Quarterly Journal of Inebriety 9.1887

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Boston
MepicaL LIBRARY

ASSOCIATION,

19 BOYLSTON PLACE.

THE QUARTERLY JOURNAL

INEBRIETY.

PUBLISHED UNDER THE AUSPICES OF THE AMERICAN
ASSOCIATION FOR THE CurE OF INEBRIATES.

Editor,

T. D. CROTHERE
ie pore Bs

© JUN 27 1888"

lies, He

Vol. IX, 1887.

HARTFORD, CONN.:

THE CASE, LOCKWOOD & BRAINARD CoO.,
PRINTERS.

EUROPEAN AGENCY:
BAILLIBRE, TINDALL & COx,
20, KinG WILLIAM STREET, ON THE STRAND, Lonpon, W. C.

CATALOGUED,

rife,

INDEX TO VOL. IX.

A.
n Page.
Alcohol and respiration, . . . 7 . . I
Association for Cure of Inebriates, 5 < . . 12
Alcohol and tobacco statistics, . 5 re A ‘: 40
Acute psychosis in opium cases, . 6 6 ¢ . 89
Advising suicide to Inebriates, . cS 2 5 114
Aged Inebriate, . . . . : . 116
Alcohol in tonics and bitters, —. 4 5: . . 117
Alcohol as a remedy for children, . S z c 122
Alcohol on the heart, , a ‘ . 3 : 143
Arsenical and alcoholic poisoning, . . . . 172

B.

Brodie, Dr. David, ; 7 3 . * . I
Ball, Dr... . . . . . . . 104
c.

Cocaine Inebriety, " . : 5 . 16
Clinical notes and comments, . . ‘ < ‘ 59
Cerebral pneumonia in Inebriety, . 2 . bees
Colonial and International Congress of Inebriety, . : 113
Capacity of jurors, ; . f ° 3 ‘ 1S
Cocaine usage and cocaine addiction, . + . ‘ A 123
Curability of Inebriety, . . 5 172

Crothers, T.D., 16, 45, 47, 49, 50, 54, 55, 57, 108, nf, 113, 114, 115,
177, 189, 191, 237

D.
Death in a Turkish bath, . 4 . . . 79
Degeneration of the column of gall in an Inebriate, . . 95
Druggists’ frauds, . 7 . : 7 . 119
Delirium tremens, : : e 5 ; 120

Disorders of memory and consciousness, 2 . 2 248

iv Index.

E.
Eye symptoms in Inebriates, . ry . .
Effects of tea-drinking on the nervous system, . .
F.
Fisher, T. W., ° is a < G
G.
Geyser Spring water, 3 s ‘ . °
H.
Homicidal and suicidal Inebriety, . . :
Horsley, J. W., . . . . > .
Herman murder case, - . e . .
I.
Inebriate maniacs, . . é ‘ .
Influence of alcohol and beer, . A _ 5
Inebriety in Paris, . . . .
Inebriate jurors, . . : ‘ .
Inebriates in insane asylums, . . . .
Inebriety in Paranoia, . . : . .
Influence of alcohol in nursing, . - .

International Congress of Inebriety, opening address 0 on treat-

ment of Inebriety, - a 5
Inquiry concerning the influence of alcohol on mind and morals,
Inebriety in Minnesota, . : : : .
International Medical Congress on Inebriety, . .
Inebriety in Belgium, . . . .
Internal revenue reports, . . . . .
J.

Journal for 1887, . 5 % é 7
K,

Kerr, Dr. Norman, <
L.

Legislation for Inebriety, . “ . 2

y

177,

73

193

45

129

222

Morphomania in France,
Meconeuropathia, .
Moral insanity in Inebriety,

Mental dyspepsia a cause of Inebriety,

Morphine habit, . 2
Murders by Inebriates, .
Morphinism in acute diseases,
Mattison, J.B, .

Mana, E. C., . Fy
Mason, Lewis D., .
Meller, Dr., . .

Need of Inebriate asylums,

Opium antidotes, . .
Opium neurosis, .
Observations on Inebriety,

Periodic opiomania, .
Physical soundness, 7
Periodical Inebriety, 5

Physiological action of alcohol,

Post-mortem records of Inebriates,

Pringle, Dr. Robt., .
Parrish, Joseph, . .
Pathology of Inebriety, .
Petithan, Dr., a %

Richardson, B. W., .

Relation which disease bears to alcoholic heredity,

Special phases of Inebriety,
Sixty-seven years ago, .
Shepard, Dr. Charles, .

Some facts from the last Internal Revenue Report,

Sexual insanity in Inebriety,

R.

s.

23,

vi Index.
T.
Page,
Treatment of Inebriety, . : . 3 . 55
Tendency of drunkenness to crime, - . . . 65
The cure of Inebriety, . . é: . . . 99
Tobacco amblyopia, . . , . E 245
The medical aspect of Inebriety, : . . = 246
The Zurich congress on alcohol, . é . . 249
U.
Unconscious deception in Inebriety, . A : ; 189
,
Ww.
Wright, Dr. T. L., . . 3 . - 65, 165

iethee

© WN 27 1888"

CY see ee

QUARTERLY oe OF INEBRIETY.

Vol. IX. JANUARY, 1887. No. 1.

This Journal will not be responsible for the opinions of contributors, unless
indorsed by the Association,

ALCOHOL ON RESPIRATION.

By Davin Bropig, M.D.,

Honorary Member of the American Association for the Cure of Inebriates,
Canterbury, England.

* [Continued from page 203.]

Dr. Hammond published his physiologico-chemical re-
searches in the “American Journal of Medical Sciences”
for 1836. His experiments embraced a wide range both as
to the materials submitted to experiment and the effects
produced on all the various excretory functions of the body.
But we limit our references to the influence of alcohol on
the elimination of carbonic acid. Dr. Hammond experi-
mented also on himself. First, with the supply of food, so
adjusted as to maintain the weight of the body. Second,
with deficient food supply, so adjusted as to secure loss of
weight, and third, with excessive food so as to secure an
increase of weight. Under each of these conditions he took
an average, carefully determining the quantities of all the
excretions of five days, first without alcohol, and then with
the addition of half an ounce of ‘alcohol to each of his three
meals, viz.: at seven, one, and five, the observations on the
respiration being made at nine, two, and ten. In the first
case with food sufficient to maintain the weight of the body,

2 Alcohot on the Respiration.

under alcohol, the average diminution of carbonic acid was
from 11.674 grains to 10.344 grains, equal to 1.330 grains per
day.

In the second case, with deficient food, the diminution
with alcohol was from 10.774 grains to 9.945 grains, equal to
729 grains.

In the third case, with excessive food, the diminution was
from 12.159 grains to 11.577 grains, equal to 581 grains.

Dr. Hammond reports that the effect of the alcohol on
the diminution of the carbonic acid was constant and un-
varying. Dr. Hammond was preoccupied with the theory of
which he was an enthusiastic advocate, that diminution of
excreta was evidence of diminished waste and a “saving of
tissue,” and we are losers by the times unfortunately chosen
to make the observations, viz.: two, one, and five hours after
the administration of the alcohol. All the truth, therefore,
regarding the influence of this strange agent has not been
disclosed by this experimenter, but we shall take what he
gives us. ;

Dr. Hammond’s account of his experience under these
three conditions are worth noting.

Under the first (with alcohol), he reports: My general
health somewhat disturbed, pulse increased from 81 to 90;
headache and'increased heat of skin. Mental faculties were
certainly not so clear as on abstinence days, general lassitude,
and indisposition to exertion of any kind.

Under the second, the report with alcohol is, general
condition never better, pulse down (to 83 from 88 without
alcohol) ; no headache, intellect clear, and normal energy, all
functions regular and satisfactory.

Under the third, Dr. Hammond reports (first, without
alcohol), health much disturbed, headache almost constant,
pulse 92-full, sleeplessness, unpleasant dreams. Second,
with alcohol, healthy action very much disturbed, headache
constant, sleep disturbed, skin hot, pulse 98 — full and bound-
ing, palpitation, severe illness, threatening diarrhoea of con-
siderable violence occurred, lasting forty-eight hours.

Alcohol on the Respiration. 3

Dr. Edward Smith is the next investigator who undertook,
(in 1859), to prosecute this important research. His obser-
vations are . ost elaborate ; they were sustained for two years,
and extend to 2,000 experiments performed on himself and a
friend. The results have been most widely circulated through -
many channels, and much attention and a too general cre-
dence has been accorded to the inconsistent and most incon-
clusive conclusions presented. Dr. Smith’s deductions as to
the action of alcohol on the respiration are not consistent
with those of the scientific observers of the highest reputa-
tion, who preceded him in this inquiry, nor with those of
others who followed after, which we shall by-and-bye adduce.
But we think it will be possible to show, notwithstanding Dr,
Smith’s very confident assurance to the contrary, that in
several respects his conclusions are altogether untrustworthy.
We think, also, it will appear that he greatly overestimated
the accuracy and value of his conclusions. The effects of
alcohol which Dr. Smith regards as a class of agents, having
among themselves fundamentally different, even antagonistic,
actions, are thus summarized.

First. The direct action of pure alcohol does much more
to increase than to lessen the respiratory changes, and when
the quantity is sufficient to act upon the sensorium the in-
fluence is chiefly a disturbing one.

Second. Brandy and gin, particularly the latter, always

_ lessened and sometimes caused great depression of the res-
piratory changes.

Third. Whisky commonly lessened them, but sometimes
it increased them.

Fourth. Rum increased them almost always and to a
greater extent than alcohol alone.

Fifth. The vapor of all spirits, pure alcohol, gin and rum,
and wines, when inhaled lessened in the course of ten or
fifteen minutes the quantity of carbonic acid exhaled and
usually lessened the quantity of air inspired, but increased
the quantity of watery vapor exhaled from the lungs. The
vapor of fine old port had the same influence, but in a greater

4 Alcohol on the Respiration.

degree. This result was without one exception. We have
seen that the experiments of Prout and Fyfe, Vierordt and
Rocker, were performed under the various conditions which
enable their effects to be fairly and usefully compared with
those which attend the use of alcoholic liquors in any of the
ordinary, though sufficiently varied circumstances in which
they are employed. But Dr. Smith believed that he greatly
enhanced the value of his results by performing his exper-
iments under conditions which are as exceptional and pecul-
iar and as far removed from the normal circumstances under
which alcohol is used, as can well be imagined. Thus, for
instance, he choose the early morning hours from seven to
nine o'clock for taking the tremendous dose of alcohol (one
and half to two ounces) diluted with water, and this on an
empty stomach ; next he maintained throughout the exper-
ment body and mind in a state of perfect quietude and rest ;
and lastly he limited the observation of the effects to two
hours. Dr. Smith fixed on the early hour on the assumption
that the body was then in the most sensitive and vigorous
condition and best fitted for testing the physiological action
of alcohol.

Popular experience gives a very different estimate of the
effects of the morning dram, even when limited to half the
quantity taken by Dr. Smith and his friend. From the nar-
tative of their sensation, we may well be allowed to question
their capability to give a true record of observations requir-
ing so much care and acumen. This Dr. Smith reports
lessened consciousness occurred in from three to seven
minutes, and as it increased the power of fixing the attention
was lessened, the perception of light, and we believe of sound
also, was lessened. My friend, whose countenance I could
watch, had a flushed face and streaming eyes, and was very
hilarious in about ten minutes, and for about fifty minutes
seemed as happy as a king, but gradually we both felt less
happy and became less talkative, our excitement subsiding
by degrees until we became quite taciturn and felt extremely
miserable. A condition of intense depression, with muscular

Alcohol on the Respiration. 5

relaxation, was realized ; he was nearly unconscious. There
was a sense of impeded respiration—it was panting and
gasping, coldness of the feet, and general chilliness, even to
shivering, and diminished frequency in respiration and pulsa-
tion. Then we felt the horrors and the sorrows as we had
experienced the so-called pleasures of the drunkard’s lot, the
duration of the effects varied with the different alcohol
“from 46 to 120 minutes,” the description concludes.

It must be remarked that the last power to be regained
was that of consciousness. We ask earnestly, is it the con-
clusion of a sober mind, in view of these effects of alcohol,
that the experimenter is using an agent which can augment
or increase any of the vital functions, or can be anything
else than a depressor of vital action, and we further ask are
we not fully justified in absolutely ignoring the conclusions
of Dr. Smith in reference to the variation in the action of
alcohol? He stands alone among the distinguished scientists
who have with the greatest ability and care prosecuted this
inquiry in maintaining an essential difference in the various
alcoholic liquors, and in maintaining that any form of alcohol
augments the exhalation of carbonic acid from the lungs.
We make no remark on the strange hypothesis which under-
lies Dr. Smith’s entire research, viz.: the classification of
alimentary materials into excito-respiratory foods and non-
excito-respiratory foods. It seems to belong to the same
department of science as the famous theorizing of Liebig,
and strangely enough it seems to have proved nearly as
captivating to a large section of the profession.

Dr. Smith would have done well if he had simply accepted
Dr. Prout’s judicious conclusions from his observations that
the effects observed from food have not been remark-
able, a sound physiology, even in Dr. Smith’s day, might
have told him that the carbonic acid eliminated within two
hours of taking food had no connections whatever with the
food value of the materials so recently taken, and might thus
have saved him all the labor, including “the horrors and sor-
rows” involved in this most heroic research. Dr. Smith,

6 Alcohol on the Respiration.

however, has left on record in the Philosophical Transactions,
his claim to two positive results of his great and laborious
inquiry, to which we by no means dispute his right, viz.:
that alcohol is the great disturber of the system, and that,
men differ in every subject which has been investigated.
M. Perrin of Paris, professor at Val de Grace, published, in
1864, a valuable contribution to this inquiry, which had been
presented to the Academy of Sciences. The entire essay
would well repay translation, but we must be content to pre-
sent some only of the facts and conclusions. White and red
wines of various alcoholic power, which was in all cases
accurately determined, pale ale, and Strasbourg beer, and
grogs, or simple diluted alcohol, were submitted to experi-
ment, the drinks were limited to strictly hygienic doses, so
as not to disturb the stomach or-brain, an important precau-
tion, and were taken to dejeuner at 10.30 A.M. The observa-
tions were begun at 12.30, and continued till 5.30, six records
made during that time. A rich, white wine (Chablis) of 11
per cent. alcohol, determined a diminution of carbonic acid
of 22.44 per cent. A very light wine of 6 per cent. alcohol,
a diminution of 11.43 A light, red wine of g per cent.
alcohol, a diminution of 20.00. Strasbourg beer a diminu-
tion of 17.71. In general the diminution of carbonic acid
has been in direct relation to the alcoholic richness of the
liquid employed, but as a contre preuve, M. Perrin tried sim-
ple diluted alcohol “ grogs,” with the following results : go
grammes of diluted alcohol of 45° according to the alcooli-
metre of Gay Lussac, determined a diminution of carbonic
acid of 11 percent. These observations are quoted by Dr.
Parks in his “ Practical Hygiene,” as proving a very great
diminution in the exhalation of carbonic acid when alcohol
is present in the system, and we gratefully accept the facts
which have been so carefully established by M. Perrin.
Unfortunately, for purely hypothetical reasons, and evidently
to support a preconceived theory, like Dr. Hammond, M.
Perrin did not commence his observations till two hours had
elapsed from the imbibition of the alcohol. The value of

Alcohol on the Respiration. 7

the observations would have been much enhanced had M.
Perrin followed Dr. Prout in instituting his observations
. immediately after partaking of the liquid. We should then
have had the opportunity of learning M. Perrin’s explanation
of the almost instantaneous action so emphatically remarked
upon by Prout and Vierordt.

It would have been interesting, also, had he followed Dr.
Fyfe in making observations on the day following that on
which a somewhat large dose of alcohol had been taken.
From M. Perrin’s conclusions we present the following: Ist.
Taken in moderate doses and under the usual conditions,
which may be regarded as hygienic, these drinks have for
their constant effects the diminution of the quantity of car-
bonic acid exhaled by the lungs. This diminution which
progresses during the three first hours which follow the
ingestion, varies from 5 to 22 per cent., according to their
respective alcoholic strengths. 2d. When the production of
carbonic acid diminishes, as it does steadily during the first
three hours after a repast in which alcohol has been taken,
the volume of air expired diminishes also, but in a less
marked degree, and not with the same regularity. |

Dr. Richardson, in his Cantor Lectures on Alcohol, 1875,
adduces his own observation on the diminution of carbonic
acid exhaled by the breath under the action of alcohol. He
says, in the extreme stage of alcoholic insensibility, short of
the actually dangerous, the amount of carbonic acid exhaled
by the animal and given off into the chamber I constructed
for the purposes of observation, which was reduced to one-
third below the natural standard. On the human subject in
this stage of insensibility, the quantity of carbonic acid
exhaled has not been measured. But in the earlier stage of
alcoholic derangement of function, the exhaled gas was
measured with much care by a very earnest worker, Dr.
Edward Smith. In these early stages, Dr. Smith found that
the amount of carbonic acid was reduced in man as I have
found it in the lower animals, so that the fact of the general

VoL, IX.—2

8 Alcohol on the Respiration.

reduction may be considered as established beyond disputa-
tion.

Lehmann, in his valuable work, has recognized the great
practical importance of the investigation bearing on the
various conditions which influence the elimination of car-
bonic acid. Of the effects of different diseases in their
influence on the respiratory products, and the various results
deducible from the numerous experimental researches in con-
nection with the phenomena of respiration, no better or
more enlightened account can be found than is given in the
third volume of his “Physiological Chemistry” (pp. 376-
382). Lehmann mentions some original observations of his
own, and he had himself proved by experiment the diminu-
tion, both absolutely and relatively, of the exhaled carbonic
acid after the moderate use of spirituous liquids, which he
observes confirmed the observation of Prout and Vierordt
on the subject, in his remarks on this influence of alcohol on
the respiration, he says: We cannot believe that alcohol
belongs to that class of substances which is capable of con-
tributing towards the maintenance of the vital functions.
Lehmann takes a wide grasp and sound philosophical view
of the subject, and presents some most valuable reflections
in the direction of applying this knowledge to important
practical purposes in the treatment of disease. We offer no
apology for presenting them here. He says the value of
investigation on normal respiration in reference to the

. science of medicine can never be over-rated, for when once
the fact is universally admitted that the thing to be con-
sidered, in many diseases, is to furnish a copious supply of
oxygen to the blood, which has been loaded with imperfectly
decomposed substances, and to remove as speedily as possible
the carbonic acid which has accumulated in it, these observa-
tions will have afforded as true remedial agents which exceed
almost any other in the certainty of their action. We may
thus aid a tuberculous patient quite as much by recommend-
ing him to respire a moist, warm air, as if we prescribed
Lichen Carragheen or Ol. Fecoris Aselli, instead of torment-

Alcohol on the Respiration, 9

ing our emphysematous patient suffering from congestion
and hemorrhoidal tendencies with aperients and saline
mineral waters, we might relieve him far more effectively by
recommending him to practice artificial expansion of the
chest in respiration (filling the lungs several times in course
of an hour), or take such exercise as is fitted to produce this
result, while we should forbid in this and many other cases
the use of spirituous drinks, and not prescribe tinctures
which hinder the necessary excretion of carbonic acid. We
abstain, however, from offering any further illustration of
these doctrines, since the reflecting physician will not blindly
follow any guide, while the mere empiricist can never learn
thoroughly to heal any disease, whatever may be his knowl-
edge of physiology and pathological chemistry. We have
now presented a sufficiently extensive and conclusive body
of evidence for the establishment of a great fact, that under
all circumstances and under all conditions the introduction
of alcohol into the system diminishes the product of respira-
tion. To convey to the unprofessional reader an adequate
conception to the terrible significance of this interference
with this most essential of all the vital functions, would
require such detailed discussion of the elementary principles
of physiological science, as would be impossible within our
limits. To these we would, therefore, very earnestly suggest
the careful study of the respiratory function, which may be
accomplished with the aid of those excellent text-books on
physiology which are now within the reach of all, and where
the value of oxygen as a life sustainer, and the power and
danger of carbonic acid as a life depressor are fully set forth.
This study will be the more profitable and the more
attractive, the more extensively it is prosecuted, and the
whole truth which concerns the science of life, and of living
wisely and well, will abundantly reward the student in the
pursuit of such knowledge. For the present we must be
content in few words to indicate to our medical brethren
some of the many weighty truths which are brought to the
surface in this research. There we find truth overflowing

fe) Alcohol on the Respiration,

and abundant, truth profitable for doctrine, for reproof, for
correction, for instruction. It is a veritable scripture written,
we say it with reverence, by the finger of God, in the hidden
recesses and secret places of vital phenomena, and revealed
and read to us by these painstaking interpreters of His
works and ways of working, and to be read by all those (if
they will know His will in this matter) who take pleasure
therein. True doctrine and sound instruction on the nature
and action of alcohol are required, that we may protect our-
selves individually, socially, nationally, from the dangers of
which it is the prolific cause; reproof and correction are
needed, scathing as the truth of God can make them, for the
exposure of the many plausible pretences which are current
and fostered under the cloak of interest and prejudice as to
the innocency and benignancy of this deceitful spirit, this
enemy of the human race.

One important consideration we must not omit to state,
viz.: that all this accumulation of evidence as to the deport-
ment of alcohol, comes at the cost of much ‘personal labor
from men of science, with no prejudice against vinous or
other alcoholic liquors, many of them with strong and
decided prejudices in their favor, and what have they dis-
covered for us?

ist. What alcohol is in its action on the body. A.
That it is always a depressor of the vital functions. 2.
That its effects are immediately and directly depressant, with-
out any previous stage of excitement. C. That it deports
itself as poisons are known to operate. DD. That the
phenomena of alcoholic intoxication are largely influenced
and determined by the detained carbonic acid caused by
alcohol.

2d. What alcohol is not. A. That it is not a stimulant
of any of the vital functions. 2B. That it is not a food,
accessory or otherwise; it acts by depressing the respiration
almost instantaneously, and before any modification of or
influence on the tissue changes is possible. No more impor-
tant, practical lesson can be drawn from these researches,

Alcohol on the Respiration. II

than a sound principle of guidance as to the true and proper
place which alcohol ought to hold as a therapeutic agent, and
if any deduction can be more direct and conclusive than
another, or more inevitable, it is this, that when exalted
sensibility or vital activity require to be repressed, when a
vital stimulus is contra-indicated, when the detention of the
products of vital changes in the system is to be desired, and
by all means secured, then the physician, guided by science,
will find his most powerful resources in alcohol.

To complete the picture of the doings of alcohol in this
hidden sphere of its operations, the examination of other
facts in its history will be necessary. In tracing its action
in the system, the characteristic physical properties of
alcohol claim attention, its low specific gravity, and low boil-
ing point, its extreme volatility, its perfect and singular
diffusibility in the animal fluids, its solvent power over and
capacity for adhering to the living tissues; then must be
traced the influence of this peculiar agent on the chemical
constitution and vital properties of the blood, its influences
on the temperature of the body and on the processes of the
nutrition and-metamorphosis of the tissues, determining, as it
is known to do, an infinity of morbid degenerative changes
in these.

On all these subjects a large amount of most valuable
material has been accumulated, and only waits to be effec-
tively utilized to supply light and leading on this most per-
plexing and momentous question. We regard the depressant
action of alcohol on the respiration as the starting point, the
prime fact in a great series of most important consequences
which attend upon its introduction into the living system,
the full significance of which will not be realized, till they
are viewed as a whole, and in their true relations one with
another.

12 Annual Meeting of the

ANNUAL MEETING OF THE AMERICAN ASSO-
CIATION FOR THE CURE OF INEBRIATES.

The sixteenth annual meeting of this association was held
in Brooklyn, N. Y., November 10, 1886, in the parlors
of Dr. Shepard’s Turkish Bath Hotel. The president, Dr.
Joseph Parrish of Burlington, N. J., occupied the chair,
and delivered the regular address, “On Climacteric Periods
in Inebriety.”” The usual resolution of thanks followed, and
also a very commendatory discussion in which all the views
of the president were most heartily sustained. (This address
will appear in our pages in full in the future.)

Dr. T. D. Crothers of Hartford, Conn., read a paper on
Cocaine Inebriety (published in this number.)

In the discussion which followed, Dr. J. B. Mattison of
Brooklyn, N. Y., said he had seen seven cases, and been con-
sulted in three others. Of these, five were physicians, two
druggists, and one a journalist. All took it hypodermically,
and nearly all had begun it in the hope of freeing themselves
from opium, to which they were more or less addicted. One
physician asserted that he used it as a stimulant after fatigu-
ing professional work. None succeeded in the effort at self-
cure, and all but one forged another link in their chains. Of
the ten, one became demented in less than a fortnight, six
had hallucinations or delusions, or both, while two were
greatly emaciated — one more so than he had ever noted.
He believed addiction to cocaine alone quite uncommon,
though such cases had been reported abroad, and probably
would be here. He regarded its continued use, hypoder-
mically, in any disorder as one calling for caution, and
thought this method of employing it more dangerous, espec-
ially for self-using, than when taken by the mouth. Cases
of its habitual use, with or without opium, he considered
more disastrous, less hopeful, and requiring longer treatment
than where opium was used, and that any estimate of its

Association for the Cure of Inebriates. 13

effect which did not include its power for ill, as well as good,
was mistaken and incomplete.

Dr. F. A. Blanchard, superintendent of the Inebriates’
Home, had noted two cases under his care. Mental impair-
ment, delusions, and hallucinations, were observed. One
patient,as Dr. Crothers had mentioned, used the drug fre-
quently, sometimes every fifteen minutes. He thought its
use by those addicted to alcohol or opium intensified the
injurious effect, and that when the drug was withdrawn, the
bodily recovery was more prompt and deci:led than that of
the brain hallucinations and delusions, the latter persisting
after marked physical improvement, and necessitating a more
prolonged period for complete convalescence. He believed
it impossible for any one to use this drug in doses of eight
or ten grains a day, without becoming insane. The halluci-
nations which followed from large or long-continued doses,
very closely resembled those of general paralysis, only they
were more transient. In all cases, great disturbances of nu-
trition are noticed ; nausea, vomiting, and inability to retain
solid food in the stomach. This seems more of a nerve fail-
ure than from local irritation or inflammation of the stomach,
In one case a bronzed skin, and hyperanzesthesia of the sur-
face of the body was prominent. He also thought great dan-
ger came from the extravagant accounts of such cases pub-
lished in the daily press. It attracted attention, and roused
inquiry among the drug neurotics, to test the drug, and
should its first effects be pleasant they continued its use
ever after. Mania and dementia was sure to follow its use,
and he advised strongly against its use except for specific
purposes under the direct care of a physician.

Dr. E. C. Mann of Brooklyn, N. Y., had seen onlya few
cases, and they were all mixed ones, associated with other
neuroses. He had no doubt of the existence of simple un-
complicated cases where cocaine was found to pruduce pleas-
ing effects, and its use was continued. In small doses in
neuresthenia it was valuable ; an increase of the dose seemed
to be followed by different effects. The acute delirious
mania and dementia, which is noticed in these cases, are

14 Annual Meeting of the

undoubtedly distinct forms of drug mania. Great fear and
dread of danger in the future was one symptom, the painful
hallucinations of the senses was another. This associated
with states of anzemia and hyperaemia were very marked.
Its action in large doses was very profound and rapid, and it
could not be used indiscriminately without great danger.
He agreed with the remarks of others that these cases of
coca inebriates were difficult to treat, and the use of this drug
should be restricted, and should never be used as a substitute
for narcotics.

Dr. Lewis D. Mason of Brooklyn, N. Y., fully agreed with
the experience of others in these cases. He had found coca-
preparations vary greatly, and had c ncluded this was due in
many cases to the alcohol, the drug itself being inert. The
use of tinctures of coca in the opium or alcohol inebriates
were dangerous, and also cocaine, which instead of benefiting
the case, brought on other and worse disorders. As a local
anzesthetic, cocaine was valuable, but its effects on the sys-
tem taken hypodermically or by the mouth, were entirely
different. He did not think it would come into general use
as a narcotic, and be used as alcohol or opium, but it was the
duty of physicians to warn others of its dangerous effects.

Dr. Albert Day of the Washingtonian Home, of Boston,
Mass., remarked that he had treated eight cases, and had
seen a half a dozen more in the course of the year. Most of
these were drug neurotics who had used alcohol and opium
before. Three of them seemed not to have used any narcotic
before, and began its use from a physician’s prescription, for
some nerve trouble or defect. In all of these cases, pro-
nounced and delirious mania followed its use. After this
subsided, dementia and stupor followed. I have seen several
cases of insanity that was traced to this cause. The mania
in two cases resembled that seen in delirium tremens, and
the man was thought to be suffering from this disease. He
had cocaine secreted about his person, and was using it every
hour hvpodermically. He soon became demented and lost
control of his extremities, and was quite manageable. He
suffered from a period of suicidal depression. These are the

Association for the Cure of Inebriates. 15

worst cases of inebriety I have ever treated, and their recov-
ery seemed unusually prolonged and complicated. For weeks
the nutrition of the body suffered. I should never use
cocaine for its narcotic properties ; it is too dangerous and
uncertain. I feel assured it will never come into general use
as a narcotic drug. I have never obtained much benefit from
the coca preparations, unless given in enormous quantities,
and even then its action was transient.

Dr. Foseph Parrish, the president, remarked that his ex-
perience was limited with the use of cocaine. He had seen
cases of cocaine inebriety, and considered them very dan.
gerous and difficult to treat. In these cases, it was taken
to relieve a feeling of weariness and pain, and its effects were
most charming. But the action of the drug on the nutri-
tion was marked, and while bringing relief, was associated
with intense lassitude and debility. He thought the fact
that coca users in Central America die of phthisis so com-
monly, was good evidence of its peculiar action on the nu-
trition, and that its poisonous effects might be traced to the
disturbance of this function. He trusted that these cases
would be studied more carefully by the profession, and the
facts be better known.

Dr. Shepard of Brooklyn, N. Y., thought that hot air
baths and free perspiration would, by diverting the blood to
the surface, greatly relieve the evident internal congestion in
many of these cases, and be a most valuable remedy.

Dr. F. E. Turner of Wilton, Conn., thought all these
cases should come under early restraint, and be prevented
from using this or other drugs until they’were insane. He
would restrain any one who was found using narcotic drugs
regularly. It was suicidal insanity and should be recognized.

Dr. Albert Day of the Washingtonian Home, Boston,

Mass., read by title a paper “On the Hygienic Care of Ine-
briates,” which will be published later.

The annual election of officers resulted in the re-election
of the former board. After the usual resolutions of thanks
to Dr. Shepard for the use of his parlors, and his election as
member of the association, the association adjourned to meet

in Hartford, Conn., June 10, 1887.
VoL. 1X.—3

16 Cocaine Inebriety.

COCAINE INEBRIETY.

By T. D. Croruers, M.D.,
Superintendent Walnut Lodge, Hartford, Conn.

My experience in*cocaine inebriety is limited to seven
cases. Two were under my care for treatment, three came
personally for advice, and two consulted me by letter.

In the cases under my care a correct history was obtained ;
in the five cases who sought my advice by person and letter,
their own personal statements were the chief sources of in-
formation. In two cases their statements were confirmed by
other parties, and where such statements corresponded with
the facts in other cases, they were accepted as probably true.
The following are some of the facts which appeared from the
history of these cases :

Alcohol, opium, chloral, bromides, and other narcotics,
had been used more or less to excess in all these cases before
cocaine was taken. In four of these cases coca had been
used for months before cocaine was tried. Hence, they were
all literally drug maniacs, or inebriates, whose special symp-
tom of disease is a morbid impulse for narcotic drugs, which
will bring rest and relief to the organism. Some details of
the history of these cases will indicate the leading facts.

Case 1. Had been under my care twice before for alco-
holism and opium excesses, at intervals of two or three years ;
he had taken cocaine for six months, but latterly had suffered
a delirious mania after using this drug, and becoming alarmed,
came to me for treatment. He was a “ repeater,” who alter-
nately went from one drug to another for relief.

Case 2. Under my care; had been treated for morphine
excess two years before. He had used cocaine for one year,
and had been a moderate and occasionally excessive user of
spirits. He belonged to that class of drug-takers who try
everything that promises relief for real or imaginary ills.

Cocaine Inebriety. 17

Case 3. Not under my care; was a landlord who had
used alcohol for a long time; finally he resorted to chloral
and bromides to break up the alcoholic impulse. He suffered
from rheumatism, and took coca and then cocaine. He had
used the latter for six months, and was alarmed at the ex-
treme debility and nausea it produced.

Case 4. Not under my care; had used the bromides for
insomnia, then changed to alcohol, and finally used cocaine ;
he had taken cocaine eight months; and was greatly debili-
tated, had night-sweats, and thought he had consumption.

Case 5. Had used alcohol for years, then tried chloro-
form, finally used coca, then cocaine ; the latter he had used
for over a year ; he was anemic, and had deranged nutrition,
and his mind was greatly enfeebled.

Case 6. Facts by letter. Had used patent bitters for
years, then wine, and finally coca and cocaine. He was deliri-
ous from the latter at times, and unable to do business.

Case 7. Facts by letter. Had always used wine and
cider ; took bromides for sleep, then tinct. coca, then cocaine.

In these cases the use of cocaine was merely another
stage of the drug mania. The use of alcohol and other nar-
cotics to excess had developed a state of the nervous system
which called for relief, and they turned to any drug that
would answer this purpose. Such persons often develop a
credulity and a morbid impulse to try everything that prom-
ises relief, hence they are pioneers among experimenters.

Another fact of general interest from these cases was an
inherited neurotic taint or tendency. Thus, four cases in-
herited a marked nerve defect from their ancestors; two had
acquired a brain and nerve debility, and no history on this
point was obtained from one case.

To particularize, Case 1 had an inebriate father and con-
sumptive mother, and was an unstable, impulsive man.

Case 2 had an insane father and an epileptic brother, and
two inebriate uncles on his mother’s side.

Case 3. Had a pauper ancestry, paralysis, hysteria, and
great eccentricity of conduct in parents and near relatives.
He was a very nervous, excitable man.

18 Cocaine Inebriety.

Case 4. Had two uncles in insane asylums, mother died
of consumption, one brother an imbecile, and his ‘father was
a wine-drinker.

Case 5. Had a severe army experience, was a neurotic
dating from wounds in the army, attacks of malaria and
typhoid fever.

Case 6. Had a head injury in childhood, a sunstroke
later, followed by a most persistent dyspepsia for years.

I think that further study and experience will sustain
these two facts :

First. That nearly all the cocaine, bromide, chloral,
ether, chloroform, and coca inebriates are complex cases or
those who have used other drugs, including alcohol and opium,
and have finally turned to some one of these drugs. That
all of these cases have had a period of drug preparation, and
may be called drug neurotics, who are always using some
similar compound. Probably a large proportion of the alco-
hol and opium cases begin without this drug taking, but it
may be said that the cocaine, bromide, ether, chloroform, and
chloral takers follow as a rule from states of previous excess
in drug taking.

The second fact is, that nearly all these drug maniacs are
neurotics from inheritance and acquired states of degenera-
tion. The morbid impulse for this or that drug is only
another symptom of brain defect.

It is evident that a study of the symptoms and effects of
any new narcotic must include the heredity and history of
other drug excess. Where these clinical facts are not con-
sidered, such cases will present many confusing histories.

While cocaine has come into prominence as a local anzs-
thetic, the statements of its action in large and long-continued
doses are of necessity vague and contradictory. Exhaustive
histories and studies of many cases are needed before accu-
rate conclusions can be reached.

The following are some of the facts which seem to be
peculiar to cocaine cases. The first effect seems to have
been that of a transient stimulant; a most agreeable exhil-

Cocaine Inebriety. 19

aration ending in sleep, with no unpleasant after effects.
Later, when large doses were taken, the general stimulation
at first became a marked exaltation, and in many cases a
mania. The mind seemed to be in a whirl from one thought
and subject to another, without ability to concentrate on any
one object.

This stage would of course vary largely with the case and
conditions, and resembles alcoholic delirium, only it is more
diffuse and transient. The second stage, that of sleep and
stupor, comes on quickly, and the desire for sleep seems over-
powering and intense. The stupor is more like that from
opium, only less pronounced and more easily broken up. On
awakening, the least exertion is followed by extreme and
most wretched debility; nausea and vomiting came on in
some cases, also a pronounced melancholy which seeks relief
from this drug again. The three stages of stimulation, nar-
cotism, and depression, seem very intense, and may be called
literally mania, coma, and melancholy.

In three of the cases I have noted, the first stage of ex-
hilaration was protracted for a long time by taking small
doses. The state produced was one of great satisfaction,
with freedom from care and contentment with everything.
After a time, the sleep impulse became annoying for the’
reason that it was not gratified. A short sleep would be fol-
lowed by a waking period, filled with similar ungratified im- .
pulses. Large doses had to be taken to break up this impulse.
In two cases large doses were taken for its rapid narcotic
action. The first stage was to the patient a short confused
exaltation, with a pleasing rush of thought and events. To
others, this stage was a wild confused mania. The sleep
which followed was deep and profound. Profuse perspiration
and general failure of nutrition followed.

In one case under my care a relapse took place, and I
observed the heart’s action. In the first stage of mania it
was increased to 108, and as stupor came on, ran down to
70, but at all times was regular. The temperature did not
vary over one degree, and was generally higher than natural.

20 Cocaine Inebriety.

The pupils were at first dilated, then contracted. A profound
anzesthesia of the mucous membrane of both eyes, nose, and
mouth was noticed. The narcotism resembled that from
opium. On awakening a general prostration was apparent ;
the pulse and temperature were lowered. The stomach
would not retain anything. Intense hyperzsthesia pervaded
all parts of the body; insomnia and the deepest melancholy
was present, and yielded slowly to treatment.

Another case, of an intelligent man, who described the
first effects of cocaine as a sudden expulsion of all aches
and pains, followed by a quiet satisfaction and a most pleas-
ing natural sleep. Later, when taking large doses, his
wretchedness would lift like a cloud, and great activity of
both mind and body that was pleasurable followed. After
the narcotic stage ended, he seemed to be worn out, without
any hope or faith in the present or future. Every sensation
was most miserable. Taste, sight, hearing, and feeling were
all perverted, and, as he expressed it, seemed in league to
drive him to madness.

In one case the mania of the first stage was noted by loss
of memory and inability to recall any event of the past.
The duration of the different stages varies greatly. Some-
times the mania of the first stage is longer than the period
of narcotism, and vice versa. In some cases the last stage
of melancholia is of great length.

So far, I believe the common sequelz of alcohol and
opium inebriety, particularly the neuralgias and congestions,
are much less frequent in these cases. But in their place
appears a general mental and muscular degeneration with
extreme depression, particularly of the nervous, respiratory,
circulatory, and vaso-motor systems. I think it very prob-
able that the continued use of coca is often followed by
excess in cocaine. One of the reasons is that the various
preparations of coca on the market are compounded often
from dangerous alcohols. In this case the action of coca is
destroyed and replaced by the degeneration which comes
from the alcohol. Thus, when tinctures of coca are given,

Cocaine Inebriety. 21

made from wood spirits, the effect of this remedy is to pro-
duce degeneration of both brain and nerves, which will seek
relief from narcotics of any kind. Iam also persuaded to
believe that cocaine inebriety, or coca mania, will never
become prominent, and will be confined to a class of neurotics
who, by the use of other drugs, have prepared the soil for
this new drug-mania. It will never take the place of alcohol
or opium in common use. Its action is too uncertain and
transient. The present novelty and glamour about its effects
will die away when its real value is ascertained. The element
of contagion in these cases presents a curious psychological
phase ; thus some extravagant newspaper statement of the
terrible effects of this drug will rouse curiosity to test it.
Or the printed history of a case appearing as daily news
draws the attention of neurotics, and it is safe to say that a
large per cent. not only purchase, but test this drug on
themselves. Cocaine should not be used as a substitute in
breaking away from the use of other narcotics. It should
not be used in large or long-continued doses. In melan-
cholia it is likely to provoke the disorder it is supposed to
break up. It cannot be used indiscriminately. However
valuable it may be, there is a certain limit to its power and
practical use.

The treatment of cocaine inebriety is the same as that of
alcohol or opium cases. Forced abstinence from the drug,
rest, and building up the system, are the general methods ~
pursued. More profound degeneration and debility exist
than in other forms of inebriety, requiring a longer time for
successful treatment.

States of mania and melancholy often continue for some
time after the use of the drug is given up, and disappear
very slowly. It is for these states that special surroundings
and care are essential. The prognosis is always uncertain.
The craving for drugs for their effects may be broken up
and restoration follow, but such cases generally are unable
to bear much exposure, and not unfrequently relapse on the
slightest temptation. In the cases under my care, both

22 Cocaine Inebriety.

recovered, but will probably relapse, using the same or some
other drug in future.

The following conclusions are sustained by the best
evidence which has been presented so far.

The use of cocaine to excess in persons who have never
used alcohol or other narcotic drugs before, is very rare.
Among inebriates and drug maniacs, cocaine inebriety is no
doubt increasing. Its peculiar dangerous effects on the body
will prevent its general use as an intoxicant to any great
extent. It acts more rapidly than opium, but its effects pass
off more quickly. Its first effect is more exhilarant than
alcohol, but it is uncertain and variable. This stimulant
action develops mania, followed by narcotism and melan-
cholia. When given in cases of melancholia in large doses, it
changes the case to mania, then finally relapses bringing back
the case to melancholia again. As an intoxicant it is more
dangerous than alcohol or opium. As a form of inebriety it
is more difficult to treat, requiring a longer time to break up,
because of the physical and psychical complications. It
cannot be used as a substitute for any other narcotic, or as
an antidote or remedy.

The exportation of New England rum from Boston and
other ports for the last few years shows the same tide-like
movements that we have called attention to before. Thus
in 1880, over 1,200,000 gallons were sent away, the next
year it fell to 889,599 gallons. In 1882, it was at the lowest
point, 563.911 gallons. In 1883, it went up to 578,789 gal-
lons. In 1884, it rose to 667,847, and last year it was 875,-
539 gallons, It is noticeable that the most of these spirits
go to places on the coast of Africa.

It is a curious fact that although the use of opium and
its preparations are increasing, the American market has
lately been over stocked, and a lot which cost four dollars a
pound was sold at auction for one dollar and seventy-five
cents a pound.

Opium Antidotes. 23

OPIUM ANTIDOTES.
BY J. B, MATTISON, M.D., BROOKLYN, N. Y.

If ought were asked for as to further proof of the wide-
spread extent of opium addiction in this country, it could
easily be given by citing the number of individuals engaged
in vending the various nostrums, each of which it is asserted
has the only true claim to merit as the one genuine sovereign
cure for this phase of human ill. It is now about seventeen
years since an illiterate brick-layer in a western city, who
made some pretension to the healing art, by virtue of a small
stock of herbs stored in a little back apartment, was struck
with the shrewd idea that in this peculiar field lay a mine,
which, perchancé, might be worked to no little pecuniary
profit. Acting on this impulse, the opiate mixture was com-
pounded, advertising circulars, vaunting the nostrum, made
their appearance, the aid of the press was secured, and busi-
ness began. It grew apace, and the coffers of its enter-
prising projector expanded as the circle of his deluded vic-
tims widened, in their costly but luckless efforts for relief.
It was not to be expected that this genius would long be per-
mitted to enjoy a monopoly of such a stroke of fortune, and
so, ere many moons had waned, claimants for like honor put
in an appearance, the rivalry between them being measured
by extent of their pecuniary resources, and fertility of
advertising device. It proved a fatal attraction to more than
one, who had begun a legitimate medical career, and had
taken obligations, binding as an oath could make them, to da
right by their suffering fellows, but who ignored both per-
sonal and professional pledges in their greed for gold, and
betook themselves to the camp of the common charlatan.
The reason of this, probably, is the peculiar nature of this
disorder, which impels its subjects to court privacy, and in
every way secure themselves from public gaze. This feel-

VoL. IX.—4

24 Opium Antidotes.

ing, which is largely the outcome of that mistaken opinion,
held by the laity, and, strange to say, some in the profession
as well, that those who by force of necessity, quite beyond
control, have become victims to opium, are simply the slaves
of a vicious indulgence, deserving censure rather than
charity ; this feeling, we say, is the main cause of that desire
for secrecy on the part of the patient, so essential to the
charlatan in this special field, and of which he cunningly
takes advantage, to his own financial good. In hope of
escape, the habitue often spends much of both time and
treasure to no purpose, and after months or years, may be,
realizing it futile, he abandons further efforts, and berates
himself for his folly, yet finds some consolation in the
thought that no one else is aware of the course he has been
pursuing. Proof of this fact is not needed, yet it may be
noted, one of these nostrum circulars is before the writer, in
which, among several asserted claims to special merit, his
absolute secrecy, even from nearest and dearest friends, or
relatives.

It really is surprising, that men of more than average
intelligence, some of our own fraternity, again and again, we
have known such, will consign themselves to such keeping ;
case after case has been under our care in which months and
years of time, and hundreds of dollars had been expended
on these nostrums without good; in many instances, doubt-
less, ignorance as to the make-up of the mixtures leads to
their purchase, yet it would seem that every well-educated
physician should be aware of their nature. Such, however,
is not the fact, and so with the hope that the reports given
in this paper may be accorded with as wide publicity as their
value demands, that it here sufficed to say, that what great
advance has been made in the knowledge of drugs and their
uses, no agent has yet been discovered that will take the
place of opium, when once the system has become habituated
to its use, and any individual making an assertion to the
contrary, may be safely set down as a knave or a fool.

Some time ago, the writer was requested by an editor of

Opium Antidotes. « 25

a well-known journal, to prepare this exposé, and not long
after a letter was received from the gentleman who has made
the main report given, stating that he had been instructed by
the State Board of Health to examine as many specimen
opium antidotes as could be secured, and asking my aid in
making the list as large as possible. The result is appended,
making, it is thought, the most extensive yet presented, and
one which should suffice to convince every reader, who may
have had any doubt as to the true nature of these nostrums.
Before giving details, it may be of interest to note the
modus operandi of these individuals. In every instance, an
accurate statement as to the daily or weekly amount of
opium, or its equivalent, used, is an absolute essential in
their so-called treatment, as one says: Be especially careful
to determine accurately, how much of the drug you use in
twenty-four hours, or in every,seven days, if preferred. The
time of taking, at what hours, is another point desired, and -
these being given, it is quite easy to prepare the mixture of
such opiate strength as will give a certain amount of the
habitual narcotic in each prescribed dose, this amount being
exactly that of the previous taking. This done, the habitue
is simply continuing his addiction under a new name, and
care having been taken that the opiate shall be quite enough
for his need, he trudges along, hugging the delusive hope
that in no very long time he will reach his wished-for good.
The initial amount of the nostrum supplied, is intended for
one month’s using: Then the patient having become accus-
tomed, it is supposed, to this new order of things, another
supply is given for a similar period, differing from the first,
only in that the amount of opium is lessened with each suc-
ceeding month, and so the play goes on until the patient,
failing in his effort, becomes distrustful and betakes himself
to some other specimen of the same genus, or else abandons
the whole affair. The price, per month, of the nostrum,
depends mainly, of course, on the amount of opium it con-
tains ; supposing a habitue to be taking one grain of morphia
daily, it ranges from two and one-half to twenty dollars.

26 Opium Antidotes.

Patients are urged to procure a “ full course,” several months’
supply, in the out-set, the reward for which is a more or less
generous reduction in the cost of the nostrums, and though
this is not very explicity stated, a large stock of shekels to
the credit of the vender. The mock honesty of some of
these charlatans is amusing. One writes: I do not advertise
or send out circulars ; as there are hundreds of quacks who
are doing such low and mean work, I have become dis-
gusted. Another says, I am aware that there are heartless
imposters, destitute alike of position and principle, who are
constantly endeavoring to entrap and victimize the anxious
and, perhaps, too credulous, sufferer. The cunningly-devised
spurious recommendations of these swindlers are well calcu-
lated to deceive the unwary. You will most certainly be
swindled by trusting to their representations. Still another,
speaking of the so-called treatment which he, in common
with others adopts, says, with an outburst of indignant virtue,
it is practiced so shamefully and heartlessly by charlatans
in various western and southern States.

Some of these nostrums are nothing but disguised solu-
tions of morphia. Several years ago, the writer read a
paper on this topic, before the Kings County Medical
Society, and among the specimens, presented one analysis
made by a competent chemist :

Water, . 7 : " 2 . 3 a 28.66
Glycerine, s 5 e a . 4 Fs 66.89
Morphia,. a y 2 : 4 . e 4-45

100.00

The coloring was aniline; others may contain quinine,
strychnine, cannabis, atropia, hyoscyamia, or other ingre-
dients ; but be the mixture what it may, the prospect of
failure is vastly greater than that of success.

Through the kindness of Dr. Abbott, health officer and
secretary of the Massachusetts State Board of Health, 1
quote from the last official report of that gentleman, as
follows :

One of the most evident proofs of an increase in the

Opium Antidotes. 27

consumption is the existence and growth of a considerable
number of so-called cures or antidotes of the opium habit.
These preparations are advertised broadcast in the public
prints, and occasionally in professional journals, which should
serve a better purpose. If these so-called cures were of a
similar composition to the great mass of empyrical remedies,
but little harm would result from their use. This is not the
case, however, with the preparations in question. With but
one exception, the active ingredient in the so-called cures
examined by the analyst, prove to be opium itself, in one or
another of its varied forms. The preparations of this
character, enumerated in the analyst’s report, were obtained,
in all instances, either directly from the proprietors or from
their authorized agents, and were accompanied by their pub-
lished circulars.

The purchaser of such preparations thus becomes the
victim of a cruel fraud, under the supposition that he is
obtaining a remedy or antidote, the article which he receives
being simply the enemy in disguise, against which he is
bending his energies to obtain relief. This shameful practice
deserves nothing but the severest condemnation. The cir-
culars referred to as accompanying the cures, are omitted
from this report. It is sufficient to say that their style is
remarkably similar, in their methods of securing and fleecing
their victims. Each one accusing the other of fraud, and
publishing as endorsements the names of many prominent
persons in various parts of the country. We have sufficient
proof that, in many instances, such names are published
without the least shadow of authority.

The nostrum samples we secured were examined by Dr.
B. F. Davenport, State analyst of the Massachusetts Board,
and his report is appended:

“T have to report upon twenty samples of so-called opium
cures, which have been obtained from their proprietors. They
have all been tested for the presence of morphine, and they
have all responded to the usual reaction thereof, except the
‘Keely’s Double Chloride of Gold Cure.’ This one, how-

28 Opium Antidotes.

ever, gave no reaction for the presence of even a trace of
gold therein. The cures were all uniformly obtained, as for
one who had acquired the habit of taking the, for an opium
eater, very moderate quantity of only one grain of morphine
per day. It was expected, as proved to be the case, that the
-cures for even such a mild case, would contain enough. mor-
phine to furnish unmistakable evidence of its presence, if
they contained any at all. The twenty varieties of cures,
were as follows: S. B. Collins, La Porte, Ind.; Mrs. J. A.
Drollinger, La Porte, Ind. ; W. B. Squire, Worthington, Ind. ;
P. B. Bowser, Logansport, Ind.; J. C. Beck, Cincinnati,
Ohio ; J. L. Stephens, Lebanon, Ohio; H. L. Baker, Toledo,
Ohio; J. S. Carleton, Chicago, IIl.; L. Meeker, Chicago, II. ;
W. T. Phelon, Chicago, Ill.; L. E. Keeley, Dwight, Il. ;
H. Kane, New York city ; Charles C. Beers, New York city ;
Salvo Remedy Co., New York city ; F. E. Marsh, Quincy,
Mich.; B. S. Dispensary, Berrien Springs, Mich.; B. L.
Woolley, Atlanta, Ga.; Geo. A. Bradford, Columbus, Ga. ;
J. C. Hoffman, Jefferson, Wis-; Jos. A. Dunn, Elizabeth,
N. J.”—Fournal of Medical Association.

The following are some of the conclusions from the late
excellent address by Dr. Peterson, president of the Alabama
Medical Society. Alcoholic liquors are never necessary in
health. They are never necessary as food for man, etc.
They do not give warmth and strength to the body, but
diminish both. They do not increase the powers of resist-
ance and endurance of mental and physical fatigue. They
do not increase mental vigor. They give the heart accelerated
action, temporary, followed by a reduction of tonicity. They
may increase nerve tension for a time, but reaction follows
quickly and greater exhaustion. They are harmful to brain
‘workers who take but little exercise. In a physiological
condition of the system they are never beneficial, and in
disease should only be prescribed by an expert. As a med-
icine they are often important, but every possible restriction
should be thrown around their improper sale and use.

Abstracts and Reviews. 29

Abstracts and Reviews.

INEBRIATE MANIACS.

Psychologists and students of mental science have long
been aware of the presence of a new division of the army of
the insane, a division which is steadily increasing, more
mysterious and obscure than the ordinary insane, and con-
stituting a new realm of the most fascinating physiological
and psychological interest. It consists of the alcoholic,
opium, chloral, ether, and chloroform inebriates. They ap-
pear in law courts, as both principals and associates in all
degrees of crime, and are called drunkards, tramps, and
dangerous classes. In conduct, character, and motive, they
constantly display many prominent symptoms of insanity,
such as manias, delusions, deliriums, and imbecilities. Yet
public opinion refuses to recognize these symptoms, because
they are associated with intervals of apparent sanity in act
and conduct. Clergymen and moralists teach that these
cases are simply moral disorders, growing out of ‘‘a heart
deceitful and desperately wicked,” and only remedied by
moral and legal measures. Scientists, who study the history
and progress of these cases, find that they are diseases,
following a regular line of march, from definite causes, on
through certain stages of growth, development, and decline,
the same as in other maladies.

Many theories are urged to explain the presence of this
army of inebriates ; one of which asserts that inebriety is
evidence of the moral failure of the age, of the increasing
wickedness of the times, of the triumphs of the growth of
evil over the good, etc. Another theory assumes that the
great increase in the manufacture of all forms of alcohol and
other drugs, and the facility with which they are procured,
will fully explain the presence of this class. A third theory

30 Abstracts and Reviews.

considers them the defective, worn-out victims of this crush-
ing, grinding civilization ; the outgrowths of bad inheritance,
bad living, and the unfit generally, who are slowly or rapidly
being thrown out of the struggle. A fourth view regards
them as simply coming into prominence, through the great
advances in the physiology and pathology of the brain and
nervous system, in which the physical character of these
cases is recognized.

Inebriate maniacs have been called “ border-land ” lunatics,
meaning persons who move up and down on the border-line
between sanity and insanity, and, when studied closely, divide
naturally into many classes. One of these classes, which in
most cases represents extreme chronic stages, appears prom-
inently in the daily press, in reports of criminal assaults and
murders. When the genesis of the crime and the so-called
criminal are studied, unmistakable symptoms of mental
unsoundness appear. In most cases the victim is a neurotic
by inheritance and growth. In other words, he was born
with a defective brain and organism, and both growth and
culture have been imperfect. Many and complex influences,
of which alcohol or other narcotics are prominent, have pre-
pared the soil, furnished the seed, and stimulated the growth
of a positive disease of the brain. The higher brain-centers
have slowly succumbed to a paralysis, as mysterious as it is
certain in its march. The victim’s capacity to comprehend
his condition, and adjust himself to the surroundings, be-
comes less and less, and he is more and more a waif, drifting
with every possible influence. In appearance, head, face, and
body are angular and imperfectly developed, the nutrition is
defective, the eye, the voice, and every act and movement
indicate degeneration and disease. Any general history of
the crime reveals delirium, hallucinations, delusions, and
manical impulses. Thus, in one day, the papers recorded the
following among other cases of this class: An inebriate,
of previously quiet disposition, killed his wife, supposing she
had put poison in his food. Another man in a similar state
shot a stranger who differed with him on the age of Queen

Abstracts and Reviews. 31

Victoria. Another man killed his father, who remonstrated
with him for overdriving a horse. Still another assaulted
fatally his brother, who would not give him money. Two
men, both intoxicated, mortally wounded each other in a quar-
rel as to who should pay for the spirits drank.’ Another man
killed both wife and child, supposing the former was going
to desert him. Thus, day after day, the records of these
inebriate lunatics appear, and each case is as positively the
act of a maniac as if committed by an inmate of an asylum,
whose insanity was long ago adjudged. In each case a long
premonitory stage has preceded this last act ; the individual
history of almost any inebriate furnishes abundant evidence
of this. In the court-room this insanity of the prisoner is
ignored, and the legal fiction, that drunkenness is no excuse
for crime, prevails. The prisoner is assumed to be always a
free agent, and the use of alcohol a willful act, the conse-
quences of which he should be held accountable. Asa result,
the victim is destroyed, and the object of the law, to reform
the offender and deter others from the commission of crime,
lamentably fails.

The second class of these inebriate maniacs are less »
prominent in the press, but are more often seen in the lower
and police courts. They are arrested for drunkenness, minor
assaults, and all grades of breaches of the peace. They use
alcohol, opium, or any other drug for its effect, and their
character and conduct are a continuous history of insane and
imbecile acts. In.appearance they are suffering from disease,
and the hereditary history is prominent in ancestral degener-
ations and defects. They are repeaters for the same offense
over and over again, and their crime is of a low, imbecile type
against both person and property, characterized by profound
mental and moral paralysis. In popular estimation they are
simply armies of vicious, wicked persons, who are so from
love of the bad and free choice of evil. This idea prevails
in the court-room, and the judge, with a farcical stupidity,
admonishes, rebukes, and sentences these poor victims, who
are supposed to be made better by the moral and physical

VoL. IX.—5

32 Abstracts and Reviews.

surroundings of the prison, and the sufferings which the
vengeance of the law inflicts. The case may have appeared
many times before for the same offense, and the act com-
mitted may have been particularly insane and motiveless, and
yet the judge deals out justice on the legal theory that the
prisoner is of sound mind, and fully conscious and respon-
sible. The result is clearly seen in the records of police
courts, showing that the number of persons who are repeat-
edly arrested for drunkenness are increasing. Another
result more startling but equally true, appears. Every law
court where inebriate maniacs are tried and punished, on the
theory that drunkenness is no excuse for crime, and that
the victim should be treated as of sound mind, with free will
to do differently, is a court of death, more fatal than all the
saloons and beer-shops in the world. Such courts destroy
all possibility of restoration, and precipitate the victim to
lower grades of degeneration. It has been estimated that
ninety-nine out of every one hundred men who are arrested
for drunkenness for the first time, and sentenced to jail, will
be returned for the same offense within two years, and appear
again with increasing frequency as long as they live. The
report of the hospital at Deer Island, near Boston, where
drunkards are sent on short sentences, for 1883, showed that
one man had been sentenced to this place for the same offense,
drunkenness, seventy-five times. Before the temperance
committee of the English Parliament, in 1882, many cases
were cited of men who had been sent to jails and work-
houses from twenty to two hundred times for drunkenness.
Practically, every sentence for drunkenness for ten, thirty,
or sixty days, costs the tax-payers from fifty to one hundred
and fifty dollars; and more completely unfits the victim and
removes him from the possibility of living a temperate,
healthy life. Enthusiastic temperance men have drawn the
most startling conclusions from these lower court records of
arrests for drunkenness. Here each arrest stands for a new
man and case. The nine thousand cases recorded as having
been sent to Deer Island in 1883 in reality only represent a

Abstracts and Reviews. 33

little over two thousand different men and women, and yet
the number of arrests is taken as evidence of the increase of
drunkenness.

A third class of inebriate maniacs are less common, and
yet they often come into great, notoriety from some unusual
act or crime. They are known as moderate or occasional
excessive users of alcohol; or opium and chloral takers. In
most cases they are from the middle and better classes of
society, and are beyond all suspicion of insanity, and their
use of these drugs are considered mere moral lapses. Such
persons will suddenly exhibit great changes of character and
conduct, and do the most insane acts, then resume a degree
of sanity that corresponds with their previous character.
Thus a prominent clergyman of wealth and high standing in
the community, who was a wine-drinker, suddenly began a
series of Wall Street speculations of the most uncertain,
fraudulent nature. He implicated himself and a large number
of friends, and finally was disgraced. A judge, occupying a
most enviable position of character and reputation, who had
used spirits and opium for years at night for various reasons,
suddenly gave up his place and became a low office-seeker —
was elected to the legislature, and became prominent as an
unscrupulous politician. A New England clergyman, after
thirty years of most earnest, devoted work, renounced the
church and became an infidel of the most aggressive type.
Later it was found that he had used chloroform and spirits
in secret for years. A man of forty years, of tested honesty
and trustworthiness, proved to be a defaulter. It was ascer-
tained that he used chloral and opium in secret.

Hardly a year passes that bank defaulters, forgers, and
swindlers do not appear among men whose previous charac-
ter has given no intimation of such a career. When their
secret history is ascertained, the use of alcohol, opium, and
other drugs is found to be common.

Another class of previously reputable sane men suddenly
commit crimes against good morals. The unusual boldness
of their acts points to insanity, and it is then found that they

34 Abstracts and Reviews.

are secret or open drinkers, using alcohol or compounds of
opium. Such men come into politics with a most insane
ambition for office and childish delirium to appear in public
as great men. They often become enthusiastic church and
temperance men, acting along very unusual lines of conduct,
and doing unusual things. Signs of mental failure are
clearly tracedin the childish credulity, or extraordinary skep-
ticism, or extreme secretiveness, which are all foreign to the
history of their past. Then, at last, such men leave strange
wills, with strange bequests. They are contested; the
expert is called in ; and, while he is certain of insanity and
irresponsibility of the testator from the history, he can not
make it appear clearly to the court. These cases are more
or less familiar to every one, yet the history of drinking or
using narcotics is concealed. In an instance of recent date,
the will of a very rich man contained a large bequest to the
Freedman’s Bureau. This was a very strange and unusual
act ; but the heirs, rather than expose the secret drinking of
the testator, let the will stand. To history this was a very
generous deed, but in reality it was the mere freak of a
maniac.

These persons appear to all general observation sane and
fully conscious of the nature and character of their acts ; yet
they are in a state of intellectual delirium and instability,
which comes out prominently in the strange, unusual con-
duct. The co-ordinating brain-centers are so damaged as to
prevent healthy, consistent, uniform brain-action. A certain
range of thought and action may seem sane, but an ever-in-
creasing undercurrent of disease carries them further from
normal brain-health. These cases excite the wonderment of
the hour, and to moralists are phases of human depravity,
but to the psychologist are explosions of masked diseases
almost unknown and undiscovered.

It will be apparent to all that the most unfortunate treat-
ment and injustice is meted out to these cases. Thus, the
inebriate maniac in delirium who commits murder and
assault is not a criminal to be cured by punishment. His

Abstracts and Reviews. 35

brain has broken down and needs the most careful restora-
tive treatment. He is physically sick, and can never recover
except by the use of well-directed remedies and along the
line of exact laws and forces.

In the second class, the profound failure of the present
methods of management should direct attention to the real
means of cure. Science shows, beyond all doubt, that a sys-
tem of work-house hospitals, where all these cases can come
under exact physical care and restraint, and be organized
into self-supporting quarantine stations, will not only pro-
tect the community and tax-payer, but put the victim in the
best condition for permanent recovery. Here he can be
made a producer, and taken from the ranks of consumers
and parasites of society. If he is an incurable, he can be
made self-supporting, and society and the world can be pro-
tected from his influence.

In the third class, when public opinion recognizes that
the occasional or continuous use of alcohol or other narcot-
ics is dangerous and likely to produce grave mental disturb-
ance, these alterations of character and conduct will be no
mystery. Such men will be recognized as diseased, and
come under medical care and recover. Medical and scien-
tific men must teach the world the nature and character of
alcohol, and the diseases which are likely to come from its
use. This moralists, clergymen, and reformed inebriates,
can never do. To-day these inebriate maniacs appeal for
recognition and sympathy from many homes and firesides.
They call for help. They ask for bread. We are deaf to
their entreaties— we give them stones. In language that
can not be mistaken, they tell us of unstable brain-force, of
tottering reason, of marked, insidious disease. We call it
vice, and treat them as of sound mind and body. They ask
for help for the brain, starved, disorganized, and growing
feebler. We give them the pledge and prayer, and taunt
them as vile, and willful, and wretched sinners. What won-
der that the glimmerings of reason and the lights of a higher
manhood should disappear in the darkness of total insanity

36 Abstracts and Reviews.

under such treatment? In the delirium of criminal assault,
or the imbecilities of the low drunkard, or the strange acts
and changes of character in the so-called moderate drinker,
they mutely appeal for aid, and we brutally fine, imprison,
and persecute them. This is the spirit and theory which
seek to support through temperance efforts, through the
church, and political parties, to remove an evil of which they
have no comprehension. When all this thunder and roar of
temperance reformation shall pass away, the still, small voice
of Science will be heard, and the true condition of the ine-
briate and the nature of his malady will be recognized.
Dr. Crotuers in Popular Science Monthly.

MORPHOMANIA IN FRANCE.

M. le Prof. Ball, the celebrated alienist of St. Anne, dedi-
cated a special article in the Journal de Medicine to morpho-
mania, which, according to him, is rapidly assuming great
proportions in France, especially amongst the gentler sex.
The symptoms are very characteristic, but often the patient
tries to put the medical attendant off the scent and then
some difficulty in the diagnosis is experienced ; but if a close
observation is made, something unnatural in the conduct of
the person will arouse suspicion. For instance, if he is in a
meeting, his face will become changed and downcast and he
no longer takes interest in what is passing around him, but
if he gets an opportunity of absenting himself for a few min-
utes, he will return quite bright as before, for in that short
interval he has given himself an injection. However, there
are two sure signs which will betray the patient, no matter
how he may try to conceal his habit, and those are to be
found in the skin and the urine. The skin will be found to
be covered with little dark spots, situated in the center of
little indurations, about the size of a large shot. It is need-
less to add that these indurations are the result of the little
wound of the needle, but as these lesions are generally found
on the inside of the thighs, the patient refuses to let them be

Abstracts and Reviews. 37

seen, and in that case examination of the urine will prove of
great service. A few drops of tincture of iron are put into
the suspected liquid, and, if morphia be presented, a blue
tinge will be produced. The prognosis of morphomania is
not as fatal as is generally supposed, but there is a danger
from the fact that the dose has to be continually increased,
and in the end the cachexia becomes so pronounced that the
patient falls an easy prey to tuberculosis. As to the treat-
ment, Mr. Ball recommends a brusque suppression of the
drug, provided the patient can be well watched, but in pri-
vate practice he thought that it would be found necessary to
proceed gradually.

Preparations of belladonna might be employed to calm
the irritation, or cocaine, but this latter remedy might prove
to be as bad as the evil it was given to cure.

Medical and Surgical Reporter.

REPORT ON THE INFLUENCE OF ALCOHOL
AND BEER.

Dr. Bikfalvi reports a series of experiments on digestion
in the Deutsche Medicinal Zeitung, with the following
conclusions :

1st. Alcohol even in small quantities arrests the digestive
processes. The digestion of albuminates is arrested more
than the transformation of dextrine to grape sugar. Gastric
juice with 20 per cent. of alcohol digests six to seven times
smaller quantities than the normal secretion. This is ex-
plained by the precipitation of pepsin by the alcohol.

2d. Beer does not promote digestion. It appears that
this is due not so much to its alcohol as to the presence of
large quantities of neutral salts that bind the free acid of the
gastric secretion. If a few drops of hydrochloric acid are
added this no longer inhibits. ¥

3d. Wine in small quantities appears to promote diges-
tion; in large quantities its action is that of alcohol.

4th. Black coffee also when taken in small quantities

38 Abstracts and Reviews.

stimulates the digestive function, large quantities act unfa-
vorably.

5th. Moderate smoking does not alter digestion, excessive
smoking however is of bad influence, because the tobacco
derivative alkaline reaction of nicotine neutralizes the gastric
juice.

PERIODIC OPIOMANIA.

Dr. Hughes, in a late number of the Alzenist and Neurol-
ogist, writes as follows on this subject :

There is a periodic form of morphia-craving, so much
like periodical dipsomania as to entitle it to the term opio-
mania, which develops in patients of neurotic temperament
who have been given morphia or opium to any considerable
extent. This shows itself sometimes in persons who have
been broken of the opium habit, and these are the most
hopeless cases to treat.

This periodic opiomania is characterized by an over-
whelming morbid craving for the drug, which comes on like
the craving for drink to the periodic drinker, without warn-
ing, except a morbid restlessness and sometimes an irritable
stomach; which a full dose of morphine a third to half a
grain will appease, and if followed by a night of sleep, the:
craving will be allayed sometimes for a week, sometimes for
a month. These cases should be studied more than they are
in the light of what we know of the periodic drink craving.
They are easily developed by the administration of morphine
or opium to neuropaths, in whose ancestry insanity and allied
nervous diseases have been numerous.

But this is not the acute neurosis suz generis developed
by repeated excesses in opium-taking, in the non-hereditarily
neuropathic, but rather a less painful and less violent and
more chronic and enduring form. From three to six weeks
of abstinence or abstinence and substitution combined, or-
dinarily suffices to cure the acute opium neurosis. The
chronié form of the trouble is much more persistent, per-
sisting oftentimes for a life-time, because a dormant morbid

Abstracts and Reviews. 39

heredity has been awakened into active life not to slumber
again till the last sleep of life overtakes the unfortunate
sufferer. The true opium neurosis sustains about the same
relation to the chronic periodic form of opium neuropathy
that alcholism sustains to dipsomania.

Alcoholism is a morbid condition of the nervous system,
developed. by repeated alcoholic libations, dipsomania, a
latent neuropathic condition, readily excited into activity by
the poison. And the poison often develops this disease with
surprising rapidity. These are the persons to whom a sin-
gle drink is often dangerous and astonishes us with its conse-
quences, because the latter are so extraordinarily dispropor-
tionate to the time the victim has been given to drink.
Such persons become drunkards in-a day, as it were; and
persons like them become opiomaniacs or periodic opium-
takers, or have for the intoxication insatiable desire after a
few doses of morphia or opium.

The opium maniac, like the dipsomaniac, is prepared by
inherent organic instability to be made so after one or a
limited number of toxic impressions. In some instances
he is as susceptible, by hereditary instability of psychical
nerve elements, as powder or dynamite are to explode,
needing only the exciting spark or concussion of a marked
opium impression. But true meconeuropathia, or the conse-
quences of prolonged and continuous meconism in non-
narcotic doses, so gradually induced that a kind of tolerance
to the graver direct toxic effects is established, and the ordi-
nary prompt narcotic effects are resisted by the organism,
is, like chronic alcoholism, as contradistinguished from dip-
somania, more gradually effected and developed by changes
induced in the cerebro-spinal centers, through slow poisoning
and nutritional perversion of neural tissue.

THERE are eleven different specifics on the market for
the cure of inebriety, and over fifty different patent methods
of reform and cure; and still the army of inebriates keep on
undiminished.

VoL. IX.—6

40 Abstracts and Reviews.

ALCOHOL AND TOBACCO STATISTICS.

The Boston Advertiser is responsible for the following:

The increase in the amount of whisky distilled and drunk
during the year now ended was 1,600,00c gallons over the
amount for 1885, the total consumption of this liquor being
7,700,000 gallons.

Estimating the population of the country at 60,0¢0,000,
this gives about one gallon and a pint for each one of
us, including women and school children and those of yet
younger years.

The consumption of beer amounts up to some 264,000,-
ooo gallons, an increase of more than 1,500,000 from the
preceding year, which admits of an allowance of eleven
gallons to each inhabitant, or, counting out the children and
one-half the adult population as total abstainers, the rest are
to be credited with the imbibition of one-half pint daily.

Analyzing these figures further it is seen that while the
increase in the total amount of spirits consumed is consider-
able, individually we are growing more temperate.

For in the years closely preceding, the quantity of whisky
drunk in the United States averaged almost six quarts for
each inhabitant ; and going back to 1870, the records of the
department show a production, under a low tax, that gave
nearly two gallons yearly to each man, woman, and child in
the country.

The growth of a preference for malt liquors, which these
figures show very plainly, the average consumption of beer
having increased from seven to eleven gallons within eight
years, is doubtless one of the influences that have produced
this result.

The use of tobacco is also constantly increasing, except
in the form of snuff, the falling off in the consumption of
that article reaching nearly two hundred thousand pounds.

In the comparatively novel practice of cigarette smoking,
which has, in fact, come into vogue within less than fifteen
years, there has been an increase of 25 per cent., the total

Abstracts and Reviews. 41

number burned being 1,310,000,000 or about twenty-two
apiece all around.

Of manufactured tobacco for smoking and chewing, there
were 191,000,000 pounds used, averaging about three and
one-fourth pounds each, and of cigars 3,500,000,000, an
increase of 152,000,000 from last year, or about fifty-nine for
every inhabitant.

If, now, a calculation is made of what these large aggre-
gates have cost the consumers, supposing them to have made
their purchases at retail, we may reach an approximate im-
agination of the tax which our minor vices lay upon the
collective purse of the average man. Taking the lowest
prices—as four cents for a cigar, and ten cents for a gill
of whisky, the total will be found to amount to more than
$1,280,000,000 — not so very much less than our National
debt — or $20 each from all who live in our prosperous land.

PHYSICAL SOUNDNESS.

The Philanthropist is a monthly journal published in New
York, devoted to the promotion of social purity and the sup-
pression of vice. It is a valuable paper and is doing grand
work. We give the following extract from an article by Dr.
Lewis : é

By physical soundness, we mean, a life in such conso-
nance with the divine laws expressed in physical being, that
strength, health, and long life are the normal results. Mu¢h
the larger share of human suffering comes through impaired
physical life. Weakness and disease make men a burden on
society, rather than a help and blessing to it. Weakness
and disease lead to poverty ; these three are the prime cause
of drunkenness, social impurity, larceny, and kindred evils.
Mental imbecility is also promoted through weak and dis-
eased physical life. This promotes crime and increases so-
ciety’s burdens. We can only state these salient facts.
Each thoughtful man will apprehend their truth: Hence no
man is free from guilt who transmits a single element of
physical weakness or disease which he can avoid.

42 Abstracts and Reviews.

This is doubly true of all tendencies and diseases which
impair nerve force. This is so intimately connected with
character, mental and moral, that one cannot be touched
without direct effect upon the other. The habitual use of
stimulants and narcotics destroys nerve force and mental
balance. These effects are often more prominent in the sec-
ond and third generations, than in those who first indulge.
Every man who uses alcohol, tobacco, opium, and the like,
must transmit to his posterity, physical decay, mental unbal-
ancing, and moral perversity.

MECONEUROPATHIA;; By Dr. C. H. Hucues, Epiror
OF THE “ ALIENIST AND NEUROLOGIST.” REPRINT FROM
THIS JOURNAL.

In this excellent monograph the author draws a line of
distinction, between the direct effect in physiological dis-
turbance of chronic opium poisoning, and the remoter
sequences to the central neural mechanism, cerebral, spinal,
and ganglianic. He places the neural psychical entailments
of both alcohol and opium upon the same morbid plane, so
to speak.

The author, in a personal note, calls attention to chronic
morphia neuropathy in its medico-legal aspects, and hopes to
write a work on this subject. He believes that chronic
morphia taking is like that of chronic alcoholism. In both
cases the impaired volition and modified psychical character,
entitles the victim to a most charitable consideration in
courts of law, and often legal protection. He thinks the
granting of divorces to husbands, on the ground of opium
eating on the part of the wife, should be condemned as a

- crime against the victim of nervous disease, who was in most
cases irresponsible. ,

Opium cases come frequently from some painful affection,
either physical or psychical, for which opium has been found
of great value, given by the druggist, physician, or husband
of the victim. They are literally the agents leading her into

Abstracts and Reviews. 43

degradation and ruin; then, with the aid of the courts,
abandoning her to the “ Inferno of Despair.”

The author has opened a’“rich mine” of facts, and will
no doubt develop some most practical truths in his further
researches,

Stinson & Co., the great publishing house of Portland,
Me., is one the best places to purchase fine steel plates in
the country.

Inebriism, a pathological and psychological study, by T. L.
Wright, M.D., Bellefontaine, Ohio, has reached its second
edition, and we most heartily commend it to all.

An Epitome of New Remedies, by Parke, Davis & Co., De-
troit, Mich., is a valuable reference work for the office table,
giving a short history of all the new and many old drugs and
their uses.

The Electrical Engineer, published at 115 Nassau St.,
N. Y. city, is the best journal published in this most fascinating
field of research. It is edited by superior experts as well as
scientific philosophers.

Science, a weekly publication of comments and notes on
matters of science and progress, is both ably edited and prac-
tically the most valuable periodical that comes to the home
of the thinking man.

New York to the Orient. By J.M. Emerson. E. R.
Pelton & Co., publishers, 1886. This is a new practical record
of a European trip by a practical man, and one that will amply
repay the time spent in reading it.

The Homitletic Review for January and the new year prom-
ises a rich treat of the best thought from the ablest clergy-
men in the country. The subscription is three dollars a year.
Funk & Wagnals of New York are the publishers.

Natural Causes and Supernatural Seemings is the name
of the last work of Dr. Maudsley. It is undoubtedly his
best work and one that will live a long time as the best pre-
sentation of the scientific side of the mysteries of life.

44 , Abstracts and Reviews.

The Popular Science Monthly for January, 1887, D. Apple-
ton & Co., publishers, New York city, begins the new year
with a rich feast of scientific facts. A year’s subscription to
this monthly will bring larger returns than from any other
source.

The Scientific American, published by Munn & Co., of
New York, presents weekly to its readers the best and most
reliable records of various improvements in machinery, while
the scientific progress of the country can in no way be
gleaned so well as by the regular perusal of its pages.

How to Strengthen the Memory. By M. L. Holbrook,
M.D. Price $1.00. New York: M. L. Holbrook & Co.
This is a very clear, sensible work, describing the natural
philosophical methods of strengthening the memory. To all
who wish to improve their memories Dr. Holbrook’s work
will be of great aid, and we commend it cheerfully.

The Essential Nature of Religion. By J. Allanson Picton.
Price, 15 cents. J. Fitzgerald, Publisher, 108 Chambers St.,
N.Y. The author of this profoundly philosophical essay
holds that in the relation of our personal life to the world
about us is found that which insures to religion an adequate
scope and a permanent place, under all fairly. conceivable
resolutions of thought; and that though religion may be
called by many names, its essence is recognizable in all the
highest activities of human life, even where these have been
condemned as irreligious and impious.

The History of the First Inebriate Asylum in the World,
by its founder, Dr. Turner, is in the press of The Case, Lock-
wood & Brainard Co., and will beout soon. This will undoubt-
edly be the most important work on this subject issued, not
only from a historical and scientific point of view, but as
illustrating the storms of opposition and slow growth which
greets every new advance of’ science. The story of its
author, who like all other pioneer benefactors of the race, was
denounced and bitterly opposed, is a sad, fascinating record.
This work will mark a new era in the inebriate asylum
movement.

Editorial, 45

Editorial.

JOURNAL FOR 1887.

Ten years ago the first number of the Journal appeared.
By the few specialists and pioneers in this field it was most
warmly welcomed. But it was evident that only in the next
century, and by the next generation would its real worth be
understood and appreciated. The ten years which have
passed, have been marked by struggles, misrepresentations,
sneers, and doubts, from both moralists and scientists. But
through all this there has been a steady, silent growth of the
facts, and recognition of the principles which have been pre-
sented in this journal. ‘

The dogma of the disease of inebriety was sharply dis-
puted ten years ago, To-day it is accepted by all advanced
students of science. Asylums for the treatment of inebriates
were denounced as pretending to treat a disease which did
not exist. To-day such statements would reflect on the in-
telligence or honesty of the author.

Here, as elsewhere, a few men are always doubters. The
war is still a failure, religion and history a sham, and scien-
tific advance only a retrograde. To these men inebriety is
still vice and wickedness, and all really scientific efforts to
solveit adelusion. The JourNAL oF INEBRIETY has the unique
experience of seeing its essays and papers going the rounds
of the literary world, credited to every other source but the
right one. Whenever its articles are translated into German
or French, they are very sure to be re translated into Eng-
lish and be credited to foreign authors. Many very valuable
papers which appeared first in its pages, have brought great
credit to new and unknown authors, and given permanent
place in temperance works and prize essays. Some temper-
ance critics after denouncing us sharply have appropriated as
their own entire articles from the JouRNAL with but little

46 ' Editorial,

change. Medical and temperance politicians have been
fortunate in getting the credit for learned articles that were
first published in the JouRNAL under the signature of different
authors. Many of the editorials have had a strange itinerate
history and appear in many unexpected forms and places.
Dr. Mason’s statistical papers, and Drs. Parrish, Wright, and
Day’s philosophic deductions, like the “ Wandering Jew,”
are ever on the march, incessantly appearing here and there,
in both new and old dresses and shapes, but never credited
or labeled so they can be traced to their real authors. The
JournaL oF InEBRIETY is not complaining, and has no time
to hunt down this parasitical army who feed on its pages.
The next century is rapidly nearing, and the army of scien-
tific advance are joining us from all sides. Their aid and
encouragement are increasing; voices of cheer and kindly
criticism come up from all sides. Over the seas, into the
libraries and homes of many of the scientific workers of the
world, this journal goes with welcome. Its pages are open
for all truth. It represents no one man, asylum, or theory.
Its aim is to present the facts, which the largest experience
and study indicates tobe true to-day. The scientific study
of the inebriate and his malady has scarcely begun. Only a
few men have landed on the shores of this new continent of
psychological research, and are preparing to move inland to
discover the country.

The Journat or INnEBRIETY seeks to record these discov-
eries, and point out the way to understand the laws and forces
which control inebriety and the inebriate. Who will join
with us in this great work? who will study these poor ine-
briates in their homes and firesides, and ascertain the physi-
cal conditions which made them what they are ? who will
unite with us in our efforts to solve this problem, on the lines
of physical and psychological researches. The JouRNAL OF
INEBRIETY has left the stream of experiment and is headed
out into the great ocean of discovery! Another ten years is
before us ; years of constantly increasing growth, of fuller
and larger acceptance of the truths we urge.

\

rr re iy ee ee

re elena es

Editorial.” 47

PERIODICAL INEBRIETY.

No class of inebriates present more fascinating interest,
than those in whom the drink impulse recurs at fixed and
stated intervals. Like the paroxysms of intermittent fever,
their regular recurrence and distinct free intervals, point to
some unknown laws whose uniformity is both mysterious and
startling ; or, like bodies approaching the sun, their orbit
grows smaller, and the free interval of sobriety shorter, until
finally they merge. The periodical drinker has become the
steady user of spirits, and has passed into the realm of
dementia and paralysis. In the following case, the exact
recurrence of the drink impulse, and its unchanging history,
make it noteworthy.

R. a graduate of Yale College, and a lawyer of great
oratorical abilities, became a steady drinker of beer and wine
in 1868. In 1874, he was an inebriate, drinking constantly
to intoxication. He had two attacks of delirium tremens,
lost all position in society, became an outcast and inmate of
the lowest places, and was also frequently arrested for drunk-
enness. His heredity was from a drinking, gambling father,
and nervous mother, who became insane finally, and died in
an asylum. In 1876, he joined the Murphy Movement, and
became a lecturer. Fora long time he worked with great
power and sobriety, then suddenly drank to great excess for
a week or more. Then signed the pledge and began again.
Three months after, he fell as before, and after a few days
became temperate and started again. In 1879, he came
under my care for a short time. It was ascertained that this
drink paroxysm returned every ninety-one days, rarely ever
varying more than a few hours. It came on most unex-
pectedly, and if he could drink to stupor for two or three
days, it would seem to wear away, and in a week die out
altogether, if not, it might last ten days, but not longer. In
1884, I saw this case again, and learned from him these very
curious facts. He is still in the lecture field, speaking every

week from three to five times, for nine or ten months of the
VoL. 1X.—7

48 Editorial.

year. He is constantly traveling, and has good health, takes
great care to live as regular as possible; never uses any
spirits or tobacco, and has no desire or taste for them.
Every ninety-one days (no matter where he is, or what he
may be doing), a strange, nervous trembling comes over him.
This is followed by a great thirst for water, and finally spirits.
His mind becomes filled with thoughts of the pleasures of
the effects of spirits. Everything suggests this in new and
fascinating forms. All his old drink experience will come
back with ravishing minuteness. Ilis fear of betrayal of
this condition, produces the most intense agony of mind.
He becomes pale, and perspires, cannot talk well, breathes
with great rapidity. If he can be taken to a room and be
alone, he will drink large quantities of water, and vomit
freely ; then if he can get spirits, or bromide of sodium, and
become stupid for a few hours, this feeling will wear away.
A high fever and great prostration follows, and in a week or
more, he is able to go on with his work. For three years
past he has not taken spirits at these times, but keeps by
him always large quantities of bromide of sodium. So
regular and certain is the return of this drink paroxysm, that
he prepares for it in advance, arranging to be with some
friends, on or about this time. He is obliged to do this, for
fear he will be caught at some hotel or among strangers, and
use spirits. He has tried repeatedly (by becoming interested
in some work or topic) to forget the time of this drink
impulse, and has partially succeeded, but it invariably comes
on again. He has been seized on the lecture platform, in
the cars, or in the night, wakened from a sound sleep and
filled with this drink delirium. He calls these attacks his
“mind drunks,” and when over, never thinks of them until a
day or so before the regular time of approach. Then he is
filled with apprehension that they will result in apoplexy and
death. He is a most earnest, energetic man, clear, and fully
sensible of his condition, reasons well, and seems above the
average in culture and intelligence. As a lecturer in the
temperance field, he is a man of great power and force.

Editorial. 49

Recently, I received a letter from him, in which he says that
it is twenty years since he stopped the use of spirits, and
during all this time, this drink craze has come back regularly
every three months. He thinks they are as intense as ever,
but not of so long duration. He has been able for several
years to pass over them without taking spirits, but he must
have bromide or chloral to help him. He now takes better
care of his health, works less, takes more rest, and thinks he
will finally overcome these paroxysms. The same desire for
the effects of spirits follows an intense thirst, as before. He
says he “is crazy at these times, and worse than all, he is
most painfully conscious of it.” What he seeks is stupor to
keep down this impulse, and enable him to control himself.
In all probability this drink paroxysm will die out, or develop
into some form of mania, from the use of spirits again, and
from which he may not recover. As long as he retains his
usual vigor and power, no change will naturally follow. But
should he break down, and his health be permanently
impaired, a very uncertain future is before him.

_ There is a very striking correspondence in the following :
A judge in a court of last resort gave among other reasons
for denying a new trial to an inebriate who was convicted of
capital crime: that drunkenness had been considered always
a vice and wickedness in all nations, and laws had been insti-
tuted for its punishment; that all moral teachings, as laid
down in the holy writ and common law, based on experience
and medical testimony, sustained this view. The drunkard
has ever been considered a criminal to be punished.

In 1662 Sir Matthew Hale in condemning two women to
death as witches in London gave as his reasons: “ That
there are such creatures as witches, he made no doubt at all;
for, first, the scriptures affirmed so much ; secondly, the wis-
dom of all nations had provided laws against such persons,
which is an argument of their confidence of such crime ;
third, Sir Thomas Brown, a physician, was clearly of the

50 Editorial.

opinion that such persons were bewitched ; that in Denmark
lately there had been a great discovery of witches who used
the same way of afflicting persons.”

These profound errors may have the sanction of religious
and secular teachings, and-be “4 d by the most learned
and intelligent, and ofily in'the “nextAage be recognized and
excite profound wgeger at theftexistente,

MORAL NITY INS BN BRIETY.

The inebriate is a oiiaes insane. His conduct
and thoughts indicate clearly impairment of the higher brain
functions. Brain nutrition and circulation are deranged,
and both structural and functional lesions follow. Conditions
of anzsthesia of the higher brain centers, and failure to
recognize the difference between right and wrong are com-
mon. Beginning in selfishness, loss of pride, indifference to
honor, truthfulness, and the rights of others, with grossness
of thought and act, it finally culminates in a moral palsy
that cannot be mistaken. Often the intellectual activity and
physical condition seem unchanged. The ordinary duties of
life are fulfilled and realized, and no criminal act or word
reveals the real condition. The victim has been born with
a defective brain, and alcohol with other causes have
developed this defect into positive degeneration. Or the
brain has suffered from some injury which takes on this
form of degeneration. The following brief notes of cases
point to a new field of research, that is, so far, practically
unknown.

Dr. Hall, professor of Physiology at Vassar College, for-
merly Physician of the Woman’s Reformatory Hospital in
Massachusetts, sends us the following:

Case one was a woman who had been imprisoned over a
hundred times for inebriety. She began to drink early in
life, and was never free from spirits except when in prison.
Her husband was dead, her family had grown respected
members of society, and had practically disowned her, as

Editorial, 51

beyond all hope of recovery. She never was known to utter
a word which would indicate that she felt the least sorrow or
remorse for her conduct. Arguments were useless, she was
irresponsive to every appeal to her pride or honor. Finally,
she died utterly unconscious of any wrong or moral injury to
herself, or others. : F

The second case was a girl of sixteen, who drank spirits
from early life. She declared she would always drink when-
ever she could get it. She gave no reason or excuse for this
course of conduct; neither was she obstinate or obdurate, but
simply outside the pale of ordinary motives and reasoning.
No further history of this case is given, but a short, troubled
life and early death is the common fate of such cases.

Dr. B. sends me the following :

An only son, well educated, of fine, moral character, after
three months’ service in the late war, came home a moderate
drinker. Slowly he developed the very lowest traits of
character, became a bar-keeper and steady drinker. Was
treacherous, deceitful, and slanderous. He forged notes on
his father, and used every means to procure money. All
love for his parents, honor, pride, and self-respect, were gone.
While he did not commit any criminal act, and seemed to
possess a degree of intelligence, he seemed to have no con-
sciousness of duty to others. He was in a semi-intoxicated
state most of the time, and never gave any excuse or reason for
his course of life. Some years ago I was called in consultation
in the case of a merchant, who had been a loving, gentle hus-
band up to the time of failure in business, when he became an
inebriate, and drank every day to excess. His character
changed, and he became brutal to his wife, using violence on
every occasion. He told falsehoods, deceived his friends,
and was dishonest and treacherous. He seemed keener and
more active in business, but his moral character had changed.
He spent his evenings in low brothels and bar-rooms, was
very profane in his language, and changed in pride and
appearance. The question of his sanity was raised, and a
commission decided he was fully sane. Ina second examina-

52 Editorial.

tion, in which I was present, he was affirmed to be insane.
Two years later, general paralysis developed, and he is now
an inmate of an asylum.

A middle-aged man was placed in my care, who, when
under the influence of spirits, engaged in the most extra-
ordinary swindling schemes. He associated with gamblers
and the lowest characters, and acted as a receiver for articles
that had been stolen. During this time he was not intoxi-
cated, but drank steadily. He treated his family brutally,
and neglected his business, that of a druggist. He seemed
of fair intelligence, gave no reasons or excuse for his conduct,
and seemed to have no conception of honor or duty. He
obeyed all the rules, when under observation, but could not
be trusted in any respect. He was under treatment four
months, and remained free from spirits, but was ever plan-
ning schemes of dishonesty, and intensely selfish and un-
truthful. His former history was that of a proud, kind-
hearted man, who was always very generous and honorable
in his relations to others. A few months after leaving my
care, he was sentenced to State prison for forgery.

A man of twenty-two came under care, for continuous
drinking and spending his time in the lowest brothels. He
was the only son of a distinguished professional man, and had
been brought up in surroundings of great refinement and cul-
ture. At puberty he manifested a taste for low company, which
steadily increased. He would spend all his spare time with
hackmen, and in low saloons. He entered college, and
seemed very bright and capable. He was very selfish to his
parents and associates, was untruthful, dishonest, and treach-
erous. He brought his low companions in college, and
seemed to take pleasure in involving others in trouble. He
was expelled from college, and drank to great excess for a
time, then became a steady, moderate drinker. He listened
in silence to all rebukes and entreaty, made no apology or
gave any reason for his conduct. When urged, said he
would do better, but never altered his conduct, or tried to
change. He drank with every opportunity, and was without

SS ee

Editorial. 53

honor or sense of duty to any one. I testified that he was
insane, and he was taken to a private asylum, where the
superintendent, after an examination, discharged him as sane.
A few weeks later, he was arrested for swindling, and finally
went to an insane asylum, and died Jater.

In a case in which I was consulted, three boys in a
family all manifested, in early life, the lowest tastes, with
cruelty to animals, and all drank, and were intoxicated from
early childhood, with every opportunity. One died at
thirteen, from some acute disease following syphilis. The
second one drank, had syphilis, and finally was sent to an
insane asylum for dementia. The third one is living at
home, associating with the coachman, and the lowest com-
pany he can find. He drinks every day, and has no sense of
honor, or affection for any one. The father was a moderate
drinker, and speculator, who died early, leaving a fortune.
The mother was a leader of fashion, a proud, spirited, nervous
woman, whose mind was much impaired at the singular con-
duct of her sons.

These cases are sufficient to show that moral insanity is
very intimately related to inebriety. The term moral insanity
is clinically correct, and describes a diseased state of the
higher brain centers, which are called the moral faculties.
Of course, other diseased states are associated with it.
While the man may reason and exhibit a fair degree of brain
vigor, he seems without any power to distinguish between
right and wrong, or to recognize any claims of honor or
duty. This is a physical condition, either congenital or
acquired, whether it can be cured or not, is a problem for the
future. There can be no question of the value of physical
restraint, and early care and treatment.

Morpheomania may always be treated by abrupt with-
drawal of the drug, except in conditions when such methods
are contra-indicated by the vital forces of the patient, or
concomitant pathological phenomena. The method should
also be abandoned if reactionary collapse result.

54 Editorial.
INEBRIETY IN PARIS.

A correspondent sends us the following : “ Drunkenness
is apparently on the increase in Paris. The number of
workingmen who ruin themselves by absorbing too much
absinthe, and other deleterious mixtures, grows more and
more. There is, therefore, abundant room for the operations
of an energetic temperance society to repress the ravages
caused by ‘petit bleu’ and the opal colored liquor, which is
imbibed by most Parisians in a moderate quantity in order
to give them an appetite for dinner. Within the past fort-
night several deaths from drunkenness have occurred in the
metropolis. In one case a respectable official in one of the
public departments was found dead in his bed. In a cup-
board near him were several empty bottles which had con-
tained rum. The post-mortem examination disclosed the
fact that he had died from the effects of large and frequent
doses of undiluted Jamaica. Only yesterday a drunken
woman, hitherto an abnormal spectacle in the streets of Paris,
set fire to her clothes with a match on entering her room and
was burned to death. It is not at all uncommon to meet
workmen returning home so utterly intoxicated that they fall
down at every step, and are only preserved from breaking
their skulls or being run over by vehicles by the providential
intervention that watches over the inebriate. A short time
since I saw a drunken lamplighter trying to illuminate the
shades of evening by lighting a tree with his six-foot pole.
A magnanimous policeman, who for a few moments placidly
watched the man’s effort to pursue his occupation under
difficulties, finally went over to him, took the pole, lighted the
lamps, and sent the devotee of Bacchus home between two
boys.”

HE was Professor of Diseases of the Mind and Nervous
System, and wrote me, “ Your views of inebriety are extrav-
agant. I have never seen a case of disease pure and simple
among inebriates, and I think your journal and the theories
it promulgates are beyond the pale of scientific recognition.

my

~

Editorial, 55

.
Later, he wrote, “ My cousin is on trial for murder committed

in a state of intoxication. I am convinced he is diseased and

irresponsible ; will you send me papers and books that I may

be posted on the disease side of these cases.” The answer

was, “ Study your cousin’s case, as you would one of general »
paralysis. Go out in the street and study every inebriate you

can ; you will find more facts from this source, than has ever

been printed.”

THE TREATMENT OF INEBRIETY.

The result of all experience hitherto may be summed up in
one word—asylums. The patient should be placed where
restraint can be used to replace his own weakened will
power. His mode of life should be the most placid and
uneventful one, compatible with a certain degree of content-
ment, and he should be under the daily, nay hourly, observa-
tion of men skilled in that branch of the profession which
relates to inebriety. These indications can only be fulfilled
in an asylum. and to such he should go. It is to be hoped
that the public will one day see this matter in its true light,
and provide shelter for a class which needs medical care and
treatment to the full, as much as they who crowd our insane
hospitals, and which promises so much better results than
those suffering from any other form of mental alienation.
As bearing particularly upon this point, and showing the
opinion of men who have made a study of the matter, I can-
not forbear making the following quotation from a paper by
Dr. Crothers, of Hartford, Conn.: “In every town and city
of the country there are men and women who are slowly
committing suicide by drink; destroying the peace and hap-
piness of others, breaking up good order and healthy society,
and gathering about them influences which always end in
misery and ruin. Because such cases do not give strong evi-
dence of mental disorder, they are allowed to go on destroy-
ing both themselves and their families. Nothing can bemore
reprehensible than to stand by and see all this sacrifice of

both life and property, and not forcibly stop it. Every ine-
VoL. IX.—8

56 Editorial.

briate should be placed in an asylum, and cared for as an
insane man ; if he is incurable, keep him under restraint all
his life-time. This is humanity, this is charity, this is econ-
omy, and this is the highest civilization of the brotherhood
of man.” — Dr. Vittum.

NEED OF INEBRIATE ASYLUMS.

Dr. Jewell, the Superintendent of the Home for Inebriates,
in San Francisco, Cal., in a paper printed by the State
Board of Health, makes the following reference to inebriate
asylums: ‘“ The State should establish asylums for drunkards,
under the management of those having great experience, and
the courts, and Commissioners of Lunacy, should be author-
ized to commit chronic drunkards to these asylums, for not
less than one year, and in some cases for life. The first com-
mitment should be for one year, during which time the
patient should undergo a course of treatment for this malady.
At the end of his term he should be released, but if he
resumed his former habits of intoxication he should be again
committed, for two years. If committed a third time, it
should be for three years. The patients in these asylums
should be made to reimburse the State for their expenses,
either by paying for their keep, or by laboring at some trade
or employment, so as not to be an incumbrance on the State.
The money for the support of these institutions should come
from those benefited by the sale of alcoholic liquors ; and
there should be provision made in the law so that a certain
amount, say one-fourth, of the patient’s earnings should go
to the State, one-fourth to be retained for him, and paid to
him on discharge, and one-half to his family, if he has any ;
if no family, then one-half to the State, and one-half to the
patient on discharge. The State, the patient, and his family
would benefit greatly by such a course. Crime would
decrease, the death-rate would decrease, and human happi-
ness would be greatly increased. Time, restraint, moral in-

Editorial. 57

fluences, the exercise of strong will power, and constant
employment, are the means, with proper medicines and
discipline, by which drunkenness is to be cured.”

Tue end of the long trial was reached, the verdict was,
“Guilty of murder in the first degree.” The counsel for the
defense asked for a stay of sentence, and intimated the injus-
tice of the verdict. The judge denied this, and in his sentence
sneered at the medical witnesses, “as so-called experts in
drunkenness,” whose testimony was contradicted by two
centuries of study and experience, and who sought to get
legal recognition of a doctrine that was subversive of all law
and order. He thanked the jury for their courage in ignor-
ing this false theory of defense, and warned the prisoner to
prepare for the more terrible punishment in the next world.
The prisoner was a poor Andersonville soldier, who after two
years of hard service on the battle-fields, was starved nine :
months in this prison. He came home a wreck and an
inebriate. For twenty years he drifted up and down the
world, drank, and was sentenced to jail repeatedly for this
offense. He was alone and had no friends except bar-
keepers, and was a poor, broken-down inebriate, with dis-
eased body and brain. In a moment of great provocation
he struck a man, who was killed by the blow. Two medical
men examined him and swore that he was diseased and
irresponsible. They swore that inebriety was a disease, and
in this case the prisoner was fully insane. The governor
commuted this sentence to imprisonment for life, and the
judge labors under the delusion that the cause of justice was
subverted, and law and order is in great peril.

Demorest's Monthly Magazine for the new year, has in-
creased attractions, and may be said to be one of the best
family and home magazines published. Send the subscrip-
tion, two dollars for a year’s numbers, to the publishers, New
York city.

58 Editorial.

INEBRIATE JURORS.

A valued correspondent vouches for the following: Ina
western city an inebriate was on trial for manslaughter. The
defense was insanity from alcohol. After a long trial, and
deliberation of two days, the jury brought in a verdict of
guilty. A new trial was granted, on the grounds that two of
the jury were so much intoxicated as not to be able to decide
on the verdict. It was alleged that all the jury drank, and
had several free fights in the jury-room. At the close of the
second trial, one of the jury had an attack of delirium
tremens, and rushed for the judge, to whip him. In the
third trial, the jury brought in a verdict of guilty, but not
responsible. This was not accepted, then they disagreed.
The case was then taken into another court, where the plea
of guilty was made, and the judge sentenced him for life,
with a heavy fine. The defense now asks for a new trial, on
the ground of the incompetency of the judge, who, it is
claimed, was partially intoxicated when sentencing the
prisoner.

Tue inebriate is on trial for murder. The law inquires:
Did the prisoner have the power to distinguish between
right and wrong? Was the crime committed under an
insane delusion? No matter what the answers may be to
these inquiries, the law assumes that all drinking is voluntary
and under the control of the person, and hence he is to be
condemned and punished always. The only defense allowed
is that of delirium tremens. The victim is punished. The
supposed justice is great injustice. The truth of voluntary
control in drinking is a great untruth, which any study will
disprove.

Tue great mortality among English medical men contra-
dicts the oft-repeated assertion that education in physiology
and the nature of alcohol will prevent men from drinking.

Clinical Notes and Comments. 59

Clinical Notes and Comments.

CHLORAL POISONING.

Dr. Lewis in the New York Medical Monthly, writes on
the above subject, that alcohol is in no sense an antidote for
chloral poisoning, yet persons who take alcohol are less
susceptible to chloral poisoning. He mentions a case where
a dipsomaniac, under treatment, was given 100 grains to
procure sleep, and died soon after. He mentions another
case, where an inebriate was given 80 grains, at one time,
with no bad effects, and after died from the effects of 20
grains. He concludes that chloral is a dangerous remedy to
produce narcotism in inebriates, that it should always be
given with great care, and also, that its habitual use is worse
than that of opium.

OPIUM NEUROSIS

is a central neurotic change brought about by the long-per-
sisting perversion of function and impairment of central
nervous nutrition from its persisting presence in the
nutrient pabulum of the circulation. The psychosis of
opium taking is a blended intoxication and chronic poisoning
of the psychical centers of the brain; other symptoms of
acute opium poisoning are essentially different, being mainly
a profound paralysis of sensation and of the centers of
involuntary motion, especially having their origin in the
medulla and upper part of the spinal cord— profound nar-
cosis, lowered respiratory movements, etc., while chronic
opium poisoning, or meconeuropathia, is characterized by
repeated nerve excitations, in which the nerve centers, not
being completely overcome, a kind of tolerance is estab-
lished, with progressively developing abnormal molecular
neural changes, which are as repeatedly covered up and

60 Clinical Notes and Comments.

masked by the renewed doses, till some sudden deprivation
of the drug or failure to appropriate it, reveals, in full force,
the neural mischief which has been gradually done. Opium,
like a bank defaulter, both makes and masks the mischief
done, which may be kept concealed so long as he stays in the
institution. — Dr. Hughes in “ Atienist and Neurologist.”

SPECIAL PHASES OF INEBRIETY.

Some inebriates are exceedingly economical during the
carouse, and so manage to satisfy their desire for drink
through the pockets of friends or fellow-drinkers, and only
drink when they are invited. On the other hand, a lavish
wastefulness characterizes some, and they are ever ready to
treat, not only friends, but any who may be near at hand.
These peculiarities are not accidental, but uniform in the
individuals possessing them. Some drink only. on Satur-
days, and oftener after sundown on that day, sleep off the fit,
go to church the next day, and are sober the remainder of
the week. Some have peculiar days on which they become
debauched, and do not indulge at other times. Public holi-
days, private anniversaries, as of marriage, or the birth of a
child, are occasions that are thus celebrated. I have known
the proprietor of an extensive mercantile house, who, for
eleven months and two weeks of each year, applied himself
closely to business, in which he was successful, who, on the
same day of the same month in each year, joined himself to
a man of low estate, with whom he could not be on terms of
social freedom when at home and sober, and occupied two
weeks on a fishing excursion. Before the arrival of the
appointed day he arranged his business for a fortnight’s
absence, drew checks to meet the wants of his home and his
store, made appointments for the day of his return, and
equipped himself to meet his companion, who was to serve
as his guide and caretaker. With a boat on the bay, or
river, a tent for the shore, and an abundant supply of
“creature comforts,” they commenced at the appointed time.

Clinical Notes and Comments. 61

Fishing by daylight, and tenting at night were to be con-
tinued during the allotted vacation, under the following
agreement:

For a dozen consecutive nights, the merchant was to be
supplied with whisky in quantities sufficient to produce
intoxication, and his companion was to keep sober, in order
to protect their property and themselves, and to do all the
offices of cook and “ maid of all work.” The last day and
night were to be spent in “ sobering up,” and getting things
in order for a return to the duties of the head of a family,
and the head of a mercantile house. At no other time in the
year did this gentleman indulge in strong drink, and it was
the only specified time when the fisherman was under bonds
to keep sober. Before leaving home, an estimate was made
of the exact quantities of spirits needed for the whole time,
and no more procured; so that the fisherman was obliged to
be exact in portioning his rations, and a check was thus
placed upon himself— Dr. ParrisH.

Inebriety is a disease, and often a symptom of cerebral
disorder. Like other diseases of the brain it may be inher-
ited; may skip over two or three generations and break
out in a family that supposes it had long been delivered from
its presence. Like other chronic nervous diseases it is very
obstinate, and sometimes utterly incurable. Like other
chronic brain diseases, it needs both physical and metaphysi-
cal medical treatment, medicine for the congested or ex-
hausted brain, as well as rest, relaxation, advice, care, watch-
fulness, exhortation, and in some cases compulsion.
Moral or metaphysical treatment alone will not avail to cure
it usually, any more than it will avail to cure epilepsy, or neu-
ralgia, or paralysis, or insanity.— Dr. GzorGcE M. Brarp.

Coffee-houses to take the place of bar-rooms are being
established in New York, and will no doubt serve a very
useful purpose.

62 Clinical Notes and Comments.

The inebriate is always a man with an intemperate and
distempered mind. He is thoroughly insincere to himself
and every relation of life about him.

Jnebriety must be studied outside of any preconceived
theory of its origin and character. Each case must be
examined as something new, and from its classified symp-
tology, the real facts will be apparent.

The Physicians Visiting List for 1887, by Lindsay &
Blakistons of Philadelphia, Pa. has been before the public
thirty-five years, and has attained a degree of perfection
that commends it to all physicians.

The Reheim’s Chamber of Commerce reports that over
five millions bottles of champagne less were sold in 1886
than in 1885, also ten millions less than in 1882-3. England
is the greatest consumer of champagne.

Seventeen per cent. of the insane under treatment in
Ohio, are classed as coming from inebriety. Heredity is put
down as present in thirty-eight per cent. Of the insane in
the professions, physicians are in the largest proportions.

Destructive manias in inebriates who are intoxicated,
seem to depend on some state of cerebral anemia. In such
cases, both heart disease and severe forms of dyspepsia will
be found associated. In some cases, an irregular heart
action precedes the mania, which may be foreshadowed for
some time.

Dr. Mays, of the Stockton Insane Asylum of California,
writes: ‘One-half of the insane owe their derangement to
hereditary influence, inheriting an ancestral taint or predis-
position. The families of intemperate parents furnish the
recruiting ground for insane asylums. These unfortunate
children, if not idiots or epileptics, are liable to grow up with
querulous, explosive tempers, with feeble powers of self-
guidance, weak in temptation, unstable, self-indulgent, vicious,
hysterical. They form the bulk of what is known as the
defective classes.”

Clinical Notes and Comments. 63

The fartherest researches into the nature and character
of inebriety, give us only fragmentary views of the whole
subject. Like men looking out from a window, we only get
narrow and partial conceptions of this great army of neu-
rotics. From the procession in front of us, we can faintly
realize the origin and destination of the march.

According to the internal revenue returns for 1883, two
hundred and six thousand, nine hundred and forty-four
places were licensed in the United States as wholesalers and
retailers of malt liquors and spirits, including breweries and
rectifiers. In 1884 this number had decreased eight thous-
and eight hundred and fourteen from the year before.

An, eminent physician, now dead, protested earnestly
against the ignorance of explaining morbid mental phe-
nomena by theological terms, and yet fell into the same
error in calling all drunkenness a vice and sin. His errone-
ous observation and reasoning has done much to retard the
progress of truth in this direction, and the real aid he gave to
science, was neutralized by his defectively biased judgment.

The first Asylum for Inebriates has just been opened
near Milan, Italy. It is intended for the better class, who
can pay for the best medical care and surroundings. In all
the hospitals for insane, wards are set apart for inebriates,
and their treatment as partially insane, has been carried on
successfully for many years, but this is the first organized
effort to treat them in a separate hospital.

According to Mr. Brace of the Children’s Aid Society of
New York city, the Industrial Schools of that organization
are doing much to prevent the growth of a race of inebriates.
He says that drunkenness has decreased fifty per cent. in
the last ten years, from the police returns, and crime has
decreased twelve and a half per cent., all of which can be
traced to these efforts to prevent recruiting from the young
into these dangerous, defective classes. During the past
year, eleven thousand children have been under their care
and instruction, and thirty-two hundred have been sent to
new homes in the West.

Vox. IX.—9

64 Clinical Notes and Comments.

MEDICINES FOR INEBRIATES.

We have sought to have on our advertising pages only
such remedies as we could commend to all our patrons. We
take great pleasure in calling attention to the following,
believing they will be found of great value and ‘usefulness :

Coca Cordial, prepared by Parge, Davis & Co., is very
extensively used as a tonic in all ‘cases of nerve debility.

The Hypo-Phosphates of Fellows can be relied upon in.
states of general degeneration and failure of brain and nerve
force. It has been used for years in England in large hospi-
tals, as well as private practice.

The Murdock's Liquid Food may be given as a nutrient
tonic where syphillis or scrofula has complicated the disease.
It is largely used in Boston, and is highly commended.

Lactated Food, by Wells, Richardson & Co., has been
used in opium cases to allay‘the irritation of the stomach
with the best results.

Peptonized Cod Liver and Milk, by Reed & Carrick, is
the best and latest preparation of oil as a medicinal tonic.
In cases of inebriety where profound degeneration is going
on, this is unequaled as a remedy.

Mattine, with the various iron and vegetable.tonics com-
bined, is an indispensable remedy in a great variety of cases.
It should be in the stock of all physicians.

The Anglo Swiss Milk Food, made by a company of
this name in New York, has the endorsement of the leading
physicians in this country, and its medicinal value seems to
be established beyond question.

Colden’s Liquid Beef Tonic should be given in gastric
disturbances following nerve exhaustion, and in many forms
of inebriety it is a good substitute for spirits for a time.

Lactopeptine is a standard remedy which every physician
should have in his case.

Horsford's Acid Phosphate is another remedy that can
be used in a great variety of diseases with the best results,
and should be always at command.

Papine is a de-narcotized opiate, which we have used in
insomnia and the delirium from alcoholic excess, getting
better results than from any other sedative. In delirium
tremens it is highly commended.

THE

QUARTERLY JOURNAL OF INEBRIETY.

Vol. IX. " APRIL, 1887. No. 2.

This Journal will not be responsible for the opinions of contributors, unless
indorsed by the Association.

THE INVARIABLE TENDENCY OF DRUNKEN-
NESS TO CRIME.—WHENCE COMES IT?

By T. L. Wricut, M.D., BELLEFONTAINE, O.,
Author of “Inebriism, a Pathological and Psychological Study.”

I refer to the essential nature of drunkenness as weak-
ening the moral perceptions, and thus favoring the assaults
of temptation, whether it comes in the guise of seductive
immorality or in the form of flagrant criminality.

With respect to the irrepressible proclivity to wrong-
doing which is characteristic of drunkenness, the key to the
whole discussion is found in the words: weakening the moral
perceptions. It is therefore right that some attention should
be given to the existence of the fact, as well as to the mean-
ing of it. In addressing the readers of this Journat, I
assume some things as granted, upon which, in popular pub-
lications, I would think it proper to dilate somewhat.*

The anzesthetic — the benumbing — the paralyzing influ-
ence of alcohol upon the nervous system is distributed im-
partially over the whole, the universal nervous organism. It
is displayed in the structures of ordinary sensibility through

*1I have discussed the points referred to, in the JoURNAL OF INEBRIETY,
July, 1882, and October, 1883, and also at length, in my little book — INEBRI-
Ism.— W.

66 Tendency of Drunkenness to Crime.

the ‘more or less complete suspension of common feeling,
considerable injuries being but slightly noticed, or not
noticed at all. It is seen in the system or centers of the
motor capacities through the inco-ordinate and partially sus-
pended motor movements: the sensibility and force of that
sub-system of nerves being, in a great measure, destroyed.
The lethargic influence of alcohol upon nervous function is
seen also in the suppression of acute and vivid intellectual
movements ; the nervous centers presiding over the rational
powers being disabled, repressed, stupefied. “They err in
vision, they stumble in judgment,” being “swallowed up of
wine.” The disabling effects of ‘strong drink are likewise
observed in the obtunding of the association fibres and cen-
ters of the nervous system — out of the perfect freedom and
vitality of which, the sense of personal identity, and all ideas
of moral responsibility and duty are formed and have their
being.

The corruption, and indeed dissolution, of the moral na-
ture through the power of alcohol, are open to observation
in the petty and despicable vices of drunkenness, as well as
in the astounding baseness and seeming depravity of its
more conspicuous outrages.

The very nature of the offenses against law and decency
which belongs to drunkenness, often betrays their origin.
As a rule it may be said that the shortcomings and crimes
of drunkenness are not those of premeditation and malevo-
lent reasoning ; are not of choice; are not incited by natural
and regular motive: but they owe their existence to simple
defect —to the incapacities and’ irregularities of moral
deformation — to impulse, rather than to deliberation and
will. These crimes become possible, and indeed inevitable,
because the only power really adequate to their repression is
physically inoperative. The natural defense against their
exhibition and activity — the nervous basis of the moral con-
stitution — is broken down and disabled.

While this condition of nerve-defect may, to a certain
degree, eliminate premeditated malice from drunkenness,

Tendency of Drunkenness to Crime. 67

that condition is all the more dangerous to society, by reason
of its entire independence of mental control. The limit to
crime is unbounded. It may extend into the regions of
frenzy — knowing no law, and being totally insensible to
restraint. It is obvious that, in proportion as the feelings
are removed from the restraints and supervision of reason
and judgment, they come under the dominion of selfishness,
passion, and trust; and these, in drunkenness, often com-
prise, in themselves, the whole being. The moral feelings
having become oblivious, selfishness, passion, and lust assume
their place and sway and drive the mind to their own
interests.

Hence the offenses and crimes of drunkenness, while not
always henious in the ordinary sense of the term, are apt to
exhibit an astonishingly selfish turpitude. They extend all
the way from simple untruthfulness to the vilest indecencies,
to assaults evincing unspeakable depravity, and very often,
also, to the most unpitying truculence and murder.

Remorse is feeble in the drunkard, even when sober;
but when actual intoxication is upon him, it is impossible.
The more terrible crimes of drunkenness, therefore, resemble
the deliberate, but insensate bloodthirstiness of some rep-
tilian monster, in whose physical structure the neurine
instruments of the finer sensibilities have never been placed.
And the reason of this is plain: the drunken man and the
saurian are, for the time being, established in some consid-
erable degree of relationship with each other. The moral
sensibilities of the former are stupefied and dormant ; while
in the latter they have not, and never had, an existence.

In short, all the several portions of the nervous organism
are obtunded, paralyzed, repressed by the toxic properties of
alcohol when a man is drunk. Not only are the nerve-func-
tions subdued and hindered by a reduced impressibility of
the nerve structure, but the strength and tone of the really
repressive nervous functions themselves are impaired, so
that inhibition is itself inhibited. The mind acts not unlike

68 Tendency of Drunkenness to Crime.

a team of balky horses — there is much splashing and plung-
ing, and make-believe, but little actual force or progress.

The nerve tissue being disabled and poisoned, its func-
tions are correspondingly incomplete and irregular. And
this state is one of the constituent conditions of drunkenness.
The idea that intoxication is the representative of some radi- °
cally new power or force introduced from without, that it is
solely an exposition of the peculiar'and superadded proper-
ties of alcohol, is an error. Drunkenness is the representa-
tion of disabilities imposed upon the entire round of nerve-
function by virtue of the abortive impress of alcohol. It is
incorrect to say that alcohol invests the mind and disposition
with new characteristics, either good or bad, derived wholly
from that substance, and which have no actual foundation in
human nature. It deranges, and at times destroys the
mutual inter-dependence of the several subsidiary nervous
organizations which, in their collective capacity, preside over,
and formulate human character. It also weakens, and in
varying degrees depresses, or even extinguishes them in
severalty.

The great law of physical or mental, or moral monstrosity,
is defect. Deformities of redundancy may be corrected in
the physical body by amputation or excision ; and undue
excitement of the natural powers of mind and morals is fre-
quently amenable to therapeutical appliances, as well as to
the restraints of mental effort and volition. But absence of
feature or limb, or deficit in the mental or moral instruments
is irremediable, is fatal. Drunkenness, when in full tide and
completion, is moral monstrosity.

It is doubtful if the influence of alcohol upon the moral
constitution of man is in any degree modified by the civil or
the social habits of life. Education, in many ways a power-
ful conservator of morality, is nearly, if not quite, powerless
for good in drunkenness ; for the moral capacities, ordinarily
obedient to the commands of mental culture, are absent, or
in a state of insensibility. A rational view of this subject,
as well as observation, teaches that with respect to the refine-

Tendency of Drunkenness to Crime. 69

ments of education, drunkenness is entirely independent of
them, because unconscious of them. In so far as this point
is concerned, alcohol appears to produce the same effects
upon the cultivated, as upon the ignorant and vulgar.

But in its specific effects upon personality, alcohol un-
questionably acts in a disabling manner, in some degree
differently, in different individuals. And it is reasonable to
suppose that in particular persons it acts more directly on
certain sub-systems of the nervous organism, while in others
it affects more decidedly other systems. Sometimes, for
instance, the disability seems to be confined especially to the
movements of the limbs: at other times, the intellectual
faculties appear to be the most affected; while again, the
moral capacities are mainly impressed and paralyzed. These
considerations sufficiently explain the well-marked distinc-
tions that often appear in the leading characteristics of
intoxication in different individuals. “They also show the
reason why drunkenness in the same person exhibits differ-
ent leading features in separate seasons of excess. In addi-
tion, they interpret certain facts which appear most clearly
in a protracted period of drunkenness ; the most obvious and
dangerous moral obliquities, for example, come into view, as
a rule, near the end of a debauch, when the moral feelings
have been bereft of sensibility, if not, indeed, of existence.
But notwithstanding the differences that may appear in the
completeness of the anzesthetic state in divers and sundry
persons, and notwithstanding its greater oppression at times,
on one part of the nervous system than upon another, the
leading fact remains, that in every instance of intoxication
the entire nervous organism is, to a notable extent, brought
under the corrupting and ignominious domination of alcohol.

It evidently requires the active and working powers of
the nervous system to bring the intellectual faculties into
normal relationship with things exterior to them. The same
qualities of nervous freedom and brightness are necessary,
in order to rightly contemplate and understand the nature
and duties of morality. The anesthesia of drunkenness pre-

7O Tendency of Drunkenness to Crime.

vents a just and natural conception of the moral nature, and
of its proper relationships and dependencies. When a man
is drunk his moral perceptions are dulled and obscured ; they
take place in shadow and darkness. Moral characteristics,
as seen clearly and readily by the healthful powers, are un-
noticed by the mind whose instruments are pinioned and
prostrate through alcohol. The final result is, that drunken-
ness always so affects the moral perceptions that the natural
barriers and antipathies to vice and crime are thrown down ;
and the way is smoothed over for the approach and entrance
of temptation in every form, and from every direction.
Compunction is impossible in drunkenness, and the ine-
briate indulges, unrestrained, in a swarm of vices. Amongst
these, none is more audacious or contemptible than lying.
No matter how “fine a fellow” the drunkard may be, his
word is taken with suspicion or protest. Yet, it is not pre-
sumed that drunkenness strenuously seeks out falsehood. It
does not take much pains to seek anything. The drunken
man simply seizes the shortest and easiest way to solve any
and every problem presented to him. His moral imbecility
is so great that,he holds truth in cheap estimation. He is
incapacitated from analyzing its nature, for he is incapable
of feeling it; and he is very liable to employ falsehood in all
emergencies that will, in his opinion, subserve his interest
or contribute to his ease. This is especially the case in
things that relate to the gratification of his propensity for
intoxication. In pursuit of this object, there is a pretty con-
stant resort to some kind of deceit and misrepresentation.
Only a few days ago a man who is a frequent and furious
spasmodic drunkard, and who had recently pledged himself
to total abstinence from liquor, called to see his sick mother.
Having satisfied his mind that there was not likely to be any
sudden crisis or emergency in her case, he informed her that
he had very pressing business in two or three of the neigh-
boring towns. Ile solemnly declared to her that she need
not be uneasy about his drinking, as he had not the least
desire to indulge in liquor. He started for the depot, and

ae

Tendency of Drunkenness to Crime. 7

before reaching it, was well filled with whisky. In two days
he returned bloated, shameless, and defiant. His “business”
was all a lying pretext. Such men often form their schemes
for a season of drunkenness with great elaboration and cun-
ning ; beginning their approaches from afar, and never hesi-
tating to employ a mountain of lies in furtherance of their
object.

The chronic drunkard is apt to become habitually false on
all subjects and on all occasions. He is prone to indulge in
stories that are silly as well as incredible, and that, too, with
great precision of statement, and detail of circumstance. I
knew a physician who had for many years tampered with
alcohol, and morphia, and chloral. He lived in the capital
city of a Western State. Ona visit East he busied himself
in recounting wonderful stories. He informed some friends
that “it was a curious fact that drugs were cheaper in the
Western cities than in the Eastern. Take quinine, as an
example,” said he, “I purchased an ounce out West, and I
was surprised to learn that the price was only fifty cents. I
told the druggist,” he continued, “ I would take two ounces at
that price, but he replied that if I took a dollar’s worth he
would make it three ounces for that money” —and much
more in the same strain.

This habit seems often to be a kind of automatic repre-
sentation of the long-existing moral deficiency inseparable
from drunkenness. It is the unconscious outcome of pro-
longed moral hebetude in relation to many essential elements
of a useful life, and especially in relation to the cardinal vir-
tue of truthfulness. It is, however, an incident showing the
innate tendency of drunkenness to vice and crime.

The news of the day fully illustrates the effects of alcohol
in the production of crime. Some man in a responsible posi-
tion begins to indulge in wine. The next thing to appear is
the “strange woman.” Then expenses increase, and funds
are embezzled; then gambling or forgery are resorted to;
and last of all, flight, or punishment, or suicide: but in every

instance comes degradation and ruin. All this time alcohol
VoL. IX.—10

72 Tendency of Drunkenness to Crime.

is paralyzing the moral sensibilities, and deceiving the rational
judgment as to the facts and consequences.

And so it is that intemperance always modifies the nor-
mal characteristics of human nature. The mind, therefore,
being indelibly impressed by the defects imposed upon it by
drunkenness, is transported from a position distant from
crime, to another position not so distant.

Unquestionably the natural predisposition to criminality
is greater in some minds than in others; and in such, the
work of alcohol in the production of crime is easy. While
the movement /owards crime always is present under alco-
holic influence, yet, the goal of actual criminality is not
reached under equal alcoholic impressions—the natural
affinity of the human disposition with criminality being un-
equal in different’ individuals-— being, no doubt, entirely
absent in many. But that drunkenness increases the sus-
ceptibility to criminal influences where it is already in exist-
ence, and creates a susceptibility where it does not naturally
exist, must be true from the fact that an obtuse and lethargic
moral sense is an invariable and impregnable part of that
abnormal condition known as drunkenness. An intoxicated
man will commit offences in thought, in speech, and in con-
duct which, in his sober mind, he would view with shame
and indignation. The unvarying tendency of drunkenness
is towards crime.

I will indulge in a single general inference. When soci-
ety, in consideration of money paid into the public treasury,
becomes a partner in the dramselling business, it is engaged
in weakening the moral perceptions of human kind, and it
becomes a party to the crimes of alcohol.

The expenditures for Wine, Spirits, and Porter at the
Pennsylvania Hospital for the past year, were $2,031.95.
The bills for medicines, for the same period, were $1,774.88.
The physicians seem to be ardent followers of the Todd4md
Bennet system ‘of practice.

Inebriates in Insane Asylums. 73

INEBRIATES IN INSANE ASYLUMS.

By T. W. Fisuer, M.D.,

Superintendent Boston Lunatic Asylum.

For many years there have been attempts on the part of
superintendents of insane hospitals to secure the passage of
a law allowing the commitment of dipsomaniacs to some
special institution for their custody and treatment. In Eng-
land this movement resulted, after years of discussion in
Parliament, in the passage of an habitual drunkard’s bill,
whereby such persons may voluntarily seclude themselves in
special institutions for definite periods. The writer has often
advocated before legislative committees, and the Board of
Health, Lunacy, and Charity, and in a paper on “Insane
Drunkards,” read before the Massachusetts Medical Society,
in 1879, legalizing the commitment of inebriates to special in-
stitutions for long periods of from one to three years. He also
demonstrated, in defending an action for damages for im-
proper certification of an inebriate, at considerable trouble
and expense, that, in the opinion of the Supreme Court of
Massachusetts, there is such a disease a dipsomania, and that,
in the absence of special institutions, such cases might be
committed to hospitals for the insane.

Soon after this decision, if not in consequence of it, re-
newed efforts were made by the Board of Health, Lunacy,
and Charity, to secure the passage of a law on this subject,
and in 1885 the following law, not wholly in accord with
their recommendation, was passed :

An Act CoNCERNING HOSPITAL TREATMENT FOR CERTAIN PERSONS SuB-
JECT TO DIPSOMANIA OR HABITUAL DRUNKENNESS.
Be it enacted, etc., as follows :

SECTION 1. Whoever is given to or subject to dipsomania, or habitual
drunkenness, whether in public or in private, may be committed to one of the

74 Inebriates in Insane Asylums.

State lunatic hospitals ; provided, however, that no such person shall be so com
mitted until satisfactory evidence is furnished to the judge before whom the
proceedings for commitment are had that such person is not of bad repute or
of bad character, apart from his habits of inebriety.

SEc. 2. The provisions of chapter eighty-seven of the Public Statutes, and
of acts amendatory to such chapter, relative to the commitment of an insane
person to a lunatic hospital, shall be applicable to, and shall govern the com-
mitment of, any person under this act except that in all proceedings relative to
the commitment of any such person it shall be specifically alleged that he is
subject to dipsomania, instead of alleging that he is insane.

SEc. 3. All the laws relative to persons committed to lunatic hospitals on
ground of insanity shall apply to persons committed thereto under the pro-
visions of this act ; provided, that no person so committed shall be discharged
therefrom unless it appears probable that he will not continue to be subject to
dipsomania or habitual drunkenness, or that his confinement therein is not
longer necessary for the safety of the public or for his own welfare.

Src. 4. This act shall take effect upon its passage. [Approved Fune 18,
1885.]

It will be seen this act does not include this hospital in
its provisions; but it has been construed as applying to it by
the committing magistrate. The provision allowing commit-
ment to lunatic hospitals may have been a compromise on
the part of the legislature to avoid the expense of establish-
ing a special institution for inebriates. It certainly was not
what superintendents had asked for, but what they had al-
ways earnestly protested against. They had hoped for a
law to relieve them of such inebriates as did, from time to
time, get committed to their hospitals on the claim that they
were insane; and a law was passed legalizing the commit-
ment to insane hospitals of habitual drunkards without any
inquiry as to their sanity. This law was passed in the face
of the fact that all the hospitals were full to overflowing with
cases of ordinary insanity, so ‘that hundreds were compelled
to sleep in attics and on corridor floors. Under this pres-
sure one superintendent expressed himself as having degen-
erated into a big policeman, spending his time in trying to
keep order and maintain. discipline in a crowd of lunatics
and inebriates, instead of devoting his time to his proper
work of treating insanity.

This law, as it stands, is defective, and liable to abuse in
several ways. In the first place, inebriates should be com-

Inebriates in Insane Asylums. 75

mitted to some special institution and not to a lunatic hos-
pital. They not only take up the room needed by the insane,
but after the first few days they are practically sane, and
find themselves surrounded by the depressing influences of
an insane hospital, and subjected to restraints and regula-
tions primarily adapted to the insane _To be sure, they are
better off then when at large, exposed to temptations to
drink, and much may be done for them in the way of kind
treatment and moral management ; but they are out of place,
and they often feel it and show it ; while many are consider-
ate and give little trouble, sometimes they interfere
sadly with the discipline and interrupt the harmony of an
asylum ward. They may refuse to associate with the insane,
or claim privileges which cannot be granted their insane
neighbors, and which if granted them, cause more or less
jealousy and hard feeling. In the second place they should
be committed for a definite time, either for one, two, or three
years. This is necessary, because a long hygienic treatment
is required to restore the enfeebled brain to its normal state
of health and vigor, and to allow the weakened will to regain
ascendency over the appetite for stimulants. The inebriate’s
whole constitution needs reconstruction, and this process
must not be interrupted by occasional drinking. It is better
also for the inebriate to know definitely what he is to look
forward to, so as to ensure contentment and repose of mind
as far as is possible. The patient should expend his energies
in healthful employment and in the attempt at recovery, and
not in efforts for his own release. The present law subjects
the superintendents to constant importunities for discharge
on the part of the inebriate and his friends. Plausible reasons
are advanced, ingenious schemes are made use of, and all
sorts of influence brought to bear for a patient’s discharge
when one would have supposed that removal from home for
‘a year would have been a great relief to the inebriate’s fam-
ily and friends.
I havé endeavored to conform to the rule here that no
habitual drunkard shall be discharged under a year’s deten-

76 Inebriates in Insane Asylums.

tion, as that was the shortest period of commitment ever pro-
posed in the discussion in the Legislature and Parliament. I
failed in applying this rule in almost the first case committed.
After a two months’ residence, this person was allowed to go
home on trial, at the personal request of the judge who com-
mitted him, to avoid a long and unprofitable rehearing of the _
whole case on its merits. Fortunately, this patient has so
far justified the confidence reposed in him, and has been
discharged.

In the third place, the law should allow compulsory labor
to be performed by inebriates, within certain limits, and
at the discretion of the superintendent, partly to re-imburse
the Commonwealth for their support, but more especially as
a hygienic measure. Idleness in the wards of a lunatic
hospital is as far as possible from the best treatment of in-
ebriety. Varied employment in the open air when possible,
for a few hours daily, with similar periods for recreation out
of doors is the essential feature of such treatment. The ma-
jority of insane persons are unable to work, while most in-
ebriates are. It would be wrong to compel an insane person
to work, while inebriates might be induced to work, by prom-
ises of reward, deprivation of privileges, and other forms of
moral suasion. The opportunities for work in most hospitals
are already too limited, and lack in variety, while in an inebri-
ate asylum there would be no objection to the use of tools of
any‘kind.

The law is also liable to abuse in several ways. In the
first place, physicians are not unlikely to apply the law to
some inebriates who are not of unsound mind. The use of
both terms, *‘dipsomaniac” and “habitual drunkard” tends
to create confusion and ambiguity in certifying. Dipso-
mania, either inherited or acquired, would be a proper cause
of commitment. Persons affected with an inherited tend-
ency to that form of impulsive insanity, characterized by an
insane desire to drink, are dipsomaniacs by inheritance.
These cases are rare; they have a defective or degenerated
cerebral organization, which leads them to impulsive acts

Inebriates in Insane Asylums. ugg:

through a weakness of the will and excessive energy- of the
animal instincts. In another more numerous class the brain
has been so damaged by inebriety or other causes, such as ill
health, blows on the head, sunstroke, etc, as to prevent all
possibility of self-control in relation to drink. These are
causes of acquired dipsomania. Persons of sound mind who
drink habitually from choice are not proper subjects for com-
mitment. They are vicious drunkards, who should be pun-
ished rather than treated. These are nice distinctions it is
true, but they are real ones, and it is therefore important that
physicians should look carefully for the element of unsound-
ness of mind in the cases they are called on to examine.

There is also some danger that the judges may not suf-
ficiently regard the clause which requires that satisfactory
evidence shall be furnished that the inebriate is not a person
of bad repute or of bad character apart from his habits of
inebriety. Such evidence is not likely to be presented unless
demanded, and the facts carefully elicited from reluctant wit-
nesses. It would, indeed, be unfortunate if our insane hos-
pitals should be used as convenient retreats for vicious and
disreputable drunkards to recuperate in.

The preceding remarks are based not so much on the
actual operation of the new law as upon our past experience
with inebriates, generally. From January 1, 1881, to the
passage of the new law there had been received, either com-
mitted as insane, or as voluntary patients, fourteen dipso-
maniacs. Of these, two voluntary cases still remain, one
slightly demented, and one who goes out daily in search of
employment, and who is about to be discharged ; two volun-
tary cases are at home, and doing fairly well; one is at work
in a good position ; one is in the house of correction; and
one has been committed to another hospital. Of the com-
mitted cases, one has been repeatedly sent to Deer Island,
and six are at home, and doing well as far as is known. The
results in these fourteen cases are certainly more favorable, as
regards recovery, than the same number of insane cases
would show.

78 Inebriates in Insane Asylums.

Ten persons have been committed under the new law
since June 18, 1885,— seven males and three females. Of
these, one was discharged six months ago, and has not re-
lapsed ; two have been out on trial, and relapsed; and the
rést remain,—three of them being hopelessly demented.
These three might have been committed as insane, and they
now belong to the numerous class of patients made insane
by drink. i :

Report on Classification of Mental Diseases, as adopted
at the Saratoga meeting, by Hon. CLark BELL, the Ameri-
can delegate, is an admirable grouping and plan of classifica-
tion which reflects great credit on the committee. It is as
follows: 1. Mania— Acute, Chronic, Recurrent, Puerperal.
2. Melancholia— Acute, Chronic, Recurrent, Puerperal. 3.
Primary Delusional —Insanity. 4. Dementia — Primary,
Secondary, Senile, Organic Tremors, Hemorrhages. 5. Gen-
eral Paralysis of the Insane. 6. Epilepsy. 7. Toxic
Insanity (Alcoholism, Morphine, etc.). 8. Congenital Men-
tal — Deficiency, Idiocy, Imbecility, Cretinism.

The Internal Collector reports an increase of seventeen
more distilleries in Georgia, during the last year, and also
increased production of spirits. A great increase of licenses
granted are also reported, in Vermont, Pennsylvania, Indiana,
Michigan, Wisconsin, and Kansas. One hundred and four-
teen new distilleries have gone into operation in 1886, over
the country.

The Annual Report of the New York State Board of
Charities for 1886, show an increase of insane, in the different
asylums, of eight hundred and twenty-six during the year.
Also an increase of paupers and reformatory classes. This
can be traced in some measure to the ruinous policy of “ Ring
rule” which has existed for a long time.

Death in a Turkish Bath. 79

DEATH IN A TURKISH BATH.
By Cuarves H, SHeparp, M.D., Brooxtyn, N. Y.

The recent case of death of an inebriate who went to
sleep in a Turkish bath, reported by the Loxdon Daily News,
has been the text for much comment and many reflections,
based more on imagination than solid facts. There may be
danger in sleeping in a temperature of 120°, but it is infini-
tessimal. Do we hesitate to go to sleep because the night
is very hot? By no means. There is, however, great dan-
ger in the habit of excessive drinking, whatever the person
may do afterward, whether it be going to the Turkish bath
or to church, but the bath would be the safest place to go at
that time. The habit of the bath is a most laudable one,
and is to be encouraged at all times, as it tends to the wel-
fare and betterment of the community — to elevate, and not
degrade, man. It is on the side of virtue, and not of vice.
Because some may, at times, use it to get relief from their
excesses is no more the fault of the bath than is the fact that
people will sin during the week and go to church on Sunday
to get absolution the fault of the church. People are not
made weaker or debilitated by the bath. On the contrary,
they are made stronger and more vigorous and more able to
use what strength they have. Disease and bad habits most
certainly weaken, but the bath never. Let us look a little
further and not hastily say, when a man dies, that the last
thing he touched killed him. There is too much reasoning
from the surface. Is the sun to be blamed for bringing
noxious air from undrained swamps? If one takes a Turk-
ish bath to-day, and to-morrow is attacked with rheumatism
or other disease, is that the fault of the bath? Emphati-
cally no.

Prof. Draper, in one of his lectures, states that “a sea-
VoL. IX.—11

80 Death in a Turkish Bath.

man will pass from regions where the mercury freezes to the
equator, where the temperature is 130° in the shade, without
serious injury.” Could any one be so foolish as, for one
moment, to think that, when in the higher temperature, they
did not both eat and sleep with impunity, and does not the
experience of travelers confirm this, over and over again?
Then there is the region of equatorial Africa, where the heat
experienced and recorded by Capt. Griffiths was 156° in the
sun, and 132° in the shade. Had they not slept and eaten
while there, neither he nor his companions would have sur-
vived to tell the tale. As an instance of desert temperature,
Humboldt refers to Capt. Lyon, who experienced, for “ whole
months, the thermometer between 117° and 128°, in the
oasis of Mongouk, Sahara. In the western part of Turkis-
tan, a region of Central Asia, the temperature ranges from
26° below zero in winter to 150° above in summer; and yet
people are born, live, and die there.

Dr. Hammond says: ‘The place with the highest tem-
perature, within my knowledge, at which a man can sleep
with safety, not, however, with any degree of comfort, is Fort
Yuma, in Arizona. I have known the temperature there to
be 120° in the shade, and fully as hot at night.”

The mean temperature at Fort Mojave, Arizona, for the
months of June, July, and August, in 1870 and 1873, ranged
from 116° to 118°. Of course the extreme was much above
that.

If it is a fact that the bath is weakening, how is it that
persons, weakened and debilitated by disease, can take one
or two baths a day and rapidly recover? Again, how is it
that the attendants have worked in the heat of the bath sev-
eral hours daily for years and not lost a day from sickness?
A fact most prominent in relation to these attendants is that
they invariably improve in health and strength after com-
mencing that kind of work. Mr. D. Urquhart, to whom
modern civilization is indebted for the revival of the ancient
Roman, or Turkish bath, as it is now called, states, in the
“ Manual of the Turkish Bath,” that the best shampooing he

Death in a Turkish Bath. 81

ever received was from a man ninety years old, who had been
a worker in the bath since he was eight years of age.

The lace-makers of Nottingham, England, carry on their
business, day after day, in rooms heated to a temperature of
120°. Ina report regarding the workers in the Comstock
mines, where the temperature varies from 108° to 116°, and
not unfrequently rises to 123°, it is stated that the constant
enormous activity of their perspiratory functions and the
personal cleanliness resulting from their daily baths seem to
have abolished among them the disease supposed elsewhere
to be characteristic of their avocation. It is admitted by all
observers that they are healthier than their wives and chil-
dren. In some of our naval vessels, particularly of the
“Monitor” pattern, the average temperature at which the
firemen and coal-heavers worked was 157°. The highest
recorded temperature was 181°.

Prof. Carpenter, in “Human Physiology,” says : “Many
instances are on record of heat of from 250° to 280° being
endured in dry air for a considerable length of time, even by
persons unaccustomed to a particularly high temperature,
and persons whose occupations are such as to require it, can
sustain a much higher degree of heat, though not, perhaps,
for any long period. The workmen of the late Sir F. Chan-
trey have been accustomed to enter a furnace in which his
molds were dried while the floor was red hot and a thermom-
eter in the air stood at 360°; and Chabert, the ‘ Fire King,’
was in the habit of entering an oven whose temperature was
from 400° to 600°.

The physician who stated that the frequent use of the
Turkish bath was killing cannot have had much practical
knowledge of the bath, for a long-continued personal acquaint-
ance with its workings has more than disproved such an idea.
Since our establishment of the Turkish bath in Brooklyn
we have given over three hundred thousand baths, with not
a single death, nor even a serious injury to any one from the
bath. Many of the ablest and best physicians in the land
both use the bath themselves and send their patients fre-

82 Death in a Turkish Bath.

quently to it.’ This fact is well known to all who keep up
with the advancing strides of modern medicine.

The frequent use of the Turkish bath, instead of being
killing, is enlivening and helps to prolong life and increase
its vigor. A person who is given to excess in drink, and
who makes frequent use of the Turkish bath, is therefore
more likely to live longer than if he did not so use the bath.
The effect of the bath in such cases is to soothe and quiet the
morbid craving for drink by. reducing the inflamed condition
of the mucus membrane and taking the inflammatory mate-
rials from the blood. Indeed, the bath has been used with
much success in Great Britain as an antidote to the cravings
of the drunkard.

The daily use of the bath has been found in many cases
of great advantage to persons in ordinary health. By that
means they are fortified against disease and their systems
toned up and invigorated. Death has come to man in the
pulpit, on the ferryboat, at the table. Is it at all wonderful
that it should come to one while in the bath, when he has
taken the surest course, by dissipation, to bring that condi-
tion about? Rest assured, the bath, in and of itself, is not
the thing to hasten that time. Over a quarter of a century’s
study and use of the bath has convinced me, by overwhelm-
ing proofs, that it is one of the greatest blessings vouch-
safed to man. It has attained its present position in spite
of stolid conservatism, and when the laws of hygiene are as
well understood as their surpassing importance renders im-
perative, its triumph will be more conspicuous than that of
any other therapeutical agent. When the bath shall have
become the frequent practice of the people there will be less
sickness and suffering in the land, for the whole community
will thereby be placed on a higher plane of health.

Abstracts and Reviews. 83

Rbgtracts and Reviews.

PHYSIOLOGICAL ACTION OF ALCOHOL.

Dujardin-Beaumetz, in a recent lecture on “ Beverages in
Common Use,” speaks of alcohol as follows :

“ Alcohol is of itself an irritant, and when applied to
mucous membranes, it develops a sensation of heat and burn-
ing which is the greater the more concentrated the alcohol.
When introduced into the stomach, besides the symptom of
irritation, it occasions an exaggeration in the acidity of the
gastric juice.

“In the normal state the acidity of Marcellin’s gastric
. juice was represented by 1.3 gms. of hydrochloric acid per
litre. During digestion, the acidity rose to 1.7 gms. but as
soon as an alcoholic stimulant was introduced the acidity
went up to 2.7 gms. and even 4 gms. per litre.

“ This is a capital point in the physiology of alcohol as far
as its influence on digestion is concerned, and this property
is utilized to a certain extent in all countries, and especially
in Normandy, where it is a common custom to make a hole,
as they call it, in the middle of a meal by drinking a small
glass of brandy. In this way the acidity of the gastric juice
is augmented, and the stomachal digestion is increased.
From this fact there arises an important indication,— to give
to patients affected with dyspepsia from want of secretion of
gastric juice a small glass of liquor after their meals.

“ But it will not do to prolong this action of the alcohols,
for little by little the pepsin glands become worn out and
cease their functions, to give place to the increased secretion
of the mucous glands.

“ All our alcoholic dyspeptics go through about the same
history. There is first of all, gastric irritation with pyrosis
resulting from the exaggerated acidity of the gastric juice,

84 Abstracts and Reviews.

then these symptoms give place to gastrorrhcea, character-
ized by the pituitous vomiting and dyspepsia of drunkards.
Alcohol when ingested, is absorbed by all parts of the diges-
tive tubes, but especially by the intestines. It is taken up
by the radicles of the portal vein and passes into the hepatic
circulation, where its presence determines portal periphle-
bitis, the origin of the cirrhosis of drunkards. Then it
enters the general circulation to be eliminated by the lungs
and kidneys, whether in the state of unchanged alcohol or in
that of acetic acid and aldehyde.

“Many hypotheses have been put forth as to the physio-
logical action of the alcohols. It is one of the most interest-
ing of medico-physiological questions, of which I can only sum
up here the leading points. All these hypotheses may be
reduced to two. The first is the theory maintained since
1869 by Lallemand, Duroy, and Perrin, which affirm that
alcohol is neither transformed nor destroyed in the organ-
ism, and that the total quantity being eliminated unchanged,
it cannot be considered a food. The other theory is, that
alcohol undergoes combustion and transformation in the
economy and therefore acts the part of a food. This is the
view which I hold. You put together in the circulating
blood two chemical bodies, the one alcohol, having a strong
affinity for oxygen, the other haemoglobin, ready to yield up
its oxygen under the most feeble influence, that of an inert
gas for instance, and you pretend that no exchange takes
place between these bodies. Exchanges do take place, and ©
I have demonstrated with my pupil, Jaillet, the transforma-
tion zz vitro of alcohol into acetic acid under the influence
of hemoglobin. I believe, then, fully in the combustion of a
part of the alcohol ingested, and this combustion takes place
at the expense of the oxygen of the haemoglobin of the blood
corpuscles.

“Sa, then, to sum up my view as to the physiological
action of alcohol, I should say that, when introduced into the
economy in non-toxic doses a certain part of the alcohol is

Abstracts and Reviews. 85

oxidized and is transformed into acetic acid, then alkaline
acetates, then into carbonates.

“‘ Alcohol is, then, a food, but a waste-restraining food,
which, instead of energizing the combustions, slows them by
robbing the blood corpuscles of a certain quantity of oxygen.
It is this action on the blood corpuscles which explains to us
the antithermic power of the alcohols, and action which
attains its maximum of intensity when toxic doses of alcohol
are administered. In such toxic cases the alcohol is no
longer burned but destroys the globules and dissolves the
oxyhaemoglobin. Ordinarily not all the oxygen ingested
undergoes combustion, a part unchanged acts directly on the
cerebro-spinal axis and there determines phenomena of intox-
ication of sleep and of vaso-motor modification, varying
according to the quantity of alcohol ingested.

MENTAL DYSPEPSIA A CAUSE OF INEBRIETY.

Ina recent paper read before the Macon Medical Society,
and published in the Atlanta Medical and Surgical Fournal,
Dr. Fuller writes as follows :

“The average American is to a greater or less extent a
confirmed dyspeptic. He complains of his stomach as the
weakest part of his physical system. It is to him the heel
of Achilles, where the arrows of pain and disease inflict the
mortal wound. Like the bankrupt treasure of a nation, it
not only ceases to afford a generous relief to a thousand
legitimate demands, but it becomes a cause of pain, appre-
hension, and torment. The stomach supplies building mate-
rial to the architectural edifice of the human body. It
supplies material to repair the waste incidental to organic
and intellectual life. The nervous tissue must suffer waste
in order that the current of thought may flow. Every
thought, every logical process, is the product of certain
chemical changes in the elements of the nervous tissue,
from the condition of organic life to that of dead matter.

86 Abstracts and Reviews.

“In mental dyspepsia the stomach has ceased to furnish
the brain with sufficient material to equal the waste caused
by the intellectual effort. The successive steps by which
the scholar is unconsciously led down a pathway of physical
bankruptcy, having their origin in mental dyspepsia, are
important and interesting from a physiological point of view.
The relations existing between mental dyspepsia and ine-
briety are entirely overlooked by the physiological writer
and teacher. The nervous tissue is, without exception, the
most important of any part of the body. Within the gray
cells of this. tissue the life force is stored, that mysterious
life-principle that awakens into activity all of the phenomena
of vitality exhibited by the various organs of the body. Of
course this tissue requires a constant supply of building
material to compensate the waste that is constantly going
on in its substance. Every thought of the brain, every con-
traction of a muscle, and every secretory or excretory func-
tion of an organ requires in the act a certain expenditure of
nerve force or enérgy, and the production of this must nec-
essarily require in turn the supply of nerve food. Now an
animal tissue has the habit, like the cannibal, of feeding
upon its own substance, relying upon the stomach to replace
the amount consumed as rapidly as it takes place.

“From this it will be clearly understood that the labor
performed by the nervous tissue is incomparably greater
than any other in the human body. Now the amount of
building material required by a living tissue to meet the
waste resulting from labor is always in proportion to the
amount of labor performed. Food is a latent form of vital
action, and vital action is the source of labor. Hence when-
ever it happens that the stomach is not supplied with proper
and sufficient food to repair the waste of nervous tissue,
almost infinite physiological mischief follows. The nervous
tissue falters in its functions, and the wheels and levers in
the various dependent organs vibrate with a diminished
speed. While the instinct of self-preservation becomes
aroused as the starving nervous tissue through the sense of

Abstracts and Reviews. 87

hunger clamors for food, every other tissue experiencing a
deficiency in vital action demands food.

“The victim of this dietetic error is rational conscious of
a deficiency. His reason hears the voice of Nature, but her
language is unintelligible, or he does not wish to understand.
The victim devours with an almost insatiable appetite the
fat and muscle-forming varieties of food that chiefly consti-
tute the present popular bill of fare. At last his digestive
organs falter in their functions beneath the weight of the
useless burden. His nature, intellectual and physical, feels
crushed beneath an unsatisfied want, and even staggers and
reels under the invisible burden. If the labor he is accus-
tomed to perform is chiefly intellectual, the mischief and
disaster to the whole system is doubly increased. For the
process of intellection occasions a much greater proportional
waste of the elements that compose its substance than is
exhibited by the other portions of the nervous tissues in the
performance of the purely organic processes.

“At this juncture the condition of the victim, from a
physiological point of view, is painful in the extreme, for the
stomach, in common with the other organs of the body, expe-_
riencing a deficiency in vital energy, besides being crushed
beneath a fatal burden, signally fails to fulfill its important
office of supplying the waste incidental to vital action, and
the blood in consequence becomes still more impoverished
in elements requisite to supply the demand of the nervous
tissue. The germ of that uncomfortable disease, mental
dyspepsia, has taken root. The victim is tortured with a
longing and craving that is almost insupportable. He feels
depressed, languid, and gloomy. A sense of weariness,
which he expresses in the significant word “goneness,”
never forsakes him. He toils at his daily task, but he does
it with a painful effort. He will not admit to his friends
that he is sick, and he becomes ill-natured and indolent.
An effort that he once would have made with assurance and
delight now assumes proportions from which he recoils with

fear and distrust. At last the torture becomes unbearable,
Mou, IX.—12

88 Abstracts and Reviews.

and he calls a physician. Then the crisis has come. Nine
times out of ten, to “brace up his system” and to quiet his
rebellious nerves, the medical practitioner prescribes a brain
stimulant, either alcohol or opium, as the thing indicated as
the proper remedy, or frequently combines them in a single
prescription. A poison is given to supply the place of con-
crete, assimilable brain food; under its stimulating effects
the patient feels invigorated. But the seeming salutary
effect is founded upon the fatal physiological law that brain
stimulants temporarily supply the place of brain and nerve
food. The dose of the poison from time to time is given
more frequently and increased in quantity as the demand
arises. The victim finds on experience that during the
period of excitement resulting from its stimulating effect he
can resume his interrupted labor. But between the periods
of excitement his mental and physical torture seems to be
doubly aggravated. It may be that his daily toil earns his
daily bread. If so, he. must work, even if he works under
the excitement of a stimulating poison.

“In this manner the appetite for stimulating brain poisons
is innocently and unconsciously acquired by the victim of
mental dyspepsia. The number of these victims is increas-
ing from year to year in a frightful ratio. After a little
thought and reflection all will agree that intellectual activity
has increased in our land for the past fifty years; that
among a given number of population, four times as many
subjects studied and mastered, four times as many opinions
promulgated and defended in the place of a single one fifty
years ago.

“As aresult from the friction incidental to social, pro-
fessional, commercial, and political life, an ill-fed cerebral
tissue is the inevitable: hence the average individual en-
gaged in any occupation or profession requiring continuous
and intense intellectual activity is usually broken down
physically and intellectually between the ages of forty and
fifty years. Now and then these conditions become so
extreme that reason is dethroned. We cannot tell how soon

Abstracts and Reviews. 89

that destroying bolt will descend. Incipient insanity may
gradually come on, subdue the strongest will, and cloud the
brightest intellect long before the victim dreams of what is
coming. How many men and women become old at this
age and give up their places for younger ones who are only
too soon to follow in their footsteps. This condition to me
seems to be a great loss of time; a failure in the end that
might have been avoided if the foundation had been fitly
laid; but instead, he or she crawls away upon the shelf to
die a physical and intellectual wreck.

“The remedy for mental dyspepsia is suggested by its
cause. It can be nothing else but natural assimilable brain
food joined to an efficient fulfillment of the digestive func-
tions. This food must contain in itself the same chemical
elements that enter into the constitution of the nervous
tissue. It must be concrete, soluble, with chemical affinities
so easily broken as to impose the least possible tax upon the
digestive organs. To this we must add an observance of
physical laws relating to the functions of digestion and
assimilation.”

ACUTE PSYCHOSIS IN OPIUM CASES.

An acute psychosis resulting from opium in the blood in
moderate quantities is, I am convinced from long observa-
tion and diligent inquiry, associated with inherent central
nerve instability, often and most usually associated with the
insane temperament, already actively displayed in some mem-
ber of the family, and only dormant in the individual till
aroused by the disturbing influence of the drug, and, like
acute insanity, developed by alcoholic intoxication; hence
the latest neuropathic tendency becomes an active disease.
Here both opium and alcohol become valuable diagnostic
signs in our search for a dormant hereditary psychopathic
tendency. Alcohol never develops acute mania, nor opium
real insanity, unless there is an organic tendency in that

“go Abstracts and Reviews.

direction. An inherent instability must be there, only await-
ing its peculiar train of exciting causes.

The sum of this subject, as thus only preliminarily and too
cursorily presented, is this :

1. Single or a few large doses of opium cause an acute
narcosis and well-known forms of physiological depression,
which we are not here considering.

2. Under gradual habituation to increasing doses, acute,
narcotic, ordinary toxic effects are, in great measure, resisted
by the organism, and sensory analgesia and psychical exalta-
tion, followed by brain-weariness, somnolentia, and sleep
after each repetition of the dose, are the chief ordinary mani-
festations, with a final more or less impaired function of
bowels, liver, and skin, and with certain psychical features.
This true chronic meconism or papaverism and its character-
istic symptomatology is due to the combined influence of a
damaged and a poisoned nervous system.

3. A true acute psychosis is developed in the neuropath-
ically inclined, as insanity is developed by a large drink or
two of some strong alcoholic beverage. This is the acute
insanity of opium, requiring two factors, hereditary predis-
position and a central toxic influence, to induce it.

4. A hereditary instability of nerve element leads some
organisms to irresistibly crave stimulants at certain times,
generally after ordinary nervous and physical exhaustion,
and these are satisfied with alcohol or opium. If they hap-
pen to find solace in opium readily, they become mecono-
phagists ; or if alcohol first falls in their way, and the insa-
tiate longings of their unstable nervous organisms find, in
some beverage containing it, the agreeable and temporarily
satisfying impression their neuropathic organisms crave,
their will (mastered by the lower dominant organic feeling)
becomes a slave to the tyranny of a bad organism, regardless
of consequences, and they enter, like the luckless DeQuincy,
into an Iliad of woes.

The mark and impress which it makes upon the central
nervous system after the poison is no longer present in the

Abstracts and Reviews. gI

blood masks or modifies the symptomatic expression of the
damaged neural mechanism.

This is the true meconeuropathia, or morbid condition
of nervous system engendered by the repeated and long-con-
tinued assaults of the toxic enemy on the cerebro-spinal and
ganglionic centers, and which comes on shortly after the
withdrawal of the drug, and abides with the system long
after the drug is taken away, especially in pemaanent psy-
chical aberration and final dementia.

If we contrast the prominent symptoms of opium present
and opium absent in meconophagism and meconopathia or
meconeuropathia, we find in all cases in the former constipa-
tion, psychical satisfaction or exaltation, followed by drowsi-
ness and sleep, analgesia, fair tonicity of stomach and skin.
In the latter,'we find always very loose bowels, requiring
medical restraint after the first day. Relaxed and perspiring
skin, nausea and vomiting, sensory hyperasthesia of special
senses, hyperalgesia, especially about flexor regions of fore-
arm and about joints of lower extremities (true meconalgias),
psychical depression and insomnia, psychical delusions of
dread and of approaching calamities.

The opium neurosis is not cured, even when the patient
has been weaned from his accustomed drug, but he is often
subject to neuropathical symptoms, and a proper subject for
continued neurological treatment, requiring treatment for
many months after cessation, to prevent a return to the use
of the drug that damaged and enslaved. The patient is not
safe from neural damage, even though he may never return
to the drug, until he fattens some, feeds well habitually, and
sleeps much, and can resume his ordinary occupation with-
out nervous fatigue’and an ‘inclination to take to opium or
other form of stimulation. With this view of this disease, it
would be fitting here to protest against the substitution of
some other form of stimulation for opium, abandoned or
withdrawn, and, when the disease-weakened nervous system
has been enslaved by another stimulant narcotic, call that a
cure.-—Dr. Hughes in Alienist and Neuralogist.

92 Abstracts and Reviews.

SOME FACTS FROM THE LAST INTERNAL
REVENUE REPORT.

The number of distilleries registered during the year was
6,422 and the number operated 6,034. Of this latter number
5.075 were fruit distilleries. The total spirit producing
capacity of grain and molasses distilleries in operation Sept.
1, last, was 188,747 gallons per day. The préducing capacity
of similar distilleries operated Sept. 1, 1880, was 282,928 gal-
lons a day. The number of grain distilleries registered dur-
ing the year was 1,132, of which number 950 were operated,
a decrease of 63 in the number registered and an increase of
32 in the number operated, as compared with the previous
year. The decrease occurs in the class of distilleries having
the smallest capacity for the production of spirits, there
having been a falling off of seventy-four in the number of
distilleries of this class registered and of five in the number
operated. In the larger distilleries there was an increase of
eleven in the number registered and an increase of thirty-
seven in the number operated. There were nine rum dis-
tilleries registered and nine operated, the same number
reported for the previous fiscal year. There were 5,101 fruit
distilleries registered and 5,075 operated, an increase of 806
in the number registered and eighty-three in the number
operated during the previous year. :

The- quantity of grain used in the production of spirits
during the year is an increase of 1,340,129 bushels over the
amount used in the preceding fiscal year, and is 2,003,361
bushels less than the average for the last nine years. The
number of gallons of spirits produced from grain during the
year shows an increase of 7,310,182 gallons over the product
of the year ending June 20, 1885, and is 873,605 gallons less
than the average product for the last nine years. The quan-
tity of spirits produced and deposited in distillery ware-
houses during the year is more ‘than the production of the
year 1885 by 5,429,017 gallons. The quantity of spirits
withdrawn tax paid, from distillery warehouses during the

Abstracts and Reviews. 93

year is more than the quantity withdrawn from distillery
warehouses during the previous fiscal year by 1,447,519 gal-
lons. If the 967,500 gallons of domestic spirits exported and
re-imported during the year upon payment of a custom duty
equal to the internal revenue tax be added the quantity vir-
tually withdrawn from distilleries was, during the year,
70,064,400 gallons, or 1,592,462 gallons more than during the
previous year. The quantity of distilled spirits removed in
bond for export during the year was 5,646,656 taxable (proof)
gallons, as compared with 10,671,118 gallons withdrawn for
export during the previous year, being a net decrease of
5,024,462 gallons.

The falling off in exportation in 1886, as compared with
1885, is due mainly’to the decreased withdrawals for export
of bourbon and rye whiskies and of alcohol, although there
was a decrease as to all kinds of spirits except high wines, as
follows: in bourbon whisky, 1,829,179 gallons ; rye whisky,
373,641; alcohol, 2,623,607; rum, 143,302; gin, 79; pure,
neutral, or cologne spirits, 16,172; in miscellaneous, 40,304.

Although the tax was paid during the last year on more
than a million gallons of bourbon and rye whiskies in excess
of the quantity on which tax was paid during the preceding
year, the production in 1885 was so much greater than the
withdrawals as to leave a net balance in warehouse, June 30,
1886, of 4,000,000 gallons greater than was on hand July 1,
1885. The production of all kinds of spirits was also two
million gallons greater during the months of July, August,
and September, 1886, than during the corresponding months
of 1885, while the tax-paid withdrawals were 500,000 gallons
less. The bulk of the bourbon and rye whiskies reported in
1886 went to swell the stocks in the warehouses of Bremen,
Hamburg,and Bermuda. The tendency since June 30, 1885,
the Commissioner says, has been to the present time to
increase the stock of bourbon and rye whiskies in distillery
warehouses. The largest importation of rye and bourbon
whisky are to Bremen and Hamburgh, and the largest impor-
tations of rum are to Africa.

94 Abstracts and Reviews.

The production of tobacco shows an increase in manu-
facture of 10,798,280 pounds; in the number of cigars and
cigarettes of 433,507,247; in tobacco exported of 29,369,220
pounds. The number of cigars imported during the fiscal
year ending June 20, 1886, was 73,139,078.

.INEBRIETY IN PARANOIA.

The following extract is from a paper on Paranoia, by
Dr. Zenner, before the Academy of Medicine: .

“There is one complication of which I wish to speak
while stili on the subject of diagnosis, and that is alcoholism.
Some of these cases, especially when the disease is con-
genital, become addicted to drink, and thus mask the real
disease. I saw a case of this kind very recently: a man
who had been sent to the asylum several times as a case of
alcoholism, and in each instance detained a few weeks, when
he should have been kept there indefinitely. He is thirty-
one years of age, has a family taint of insanity, and striking
irregularities about the face and head. His mental symp-
toms appear to date back about six years. He has frequent
hallucinations of both vision and hearing.’ His chief delu-
sion is that the foreman in a shop where he formerly worked
is his enemy and trying to injure him. A girl passed his
home, and as she worked in the shop with the foreman, he
knew the latter sent her there to watch him. The same was
true of a man he saw, who only lived in the same neighbor-
hood as the foreman. A number of articles in the daily
papers, one about a monster in South Carolina, others about
various bits of scandal, which a sound mind could bring into
no possible relation with the patient, he knew were written
about himself. They were instigated by the foreman, and
were intended to convey to a young lady to whom patient
was engaged the idea that he was immoral. At another time
he believed the foreman prevented him from marrying a lady
by the influence of magnetism, and he went to the court in
order to have the foreman restrained in this action. He

Abstracts and Reviews. 95

subsequently shot at and slightly wounded said foreman, and
the case gained a medico-legal interest. The prognosis of
this disease is usually very unfavorable. The patient’s con-
dition may remain at a standstill for a long time, but he very
rarely recovers. Very rarely recoveries have been reported
after the disease has existed a long time. In women this is
most likely to occur at the second climacteric. It is said to
occur more frequently where there is no hereditary taint.
In old cases the delusions often multiply, and the intelli-
gence becomes correspondingly impaired. The prognosis is
much more favorable in the abortive forms of the disease.
The treatment should be of a tonic character, every effort
being made by diet, medicines, and hygienic regulations, to
strengthen the nervous system. Efforts should be made to
keep the mind pleasantly employed, and to direct it away
from the bodily functions, Patients who conceal their delu-
sions are able to attend to business and associate with others.
But when delusions of persecutions are prominent, especially
if they be of such character as to threaten others with dan-
ger, the patient should be kept under constant surveillance.”

DEGENERATION OF THE COLUMNS OF GALL
IN AN INEBRIATE.

Dr. Vierordt, in a late number of Arch. of Psychiatrie,
mentions the following case. A. M., workingman, zt 30,
phthisical, had been drinking to excess for years, gastric
disturbances in consequence. March, 1884, was suddenly
seized with stabbing pains ascending from feet to trunk,
periodically weakness and ataxia of lower extremities with
anorexia and vomiting, weakness increased up to June, 1884,
from that time onward great improvement in this respect.
All symptoms returned in October, to which formications in
the legs were superadded. Middle of September, patient
became bedridden. Venereal infection denied; no chest
trouble at the time was received into clinic. January, 1885,

examination revealed slight inequality of pupils ; light reflex
VoL. IX.—13

96 Abstracts and Reviews.

normal; evidences of pulmonary trouble, testicles small ; no
objective symptoms of syphilis. Considerable uniform atro-
phy of all muscles of upper extremities with corresponding
diminution of muscular power ; toxic condition of muscles
about normal; no ataxia and no disturbance of muscular
sense ; no hyperzesthesias or paraesthesias anywhere ; peri-
pheral nerves neither thickened nor painful. Tendon phe-
nomena very weak; muscles sensitive to slightest touch.
Lower extremities muscular status about the same as in
upper extremities, atrophy more pronounced in lower legs
than in thighs; muscular power in keeping with atrophy;
legs fall asleep ; also formications; no marked sensory dis-
turbances and no hypereesthesia; muscular sense normal ;
knee-jerks abolished; cutaneous reflexes fairly preserved ;
distinct ataxia; Romberg’s symptom present. Bladder and
rectum normal. Increased excitability of muscles in upper
and lower extremities ; percussiom of nerves produces con-
tractions in muscles supplied by these nerves; electrical
reactions unaltered. All symptoms progressed ; occasional
variations in amount of paresis ataxia less marked. In the
latter stages hyperaesthesia of the skin of lower extremities ;
knee-jerks remain absent, plantar reflexes normal. No vesi-
cal or rectal trouble at any time ahd no changes in electrical
reactions. Patient developed pleuritis with effusion and
died April 12th. Dr. Vierordt made a diagnosis of multiple
neuritis. The autopsy revealed besides evidences of pulmo-
nary tuberculosis, etc., a degeneration of the column of gall,
most marked in the oblongata and cervical spinal cord. In
the middle and lower dorsal segments very slight disease of
posterior root-zone Lumbar segments entirely normal; in
the medulla oblongata the degeneration of columns of gall
was complete, peripheral nerves normal. Vierordt looks
upon the disease of the columns of gall as a primary degen-
- eration and not secondary to the affection of the posterior
root-zones in the lower and middle dorsal segments, but the
affection of the posterior roots might have followed upon
diseases in the columns of all,

Abstracts and Reviews. 97

POST-MORTEM RECORDS OF INEBRIATES.

The following notes of autopsies of inebriates who died
at the Boston Lunatic Asylum, taken from the last report, is
of inuch interest, and suggests a new field of study not yet
occupied.

Case 1. Inebriety with delirium of grandeur and general
paresis, ch. leptomeningitis ; ext. hydrocephalus ; ch. epen-
dymitis ; atrophy of the cortex; oedema of brain; etat crible
of white matter and basal ganglion ; ch. endarteritis of basal
vessels. Microscopic appearance — Vessels of gray matter
of convolutions showed effusion beneath adventitia; lamina
not contracted. Lungs— double hydrothorax ; ch. adhesive
pleurisy ; gen. visic. emphysema; atelactasis of lung; hypos-
tatic congestion. Fibro-myoma of stomach ; fatty infiltration
of liver.

Case 2. Inebriety with delirium of grandeur; general
paresis: epilectic attacks; gross lesions, oedema of pia;
atrophy of frontal convolutions. Heart—ch. endarteritis of
coronary arteries. Lungs—recent pleurisy with effusion ;
putrid bronchitis ; gangrene of the lungs ; senile atrophy of
the spleen and kidneys ; diphtheritic inflammation, and sup-
purative prostatitis with calculi, in the bladder.

Case 3. Inebriety with general paresis ; comatose attacks ;
cedema of pia; atrophy; ch. ependymitis; eat crible of
white substance. Microscopical appearance — pigmentation
of ganglion cells. In the spinal cord pigmentation of cells;
numerous corpora ; amylacea ; sclerosis of posterior columns
in lumbar and dorsal regions. Thickening of the pericardium
and brown atrophy of the heart, and same of the liver.
Interstitial nephritis. Putrid bronchitis ; broncho-pneumonia.
Gangrene of both lungs.

Case 4. Inebriety— suicidal melancholy; cedema and
anzemia; myxo-lipoma of valve; ch. pericarditis of heart.
CEdema and emphysema of lungs.

Case 5. Inebriety—general paralysis ; epileptiform at-

98 Abstracts and Reviews.

tacks; ch. int. hem; pachymeningitis; oedema of pia;
atrophy ; ch. ependymitis, Microscopically —ch. mening-
encephalitis ; infiltration of adventitial sheaths ; fatty degen-
eration of the heart, and the same of the kidneys and tubules,
ch. adhesion of lungs, pleurisy; acute bronchitis ; broncho-
pneumonia.

Case 6. Inebriety— general paralysis; oedema of the
pia; atrophy ; ch. ependymitis; e¢at crible. Microscopically
—ch. interstitial encephalitis; infiltration of vessel walls ;
fatty infiltration of wall of the right ventricle of heart.
Embolism of pulmonary arters, hemorrhage; congestion of
liver, kidney, and spleen; enchymosis of bladder and throm-
bosis and oedema of the lower right extremity.

Case 7. Inebriety— syphilitic; general paralysis. Ch.
leptomeningitis and cedema of the pia; multiple epnumata ;
apoplectic cysts of basal ganglia; ch. ependymitis; chronic
adhesions ; pleurisy and ephysema of lungs; nodules in
mesentaria.

Case 8. Inebriety — hallucinations of liquids; delirium
of persecution, melancholia ; anzemia ; ch. adhesions, pleurisy,
and chronic tuberculosis in both lungs. Tubercular ulcera-
tions and perforations of the intestines; ch. perisplenitis,
and acute purulent peritonitis.

Case 9. Inebriety — heredity ; hallucinations of hear-
ing and seeing ; cataleptic attacks ; strange muscular move-
ments; dementia; old tuberculosis: broncho-pneumonia ;
tuberculous ulcerations in intestines, and miliary tuberculosis
of the liver. ;

Case 10. Inebriety—hallucinations of sight; senile
dementia; oedema of pia; circumscribed osteo-porosis of
calvaria atrophy; also atrophy of cortex under the micro-
scope. Hypertrophy of the heart and insufficiency of the
tricuspid ; chronic adhesions of the lungs; pleurisy ; em-
physema; cedema; necrosis and circumscribed gangrene of
colon ; congestion of the liver, spleen, and kidney, and re-
cent circumscribed peritonitis.

Abstracts and Reviews. 99

THE CURE OF INEBRIETY.
[The following extract from a lecture by Dr. Crothers, was read before the
Institute of Social Science of New York City.]

In the cure of inebriety there is probably more agitation
and interest than ever before. The efforts of societies and
parties, of the pulpit and rostrum, with the increasing books
and papers from the press, have never been more active than
to-day. Yet reports show that inebriety is increasing, and
that more spirits are made and consumed every year.

Ail the temperance efforts and legal means for the cure
and prevention of inebriety are based on the theory that it is
a moral disorder which the victim can control at will, or a
wicked habit that he can continue or put away at his own
pleasure. This theory of inebriety is theoretical, and em-
bodies the same error which follows every new advance of
thought, namely, explaining all human action from some
moral or theological standpoint. Thus the phenomenon of
insanity was explained as a possession of the Devil, and the
victims were supposed to enter into a compact with evil
spirits, voluntarily. The remedy was severe punishment.
Public attention was occupied for ages in persecuting and
punishing the insane and epileptics on this theory of the
causation, Law, religion, government, and public sentiment,
all failed in the cure and prevention by this means, and these
diseases went on unchecked, simply because the real causes
were unknown.

Inebriety is regarded in the same way as wickedness, and
the same means are urged asa remedy. Over fifty thousand
inebriates were sent to jail in 1886, and punished as willful
and voluntary drunkards. Armies of moralists and temper-
ance people are pledging and praying the inebriate to stop
drinking, and exercise his will, and be temperate and well
again.

Yet all such efforts fail, and often tend to increase the
very condition which they seek toremedy, They fail because
they are based on a false assumption of the causes, and not
on any accurate study of the history or real condition of the

100 Abstracts and Reviews.

patient. A new era is dawning for the inebriate. His dis-
eased condition, and the need of special medical care in
special surroundings, is a truth that is spreading slowly and
surely in all directions. Not far away in the future inebriety
will be regarded as small-pox cases are now in every com-
munity. The inebriate will be forced to go into quarantine
and be treated for his malady until he recovers. The delu-
sion that he can stop at will because he says so, will pass
away. Public sentiment will not permit the victim to grow
into chronic stages; the army of moderate and periodic
drinkers will be forced to disappear, and the saloons which
they have supported will close in obedience to a higher law
than any prohibition sentiment.

Public sentiment will realize that every inebriate is not
only diseased, but dangerous to society, to himself, and all
his surroundings, and demand legal guardianship and restric-
tion of personal liberty until he recovers. When these poor
victims realize that society will not tolerate their presence
or allow them personal liberty in this state, they will seek
help and aid before they reach extreme stages.

This is the teaching of all modern science,— to check the
disease at the beginning, to seize the poor waif on the street
and the rich man’s son, who are just at the beginning of
inebriety, and force them into conditions of health and sobri-
ety, to save the one from becoming a prey on society and a
burden to the producer and tax-payer, and the other from
destroying society and himself and leaving a tide of misery
and sorrow that will continue long after. When society
shall realize and act on these facts, the great centers of pau-
perism and criminality will be broken up. This will be
accomplished by the establishment of work-house hospitals,
where the inebriate can be treated and restrained. Such
places must be located in.the country, removed from large
cities and towns, and conducted on a military basis. They
must have all the best appliances and remedial means to
build up and restore the debilitated victim. They should be
military training hospitals, where all the surroundings are
under the exact care of the physician, and every condition of

Abstracts and Reviews. 1ot

life is regulated with steady uniformity. Besides the medi-
cinal and hygienic treatment, there should be educational
and industrial training, and each one should be employed,
both in body and mind, every day. He should be placed in
a condition for the best culture and building up of the entire
man. Every defect of body and mind should be antagonized
and remedied as far as possible. Each case should be an
object of study to ascertain the real state and the means to
strengthen and improve it. These hospitals should be built
and conducted entirely from the license fund or the taxes on
the sale of spirits. They should, in a large measure, be self
supporting from the labor of the inmates, and independent
of the tax-payers. These places would most naturally divide
into three distinct grades, The first class of -hospitals
should be for recent cases, where the inmates can be com-
mitted by the courts, or voluntarily commit themselves for
one or two years. The second class should receive chronic
cases for longer terms of treatment—from one to three
years, The third class should be for the incurables, or those
who give no reasonable promise of restoration. The time
should be from five to ten years and life. The latter class
should be thoroughly organized into military habits of life
and work, and kept in the best conditions of forced healthy
living. Employment and mental occupation should be car-
ried out literally as a stimulus to strengthen the body and
mind. Where it was possible the rewards of his labor,
beyond a sum to pay for care, should be turned over to his
family and friends or held in trust for him. He should be
encouraged to healthy work and living by all possible means
and surroundings. The semi-chronic cases should be treated
substantially the same way, only occupation and training of
the mind and body should be more suited to the wants of
each case. The amusements should also be of a sanitary
character.

The recent cases should have the same exact discipline,
filling the mind with new duties and new thoughts, and
suited to build up the exhausted, overworked man, as well as
the gormand and under-worked idler. All persons should

102 Abstracts and Reviews.

pay for their care if possible, and be required to render some
service which would be credited on their bills. These hos-
pitals should be literally quarantine stations, where the ine-
briate can be housed and protected and society saved from
the losses following his career.

If ten thousand poor chronic inebriates could be taken
from New Yoak and placed in such hospitals, and made self
supporting, who could estimate the gain to society, to morals,
to the tax-payer, and to civilization? This can and will be
done in the near future. If ten thousand semi-chronic cases
of inebriety could be taken from New York and quarantined
two or five years in such military hospitals, and made to pay
for their care by labor, who could estimate how many would
be returned to health and temperate living again ?— who
could estimate the relief from sorrow, misery, wretchedness,
and losses? This will also bea reality a little farther on.
If ten thousand recent cases of inebriety could be taken out
of their surroundings in New York and placed in these hos-
pitals, where forced conditions of the highest degree of
health and vigor are maintained, a large percentage would
recover. The gain to society and the world would be
beyond all computation. Now each one of these proposi-
tions and the practical working of a military hospital is a
reality, based on evidence constantly accumulating. Every
prison, penitentiary, or hospital, every asylum or home where
inebriates come under care and restraint bring such évi-
dence. They show that such a method of treatment, com-
bining the varied experiences of all these institutions can be
made practical and is the only scientific way of solving this
problem. To banish the still and saloon does not prevent
inebriety or cure the inebriate ; it only changes the direction
of the drink current. But quarantine the inebriate in a hos-
pital, as one suffering from contagious disease, and the vic-
tim is cured, the spread of the disease is prevented, and
a knowledge of the causes ascertained, from which the
remedies can be known and applied. To punish the inebri-
ate as a criminal cannot cure his inebriety, but it always
unfits him for living a temperate, healthy life hereafter. To

Abstracts and Reviews. 103

attempt a cure by faith and prayer is to depend on false
hopes, the failure of which is followed by increased degen-
eration. To attempt any form of treatment without know-
ing any other fact except that the victim drinks to excess is
always to blunder and fail.

The time has come to recognize the physical conditions
which enter into all cases of inebriety, and to apply exact
remedies along the line of nature’s laws and forces.

The late Dr. Bellows, in an address delivered ten years
ago, said: “Inebriates, like criminals and insane, will all be
eventually restrained in hospitals, and treated with medical
and psychological skill the moment their liberty becomes
dangerous to society. The terms of their confinement will
be limited only by the possibilities of cure and the conditions
of their disorder. Society gains nothing by holding prisoner
for an hour any man who is fit to be at large. Liberty and
human rights gain nothing by allowing any man to be at
large for a moment who is destroying himself, his family, and
his neighbors. What we need is what we are fast gaining,
namely, a possession of the tests and gauges of the fitness
and unfitness, and we shall be able to treat the inebriate suc-
cessfully the same as in other diseases.”

As scientific men the question comes to us, can this great
army of five hundred thousand inebriates in this country be
the outburst of a vicious element in human nature? If this
is so, religion and civilization have failed. If this army of
inebriates sprung from physiological and psychological
causes, then the problem of cure and prevention is a question
for science. If inebriety is a vice and sin, then the Church
and State must apply the remedy.

Insanity has been studied for over a century by many
able and learned scientists, and yet only a few facts have
been established, and preparation made for more exact study.
The realm of the unknown has been scarcely penetrated.
Inebriety, an infinitely more complex disease, has never been
studied. Only a few pioneers are approaching it from a
physical standpoint, and their views of necessity must be

outlines of laws, forces, and facts, that are yet to be dis-
Vou. IX.—14

104 Abstracts and Reviews.

covered. Some of these outline facts may be summarized
as follows:

All accurate study of the inebriate indicates a distinct
range of causes, both physiological and psychological, from
which inebriety springs. ;

When the histories of inebriates are compared, they are
found to follow a regular line of progress, obeying a certain
order of events, from the beginning, development, progress,
decline, on to extinction. .

This march is governed by conditions and forces of which
we have only a faint conception. Heredity, disease, injury,
starvation, neglect, are only the general names for some of
these forces.

In the cure of inebriety all study of cases points to a
physical causation to be removed by physical means.

Work-house hospitals as quarantine stations, where every
condition of disease can be treated, give the greatest promise
of relief. Here: the victim is removed from all exciting
causes, and protected from himself and others ; and here we
can understand some of the causes beyond the saloon, and
so-called free will, and deceitful heart.

From this very general review of some of the causes of
inebriety, and the means of cure, it is apparent that, like the
early Northman, we have only touched on the shores of a vast
continent of the unknown, which, not far away in the future,
the march of science will disclose.

THE MORPHINE HABIT: By Dr. B. Batu, OF THE
Paris Facutty oF MEpIcINE; J. Fitzgerald, publisher,
108 Chambers St. New York. Price 15 cents, post-free.
This work contains three lectures on Morphiamania,

which were delivered at the clinic of Mental Diseases. In

the first lecture, which discussed the effects of the abuse of
morphia, the following distinction is made: “It is first nec-
essary to distinguish between morphinism and morphia-
mania. By morphinism must be understood the sum of the
effects produced by prolonged abuse of morphine. Morphia-

Abstracts and Reviews. 105

mania is with respect to opium what dipsomania is with
respect to alcohol. There is morphiamania when the person
feels the irresistible need of taking morphine. It is thus an
independent disease, having its own characteristics ; but just
as dipsomania leads to alcoholism, so morphiamania leads
inevitably to morphinism. There is, however, a very great
difference. Dipsomania is an intermittent neurosis; the
longing for drink does not exist continually in the dipso-
maniac, and his disease is almost absolutely incurable, as are
the greater number of nervous diseases in which the attacks
occur at intervals. Morphiamania is, on the other hand, a
continuous neurosis ; those suffering from it have constant
need of their stimulant, and for this very reason it is curable,
and often is cured. Hence it is that confirmed drunkards,
who are drunk every day of their lives, may be cured; the
dipsomaniac, never.”

One of the reasons given for the first use of morphine
“is that it allays physical pain, mental suffering, and moral
neuralgia.” The latter term is new and suggestive.

The second lecture treats of the “effects of abstinence
from morphia.” The various symptoms are detailed, and
the Mania Lectuaria is described at length. Of the cases
where other stimulants are taken, he remarks: “The mor-
phiamaniac often takes other excitants in addition to his
favorite drug. Some take coffee, and this practice is approved
by Zambaco. The greater number combine with morphine
the use of chloroform, of chloral, and, above all, of alcoholic
liquors. Many morphiamaniacs are at the same time habitual
drunkards. Patients of this class are most liable to expe-
rience serious trouble as the result of abstinence; collapse
is with them more frequent ; they present much more often
the phenomena of delirium tremens. Their organization is
seriously impaired, and their nervous system radically dis-
ordered; in such cases the efforts of the physician are
absolutely fruitless

The third lecture discusses the diagnosis, prognosis, and
treatment, concluding that morphiamania is a curable affec-
tion ; “it is more curable than dipsomania, but is none the

106 Abstracts and Reviews.

less a powerful enemy to combat. We must be armed
against it with all the means which science furnishes, and
never make the slightest concession to the whims of the
patient. We must never forget that the habitual duplicity
of these patients continually tends to lead the physician into
error.”

Four lectures by this author fill up the rest of the volume,

on the following topics: Borderland of Insanity, Cerebral
Dualism, Prolonged Dreams, Insanity in Twins.

The author has evidently not studied of morphiamania
as thoroughly as our American experts, but he has presented
some very suggestive and interesting details, that are posi-
tive contributions to the literature of this subject.

The Twenty-Third Annual Report of the Washingtonian
Home of Chicago, Iil., for 1886, is of more than usual inter-
est. Eight hundred and sixty-seven inmates were admitted
during the year. The average number was over seventy-
three, and the average time of treatment was about twenty-
eight days. Of the forms of inebriety, eight hundred and
fifty-five were put down as periodical inebriates, and only
one hundred and one as constant inebriates. Only five of
this aggregate number were due to heredity, and all the rest
acquired this disorder or habit. Sixty had delirium tremens,
and only sixteen were insane. One hundred and eighty-
seven had had delirium tremens. The physician’s report is
equally startling in unusual statistical figures. Thus, six
hundred and forty-seven are put down as moderate alcohol-
ism, and one hundred and eighty-seven as persistent alcohol-
ism ; insane, thirteen. Under the head of complications of
the nervous system, only thirteen in nine hundred and
thirty-three had nervous prostration ; one had neuralgia, and
one general debility. Of the liver troubles, in all these
cases, one had hepatitis, one congestion of the liver, and one
cirrhosis. Of the kidneys, only one had intlammation of the
kidneys ; three had dyspepsia. Twenty-three of the persons
under treatment were not under the physician’s care in the
hospital. To the average student of inebriety the number
of periodic inebriates who have no heredity and the great
freedom from complicating diseases completely upsets all
previous notions and studies of this disorder.

Abstracts and Reviews. | 107

Science and Crime: and other Essays. By Andrew
Wilson, F.L. S.J. Fitzgerald, publisher, 108 Chambers St.,
New York. Price, fifteen cents, post free. This pleasant
little volume comprises seven chapters on as many different
subjects of popular scientific interest. The leading essay,
“Science and Crime,” shows what effective aids science is
able to render to the legal Nemesis in tracking the criminal.
The other essays bear the titles of “The Earliest Known
Life-Relic,” “Skates and Rays,” “About Kangaroos,”
“ Leaves,” “Giants,” “The Polity of a Pond.” The book
will serve to entertain the mind pleasurably, as well as profit-
ably, during an hour of leisure.

The Swiss Cross, a monthly magazine of the Agassiz
Association, is devoted to the spread of science among all
classes. It is an admirable journal and deserves a wide pat-
ronage.— N..D. C. Hopces, publisher, 47 Lafayette Place,
New York city.

The TZherapeutical Drinking of Hot Water, by Dr.
Ephraim Cutter of New York, is a very suggestive little
volume.

The Popular Science Monthly has suffered in the loss of
its most distinguished founder, Dr. Guamans. But as in all
other great enterprises of the world, the Journal goes on with
increasing value, a grand monument to the genius of its
founder.

The Homiletic Review, by Funk & Wagnalls of New
York city, grows better every month and will well repay the
time spent in reading it.

The Electrical Engineer of New York city, comes every
month crowded with new and most interesting facts, which
are almost of necessity essential to every thinking man.

Science is a weekly New York journal, which comments
very fairly on all matters of science and progress, and
is reliable in all its teachings.

The Scientific American has become the great weekly
journal of mechanists, and all who are watching the new in-
ventions of the age. Munn & Co., New York city, are the
publishers.

108 Editorial.

Editorial.

SIXTY-SEVEN YEARS AGO.

In May, 1830, a report was made by a special committee of
the Connecticut State Medical Society at their annual meet-
ing, which is of rare historic interest. This committee con-
sisting of Dr. Todd (then superintendent of the Hartford In-
sane Retreat), Drs. Cogswell, Woodward, Sumner, and Grid-
ley, had evidently been appointed the year before “to inquire
whether it is expedient and practicable to establish an insti-
tution for the reformation of intemperate persons.”

This report was probably written by Dr. Todd, and the
following free extracts show a remarkable conception of
inebriety and its treatment. The report opens with a state-
ment that inebriety is a misfortune, and associated with dis-
ease of body or mind. That the victim is without strength
and resolution to recover. “Their disease excites no sym-
pathy ; their sufferings call forth no pity ; their consciences
and friends reproach them ; their resolutions fail them ; and
promises of reformation are made only to be broken.” Ignor-
ance of parents and facility for getting spirits are mentioned
as causes. The contagion of inebriety is outlined in the fol-
lowing : “It often happens that inebriates are possessed of
uncommon vivacity and fascinating address, which render
them interesting, and in proportion as they are interesting,
they became dangerous associates. One individual of this
character has been often known to seduce an extensive cir-
cle of unsuspecting companions into inebriety, from which it
was difficult if not impossible to reclaim them.”

The danger of legal treatment in fine and imprisonment
was recognized in the following. “By the existing laws of
the State a person guilty of inebriety may be sent to a work-
house for punishment. There he is looked upon as a crimi-

Editorial. 109

nal; his associates are criminals, some of them guilty of
heinous offenses; and instead of being reclaimed he is usu-
ally made worse. Being associated with companions who
have lost all self-respect and all regard for the opinions of
others, he is by their companionship prepared for the com-
mission of gross crimes, and consequently returns a more
dangerous member of the community. This is no picture of
imaginary evil, but a statement which every day’s observa-
tion proves to be literally true. Whenever an attempt has
been made to effect a reformation of an intemperate person
through the agency of legal penalties he has become more
degraded and more desperate.”

Temperance societies are mentioned as having produced
“a most desirable change in the opinions and practices of
others, but they do not brighten the prospects of permanent
restoration in the inebriate.” 3

“There never wasa time when greater and more success-
ful efforts were made to prevent the extension of this vice,
and we are compelled to believe there never was so faint a
prospect of the drunkard’s forsaking his companions or his
cup. In support of this statement the records of courts and
hospitals are referred to, and a question is asked, Shall ine-
briates be permitted to pursue their unhappy career without
an effort made to restrain or correct them? shall they be
subjected to penal discipline, which has proved so posi-
tively injurious and ultimately detrimental to society ?”

The philosophic method of first investigating the nature
and character of inebriety, before attempting its cure, is re-
ferred to as the true scientific way of solving the problem.
The first use of alcohol to remove lassitude and dejection,
and its continued use, bringing on disease of both function
and structure, are mentioned at some length. Also the folly
of attempting restoration of the physical system by moral
means. From this the conclusion is reached that institu-
tions for inebriates are absolutely necessary for their treat-
ment and cure. The following are a summary of the ends
accomplished by such institutions : ‘Where they shall be

110 Editorial.

subjected to salutary discipline and needful restraint.”
“Where they shall have no access to intoxicating liquors.”
“Where they shall be constantly and usefully employed.”
“Where they shall not be contaminated by evil associates,
and where they shall have no opportunity of exerting an un-
favorable influence upon others.” ‘Where they shall re-
ceive medical aid to restore their debilitated constitutions ;
torelieve the sufferings occasioned by past habits, and to
eradicate the strong but artificial propensity, which they
have acquired for indulgence in the use of inebriating drink.”
“ Where they shall receive the benefit of moral precepts, cor-
rect examples, and such instruction and preparation for the
performance of those long-neglected duties, which they owe
to others and themselves.” ‘“ Where in short, by an enlight-
ened system of physical and moral treatment, they may be
reformed and restored to their families and society.”

The authors make a financial argument showing what
it costs to care for the inebriate and paupers who spring
directly from this source, and the direct gain to the tax-
payers and to society by the establishment of an asylum for
inebriates.

The following describes the superintendent who would be
successful in such an asylum. “In him must be found a
combination of rare and excellent qualities which will secure
the affection as well as the respect of those who are to be re-
formed by his exertions. He must himself be a pattern of
industry and temperance in order to induce others to prac-
tice temperance, and pursue industriously whatever they
may be required to perform. In him dignity must be com- .
bined with cheerfulness, energy with mildness, and firmness
with forbearance. His moral character and his moral pre-
cepts must be of that elevated standard which will secure
the confidence of the public as wellas those who are com-
mitted to his charge.”

This report closes with a reference to the changes of the
law needed to hold these cases at least one year, and the
practical nature of this movement. A series of resolutions

Editorial, III

were adopted on the acceptance of this report, fully endors-
ing it, also providing a committee to form an association for
the establishment of an asylum. A committee of corre-
spondence was appointed consisting of two of the most emi-.
nent physicians in each county of the State.

Thus ended an effort which indicated a remarkably clear
view of this subject. Over half a century has passed, and
these facts are still unrecognized by the masses. The birth
of great truths is long and laborious. Pioneers point them
out far in advance. The mass of the profession follow on
slowly, dragging up public sentiment to recognize the great
facts. In another century the inebriate and his malady will
be recognized practically by all.

CEREBRAL PNEUMONIA IN INEBRIETY.

A large per cent. of all inebriates die from pneumonia.
Cerebral symptoms and complications are common in these
cases, and are described by the term, cerebral pneumonia.
The symptoms in such cases vary widely, depending on the
causes, also brain susceptibility and exhaustion. The effect
of high fever and increased heart action on degenerate
brain and nerve centers in inebriates is manifest in symp-
toms that often mask the pneumonia, requiring a careful
examination to determine meningial inflammation or men-
ingial irritation or pneumonia.

Thus, in one case, an inebriate suffered from chill and
pain of the lungs. The next day he was delirious, and died
a few days later of supposed acute meningitis. The autopsy
revealed the pneumonia. In another case, after a short
period of exhaustion and dull pain, profound depression and
melancholy came on. Except a rapid pulse and high tem-
perature, no other symptom of note was present. He died
a week after the attack, and the post mortem indicated pneu-
monia. Ina third case, after a chill and fever of two days,

the patient suddenly became delirious and remained so until
VoL. IX.—15

112 Editorial.

death, within a week. Pneumonia was found, though unsus-
pected during his illness,

Magnus Huss long ago pointed out two varieties of pneu-
monia appearing in inebriates that are even now overlooked.
The first form appeared in those who used alcohol to great
excess, and all the symptoms came on suddenly. Gastric
derangements and a feeling of faintness, with enervation and
loss of sleep, are the first symptoms. Often a chill is the
first mark of any disturbance. From this point two different
conditions may come on, one of great muscular and mental
activity. The face will seem to swell and the eyes glisten
and flash, the hands and arms tremble, and the patient talk
incessantly, often stammering. Delusions that are first tran-
sient, then permanent, appear. Often this state closely
resembles delirium tremens, only it quickly merges into
extreme exhaustion and death. In some cases, the trem-
bling delirium begins as soon as the chill subsides ; in others
it comes on slowly, but seldom lasts over three or four days.
No complaint of pain is made, and no cough is apparent.
The second condition of this disease will first appear in a
sudden change of expression, sunken eyes, and great apathy
of mind, high fever, rapid pulse, and a rapidly increasing
exhaustion. Both body and mind seem struck with paraly-
sis, and except a chill and hectic flush in the evening, no
prominent symptoms are noticed.

In the second variety of cerebral pneumonia, an adynamic
condition develops at once. Insomnia, or drowsiness, and
mild delusions appear at first. Trembling of the hands and
legs and stammering speech follow; then picking at imag-
inary objects, whispering to imaginary persons, and finally
death. No chill or cough are noticed, only high tempera-
ture and pulse.

Another form has been described, in which delirium of
anxiety to do something is the first symptom. The person
will go to bed with exhaustion, and have this confused and
changing delirium which ends in death in afew days. He
looks bad, will not eat, has high pulse and temperature, and

Editorial, 113

rolls and tosses in bed. The delirium may concern his busi-
ness or family interests, and may last for two or three days,
during which he will walk about, then suddenly he will go to
bed, and soon after die.

These are only general symptoms, which appear among
those who are greatly enervated. Almost endless varieties
of symptoms will appear in those who have had syphilis,
head injuries from heat and traumatism, nerve and spinal
injuries, and lesions of the heart, liver, and stomach.

One practical fact should never be forgotten. Whenever
inebriates exhibit cerebral changes or great exhaustion, the
Tungs should always be examined. A rapid pulse and high
temperature should suggest the same examination. Delirium
tremens, or great depression, melancholy, change of face,
insomnia, stupor, and other symptoms point to inflammation
of the lungs, as both a primary and secondary cause. Com-
plications with malaria, cirrhosis of the liver, abscess in both
the liver and lungs, or gangrene, are all factors to be consid-
ered in cerebral pneumonia. If the case appears as one of
delirium tremens, the question of alcohol in the treatment
will be prominent. How far it can be given, and how far it
will aggravate or relieve conditions of disease present are
most important problems to be settled from the symptoms
of each case.

THE COLONIAL AND INTERNATIONAL CON-
GRESS ON INEBRIETY.

This Congress, organized last year, will hold a session in
London, England, Wednesday, July 6, 1887. The meetings
will be held at Westminster Town Hall, and consist of three
sessions. The morning session at 10.30 A. M., and the after-
noon at 2 Pp. M., followed by a public dinner a 6.30 P. M.
The next day a lunch and meeting will be had at the Dal-
rymple Home for Inebriates, under the auspices of Canon
Duckworth and committee. Dr. Norman Kerr will preside,
sustained by alist of the most distinguished physicians and

114 Editorial,

others as vice-presidents. Among the persons who will read
papers from this country are the following: Drs. Parrish
Davis, Mason, Mann, Crothers, and Clark Bell, Esq.
Among the vice-presidents from this country, are Drs. Day,
Blanchard, Matison, Wright, and Hughes. This is the first
congress devoted to the study of inebriety ever held, of an
international character. The list of vice-presidents embrac-
ing names of the most distinguished men in Europe, which
we published in the last number, shows that at last the sub-
ject of inebriety is coming to the front asa scientific topic.
The scientific world is prepared for it, and from this and
future gatherings we shall anticipate the best results.

ADVISING SUICIDE TO INEBRIATES.

It is not generally known that advice to commit suicide
is an offense, and punishable by law. If it can be proved
that the suicide was the direct result of the counsel of
another, the crime is a misdemeanor. The relatives of the
suicide may have a civil action for damages, the penalty of
which is both fine and imprisonment. Under certain cir-
cumstances the charge would be accessory to the act, and
would be manslaughter in the first degree. Ina case of an
inebriate who committed suicide lately, where the insurance
was contested, the following facts appeared. The victim had
just recovered from a protracted drink paroxysm and applied
to his guardian for help. The guardian, after scolding him
severely, advised him to go and drown himself. This he did
within an hour after the advice was given. The probability
is, that he acted on this advice and would not have done so
had it not been given. An inebriate under my care went
home, and after a severe paroxysm of drink, came to his
brother begging to be sent back. In anger his brother
advised that he go and shoot himself. He went away and
drank freely that afternoon, and committed suicide in the
evening by shooting.

Editorial, 115

These cases are by no means uncommon, and follow most
naturally from the dangerous theories of the vice of inebriety.

The inebriate’s mind is always very susceptible to sui-
cidal impulses. The despair at his failure to control himself,
and the degeneration of both brain and nerve centers, with
impaired vigor, encourage morbid impulses of any form, and
more particularly if suggested from without. A word or
look, or the slightest suggestion to such men in this state,
may explode or give direction to diseased brain force, that
will develop homicidal or suicidal maniacs. The same cau-
tion should be observed with inebriates, as that exercised
among the insane. The appearance of sanity and control
should never be accepted as conclusive, or relied upon. The
advice to end inebriety by suicide should be severely pun-
ished in all circles and under all conditions.

CAPACITY OF JURORS.

An inebriate shot a stranger while intoxicated. On the
trial for murder, the defense was insanity and irresponsibility
at the time. A number of medical experts testified, and
were crossexamined on the nature and character of insanity.
Hypothetical cases involving the mental state, and possible
mental action, at the time of the murder, were presented,
and answered in all degrees of confusion. Statements,
exceptions, and qualifications of insanity and responsibility
were made by each expert. Different views of different
authors and different conclusions of the facts were cited
freely.

The most profound questions of the nature and action of
the mind, were handled with reckless familiarity. Both
counsel and judge commented with increasing confusion on
these questions, and the jury went out to agree upon the
true facts of the case. Three farmers, one horse trader,
four merchants, two mechanics, and two clerks, set down to
determine the degree of sanity and insanity of the victim.
With the training which comes from these separate avoca-

116 Editorial.

.
tions they are called to determine questions of mind and
body, mental health and disease, and the judicial obligations
and relations. All questions which the philosophers and
experts of ages have failed to solve. In two hours these
great questions are decided. The prisoner was of sound
mind at the time of the murder, hence was guilty.

In the sentence to death the judge comments on the fair
trial and impartial judgment of the jury. Later the man is
hung and justice is supposed to be appeased. and others
deterred from similar crimes. A century hence these farcical
efforts to administer justice will be matters of wonder and
ridicule. Inebriety or insanity is not a mere nomonial con-
dition, which can be determined from the limited observation
of twelve non-experts, before whom a mass of conflicting
testimony by opposing counsel are presented. No inebriate
or insane person should ever be tried for crime before a jury.
His case should be determined by experts after a long ex-
haustive study and inquiry.

AGED INEBRIATE.

In the Boston Courier for September, 1825, occurs this
paragraph: “Donald McDonald, who claimed to be one
hundred and three years of age, was brought before the
court, charged with being a common drunkard, of which he
had been convicted once before. Donald stated that he had
been in various battles of the Revolution, and sailed with
Paul Jones, and was at the taking of Quebec. He was found
guilty and sentenced to the House of Correction for three
months.”

The following notice in the Boston Patriot of 182g, indi-
cated that “ Donald” was still living and uncured: “ Don-
ald McDonald, the Scotchman, who has numbered upwards
of 110 years, was sent to the House of Industry on Saturday
of last week in a state of intoxication. He had been suffered
to go at large but four days previous, and during two of
them was seen about our streets, a drunken brawler.”

Clinical Notes and Comments. 117

Clinical Notes and Comments.

ALCOHOL IN TONICS AND BITTERS.

The analyst of the Massachusetts State Board of Health
has lately made a report of the examination of forty-seven
samples of patent fonics and bitters which are sold on the
market as medicines ; many of them are claimed to be tem-
perance drinks and free from alcohol. In all of them alcohol
was found, showing that this was the real agent and basis of
the medicines. The following is the name of the medicine
and the per cent. of alcohol by volume found in each one:

Tonics.— Carter's Physical Extract, Georgetown, Mass.,
22 per cent.; Hooker's Wigwam Tonic, Haverill, Mass., 20.7
per cent.; Hoofland’s German. Tonic, Philadelphia, 29.3 per
cent.; Hop Tonic, Grand Rapids. 7 per cent.; Howe’s Ara-
bian Tonic, New York, 13.2 per cent.; Jackson’s Golden Seal
Tonic, Boston, 19.6 per cent. ; Liebig Company's Coca Beef
Tonic, New York, 23.2 per cent. ; Parker’s Tonic, New York
(advertised as without stimulants), 42.6 per cent. ; Schenck’s
‘Sea Weed Tonic, Philadelphia, 19.5 per cent.

Bitters.— Atwood’s Quinine Tonic Bitters, Boston, 29.2
percent.; Atwood’s Jaundice Bitters, Portland, 22.3 per cent. ;
Baxter’s Mandrake Bitters, Burlington, 16.5 per cent. ; Baker's
Stomach Bitters, New York, 42.6 per cent.; Brown’s Iron
Bitters, Baltimore, 19.7 per cent.; Burdock Blood Bitters,
Buffalo, 25.2 per cent.; Carter’s Scotch Bitters, Georgetown,
17.6 per cent.; Colton’s Bitters, Westfield, 27.1 per cent. ;
Drake’s Plantation Bitters, New York, 33.2 percent. ; Flink’s
Quaker’s Bitters, Boston, 21.4 per cent.; Goodhue’s Bitters,
Boston, 16.1 per cent. ; Hartshorn’s Bitters, Boston, 22.2 per
cent. ; Hoofland’s German Bitters, Philadelphia, claimed to
be free from all alcohol, 25.6 per cent.; Hop Bitters, Roch-
ester, 12 per cent.; Hostetter’s Stomach Bitters, Pittsburgh,

118 Clinical Notes and Comments.

44.3 per cent.; Sulphur Bitters, Boston, contains no sulphur,
20.5 per cent.; Langley’s Bitters, Boston, 18.1 per cent. ;
Mexican Tonic Bitters, Boston, 22.4 per cent.; Porter's
Stomach Bitters, New York, 27.9 per cent.; Bush’s Bitters,
New York, 35 per cent.; Sherry Wine Bitters, Wakefield,
47.5 per cent. ; Cinchonia Bitters, Providence, 13.1 per cent. ;
German Bitters, Concord, 21.5 per cent.; Strengthening
Bitters, New Bedford, 29 per cent. ; Old Continental Bitters,
Lynn, 11.4 per cent.; Walker’s Vinegar Bitters, New York,
61 per cent.; Warner's Safe Tonic Bitters, Rochester, 35.7
per cent.; Warner’s Billious Bitters, Boston, 21.5 per cent. ;
Wheeler’s Tonic Sherry Wine Bitters, Boston, 18.8 per cent. ;
Wheat Bitters, New York, 13.6 per cent.; Faith Whitcom’s
Nerve Bitters, Boston, 20.3 per cent.; Williams’ Vegetable
Jaundice Bitters, Lowell, 18.5 per cent.

INFLUENCE OF ALCOHOL IN NURSING.

Dr. Decaisne, in La Temperance, calls attention to the
great mortality of infants who nurse women that use spirits.
A number of cases are cited which have been reported by
physicians in Paris, where previously healthy children became
restless, nervous, and finally died of convulsions. It was
ascertained that the nurses used spirits freely. In some
cases, extreme indigestion was first noted, this soon passed
into enteritis and death; in others the nervous symptoms
were more prominent, and convulsive phenomena followed.
Several cases were mentioned where the stupor, and finally
the death of infants, were due to the opium taking by the
nurses. He gives several instances which came under his
care, where the convulsive symptoms and marasmus of pre-
viously healthy children, were found to come from the beer
and wine-drinking nurses. When these nurses were dis-
charged, and healthy, temperate women put in their place,
these symptoms of disease in the children passed away. He
condemns the practice of many nursing women, taking beer
or any form of alcohol to keep up their strength. Ile warns

Clinical Notes and Comments. 119

all mothers to watch the habits of nurses, and on no account
permit them to use any form of alcohol or opium. He calls
attention to the fact, that many obscure diseases of infants
may be traced to this source. In all cases he asserts that
alcohol; in nursing women, increases the urinary secretions,
and diminishes the carbonic acid; also the alimentation and
assimilation, and both the quality and quantity of milk. He
also believes that both alcohol and opium are directly trans-
mitted through the mother’s milk.

DRUGGIST’S FRAUDS.

The St. Louis Medical and Surgical Fournal calls atten-
tion to the substitution by druggists of poor inferior drug
compounds, for those called for by physicians. In the West,
where “ Bromidia” is used extensively, druggists often make
up this preparation from drugs and sell it as the original
Bromidia. Horsford’s Acid Phosphate, Park Davis’ Coca
Cordial, Fellows’ Hypophosphites, and many others are fre-
quently substituted by the druggist to the great damage of
all. Reputable pharmacists owe it to themselve to expose
these vultures and drive them from the trade. In doing so
they should have the aid and countenance of every physician.
In the meantime, let every physician not content himself with
shunning the shops of those whom he detects in the nefari-
ous habit of substitution, but boldly denounce them, and
warm his patients against carrying prescriptions to them.
Concerted action of this sort will soon purge the trade of
the offending members.

The Baltimore Academy of Medicine has lately dis-
cussed the use of alcohol as an anesthetic. Drs. Van Bibber
and Ashley related some very striking cases where its anzs-
thetic effect was more favorable than that of chloroform. In
labor and puerpural eclampsia, it had been used with great
efficiency.

VoL. IX.—16, ,

120 Clinical Notes and Comments.

MURDERS BY INEBRIATES.

A correspondent sends us the following: “ During the
year 1886, there were eighteen hundred and seventy-four
murders reported by telegraph in the United States and
Canada. Three hundred and ninety-six were caused in part
or entirely by spirits. Six hundred were put down as coming
from quarrels. Of this number at least half were provoked

‘ or grew out of states of intoxication. Of four hundred
cases ascribed to jealousy, one-third started from drink.
Nearly two hundred cases were put down as from unknown
causes. Here, also, a large per cent. might be traced to
spirits as the real cause.”

From these and other statistics he concludes that at least
twelve hundred murders occur every year which are due to
inebriety.

DELIRIUM TREMENS.

Dr. Reed, in the Massachusetts Medical Journal, writes
as follows: “Formerly it was a universal and it is a com-
mon custom to regard this disease as the characteristic event
in the nervous life of drunkards, but now it is known to bear
but small importance in comparison with the long train of
chronic nervous symptoms which make up the picture of
chronic alcoholism. Formerly it was supposed that delirium
tremens was the inevitable result of temporary abstinence
after habits of drinking. The system lost its accustomed
stimulus. Both these ideas were quite wrong. Delirium
may never occur — never does occur—in the vast majority
even of excessive drunkards, and its outbreak is not caused
by abstinence, but the abstinence is a symptom of the out-
break ; moreover, many patients do not abstain, but drink
.on into the heights of delirium. All one can say is that ina
certain (not large) percentage of people who drink heavily
the course of chronic symptoms occasionally culminates in
an attack of delirium tremens. Now, the important thing
to remember is, that all the alarming train of symptoms

Clinical Notes and Comments. 121

would (barring accidents) subside spontaneously in about three
days from the outbreak of the more acute symptoms, or per-
haps a week from the first occurrence of total insomnia and
spectral illusions, the average delirium tremens patient will
get his first sleep, and from that moment will rapidly conva-
lesce, provided he has been kept entirely from alcohol and has
been fairly fed, and provided that no violent attempts have
been made to narcotize him with opium. However, it is not
necessary nowadays to let the attack run so long a course;
for in the bromides and hydrate of chloral we possess reme-
dies which we may safely give with boldness to procure
sleep, whereas opium was never safe when given boldly.”

EYE SYMPTOMS IN INEBRIATES.

In one case the eyes are intensely red when the patient
is under the influence of spirits. These states only last a
short time and go off quickly. A state of mild inflammation
goes on that often clears up quickly. The eyes seem to be
paralyzed and fixed, the muscles are rigid, the eyes protrud-
ing and seemingly incapable of turning from one side to the
other. In other cases the eyes have a rocking, oscillating
motion, as if in a state of quivering and trembling. In some
cases they are drawn together, squinting, as if the light was
unpleasant and would be shut off. x other cases the eyes
are dilated and stand out from the head. In others they
flash or are dull and heavy, or change suddenly from one
state to the other. Jn other cases one eye is turned up and
the other down. Astigmatism is often seen. Palsy of one
or more muscles may come on any time.

The number of persons arrested in England and Wales
as drunk and disorderly for the six years past were as fol-
lows : 1880, 172,859; 1881, 171,481; 1882, 189,697; 1883,
192,907 ; 1884, 198,274; 1885, 183.221. This shows a reg-
ular increase up to 1884, then a decline.

122 Clinical Notes and Comments.

ALCOHOL AS A REMEDY FOR CHILDREN.

The Fournal of the American Medical Association gives
some extracts from Prof. Deunne’s paper on the above sub-
ject, in a report of the Jenner Hospital for children at Berne,
Switzerland. He believes alcohol very dangerous in all
diseases of children, and should never be used as an anti-
pyretic. He has seen two cases of children who had
cirrhosis of the liver, where alcohol had been taken for a
long time, and was used for dietetic purposes. In other
cases a marked cessation, or even a retrogression, in mental
development was noticed where alcohol was used. Five
cases developed epilepsy from the abuse of drink, in his
observation. In seventy-one cases of epileptics in children,
he was able to trace twenty-one to parents who had used
spirits to excess. Alcohol was always a prominent factor in
causing night terrors and chorea in children. He thinks
alcohol in many cases of children will prove injurious, and
give rise to severe diseases of the nervous system. He
doubts the value of alcohol as a food or dietetic remedy, and
says it should never be given.

MORPHINISM IN ACUTE DISEASE. ,

M. Richardiére lately read a paper on this subject, before
the Paris Société Medico-Pratique, in which he mentioned at
length some of the unrecognized influences which compli-
cated acute diseases in morphia causes. Delirium is com-
mon in all acute diseases that appear in morphiamanias.
Delirium tremens will start up often from some profound
shock to the organism. Pneumonia will be ushered in and
followed all along by delirium. Spasmodic coughing and
varied extreme nerve symptoms will come and go. When
the morphia is withdrawn, many very serious symptoms
appear, and at times take on such an alarming aspect as to
require a return to the use of morphia. Gastritis, pleurisy,
rheumatic affections of the joints, and other diseases may

Clinical Notes and Comments. 123

appear on the removal of the morphia. These and other dis-
eases may appear more or less marked while the morphia is
used,

The caution he gives is to watch all such cases carefully,
and be ready to return to the morphia, where it has been
withdrawn, or to recognize the influence of morphia when
these cases appear.

COCAINE DOSAGE AND COCAINE ADDICTION.

Dr. Mattison, the well known specialist of Brooklyn,
N. Y., has lately read an exhaustive paper on this subject, be-
fore the King’s County Medical Society, and which has been
published in the Medical Register.

The object of this paper is to show the dangerous and
fatal effects from the ignorant and incautious use of cocaine,
and also to indicate that the statements of Drs. Hammond
and Bosworth of New York concerning the harmless charac-
ter of cocaine, are contradicted by all clinical experience, so
far. Ce

Notes and records of fifty cases of cocaine poisoning are
detailed at some length. The principal symptoms seem to
have been in all these cases the sudden prostration and
collapse, with violent headache, vertigo, nausea, delirium,
vomiting, and unconsciousness. In many cases mania and
delirium, with motor paralysis, were prominent. The ques-
tion of cocaine inebriety which has been denied, is answered
as follows: “I venture to assert there are more cases of
cocaine taking in this country to-day, less than three years
since its arrival, than of chloral, after a period of more than
six times as long.” The doctor announces that this paper is
only a preliminary to a more extensive study of cocaine ine-
briety. This we shall look forward to with great interest,
and expect from his great energy and wide-spread studies an
exhaustive summary of the entire subject.

The following are the conclusions of this paper: “ Co-
caine may be toxic, sometimes deadly, in large doses. It
may give rise to dangerous or even fatal symptoms in doses

124 Clinical Notes and Comments.

usually deemed safe. The danger near and remote is great-
est when given under the skin. It may produce a diseased
condition, in which the will is prostrate and the patient
powerless —a true toxic neurosis, more marked and less hope-
ful than that from alcohol or opium.”

If education in physiology and the nature of alcohol
would prevent men from becoming inebriates, we should
expect physicians to be the most temperate of men. In
England inebriety among medical men is very common. In
this country it is a source of great mortality among physi-
cians, either directly or indirectly. It is asserted that medi-
cal men are more often inebriates than any other professional
class. If this is true, there can be but little hope in temper-
ance instruction in the school-room.

The mental effect of punishment where the labor is
monotonous, uninteresting, and devoid of all activity of
mind, is depressing, irritating, and finally debasing to the
mental faculties. Where the mind is acute and hypersensi-
tive, acute melancholy and degenerative changes come on.
But where it is coarser and already palsied and degenerative,
the effect is to harden and increase the debasement and
debility.

Dr. Lauze writes in the Le Medical Progress of Paris,
France, that the continuous use of alcohol produces constant
cerebral congestion and degeneration of the layer of brain-
cells closest in contact with the vessels of the pia mater.
General paralysis is the most common result, and is partic-
ularly a disease of a worn-out brain forced into abnormal
activity, and driven beyond the point of exhaustion.

A leading daily has a very prominent advertisement of a
brand of “Hand Made, Sour Mash Bourbon Whisky.” In
large head lines occurs the following terribly literal statement:
“Is death to malaria, chills and fever, typhoid fever, indi-
gestion, dyspepsia, surgical fevers, blood poisoning, consump-

Clinical Notes and Comments. 125

tion, sleeplessness, and dissimilation of food.” As usual,
several distinguished chemists certify that it is good for
family uses.

Fournier maintains that the poison of syphilis is increased
to great virulence by inebriety, bringing on cutaneous lesions,
and producing severe symptoms, tertiary in character,
early in the secondary stage, creating special types of
malignant eruption, involving large areas of skin surface,
causing more frequent outbreaks of the syphilides, depress-
ing the system, and finally predisposing to early nervous man-
ifestations, causing deposits in the brain and spinal mar-
row.— Medical Record.

The Doctor, a paper devoted entirely to personal medical
news and gossip, first appeared in December last, and has
been seen twice a month ever since. Every observation
proves that this paper fills a great void in the medical heart,
of wanting to know something personal of his neighbor and
his neighbor's doings. The genial editor, Mr. Wells, is an
astronomer, and his pages are full of discoveries of great
Stars, Planets, and Comets, and their movements, in the
medical heavens. Send two dollars to the editor's address,
20 Astor Place, New York City, and get this semi-monthly
Doctor, filled to the brim with facts and fancies concerning
the great unwritten work of physicians.

The English report of the commissioners of lunacy for
the year ending 1885, indicate that twenty-one and nine-tenths
per cent. of all the insane were made so by alcoholic spirits.
The whole number of the insane were 79,704. : It is evident

. from the list of causes, that an equally large proportion of
cases, due to inebriety, were put down to other causes. Dr.
Brown’s statement that fully fifty per cent. of all insanity
were due to excess of spirits, seems to be confirmed from
these figures.

Dr. Formad, in his recent analysis of the anatomical
lesions of two hundred and fifty inebriates, shows that cir-
rhosis is not a common condition of the liver in these cases.

126 Clinical Notes and Comments.

He found only six cases in two hundred and fifty autopsies,
and these were all in the chronic and worst class of inebri-
ates. The old view that every inebriate had cirrhosis, and
that cirrhotic liver was always an indication of severe drink-
ing, must be given up. Dr. Formad also found that cyan-
itic induration of the kidney, and chronic gastritis with
mammillation of the stomach, was present in nearly every
case.

The report of the Committee on provision for Idiotic and
Feeble-minded persons read by Dr. Kerlin at the Conference of
Charities and Correction, has the following among other con-
clusions : “ That in thirty-four per cent. of idiocy, there should
be the family history of alcoholism, with cases of epilepsy,
nervous disease, and crime. In the same inheritance is an
argument for the restraint of alcoholic inebriety.” This is
confirmed by Dr. Beech of England, who reports from 38 to
40 per cent. of all idiocy caused by alcoholism. The Ger-
man Conference for the Care of Idiots, declared inebriety was
the principal cause of idiocy.

The inebriate, of all men in every community, needs pro-
tection. While they are not technically insane, they are
without mental power of control, and subject to contingen-
cies and influences which they are powerless to resist.
They become the prey of their own diseased fancies, and the
wills of those who wish to use them for some selfish end.
They often possess a mental constitution so fragile and even
tottering that the least strain carries them over into the do-
main of insanity. Their history clearly points out their
feebleness, and the need of help and protection, not of jails or
prisons, but of hospitals and homes.

Every one who examines the Turkish Bath as a remedy
for inebriety and nervous diseases, is astonished at its value,
and that it is not better known and more generally used. An
inebriate physician wrote me, that after the drink paroxysm
he suffers acutely from gastritis, most intolerable thirst, and
inability to retain anything on his stomach. He has never
found any relief from remedies at these times. He finally

Clinical Notes and Comments. 127

used the Turkish bath, and the relief was rapid and perma-
nent. From that time he has used these baths in gastritis
from all causes, and has found them very valuable. Dr.
Shepard’s Turkish baths on Brooklyn Heights, are no doubt
the most scientific and complete in this country, and should
be tried in such cases.

Dr. Baudug speaks of Maltine as follows: “My very suc-
cessful experience with Maltine makes me feel it a duty to
the profession to point out some of the principal features of
merit this very valuable preparation possesses.

It contains ¢kvee most nutritive and digestive agents, rich
as they are in phosphates, diastase, and albuminoids. Hence,
at a glance, it is apparent that, for constructive metamor-
phosis of the brain and nervous system at large, this prepa-
ration must prove most efficacious. The large proportion of
brain and bone-producing food it contains, therefore, makes
it of incalculable benefit in many forms of wasting and
asthenic disease. The large proportion of diastase and other
albuminoids present in its composition gives it both digestive
and nutritive value. Its digestive properties, in fact, enhance
its nutritive or tissue-forming capacity.

“Tn a word, in nearly all cases of general debility, wasting
or atrophic affections, and in nearly all varieties of indiges-
tion, Maltine is a therapeutic auxiliary, the most valuable we
have as yet encountered, and of which we can conscien-
tiously say we do not tire, being daily more and more con-
vinced of its advantages. With the long and very extensive
practical experience we have had of its value, we would be at
an infinite loss to replace it in our daily practice now that
our confidence in its real merits has been so fully established.”

It appears to me that the “ Acid Phosphate,” originally
prescribed by Prof. Horsford of Cambridge, U. S. A., is not
so well known in this country as its merits deserve. A

glance at the formula will, however, readily convince one of
VoL. IX.—17

128 Clinecal Notes and Comments.

its value in suitable cases. Each fluid drachm gives, on
analysis, 5} grains of free phosphoric acid, and nearly four
grains of phosphate of lime, magnesia, iron, and potash. The
following are a few brief rotes of some of the cases in which
I have prescribed it with complete success.

Mr. G., aged 69, consulted me November, 1885, for ec-
zema on the arms, legs, palms of the hands, and trunk. The
patient complained of much debility and nervous exhaustion,
and he was a man who had led a very busy business life with
much worry. In December, 1885, I prescribed Horsford's
acid tonic with much good effect, and in February, 1886, I
heard that he was quite well.—Dr. Starlin, London Medical
Press.

We mentioned in the last issue of the JourNAL some of
the remedies we could cheerfully endorse. We repeat it,
with some of the reasons why each one may be good.

Murdock Liquid Food is employed with excellent results
in anzemia and non-assimilation of food.

The Anglo-Swiss Milk Food of New York is particularly
+ a farinaceous food for invalids. :

Colden's Liquid Beef Tonic has taken high rank for con-
ditions of nerve exhaustion following the use of alcohol.

Peptonized Cod Liver Oil and Milk, by Reed & Carn-
rick, should always be given as an oil tonic and stimulant.

Lactated Food is fast becoming a standard remedy in all
forms of inebriety.

Fellowes’ Hypophosphates is unequaled as a remedy in all
forms of nerve and brain degeneration.

Lactopeptine should be in the case of every physician. Its
uses are as varied and valuable as quinine or salts.

FHforsford’s Acid Phosphates is equally valuable and use-
ful in a widespread class of cases.

The Bromidia has come into very general use, despite
all competition.

Cold Cordial has an ever-increasing reputation, and is the
safest form of any cold preparation to give.

THE

QUARTERLY JOURNAL OF INEBRIETY.

Vol. IX. JULY, 1887. No. 3.

This Journal will not be responsible for the opinions of contributors, unless
indorsed by the Association.

INTERNATIONAL CONGRESS OF INEBRIETY —
OPENING ADDRESS ON THE DISEASE
AND TREATMENT OF INEBRIETY.

By THE PRESIDENT, NorMAN Kerr, F.R.S., M.D.

Dr. Kerr, after welcoming the members, said:

The past half century has exhibited no more striking
phenomenon than the rise and progress of the great Temper-
ance reformation, the jubilee of which was celebrated all
over the world a year or two ago. The early abstaining
heroes, the memorable men of Preston, and the other brave
souls who, some fifty years ago, amid the scorn, the contempt,
and the ridicule of the learned, the religious, and the fashion-
able, founded that grand reform of which total abstinence
and prohibition are to-day the practical outcome, had for
their aim two great ends—the rescue of the intemperate
and the prevention of intemperance.

The undaunted Temperance pioneers thoroughly under-
stood the material character of the intoxicating principle, and
its physiological influence on the body and brain of man.
In a word, our nephalistic ancestors had a clear conception
of the genesis of inebriety, and had their nephalian progeny
all shown as intelligent a comprehension of the subject, there
would have been little occasion for the assembly to-day of a

130 Disease and Treatment of Inebriety.

Colonial and International Congress for the consideration of
the remedial and legislative needs of the habitual drunkard.

Of recent years, however, there has in some quarters set
in a bad fashion of stigmatizing early temperance advocacy
as “low,” and of boasting of the so-called “ higher platform”
of the modern temperance crusader. The true doctrine was
taught by the founders of teetotalism, and the pretentious
“higher platform” is simply the exclusion of one-half of the
truth (the physical aspect) concerning intemperance.

The earliest teaching was that intoxicating liquors are
dangerous articles, that there are multitudes of persons so
susceptible to the narcotic influence of the witching poison
that, whatever their accomplishments or their station, if they
drink at all they drink to drunkenness ; that the confirmed
inebriate is a diseased individual, undergoing the tortures of
a living death, manifesting symptoms characteristic of the
operation of an irritant narcotic poison. Some of our latter-
day enthusiasts deny that inebriety is ever a disease, insist
that the fault always lies with the drunkard, never in the
drink; that only the evil-disposed and fools fall victims to
alcoholic excess.

Need I add that the former well-informed friend of the
inebriate recognizes the physical phase of narcotic indul-
gence, the arduous and protracted character of the struggle
of the habitual drunkard for emancipation from his tyrannous
task-master ; while the latter ill-informed visionary indig-
nantly denies that there is any physical element in the mat-
ter, asserting that drunkenness is nothing but a wanton
immorality, a willful sin, and complacently declaring that
moral and religious influences are alone of service in the
reformation and cure of the inebriate.

The illustrious forerunners of Temperance, Erasmus
Darwin, two centuries ago, and Benjamin Rush, a century
ago, besides other far-seeing and profound thinkers long
before, knew and taught the truth. It is not the vicious,
the ill-disposed, or the poor who alone swell the great army
of the drunken, The most guileless spirits, the purest

Disease and Treatment of Inebriety. 131

minds, the warmest hearts, the most unselfish souls, the
loftiest understandings, and the clearest heads have gone
down before the irresistible power of the Bacchic tyrant.

Swells the refrain of ten thousand parrot voices, “Men
become drunkards because they drink.” If ever it were true,
in the language of Tennyson, i

“ That a lie which is half a truth is ever the blackest of lies,
That a lie which is all a lie can be met and fought with outright,
But a lie which is part a truth is a harder matter to fight,”
itis here. Men become drunkards through drinking, it is
true. That is, drinking is the means by which they attain
to a state of intoxication. But the majority of those who
drink do not become drunkards. Only a certain proportion
drink to excess. Drinking, though a cause, is not the sole
cause of drunkenness. It is, in our country, and in some
other countries, the principal means by which drunkenness
is arrived at. In other lands, to some extent even among
ourselves, opium or some other narcotic anesthetic is the
intoxicating agent.

The act of drunkenness should not be confounded with
the disease of inebriety. There may be a succession of
drunken acts, yet no diseased condition underlying these.
On the other hand, where there may have been no actual
drunkenness, or even limited drinking, the individual may
have been the inheritor of so strong an inebriate predisposi-
tion as to have been unable to taste an intoxicant without
drinking to excess.

Inebriety may be defined as a disease of the nervous
system allied.to insanity, characterized by an almost over-
powering impulse to, or craving for, the oblivion of narcotism.
It is, in reality, an intoxication mania.

The causes of inebriety lie deeper than the mere inebriat-
ing substance ; and until we unravel the etiology and pathol-
ogy of the disease, until we fully comprehend the philosophy
of intemperance, though we even succeed in expelling
alcoholic intoxicants from within our borders, the remote
causes of inebriety will continue to operate, pleasure, seeking

132 Disease and Treatment of Inebriety.

mankind will strive to appease its craving for narcotism by
some other inebriant, such as opium, or chloral, or ether, or,
as is already being furtively used, chloroform.

The disease of inebriety assumes varied forms. Inebriates
may be classed as periodical and constant. The occasional
drunkard does not generally labor under the disease, so
need not be regarded here. The periodic attacks may be
quotidian, tertian, quartan— once a week, once a fortnight,
once a month, once every two or three months, or they may
occur irregularly. Functional disturbance is the most com-
mon cause of periodic outbreaks. There are other periodi-
cities, such as the periodicity of climate, of season, of
occupation, and of occasion.

The indulgence of the inebriate may be social or solitary.
The majority drink freely only when in “ good company,” but
a considerable minority are secret drinkers.

The particular form which inebriety may take may be
determined by the complicating affection. Thus we have
the inebriety of insanity, of syphilis, of sunstroke, and of
injury (traumatic inebriety).

The form may. correspond to the particular inebriant used.
In this way we have alcoholomania, opiomania, morphino-
mania, chloralomania, etheromania, chlorodynomania, chloro-
formomania.

Alcoholic inebriety is not confined to ardent spirits,
though strenuous efforts are being made to show that beer is
harmless, while spirit is injurious, and to establish a differ-
ence in kind between the action of fermented wines and
spirituous liquors. At the Dalrymple Home nearly 10 per
cent. of the cases treated have been examples of beer and
wine inebriety. The difference is in degree, not in kind.
All intoxicating drinks are poisonous. The lightest beers
and the finest fermented wines are as truly, though not so
strongly, intoxicating as are the coarsest and cheapest
spirituous drinks,

The real question to which an accurate reply should be
sought is, “ Why do men fly to narcotics?” If we can ascer-

Disease and Treatment of Inebriety. 133

tain this, we will be in a position to understand the alarming
nature and extent of the inebriety which is so prevalent
among us.

Fashion ; the habits in which they have been brought up
from their childhood; custom, which, with its hoary head and
blanched locks, has made the intoxicating cup seem natural
and familiar ; tradition, which has shed so venerable and be-
nign an aspect on drinking; poesy, which has wreathed
around the intoxicating bowl garlands of surpassing beauty ;
piety, which has blessed and sanctified the inebriating cup,
account for probably the great majority of attempts on the
part of individuals to drink moderately. The greater part
of these, fortunately, though many injure their physical sys-
tem and shorten their life by what may more truly be called
“intemperate” than “moderate” drinking, have never be-
come “drunkards” in the ordinary acceptation of the term,
2. é., they have never lost complete self-control. All who are
slain by alcohol are not inebriates. Many who have been
killed by it have never once been what is denominated
“drunk,” in the whole course of their lives.

But, though the majority of drinkers stop short of habit-
ual or periodical intemperance, there is a vast array of men
and women —and, alas, of children — who, from various pre-
disposing causes, are so handicapped in the race for “ mod-
eration,” that, strive as they may, they are unable to attain
to it. They set out on their alcoholic career with an utter
abhorrence of excess, and with a resolute determination never
to exceed, never to come under the grinding yoke of strong
drink. They have been educated from infancy in the art of
drinking. Infants in arms, they have imbibed the intoxicat-
ing draught, it may be, from the maternal bosom. As chil-
dren they have been accustomed to see fermented wine on
the social board, to witness their parents and visitors partak-
ing of it, as a matter of course, without any apparent ill effect ;
they have been treated to a sip, then half-a-glass, then a glass
of some comparatively light, pleasant wine or beer, as an in-
tegral part of their daily diet. In adolescence or manhood

134 Disease and Treatment of Inebriety.

they bound forth on the path of life with a buoyant step,
quaffing the alluring and enlivening cup, thinking no evil
and fearing no harm. Oftener, and yet more often do they,
all unconscious of peril, resort to the narcotic for the pleas-
urable though fleeting sensation which follows, till, bye-and-
bye, before they feel the chain even tightening, they are
firmly bound by the gilded fetters of an acquired appetite for
intoxicating agents. With many such the habit has been so
confirmed, the brain and nerve centers, if not the body, have
been so affected by alcohol, that a veritable diseased condi-
tion has been established which renders exceedingly difficult
the cure of what was once perhaps only a social indulgence,
in which pre-disease state the entire abandonment of intoxi-
cants would have been comparatively easy.

Whatever the difference of opinion as to the precise char-
acter of the drinking habit in the first instance, the latter
stage is admitted by nearly all to be an unmistakable stage
of actual disease.

Causes may be considered as predisposing and exciting.
An exciting cause provokes the inebriate paroxysm in a con-
stitution predisposed to inebriety, while the same excitant
has no effect in stimulating a person who has not this pre-
disposition to excessive narcotic indulgence.

What are the causes which have hindered so many from
steadfastness in “moderate” or rather “limited drinking”?

Above and beyond all other predisposing causes stands
heredity.

This heredity may be regarded as twofold. There is the
direct alcoholic inheritance. That drunkards beget drunk-
ards is an axiom dating from very early times. There are
also large numbers of children born with an inherited and
extremely delicate susceptibility to the narcotizing action of
alcoholic intoxicants, whose parents were not in the habit of
getting drunk, but drank regularly and freely, physiologically
intemperate, though considered by the world to be models of
sobriety.

There is also the indirect inheritance of alcohol. Under

Disease and Treatment of Inebriety. 135

this category are ranged individuals who have no special pro-
clivity to excess, who have no direct though latent proneness
to inebriety, but who are weighted from their birth by a con-
trolling power too feeble to. stay the advances of alcohol
within their very being. Alcohol, if it gain an entrance into
such constitutions by however tiny an inlet, slowly yet steadily
widens the aperture by increasing in volume, as the dykes
built to resist the encroaches of the ocean, till all the defenses
are swept away by the overpowering and overwhelming flood.
In no inconsiderable proportion of cases this defective power
of control is the product of alcoholic indulgence on the part
of one or both parents.

IT have seen the alcoholic habit in the parent bear diverse
fruit in the persons of the offspring, one sister being nervous,
excitable, and inebriate, a second consumptive, a third insane;
one brother an epileptic and a periodic inebriate, the second
in an asylum, the third a victim to chronic inebriety. In
another instance where all the four children have become
habitual drunkards the grandfather had also been addicted
to excess.

The heredity is sometimes crossed. The daughters of a
drinking father, and the sons of a drinking mother may be
the only children affected with the inebriate taint.

The heredity may be either insane or inebriate. As ine-
briate parents not unseldom beget insane offspring, so from
insane parentage we sometimes get inebriate children. The
heredity may be of some other type. Any transmitted dis-
ease or effect of disease which increases nervous susceptibil-
ity, unduly exhausts nerve strength, and weakens control,
may bear a nervine crop, in the form of asthma in one child,
hysteria in another, epilepsy in another, idiocy in another,
and inebriety in another.

A considerable predisposing cause is the effect on the
system of accident or disease — traumatic inebriety. Blows
or falls on the head and: sunstroke, are typical examples of
this class of causes.

Injudicious diet and bad hygienic conditions, by their de-
Vo, IX.—19

136 Disease and Treatment of Inebriety.

pressing influence on the nervous system, predispose not a
little to inebriety. Thus it is that the improvement of dwell-
ings for the poor is so valuable an aid in true Temperance
effort.

The influence of sex, age, religion, climate, race, educa-
tion, pecuniary circumstances, occupation, marital relations,
temperament, and associated habits, are all worthy of inquiry.
The terrible increase of female inebriety in England of late
years is a fact of serious import to the future of the British
race, as yet little recognized, and less understood. The
health, sobriety, and morality of the coming generation, are
deeply involved.

Intoxicating drinks themselves, by their toxic effect on
body and brain, markedly predispose to inebriety, by degen-
eration of tissue, by perversion of function, by brain disturb-
ance, by dulling of the moral sense, and by paralysis of will,
all of which unhealthful conditions may be handed down.

What are the causes which excite to inebriety? Some
form of nerve shock takes the lead. The shock may be
caused by sudden and appalling bereavement, financial ruin,
worry, unhappy marriage, disappointed affection, desertion,
or sudden and unexpected good fortune. Accidents and
disease excite as well as predispose. I have known, for
example, sober men and women precipitated, as it were, into
drunken excess, immediately after sustaining some obscure
brain injury, and in convalescence from enteric fever. Some
occupations, such as liquor trafficking, sedentary employ-
ment, and daily newspaper work, are more exciting to
Intemperance than others, being more productive of nerve
exhaustion. Climate exerts an influence. I have seen an
Italian who led an abstemious life at home, suddenly break

out here into inebriate habits. The state of.the atmosphere, ~

and the direction of the wind, have a marked effect on some
inebriates. Functional derangement is an influential factor.
So is idleness, Overwork, overstrain, sociability, and intoxi-
cants, themselves all excite to an outbreak.

Age must not be left out of consideration, the inebriate

Disease and Treatment of Inebriety. 137

climacteric ranging generally between thirty-five and forty-
five. Unhappily, of recent days, tender years have not
secured exemption. Children of eight, six, and even four
years, have had attacks of delirium tremens, while even
younger little ones have exhibited a mania for intoxicating
beer, wine, and ardent spirits. I have heard children who
had been rendered insensible by an accident, on recovering
consciousness, ask for gin, or some other similar drink.

The pathology of inebriety is a most interesting study,
and reveals the fact of diseased conditions of brain and
nerve centers, antecedent to both constant and periodic
inebriety.

The importance of a knowledge of the causation of
inebriety, consists in the basis which this affords for judi-
cious treatment. When we have discerned the unhealthy
condition preceding an attack of disease, we are in a favor-
able position to prevent a recurrence by remedying the
prior morbid state. -

Philanthropists and quacks —the former from the high-
est feelings of benevolence, the latter from the lowest
motives of the pocket—have eagerly sought ‘for some
charmed elixir, some de-narcotizing talisman, which would
cure drunkenness and restrain the drunkard from even tasting
an intoxicant again. The magic potions have been in num-
ber without end. Each in succession has been proclaimed
as a perfect cure. But all the pretentions advanced on
behalf of them have been found baseless, from the curious
alcoholic extract of frog, to the “ bark cure,” which latter
was believed by good Christian people among us to have
miraculously cured thousands of the worst drunkards in an
American city. The nostrum had in reality cured no one
there, but has caused many,a reformed inebriate to relapse
into his previous drinking habits. Verily, John Bull should,
by the transformation of a letter, be called “ John Gull”!

Others, again, in the fervor of their rage against the
consumption of the flesh of slaughtered animals as food, have
solemnly declared that the cause of drunkenness is the eating

°

138 Disease and Treatment of Inebriety.

of beef, that we are mainly indebted for our inebriety to the
devouring of pork pies, sausages, and the fleshpots of Egypt
generally, and that abstinence from fish, flesh, and fowl
would destroy the crave for narcotics. A knowledge of the

true nature of inebriety and of the facts, would dispel this,

astounding delusion. Whole races—who would not taste
animal food if they were put to death for their refusal — will
get as thoroughly and as often drunk as you.choose to
supply them with the wherewithal. a

There are certain indications of sound treatment.. The
first is the withdrawal of the narcotic poison, so that the
toxic process may cease. This can be immediate with
alcohol, ether, chloroform, and chloral, but generally should
be gradual with opium and morphia. The second indication
is the removal, if possible, of the exciting cause. The third
consists in the reparation of the physical damage wrought by
inebriety, the remedying of the pre-inebriate morbid con-
dition, and the strengthening of the moral control.

In all these curative measures medical treatment is
called for. As is the treatment of insanity, the physical
disease should be dealt with, moral and religious influences
having their appropriate sphere of action. The bodily
unsoundness must be set right, while the concerns of the
mind, the conscience, and the spirit are not overlooked.

The disease should be dealt with in its early and more
curable stage, as the more chronic it becomes the more diffi-
cult is the cure. As skilled advice is not usually invoked
until the disease is in an advanced stage, — the clergyman,
the lawyer, and every irregular and amateur practitioner
having been consulted before the medical man, —in most
cases removal from the former inebriate associations affords
the best hope of benefit. Sometimes, though rarely, this
may be secured by a voyage in a teetotal ship, or by residence
with an abstaining family; but as a rule the only resource
is to try a residence in a Home for Inebriates. This should
be of at least twelve months’ duration. As many such
establishments are really homes for the confirming or train-

Disease and Treatment of Inebriety. 139

ing, and not for the cure of inebriety, it is imperative that
the most scrupulous care be taken to see that the institution
is genuine, and does not allow the presence of intoxicants.

The results of the treatment at the Dalrymple Home for
Gentlemen at Rickmansworth are most gratifying. There
have been 103 admissions and 8§ discharges. Of the
patients who have been treated in that Home (which is the
only retreat for males with a disinterested proprietary, and
at the same time licensed under the Habitual Drunkards
Act), more than one-half have been restored to their friends,
and have been enabled to again fulfill their duties in life.
A like experience has rewarded the treatment at other genu-
ine homes in this country and abroad. So that it may fairly
be claimed that one-third of discharged male inebriates have
been cured. The record is not quite so favorable in the case
of females.

In America and in many of our Canadian and Australian
colonies there is excellent legislation for the compulsory
committal of inebriates to authorized homes for care and
treatment; but in the United Kingdom a lively jealousy of
interference with the liberty of the subject has prevented us
from being favored with a similar provision. The British
Legislature is so enamored of freedom that it has declined
to emancipate the drunkard’s hapless wife and starving chil-
dren from their slavery, or by effective temporary seclusion,
to give the broken-down, volitionless inebriate his only
human hope of deliverance from a worse than Egyptian
bondage. Involuntary internment in a genuine retreat for
inebriates would be the freeing of many an abject serf, for
such might truly, with the poet, say of themselves:

“Our freedom chained; quite wingless our desire ;
In sense dark-prisoned all that ought to soar!
Prone to the center; crawling in the dust;

Dismounted every great and glorious aim;
Embruited every faculty Divine.”

Our Habitual Drunkards Act, which will expire in two.
years, unless renewed, empowers an inebriate, in the presence

140 Disease and Treatment of Inebriety.

of two justices, to sign away his liberty for any period not
exceeding twelve months. As there is no licensed accom-
modation for patients under £2 2s. per week, there is there-
fore no provision whatever under the Act for the poor, or for
persons of limited means. In America, and in our colonial
possessions, it is far otherwise. There the State of the in-
ebriate can be held liable for the cost of his maintenance;
and when no funds are forthcoming, he is treated for a time
at the public charge.

There is a residuum of inebriates in whom the disease
‘has become so confirmed that they are apparently incurable.
They are not amenable to treatment, and, therefore, have to
be discharged from homes for inebriates, as their retention
would interfere with the treatment of the other more hopeful
cases. For this residual chronic, insusceptible class, provis-
ion should be made for compulsory and permanent constraint.
It would be true economy for the State to provide for all
these classes of inebriates, who for criminal and police ex-
penditure necessitate an enormous annual outlay.

The Medico-Legal Relations of Inebriety are of deep
interest. In some countries crime committed during in-
sanity from drink is not visited with heavier penalties than
if the insanity were from other causes, and, therefore,
exempts from responsibility. In America, France, and Eng-
land full responsibility is, however, exacted. In America
the severity of the law is in practice mitigated in capital
cases by the choice of degrees in criminality. The result of
our present jurisprudence is that men and women have been
sometimes severely punished for deeds done when the doers
were undoubtedly beyond control, and even unconscious of
their violence. Our existing jurisprudence was built up
when we had little knowledge of the physical phases of
inebriety, and a mixed commission of legal and medical
experts might be able now to somewhat modify, in the
interests of justice, our criminal procedure with reference to
the diseased inebriate.

To the great Republic of the West the world is indebted

Disease and Treatment of Inebriety. 141

for the dawn of a new era of hope for the habitual inebriate,
who has been too long the scorn, as well as the reproach, of
modern civilization. In the victorious freeing march of the
beneficent Temperance reform, not a few human captives
have been rescued from a living death, not a few human
slaves have been restored to abstaining liberty and life.
With a fuller knowledge of the causes and conditions of
inebriety, which we trust the labors of this Congress and
similar efforts will afford, we may confidently look forward
to a more successful, because a more intelligent warfare,
against intemperance, to the more effective protection of
those who have to come after us from the sorrows and the
evils of narcotic excess, to the more hopeful treatment of ‘a
dire and dreadful disease.

A general recognition of the diseased state of the inebri-
ate may not be realized in our day; full justice may not be
accorded to his physical infirmities in our time. But our
duty is clear. Our mission is to proclaim the truth. Strong
in the righteousness of our cause, let us be content to sow
the seeds of knowledge. Let us, each one of us, in our heart
of hearts, say with the grand old Quaker poet of America:

“T have not seen, I may not see,
My hopes for man take form in fact.

But God will give the victory
In due time. In that faith I act.”

The following Address to Her Majesty Queen Victoria
was then adopted, and the President was authorized to sign
it on behalf of the Congress :

“To Her Most Gracious Majesty Victoria,
Queen of Great Britain and Ireland.

“We, the members of the Colonial and International Con-

gress on Inebriety, assembled at London this sixth

day of July, eighteen hundred and eighty-seven,

under the auspices of the Society for the Study of

Inebriety, respectfully tender our homage and con-

gratulations to your Majesty on your Majesty’s long

and beneficent reign.

142 Disease and Treatment of Inebriety. .

“We desire to record our thankfulness to Almighty God for
those graces and virtues and that ever-living interest
in the material and moral well-being of the people
over whom your Majesty rules, which have touched
their hearts, and have won.the devotion and affection,
not only of your Majesty’s loyal subjects, but of all
the nations of the earth.

“While we beg to acknowledge our gratitude for the deep
interest which your Majesty has taken in the sobriety
of the British people, we humbly submit to your
Majesty’s consideration the pitiful case of the sub- ,
jects of the truly terrible disease of inebriety, who
from unhealthful conditions have fallen victims to
alcoholic excess, and have thereby been so enfeebled
in will that they are, without remedial moral and
legislative treatment, unable to resist the power of
intoxicants.

“We fervently pray that your Majesty may be long favored
by the Almighty with health and happiness, and long
spared to reign over your Majesty’s devoted subjects,
as well as to afford your Majesty’s royal encourage-
ment to every judicious movement for the welfare
and the improvement of mankind.

Norman Kerr, M.D., F.L.S., President.”

The President then resigned the chair to Dr. Cameron,
M.P., who presided at the morning sitting.

There were sixteen hundred and twenty-six persons of
both sexes in the insane hospitals of Pennsylvania for 1886.
Of this number only two were dipsomaniacs, eight were
opium cases, one of cocaine inebriety. One hundred and
twenty-three are put down to intemperance.

In many cases the inebriety of the children have been
traced to the social and business disturbances of the parents
at the time of conception.

Alcohol on the Heart. 143

ALCOHOL ON THE HEART.*
By Dr. B. W. Ricnarpson, F.R.S.

Dr. Richardson said that his observations had taught
him that although the primary action of alcohol was upon
the nervous system, the first organ which bore witness to
the action was the heart. This is not peculiar, because the
heart is always the first witness to the fact of nervous dis-
turbance. When the sphygnophone is applied, the mere act
of the patient listening to the sounds disturbs the heart and
alters the pulsation. The effect of odors and of strange
sights is the same.

The distinguished Dr. Wilson Phillip showed, originally,
and Dr. Richardson has since confirmed it, that if the sur-
face of the brain of an animal be simply exposed to the
action of alcohol the motion of the heart is influenced, and
the disturbance is so rapid that it looks as if there were a
direct impression from the brain to the heart.

Dr. Richardson then demonstrated from pulse readings
what were the dangers that occurred in the circulation
through an acute course of alcohol leading up to complete
intoxication. These changes were written from the pulse
of those affected by alcohol, and they showed a deviation
from the standard in every stage. After a complete intoxi-
cation up to the fourth degree, the pulse would recover its
tone if it were left to gain its natural condifion, but it was
quite three days before the return to health was declared.

In the inebriate the heart was never allowed to declare
itself naturally. Once put off the natural lines, and if con-
tinued off, then it will, in time, become so fixedly unnatural
that intervals of relief from the disturbing agent extending
over eighteen to thirty-six months were often required before
the circulation re-assumed the 7é/e of health.

* An address delivered before the International Congress of Inebriety,
Vat, IX.—2a

144 Alcohol on the Heart.

To what extent the heart is disturbed in the inebriate
was a point which Dr. Richardson next demonstrated from
pulse readings. He showed: (1) the reading of a natural
pulse ; (2) the reading ofa pulse of an inebriate at his best;
(3) the pulse of the same man after he was what he called
“elevated,” or supported by a full measure of alcohol ; (4)
the pulse of the same man during the period of depression
following upon the alcoholic indulgence.

These readings showed the continued and continuous
variation and irregularity of action of the heart. Among all
the stages of the life of this man, the character of the
changes exhibited being as varied as his words and actions,
his circulation was at the best feeble and uncertain, watery.
Under the alcohol it was sharp and vehement, but easily
depressed ; under depression it was simply, as the old writers
well expressed it, “rotten.” It showed no regular outlines.
While, then, it may be true, and, no doubt, is true, that alco-
hol acts primarily on the heart, its mode of action is through
the circulation by a third movement back again upon the
brain, the volition, the emotion, and the reason.

So soon as these changes, therefore, become permanent
or habitual, they produce that confirmed disease and habit of
body which we call inebriety, the center of which is in the
heart and circulation. At first, the heart of the inebriate is
made tense and full by alcohol. This, under continuance,
extends to permanent enlargement of dilatation with stretch-
ing of the valves, especially the semilunars, and distention of
the arterial system throughout, leading to loss of elasticity.
As a further change, there is modification of structure, both
cardiac and vascular; a feeble, large heart, dilated, rigid
arteries, distended and bulging veins. The corporeal mech-
anism is, in short, changed altogether. As an accompani-
ment of these changes of structure there is a change of dis-
position of will, of nature. :

There are many who are not, strictly speaking, accepted
as inebriates, but who are really so,in a minor degree,
against their own admission or belief. They are inebriates

Alcohol on the Heart. 145

of the minor key. They tell the physician nothing more
than the fact that they know and feel the “sustaining”
power of alcohol. They feel, they affirm that they cannot
live without it, and when abstainers assure them that the
sense of the requirement is an idea, and no more, they reject
the statement as either ignorant, unsatisfactory, or even
cruel. This sense of want, in fact, divides the moderately
inebriate from the truly temperate. The nonsense, if the
want is the true sense of the danger, this fact they who do
not feel the want know quite well, and they who do feel it
know partly, their better judgment leading them to it as the
first step towards positive inebriety. In confirmed inebriates
the state of the circulation is supposed by the sufferer to be
actually natural. It is strange to say, but it is correct, that
the confirmed inebriate forgets what it is to be a natural
man. He is ina distinct and unnatural sphere, like a man
who has been cast amongst savages and made to acquire, by
habit, their habits, tastes, and tongue. With the circulation
so modified, the heart so feeble, the arteries so imperfect, as
in the confirmed case from which the pulse reading was
made, there could be nothing but uncertainty of physical and
of mental manifestations.

From these reflections on the changes of the heart and
circulation under inebriety, Dr. Richardson surveyed the
question of treatment. Here two facts presented them-
selves,— firstly, that with the heart and circulation of the
pathological inebriate state there can be no rapid or immedi-
ate change, that is physically impossible ; secondly, that so
long as alcohol is permitted to enter the inebriate body
there can be no chance of successful restoration of the natu-
ral state.

There were, therefore, on pure physiological lines of argu-
ment, setting all sentiment on one side, only two elements of
cure for the inebriate, minor or major—namely, time and
total abstinence from alcohol. It is not simply that the evil
spirit must be cast out, it must be kept out until the body it
has perverted comes back to its own natural state, and has,
so to speak, been born again.

146 Alcohol on the Heart.

For what may be classified as the minor forms of inebri-
ation, two years, at least, of abstinence are necessary in the
adult, fully-developed sufferer; for the major form, two to
six years are necessary in order to insure a restoration from
the disablement that has been developed and sustained into
permanent habit of disease.

Up to this present time nothing more has been discov-

ered as acure for inebriety, and this discovery is of much
value. But we need not suppose that science has exhausted
all her other resources. In plain truth, she has but just
begun to see her way. Let those practitioners of medicine
who are called upon to treat the inebriate sick get into their
mind’s eye the exact condition of the circulatory organs of
those who are under their care ; the large, feeble heart, the
arteries, like an india rubber ring that, from long use, has
lost its grip over a book or parcel of letters which it has held
together, inelastic and ready at any moment to give way, the
veins or rivers of life distended and unresistant, and he will
fairly grasp the difficulties which lie before him from their
core. Then he will be in a condition quietly to study out
how this crippled state may be helped so that time for recov-
ery may be shortened and. recovery itself be made more
complete.
- He (Dr. Richardson) had no doubt that some aid would
come from this study. But one thing at a time, and the
first thing was a clear and absolute definition of the physical
nature of the evil that had to be met and relieved in the dis-
ease of inebriety, which, in however many forms presented,
was one disease with variety of phenomena, dependent on a
common causation and a common cause.

Where rheumatism is associated with inebriety, often
sensory hallucinations or melancholy will appear. Where
the use of spirits is continuous for a long time, general
paralysis may be expected. Dementia will follow in periodic
inebriety where the drink craze is severe. Hereditary dis-
position to inebriety may be surmised when the drink craze
is sudden and of long duration.

Observations on Inebriety. 147

OBSERVATIONS ON INEBRIETY.*

By Rev. J. W. Horsey, M.A., Oxon,
Late and last Chaplain of H. M. Prison, Clerkenwell.

As chaplain of H. M. Prison, Clerkenwell, to which there
were in-a single year 20,000 admissions, the questions con-
nected with the subject of inebriety inevitably came promi-
nently and perpetually before me, especially as my friends
were almost exclusively those on remand or awaiting trial.
In an ordinary prison half of the inmates would, by a
moderate computation, owe their position directly, and an
additional one-fourth indirectly, to intemperance, but at
Clerkenwell many had not had time to get sober by the time
I saw them ; many were entering upon, and many recovering
from, delirium tremens, and many were plainly dipsomaniacs,
and even then and there suffering from the drink crave,
whether in its circumstantial or periodic form. I proceed to
give some observations as succinctly as possible under a few
distinct heads.

1. LInebriety and Crime.—My estimate of seventy-five
per cent. as the proportion of crime attributable directly or
indirectly to intemperance is a moderate one, for other
observers and experts give a higher figure. From the
evidence given before the Lords’ Committee on Intemper-
ance, I find that the mean of the estimate given by chief
constables of counties is higher. So is that of the governors
and chaplains of gaols. Our metropolitan magistrates, as far

"as I have heard from them or read their utterances, would
take a higher figure. When I obtained a return of all the
charges at a court for a week, I found that of 154 no less
than 124 were for drunkenness. Frequently I would find
that out of any twelve on my daily lists of newly received

* Read before the International Congress of Inebriety.

148 Observations on Inebriety.

prisoners ten or eleven, invariably nine, were drink-caused
cases. Getting a return of the cases for a week in another
prison, I found that of 216 convicted prisoners 187 were
convicted for drunkenness or offenses arising therefrom.
The Swansea Stipendiary told the Lords’ Committee that
three-fourths of crime, or a great deal more, is the result of
drinking ; Mr. J. Jervis that three-fourths of crime in Ports-
mouth is attributable to drink ; and the Crown Solicitor for
Ireland that three-fourths of all the crimes prosecuted by
indictment in Ireland (and a portion of the summary cases)
are so caused, directly or indirectly. Take, therefore, what-
ever class of experts we may, they either confirm or go
beyond my estimate.

2. Inebriety and the Law.— A committee of the House
of Commons, in 1872, reported “that there is entire con-
currence of all the witnesses in the absolute inadequacy of
existing laws to check drunkenness, whether casual or other-
wise ; rendering it desirable that fresh legislation on the sub-
ject should take place, and that the laws should be made more
simple, uniform, and stringent.” And again, ‘that small
fines and short imprisonments are proved to be utterly use-
less.” The matter, however, seems to have run the usual
parliamentary course of much evidence, some debate, no
action. I have dealt with the question at length in my
“Jottings from Jail” (Fisher Unwin). Suffice it here to say
that I obtained answers from the governors and chaplains of
all English and Welsh prisons to certain questions, and it
was almost unanimously asserted that the present system of
imprisonment for drunkenness was not to an appreciable
extent curative, many being hardly sober when discharged,
and confined not so long as the natural consequences of a .
debauch might keep them to their own homes. If the idea
of retributive or punitive justice enters into the normal
sentences of three or seven days, they are but mockeries and
shams ; if the curative or reformatory idea is supposed to be
co-existent, the present system is simply unkind to the per-
son supposed to be affected by it. And, moreover, there is

Observations on Inebriety. 149

not only the absence of benefit, but probably the presence
of harm, not merely moral from the low estimation of the
evil which must come from the slight punishments or checks,
but also physical, as short sentences on the lowest scale of
diet tend rather to increase intemperance, and sharpen rather
than allay the appetite or craving for alcohol. Secondly, it
was almost unanimously answered that the fact that’ the
period of a month, which is the maximum that can be in-
flicted for the offense of being drunk and disorderly, was
obviously insufficient for reformation and deterrence, while,
morally and physically, benefit would certainly accrue to the
majority of habitual drunkards by an increase of the maxi-
‘mum punishment and the adoption of a progressive system
of penalties. ‘Why can’t the magistrate give me time in
prison to get straight,” was a typical and reasonable com-
plaint of a prisoner. Let an habitual drunkard come in for
the usual short term sodden, inflamed, and shaky, and in a
not much better state will he or she be discharged ; but let
them have received a longer sentence for some concomitant
offense, e. g., an assault, and they seem on exit some years
younger, and even their weight having not unfrequently
increased.

3. Inebriety and Immediate Abstinence.— A prison official
is in a better position than any one else to see whether or
not there is truth or wisdom in the idea, carefully promoted
by not a few doctors, and eagerly caught at and preached by
their patients, that an habitual drinker, or even an habitual
drunkard, must be “let down by degrees.” An ordinary
perusal of the papers would prepare one to believe the fact
that at any moment our prisons must contain thousands of
living contradictions of this common and popular fallacy.
Years of drinking may have preceded the momentary crime
that brings on aman many years of penal servitude ; another
may be hardly sober when admitted for his three or six
months for an assault committed when drunk, and yet at
once his drink is stopped, except in a few cases of incipient
delirium tremens, when (in some prisons, not all) a little

150 Observations on Inebriety.

alcohol is given, until the fit has passed. Why, even in
cases of prisoners who have been opium-eaters or chloral-
drinkers, and have a far stronger and more abiding crave
than that the dipsomaniac knows, there is no “letting down
by degrees” ; while the simple drunkard, who ventured to
quote the wisdom of his quondam associates, or even of his
doctor, as an argument for receiving some proportion of what
had been his daily poison, would probably find himself by no
means let down by degrees by the warder to whom he
addressed his request. ‘(It is impossible for me to give it
up,” has often been said to me by those who have, unfor-
tunately for themselves, been externs from a prison point of
view. “How would you manage if you were run in?” I
would answer. ‘At any rate I can’t give it up at once.”
“ Again, how would it be if you were run in?” I remember
a clever doctor who was under my care for three months
before he was hung, saying to me, before he admitted his
guilt, “this imprisonment is a blessing to me, for I could not,
or would not, cure myself of the morphia habit, and now
through prison I am free.” I commonly noticed that the in-
convenience from the sudden cessation of a narcotic, re-
mained twice as long as that arising from the loss of alcohol,
but frequently the latter would be dissipated in a week, and
the former in a fortnight. Dr. B. W. Richardson, when first
studying alcohol, sensibly enquired of all our prison doctors
what evil effects they observed from the sudden and total
disuse of alcohol. One word sufficed for the answer —
“None.”

4. Inebriety and Suicide.— No one in the world, I presume,
has had the opportunity and necessity of studying the phe-
nomena of suicide as much as has been my lot. I have had
27 on one day under my care for attempting suicide; 61 in
a single month remanded for this offense; 395 in a year;
while, as one memorial of ten years spent in Clerkenwell
Prison, I have full notes of 3,101 cases. Intemperance was
almost usually the cause. When I specially tabulated 300
consecutive cases I found 172 were due to drunkenness, and

Observations on Inebriety. 151

in 145 of this number no other cause could be found as con-
tributory. ‘Crime is zestival,” is a well-known canon, and
suicide presents no exception to the rule, because drinking
is, for several reasons, more common in summer than winter.
Even of 46 consecutive cases of attempts at suicide on the
part of boys and girls, I find ten were directly caused by in-
temperance. An hereditary tendency to suicide was to be
observed in but a few cases, but where suicidal mania was
evidenced by repeated attempts I only call to mind one in-
stance in which intemperance was not a contributory cause
of the attempt, and even here I see the girl, who attempted
her life to my knowledge twenty-eight times in two years,
was once in that period sentenced to a month for being drunk
and disorderly. With the majority the idea of suicide never
was entertained, and was even abhorrent, except when in
liquor.

5. Lnebriety and Infant Mortality.—Infanticide is the most
common form of murder, and alcoholic infanticide accounts
for the majority of cases of slaughtered innocents. Three
hundred inquests in London, and more than half that number
in Liverpool, are held annually on babes that are overlain,
and most of these are found to have been slain on Saturday
night, when the alcoholized mother is unable to hear or feel
the cry or the struggle of the infant, if that be not already
narcotized by the alcoholized milk from her breast. I have
had five women in prison at once for infanticide, and only
one was sober at the time of the child’s death. Others die
by drinking the gin left about by the mother. Others have
no fair chance of life and health in view of the laws of hered-
ity and the physical influence of the mother’s habits and
state. Hardly a week passes without some horrid act of
child murder committed by those who, when sober, may be
as affectionate and careful as any. The mortality amongst
the infants of the intemperate probably accounts for more
deaths than all other causes of preventible mortality put to-
gether. After much observation and record of cases it seems

to me that 64 per cent. would be a moderate estimate of the
VoL. IX.—21

152 Observations on Inebriety.

death-rate in the first year after birth of such ill-fated chil-
dren. I select some typical cases out of my note-books:
(a) A man aged fifty has two children alive out of thirteen,
and says, “I am one of the worst drunkards in the world ;
my wife don’t drink so regular, but very hard when she goes
about it.” (4) Man, fifty-three, has had eleven public houses,
and wishes he had never known the trade; his wife died of
alcoholic phthisis, and he usually has twenty glasses of beer
per diem; has had nine children, of whom one survives and
is a paralytic. (c) Man, thirty, in prison for a drunken as-
sault on his wife, who also drinks; one of seven children lives.
(2) Woman, forty-one, has a drunken husband; she claims
to be temperate for the last two years only ; of eighteen chil-
dren fourteen are dead and one in an asylum. (e) Man,
thirty-six, a drunkard ; seven of eight children died in infancy.
(f) Woman, forty-two, imprisoned for drunkenness ; her hus-
band also drinks much; two of ten children survive. (g)
Woman, fifty-two, stole when drunk; husband gets drunk
every Saturday; has seven children alive out of nineteen.
(2) Woman, thirty-eight, both parents drink, and all their
nine children are dead. (¢) Woman, forty-four, husband died
of paralysis of the brain from what she calls “a gay life” ;
she drinks hard, and has been several times in prison; one
of her twelve children is alive. (7) Woman, thirty-one,
twelve years immoral, a hard drinker, and occasional thief ;
has had nine children, “All dead, thank God,”—to which
ejaculation, when one weighs the forces of heredity, environ-
ment, and example, one is tempted to respond, “Amen!”
(2) Man, fifty-four, an old soldier; murdered his wife, who
was an habitual drunkard ; has had nine children, still-born.
(2) Woman, forty, charged with neglecting her children ;
drunk when. apprehended, has been drinking since her first
child; three of thirteen are alive. These cases, taken out of
a multitude, give 114 children out of 136 who have pre-de-
ceased their parents, many being still-born, and many dying
early in infancy. Is this either inevitable or inexplicable?
Inebriety and Sex. — Prison experience clearly affirms the

Observations on Inebriety. 153

great increase in late years of female intemperance ; the great
difference between the fashions and habits of intemperance
in the male and in the female; the greater susceptibility of
females to the contraction of the habit or disease; and the
infinitely greater difficulty there is in curing a female dipso-
maniac or even habitual drinker.

As to the first point, it is from the increase of drunken-
ness among women that we find the proportion of male to
female prisoners not seven to one, as it used to be, but three
to one at the outside.- In the apprehensions for simple
drunkenness in London, the women were, in 1878, just 1751
behind the men, in 1879 only 530, and in 1880 only 470.
In some London police divisions, as Westminster, St. James’,
Lambeth, and notably Marylebone, there have been more
women than men apprehended for being either drunk, or
drunk and disorderly. In 1880, in London, 7,431 females
were apprehended on the latter charge; in 1882 there were
8,927. But the most important and most saddening thing is
to scrutinize the records of those who have been over ten
times convicted, and are chiefly habitual drunkards. In this
category in 1884, taking the figures for England and Wales,
there were 5,188 males, and 9,451 females. Looking at it in
another way, we, see that the men are only 10 per cent. of the
total commitments of already convicted offenders, but the
women are 31.6 per cent. Looking back over a series of
years, we see that the men in this incurable class have varied
only from 8.2 per cent. to 10.1 per cent., whereas the women
begin 27.3, and steadily increase up to 33.2 percent. Tak-
ing seven years to see if there be an increase amongst the
women, we find that in 1878 they numbered 5,673, and in the
succeeding years 5,800, 6,773, 7.496, 8,946, 9,316, and 9,451.
This increasing preponderance of women, who have caught
up, outstripped, nearly doubled the men in this special class,
is almost entirely due to the distinctive character and the
increase of female intemperance, and the absence of any
effort on the part of the State to deal rightly with the disease.

With regard to the fashions and habits of female drinkers

154 Observations on Inebricty.

we notice that they chiefly consume spirits ; often drink
earlier in the day, and more continuously through the day
than men ; that delirium tremens is not so common, but the
dipsomaniacal craving more common in their sex ; that they
are almost usually solitary drinkers, where the male’s drink-
ing will be circumstantial and partly originated, and partly
increased, by companionship; and that, for various reasons,
they, more than men, conceal and even deny the fact ef their
drinking, though when on the brink of an alcoholic death.

Thirdly, there is no doubt of the peculiar susceptibility of
women to contract habits of intemperance at the times of
pregnancy, lactation, and middle age, even apart from the
criminal, if it be not ignorant, advice given them by midwives
and some doctors. Nor, again, of the connection between
dipsomania and a disordered state of the uterus. A restora-
tion to purity of life is frequently the cause of astonishing
progress in combatting the dipsomania of long standing.

Lastly, there is simply no comparison between the diffi-
culty of curing the male and the female dipsomaniac. I only
remember one instance in prison of the drink crave surviving
in a man after six months of abstinence in prison, but with
women I have known of its existence and periodic potency
after two years, or even more, of abstinence in a penitentiary.
When asked if I have known of female drunkards being
cured, I can only say that I have known some cases.
Engrossing occupation and strong religious sentiment will
usually cure the male, especially when conjoined with the use
of physical and medicinal aids; but innumerable instances
prove that these same causes most frequently do not produce
the same effect in the female. In the male some external
temptation usually causes the relapse; in the female self is
the tempter.

6. Inebriety and Heredity— No evidence from prison is
needed to prove the hereditary character of intemperance
and dipsomania. It is the acquired habit more than the
natural characteristic that is most surely transmitted. At
one time there were in separate cells for being drunk and

Observations on Inebriety. 155
>

disorderly a grandmother, a mother, and a daughter, the
latter having a baby girl at the breast. What chance had the
baby of escaping the scourge her progenitors twined and
applied. “I was born in prison while my mother was doing
a month for drink,” said a prisoner to me, “and I expect to
die in prison.” ‘Another man was only thirty-three, but had
two terms of penal servitude, and shorter punishments ;
when free he was a great drinker, and came of a drunken
family, his mother having drowned herself when in drink,
and of four uncles one poisoned himself, one hung himself,
and one got twenty years for murdering his wife. A mere
lad was in for a drunken assault ; his father and mother were
drunkards, and separated, and he and his brother (who also
drinks) were the survivors of eight children their parents
damned into the world. I might multiply cases ad infinitum,
but the point is admitted.

In conclusion, I would merely express my thankfulness
for the attention this Congress, and the Society which sum-
mons it, will cause to be drawn to the phenomena of inebriety,
and especially to the physical side of the matter, which must
ever be kept in view by those whose professions or inclina-
tions lead them to dwell chiefly on religion or on law as
palliatives or remedies.

The march of civilization is always followed by a rear-
guard of inebriates and insane. They are the unfit, the
worn-out, the incompetents to bear the strains of intense
and rapidly-changing environments, conditions of living, of
work and thought. This rear-guard is a perpetual menace
and obstacle neutralizing and shadowing the results of all
progress and advance in the great evolutionary race-march
of the age.

Where the father is nervous, irascible, and changeable,
and the mother of feeble judgment and under the influence
of her emotions altogether, the children will become inebri-
ates from the slightest exposure.

156 Homicidal and Suicidal Inebriety.

HOMICIDAL AND SUICIDAL INEBRIETY.*

By Surcron-Major Rospert Princve, M.D.,
HY. Ms Bengal Army.

The prevalence, alas! of inebriety, with its consequences,
affecting the safety both of the individual and the public, has
lately led to the passing of an act known as the Habitual
Drunkards Act, 1879, yet those who have studied the sub-
ject most, have felt that the legal powers necessary to deal
with inebriety in its various phases must be increased if the
public is to be protected from some of these phases of
inebriety, at present absolutely unknown to the public, and
as yet not sufficiently studied by the profession. As, how-
ever, all legal help to be of any practical value must have for
its basis a careful study of the diseased condition, known as
inebriety, which, now that heredity and environment are
bearing the harvest, which was to be expected, has reached a
prevalence calling for further legislative action and powers,
it has occurred to me that a discussion at this Colonial and
International Congress, on what appears to me a unique
instance of the diseased condition under notice, founded on
careful observation and study of the case, and supported by
a full confession of the crime and the previous history, and
symptoms might be of benefit not only to the sufferers them-
selves, but to the public at large. I have accepted the offer
of the President to read a brief paper on the case, looking to
the subsequent discussion to draw out further light on the
subject, and thus to attract the attention of the profession,
and through them the legislature to an unknown, or at
least little studied danger in our midst, not to the individual
alone, but to the innocent, unprepared, indeed, unsuspecting
public, by whom he may be surrounded, when laboring under

* Read before International Congress of Inebriety.

Homicidai and Suicidal Inebriety. 157

this mental derangement due to this diseased cerebral ‘condi-
tion. With this preface, or rather apology, I enter on the
subject of this communication.

I have for long felt that suicide and homicide, the result
of alcoholic stimulation, are but phases of a cerebral condi-
tion, which may lie dormant or inactive through life, or if
only lighted into action by some specific inherent power in
alcohol, may exhibit themselves in every phase of these two
great final symptoms, murder and suicide — from the slight
attempt at suicide or the angry blow of the partially inebriate,
to the complete and rapid attainment of self-destruction, and
the perpetration of the foulest murder, or the most carefully
and deliberately plotted scheme for murder designed and
carried out with a skill and forethought more in keeping
with the impulse and instinct of one who had made murder a
profession, rather than the sudden unexpected and uncontrol-
lable development of a latent force in the brain of a well edu-
cated, God-fearingly brought-up young man, described by his
superior officer at the trial for murder as the smartest man
in the regiment when sober, and the most foul-mouthed and
insubordinate when drunk. And I repeat, it is only because
we possess in the confession of one who stated that on two
previous occasions, when he indulged very freely, he was on
one of them prevented by the merest accident from murder-
ing a comrade, and on the other from taking his own life,
that it seems to me we have a light thrown on the subject,
which we will do well to discuss, more especially since, as far
as my knowledge goes, a similar case, illustrated by a similar
confession, has not previously been brought before the pro-
fession. I use the term alcoholic stimulation advisedly,
because I am quite satisfied from the observations and ex-
perience of thirty years’ service in India, that there is sucha
condition as narcotic stimulation, which will produce homi-
cidal or suicidal tendencies, and that certain narcotics, such
as the various preparations of Indian hemp, when indulged
in to excess in certain cases do certainly produce these
results, and what is called ‘running a molk” is really the

158 Homicidal and Suicidal Inebriety.

homicidal or suicidal development of narcotic stimulation,
acting on certain diseased cerebral conditions.

Now, the points to be ascertained in the diseased condi-
tion under notice are the following: 1st. What are the
symptoms, if any, which would point to the latent presence
of this diseased cerebral condition ; and 2d, the best means
of restraining or curing them.

With reference to the first point, the confession of the
prisoner under consideration clearly lays down the fact of
this poor man knowing that he was a victim to this diseased
cerebral condition, which might be lighted into activity by
any excessive indulgence in alcohol; for after suffering from
two attacks of this derangement, one homicidal and the other
suicidal, he came to a Temperance meeting I was holding in
his regiment, and there and then signed the total abstinence
pledge (for in the Soldiers’ Total Abstinence Association in
India, of the executive committee of which I was at the
time, and continued so till I left India, chairman, there is no
double basis), and he told me himself, in the condemned
cell, before he made the confession which he subsequently
did, that had he been true to that pledge he would not have
been in that cell. The premonitory symptoms of such a con-
dition existing can, I fear, only be ascertained by an excess-
ive indulgence in alcohol lighting up an action, its intensity
being in proportion to the quantity consumed. Thus, for in-
stance, a few glasses may tend to the hasty blow of the par-
tial inebriate, and a few more to the foul murder of a kind
and compassionate host, as given in the case recorded in
India, the details of the perpetration of which are I think
unequaled, even in the tales of horror associated with what
the Bible in Prov. iv, 17, describes as the “wine of
violence.”

As regards the second point, viz., the restraining or pre-
venting of the development of this latent homicidal or
suicidal tendency, there can be no doubt this poor victim of
this diseased cerebral condition felt, that there was only one
aeans of restraining or preventing the outburst of this latent

Homicidal and Suicidal Inebviety. 159

force, and that was in total abstinence from alcohol in any
shape and at all times. How true and successful this
decision was, was amply proved by his rapid promotion fol-
lowing his mode of performing his military duties when sober ;
and the consequences rapidly following the failure to main-
tain this mode of restraint and prevention, also sadly proves
what alone was the proper treatment in his case. For
obvious reasons I withhold the name of this young man, and
the details of where the occurrence took place, but the man
being a soldier the facts elicited at the trial are of course
carefully recorded, and are available for any one who would
like to study them in detail. In my opinion some of the
most remarkable points in the case are the manner this
soldier went about the murder of his comrade, which took
place in the center of a crowded cantonment, in a barrack
filled with his sleeping comrades, after four-and twenty hours
of heavy drinking, which, as he told me, took all his savings,
after all this it would appear that he planned and carried out
the deliberate murder of a comrade, against whom he person-
ally had no grudge whatever, but of whom some soldier had
thoughtlessly said, “ It would be well if‘ his peg was vacant,”
or some similar slang barrack expression. The man who
had spent a whole day in drinking from canteen to canteen,
and goes to his bed, as he told me, with a private supply,
rises in the dead of night, and commits the murder in such a
manner as to bring the guilt upon him only in a chain of
circumstantial evidence, but not a vestige of visible evidence.
No human eye saw the deed done, and, but for the fullest
confession of his guilt, this man would have been executed
on circumstantial evidence alone. There was nothing about
this poor man to show that his antecedents were such as to
account for his being able to plan so careful, yet deliberate, a
murder; on the contrary, as I said before, he was a member
of a God-fearing family, piously brought up, and his exem-
plary behavior, while in confinement, and under trial, and
subsequent to his sentence being passed, I know, for I saw

him repeatedly, made such an impression on his heathen and
VoL. 1X.—22

160 Homicidal and Suicidal Inebriety.

Mahomedan guard and jailor, that the latter was touched to
pity for him, and said to me, “The Government let their
youths get as much liquor as they can drink, and, when mad
with it they commit murder, it hangs them for it.” Never
was a truer and sadder charge brought against any govern-
ment. Uncomplainingly this poor man underwent treat-
ment during his confinement in a large central prison, which
was a disgrace to the English Government, not a regimental
polo pony in the station but was better treated in its mas-
ter's stable, or the polo-ground, than was this victim of a
vicious canteen system, suffering from a latent and little
known or understood disease, who was confined in a barred
cell, with a palm-leaf thatch hurdle to keep out the cold, in
the height of winter, in a station where ice is made by
exposure to the midnight air of water in special vessels —
and the poor fellow subject to dysentery —guarded by
natives, and ultimately chained to a post like a mad elephant,
forsaken apparently by his countrymen, the Chaplain and
the Army Scripture Reader,and a comrade or two beside
myself, alone seeing him. As for the rest of his country-
men, too many, alas, as I had cause to learn, knowing noth-
ing of this latent diseased cerebral condition, considered him
a drunken good-for-nothing soldier, unfit to have his life pro-
longed into a life-long punishment. Nothwithstanding all
this, the full confession of his crime, and the admission that
he alone was to blame for it all, followed by the spirit of his
last words on the scaffold, illustrate and encourage the hope
that even in such a dark history, it is possible that, by God’s
mercy, there may be light at its close.

And now, what practical lessons are to be learnt from this
sad history ?

Ist. That it is possible for a human brain to carry on its
functions without any discernible defect, or fault, and yet to
be liable to an outburst of homicidal and suicidal mania, such
as I have described, and this more than once, and —

2d. That entire removal of the exciting cause effectually -
keeps this diseased condition in a latent state, though it had

Homicidal and Suicidal Inebriety, 161

been twice lighted up before. I have collected a number of
cases bearing on this diseased condition, but would only
point to three, two of which occurred in India within the
last six months, one in the case of a railway employé, who,
when drunk, was reproved for something he had said or
done, and rapidly following each other committed both
homicide and suicide, and the other of a poor, wandering,
Eurasian “loafer,” who, because he was checked for his
behavior, after having had some drink, by his kind host who
had given him shelter and food, nursing his wrath, took
advantage of his benefactor being asleep, and foully mur-
dered him, with a brutality which was perfectly diabolical.
The third case is reported in the Zimes, of the 3d June, and
the remarks of the presiding magistrate are worthy of note.
Mr. De Rutzen is reported to have said he should send the
case for trial, adding — ‘“‘ These cases would never happen if
persons were not allowed to remain in public houses until
they became drunk. The wonder to him was that there were
not more of such cases.” The Mahomedan jailor in India,
and the English magistrate in London, place their fingers on
the plots in the liquor traffic system in both countries, but
both, I fancy, were ignorant of the true physiologically
diseased cerebral condition to which the acts were due. If
all cases of attempted murder, whether followed or not by
attempted suicide, were carefully inquired into, I am sure,
in the majority of cases, a previous history, like that illus-
trated in the confession under discussion, would be elicited,
and, if so, and the public are to be protected from an un-
known, dangerous inebriate at large in their midst, some
extra legislative power, as regards restraint and treatment,
will have to be granted, that cases similiar to that of the
poor man we are considering, may be prevented from cause-
lessly, yet secretly, and deliberately taking the life of an
innocent and harmless man “only doing his duty,” as was
the case of the non-commissioned officer, who lost his life
owing to the thoughtless remark of one who had been justly
reproved for some breach of military discipline.

162 Homicidal and Suicidal Inebriety.

Since the preceding was written a most remarkable case
of murder has been reported from India, for the details of
which, and the judgments of the officers acting as sessions
judge, and the final Court of Appeal, I am indebted to the
Pioneer Mail of the 11th May, 1887. The judgment of the
sessions judge (owing to the defective character of the
medical evidence), appears to have lost sight of the real
cause of the murder, but that of the final Court of Appeal,
viz., that of Sir Lepel Griffin, acting as such, is a model of
clearness, and logical reasoning. He dismisses the medical
evidence in terms which the profession would do well to lay
to heart, and this society may feel not only fully justifies its
formation, but shows a marked necessity for its increased
activity, such as probably has not been thought of before,
and for this cause I give a long quotation from the judgment.
When I entered the service of the late “H. E. I. C.,” in
1854, a course of study of insanity, with clinical lectures on
the cases, was made obligatory on all candidates for admission
into the service ; and well do I remember the valuable lessons
learnt at the Morningside Lunatic Asylum, from that most
careful and accurate observer, the late Dr. Skae. Indeed the
lessons there learnt led me to study insanity most carefully,
as met with in India; and on one occasion this study was
the means of enabling me to obtain the immediate release of
a sane man, who had been put into the lunatic cells as a
dangerous lunatic, whereas he was a most sane individual,
resisting a most deliberate plot to plunder him. But to
return to Sir Lepel Griffin’s remarks and judgment, in which
he places the following on record regarding the medical
evidence in the case: ‘We have no history of his family,
and cannot say whether he had any constitutional predis-
position to madness, either hereditary or congenital. We
are not informed (and here I think the evidence of the regi-
mental surgeon is deficient and unscientific) of the previous
history of the sowar (trooper), what were his habits, whether
addicted to intoxicating liquors or drugs, whether he had at
any time previous to his reception into hospital received any

Homicidal and Suicidal Inebriety. 163

severe physical injury, or shock, or whether he was of such
debauched habits as are most commonly the direct predispos-
ing causes of mental disease. It is possible that the medical
officer, who is a young man, has not specially studied mental
pathology, and it is unlikely that in his position he could
have had much experience in the treatment of cerebral
disease, and, seeing that the whole case turns on the mental
condition of Musar Ali, I think we might have expected a
more careful and scientific analysis of his symptoms.”

Sir Lepel Griffin confirmed the sentence of death passed
by the lower court, attaching no weight whatever to the
plea of “spiritual delusions” advanced in palliation of the
charge.

I offer no apology for the long quotation, from which it
is clear Sir Lepel Griffin traces the true cause of the mur-
der, not to “spiritual delusions,” a most dangerous theory in
a country not wanting in fanatics, but to some diseased
cerebral condition, inherited or produced by indulgence in
narcotics, rendering the victim subject to impulses and
passion, which, but for the indulgence might have lain
dormant, or it may be unknown, and the stimulant narcotic
drugs often taken in India to nerve the would-be hero for
some grand deeds of daring are not unfrequently resorted
to for baser purposes ; and who can tell, with the knowledge
acquired from previous experience, for murder, the outcome
of religious fanaticism. When this latter takes place, the
perpetrator of it, to acquire a lasting fame, may plead spiritual
or Divine commands as his authority, himself and his relatives
carefully concealing all that would lead the authorities to
suspect the deed to be the result of narcotic indulgence ; as
by this time, the natives in India, and particularly those in
cantonments, know that any crime, such as murder, com-
mitted by a European soldier, under the influence of drink,
is viewed and punished as deliberate murder, and no allow-
ance made for the condition into which his own acts brought
him. In the case in question there were evidences of nar-
cotic indulgence in some of the prisoner’s acts recorded in
evidence.

164 Homicidal and Suicidal Inebriety.

My introduction to field service in India, in 1855, was
seeing my commanding officer shot dead in front of me, the
second bullet passing over my head, and when the murderer
was apprehended, and told his musket was loaded, he coolly
remarked, it was for the lieutenant of the company, Mowbray
Thompson, who subsequently escaped from the massacre at
Cawnpore, and added, he intended to load again and shoot
the Doctor Sahib (myself). When asked what harm I had
done him, his remark was, ‘He is an Englishman, and that
is enough.” This was in February, 1855, and the remark,
no doubt, was one of those little clouds of the then coming
mutiny ; in his case the product of thought acting on a nar-
cotically diseased brain, which had received from whispers or
eavesdropping vague impressions of the approaching rising,
on which, no doubt, he had been pondering ; and a slight
reproof, and trifling punishment, from which he was released
before its expiration, was the light to the train; and the
result — an explosion which assumed the phase of murder,
limited mercifully to one individual, though intended to in-
clude every European officer with the detachment.

Now that narcotic indulgence is, alas! far from uncom-
mon in this country, these cases may be of importance,
where heredity and environment have produced in Britain
the mental conditions, which it is much to be feared are
present in India, to a far greater extent than the authorities
are aware of, or the medical profession sufficiently alive to.
In conclusion, it would almost seem that the would-be want
of responsibility attached to murder and outrage on the plea
advanced in a case this day (June 19th), viz., that it was done
“under the influence of drink,” has reached such an extent
that, as the London magistrate, already quoted, points out, it
is time some legal protection was granted to the public from
the consequences of those allowed to become drunk in the
public houses of this land. The victim pays for his crime
with his life, but the true cause pointed out by Mr. De Rut-
zen remains unchecked, indeed, unnoticed.

Influence of Alcohol on Mind and Morals. 165

AN INQUIRY CONCERNING THE INFLUENCE
OF ALCOHOL ON MIND AND MORALS.

By T. L. Wricut, M.D., BELLEFoNTAINE, O.

The two great principles, Good and Evil, which under
various names and personifications have claimed the atten-
tion of the world in all times and in all countries, and the
history of whose conflicts is the history of mankind, are not
simple, indivisible elements. They consist of parts. They
are composed of divisions and subdivisions. It may be said
that flowing into them from all directions are tributary
streams of good or of evil; some, small and apparently triv-
ial, others, mighty, impetuous, irresistible, swelling the tide
of the whole, and giving volume, power, influence, and do-
minion to the grand total.

One of the mightiest contributors to the power of evil is
alcohol. Through drunkenness, or rather through the deeds
of prevailing inebriation, alcohol augments the momentum of
crime, and deepens its flood; while through its habitual or
chronic influence upon the nervous basis of intellectual and
moral projection, without, of necessity, the complication of
actual drunkenness, alcohol affixes and perpetuates criminal-
ity upon generation after generation.

The elementary and essential conditions which cause and
constitute inebriation are some of them of such a nature that
they exert powers which, in the end, are more destructive
and far reaching than any possible demonstration of mere
drunkenness itself. To rightly comprehend those pernicious
and invariable constituents of the drunken state which are
so potent for evil, it is necessary to analyze them as they ap-
pear in the man actually drunk.

The most striking as well as important effect of alcohol
upon the nervous system is paralysis. When taken into the

165 Influence of Alcohol on Mind and Morals.

human system in a quantity sufficient to produce the slight-
est indication of intoxication, it paralyzes to some extent or
other the entire nervous organism. When the quantity of
alcohol consumed is considerable, the impediments in ner-
vous function are exhibited in many ways. Some notice of
the invasion or inception of the paralytic onset may prove
interesting as well as profitable.

When a quantity of alcohol is received in the stomach
(after the initial nervous shock, which soon passes off), the
first notable appearance will be an occasional slipping or
sliding of the feet upon the pavement when walking. In the
slight motor paralysis then present the foot is not raised
quite as high as it is in the usual and undisturbed state of
the nervous energies. The consequence is, that any trifling
irregularity in the pathway will intercept the moving foot, —
and a slipping or sliding of the sole of the shoe upon the
pavement will be perceptible every few steps that are taken.
There are other very delicate motor disturbances that are
observable at the beginning of inebriation from alcohol, but
they may be omitted from notice at present.

Careful attention will likewise detect at this conjuncture
a weakness and levity in the operations of the intellectual
faculties, auguring partial paralysis of their nervous bases.
This change does not, of course, always appear in the same
identical way, although it is generally very obvious in some
direction or other. The inebriate perhaps, instead of pre-
serving a dignified and unobtrusive demeanor, such as may
be natural to him, will feel impelled to assume the character-
istics of assertive geniality. He will seem to be impressed
with the idea that he must make a hit in personal magnetism
and goodfellowship. He will probably express his feelings
in some attempted witticisms, born of his own internal in-
congruities, and without legitimate parentage or natural asso-
ciation. He must, forsooth, without provocation or solicita-
tion, perpetrate some pun, some joke, some little pleasantry,
before he parts with any familiar interlocutor.

Many of the so-called “flights of eloquence” in oratorical

Influence of Alcohol on Mind and Morals. 167

efforts, likewise betray the dwarfing influence of alcohol upon
the intellectual faculties. In their more pretentious pass-
ages, the baseness of their origin may often be surmised
through their owtve and unexpected associations and sugges-
tions. But when analyzed, they are perceived invariably to

- consist of the merest fustian. Undoubtedly the thoughtless
world is often deeply moved by this kind of speech; but the
movement is in ways that lead to tears and woe, not peace
and contentment. Alcohol is a bad counselor.

The disabilities attending the operation of the moral
powers, consequent upon the primal impediments thrown in
the way of nerve function by alcohol, are possibly less con-
spicuous than those attending the motor and intellectual
movements ; but they are none the less real. In the first
slight impressions of incipient paralysis the lines of restraint
in reference to the moral duties are somewhat relaxed. The
soul is not held in its careful and exalted position in respect
to the moral responsibilities incumbent upon it. This is
especially evident in the indefinite and lax liberality of senti-
ment displayed by it in relation to follies, indiscretions, and
even vices, wheresoever they may appear. And indeed, for
this proffered charity in behalf of wrong-doing, the inebriate
mind is prone to assume unto itself great store of credit, as
though worthy of praise for a broad and enlightened sym-
pathy with the weaknesses of poor human nature.

There is nothing disagreeable to the drunkard in the con-
dition of incipient intoxication. Quite the reverse. It isa
happy state, as of one having been releived of the cares of
life ; such, for example, as the acute and rigid feeling of ac-
countability, which a truthful report from a healthful nervous
function always impresses upon individuality.

But the present inquiry is chiefly concerning intoxication
when fully established. In complete inebriation there is
evident incodrdination of the motor functions. It is through
the unwilling displays of motor incapacity that the drunken
state is first perceived. The characteristics of the motor dis-

abilities in drunkenness very accurately measure the usual
VoL. IX.—23

168 Influence of Alcohol on Mind and Morals.

extent of co-existing intellectual and moral incoherence. The
latter may be examined through the former. The actual, but
imperfectly seen, may be illustrated by the obtrusiveness of
what is plainly visible to all.

When the reeling gait, the rolling eye, the indistinct ar-
ticulation, the distorted countenance of a man thoroughly
drunk are seen, the complete subjugation of his motor capac-
ities is readily admitted. Unlike most agents having control
over nerve function, as, for example, strychnia, prussic acid,
and many others, alcohol exerts its pernicious influence upon
the universal nervous organism. And yet while the abject
condition of the motor functions evinces the paralysis, to
some extent, of the motor centers of the nervous system, it
is observable that the disabilities of the nerve centers are
not equally complete, even under apparently equal conditions
of alcoholism. Sometimes a man is very drunk in his legs
and his motor functions in general, and yet is not equally
overcome intellectually. And this demonstrates the truth
that there is no natural affinity, no special tendency, of alco-
hol towards one portion of the nervous centers more than to
another. Seen in differing relationships, its guilty influence
is perceived to be impartial, universal. The paralysis of the
centers and systems of common sensation (anzesthesia) is
also of varying degrees of intensity in different seasons of
equal intoxication, as well as in different individuals. The
consequence is, that the perceptive functions are unequal in
acuteness and reliability in drunkenness. The codrdination
nerve centers likewise display evidences of similar irregulari-
ties in nerve capacity when they are under the impress of
alcohol. The ideas and conceptions of responsibilities, rights,
duties, and the like, are repressed and obscured ; and the
moral nature of the inebriate is greatly impeded in its move-
ments, if it is not entirely extinguished.

One of the immediate effects of this general disturbance
in nervous function is, the new and unnatural relationship
which the several nervous sub-systems assume towards each
other. Instead of harmony, there is distortion in their

Influence of Alcohol on Mind and Morals. 169

mutual interdependence; and the elements of thought —
sensation, perception, association, suggestion, memory, and
so on—are forced into strange and absurd situations and
attitudes, The expression of ideas, born of such parentage,
shows them to be of fantastic origin. Thoughts and phrases
are surprising, uncommon, dzzarre. The looker-on is aston-
ished. For, while the enunciation of the ideas of drunken-
ness shows that they are possible, yet they are not composed
of the common elements of thought, naturally allied. The
consequence is, that these wonderful and inexplicable phe-
nomena of the mind are frequently viewed as the exponents
of exalted mental brilliancy and power, while, in fact, they
are infallible evidences of mental debility, discordance, rot.
This is the specious brightness, without force, with which
alcohol invests the human mind.

Is a mind under the influence of alcohol capable of self-
control? To answer this question it will be well to observe
the effects of habitual alcoholism on the mind, as compared
with other habitual states into which the mind may fall.
And a mere statement of certain well-known facts will, I
think, be sufficient to determine the answer. The healthful
mind always improves with opportunity. Habitually active
in any direction, its aptitude, its skill, strength, and quickness
: increase in its particular species of movement. As a man
works at a trade, he improves until he ceases to be a bungler,
and becomes an expert. And the same is true of profes-
sional life; and indeed of all the various kinds of mental,
moral, and physical activity of a legitimate nature. When
the alert and unpoisoned mind finds itself in a wrong place,
and surrounded by undesirable circumstances, it not only
extricates itself from difficulty through its own efforts, but it
prepares, by premeditation, a way of escape in future embar-
rassments ; and it possesses and exercises the power to give
execution to its plans. The drunkard, likewise, humiliated
and endangered, fully determines never again, while intoxi-
cated, to be guilty of his old line of follies and delinquencies.
What is the outcome? Every season of complete inebriation

170 Influence of Alcohol on Mind and Morals.

is characterized by substantially the same phenomena.
There is no practical change, certainly no improvement in
conduct. Be it the first or the last season of intoxication —
from young manhood to old age — similar periods in the de-
bauch are attended by like manifestations. In the early
stage of drinking, the fun, the foolishness, and the extrava-
gance are the same; while later on, there come in view the
same vile ideas, the same cursing rigmarole, the same threats ;
in short, the same mental and moral baseness that have
always distinguished corresponding seasons of alcoholic
excess. And thus it is throughout the drunkard’s life. The
drunken mind never improves, nor changes; it cannot.
Alcohol possesses undivided sway over the faculties of drunk-
en men. Humanity is not capable of asserting’ itself while
alcohol is in possession of its instrumentalities. Alcohol
never strengthens nor brightens nervous function.

When drunkenness has passed off the mind resumes its
natural state and equilibrium; such is the usual mental
movement in the ordinary recurrences of drunkenness and
sobriety. But in course of time the use of alcoholic drinks
becomes habitual. Now the habitual disuse of function will
at length render function impossible. Absence of function
will not only produce incapacity to act, but will occasion
actual atrophy of structure. It will, in the course of genera-
tions, eventuate in the absorption of entire organs ; or rather,
in their non-development. This is observable in the eyeless
fishes inhabiting subterranean waters, as well as in many
other examples. In a parallel way the alternations of latency
with activity of moral function, that characterizes the recent
drunkard, give place to a steady and enduring incapacity of
nerve in the chronic inebriate. The habit of untruthfulness,
always present in the drunken,state, ceases to be intermit-
tent. It is fixed, in the form of a constitutional moral inca-
pacity and unreliability. The moral constitution of the
chronic inebriate has at length taken a final position; and
the approximation of the family strain towards criminality
has taken the first irrevocable step. The new constitution
in progeny begins where the old one ends, in the progenitor.

Influence of Alcohol on Mind and Morals. 171

Heredity hands down the hateful deformation. And thus
the progress of alcoholism through two or three generations
fully develops the criminal constitution.

To use an expressive phrase, alcohol always “ gets there.”
It may develop the criminal constitution in other ways than
that just indicated. Sometimes it operates through physical
injury to certain nerve centers by means of hypertrophy and
pressure of adjoining tissue ; as through hyperplasia of the
connective tissue. Or, it may act by mere automatism —
that is, through the unconscious representation of the moral
deficiencies inseparable from long continued drunken courses.

The chronic inebriate, then, transmits a moral constitu-
tion of lower grade and coarser grain than his own primitive
and normal constitution. His constitutional proclivity to
lying —so surely the outcome of alcoholic habits—in its
natural affiliation with nearly every species of vice and im-
morality, readily reappears in his posterity in the guise of
the swindler, the gambler, the traitor, the false friend, the
insidious enemy ; while other and more brutal criminal pre-
dispositions appear in their due time, and in their proper
generation.

Consciousness, according to Wundt, while a unit, is also
a unification of parts—of perception, representation, idea,
feeling, and volition. But if these elements of consciousness
are imperfect, as through the disabilities imposed by alcohol,
the resulting state of consciousness will be correspondingly
imperfect. Consciousness, while the principal basis of con-
duct, is not an infallible rule of right and fact. It is evident
that a state of the nervous organism, wherein the entire
round of the nervous centers is paralyzed in various degrees,
the nervous functions which are unified in consciousness,
must give to that mental trait an imperfect and misleading
character. The consciousness of drunkenness is of necessity
misdirecting, and the conduct of drunkenness must be large-
ly irrational and vicious. No matter how honest and sober
a man may be, he is a bad witness respecting facts that come
under his observation when intoxicated.

172 Abstracts and Reviews.

Abstracts and Reviews.

ARSENICAL AND ALCOHOLIC POISONING.

Drs. Cushing and Prince lately presented a case before
the Massachusetts Medical Society that is of medico-legal
interest. The patient was a chronic inebriate, who became
paralyzed. An analysis of the vomitus and excretions
showed arsenic in poisonous quantities; it was evident he
had been given arsenic for some unknown disease. The
question came up, Was the paralysis due to alcohol or
arsenic, the latter given for criminal purposes? Dr. Prince
found a typical case of alcoholic paralysis, such as loss of
sensation, with hyperzesthesia, pain, and atrophy, with re-
actions of degeneration, and characteristic delirium. The
characteristic symptoms of arsenical poisoning were also
present in all their details. It appeared that he was at the
house of a friend who had persuaded him to invest large
quantities of money in a patent medicine he was interested
in, and was under treatment of a quack doctor, and alter-
nated from there to a house of ill-fame. The circumstances
of the case indicated an effort to take his life by arsenic, and
the intervention of paralysis, either due to the arsenic alone
or to the alcohol he had taken, the latter producing multiple
neuritis. This case excites much interest, and may come
into court, when a differential diagnosis between these two
forms of paralysis will be studied.

CURABILITY OF INEBRIETY.

The following extract from a paper read before the Eng-
lish Society for the Cure of Inebriety, “On the Prevailing
Indifference to Inebriety,” by Mr. Trevor, Secretary of the
Church of England Temperance Society, indicates an ad-

Abstracts and Reviews. 173

vance of half a century over the American Temperance
Society’s work :

‘“‘Numberless institutions are spread over the country,
thank God! for the general treatment of disease, such as
hospitals, infirmaries, and the like, while there are also
admirable institutions for the treatment of diseases of a
special character, — consumption, cancer, fevers, diseases of
women and children, and of bones and special organs; but
for the treatment of the poor diseased inebriate there are
about sixteen recognized retreats or organized establish-
ments only, as far as I have been able to gather, all the
results of private enterprise, and in nearly all of which
detention is voluntary, which experience shows is next door
to useless if a permanent cure is wished for or expected.
Let me ask you to note this significant fact, which is surely
a terrible sign of the direction in which the stream of
inebriety is now running, and fraught with so much disaster
to the whole community, viz. that out of these sixteen ine-
briate retreats, all but two (both licensed under the Habitual
Drunkards Act) are for females alone; and I may add a
remark I once heard made, that the applications for admis-
sion to these retreats for females were always very far in
advance of their possible accommodation. Thus it may be
truly said, to the everlasting reproach of this Christian coun-
try, that the only refuge open to the penitent dipsomaniac or
the habitual drunkard who cannot pay for his detention in
one of these private homes, is the ward either of a work-
house, a goal, or a lunatic asylum, and not there even until he
has qualified himself for entrance and reception by becoming
either an absolute friendless pauper, a disgraced criminal, or
a mindless lunatic. The necessity for such retreats or homes
for the cure of inebriety is not only absolute and urgent, but
it seems to be a paramount duty, especially on the part of a
nation calling itself Christian. But the value of them’ is
beyond all contradiction. There is doubtless still room for
much improvement in their method and management, but
the results are, on the whole, most satisfactory and encour-

174 Abstracts and Reviews.

aging. Doubt is often cast upon the permanency of the cure
of inebriety; but there is surely the same uncertainty as to
the permanent cure of all other diseases and evils. And yet,
I hear no objection to the attempts which are made on all
sides, with very strong hopes of success, to reform the crimi-
nal, to restore the insane, to repair the damaged body, to bind
up the broken-hearted, and recover the fallen. Then why
should such exception be taken to the permanency of the
cure of the inebriate? But the results of medical and Chris-
tian experience show beyond all question that inebriety may
be cured as effectually and reliably as any other of the many
ills which flesh is heir to, hampered though its treatment is by
many complications. At any rate it has been said authorita-
tively that one out of three men who have been under any-
thing like proper treatment in an inebriate asylum has been
saved, —a result for which, I think, we may well thank God
and take courage.”

INEBRIETY IN MINNESOTA.

A few years ago this State built a fine building for the
exclusive treatment of inebriates. Before it was put into
practical operation, the medical treatment of inebriety was
denounced so bitterly that the building was changed to an
insane asylum, with an inebriate ward. From the last report
only four inebriates were under treatment, while nearly four
hundred insane (who of necessity are largely incurables)
occupy the fine buildings. This is the same blunder which
has been made many times before. These four hundred
insane should be scattered round in small homes, and farm
hospitals. Many of them are incurables, and all that can be
done is to house and protect them. While the inebriate is
to a large degree curable, and can be made self-supporting.
It is this neglect and failure to care for the inebriate that
keeps the insane asylums full. When inebriety is regarded
as a disease and is treated in hospitals, the State will be
doing a charitable work that will be felt in all circles and
societies,

Abstracts and Reviews. 175

The Medical Record has eclipsed all their rivals in offer-
ing to send free to every medical journal proof slips of all the
papers to be read at the International Congress at Washing-
ton in September next.

The Demorest Monthly is a most excellent, pure-toned,
healthy, bracing journal. It is also progressive, and should
be read by every family in the land.

The Sczence Journal comes each week with a rich freight
of new and most fascinating matter.

' The Scientific American keeps abreast of the restless
march of science, always giving the latest news from the
“ front of this field.”

The Homiletic Review, published by Funk & Wagnalls,
has some very entertaining and instructive papers in the
July and August numbers. :

The Electrical Engineer of New York city grows in
value every month. The new lands of electrical force are
opening wider every day, creating new interests, which this
journal most aptly describes.

The June, July, and August numbers of the Popular
Science Monthly may each be called a separate library of the
best thought and latest researches of science. This monthly
has become an essential to every library in all conditions of
life.

The Rise of Universities. By S.S. Laurie, LL.D. Published

by J. Fitzgerald, 4 East 24th street, New York. Price,
post free, thirty cents.

Notes on Earthquakes, with fourteen Miscellaneous Essays.
By Richard A. Proctor. Price, fifteen cents, post free.
J. Fitzgerald, publisher, 24 East 4th street, New York.

The Formation of Vegetable Mould through the Action of
Earth-Worms. By Charles Darwin. J. Fitzgerald,
publisher, 24 East 4th street, New York. Price, post
free, thirty cents.

These three works should have a place in the library of
every thinker and student. They place the best thought of
the day in the reach of all persons.

VoL. IX.—24

176 Abstracts and Reviews.

The Nursing and Care of the Nervous and Insane. By C.
R. Mills, M.D., Professor of Diseases of the Mind and
Nervous System in the Philadelphia Polyclinic. J. B.
Lippincott & Co., publishers, Philadelphia, Pa., 1887.

This is a capital little book, full of hints and suggestions
of great value to both the nurse and physician. The author
understands clearly what a nurse should and should not know
in the care of mental disease, and has a concise, happy way of
expressing it. This book is unique in both the matter and
the manner of presenting the subject, and we advise our
readers to possess it as a really valuable aid to the often

very confusing field of practical treatment of this class. A

physician should know what a good nurse is and what is

required, and this work supplies the facts in this field.

Nervous Diseases and Their Diagnosis: a Treatise upon the
Phenomena Produced by Diseases of the Nervous Sys-
tem, with Especial Reference to the Recognition of
Their Causes. By H.C. Wood, M.D., LL.D., member
of National Academy of Sciences, Philadelphia, Pa.
J. B. Lippincott & Co., 1887; pp. 500. Price $4.00.

This work is especially devoted to the phenomena of
nervous diseases and their recognition from the symptomatic
and diagnostic side. The following paragraph from the
introduction gives a good idea of the plan of work: ‘‘ When

a case offers itself for examination the physician must needs

travel from the symptoms back to the lesion, and not from

the lesion to the symptoms. He does not say this man has

a clot in the brain, therefore he has hemiplegia; but he

begins with the paralysis, and passes from it by a process

of induction to the lesion. Hitherto, the authors of text-
books have traveled from the lesion to the symptoms. The
present treatise is an attempt to follow the route which the
practitioner must pass over daily.” The author starts with
the different forms of paralysis, passing from motor to sen-
sory symptoms, and ending with the lesions of conscious-
ness and intellection. The faults and omissions of the work
are so few compared with its merits and the suggestive,
practical interest which it creates in these subjects that it
may be justly called the best practical work on this subject
published. The author is clearly a thoughtful and thorough
student, also an excellent teacher, knowing exactly what is
needed and how to present it in its most attractive way.

We have published some extracts from its pages elsewhere,

and heartily commend this work to our readers.

Editorial. 177

Rditorial.

INTERNATIONAL MEDICAL CONGRESS ON
INEBRIETY.

The first International Medical Congress for the Study
of Inebriety, which convened in London, July 5th and 6th,
marked the beginning of a new era in the history of this
subject. The exercises began July 5th with a special recep-
tion to Dr. T. D. Crothers with other American and foreign
delegates. Among them were Drs. Parrish, Wright, Thwing,
and Mr. Schemerhorn of America, Dr. Mcellier of Brussells,
and Dr. Koch of Holland, and others.

The following is the official record of this occasion :

On the afternoon of Tuesday last, an influential and
representative company assembled in the rooms of the Med-
ical Society of London, on the invitation of President and
Council of the Society for the Study of Inebriety, at a recep-
tion to Dr. T. D. Crothers, Hartford, Conn., U.S. A., Secre-
tary to the American Association for the Cure of Inebriates,
and editor of the QuARTERLY JOURNAL OF INEBRIETY.
Among the audience were members of the medical profes-
sion, visitors to the Congress on Inebriety, and leading
temperance workers. After a service of tea and coffee, the
chair was taken by the president, Dr. Norman Kerr, who
said that for the marked advance of the recognition of
inebriety as a true disease calling for treatment like other
diseases, for the establishment of special homes for the pur-
pose, as in insanity, and for legislation to protect the
inebriate against himself, the world was indebted largely to
American physicians, several of whom were with them that
day. He (the chairman) rejoiced at the presence of so
many abstainers and prohibitionists, as the physical aspect
of intemperance ought never to be forgotten. Alcoholic in-

178 Editorial,

toxicants were always poisonous, and no moral or religious
influences could modify the action of a material chemical
poison. They all hoped for amended and improved legisla-
tive measures for the effective cure and control of the
diseased inebriate (poor as well as the rich). A year and
a half ago they had welcomed the president of the American
Association, Dr. Parrish, and now they had the pleasure to
welcome his active colleague, Dr. Crothers. Dr. Kerr con-
cluded by proposing the following resolution: “That this
Congress of British, Colonial, and foreign members, compris-
ing members of the legislature, ministers of religion, physi-
cians, lawyers, philanthropists, abstainers and non-abstainers,
prohibitionists, and other friends of the habitual drunkard,
convened by the Society for the Study of Inebriety, offers a
hearty welcome to Dr. T. D. Crothers, Hartford, Conn.,
U.S. A., secretary of the American Association for the
Cure of Inebriety and editor of the QUARTERLY JOURNAL OF
INEBRIETY.

“That this Congress tenders its hearty congratulations to
Dr. Crothers and his American colleagues for the excellent
work done by their association and journal in enlightening
the profession and the public on the physical aspect of
inebriety ; and trusts that through the united efforts of all
who are interested in temperance and legislation the time
will soon arrive when the diseased state of the inebriate will
be generally acknowledged, and when effective measures will
be passed by the legislators of every country for the judicious
care and treatment of all inebriates willing to be treated in
special homes, and for the compulsory seclusion in such in-
stitutions of inebriates unwilling of their own accord to put
themselves under restraint.”

The resolution having been seconded by Dr. G. B. Clark,
M. P., was carried by acclamation, after which Dr. Crothers
delivered a brief address, in which he reviewed the history of
the movement in America. Dr. Joseph Parrish of America,
afterwards read a short paper on the subject of “Is there a
Climacteric Period in Inebriety?” Dr. T. L. Wright, also

~~

he

Editorial. 179

of America, read a short paper, in which he spoke of the
morbid force of the drunkard’s convictions. He said that a
sober person in the witness-box testifying to events that had
occurred when he was intoxicated was less reliable than an
intoxicated person testifying to events that had occurred
when he was sober. Dr. Thwing, Dr. Koch, Dr. Bridge-
water (Harrow), and Sergeant-Major Haskett afterwards
spoke, the last-named gentleman dwelling upon the difficulty
of placing destitute inebriates in positions where they would
be properly cared for. The chairman remarked that the
present condition of the law was accountable for that diffi-
culty. He thought it was a national disgrace that there are
no places for the treatment of male inebriates unable to pay.
Female inebriety was increasing enormously.

The regular session of the Congress began the next day,
the 6th, at 10 A.M., at Westminister Town Hall. Dr. Cam-
eron, M.P., vice-president, as chairman, opened the exercises
with a short address on the importance of a medical study of
inebriety, then introduced the president, Dr. Norman Kerr,
who delivered an address on Jnebriety ; a Disease Requiring
Medical, Moral, and Legislative Treatment. This was amost
suggestive and graphic presentation of the disease of in-
ebriety, and its treatment in special hospitals.

Inebriety in Austria was the title of the next paper, by
Chevalier Max Proskowetz de Proskow-Marstorff. The
author stated that in Austria inebriety was increasing every-
where on a dangerous scale. The consumption of alcohol
was 6.7 litres a head in a population of 39,000,000; but in
some districts 15} litres was the average (4} litres go toa
gallon). In all Austro-Hungary there was an increase of
nearly 4,000,000 florins in the cost for alcohol in 1884-85
over 1883-84. In 1885 there were 195,665 different places
(stations, ginshops, and subordinate retails) where liquors
were sold. Dr. Julius Wolff had shown that the proportion
of liquor stations to the inhabitants varied from 1 for every
173 to 1 for 1,181. In districts where the most spirits were
used there were fewer fit recruits. Of 2,742 homicides and

180 Editorial.

murders in Austria in 1876-80, 978 were by drunken per-
sons ; in Bohemia, 103 out of 435; and in Moravia, 74 out of
242. Austrian inebriety was increasing in county and in
towns. 33.41 per cent. of the insane in the Vienna asylum
were from alcoholism, or seven times more than ten years
ago. Alcoholism and inebriety had spread more rapidly
since spirits had been made from molasses, potatoes, sweet
turnip, Indian corn, etc. Inebricty was also causing graver
diseases. The Austrian Inebriety Society has asked the
Parliament to establish homes for inebriates. By the Aus-
trian Penal Code (1852) accidental intoxication exempted
from criminal responsibility ; but it was an aggravation if the
person knew from experience that he was very emotional
when intoxicated. Inveterate drunkenness was a mis-
demeanor in craftsmen working on roofs or with materials
easily inflammable. Austrian workmen generally took
spirits to breakfast. Introducers of spirits into factories
were severely punished. In the Tyrol, C. Payer says that
two-thirds of ‘the people are inebriates, including women.
At the request of the Inebriety Society, the common Imper-
ial Minister of War had requested commanders of troops and
garrisons to insure the sale by settlers of tea and coffee at
low prices. The Chevalier Proskowetz de Proskow-Marstorff
had asked Parliament to teach the intoxicating nature of alco-
hol in schools. The Austrian Inebriety Society was
founded on January 17, 1884, and had done good work by
collecting statistics, publishing pamphlets and proceedings,
chemically examining spirits, and promoting tea-cars and
coffee-rooms.

The following are short abstracts of several papers which
were read :

Lhe Physical Aspect of Inebriety, by N. S. Davis, M.D.,
Chicago, President International Medical Congress. The
conflict between the vice view and the disease view of ine-
briety is the result of a misapprehension of terms. Inebriety
is inherited as cancer or consumption is inherited, but no
one is born with a cancer or a tuberculous lung. Some are

—7$—- — 2

Editorial, 181

born with such a physical organization as embodies a liability
to cancerous growth and tuberculous development. In the
same way the drinking parent begets a child with a degener-
ated type of organization, rendering the latter liable to ine-
briety, as to convulsions or imbecility. Therefore, if such a
congenitally weak child drinks at all, he cannot resist the
narcotic power of alcohol. Inebriety is a disease, inasmuch
as it is a departure from health, persisting, in certain cases,
after the immediate act of drunkenness is over. While
inebriety is primarily the result of voluntary drinking in most
cases, there being some self-control in the early stages, if
persisted in from year to year until permanent tissue changes
are established, the inebriate is no longer able to exercise
self-control. He should then not be held responsible for his
acts, but should be recognized, legally and morally, as in a
similar category to the insane, and appropriate asylums
should be provided, where he should be compelled to reside
till forced abstinence and medical treatment effected a cure.

Legislation for Inebriety, by Dr. Petithan, Liége. Alco-
holism in Belgium has augmented with frightful rapidity,
and calls for immediate and thorough action. England and
the Netherlands, these two classic countries of progress and
liberty, and France had adopted repressive measures. Bel-
gium ought not to lag behind. At present, the alcoholized man,
unless in extreme insanity or violence, is not dealt with, He
is not responsible, being under the power of alcohol, and yet
he has the control of his family, the administration of his
affairs, and he is a juryman. He cannot be interdicted un-
less he is mad, yet he has lost his will, is no longer free, and
no more responsible. This newly-discovered disease — ine-
briety—ought to be recognized by the law. The inebriate
should be liable to interdiction, not only by his family, but
by a public officer. This can be done now only in the event
of fury or imbecility, but it can be done in a lucid interval.
The alcoholized man, when his diseased state is medically
and legally recognized, ought to be interdicted. When he is
interdicted, there ought to be power to shut him up ina

182 Editorial.

special home, where he should be treated and obliged to
work according to his strength.

Asylums for Inebriates in Sweden, by Axel Dickson. In
Sweden there are two such asylums. One is at Bic, under
medical superintendence, where the charges can be afforded
by only the economically independent. The other is for
working people, at Térnas, the charges varying from £11 to
422 per annum. The patients have to work on the farm, in
the dairy stables, and elsewhere on the premises. One
year’s residence is required. No intoxicants are allowed.
The farm has been open for only six months. Already there
have been seven patients, some of whom are hopeful cases.

German Law on Inebriety, by Professor Binz, Bonn.
Prof. Binz stated that, by the German Penal Code, § 261,
No. 5, whoever surrenders himself to drinking so as to fall
into a condition in which, through the interposition of the
court, foreign help must be resorted to for his support or for
the support of those whom he is in duty bound to maintain,
is punished with imprisonment. On a repetition of the
offense, imprisonment can be arranged in a work-house for a
longer time. The closing hours of drink places are usually
10 o'clock Pp. M. in the country and 11 P. M. in towns.

Inebriety in Belgium, by Dr. Moeller. The author traced
the history of the movement for legislation for inebriates in
Belgium, particularizing the labors of Drs. Petéthan, Harella,
Carpentier, Jansen, and others. Dr. Carpentier had found
ninety per cent. of his post mortems on males and ten per
cent. of his post mortems on females at the Brussels Hos-
pital show signs of incurable organic alcoholic disease. The
ages at which these inebriates had begun to drink ranged
from fifty-five to eight years. In Belgium they were agitat-
ing (1) for interdiction of the inebriate; (2) for seclusion of
the inebriate in a special asylum for treatment of his disease.
Dr. Moeller was in favor of the government opening such
establishments, rather than their institution by private indi-
viduals. Inebriety was a true disease, and required not only
medical treatment, but also legislative care and control.

oN ee ee epee

Editorial, 183

Continental Legislation for Inebriates, by the Rev. Dr.
M. De Colleville, Brighton. In Austria, Belgium, France,
Germany, Greece, Holland, Italy, and Switzerland, drunken-
ness is not in itself an offense, but public and disorderly
drunkenness is punished by short imprisonment and fines.
In some countries the fines are increased by the number of
convictions. In some places bankrupts and paupers, as well
as interdicted persons (for prodigality), are not allowed to
enter a drink establishment for thirteen months or more, as
at Lucerne and in Galicea, except for food in necessity.
Drunkenness is spreading beyond the Northern Continental
regions. Italy and Greece are becoming infected. Corn
and other allied alcohols discovered by Libavius in 1585
(Halle University), had greatly increased drunkenness. In
France, in 1885, 511,280 gallons of ettylic and 40,506,642
gallons of heavier and more hurtful alcohols were consumed.
This, with the alcohol of wines, etc., gives an average annual
use per head of four gallons. Laborers and mechanics are
there losing £40,000 annually. There has been a decrease
in Holland, North Germany, Russia, Norway, and Sweden.
Only in fury, etc., is there interdiction. By the German
Penal Code, Clauses 361 and 362, boisterous inebriates can
be sentenced for two years to prison in-door or public work
out-door labor. The English Habitual Drunkards’ Act
should be made compulsory in the freeing of the inebriate
from his slavery, as a fit memorial of the Jubilee year.

Dr. B. W. Richardson presided in the afternoon session,
and delivered an address on Alcohol and Its Effects on the
Heart. Other papers were read as follows: Furisprudence
of Inebriety, by Clark Bell, Esq.. Ex-president Medico-Legal
Society of New York; Pathology of Incbriety, by E. C.
Mann, M.D., Brooklyn, U.S. A.; Zhe Relation of Disease
to Inebriety, by L. D. Mason, MD., Consulting Physician,
Fort Hamilton Home for Inebriates; A Prison Chaplain’s
Observations on Inebriety, by Rev. J. W. Horsley, M.A. ;
The Meeting-Place of Vice and Disease, by Alfred Carpen-
ter, M.D., J.P.; Homicidal aud Suicidal Inebriety, by Sur-
geon-Major Pringle, M.D.

VoL. IX.—25

184 ; Editorial.

’ The president, Dr. Kerr, read a paper on the following:
Colonial Legislation for Habitual Drunkards.—In view
of the approaching expiration of the Habitual Drunkards
Act, 1879, and the call for permanent and improved English
legislation for habitual drunkards, I have to lay before you
the result of a special inquiry into our Colonial legislative
provision, immeasurably more satisfactory than with us, for
the numerous and wretched victims of the terrible and truly
serious disease —inebriety. For the information which I
am enabled to present to you I beg to acknowledge most
grateful thanks to the High Commissioner of Canada, Sir
Charles Tupper, and to the Agents-General of South Aus-
tralia, Victoria, and New Zealand, Sir Arthur Blyth, Sir Gra-
ham Berry, and Sir F. Dillon Bell, with their respective
secretaries.

Canada.— Nearly all the Canadian Provinces have effect-
ive legislation.

Ontario.— An inebriate can be admitted, provided it is
certified to the satisfaction of the superintendent that appli-
cant is an inebriate, simply on voluntary application and the
signature of an agreement to conform to the rules for any
period not exceeding twelve months. Within that term he
can be discharged either as cured, as incapable of benefit, as
(with means) having neglected to pay for his maintenance, or
as refractory. An habitual drunkard can be committed to a
home by the provincial secretary, after inquiry by a judge.
The inquiry can be asked for by any friend, and the indicted
has eight days’ notice, with power to produce and examine
witnesses. Twelve months is the full term, and the commit-
ted can be discharged in the same way as the voluntary pa-
tients. Any voluntary or involuntary patient can, on escape,
be retaken and reconveyed to the home by any official or by
any person authorized by the superintendent. The inspector
appointed by the lieutenant-governor can, subject to review
by a county court judge, sell inebriate’s property to pay for
maintenance. Poverty is no bar to committal, but those who
are able, or whose family are able to pay, are compelled to
do so. The lieutenant-governor has power to purchase,
equip, and maintain a hospital for inebriates ; the inspector
of prisons and asylums having the same power over an ine-
briate’s retreat as over asylums for the insane.

ns

Editorial. 185

Quebec.— Habitual drunkards can be interdicted by a
superior court judge, as in insanity, after a report by a family
council, the petitioned against having eight days’ notice to
show cause against the interdiction, which involves loss of
civil rights. The curator can proceed against persons wil-
fully selling or giving intoxicating liquor to the interdicted.
The curator can place the inebriate in a special home.

Nova Scotia.— Interdiction and power to intern the inter-
dicted similar to Quebec, only fourteen days’ notice must be
given to the inebriate.

New Brunswick aud Manitoba.— The interdiction is by
a judge, and a committee of the inebriate is appointed. There
is the same power to confine in any place of which the judge
may approve.

South Australia.— Patients may be admitted for any
period not exceeding twelve months, on attestation by any
justice. On production of a certificate by two medical prac-
titioners, and an application by any friend, any judge or
special magistrate or two justices, can order committal to a
home for a period not exceeding twelve months. An incor-
rigible inebriate (that is, one convicted of drunkenness three
times within six months) can be similarly committed. Any
patient who has escaped can be retaken and reconveyed to
the retreat by any person authorized in writing by the super-
intendent. There is power over the property of patients able
to pay, but those unable to do so can be employed at a fair
rate of wages.

Victoria— Voluntary admission can be had on applica-
tion to any justice. A county court judge can order com-
mittal to a home on production of a statutory declaration by
two medical men, and application by a friend. On escape,
any one authorized in writing by superintendent can retake
and reconvey to the home. The medical superintendent can
appoint a substitute to act in absence.

New Zealand.— Voluntary application for admission may
be made to a judge. A judge, on certificate of two doctors,
may order detention in an asylum, twenty-four hours’ notice
of the procedure having been given to the alleged inebriate.
Patients are bound to work, the penalty for refusal being
450. Patients are received though they cannot pay for their
maintenance.

It is only fair to add that there is as yet very limited
accommodation in Special Homes for Inebriates in the Colo-

186 Editorial,

nies, a practical haven of refuge, and a means of restoration
to health for the narcomaniac, which is much more abundant
here. We have a number of such homes for the well-to-do,
though none licensed under our Act for the poor. Is it not
high time that the legislature of the United Kingdom should
take a lesson from her vigorous Colonial offspring by caring
for the destitute as well as for the rich diseased drunkard, by
offering an opportunity for the treatment of every inebriate
willing to give up his freedom for a time, and by investing
the proper authorities with power to compulsorily seclude
the victim to narcotics for the threefold purpose of effecting
his cure, of saving his wife and family from a life of inex-
pressible sadness, and of protecting the community from the
violence and riot of a morbid maniac?

A grand dinner closed the exercises in the evening, of
which the following is an account:

On Wednesday evening, July 6th, two hundred and fifty
ladies and gentlemen sat down to dinner in the Westminster
town hall, Dr. Norman Kerr, F.L.S., in the chair. Among
those who had accepted the invitation were Lord and Lady
Denman, Lord and Lady Mount-Temple, Baron Ferdinand
de Rothschild, Sir Wilfrid Lawson, M.P., Sir Trevor Law-
rence, M.P., Dr. Cameron, M.P., P. Maclagan, M.P., T. W.
Russell, M.P., W. B. Rowlands, Q.C., M.P., William John-
ston, M.P., Dr. Clark, M.P., Sir Edwin Saunders, Drs. Par-
rish, Crothers, Wright, and Thwing (U.S.A.), Dr. Moeller
(Brussels), Drs. B. W. Richardson, Alfred Carpenter, Dan-
ford Thomas, Mrs. Norman Kerr, and a number of other
ladies, clergymen, and representative temperance reformers.
The dinner was served by A. B. Marshall, of the West End
School of Cookery. The Anglo-Hungarian band played dur-
ing the evening.

The toasts were honored in five varieties of non-intoxi-
cating wine, imported by Frank Wright, Mundy & Co.
There was also on the table Brunnen table water and Brin’s
oxygenated lemon water, charged with oxygen prepared from
the atmosphere.

Editorial, 187

The toasts were “The Queen and the Royal Family,” by
the chairman ; “the Houses of Parliament,” by Sir Edwin
Saunders, F.R.C.S., responded to by Lord Denman and Mr.
P. Maclagan, M.P.; “Religion, Law, and Medicine,” by
Lord Mount-Temple, responded to by Rev. Dr. Lansdell,
F.R.G.S., the distinguished Siberian traveler, Mr. W. B.
Rowlands, Q.C., M.P., and Dr. Withers Moore (president
British Medical Association) ; “The Study and Cure of Ine-
briety,” by Dr. J. S. Bristowe, F.R.S., responded to by Dr.
Crothers ; “Our American Guests,” by Dr. B. W. Richard-
son, responded to by Dr. Joseph Parrish; “Temperance
Organizations,” by the chairman, replied to by Sir Wilfrid
Lawson, M.P. (U.K.A.), Canon Ellison (C.E.T.S.), and Mr.
John Taylor (N. T. League) ; ‘Our Foreign Guests,” by Dr.
T. L. Wright, reply by Dr. Moeller (Brussels) ; ‘‘ Legislation
for the Inebriate,” by Dr. Alfred Carpenter, J.P., responded
to by Sir T. Lawrence, M.P.; “Our Colonial Guests,” by
Dr. Danford Thomas, reply by Rev. J. Gelson Gregson;
“The Dalrymple Home,” by Consul-General Waller, replied
to by Dr. Cameron, M.P., president of the Dalrymple Home ;
“The Ladies,” by Dr. George Harley, F.R.S., replied to by
Dr. Thwing (Brooklyn, U.S.A.). The company separated
at an early hour after having spent a very pleasant evening.

A large party of the Colonial, Foreign, and Provincial vis-
itors were entertained at lunch at the Dalrymple Home,
Rickmansworth, on the following day, the 7th inst. The
guests, who went out by train from Euston va Watford,
were conveyed by carriages in waiting at Rickmansworth
station, to the Home, one mile distant, and were received by
Canon Duckworth (the chairman), Dr. Norman Kerr (con-
sulting physician), Mr. Branthwaite (the medical superin-
tendent), and the committee of management. After lunch,
an informal meeting was held in the spacious concert room,
when Dr. Parrish, Dr. Crothers, Dr. Wright, Dr. Thwing
(U.S.A.), Dr. Moeller (Brussels), and others expressed their
delight with the charming grounds, their high opinion of the
scientific and practical methods of treatment of the disease

188 = Editorial.

inebriety, and their gratification at the excellent results
already attained.

It will be of interest to our readers to hear some of the
conclusions which seemed evident. The number of the
papers both presented and read at this Congress, and their
general literary and scientific character, was unmistakable
evidence that the disease of inebriety had been recognized,
and an interest created for a wider, clearer knowledge of this
subject.

It was also evident that the time had come to organize
and place on a scientific basis the many facts concerning in-
ebriety which have been known and urged by observers all
over the world.

The evidence on which the disease of inebriet and its
curability by medical means in hospitals are based, demanded
a recognition, and received it in this Congress beyond the
expectations of its most sanguine supporters.

Leading medical men in both Europe and America either
contributed to this Congress or endorsed it with letters of
hearty sympathy. The large number of leading scientists
and distinguished men who joined in the banquet, and the
full reports given in the medical, secular, and temperance
press of the proceedings, indicated beyond all doubt a great
advance of public sentiment, and the permanent growth of
the teachings of the JourNaL oF INEBRIETY and its numer-
ous writers.

The papers presented by the Americans at this Congress
indicated a more thorough study of inebriety, but the thought-
ful, conservative tone of the English papers, and the statisti-
cal papers of delegates from the Continent, showed a solidity
of growth in the study of this subject very promising for-the
future.

Both the addresses and papers presented to the Congress
were more suggestive of the possibilities from further study
in this field than of the results already accomplished. This
was the grand feature of the Congress, showing that practi-
cal men had begun on the practical side of this great new
land of psychicatry.

Editorial, 189

Of course such a movement, with all its praise and en-
thusiasm, must bring out some adverse criticism. Here as
elsewhere the same temperance reformers and clergymen
were shocked and pained at the infidel error of attempting
to recognize a physical side to this subject. Happily many
of the best men in these classes supported this movement
with much enthusiasm. While the success of this Congress
was due to the efforts of its talented president, Dr. Kerr, it
was evident to all that the subject had grown to such propor-
tions that hereafter it would be discussed in great conven-
tions, of which this was but the beginning.

The social features of the Congress were very pleasing,
and will be long remembered by all who participated. The
American delegation formally thanked the president in a
printed letter for his courtesies. It is very pleasing to note
that the papers by Drs. Parrish, Wright, Mason, and Mann
attracted much attention, and quite a demand for separate
copies was created, which the temperance press supplied.

Our space prevents further reference to this most inter-
esting event, which we hope to outline more fully in the next
number.

UNCONSCIOUS DECEPTION IN INEBRIETY.

The following case excited much interest in a large circle
of friends, and came to my notice for advice. A, a wealthy
brewer, who had been a widower for years, died, leaving most
of his property to his sister-in-law. This was unusual, as he
had brothers and sisters and others who had more claims on
his property. He was an excellent business man, kind and
conscientious and above reproach. The family physician,
an inebriate who drank steadily for years, and was also a man
of character and respectability, volunteered under oath an
explanation of this peculiar will. He said on such a day he
overheard the sister-in-law urging and threatening the brewer
to have his will changed. The next day he overheard a
strange man writing it at the suggestion of this woman.
This occurred a few days before the death of the brewer.

190 Editorial.

As the doctor could have no visible motive, and the act was
strange and unusual, a detective was called in to confirm his
sworn statement by other evidence. It was found that the
doctor was ‘ten miles away on the night he alleged to have
heard this effort to change the will, and his associate physi-
cian made a visit at nearly midnight of that day, seeing no
one but the nurse. It was also found that he did not call on
the day he swore he heard and saw a strange man making

out a will. It was also found that the will was written sev-'

eral months before in a distant city, and had not been altered
in any way from the first writing. The indignation of the
friends at this evidence prompted them to arrest the doctor
for perjury. The doctor was very positive of his correctness,
and the case came under my notice. The result of an ex-
amination made it very probable that the doctor had heard
in his rounds some suspicion that the testator of the will had
been forced to make such a will. This suggestion had re-
volved itself in his mind until he conceived that he had over-
heard this very thing. From this the false conception grew,
and finally shaped itself into the writing scene.

There was no object in the statement, as the parties to
be benefited by such a statement were not friendly to him,
and those who would suffer were his friends. My opinion
that this was a case of unconscious deception, growing out
of a degenerate and diseased brain, was accepted, and the
charge of perjury was withdrawn. Yet the doctor insists it
was true, and thinks the deception was in the investigations
of the detective.

The American observer notes the fact that inebriety in
England is hedged in with social customs, hygienic and
sanitary conditions, making its study and treatment a more
difficult problem than in America. It is also clear that
inebriety is literally poverty of both mind and body more
than in America, and is a symptom of degeneration, more
than accidental conditions The unsanitary conditions of
homes and absence of home life are apparently greater

Editorial. I9l

sources of danger than the saloons. The physical degenera-
tion of the inebriate is more prominent among the lower
classes. Public drinking and intoxication on the streets
attract less attention, and attempts to control inebriety are
resented as infringements of personal liberty. Many homes
have been established for inebriates, but with few exceptions
they are inadequate for the work, because based on errone-
ous views of inebriety and its cure. The temperance agita-
tion, while intense and dogmatic, has a conservative element
which prevents extreme radicalism, and both clergymen and
temperance men are alive to the progress of science. The
unfortunate Habitual Drunkards Act has been an obstacle
in the growth of asylums, but as the act expires soon, great
efforts are being made to pass a more practical: bill. In
many of the discussions noted the confused attempts to
explain will and disease in inebriety indicates an early stage
of the study of the subject.

A Boston journal presents some statistics of the arrests
for drunkenness and assault in ten leading cities of the
Union. From these figures it appears that one in every
eighty persons are arrested for this offense in Washington,
D. C.; one in every one hundred and twenty in Albany,
N. Y.; then comes Baltimore, Boston, Buffalo, New York
city, and finally Columbus and Cincinnati, which have the
least arrests of any cities for inebriety and assault. The
inference is that these are the most temperate, law-biding
cities of our country.

Governor Hill, in his veto of the New York High License
Bill, brought out some curious facts of the number of
licenses granted per one thousand inhabitants in the leading
cities of New York State. Buffalo has thirteen licenses to
every one thousand people, the highest on the list, and
Albany the least, less than one to a thousand; New York
has seven and Brooklyn five, Troy has ten, Syracuse eleven,

VoL. IX.—26

192 Editorial.

and Rochester eight. These curious statistics indicate a
great variety of local causes which permit spirits to be sold
so freely in one place and checks it in another. In Buffalo
the climate is no doubt a predisposing cause. The sharp
extremes of high winds and cold rains have much to do in
breaking up the nervous equilibrium of the body and intensi-
fying the nutritive disturbances calling for the narcotic of
alcohol.

In the comparison of the histories of many cases of
inebriety, certain ranges of fact appear in a regular order.
Continuous chains of cause and effect run through all the
events. What appears to be the free will of the victim is
but a narrow channel along which he is forced by conditions
which he cannot escape. Appeals to his feelings and reason
are useless, for these faculties are unable to direct or control
the progress of disease. Often the victim is unconscious
that he has lost his power of control, unconscious of the
march of events; the steady disintegration of brain vigor
and health, and never realizes it. Delusions of health and
self control become fixed as the disease goes on. The range
of his mental powers steadily narrow and approach the ani-
mal in comparison, and are finally lost in a general dissolu-
tion.

The delay in the appearance of the Journal was for the
purpose of publishing some of the papers and proceedings of
the Congress of Inebriety. Other papers and proceedings
will appear in the future numbers of the Journal.

The time for argument to prove inebriety a disease has
gone by. The facts of inebriety are so accessible and
numerous that it is a question of observation and interpreta-
tion of these facts, and not of theory or speculation. Opin-
ions on questions not based on facts may differ, and even
the teaching of facts may vary with the observer, but the
truth is always and ever the same.

Clinical Notes and Comments. 193

Clinical Notes and Comments.

GEYSER SPRING WATER.

In 1870 an experimental drilling near Saratoga Springs
struck a vein of mineral water at a depth of one hundred and
thirty-two feet in the solid rock below the surface. The
pressure of gas was so great that the water was forced out
over thirty feet above the surface, and has flowed contin-
uously ever since. From analysis this water is found to be
very rich in chloride of potassium, bicarbonate of soda, mag-
nesia, and lithia, and coming from such a great depth is free
from impurities common to other waters. Unlike other
Saratoga waters it is found to be a marked nerve tonic,
especially in cases of nervous prostration associated with
dyspepsia. We have used it in a few cases of alcohol and
opium inebriates, giving it in small doses night and morning
with the best results. Its tonic effect comes no doubt from
its action on the liver and other glandular organs, and while
not purging the bowels, it seems to excite to a healthier
action. The natural carbonic acid gas in this water has a
marked medicinal value, and so far there seems every indi-
cation that this Geyser water will be found a nerve remedy
of great power. We urge our readers to try it in all neurosal
diseases.

The Lactated Food is one of those remedies that are
almost a specific in some cases of inebriety.

The Acid Phosphates of Horsford is probably the most
extensively sold and widely known of all remedies in the
market.

Parke, Davis & Co.’s Coca Cordial is a most excellent
preparation for all cases of nervous disease, and should be
used in all cases of inebriety and opium taking.

194 Clinical Notes and Comments.

Lactopeptine has come to be regarded as the great new
remedy for nutrient disturbances.

Peptonized Cod Liver Oil and Milk, by Reed & Carnrick
of New York city, has a special power as an oil tonic and
stimulant which is invaluable at times.

The Murdock Liguid Food will be found of good service
in anzemia and insomnia and dyspepsia.

The Anglo-Swiss Milk Food can be used with most ex-
cellent results as a concentrated food for nervous invalids.

Colden’s Liquid Beef Tonic is a stimulant of great power.
It can be used in the place of alcohol in emergencies, with
the best results.

Maltine with Alteratives is combined with the most valu-
able alteratives known, such as iodides, bromides, and chlor-
ides, and will be found a remedy of the highest value in
syphilis and all depraved conditions of the blood. Each
fluid ounce of Maltine contains: chloride calcium, 5 grains,
chloride magnesium, 5 grains, bromide sodium, 5 grains,

- iodide potassium, 1 grain, iodide iron, } grain.

Valentine's Preparation of Meat Fuice has proved in our
hands to be superior to any other form on the market. As
a stimulant and tonic it seems unrivaled in alcohol and
opium cases.

W. H. May, M.D., New York city, says: “I have had
very successful results in the administration of Bromidia in
cases having their origin in disorders of the nervous system,
such as cholera infantum, paralysis, insomnia, etc. But J
Jind it to be of special value in treatment of delirium tremens,
and the results of debauch; it being retained upon the stom-
ach and speedily controlling the most dangerous symptoms,
and producing the desired calmness and sleep necessary
when morphia and other soporifics have failed to do so, and
thus rendering the disorder amenable to further treatment.
Have also prescribed it successfully in the terrible state of
nervous exhaustion due to opium habitues endeavoring to
relinquish the habit. And, finally, as result of experience, I
pronounce it the ‘hypnotic par excellence.’”

Fellow's Hypophosphites are an excellent combination of
remedies that have been found of great value in nervous
prostration, anzemia, and many other diseases of nutrition.

THE
QUARTERLY JOURNAL OF INEBRIETY.

Vol. IX. OCTOBER, 1887. No. 4.

This Journal will not be responsible for the opinions of contributors, unless
indorsed by the Association.

THE PATHOLOGY OF INEBRIETY, AND THE
IMPORTANCE OF THE EARLY RECOGNI-
TION AND REPRESSION OF THE DIS-
EASE IN ITS EARLY STAGES. *

By Epwarp C. Many, M.D., Brooxtyy, N. Y.,

Author of “ Psychological Medicine and Allied Nervous Diseases, etc.” Physi-
cian to Sunnyside Private Hospital, etc.

Before entering upon the discussion of the pathology of
inebriety, I desire to say a word relative to the lack of
interest in the disease of inebriety by the general profession.

When we reflect upon the fact that an insane tempera-
ment which may be transmitted to offspring may be
established by the alcoholic habit; that the alcoholic appetite
may originate in moderate indulgence to become fixed and
hereditary; that epilepsy, hysteria, idiocy, and insanity
result from the alcohol habit and become hereditary ; that
the people of the United States spend, in the period of
eleven years, for alcohol, more than the entire value of their
agricultural, mechanical, and manufacturing products; that
thirty-three and one-third per cent. in New York, and probably
a similar per cent. in every large city, of all deaths are
occasioned directly or indirectly by the use of alcoholic
drinks; that from thirteen to twenty-five per cent. of all

® Read at the International Congress of Inebriety, London, England, July 6, 1887.

196 The Pathology of Inebriety.

cases of insanity, according to different asylum superintend-
ents, become insane through alcoholic drink; that the
progeny of alcoholics are peculiarly liable to degenerations
of the nervous system; that the alcoholic habit is antago-
nistic to the highest standard of bodily health and vigor, and
of capacity for work of individuals and of communities ;
when we reflect upon these indisputable facts, then every
thoughtful physician must realize that we have before us one
of the deadliest evils that curses modern society, and we
can but wonder at the astonishing apatlay that exists in
regard to the importance of a thorough knowledge of the
disease of inebriety in the daily work of every member of
the profession. The chief study in this direction ought not
to be limited to the small band of specialists in the pro-
fession who are devoting themselves to the care and cure of
inebriates. The disease of inebriety does not chiefly fall in
its practical relations within the working limits of this
exceedingly small band of specialists in the profession, nor
is its study so difficult as to be at all impossible to the busy
practitioner. He is the one who first meets with it in its
early, curable stage, and it should be alike his duty and
pleasure to instruct the public that the effect of alcohol
penetrates to every part of the living body, that there are
but few blood-vessels, not a muscle, not an active portion of
any of the membranes, not a secreting gland, small or large,
not an organ of sense, not a single viscus, whether pelvic,
abdominal, or thoracic, which is not interpenetrated by
alcohol, when the alcohol habit is indulged in. That it
causes marked changes in the rate and force of the heart’s
action, in the tonicity of the muscular arteries ; that it alters
temperature, and causes changes in the rate of action of
glands and muscles ; that it causes changes in the varied
forms of sensibility, from the most general to the most
special ; and that it causes the most grave changes of all in
the most exalted of all functions comprised under the head
of mind and mental operations, until finally the co-ordination
function in the brain is overthrown, and the consciousness
of personal identity and responsibility is destroyed.

The Pathology of Inebriety. 197

We desire to say that from some years’ experience in the
field of diseases of the mind and nervous system, that we know
of no disease of the nervous system more grave and more
demanding a careful, methodical, intelligent plan of treat-
ment than the disease of inebriety.

Let the profession regard inebriety in its true light as a
physical disease, amenable to treatment, and aim to instruct
the communities in which they practice medicine as to the
physiological action of alcohol on the functions of the human
body, and the science of preventive or state medicine will
owe an incalculable debt of gratitude to them for disease and
death prevented, and much domestic misery averted. With
these preliminary remarks we come to the subject of this
paper, “The Pathology of Inebriety.”

In considering the pathology of inebriety, we must look
for a moment primarily at the complexity of the nervous
system, its manifold functions and its extensive distribution.

We have the cerebro-spinal system, consisting of the
encephalon, the spinal cord, and the encephalic and spinal
nerves, the organic system of nerves, consisting of the
pneumogastric or vagus nerves, and the great sympathetic
system, including the vaso-motor system of nerves. In the
disease of inebriety the primary morbid changes are not in
the nerve elements themselves, or in the interstitial con-
nective tissue of nerve, except in those who inherit a
structurally degraded nervous system, but it is initiated by
altered quality of blood and secondary disturbance of
nerve function. The interference with the proper and well-
balanced working of the nervous system in the disease of
inebriety depends primarily upon the supply of blood to the
different nerve centers, being neither definite in amount, nor
uniform in quality. The proper nutrition of such centers,
and their normal molecular mobility, is at once disturbed,
and the maintenance of the accustomed degree of excita-
bility in the different nerve centers is interfered with, and
we get at once an exaltation, diminution, or other perverted
activity of the whole nervous system. The variations taking

198 The Pathology of Inebriety.

place in the nutritive conditions of the nerve centers involve
not only an altered action in that part, but a perverted
functional activity of all other related parts. Thus, in the
disease of inebriety we get the most varied grouping of
abnormal phenomena traceable to altered action in the
nervous system, and having for a starting point some per-
verted functioning of one or more nerve centers. We have
in inebriety morbid conditions of a progressive type, ending
in special forms of atrophy and degeneration, showing them-
selves more especially in the nerve cells of the brain, spinal
cord, or sympathetic ganglia.

Clinically, in the wide and varied phenomena of the disease
of inebriety, we meet with perverted sensation and perception ;
perverted emotion and ideation ; perversions of consciousness ;
perversions of motility ; nutritive or trophic change and per-
verted visceral actions. In the class of perverted sensation and
perception, we have the special senses interfered with. Inthe
class of perverted emotion and ideation we have a long range,
from mere emotional display, to actual insanity. In the class
of perversions of consciousness we see drowsiness, stupor, and
coma. Inthe class of perversions of motility we see tremors,
twitchings, spasms, both tonic and clonic, and also co-ordi-
nated spasms, as in the epileptiform attacks of inebriates,
paralysis and defective co-ordination of muscular acts. In
the class of nutritive or trophic changes, we meet with
degeneration of brain tissue itself, inflammation and con-
gestion of the lungs, or as hemorrhages into these organs,
blanching of hair and altered pigmentation of the skin. In
the last class, that of perverted visceral actions, we see
exalted activity of the stomach, intestines, bladder, and
heart, and, in women, of the uterus.

Inebriety is a disease caused by heredity, by defective
nutrition, by emotional shock, by physiological crisis, by
visceral diseases, and by structural changes in the brain.
We may have anemia of the brain in inebriety, with the
blood in the capillaries deficient in quantity and defective in
quality ; we may have secondary atrophy of the brain; we

calre
ted
the
of

the

we

The Pathology of Inebriety. 199

may have hyperzemia of the brain, with increase of quantity
of blood in the capillaries, with symptoms either of excite-
ment or depression. We may have cedema of the brain,
with infiltration of it and of the pia mater with serum,
especially when the case of inebriety is associated with
Bright’s disease. The cerebral substance itself is not infil-
trated. In these cases we see a slow diminution of mental
power and motor force. We may have softening of the
brain from vascular obstruction, depending on vascular
degeneration, causing trombosis, or valvular disease of the
heart causing embolism. The former in inebriates is the
usual form, and it is associated with chronic alcoholism and |
Bright’s disease. There are generally the premonitory
symptoms of mental deterioration, numbness, pains in the
limbs, and pains in the head, in the brain softening of
inebriates. Subsequently we see mental dullness, defective
perception, drowsiness, loss of memory, slight delirium,
emotional . attacks, headache, articulation and handwriting
bad, the delicate motor acts badly performed, and less of
physical power. Dementia may end the scene.

Inebriety is a disease exhibiting certain essential psychic
and physical signs. It is a disease in which the tone and
power of the nerve centers are lost. There is generally, and
I believe always, could we get at the true family history, an
inherited neuropathic constitution ; but here, as in insanity,
it is in the higher classes very difficult to elicit the whole
truth from the relations. It is a disease, perhaps more than
any other excepting insanity, requiring for its cure time, and
long-persisted hygienic influences to restore the normal vaso-
motor condition, affecting the nutrition and circulation of
the brain and nerve centers. The importance of the early
recognition and the repression of the disease of inebriety in
its incipient stages, has thus far received very little or no
attention, even at the hands of those who have written
extensively on the subject.

Inebriety is, like insanity, a psycho-neurosis, which
either attacks an intact brain, or more frequently a brain not

200 The Pathology of Inebriety.

intact, but predisposed to the acquisition of inebriety ‘by
hereditary or acquired vices of conformation or nutrition.

It has an early prodromic, very curable stage. The same
remarks, which in my writings on insanity I have applied to
that disease, apply with equal force to the disease of inebriety,
that there is an early, neurasthenic, equivocal state, differing
but little from perfect sanity, but which is the earliest phase
of mental alienation, and if recognized by the general practi-
tioner, and promptly treated in this incipient stage, subse-
quent trouble might be averted. A very careful study and
comparison of the two diseases of inebriety and insanity has
shown conclusively that in both alike we have early premoni-
tory symptoms, which, unrecognized and unchecked, lead or
lapse into active inebriety and dipsomania upon the one side
and into insanity on the other. They are grave phychical
symptoms, and should lead to an early diagnosis by an intel-
ligent physician, especially if he suspects that his patient has
been previously a so-called moderate drinker. As I shall
show presently in detail, in this early stage of the disease of
inebriety we have general malaise, impaired nutrition and
assimilation, muscular atonicity changing the facial expres-
sion, and neuralgia. There is at times cerebral anzemia, and
there is mental depression and insomnia. There are profuse
perspirations and a loss of the normal elasticity of the skin.
There are periods of marked mental inactivity, alternating
with a hyper-activity of the mental functions. There is
physical and mental prostration, muscular feebleness and
mental dullness. There is, or may be, vertigo and confusion
of mind also. Dyspepsia is also often present.

Inebriety is to-day a neurotic affection, preceded by a
distinct interval of morbid nervousness. In the American
of to-day, and I think in the Englishman also, there is a
greatly augmented susceptibility to the action of stimulants
and narcotics. This is due to the increasing complexity of
the nervous system, and to the increased complexity of life.
Our brains, as Sir Crichton Brown has truly said, are finer in
structure, more subtle in mechanism, and also more unstable

The Pathology of Inebriety. 201

than were those of our ancestors. Theconditions of modern
life acting on our complex and excitable nervous systems,
cause our increased nervous diseases, prominent among
which stand inebriety and insanity. Given in a certain case
an inherited neuropathic constitution, and dipsomania will

appear in the exhibition of the slightest exciting causes, °

This causes an important feature of the disease. Cosmical
influences operate with great readiness in producing an out-
break of the disease in persons thus predisposed to it. The
phenomena of nervous exhaustion, which one who inherits
this neuropathic constitution generally exhibits before the
actually developed disease, are certain functional disturbances
of the whole bodily organism. There is a relaxation of the
general muscular tone which gives rise to partial or total loss
of voice, generally partial, the chest tones being weak ; relax-
ation of the facial muscles, giving the face an enervated,
spiritless appearance; relaxation of the ocular and orbital
muscles, giving a tired, worn-out expression to the eye, and
this same relaxation of the general muscular tone in extreme
cases may produce involuntary defecation and micturition.
There is cardiac stimulation and palpitation, the palpitation
being the more prominent. Irregular action of the heart
best expresses this state I refer to. If you command the
individual to hold out his hand and arm perfectly straight
before him with the palm downwards, you will perceive that
the hand trembles visibly. This is a very good test for the
general relaxation of muscular tone all over the body, and a
very simple one. There is vocal tremor; trembling of the
legs especially about the knees; atony of the digestive,
excretory, and other organs, producing a general malaise;
idiopathic fits of perspiration and rigors. There is also great
irritability of the cerebral cognizant centers, evinced by
frights from slight causes. These persons have fears of in-
ability to perform certain acts, and the fears of involuntary
performance. There are muscular twitchings, a hasty or
imperfect utterance, and a quick agitated manner. If from
this simple state of neurasthenia our patient passes into the
Vor, TX.— 28

202 The Pathology of Inebriety.

graver state of hysteria or hypochondriasis, according as it is
a female or a male, we shall now observe more complex phe-
nomena which may or may not usher in the paroxysm of
dipsomania. There will be local pain due to visceral disease.
There will be pains referred to parts not diseased, due to
transference of the nerve force or vascular disturbance of
nervecenters. There is defective functional action of viscera
due to reflex action. There are disordered muscular move-
ments due proximately to reflex action or vascular disturb-
ance of nerve centers. Aside from heredity, excessive
sexual indulgence, loss of blood, excessive mental and mus-
cular exertion, or any painful disease may be the cause of the
neurasthenia, or nervous exhaustion, which ends in inebriety.
The heart, the spinal cord, and the brain, all functionate
abnormally in the neurasthenia of inebriety, and all the forms
of fear of which I have spoken are the characteristics of
debility of brain, due to general failure of the normal appro-
priating power of the brain, and all this is very often directly
traceable to the daily use of alcohol in some shape, in what
is conventionally termed moderation, but which has never-
theless paved the way for the establishment of the disease of
inebriety. What physician of experience has not witnessed
in the neurasthenia of the dipsomaniac and insane man alike,
that change of the mental character in which irresolution has
replaced former decision of character? As active dipsoma-
nia or insanity appear well developed all the psychical char-
acteristics of the prodromic neurasthenia of which I have
spoken, increase. I would therefore insist on the existence
of this early neurasthenic stage of inebriety — especially
when occurring in those who daily use alcohol in moderation —
as one of the most important points in the pathology of the
disease, a stage which the general practitioner should regard
as the danger signal of active dipsomania not far off, although
the irresistible craving for alcohol, which is the great diagnos-
tic mark of dipsomania, may not yet have been actively dis-
played. Now is the time to prevent the neurasthenia of in-
ebriety from lapsing into the actively developed disease.

The Pathology of Inebriety. 203

The constant current of electricity, as centric galvanization
and cerebral electrization, will do much to antagonize the
symptoms of this early stage, while attention to rest, sleep,
mental hygiene, cod liver oil, with the free use of malt and
hypophosphites, strychnia, iron and arsenic, zinc and phos-
phorus are all indicated as circumstances may dictate, both
to combat the disease, and build up and restore the shattered
nervous system. The fluid extract of coca is also at times
very valuable, as is also Warburg tincture and quinine. A
single teaspoonful of Warburg tincture taken before break-
fast daily is one of the most efficient nerve tonics with which
Iam acquainted. Inthe children of even moderate drinkers
who have never been suspected of being inebriates, I have
witnessed the neuropathic constitution strongly marked.
The phenomena which I have seen have consisted of sleep-
lessness, and night terrors, and emotional outbursts in early
childhood, the train of nervous phenomena in cases untreated
becoming gradually intensified, and becoming well marked
at the age of puberty, when a disposition to either recurrent
mania or dipsomania may appear. There are vaso-motor
neuroses with recurrent cerebral hyperzemia, the outward
expression of which state may be either the development of
a true periodic insanity, or dipsomania, as the case may be.
The phosphates and cod liver oil should be fed to such child-
ren from the earliest childhood, so that nature, if possible,
may restore herself to the normal standard, and over-stimu-
lation of the brain in too premature education of such child-
ren be avoided with like care.

The great danger to American children to-day is in the
inheritance of the neuropathic diathesis, which will, if not
antagonized as they grow up, tend to make many of them
inebriates and mentally unsound. This is particularly true
of the refined.and cultivated classes, where by premature and
stimulating processes of education, an elaboration of cerebral
structure is forced, and the functional activity of the brain
in children hastened, overstraining the brain centers at
their nascent period, thereby dwarfing and weakening

204 The Pathology of Inebriety.

them, disturbing the balance of mind by seriously inter-.
fering with the natural sequence of the evolution of the
brain centers, and preparing the child to fall an early victim
to some of the modern nervous diseases. Careful building
up of the nervous system, and a careful direction of the mode
of life and observance of the rules of mental hygiene may,
even in children who inherit the neuropathic diathesis, re-
store functional energy, antagonize the morbid psychosis,
build up the nervous centers, and prevent much inebriety
and mental disease in later life. Preventive medicine is a
wide field for study, and by such study must inebriety and
mental disease be stamped out, if they are to disappear. I
have endeavored to be as brief as possible in these remarks
on the Pathology of Inebriety, and the importance of the
early recognition and repression of the disease in its early
stages.

The fully developed disease exhibiting the great nervous
irritability and restlessness, the unnatural sensations, the
uncontrollable desire for alcoholic stimulus, and the dispo-
sition to frequent fits of intoxication, are familiar to all here
present. The great salient point to me in the Pathology of
Inebriety is, that there exists a departure from a healthy
structure of the nervous system, and that it is this abnormal
condition of the centric nervous system demanding stimu-
lants that is essentially the disease. How far and to what
degree the phenomena of inebriety are controlled by cos-
mical influences, such as electrical phenomena, lunar attract-
ions, velocities and directions of winds, geological formations,
elevations above the sea level, the approaches of storms,
barometrical changes and temperature, are most interesting
questions, for the complete elucidation of which time is yet
required. Accumulated results of experience indicate, how-
ever, decisively that the propensity for drink in this disease
arouses the appetite, overcomes the will, blunts the moral
sensibilities, and makes everything else subservient to its
demands. The will power of the individual is overborne by
the force of the disease precisely as in mental disorder ; and

The Pathology of Inebriety. 205

just as the periodically insane man has free intervals of com-
parative sanity, just so does the dipsomaniac have free inter-
vals of sobriety, when the irresistible craving for stimulants
passes away, to return again, however, with the next parox-
ysm, unless the proper remedial measures are applied. If
this morbid craving for stimulants is clearly traceable to a
brain condition, what is the mental responsibility of the
inebriate? To mea modified responsibility in the disease of
inebriety is clearly demonstrated, and we hope the day is not
far distant when the protection of the courts will be
extended to the inebriate.

The study of the Pathology of Inebriety would lead us, if
carried out to its fullest extent, through inquiries into physio-
logical action of alcohol with its stage of vascular nervous
excitement, the cerebro-spinal changes induced, the fall of
animal temperature, the collapse of the volitional nervous
centers, modification of animal function and structural degen-
eration. The study of the functional disease from alcohol
would reveal the diseases of the digestive system, the result
of alcohol, the sensory changes, the vascular changes in the
skin, alcoholic thirst, and early systemic failure. The i
organic disease from alcohol would show us fatty and dis-
eased hearts ; weakened and diseased blood-vessels ; alcoholic
phthisis, diseases of the liver and kidneys; diseases of the
eyes ; and serious deterioration of cerebral structure. The
nervous diseases would reveal, aside from insanity, epilepsy,
paralysis, and delirium tremens. We may see chronic men-
ingitis, with impairment of memory, dullness of intellect bor-
dering on dementia, tottering gait, hesitating stammering
speech, and other symptoms indicative of gradually progress-
ing paralysis. Softening may also occur from the slight
attacks of cerebral hemorrhage not infrequent in inebriates.

Finally, I would speak of the great importance of the
recognition of the mental condition that in inebriates is the
precursor of actual insanity. I have had the opportunity of :
studying carefully several such cases, many of whom I have ,
been so fortunate as to restore to home and society. The

206 ' The Pathology of Inebriety.

clinical manifestations which I have observed in these cases
have been depression, unwonted excitability, disregard of
the minor proprieties of life, a change coming over the
warmest affections, quick changes and rapid transitions in
the current of the feelings, sleeplessness and a complete
change of character and habit ; the person meanwhile enter-
taining no delusions, but occasionally losing his self-control,
the general acts and manner at such times being strongly
expressive of the inward emotion. There. are intervals of
perfect calmness and self-control, during which the person
clearly discerns his true relation to others, and even perhaps
recognizes the influences which the incipient disease exer-
cises over his feelings and actions. In those cases where
insanity appears, we see the utter downfall of the intellect
manifested by the fury of mania, or the moodiness, suspicion,
depression, and impulse toward self-destruction, of melan-
cholia. All these are the successive links forged in the chain
of the insanity of the inebriate, the study of which is full of
interest, not alone to the student of mental pathology, but to
everyone who desires to lead the wandering mind out of the
darkness and mazes of disease back into the light of reason.

The inebriate is always unconscious of the influences
which are determining his actions. He seeks reasons to
explain the act after, and is indignant when told that diseased
impulses control, and thinks his own conception of his acts
far more accurate than that of others. It is impossible for
him to detect the real condition and causes which control
him.

To reason abstractly as to the nature and ‘causes of ine-
briety without first having found what these actual condi-
tions are is to plunge into a fog-bank of error and miscon-
ception that is fatal to all true, practical realization of this
subject.

Relation which Disease bears to Alcoholic Inebriety. 207

THE RELATION WHICH DISEASE BEARS TO
ALCOHOLIC INEBRIETY.*

By Lewis D. Mason, M.D.,

Consulting Physician to the Inebriates’ Home, Fort Hamilton, N. Y.

Disease may act as the predisposing, exciting, or compli-
cating and protracting cause of alcoholic inebriety. .The
disease may be inherited or acquired. It is proverbial that
the progeny of insane or inebriate parents frequently become
insane or inebriate, either at or near puberty or middle life,
when the exciting causes are presented that develop the
latent tendency. As many are born imbecile, epileptic, or
idiotic, because of some defect in the procreating power,
so many are born who inherit an “inebriate diathesis ” — it
is their sad birthright. They are the product of a defective
and degenerate parentage. Of several hundred cases of
inebriates whose ancestral record we have noted, over one-
third had either insane or inebriate parents, the latter being
in excess.

While we may regard inebriety or insanity in parents as
the principal predisposing causes of alcoholic inebriety in
their offspring, we should also include among the predis-
posing causes of a hereditary character, only secondary in
importance to those mentioned, all neurotic tendencies, all
hereditary diseases accompanied by degenerative changes,
congenital syphilis, tuberculosis, epilepsy, or other neuroses.
The subjects influenced by such diathesis are born with a
defective nervous system. They havea low resisting power

to the inroads of disease that still further degenerate the
" nervous system; they are congenital neurotics; they have a

*Read at the International Congress of Inebriety at London, England,
July 6, 1887.

208 Relation which Disease bears to Alcohelic Inebriety.

natural tendency toward drugs, either stimulating or nar-
cotic, and readily become insane, or inebriates, or opium
habitucs whenever a sufficient exciting cause is presented.

In brief then, any disease of a hereditary character, act-
ing either directly or indirectly upon the nervous system,
while it may not be as important as hereditary insanity, or
inebriety in determining the channel in which the future
life shall drift, nevertheless it imposes upon that life a dimin-
ished resisting power to the use of alcoholic stimulants or
narcotics, and so predisposes the individual to inebriety.

Let us now consider those circumstances which may be
denominated the exciting causes of alcoholic inebriety and
these we shall find are acguired in the form of disease or
injury by the person at some period of his life antedating
his inebriety.

These exciting causes may operate upon a person predis-
posed by heredity to inebriety, and so precipitate or hasten a
tendency that might have manifested itself later, or they may
act upon one who has not any hereditary tendency to inebri-
ety, but who becomes an inebriate from disease or injury.

These exciting causes may be divided into —

Direct, Those that operate immediately upon the cere-
bro-spinal axis, as cerebral concussion, fracture of skull
with or without depression, sunstroke, cerebral syphilis, or
other disturbance of the encephalon more or less profound ;
and,

Indirect, Or any disease or injury not producing direct
changes on the cerebro-spinal axis, but localized outside of
it and operating upon it by reflex influence, viz.: painful
ulcers, neuritis, neuromata, urethral stricture, and dysmen-
orrheea. In brief, any distressing or painful condition,
acting thus indirectly upon the nervous system.

In our experience “head injuries” hold an important
place among the direct exciting causes. At least one in six
had received blows on the head, forty-one of one hundred
and twenty-three. cases of head injuries recorded at Fort
Hamilton, were fractures of the skull. In four of these

Relation which Disease bears to Alcoholic Inebriety. 209

cases there was loss of bone; seventy-one of the one
hundred and twenty-three became habitual inebriates, the
balance periodical.

Sunstroke. Our records show only a limited number of
cases assigned to this cause, but we believe that further.
research in climates where it is of more common occur-
rence, might give it more prominence as one of the exciting
causes of inebriety. :

Syphilis, About one in four of the cases entering our
asylum were syphilitic. Syphilis is not unfrequently the
exciting cause of inebriety, more especially in the later
stages, when the nervous system becomes involved. We
have cases on record in which the syphilitic did not become
an inebriate until the nervous system was affected. At
whatever stage the disease may manifest itself it should
always be regarded as a complication and receive proper
treatment.

Mental Shock, Resulting from sudden or excessive grief
or joy may be an exciting cause of inebriety, acting as it
does directly upon the nervous centers by vaso-motor dis-
turbance.

The relation which insanity bears to inebriety and the
reverse, is one with which every asylum superintendent is
familiar. The distinction to be made is whether the inebri-
ety is causative or preceded the insanity, or whether con-
tributive, that is, accompanies and is due to the insanity.

The history of a sudden transition from habits of sobri-
ety to the reverse, especially if preceded and accompanied
by marked mental changes, we should regard as strong pre-
sumptive evidence in favor of the insanity, not arising from
alcohol; whereas, in chronic alcoholic mania or dementia,
there is the evidence of intemperate habits extending over
a long period antedating the mental alienation. The his-
tory then of the patient preceding his insanity will enable
us to determine the relation that alcohol may have to the
insanity.

The differential diagnosis is *more readily made in the

VoL. IX.— 29

210 Relation which Disease bears to Alcoholic Inebriety.

more acute forms of mental disturbance that arise in con-
nection with alcoholism. When an insane person has been
using alcohol over an extended period, it is somewhat diffi-
cult at first to determine what part alcohol holds in produc-
ing the mental trouble, so that it is necessary to keep such
cases under observation for a while after the withdrawal of
the alcohol, before determining whether it is causative or
contributive to the insanity.

But while mental shock, if it does not kill outright, may
precipitate the subject of it into insanity or inebriety, and
while the first overt act of the insane may be an outbreak
of intemperance and licentiousness in a person heretofore
temperate and moral, these exciting causes of inebriety are
insignificant, when compared with neurasthenia or nerve-
exhaustion, a prolonged vaso-motor disturbance of the cere-
bral circulation, resulting from under-feeding and overwork-
ing and worry or other depressing causes, producing physical
weakness, want of mental energy, and almost total inability
to perform the ordinary duties of life; under these conditions
alcohol is sought for its stimulating effect. It is the spur
by which the tired heart and wearied brain are goaded on in
the treadmill of routine and daily toil. These galley slaves
are chained to the desk and to the ledger, they carry their
task into the small hours of the night, they rob the body of
its needed rest until wearied nature refuses further to carry
on the unequal conflict and a protracted illness ensues, or a
cerebral effusion or the failure of a weakened heart ends the
scene if these crises are past, these unfortunates join the
ranks of the confirmed inebriate, the staff on which they
leaned for support becoming a rod of torture. It is for the
neurasthenic we invent the “rest cure,” “massage,” “sys-
tematic feeding,” and happy is he who seeks it early, before
the chains of habit and disease engendered by habit, have
made him fast a prisoner. —

The social customs and tendencies of the age in which
we live are oftentimes the foundation causes of neurasthenia,
the fierce rush in the race of life for wealth, position, and

oe a

Relation which Disease bears to Alcoholic Inebriety, 211

“that honor that comes from men,” is so great that to outstrip
our fellows, the words “ rest,” “diet,” “recreation,” must be
erased from our vocabulary. We have presented a few of
the principal direct exciting causes of alcoholic inebriety, let
us now consider those exciting causes that operate éxdirectly
or by reflex influence upon the cerebro-spinal axis. Some of
these have already been mentioned: painful ulcers, neuromata,
neuritis in its multiple forms, urethral stricture, dysmenor-
thoea, diseases which are accompanied by much distress or
pain, and which are often and necessarily chronic.

A case entered the Fort Hamilton Asylum some years
since, which at the time impressed me very much. The
patient, a young man affected with tertiary syphilis, mani-
festing itself in a severe neuralgia of the face and neck.
This had yielded partially to the usual treatment, but not so
as to give the patient permanent or satisfactory relief. He
assured me he drank for the relief it gave him, and— he was
only free from pain when “comfortably full—” to use his
expression; and that his pain made him drink. He further
stated that he had tried opium, but did not like its effects.

Cases are on record where an inebriate cured of his strict-
ure was cured of his inebriety also, and of one who was relieved
of his inebriate tendencies by the passage of a tape worm.
We might multiply examples, but let these suffice. We desire,
however, to suggest that this return to habits of sobriety
after the relief or cure of some painful disorder is oftentimes
so marked, that with a fair family and personal history and
absence of alcoholic changes, we can almost guarantee a
cure of the inebriety coincident with a cure of the co-exist-
ing disease, and this cure is often so prompt that there
seems to be a compensatory influence between the relief
from the depression incident to a painful disease, which
more than balances the depression that would naturally
follow the withdrawal of the alcoholic stimulant, hence the
rapid recovery from the inebriety.

Having pointed out, briefly, the relation which disease or
injury may hald ta alcoholic inebriety as its predisposing,

212 Relation which Disease bears to Alcoholic Inebriety.

exciting, or protracting cause, let us reverse the considera-
tion and see what relation alcohol bears to disease as its
exciting cause.

Before considering the special effects of alcohol on the
various organs or tissues of the body, we may remark that
alcohol is no respecter of tissue, while it has some habitats
or localities in which it seems to perfer to exert its effects,
and is probably more rapidly destructive there than else-
where, and in this respect may be local in its action; it is
general also, There is not any tissue or organ of the bocy
that escapes its deteriorating effects.

As to the cerebro-spinal axis upon which its most pro-
found effect is felt, we note its action on the cerebral vessels,
as seen in vaso-motor paralysis and its sequence, or fatty
degeneration of the capillaries and leakage of the watery
constituents of the blood, constituting serious apoplexy or
wet brain, a not unusual, and, in our experience, fatal form
of cerebral disturbance in the inebriate. ;

Epilepsy is one of the most common of the neuroses due
to alcohol. About one in fourteen was the proportion in
several hundred cases of inebriety recorded at Fort Hamilton,
and exclusive of a few complicated cases resulting from
traumatism, all were due to alcohol as the exciting cause.

The relation of alcohol to the various forms of acute and
chronic mania, as the exciting cause, is shown in the many
types of mental alienation peculiar to alcohol. These are:
mania-a-potu, delirium tremens, chronic alcoholic mania,
chronic alcoholism ; but we are not limited to these special
manifestations of alcohol on the nervous system, resulting in
mental disturbance; we can also recognize its causative
effect, in other diseases of the nervous system which also
arise from other causes, namely, general paresis, hemi-
plegia, and the multiple forms of neuritis, etc.

Whether these results be due to the direct effect of
alcohol, acting as a poison on the nervous centers, or to
degenerative changes, we must nevertheless recognize the
fact, that alcohol cannot be ignored in its causative relation

sara

Relation which Disease bears to Alcoholic Inebriety. 213

to most, if not all, diseases originating in the nervous system,
and that it impresses its special characteristics on these,
whether it be an exciting cause, or contributive only in its
action,

Passing then to consider the effects on other organs of
the body, we find gastric derangement, dyspepsia, atony or
actual degeneration of the mucous coat, and glandular
structure of the stomach, so that the organ is rendered
incapable of performing its simplest function. This con-
dition is oftentimes secondary to acute or chronic hepatic
derangement. A serious complication, and in the latter
stages of inebriety, hastening the end of a patient, owing to
the inability to retain or assimilate proper nourishment.

As to the frequency of chronic gastric disturbance, or
serious liver complications, our experience does not coincide
with the general impression, that these conditions are
extremely frequent. Indeed, serious disturbance of the
stomach, intestines, or liver, are much lower in the scale of
fatality in inebriety than in disease affecting the lungs or
nervous system. At least this observation applies to our
asylum experience. *

Private or public inebriate asylums, in which cases are
taken for reformation, if we can use that expression, as a
rule are privileged to receive selected cases only, and also to
discharge cases affected by incurable disease. Indeed, such
cases are often. removed by the friends, preferring that the
inebriate shall die in his own home. Hence the death rate
is small, and the opportunities for autopsical research are
limited, or only occasional.

It is in large hospitals and pauper asylums that such
research can be carried on, to any extent, and to those we
must look principally for the pathological effects of alcohol.
We therefore take pleasure in presenting here “An Analysis
of 250 Autopsies on .Drunkards, Illustrating the most Promi-
nent Anatomical Lesions of Chronic Alcoholism,” by Dr.
H. F. Formad, at the stated meeting of the Philadelphia
Pathological Society, who presented specimens and read a

214 Relation which Disease bears to Alcoholic Inebriety.

paper, with the above title. We will give a brief synopsis of
the paper and the discussion of it as published in the
Society’s proceedings :

“Dr. Formad considered the most conspicuous lesions to
be cyanotic induration of the kidneys, fatty infiltration of the
liver, and mammillated stomach. His cases had been those
in which there had been a history of a long-continued series
of debauches, the subjects often dying in one of these
debauches, and did not include moderate drinkers or those
who perished after imbibition of an enormous quantity of
alcohol without any previous chronic causes. He thought
that the exposure, irregularities of diet, etc., incident to a
state of drunkenness, had much, probably more than the alco-
hol itself, to do with the production of the lesions, but it was
not at all possible to separate one from the other. He gave
a long list of lesions considered by various authors to be
results of chronic alcoholism, among which the cirrhotic
liver, with contraction, held a prominent place. He had
himself at one time considered cirrhosis a very frequent, if
not almost necessary, concomitant of long-continued excess-
ive use of alcohol, and had even testified in court that a
certain person was not likely to have been a hard drinker
because at the autopsy no cirrhosis of the liver was found.
He had thought, too, that the connection between the two
was so Close that it was impossible to have a case of cirrhosis
without a previous history of alcoholism, as is held by
various authors. Therefore, it was surprising to him to
meet in his 250 autopsies with only six cases of cirrhosis of
the liver with contraction. In 220 cases the liver was con-
siderably or even very much enlarged, the enlargement in
most cases proving to be due to a fatty infiltration. Cyano-
tic induration of the kidney, and chronic gastritis with
mammillation of the stomach, were found in nearly every
case. This cyanotic induration is peculiar, and differs from
the cyanotic induration due to heart disease. At a future
time he will give a detailed account of the above lesions, and
a more extensive analysis of the cases.”

Relation which Disease bears to Alcoholic Inebriety. 215

“Dr. James Tyson could not speak from a systematic
observation of a large number of autopsies in the cases of
confirmed drinkers, but he remembered distinctly being sur-
prised, in several cases, by the absence of cirrhosis where he
confidently expected to find it.”

“Dr. Wilson said that Anstie, in the article on alcohol-
ism in ‘ Reynold’s System of Medicine,’ had called attention
to the comparative infrequency of contracted liver in con-
firmed drinkers. This observer, in an extensive out-patient
practice in London, had seen large numbers of cases of
alcoholism, but very few among them presented the physical
signs of cirrhotic (contracted) liver. The experience of the
staff at Blockley Hospital confirms this view. There, many
of the patients are soaked with alcohol, but even among
those whose death is directly or indirectly due to alcoholic
excess, fatty liver is much more common than contracted
liver.”

“Dr. Osler thought the experience of pathologists and
morbid anatomists with histories of patients not of the most
satisfactory character, he often having had cases to dissect
where he knew very little of the history. Before saying
these cases were chronic alcoholics, Dr. Formad should pre-
sent more specific statements about them. His own experi-
ence with livers, in a large number of autopsies on cases of
chronic alcoholism, had led him to divide them into four
classes: 1. Those in which the condition of the liver is
pretty satisfactory, some of these cases may take alcohol
for many years and yet the liver pass muster. 2. Fatty
cirrhotic livers; the cirrhosis may not, perhaps, be dis-
tinct to the naked eye, but plainly shown by the micro-
scope; this is the largest class. 3. Hobnail livers; these
he would say were much more common than in Dr. Formad’s
series. 4. Hypertrophic cirrhotic livers. The difference
between his observations and those of Dr. Formad, might
possibly be accounted for by a difference in the form of
alcoholic beverage taken. He had not observed the special
form of kidney described by Dr. Formad. In reply to a

216 Relation which Disease bears to Alcoholic Inebriety.

question he said, in order of frequency he would place them,
fatty cirrhotic, hobnail, hypertrophic, cirrhotic, apparently
normal.”

“Dr. S. Solis-Cohen said that there were certain theo-
retical considerations which suggested themselves in this
connection, The text-books teach that the lesions of alco-
hol are of two kinds, sclerosis and steatoris. It is known
that in some organs the fibrous change precedes the fatty
one. The latter is the higher grade of degeneration. The
subjects of Dr. Formad’s autopsies were confirmed whisky-
soakers, in whom one would expect to find more intensity of
degeneration than in those whose use of alcohol, though
persistent and excessive, was not so outrageous. Another
point which had not been alluded to was the fact that some
lesions might result from a local action of the poison upon
the tissues, while others might be due to its systematic
action. No study of the subject could be complete in
which these points were overlooked.”

“Dr. B. A. Randall suggested that the point touched
upon by Dr. Osler, ‘the character of alcoholic beverage,’
might be very important. In Vienna, among beer-drinkers,
he had found the fatty liver much more common than the
cirrhotic, while in England, where much gin is drunk, and
he should suppose in Scandinavian countries, where they
drink altogether strong spirits, the cirrhotic liver is doubt-
less comparatively frequent.”

“Dr. Musser had recently had to go over the records of
the Pathological Society, especially in liver diseases, and had
found the total experience of different observers the same
as Dr. Formad’s, and also in those cases cirrhosis was caused
not so much by heavy drinking as persistent drinking of
spirits on an empty stomach.”

The effect of alcohol on lung tissue results in fibroid
degeneration, interstitial changes, hence the term “fibroid
phthisis,” “chronic interstitial pneumonia.” It is bilateral,
fine crepitant rales are diffused over both lungs, the sputa
is limited or largely bronchial mucous, not marked by pro-

Relation which Disease bears to Alcoholic Inebriety. 217

ducts of disintegration; temperature and pulse progressively
high. Dyspnoea become more and more marked, the dis-
ease in the latter stage becoming rapidly fatal. This is an
intractable and inevitably fatal form of phthisis. As to the
prognosis, the question is not whether the inebriate will
become sober, but only how long he will live. The mischief
is done and is beyond repair, irremediable tissue changes
have taken place; alcohol is master of the situation and to
withdraw it would simply mean to hasten the death of the
patient.

About one person in twenty who enters our asylum has
phthisis in some form.

The origin of these cases could be traced in some
instances to a tubercular or syphilitic diathesis, although a
certain proportion were produced by the long-continued
action of alcohol on lung tissue.

We have dealt with cases of phthisis under several
conditions.

1st, Cases of inebriety have died in our asylum from
phthisis, which they had contracted previous to admission.

2d, Cases of inebriety, complicated with phthisis, in
the advanced stage have applied for entrance into our asy-
lum and been refused, as improper cases for admission.

3a. Cases of inebriety complicated with phthisis have
been discharged from our asylum as improper cases for
further special treatment.

We cannot pass this phase of our subject without asking
what relation the consumptive from any cause, not alcoholic,
bears to alcohol? Whether ushered into the world with a
tubercular diathesis or whether the phthisis be acquired in
the ordinary catarrhal form from exposure, etc., he must face
alcohol as a medical prescription ; his case necessarily chronic,
he must use alcohol for a long period. Query: A certain
proportion of cases of phthisis prove fatal; a certain pro-
portion end in temporary if not permanent recovery; what
proportion of those in whom the disease was arrested or
reported cured, became addicted to the excessive use of alco-

VoL. IX.— 30

218 Relation which Disease bears to Alcoholic Inebriety.

hol, that is, became inebriates? It seems to me that this
question might well be agitated in professional circles.

Whether then the alcoholic degeneration is fatty or
fibroid, whether it produces alteration of tissue or acts by
vaso-motor disturbance, as in some cerebral conditions, a/co-
hol produces disease and very destructive forms of disease,
which in the advanced stages are irremediable and eventually
fatal.

The question naturally suggests itself: why does the
inebriate use alcohol, or why do people afflicted with dis-
ease use alcohol, and so eventually become inebriates? With-
out attempting to exhaust this question we shall at least give
it a partial answer.

Aside from those who use alcohol as a beverage or from
social custom, who belong to the great class of so-called
moderate drinkers, we should say that a large proportion,
larger than we are aware of, are addicted to alcohol because
they are diseased and use it for one of two reasons:

First. Asa stimulant, cardiac primarily, then upon the
cerebral circulation. The neurasthenics already alluded to
are of this class, also those who are suffering from physical
weakness, engendered by exhausting or depressing diseases.

Second. A certain class use alcohol because it is an
anzsthetic in painful or distressing diseases or conditions.
A familiar example is the use of alcohol in dysmenorrhea,
an effective but dangerous remedy. How many women can
trace the first use of alcohol to this cause? The decided
anzesthetic effects of alcohol have been not only proven by
the direct experiments of Anstie and others on the inferior
animals, but the older records of surgery bear ample testi-
mony to its anzsthetic effects upon the human subject.
There is no doubt as to its pain-relieving qualities, and this
does not necessarily imply a complete toxic effect or alcoholic
coma. It is also known that tactile sensibility is much im-
paired in the habitual inebriate, indeed so much so as to con-
stitute a diseased condition.

Without multiplying examples, or further demonstrating

Relation which Disease bears to Alcoholic Inebriety. 219

the premises laid down, we have endeavored to impress the
fact that disease, either hereditary or acquired, may be in a
certain proportion of cases the underlying cause of the alco-
holic inebriety, and that a/cohol by its well-known degenera-
tive tendencies will produce disease, which, when established,
tends not only to produce, but also keep up habits of
inebriety.

If these premises which we have presented and endeav-
ored to prove as to the relation which alcohol holds to disease
and the reverse, are correct, then we are warranted to draw
the following conclusion :

“ Alcoholic inebriety is often based upon and dependent
on diseased conditions, and demands proper medical treat-
ment to remove, if possible, these diseased conditions.” ‘The
inebriate is a diseased person, and the disease has either
preceded the inebriety, or is dependent upon it.”

The “ moral view” has had full sway; the “moral respon-
sibility of the drunkard” has been the topic of a century ;
institutions have been founded on the “moral basis,” and
society and the law have treated the inebriate, not as a sick
man, but as a “ moral delinquent.”

The relation which morality bears to inebriety, ceases or
assumes a secondary position when the inebriety is dependent
upon diseased conditions. We do not desire to exclude those
moral influences that operate on the higher and better nature
of man, from our asylum, but would assign them their proper
place. Let the authorities of the church and all philan-
thropic bodies and individuals be co-workers with us in the
return of the inebriate to his normal condition, but let not
those supplant the hospital, the physician, andthe medical
means used for his recovery.

There is not any quarrel between the true moralist and
the true physician. The true physician is the highest type of
a moralist ; he is the exponent of right living and right think-
ing, and is foremost in all that pertains to the physical and
mental elevation of the race.

It is not extravagant to assert that the so-called “moral

220 Relation which Disease bears to Alcoholic Inebriety.

treatment” of the inebriate has been the great obstacle in
the proper treatment of inebriety. One of its evil effects has
been inefficient, irregular, or improper treatment — worse than
none —and the long delay that frequently elapses before the
patient is placed under proper and systematic treatment and
restraint. Hence the hospital and the physician, that ought
to have been placed first, have been placed last, and sought
only when every other means have been exhausted. Our
records show that the majority of inebriates do not apply for
asylum treatment until the inebriety has existed a long time
— in nearly all instances over five years, and in a large propor-
tion of cases over ten years. Often during this period organic
disease, the direct result of the habitual use of alcohol, has
undermined the system, and the patient is beyond relief.

It would seem almost puerile to bring before your associa-
tion the various methods and expedients that society has
invented to deal with the inebriate, and if possible to effect
his reformation. They are simply the outgrowth of viewing
and dealing with the inebriate from the “ moral standpoint.”
There has been a fog of mysticism, not only among the laity,
but in our own profession also, as to the exact status of the
inebriate.

Let us now epitomize the facts that we have endeavored
to demonstrate.

First. There is an “inebriate diathesis.” A certain pro-
portion of persons inherit a tendency to inebriety, just as
others inherit syphillis, tuberculosis, or other disease, or ten-
dency to disease, from parents.

Second. A certain proportion of persons become inebri-
ates as the result of injuries or diseases affecting the nervous
system, either directly or indirectly, and these may operate
on persons with a good family and personal history ante-
dating the disease or injury, or prove the exciting cause when
a latent tendency or predisposition exists. In the first in-
stance the inebriety may be said to be acquired ; in the latter
the tendency simply developed.

Third. Alcohol by vaso-motor paralysis, or degenerative

o_o

Relation which Disease bears to Alcoholic Inebriety. 221

changes, produces disease. The disease so produced not
only develops inebriety, but tends to protract it, and will do
so until the person is relieved or cured of the disease.

Fourth. Disease associated with inebriety, whether it be
hereditary or acquired, whether it be regarded as the exciting
cause of the inebriety or not, must always be regarded as a
complication protracting the inebriety, and rendering the
recovery of the inebriate practically hopeless, unless the
associated disease be removed or modified.

We have endeavored in this paper to give a general review,
rather than an elaborate and exhaustive presentation of the
facts herein embodied. Our object has been mainly to give
prominence and emphasis to a few observations accepted by
the profession, here and elsewhere—at least that portion of
it who have given especial attention to the “cause and cure
of inebriety.”

We have endeavored to demonstrate the relation disease
bears to alcoholic inebriety, and thus answer in part at least,
what is the “ Etiology of alcoholic inebriety,” a question we
cannot ignore nor refuse to answer ; that precedes all others
in point of importance; a problem the solution of which can-
not be delayed, as it is one that affects not only the well-
being of society, but the destiny of the race itself.

The following papers, read at the International Medical
Congress at Washington, will be of interest as showing the
drift of medical thought towards inebriety and its disorders :
“The Application of Alcoholic Stimulants to Medicine, or
the Therapeutics of Alcohol in Disease,” by Dr. E. N. Liell.
“On Alcohol in the Organism,” by W. Hudson Ford, M.D.,
St. Louis, Mo. “ Pathological Anatomy of Alcoholism,” by
Henry F. Formad, M.D., Philadelphia, Pa. “The Relation
of Psychological Medicine to the Disease of Inebriety,” by
Edward C. Mann, M.D., Brooklyn, N. Y. “Cocaine Ine-
briety, its Cause, Consequence, and Cure,” by J. B, Matti-
son, M.D., Brooklyn, N. ¥. “ The Disease of Inebriety and
its Treatment,” by T. D. Crothers, M.D., Hartford, Conn.

222 Legislation for Inebriety.

LEGISLATION FOR INEBRIETY.*

By Dr. PetiTHAN,
President Society of Medicine, Liege.

Of recent years this question has ripened. Alcoholism
has augmented in frightful proportions. The number of
ruins, diseases, suicides, insanities, and crimes it causes is
frightful. Shall we continue to cross our arms, to let the
people become willingly depraved, or have we the right, be-
fore a supreme peril, to save him in spite of himself: Sa/ux
populi suprema lex. Let no one say that the nations can
always save themselves, and that liberty and instruction are
sufficient to cure them. England and Netherland, these two
classic countries of progress and liberty, have not hesitated
to make repressive laws for alcoholism. France has preceded
them. We must not remain behind these sister nations.
The same blood is flowing in our veins, the same spirit in-
flames us; we wish, absolutely like them, the progress of lib-
erty; but there is neither progress nor liberty for the em-
bruited nations.

Needless to show all the marvels of industry, all the treas-
ures of our soil, make the proud statistique of the national
riches; there is, besides, morally and physically profound
miseries, madness, phthisis, scrofula, brain-illness, incontest-
able degeneracy of the race. It is important to determine
the present situation of the alcoholized man, if it be possible.
When this will be determined, we shall recognize the imperi-
ous necessity to take immediate preservative measures for
family and society.. They will constitute by themselves, if
they be energetical, the best prophylactic of alcoholism.

At present the alcoholized man who is not yet arrived to
the last period, is not dealt with. He does not really enjoy
his free will; this delicate property of will, which to the most

* Read before the International “Congress at London, England, July 2, 1887.

Legislation for Inebriety. 223

advanced spiritualist point, requiring a rare concurrence of
circumstances, has left him. There is no more personal de-
termination, or deliberation, or a thorough knowledge of .the
matter. :

The alcoholized man being not free, is no more responsi-
ble; and, nevertheless, he continues to take part in civil and
politic life. He has the direction of his family, the adminis-
tration of his goods; he is elector, he is juryman. Is it pos-
sible? Yes, it is possible; and every day we ascertain it.
Unless he be completely mad, it is even forbidden to inter-
dict him, according to the civil code. The mental state is
neither madness, nor fury, nor imbecility. That is a special
and indefinable situation in the actual terms of law, but which
ravish their responsibility and culpability, in allowing him the
means to commit the most criminal acts. Every day he is
ruining and disgracing his family; he robs and he kills.
Nothing can stophim. What do I say, he is excused, as one
may say, by the tribunals? He is alcoholized. The barris-
ters never want to plead irresponsibility, and they succeed to
make acquit all the infamies, all the most detestable faults ;
and they have reason, because, till this moment, this new dis-
ease, characteristic of our epoch, could not receive in our civil
or penal laws the place it ought to occupy. First, the alco-
holized man, whose state is medically and legally recognized,
must be interdicted ; second, when he is interdicted, one must
have the power to close him into a special establishment,
where he should be treated, and obliged to work, according
to his strength.

There are two propositions which must be introduced in
our laws, and if they are adopted, they would already consti-
tute a mighty curb for alcoholism. They would diminish, by
half, criminality, and prevent incalculable damages.

How is it possible to arrive to the interdiction? We
must not leave to the family only the right to provoke it.
Even I should say, in order to prevent reproach and ven-
geance, always to be feared in such a situation, that the pub-
lic attorney, as representing the social interests, ought, before

224 Legislation for Inebriety.

all, to ask and to bring it before the court of first instance,
conformably to article 491 of the civil code.*

But this article gives only the right to act in case of fury
‘or imbecility. These warped or old designations do not cre-
ate a sufficiently strict duty. Alcoholism constituted a bet-
ter determinated state for the physicians; and the alcoholized
man can instantly commit all the faults, without being imbe-
cile or furious before their perpetration. The alcoholism is
a chronic poisoning, so well defined in its lesions or symp-
toms, as the typhic, plombic, or mercuric intoxication. The
question is to obtain a simple addition to the article 489,t
and thus to deprive, by judiciary way, the alcoholized man of
all his rights, to make of him an under-age.

The article 510 $ says that, according to the character of
the disease, the family council could decide that the inter-
dicted man should be treated at home, or in a lunatic asylum,
or in an hospice.

It is yet evident that the public attorney, enlightened by
the legist physician, is more able to determine such a meas-
ure, and that it is greatly preferable to leave to justice the
care to provoke it.

But what will this asylum or this hospice be that the leg-
islator wish for the alcoholized man? The hospital and the
asylum are actually closed for him. Unless the diseased
man have arrived at mania or madness, the directors of these
establishments, the special physicians, do not dare to receive
them. We do not imagine the difficulties that present every
day similar cases.

* Article 491.—In the case of fury if the interdiction is provocated neither
by the husband or wife, nor by the parents, it must be so by the procurer of the
king, who, in the case of imbecility and madness, can also provoke it against a
man who has no known wife, or husband, or relations.

t Article 489.— The major, who is in an habitual state of imbecility of mad-
ness, or fury, must be interdicted, even when his state presents lucid intervals.

$ Article 510.— The revenue of an interdicted man must be especially em-
ployed to soften his lot and to quicken his cure. After the character of the
disease and the state of his fortune, the family council could decide that he
shall be treated at home, or that he shall be placed in a lunatic asylum, or even
an hospice.

— ete oe

Legislation for Inebriety. 225

If we cannot confine the irresponsible alcoholized man in
a lunatic asylum, we can establish special establishments un-
der the direction of intelligent physicians.

. The interdicted alcoholized man should be shut up by
the magistrates. That is what I call preventive justice, the
only one which may be human and efficient. In society
should remain only responsible beings, or men whose respon-
sibility is covered by bondsmen. Every experienced physi-
cian knows that the determined alcoholized man refuses this
measure which alone could save him.

These special establishments must be fitted up so as to
accomplish all the conditions of health. We must not take
away from these unhappy men the hope to come back into
society with the consideration so necessary to all conversion..
Amongst the objections remains the question of money. I
do not consider it before so great a social peril. It is neces-
sary to save the people whatever may be the price. Is there
a better use of our great riches than the cure of such a terri-
ble illness? Should it not be a real economy upon the hos-
pital and prison budget? The spent money for instruction
and hygiene is lost by alcoholism. On the economy point,
it is a thousand times better to prevent the destruction of
capital resulting from interrupted labor, made by brutish
beings.

In some parts of Bohemia one liquor station is found for
fifty-seven, nay for twenty-one inhabitants. In Bohemia and
Carinthia mothers were found lulling asleep their nurse-chil-
dren with dram, and schoolboys were seen lunching on spirits!
Vienna has one liquor station for every twelve houses ; the
number of ginshop-keepers has trebled at Vienna since 1859.
33.41 per cent. of the insane kept in the Vienna asylum are
sick from alcoholism, that is, seven times more than ten
years ago.

Alcoholism and inebriety have risen on a large scale since
spirits are made out of amylaceous materials like molasses,
potatoes, sweet turnips, Indian corn, etc. Inebriety has risen
in Carinthia since the consumption of genuine Tyrolean wine

Vou. IX.—31

226 Legislation for Inebriety.

has decayed, since a tax was levied on the light stone beer,
since the production of wine was diminished by the oidium
Tuckeri. Inebriety is not only increasing, but it causes
also much heavier disease, since the empyreumatic alcohol
is distilled from potatoes, etc. ;

We wish to see the duties on spirits considerably height-
ened, and the amount of liquors checked. It would be use-
less to strive for a suppression of the spirit production, as
we have to reckon the maintenance of distilleries by financial,
agricultural, and industrial motives. But we wish the Gov-
ernment would lay heavy duties on the spirits the moment
they get drinkable and enter the public intercourse; thus
the consumer will be repelled from taking liquors, by their
raised price, and the unscrupulous retailer will lose a profit,
which now is pernicious and enormous — one litre of brandy,
worth 8.5 kr., being sold up to 30 kr.

The cleaning of liquors from empyreuma should be care-
ful and obligatory, the official control a very sharp one.

Licenses ought to be given to liquor stations only in strict
correspondence with the exigencies and the number of full-
grown inhabitants, on a rational scale, as the Dutch law does.
Notorious drunkards and abusers ought to be punished.
Habitual drunkards ought to be kept in homes for inebriates.

An elaborate statistic is necessary.

The Magistrates of towns and boroughs should heighten
the excise on spirits of all kinds, and lower it for victuals and
light beverages. It is a fact—for England, too—the con-
sumption of spirits increases, the more taking light and
healthy drinks are impeded by their price or the duties.
There is certainly a relative progress established if the
people, instead of empyreumatic liquors—holding an
alcoholic body of 24 per cent. to 30 per cent. volume —are
enabled to consume the light Austrian beer and wine, tea,
coffee, etc., the national character being inept for the pledge
of abstinence.

The Vienna excise on 1 hectolitre (100 per cent.), of
spirits is in summa— fl. 11 kr. (the same quantity pays at

Legislation for Inebriety. 227

Paris 66.50 francs). The excise on 1 hectolitre of beer is
equal to 1 fl. 81 kr. The Austrian Inebriety Society has
therefore, in 1885, réquested the Provincial Diet to tax spirits
with twenty-fold of the actual beer tax, viz.: with 20 by
1.81 fls.— 36 fis. 20 kr.

A new consumption impost on spirits is in preparation,
and will afford about fifty million florins for the whole
monarchy. The minister of the finances refused any dis-
cussion on monopolizing the spirit production, and there is
for our purpose certainly a great danger in the establishment
of official liquor stalls inciting the public by the agents of the
monopoly.

(a). Austrian Legislation on Inebriety. Laws affecting
whole Austria.

I. Drunkenness itself is punished in two cases by the
penal laws, 27th May, 1852. (1). Malefactions otherwise
reckoned as crimes cannot be considered such, when perpe-
trated in accidental intoxication; but drunkenness in that
case is punished as trespass ; it will be considered a particular
aggravation, if the drunkard knew from experience he was
severely emotional when intoxicated (Secs. 236 and 523).
(2). Inveterate drunkenness punished as misdemeanor, with
craftsmen working on roofs and superstructures, or having
to do with objects easily taking fire, and with servants whose
carelessness might cause a fire. (Sec. 524.)

Neither the penal law, nor the new bill on it, punish
inebriety as immorality, but only for troubling public order
and security.

II. Imperial spirit tax, 23d July, 1881 (vide supra).

III. Imperial law, 8th March, 1885, declaring Sunday
a resting-time for all professional and industrial works, in a
stricter way. Among the exceptions granted for the neces-
saries of the consumers is selling spirits. The poison of
liquors ought not to have any privilege. The easier and
frequenter the occasion, the more will be drunk. The liquor
stalls should be shut as well on Sundays as commercial
shops; if possible from Saturday 5 p.m. till Monday 9 a. .

228 ' ‘Legislation for Inebriety.

Inns, dealing with light beverages, will be quite sufficient for
the public exigencies.

The same law determines: Auxiliary workmen may be
dismissed without warning when inebriated, having been
admonished in vain. (Sec. 82.) The payment of wages in
taverns and inns is prohibited. (Sec. 78a’) Credit of spirits
to workmen in factories and to auxiliaries is neither action-
able nor accountable (Sec. 78b.), neither between tradeholders
and workmen, nor between the surveyors or the employers’
relatives and workmen. As spirits are a general breakfast
with Austrian workmen, the Austrian Inebriety Society has
suggested the institution of soup and coffee-rooms near the
factories. Introducers of spirits into factories are severely
punished or dismissed.

The wages ought to be paid on Monday night, to restrain
people from spending their week’s pay on Saturday night, or
on Sunday, their day of rest.

IV. Imperial law, 1835, and f

V. Imperial law, July 23d, 1883, on controlling the
cleaning of spirits.

(6). Austrian Parliament, Vienna, March 13, 1885, and
May 7 and 10, 1887. Chev. E. de Proskowetz (member of
the Austrian Inebriety Society) requests restraining inebriety,
and desires the ministers to propagate in schools the notion
of intoxication’s fatal consequences. He desires, accordingly,
pamphlets to be posted everywhere.

(c). Provincial Legislation.

I. Law for Gallicia and Bucovina, July 19, 1877 (given by
the Austrian Parliament).— This law intends punishing
inebriety, and checking the economical danger of drinking-
bouts, which often, by drafts and bills of credit, prolongation
and anatocism, ruin the thoughtless debtor (the debt of 20 fis.
increased to 1,000 fis. in a space of three years, in one case !).

Punishable by the law:—1. Whoever gets drunk, or is
found so in public places. 2. Whoever makes another drunk
on purpose thereabouts. 3. Inn-keepers delivering liquors
to a drunken customer, or to minors. Penalty — Imprison-
ment up to one month, or a fine of 50 fis.

Legislation for Inebriety. 229

The district police are authorized to interdict a person,
punished thrice a year for inebriety, from liquor stalls in his
domicile and around it. Abusing tavernmen to lose their
license for ever, or for some time. Claims from drinking-
bouts are not actionable, if the debtor owed such in the
moment of entering the new score, or if the claim was ceded
meantime. Sham transactions punished by prison (up to
two months), or by a fine (of 200 fls.). The laws’ text to be
posted in all taverns. Omitting this is punishable by a fine
of 50 fls. In 1878-83, 132,403 persons were punished for
offense against this law.

The law contested in 1877 as an “affronting guardian-
ship” by the Gallician deputies, proved an efficacious expe-
dient. The Provincial Diets of Moravia, Salzburg, Tyrol,
and of Bohemia, have brought according bills, without till
now being able to make them pass.

II. Bosnia law, 6th February, 1885 (nearly equal to the
precedent).

III. Moravia (Provincial Diet), 1878. A law on inebriety
solicited by P. Wurm. 1885. (Idem.) 1885. Alfred Skene’s
motion on limiting the validity of drinking-bouts. Chev. E.
de Proskowetz’ motion for a new spirit-tax (50 fis. a sta!l).
1886. H. E., the Governor Count Schoenborn orders, on sug-
gestion of the Austrian Inebriety Society, by a public act, a
strict revisal of distilleries and liquor-stalls. 1887. Chev. E.
de Proskowetz’ motion renewed.

IV. Bohemia (Provincial Diet.) 1885. K. Adamek (Mem-
ber Austrian Inebriety Society) requests a reform of the
inebriety legislature. Dr. Roser (honorary member Austrian
Inebriety Society) requests the selling of liquors in groceries
to be prohibited. Dr. Tausche says: the petitions of 1880
spoke of immoderateness, those of 1882, of inebriety, those
of 1885, of drunkenness as an epidemic pestilence.

A half drachm of alcohol to each pound weight of the
body, is the quantity capable of producing intoxication in
most cases. An increase of this is dangerous and often
fatal.

230 Inebriety in Belgium.

INEBRIETY IN BELGIUM, FROM A MEDICAL
AND LEGAL POINT OF VIEW.*

By Dr. MoELLER, BrussELs,
Member of the Belgian Royal Academy of Medicine.

When I accepted from your learned president the charge
of presenting a communication on “ Inebriety in Belgium,”
I experienced a great embarrassment.

I have to confess for my country that little has been done
by us for this great and difficult class of degenerates, whose
existence is practically ignored by the civil authority as well
as by the people in general. But let it not be supposed that
no one in Belgium cares for the state of the unhappy
inebriate. One of the most valiant advocates of the cause
of temperance, my courageous and eloquent friend, Dr. Peti-
than, has for many years drawn the attention of his fellow-
countrymen to the danger of leaving uncontrolled those who
are no longer altogether responsible for their actions, and to
the necessity of providing for such diseased persons asylums
where they can not only be secure from doing an injury to
anyone, but also where they can be treated with the hope of
cure, or at least amelioration. The short history I shall
present to you will make known the work of Dr. Petithan,
and at the same time show where we are on this question,
one most worthy of the solicitude of the physician, of the
philanthropist, and of the Christian. :

You know that the struggle against alcoholism has been
comparatively recent with us, though there have always been
men who have raised their voices to denounce the ceaseless
progression of the plague of modern society. I specially
mention Drs. Durpetiaux, Frere-Orban, Lefebvre, Barella,
Desguin, Jansen, and Petithan. But these voices for long
awoke no echo. Only in 1880 was an association formed to
study the fittest means to arrest the progress of the evil

* Read before the International Congress on Inebriety at London, England,
July 2, 1887.

Inebriety in Belgium. 231

which we all deplore. In that year the second International
Congress on Alcoholism was held at Brussels, in which
many Englishmen took an active part. One of the sittings
was signalized by an interesting communication by Dr. Car-
pentier of Brussels, who contended for the necessity of
enlightening the public mind with precise knowledge, and
reducing the inebriety of the country. He added that his
researches in the Brussels Hospital, which agreed with those
of the learned Professor Croig, had discovered post mortem
signs of alcoholism in eighty per cent. of the autopsies held
under his direction. He concluded that the working popula-
tion of the Belgian capital ought to shut up about eighty
per cent. of the subjects of alcoholic intoxication. This
communication and its figures created a great effect in our
country. They in a moment showed to many persons the
profundity of the abyss into which we have fallen. At
this sitting Dr. Petithan proposed: (1) That the alcoholized
should be put under interdiction at the demand of the
minister of justice. (2) That they should be placed in
establishments specially organized for their detention and
cure. These propositions provoked a lively discussion, in
which Drs. Barella, Lunier, Decroix, Lefebvre, Petithan, and
Reding took part, and were finally adopted by a majority of
sixteen to six, with nine abstentions. Great opposition had
been encountered, which was not surprising, for at that time
the opinion enunciated by Dr. Benjamin Rush was not
known, viz.: that intemperance is often a physical malady.
Thus there was then little difference supposed to exist
between drunkenness and alcoholism. However, public opin-
ion changed. In 1881 the Belgian Royal Academy of
Medicine asked the following question: “Determine from
precise observations the effects of alcoholism, from a material
and physical point of view, upon the individual and upon his
descendants.” The replies proved that the Academy of
Medicine agreed with the opinions of Dr. Rush, and con-
sidered alcoholism to be a true organic disease, transmitable
by heredity. The learned body added this recommendation :

232 Inebriety in Belgium.

that the observers should endeavor to define the boundary
‘ separating drunkenness from madness, as well as the responsi-
bility of the drunkard for acts of which he is the author.
Five memoirs were returned. A very remarkable report
was presented to the academy by Dr. Kuborn. The prize
was awarded to an original work by Dr. Lentz of the
Asylum for the Insane at Tournai, which was published in
the annals of the academy. Dr. Teeters of Gheel Asylum,
received honorable mention for a work which he published.
Both writings embodied numerous observations on alcohol-
ism, proving the extent of the evil which ravages our
population.

However, Dr. Petithan did not rest inactive, and on
every possible occasion strove to create a sound public
opinion, and at the International Congress at Antwerp in
1885, when a hope was expressed that the government
present to the chamber a project of law demanding the
interdiction of the alcoholized and their restraint in mazsons
de temperance. Yet the question made slow progress.
Though the economics of inebriety were well promulgated,
little was done to make clear the medical and legal aspects.
In 1886, following the effervescence of the working classes
in some parts of the country, and some profoundly afflicting
occurrences, the government appointed an inquiry to
examine into the causes of the social, economic, and indus-
trial misery. This commission necessarily occupied itself
with the question of alcoholism. From all parts of the
country came accounts of the lamentable progress of the
drink plague and its serious results. One of the members
of the commission, M. Deridder, Professor of Political
Economy at Gard University, issued a valuable report on
the various measures which had been resorted to to combat
the abuse of alcohol, yet he did not allude to interdiction or
to confinement in asylums for inebriates; one more proof
that the importance of this subject is yet far from being
recognized. However, a few months thereafter Dr. Carpen-
tier, in a short, useful paper in Les Cliniques, stated that his

Inebriety in Belgium. 233

former estimate of 80 per cent. had not been too high, and
gave the following results of his more lengthened hospital
experience: In 86 cases (48 men and 38 women), 45 men
were inebriates (93 per cent.); 4 women were inebriates (10
per cent.); of the male alcoholics the youngest was 16, the
others from 20 to 55. All exhibited incurable organic
lesions, characteristic of alcoholism. .One began to drink
at the age of 30, I at 25, 10 at 20, 2 at 19, 4 at 18, 2 at 17,
4at 16, 6 at 15, I at 14, 2 at 12, 2 at 10, I at 8 years of age.

Quantities drunk’ daily: 3 drank about 4 glasses of
spirits ; 5 drank about 6 glasses of spirits ; 3 drank about 8
glasses of spirits; 1 drank about 9 glasses of spirits ; 8 drank
about 10 glasses of spirits; 2 drank about 17 glasses of
spirits ; 3 drank about 20 glasses of spirits; 1 drank about
} litre of spirits ; 1 drank about 14 to 2 litres of spirits. Are
not these figures terrible? What can one hope for a popu-
lation which is so drunken with, for the most part, the most
pernicious alcoholic beverages? Is it not sad to think that
nothing has been done for these unhappy victims of this
most inexorable and degrading passion ?

It is with lively satisfaction that I refer to a fact which
will show that our efforts have not been altogether sterile.
The minister of justice has presented to the legislative
chambers, measures repressive of public drunkenness,
though they do not touch our special project. But the
Prince de Rubempré, who has been entrusted with the prep-
aration of the report, calls attention to the labors of Dr.
Petithan, and points to what has been done in England for
the treatment of inebriates, while directing the notice of the
Belgian government to this.

On the 16th of April last, the president of the council of
ministers received a deputation from the Belgian Patriotic
League, against alcoholism, when Dr. Petithan presented
startling facts on legislation for inebriates, which created
considerable impression.

On the 12th of June last, the League devoted the most of

its sitting to the discussion of interdiction of the alcoholized,
VoL. 1X.—32

234 Inebriety in Belgium.

when Dr. Petithan and I were accorded a patient hearing,
and an interesting discussion ensued, to be resumed at a
future date.

It seems, therefore, that we are coming nearer in Belgium
to a satisfactory solution of this problem, the importance and
urgency of which are still further deepened by the continued
increase of alcoholism in all grades of society. There is
with us a growing demand for these two measures: I. Inter-
diction of the inebriate. 2. His seclusion in special homes.
Interdiction is a judicial decision, in virtue of which an indi-
vidual is deprived of certain rights, which he is held to be
unworthy or incapable of exercising. These rights are the
administration of their substance, the direction of their
family, the disposal of their fortune, taking part in political
elections, making part of a constituted body, such as a jury
called to judge a citizen. Actually interdiction, at present,
lies only in dementia, madness, and imbecility. Now the
alcoholized may be neither demented, nor furious, nor imbe-
cile, and yet be incapable of properly exercising civil and
political privileges.

Is it necessary to resort to this interdiction? Yes; for

* the alcoholized himself, who will be placed so that it will
be almost impossible for him to satisfy his passion; for his
family, whose honor and patrimony will be safeguarded; for
society, for it is dangerous to trust any part of the govern-
ment of a country to one whose freedom is enchained by a
vile passion, and whose intelligence is completely obscured
by a profound and permanent poisoning. The interdiction
would apply only to the alcoholized who are not dangerous
to themselves or to others. On the other hand, it only
feebly augments the chances of cure. If it is wished to put
the inebriate in the condition most favorable to cure, it is
important to place them in institutions created for that
purpose.

Two questions arise. 1. In Belgium, as elsewhere, it is
necessary to have a new law to seclude in a special home
inebriates, whether they are willing or unwilling, every time

Inebriety in Belgium. 235

that the need arises. In practice, one can forfeit the liberty
of the alcoholized only when attacked by delirium tremens,
and they must be set free as soon as the attack has passed,
or, at least, ‘there no longer persists a diseased craving for
drink; in other terms, the symptoms of a veritable dipso-
mania. This is what I gather from the terms of a circular
of the minister of justice.

As medical men, we are in the greatest difficulty in the
presence of the alcoholized, who are not laboring under
delirium tremens; who have only intermittent inebriate
paroxysms, and who would benefit greatly by being retained
in a special establishment.

Objections are raised to our contention. It is urged that
it will be difficult to distinguish between those who are, and
those who are not, alcoholized; that the gradations between
moderate drinking and drunkenness are so insensible as
often to be extremely difficult, if not impossible, to discrimi-
nate. But we may reply that there is the same difficulty in
the case of the insane. There is the same insensible grada-
tion between the most sane and the most idiotic. Are we,
because it is difficult to place in different categories those
who are difficult to class, either as insane or inebriate, are
we to hesitate to compulsorily restrain those about whom
there is no doubt whatever?

We can shut up only those alcoholized who are danger-
ous to themselves or to others. Here is the principle to
guide us. Acting on this, the embarrassing cases will be
rare. :

2. The second question is, should we ask the inter-
vention of the state in the establishment of asylums for
inebriates? I do not hesitate to pronounce in favor of the
institution by the government of these establishments. It
is not that I do not recognize the generosity of my fellow-
countrymen. The philanthropic and charitable institutions
which cover the soil of Belgium attest their benevolence.
But I fear that a private initiative will fail from the wide-
spread prejudice that “who has drank will drink.” We meet

236 Inebriety in Belgium.

this prejudice everywhere, even in men who are in the fore-
most ranks of the temperance cause. The prejudice is false.
The results of the efforts of numerous total abstinence soci-
eties in the rescue of drunkards, prove that it is unfounded.
So false and prevalent is this baseless prejudice, that I fear
it would paralyze for a long time a private initiative, which
does not care to enter upon any course of which it does not
clearly see the issue.

Another reason which makes me prefer state to individ-
ual action, is that we might see speculation hinder this
idea of the treatment of the alcoholized. Asylums can be
opened for the object of gain, as well as for the sake of good.
A first trial, injudiciously essayed, might yield deplorable
results, which might for long sadly injure the great work of
which we hope to see the realization.

I have, gentlemen, dilated at length upon the state of the
inebriates in my country. You will pardon me. I have,
alas! only regrets to express. I am tempted to reproach
myself with the length of my communication. Instead of
placing before you the blots of my fatherland, I would, per-

_ haps, have done better to imitate the example of the two
good sons of Noah, and thrown over the alcoholized condi-
tion of Belgium a discreet and patriotic veil. But this would
not have been the means to attain my end, to be able to
stimulate my countrymen to accomplish what has already
been realized in the beautiful country of England, where all
generous ideas always find men and devotion ready to put
them into execution,

Some recent researches into the energy-producing quali-
ties of foods, show that certain articles of diet entail double
work on the excretory organs to get rid of the waste of the
body. This explains why the turkish bath is of such a
signal service in many cases. Cases where the restoration
appears to be almost in the nature of a miracle, are seen
every day at Dr. Shepard’s Turkish Rath Sanitarium at
Brooklyn, N. Y. Is is evident that this therapeutic agent
has a great future in practical medicine.

The Herman Murder Case. 237

THE HERMAN MURDER CASE.
By T. D. Crotuers, M.D., Hartrorp, Conn.

Charles Herman was arrested for the murder of his wife
at Buffalo, N. Y., November 1, 1885. Seven weeks later,
December 21st, he was tried for this crime, found guilty, and
executed February 12, 1886, about fourteen weeks from the
time the crime was committed.

A study of the evidence in this case from a scientific stand-
point brings out some very interesting conclusions.

The following facts in the history of the prisoner and the
homicide seemed to be unquestioned: The prisoner, a Prus-
sian by birth, could give no history of heredity. He was
about forty-two years of age, and had drank for many years,
seemingly governed by no other motive except his ability or
inability to pay for it. He had been married for eleven
years, and lived happily with his wife up to within four or
five years. When after drinking he manifested an intense
suspicion of her infidelity. This had grown into a settled
conviction, although there was no evidence that it was true.
When sober no reference was made to this suspicion, He
worked at his trade as a butcher, but changed places often,
probably because of his drinking. Two years before the
crime he sold out his furniture, tramped to Chicago and back,
and commenced to keep house again. He was a quiet, re-
served man, but when drinking talked of his wife's infidelity,
and threatened to kill her in the hearing of some friends.
On several occasions when drinking freely he had quarreled
and attempted violence to her. He was not often stupid
when drinking, but was irritable and suspicious and greatly
changed in conduct and manner.

In regard to the crime, it was in evidence that he had

238 The Herman Murder Case.

been drinking freely every day for a week before, and
although not intoxicated, was under the influence of spirits.
He was known to have drank beer and spirits on the Sunday
on which the crime was committed, and was seen on this
day with his wife as usual. On Monday, Tuesday, and
Wednesday he was noticed coming and going, drinking as
usual, only his wife was not with him. The absence of his
wife created suspicion, and from a search she was found in bed
with her throat cut. He was arrested, and acknowledged kill-
ing his wife on Sunday evening, and placing her body in the
bed and sleeping with it for three nights from Sunday to
Wednesday, going away in the morning and coming back
every night. He seemed to have no conception of the crime,
and made no effort to escape. When arrested in a saloon
he talked freely, describing the incidents of the murder, giv-
ing no reason for it, except that his wife was going out and
would not stay in when he asked her, hence he threw her
down and cut her throat. A few hours later, in the jail, he
became restless and very nervous from the withdrawal of
spirits, and could not sleep. This passed off in a few days,
then he denied all memory of the past, claiming to have
forgotten every detail of the murder. This he continued to
assert up to death, and also manifested general indifference
and unconcern about himself.

The following conclusions from these facts were fully
sustained by the testimony: Ist, The history of the prisoner
was that of an inebriate who drank steadily whenever he
could get spirits, chiefly beer and whisky. He was un-
thrifty, and changeable in his character and habits. His
suspicions of his wife’s infidelity grew with the increased
use of spirits, and finally culminated in the murder. 2d, The
circumstances of the crime, the act itself, and his oblivious-
ness to the consequences following from it; also his conduct
at the time and later, with the absence of all reason or emo-
tion, suggested some form of insanity. 3d, His conduct in
in jail, after the first few days, when suffering from the re-
moval of alcohol, was not unusual. He was very reticent,

The Herman Murder Case. 239

but acted with reasonable sanity; the only fixed idea con-
cerning himself was that the man he alleged to be intimate
with his wife was responsible and should be in his place.

The defense was insanity and irresponsibility due to alco-
hol, and probably alcoholic trance. ’ This was based on the
history of excessive use of spirits, with the usual character-
istic delusions of marital infidelity. The trance state was
indicated by his conduct after the crime and general indiffer-
ence of the act and its consequences; also the automatic ‘
character of the crime, done in the same way he had been
accustomed to kill animals. His first recital of the details
of the crime, then loss of memory of all these events, was
also characteristic of this state. His crime was probably
committed in a trance state, in which he was oblivious of
what he was doing, and most naturally acted automatically
from an insane impulse and in a state of partial dementia.

The prosecution denied all evidence. of insanity and
claimed that premeditation and brutality marked all the
symptoms. The medical witnesses for the prosecution
doubted the existence of alcoholic insanity and alcoholic
trance. Two medical men were confident that spirits could
be used for years to excess without causing any degree of
insanity or mental impairment. One physician swore that
he did not think it was the alcohol that intoxicated. The
usual hypothetical questions were answered in the usual
dogmatic and confused way. The possibility of insanity was
doubted, because the prisoner did not then appear like an
insane man.

The judge’s charge to the jury entered minutely into the
question of premeditation and knowledge of right and wrong
and responsibility of inebriates. The letter of the law was
followed closely, and the jury was told to discriminate on
questions of fact and science which were clearly beyond the
mental range of the judge or even the most scientific experts
to determine.

The verdict was guilty, and the prisoner manifested the
same indifference to his condition up to his execution.

240 The Herman Murder Case.

A review of the facts brought out on the trial appears to
fully sustain the following:

Ist. Charles Herman belonged toa not uncommon class,
who both drink and act in a way and manner that proves a
defective brain and faulty judgment also a degree of mental
incompetency that should never be mistaken.

2d. Such men always have a defective heredity and a
history of neglect, bad living, bad surroundings, bad nutri-
tion. If to this is added inebriety, mental unsoundness is
always present.

3d. The prisoner had used spirits for many years to
excess, and although not often intoxicated, he would be
under the influence and exhibit the effects of spirits nearly
all the time. This of necessity would impair his sanity and
render him more or less incapable of realizing the nature and
consequences of his acts. Any man of average health who
uses spirits continuously for years will have a defective brain
power and brain control. Such men are practically suicidal
dements, living along the border lines of pronounced insanity,
and likely any moment to explode into wild mania. The
paralyzing effect of alcohol, even in small doses, always
breaks up normal brain control and conception. The terms
voluntary intoxication, and free will to abstain at pleasure,
are metaphysical delusions, contradicted by all scientific
study of these cases.

4th. For the past four years Herman exhibited delu-
sions of his wife’s infidelity. This, all writers agree, is a
characteristic symptom of alcoholic insanity, and exists with
or without any reason or basis. These delusions had grown
steadily with the increased degeneration from spirits. He
had most naturally talked about it to his friends, threatening
vengeance, and in his inebriate state saying many things
which on the trial were considered evidence of long premedi-
tation. He had frequent quarrels with his wife and had
attempted violence on several occasions, but the fact that
he was not stupidly intoxicated, was regarded as proof of

The Herman Murder Case. 241

sanity, and such acts were called willful and signs of bad
temper. In reality such persons are more insane, irrespon-
sible, and dangerous than if stupid from spirits. The fact
that when sober he did not complain of his wife, and was a
good-natured, quiet man, and only irritable and suspicious
of her when drinking, was strong evidence of his mental
aberration.

5th. The fact of drinking to excess, with peculiar delu-
sions of his wife’s infidelity, was evidence of impaired and
disordered brain. No apparent sane realization of his acts
or conversation could alter this fact. Such cases not un-
frequently exhibit a degree of mental soundness and pre-
meditation in thought and act, which, from a careful study,
are found to be only a mask. They are the really dangerous
classes of the insane, because their mental condition is more
or less concealed.

6th. Herman was using spirits to excess for a week and
more before the murder, and on the day of the murder he
was in a mental state fully prepared for some insane act.
A quarrel with his wife was most natural, resulting in a
murder committed in the way he had butchered animals
before. Had he manifested a realization of this act, in try-
ing to escape or conceal the crime, or given himself up with
reasons and explanations, some sanity might have been
inferred. On the contrary, he seemed profoundly oblivious
to what he had done, and not only threw the body on the
bed, but laid down and slept three nights with the corpse.
He drank during the daytime, and seemed in no way dis-
turbed or different from what he had been before. His con-
duct was unmistakably that of an insane man, and one inca-
pable of realizing the nature and character of his acts.

7th. His conduct after the crime, in giving all the
details of the act, and then, when he recovered, losing all
memory or recollection of them, whether real or feigned,
was not that of a sane man, or one who had any clear
comprehension of the nature and consequences of his acts.
Alcoholic trance was a condition likely to be present. The

VoL. IX.—33

242 The Herman Murder Case,

character and manner of the crime would point to it, but
his statements after, unless confirmed by other facts, would
not be positive, but would only sustain a supposition of this
state.

8th. His conduct and appearance in jail after the first
few days might not give any indications of his real state.
The absence of delusions, hallucinations, or any gross physi-
cal symptoms of insanity was by no means evidence of a
sound mind or responsibility.

oth. The medical experts for the people assumed that
the conduct and acts of the prisoner were sane, and that evi-
dence of insanity must be found in his present appearance
and conduct. His apparent sanity in act and thought and
the general good physical condition sustained their views
of full responsibility and mental health. These examina-
tions were limited to one or two interviews of an hour or
more, and were made with a view of finding some well-
defined symptoms of insanity. No scientific study of the
case seems to have been made. Each witness apparently
brought to the case a group of symptoms by which to gauge
the mental health of the prisoner. All previous conduct,
unless marked by great mental aberration, was not con-
sidered.

oth. In reality, from a scientific study, if the facts of
his inebriety were true, his brain was impaired. He was
practically a lunatic, incompetent to judge of his acts, and
his power of control and responsibility was certainly im-
paired. The crime and his conduct after sustained this
inference. His general indifference of manner and interest
in himself and future was further evidence.

The hasty trial, speedy execution, and failure to compre-
hend the criminal and the crime, and the pressure of public
sentiment were all inimical to justice. The progress of
humanity and the cause of truth gains nothing by taking the
life of a poor alcoholic imbecile, while the intelligence of the
age is outraged by the application of medizval theories of
human responsibility and divine vengeance. Whatever the

The Herman Murder Case. 243

law may be concerning crime committed under the influence
of spirits, science demands that its application shall be along
the lines of natural law and observed fact. If Herman was
of sound brain and capacity to realize the nature and conse-
quences of his act, the punishment by the law was just; but
if Herman possessed a defective brain and impaired con-
sciousness of his acts, such punishment was a crime, as much
so as the murder itself. Security to life and prevention of
similar crime can never be secured by the injustice of taking
the lives of irresponsible persons.

The hanging of insane and idiot criminals never checks
the crime of such persons. Other Hermans and Ottos*
will go on committing crime just the same. The time has
come for a change. The progress of science demands it.
The confusion of courts, the uncertainty of juries, and the
difficulty of physicians in deciding on the brain health of
prisoners in a few interviews make it impossible to secure
the ends of justice in such cases. Herman’s case should
have been the subject of scientific study before it was brought
into court. The inebriety of the prisoner and the peculiar
character of the crime called for a special study that could
not be limited to a few observations by physicians, and
also could not be decided under the pressure of public
feeling. The conclusion is inevitable that the supposed
justice of Herman’s trial and execution was grave injustice.
and was only another example of judicial murder, which,
unfortunately, is not uncommon in this country. The trial
and execution of Herman is beyond recall, but the failure to
realize the true condition of the man and the crime may
serve as a landmark and warning in future cases.

* At the time of the trial a poor lunatic, Peter Otto, was under sentence of
death for wife murder, and, although bravely defended, was finally hung. The
same strange medical testimony and misconception of the case prevailed. The
strange delusion that both Herman and Otto were sane pervaded the court and
community, and was a strong influence in both trials. Later reflection strength-
ens the conviction that both cases were sad judicial blunders, in which twa
irresponsible men were punished as sane and responsible,

242 The Herman Murder Case,

character and manner of the crime would point to it, but
his statements after, unless confirmed by other facts, would
not be positive, but would only sustain a supposition of this
state.

8th. His conduct and appearance in jail after the first
few days might not give any indications of his real state.
The absence of delusions, hallucinations, or any gross physi-
cal symptoms of insanity was by no means evidence of a
sound mind or responsibility.

oth. The medical experts for the people assumed that
the conduct and acts of the prisoner were sane, and that evi-
dence of insanity must be found in his present appearance
and conduct. His apparent sanity in act and thought and
the general good physical condition sustained their views
of full responsibility and mental health. These examina-
tions were limited to one or two interviews of an hour or
more, and were made with a view of finding some well-
defined symptoms of insanity. No scientific study of the
case seems to have been made. Each witness apparently
brought to the case a group of symptoms by which to gauge
the mental health of the prisoner. All previous conduct,
unless marked by great mental aberration, was not con-
sidered.

1oth. In reality, from a scientific study, if the facts of
his inebriety were true, his brain was impaired. He was
practically a lunatic, incompetent to judge of his acts, and
his power of control and responsibility was certainly im-
paired. The crime and his conduct after sustained this
inference. His general indifference of manner and interest
in himself and future was further evidence.

The hasty trial, speedy execution, and failure to compre-
hend the criminal and the crime, and the pressure of public
sentiment were all inimical to justice. The progress of
humanity and the cause of truth gains nothing by taking the
life of a poor alcoholic imbecile, while the intelligence of the
age is outraged by the application of medizeval theories of
human responsibility and divine vengeance. Whatever the

The Herman Murder Case. 243

law may be concerning crime committed under the influence
of spirits, science demands that its application shall be along
the lines of natural law and observed fact. If Herman was
of sound brain and capacity to realize the nature and conse-
quences of his act, the punishment by the law was just; but
if Herman possessed a defective brain and impaired con-
sciousness of his acts, such punishment was a crime, as much
so as the murder itself. Security to life and prevention of
similar crime can never be secured by the injustice of taking
the lives of irresponsible persons.

The hanging of insane and idiot criminals never checks
the crime of such persons. Other Hermans and Ottos*
will go on committing crime just the same. The time has
come for a change. The progress of science demands it.
The confusion of courts, the uncertainty of juries, and the
difficulty of physicians in deciding on the brain health of
prisoners in a few interviews make it impossible to secure
the ends of justice in such cases. Herman’s case should
have been the subject of scientific study before it was brought
into court. The inebriety of the prisoner and the peculiar
character of the crime called for a special study that could
not be limited to a few observations by physicians, and
also could not be decided under the pressure of public
feeling. The conclusion is inevitable that the supposed
justice of Herman’s trial and execution was grave injustice.
and was only another example of judicial murder, which,
unfortunately, is not uncommon in this country. The trial
and execution of Herman is beyond recall, but the failure to
realize the true condition of the man and the crime may
serve as a landmark and warning in future cases.

* At the time of the trial a poor lunatic, Peter Otto, was under sentence of
death for wife murder, and, although bravely defended, was finally hung. The
same strange medical testimony and misconception of the case prevailed. The
strange delusion that both Herman and Otto were sane pervaded the court and
community, and was a strong influence in both trials. Later reflection strength-
ens the conviction that both cases were sad judicial blunders, in which two
irresponsible men were punished as sane and responsible,

244 Abstracts and Reviews.

Rbstracts and Reviews.

EFFECTS OF TEA DRINKING ON THE NER-
VOUS SYSTEM.

Dr. Bullard of Boston, in a paper read before the Massa-
chusetts Medical Society on the above topic, draws the follow-
ing conclusions :

1, Chronic tea poisoning produces a condition of irrita-
bility or hyperexcitability of the nervous system, and does

this both directly by the action of the tea upon the nervous |

system, and indirectly by the production of gastric derange-
ment.

2. Tea taken directly and in moderate doses, for a con-
siderable period of time, tends therefore to place the nervous
system in a condition in which it is more nearly affected
injuriously by slight external influences. It therefore favors
the production of many forms of functional neurosis, and if
such neurosis already exists, aids in their continuance. -

3. There is no evidence that tea taken in the manner
described, causes any organic nervous lesion, but it is prob-
able that if such nervous lesion should exist, tea thus taken
might tend to cause an aggravation and continuance of cer-
tain symptoms.

4. There is no evidence that chronic tea-poisoning pro-
duces unaided any serious functional neurosis, in a person
not in any way seriously predisposed thereto. It does, how-
ever, in a manner above described, act as an important factor
in the production of neuralgia, hysteria, and allied affections.

5. When taken constantly in very large doses, dyspeptic
symptoms usually intervene before irreparable harm is done
to the nervous system.

6. In hemicrania, and possibly some other functional
neurosis, there is probably a craving on the part of the ner-

Abstracts and Reviews. 245

vous system for a slight stimulation, which is better afforded
by tea, than by any other equally accessible article, and for
this reason patients with hemicrania are so frequently tea-
drinkers.

TOBACCO AMBLYOPIA.

The following extract is from Dr. Woods’ late work on
“Nervous Diseases” :

“Toxzemic ambloypia is usually of organic origin, but as
this lesion is directly produced by the poisoning and is likely
to be recovered from, on removal of the poison from the
system, the separation of toxeemic amblyopias is of practical
importance. The most common, and the most important of
the class, is the loss of vision produced by tobacco. Ina
large proportion of cases the excess in the use of tobacco,
has been associated with an excess in the use of alcohol, and
there has been much discussion as to which of these agents
was the cause of the optic derangement. The amblyopia is
frequently present in those who smoke excessively, but do
not drink, and tobacco seems to exert the more potent influ-
ence, The victims of tobacco amblyopia shows no difficulty
or awkardness in going about, but especially complains that
vision is very bad in direct sunlight. He almost invariably
sees better on dull days, and in the early morning and even-
ing. If this be not noted by the patient himself, it may be
shown by testing vision with type in full daylight, and again
in a darkened room. An examination of the visual field will
show that a great functional defect is in the center of the
field, occupying an oblong or oval patch, which extends from
the fixing point (corresponding to the macula lutea), out
towards and often immediately beyond the blind spot (corres-
ponding to the disk). This central scotoma is relative, and
not absolute; z. ¢., loss of vision in it is never complete. It
is especially marked for the perception, for green and red in
particular; the former is usually described by the patient as
“white” or “gray,” and the latter as “brown” or “no color
at all.” In most cases the scotoma is smaller that the visual

246 Abstracts and Reviews.

field for central colors, green and red, and hence a zone is
present beyond the scotoma in which these colors are
observed. This is especially the reason that the patient will
recognize the color of a large body, and mistake that of a
very small one. The scotoma of tobacco amblyopia is invari-
ably automically symmetrical, occupying exactly the same
position in each retina. It is believed by oculists to be
chiefly due to the change in the peripheral portion of the
nerve-axis. It has been asserted in the rare cases in which
the scotoma is central and surrounds the fixation spot equally
on all sides, that the cause is alcohol. Dr. Edward states,
however, that in all cases of such scotoma which he has seen,
the patients were smokers. And Dr. G. De Schweinitz has
reported an.example of such scotoma in a woman who used
neither alcohol nor tobacco, but made cigars,— and in whom
the eyes became normal after she left the occupation. In
investigating it should be remembered that chewing tobacco
is more injurious than smoking.”

THE MEDICAL ASPECT OF INEBRIETY.

The failure of prohibition to prevent drunkenness must
be generally admitted. Neither the enactment of constitu-
tional amendments, the appointment of special police, nor the
multiplication of temperance societies, has brought to the
world or to any community that decrease and disappearance
of inebriety which the advocates of these measures have
promised.

This failure to prevent inebriety by legislative enactments
is due to a total misconception of the nature of the evil which
it is desired to eradicate. Drunkenness is still looked upon
and treated by the law as a vice, just as it has been in all
ages since it has been looked upon as an evil at all. But in
the medical mind there has been gradually growing the con-
viction, that even while it may be too broad a generalization
to say that all drunkenness is disease, nevertheless it is un-
doubtedly true that most habitual drunkards are diseased,
and should be sent to the hospital instead of the jail.

Abstracts and Reviews. 247

Take the commonest form of inebriety, for instance, that
of the periodic drunkard, and compare his case with one of
recurrent mania or of epilepsy. There is the same interval
between the attacks when the subject is to all appearances
in perfect health, his behavior as correct, and his moral sense
as sharp as that of any man; during this interval he may
drink, but his appetite is as much under control as that of
any moderate drinker, and he avoids excess. Then comes
the attack, often preceded by a well-marked aura. The un-
fortunate victim is then seized with an uncontrollable desire,
not to drink as is often represented, but to get drunk. It is
the end and not the means which is uppermost with him;
indeed the taste of liquor may be even disagreeable to him,
and lead him to pour the drink down his throat with as little
taste as possible. When the desire for intoxication is ex-
hausted the paroxysm ends.

The close relationship of insanity, epilepsy, and inebriety
is also strongly shown by the remarkable manner in which,
through heredity, one form of disease may pass into another,
as where drunkenness in one generation is followed by epi-
lepsy or insanity in the succeeding generations. This indi-
cates clearly a similar cause in the existence of a morbid
condition of the nervous centers, although the changes have
so far escaped the microscope. This pathological condition
is spoken of by writers on inebriety as the “ neurotic diathe-
sis,” or an “alcoholic neurosis.” Although we do not know
exactly in what the change consists, we can recognize its
consequences, and feel sure that in the determination and
abolition of its causes lies the true and rational treatment of
inebriety.

The signs of the times all point to the rapid approach of
the recognition of inebriety as a disease, and our descendants,
in the next century, will no doubt denounce the cruelty of
our present treatment of the inebriate with as much energy
and justice as we condemn the use of the scourge and chains
in the treatment of the insane a hundred years ago.— Edi-
torial in Northwestern Lancet, of St. Paul, Minn.

248 Abstracts and Reviews.

DISORDERS OF MEMORY AND CONSCIOUS-
NESS.

The following extract is very suggestive in the pathology
of alcoholic trance: “All functional acts are accompanied
by, or dependent upon, a nutritive disturbance. It matters
not whether the functional act is connected with thought,
consciousness, or secretion, the generation of nerve force by
the ganglionic cell and its transmission by nerve-fibre are
accompanied by nutritive changes in their bodies. A nutri-
tive act, although temporary, has a distinct tendency to im-
press permanently the part implicated, and this tendency is
especially pronounced in nervous tissue. All nervous tissue
is, therefore, liable to be permanently affected by its own
functional actions, This, it must be remembered, applies
equally to normal and to pathological activities. Thus the
child in learning to walk by repeated efforts trains the lower
nerve-centers until, in response to appropriate stimuli, a
definite series of nervous discharges and transmission occur
independently of the will, and walking becomes automatic.
This, in short, is the history of all training, mental and
physical. All nervous tissue, therefore, have memory, z. ¢.,
the faculty of being permanently impressed by temporarily
acting — stimuli, the thing remembered, being in fact the

functional excitement. The recognition of the universality .

of memory in nerve-tissues is of great importance in the
consideration of treatment of disease. Thus an epileptic
fit is produced by a peripheral irritation. If that peripheral
irritation be at once removed, the fit does not recur, and the
patient is cured. If, however, the irritation be not soon
taken away, but produce a series of convulsions, the fit may
continue after the removal of the irritation, simply because
of the permanent impression which has been made upon
those cells in the brain cortex, whose discharge of nerve-
force is the immediate cause of the epileptic paroxysm.
The nutrition of the cells has been so altered that at irregu-
lar intervals they fill up and discharge nerve-force, owing to

Abstracts and Reviews. 249

this power of memory a physical habit may become so per-
manently engrafted upon the nervous system that the patient
is unable to control it. An example of this is seen in the
so-called habit-chorea, movements at first controllable, mere
bad habits, become at last fixed, not to be altered by any
power. The hysterical woman who gives way to hysterical
nervous impulse, thereby strengthens their hold upon the
system so that in time she may lose all power of control
over the lower nerve-centers. What is true of the lower
nerve centers and fibres is true of the upper ones. Intel-
lectual acts, or thoughts and perceptions, tend to stamp
themselves upon the centers connected with them, and when
the function of the nerve-cell is connected with conscious-
ness, the changes which occur in the nutrition give origin
to conscious memory, 2. ¢., to memory in the usual sense of
the term.” — Dr. Wood in Nervous Diseases.

THE ZURICH CONGRESS ON ALCOHOL.

A large gathering of statesmen, philanthropists, and
physicians discussed the subject of alcohol in all its phases
at Zurich, Switzerland, last August. On the question of
the food value of alcohol, a unanimous conclusion was
reached denying all nutrient value. On the medicinal value
of alcohol in the sick-room, no agreement was reached. One
physician urged vegetarianism as the best means of prevent-
ing excess in spirits. Temperance societies were considered
as doing great work. Coffee-houses and halls were also
urged as valuable. The valuable influence of these various
movements were mentioned in the pressure on the various
governments, raising the tax on spirits, and forming more
stringent laws for the control of the sale of spirits. Dr.
Kerr of London, sent a paper on Inebriate Asylums, which
was read. The official report when published, will, no doubt,
bring out many new facts.

Opium and alcohol should never be given as a medicine
long to children who are feeble-minded or of weak, unstable
organism.

Vou. IX.— 34

250 Abstracts and Reviews.

Environment. A story of modern society, by Florin Thayer
McCray. Funk & Wagnals, publishers, New York
city. 1887.

This story is chiefly of interest from the fact that the
heroine is an inebriate, a lady in good society whose drinking
is concealed, and who finally recovers. The author is evi-
dently a wide reader of fiction, but not a close student of
human nature. The picture of an inebriate woman is more
ideal than literal, and the views of inebriety and its treat-
ment urged by her characters are open to very serious objec-
tions. The tone and style are markedly that of an amateur.
Yet the author and her book is to be commended for this
first attempt to portray the rapidly increasing class of inebri-
ate victims in high life. Other and more accurate studies in
this field will bring enviable fame to this author. The pub-
lishers have issued an attractive volume. ©

Maternity, Infancy, and Childhood, by Dr. John M. Keating.
J. B. Lippincott & Co., publishers, Philadelphia, Pa.,
1887.

This is a most excellent hand-book of practical lessons in
nursing, written by an accomplished physician in a vein of
clear, strong common sense. It is a book that can be placed
in the hands of laymen with great satisfaction and profit.
This book contains 225 pages, being pleasantly divided into
chapters and headings that greatly facilitate the pleasure of
the reader.

The Science Weekly is one of the best journals that a
scholar can have to keep abreast with the times. It is edited
with great scientific skill, and its pages are thoroughly relia-
ble. No more acceptable present could be made than a
year’s subscription of this excellent journal. The subscrip-
tion is $3.50a year. Address publishers, 47 Lafayette street,
New York city.

The Fournal of Morphology has appeared, devoted en-
tirely to zoological literature. Ginn & Co., of Boston, are
the publishers.

a ee,

,

Abstracts and Reviews. 251

The Scientific American grows in interest each month,
until it takes rank, as a need to every thinking man, with the
great dailies of the world.

The Open Court is a journal published in Chicago, in
which all phases of religion and science are discussed with
charming frankness and dignity.

Thé Demorest Monthly comes freighted with a rich table
of contents, to an evér increasing army of readers. Its in-
fluence for good is in pleasing contrast to many more preten-
tious rivals.

The Chmatologist is a quarterly, published in Baltimore,
Md. The editor, Dr. Rohe, brings to this new field a rare
experience and culture, giving success to this journal from
the beginning. :

The Electrical Engineer, published at 115 Nassau street,
New York city, is a monthly review of theoretical and applied
science in electricity. It is a journal of great value to all
scholars and thinking men.

The Homiletic Review is a theological monthly, edited
on a generous, broad plane, appealing to scholars and think-
ers of all classes by its vigorous, stirring thought. Funk &
Wagnals are the publishers, New York city.

The Humboldt Library, published by J. Fitzgerald, 24
East 4th street, New York city, is a great educational work,
placing the best scientific works of the age within the reach
of the masses. Send for a catalogue.

The Popular Science Monthly has published some of the
most important contributions to science this year. The
September and October numbers are volumes in themselves,
which should be read by every student of science. D. Ap-
pleton & Co, are the publishers, New York city.

Medical Classics, a monthly devoted to a study of the
writings of the fathers in medicine, is a most commendable

effort to place the views of antiquity before the modern Eng-
lish reader. The two numbers before us give great promise
for the future, It is published in New York city, at one
dollar a year.

252 Editorial.

Hditorial.

THE INTERNATIONAL MEDICAL CONGRESS
ON INEBRIETY.

This year will be eventful in medical history for two
widely different gatherings of physicians, whose work and
influence will go down into the future, long after the partici-
pants are forgotten. The congress at Washington was
devoted to all departments of medicine, and called together
a large number of physicians ; was opposed, criticized, and
sneered at; yet, in character and spirit, it marked the begin-
ning of a new epoch in the progress of medical science.
The papers and discussions of the American physicians at
this congress, not only exhibited an aggressive energy and
restless freedom from prestige and theory, but a practical
application of the laws of prevention and cure of disease
beyond all comparisons by any old-world standards.

The congress at London was for the study of the disease
of inebriety, and was the first international convention of a
little band of medical explorers who had crossed the frontiers
of a new borderland realm of disease. Less than a hundred
physicians and friends gathered and listened to the reading
and discussion of twenty or more papers. The session
terminated with a banquet, in which over two hundred lead-
ing men of all professions expressed their warm sympathy in
the effort to study these cases ; the daily papers gave brief
notices of this congress ; the temperance weeklies published
full reports, and the medical journals gave abstracts ; and
thus the event passed into history. No loud voices of praise
or criticism was heard. In this country — except a few brief
notices in the medical press—no reference was made to it.
In reality, it was among the most important medical events of
the century. It was, practically, the first general recognition

Editorial, : 253

that all this great tide of evil, coming from the excess of drink,
was under the control of law, which could be understood and
prevented by the scientific study from scientific men.
The central idea of this congress, that inebriety was a
disease and curable in hospitals, is the beginning of a great
revolution and evolution in the science of medicine. The
vast army of inebriate defects are to be transferred into the
realm of medical science for study and treatment. The
temperance theories and efforts to reach the inebriate, will
disappear in the evolution of a broader, clearer knowledge
of the nature and causes of inebriety.

This congress marks the beginning of a new era, in
which the complex forces of heredity, surroundings, food cul-
ture, mental and physical strain and drain, with all the vast
ranges of causes now unknown, will come into the realm of
scientific study, and be known with all the means of cure and
prevention.

The congress at Washington was a record of the ad-
vances in the general science of healing; the one at London
was the formal opening of a new realm and territory for
medical research. It announced that the intimations and
statements of a thousand years ago, concerning inebriety,
had been practically tested in the last quarter of a century,
and were found to be true, in a wider sense, than ever before
conceived. That the vast armies of inebriates were diseased
and curable, and this great borderland region of disease was
to be reclaimed from the superstitions and theories of the
past. Sixteen years has passed since our association for the
cure of inebriates was organized, and this congress was the
first world-wide endorsement of our work and its objects.
The confidence and faith which has inspired the members
of this association these years, receives a grand uplift from
this event.

Inebriety, its study and cure, is carried by this congress
beyond the monopoly of any society or individuals. It is the
world’s great new field for the prevention and cure of human
ills and human sufferings.

254 Editorial.

SEXUAL INSANITY IN INEBRIETY.

The psychical paralysis of the higher brain centers which
appear early in all cases of inebriety, are often associated
with the most extraordinary sexual perversions and insani-
ties. In most cases these morbid impulses follow after the
inebriety has been established, and seem to be the result of
some central nerve irritation. In other cases it precedes the
inebriety and dies away when the drink paroxysm is fully
developed. Here it seems to follow as a reflex irritation of
some unknown state. In a third class, some congenital con-
dition predisposes to morbid sexual impulses which merge
into inebriety, and afterwards, when one is active the other
is unnoticed, and vice versa.

In the first class, most commonly noted, after inebriety
has begun, sexual irregularities appear. Thus, a man pre-
viously moral will consort with the lowest women, or have a
mistress and pursue a line of most unusual conduct, irre-
spective of all social and family relations. The boldness
and impetuosity of this conduct suggests disease and failure
of the brain to realize the nature and consequence of acts.
As an example, a man of excellent character, married, with
fine family, became an inebriate, dating from an obscure
brain injury. Suddenly he became a constant visitor to a
house of ill-fame, appeared in public with the inmates, and
gave no reason for this. A professional man of high stand-
ing became an inebriate, and began to keep mistresses and
associate with fast women. In these cases such conduct
indicates a sexual delirium and degeneration associated and
following inebriety that is very grave. It is more often
noticed among the steady and constant drinking inebriates.

In the second class, where sexual exaltations precede the
drink paroxysm, there is always a marked neurotic element
present. Such cases are often periodical inebriates. Thus,
in a case under observation, a man of correct habits will, for
two weeks before drinking, manifest almost ungovernable
sexual impulses. He will consort with many women each
day, have sexual dreams at night, and conduct himself ina

_.-- A -

Editorial. 255

very unusual way. Finally he becomes intoxicated, and the
sexual impulse dies out. Long intervals, sometimes months,
follow before it returns, during which he is entirely abstinent.
In gther cases this impulse will begin with intrigues with
women, and secret journeys to large cities, visiting bad
houses, and show itself in voluble conversation on these
topics. A female inebriate, occupying a high position in
society, exhibits this erotic impulse before the drink parox-
ysm, by the most scandalous stories of sexual wrongs, that
are always creations of her imagination.

’ In the third class, where sexual perversions have appeared
from childhood, both congenital and acquired, founded ona
neurotic constitution, inebriety seems to be only another
phase of the diseased state. Often in these cases there is a
strange periodicity, in which the sexual impulse is dominant
for atime. Such cases go from one house of prostitution to
another, rarely drinking anything. After a time they begin
to use strong spirits, become intoxicated, then this sexual
impulse dies away. The history of such cases are often
marked by masturbation, intense sexual activity early in life,
and other irregularities. The inebriety is paroxysmal, and
seems to have grown out of the surroundings, and the sexual
impulse seems to gather and explode like nerve storms of
epilepsy or hysteria.

In all of these cases delusions of the infidelity of others
are marked symptoms. A husband suffering in this way
will always suspect his wife, or those about him of the same
immorality.. In some cases the capacity to gratify this
impulse becomes paralyzed, but the mind exhibits a delirious
pleasure in dwelling on the details of such acts.

The sexual crimes committed by inebriates have always
been regarded as entirely within the control of the person,
yet when carefully studied appear like the acts of a maniac,
controlled by a blind irresistible impulse. Practically, a
knowledge of these associated insanities throw much light
on inebriety and its treatment.

These facts are presented as only hints and suggestions of
an unknown field that comes under almost daily observation.

256 Editorial.

The Dalrymple Home at Rickmansworth, England, under
the charge of Dr. Branthwaith as superintendent, is undoubt-
edly one of the best equipped inebriate asylums in Europe
to-day. Situated in a rich farming country a few miles out
from London, it has many attractions. This with the admira-
ble plan of management, tone, and spirit of the place, may
serve as a model to be copied after. Dr. Norman Kerr is
consulting physician. This, in itself, is an evidence of the
thorough scientific treatment of the inebriate, above all
levels of faith and superstition. The Dalrymple Home is
really a modern hospital, where the disease of inebriety is
studied and treated with the best means and appliances
known to modern science. It is practically where the splint
and bandage are applied until the poor fractured inebriate
recovers. The cheerful quiet and seclusion of a large park,
bounded by a river on one side, and overlooking a fine
farming country, add greatly to the beauty of this place.
The superintendent is one of those cheery scientific men,
whose presence inspire confidence and respect everywhere.
There is probably no new work in all Europe upon which
more interest is centering, than on this Dalrymple Home.
On its progress and success the future treatment of ine-
briety in Europe will turn very largely.

Dr. Norman Kerr of London, England, is one of the
most advanced students and writers on the subject of inebri-
ety in Europe. His papers and addresses have become
authority, and are copied very widely all over the world.
Mr. Chang Luii of the Chinese Embassy at Washington,
has translated parts of his late address before the Interna-
tional Congress of Inebriety, for the eat notice of the
Chinese Emperor.

A study of the nature and causes of inebriety shows
clearly that, to a large degree, it is as positively preventable
as small-pox, typhoid fever, or diphtheria.

Editorial, 257.

The theorists are unwilling to acknowledge that inebriety
is a disease, after having so long denied this fact, so they
seek a compromise. They must save their old theories, by
showing that they were half right. Hence they assert that
all cases are at first sin and vice, but later may become
disease. This is a repetition of every dying theory, seeking
to live on the fact that they were partially right. Precedent
history, and the Bible, are called in to sustain the old dogma,
but, like the horns at Jericho, the louder they sound the
more perfect the destruction of the walls.

4

A young man with an unstable nervous organization
becomes reduced in health and is subject to contagion of
drinking companions, uses spirits to intoxication ; the result
is, his physical system takes a diseased tendency, which
quickly develops into inebriety. No matter what the
surroundings may be, he is under the control of diseased
impulses, which carry him farther from health and sanity.

The vaso-motor paralysis, following the use of alcohol,
interferes with the venous circulation. The blood return-
ing from the extremities, fails to bring all the carbon and
other excrementitous matters, The exchange of oxygen is
interfered with, and a species of oxygen starvation comes on,
resulting in fatty degeneration. Atrophy, inflammation of the
nerve extremities, called neutritis, comes on.

In the treatment of inebriates, it should always be remem-
bered that they are sick people with damaged brains, which
aré more or less capable of being repaired, such repairs
being a slow process, requiring a combination of physical
and mental remedies, and long time with rest. If they can-
not be cured, they can at least be improved, and should

always be treated as wards of society instead of its enemies.
VoL. IX.—35

258 Editorial.

Epilepsy which develops after the thirty-fifth year of age
is frequently due to some organic disease of the brain caused
by alcohol.

Dr. Webb asserts that only ten per cent. of the distilled
spirits consumed in this country are used for medicinal and
manufacturing purposes, the other ninety per cent. being
used as a beverage.

“The study of inebriety from a scientific standpoint is a
matter of the utmost consequence, of immensely greater im-
portance than any amount of so-called temperance agitation.”
—ELditorial in Northwestern Lancet.

Dr. Holmes’s remark that the patient might have been
saved if the physician had been called two or three genera-
tions back to treat his forefathers is a fact that every spe-
cialist in inebriety will most heartily endorse.

The study of inebriety to-day is largely the record of the
facts, a description of cases and phenomena which they pre-
sent. Later comparisons of these facts and records will be
made, and the laws which govern them will be deduced.

In a case of death from chronic alcoholism, after life had
become extinct the temperature of the body was observed to
rise to 110° and remain there for some time. A correspond-
ent asks if this has ever been observed before? also, what
explanation can be given of it?

Lindsay & Blakeston’s Visiting List for 1888 is out, and
may be said to be one of the best in the market.

The Association for the Cure of Inebriates will hold
their semi-annual meeting in Brooklyn, N. Y., Nov. 2, 1887.
Besides the president’s address, papers will be read by Dr.
Kerr of London, Drs. Wright, Day, Searey, Mason, Mann,
Crothers, and others.

The New York Medico-Legal Society will discuss the
Medical Jurisprudence of Inebriety at their regular meeting,
Nov. 2, 1887. Papers on the medical side of this topic will
be presented by Dr. Kerr of London, Drs. Wright, Parrish,
Mann, and Crothers of this country.

Clinical Notes and Comments. 259

Horsford’s Acid Phosphate is a preparation of the phos-
phates of lime, magnesia, potash, and iron, with free phos-
phoric acid. For the various disorders incident to wasted
or prostrated energies, weakened vitality, exhaustion, head-
ache, nervousness, dyspepsia, etc., etc., it will be found
incomparable, giving almost instantaneous relief, and pro-
ducing refreshing, dreamless sleep.

George Stinson & Co. of Portland, Maine, are the great
Art Publishers of America. Their steel plates are the finest
sold in this country. Send fora price list before the holi-
days, and take advantage of the reduced rates.

The Anglo-Suiss Milk Co. of New York city, are pio-
neers in placing within the reach of every physician this
most excellent food, which has an international reputation,
and is used in all civilized countries.

Colden's Beef Tonic has been used as a substitute for
spirits in cases of inebriety with most excellent results.

Bromidia and Papine have become household remedies
in many cases of inebriety and insomnia. They are specifics
in the hands of many physicians.

Lactopeptine has won a permanent place among the reme-
dies whose value is universally recognized. It is a nutritive
tonic. In all cases of debility its effects are very marked.

Peptonized Cod Liver Oil and Milk, by Reed & Carnrick
of New York city. ~ In alcoholic phthisis this is a most
admirable remedy. In the convalescence from pneumonia
its effects are very marked.

Maltine, with the iron and vegetable tonics combined,
should be among the remedies in the office of every physician,

Murdock's Liquid Food has steadily grown into great
popularity. As a nutrient tonic in old cases of stomach and
brain disorder, it is invaluable.

Lactated Food, by Wells, Richardson & Co., according to
a local paper, is selling over five thousand bottles a day of
their famous food. This is unmistakable evidence of its
practical value. }

Fellows’ Hypophosphites is a most excellent nerve remedy.
In many cases it is very nearly a specific, and should be used
in all cases of brain and nerve debility.

Coca Cordial, by Parke, Davis & Co., has been found of
great value in cases where alcohol is suddenly removed from
from inebriates. It relieves the shock and depression, and
saves the patient much suffering.

ISISSIS1SISIS1S11

S

=S1S1S1531.

i SS SS SIS SSIS SI S1S15
Established 15 Years. OBSERVE THE NAME. Beware of Imitations. q
a

OLDEN’S|

Liquid Beef ‘Tonic. :

ORIGINAL LABEL;
“* Colden’s Liebig’s Liquid Extract of Beef and Tonic Invigorator.” i

fy
Bl
Hl

An Invaluable Aid in Medical Practice. 1
Differs Essentially from all other Beef Tonics. 4

OLDEN’S Liquid Beef Tonic is endorsed by scores of physicians,
who are growing to realize more ard more its importance in repairing, in accord-

ance with the principles of dietetics, the waste which diseuse entails.

It consists of the extract of Beef (by Baron Licbig’s process) spirit rendered non-

injurious to the most delicate stomach by extraction of the Fusel Oil, soluble Citrate of
Iron, Cinchona, Gentian, and other bitter tonics. An official analysis of this prepara-
tion by the eminent Chemist, ARTHUR HILL HASSALL, M. b., F,R.S., and an

endorsement by the late SIR ERASMUS WILSON, F. R. S., are printed on the labet
of each bottle.
As a nutrient, and a reliable tonic in all cases of debility and weak-
ness, Malarial Fever, Anemia, Chlorosis, Incipient Consumption, etc., it is the best
reparation ever used. It acts directly on the sentient Gastric Nerves, stimulating the
follicles to secretion, and gives to weakened individuals that first prerequisite to improve-
ment —an appetite. It strengthens the nervous system when unstrung by disease, and
has been employed with remarkable success as a remedy for Drunkenness and the
Opium Habit.

Its Range of Action Embraces all Cases of Debility.

In order that physicians may form some idea of the nature of its ingredients, I will
upon application in person: or by letter (enclosing a card), send a sample bottle of
Coben's Liquip BEEF TONIC to any physician in regular standing, in the United
States. lease ask your Dispensing Druggist (if he has not already a supply) to order
it. In prescribing this preparation, physicians should be particular to mention
“COLDEN'S "'—viz.; * Ext, carnis, fl. comp. (Colden's).” Itis put up in pint bottles,
and can be had of Wholesale and Retail Druggists generally throughout the United

States. C. N. CRITTENTON, Sole Agent, 115 Fulton St. New-York.

GLENN'S — | @ONSTANTINE’S
Sulphur Soap. PINE rar ane

At physicians know that skin diseases
are more or less constitutional, ordependent
upon some specific poison in the blood, which, i

if J ris veen on trial among physicians for very

eradicated by internal treatnv-nt, needs something J many yeara as a Toilet Soap and Healing
ii A

r
t, and its superior virtues have been

to remove its appearance from the surface. Ex-
ee !mously conceded in all cases where

perience has proved that the best possible aid in "
the accomplishment of this end is obtained by the nee! tar Js indicated: uUnnolies fed
use of Sulphur in soap. GLENN'S SUL- ssions of its excellence have bec

PHUR SOAP is the best combination ofits kind, gulved from the Botical Bagnitr generally:

and the one now generally used. It is for sale by [J None genuine unless stamped “ A. Constan-
all Druggists, at 25 cents a cake, or 3 cakes tine’s Persian Healing Pine-Tar Soap.” For
for 60 cents. sale by all Drugyists,

Digtzes ty GOORle

Diatzes ty GOORTe

Digtzes ty GOORTe

~