habit is car¬
ried on in secret for years, till it bursts upon the public in
some unexpected way.
The user of the drug will sacrifice money, place, position,
honor; nay verily, in some cases even virtue itself, to obtain
the vile stuff, arid until some sacrifice of this kind is made
upon the altar of appetite the habit remains concealed. It
is a habit more seductive than alcohol, because, so to say, for
a long time it can be kept as a private vice, while the habit
of using alcoholic drinks cannot be kept long concealed.
The odor upon the breath, the bloom upon the nose, the
flushed face, the protruding abdomen, and many other signs
soon proclaim the dram-drinker, while opium can long be
indulged in without being generally known. The sleepy
state as the drug wears off can be accounted for by a rest
broken by watching a sick friend, of an undue nervousness
from some cause.
The female sex does not often, in the country and small
towns, become addicted to the use of alcohol, while opium
claims more of them as its devotees than of the male sex.
The latter attracts men and women; the former, as a rule,
men only.
If the vicious habit, the use of opium in any of its forms,
imposed a penalty only upon the person using, then the
damage done would not be so great, but the unborn child
Digitized by i^-ooQie
246 The Opium Curse and its Prevention .
suffers—the evil is entailed. The sins of the mother are
visited upon the children of even the third and fourth gener¬
ations. The child, through no fault of its own, must suffer
from the evil habits of one or both of its parents. This state
of affairs should not be. The strong arm of the law, which
looks closely after the moneyed interests of the child left an
orphan, should be invoked to prevent a far worse condition
than that of a moneyless orphanage. The child with no
constitution at all, or with one leaning to vice and immoral¬
ity, is a proper charge upon the state. If the state does not
engage in prophylaxis, later on she will find that curative
measures are both costly and, in many cases, without favor¬
able results. Let, then, the physician do his part, and the
laity do its part. Let both see that the existing laws are
carried out to the letter: let them work together to get
better laws enacted, and a great step will be taken in the
fight against opium. Prevention is better, and more avail¬
able in this instance than any other course.
As both a preventive and a curative measure, all chronic
inebriates and opium-eaters should be committed to the
insane asylums for treatment, and kept there until com¬
pletely cured. No half-way measures should be taken in
such cases. Laws should be passed broad enough in their
scope to reach all such cases, and so drawn as to meet all
objections that could possibly be urged upon the grounds of
personal liberty. Opium-users should, to all intents and
purposes, be treated as persons dangerous to the public, and
not permitted to be at large.
The insane dodge is set up by them, when they violate
the laws of our State, and this method of treatment simply
would recognize the possibility of the existence of such a
condition.
This paper has been written to air no pet theory of my
own, but to invite the attention of the society to a great and
growing evil.
1. Make our druggists obey the laws. Protect ourselves
against them.
Digitized by L^OOQie
The Opium Curse and its Prevention ,
247
2. Let the patients know that if they will use the drug
the unborn generation shall be protected, so far as it can be
done, by putting the users where the drug cannot be gotten
and the habit is broken.
TOBACCO AND BLINDNESS.
The Australian papers have recently published accounts
of an epidemic of blindness in horses pastured in a district
on the banks of the Darling. The horses grew very gradu¬
ally blind. It was suspected that their infirmity was due to
eating the leaves of the Australian tobacco, Nicotiana suaveo -
lem . This plant began to grow in the affected district shortly
after a flood, and the epizootic blindness followed. Baron
Ferdinand von Muller, who has written on N. suaveolens , also
discovered that a similar plague of blindness among horses
in Western Australia arose from the animals feeding on a
plant known as the grass lily. The whole question is dis¬
cussed by Dr. Husemann, of Gottingen, in the Deutsche med.
Wochenschrift of October 25. An infusion of the native
tobacco leaf quickly killed a purblind stallion from the
affected district. The chief point of interest in relation to
“ tobacco amblyopia ” in man is the long time which this
process of poisoning took to blind the horses. The blindness
often took two years to become complete. It appeared to be
incurable. The beast showed no signs of disease elsewhere,
a blind mare and a half-blind horse being able to go 600
miles at easy stages to a veterinary station. Thus, as in
man, tobacco amblyopia is not incompatible with bodily
health.— British Med . Journal\
Paresis coming on from syphilis and associated with
excessive use of spirits is not uncommon, and is often
masked and not recognized. Cases of inebriety are often
paretic with a syphilitic origin, and require very active
medication, and even then are incurable. Traumatism is
often associated and requires careful diagnosis to eliminate.
Vol. XVII.—33
Digitized by
Google
248 Personal Observations with Nitrate of Strychnia
SOME PERSONAL OBSERVATIONS WITH NI¬
TRATE OF STRYCHNIA IN THE TREAT¬
MENT OF INEBRIETY.
By Dr. E. T. Buck, Brooklyn, New York.
Inebriety may be divided into three classes, viz .: I, Ha¬
bitual ; II, Periodical; III, Dipsomaniacal.
Patients of the first class respond kindly to treatment,
and the best results are obtained. Under this heading we
find those who, under a press of business or business re¬
verses, resort to the use of alcohol.
The man who is crowded with business cares or worry
becomes tired out. He takes a drink to keep up his
strength. It is not long before one drink is insufficient,
and he naturally turns to alcohol, and where one glass
sufficed, he now takes more. The stimulating effect of this
soon becomes nil , and he finds that it is impossible to go
long without spirits. It is at this time that the nitrate of
strychnia given in small doses (hypodermically) is of great
value if the treatment is continued long enough. Alcohol
has been the cause of the downfall of many men and women,
and if science has taught us that by the use of any drug
or combination of drugs this craving for alcohol can be al¬
layed, if only temporarily, it is a blessing to mankind. Ni¬
trate of strichnia has proven great in the cases in which
I have tried it. I take one grain to the ounce of distilled
water, adding enough peroxide of hydrogen or pyrozone
to keep the solution. Of this I inject ten to fifteen minims
three times a day for the first week, night and morning the
second week, and daily (preferably the morning) the third
week.
There are two kinds of patients of the first class, i. e.,
those who take the treatment because they themselves want
to stop drinking, and those who place themselves in your
Digitized by t^-ooQie
in the Treatment of Inebriety\
249
care to please somebody else, and not as an act of their own
volition. The latter class is much more difficult to treat, as
they will not try to help themselves. During the first few
days visitors should not be allowed, and the patient should
have as little excitement as possible. Dr. Crothers, Dr.
Arnold, and others of experience give fluid extracts in place
of tinctures, and in some cases an aqueous solution, where
any amount is used or the remedy is used for any length of
time. Patients suffering with this disease are extremely
sensitive to alcohol, and the greatest care should be observed
in giving anything which contains it, even to the slightest
extent.
To illustrate the subdivision of the first class, i. e ., habitual
inebriates, I give the histories of two cases that I have had
under my care :
Mr. X. JE t. 30. U. S. Married. Clerk.
Father always healthy, never drank any liquor, and would
not allow it in his house. Mother's history good. Patient
came to me with the history of having drank in moderation
since twenty-first birthday. Had been obliged to do consid¬
erable extra work, which caused him to be at his office
nights, and had taken a drink to brace himself up. Felt
so much better that he continued the practice. Soon found
that he wanted more than one drink, and not very long after
he began drinking he was unable to eat his breakfast until
he had something in the way of alcohol to give him an appe¬
tite. Had up to the present time been a man of regular
habits and spent most of his evenings with his family. Now
if he goes home early the children bother him. He reads
his paper and then goes to sleep. About the time everybody
else is going to bed, he wakes up and must have a drink.
He meets acquaintances, and instead of one glass he has
several, and goes home in a very poor condition. His wife
has reasoned with him, but to no avail, and his friends have
talked to him about his drinking, but he derives no benefit
from them. Has tried several times to stop, but could not.
When he consulted me he had been drinking for three
months.
Digitized by ^ooQie
250 Personal Observations with Nitrate of Strychnia
Treatment given hypodermically, ter in die , for first
week, and at the end of fourth day did not care for alcohol.
Nervousness and sleeplessness controlled with full doses of
bromides, fluid extract cannabis indica, and trional. In this
case trional was almost a specific. During second week
gave treatment morning and night, and patient took long
walks in the country, which did a great deal of good. Slept
well and appetite improved.
Third week. One treatment per day, and washable to
attend to his business. At this time I stopped the use of
the hypodermic and gave tonic containing the nitrate of
strychnia and arsenic, this tonic to be continued for a con¬
siderable length of time, varying the combination of drugs
from time to time according to circumstances, but using the
strychnia and arsenic as a basis. It has been over a year
since the patient first came under my care, and he has not
touched a drop of liquor since.
The second case, one that came under my care the same
day, is in some respects quite different.
Mr. G. Ait. 35. Married. Painter.
Family history poor. Father had always been a heavy
drinker, and for the past few years has had dipsomania and
has had to be confined. Mother used to have periodical
spells of heavy drinking, which would last for ten days or
two weeks at a time. Would average six of these spells a
year. Could get no history of any other trouble in either
parent. Patient came to me at his wife's request, and,
although he promised to do what he could to stop his drink¬
ing, still retained the idea that very little, if anything, could
be done for him, as he had been to several physicians in
years gone by, and received no benefit from them, with the
exception of building up his appetite. Did not act as a
person who would be glad to rid himself of the habit,
but rather as one desirous of pleasing somebody else.
Began treatment at once, and he did fairly well for about
twelve hours. He then began to get restless, and on his
wife's leaving the room for a few minutes, he arose, dressed,
Digitized by C^ooQie
in the Treatment of Inebriety .
251
and went out before anyone knew of it. Some friend found
him and brought him home. When I saw him, shortly
afterwards, I gave him twenty minims fluid extract cannabis
indica. He had made the most of his short period of liberty
and was well under the influence of alcohol. I now took
the precaution to confiscate his clothing, and after a while
succeeded in getting him to the state where liquor had no
charms for him, and he remained in that condition for over
a year, and had every prospect of continuing, but on losing
his position he began drinking again, and I am told that he
is as bad as ever.
One thing of importance in treating inebriates at their
homes (virtually without restraint) is to gain their confidence
from the first. In connection with the medical treatment,
the diet and hygienic surroundings must be considered.
Plenty of good wholesome food, and as much milk as may be
desired. Long walks through the country are of consider¬
able benefit. Patients should be required to retire at a regu¬
lar hour, say ten -o'clock, and rise at seven.
The second class, i. e ., periodicals, are much more difficult
to treat. The physician cannot be too guarded in his prog¬
nosis as regards a permanent cure. Very few of the “ cures ”
that are reported can be authenticated. The most the phy¬
sician can hope to do with this class of patients is to stop
their drinking for the time being and get them into such a
condition that they will be able to attend to their business,
and, as a rule, that is all they want you to do. The period
of abstinence will, of course, vary with each case. I have
known patients who have been used to going on “ sprees ”
every three months, to go a year and more after being treated
without “ breaking out ” again. As in the first class, the
craving for alcohol ceases after the first few days, after
which time a little more liberty may be allowed. As this
class of patients are so liable to relapses, I advise that some¬
body be with them when out of doors, for a week or ten
days. After that, if the attendant’s report is favorable, they
may be trusted to go alone. Early rising and retiring to be
Digitized by t^-ooQie
252 Personal Observations with Nitrate of Strychnia
strictly followed out, and a brisk walk of half an hour before
breakfast will be found advantageous. The following history
will illustrate:
Mr. T. JE t. 30. U. S. Married. Merchant.
Father was a man that used to have his “sprees” about
every three months. His health was fairly good. Further
than that patient refuses to give family history. I learned
from outside sources that the last few years of his father’s
life were spent in a retreat.
Patient began drinking when eighteen years of age, and
says that ever since his twentieth birthday he has had two
“sprees” a year. Says he can no more help drinking at
those periods than he can stop breathing. During the rest
of the year he is a “ teetotaler.” A spree with this patient
usually lasts two weeks, and during that time he can do no
work, does not eat, and more than half the time does not
know where he is or what he is doing. His wife came to
me to help him to “ sober up.” My first treatment was
given when he was sleeping off the effects of a five days’
“ steady drunk.” On awakening he wanted to go out; said
he’d go, and if he did not get his clothes would go without
them, but after being reasoned with, decided it would be
better not to venture. Suffered considerably with tremors,
but these were controlled with bromides, and sleep induced
by trional. After third day did not care for liquor. Appe¬
tite returned and slept well. This patient took long walks
during second and third weeks, and was in good condition
at the end of that time and able to attend to business. He
reported once a week for a while, and then once a fortnight
for a period of four months, and had no desire for liquor, but
when six months had passed and he was about to make me
his last visit, I noticed unmistakable signs of his getting
ready for another spree. I put him under treatment for a
week and aborted that attack. He has been very steady up
to the present time, but I should not be surprised to hear of
his backsliding at any time.
Those patients coming under the third division, i. e.,
Digitized by ^ooQie
in the Treatment of Inebriety .
253
dipsomaniacs, or true inebriates, are essentially institution
cases, and unless they are able and willing to have trained
assistants with them all the time, it would be very impru¬
dent, if not impossible, to care for them in their homes, and
to my mind should not be attempted, as they are liable to do
themselves, and possibly others, harm.
Even if they are in a position to have trained assistants,
it is an open question whether they would not do .better if
they were placed in some institution where they would be
under the proper kind of restraint, which they could not
possibly have when cared for in their own homes.
Some Forms of Intolerance of Alcohol and their
Prognosis. — Dr. Smith calls attention to certain forms of
alcoholic intolerance, and finds that those addicted to nar¬
cotics bear alcohol badly. Neuropathic subjects are also
intolerant, but the outlook is favorable if the physician under¬
stands the circumstances, on account of its easy suggesti¬
bility, otherwise it is unfavorable. Psychopathic intolerance,
with moral insanity in a more or less pronounced form, offers
a gloomy prognosis, for relapses will be frequent. In epilep¬
tic intolerance one should determine if the epilepsy set in
before or after its use. He is inclined from his observations
to believe in an alcoholic epilepsy where small quantities of
alcohol provoke pathological conditions of drunkenness, half
conscious states with an inclination to wander about, and
finally pronounced epileptic seizures. Contrasted with the
seeming gravity of this affection the prognosis is extremely
favorable, as the patients are easily convinced of the cause.
Relapses are frequent from such slight causes as the com¬
munion cup, wine sauces, etc., as but a few drops suffice to
demonstrate the intolerance. With previously existing epi¬
lepsy alcohol may have been taken as a sedative with transi¬
tory beneficial effect, and to ward off the anxiety of a seizure
larger doses are taken, and thus the disease is aggravated.
After withdrawal the attacks frequently rapidly decrease or
disappear .—Medicinishe Neuigkeiten , No. 48, 1894.
Digitized by t^-ooQie
254
Inebriety in Women.
INEBRIETY IN WOMEN.
By Dr. Andrew Wilson of London.
Of late days much interest has been taken in the topic
which heads this article as its title. The Daily Telegraph
started a discussion on the subject a short time ago, and, as
is usual in such cases, a mass of opinions, suggestions, and
propositions in the way of cause and remedy was elicited in
the course of the abundant correspondence which ensued.
Perhaps the discussion is only one phase of the inebriety
question which is everywhere being “ boomed ” at the present
time: There appears to have been an awakening on the sub¬
ject of intemperance all round, and an earnest desire has
been aroused once again in social history to get at the root
of this great social evil, and as far and as quickly as possible
to modify it or “ reform it altogether.”
The special phase of intemperance — that among women
— has, of course, many very pathetic and heart-breaking
phases of its own. First and foremost, there is the loss of
self-respect, which is more to a woman than it is to a man.
I say this advisedly, because I think it is probable that a
lapse in any direction on the woman’s part is attended with
much more serious consquences than a similar slip on the
part of the man. A woman’s self-respect is her all. She is or
can be damaged nowhere more severely than in her own eyes.
The lowering of the standard of moral worth is to her an irre¬
parable loss. She rarely recovers from the blow or event
which she knows or thinks places her at a lower level than
her sister-women.
Physicians are commonly of opinion, expressed as the
result of experience, that the reclamation and cure of a
drunken woman is a task of extreme difficulty. They will
tell you that for one man who pulls himself together and
Digitized by t^-ooQLe
Inebriety in Women.
255
gets straight again, there are hundreds of women who are
irreclaimable and incurable. I say the reason why the cure
of inebriety in women is so rare depends on the fact that the
loss of self-respect means so much more in the way of de¬
spair to the woman than it does to the man. And there is
another reason still. Society, which looks leniently upon
the faults of men, judges with Spartan severity the slips of
women. For this, women have to thank women. It is they
who are hardest on the erring sister; theirs is the voice lifted
loudest in her condemnation ; theirs is the hand which points
to the streets ; and theirs the sentence which ostracises their
sister forever as a social pariah. The case of the man is
very different. He is always treated, however many his
faults, under a social First Offenders Act. When people
talk, as talk they will and do, about the necessity for preserv¬
ing intact the purity of society, they conveniently forget that
there are two parties to be dealt with, and that the attain¬
ment of the social millenium is only to be accomplished by
the condemnation of the man equally with the ostracism of
his victim. But, as Rudyard Kipling says, “ that is another
story” altogether.
The recent discussion on drunkenness in women has
elicted an opinion — I can hardly call it a fact — that ine¬
briety is on the increase among females. Lady Frederick
Cavendish, and other social reformers, boldly assert this
opinion as true. The tippling of the East End ginshop is
said to be reflected in the boudoir of the West End. The
craving for stimulants, it is held, follows upon the life of
unnatural excitement many women lead, and this may possi¬
bly be perfectly true.
The question of remedy is perhaps as difficult of discus¬
sion as that of the whole drink-traffic or of prostitution itself.
Personally, I scarcely see that abolition of the drink-traffic
will better an evil which reaches far below the surface of
things on which the public-house stands. Limit licences,
and you only increase a monopoly which, as things are, exists
in full force. I do not believe legal measures alone will ever
Vol. XVII.—34
Digitized by CjOOQle
256
Inebriety in Women .
touch the root of drunkenness either in women or in men.
They may palliate the evil; they can never cure it.
Regarding the question from the biological standpoint,
one seems to get a little hope from the consideration that to
remedy evils of our constitution we must work constantly,
expecting to influence the living host by degrees and by
small variations rather than by fits and leaps and starts.
In every living species we find those who go to the wall; sad
fact though it be, these represent the wasted lives — the
suppression of the unfit, in a word, which clears the ground
of those who cumber it. Are we, then, working uncon¬
sciously to a better state of things through all this terrible
sacrifice of health and hope and life ? I would fain hope so,
although the prospect, I admit, is depressing enough as it
stands.
Agencies are happily at work around us which must
influence the question of inebriety in time. Education is
doing much, and example is perhaps doing more. The spirit
of the time is in favor of moderation, abstinence, and a
higher standard of life all round. I say so, despite the fact
that Cassandras are warning us that society is rotten to the
core, and that the worst days of Rome are fast being repeated
in our midst. Perhaps all this is inevitable from the rate at
which we live. Each day of Europe is really “ a cycle of
Cathay ” ; and we must pay for the pace at which we go.
It seems absurd for us to expect that, in a complex system
of civilization like ours, we should have perfection of life and
living attained so quickly as philosophers of an ultra-hopeful
turn of mind would expect. “ Slow and sure ” is the way of
life all round ; and surely we may look with some hopeful¬
ness to the decrease of inebriety among men and women
alike, when education and like agencies have had time to
make their mark. Meanwhile, if there is no panacea for the
evil, there is no need to despair. While we wait for better
things no man need find in waiting an excuse for not putting
his hand to the plough, or for delaying to work as best he can
for the bettering of our life as it exists to-day. — London Post .
Digitized by
Google
Abstracts and Reviews.
257
ki\d f^eview^.
REPORT OF THE ELLIKON HOME ASYLUM
FOR INEBRIATES IN THE CANTON OF
ZURICH, SWITZERLAND.
The following extracts from the annual report of this
asylum will be of interest:
The rules of admission require a written agreement to
remain in the home for not less than four months. In the
case of wards and persons in receipt of charity, the agree¬
ment may be with the legal representative of the inebriate.
The cost of maintenance must be guaranteed. “When there
is want of room, cases holding out the best prospect of cure
and Swiss subjects have the preference. Discharge follows
on the expiration of course of treatment. If the cure is not
yet sufficiently established, a new agreement shall be ten¬
dered.”
With regard to the treatment in this home, we read:
“The main principle for the treatment of inebriety is
complete abstinence — that is, entire abstinence from all
alcoholic drinks. For the drunkard every form of alcohol is
a poison which destroys him mentally and bodily. He must
make the resolve to give it up for the whole of his life if he
would be free from the debasing slavery of drink. Accord¬
ingly the principal, his family, and the entire staff must
abstain from all spirituous liquors, so that in the whole house
no mischievous example may be set to the inmates. The
institute will, therefore, form a temperance community, whose
members shall set before themselves the ideal and moral
duty of zealously fostering and spreading this moral reform
amongst inebriates. In the practical work of the moral
elevation of the inmates of the institute each must, without
exception, take his part according to the measure and char-
Digitized by i^.ooQle
258
Abstracts and Reviews .
acter of his capacities. In work, of whatever kind it may be,
lies the best means of strengthening his bodily and spiritual
powers, above all his weakened will and character. The
work accomplished by the inmates falls to the profit of the
institution.
“With regard to religion, while all compulsion of special
creeds shall be avoided, moral and religious restraint and
consolation, indispensable for the higher working of the
institute, shall be enforced and fostered with love and zeal.
The principal shall, every day after breakfast and after sup¬
per, hold a religious service, which all inmates and staff,
except the sick, shall be required to attend. Moreover, the
creeds and religious wishes of the inmates shall be respected.
Sundays, as far as circumstances allow, shall be taken up
with Divine service, reading, general walks, conversation, and
spiritual co-operation in combatting drink by the study of
suitable works.”
The principal must devote his whole time to the institute
and have no subsidiary calling. He administers the institute,
has control over the inmates and staff, orders the occupations
of the inmates, and presides over the same. His wife has to
supervise the kitchen, and the sewing and washing, with the
help of the necessary assistance.
“The introduction of any alcoholic liquor into the house
is most strictly forbidden. Every inmate and former inhabit¬
ant of the institute is strictly forbidden to partake of any
drink containing alcohol, supper excepted. When medical
precautions render it absolutely necessary to order wine for
an inmate of the institute, then and then only may this be
allowed in the form of a medical prescription under the strict
control of the principal, with full notice of the amount, and a
written intimation of the fact to the president of the com¬
mittee of administration.
“As a rule no inmate may leave the institute during the
first three months, not even with relations or guardians.
Later on permission to go out is granted by the principal
according to the circumstances and condition of the inmate.
Digitized by ^ooQie
Abstracts and Reviews.
259
The keys belonging to the boxes and other receptacles of the
inmates remain in the possession of the principal. It is
strictly forbidden to send food, liquors, medicines, money, or
postal orders to inmates. It is strictly forbidden to inmates
or attendants on their walks out, or on any other occasion, to
visit inns or touch alcoholic drinks. Such acts will be visited
by instant dismissal by the committee of administration, or
in special need, by the principal. Inmates are required upon
their honor to hinder such offenses, or to report them at once
to the principal. . . No inmate may have money on him.
Money brought must be left by the patient at the time of
entering the institute with the principal, a receipt being
given.”
The fourth yearly report of this institute, that for 1892,
shows that there was one patient under twenty and three
between twenty and twenty-five, out of a total of sixty-two.
The following table shows the result of the home treatment
as regards cure or reformation, and it is gratifying to note
that the percentage of those who have been benefited has in¬
creased each year, while the percentage of those who have
relapsed has decreased:
1889.
I89O.
1891.
Have remained abstainers..
Per cent.
27 .7
Per cent.
77 .7
Per cent.
37 -5
32 -5
70 .O
Have remained temperate.
*/
27 .7
40.0
26 .7
Relapsed...
45 -4
“The principal cause of cases of relapse, of which we
have still to complain, is the short time the patients stay in
the institution. It generally needs some months before an
alcoholic subject has so far recovered that he has a true
insight into his circumstances, and shows nothing morbid in
his train of thoughts. A much longer time is needed before
the patient’s character and will is sufficiently strengthened
that one can confidently trust him to the trials and tempta-
Digitized by i^-ooQie
26 o
Abstracts and Reviews.
tions of social life. The average term of five and one-half
months in the case of patients who have been discharged
this year is therefore too short; in most cases the duration
of cure should last twelve months. . . The state should
not only, under certain circumstances, bear the entire cost
of maintenance, but, when necessary, support the family
during the absence of the bread winner, and in such a way
that the support should not assume the character of charity.”
In the canton of St. Gall there is established an asylum
for inebriates. In 1891 laws regulating this were passed as
follows:
“ Persons who habitually abandon themselves to drunk¬
enness can be placed in an institution for inebriates. Art. 2.
The duration of their stay in the said institution shall be, as
a rule, from nine to eighteen months. In cases of relapse
the term shall be correspondingly prolonged. Confinement
in such an institution shall ensue—( [a ) by voluntary applica¬
tion ; (£) by a declaration of the council of the commune.
“The costs of treatment in an institute for inebriates shall
be defrayed out of the patient's own means. If he is without
resources, or the costs of treatment are too heavy for his
family to incur, they shall be levied on the poor rates in
accordance with the existing legal prescriptions. Where it
appears necessary, the state shall contribute to the cost of
maintenance in the institute, and in exceptional cases a pro¬
portionate sum for the maintenance of his family during the
time of the patient’s treatment.
“ One month before expiry of the course of treatment the
managers of the institute shall furnish a report to those
authorities who committed the patient to their care, and if
the cure is not yet complete it can be prolonged within the
limits of the time established in Article 2.
“During the time of treatment a temporary guardian can
be appointed to represent the patient concerned. The same
can be done even before transfer into the institute, as soon
as a serious weakness of will consequent on an excessive use
of alcohol is proved to exist by medical certificate.”
Digitized by ^ooQie
Abstracts and Reviews .
261
Hypnotic Suggestion for Alcoholism. —Bushnell
(Med. News') reports twenty-three cases in which hypnosis
and hypnotic suggestion was the line of treatment resorted
to for alcoholism. In no case did he fail to hypnotize the
patient. Eighteen were hypnotized on the first attempt,
one on the second, one on the third, and one on the
fifth.
The method was usually that of requiring the patient to
fix his gaze on an object while the operator stood behind him
and stroked the forehead evenly with both hands. Gener¬
ally the patient’s eyes close spontaneously in from two to ten
minutes. In some cases they remain open and require to
be closed with the hand. A more effectual but less agreeable
method, is to sit facing the patient, who is to fix his eyes on
those of the physician.
Hypnosis being induced, suggestions are given to the effect
that the patient will have no craving for liquor; that it will be
disagreeable to the taste and unpleasant in its effects; that
sleep, appetite, and digestion will be good; that nervousness
will disappear, etc. It is well to suggest that there will be
no nervousness, no pain in the eyes, and no headache upon
awaking, also, especially in the case of those who are hypnot¬
ized with difficulty, that there will be no drowsiness.
Hypnotism becomes easier with each repetition; and in¬
toxication renders it easier. The treatments are repeated, if
possible, daily for a week, then once a week for a month.
The results of treatment were : remained abstinent, eight;
relapsed, but abstinent after further treatment, three; relapsed,
and passing out of reach declining treatment, or continued to
drink in spite of it, eight.
Bushnell has noticed that it is easy to render whisky
repugnant to the senses of the patient, but it appears to be
impossible to accomplish this in the case of beer. The loss
of tolerance and cessation of craving for alcohol are reached,
however, in the one class of drinkers as certainly as in the
other.
Digitized by i^-ooQie
262 Abstracts and Reviews .
ALCOHOL AND HAPPINESS.
The body uses its powers in resisting the outside forces
which act upon it Normally, there is a balance between
body and environment. If environment prevails we are dis¬
couraged ; if we are able to prevail, our spirits rise and our
happiness grows. And it is not for the moment only, but
we compare the accumulated impressions of the powers out¬
side of us with the powers which our brains develop, and are
happy or unhappy according as we feel our superiority or
otherwise. Just how much does alcohol interfere in this
balance of powers ? It clearly can not lessen the power
of outside influences which harm us ; it can as clearly not
increase our own powers in so far as they enter into this
conflict with the outside world — it rather makes us less
skillful and able. What can it do, then ? It can deceive us.
It dulls our appreciation of powers outside of us until they
seem so much smaller that we are sure we can conquer
them, and so we gain a feeling of satisfaction. Nine-tenths
of those who take strong drink seek this feeling in alcohol*
This is their “ refreshing ” at eventide, their “ rest from the
day’s cares,” their forgetfulness of sorrows ; but it rests upon
a deceit, and at the least trial falls into ruin. He who to-day
forgets is not any stronger to-morrow, and so is constantly
tempted to a new appeal to his false friend until his senses
are so dulled that every duty is forgotten. His holiest
interests are but shadows and mist before his eyes, and
he knows nothing more but thirst for the deceitful drink.
Even the defenders of alcohol at last call a halt; but they
have forgotten that the first steps are much more easily
undone than the later ones, when the brain has in a measure
lost its power to control. They do not forget through
malice, but because they have not rightly understood
the physiological effect of alcohol.— Dr\ Justus Gaule , in
The Popular Science Monthly for November .
Digitized by L^ooQie
Abstracts and Reviews. 263
TRIONAL AS A HYPNOTIC IN ASYLUM
PRACTICE.
In the treatment of the protean forms of mental disease
encountered in asylums for the insane, trional has proved a
safe, reliable, and effective hypnotic and sedative, pleasant to
take and free from irritating effects on the gastro-intestinal
tract. The latest contribution to the therapeutics of the
remedy is an article by Dr. Karl Grunfeld, a physician to
the Insane Asylum at Budapest (Pester Med. Chirurg.
Presse, No. 47, 1894) who has carefully compared the action
of trional with that of other hypnotics in forty cases. The
following is a r6sum6 of these experiments.
In simple agrypnia, melancholic depression, conditions of
moderate oppression as well as mania not attended with
violent hallucinations, a refreshing sleep of six to eight hours*
duration is produced often by doses of 1.0 grams, and always
by 1.5 grams. The dose need but rarely be increased to 2.0
grams, and if so. especially in paralytics.
The agrypnia, which in secondary dementia is usually
dependent upon conditions of irritation, or is caused by the
varied hallucinations of the insane, can frequently be combat¬
ted by 1.5 grams trional, and 2.0 grams will fail to exert an
effect only in special and exceptional cases.
In the more active conditions of excitement of chronic
mania, and in paralysis attended with moderate motor rest¬
lessness, 2.0 grams trional usually had a reliable action, the
effect being absent or very slight on the first, but satisfactory
during the following days.
In paralytics suffering extreme motor and psychical man¬
iacal excitement a satisfactory effect can only exceptionally be
expected from 2.0 grams trional, while in many cases even
3.0 grams proved inactive.
As a sedative trional was tested in but one case and gave
very satisfactory results. Grunfeld thinks that smaller
doses will be required for this, since 1.0 gram sufficed to
produce sleep in a case of chronic mania. A good effect
was also obtained from the remedy in fractional doses in a
Vol. XVII.—35
Digitized by ^ooQle
264
Abstracts and Reviews .
case of obstinate restlessness produced by marked hallucin¬
ations. In conclusion the author remarks that while the
introduction of trional in psychiatric practice must be
regarded as a gain, this concerns even more the general
practitioner, since in the forms of insomnia met with by the
latter the remedy proved of positive value.
NATIONAL INQUIRY INTO THE DRINK TRAFFIC.
After seven ineffectual efforts extending over as many
years to have the government make an investigation into the
traffic in alcoholic liquors, Congress has at last passed a
bill to have the subject investigated by the National Bureau
of Labor. Hon. Carroll D. Wright, the commissioner, has
decided to conduct the inquiry along the following lines :—
“ 1. The relations of the liquor problem to the securing
of employment: how far do, or may, employers exercise an
influence by refusing work to persons who are known to be
addicted to the use of intoxicants ? The practise of govern¬
ment officials, large corporations, especially railroads, etc.,
should be learned. 2. Its relations to different occupations :
how far is the use of liquors increased by night work, over¬
work, exposure to severe weather, etc. ? 3. Its relations to
irregularity of employment, such as may be caused by em¬
ployment in trades which work by the season ; the interrup¬
tion of occupation by strikes, commercial crises, etc. 4. Its
relations to machinery ; how far does the liquor habit prevent
the use of fine and highly specialized machinery ; and, on
the other hand, how far does the nervous strain involved in
work with machinery induce the liquor habit? 5. Its re¬
lation to the mode and time of paying wages; is the con¬
sumption of intoxicants affected by the frequency of pay¬
ments, by the time of the week at which they are paid,
and by persons to whom they are paid ? 6. Its relation
to workingmen’s budgets in different occupations and
in different countries, or the ratio between the cost
of liquor and the cost of living. 7. Its relations to com-
Digitized by L^OOQie
Abstracts and Reviews .
265
forts, luxuries, and pleasures; how far is the liquor habit
counteracted by home comforts, good cooking, coffee houses,
music halls, theatres, outdoor sports, etc. ? 8. Its relations
to sanitary conditions ; how far is it affected by the plenti¬
fulness of food, by the ventilation of dwellings and work¬
shops, by good drainage, etc. ?”
THE PROBLEM OF HEREDITY IN REFERENCE
TO INEBRIETY.
The problem of heredity, by which is meant the trans¬
mission of a parental and ancestral character to each new
generation of organic beings, is one of transcendent interest
in biology at the present time, not only because it seems to
hold the key to a large part of evolution, but on account of
its relations to many social, moral, and even political and
religious questions.
Just now opinion seems divided among those who have
studied the matter. One class, led by Weismann, holds to the
theory of the “ Continuity of the Germ Plasma,” which
teaches that “ the germ cells are not derived at all, as far as
their essential and characteristic substance is concerned,
from the body of the parent, but directly from the parent
germ cell, from which the individual has also arisen ; so that
heredity is brought about by the transference from one gen¬
eration to another of a substance with a definite chemical,
and, above all, molecular constitution,” and ‘‘from this
identical starting point an identical product necessarily
arises.”
Herbert Spencer attaches the greatest importance to the
environment. Along this line of thought are those — per¬
haps in the majority — who believe that the predisposition
to inebriety is inherited, due to the various neuroses present
in the children of the intemperate parent.
The weak point in Weismann’s theory is brought out by
the observation that " the effect of use and disuse of limbs
Digitized by ^ooQie
266
Abstracts and Reviews .
and those of habit are transmitted to posterity in only a
slight degree.”
It has been pretty well established that the children of
intemperate parents are afflicted with degeneracy and various
neuroses. Associate this, then, with suitable environment
and the drunkard or inebriate is an inevitable result.
Take a long line of inebriate ancestry of both parents,
and it is more than likely that the direct inheritance of in¬
ebriety may be established. But, again, mix it with pure
blood from either parent—especially the mother—and we
believe the chain would be broken and merely the predis¬
position to inebriety be present in the offspring.
Another point in this question, which is likely to be over¬
looked and which, as far as results are concerned, might
appear to favor Weismann’s theory, is the inebriety of the
mother during pregnancy. The impregnated germ, which
has entered upon its career of development, is drawing to itself
large and hourly increasing supplies of nourishment for
many months out of the maternal blood, which contains
alcohol in pathological percentage. In this case we deny, as
some claim, that the inebriate offspring has directly inherited
the disease, but has acquired the habit in the same way as if
the feeding of the alcohol to the child had been delayed nine
or ten months later and when the fetus had become an infant.
Certain it is that the establishment of the direct inherit¬
ance of inebriety in the human race is going to be very hard
to prove.— Editorial in Medical Progress.
From the Report of the Registrar-General for Scotland,
the mortality of physicians from inebriety was 35 per 1,000,
of saloon-keepers it was 169 per 1,000, butchers were 36 per
1,000. Deaths from diseases of the liver was below the
mean among physicians, but away above the mean among
lawyers. The risk of life was shorter than coal miners and
his chances of inebriety was greater than cabmen, grooms,
and hotel servants.— Medical Press.
Digitized by CjOOQie
Abstracts and Reviews .
267
THE ALCOHOL QUESTION IN GERMANY.
In a letter to the Echo , Dr. C. R. Drysdale says : “ It is
interesting to find that the excellent attempts which have
been made in this country and the United States of America
to wean the public from the use of alcoholic drinks are being
appreciated by some of the ablest physiologists and pathol¬
ogists in Switzerland and Germany. The Berliner Klinische
Wochenschrift of September 10th, 1894, contains an admira¬
ble address by Dr. A. Smith, physician to a lunatic asylum
on the Lake of Constance, on the attitude which medical
men ought to maintain upon the alcohol question. Dr.
Smith tells his hearers that as many deaths take place
annually from diseases brought on by drinking as are caused
by that terrible scourge of our race, pulmonary consumption,
and he remarks that, of course, all deaths from alcohol are easi¬
ly preventable, so that these common forms of misery would
disappear if total abstinence were to come into fashion. But
he has found, by examining the letters of 1,500 medical men
who wrote him concerning patients to be sent to his asylum,
that there is as yet a great ignorance prevailing as to the
part played by alcohol in causing disease. Dr. Smith advises
his medical brethren in Germany to abandon the ideas
received by them when attending hospitals long ago, and to
attend to the evidence of facts regarding alcohol recently
brought to light. If they do this, they will soon see that all
the favorite phrases—that alcohol is a valuable nutriment,
a necessary roborant, and a very valuable exciter of
warmth — are only the fancies put forward by those inter¬
ested in the sale of alcohol, and that the truth is quite in
contradiction of such fancies. They will then, he says, begin
to recognize alcohol, whether in beer, wine, or spirits, as a
poison of the brain and nerves of the worst sort, and find out
that the so-called stimulating and care-destroying properties
of alcohol are non-existent; but that these are caused by a
paralysis of the intelligence and of the judgment, as any
sober person can see if he enters a room where men have
been drinking. Besides this, the observer will have to notice
Digitized by i^-ooQie
268
Abstracts and Reviews .
that a whole list of dangerous diseases of the system and
organs, which he used to treat by their symptoms alone, have
their cause in chronic alcohol poisoning, which need not be
very excessive, and that, unless he withdraw the patient en¬
tirely from the use of alcohol, he will fail to cure him. And,
above all, he will learn how greatly the brain is affected by
the use of alcohol, and how impossible it is often to restore
insane patients to health unless all alcohol is withheld from
them.
“ Dr. Smith alleges that, in his country, the prescription
of the medical adviser has, in an immense number of cases,
been the origin of drinking in the patient ; and this pre¬
scription is constantly quoted when advice to the>contrary is
given by those who see the damage done by alcohol. Dr.
Smith observes that, in Germany, at present an alcohol ration
is to be found in the diet lists of many of the hospitals. He
narrates the case of a young man who had been a total ab¬
stainer, and who was given to alcohol in a military hospital
to such an extent that he afterwards had an attack of delirium
tremens . Delirium, he maintains, is extremely rare where
diseases are not treated with alcohol. Because of the grave
effect produced by alcoholic drinks upon the brain, physicians
who direct lunatic asylums are most of all acquainted with
the dangers arising from drinking. Dr. Smith believes that
great drinkers are apt to engender children with tendency to
nervous diseases, and points out that such diseases are in¬
creasing with the increase of beer palaces in Germany,
especially since woman began to frequent them. Dr. Smith
alludes with praise to Dr. Forel of Zurich, who conducts the
lunatic asylum of that town entirely without alcoholics, and
also refers with admiration to the practice of Colney Hatch
and Han well in this direction. He goes on to say that medi¬
cal practitioners ought to be total abstainers from alcohol.
One reason he gives for this is that German practitioners
often suffer greatly from alcoholic diseases, for country medi¬
cal practitioners, he says, in Germany often drink to excess.
Of 1,500 letters to himself concerning patients, no less than
Digitized by i^.ooQle
Abstracts and Reviews.
269
436 were about doctors of medicine, 162 being both morphin¬
ists and alcoholics, and the rest simply intemperate in alcohol.
He much regrets that so many physicians are against total
abstinence, and, at most, favor simply moderation. No
drunkard was ever cured by moderation, but only can be
cured by total abstinence. And it is just moderate drinking
which at present is the cause of drunkenness. Moderate
drinkers, every now and then, take more than they can with
impunity at Christmas and other festivals.
“ Some medical men in Germany contend that they only
use very little alcohol, says Dr. Smith, but that for the sake
of social custom they must take a little. He, however, re¬
fers to the examples of five very distinguished physiologists,
viz., Drs. Bunge, Gaule, Hoffman, Forel, and Fick, all of
whom are total abstainers. The very refusal of a physician
to take wine will be certain to give rise to a debate on the
subject of the use of alcohol in the society, and this, says Dr.
Smith, will give a good opportunity for imparting information
about it. Medical men ought, in short, to be the evangelists
of total abstinence, since they alone well know the details of
the diseases produced by this dangerous article of daily con¬
sumption to the masses.
“ This lecture shows that in Germany the same arguments
which have led to the existence of some 5,000,000 of total
abstainers in this country are being heard among learned
men and physicians. The consequence of this will be that,
ere long, the modest virtue of teetotalism will become
common on the Continent.”
THE COURT’S OPINION OF INSANE DE¬
LUSIONS.
Until human nature radically changes, there will proba¬
bly always be those who will seek some scapegoat for their
crimes. At one time it may be one thing, and on another
occasion something quite different. This explains much of
the talk about irresistible impulse, hypnotism, insane delu-
Digitized by LjOOQie
270
Abstracts and Reviews .
sions, and the like. In this connection, one of the most in¬
teresting of recent legal decisions is that of the Supreme
Court of Tennessee in the case of Wilcox vs. State, rendered
Nov. 12, 1894. This was an appeal from a conviction of
murder in the second degree. The defense relied on was
the insanity of the defendant at the time of the homicide, it
being insisted that the act was the result of an insane delu¬
sion upon his part, rather than a general derangement of his
entire mental faculties upon matters generally. It was con¬
tended that when he did the killing he was suffering from
the insane delusion that the deceased had been on too inti¬
mate terms with his wife. He had been addicted to the ex¬
cessive use of morphine and cocaine, taking the drugs in doses
sufficient to kill twenty men not addicted to their use, at a
single dose; and he had carried on this habit for years, and
had grown rapidly more and more addicted to their use, and
come more and more under their influence. Many witnesses
were examined, both experts and non-experts, in regard to
his mental condition. It appeared that he was at one time
a man of good mental capacity, described by many of the
witnesses as an exceptionally bright man; that he was an
active business man, had studied and practiced medicine
with success, and was regarded universally as a man compe¬
tent to attend to his business affairs. He was also shown
to have been an arbitrary dictatorial man, of strong will
power, and from his boyhood of quick, active, irritable tem¬
per. It was strongly pressed upon the court that many of
his arbitrary and dictatorial acts were evidences, and the re¬
sult, of his mental unsoundness and the strong hold which
the drugs had obtained over his actions, and that the evi¬
dence presented a case of insane delusion, on account of
which the verdict should not be upheld. But the court holds
otherwise. Its answer is that in criminal cases the correct
issue is not that of sanity, but of responsibility. The delu¬
sions of a sane man do not make him irresponsible. The
question is in such cases, Is the delusion set up as a defense
the delusion of an insane person? Many men of strong
Digitized by ^ooQie
Abstracts and Reviews .
271
minds, continues the court, have delusions. Remarkable
instances are given in the works on medical jurisprudence of
delusions in men of prominence in all the walks of life.
Lord Kenyon had an unreasoning fear of poverty, and so did
Lord Stowell, although he was a man of immense fortune,
his home being absolutely destitute of the necessities and
comforts of life. Lord Erskine would never sit at a table or
remain in a company as one of thirteen persons. Lord
Eldon, after he had made up his mind and expressed his
opinion lucidly and conclusively, was at all times a prey to
grave doubts of his correctness. Lord Brougham, upon
more than one occasion, was placed in seclusion, his mind
being clearly off balance. Judge Breckenridge of Pennsyl¬
vania is reported to have on a hot day, while holding court
at Sunbury, gradually taken off his clothes, until he sat naked
on the bench. Judge Baldwin of the United States Supreme
Court was a hypochondriac. A distinguished New England
judge imagined that a dropsical affection under which he
labored was a sort of pregnancy. And yet none of these
men were insane, because they had reason and sanity enough
to conquer and overcome these delusions. A familiar illus¬
tration is that of the Mormon elders, who claimed that they
had a direct revelation from heaven permitting them to prac¬
tice and teach polygamy. The world generally regards this
as a rank heresy, and the claim to be the evidence of an un¬
reasonable delusion. It has, however, been held that they
cannot defend on the ground of such delusion, inasmuch as
otherwise they are sane, shrewd, active, successful, and un¬
usually practical men in their business and social relations,
and they have been held responsible for such delusions.
Nor can it be that the jealous suspicions which so many
men entertain without any foundation can be magnified into
insane delusions, which will exempt them from punishment
for crimes originatin'* in such jealousy. In a sense, all un¬
founded suspicions are delusions, but they do not for that
reason excuse crime.
The rule is tersely stated in Archbold’s “ Criminal Prac-
Vol. XVII.—36
Digitized by i^-ooQie
272
Abstracts and Reviews.
tice and Pleading” as follows: “The insanity must have
• been of such a kind as entirely to deprive the prisoner of the
use of reason, as applied to the act in question, and the
knowledge that he was doing wrong in committing it. If,
though somewhat deranged, he is able to distinguish right
from wrong in his own case, and to know that he was doing
wrong in the act which he committed, he is liable to the full
punishment of his criminal acts.”
Moreover, the court makes the point that the insanity
set up as a defense in this case was not hereditary or natural,
but voluntary, in the sense of having originated from the use
of drugs. While this is an unfortunate and unhappy condi¬
tion, the law, it says, does not and can not regard it with the
same leniency that it does cases of adventitious insanity, not
caused by the act of the party himself. Parties who persist
in subjecting themselves to the persistent use and habit of
taking alcoholic drink or other poisonous compounds and
drugs, cannot expect the same forbearance and immunity
from punishment as those bereft of reason by the act of God.
Still it is admissible and proper to show the immoderate use
of drugs or whisky, not to excuse crime, but to illustrate the
mental condition, with a view to fixing the degree of the
crime as it depends upon deliberation and cool malicious
purpose.— Medical Review .
COCAINE INEBRIETY.
It is but recently that this form of narcomania has found
place in our nosology—so recently, in fact, that the profes¬
sion at large at very much at sea regarding it, since reliable
reports are few and far between, and the habit is very likely
to be complicated with some other, such as the taking of
morphine, excessive indulgence in alcohol, etc.
Doctor Norman Kerr, who easily stands foremost among
authorities on inebriety and narcomania, in his latest work,
mentions for the first time the cocaine habit, remarking en
passant that in his experience it is comparatively rare and
Digitized by ^ooQie
Abstracts and Reviews.
273
for the most part confined to members of the medical pro¬
fession. Per contra, a. recent writer in the Bulletin of Phar¬
macy, writing from the standpoint of a pharmacist, seems to
imagine the habit is much more widespread that has hereto¬
fore been considered, that it is continually increasing, and
that its growing prevalence is largely due to the greatly
reduced price of the drug. He also remarks that it is a per¬
nicious habit among a certain class of pharmacists to offer
“ cocaine when asked for something that will relieve tooth¬
ache, neuralgia, and countless other aches and pains; that
in some way the erroneous notion has come to prevail that
in treating the morphine habit cocaine is of great value in
counteracting the effects of the former drug. Proceeding
on this principle, numerous quacks have claimed ability to
cure the morphine habit, . . . but in its stead the pa¬
tients become cursed with a vice far more ruinous than all
their former ills. ... To use cocaine to cure the mor¬
phine habit is like jumping from the frying-pan into the fire.”
Certain it is, the cocaine habit is the most seductive and
terrible form of inebriety—the pleasant elation which the
drug induces, and the apparent absence of unpleasant
sequelae that accrue to other forms of narcomania, lead to
rapid destruction of the mental powers. Numerous cases of'
fatal poisoning by cocaine have been reported in current
medical literature, but the number of known cocaine hab¬
itats is very few—perhaps because unrecognized or, as before
mentioned, complicated with some other form of chronic
intoxication.
If it is true that both the medical and pharmaceutical
professions are responsible for the spread of the cocaine
habit, owing to the freedom with which this most potent and
treacherous narcotic has been prescribed for the relief of
pain, it is certainly imperative that there be thrown about
the sale of this drug restrictions which alone can be formu¬
lated and carried out by these professions, without any refer¬
ence whatever to measures employed by the state.
That many of the victims are themselves medical men, is
Digitized by ^ooQie
'274
Abstracts and Reviews .
undoubtedly true; the remainder are for the most part made
up of women and litterateurs . Doubtless pain has recurred
after the soothing effect of the first use of the drug has
passed away, and the same handy and charmed remedy is
again had recourse to without any knowledge of the results
that are certain and swift to appear. Thus the craving,
beside which the fascination of morphine and opium is infin¬
itesimal, has been acquired, and the victim awakes to the fact
that he or she has become bound fast to a habit entirely un¬
suspected. In a few cases there is evidence that herculean
effort and iron will have succeeded in effecting a deliverance,
but unfortunately such instances are most rare.
It would appear also that in some instances the cocaine
habit has been acquired through the ignorant employment of
a prescription by the physician as a succedaneum to opium
or morphine, or for the relief of some teasing malady like
vaso-motor coryza (hay fever). Nothing can be more disas¬
trous than the substitution of cocaine for some other drug,
since it is considerably more speedy than any other narcotic
in displaying its characteristic effects, and quicker in secur¬
ing an abiding mastery over the taker; the stage of exhila¬
ration being more pleasant than that of morphine or opium,
the drug is on this account also correspondingly more dan¬
gerous. Inebriates may indulge to most pernicious extremes
in strong spirits for years without apparent mischief: some
are even able to carry morphine narcomania to almost incred¬
ible lengths ere the drug manifests its deleterious qualities
upomthe physical and mental organism ; but y per contra, the
mental decay and moral perversion of cocaine excess quickly
appear and as speedily increase in intensity. In some in¬
stances where the drug has been employed subcutaneously
several times daily, an insane condition has developed lead¬
ing to crime and to suicide ; indeed, the cocaine habitui is
always insane, and not infrequently a “raving maniac. ,,
There is also, under the influence of this drug, less sense of
time than from any other narcotic, though all substances
Abstracts and Reviews. 275
possessed of anaesthetic properties seem to have a disturbing
effect on the mental capacity.
While cocaine raises the temperature, its effects are much
more swift and short-lived than those of morphine, while its
tendency, in excess, is always toward delirium and raving
madness. In fatal cases stupor and coma follow, with con¬
vulsions and paralysis of respiration—or, as Mosso and Kerr
put it, “ tetanus of the respiratory muscles.”
That cocaine acts chiefly upon the central nervous system,
first stimulating and then paralyzing, is manifest; it con¬
tracts the peripheral blood-vessels. Under its use there is
at first, usually, increased mental and bodily vigor, which
speedily gives way to intense mental depression along with
anorexia, insanity, hallucinations, and complete breaking-
down of the mind, with volitional palsy and inhibitory pros¬
tration, all taking place in a much shorter time than the
mental degeneration and physical decadence of alcoholism—
in fact, demanding in many cases only as many weeks as
alcohol inebriety requires years.
The peculiar overwhelming danger of cocaine addiction
undoubtedly lies in the fact of the comparative absence of
immediate after-effects. For some time at least—always, we
might say, where the drug is partaken of in only limited
quantities—“ there is no arrihre gout ; no unpleasant taste in
the mouth next day ; no dry tongue ; no nausea or morning
headache; the pleasurable flow of happiness which seems to
have left ‘ no sting behind’ has indeed been a ‘ rose without
a thorn.’ Thus, deadly to all that is noblest and manly, to
all that is ‘ lovely and of good report ’ in human kind, this
speediest of brain disturbers threatens to excel all other mind
poisons in its fell sway over the intellect and conscience of
man.” (Kerr.)
The drug is usually taken subcutaneously, and the doses
frequently follow one another in rapid succession. Taken,
as it doubtless frequently is, along with or after some other
narcotic, it greatly complicates any attempt at alleviation of
the latter. Doctor Mattison of Brooklyn has reported a
Digitized by ^ooQle
276
Abstracts and Reviews .
number of interesting cases, as have likewise Erlenmeyer,
Kerr, Connolly, Norman, and others, and all unite in the
opinion that if taken in time the incipient form of cocaine
inebriety is quite easily relieved, but the habit once con¬
firmed is most intractable. Kerr declares one of his cases
consumed thirty grains of cocaine daily ; the writer person¬
ally knows of an instance where three times this amount of
the drug was daily consumed ; and yet one-seventh of a grain
has been known to prove fatal to a stout, healthy man.
As regards treatment, there can be no dispute. It must
be both mental and physical, and, like the treatment of all
habits, is seldom of any utility except when carried on under
complete and definite restraint .—Editorial in Medical Age .
DEGENERATION. By Dr. Max Nordau. D. Apple-
ton & Co., Publishers, N. Y. City, 1895.
This work is translated from the second edition of the
German in which it was originally published. No book for
many years past has created more comment among scientific
and semi-scientific readers. It points out in sweeping terms
the evidence of degeneration in literature, religion, art, and
music. With a free hand it levels the popular idols of the
day, and with true iconoclastic spirit shows the folly and
frailty of trusting degenerate leaders and theories.
The author is a physician and specialist, who is fully con¬
versant with his subject and the authors he attacks, and
while fair in his general treatment of the topic, has a strong
personality that gives the reader an impression of intense
feeling and desire to make out a case. On this, critics
differ as to the value of his deductions. Beyond this there
is a rich mine of truth and fact, that is new to most readers
of psychology. His treatment of these topics is thoroughly
scientific, giving the facts and drawing conclusions from
them, showing the physical conditions that prompts this or
that theory or line of reasoning.
The physical basis for the strange theories and isms of
Digitized by ^ooQie
A is tracts and Reviews .
277
the day is made prominent, more so than in any other work.
The mysticism and strange confusion of ideas and concep¬
tions of life noted in the writings of many modern authors
are traced to brain failures and degenerations. Many of the
aberrations and inconsistencies of inebriates are signs of de¬
cadence. Practical acquaintance with the physical and psy¬
chical defectives who are actively engaged brings out many
problems which this work makes clear for the first time. In
this respect it is the most suggestive and helpful study of
strange men and women who pose as leaders. As a psycho¬
logical study we think it is among the great works of the pres¬
ent day. Every specialist and medical man should read it,
and be able to form some opinion of one of the most widely-
read and critically-discussed books of the present time.
THERAPEUTIC SUGGESTION IN PSYCHOPA-
THIA SEXUALIS. By Dr. A. von Schrenck-Notz-
ing. Translated by Charles Gilbert Chaddock, M.D.,
Professor of Diseases of the Nervous System, Marion-
Sims College of Medicine. Phila.: The F. A. Davis
Company. 1895. [Price, $2. 50.]
The great sensation made by the forerunner of this work,
“ Psychopathia Sexualis,” by Krafft-Ebling, will certainly
attract much attention to the sequel in which treatment
by hypnotic suggestion is chiefly dealt with. A great
many cases are cited in which the treatment has met with
more or less success, on the whole the results being good,
particularly considering the hopeless character of the malady
under ordinary methods of treatment. No one can read
these works without being impressed by the wretchedness
of the unfortunate subjects of the maladies described, and
the conviction is inevitable that many a one has been pun¬
ished as vicious who was really diseased and deserving of pity.
This work gives another most impressive view of the
new land of degeneration and dissolution which has not been
occupied by scientific settlers before, a land that is being
opened for study and promises to gives a wider range for
therapeutics than has been supposed possible.
Digitized by ^ooQie
278 A 6 stracts and Reviews .
COD LIVER OIL AND CHEMISTRY. By F. Peckel
Moller, Ph.D., London, 33 Snow Hill, E. C.; Christiana,
Norway: Peter Moller, New York: W. H. Schieffelin &
Co., Copenhagen : A. T. Moller & Co., 508 pages. 1895.
This well-known firm of manufacturers have produced a
book of great merit, not alone on account of the novel and
interesting information in connection with the fishes and oil,
but on account of the advanced chemistry it contains. One
of the peculiar features of the chemic part of this work is the
abandonment of the usual method of representing atomic
parts in chemic formulae and the introduction of a diagram¬
matic illustration. The book is an exceedingly interesting
one, and notwitstanding its commercial origin is a distinct
addition to medical literature.
HERNIA, ITS RADICAL AND TENTATIVE TREAT¬
MENT IN INFANTS, CHILDREN, AND ADULTS.
By Thomas H. Manley, A.M., M.D., Visiting Surgeon to
Harlem Hospital, etc., etc., etc.
This work is illustrated by sixty-five engravings and
drawings with a full history of the ancient and modern
operations for the hernial infirmity of every type, in both
sexes, along with a full description of the varied anatomical
types and the condition and the multiplicity of technique of
modern time; it also embraces an entire chapter on cocaine
analgaeses as a substitute for pulmonary anaesthesia,* with a
full and complete set of rules for its indications and technique.
This is an excellent work, clear and practical, and is pub¬
lished by the Medical Publishing Co., Philadelphia, Pa<
The American Journal of Insanity has given marked
evidence of new environments, new energies, and a broader
editorial spirit in its change to Chicago, and to the care of
a committee of which Dr. Dewey is editor-in-charge. It is
without question the best journal published in both the
quality of papers presented and typographical make-up. It
is replete with signs of the new century, and broader, wider
studies of psychiatry that are to come.
tize d by
Google
Abstracts and Reviews.
279
The Voice continues the “ On to Richmond movement ”
for prohibition with earnest vigor and faith that promises
success and fruition somewhere in the future.
The Homiletic Review for July contains a varied and
exceedingly interesting collection of articles from some of
the ablest writers on theological, ecclesiastical, and social
subjects in the land. Published monthly by the Funk &
Wagnalls Co., 30 Lafayette Place, New York city. $3.00
a year.
Medical Declaration Concerning Chastity is an eight-
page leaflet, just published, No. 29 of The Philanthro¬
pist Series. It is signed by many leading and influential
physicians, and is a timely, important medical testimony for
the promotion of purity. It is especially valuable for distri¬
bution by White Cross and Purity societies among young
men, and should be given the widest possible circulation.
Price, by mail, 20 cents a dozen ; $1.00 a hundred. Address
“The Philanthropist,” United Charities Building, Fourth
Avenue and Twenty-second street, New York.
The Phrenological Journal has taken a high rank in its
critical studies of eminent men. It has become national in
its broad, generous criticisms, and should be read by every
student of science. Send to Fowler, Wells & Co., New York
city, for a copy.
The Journal of Hygiene , published and edited by Dr.
M. L. Holbrook of New York city, has been before the
public for forty-five years, and has attained an eminence and
authority as the leading popular health journal of the world.
It is both a teacher and preacher of hygiene in its highest
and best sense.
The publication of Herbert Spencer’s recent studies on
sociology in the Popular Science Monthly gives additional
value to this journal. “ Professional Institutions,” “ The
Vol. XVII.—37
Digitized by
Google
280
Abstracts and Reviews .
Physician and Surgeon,” “ The Dancer and Musician,” are
among Mr. Spencer's most suggestive papers. Dr. White's
articles on “ Science ” and “ Criticism ” are very attractive
and widely copied. It is safe to say that no other monthly
published brings a richer and more instructive table of con¬
tents.
Map of the World. — We are in receipt of a neat wall
map, showing both the old and new worlds, according to the
latest authorities. This makes a valuable addition to any
doctor's office, and a copy may be obtained by addressing the
Rio Chemical Co., St. Louis.
The Open Court Publishing Company of Chicago, Ill.,
issue many excellent works of psychology and mental medi¬
cine. The Manist , a quarterly, gives the reader a very clear
view of the studies of evolution. This firm has recently
issued a second edition of their authorized translation of Th.
Ribot's Diseases of Personality, the first having been ex¬
hausted in three years. The popularity of Professor Ribot's
works is certainly deserved, as they form delightful intro¬
ductions to the study of psychology and are remarkable
specimens of economy and lucidity of exposition. No other
author displays such originality in placing under lucid points
of view the disordered mass of data gathered by the psy¬
chological specialists. The present translation has been
revised throughout and embodies all the corrections and
additions of the new fourth French edition. The biblio¬
graphical references have been verified and an analytical
index made, which will much enhance the usefulness of the
book. (Pp. 163, cloth, 75 cents, paper, 25 cents.)
Bromidia has attained a great popularity and immense
sale. It is an excellent combination and should be tried in
every practice. J. W. Snowden, M.D., A.E., San Jos6, Cal.,
on April 12, 1895, writes : “Your Bromidia acts like a charm.
I believe it a safe, effectual, and reliable hypnotic.”
Digitized by C^ooQie
Editorial.
281
Ejditorikl.
ARRESTED DEVELOPMENT AND INEBRIETY.
A certain class of inebriates have arrested cerebral de¬
velopment and malformations. Certain organs and brain
centers have stopped growing before maturity and left this
part of the brain in a childhood and imbecile stage. If this
arrest of growth is limited to the higher cerebral centers,
abnormalities of conduct and character follow. Faults of
judgment, of instincts, of consciousness, of the relations of
right and wrong exist. Surroundings and conditions of life
may conceal the real condition, but when they fail the im¬
becility appears. Often these forces are noted in quiet
hygienic living, removed from mental excitement and strain ;
or from the influence of a wife, or parent, or friend who
directs the higher mental activities. When these are with¬
drawn they are without power of control and suffer from
irritative excitement, which finds relief in alcohol. The use
of spirits is continuous and the inebriety is of a low imbecile
type. The increased action of the heart from spirits is
fitful, and followed by depression and sudden violent im¬
pulses, particularly where the lower animal instincts are
disturbed. The attempt to rouse a person in this state for
any purpose is repelled with violence, because it breaks up
the calm of the present. Obstacles to the gratification of
his present wants are overcome, in a wild unreasoning way ;
ignoring all other considerations except the immediate object
of his impulses, he is at once most uncertain and dangerous
in his acts. The brain in such cases is not only undeveloped,
but is incapable of receiving impressions of duty or obliga¬
tion, and particularly from acting from outside impressions,
unless directed by others. In a recent case the following
facts appeared. A, born of neurotic parents, suffered from
Digitized by i^-ooQie
2%2
Editorial\
a severe attack of scarlatina at seven years of age, was a
strange, impulsive boy, both stupid and unreliable. At
nineteen he married, and for the next ten years was a quiet,
steady workingman of low intellect, but inoffensive, tem¬
perate, and living normally. His wife died, and very soon
he became an inebriate, drinking at all times and places to
great excess. He was violent when disturbed or opposed,
and resisted arrest, and attempted to run away when in the
court-room. He was sent to jail for drinking and assault
many times; finally he killed a man who resisted his attempt
to steal a dinner-pail. He was hung as a sane man, who
deliberately and willfully gave himself over to evil impulses.
The defense of inebriety from arrested development and
inherited neurosis, which broke out at the death of his wife,
was treated with contempt. Physical signs of degeneration
externally, and the insane conduct and unusual acts, coming
on suddenly, were ignored by the jury. These cases are
not uncommon, but it is remarkable that they should not be
recognized in the court-room.
NEUROTIC INEBRIATES.
Inebriety which arises from a defective nervous organiza¬
tion is very common in every circle of life. Many of these
persons possess an unstable invalid brain, with feeble and
imperfect power of control, making it impossible to live
along lines of consistent uniform thought and act. This
often comes from inheritance, and early disease and faults of
nutrition and training. They become mental cripples, and
need care and the control of others as positively as invalids
from surgical disease. They are unfitted to properly care
for themselves in society, or to rationally adapt themselves
to surroundings, and early become wrecks, because they are
without power for rational adjustment. They may be en¬
dowed with a highly organized brain, but so unstable and so
easily disturbed that alcohol, opium, or other narcotics are
most grateful drugs to cover up the real condition. The
Digitized by ^ooQie
Editorial.
283
distress which follows strains and drains, and conditions of
surroundings, ill adapted to favor the normal conditions of
living, finds relief in spirits. Quickly this brain infirmity
becomes organized into progressive degeneration. This may
continue for a long time without marked symptoms of active
disease, but the deviations from health and nerve and cell
degenerations continually increase. Friends, society, and
even physicians fail to recognize this condition, until extreme
stages appear, and even then, theories of free will, willfulness,
and capability of control prevail. These cases should have
been recognized and protected from the first. Their lives
and surroundings should have been ordered and regulated
along fixed uniform lines. They needed protection from
many conditions that were harmless to well persons. They
needed direction and guidance where others could have
walked alone. Many things in society and surroundings
were injurious to them and they should have been guarded
against the danger which was inevitable. Such persons are
without the mental stability to apply absolute rules on them¬
selves, they cannot resist the contagion and infection of
surroundings, they are helpless before the impulses of their
organism, they need constant direction and support.
Many of these persons appear well, and only when they
become marked inebriates is their real condition recognized.
From this class are recruited the wild enthusiasts and
neurotics, and the dangerous criminals and contagious
degenerates, who appear in mobs and advocate the most
dangerous theories.
These cases of brain defects and disabilities must be
recognized and proper remedies provided to protect indi¬
viduals and society from the inevitable consequences of their
unrestrained conduct.
The conductors of the Northwestern railway are not
allowed to enter a saloon, much less to use intoxicating
drinks, whether on or off duty.
Digitized by ^ooQie
2$4
Editorial .
THE GOLD CURES.
No pretended discovery of modern times exhibits so
clearly the motives and character of its authors as the gold
cures for inebriety. The means used are enshrouded in mys¬
tery and concealment, and the theories are proclaimed and
defended with extravagant dogmatism, and hysterical asser¬
tions of positive cures by the victims.
As empiricism, it lacks the usual psychological skill and
commercial cunning, and displays a coarse transparency of
purpose and methods, with egotistical assumptions of the
credulity of science and intelligence, and the purchasable
quality of truth. Scientifically it exhibits rapacity, shallow
pretension, mysticism, misconception, and a very little
knowledge of inebriety.
Psychologically it is simply an inebriate’s theory for the
cure of inebriates; a scheme of degenerates for the resto¬
ration of degenerates ; an insane man’s treatment for the cure
of the insane, and all revolving round a center of cupidity
that is kept very prominent in all cases.
Rev. Dr. Buckley, the famous editor of the New York
Christian Advocate , a leading religious paper in the Metho¬
dist church, has made a serious attempt to ascertain the
reality of the claims of ninety-five per cent, of all cases as
permanently cured by the Keeley Gold Cure. From a cir¬
cular mailed to his subscribers inquiring how many persons
were known personally who were cured after taking the gold
cure, he received ninety-three answers. The Medical Record
writes of this as follows :
“ Through these 93 persons he obtained reports of 534
cases of inebriety treated by the ‘gold cure,’of which num¬
ber 275 remained cured and 251 relapsed. This gives a
proportion of cures of 51J per cent. It might be said at
once that if 50 per cent, are cured, something is accom¬
plished ; but the answer is that this same result can be
secured by ordinary measures not involving the resort to
secret preparations. Of 100 drunkards who deliberately
and honestly desire to break up their habits, surely over half
Digitized by C^ooQie
Editorial.
285
will be rescued by measures known to the profession. As
two-thirds of Dr. Buckley’s correspondents were clergymen,
and many of these were believers in the treatment, the per¬
centage of cures obtained by the inquiry is probably too
high. Even admitting it to be as high as 50, the validity of
the claim that the 1 gold cure ’ is specific is surely disposed
of/’
Dr. Stearns, superintendent of the Retreat for the Insane
at Hartford, Conn., in his annual report makes the following
remarks on this subject:
“ Keeley Gold curers claim that 90 or 95 per cent, of all
cases of inebriety can be cured in a space of four weeks by
a mode of routine treatment, and on the basis of this claim
are besieging the legislatures of different States to pass acts
endorsing their method of treatment and providing means
for its use at the expense of the public. The audacity of
such a movement would be less provided the nature and
properties of the medicines which they use were known.
They now hold the same position in relation to the public
that any other quack remedy does ; and it would be equally
proper for the legislature to order the administration of
‘ Warner’s Safe Cure ’ or any other of the numerous reme¬
dies, the marvelous virtues of which are spread on the pages
of our daily papers, to patients in public institutions.
“ But it is said that abundance of proof that patients are
permanently cured is found in the numerous patients wh9
testify to this fact in different parts of the country. The
same, however, can be said concerning the claims of almost
every other much-advertised remedy. Still, it is not disputed
that many persons who have taken the Keeley-Cure treat¬
ment remain permanently well; but it is claimed that the
real cure takes place after leaving the Keeley Institute, if at
all, and through such measures as have been indicated above.
It is also claimed that many such cures are effected in cases
which never reach Keeley Institutes or any others. They
are not, however, heralded about in a public manner. Such
patients come from the more promising classes of inebriates,
Digitized by ^ooQie
286
Editorial .
that is, those who have a good heredity, mature age, and in
whom the morbid changes of nervous tissue have not become
far advanced. They are also such patients as are able to
fully appreciate their condition, and have a strong desire and
determination to get well, backed by a strong will. There is
nothing new or*wonderful in such cures. That so many
have occurred among those who have been in Keeley Insti¬
tutes arises from the fact that more cases have been treated
there than in other institutions, and that a much larger
proportion of them are voluntary patients, who greatly de¬
sire to overcome the habit, and have come from the more
curable classes of inebriates.
“ It should, however, be stated that there are not, and from
the nature of the case cannot be, any really reliable statistics
regarding the percentage of cures claimed to be effected in
Keeley Institutes, for this reason (among others) that
patients are received, treated, and discharged, and little or
nothing can be known regarding the subsequent history of
many of them. . . .
“ The course pursued by Dr. Keeley in keeping the nature
of the supposed cure a secret proves very conclusively that
he has little confidence in it himself. He does not dare to
make it public, but rather prefers to trade upon the desires
and hopes of credulous families and legislatures and the
unfortunate weaknesses of inebriate brains. If he or any
other person should discover a remedy for chronic inebriety
which would effect a cure in ninety per cent, of all cases in
four weeks, and make its nature public for use by all physi¬
cians, he would be hailed by men everywhere as one of the
great benefactors of the race, and both wealth and honors
would be showered upon him.”
It is evident that this empirical epidemic of Gold Cures
is rapidly disappearing and will soon be numbered with the
South Sea bubbles, Perkinsism, and other delusions of the
past. It is a serious question whether it is not wise to per¬
mit the obsequies to go on without comment rather than to
galvanize the corpse into activity by calling attention to its
frailties.
Digitized by i^-ooQie
Editorial.
287
A certain class of persons have a blunted sensibility and
seem oblivious to any ordinary impressions that are not
directed to their appetites, or the animal instincts. In such
cases, alcohol, by increasing the activity of the heart’s action,
produces strong impressions on the cerebral centers, which,
for the time, seem pleasurable. These are the only agents
which rouse up the inert and obtuse centers, and for a short
time seem to satisfy the desire for a new sensation. This
desire for strong feelings in the degenerate stupid laborer
and persons who live on low planes of intellectual activity
creates a longing for alcohol for a time, but when the tran-
scient excitement from the drug is followed by pain and
increased discomfort, alcohol is abandoned. They use spirits
for the excitement it produces and detest the stupor which
follows, hence drink the strongest alcohols that can be pro¬
cured. This is apparently a confused effort to reach some
level of healthy brain functioning, some physical ideal of
health. Some of these cases will drink very large quantities
of raw spirits and have a short period of marked delirium,
then become intensely stupid. For a long time after ttfey
will have a marked disgust for spirits, and show an increas¬
ing debility of nerve and brain centers.
There are excellent physicians who have done good work
for medicine, and made a reputation and following who have
clearly outlived their usefulness. Such men have passed the
summit of growth, and their minds are becoming more and
more impervious to new facts and evidence, and literally in
many cases they are dangerous as guides and exponents of
science. Such a man has recently in an address on crime
and inebriety, repeated the theories and arguments of a half
a century ago in a most offensive, dogmatic way. It is not
practical to attempt any reply, or even to call attention to
statements that have long ago disappeared as worthy of note
or to even hint at the assertions of incapacity and dishonesty
of persons who sustain the modern views of crime and ine-
Vol. XVII.—38
Digitized by ^ooQie
2«8
Editorial .
briety. It is only sufficient to note with sorrow and regret
that these unfortunates are dying at the top. Dissolution
is making them more and more oblivious to progress in
science and new truths. They are still in the world but
not of it.
A patient under my care said, “I do not wish to give up
all use of alcohol, for the reason I am so miserable when free
from spirits. I am depressed, and have pain, and everything
is a burden to me. It is an effort to think, or do anything;
the presence of others is wearisome. I cannot sleep. I
cannot think, and I seem to be cut off from all pleasing asso¬
ciations with the world. Alcohol restores me. I am myself
again when drinking spirits. The world again is clear and
bright. When I drink to intoxication I regret it and try to
avoid this state. I have drank twenty years; four times I
have stopped all use of spirits, and each time suffered
intensely during this interval. I cannot take any form of
opium. Spirits is the only drug that helps me.” Six weeks
of ft)tal abstinence confirmed clearly this man’s statements.
Notwithstanding all the appliances of medical skill and
efforts, he continued to be what he so graphically described,
a most miserable sufferer, then went back to his family and
relapsed as usual. Some weeks later I met him on an excur¬
sion, a quiet, genial, happy man. He was using spirits twice
a day and had started in business again.
Physicians in Arkansas who become inebriates are
debarred from practice by having their license revoked by
the State board of health.
Michigan has passed a law fixing a heavy penalty upon
railroad companies for the employment of persons addicted
to the use of intoxicants.
Digitized by v^ooQie
Editorial.
289
TREATMENT OF ALCOHOLIC COMA.
The report of a committee of Kings County, New York,
Medical Society, on the treatment of alcoholic cases found
unconscious on the street, is widely circulated and meets
with general approval from all sides. Resolutions to the
same effect were offered by the Neurological section of the
American Medical Society. It is a pleasure to note that Dr.
Mason's efforts are bearing fruit so quickly. Nothing can
be more practical and more needed than a change of the
present system of treating these cases. The following is
a note of the changes already made:
Health Commissioner Emery of Brooklyn, New York,
has sent to each hospital in the city a new set of rules gov¬
erning the work of ambulance surgeons and specifying con¬
ditions under which hospitals receiving money from the city
must receive patients through the ambulance surgeons. Too
much latitude, it is claimed, has been given heretofore to
ambulance surgeons, often young men of little practical ex¬
perience and an exalted opinion of their own importance.
Dr. Emery has given some time of late to an investigation
of alleged ambulance abuses, and in one or two instances he
has discovered patients have died for lack of medical attend¬
ance in cases where the surgeon, when called, refused to in¬
terfere. All patients suffering from coma must be taken to
the nearest hospital according to an order recently issued by
the health commissioner. The rules sent out are for the
government of the hospital and ambulance service under or¬
dinary conditions. Dr. Emery’s address to the superintend¬
ents is as follows:
To Superintendents of Hospitals:
Although the accusation of inhumanity, occasionally
made against the hospital authorities and ambulance sur¬
geons of this city, is generally undeserved, it must, neverthe¬
less, be admitted that, unfortunately, such is not always the
case, as there have come to my knowledge certain well-
authenticated instances of patients in a dying condition hav-
Digitized by L^ooQie
290
Editorial.
ing been refused transportation by ambulance surgeons, and
of others who have been denied admission to hospitals which
are under contract with the city to care for the sick and
poor. In order to diminish the possibility of the future
occurrence of these deplorable mistakes, your attention is
called to the following rules, which take effect immediately:
1. All ambulance surgeons must be appointed by the '
commissioner of health, but the candidates nominated by the
hospital superintendents will be accepted if they present sat¬
isfactory evidence of the possession of the proper qualifica¬
tions for the position.
2. The hospital that is under contract with the city to
treat the sick poor must maintain an emergency ward, con¬
taining not less than two beds, for the temporary reception
of ambulance cases. This ward is to be used for no other
purpose.
3. When an ambulance case is brought to a hospital
from the latter's own district, the patient must be promptly
admitted. Whether he shall be retained or not may be de¬
termined later.
4. Cases of grave injury or sickness must be admitted
even when brought from another district.
5. Cases of delirium and insanity, when brought in an
ambulance, must be admitted and cared for until they can be
transferred to the department of charities.
6. Unless the free beds are all occupied, no applicant
for hospital treatment is to be refused without a medical
examination.
MEDICO-LEGAL CONGRESS.
The Medico-Legal Society of New York will hold a Con¬
gress on the 4th, 5th, and 6th of September next, near New
York city. The topics will be arranged and grouped in sec¬
tions, and discussed together. One section, “ On Inebriety
and its relation to Crime and Responsibility," is under the
charge of Dr. Crothers. The following papers are an¬
nounced :
Digitized by CjOOQie
Editorial\
291
“ Inebriety and the Opium Habit, and their Relation to
Testamentary Capacity,” by Dr. E. C. Mann.
“ What Shall We Do with the Alcoholic Inebriate Ap¬
parently insane ? ” by Dr. Norman Kerr.
“ Alcoholic Anaesthesia a Factor in Crime,” by Dr. I. N.
Quimby.
“ Questions of Responsibility in Alcoholic Coma Found
on the Street,” by Dr. L. D. Mason.
“ How Far Should We Hold the Inebriate Responsible ?”
by Dr. T. D. Crothers.
In other sections, various questions of criminality, hyp¬
notism, medico-legal surgery, microscopy, bacteriology, chem¬
istry, and sociology are to be discussed from the side of juris¬
prudence. A large number of eminent men are to present
papers and to take part in the discussions, and this meeting
promises to be one of the great events of the year, in scien¬
tific circles.
The editor of the Review of Reviews , in his record of
“ The Progress of the World” for the July number, com¬
ments on many matters of national and international mo¬
ment— the recent cabinet changes following Secretary
Gresham’s death, the peculiar prominence of Mr. Carlisle in
the leadership of his party, the present status of the silver
question in politics, the duty of the United States toward
Spain and Cuba, the progress of American universities,
Russia’s relations with China and Japan, the prospects of
Pacific cable construction, the opening of the Kiel Canal, the
progress of amateur sports in England and elsewhere, the
recent Italian elections, the fall of Count Kalnoky, anti-
Semitism in Vienna, British politics, the future of Chitral,
the Armenian question, and various other timely topics.
This department of the Review is illustrated by a score or
more of portraits of the men and women of the day, together
with maps and views.
Digitized by i^-ooQie
292
Clinical Notes and Comments .
dlii)i<&,l ]Sfote$ Conqir|ei\t^.
PATHOLOGY OF DELIRIUM.
The condition of the brain cells which underlies confu-
sional insanity may be produced by other than toxic causes ;
it seems to me indisputable that it may also be produced by
toxic disturbances of nutrition. This is well seen in delirium
tremens, a disorder which is getting more and more to be
recognized as a variety of confusional insanity. The mental
disturbance of delirium tremens cannot be due to a direct
action of alcohol in the blood or in the nerve-tissues at the
time of the breaking out of the disease. The “ horrors ” of
the drunkard is the beginning of delirium tremens, and if the
cerebral manifestations of the horrors or of the delirium tre¬
mens were due to a direct action of the alcohol, then they
should be intensified, not relieved by further doses of the
poison. Evidently, the symptoms are the result of nutritive
changes in the ganglionic protoplasm which have been pro¬
duced by the poison. In other words, the symptoms are only
indirectly caused by alcohol. As acts alcohol, so in all
probability may septic poisons act; as there is an alcoholic
delirium, and also a confusional mania which we call*alcoholic,
because it is indirectly caused by alcohol, so also are there
in all probability a septic delirium and a confusional mania
which is the secondary result of septic disturbance of nutri¬
tion.— Prof. Wood , in American Journal of Medical Science
for April , 1895.
There are twenty specific gold cures for inebriety and
opium-taking in San Francisco. Each one claims to be the
best and to have had the greatest success. The soil is evi¬
dently very fertile for this kind of quackery, and, next to
saloons, these specifics are actually destroying and making
incurable a large number of cases.
Digitized by t^-ooQLe
Clinical Notes and Comments .
293
CASES OF COAL-TAR INEBRIETY.
Jeff. Suttle Davis, M.D., health officer of Shelley county,
Montevallo, Ala., writes (American Medico-Surgical Bul¬
letin) :
During the last decade coal-tar derivatives have been
largely employed as antipyretics, analgesics, and anodynes.
As they all have a powerful effect on the nervous system, it
is but natural that they should be habitually indulged in ;
and as they are easily obtained, the wonder is that so few
cases have been reported.
These drugs are unfortunately becoming household rem¬
edies, and if their sale be not restricted much mischief will
inevitably result from their indiscriminate use.
It is my opinion that many cases of addiction to these
various products are unrecognized by the physician. My
attention was first called to the danger of their long-con¬
tinued use by a brother physician, who, several years since,
favored me with the report of a case of sulfonal habit. The
patient was a gentleman 32 years of age, for whom sulfonal
had been prescribed for insomnia of a year’s duration. Being
of a supra-nervous temperament, it was not long until he
desired to be constantly under its influence, and instead of
the twenty-grain dose at bedtime he took six such doses
daily. His condition was pitiable in the extreme, anorexia
being so marked and constant that he was gradually dying
of inanition. His nervous system was a complete wreck,
his condition being one of listless apathy, alternating with
coma-vigil; sound sleep entirely absent, constipation marked
and urinary secretion scant. Every effort to cure him had
failed. I do not know how the case ultimately terminated.
In speaking to my druggist in regard to the stubborness
of a case, he remarked incidentally that the patient bought
large quantities of acetanilid, and it at once occurred to me
that I was dealing with a case of acetanilid habit. He
denied the charge at first, but finally confessed. ... In
summing up these cases, it will be observed that a weak
Digitized by L^OOQie
294
Clinical Notes and Comments .
heart, anaemia, indigestion, insomnia, constipation, and neu¬
rasthenia were conditions more or less marked in each case.
Albuminuria was present in two cases, while in the third
case the specific gravity was quite low. In two cases there
was an almost constant perspiration, with occasional pros¬
trating night sweats. A marked recurring cyanosis was also
observed in two cases. These were the most prominent
symptoms and can very reasonably be accepted as those to
be expected in similar cases.
It is also seen that the symptoms following the with¬
drawal of these drugs in cases of addiction resemble very
closely those following the withdrawal of the narcotics in
similar cases, i. e . 9 depression, insomnia, vomiting, and diar¬
rhoea.
Strychnine hypodermically, with morphine when neces¬
sary to relieve “ nervousness ” and chloral per rectum at night,
gave the best results in the treatment.
AUTO-INTOXICATION AS A FACTOR IN
MENTAL DISORDERS.
Drs. Regis and C. Lavaure submitted a report on this
subject at the last meeting of the French Congress of Mental
Medicine. They arrived at the following conclusions: (i)
The toxicity of the urine is notably diminished in maniacal
and augmented in melancholic conditions. The urine of
maniacs and that of melancholiacs have different actions on
the animals in which they are injected. The former causing
chiefly excitation and convulsibility, and the latter depres¬
sion, inquietude, and stupor. This would rather prove that
auto-intoxication is the cause and not the effect of the mental
state. (2) These results, though incomplete, show that the
phenomena of auto-intoxication play an important part in
mental diseases, and this is further indicated by recent noso¬
logical investigations on the insanities of the acute infectious
diseases, and those of the visceral and diathetic disorders.
As far as the psychoses of the infectious disorders are con¬
cerned, they are the result either of the direct action of the
Digitized by
Google
Clinical Notes and Comments .
295
microbes or of their mediate and indirect action through the
toxines they secrete. From a clinical point of view they
may present themselves at two different periods. During
the febrile stage the disorder ordinarily takes the form of an
acute delirium. During the post-febrile stage, or during
convalescence, we find the so-called asthenic psychosis pres¬
ent ; this is a more or less variable mental condition, consist¬
ing usually of a mental confusion, stupidity, clouding of the
faculties, a pseudo-dementia. An intermediate form between
these two may possibly be admitted to exist. The visceral
psychoses are in reality genuine insanities from auto-intoxi-
cation. It may be said that where the intoxication is acute
it shows itself as an acute toxic delirium, resembling alcoholic
delirium, as in uremic insanity; when the intoxication is
chronic it generally induces a melancholic condition. Some
cases resemble more or less paretic dementia. General or
local anti-infectious antiseptic treatment is found to give
excellent results. Although it is not possible to formulate a
definite therapeusis, there are enough facts to show that in
the infectious or auto-toxic insanities one must resort to the
treatment of the infection or the auto-intoxication to relieve
the mental disorder .—Progrts Medical .
Mechanism of Death in Cocaine Intoxication.—
Maurel ( Gaz . MM. de Paris , 1894, No. 6) gives a number of
experiments on the toxic character of cocaine, and concludes
that cocaine has a distinct action upon the leucocytes of the
blood and upon the small vessels, the leucocytes assuming a
spherical form and tending to place themselves next to the
vessel-wall. The contraction of the small vessels is often
followed by embolism. Small doses of cocaine were suffi¬
cient to cause alteration in the leucocytes, while intravenous
injections were found to be very dangerous, even in the
smallest doses, owing to embolism which formed in the
lungs. The writer is of the opinion that the chief danger in
cocaine intoxication arises from the contraction of the smaller
blood vessels.
Vol. XVII.—39
Digitized by t^-ooQie
296
Clinical Notes and Comments .
BRITISH OPIUM COMMISSION.
The Medical Standard\ commenting on the provisional
report of the British Opium Commission, remarked over a
year ago that: “ The same ‘ respectable business men * who
forced Great Britain into the brutally unjust opium war
have bulldozed the British Opium Commission into a report
which establishes: the harmlessness of opium as ordinarily
used in India; the value of opium in malarious provinces as
a preservation against fever ; that opium is not a predispos¬
ing cause to disease, insanity, or crime in India; that it is an
infinitely safer form of stimulant for the Indian races than
the alternative stimulant of alcohol. A report of this kind
would be deservedly regarded as the product of 1 boodle 9 in
America. The recently published complete report merely
emphasizes the conclusions just cited. These conclusions
are based, not on carefully analyzed facts, but on isolated
instances of longevity such as are common in all neurotics.
The conclusions, moreover, are directly contradicted by the
testimony of American medical witnesses like Dr. Coltman,
who remarks that those who use opium in the ordinary
amount soon become helplessly besotted and unfit for active
duty. He has frequently noticed that opium-eaters do not
bear surgical operations well. The testimony of physicians
in regard to opium will vary in value according as the phy¬
sician be an opium-user or not. The alcoholist has a ten¬
dency to hold himself up as a horrid example, while the
opium-user underrates the dangers of opium as compared
with alcohol and prescribes it largely. More than one work
fiercely denouncing alcoholic inebriety has been written by
an opium-user. Exact data as to the effects of opium-using
are not easily obtainable where public official opinion favors,
as in the British colonies, opium-using may be directly
inherited. The children of opium-eating mothers require
opium to preserve them during early infancy. Whether
long-continued opium-using for generations might not pro¬
duce immunity from opium toxic effects is an open question.
This undeniably has occurred in pigeons on whom opium is
Digitized by i^-ooQie
Clinical Notes and Comments .
297
without toxic effects. That similar results might obtain in
man there can be no doubt; still such immunity no more
proves the harmlessness of opium-using than does the
immunity of the vaccinated prove the harmlessness of small¬
pox.”
Dr. C. P. Landon of Columbus, Ohio, in discussing the
“ State’s Care of Dipsomaniacs,” before the State Medical
Society, said:
“ Dipsomania is a disease — a lesion over which the vic¬
tim has no volition beyond the power of his self-control; of
indefinite recurrence; a periodic insanity — and because of
the environments, not amenable to successful therapeutics in
private practice. The physician is left helpless because of
the want of co-operative helps and imperative restraint.
“ The State has been generous, munificent, in caring for
her wards, and the profession of medicine ever has been
watchful of the needs of the same The first public pro¬
vision for the care and cure of the insane of Ohio was the
inception and effort of the fathers of this society, and each
advanced movement has been the result of the want made
known by the medical profession.
“ By the benevolent and humanitarian acts of the govern¬
ment many changes and great advancements have been
wrought reflecting the sunlight and life of a quickened and
new-born humanity, evincing a clearer understanding of man
and his relation to society, and of the great law declaring
that each man is the keeper of his brother. Yet, I repeat, in
the twilight of the nineteenth century the State has built
hospitals and asylums for all other forms of maniacs, for all
other classes of the insane; for the dipsomaniacs she has
provided penitentiaries, poorhouses, and the scaffold. But
yesterday the State provided a hospital for the epileptics —
for the care and cure of epilepsy, a recognized incurable dis¬
ease. For this I rejoice, you rejoice. It separates and gives
relief to the overfull institutions of the State; it will give
needed care and help and good to that class of sufferers.
Digitized by
Google
298
Clinical Notes and Comments.
But how much greater the demand and rationality of provid¬
ing for a much larger class of curable maniacs.
“The State's care of dipsomaniacs would result in the
reflection of the sunlight of a new life in thousands of homes ;
the redemption and preservation of thousands of noble
natures, which otherwise would be lost, destroyed; making
manifest a truer Christianity, and a more humane and merci¬
ful administration of law ; making clearer the pathology and
psychological condition of the dipsomaniac; making the
cause, care, and the cure of the mania a solved problem."
Tobacco Smoking in Disease. — Dr. Jankau ( Zeit -
schrift fuer Krankenpjlege) in many cases regards moderate
smoking as indicated, and especially where there is an
express desire. In the majority of surgical affections it is
permissible, with the exception of convalesence from opera¬
tions upon the bladder and abdomen. Patients with dis¬
eases of the eyes, nose, throat, or pharynx should never
smoke. The internal diseases which would not permit
smoking are peritonitis, typhoid fever, and similar affections.
In stomach affections, smoking may be allowed if the smoke
be filtered. Patients with organic heart diseases should
smoke as little as possible. In lung diseases, under certain
circumstances, he would hold smoking to be indicated ; also
in syphilitics. In those with nervous diseases there is no
general rule; sudden withdrawal often does harm, while in
cardiac neuroses only a very weak tobacco with filtration of
the smoke is allowable. To smoke in the sick-room where
there are several patients present is hardly to be commended.
The best time to smoke he would believe to be several hours
after meals.
W. H. Schieffelin & Co. of New York are the American
agents of Trional\ Sulfonal, Phenacetine } and other excellent
preparations which have come into very general use. See
article on trional in this issue.
Digitized by
Google
Clinical Notes and Comments.
299
The Scientific American is unrivaled as a practical scien¬
tific paper to all class of readers. Every issue contains a
rich table of contents.
Antikamnia and Quinine are put up in tablet form,
each tablet containing two and one-half grains of antikamnia
and two and one-half grains of quinine, and is the most sat¬
isfactory mode of exhibition. This combination is especially
valuable in headache (hemicrania), and the neuralgias oc¬
curring in anaemic patients who have malarial cachexia, and
in a large number of affections more or less dependent upon
this cachectic condition.
It is a pleasure to call attention to two new drugs, Proto¬
nuclein , which is of special value in destroying toxic germs
in the body, and Peptenzyme. This latter is a remedy for
intestinal troubles and various forms of cholera. They are
prepared by Reed & Carnrick of New York, scientific
pharmacists of wide reputation.
Wheeler's Tissue Phosphates combine calisaya, sodium,
and iron with wild cherry, and is a most excellent prepara¬
tion. It approaches a true tissue construction in many ways,
and should be tried in all exhaustive cases.
The Arethusa Spring Water of Seymour, Conn., has
become a rival of the famous apollinaris as a healthy table
water, and medicinal agent.
Maltine with Coca Wine is particularly valuable when
spirits or narcotics are withdrawn at the beginning of the
treatment of these cases. Later, maltine with phosphates
can be substituted with excellent results.
Fellows' Syrup of Hypophosphates has come into very
general use, notwithstanding all criticism it is increasing in
popularity and value as a practical remedy, and is more
largely used than ever before.
Parke, Davis & Co., have at last procured an isolated
ferment called Taka-Diastase in the powdered form for
Digitized by CjOOQie
300
Clinical Notes and Comments .
amylaceous dyspepsia. This new remedy should be tried in
all cases of indigestion.
After the removal of alcohol Celerina is found to be one
of those rare drugs that diminishes the neuralgias and lessens
the nervous irritation. Send to the Rio Chemical Company
of St. Louis for a trial bottle.
The Inebriates Home of Fort Hamilton, N. Y., Dr.
Spark’s Home for Inebriate Women in Brooklyn, N. Y., are
very prominent places. The former is the largestand oldest
asylum in America.
The Acid Phosphates of Horsford supplies the phos¬
phates and phosphoric acid needed in exhaustion, and in
many cases is practically a specific.
McClure’s life of Napoleon , edited by Miss Tarbells, is
one of the best short histories published. It contains the
largest number of authenticated portraits and excellent
pictures, and gives a clear, graphic account of this most
remarkable man. This work has had immense sale and is
one of the class of histories that are read by the masses.
It is published in one volume in paper at 50 cents. Send to
S. S. McClure, 30 Lafayette Place, New York city.
Dr. Mann’s new preparation of the Glyceride of the Hypo-
phosphites comp.— a mixture of lime, soda, potass, iron, qui¬
nine, and strychnine, is coming into prominence as a chemi¬
cal food. Send to the author for a sample, to 305 West
86th Street, New York city.
The Taylor Brothers Clinical thermometers, of Roches¬
ter, New York, are among the most valuable on the market
Send to them for a circular.
Digitized by t^-ooQie
THE
Quarterly Journal of Inebriety.
Subscription, $2.00 per yefir.
Vol. XVII. OCTOBER, 1895. No. 4.
This Journal will not be responsible for the opinions of contributors, unless
indorsed by the Association.
DIPSOMANIA AND HYPNOTISM.
By John Gordon Dill, M.A., M.D.,
Assistant Physician to the Sussex County Hospital\ England.
Among the many disorders of the mind, one of the most
prevalent in this country is that form of moral insanity which
leads to dipsomania, and there is none which causes such
widespread misery, or which leads oftener to crime. For, in
the course of his unfortunate life, the drunkard not only be¬
comes himself a physical and moral wreck, and in time swells
the immense army of paupers and criminals, but he is a per¬
petual source of grief and disgrace to his relations and friends,
and his children inherit from him in a marked degree an
intellectual, a moral, or a nervous instability, which may
hopelessly cripple them from their earliest years, or develop
later into some neurotic disease. Now it cannot be too
strongly insisted upon that habitual drunkenness is a disease
— a moral, as opposed to an intellectual insanity — and that,
no matter how real the resolution to reform, or how intense
the pangs of remorse for the past may be, it is a positive fact
that the power of resistance does not equal the impelling force
of the temptation and craving to drink. The drunkard, in
other words, is not his own master.
Digitized by v^ooQie
302
Dipsomania and Hypnotism .
The English law, unfortunately, does not recognize this,
and the penalty for drunkenness serves to keep many a mis¬
erable being in existence, by the periods of enforced absti¬
nence between his orgies, which he passes in prison. Nor
has any systepi of treatment been discovered which can be
relied upon, although innumerable specifics have been intro¬
duced from time to time, only to be discredited after trial.
Certainly the power of resistance does increase during total
abstinence, and, given the will to reform, a long period of
compulsory abstinence has often the effect of getting rid of
the craving to drink, and the patient is cured if he remain a
total abstainer ; but even thus, one glass of alcohol may be
enough to restore the disease, and cases are by no means
uncommon in which, after many years of apparent cure, the
patient has felt confident of his power to drink in modera¬
tion, and the disease has returned. In so terrible and often
hopeless a malady, the merest straw of possible salvation is
naturally grasped, and the encouraging results which hypnot¬
ism had given in the hands of other observers led me to give
it a trial.
Time alone can prove the value of any treatment, even if
it is apparently successful at the outset, and I shall there¬
fore only record the results of the first few cases which came
under my observation some years ago, with their subsequent
history as far as I have been able to trace it.
Case I .— Mrs. J. was a lady between 40 and 50 years of
age, a confirmed drunkard, who had been deprived of the
care of her children, and was subjected to more or less con¬
trol. There was no apparent wish to reform, but consider¬
able violence and impatience of restraint when the desire to
drink was strong.
I first saw her in 1886, and about a year later determined
to try the effects of hypnotism. She was not very suscepti¬
ble, and the unconscious stage, which was not often reached
during a course extending over many weeks, was not deep,
but she became very much quieter, and the craving for drink
abated for a time. It was thought wise, however, to place
Digitized by ^ooQie
Dipsomania and Hypnotism. 303
her under stricter surveillance in the country, and I have
lost sight of her.
I may here mention that I have noticed with some drunk¬
ards that the craving for drink comes on with great intensity
at more or less regular intervals, with periods of intermis¬
sion, during which they may have little or no temptation.
Moreover, in the course of many cases, this “lucid interval ”
appears in time to shorten, until it almost disappears.
Case II. — A. W. was a housemaid, aged about 32, who
had lost her character and her virtue by her drunken habits.
I first saw her at “ St. Monica’s Home,” to which, at the
time, I was Honorary Physician, and after three or four sug¬
gestions that she should dislike all forms of alcohol and be
unable to take it, she lost all desire for drink.
Eventually a situation in a gentleman’s family was found
for her, which she has retained for the past six years, and
she is a most valued and trusted servant.
It is worth notice, that when she was suffering from influ¬
enza and had been ordered port wine by another medical
man who was attending her, she resisted strenuously, and
deceived her mistress by pouring it away.
Case III. — Miss I. was a well-connected woman, whose
relations had disowned her, and who had found a temporary
asylum in the home above mentioned.
Although she really wished to be cured, I was unable to
produce the slightest effect upon her, nor were two other
more experienced hypnotists than myself, who very kindly
came with me to see her, more successful.
A curious point about this case was that the craving for
drink came on with a hallucination that she could smell
brandy, and then nothing could stop her drinking.
Case IV .— Captain A., an officer retired from the army,
had been an inebriate for at least nine years. Mr. Hugh
Wingfield, who happened to be at Brighton, very kindly
came with me to see him, and at his first visit attempted
hypnotism, and managed to render Captain A. powerless to
get up from his chair. He then arranged to see him again
Digitized by t^-ooQie
304
Dipsomania and Hypnotism .
the next morning, but unfortunately during the night Cap¬
tain A. developed the first symptoms of an attack of pneu¬
monia, which became complicated by delirium tremens. After
six weeks of a most dangerous illness, I advised him to go to
Cambridge, and to put himself under Mr. Wingfield, who had
most kindly offered to do all he could for him, but apparently
he had become quite insusceptible to hypnotism. He had
been a total abstainer during his convalescence, but after
leaving Cambridge he relapsed into his former habits, and I
have since heard of his death.
Case V .— Mrs. P., a lady aged about 55, had contracted
habits of intemperance during a period of great domestic
anxiety. I had very few opportunities of hypnotism, but the
effect appeared to be good at the time, and although I have
seen very little of her during the past few years, she has
never, to my knowledge, caused any scandal by a relapse,
though it is quite possible that she may drink secretly.
Case VI .— Captain B., a retired officer of the navy, aged
42, had been a drunkard for years. Although a wealthy
man, he was accustomed to leave home when he began to
drink hard, and would sometimes return covered with vermin,
and without having changed his clothes since the day he
went away.
He expressed no wish to reform, and although he was
treated under my direction by a most experienced hypnotist,
he was not very deeply affected, nor was absolute uncon¬
sciousness ever reached. At the same time he was quieter
and more reasonable during the course of hypnotism, but
after a few weeks he grew tired of it, and had a relapse
shortly afterwards.
Case VII .— Mrs. A., aged 40, was the widow of a clergy¬
man. The discovery of her failing had been made during
the life of her husband, and for a time all forms of alcohol
were kept from her, but when his decease took place, she
bribed one of the undertaker's men to put a bottle of brandy
into the coffin when it was brought into the house, and then
got drunk in the room with the corpse.
Digitized by ^ooQie
Dipsomania and Hypnotism.
305
I first saw her, some years later, when she had been res¬
cued from the lowest depth of depravity by her sister. She
was treated by the hypnotist mentioned in the last case, and
was easily influenced, but although a post-hypnotic sugges¬
tion, that any alcoholic liquor would make her violently
sick was effectual for about three days, at the end of
that time it had apparently quite passed away, nor did re¬
peated trials lengthen the period during which it took effect.
This could not be continued indefinitely, and she was finally
sent to a retreat under the act. I regret to say that I have
had no information about her during the past few years.
Case VIII\ — Mrs. E. was an excellent cook, but she
had lost situation after situation, owing to her drunken
habits. When I first heard of her, some former friends, who
believed in the sincerity of her remorse, and trusted her prom¬
ises of amendment, having found a place for her with a lady
who knew her history, collected a small sum of money, part
of which they expended in the purchase of some respectable
clothes, which they gave her, with the balance of the money,
some three or four days before the time when she was to en¬
ter upon her new duties. Needless td say that she had sold
the clothes and spent the money, and was hopelessly drunk
when the day arrived. I found her in a state of great desti¬
tution, in a miserable lodging with her half-starved child,
and for about three weeks supplied them with the bare ne¬
cessaries of life, while I hypnotized her diligently. She was
very susceptible, and soon found, to her surprise, that she
was unable to take her share in a bottle of gin, which some
boon companion had offered her. She rapidly regained re¬
spectability of manner and appearance, and in the course of
about three weeks found herself a situation as cook, while
her little daughter was admitted to an orphanage. From
that time to this — now nearly five years — she has main¬
tained her character as a most respectable servant, and was
so highly valued by her employers that they kept the place
open for her when she was obliged to go into a hospital to
be treated for a varicose ulcer of the leg.
Digitized by ^ooQie
306
Dipsomania and Hypnotism .
An interesting point about the case is that the effect of
the suggestion has gradually worn off, and she is now able
to take a glass of beer at dinner, but as yet she has suffered
from no temptation to drink in excess.
Although it would be rash to base any conclusions upon
the results of so very meagre a series of cases, they served,
perhaps, to indicate that there is a possibility that this mode
of treatment may be successful, or that, at any rate, until
hypnotism has been tried, no case of dipsomania should be
pronounced hopeless. Doubtless, in more experienced hands
better results might have been obtained, and had we any
certain means of ensuring a susceptibility to hypnotism,
there is no reason that it should not be much more uni¬
formly successful. I have noticed in more than one case
that the best time to make an attempt is very shortly after
a bout of drunkenness, and that the patient is less easily
hypnotized the longer he is kept sober. Possibly, there¬
fore, it may be discovered that some drug may have the ef¬
fect of increasing susceptibility, but the few experiments
which I have had an opportunity of making in this direction
have hitherto yielded barren results. Such experiments,
however, might well repay the trouble they entail, for could
we but discover a certain and reliable method of dealing
with dipsomania, it would be difficult to exaggerate its be¬
neficent results, not only in the present by lightening the
heavy burden of human misery, but in the future by promot¬
ing the health and happiness of unborn generations.
Smoking. — The use of tobacco does not decline, despite
the warnings of hygienists and moralists. According to a
tobacco trade journal, there is a steady increase in the num¬
ber of cigars and cigarettes smoked in this country, and no¬
tably in the consumption of cigarettes. During the fiscal
year just closed there were sold in the United States 3,333,-
845,560 cigarettes, and 4,130,440,370 cigars. The increase
in the consumption of cigars over the previous year was
68,522,938.
Digitized by ^ooQie
The Treatment by Suggestion.
307
THE TREATMENT BY SUGGESTION, WITH CURE
IN FOUR SITTINGS, OF A MAN ADDICTED
TO THE ABUSE OF ALCOHOL, BROMIDES,
AND CHLORAL.
By Mr. C. Theodore Green, M.R.C.S., L.R.C.P., of
Birkenhead, England.
On October 6, 1893, a man aged 32, came to me com¬
plaining that for two months past he had been unable to get
a night’s rest without bromides and chloral; and also that
he had an irresistible craving for whisky, and that his brain
was not able for his work — that of cashier in a very large
wholesale business. His account of himself was incoherent
and vague, and he presented the restless appearance and ex¬
cited manner of a person very near dementia. He was of
fair complexion and hair, 5 feet 10 inches in height, in good
physical condition of body, and having a cerebral develop¬
ment decidedly above the average. I gathered from his con¬
versation that in 1887 he had a serious bout of drinking,
from which he recovered.
Some few months ago he began to be worried about
his work, and then commenced taking a single glass of
whisky or beer in the evening. He soon found that one
glass was not enough, so he had two, in this manner increas¬
ing his daily dose of stimulant till the craving for it was
present all the time. He consulted some doctor, who told
him to 41 go to Llandudno and drink lots of stout.” Well, he
went to Llandudno and drank several bottles of stout daily;
but as he was nothing bettered, but rather grew worse, from
the development of insomnia, he consulted another medical
man, who gave him a prescription for 44 bromides and chloral.”
Without the nightly use of this sedative draught he got very
little sleep, and, of course, his brain became more and more
unfitted for the accurate work required of him.
Vol. XVII.—41
Digitized by ^ooQie
308
The Treatment by Suggestion .
He told me he had never been hypnotized before. As
he expressed disgust for his unconquerable craving, and a
belief that he could be influenced by hypnotism, I agreed to
try what it could do for him. I insisted that this form of
treatment would give him back his normal strength of will,
so that he would be able to conquer his unnatural cravings.
In fact, I made him understand that it was not / who was
curing him, but that I was merely showing him how to cure
himself by the exercise of his will. So, throughout the four
sittings that I gave him I suggested that his will was grow¬
ing stronger, and that all his functions were coming more
and more under his own control. I also ridiculed the idea
that the person hypnotized need give up or lose all his will
power to that of the operator.
On October 6th he fell into a hypnotic slumber in seven
minutes by gazing at a diamond. I then made suggestions
that he would sleep well, and not awake at 2 a.m., as usual;
that alcohol in all forms would taste vile, and, if swallowed,
would be vomited. The next day he telephoned, saying
that he had slept right on to breakfast time — the best sleep
he had had for two months, and that he had had a glass of
whisky, but had difficulty in keeping it down.
He now went away into North Wales with some friends,
and I did not see him for a fortnight. Shortly before he re¬
turned he wrote me a long and very rambling letter that
made me fear still more for his sanity. He said that he slept
very well for four or five night after being hypnotized, but
that since then he had been getting worse in every way. I
advised his speedy return.
So, on October 22d, I hypnotized him again. This time
the sleep was more profound, and he seemed unable to answer
my questions till I suggested that he could do so quite easily.
I repeated the former suggestions, and made use of ordinary
mesmeric “ passes,” which I regard as a most useful form of
suggestion.
On October 24th hypnosis was produced by my gazing
into his eyes for two minutes. On this occasion he seemed
Digitized by t^-ooQie
/
The Treatment by Suggestion. 309
rather less excitable. He said he had been sleeping well
except for a billious attack that occurred during the night of
the 22d. He also said that he had taken no more sedative
draughts, and that he had very little desire for alcohol.
On October 28th he said he slept quite well each night,
and had no desire either for alcohol or sedatives, and that his
brain was clear. As a test of the latter he procured one of
his cash books on the 27th, and worked at it for two hours,
and was delighted to find that he could work as well as ever.
His manner is totally changed. He is restful, and acts and
speaks as a man should when in perfect possession of his
faculties. I now hypnotized him for the last time, and re¬
peated the former suggestions.
Also I found I could inhibit all the special senses. I
also gave him a crystal, and bade him see a picture of his
dining-room, which I had not seen. He described it and the
persons he saw moving about in it. But I was unable to
make him see the picture of a room he had never seen, but
of which I was thinking intently at the time.
Up to date (March, 1894), there has been no relapse.
Time only can show whether this cure be permanent; but I
think I am safe in assuming that any recurrence of the above
symptoms will be as easily abolished by hypnotism as they
were before.
Alcohol in Shock. — Dr. Wood is authority for the state¬
ment, “That alcohol is probably of no value whatever in
shock : indeed, I am perfectly sure that a large dose of alco¬
hol in shock puts one nail in the coffin of the patient, and if
you want your patients to come out of .shock you will be
very careful in giving them alcohol. Alcohol stimulates the
heart, but it paralyzes rather than stimulates the blood ves¬
sels.” The theory is, “by its action on the blood cells it
checks oxidation and limits the power of absorbing oxygen
and eliminating carbonic gas.”
Digitized by
Google
Post-Alcoholism and Inebriety.
3 K>
POST-ALCOHOLISM AND INEBRIETY.
By S. V. Clevenger, M.D., Chicago.
Alienist and Neurologist of the Reese and Alexian Hospital , Chicago ; Late
Medical Superintendent of the Illinois Eastern Hospital for the Insane ,
and Pathologist of the Cook County Insane Asylum ; Author
of “ Comparative Physiology and Psychology ,”
u Spinal Concussion ,” etc .
Ethyl alcohol, spirit of wine, is commercially assumed to
be the base of intoxicating drinks, and the purest of these is
capable of working great havoc when abused, but the
demand for cheap liquor in vast quantities substitutes for
portions of the less harmful ethyl or vinic alcohol what is
known to chemists as the poisonous amyl alcohol (potato
spirit or fusel oil). The aroma or bouquet of liquors is
largely due to certain ethers of the more poisonous amyl and
butyl alcohols, notably the acetic and valeric; then super-
added, all too often, by distiller, rectifier, wholesaler, and
especially by the retailer, are sophistications, flavors, and
perfumes for the purpose of cheapening the resulting com¬
pound, which, by the time it reaches the average consumer,
contains, in addition to the alcohol diluents to increase bulk,
articles to give it false strength, fictitious appearance, odor,
and taste.
In the English Licensing Act of 1872 (35 and 36 Viet., c.
94) there is a schedule of substances called “ deleterious
ingredients ” found to have been used in adulterating intoxi¬
cating liquors; they are cocculus indicus, common salt, cop¬
peras, opium, Indian hemp, strychnine, tobacco, darnel seed,
logwood, salts of zinc or lead, and alum. Since then, inge¬
nuity and cupidity have extended the list indefinitely among
dye materials, both organic and inorganic; and there are also
added correctives of acidity, such as litharge, lime, soda,
potash ; astringents like catechu, oak bark, and aloe leaves;
earths for decolorizing; sweetening agents, and ethers for
Digitized by ^ooQie
Post-Alcoholism and Inebriety . 311
flavoring. Most of these articles are unwholesome, to say
the least, and tend to debilitate and otherwise set up de¬
praved bodily states.
Chronic alcoholism in its most obvious features is a con¬
dition of functional poisoning such as is seen in its produc¬
tion of lethargy, stupidity, and acute narcosis. Less notic-
ably, but gradually, it operates as a tissue poison, affecting
parenchymatous elements, particularly epithelial and nerve
structure, if not to a greater or lesser degree all the cellular
components of the body. A slow degeneration is produced
until the blood vessels are involved in thickening and fibroid
changes. Oxidation of tissues is checked, since alcohol is
consumed in place of the fat, leading to fatty changes which
may advance to general steatosis.
Dr. Magnus Huss of Stockholm in 1849 first promi¬
nently directed the attention of physicians to the subject of
alcoholism, a term he was the first to use. He described
the paralytic and anesthetic forms of chronic alcoholism,
also later referred to by Hammond (“Diseases of the
Nervous System, 1 ” 1881), Ross (“Diseases of the Nervous
System,” 1885), and other neurologists.
Gowers (“ Diseases of the Nervous System,” vol. 1, no,
et seq. y 1892) under the heading “Multiple Neuritis,” gives
still more recent details of these distressing consequences of
driking alcoholics.
Magnan (De VAlcoolisme des diverses formes du Delirp
Alcooligi/e, et de leur traitement , 1874), Virenque, Ham¬
mond, and others observed an occasional loss of sensation
involving only one lateral half of the body, as in hysteria.
The other special senses are generally implicated. Thus
the patient loses the sight of one eye, cannot hear with one
ear, can taste with only half the tongue, and smells with but
one nostril.
Gowers ( op. cit. 119) states that alcoholic polyneuritis is
most frequently met with and preponderates over all other
forms of nerve inflammation. It results chiefly from the
stronger forms of alcoholic drinks, and especially from spirit
Digitized by ^ooQie
312
Post-Alcoholism and Inebriety .
drinking. It is more common among those who take small
quantities frequently, than among those who indulge in an
occasional spree, probably because the total quantity is
greater by the former. It is far more frequent among
women than among men; probably three times as frequent.
Other causes often co-operate with alcohol in exciting poly¬
neuritis, especially exposure to cold, and, in the poor, insuf¬
ficient nourishment.
The symptoms consist in motor weakness, sensory dis¬
turbance, and inco-ordination. The weakness involves first
and chiefly the flexors of the ankle and extensors of the
wrist and fingers in the forearm ; the result is wrist-drop
and foot-drop. Other muscles suffer in severe cases. The
sensory symptoms are tinglings, pains, varying in place and
degree, tenderness and loss of cutaneous sensibility. The
inco-ordination resembles that present in the slighter forms
of locomotor ataxia.
Neuritis is the most common finding in chronic alcoholic
autopsies.
Catarrh of the stomach, with furred tongue, heavy
breath, a feeling of epigastric distress or “sinking,” impaired
appetite, and constipation are ordinarily experienced.
The liver may undergo changes leading to various forms
of cirrhosis. Sometimes moderate drinking may reveal a
special liability to hepatic cirrhosis, while, on the other hand,
hard drinking for thirty years may leave the liver nearly
intact..
The stomach and liver disorders of drunkards produce
dilated veins of the cheeks and nose, causing suffusion of
those parts; acne rosacea. The eyes are watery, the con-
junctivae hyperemic and often tinged with bile.
Formad claims that the kidneys are hypertrophied with¬
out other change as a rule, and Guy's Hospital Reports
verify this finding. Pitt places this as occurring in 43 per
cent, of hard drinkers, and where the typical granular kidney
occurs it is indirectly caused by arterial changes. (Osier,
“Practice of Medicine,” 1001, 1892.)
Digitized by LjOOQie
Post-Alcoholism and Inebriety . 313
The greatest variability in general manifestations can be
found in different patients amounting to idiosyncrasies in
particular cases, and in other patients are classifiable into
groups of a great or less number.
The organic changes seem to be erratic, but are accord¬
ing to the resistance of organs. As a forerunner of serious
alterations in the spinal cord, neuritis is not a simple and
harmless disorder.
Magnan has demonstrated an alcoholic paraplegia in
which Buzzard found electrical degeneration reaction.
Some cases end fatally, though Bramwell ( “ Diseases of the
Spinal Cord,” 307, 1884), considers it for [the most part
functional. Broadbent’s description (.Medical Tiifies and
Gazette , Feb. 16, 1884), in which myalgic pains, hyperes¬
thesia and double wrist-drop is included, should be compared
with the pathologic changes found by Eichorst of Zurich
(London Lancet , May 19, 1888) attending alcoholic neuritis,
in cases of inco-ordination followed by paraplegia and wrist¬
drop, tenderness of muscles, anesthesia, abolition of reflexes,
and, finally, vesical and rectal paralysis. The pathologic
anatomy consisted in cord hemorrhages in the dorsal, gray,
thickened blood vessels, degenerated and atrophied tibial
and radial nerves with axis cylinders destroyed; the peri¬
pheral extremities were worst diseased; connective tissue
proliferations of endo and perineurium and inflammatory
changes in their vicinity. A muscular atrophy was second¬
ary to the neuritis, the nerve sheath inflammation extended
to the interstitial muscular tissue. Bramwell notes that
myelitis and other forms of organic disease may be caused
by alcoholic excess, hence the paralysis may be permanent
and incurable.
The enfeeblement of judgment and will may finally end
in dementia.
Post-mortem does not show any particularly character¬
istic changes in the nervous system invariable for all cases
of chronic alcoholism, showing that resistance is greater in
some than in others. Sometimes hemorrhagic pachymen-
Digitized by ^ooQie
3*4
Post-A Icoholism and Inebriety .
ingitis is observed with thickening and opacity of the pia-
arachnoid membranes and wasting of the convolutions, or
there may be a chronic encephalo-meningitis with membrane
adhesions, but most of these pathologic states are in ad¬
vanced cases of alcoholism, the more incorrigible sort, as can
be readily believed when we note the fact of many chronic
drunkards having been reclaimed and restored to the world
about as they were before the habit was formed. The older
the patient and the longer the addiction, the greater proba¬
bility would there be of finding organic changes in the brain
and its envelopes and blood vessels.
Many chronic alcoholic insane exhibit remarkably close
resemblance of symptoms to those commonly found as the
result of injury to the brain, in traumatic insanity. These
symptoms are: changes of character, lapses of memory,
headaches, sleeplessness, irritability, suspiciousness, long ap¬
parently lucid intervals, homicidal and suicidal impulses, de¬
lusions of persecution. These peculiarities appearing in the
alcoholic insane long after being incarcerated in an asylum,
during which time no intoxicating liquor has been taken by
them, point clearly to organic brain destruction, accom¬
plished from within, but as severe and hopeless as when the
brain had been injured by a blow upon the head, with subse¬
quent extension of inflammation to the membranes and cer¬
ebral tissues.
It is when the mental degradation which temporarily
occurs in alcoholism becomes permanent that chronic alco¬
holic insanity may be said to exist. During the acute stages
there may be hallucinations, illusions, and delusions which
disappear on recovery from the blood poisoning; the per¬
sistence of some of these states betokens permanent damage
to the mental apparatus, and the brains of the chronic alco¬
holic insane invariably exhibit evidences of destructive or¬
ganic changes. •
It is with astonishing frequency that jealousy of the wife
or mistress exists to an exaggerated degree in most forms of
drunkenness, from simple suspicion to delusions of marital
Digitized by i^-ooQie
3 i 5
Post-Alcoholism and Inebriety.
infidelity, which in extreme cases may originate hallucina¬
tions of gross amours being carried on in the patient’s pres¬
ence.
It sometimes happens that the alcoholic may have
grounds for suspicion in facts, but this does not lessen the
delusional origin of his accusations. A frequent outcome of
the notorious marital unhappiness thus caused is a brutal
wife murder, the body of the victim sometimes being found
hacked to pieces or partly destroyed by fire. The insane fiend
may make but a stupid attempt to escape, or none at all,
either expressing surprise at, or doubt of the reality of the
event, or attempting justification in explanations.
The memory and intelligence suffer gravely, though not
always obviously, for it may require considerable familiarity
with the former peculiarities of the patient to determine the
degree of mental impairment, and comparisons of his past
and present are often possible only when he has been under
observation for a greater or lesser period; in some cases,
months may be necessary. He may be able to attend to
routine duties, but is inconstant and easily diverted. The
reasoning powers are lessened in varying degrees, and many
such changes are not determinable off-hand.
Delusions, particularly such as relate to the wife’s un¬
faithfulness, are fixed, but not systematized, for his explana¬
tions concerning them are vague and illogical. There is a
melancholic persecutory tinge to all his ideas.
Some cases .of chronic alcoholism on the verge of chronic
alcoholic insanity experience auditory hallucinations of man¬
datory and accusatory kinds, and these may become so dis¬
tressing as to lead to suicide, homicide, or insane acts gener¬
ally. The dangerous character of insanity with auditory
hallucinations is fully recognized by alienists.
In asylums for the insane will be found many cases of in¬
sanity that have been complicated with alcoholism, particu¬
larly a peculiar form called traumatic insanity, the result of
head injuries, after the receipt of which there is a remarka¬
ble tendency to drink to excess, and the alcoholism may be
Vol. XVII.— 42
Digitized by i^-ooQie
316 Post-Alcoholism and Inebriety.
combined with the traumatic insanity in every conceivable
degree, sometimes outrunning the original psychosis in its
influence for evil. Epileptics are sometimes incorrigible
drunkards, and epilepsy may appear for the first time when
an alcoholic has abstained from liquor for some unusual
length of time. In such cases there may have existed petit
mal\ unnoticed previously, or even convulsions may have oc¬
curred at night, during sleep, and after stopping the use of
liquor the fits have appeared during the day, through the al¬
terations in habits. Any other form of insanity may have,
to some degree, the impress of alcoholism to modify it, and
where this complication is extreme, as it is frequently in the
head injury cases mentioned (sunstroke victims fall into
this category), there are characteristics in common with
those of chronic alcoholic insanity that are well recognized
by asylum physicians and that often cause considerable an¬
noyance.
Soon after the commitment of a chronic alcoholic insane
case to the asylum or hospital, he appears to improve re¬
markably, if he escape the consequences of his last debauch
and does not die of pneumonia or exhaustion; locked up at
first in a ward, he is sooner or later trusted about the
grounds, and can be made very useful as a workman of some
sort. He may refrain from asking for a discharge for a long
while for the purpose of convincing the superintendent of
his recovery, but unless the patient conceal his delusions, as
many insane do, he is liable, with a little questioning or in
his letters to friends or relatives, to reveal the permanency
of his delusions of persecution. The writings of some of
these apparently sane alcoholics contain the foulest abuse of
mother, wife, or children, without the least warrant for it in
their former treatment of the patient.
Sometimes a weak-minded relative may be found espous¬
ing the cause of the “ unjustly detained ” alcoholic, or well-
meaning but misguided friends may satisfy themselves of
the “ recovery,” and even resort to habeas corpus proceedings
to secure the patient’s discharge.
Digitized by t^-ooQie
Post-Alcoholism and Inebriety. 317
Under the watch and restraint of hospital sojourn and
their gradual admission to parole, with occasional breaks
thereof, many of these patients assume, to all appearances,
their original mental condition. To the superficial observer
they are perfectly sane; many work cheerfully in the shops
and talk quite intelligently about the possibility of relapses
if allowed to go. But a large percentage are importunate,
and these are the least to be trusted, for their anxiety to flit
is born of their inability to gauge their feeble will power to
resist temptation. If they are discharged, back they come,
not infrequently with newspaper and other criticism of the
hospital authorities for having liberated such a dangerous
character. These same critics are just as liable to write up
sensational comments on the injustice of keeping perfectly
sane persons at the behest of relatives who, the critics affirm,
have some pecuniary motive in the patient's being deprived
of liberty. Nor is the trouble taken to inquire whether the
county is charged with the case as a pauper or not.
When habeas corpus proceedings are begun, the natural
inference is that there must be some malign reason for the
detention. Probably it is just as well in the long run that
the public, should be suspicious, but the conscientious hos¬
pital physicians are put to unnecessary trouble in explaining
matters of pathology and general medical experience to lay¬
men who are much more familiar with business affairs.
The hospital physicians will congratulate themselves that
cases of this kind are improving, and discuss the advisability
of trusting them on parole, preliminary to letting them go
home on trial, but the records of the cases suggest caution,
such as domestic horrors, including attempted wife murder,
brutality to children, improvidence to a criminal degree, the
wife usually faring the worst, though when he is not drink¬
ing she claims her husband to be the “ best and kindest of
men."
Notwithstanding all this, such near relatives often beset
those in charge of the hospitals to liberate their husbands,
sons, or fathers ; poor ignorant creatures, because they can
Digitized by ^ooQie
318 Post-Alcoholism and Inebriety .
only see the hopeful side of matters for themselves, and can
not appreciate the vast fund of information possessed by the
doctors as to the frequently disastrous consequences of too
early discharges, or, sometimes, any discharge at all.
The alcoholic insane have been apparently sane while at
the asylum, and even after ten years* trial when they were
allowed to return home they would resume all their bad
habits, such as furniture smashing, chasing the family into
the streets with axes or knives, and after being returned to
the asylum in a maniacal state they would resume all their
apparent sanity and sweetness of disposition, which arouse
the suspicion of the visitor that some unworthy motive on the
part of somebody withholds so useful a person from society
at large.
Among the sadly comic instances of this kind appear lib¬
erations after carefully weighing probabilities and enduring
the threats, entreaties, and promises of the family and the
patient, against the better judgment and misgivings of the
physicians; and when something does occur from the risk,
as too often happens, forthwith not only the public but the
relatives censure the weakness of the doctors for having lis¬
tened to them at all.
A washerwoman, who had about as much experience with
the inner life of a large city as some physicians acquire, used
to dub the defects produced by alcoholism as “ street angels
and home devils.” Much danger to the community exists in
the seeming sanity of such cases. There is no provision for
their incarceration on the ground of their great liability to
be homicidal, and when they do commit a murder it is a dif¬
ficult matter for the public to comprehend the insanity
during the quiet stage induced by imprisonment and liquor
deprivation.
Alcoholic dementia is simply a secondary or terminal de¬
mentia of profound type, that has usually supervened upon
alcoholism, the intermediate stage of chronic insanity being
often short, or having escaped notice altogether, as such ;
being merged from the general alcoholism. It is as perma-
Digitized by ^ooQie
Post-Alcoholism and Inebriety .
319
nent and incurable as any other secondary dementia. The
organic brain and blood vessel changes in this, and other
chronic alcoholic insane states often shorten the lives of pa¬
tients ; many succumb from pneumonia which proves so fatal
to drunkards generally.
Post-alcoholic conditions are such as become evident
during abstinence after the protracted use of liquor.
If the shock of abstinence is rallied from, we can then
determine how much is left of the patient. Destructive
changes in the brain may be, to an extent, masked by drink¬
ing ; that is, the behavior of the patient may be erroneously
ascribed to the drinking when it in larger part may be due to
brain alterations produced by over-indulgence.
The extreme ground is taken that by whatsoever means
recovery from habitual drunkenness is made, the health is
never regained. Dr. Clum ( Quarterly Journal of Inebriety,
October, 1891, 382), observes that those who have been ad¬
dicted to the excessive use of alcoholic beverages for a num¬
ber of years may be restored to a state of sobriety, but they
are generally left with an entail of chronic disease which
eventually ends their career. They die temperance men, but
die as a result of disease contracted by the excessive use of
liquor. The habit is abandoned and nature and remedies
are given a chance to do their part toward reinstating the
individual, but the vital organs have been injured beyond
reparation.
This gloomy outlook for the “ reformed ” inebriate con¬
cerns a large percentage of cases, but is far from being uni¬
versal. Drunkenness is not the only consideration ; the
health previous to and during the addiction should be re¬
garded, aside from, as well as with, the drinking habit and
its extent; the age, associations, and conditions, such as ex¬
posure and immoral practices, as incidental or consequential
matters, need consideration in ascertaining how far a break¬
down is ascribable to drink or its stoppage.
Heart weakness, that had previously been compensated
to some extent by stimulants, whether created by their use
Digitized by ^ooQie
320
Post-Alcoholism and Inebriety.
or not, often becomes apparent in post-alcoholic life. Syph¬
ilis is known to have become modified and somewhat checked
through alcoholic poison acting upon the syphilitic poison,
and when this antagonism ceases the syphilis has become
more virulent. Livers, kidneys, nerves, and brains that have
been structurally degraded cannot be restored by mere
change of habit; indeed paralytic states may become evident
immediately after liquor withdrawal through the shock of re¬
adjustment to new vascular workings. For example, when
an alcoholic neuritis with membrane thickening and begin¬
ning spinal cord myelitis has been inaugurated through alco¬
holism, the sudden change in the circulation caused by absti¬
nence will inevitably render the physical consequences of
such inflammatory and neoplastic states more apparent.
Pressure symptoms, debility, and marked sensory and motor
impairment are liable to occur, from monoplegias to complete
paraplegia.
Tremens begins during the abstinence of drinkers, and
from circulation changes in the brain ; temporary sobriety
causes a dazed, bewildered mental state in the hard drinker.
Even were the craving destroyed, and were the will-power to
resist drinking to be imparted, by any means, too often the
inebriate then finds himself so completely out of his environ¬
ment, so changed are inner to outer relations as to what con¬
stituted his previous existence, that he rushes back to his
former habits about as a fish would take to water, and for
analogous reasons.
Hard drinkers are the first to succumb to epidemics, such
as cholera and yellow fever, and abstinence merely uncovers
the debased organic weaknesses that these epidemics cooper¬
ated with destructively.
After prolonged use of liquor, abstinence sometimes is
followed by acute melancholia, in which the delusions of that
psychosis are commingled with some that are peculiar to
alcoholic insanity. This depressed state seems to be owing
to exhaustion of the system habituated to alcoholic suste¬
nance, and not yet readjusted to the assimilation of proper
food.
Digitized by ^ooQie
Post-Alcoholism and Inebriety .
321
A demented condition, more or less profound, may set in
from the same causes. A well-known stock-yards millionaire
of Chicago had, up to his sixtieth year, guzzled fusel oil in all
its disguises as ethyl alcohol compounds, and a sharper,
shrewder person was hard to find; but he abandoned his
drinking suddenly, utterly and completely, and during the
succeeding three or four years gradually became incapable of
attending to business, presenting the apathy, memory loss,
and other characteristics of what was known as “ primary
mental deterioration,” but which Voisin claims to be ‘/ather¬
omatous insanity,” the blood-vessel destruction found post¬
mortem justifying the designation. While this mental mala¬
dy is often independent of alcoholic habits, its appearance as
apparently connected with the stoppage of drinking is worth
noting. In those who indulge many years and then quit
drinking, the alteration in behavior is quite observable ; they
are certainly quieter, calmer, and while doubtless far better
off than when stimulating, the general tone is below what it
used to be, or what it would have been had they not drank at
all; meddling with fire must be at the expense of some scars.
While atheromatous insanity may occur in the temperate, a
condition like it, if not identical with it, could readily be con¬
ceived as consequent upon abstinence after long addiction, or
the pathologic condition mentioned itself could be directly
induced by alcohol, and persist, whether alcohol is or is not
taken after the condition is instituted. The tendency to
steatosis in the intemperate can be recalled in this connec¬
tion, and doubtless many cases of so-called dementia from
abuse of alcohol may be found to be of Voisin’s type of ather¬
omatous insanity.
The hyperemic state of chronic alcoholism necessarily
alters the cerebral circulation in various ways in many, but
not in all cases, causing endarteritis, leucocytic exudation,
neoplastic organization, and capillary extravasation into the
cerebral tissues, comparable to the rosacea observable in
some drunkards’ cheeks and noses. In my autopsies of the
alcoholic insane at the county asylum, I invariably noticed
Digitized by t^-ooQie
322
Post-Alcoholism and Inebriety .
a rusty discoloration of the dura matter along the course of
the superior longitudinal sinus, and other evidences of old
inflammatory conditions such as adhesions of the membranes
and cerebral tissue of the convexity and basilar regions. The
vascular and meningeal alterations varied in degree accord¬
ing to the patient’s age. Where frailty of bloodvessel organ¬
ization existed congenitally there was greater liability to
pathologic change in such cases.
The finer mental coordinations in any one are maintained
by effort; being the latest faculties acquired, and their tenure
being so dependent upon full brain integrity, it is plain that
the moral nature has been superimposed upon the less easily
destroyed brute nature, through finer and weaker histologic
arrangements acquired and ihherited, demanding for their
exercise the clearest kind of brain activity. Vitiated blood
quickly blots out these better but feebler functions for the
time being, just as exhaustion is felt first in our weakest
joints. So the moral nature, which is merely a higher intel¬
ligence, may depart when the seat of intellect is weakened
by any cause such as senilty, drinking, insanity, arrest of
development, traumatism, and some diseases.
When certain pathologic adjustments, involving imperfect
compensation, occur, such as thickened arterial walls which
resist the increased flow of blood, then a new plane of men¬
tal operation is established, which, if disturbed by change
of habits, as by withdrawal of the customary greater heart
impulse, it is but partially and inadequately recompensated
by the pure blood. Practically, the adjacent cerebral tissue
must suffer from anemia to a greater or lesser extent, and
where previously the blood was driven through disarranged
avenues, it now makes its way feebly and in places not at
all. Nor is this all; the schlerosed and otherwise changed
tissue becomes a more prominent hindrance to function when
the artificial nutrition and circulation is cut off. So the poor
fool of a drunkard is too often thus “ damned if he does, and
damned if he don’t ” continue.
Summarizing post-alcoholic bodily and mental states there
Digitized by ^ooQie
Post-Alcoholism and Inebriety . 323
may be found many organic destructive changes in the blood
vessels, liver, nerves, and brain, which were not so evident
during the addiction, owing to the somewhat compensatory
effect of the alcohol, and hence the masking of diseases.
The simple privation may kill through the weak heart
losing its wonted stimulant, but such cases are not very
common; debility is the most frequent consequence of
“ reform,'” but this is often a return to what preceded and
may have led to the over-indulgence. Cerebral blood vessels
subjected to engorgement are liable to rupture at any time
where weak points exist, and fatty degeneration of vessel
walls, induced by the liquor, may culminate in apoplexy,
whether drinking is continued or not.
A single severe attack of delirium tremens may make
profound changes for the worse in the future workings of the
brain, and the typhoid stage of some cases of delirium tre¬
mens show the ravages of the poison often in life-long
sequelae.
Chronic alcoholic insanity may make its first gross appear¬
ance after abstinence enforced in jail or otherwise.
Necessarily, when liquor is withdrawn, a change for the
better is ordinarily the rule, but such withdrawal in some
cases may operate as a shock, and in all cases a readjustment
of the entire physiologic make-up must occur. It is con¬
ceivable that epilepsy or insanity may find in such shock a
potent exciting cause and the whisky soaking is ample as a
predisposing influence, when it can alter the brain structure,
in time, as thoroughly as a contusion or a concussion.
But what the inebriate has drank, how long he has been
drinking, and his power of resistance, associated diseases,
hereditary and other tendencies, are to be taken into account;
and with these it is surprising how large a number of heavy
drinkers escape any obvious trouble due to such excesses.
A well-known druggist of Chicago was a sot until his fortieth
year, stopped drinking and died at 70 years, having built up
a large business; while others who had not taken half his
Vol. XVII.—43
Digitized by CjOOQie
324 Post-Alcoholism and Inebriety.
risks with liquor succumbed during or after ceasing their
bad habits.
Post-alcoholic conditions, such as insanity, paralysis, weak
heart, etc., that occur in a minority of cases after alcoholic
disuse, only the most thoughtless or perverted could use as
arguments against the stopping of drink ; as the liquor in
such cases produced the trouble which merely culminated
after the habits were changed ; such climax, being inevitable
in any case, and impending, might have been reached earlier,
or in a graver form, had the inebriety continued.
In a few words, drunkenness is a constant menace to the
mental and bodily health, and it is far safer to escape from
its ravages scarred and maimed, than to go on sooner or
later to certain destruction. Though the vast majority may
be rescued entire, or nearly so from intemperance, no one
can tell what the chemic devil has left of him until months
or years of sobriety have passed.
A Continental Medical Temperance Society. —We
are very glad to hear (says the Medical Pioneer ) that one of
the results of the International Congress against the abuse
of intoxicating liquors, recently held at Basle, Switzerland, is
the formation of a Medical Temperance Association among
the medical men on the Continent. We believe that total
abstinence is one of the conditions of membership, and very
properly so, as nothing short of this can be effectual. The
president is Dr. A. Smith of Grossherz, Baden, and the hon¬
orary secretary, Dr. Fuer, assistant professor of psychology
in Heidelberg. Both these gentlemen read excellent and
thoroughgoing papers, from a temperance point of view, at
the recent Congress. About five-and-twenty names were#
we believe, given in as desiring membership at the first
meeting. This is a good beginning, and we trust that this
infant society will speedily grow in strength, and accomplish
a great work. The number of medical men on the Conti¬
nent being so very large, we may expect it will have a large
membership in course of time.
Digitized by C^ooQie
Influence of Alcohol upon Urinary Toxicity . 325
THE INFLUENCE OF ALCOHOL UPON URIN¬
ARY TOXICITY, AND ITS RELATION TO
THE MEDICAL USE OF ALCOHOL*
By J. H. Kellogg, M.D., Battle Creek, Mich.
The biologic test for the urine, perfected by Bouchard,
is a most important addition to our means of studying dis¬
ease processes in the body and the effects of various infec¬
tious and toxic agents upon the animal organism. Bouchard
demonstrated what had previously been suspected, that urea
is not the most important toxic agent of urine, although the
most abundant excretory product. His researches demon¬
strated the fact that urea is only very slightly toxic in
character, and that it, in fact, serves a very important and
useful rdle in the economy by stimulating renal activity, act¬
ing thus as a true physiologic diuretic. The experiments of
Bouchard and Rogers have shown very clearly that the urine
contains more than half a dozen toxic agents, most of which
are far more important in character than urea. Urea is,
however, a useful measure of these agents under ordinary
circumstances, that is, when the urine contains only the
normal toxins; but, under unusual morbid conditions pro¬
duced either artificially for experimental purposes, or natur¬
ally as the result of an infection of some sort, the quantitative
determination of urea is no longer a reliable guide; in fact, it
may give no suggestion in relation to grave morbid pro¬
cesses resulting in the formation of large quantities of toxic
substances and a consequent condition of general toxemia.
The same is true with reference to the various other modes
of examining urine in common use.
The biologic test of the urine does not require a chemic
examination of the urine, hence does not depend upon the
* Read in the Section on State Medicine, at the Forty-sixth Annual Meeting
of the American Medical Association, at Baltimore, Md., May 7-10, 1895.
Digitized by ^ooQie
326 Influence of Alcohol upon Urinary Toxicity ,
chemic recognition, by reagents, of minute quantities of
chemic substances, the reactions for which may be obscured
by the presence of other known or unknown substances, but
makes a direct determination, both quantitatively, and, to
some extent qualitatively, respecting the toxic character of
the urine in both normal and pathologic conditions. The
following is the method: The urine collected for a definite
time, and, if necessary, calculated for twenty-four hours, is
carefully neutralized and then injected at the rate of 1 c.c.
per second into the venous system of a rabbit which has
previously been carefully weighed ; the weight of the patient
must also be known. The exact quantity required to cause
the death of the rabbit, and the symptoms occasioned as the
result of the injection are carefully noted. The following
are obtained, directly or indirectly :
1. The amount of urine required to kill a kilogram of
rabbit.
2. The number of kilograms of rabbit which might be
killed by the total amount of urine produced in twenty-four
hours.
3. The amount of rabbit which might be killed by the
quantity of toxic substances produced in twenty-four hours
by each kilogram of the patient. The latter quantity is
termed the urotoxic coefficient, and is represented normally
by the fraction .44, that is, the quantity of urine produced
in twenty-four hours by each kilogram of normal human
being is capable of destroying the life of .44 kilogram of
living being; consequently, if these substances were retained
within the body by failure of the kidneys to eliminate them,
death would result, approximately, in about two and a half
days. Clinical observation with reference to the effects of
complete suppression of the urinary function agrees with the
results of experimental study.
I have employed the biologic test a very considerable
number of times, some hundreds of times in all, and am
fully satisfied with regard to its reliability and accuracy.
It is, indeed, a most remarkably delicate test of the condition
Digitized by t^-ooQie
and its Relation to the Medical Use of Alcohol . 327
of the system in general, and of the renal function in partic¬
ular. A few observations which I have made will serve to
illustrate the value of these means of investigation. In a
case of tuberculosis the toxicity of the urine was found to be
double the normal. Among the most prominent symptoms
occasioned by the injection was a very great rise in temper¬
ature, the elevation in temperature amounting to over three
degrees C. In a considerable number of tests made, in
which the urine of a patient suffering from typhoid fever was
employed, the toxicity of the urine was found to be greatly
increased in every instance, and occasioned a marked eleva¬
tion of temperature. In a case of intermittent fever of
malarial origin, the urotoxic coefficient of 2.36 was found
during the paroxysm, the coefficient of being .76 before, and
.78 after. This observation seems to show that during the
paroxysm of malarial fever there is produced by the parasites
of this disease a febrile substance to which the febrile action
is due. This subject the writer has considered at length
elsewhere.
One of the most interesting observations I have made
was in a case of idiopathic epilepsy; the urine employed
was collected while the patient was just recovering from a
succession of epileptic seizures, having been in what is
known as the epileptic state, or static epilepticus, for nearly
thirty-six hours. The urine was found to be extremely toxic,
the degree of toxicity being three times the normal. The
rabbit died in convulsions which were distinctly epileptiform
in character.
The biologic test applied to the urine of pneumonia, ery¬
sipelas, scarlet fever, diphtheria, and all other infectious
maladies shows a marked increase in the toxicity, when
the patient is doing well, that is, when the poison is being
eliminated by the kidneys. In pneumonia, for example, the
toxicity of the urine may be considerably diminished during
the first few days, but when the critical period is passed and
favorable symptoms make their appearance the toxicity of
the urine is found to be three or four times the normal.
Digitized by t^-ooQie
328 Influence of Alcohol upon Urinary Toxicity ,
Delicate chemic investigations of the urine which have
been made by Gauthier, Brieger, and others, have revealed
the presence in the urine of definite organic compounds
which possess characteristic toxic properties. Chemic
researches, when sufficiently refined and delicate, thus agree
with the biologic test, but the modes of investigation
employed are too troublesome to be ordinarily used, hence
the value of the biologic test.
The above-mentioned observations, and many others,
having fully established my confidence in the biologic test as
a reliable mode of investigation, I determined to make an
experiment for the purpose of determining the influence of
alcohol upon urinary toxicity. The subject of the experi¬
ment was a healthy man of 30 years, weighing 66 kilos.
For fifty days prior to the experiment he had taken a care¬
fully regulated diet and the urotoxic coefficient had remained
very nearly uniform. The urine carefully collected for the
first eight hours after the administration of eight ounces of
brandy diluted with water, showed an enormous diminution
in the urotoxic coefficient, which was, in fact, scarcely more
than half the normal coefficient for the individual in ques¬
tion. The urine collected for the second period of eight
hours showed an increase of toxicity, and that for the third
period of eight hours showed still further increase of tox¬
icity, the coefficient having nearly returned to its normal
standard.
The bearing of the results of this experiment upon the
use of alcohol in pneumonia, typhoid fever, erysipelas,
cholera, and other infectious disorders will be clearly seen.
In all the maladies named, and in nearly all other infectious
diseases, which includes the greater number of acute mala¬
dies, the symptoms which give the patient the greatest incon¬
venience, and those which have a fatal termination, when
such is the result, are directly attributable to the influence
of the toxic substances generated within the system of the
patient as the result of the presence of the specific microbes
to which the disease owes its origin. The activity of the liver
Digitized by ^ooQie
and its Relation to the Medical Use of Alcohol. J29
in destroying these poisons, and of the kidneys in eliminat¬
ing them, are the physiologic processes which stand between
the patient and death. In a very grave case of infectious
disease, without this destructive and eliminative activity the
accumulation of poison within the system would quickly reach
a fatal point. The symptoms of the patient vary for better
or worse just in relation to the augmentation or diminution of
the quantity of toxic substances within the body.
It is the recognition of this fact which has led to the
recent general revival of hydrotherapy in the treatment of
acute febrile disorders. Water applied externally stimulates
cutaneous elimination, and employed freely internally by
water drinking and the introduction of water in quantities
into the colon to be retained for absorption, aids liver and
kidney activity. If the patient dies it is because his liver
and kidneys have failed to destroy and eliminate the poisons
with sufficient rapidity to prevent their producing fatal mis¬
chief among the delicate mechanisms of the body.
In view of these facts, is it not a pertinent question to
ask how alcohol can be of service in the treatment of such
disorders as pneumonia, typhoid fever, cholera, erysipelas,
and other infections, since it acts in such a decided and
powerful manner in diminishing urinary toxicity — in other
words, in lessening the ability of the kidney to eliminate
toxic substances ? In infectious diseases of every sort, the
body is struggling under the influence of toxic agents, the
result of the action of microbes. Alcohol is another toxic
agent of precisely the same origin. Like other toxins result¬
ing from like processes of bacterial growth, its influence upon
the human organism is unfriendly ; it disturbs the vital pro¬
cesses ; it disturbs every vital function, and, as we have shown*
in a most marked degree diminishes the efficiency of the kid¬
neys in the removal of the toxins which constitute the most
active factor in the diseases named, and in others of anal¬
ogous character. If a patient is struggling under the influ¬
ence of the pneumococcus, or Eberth's bacillus, Koch's
cholera microbe, or the pus-producing germs which give rise
Digitized by i^-ooQie
330 Influence of Alcohol upon Urinary Toxicity ,
to erysipelatous inflammation, his kidneys laboring to undo f
so far as possible, the mischief done by the invading para¬
sites, by eliminating the poisons formed by them, what good
could possibly be accomplished by the administration of a
drug, one of the characteristic effects of which is to diminish
renal activity, thereby diminishing also the quantity of
poisons eliminated through this channel? Is not such a
course in the highest degree calculated to add fuel to the
flame ? Is it not placing obstacles in the way of the vital
forces which are already hampered in their work by the pow¬
erfully toxic agents to the influence of which they are sub¬
jected ?
In his address before the American Medical Association
at Milwaukee, Dr. Ernest Hart very aptly suggested in rela¬
tion to the treatment of cholera the inutility of alcohol, bas¬
ing his suggestion upon the fact that in a case of cholera the
system of the patient is combating the specific poison which
is the product of the microbe of this disease, and hence is
not likely to be aided by the introduction of a poison pro¬
duced by another microbe, namely, alcohol. This logic
seems very sound, and the facts in relation to the influence
of alcohol upon urinary toxicity or renal activity, which is
elucidated by our experiment, fully sustain this observation
of Dr. Hart.
It is also easy to show the important bearing of the fact
to which we have called attention upon the relation of alco¬
hol to chronic disease. Alcohol is doubtless, at the present
time, much less frequently prescribed as a remedy in chronic
disease than a quarter of a century ago.
In a recent number of the British Medical Journal , Dr.
Lauder Brunton, the eminent English physiologist and neu¬
rologist, in mentioning the fact that death from chloroform
anesthesia rarely occurs in India, but is not infrequent in
England, attributed the fact to the meat-eating habits of the
English people, the natives of India being almost strictly
vegetarian in diet, partly from force of circumstances, doubt¬
less, but largely also, no doubt, as the result of their religious
Digitized by v^ooQie
and its Relation to the Medical Use of Alcohol. 331
belief, the larger proportion of the population being more or
less strict adherents to the doctrines of Buddha, which
strictly prohibit the use of flesh foods.
The theory advanced by Dr. Lauder Brunton in relation
to death from chloroform poisoning, is that the patient does
not die directly from the influence of chloroform upon the
nerve centers, but that death is due to the influence of
chloroform upon the kidneys, whereby the elimination of the
ptomaines and leucomaines naturally produced within the
body ceases, their destruction by the liver also ceasing, so
that the system is suddenly overwhelmed by a great quantity
of poison and succumbs to its influence, its power of resist¬
ance being lessened by the inhalation of the chloroform.
The affinity between alcohol and chloroform is very
great. Both are anesthetic. Both chloroform and alcohol
are simply different compounds of the same radical, and the
results of our experiment certainly suggest the same thought
as that expressed by Dr. Brunton. How absurd, then, is the
administration of alcohol in conditions in which the highest
degree of kidney activity is required for the elimination of
toxic agents.
Another thought is suggested in this same connection,
namely, the absurdity of injecting alcohol in a case of threat¬
ened death in chloroform anesthesia. Notwithstanding the
extensive use of alcohol for this purpose during many years,
can any person testify that he has seen a single life saved by
it? The evident danger of establishing the alcohol habit by
such a use of the drug doubtless influences most intelligent
physicians sufficiently to lead them to consider it better for
the patient to forego any possible benefit which he might
receive from the use of alcohol, rather than become a con¬
firmed inebriate. Nevertheless, there are still many practi¬
tioners who recommend to certain classes of patients the
habitual use of beer, wine, or some other of the so-called
light liquors, with the idea that by their use nutrition may
be improved, and appetite, digestion, or assimilation in-
Vol. XVII.— 44
Digitized by ^ooQie
332 Influence of Alcohol upon Urinary Toxicity .
creased, or some good be accomplished in some way which no
one has attempted to explain.
In a certain proportion of these chronic cases there is a
tendency to tissue degeneration. Modern investigations
have given good ground for the belief that these degenera¬
tions are the result of the influence of ptomaines, leuco-
maines, and other poisons produced within the body upon
the tissues. It is well known that many of these toxic
agents, even in very small quantity, give rise to degenerations
of the kidney. It is this fact which explains the occurrence
of nephritis in connection with diphtheria, scarlet fever, and
other infectious maladies. Dana has called attention to the
probable r 61 e played by ptomaines produced in the alimen¬
tary canal in the development of organic disease of the cen¬
tral nervous system.
It is thus apparent that the integrity of the renal func¬
tions is a matter of as great importance in chronic as in
acute disease; hence any agent which diminishes the effici¬
ency of these organs in ridding the system of poisons, either
those normally and regularly produced, or those of an acci¬
dental or unusual character must be pernicious and danger¬
ous in use.
The Morphine Habit in China. — According to the
London Lancet the British consuls in China have repeatedly
drawn attention to the increasing prevalence in several ports
of the pernicious habit of injecting preparations of mor¬
phine, practiced by unqualified persons among the natives.
This custom was originally introduced as a cure for opium
smoking, but it is a case in which the remedy is worse than
the disease. Those who sell morphine and make the injec¬
tions procure a profit of from two hundred to four hundred
per cent. The charge for making an injection is one cent.
One of the victims of the practice said : “ It is much cheaper
than opium smoking, and I get the same satisfaction out of
it. I know of ten Chinese doctors, each of whom treats
fifty to one hundred men daily with this medicine.”
Digitized by CjOOQie
The Cigarette Habit .
333
THE CIGARETTE HABIT*
J. C. Mulhall, M.D., St. Louis, Mo.
As a member of this and the Climatological Association,
and as one who has smoked cigarettes for twenty-five years,
I feel that I may speak with a certain amount of authority on
this subject. “ You, a throat doctor, and smoke cigarettes ! ”
is a phrase that has finally wearied my ears, and, bubbling
with mild wrath, I “ rise to explain.”
The pleasure and the penalty of this vice have never been
rationally described, to my knowledge, other than by myself.
This I did in a paper published in the St. Louis Courier of
Medicine , some eight years ago, but so little notice was given
it that what I now say will be practically new.
A word as to the tobacco habit in general. Mankind
pursues various methods in using it. By chewing it, by
dipping, by cigar or pipe, by snuffing, and by cigarettes.
There is a reason why each one pursues a particular plan.
Early associations have much to do with the selection of the
plan ; but, apart from this, each method has its own particu¬
lar pleasure. The man who both chews and smokes derives
a different kind of satisfaction from each method, and he
would derive a still different kind did he take snuff. Cigar¬
ette smokers maybe divided into those who inhale the smoke
and those who do not. The latter class is a very small one,
and the pleasure derived is the same, in a milder degree, as
that of the cigar and pipe smoker, wherein the smoke cham¬
ber is the mouth. But all real devotees of the cigarette
inhale. That is, with a quick respiratory act, the smoke is
drawn through the larynx, into the trachea, and, as far as I
have been able by different experiments to learn, into the
first division of the bronchial tubes; not, as the public
believes, into the lungs proper. These inspirations are
♦Read before the American Laryngological Association, May, 1895.
Digitized by CjOOQle
334
The Cigarette Habit.
nearly always superficial, and the fact alone that there is a
tidal and residual air would teach that the smoke does not
reach beyond the bronchial tubes. Inhalation explains the
pleasure of cigarette smoking. If the cigarette smoker did
not feel the smoke in his larynx and windpipe his pleasure
would be gone. Every old cigarette inhaler will tell you this
fact: that if he perchance smokes a brand of cigarette very
much milder than that to which he has been accustomed, he
will at once reject it, simply for the reason that larynx and
trachea have been accustomed to a certain degree of irrita¬
tion. The larynx and trachea have, so to speak, acquired a
habit which rejects any unusual departure. For the same
reason the inhaler rejects a brand of cigarettes much stronger
than that to which he is accustomed; nor will he inhale the
smoke of a cigar, vastly more irritating than that of any
cigarette. The inhaler may change his cigarette for one
more pleasing to his sense of flavor, provided always, how¬
ever, that it satisfies his accustomed degree of laryngeal and
tracheal irritation.
The pleasure in cigarette smoking, therefore, as compared
with other tobacco habits, may be said to be a pleasurable
irritation of the laryngeal and tracheal sensory branches of
the pneumogastric nerve.
Another question frequently hurled at me in all these
years has been : “ What satisfaction can you get out of those
weak little things ?” The question means nicotine satis¬
faction. I once more rise to explain.
One absorbs nicotine in accordance with the amount of
absorbent surface in contact with the column of smoke. In
ordinary smoking the mouth alone is the smoke chamber;
but when one inhales, one must add to the mouth the mucous
membrane of the larynx, windpipe, and larger bronchi.
There is hence, roughly speaking, three times as much sur-
. face for the absorption of nicotine ; and consequently, though
a cigar contains vastly more nicotine, three-fourths of it is
wasted as far as the question of nicotine intoxication is con¬
cerned, as compared with the cigarette. Moreover, the cigar-
Digitized by {jOOQle
The Cigarette Habit.
335
ette smoker consumes two or three cigarettes while the cigar
smoker consumes one cigar. The puny cigarette is there¬
fore not so weak as it appears, and with this explanation
begins to seem worthy of the newspaper term “ deadly.”
Again, the cigar smoker as compared with the cigarette
smoker, is an infrequent consumer. We know that, with
most drugs, if we divide an ordinary dose into ten equal parts
and give one part every ten minutes until the ten parts are
taken, we get a more powerful effect than if the whole were
given at one dose. So it is with cigarettes. The dose of
nicotine is smaller, but the doses are much more frequently
repeated. I can smoke one large, strong cigar in the Ordi¬
nary manner without evidence of nicotine intoxication, but I
cannot smoke three cigarettes inhaled, in succession, without
nausea or vertigo or a rapid pulse.
The evil effects of cigarette smoking may be divided into
the local and constitutional. As compared with other tobac¬
co habits, if the cigarette were composed of other ingredi¬
ents than tobacco and paper, we should as clinicians be pre¬
pared to look for different signs and symptoms. As far as
the constitutional effects are concerned, I wish to state, as
one who has carefully watched this question for fifteen years,
that they are absolutely the same as that of tobacco used in
any other form. The evil symptoms are always those of
nicotine poisoning; not those of any other drug. The only
chemist of high standing who, to my knowledge, has analyzed
cigarettes is Dr. Ledoux, who last winter presented to the
New York Society of Medical Jurisprudence a report of the
analysis of several popular brands of cigarettes. The dealers
from whom he obtained the samples expressed their hope to
him that he might find all kinds of narcotics in them ; that
all the profit accrued to the Cigarette Trust. He found
absolutely no evidence of any other drug but nicotine in the
tobacco, and in the paper a harmless quantity of cellulose.
The W. C. T. U. has endeavored to crush the cigarette
evil by asserting that opium, cannabis indica , and other nar¬
cotics were present in cigarettes. Vice cannot be cured by
Digitized by v^ooQie
336
The Cigarette Habit.
misrepresentation. The only narcotic present is nicotine,
and this is an evil or not according to a great many different
circumstances. That chief circumstance when, without ex¬
ception, it is always productive of great harm, is youth.
Every medical man will admit, theoretically, that this should
be a fact, and the few who, like myself, have made practical
observations, will tell you that they never saw a child (I
mean by this term those who have not reached puberty) who
used tobacbo habitually whose health was not in some man¬
ner badly impaired. What else could one expect the tender,
growing, nervous organism to do but wilt under the steady
daily influence of a drug like nicotine? In adolescence,—
and practically this may be said to be from puberty until 18
in females and 21 in males, —the evil is not so great, but is
still a great one. For though the nervous crisis of puberty
has been passed, the nervous system is still rapidly develop¬
ing. The nerves are more resistant than in childhood, but
on the other hand, greater demands are correspondingly
made upon them, either by the higher phases of education in
one class, or by the actual daily struggle for existence in the
other. That the use of tobacco is a serious handicap in
adolescence is proved by the investigations of others than
myself. At several of our great universities it has been
found by exact and scientific investigation that the percent¬
age of winners in intellectual and athletic contests is consid¬
erably higher in the total abstainers from tobacco. Sammy,
the best-known newsboy of St. Louis, who, by his wit and
energy at the age of fourteen, has accumulated quite a bank
account, at my instigation made a series of unbiased observa¬
tions concerning the newsboys of St. Louis. He found,
other things being equal, that the selling capacity of the boy
who used no tobacco was much greater than that of the boy
who used tobacco, either by chewing or smoking.
^ It being admitted that the use of tobacco is a great evil,
in the young, it follows as a self-evident proposition that any
method which encourages its use must be more reprehensible
than a method which discourages its use, and the cigarette
«
Digitized by ^ooQie
The Cigarette Habit.
337
above all other methods presents this encouragement to the
use of tobacco. In its mildness is concealed its very capaci¬
ty for doing harm, for the reason that it teaches the use of
tobacco. Every one knows the picture, by Brown, of a news¬
boy clinging to a lamp-post, limp, pallid, and vomiting, enti¬
tled, “ His First Cigar.” Had it been “ His First Cigarette,”
the picture would not have been true to nature, for, unfortu¬
nately for our growing youth, the first cigarette does not
induce this deathly nausea. Were this only the case, there
would be but one cigarette smoker in youth where there is
now one hundred. The boy at first uses only the mouth as
a smoke chamber, and as a cigarette is so mild he absorbs
but a minute quantity of nicotine,— insufficient for nausea.
He gradually becomes able to consume more cigarettes, and
quickly acquires nicotine tolerance. He is not allowed to
pursue this method long. Invariably some other boy teaches
him to inhale. At first it causes violent cough, and many
would never repeat the attempt, but the taunts of the other
boy are heard, and with the bravado of boyhood he perseveres.
The larynx and windpipe soon tolerate the smoke, then
demand it, and the boy is a full-fledged cigarette fiend.
The mildness of the cigarette explains also its fast-spread¬
ing use among young women, especially the leisure class of
young ladies. As a rule they do not inhale, for, at the first
attempt, the violent cough ensuing quenches ambition in this
direction, and, unlike the youth or the boy, she is seldom
encouraged to persevere. The fear of a tobacco-tainted
breath also curbs her habit. In young ladies who smoke
cigarettes very moderately, and who do not inhale, I have
never seen evidences of nicotine poisoning. Their immoder¬
ate use, even without inhalation, may, of course, afford suffi¬
cient nicotine to disturb the health. Apart from this, how¬
ever, I join hands with the ladies of the W. C. T. U., who in
New England have established anti-cigarette leagues among ►
young ladies reformed of the habit, because of the pernicious
example these young ladies may set to the youth and child¬
hood which surround them.
Digitized by t^-ooQie
338
The Cigarette Habit.
Personally I may add that when I am appealed to on the
same ground I freely admit the force of the argument. I,
however, do not pose as a reformer or advocate,—only as an
expert.
The great evil of tobacco is its constitutional effect on the
nervous system. The much lesser evil, local, namely, on the
upper respiratory organs. My experience, like that of Mor¬
rell Mackenzie, is that, provided there be no other factor, the
use of tobacco provokes little or no disturbance to these
organs. That it may aggravate a throat or nose trouble,
occasioned by other causes, I will admit; or that by its con¬
stitutional depressing effect it may aggravate such trouble, I
will also admit; but, excluding all other causes, and looking
at tobacco purely in respect of its local effect, I must deny
that it ever causes, as ordinarily used, throat disease worthy
of the name. There are a few exceptions, as there are to all
laws in medicine. There are idiosyncracies in regard to the
use of tobacco, both with reference to the throat and the
nervous system. They are rare. Tobacco, in its ordinary
use, at most, produces a slight hyperaemia, or insignificant
catarrh, in the healthy throat. As used in cigarettes, that is
by inhalation, the smoke comes in contact with the laryngeal,
tracheal, and bronchial mucous membrane, and here produces
in many the same trivial hyperaemia and secretion. This
latter is pearly, and is ejected with a single gentle cough. I
am unaware that I have this slight cough unless reminded
by others. I have occasionally heard whistling rales in the
bronchi of those who inhale very deeply and are immoderate
smokers. Hyperaemia, not inflammation, acute or chronic^
is the sole disturbance. The effects in the larynx of the
ordinary healthy man seem almost nil. Mario, the great
tenor, inhaled cigarette smoke between the acts. I experi¬
ence no vocal difficulty in delivering lectures. Maxwell, the
murderer of Preller, was confined in the St. Louis jail for
two years, during which time he inhaled an average of forty
cigarettes a day. I secured the larynx and trachea of Max¬
well, but could discover no evidence of morbid change, other
Digitized by L^ooQie
The Cigarette Habit . 339
than a fracture of the hyoid bone, caused by the hangman’s
rope.
Twenty years ago, in this country, this habit existed, but
was unusual; probably because each consumer was compelled
to make his own cigarettes. But since the American manu¬
facturer, with his advertising genius, has scattered them over
this country, ready-made and very cheap, the habit has grown
enormously. Nervous diseases and insanity are rapidly
increasing in the American people, we are assured by our
own neurologists. Our nation was already noted as furnish¬
ing proportionately more neurasthenics tljan any other. If
to such an inheritance American youth then adds the nerve-
destroying nicotine habit, which the cigarette so materially
assists in spreading, there is grave reason to hope that the
cry of reform may be echoed and re-echoed throughout our
glorious country. There is no such instructor of the people
as the press, and I trust that our newspapers will publish
broadcast such information as this, and kindred essays may
give them on what is fast becoming a national vice in Amer¬
ican youth, — the cigarette habit.
There is in a large number of inebriates an underlying
strata of mental impairment and defect of organization
which prevents them acting along lines of rational self-con¬
trol. They have feeble powers of resistance to pain and
suffering, and act on any suggestion, both within or from
without, for relief. Such persons suffer from physical pain
and exhaustion, and alcohol or any narcotic is a grateful
exemption.
In estimating the crime of an inebriate, his life history,
with heredity, and all the circumstances and conditions
which entered into the act, are necessary to form some con¬
ception of the responsibility and power to have done other¬
wise.
Vol. XVII.—45
Digitized by LjOOQie
340 Diagnosing Opium Habitues by Snap-shot.
DIAGNOSING OPIUM HABITUES BY SNAP-SHOT.*
By W. W. Potter, M.D., Spokane, Wash.
We are frequently asked, “ Is not so-and-so addicted to
opium ? ” and our invariable answer is, “ I cannot tell.” Some¬
times the answer means that “ I really do not know,” some¬
times that “I do not know enough to be positive,” but it
always means that “ I do not tell what I know to disinter¬
ested parties.”
Opium addiction has become so common of late years
that the above question has become, a frequent one to the
physician, and a hasty diagnosis has often been a false one,
from lack of sufficient data.
One difficulty of diagnosis is, that misconception as to
prominent symptoms exists. Many a one, reading the usual
descriptions of a confirmed opium-taker, as given in the
text-books, is led to believe that all such habitues can be
diagnosed by “ sallowness,” “ emaciation,” “ premature gray¬
ness and aged appearance,” “a small pupil,” and “nervous
action ; ” but this is erroneous ; the above symptoms are not
“ characteristics,” and are frequently wanting altogether in
very pronounced cases. The “sallowness” is more fre¬
quently only pallor, and tells us only of a greater or less de¬
gree of anaemia. There is nothing “pathognomonic” in this
symptom. I have noted its absence recently in two well-
marked chronic cases.
“ Emaciation ” may be the rule, but it has many excep¬
tions. I recall five cases, four male and one female, all long¬
time habitues, and not one of them weighing less than 160
pounds. The female recently died of an intercurrent affec¬
tion ; was using three grains of morphia daily and weighed
over 200 pounds. One man has used opium in several forms
♦Read before the Washington State Medical Society, May, 1895.
Digitized by t^-ooQie
Diagnosing Opium Habitues by Snap-shot . 341
and various ways for twelve years (cocaine has also been
added during the past few months). He has taken as much
as thirty grains of morphia daily, and is now using fifteen by
syringe, but to my certain knowledge has not materially
changed in weight during the past two years. He is still
well nourished, though his arms and thighs are thickly tat¬
tooed by the marks of the needle, and cicatrices of superfi¬
cial abscesses. The fact is that the world is full of robust
appearing opium slaves, who ordinarily escape attention.
As to “ growing gray and prematurely aged/’ I have
never noted the former, and the latter only in children. On
the contrary, opium, by its retarding action of all the organs,
has sometimes seemed to act as a preservative of the body,
and that, too, in cases of surprisingly large dosage.
The “small pupil/’ a usual symptoms of opium, is
sometimes unaccountably absent in the habitud. I have
notes of one case using fifteen grains of morphia daily hypo-
dermatically, whose pupil was nearly normal at all times.
His addiction had lasted eight years, and I am positive no
other drug was used. Another case of smaller dosage and
shorter term presented this same exception, which can only
be explained on the grounds of idiosyncrasy or habituation.
And when it is remembered that the pupils of an habitu&,
when not under the direct act of opium, are dilated, and
sometimes unequally, then the appearance of a small pupil
as a prominent diagnostic aid loses its weight.
“Nervousness” is never seen when the habitu6 has his
accustomed dose; it is the want of the opium that causes
this symptom, and many others. Its severity will depend
much upon the physique and temperament of the individual,
and the physician will rarely have the opportunity of observ¬
ing this if the habitu6 can help himself.
All these are the symptoms usually sought for "by the
hasty diagnostician, and in my experience are the ones least
to be relied upon. They are the only ones on which a
“snap-shot” or hurried diagnosis can be made. When
found they may indicate some wasting disease or neurasthe-
Digitized by t^-ooQie
342 Diagnosing Opium Habitues by Snap-shot .
nia as well as opium habituation. Nor will the absence of
these symptoms settle the question of opium using in the
negative. A physician recently testified in court that “ he
was able to tell an opium user across the street.” He “ had
met the accused only casually ” and declared “ there was not
a symptom of opium about him.” But his testimony was
false as to fact, for three reputable physicians who had care¬
fully observed the case, gave opposite testimony. Snap¬
shot diagnoses resulting in an opinion that brands a man as
an habitu6 have too often been made, and great injustice
done.
But there are other difficulties than those first mentioned
in the way of correct diagnosis. The drug-user himself
hides all the symptoms possible of his drug using. It is
even difficult to find where he purchases his drug, and when
or how he takes it, and he resorts to many tricks that are
blinding to the uninitiated.
Opium contracts the pupil; he therefore resorts to some
mydriatic like atropia, or preferably, on account of its stimu¬
lating effect, cocaine. By experience he learns to gauge his
dosage so as to hold the pupil at a certain size. But this
ruse can be detected easily ; the pupil will not respond to
the varying light.
Alcohol in some form is sometimes combined with opium
taking, not for the sake of the alcohol, but that its odor may
lead the enquirer astray, and blind him as to the real stimu¬
lant used. The odium of being “ a drinker ” is always pre¬
ferable to the detested and detestable term “ fiend.”
Less frequently we find the opium habitud combining
chloral or some other hypnotic, and occasionally one will be
found where it will be difficult to tell what intoxicating drug
he does not use in combination. It is quite safe to assume
that if the habitu£ be a physician, and the habit one of long
standing, that many substitutes for opium will be tested
alone or in combination, and he is likely to run the gamut of
chloroform, ether, conium, cocaine, hyosciamus, cannibis in-
dica, and proprietary remedies like bromidia, chlorodyne,
Digitized by L^ooQie
Diagnosing Opium Habitues by Snap-shot. 343
chloranodyne, and the like, thus obscuring his opium by
complexing symptoms, and his ever-ready lying explana¬
tions. I know of one who successfully hid his opium habit
for two years by just such practices.
The most surprising deceptions will sometimes be re¬
sorted to, particularly upon the laity. I am familiar with a
case where a man accused of using morphine by the syringe
made a great show of courting a full and free investigation,
and stripped himself to the waist for the purpose of examina¬
tion ; the investigating committee reported that “ his skin
was as smooth as a new-born babe’s.” In this case the site
of injection was unusual, it being the posterior aspect of the
upper arm, or triceps region. It is easy to conceive how he
could make such a display of himself, and with outstretched
arms and rotating motion still hide the needle marks from
discovery by superficial examination.
Another surprise sometimes awaits the doctor who at¬
tends opium habitues. He may be rewarded not only with
ingratitude, but calumny as well from those he has attended,
while some whom he has never seen will proclaim him as
the man who cured or failed to cure them. But such is the
lot of a physician, and it will probably never change. We
think it sufficient to here add in paraphrase that —
“ For ways that are dark,
And for tricks that are vain,
The modern drug-user is peculiar,
Which the same, we’ve tried to explain.”
But there are some symptoms of opium which the hab-
itu 6 cannot hide. It will congest the conjunctiva and suffuse
the eyes. The vision will have a pecular stare, like one in
constant day-dream. He looks not at you, but beyond and
through you. His voice will be husky under a full dose.
His skin usually itching. He will complain of disturbed
digestion. His appetite, to-day ravenous, will be entirely
wanting to-morrow; to-day he complains of diarrhoea, to¬
morrow it is constipation ; he is all activity to-day, to-mor¬
row overcome by extreme lassitude; his sleep is disturbed
Digitized by t^-ooQie
344 Diagnosing Opium Habitues by Snap-shot.
and never restful. He “stretches out the hours of recum¬
bence to their last possible extent — with a secret wish to
have lain on still.” In older cases night sweats, with rap.
idly alternating hot and cold flashes over the spine, tremors,
neuralgias, nervous excitability and restlessness, all these
changing in a very short time to serene composure, somno¬
lence, or sleep. These represent in brief outline two distinct
states, one of a satisfying dose, the other the period of absti¬
nence when the whole system is loudly demanding its ac¬
customed opium.
The evidence of these two states must be established,
and other causes than opium removed by exclusion. Then,
and then only, are we justified in our diagnosis of opium ad¬
diction, and, in view of our great liability to err, I here enter
a vigorous protest against “snap-shot” opinions, knowing
full well how they hurt, and the difficulties of removing such
a stigma. —Medical Sentinel .
It is very evident that at no distant day some change
must be made in the law governing the sale of intoxicating
drinks. In the preparation of that law, we respectfully urge
upon our law-makers and law-enforcers a careful considera¬
tion of the law adopted in Denmark, and rigidly enforced by
the police. The police, when they find a drunken man in
the streets, summon a cab, place him inside, and drive to a
police station, where he is detained until he is sober. Then
he is driven home, the police never leaving him till he is safe
with his family. The cabman then makes his charge, the
police surgeon his, the constables theirs, and this bill is pre¬
sented to the proprietor of the establishment where the cul¬
prit took his last and overpowering glass. This system
works well in Copenhagen. Why would it not be equally
effectually in New York ? It would not only be much more
easily enforced than the present excise law, but also be pro¬
ductive of much more good.
Digitized by (^.ooQie *
Alcoholism, with Suggestions as to Treatment. 345
ALCOHOLISM, WITH SUGGESTIONS AS TO
TREATMENT —STATISTICS FOR BUFFALO*
By Sidney A. Dunham, M.D., Buffalo, N. Y.
Physician to Lexington Heights Hospital , Department of Alcoholism and
Dipsomania .
From the police reports we find from 1890 to 1894,
inclusive, that there were 33,909 arrests for drunkenness in
Buffalo. Of this number of arrests 29,895 were men, 4,014
were women, or an average for each month of 498 men and
66 women. During the same period of five years there were
16,213 arrests for disorderly conduct. Of this number
13,480 were men, 2,733 were women, or an average for each
month of 224 men and 45 women. Of those classed under
this head, it is safe to say that the majority were drunk as
well as disorderly. During the same period 490 were classed
under the head of dipsomaniacs and sent to the jail to sober
up. The Erie county penitentiary reports for the five years
show that 16,949 men were there for drunkenness and 3,080
women were sent to the same place. While more than one-
half of the arrests for drunkenness were sent to the peniten¬
tiary, about one-third of those arrested for disorderly con¬
duct were also sent to the penitentiary. One man has a his¬
tory of being sent to the penitentiary for drunkenness four¬
teen times in one year and another thirteen times. Of
those sent to the jail for dipsomania nineteen were in twice
and nine three times.
During this period of five years, reports from the cor¬
oner’s office show that 79 died from alcoholism, and out of the
221 suicides 73 were known to have been hard drinkers.
According to French authorities, the preponderate cause of
suicide is alcoholism. The reports quoted show that nearly
half of the suicides in the city are due, directly or indirectly,
* Read before the Buffalo Academy of Medicine.
Digitized by ^ooQie
346 Alcoholism , with Suggestions as to Treatment .
to alcoholism; and if a correct history of these cases could
always be obtained there is no doubt that the majority of
suicides would be found of that class.
Comparing the small number treated at hospitals, where
drink was the cause of their confinement, with those that
were retained for punishment, we find that only 264 men and
43 women were in the Buffalo General Hospital during
those five years, and that 169 men and 39 women were at
the Buffalo State Hospital or asylum. Probably an equal
number were treated at the Sisters of Charity Hospital.
However, the reports show a very small number receiving
treatment for a disease which held these habituates as slaves
to appetite.
Dealing with it as a crime against law and order, severe
fines and heavy punishments have been applied in all ages.
But a very small percentage have been benefited of the
large number of those thus treated. Treating it as a disease,
the last decade has revolutionized the theories as to the
cause, also care, of such maladies, and the progress has been
as great in this direction as that which has marked the treat¬
ment of many other diseases. Experience teaches us that
it is a disease which can be successfully treated, the time
and course of treatment depending upon the stage and char¬
acter of the disease. The treatment of this class of patients
has varied from the heroic method of blood-letting in olden
times to the empiric method of hypnotic suggestion of the
present day.
Like other diseases, dipsomania or chronic alcoholism may
be inherited or acquired. In either case the treatment is the
same, although the results may be different. The more
chronic the case, the more persistent should be the treat¬
ment. Habit leads to disease just as exposure leads to
rheumatism. The strong-nerved man finds appetite often
more than he can overcome. Therefore, we should expect
that the one who has inherited a nervous weakness should
frequently find accustomed appetites uncontrollable.
Heredity predisposes to dipsomania, the same as it pre-
Digitized by ^ooQie
Alcoholism , with Suggestions as to Treatment . 347
disposes to consumption. Both are developed under favor¬
able surroundings. Asthma is a neurotic disease, inherited,
but there is a climate for every asthmatic. Also, there is a
climate for every hard drinker (temperate climate).
Hoiv They are Treated at Present .— Medically, the
patient is confined to his room, either because he is unable
to go out of his own accord or because he is constrained by
friends. The physician prescribes medicines to overcome
the alarming symptoms, such as uneasiness and sleepless¬
ness, together with a steady withdrawal of stimulants. As
soon as the patient talks rationally and walks steadily the
physician discharges his patient or the patient discharges his
physician. This course of treatment lasts from three days
to one week, and is the sum of the entire medical attention
the patient receives when he has been suffering from a
chronic disease for several years. We need not be surprised
that relapses occur very shortly and frequently. No other
disease, so grave in character, so dangerous to the commu¬
nity and fatal to the patient, is to-day treated so carelessly and
unscientifically.
Legally, the misdemenant is arrested, spends a night in a
cell at the station-house and is fined #5.00 to $ 10.00 in the
morning, or an equal number of days at the workhouse. If
he be well connected, socially and financially, he may be
detained in the jail until his physical and mental condition is
sufficiently improved to warrant the authorities in discharg¬
ing him on the promise that it will be “ the last time.”
When the patient is given an opportunity to go out into the
world to do better, it is only a short time ere he finds him¬
self again overcome by his tempter. In those cases where
drunkenness is a vice, this treatment is insufficient; and in
those where it is a disease, it is cruel and barbarous.
Why They Should be Differently Treated .— Because a
careful physical examination reveals lessened nervous energy,
weakened cerebral functions, interference with co-ordination
and reflex action, altered secretions and diminished excre¬
tions. And further, because a mental examination reveals
VOL. XVII.—46
Digitized by L^OOQie
348 Alcoholism , with Suggestions as to Treatment.
hallucinations (painful or pleasant), delusions, melancholia,
suicidal tendencies, and the like, and shows weakened will
power, temporary loss of memory, the finer sensibilities
numbed, perceptions and emotions dulled, truth, decency,
duty, honor, and felicity doubtful or altogether lost. In
every case there is evidence of the paralyzing effect of
alcohol upon the inhibiting power of the brain, which is one
of its highest faculties; and herein the greatest damage is
wrought and the will undermined.
Again, because the pathology of this disease, in advanced
stages, shows degeneration of the nerve tissue, hyperemia of
the meninges of the brain, diffused interstitial sclerosis of the
cord, with cirrhotic changes of the internal organs.
Charpentier, out of 135 victims of general paresis, found
83 cases were confirmed alcoholics. He adds alcohol to
syphilis and heredity and calls them the triad of general
paresis. As in severe forms of indigestion, with altered
secretion and functional disturbances, when the post mortem
shows no pathological changes, so in severe and dangerous
forms of alcoholism, with perverted faculties and impulses,
the brain itself may reveal no structural changes. Sonder-
egger considers drunkenness the effect and not the cause of
the disease; that it is an irregular development and distribu¬
tion of the cells through which the will and conscience act.
There are premonitory symptoms in periodic drinkers,
such as nervousness, irritable disposition, forgetfulness, deep
meditation, poor appetite, and sleeplessness. Baker (Boston
Medical and Surgical Journal ) reports a case of hereditary
dipsomania, in which the patient, during his craving for
alcohol, though prevented from getting it, would become
sleepless, lose his appetite, appear silly, incoherent, stagger¬
ing in gait, with some delusions of persecution manifested.
As a patient expressed it to me the other day: “ I am in
another world during the drinking period.”
How They Should be Treated .— From a criminal stand¬
point, the penalties should be multiplied by ten. It should
be 100 days* imprisonment where it is now only ten days.
Digitized by t^-ooQie
A/coho/ism, with Suggestions as to Treatment . 349
This would give the patient an idea of the gravity of the
offense and will also give Nature time in which to gain
strength and fortify herself against future temptations and
indulgence. While thus restrained, the patient should be
kept at light work and receive medical aid for at least four
weeks, according to the most advanced .and successful
methods of the present day.
The medical treatment, where it is now continued for
about five days on . the average, is about one-tenth the time
required to materially benefit these cases. The indications
to be met generally are largely a disturbance of the nervous
system, which manifest themselves in an irritable disposition,
sleeplessness, fits of depression, and, later, excitability, with
all the phenomena of mania-a-potu. The digestive processes
are sluggish and weak in character, the excretions are
deficient, and there is a general loss of muscular tone.
The excitable stages are best controlled by chloral and
bromides; or, when there is much delirium with a strong
pulse, hypodermic injections of hydrobromate of hyoscine
i-icoth to i-i50th of a grain, to be repeated in six hours, or
smaller doses every four hours. Ergotin, added in small
doses to the above, Will overcome the unpleasant effects of
hyoscine with a good result on the cerebral congestion.
Stimulants should be rapidly withdrawn, and when given
should be administered in milk and other foods, but never
should be given clear or “ straight.” If there is much
nausea, it can be controlled by small doses of calomel and
bismuth, frequently repeated, with nourishment given a little
at a time and often. As soon as the patient is able to take
nourishment, it should be fluid in character and large in
quantity, highly seasoned. If the bowels are constipated,
they should be opened by injections of water and glycerine,
when the patient is not able to take alkaline aperients
through the stomach in the ordinary manner. An infusion
of digitalis, tablespoonful doses, with ten grains of citrate of
potash every four hours, will increase the urinary excretions
when they are diminished. Hypodermics of the nitrate or
Digitized by LjOOQie
350 Alcoholism , with Suggestions as to Treatment.
sulphate of strychnine, with a little digitalin, are the best to
overcome heart weakness and often relieves the delirium.
Mulford’s tablets for dipsomania for hypodermic use will be
found very serviceable — namely, gold and sodium chloride,
1-24 gr.; strychnine nitrate, 1-60 gr.; nitroglycerin, 1-300
gr.; atropine sulph., 1-200 gr.; digitalin, 1-60 gr.; sodium
chloride, i gr.
Cold to the head overcomes delirium when due to con¬
gestion or active hyperemia of the meninges.
When the acute symptoms have subsided, a three or four
weeks* course of curative treatment should begin. A tonic,
consisting of nux vomica, hydrastis, capsicum, and an infu¬
sion of gentian, should be given four times a day-and in full
doses. Also hypodermics of the chloride of gold in solution
— one-tenth of a grain to ten minims of distilled water —
should be given three or four times a day.
Tablets of the above formula are good for the first week
or ten days, followed by the gold solution. The platinum
needle will not corrode by the gold solution and should be
used for this reason. The infusion of gentian is used
because it contains less alcohol than the tincture.
Because the chloride of gold meets so many indications
in the treatment of dipsomania, there is no more reason to
call it a “gold cure for dipsomania** than there is to call it a
gold cure for consumption, where it has been used with a
certain degree of success ; or a “gold cure** for rheumatism
with deformed joints, where it has been found valuable; or
a “gold cure*’ for paralysis of the insane, where it is one of
the most efficacious remedies.
The chloride of gold I consider one of the chief thera¬
peutic agents in the treatment of chronic alcoholism. It has
been used in cases of melancholia, hysteria, chorea, and
especially nervous troubles due to syphilis. In its physio¬
logical action it seems to be a tonic for the brain and spinal
cord — an alterative like mercury; it stimulates nutrition
and digestion, increases secretions and excretions, and is an
aphrodisiac. Its action in this respect is like that of strych¬
nine and phosphorus.
Digitized by i^-ooQie
Alcoholism ,, with Suggestions as to Treatment . 351
The belief that the impotency for a time following the
treatment is due to the chloride of gold, is a delusion on the
part of the patient.
Strychnine tones up the nerve centers and the walls of
arteries are able to contract to the normal caliber, while
muscular fibres return to their healthful response.
If the alcoholic should require both punishment and med¬
icine, as they usually do, the hypodermic method, four times
a day, meets the indication beautifully. If the arms swell
from the effects of the hypodermics, Goulard’s extract will
overcome the difficulty.
In some cases, craving for drink can only be removed by
treating physical ailments. Lawson Tait reports cases of
cure following the removal of the uterine appendages in
women. Indigestion is to be treated, neuralgia and nervous
exhaustion to be remedied, irregular and weak heart action
to be overcome, environment and habits to be changed,
syphilis and kidney trouble to receive attention. Irregular
hours at meals and for sleep, the futile attempt to drink
moderately, old associations in drinking, the intention to
drink only beer and cider, all predispose to alcoholic excess
in those already habituated to excessive drinking.
Some believe in inebriate asylums under the control of
the state. Our insane asylums are just as good, and this
class of patients go as willingly to the latter as to the former.
The difficulty at present with our hospitals is their having
no power to hold these patients as long as is required for
successful treatment. Every city of the size of Buffalo,
showing the amount of alcoholism that Buffalo does, is in
need of a hospital for inebriates, endowed with power to
retain patients until dismissed as cured. Our present over¬
crowded penitentiary would be greatly relieved of some of its
very heavy burdens, the community better protected, and
the reformation and cure of the victim would be more pro¬
nounced and permanent. I agree with Dr. T. D. Crothers
of Hartford that public sentiment should not permit one to
become an inebriate, or tolerate him after that stage, unless
under legal guardianship and restriction, until he recovers.
Digitized by ^ooQie
352 Alcoholism , with Suggestions as to Treatment .
Our morning justices should impose larger fines for
drunkenness, which means longer terms of confinement.
Medical treatment should be enforced for not less than four
weeks while serving time. Our habitual drinkers who do
not voluntarily take treatment should be committed to the
asylum until a more suitable institution can be established.
The state should arrange for the proper treatment of these
cases when in penal institutions. A law is required to meet
this end. Every municipality should have this done.
Drunkenness, with beginners, is of so great moment,
because of its demoralizing effect upon youth, that, to be a
preventive, fines must be large in order to be commensurate
with the offense. While there may be a question about the
responsibility of acts committed while under the influence of
liquor, there is no doubt about the great responsibility of
such persons getting drunk as a beginner.
A portion of mankind have proven in the past that they
could not drink moderately, and ought not, therefore, to have
taken liquor at all, as the first drinks (socially, it may be,)
developed the uncontrollable desire which previous to that
time had been latent and ought never to have been cul¬
tivated.
The moderate drinkers of to-day are going to furnish us
with the dipsomaniacs to-morrow.
Those who have inherited a predisposition to consump¬
tion would not hazard their lives by continually nursing and
associating with the consumptive. This applies to all those
who have inherited irritable, nervous systems and thereby
are predisposed to drink.
It is almost impossible to carry out this system of treat¬
ment in private practice. It can be more thoroughly done
and the psychical effect upon the patient far more beneficial
when sent to an institution. The Lexington Heights Hos¬
pital of this city has arranged particularly for these cases,
and when treated according to this method the results are
very satisfactory. Those who manifest a desire to take
treatment and admit that they are unable themselves to dis-
Digitized by t^-ooQie
Alcoholism ,, with Suggestions as to Treatment. 353
continue the use of liquor, give the highest percentage of
cures. Those who receive the least benefit remind one,
when asked why they do not take treatment, of Rogers’s
lines:
“ Go! you may call it madness, folly,
You shall not chase my grief away;
There’s such a joy in melancholy
I would not, if I could, be gay.”
The report of two prominent French medical authorities,
Brouardel and Bouchet, to the French hygienic government
committee, declare that the future belongs to abstemious
nations ; that it is not only a social danger everywhere, but
that the body and mind of posterity are weakened. My
object in presenting this paper is not to stir your emotions
and entertain your higher sensibilities for the present, but to
appeal to your intellectual, scientific, and executive powers
for the better treatment and control, in the future, of these
victims of habit and disease.
Dr. J. B. Mattison of Brooklyn, N. Y., read four papers
on opium in October, before the New York Academy of
Medicine. One on “Morphinism in the Young.” The sec¬
ond paper on “A tale of the Poppy, and its Moral.” The
third paper on “ Morphinism in old cases — three score and
ten — with recovery.” The fourth, 11 Morphinism in Woman.”
These papers were read before large audiences, and created
much interest.
Maurel says that cocaine kills by: 1. Dilating the small
vessels. 2. Paralyzing the leucocytes ; strong doses taken
by the stomach act in this way. The toxic effect is propor¬
tional to the number of leucocytes paralyzed. Small doses,
hypodermically, or in the veins, may act by paralyzing some
cells which then become emboli. Large doses may be in¬
jected into the arteries without killing. — Omaha Clinic .
Digitized by v^ooQie
354
Importance of an Accurate Diagnosis in
A CASE ILLUSTRATING THE IMPORTANCE OF
AN ACCURATE DIAGNOSIS IN INEBRIETY
AND MENTAL DISEASES*
By Daniel H. Arthur, M.D.,
Assistant Physician State Hospital for Insane* Middletown , N. Y.
W. S., age 48, married, two children, native of the U. S.,
occupation hotel-keeper. Habits said to be intemperate. No
history of insanity. Remote cause — predisposition.
Exciting cause said to be intemperance, over work, and
worry.
T. 99f. P. 90. Tongue furred and dry, and very tremu¬
lous. Pupils contracted irregularly, non-responsive. Speech,
hesitating, thick, unable to give any account of himself.
Heart's action weak. Face dark, mottled. Paralysis of ex¬
tremities.
Family history states that the condition of change was
first noticed a year and a half before his admission to the
hospital. Had alternate attacks of depression, and mild ex¬
citement : at times slight attacks of vertigo and loss of con¬
sciousness. In a few months he was unable to attend to his
ordinary business properly. Unable to make change; would
demand the payment of a bill twice; became dull and easily
confused.
It was said that about six months before his admission to
an asylum for the insane, that he commenced to drink to
excess, which (if so, although not authentic), was undoubt¬
edly a result of the course of the disease. His symptoms
progressed rapidly the last few months before admission to
a hospital. His gait became very ataxic. Memory almost
gone ; inco-ordinate speech ; hands and the fibulary muscles
of face became very tremulous ; unable to control them.
* Read before the Medico-Legal Society, February meeting, 1895.
Digitized by
Google
Inebriety and Mental Diseases . 355
He sat about the house in a stupor, too weak, physically,
to move about much, and too demented to take notice of his
surroundings. He was admitted to the hospital December
9, 1891, unable to give an account of himself, but with the
preceding history and symptoms.
He died a few days later from simple exhaustion follow¬
ing — general paresis.
The patient was a member of a prominent beneficiary
association, the benefit from which, two thousand dollars, was
to go to his wife in case of death, providing the deceased had
lived strictly according to the by-laws of the order. A prom¬
inent by-law of the order as a requisite to membership was
temperance, as to the use of alcoholic stimulants, and also a
continuance of such habits while a member of the associa¬
tion.
Temperance, as mentioned here, is not to be interpreted
as absolute teetotalism, but a freedom from excess in the use
of stimulants. Of course a man’s excessive use of alcohol,
at the time of application to an order for admission, would be
known, and his name for membership rejected accordingly;
but having been admitted to the order, should he at any time
become so addicted to the use of alcohol, to the extent that
would be called excess, as might precipitate a diseased con¬
dition, and in consequence shorten life, his family would for¬
feit the right to any benefit in the event of his death — the
insurance would also be forfeited in case of the non-payment
of dues. His wife ceased the payment of dues to the order
some time previous to his commitment, as it was refused by
an officer of the lodge with the remark that it would be
money thrown away, as his family could not benefit in any
manner at his death on account of his acquired intemperate
habits. The wife insisted on paying the dues with the state¬
ment that she knew him not to be intemperate; that she was
near him all the day and night, and had never seen him
drink to excess. She stated that her husband was a sick
man. The dues were, however, refused.
On the death of the patient the beneficiaries made a de-
Vol. XVII.—47
Digitized by v^ooQie
356 Importance of an Accurate Diagnosis in
mand on the association for the amount of the insurance,
two thousand dollars, which was refused on the ground of a
violation of the insurance contract. In the suit that was
brought by the relatives of the deceased for the amount of
the benefit, the defense brought forward about twenty wit¬
nesses, including the officers of the lodge, of the town, and
could undoubtedly have brought half the village to testify
that they had seen deceased staggering about the streets of
the village almost daily ; that they had seen him as often
sitting about the hotel in a drunken stupor ; that his general
appearance was that of intoxication, and that it was recog¬
nized as a fact by most of the inhabitants of the village that
W. S. had been intoxicated almost continuously for at least
three months previous to his admission to an asylum. There
was no special time during the day mentioned but he was,
from the evidence given, as intoxicated in the early morning
as in the evening. There was no sobering-up process ob¬
served, but a continuous condition of intoxication. Although
all these witnesses were positive of the deceased’s condition
during this time, but one, and he a brother member of the
lodge, had ever seen him drink. This member testified that
he had drank liquor with him but had never seen him drink
to excess; yet he insisted he had often seen him in a condi¬
tion which he believed to be the result of excessive drinking.
All these witnesses were frequenters of the hotel at dif¬
ferent times during the day and night, of which deceased was
proprietor. His wife, clerk, bar tender, and other attaches
of the hotel, who were more closely associated with him, tes¬
tified just as positively that his condition was not the result
of excessive alcoholic indulgence, knowing it could not be
so without their positive knowledge. His family recognized
a condition of progressive mental and physical deterioration,
yet delayed sending him to a hospital until there was almost
a complete paralysis. He was committed by the village phy¬
sicians who diagnosed the case, and the cause that of alco¬
holism. These physicians (who diagnosed this case) testified
that they were unacquainted in any degree with the different
Digitized by ^ooQie
Inebriety and Mental Diseases.
357
forms of mental diseases, and in consequence were unable to
differentiate between general paresis in the last stages and
chronic alcoholism, but had made the diagnosis from the
general appearance of the patient and village gossip. The
interest in this case centers in the differential diagnosis of
chronic alcoholism and general paresis, a proper diagnosis
of which was the means of preventing the perpetration of a
grave injustice upon the widow of the deceased. Chronic
alcoholism, in many cases, recall more and more the general
appearance of paralytic dementia (the last stages of general
paresis) — “ the brutishness of the chronic drinker; the soft,
puffy, smooth appearance of the whole face; the apparent
ruin of all his faculties ; his incessant stammering, tremor,
and the motor derangement he presents causes him to re¬
semble clinically the general paralytic , 1n and the average
general practitioner is very liable to error in his diagnosis.
The case in question had many symptoms in common
with alcoholism, to such an extent, that a very careful analy¬
sis of the patient’s mental and physical state was imperative
in order to determine the real condition. A characteristic
physical symptom common in both diseases is muscular
weakness and muscular twitchings. Here, however, you find
in chronic alcoholism the fibrillary muscular twitchings gen¬
eral all over the body ; while in general paresis this is more
limited, affecting mainly the tongue, orbicular muscles of the
face, and the muscles of the hand. Rarely do you find in
alcoholism the pupils of the eye contracted, while in general
paresis this is a common symptom, and very often the pupils
are contracted unequally and unresponsive ; the speech dis¬
order in chronic alcoholism is usually less than in paresis ;
in paresis the disorder increases as the disease progresses,
while in chronic alcoholism it decreases and may entirely
disappear under the influence of abstinence and treatment.
In alcoholism the embarrassed speech is dependent some¬
what upon fear, with a constant apprehensive look ; also upon
the tremulousness of muscles of the tongue and face ; while
in paresis it is due to feebleness of the mind, and paralysis of
Digitized by ^ooQie
358 Importance of an Accurate Diagnosis in
muscles. We have again, in chronic alcoholism, a diminu¬
tion of appetite with eructions; vomiting of mucus in morn¬
ings, and often a complete paralysis of stomach and conse¬
quent inability to retain anything.
While in general paresis, the appetite is augmented and
the patient eats ravenously.
The hesitating, ataxic gait is a common symptom in both
conditions; however, in alcoholism it is a recognized condi¬
tion by the patient himself; he is ashamed of it, and tries to
rectify it, while in paresis there is a quiet contentment with
himself in all respects.
These were a few of the prominent physical symptoms
observed in this case of general paresis and their differentia¬
tion from chronic alcoholism.
Among the mental symptoms of chronic alcoholism we
have headaches, active hallucinations and illusions affecting
all the senses; delirious conceptions depending on these
hallucinations and illusions. We have, very often, great de¬
pression, with tendency to suicide, delusions of persecution,
etc.; with all these symptoms, there is a consciousness of
his condition. With the paralytic dement of this article there
was never any pain, no hallucinations or illusions; the para¬
lytic is seldom ever suicidal, there is an enfeeblement of the
understanding with delusions of grandeur, wealth, and power.
Here it took the form of strength and ability, the patient
believing himself perfectly well and competent. There are
many cases of general paresis with simply a progressive
mental enfeeblement and no delusions whatever, but all the
physical symptoms prevalent.
A characteristic symptom of general paresis (very marked
in this case) is the utter indifference of the patient towards
his family, and his temporary but apparently unconscious fits
of emotion, as anger and crying; these are also symptoms of
chronic alcoholism, but differ; the alcohol patient may be¬
come affected by the pleadings and reproaches of a mother
or daughter, give way to grief, appreciating his condition,
and make promises of reform ; while the enfeebled mind of
Digitized by v^ooQie
Inebriety and Mental Diseases.
359
general paresis is thoroughly content with himself and unap¬
preciative of interest taken in him by even friends and rela¬
tives. The emotions of the chronic alcoholic are due to de¬
pression, the result of a periodic acute appreciation of his
condition ; while those of general paresis, alternate sobs and
laughter, are utterly without order or consistency. The
symptoms of general paresis which we have recorded here
were prominent in this case, and I have endeavored to show
where they differ from chronic alcoholism without going into
minute detail. These considerations may aid in forming a
diagnosis, yet by becoming acquainted with the antecedent
habits and history of the case, extending through a consider¬
able period of time, it will help very materially in clearing
up the case. The initial history of the disorder here dates
back a year and a half, when no accusation was made of in¬
temperance : there was slight dementia with failure of mem¬
ory, slight attacks of vertigo, and occasionally periods of un¬
consciousness for a short time. The court introduced expert
testimony in the case and the jury allowed the amount of the
benefit to the widow, with interest from the time of death.
Is there an inebriate neurosis ? If the doubters will study
the inebriates who appear in the police courts and jails, and
the inmates of asylums, the answer will be clear and unmis¬
takable. The defective degenerates both in appearance and
history furnish abundant facts, far more impressive, than any
theories however well presented.
Nervous Prostration. —My son, aged 12, had been
growing nervous over the shock of his brother’s death, and
seemed to derive no benefit from any remedies used in his
case. Had him to the seashore, change of surroundings and
everything that could be doue for his benefit, he still grew
thinner and worse all the time. I put him on Celerina ,
and had marked benefit before the first bottle was used, and
he has almost entirely gotten over it with the help of another
bottle I got for him. I consider it a very nice and efficient
nervine, just the thing'for the children and nervous and
delicate persons, where there is great prostration. I shall
use it freely.—N. P. Frassoni, M.D , Moosic , Pa.
Digitized by LjOOQie
360
Alcohol and Chastity.
ALCOHOL AND CHASTITY.*
By Dr. M. L. Holbrook,
Editor of the Journal of Hygiene.
In presenting what I have to say on the subject of this
paper I shall be very brief and will not try to go over all the
ground that might be traversed. Any one who is interested
in the subject can easily do this. The Bible and many his¬
torical and temperance works, and even the common obser¬
vation of most persons, tell the story of shame caused by
strong drink. What I desire to say will come under another
head than that this subject is usually discussed.
It is now generally admitted by scientists that man has
come to his present estate by a process called evolution, that
is, the development from lower forms to higher ones, or
from simple forms to more complex ones. In this process
of evolution there has been added new functions and new
powers to man as they were required by the necessities of
his life and his environment. And it is one of the funda¬
mental laws of being that newly acquired traits are not so
fixed and well established in the nature of men as the older
or first acquired ones.
It is believed by our psychologists (a science, by the way,
we ought to study more) that one of the last acquirements of
man is the power of self’Control.
Let us stop a moment to inquire what self-control is and
how useful it has been and can be to us. If we study ani¬
mals and low organisms we see the power to control their
own acts is wanting or nearly so. Let any one observe for
an hour under the microscope living micro-organisms and
what will he behold ? Endless movement, perfectly mean¬
ingless to him. They rush along the line of least resistance
without the slightest control of their acts.
*Read before the National Purity Congress, Baltimore, October 16, 1895.
Digitized by t^-ooQie
Alcohol and Chastity .
36i
With insects it is the same. Does the silk worm say,
Now I will make a cocoon and undergo my transformations
in it, or I will not make one, but go and enjoy myself in some
other way ? Nothing of the sort; it makes it under the law
of its instinct without any volition of its own. When the
time comes it must spin it whether it will or no. It cannot
say, I will not, but will do something else.
Do the bees or the butterflies plan out and control their
movements as they go from flower to flower ? Do they stop
to reflect before they visit a blossom, or say we will gather
no more honey to-day ? No. They too are guided by an
instinct. See them fly through the air, now this way, now
that. They have practically no power of constructing their
own lines, or directing their own ways.
When it comes to higher animals, the horse, the dog, the
bull, and cow, there may be slight intimation of self-mastery,
but they are slight indeed.
With man, however, the case is different. He has had a
story or several of them added to his intellect. It takes in
a wider range, a larger view. Man has developed the power
of self-control. He takes charge of his own life and his own
conduct. He is able to say I will do this, for it is wise ; I
will not do that, for it is unwise. Even though his desires
prompt him to do one thing, he can by this inhibitory power
given by self-control, hold himself back and do something
far different, something actually disagreeable, painful. He
can even plan out a course of action which will continue for
years and hold himself up to it during a long life. With
most successful men in whatever field, this is the case. We
can hardly estimate how very valuable it has been for man
to do this. We get some notion of the use of this new power
by comparing a man whose whole life is aimed at the accom¬
plishment of some noble work and the man who has no aim,
but is carried about daily by the whims and caprices of that
day. Can any animal take its life under control as man can ?
No, not even the highest ape, and hardly the lowest man.
I said in the beginning, this power of self-control has
Digitized by
Google
3^2
Alcohol and Chastity .
been one of the last acquired by man and that it has not been
so firmly fixed in his nature as some other of his faculties,
as that of the desire for food, for air, for procreation, etc.
Many persons have it in a low degree, and, such by just so
much come short of having the full stature of men. They
yield to their likes and dislikes, their whims and caprices,
their passions and temptations, even when their best judg¬
ment tells them that it is not wise to do so. The inebriate
is a good illustration. He does not control his appetite for
drink, often cannot. The glutton is another. Our insane
asylums are full of men and women who have lost all control
over their own minds and they think and act wildly, disor¬
derly.
The sexual impulses are less under control than they
should be, often even in those who otherwise live well ordered
lives. These impulses are very important and will be so
long as reproduction of the race must go on. The greatest
good as well as the greatest evil results from them. There
is no use in denying this. But as the evolution of man goes
on, these impulses should and must more and more come
under self-control. If social purity is ever to make any head¬
way this new power in man's character, new comparatively
only, must have a far larger influence in his sexual life,
without perhaps knowing it from this point of view, this is
what the organization convened here is for, to induce men
and women to place the sexual nature under the guidance of
reason, of conscience, of hygiene.
Now if I am right in what I have said, anything that
makes it harder, or impossible to keep a mastery over one’s
own nature is a potent evil, and it is here that the relation of
what I have said to the use of alcohol comes in. Do alco¬
holic drinks increase or diminish man's self-control over any
part of his nature ? If they increase it then they are in this
respect a positive good. If any food or drink could be dis¬
covered which would make man more his own master than
he now is, we might cease half of our efforts for reform and
induce people to take them. Nor would it be difficult, even
Digitized by v^ooQie
Alcohol and Chastity.
363
though they might be unpalatable. But no such food or
drink has been or is likely to be discovered, and as relates to
alcoholic drinks, they always and invariably act reversely
and lessen the inhibitory power of man over his own acts.
If his powers in this direction are great when sober, they
grow less and less the more alcohol he puts into his blood.
If his powers are small in this respect a little alcohol upsets
it and control is gone till nature removes the poison from his
blood.
We have abundant evidence of this in that class of ine¬
briates which are found in our asylums and institutions for
their treatment. If they hacf not lost self-mastery, they
would not have put themselves under the care of another to
guide them back to health of body and mind. Let me now
enumerate some of the simple facts which go to show that
alcohol destroys self-mastery. I will take first the muscular
system. In health and in the prime of life the voluntary
muscles of a man whose body has had proper training yield
obedience and all the movements are correlated into one
movement of almost ideal perfection. Take a gymnast, a
sleight of hand performer, a dancer as extreme illustrations.
Take even a skilled wood-chopper in some of our western
forests. How perfectly the number of each obey the dic¬
tates of the brain. But how is it when the dancer, the gym¬
nast, or the axeman, are intoxicated ? The power of control
is lost in proportion to the degree of intoxication. No longer
do the muscles obey the will, but the person reels, staggers,
and falls helpless on the ground. Many of us no doubt
have had slight experiences of this power of alcohol to take
away self-control of the muscles when it has been used only
medicinally, and in very small quantities.
The same thing happens to the mind. Under alcoholic
influence the brain begins to think awry. It cannot think
straight. The judgment becomes warped. The intellect
clouded. A man under liquor once said to me: “ Do you see
that horrid creature coming down from the stars with a load
of snakes and throwing them right and left about the room ? ”
Vol. XVII.—48
Digitized by v^ooQie
364
Alcohol and Chastity .
It was a case of delirium tremens , his brain was no longer
his own, it it ran wild like an engine in full motion, and no
engineer to guide it. Who of us would knowingly trust our
lives on a railway train with an intemperate engineer ? We
know his judgment cannot be depended on to bring us safe
\ to our journey’s end. Many a battle has been lost, many a
ship sunk, because the captain had lost control of his facul¬
ties by drink.
Shakspeare tells the whole story when he says : “ Drink,
and speak parrot and squabble, swagger, swear, and discourse
fustian with one's own shadow .”
In the effect on the moral nature we find the same result
of alcohol in taking away man’s power over his own acts.
Seneca saM, ages ago : u Men will do many things in their
drink they are ashamed of when sober. It emboldens men
to do all sorts of mischief. It irritates wickedness. It was
in a drunken fit that Alexander slew Clytus. It makes him
who is insolent prouder, him who was fierce more cruel. It
takes away shame. The tongue trips , the head turns round."
I have thus by degrees led up to the final point, the effect
of alcohol on chastity. The sexual impulse is one of the
most powerful in man. It is necessary that it should be
strong, but it is equally necessary that it should be under
right guidance. There are no such checks to its abuse in
the human being that are in the animal creation. Its wrong
action must be prevented by self-mastery. In the normal
man if he knows the benefits to health and happiness which
result from chastity, he will take this part of his nature under
the dominion of his reason and his better judgment. But
the experience of* the ages shows that intemperance, drink,
alcohol so lessens the inhibitory power which is slowly grow¬
ing up in man and which distinguishes him from all lower
animals that this is impossible. Under its influence he
drops back to a primal state — yes, worse than a primal
state — and gives way to his impulses whatever they may be,
the very worst thing it seems to me that can happen to a
human creature. He now becomes a degenerate, insane,
mad.
Digitized by t^-ooQie
Alcohol and Chastity . 365
I could give abundant testimony that the use of alcoholic
drinks is one of the strongholds of unchastity, but it is not
necessary — you all know this. With the advance of univer¬
sal temperance its worst forms will, I believe, disappear, and
whatever of it remains will be easily managed by the right
kind of education and a knowledge that happiness is the
result of obedience to the laws of life, and that misery comes
from disobedience to the same.
A practical move is on foot in England under the direct
supervision of Lady Henry Somerset whereby an inebriate
home is provided for women of the better class needing other
than the help of their own resolutions to reform. 4 The Dux-
hurst Home includes first what is called the Mansion. This
building, which has been rented by the National B. W. T. A.,
will accommodate seven guests. Its entire conduct will be
that of a home wherein comfort and refinement abound.
Knowing full well the value of the exercise of a spirit of
sympathy and helpfulness, during the summer months a hol¬
iday home for poor children from London will be established
within walking distance of the Mansion, whose inmates will,
with Lady Somerset, form a council for management, doing
all they can to forward the happiness of the homeless little
ones. The profits arising from the Mansion are to be ex¬
pended in the support of a home farm for poorer women in
the thrall of the drink habit, and besides these there will be
a nursery cottage and an intermediate home for ladies' maids,
wives of small shopkeepers, etc. Into this, home patients
will only be admitted upon a pledge to remain at the home
under entire abstinence for twelve months at least. This
home is now ready, and the others will soon be. The plan
commends itself as thoroughly practical, and as one of Lady
Somerset's boundless charities. We wish for it abiding suc¬
cess.
Digitized by i^-ooQie
366
Abstracts and Reviews.
ki\d f{eview$.
RESTORATION OF INEBRIATE WOMEN.
The fifteenth report of the inspector under the Inebriate
Acts for the year 1891 was published on September 17th.
Respectihg the work done at Fallowfield, the Manchester
Retreat for Inebriate Women, the inspector gives the fol¬
lowing remarks of the licensee:
“The Grove is one of the largest retreats for women
open undA government -license. It is visited by an in¬
spector appointed by the crown. Rich and poor patients
are received, the former paying for their board, the others
paying smaller sums and employing themselves in useful
and remunerative work. There is abundant need for such
retreats. Among the well-to-do alone, no domestic miseries
are more hopeless, and few more frequent, than those which
are caused by the father or mother being a drunkard ;
probably the drunkenness of the mother is the saddest of all.
Again, it is painfully common for a woman to be brought
before the bench scores and hundreds of times for being
drunk, and punished over and over again with short terms of
imprisonment. Imprisonment in such cases is the most
futile of resources; the poor creature is released just when
the pains of debauch are over, and the craving for drink has
returned, but too early for any cure of her disease, moral or
physical, to have been made. The fact cannot be too fre¬
quently reiterated that nothing short of prolonged restraint
from the use of stimulants — until the craving has died away
and the constitution recovers its normal condition of health
— is of any avail as a remedy. Even the twelvemonth pre¬
scribed by law proves not a day too long.
“The following figures will describe the work of the
Grove during the year ending December 31, 1894:
Digitized by ^ooQie
Abstracts and Reviews . 367
\
Number of applications,.128
Number admitted,.24
Left after a year’s stay.23
At present in the Retreat.25
“The methods adopted at the Grove are simple and
natural. They are immediate and entire abstinence from
strong drink, strict regularity of life, constant and cheerful
employment, gentle firmness, and unfailing sympathy, and a
religious influence always present and often directly urged.
The Grove and its beautiful grounds form bright and health¬
ful surroundings, while skillful and kindly medical ‘help is
always at hand, thanks to the unfailing kindness of our hon¬
orary medical adviser?. It may be of interest to note that
among the patients we have had one in whom the habit of
cigarette smoking was combined with inebriety*; another
case was complicated by the opium habit. It may be added
that our experience has confirmed what has often been
proved before, that even in the case of the worse habitual
drinkers, no harm, but the reverse, is done to the health by
the sudden and complete disuse of all alcoholic drinks.
“ It is a common opinion that when once a woman has
taken to drink recovery is impossible. It is, therefore,
natural for the question to be asked, How far has the Grove
achieved success? Do the patients who leave us stand
firm ? Before answering this question it should be remem¬
bered what sort of patients we receive. They are not per¬
sons who have just begun to drink to excess, and have sud¬
denly awoke to their peril. Such persons do not seek
refuge in a licensed retreat; they try, often vainly, to
recover themselves by easier methods. The patients who
come to the Grove are those who have run their course, and
come to utter misery. They are often destitute and outcast
from their •friends, broken down in health and self-respect,
and utterly degraded. They are the wreck of womanhood.
They are among the worst cases that can be dealt with. If
then we find that 25 per cent, is the average proportion of
patients who give evidence of permanent recovery, we need
not express either wonder or regret The wonder is that so
Digitized by t^-ooQie
368
A 6 stracts and Reviews .
many should stand firm, considering the abundant tempta¬
tions which meet them upon leaving the Grove in the allure¬
ments of the ubiquitous liquor trade and the pernicious cus¬
toms of society. And it should further be mentioned that if
one of our old patients is known to take stimulants in ever
so small a quantity she is recorded in our books as relapsed,
although she may not be known, as yet, to have become an
inebriate. It is, meantime, an enormous comfort to the
committee and workers at the Grove, to receive frequent
letters and visits from former patients, who testify to the
blessings they have received. Four women who left in 1891,
our first year, still remain steadfast abstainers, and are doing
well in their several stations of life. Six who left in 1892
have stood firm ; nine from 1893.”
A REMARKABLE CASE OF THEAISM, By James
Wood, M.D., of Brooklyn, N. Y.
During investigations lately carried on to determine the
existence of a tea-drinking habit, its frequency and the
effects of the constituents of the tea-leaf upon the human
body, a very remarkable case was encountered. I had
become accustomed to meeting individuals who drank from
ten to fifteen pints as their daily amount, but when the case
to be reported presented itself it was thought rare enough to
report.
Case 306 was a tall blonde, twenty-six years of age, who
had come to this country from Ireland when quite a young
girl. She was married in her eighteenth year to a strong,
burly man, much addicted to the use of alcoholic beverages.
One year after marriage their first child*was born, and from
this time she commenced to use tea. Why she should have
begun at this particular time she could not explain. At
first she said the amount was very small, but the quantity
necessary has grown greater and greater. In all four chil¬
dren have been born to her, and while nursing them she has
Digitized by ^ooQie
Abstracts and Reviews .
369
always kept a quart-pitcher of tea by her side from which
she frequently regaled herself. She said she had become
more irritable and cross every year, and found it harder to
content herself with her husband and his drinking habits,
and that in consequence domestic infelicities had increased
in number yearly. She had also found that tea would take
the place of food, and when not particularly hungry, or too
busy to prepare meals, she had recourse to the teacup with
complete satisfaction.
This is briefly the history of the patient when she pre¬
sented herself for treatment for, as she said, nervousness and
sleeplessness.
At the time of her first visit she had paroxysms of what
she termed “ cruel and fierce ” headaches, either temporal,
frontal, occipital, or general, persistent neuralgia of the face
and neck, and dull, heavy pains in the lumbar region. She
had also attacks of vertigo and mental disquietude and con¬
fusion, and was conscious of increasing forgetfulnes. After
these attacks she would have periods of despondency, alter¬
nating with great anxiety, a feeling of impending accident
and death, either to herself or children. There would be
times when her sleep was restless and troubled ; nightmares
and dreams were frequent; after which there would ensue
insomnia, at times complete, and of several nights' duration.
She was very nervous, easily startled, and very prone to be-
hysterical. The hallucinations usually met with in cases of
tea-intoxication were also present in her case. She had at
times an almost irresistible desire to look around or under
the bed, because she imagined that some one was in the
room. She said that when she stopped to think she “ knew
it was not so, but that she must look and see." When walk¬
ing on the street there seemed to be shadows on the side¬
walk beside her, as if made by some huge animal.
This is a brief detail of the most prominent nervous
symptoms, so called. Her bowels were very much consti¬
pated, several days elapsing without an evacuation. She
had no appetite, was subject to attacks of severe cardiac pal-
Digitized by ^ooQie
370
Abstracts and Reviews .
pitation, and complained of a sinking sensation at the pit of
the stomach. Her menses occurred every three weeks and
lasted about eight days, and at this time all of the symptoms
were much aggravated.
The amount of the infusion of the tea-leaf drunk by
this woman is astonishing, and the case is for this reason by
far the most remarkable one in a large collection of tea-
inebriates.
When asked how much tea she drank a day, she hesi¬
tated, and then said, “ Oh, I drink about thirty cups a day.”
After closer questioning by both my associate, Dr. Alex¬
ander C. Howe, and myself, she confessed that she drank
five cups before and five at breakfast, but did not know how
many during the day, because she drank from a pitcher or
bowl, as drinking from a cup was too slow a process and
unsatisfactory. She said that her husband, who did not use
tea, would let her buy only two pounds a week. From this
she could make about seven “pots” of tea per day. The
teapot, she explained, had a capacity of two quarts.
Here, then, is a woman who drank on an average twenty-
eight pints of the infusion of tea every twenty-four hours,
and who said that she could have drunk more had not her
husband prohibited such an extravagance. From the his¬
tory and from her own story the reason for drinking tea in
4 his large amount lay solely in its stimulating effects. From
a study of the physiologic action of thein and the essential
oil on the system, this is not surprising, nor could a better
and at the same time more pernicious non-alcoholic agent be
found in common use.— Medical News.
LEGISLATION FOR INEBRIATES IN AUSTRIA.
The first instance in which a continental legislative as¬
sembly has treated the drink craze as a disease rendering its
victim a source of danger to the state, has just been provided
by a bill now about to be introduced to the Austrian Reichs-
rath. This bill proposes to treat the persistent inebriate as
Digitized by LjOOQie
Abstracts and Reviews .
371
a person who is mentally incapable and likely to inflict injury
upon the community, not only by actual violence, but by his
example. It is therefore proposed that the authorities shall
keep him under control, both during good behavior and for
such a longer time as in the opinion of competent physicians
will serve to wean him from his craving for strong drink.
This bill is the result of a long continued series of efforts
by the medical profession of Austria, founded on the advice
and experience of the American Association for the Study
and Cure of Inebriates. The ground has been taken that the
position of the drunkard in social life has not been hitherto
properly estimated. It is argued that he should be regarded
more as a lunatic than is at present the case, and that he
should be treated accordingly. There has always existed a
feeling that the craving for drink, with its consequences,
ought to be treated as a mere bad habit, a temporary and
recoverable error, not really a form of mental disorder. This,
there can be but little doubt, is a false reasoning, for evidence
has multiplied in recent years that the victim to alcohol is
subject to a disease, just as much as a maniac or a lunatic.
The disease has received all sorts of names, but as to its
nature it seems agreed that it consists in a weakening or
decay of the will power coupled with a craving for stimu¬
lants.
The restraint which the Austrian Reichsrath proposes to
put upon the drunkard may take the form either of voluntary
or compulsory detention in especially appointed retreats. In
cases where the confinement is compulsory provision is made
for a regular trial in which witnesses, both lay and medical,
will be heard. The justification for detention will consist in
such facts as repeated previous convictions of drunkenness,
proof of danger to life, and other evidence strong enough to
leave no doubt that the alcoholic passion has become ungov¬
ernable and has rendered its victim morally or physically a
source of danger to himself or others.
The term of detention will be two years, and this term is
liable to reduction or renewal, as the occasion may require.
Vol. XVII.—49
Digitized by i^-ooQie
372
Abstracts and Reviews .
The drunkard will therefore be made to feel that he is not
merely committing a misdemeanor when he tipples to excess,
but a grave crime, for which the state will lock him up and
treat him as a person who ought not to be allowed at large.
There is a vast difference between this mode of treatment
and that in practice in other countries*, where a drunkard is
locked up for a few days as a punishment for his offense, no
effort being made either to better his condition or to prevent
any injury he might possibly inflict when under the influence
of alcohol. The danger in the latter case is, of course, much
greater if the period of alcoholic excitement is a long one.
In case the bill passes (and there is but little doubt of this),
the Austrian citizen will have little opportunity to go on a
long spree.
The bill may be taken as fairly representing medical
opinions on this subject. Modification in detail may, per¬
haps, be found advisable as time goes on, but the profession
will probably approve the bill on its general outlines. The
attempt to repress the excessive drinking habit and to treat
it as an ingrained vice, which has absorbed all traces of a
resisting will, certainly deserves a fair trial. Every precau¬
tion will be made to render the preliminary investigation as
searching as possible, and no personal privileges will be lost
by detention.
It is rather the purpose of the bill to protect the state
and improve the condition of the victim than to inflict pun¬
ishment. The patient’s own interests will be served in a de¬
gree at least equal to that of his relatives and friends.
It is true that such measure will be adopted in all civil¬
ized countries in the course of time. A treatment such as
this one here outlined would certainly result in the benefit of
the patient, and the confinement would not be much lamented
by his family.
Digitized by i^-ooQie
Abstracts and Reviews.
373
ANCIENT PUNISHMENT FOR DRUNKENNESS.
The offense of drunkenness seems to have been a source
of great perplexity to the ancients, who tried any number of
ways of dealing with it. If none of them succeeded, it was,
in all probability, because they failed to suppress the means
by which this insidious disease is incited and propagated.
Severe treatment was often attempted without any satisfactory
results.
The Romans prohibited the drinking of wine upon the
part of men under thirty years of age, a rule which applied to
women of all ages. If a lyife were declared guilty of con¬
suming fermented liquor, her husband might legally scourge
her to death.
The Carthaginians prohibited governors, magistrates,
soldiers, and servants from drinking anything stronger than
water, and the Athenians made it a capital offense for a
magistrate to be drunk.
The Suevi seem to have realized the necessity of dras¬
tic measures, as they went so far as to prevent the import¬
ation of wine into their country.
The Locrians, under Zalenous (660 B.C.) made it a capi¬
tal offense to drink wine unless it were mixed with water;
even an invalid was not exempt from punishment, unless his
physician had ordered him to drink undiluted wine. His¬
tory does not relate whether physicians were in the habit of
giving such instructions.
Pittacus of Mytilene (651-569 B.C.) made a law that he
who, when drunk, committed any crime should receive double
the sentence which he would have received had he been
sober. Aristole and Plato considered this law the height of
wisdom. The Roman censors were empowered to expel a *
senator for drunkenness, and were at liberty to confiscate his
horse.
Mohammed ordered drunkards to be bastinadoed with
eighty blows.
Some nations seem to have approved of “ moderate ”
drinking, as they limited the quantity to be consumed at one
Digitized by t^-ooQie
374
Abstracts and Reviews.
sitting. This was the system adopted in ancient Egypt, but
the limit does not appear to be stated in any history now ex
tant. The Arabians fixed the quantity at twelve glasses a man.
Unfortunately, however, the size of the glasses was not clearly
defined. The Anglo-Saxons ordered silver nails to be fixed
on the side of drinking cups, so that each person might know
how much he had consumed. This method is said to have
been introduced in consequence of King Edgar noticing the
drunken habits of the Danes.
Lycurgus of Thrace (about 900 B.C.) was a thorough pro¬
hibitionist ; he ordered the vines to be cut down.
The Spartans tried to turn the vice (as it was then re¬
garded) of drunkenness into contempt by systematically
making their slaves drunk once a year, in order to show their
children how contemptible men looked when in an inebriated
condition.
Drunkenness was considered much more vicious in some
classes of persons than in others. The ancient Indians, for
example, held it lawful to kill a king when he was drunk.
Charlemagne (A.D. 742-814) enacted a law that judges and
pleaders should do their business fasting.
The English expression “ drunk as a lord ” proves that at
one time to become intoxicated was regarded as indicative of
aristocratic birth and breeding. Moreover, “a three-bottle
man ” was respected as one who displayed qualities which his
friends might well envy.
It is not a great many years since people supposed total
abstinence from alcoholic stimulants actually shortened life,
and there exists in London (England) to-day a gentleman
whose life was refused by an insurance company solely upon
the ground that he was a teetotaler !—Lawrence Irwell in
“ The Voice,"
Di<* zed by CjOCK^Ic
Abstracts and Reviews .
375
THE TWENTIETH CENTURY PRACTICE OF
MEDICINE, Edited by T. L. Stedman, M.D., New
York City. In twenty volumes. Vol. Ill, Occupation,
Diseases, Drug Habits, and Poisons. William Wood &
Co., New York, 1895.
Volume third of this magnificent work contains Dr.
Norman Kerr’s splendid paper 44 On Alcoholism and Drug
Habits.” Verily the world of science has moved on and up¬
wards. One hundred and thirty-seven pages are devoted to
a subject which has been looked down at with lofty con¬
tempt as a 44 fad ” and a delusional whim in many circles of
science. The bitter critics of twenty years ago have turned
round and are now the enthusiastic defenders of the disease
of inebriety. Dr. Kerr’s paper is admirable in its tone and
spirit, and presents the best review in print of the entire
subject. The American reader will be astonished to find
that American authors have been among the foremost lead¬
ers in this field. They will be also pleased to have grouped
in such a convenient form all the leading known facts of the
toxic drugs used for narcotism. The causes of inebriety and
its relations to other diseases, its physiology, pathology, and
medico-legal relations are presented concisely and in a most
practical way. We shall give our readers full extracts in the
next number of the Journal of parts of this article.
Beyond Dr. Kerr’s paper, there are exhaustive articles
44 On Shock and Collapse,” by Dr. Shrady ; also 44 On Sea¬
sickness,” by Dr. Gihon ; and 44 On Mountain Sickness,”
by Dr. Liebig; 44 On Osteomalacia,” by Dr. Councilman;
44 On Heat Stroke,” by Dr. Gihon ; 44 On Frost Bite,” by the
same author ; 44 On Diseases of Occupations,” by Dr. Lloyd ;
44 On Poisoning,” by Dr. Small. It will be seen from these
titles that this great work is thoroughly an international en¬
cyclopedia of practice, one that should be in the library of
every physician and asylum. So far it gives promise of pre¬
senting the largest number of exhaustive monographs on
practical medicine which has ever been issued from the press.
Send to William Wood & Co., New York City, for circulars.
Digitized by t^-ooQie
37 ^ Abstracts and Reviews .
THE PHYSICAL, INTELLECTUAL, AND MORAL
ADVANTAGES OF CHASTITY. By M. E. Hol¬
brook, M.D., Editor Journal of Hygiene and Herald of
Health , etc., etc., etc. M. Holbrook & Co., Publishers,
New York City, 1895. Price $1.00, postpaid.
This work of one hundred and fifty pages presents the
reasons for chastity and the various advantages in a clear,
graphic way.
The physical laws and the penalties of their violation,
also the advantages from their observances, are set forth in
a very plain, sensible manner. Such works are invaluable
for young men and women, by removing false impressions
and giving correct ideas of sensual life and control, and
inspiring to a higher ideal of living. Such works in the
hands of young persons would be of immense service to the
cause of purity, and a power against the evils of unchastity.
We most heartily commend this book, and thank the author
for his excellent contribution to the uplifting of humanity
and clearing away many of the doubts and present obstacles.
THE FEMALE OFFENDER. By Profs. Lombroso and
Ferrero, with an Introduction by W. D. Morrison of
Her Majesty's Prison, Wandsworth, England. D. Ap¬
pleton & Co., N. Y., 1895.
This is the first of the “ Criminology Series," by Dr.
Morrison, and is designed to embody the results of extended
investigations into the physical conditions of crime and de¬
generacy.
Beginning with the great teacher Lombroso, the criminal
and abnormal woman is studied in a most exhaustive way.
The anthropology, pathology, psychology, and physiology of
the criminal woman and prostitute is treated in seventeen
chapters, fully illustrated by groups of pictures. Many of
these chapters are most suggestive studies of women who
are constantly under the care and observation of physicians.
The anomalies and types of these classes, with their special
degenerations and defects, is a wonderful study, especially
Digitized by i^-ooQie
Abstracts and Reviews.
3 77
when the fact appears that alcohol in the parents is a promi¬
nent source of this degeneration. Our readers will find in
this work a vast field of allied disease to that of inebriety,
another branch of the same family dissolution. Crime in
women is always fascinating, and always obscure, and yet it
follows organized lines of movement. This work is a reve¬
lation to most readers and calls attention to the vast range
of physical causes, that are practically unknown in crime by
both sexes. As a new work, in a new field, by a great s'tu-
dent of science, it should be in the library of every student
and thinker. This is literally one of the epoch-making works
of this century, particularly in calling attention and opening
up a new field of anthropological study.
THE DISEASES OF PERSONALITY. By T. W.
Ribot, Professor of Comparative and Experimental Psy¬
chology in the College de France. Authorized transla¬
tion. Second revised edition. Chicago. The Open
Court Publishing Co., 1895.
That the works of Ribot are appreciated in this country
is manifested by the number of excellent translations which
have been published in America. It is not so long ago that
Professor Baldwin, late of Toronto University, translated
Ribot’s “ German Psychology of To-day/* while the Open
Court Publishing Company have authorized translations of
his “ Psychology of Attention/* “ The Diseases of the Will,”
and, lastly, “ The Diseases of Personality/*
Ribot is a strong advocate of the new psychology, i. e. y a
psychology which repudiates metaphysics. Experimental
psychology presents a wide field for future research, and it is
from a more thorough and practical study of the pathological
and physiological manifestations of the nervous system that
we are to expect much advance in psychological lore. For
purposes of analysis of the human personality, Ribot has
made a division into the organic, affective, and intellectual
conditions of personality.
Digitized by CjOOQie
378
Abstracts and Reviews .
Among the organic disorders he discusses slight varia¬
tions of the personality in the normal state, cases of double
personality, personality of doubles, monsters, and the per¬
sonality of twins. Among the affective disorders he dis¬
cusses depressions and exaltations of the personality, their
alteration in circular insanity, complete metamorphosis of the
personality, sexual characters, eunuchs, hermaphrodites,
opposite sexuality, total transformation of the character, etc.
In'disorders of the intellect he discusses the alterations pro¬
ceeding from paraesthesia and dysaesthesia, alterations pro¬
ceeding from hallucinations, cerebral dualism, and double
personality, the role of memory, and the role of ideas. In
another chapter on the dissolution of personality the changes
of personality in progressive dementia are discussed.
The medical practitioner interested in psychology will
peruse with interest this excellent translation of one of
Ribot's latest works.
The Scientific American by Munn & Company is a paper
of rare value and usefulness in every family, stimulating
interest in all scientific movements of the day.
The Homiletic Review should occupy a place with all the
great monthlies on the library table. Its topics are cheering
and helpful. They lead the mind into ranges of peace and
quietness, out from the excitement of the present.
The Voice still echoes the roar and clash of the battle
with rum, a conflict that must end in the abolition of our
present delusions concerning alcohol as a beverage. The
Voice y as a weekly paper, has caught the sounds of the on¬
coming revolution, and its tone is more confident and
emphatic. It demands a place in every library and family of
the land.
The Appleton's Popular Science Monthly is the new title
of our old friend whose monthly visits brings stirring news
from the scientific frontiers. No other journal is so stimu¬
lating and positively healthful to the medical man in every
possible relation. Every asylum should have a copy in its
library, if for nothing more than to show a desire to keep up
with the restless march of truth.
Digitized by i^-ooQie
Abstracts and Reviews .
379
A Noble Life is the title of a memorial pamphlet with
portrait of John Newton Stearns, who was so long and
prominently identified as secretary of the National Temper¬
ance Society. It is an excellent sketch of a good man who
was very influential in the cause of temperance in the
country.
The Review of Reviews is practically a busy man’s
journal, where he can see at a glance an epitome of the
world’s progress, and all the varied discoveries of the hour.
Every new paper that is published is noticed here, and all
the new thoughts of the best thinkers are brought in review.
Send for a copy and examine its merits.
Pilocarpine in Alcoholism. — Dr. Josham recommends
one-third grain doses of Pilocarpine hypodermatically, and
declares “ its sobering effects are remarkable ” ; sleep ensues,
and the patient wakes up a perfectly rational being. “ The
tense, red, bloated countenance and bleared, congested eyes
pass away, the features become calm and easy, the skin soft
and clear.”— Provincial Medical youmal.
Inebriety in France. — The following statistics by M.
Magnan give an idea of the prevalence of alcoholism in the
department of the Seine. Among 3,740 patients (2,072
men and 1,668 women) admitted to the Sainte Anne Asylum
in 1894, there were 775 suffering from alcoholism ; of these
624 were men and 151 were women.
A petition has been presented to the English House of
Lords praying that any person who has been twice convicted
of drunkenness within two years shall be defined as an
habitual drunkard, and that any licensed dealer serving or
harboring him, after due notice, shall be liable to penalties
and forfeiture of license.
Vol. XVII.—50
Digitized by L^OOQie
3^0
Editorial,
Sjditorikl.
THE QUESTION OF NUTRITION IN INEBRIETY.
Many cases of inebriety have a hereditary predisposition
to unbalanced and defective nutrition. From early life food
has been used with great irregularity, as to time, quality, and
quantity. Various complex derangements of digestion, with
defective assimilation, and excretion are common. Wide
variations of appetite, and periods in which the person
becomes fleshy or grows thin follow each other. This
nutritional variation was noted in the army where, under
similar surroundings and conditions of living, excretion
and assimilation varied widely. One man would become
fleshy, another would lose flesh, and constipation, diarrhoea,
defective or increased appetite, together with other changing
nutrient disorders were common. In a certain number of
cases of inebriety, nutrient irregularities were provoked in
early childhood, by reckless and indiscriminate choice of
foods ; permitting the child to have everything its taste or
inclination desired. From this a defective nutritive control
and want of balance are started which continue through
life. This derangement is always imperfect assimilation and
excretion, and the toxic products retained in the system
become sources of poisoning. Alcohol in some form is the
basis of many digestive remedies, and while acting as an
anaesthetic, quieting the irritations from the poisons, is the
cause and source of new and more dangerous degenerations.
This nutritive derangement is manifest functionally by states
of nervous irritability and rapid exhaustion all through life.
Derangements from the slightest causes, strains and varied
states of exhaustion all center on nutrition, and disturb¬
ances here become the exciting cause of the craze for spirits.
After spirits or any narcotic drugs are used continuously or in
Digitized by i^-ooQie
Editorial.
38 i
so-called moderation, the formation of toxic products are
increased, and their excretion and elimination dimin¬
ished. The inebriate is always in a semi-poisoned condition,
in which nutrition is most seriously and specifically
affected. The rational treatment should be directed, first, to
elimination, and to assist in throwing off the poisoned products,
also to correct and improve the nutrition. Baths, saline purg¬
atives, and easily assimilated foods that do not tax diges¬
tion are required in all cases. These are increased in value
by nerve rest, quietness, and correct psychical surroundings.
It will be apparent that the nutrition of all cases of inebriety
is of great importance in the treatment, but should not
absorb the entire attention. In certain cases the correction
and restoration of nutrition is the practical cure of the
inebriate ; in others it is the beginning the cure. Questions
of particular diets, such as grains, fruits, and meats, or mix¬
tures of these foods, are all practically unknown fields of
study. It is not possible at present to dogmatize or assert
positively concerning the value of any special diet in the
treatment of inebriety. From the facts at command there
can be no doubt that more particular attention should be
given to the nutritive treatment of these cases. Assimila¬
tion and elimination are functions of supreme importance
in the building up and restoration of the degenerate states
which are at the bottom in inebriety.
TRAINING ESSENTIAL IN THE STUDY OF
INEBRIETY.
It is one of the curious facts rarely noticed, that many of
the voluminous authors on inebriety and the drink evil are
without training and experience in the study of this disorder.
One man, the author of three books and many papers
minutely describing the cause and cure of inebriety, is a
clergyman who denounces physicians and scientists as
infidels and unsafe, unreasonable teachers. Another famous
author is an editor who began as a printer, and a widely
Digitized by QjOOQie
3^2
Editorial .
known reformer who boasts of his power to teach the world
the truths of alcohol, spent twenty years of his life in
excessive drinking, then stopped and became a teacher.
Another man who is very dogmatic and assertive, and has
written voluminously on inebriety is a retired merchant who
has spent most of his life behind the counter selling goods.
The list might be extended almost indefinitely, and in every
case we look in vain for the training and preparation
to become competent observers and teachers of what
inebriety is or is not. The reformed inebriate may talk
glibly and with great earnestness about inebriety, but he is
beyond the period of carefully gleaning, storing, and tabula¬
ting facts concerning inebriety. He is incompetent to
reason from the facts alone, above all dogma, theory, or
intuition. His brain cannot proceed along the lines of logical
equations, of similarity and diversity, of identity and differ¬
ence, and on these range the facts under some general law.
The clergyman and reformer who start from some theory,
then pile up evidence to support it, are unable to understand
the real facts and their true meaning. The study of inebriety
is not advanced by such men; they may keep up a certain
agitation and conflict of theory and opinion, but they never
enter into the real territory of facts. This is only done by
the trained student, who brings to the work capacity for
collecting, discriminating, and grouping facts, and from
this, discovering laws and lines of generalization that
point out the real forces at work. All this must be
done without the bias of theories or previous conceptions.
Facts concerning inebriety collected by the reformed
inebriate, by the emotional enthusiast, are incomplete, faulty
and fictitious, however honestly they are held. They are so
largely the products of the emotions and feelings as to be
practically rubbish. Yet every one assumes that such men are
competent to judge why men drink, and how they can stop.
In the lowest haunts, and in the most intellectual circles, this
great drink problem is discussed with the familiarity and
assumption of a common every-day topic, while in reality it
Digitized by t^-ooQie
Editorial,
383
is one of the most difficult psycho-scientific topics of the
age. It is toxicological anthropology, which requires not only
special training to understand, but great natural tastes and
adaptabilities for such a work. The strongest, clearest brain
powers are demanded. No one who has been poisoned by
alcohols and drugs can do this work ; no desires or emotion¬
alism, or zeal or oratory, or excellence in humanitarian labors,
will prepare one for this great field of exploration. The
time is not far away when trained men will appear to occupy
and open up this new dark continent of truth.
LEGAL TREATMENT OF INEBRIETY.
The failure of the present legal methods of treating
inebriety, and its inability to check drunkenness and
protect society is emphasized by the statistics of each year.
From police and other court records of persons arrested for
inebriety, there is evidence of a marked increase in numbers.
This is in the aggregate, not in any one place or time, but in
the course of years. While there are noted fluctuations,
such as a great decrease, then a sudden increase of persons
arrested for inebriety, the rise has been continuous, and
parallel with crime and pauperism. The present methods of
dealing with inebriety are evidently powerless; immense
expenditure of energy and money is lost in every com¬
munity and nothing is accomplished. Why are these efforts
of legislatures through laws, and the application of them by
judges, police, and prisons, such disastrous failures ? One of
the obvious reasons is the delusion that inebriates can be
controlled through fear of pain and punishment and dread of
the law. It fails to recognize that alcohol produces anaes¬
thesia and paralysis of all the higher nerve centers. The
inebriate is abnormal; no fear of punishment has any marked
impression on his mind. He might shrink momentarily
from the consequence of his conduct, but this would give
way to the delusions of strength to overcome all possible
conditions. The higher brain centres are more or less pow-
Digitized by ^ooQie
384
Editorial ’
erless to recognize the claims of duty and obligation and
responsibility to others. Another reason for this failure of
penal methods is a similar delusion that all inebriates are
alike, and the same conditions provoke and continue the use
of spirits. Hence one law and one method apply to all.
No treatment that is based on exclusive theories which apply
to all cases of inebriety will succeed. It is assumed that
alcohol is transient in its effects, and the same in all condi¬
tions of life, and that the inebriate is normal, and conscious
of his conditions and relation to others. This is fatal to any
plan of treatment based on it. The treatment of any diseases
by routine methods with the same drugs, the same diet, the
same surroundings and means is always a failure. The vast
army of inebriates arrested for inebriety and petty crime are
all treated alike, all subjected to the same penalties, and as
a result they become more incurable. No recognition of
causes and conditions, of biological anomalies, of degene¬
rations, of mental and physical peculiarities, of environ¬
ments, of relations to lunacy, to epilepsy, to criminality and
pauperism, and hence the treatment is disastrous. Inebriety
will increase until it can be studied and treated from the
physical side ; until the inebriate will be recognized as a
product of pathological and atavistic degenerations ; until the
physiological action of alcohol on a defective organism is
understood ; until he is known biologically, pathologically,
psychologically, and physiologically. Legal theories and
legal remedies will continue to destroy and increase the evils
they aim to lessen until this is done.
INEBRIATE TRAMPS.
Every one is familiar with the wretched looking degen¬
erate tramp, whose red eyes and nose and alcoholic breath
are unmistakable symptoms. There are other tramps that
are not recognized, seen in the club houses, homes of the
wealthy, rich hotels, up-town flats, and in churches, theatres,
in Pullmans, steamers, ocean liners, watering places, and
noted resorts everywhere.
Digitized by L^ooQie
Editorial ’
385
They do not always have an alcoholic breath, but they
are inebriates in every sense of the word. They drink at
meals, early in the morning, late at night, and any time
during the day. They are rarely intoxicated, but always
garrulous, or stupid, and simple in conversation. They talk
loud and long of religion, science, politics, and social ques¬
tions, but have no real knowledge or clear views of anything.
Their whole life is a round of selfish efforts to gratify every
appetite, and every impulse that comes to the brain. They
never have a thought of humanity outside of themselves, and
regard everything of value only as it ministers to their self¬
ishness. Such persons are consumers, never producers.
They are degenerates, with steadily increasing paralyzed
alcoholic brains, and belong to the same genus and same
family with the ragged, wandering nomads called tramps.
They are parasites living on the products of others, and doing
nothing for the race; nothing to make humanity better, but
by conduct and example destroying aud breaking up every
good impulse to rise. They are clogs and obstacles to all
civilization. They require the same sanitary police care that
the wandering nomad receives, and should come under the
same rules. In the near future these tramps will be recog¬
nized, and treated by larger and clearer psychological laws
of prevention and cure.
USE OF COCAINE ON THE RACE TRACK.
Within a recent period cocaine has come into use on the
race track, as a stimulant. Horses that are worn and ex¬
hausted, *or are uncertain as to speed and endurance, are
given ten to fifteen grains of cocaine by the needle under
the skin at the time of starting, or a few moments before.
The effects are very prominent, and a veritable muscular
delirium follows, in which the horse displays unusual speed,
and often unexpectedly wins the race. This agitation con¬
tinues, and the driver has difficulty in “ slowing down ” the
horse after the race is over ; not unfrequently the, horse will
Digitized by
Google
386
Editorial .
go half round again before he can be stopped. The exhaus¬
tion which follows is not marked except in the great thirst
and loss of appetite. Sometimes diarrhoea and trembling
follows. But good grooms give unusual attention to rubbing
and bathing the legs in hot water and stimulants. The gen¬
eral effect on the horse is depression from which he soon
recovers, but it is found essential to give cocaine again to
make sure of his speed. The action of cocaine grows more
transient as the use increases, and when a long period of
scoring follows before the race begins, drivers give a second
dose secretly while in the saddle. Sometimes the horse be¬
comes delirious and unmanageable, and leaves the track in a
wild frenzy, often killing the driver, or he drops dead on the
track from the cocaine, although the cause is unknown to
any but the owner and driver. Some horses have been given
as high as twenty grains at a time, but this is dangerous and
only given to worn out animals, who may by this means win
a race. It appears that cocaine is only used in running
races, and as a temporary stimulant for the time. It is
claimed that the flashing eyes and trembling excitement of
the horse is strong evidence of the use of cocaine.
ALCOHOL BY SYNTHESIS.
M. Maisson of Paris has succeeded in making alcohol
that can be sold for five cents a gallon with profit. The
process is subjecting coke and quicklime to the heat of elec¬
tricity in which carbide of calcium is formed. This prepara¬
tion in water becomes acetylene. This is transformed into
ethylene by heat, and by passing through hot ‘sulphuric
acid becomes alcohol when treated with water.
Digitized by ^ooQie
Clinical Notes and Comments.
38 7
dlir^idkl ]Sfote$ kqd Con\n\ei\t^.
TEACHING THE DANGER OF ALCOHOL IN
THE FRENCH SCHOOLS.
The committee formed by the French Minister of Public
Instruction to seek a means of combating alcoholism by the
school has approved of the terms of a report by M. Steeg,
inspector-general of primary education, in which those means
were practically indicated. In his turn the minister has
approved the conclusions of the report, and, by a double cir¬
cular, dated August 2 d, has addressed it to the prefects and
clerics, recommending them to ensure its application on the
return of the scholars. In this circular M. Poincar6 ex¬
presses his confidence that “the devoted staff of teachers
will not fail to collaborate in a humanitarian work which has
for its object the preservation of at least the younger gener¬
ations from the evils caused by alcoholism.” We have M.
Steeg’s report before us, and desire to place its principal
features before our readers. It is not necessary, in order to
organize anti-alcoholic instruction in primary schools, to alter
or enlarge the present curriculum. This curriculum, at the
different primary degrees, contains formulae to point out the
shame and dangers of intemperance. Here is the proof for
the primary normal schools. The course of morals which is
given there the second year by the director of the school
himself includes, after an exposition of the principles, a por¬
tion entitled “ Practical Morals; Application.” Now, is
there a more striking application of moral principles than
that which relates to alcoholism, that destructive scourge of
the individual, the family, and sooiety. The sub-chapters
which treat of “ Respect for one’s self, of temperance, and of
domestic and social duties,” do not they explicitly call for the
developments suggested by the terrible extension of the
'Vol. XVII— 51
Digitized by i^-ooQie
388
Clinical Notes and Comments .
evil ? The course of zoology in the normal schools treats of
human anatomy and physiology. In this the teacher, after
having described the organs in a healthy state, will only have
to show, by means of special blackboards and designs,
which, I assure you, will be impressive, the morbid troubles
and the grave deterioration caused by alcoholic intoxication.
Lastly, the chemistry course, under the heading entitled,
“ Alcohols; Ordinary Alcohol and Fermentation (wine,
beer, cider), Trials of Alcohols the course of hygiene,
under the heading of “ Water,” and that of political economy,
do they not present in the most simple and frequent manner
the opportunity of pointing out from different and topical
points of view the ravages and miseries of all sorts which
alcoholism brings with it? Even the official programme
adds the decisive word “ Alcoholism,” and it has wittingly
done so, though when the curriculum was drawn up in 1887,
the evil had not its present intensity, nor had public opinion
conceived its present alarm. This method of combating
alcoholism in dispersed order in normal and higher schools
has the evident advantage of causing different professors to
compete for the same object, and thus add the force of per¬
suasion to this teaching. In order to summarize and con¬
dense what may be too vague, lectures in each of the normal
and higher establishments will be given by competent doc¬
tors, placing the principal features of the subject in a clear
light. But it is especially in the primary elementary school,
to which all children are obligatorily called, that it is essen¬
tial to warn them of the terrible danger which threatens
them and theif country. It is, then, with perfect reason
that the ministerial committee and the minister have re¬
garded as sufficient, as regards anti-alcoholic instruction, the
present primary instruction curriculum. An immediate
advantage arises from this ; it is possible to commence with¬
out delay, and a ministerial circular suffices for everything.
— Le Temps.
Digitized by L^ooQie
Clinical Notes and Comments .
389
A New Blood Corpuscle. — When Hayem announced
the discovery of a third corpuscle, there was great enthu¬
siasm among all biologists. When he later announced the
relation of these corpuscles to the coagulation of the blood,
the interest was greatly deepened. But when Laveran pub¬
lished to the world his discovery of a parasite in the blood of
persons suffering from malaria, the very climax was reached.
It was far greater than the discovery of a new blood corpus¬
cle ; for it told of a parasite which developed and multiplied
within the red corpuscle, causing untold misery and large
loss of life. We need no longer say we think a patient has
malaria; for it is now possible, thanks to Laveran and the
microscope, to give a positive answer. Now we know why
quinine has such controlling power in this disease ; it de¬
stroys the parasite and thus removes the cause. As the heel
of man shall crush the serpent's head, so, definitely and pos¬
itively, does the alkaloid of Peruvian bark crush out the life
of the malarial parasite. But how can one describe the aches
and pains which form a part of a malarial attack ? Shall we
give an opiate and quiet the pain at the expense of locking
up the secretion of the body ? There appears to be but one
rational method: Give a remedy, if there be one, which will
quiet the pain without affecting in the slightest degree any
of the secretory or excretory organs. Such a remedy exists
in Antikamnia. Antikamnia and quinine, therefore, are the
two remedies which science has selected for the treatment
of malaria and all malarial conditions. These are now pre¬
pared in the form of tablets, each containing 2 \ grains of An¬
tikamnia and 2\ grains of Sulph. Quinine.
In an editorial in the Therapeutic Gazette in 1892, the
importance of discovering some substance possessing dias-
tatic properties which could be administered in concentrated
form to persons suffering from indigestion of the starches
was urged, and since that time they have continued to urge
Digitized by L^OOQie
Clinical Notes and Comments.
YP
this need upon those best qualified to prepare such an acthe
digestive substance.
The profession have tried to aid the digestion of starch
for many years by the use of various preparations of malt,
which have been largely given with little direct good as a
result, for the diastatic properties of most of these prepara¬
tions are so slight as to render them practically of no value
as digestants, whatever may be their usefulness when acting
as nutritives. Within the last few months a Japanese inves¬
tigator has obtained such a valuable diastatic product that
his researches deserve careful study and his results thorough
trial. If, as he has apparently proved, we possess in Taka-
Diastase a starch digestant equal to or exceeding in power
pepsin or pancreatin for proteids, we have made an extraor¬
dinary gain in therapeutics, for we are now able to relieve a
large number of persons suffering from faulty digestion of
starch, and can aid our patients, during convalescence, so
that they speedily regain their weight and strength by the
ingestion of large quantities of the heretofore indigestible,
but nevertheless very necessary, starchy foods.
We trust that the readers of the Gazette will at once give
this interesting ferment, which is capable of converting over
one hundred times its own weight of starch, a thorough clin¬
ical trial, administering it in the dose of from i to 5 grains,
which is best given in powder, or, if the patient objects to
the powder, in capsule. We also trust that those who em¬
ploy this digestant will, as soon as they obtain definite
results, communicate them to the original columns of the
Gazette for the benefit of other readers.
Indications for the Use of Sulfonal. — Among
the hypnotics brought before the profession within the last
few years, two, Sulfonal and Trional, have been received
with much favor. After careful trial each was found to have
its own field of usefulness in the treatment of the various
forms of insomnia. Of course, it is not always possible in
Digitized by ^ooQie
Clinical Notes and Comments .
39*
any case to foretell with certainty which one of these is
likely to prove of most value, although a knowledge of their
physiological actions throws much light on this subject.
Trional acts more promptly, but its effects are dissipated
more rapidly, so that the action of one dose is less apt to be
prolonged over the following night than in the case of Sul-
fonal. On the other hand, drowsiness on awakening is more
common with the latter. We recommend Sulfonal espe¬
cially for that class of patients who have no difficulty in going
to sleep when they first go to bed, but wake in a short time
and lie awake, two, three, or four hours, or may have no more
sleep that night. In these cases Sulfonal does not interfere
with the first early sleep of the night, and acts later so that
the patient does not awake at midnight as usual. Given in
small doses, not more than ten grains, it may be employed
with advantage to quiet restlessness in neurasthenia, and
various disorders which cause inebriety and opium disorders.
The chief advantage of Sulfonal over Trional, therefore, is
that the effect of a full dose continues longer, and that it
will frequently produce sleep on the second night, and in a
few cases even the third.
In a paper on Acute Mania by Dr. .DeWitt, read before
the Cincinnati Academy of Medicine : “ To procure sleep and
quiet is perhaps the greatest desideratum, and I know of
nothing so certain in its action as chloral hydrate, given in
40 or 60 grains. It may be given alone or combined with
one of the bromides. The “ Bromidia ” of Battle & Co. I
have always found very reliable. It is almost certain to
quiet and produce sleep. You will occasionally meet with
cases that resist the influence of chloral even in large re¬
peated doses ; here opium or some one of its derivatives,
either given alone or in connection with the chloral, will be
found of service. If hypodermically administered, not less
than one-third grain should be given. Small doses only
excite the patient, and do more harm than good.”
Digitized by C^ooQie
392
Clinical Notes and Comments .
PHYSIOLOGICAL ACTION OF ALCOHOL.
These gray cells are brought into action by coming in
contact with the blood. The blood reaches the corticle
structure of the brain through the vascular membrane known
as the piamater, which fits the convolutions, like a glove fits
the fingers of the hand. It is a physiological fact, that, owing
to the vascularity of this membrane and other blood vessels
that pass into this great center, one-fifth of the blood of the
body continuously circulates in the brain, especially during
the waking hours. During great mental excitement there is
more blood even than this in contact with the cephalic struc¬
ture. We find, too, that the brain is capable of contracting
and expanding as the blood fills the organ, and recedes from
it during the hour of sleep. There is another known physio¬
logical fact of importance in studying this center, and that is
this : As we all know, many people drink alcohol to excess,
and we know too that alcohol is indigestible; that when ta¬
ken into the stomach it is absorbed into the blood without
undergoing any catalytic change. When absorbed it circu¬
lates in the blood as alcohol. When eliminated by the
execretory organs it is thrown off as alcohol, and if not, then
one-fifth of the amount of alcohol that is in the blood must
necssarily come in contact with the tissues of this import¬
ant structure. It is also a known fact that when nerve
tissue is exposed to diluted alcohol, it excites it, and when
brought in contact with a strong solution of alcohol, or
alcohol that is not properly diluted, it paralyzes it; so
that if one-fifth of the blood of the body continuously
circulates in the brain, then one-fifth of the alcohol
that is taken by man and absorbed into the blood must
necessarily come in contact with this delicate structure, and
when it does, it first, in small amounts, excites the action of
the cells. But when the blood is overcharged with alcohol
it then paralyzes these cells — a fact that we see demon¬
strated when men are under the influence of this agent. We
find that the gray cells are incapable on account of this
paralyzation of performing their functions, and the man
Digitized by
Google
Clinical Notes and Comments .
393
talks incoherently or at random and is temporarily insane.
If the man is very much under the influence of alcohol, it
paralyzes the gray cells that preside over the motor functions
first, and we find him incapable of moving his limbs as he
should, and as the effect increases it invades the center that
presides over sensation, and he is completely narcotized from
it, so much so that he is not conscious of bodily injuries that
he may receive while under the influence of the drug. If
this alcoholism is crowded still further, it may not only invade
the intellectual, motor, and sensory ganglia, but it may go on
and paralyze the centers that preside over respiration and
circulation, and when this is the case the individual dies from
alcoholic poison.
Understanding, as we do, the physiological action of this
agent upon the nerve centers, we cannot help condemning,
in the strongest terms, the use of an agent that has for its
end the continuous exhaustion of the important part of man.
— Medical and Surgical Reporter.
COGNAC vs. CORN SPIRIT.
At the recent meeting of the French Acad6mie de Med¬
icine M. Daremberg endeavored to prove that while both
beverages are hurtful, if not poisonous, the higher-priced
cognac brandies are relatively much less wholesome than (as
one commentator puts it) the eaux-de-vie that are sold for two
sous over “the zinc”— that is, retailed in the low drinking
establishments which are just as common in Paris as gin
palaces are, in London. Chemical analysis shows that what
are generally esteemed as the best brands contain a far
larger proportion of furfurol and amylic alcohol than do the
cheaper spirits distilled from corn, and for this reason alone,
even though there were no other, the use of cognac must be
injurious to health. M. Daremberg, however, does not rely
solely upon chemistry in support of his theory, but maintains
that his thesis is sustained and confirmed by the results of
his experiments on animals. Ten cubic centimetres of “ au-
Digitized by t^-ooQie
394
Clinical Notes and Comments .
thentic” cognac, costing sixty francs the bottle, when inject¬
ed into a vein in a rabbit’s ear caused instantaneous death,
whereas a similar dose of promiscuously purchased eaux-
de-vie was not attended by immediately fatal effects. The op¬
position was represented chiefly by M. Laborde, who pleaded
the extreme sensitiveness of rabbits to the action of alcohol,
as well as the uncertainty attending intra-venus injections,
which may kill the subject quite irrespectively of the nature
of the fluid introduced. The speaker had, moreover, ana¬
lyzed cognac himself, and found it to contain little or no fur-
furol. In his opinion the^ alcohol of commerce must neces¬
sarily be more injurious than that derived solely from the
grape. M. Magnan agreed with the originator of the dis¬
cussion that all alcohols were poisons. He, too, had per¬
formed some experiments, but the subjects operated upon
were dogs. Fifty grammes of wine alcohol caused depres¬
sion and drunkenness, which disappeared in about five
hours. Alcohol made from beet-root produced a comatose
slumber with complete anaesthesia after from eight to ten
minutes, this condition lasting twenty-four hours, and the
animal continuing out of sorts for several days. Alcohol
extracted from maize gave similar results, with the addition
during the coma stage of subsultus tendinum. No altera¬
tion of the consecutive phenomena was observable on repe¬
tition of the experiments after rectification of the three alco¬
hols. On conclusion of the discussion the Academy de¬
cided to submit the question to a commission consisting of
MM. Bergeron, Laborde, Lancereaux, Riche, Motet, and
Magnan. The commenter already alluded to terminates his
annotation with the fbllowing sensible remarks: “ When
the best cognac is misused it becomes worthless. What
should be avoided is the habitual consumption of eau-de-vie,
the petit verre after each repast, even though it should be
‘authentic* cognac. Petits verres soon accumulate in the
organism ; the hardest stone yields to the constant drops.”
— Lancet. Temperance Record.
Digitized by v^ooQie
395
Clinical Notes and Comments .
ALCOHOLIC NEURITIS IN OLD AGE.
In the last number of Brain , Dr. Maude publishes a
brief account of a most interesting case. The patient, who
was a robust country gentleman of sporting habits, and used
to an out-of-door life, had taken stimulants in considerable
excess for at least twenty years. Even eighteen years ago
no unusual daily allowance was half a gallon of beer, a bottle
of sherry, and eight or ten liqueur glasses of “ neat ” whisky.
His favorite drink was beer, and even in the summer of 1894,
although over seventy-five years old, he would often con¬
sume two quarts of beer, a bottle of sherry, and half a bottle
of whisky in a day. He had had no serious illnesses except
broken bones from riding accidents and a fractured humerus
at the age of seventy-three from a fall downstairs one even¬
ing after dinner. During the year 1894 his great muscular
power became much impaired, and towards the end of the
year he began to complain of severe darting pains in the left
lower limb. A few weeks later the hands and feet began
to swell rather suddenly, the skin became thin and glossy,
while there were small ecchymoses over it. A similar condi¬
tion was present on the insteps of both feet, while the calves
and thighs were oedematous and the muscles shrunken. The
knee jerk could not be elicited, and the pupils were small
and did not react to light. The heart sounds were some¬
what feeble, but they were regular, and there was no sign of
dilatation. Without any previous marked change in his symp¬
toms he died suddenly after a few minutes* dyspnoea about
two months after the onset of the symptoms. Dr. Maude
considers the case to have been one of peripheral neuritis,
and directs attention to several interesting points, such as
the advanced age of the patient, the excess of his alcoholic
indulgence, and the absence of mental change; the fact also
that he was essentially a beer-drinker is interesting, with
reference especially to the views of the late Dr. James Ross
as to the kind of alcoholic beverage most likely to produce
neuritis.— Lancet , October 19.
Vol. XVII.— 52
Digitized by v^ooQie
396 . Clinical Notes and Comments .
FARM COTTAGES FOR INEBRIATE WOMEN.
There is a woman in London, Jane Cakebread, who is
brought constantly to public notice on account of the recur¬
rent charges of drunk and disorderly. In fact, she has been
arrested two hundred and twenty-seven times, and every
one who knows about her naturally asks. What can be done
for such a woman as that ? Much interest is being shown in
the question, and I have taken the opportunity to call atten¬
tion once more to the scheme that is just being set on foot
by the British Women’s Temperance Association, which will
enable magistrates to consign such a woman, if they deem it
wise, to what is practically a reformatory, instead of to short
terms of imprisonment.
A large farm has been secured in Surrey on which cot¬
tages are in process of erection, and a little village is rising,
clustered around a main building. Here habitual inebriates
will be received for not less than one year. Each cottage
accommodates a group of women with a matron, and thus a
small family circle is formed, which will enable the sister in
charge to deal individually with her patients, and remove
from the undertaking all the features of an “ institution.”
In the main building the women will dine together, but
their other meals will be taken in the cottage, and a more
domestic life will be secured in this way. The patients will
be employed on the farm in poultry rearing, fruit-picking,
bee-keeping, flower-growing, and dairy work. The maxi¬
mum charge will be 5 s., but where patients can afford no
payment, cases will be taken free. One cottage will be set
aside as a nursery for infants in order to enable mothers to
become inmates of the home without being parted from
their babies. As those who have studied this question
know only too well that inebriety is often most common
when a woman has a young child, one of the most frequent
difficulties will thus be overcome — one which often prevents
women from seeking any place of safety in order to conquer
the drink crave.
We shall, when the home is ready, be prepared to take
Digitized by L^ooQle
Clinical Notes and Comments,
39 7
Jane Cakebread, and will gladly do our utmost to save this
most unfortunate victim from the misery of her surround¬
ings.
We sincerely hope that those who are interested in this
matter will give us all possible help in this most difficult un¬
dertaking. When the home is open we shall gladly wel¬
come any who would desire to pay a personal visit to the
little village.
Yours truly, Isabel Somerset.
Reigate Priory, Surrey.
DEGENERACY FROM ALCOHOLISM.
Dr. Lannelongue, who is a member of the House of
Deputies as well as professor at the Academy, has made a
vigorous appeal against the lax laws of France concerning the
manufacture and sale of alcohoL “ Among other statements
made by Dr. Lannelongue, he said that ‘alcoholism, at the
present day, was not only endangering the public health, but
also threatening the very existence of the species; it filled
the hospitals, the asylums, the prisons, and populated the
penal settlements. Previous to 1850, alcoholism was almost
unknown ; or rather it had not the same character ; the ef¬
fects were temporary because the drink taken was pure and
natural. But four years afterwards, alcohol of vinous origin
failed, and immediately it was replaced by that derived from
molasses, beet-root, and potatoes, which poisoned the race.
In 1830 the number of suicides from alcoholism were 5 per
100,000 persons; they were 21 in 1881, while 46 per cent,
of homicides, 74 per cent, of grievous wounding, 54 per cent,
of family quarrels, 77 per cent, of outrages against public de¬
cency were due to drink. Against the many afflictions
which attack man, against the large number of contagious
maladies, epidemic or other, the characteristic of the healthy
individual is his organic resistance, which enables him to tri¬
umph over all the assaults from his most terrible enemies —
microbes. The drunkard, on the other hand, has lost all
Digitized by L^ooQie
39»
Clinical Notes and Comments .
resistance, and falls an easy prey to disease. At 40 he is
already ah old man ; his tissues are degenerated, so that he
makes the worst of patients. It is not the richer classes in
France who saturate their bodies with alcohol, because they
know better, but the lower classes, and especially the workmen,
who are ill-fed, clothed, and lodged. In Brittany, however,
women of good position give themselves up to alcohol. Out
of 107 young married women who died from drink 8 were ster¬
ile, and of the 99 others there only remained as posterity 6
sickly children. On the other hand, these same women had
28 children before having taken to alcohol, who are very
healthy, showing what the others might have been if the
mothers had led a sober life. What is still worse/ contin¬
ued Dr. Lannelongue, ‘is the fact that the passion of the pa¬
rents is transmitted to the children. The drunkard engen¬
ders an offspring with the same tendency, be they girls or
boys, and, curious to say, they begin to drink at the same
age that the father began to drink/ ” Dr. Lannelongue,
who spoke for nearly two hours, interrupted by frequent ap¬
plause, concluded by appealing to the government to take
under its own control the manufacture of alcohol, and to for¬
bid entirely all those liquors made from essences, and more
especially from absinthe.
TREATMENT OF INEBRIATES.
Consequent on the 277th appearance of the sexagenarian
inebriate, Jane Cakebread, before a police magistrate, Lady
Henry Somerset has written to the Daily Chronicle that the
projected British Women’s Temperance Home will be glad
to receive and care for this unfortunate woman, on the mag¬
istrate consigning her to such a reformatory instead of to
short terms of imprisonment. We have repeatedly advo¬
cated the reformative and curative treatment of such cases.
The adoption of therapeutic restraint instead of the existing
penal procedure of a few days’ or weeks’ incarceration in a
police cell or gaol, which latter plan is neither curative nor
\
Digitized by L^ooQie
Clinical Notes and Comments .
399
deterrent, but on the contrary, tends to confirm an inebriate
career, inasmuch as a brief enforced residence where intoxi¬
cants are not supplied suffices to enable the inebriate to re¬
cover that capacity for intoxication which had' been for the
moment lost.
But the law must be amended if such judicious and
ameliorative procedure is to be applied to police court ine¬
briate “repeaters.” Four British Parliamentary or Govern¬
mental Committees, and a Canadian Royal Commission,
have strongly recommended such amended legislation, which
was embodied in Lord Herschell’s Inebriates Bill, which had
passed a second reading in the House of Lords just before
the dissolution of the last Parliament. Again and again ex¬
isting homes have undertaken the care of cases similar to
that of Jane Cakebread, but have been foiled by having no
power to retain the inebriate against his or her will.
Every one interested in the necessary and valuable work
done by genuine homes for the treatment of inebriety should
therefore strenuously support the Inebriates Legislation
Committee of the Association and the Society for the Study
of Inebriety in their sustained effort to secure the compul¬
sory reception and detention for a period long enongh to af¬
ford a reasonable hope of cure, or at least improvement. In
the end such a method would be truly economical, as 277
committals of one person involve a large expenditure of pub¬
lic moneys. Magistrates can at present aid the curative se¬
clusion of inebriate offenders only by the moral pressure
of recognizances, for a few months at most, on the under¬
standing that the offender remain in a home. What is re¬
quired is power of committal for from one to two or three
years, or more if required. There is some reason to believe
that the Government, if not able to see their way to estab¬
lish and carry on such reformative institutions, may lend
their influence to the empowering of magistrates to send
such offenders to a genuine philanthropic home. — British
Medical Journal .
Digitized by C^ooQie
400 Clinical Notes and Comments .
TOBACCO INSOMNIA.
Many brain-workers suffer from inability to sleep. This
is frequently met with among those who work late at night.
The sufferers complain that they feel most lively just when
the time for retiring has come, and that a long period of
restlessness precedes a troubled slumber, from which the
slightest noise awakens them. This is very often caused al¬
most entirely by over-indulgence in tobacco. They smoke
just before going to bed, ignorant of the fact that not only
may tobacco prevent sleep temporarily, but that it may ren¬
der it less deep, and consequently less refreshing. A grave
responsibility attaches to those who lightly seek to relieve a
symptom which is really a warning by recourse to a danger¬
ous palliative. The inability to sleep is often merely the
outcome of an unnatural mode of life, and if this be correct¬
ed the disability disappears of itself. Men who work late
are commonly addicted to the tobacco habit. To them to¬
bacco is not a relaxation after a day’s work, but a nerve
stimulant which enables them to accomplish tasks which
would otherwise be difficult of accomplishment. When the
mouth becomes dry, alcohol in some form or other is re¬
sorted to as a fillip to enable the smoker to tolerate still an¬
other cigar or two. Under these circumstances tobacco acts
as a cerebral irritant and interferes with the vaso-motor cen¬
ters of the brain to such an extent that the vessels are una¬
ble to adjust themselves forthwith to the condition required
for healthy and untroubled sleep. Discretion in tobacco use
would save many from this distressing condition of chronic
insomnia. Smoking early in the day should be discounte¬
nanced, and it is equally undesirable within an hour or so of
retiring to rest. The best remedy for the tobacco habit,
short of total abstention, is to take a short walk in the open
air after the last pipe. Under no circumstances should
drugs be used for this form of nocturnal restlessness.— Pa¬
cific Medical Journal .
Digitized by i^-ooQie
Clinical Notes and Comments .
401
French Drink Legislation. — The French law courts
reassembled last week, and at one of them, the Cour de Cas¬
sation, Councillor Rau asked for some alterations in the law
relating to drunkenness and alcoholism, the following being
a summary of that gentleman's views: For drunkenness the
term of imprisonment to be increased for those already con¬
victed, the cumulation of penalties to apply to a second in¬
fraction. Lastly, drunkenness should become an aggravat¬
ing circumstance for crimes and offenses against the public,
especially homicide and injuries through imprudence. It
was desirable that the public ministry should make larger use
of the rights conferred on it by the law of 1889, and bring
about the fall of the paternal power against drunkenness
when'the interest of the family appeared to demand it. The
work of justice would not be complete without further pow¬
ers. It was necessary for the courts to obtain the right to
order that, after the expiry of his sentence, the alcoholic
should be detained for a determined period in special asy¬
lums. This sequestration would at least ensure the mo¬
mentary cure of the drunkard, and would temporarily re¬
lieve society from the perils unceasingly presented by alco¬
hol degenerates. M. Rau thought it was necessary to go
further in that direction, and to authorize the placing in spe¬
cial asylums of alcoholics who had been acquitted or an or¬
dinance of no case, whatever be the infraction of the law
against drunkenness charged against them.
The Protonuclein , a new tissue tonic by the famous firm
of Reed & Carnrick of New York, gives promise of being a
valuable medicine in a variety of cases, that have so far been
difficult to reach with drugs. Send for a sample and test it.
The tissue phosphates of Wheelers formula is a rare com¬
bination of bitter tonics and mineral medicines, that are
found very valuable in all cases of anaemia and debility.
The various preparations of Maltine have come into such
practical prominence, that we have no hesitation in saying
that they are literally indispensable in all general and special
practice. In hospitals and asylums where the drug is ad¬
ministered more carefully and the results are more positive,
Maltine takes a high rank as a tissue promoter and builder.
The Maltine and Coca Wine has proved of great service in the
first stages of the treatment of the alcoholic and opium cases,
and other preparations of Maltine later have a great value.
Digitized by L^ooQie
402
Clinical Notes and Comments.
The firm of W. If. Schieffelin & Co. of New York city ,
are publishing a small monthly called Clinical Experts , which
contains many very valuable facts relating to the new coal
tar preparations which are so useful in modem medicine.
Parke , Davis & Co. of Detroit , are the great pharmaceu¬
tical educators of the day. Their numerous pamphlets and
brochures, sent free to the profession everywhere, are read
with increasing interest.
Protonuclein is based on the fact that all living beings are
possessed of some property which enables them to resist
poisonous influences. The toxic germs may come from the
food, the water, the air, and direct local contact. The poison-
resisting property is therefore existent in the blood which
circulates all over the body. The element of the blood which
possesses this antitoxic property is the White Blood Corpus¬
cle, or Leucocyte. Nuclein is the direct product of the
Leucocyte. Animals possess this poison-resisting property
in a far higher degree than man, being able to resist poison¬
ous influences that would be fatal to the human organism.
By preparing, therefore, Protonuclein from the lymphoid tis¬
sues of such animals when they are in the prime of their life
and in perfect health, we get products which possess the
antitoxic and tissue-building properties in the highest degree;
far higher than the healthiest and strongest man possesses.
The Acid Phosphate of Hosford’s preparation needs no
commendation; a trial of it in various states of defective as¬
similation and growth is sufficient to prove its value.
While Celerina is not a specific for the neurasthenia
from inebriety and opium addiction, it approaches very near
to this in certain cases. Persons having large experience
depend entirely on this drug for all forms of nerve exhaus¬
tions. In all such cases we recommend a trial of it. The
advertisement of this drug in this number describes its place
in practical medicine.
We have never seen any failures in the use of Fellows'
Hypophosphites. As a nerve and brain tonic it has come
into enormous popularity. For these conditions it cannot be
excelled in the range of pharmacy. The trial of this drug is
the best test of its real merits and value.
The Arethusia Spring Water is the New England apol-
linaris. Send to Seymour, Conn., for some circulars. No
medicinal and table water will be more satisfactory.
Digitized by L^OOQie
Digitized by L DQie
Digitized by
Google
Live Music Archive
Librivox Free Audio
Metropolitan Museum
Cleveland Museum of Art
Internet Arcade
Console Living Room
Books to Borrow
Open Library
TV News
Understanding 9/11