JNEBRIETY 
 
 A Clinical Treatise on the Etiology, 
 Symptomology, Neurosis, Psy- 
 chosis and Treatment 
 
 MEDICO-LEGAL RELATIONS 
 
 BY 
 
 T. D. CROTHERS, M. D. 
 
 Supt. Walnut Lodge Hospital, Hartford, Conn. 
 
 Editor of the Journal of Inebriety, Author of Morphinism, and 
 Narcomania, Drue Habits and their Treatment, etc.. Record- 
 ing Secretary of the American Medical Society for the 
 Study of Alcohol and Other Narcotics, Member 
 of the American Medical Association, The 
 British Medical Association, Honorable 
 Member of the British Society for 
 the Study of Inebriety, etc., etc. 
 
 1911 
 
 HARVEY PUBLISHING COMPANY 
 
 CINCINNATI, OHIO
 
 u 
 
 COPYBIGHT, 1911 
 BY 
 
 HABVKT PUBLISHING Co.
 
 DEDICATED 
 
 To THE MEMORY OF THE GREAT PIONEER PROPHET, 
 STUDENT AND TEACHER OF INEBRIETY AS A DISEASE, 
 
 DR. JOSEPH EDWARD TURNER, 
 
 who was born in Bath, Maine, October 5, 1822. He was 
 the promoter, founder and superintendent of the first 
 inebriate asylum in the world for the medical care and 
 treatment of inebriates, opened at Binghamton, New York, 
 in 1864. 
 
 For over forty-five years he urged that inebriety was 
 a disease and should be studied and treated the same as 
 any other malady, and that the inebriate was curable by 
 scientific means and measures in special surroundings. 
 
 These facts were maintained with heroic persistency and 
 pressed with martyr-like courage, in season and out of 
 season. He was opposed, condemned and finally driven 
 out of the institution of his own creation, and persecuted 
 as a charlatan up to the time of his death, July 4, 1889. 
 
 This volume is offered as a slight recognition and 
 tribute to the man and his work, who was literally a dis- 
 coverer of a new realm of scientific medicine. 
 
 26427
 
 PREFACE. 
 
 The alcoholic question is positively one of the greatest 
 medical and social science problems confronting the civiliza- 
 tion of to-day. This is clearly evident from the wide- 
 spread efforts and activities of societies, churches, political 
 parties, humanitarians, philanthropists and scientists to 
 overthrow or control the evils from this source; and 
 from the intense interest in the various efforts, ways and 
 means of prevention and cure. 
 
 Every sociological and scientific study of degeneration 
 and disease reveals the magnitude of the alcoholic influence, 
 and its intimate relations to individuals and society, and 
 its destructive effects on the social, hygienic and physio- 
 logical development of the race. 
 
 Inebriety was regarded as a disease centuries ago, long 
 before insanity was thought to be other than a moral dis- 
 order, and yet the studies and literature up to recent times 
 have reversed this. Inebriety is considered a voluntary 
 vice and moral evil, and insanity a disease. 
 
 Notwithstanding the advances of scientific medicine and 
 the studies of mental disease, the theories of moral causa- 
 tion and moral remedies still occupy a prominent place in 
 the discussions of inebriety. 
 
 The purpose of this volume is to group and study the 
 phenomena of inebriety and its varied symptomology from 
 the scientific point of view, and show that the teachings 
 of ages ago are sustained by modern research, and that 
 inebriety is not a moral disorder, but a distinct neurosis 
 and psychosis, preventable and curable by the use of 
 
 physical and psychical means and measures. 
 
 5
 
 6 PREFACE. 
 
 As in other scientific work, the studies must begin with 
 a knowledge of the causes and the conditions which follow 
 and precede inebriety and are dependent on them, and 
 from this data to trace some uniform law of origin, 
 growth and development. 
 
 Statistical data with tables and charts are omitted, 
 because their conclusions are variable and open to sources 
 of error, and of necessity more or less transient and uncer- 
 tain. Experience has shown that a clinical description of 
 cases and studies of the surroundings and conditions 
 suggest a great variety of exciting and predisposing 
 causes that, furnish a wealth of facts for farther and 
 more exact work. 
 
 The studies and conclusions embodied in this volume 
 are the result of a practical experience beginning in 1875 
 as Assistant Physician in the New York State Inebriate 
 Asylum, at Binghamton, New York, and extending from 
 1878 up to the present time as Superintendent of Walnut 
 Lodge Hospital, Hartford, Conn. In addition to this, 
 the work as editor of The Journal of Inebriety, which 
 was first published in 1876, has furnished a somewhat 
 intimate acquaintance with the scientific literature on this 
 subject, both in this country and Europe. 
 
 From this experience with its accumulated data of 
 history of cases, an effort is made to arrange and compare 
 a great variety of facts and their relation to each other, 
 and trace some of the laws which evidently control their 
 movements, confirming the conclusion that inebriety is a 
 disease both preventable and curable from a larger knowl- 
 edge and the use of more exact scientific means and meas- 
 ures. 
 
 The medico-legal relations which center about the 
 inebriate and his conduct have developed many very 
 startling questions of responsibility that are coming into 
 increasing prominence.
 
 PREFACE. 7 
 
 The chapters in this book give an outline of the con- 
 fused theories and teachings concerning the practical 
 relations of crime and the responsibility of the inebriate. 
 The importance of this subject is merely indicated in this 
 work, with the hope that in the near future a more 
 extended study will be given in a separate volume on the 
 practical relations of inebriety and crime and their medico- 
 legal considerations. 
 
 One of the prominent conclusions which the evidence in 
 this work sustains is that inebriety is a disease and its 
 phenomena are controlled by uniform laws, which move 
 with exactness and certainty along lines of origin, develop- 
 ment, decline and extinction ; also that it is possible from 
 a larger knowledge and study of these causes to prevent, 
 cure and stamp out this neurosis with the same certainty 
 as in germ diseases. 
 
 The physiological and chemical action of alcohol on the 
 brain and nervous system has been the subject of many 
 exhaustive studies, and the impression has been encouraged 
 that alcohol is the specific and only cause of inebriety. 
 This, a clinical examination of the history of cases, fails 
 to confirm, but indicates that the use of alcohol is very 
 often a symptom of disease and later it becomes an active 
 cause, hence a specific study of this drug gives only a 
 limited view of the great factors and causative agents of 
 inebriety. 
 
 This work is practically a continuation and more 
 advanced study of the subject so admirably begun by the 
 late Dr. Norman Kerr, of London, England, in his work 
 on "Inebriety and Narcomania," which passed through 
 several editions and is still being sold. It is also 
 intended to make prominent the conclusions from scientific 
 studies, that the entire problem is one of scientific, curative 
 and preventive medicine, which the trained physician is 
 most competent to study and understand. Hence, it is a
 
 8 PREFACE. 
 
 medical topic in which medical men should be students, 
 teachers and authorities in the efforts of cure and pre- 
 vention. 
 
 As an outline view of a great new continent in which 
 the facts presented stand like mountain peaks, leaving 
 wide stretches of undiscovered country, this book is offered 
 for the distinct purpose of creating new interest in a 
 wider and more exact study of the neurosis and psychosis 
 which are called inebriety and alcoholism. 
 
 T. D. CEOTHEES, M. D. 
 HAETFOED, CONN., Jan. 1911.
 
 TABLE OF CONTENTS. 
 
 CHAPTEB. PAGE. 
 
 I. Inebriety as Noted in Modern Civilization 13 
 
 II. The Recognition of Inebriety as a Disease 22 
 
 III. Efforts to Study Inebriety from a Scientific Point of 
 
 View 29 
 
 IV. Forms of Classifications of Inebriety 39 
 
 V. Inebriety in America and its Peculiarities 46 
 
 VI. General Symptomology and Development 55 
 
 VII. Peculiarities of Conduct and Thought Traceable to 
 
 Inebriety 61 
 
 VIII. Periodic Inebriety and its Symptomology 70 
 
 IX. Continuous Drinkers 85 
 
 X. Inebriety in the Form of Moral Insanity 93 
 
 XI. General Causes and Favoring Conditions 105 
 
 XII. Special Causes of Inebriety 117 
 
 XIII. Injuries and Psychosis which Follow from the Toxic 
 
 Use of Spirits 128 
 
 XIV. Heredity and its Influence in the Causation of Ine- 
 
 briety 140 
 
 XV. Some of the Neuroses Following the Inebriety of 
 
 Parents 148 
 
 XVI. Psychic Phenomena of Inebriety Traceable to Heredity.158 
 
 XVII. Pathology of Inebriety 176 
 
 XVIII. Diagnosis of Inebriety 186 
 
 XIX. Prognosis of Inebriety 195 
 
 XX. Delirium Tremens 203 
 
 XXI. First Clinical Examination and Study of the Patient. .217 
 
 XXII. General Principles of Treatment 223 
 
 XXIII. Home and Office Treatment of Inebriates 231 
 
 XXIV. Institutional Treatment of Inebriates 249 
 
 XXV. State Care and Treatment of Inebriates 261 
 
 9
 
 10 
 
 CONTENTS. 
 
 CHAPTER. PAGE. 
 
 XXVI. Treatment by Hot Air, Radiant Light Baths, Vibra- 
 tion and Electric Currents 272 
 
 XXVII. Mental Therapeutics and Suggestion in the Treatment 
 
 of Inebriety 286 
 
 XXVIII. History of the Empiricism Connected with Inebriety. .298 
 XXIX. Criminal Inebriates and Medico-Legal Superstitions . . . 305 
 XXX. Forms of Irresponsibility, Alcoholic Amnesia, Claims 
 
 of Prisoners, etc 317 
 
 XXXI. Medico-Legal Questions of Inebriety 329 
 
 XXXII. Premeditation in Criminal Inebriates 338 
 
 XXXIII. Diseases and Neuroses Associated with Inebriety 345 
 
 Index . ..359
 
 CHAPTER L 
 
 INEBRIETY AS NOTED IN ANCIENT CIVILIZATION. 
 
 Synopsis. Subject discussed eight thousand years ago. Arch- 
 aeological researches of Egyptian Tombs, show that inebriety was 
 a disease in that early day. Papyri found in the tombs describe 
 the disease and its remedy. How these records were preserved. 
 The same strains and unrest produced inebriety. Egypt a land 
 of banqueting and wine and beer as votive gifts to the gods. 
 Great quantities of wine used at religious feasts. People be- 
 came drunk. Efforts to restore them. Beer made at a town 
 called Quede. For centuries this was the great beer producing 
 town. Complaints of writers about the dissipation of the people. 
 Method of making wine and the suppression of the vineyards by 
 a royal edict. Instance of a great battle. Sett'.ed by the use of 
 wine. Priests medical men at that period. Led in the efforts to 
 reform. Theories of the effects of spirits and suicides. Reigning 
 monarchs become total abstainers. Sale of wine and beer pro- 
 hibited. Restrictions concerning intoxicated persons. Poor peo- 
 ple made slaves for excessive drinking. Rich people had their 
 property confiscated from drinking to excess. Edicts that no 
 spirits should be used at times of war. Mummies have Papyri 
 about them showing that they died from the use of liquor. First 
 specialist who treated inebriety as a disease. First homes where 
 people were confined for medical treatment. Inscriptions on the 
 walls of the tombs show methods of treatment. The use of water, 
 purg-at.ives, also the use of opium and salts were prominent 
 remedies. Women drinking to intoxication noted. Pictures of 
 scenes. Researches in Babylon show similar struggles to overcome 
 the use of spirits. Cuneiform inscriptions on bricks dug up at 
 Neppo. Capitol punishment as a remedy. Secret remedies used. 
 Incidents and stories. 
 
 There is something startling in the fact that the al- 
 coholic problem was a subject of intense interest and 
 discussion at least eight thousand years ago. The re- 
 searches of the various archaeological societies, particu- 
 larly in Egypt, among the long buried records in pyra- 
 mids and tombs, the pictures on the walls and the writings 
 on papyri, enclosed in the sarcophagi, show that the 
 di.sca.se of inebriety Avas recognized, and the means of cure 
 and prevention studied at least five thousand years before 
 the Christian era. 
 
 The religion of that ancient civilization decreed that 
 the preservation of the body was necessary in order that 
 
 13
 
 14 INEBRIETY. 
 
 the soul, when it returned, in the long ages to come, 
 should have the same tabernacle to take possession of, 
 that it had vacated at death. For this purpose the body 
 was embalmed, pyramids were built, and temples and 
 tombs were erected to contain the body ; records and in- 
 scriptions, papyrus rolls were inscribed, containing the 
 history of events of the lives of the dead; the political 
 achievements of individuals, and the religious thought and 
 endeavors of sages, thinkers, law-makers, kings and war- 
 riors of that time. 
 
 The climate of Egypt, its warm, dry, drifting sands, 
 moving with every breath of wind, made the country 
 peculiarly fitted to become a vast Valhalla of imperish- 
 able records. At this day miles and miles of tombs, 
 buried deep in the hot sand for long centuries, are yet 
 uncovered. In the records found of the great events oc- 
 curring in the reigns of long lines of Pharaohs, we read 
 of the reforms which they promoted, the edicts they pro- 
 mulgated and note that the life in those far off days was 
 as full of excitement and unrest as ours at the present. 
 The same strain and stress seemed to culminate in the 
 same mental and physical exhaustion, and desire for rest, 
 which characterizes our modern civilization. 
 
 Egypt was a land of banqueting, the celebration of 
 feast days, religious rites, and sacrifices were frequent 
 and wine and beer were the votive gifts made to the 
 gods. These, with great quantities of provisions, were 
 brought to the temple on feast days, and laid on the 
 altars. It was supposed that the spirits of the departed 
 ones came back and partook of the spirits of these foods, 
 after which the remainder was distributed to the priests 
 and temple worshipers. Pliny the Elder tells us that on 
 one occasion ten thousand jugs of beer and five thousand 
 vessels of wine were offered to the gods. On another ac- 
 casion the king donated the product of five hundred vine-
 
 INEBRIETY AS NOTED IN ANCIENT CIVILIZATION. 16 
 
 yards as a special offering. On the tomb of another king, 
 among his great virtues, is mentioned the fact that, dur- 
 ing his reign, he gave for sacrificial purposes an offering 
 of two hundred thousand jars of wine and half a million 
 jugs of beer. After all services, the foods were eaten 
 and the liquor was drunk by the worshipers, and at 
 Memphis a temple was provided with chambers where 
 these offerings could be consumed. 
 
 They were practically religious banquets, and were 
 finally suppressed for the reason that they were consid- 
 ered injurious to the peace and good order of society, 
 and also because they afforded opportunities for plots and 
 intrigues against the government. Another reason was 
 given that both priests and worshipers were made stupid 
 from drink, and often had to be taken home by the slaves, 
 or to the banks of the river and left there to become sober. 
 In their stupid condition they were often robbed by 
 thieves, and then they made complaints to the courts of 
 the wrongs they had suffered. We can believe, in the 
 absence of any direct information, that those far-off 
 judges repeated the same dictum with equal solemnity 
 that we hear in our modern courts, that "drunkenness is 
 no excuse for crime, or the suffering and losses which fol- 
 low." 
 
 A town called Quede seems to have had the monopoly 
 and the reputation of producing the finest beer, and for 
 several centuries it was the "Milwaukee" of that country, 
 and is mentioned frequently. 
 
 Wine was the favorite drink of the people, and on 
 some of the tombs built at least five thousand years before 
 the Christian era, there are descriptions of the method of 
 manufacture, and the different kind of wine used. Many 
 pictures show the process of extracting the juice of the 
 grape, and the various methods of planting and cultivat- 
 ing vineyards. One writer complains of adulteration
 
 16 INEBEIKTY. 
 
 which caused much stupor in the drinker. Palm-tree wine 
 was condemned because of its rapid intoxicating qualities, 
 and beer was thought injurious, because it bloated its 
 victims. Large vases of wine were sealed up and placed 
 in the tombs of the wealthy to give nourishment to the 
 soul, when it came back to look after the body ; these wine 
 jars are found just as they were placed. The wine, of 
 course, long ago disappeared, but many of the jars are 
 covered with descriptions of the manufacture of the wines 
 and the culture of the grapes, as well as other general 
 events of the time. 
 
 One of these vases, now in the British museum, found 
 in the tomb of a monarch, who lived over six thousand 
 years ago, contains the statement that the wine was made 
 from white grapes, and that the king had suppressed the 
 culture of this kind of grapes, save only in the royal vine- 
 yards. It is stated that drinking this kind of wine is 
 never followed by evil results. On another vase is a story 
 of a great battle between the kings of upper and lower 
 Egypt, during which beer from seven thousand jugs, 
 mixed with the blood of prisoners and slaves, was left on 
 the field by one retreating king. The enemy follov.ing, 
 stopped, and drank the beer, and as a result became intox- 
 icated and were easily destroyed. 
 
 While both beer and wine were used to propitiate the 
 gods, as offerings to them, their injurious effects were 
 recognized, and many efforts were made to suppress or 
 limit their use among the common people. The priests, 
 who were the medical men of that period, seem to have led 
 in the efforts for reform. On the tomb of one of them is 
 a prediction that if wines and beers continued to be 
 used by all classes, the nation would be doomed to destruc- 
 tion, and deserted by the gods. Another tomb contains 
 an equally ominous prediction, and declares that a small 
 quantity of wine and beer will clarify the soul, and give
 
 INEBRIETY AS NOTED IN ANCIENT CIVILIZATION. 17 
 
 it greater power in the other world, but if large quan- 
 tities are used, it will stupify and chill the soul, and keep 
 it in a place of torment. On a third tomb the theory of 
 reincarnation is outlined, and the cause of excessive 
 drunkenness in some men is said to be the possession of 
 the spirits of loathsome animals. Another statement de- 
 clares that the victim of the excessive use of liquor, who 
 becomes stupid, falls down and breaks his head, liberates 
 the spirit from the body before the gods want it, and 
 hence is doomed to a long period of punishment. 
 
 From the very earliest records, mention is made of dif- 
 ferent efforts to suppress the excessive use of spirits. 
 When the reigning monarch was a total abstainer, strenu- 
 ous laws were passed forbidding the use of wine, except 
 on special occasions, but when the monarch himself was a 
 drinker, there were few if any restrictions. 
 
 Some of the legal enactments to suppress the use of 
 alcohol and punish the inebriate, have a very modern 
 sound. At one period, the sale of wine and beer was pro- 
 hibited, except in shops on side-streets, away from public 
 observation ; and the dealer paid a tax for the privilege 
 of selling, and was forced to provide clean rooms, with 
 places for persons who became intoxicated ; or he had to 
 take them home at his own expense, particularly after 
 night-fall. Poor people who drank and were boisterous 
 were fined heavily, and often made slaves to the govern- 
 ment until the fines were paid. Rich people who became 
 inebriates had their property confiscated, particularly if 
 they persisted in drinking to excess in public, making 
 themselves disagreeable to others. 
 
 One king boasted that he never lost a battle when he 
 prevented his soldiers from having wine or beer before the 
 engagement. Another statement is made that bread and 
 water are the most powerful stimulants to give soldiers 
 strength and courage on the march. The incident is
 
 18 INEBRIETY. 
 
 mentioned, that after a victorious battle, the king and 
 his army made a great drink offering to the gods. In 
 the midst of their drunken joy and stupor, the enemy re- 
 turned and frightful slaughter followed. Later, an edict 
 was made, that no wines or beers should be given in the 
 campaign, and no vinous offerings to the gods should be 
 used, until the troops had returned home. Wines and 
 beers were kept in the homes of the wealthy, in rooms 
 built for the purpose, where they could be used in secrecy ; 
 and on some of the mummies are papyri indicating that 
 death was due to the use of liquor. 
 
 In one of the tombs there is the statement that the 
 occupant, a priest, was skilled in the treatment of mad- 
 ness following the use of wine. He was, no doubt, one of 
 the first specialists to treat inebriety and the drink disease. 
 On another tomb is the statement that the deceased had 
 built a house, where persons who were made mad from 
 wine and beer were received. This was probably the 
 first inebriate asylum, and dates back five thousand years 
 before the Christian era. 
 
 Another mummy was evidently in life a favorite priest 
 in the family of a drinking king, and the inscription de- 
 scribes his skill and success in his efforts to keep the 
 monarch from drink madness. Numerous pictures and 
 inscriptions on the walls of the tombs refer to the treat- 
 ment of the drink excess, which seems to be confined 
 largely to sobering the victims. These pictures show in- 
 toxicated persons, brought home by their slaves from the 
 temple or banqueting halls ; the efforts made to force 
 fluids into the stomach through funnels, with resultant 
 vomiting; and the giving of enemas, following by purg- 
 ing. 
 
 In many instances, streams of water were poured on the 
 heads and backs of intoxicated persons, while rubbing, 
 kneading, flagellation, and pressing the body, were means
 
 INEBRIETY AS NOTED IN ANCIENT CIVILIZATION. 19 
 
 used to remove the effects of the drink excess. Another 
 picture shows a man covered with a robe, from the open- 
 ings in the folds, vapor is escaping, indicating a steam 
 bath, made by putting hot stones in water. Some of the 
 papyri give accounts of the use of opium and salts as 
 remedies. One contains the description of an injury on 
 the head, which made the victim drink madly. Another 
 speaks of the action of the sun taking away all power of 
 self-control, and leaving the victim a drunkard. All these 
 suggest physical causes. 
 
 Women appear to have drunk as freely as men. Some 
 of the pictures show banqueting halls in which women 
 were clearly intoxicated. The head-dress and robes, 
 falling from the shoulders, show that they were both 
 hilarious and stupid. Later they are vomiting and being 
 carried out by attendants. 
 
 Researches in the ruins and temples of Babylon give 
 distinct intimations of similar battlings with alcohol, dur- 
 ing the civilizations that flourished in the cities of the 
 Euphrates and Tigris valleys. Grapes were cultivated 
 and wine was the common drink. The cuneiform inscrip- 
 tions on the bricks dug up by Neppo, tell the same story 
 of drunkenness and of the efforts to correct it. About 
 the same remedies and means were used to make the vic- 
 tim sober, as were used in Egypt, and some of the bricks 
 contain bills of charges for services rendered on such oc- 
 casions. Dashing cold water over the victim and whip- 
 ping him with brushes were the common remedies. 
 
 One king appeared to have made an offer of great pre- 
 ferment with large sums of money to the courtiers who 
 would abstain from liquor. A certain prince once took 
 the prize and soon after became intoxicated. The king 
 ordered his instant death, and gave his opinion that such 
 a man was unfit to live. On one of the bricks is a state- 
 ment that has a very familiar and modern sound. It
 
 20 INEBRIETY. 
 
 records the fact that a certain priest had discovered a 
 medicine for drink madness which he would sell to any one 
 for a certain sum of money. On another brick it is said, 
 that a priest had given a certain monarch a drug, which 
 prevented him from becoming intoxicated, and yet en- 
 abled him to drink freely. In both of these instances the 
 inference is that these specific drugs were secrets, and 
 were only sold to those who could pay for them. 
 
 The specific discoveries of modern times are antedated 
 by several thousand years, and probably further re- 
 searches may tell us more of the wonderful remedies used 
 in those old days. There were saloons and wine shops in 
 ancient Babylon, and men who drank to excess were pun- 
 ished by whipping or enslavement. Although these 
 records are fragmentary and broken, they give abundant 
 evidence that inebriety as a disease attracted attention 
 and was a vital study, and that many of the physical 
 causes were understood. No doubt further researches 
 will supplement this evidence. 
 
 Our struggles with the alcoholic evil, our methods of 
 license and prohibition, are mere repetitions of the earlier 
 attempts made in the dawning of civilization to deal with 
 the self-same curse. Many of the early Grecian writers 
 on this subject made reference to ancient Egyptian lit- 
 erature. One of these references is given by Theo- 
 phrastus, a Grecian philosopher, describing the sickness 
 caused by wine, and the medicine used to cure it. This 
 was taken from an old papyrus, and is stated as we would 
 at present give the history of a clinical case illustrating 
 some fact or theory. The following is a rough transla- 
 tion. The wife of a certain king in Egypt, having drunk 
 a large quantity of Cretan wine, became immoderately 
 mad, and strangely affectionate, embracing and kissing 
 every man she met ; from laughing and singing she be- 
 came angry and quarrelsome and wanted to strike every-
 
 INEBRIETY AS NOTED IN ANCIENT CIVILIZATION. 21 
 
 body. She was violent and suspicious of everything; 
 everybody in the house was frightened, and took great 
 precautions to avoid coming in contact with her. Then 
 sorrowful and lamenting, she prayed to her dead relatives 
 and friends in plaintive songs. She was then overcome 
 by sleep, during which she snored loudly. On awakening, 
 spirits of antimony were given, and water poured over 
 her head and body, followed by inunctions of oil, after 
 which she recovered. This very clear description of an 
 attack of acute intoxication was no doubt made the text 
 for an elaborate thesis, which is lost. 
 
 Galen, one of the early Grecian physicians, describes 
 some remedies for the disease which follows the use of 
 wine. He divides the remedies into two classes, and does 
 not state what they are, but gives a theory of their action 
 in some detail. The first remedies were to be used before 
 the wine, the object of which was to prevent its fumes 
 from rising upward and affecting the brain. The second 
 remedy was to be used after the stupor and debauch, to 
 drive out the fumes of wine by the bowels and kidneys. 
 These and other very quaint references show that the 
 treatment of inebriety was very seriously considered in 
 those early days.
 
 CHAPTER II. 
 
 THE RECOGNITION OF INEBRIETY AS A DISEASE. 
 
 Synopglg. Herodotus wrote of inebriety, calling it a "Drink 
 Madness." Many philosophers insisted that inebriety was inher- 
 ited and laws were passed forbidding women and boys to use 
 wine. Severe restrictions enforced to produce total abstinence. 
 Inebriety likened to dyspepsia in the first century of the Christian 
 Era. Ulpian a Roman Jurist commented on the disease and its 
 legal remedies. Laws were passed providing that murders com- 
 mitted during intoxication should be remitted because of disease. 
 Drunkenness and Madness considered synonymous. Condillac's 
 views. Dr. Hush's teaching's. Cabanis' book on Inebriety. Sal- 
 vator's work on Inebriety, its Pathology and Treatment. Other 
 authors who wrote freely on this subject. Dr. Todd's lecture on 
 The Need of Inebriate Asylums. The literature on this subject 
 and its cold reception. The English Lunacy Commissions and its 
 Reports in 1844. The influence of the Washingtonian Movement in 
 1840. Work of Dr. Turner, beginning in 1846. The first asylum 
 opened at Binghamton, N. Y. in 1864. The first medical society to 
 take up this subject in 1870. The first Journal published devoted 
 to this subject in 1876. Other Journals published. The Interna- 
 tional Congress on Inebriety in 1887. The s'ow recognition of 
 the subject and the laws which govern its growth. Difficulties 
 which the study encountered. 
 
 Among the many references to inebriety in the Greek 
 literature was that of Herodotus, who wrote in the fifth 
 century before the Christian era. He asserted that drunk- 
 enness was a madness and sickness of both soul and body, 
 which could be overcome by proper remedies and methods. 
 Diodorus and Plutarch also declared that the drink 
 madness was an affection of the body, which had not only 
 destroyed kings and nobles, but had done infinite damage 
 to the world, and they followed these statements with sug- 
 gestions of how to correct and remove these maladies. 
 
 For several centuries the physical causes of inebriety 
 were recognized by the Greek philosophers, who insisted 
 upon the tendency of this affliction to transmit itself to 
 the next generation. At different times laws recognizing 
 
 this evil were passed, forbidding women and boys to use 
 22
 
 THE RECOGNITION OF INEBRIETY AS A DISEASE. 28 
 
 wine. Frequent reference was made to the madness which 
 sought solace in wines and liquors, and in Spartan times 
 very severe restrictions were enacted against the use of 
 liquors during athletic training, and urgent council given 
 to abstain from wine when any great work was to be done. 
 
 In the first century of this Christian era, St. John 
 Chrysostom urged that drunkenness was like dyspepsia, 
 and was a physical madness, which could be prevented, 
 and should be treated as any other ailment. In the next 
 century Ulpian, the Roman jurist, referred to the irre- 
 sponsible character of inebriates, and the wisdom and 
 necessity of treating them as sick men. His views were 
 embodied in several laws, which clearly distinguished the 
 physical nature, and need of physical treatment of such 
 cases. Ulpian's commentaries on Roman laws contain 
 many references to these enactments. The literature of 
 Roman civilization affords abundant evidence that drunk- 
 enness was recognized as a bodily disorder often uncon- 
 trollable, and frequently resulting in veritable madness. 
 
 In the 13th century, one of the kings of Spain enacted 
 laws recognizing inebriety as a disease, lessening the pun- 
 ishment of the crime committed while under the influence 
 of spirits. One of these laws provided that when murder 
 was committed during intoxication, the death penalty 
 should be remitted, and the prisoner be banished to some 
 island for a period not less than six years. In the six- 
 teenth century the penal codes of France and many of the 
 German states contained enactments which recognized the 
 disease basis of inebriety. All punishment for crimes 
 committed during these states varied according to the con- 
 ditions of the prisoner at the time. Drunkenness con- 
 tinued beyond a certain point, was regarded as a condition 
 of insanity and irresponsibility. In many of the medical 
 writings of the age, drunkenness and madness were men-
 
 24 INEBRIETY. 
 
 tioned as synonymous, and curious ideas concerning the 
 nature and treatment of the evils are recorded. 
 
 In 1745, Condillac, a French philosopher, wrote, ex- 
 pressing clear views of the disease of inebriety, also that 
 the state should recognize and provide means for its treat- 
 ment. He asserted that the impulse to drink was like in- 
 sanity, an affection of the brain which could not be 
 reached by law or religion. Dr. Benjamin Rush, of 
 Philadelphia, in his lectures given in 1790, set forth the 
 same theory, supported by a long train of reasoning. 
 To him belongs the honor of first elaborating and out- 
 lining ideas which were accepted half a century later. 
 In two essays entitled "The Influence of Physical Causes 
 Upon Moral Faculties" and "An Inquiry into the Effects 
 of Ardent Spirits upon the Human Body and Mind," he 
 described the disease of inebriety, dividing it into acute 
 and chronic forms, giving many of the causes, of which 
 heredity was a prominent one; also urging that special 
 measures be taken in the treatment, which should be in a 
 hospital for the purpose. At this time his views were 
 clear and distinctive, although they were not published in 
 book form until 1809. They were entirely independent 
 of all previous observations. In 1802 Dr. Cabanis, of 
 Paris, wrote fully endorsing the views of Condillac, that 
 inebriety, like insanity, was a disease that should be 
 studied, and that it was a distinct form of mental dis- 
 order, needing medical care and treatment. Professor 
 Platner, of Leipsic, published a paper in 1809 (the same 
 year Rush's writings appeared), affirming that inebriety 
 was like an insane impulse and a form of insanity which 
 should receive medical care and be studied by the aid of 
 science. In 1817 Salvator, of Moscow, a physician of 
 some eminence, published a pamphlet entitled "Ebriosity, 
 its Pathology and Treatment." He divided drunkenness 
 into two forms, remittent and intermittent, and urged that
 
 THE RECOGNITION OF INEBRIETY AS A DISEASE. 25 
 
 they be treated by physical means. Esquirol, in 1818, 
 described a condition of the nervous system which caused 
 inebriety. In 1822, Buhl Cramner, a distinguished phy- 
 sician of Berlin, wrote a small book defining inebriety as a 
 state of irritation of the brain and nervous system, to be 
 cured by physical means, because it was purely of physical 
 origin. In Europe the writing of these four men, Platner, 
 Salvator, Esquirol and Cramner, placed the subject on a 
 scientific basis, paving the way for a wider and more 
 thorough study. Although Dr. Rush had written on the 
 general subject more definitely than the others, yet his 
 writings were practically unknown. 
 
 Dr. Eli Todd, superintendent of the Hartford Retreat 
 for the Insane, began to urge in 1828 that the inebriate 
 be treated as insane. This was taken up by a committee 
 of the Connecticut State Medical Society in 1830, which 
 reported on the necessity of an asylum for the medical 
 care and treatment of inebriates. They recommended in 
 an elaborate essay that it was expedient to establish such 
 an asylum for the cure of inebriates. This report was 
 written by Dr. Todd, and was a strong plea for the recog- 
 nition of inebriety as a disease, and of its curability by 
 physical means. This report was published in the trans- 
 actions of the Connecticut State Medical Society and is 
 remarkable for its clear conception of the subject, so far 
 beyond the current opinions of that time. In 1833 Dr. 
 Woodard, of Worcester, Mass., in his yearly report, 
 urged that inebriety is a disease, and curable as other 
 diseases in asylums for this purpose. This called new 
 attention to the subject and was the beginning of a liter- 
 ature which has attained much prominence, especially in 
 this country. In 1839, Dr. Roesch, of Tubingen, in a 
 volume on "Spirituous Liquors," urged that inebriety be 
 considered a disease. He elaborated the idea and pointed 
 out the errors of other authors at some length. The
 
 26 INEBRIETY. 
 
 English Lunacy Commission in their report in 1844 urged 
 that inebriates should be regarded as insane, sent to asy- 
 lums for treatment, and not punished as before. Dr. 
 Nassc, of Boon, followed, urging the same view, in a 
 pamphlet which was widely circulated. 
 
 Despite the weight and authority of these scientific 
 men, their views attracted little or no attention ; if noticed 
 it was with derision and scorn. Although the Washing- 
 tonian movement of 1840 brought the matter of inebriety 
 into great prominence, the interest was ephemeral, and 
 soon forgotten. Yet the records were important, for the 
 men inaugurated a new movement, and gave the world a 
 clearer conception of the cause of alcoholism, started the 
 modern scientific medical men in their search for the 
 causes of the drink evil in the weakened or diseased con- 
 dition of those who became its victims. 
 
 Therefore, in 1846, Dr. J. Edward Turner, of Maine, 
 began a most enthusiastic effort to found an inebriate 
 asylum for the physical care and treatment of this class. 
 By herculean efforts against great opposition, he suc- 
 ceeded in founding an asylum at Binghamton, New York. 
 In 1864, twenty years later, it was changed to an insane 
 asylum. The history of this work will appear in another 
 chapter. In 1870 a medical society was formed, which 
 still continues its work in the study of this subject, and 
 in 1876 the Journal of Inebriety was first published as its 
 organ. In 1884 a kindred society with a like purpose 
 was established in London. 
 
 In 1887 an international congress was held in London, 
 in which leading men from all parts of the world met and 
 read papers demonstrating the progress in the study of 
 the physical causes of this subject. The growth of the 
 theory of inebriety being a disease, and its practical 
 recognition in the last century, will be traced in the next 
 chapter, but at this point it will be interesting to notice
 
 THE RECOGNITION OF INEBRIETY AS A DISEASE. 27 
 
 the fact that this great subject is traveling identically the 
 same path, with the same history that has marked the 
 progress of every great scientific truth. First a period 
 of denial, indifference, want of recognition and general 
 skepticism ; the world practically deaf to all statements 
 made, the advocates treated with contempt, their claims 
 denied, with contemptuous pity for their ignorance. 
 They are greeted with opprobrious terms, called cranks, 
 enthusiasts, and persons pursuing a visionary project 
 without merit or reality. Now, the second stage is the 
 opposite of the first, that of credulous acceptance, and 
 extravagant recognition and endorsement of the claims 
 made. This is the era of charlatanism, where quacks rush 
 in and take advantage of public credulity and expecta- 
 tion, exploiting the facts in the most extravagant way, 
 and turning them to personal advantage, claiming im- 
 possible results, and filling the air with wild statements of 
 discoveries and realities undreamed of before. Then 
 conies a reaction, and a third stage follows ; that of 
 critical inquiry into, and recognition of, the facts and 
 their meaning, that of the application of rational means 
 and of the full development of the subject, along lines 
 of exact science. This law of movement is illustrated in 
 the discovery of new countries, where the first reports of 
 its wealth and fertility are treated with skeptical indif- 
 ference for a time. Then comes the squatter period, of 
 persons who move in, establish towns and make the most 
 extravagant assertions about its richness and value. They 
 are called the boomers. After a few years they sell out 
 and disappear and the actual settlers arrive. 
 
 They occupy the lands and develop its resources along 
 rational normal lines. Almost every territory and new 
 country has passed through these stages, particularly in 
 the far West.
 
 8 INEBRIETY. 
 
 The claim that inebriety is a disease has passed its first 
 stage of indifference and denial. The second stage of 
 credulity has come and nearly passed away, and now the 
 third stage of critical study and scientific recognition of 
 the facts and their meaning is at hand. Back of this uni- 
 form order of events so common in the evolutionary 
 growth of truth, is another factor which is not well recog- 
 nized, namely, the intensity of American civilization, and 
 the practical demand that theories and practice shall cor- 
 respond and not antagonize each other. The question 
 now is, if inebriety is only a vice and moral lapse in the 
 progress of man, why are not the measures used to over- 
 come this condition successful? Why are not the tre- 
 mendous influences at work in church and state more 
 effectual in checking its growth? If it is a disease in- 
 cident to, and a part of, modern civilization, then the 
 question of its recognition would seem to afford the only 
 promise of relief. It is these facts that force themselves 
 before the public, demanding examination and scientific 
 study, that must be answered before any clear conception 
 can be had of the present conditions.
 
 CHAPTER III. 
 
 EFFORTS TO STUDY INEBRIETY FROM A SCIENTIFIC 
 POINT OF VIEW. 
 
 Synopsis. Assertions that inebriety is a disease bitterly dis- 
 puted. Insanity thought to be the possession of the devil, while 
 inebriety was recognized as a disease at that time. Washingtonian 
 Movement of 1840 destroyed many old theories. Physical means 
 for cure came into prominence at this time. Literature on in- 
 ebriety opposed. This opposition brought it into prominence. Dr. 
 Turner's efforts. The inebriate asylum at Binghamton attracted 
 great attention. Resulted in a new discussion of the subject. 
 Other efforts disputed gave renewed prominence. Other insti- 
 tutions opened and were the center of credulity and opposition. 
 First medical society and the first journal increased the agita- 
 tion and discussion of the subject. The early books and their 
 influence. Early pioneers and their work. Differences of opinion. 
 The first Congress on the subject. The combination of two soci- 
 eties in this country. Various controversies and assertions which 
 were disputed. Some curious theories. The last two congresses 
 against the use of alcohol and their influence. 
 
 The assertion that inebriety is always a voluntary vice 
 and a moral disorder, particularly in the first stages, and 
 that the disease theory is untrue, materialistic, and un- 
 sound, is urged by persons with little practical knowledge 
 of the subject. Much controversy has arisen and many 
 books have been written on this phase of the subject; but 
 latterly all are so modified, and the former theories de- 
 fended so very feebly that they appear like echoes from 
 the past. 
 
 It is a curious fact that the theory that inebriety is a 
 disease was advanced and defended in many scientific cir- 
 cles and by many eminent men, long before insanity was 
 considered anything more than spiritual madness, or a 
 possession of the devil. 
 
 In the second century of the Christian era, drunkenness 
 was believed to be a disease, while insanity was thought to 
 be a mere possession by evil spirits. Then these theories 
 
 29
 
 SO INEBRIETY. 
 
 died away, and the "vice" explanation of drunkenness 
 came into prominence. During the last half century the 
 disease theory of inebriety has been urged and denied 
 with great intensity; and in the sharp reaction of extrav- 
 agant credulity, quack specifics and gold cures were ad- 
 vocated; now the subject is coming up to the level of 
 exact study and scientific inquiry. 
 
 The Washingtonian movement of 1840, in which more 
 than five million persons were pledged to a life of total 
 abstinence, was a great clearing house movement, break- 
 ing up old theories and giving new ideas of the nature 
 and character of inebriety. It was literally a sudden and 
 intense projection of the ideas of the moral side of inebri- 
 ety, into public thought, and while it reacted when the 
 reform wave died out, it served to mobilize and concen- 
 trate public attention upon the question, of how far the 
 inebriate could control his malady, and what efforts were 
 needed to enable him to live temperately. This first 
 practical effort to settle these questions was the beginning 
 of the organization of lodging houses for the members of 
 the societies who had failed to carry out the pledges which 
 they had made. This was really the beginning of the hos- 
 pital system of cure, and was the first means used to give 
 practical help to the inebriate, in a proper home, with 
 protection, until he was able to go out, with a degree of 
 health and hope of restoration. 
 
 One of these lodging houses, established in Boston, 
 Mass., in 1857, has grown into the Washingtonian Home 
 of the present day, and is one of the first and oldest insti- 
 tutions in the world for the physical care of inebriates. 
 During half a century this institution has treated 
 thousands of patients and is literally the pioneer in the 
 physical care and treatment of inebriates. In 1846, Dr. 
 J. Edward Turner, a physician of Bath, Maine, became 
 interested in an effort to found and build an institution
 
 EFFORTS TO STUDY INEBBTETY. 31 
 
 for inebriates. His idea was to establish an asylum in the 
 country, where they could be treated as suffering from 
 physical disease, and where suitable surroundings and 
 proper remedies could be applied to break up and destroy 
 the malady. Each inebriate was to be recognized as dis- 
 eased and sick, requiring first, physical restraint and con- 
 trol, and then forced to live a rational and normal life 
 and be treated with remedies that would help to bring 
 about full restoration. All questions of pledges, will- 
 power, and moral suasion were to be put aside and the 
 patient was treated as a semi-lunatic, or border-land in- 
 sane man. For eighteen years he pressed this idea with a 
 reformer's zeal and energy, preaching the one doctrine 
 that inebriety was a disease, and curable by wise treat- 
 ment in an institution, with a singleness of purpose and 
 zeal, which resembled the work of the old martyrs. The 
 opposition which he met was very intense, particularly 
 from religious and other societies. It was urged that it 
 was sacrilege to attempt by physical means to remedy a 
 condition which only spiritual measures could reach. To 
 others it seemed foolishness to assume that drunkenness 
 was a disease and by this means excuse vice and immoral- 
 ity, and lessen the degree of personal responsibility. 
 
 Notwithstanding all this opposition a large amount of 
 money was raised, and in 1864 a magnificent building at 
 Binghamton, N. Y., was opened for the reception of 
 patients. It was managed by a company of which the 
 famous surgeon, Dr. Valentine Mott, of New York, was 
 president. Laws were passed incorporating it among the 
 public institutions of the state, and giving it power to 
 control its inmates. An army of chronic and degenerate 
 inebriates were sent to this institution with most extrava- 
 gant expectations, and soon after, they began to form 
 centers of opposition among themselves and friction with 
 the management arose. They objected to the restraint
 
 82 INEBRIETY. 
 
 and to other measures, insisted on having full liberty, and 
 denied that there was any disease. This increased the 
 difficulties of successful treatment. The board of trustees 
 became involved and a most bitter acrimonious controversy 
 followed. As a result, Dr. Turner, the founder, was 
 forced to leave, and the institution was placed in the care 
 of the State of New York, and soon passed into the hands 
 of managing politicians. 
 
 Its history from that time to 1889 was a succession of 
 changes, experiments and unscientific efforts, to care for 
 and restore the inebriate. Dr. Turner, who had literally 
 organized and built the institution, giving over a quarter 
 of a century of his time and his own personal fortune, 
 shared the fate of most reformers and benefactors of the 
 world in being driven out from the creation of his own 
 genius. A few years after he wrote a book entitled "The 
 History of the First Inebriate Asylum in the World," * 
 in which the story of this controversy and the injustice 
 and wrong which centered about it, is described.! 
 
 After nearly twenty years of controversy the state 
 changed this institution into a hospital for the chronic 
 insane. During the time it was used for the care of in- 
 ebriates, nine different physicians were superintendents, 
 and each one attempted to solve and treat one of the most 
 difficult and complex neuroses without previous training or 
 experience. Of the three thousand or more patients under 
 treatment during that period, the vast majority repre- 
 sented the most difficult chronic cases, and yet the results 
 of the treatment was a matter of astonishment, details of 
 
 * Copies of this book can be had from Dr. T. D. Crothers, of 
 Hartford, Conn. 
 
 t The American Medical Society for the Study of Alcohol and 
 other Narcotics erected a monument over the grave of Dr. Turner, 
 at "Wilton, Conn., October 27, 1909. Commemorative addresses were 
 delivered by Doctors L. D. Mason. H. O. Marcy, T. D. Crothers, and 
 others. This will be embodied in a memorial volume in the future.
 
 EFFORTS TO STUDY INEBRIETY. 33 
 
 which will appear in another chapter. Binghamton, as 
 a pioneer hospital, roused intense interest by the oppo- 
 sition, as well as the most extravagant endorsement of 
 its friends. Both skepticism and credulity rushed to 
 conclusions in regard to the work and its possibilities, 
 ignoring the fact of the magnitude of the subject and the 
 necessity for years of exact study and observation, neces- 
 sary to understand and treat the inebriate. The organ- 
 ization of this hospital was followed by over a dozen 
 different institutions with a similar purpose. With the 
 exception of one or two they have all disappeared. 
 
 In 1870, a number of the superintendents of these hos- 
 pitals and physicians interested in the physical study of 
 the subject organized a society called The Association for 
 the Study of Inebriety. This has held annual and semi- 
 annual meetings up to the present time, at which the 
 literature and the general study of the subject has been 
 the special purpose. Its papers and work were very 
 severely criticized at first, but the criticism served only to 
 bring the work into greater prominence. In 1876 this 
 association established a journal called the Quarterly 
 Journal of Inebriety, which has been published regularly 
 from that time on. It has been the medium through 
 which all the principal studies of the subject have been 
 published. Like the society it has been bitterly con- 
 demned, particularly by the religious press, and even the 
 medical press have looked down upon its work as un- 
 worthy of scientific notice. Strangely, from the first, it 
 was more warmly welcomed abroad than at home. Many 
 of its articles translated into foreign languages have had 
 great influence in changing public sentiment concerning 
 the inebriate. 
 
 In 1884, a similar society for the study of inebriety 
 was formed in England, with the late Dr. Kerr as presi- 
 dent. This society has been very influential and its regular
 
 34 INEBRIETY. 
 
 meetings in London attract much attention by the reading 
 and discussion of most excellent papers. Societies of 
 similar character, giving greater prominence to the action 
 of alcohol, have been formed in France, Germany, Switz- 
 erland, Sweden, and Spain. 
 
 In 1887, an international congress was held in London 
 for the discussion of the disease of inebriety, and the 
 means of its prevention and cure. Delegates from Amer- 
 ica and most of the countries of Europe were present. 
 The papers and discussions were published and created a 
 widespread interest. 
 
 In 1902, the English society established The British 
 Journal of Inebriety as its organ, and for the publication 
 of its transactions. It will thus be seen that the public 
 efforts to study this subject from a scientific point of 
 view, particularly through societies and journals, have 
 been constantly growing. 
 
 The change of the Binghamton hospital to one for the 
 care of the insane, was regarded at the time as a serious 
 misfortune, but recent events have shown that public 
 sentiment was not far enough advanced to recognize its 
 real work, or to support it, and that its management by 
 politicians and non-experts would only increase the diffi- 
 culties. Other institutions, based on special theories of 
 what inebriety is or is not, have failed to stand the test of 
 experiment and so, after a time, were abandoned. Had 
 these early institutions been managed by scientific men 
 and students, and the chronic condition of the inmates 
 been recognized and had they received the support of 
 the public, and full legal power of control, very dif- 
 ferent results would have followed. 
 
 Notwithstanding all these difficulties, the number of 
 persons restored and the bitter experience gained, in- 
 dicated great possibilities from a clearer knowledge and a 
 more perfect organization.
 
 EFFORTS TO STUDY INEBRIETY. 35 
 
 Many of the early members of the Association for the 
 Study of Inebriety, published books in addition to their 
 contributions to the Journal. Dr. Albert Day, superin- 
 tendent of the Washingtonian home at Boston for thirty 
 years, issued one of the earliest books, called "Metho- 
 mania" ; describing clearly the disease of drinking and 
 pointing out the possibilities of cure. Later Dr. Joseph 
 Parish, who was for a long time superintendent of. in- 
 ebriate homes near Baltimore and Philadelphia, issued a 
 book called "Alcoholic Inebriety," which gave a very 
 suggestive idea of the disease and its treatment. Later 
 Dr. T. L. Wright, of Belief ontaine, Ohio, published a 
 very philosophic book called "Inebriasm," which was 
 widely read and added much to the subject. Dr. Willard 
 Parker, of New York, and Dr. T. L. Mason, of Brook- 
 lyn, both wrote excellent monographs on inebriety, which 
 were widely read at the time. In 1893, Dr. Norman 
 Kerr, an honorary member of the Association wrote a 
 text-book, called "Inebriety and Narcomania." This has 
 been the leading text-book and is the most widely circu- 
 lated and influential volume on the subject. In 1893 the 
 secretary of the Association for the Study of Inebriety 
 compiled papers, which had appeared in the Journal, and 
 published them in a volume entitled "The Disease of In- 
 ebriety." This work has been largely circulated. In 
 1901 the writer issued a small volume on "Drink Habits" 
 and the same year a larger volume on "Morphinism," 
 both of which have been widely read. 
 
 Abroad, among the honorary members of this Associa- 
 tion, M. Magnan, of Paris, France, issued a large volume 
 on "Alcoholism." Dr. Lentz, of Brussels, published a 
 volume on "The Manifestations of Alcohol." Dr. Baer, 
 of Berlin, issued a volume called "Alcohol as a Malady." 
 These were large voluminous works and were followed by
 
 36 INEBRIETY. 
 
 a number of smaller works, giving great prominence to 
 different phases of the subject. 
 
 All the foreign books made alcohol and its effects on 
 the body the most prominent topics. The American works 
 consider the disease and the etiological conditions of most 
 interest. The claims of the Society for the Study of In- 
 ebriety, that the desire for alcohol is a symptom of con- 
 ditions springing from many causes, has been practically 
 ignored in most of the discussions on the general subject. 
 
 Both in England and this country, the two societies for 
 the study of the effects of alcohol have roused very intense 
 controversies, into which laymen and reformers have 
 joined with great eagerness. As a result, a large litera- 
 ture has been accumulated, out of which many new facts 
 have been evolved, and old theories have been put aside. 
 In another chapter some of the conclusions will be given, 
 which the new studies of alcohol from a scientific point of 
 view have made clear. 
 
 The theory that alcohol is a stimulant and tonic, and 
 has some food value, is replaced by evidence of its par- 
 alyzing narcotic action on both cells and nerves. The 
 peculiar palsy resulting, is found to be very general, and 
 to extend to the next generation, appearing in various 
 defects and complex degenerations ; and this is striking 
 confirmation of the disease theory. 
 
 The Society for the Study of Inebriety has warmly 
 welcomed these special alcoholic studies, and most of its 
 members took an active part in the work of the Medical 
 Temperance Association. This was formed in 1891 un- 
 der the presidency of the late Dr. N. S. Davis of Chi- 
 cago. This new association held its meetings at the same 
 time and place as the American Medical Association. Its 
 papers were largely confined to the effects of alcohol in 
 health and disease, and were published in a journal of its
 
 EFFORTS TO STUDY INEBRIETY. 37 
 
 The work of this new association attracted a great deal 
 of attention, stimulating new researches and assisting in 
 breaking up the old theories and notions of the physio- 
 logical action of alcohol. 
 
 Within the last few years, many of the medical jour- 
 nals have taken up the alcoholic problem in a controversial 
 spirit; generally to condemn the advocates of its narcotic 
 action, and support some of the theories of the past; or 
 to explain what seems to them the scientific side of the 
 subject. Thus in the year 1907 nearly one hundred edi- 
 torials, papers and addresses, on the various phases of 
 the alcoholic subject, appeared in the medical press of this 
 country and Canada.* 
 
 The two societies, The Association for the Study of 
 Inebriety and The Medical Temperance Association were 
 clearly occupying the same ground, the one given prom- 
 inence to the disease of inebriety and the other the physi- 
 ological and pathological effects of alcohol. It was 
 thought wise that the societies should unite, and this was 
 accomplished in 1904 and the name of the combined soci- 
 eties is The American Association for the Study of Al- 
 cohol and Other Narcotics. 
 
 The old society for the study of inebriety started from 
 the inebriate and went back to the causes of his malady 
 and the best means of controlling it. The new combined 
 society adds to this the study of alcohol and other nar- 
 cotics, and traces their effects on individuals and society, 
 pointing out the influences that are inherited and their 
 relation to the psychosis and neurosis of inebriety. This, 
 while not a new point of view, is a broader one, and seeks 
 an explanation of why, in inebriety, the desire for spirits 
 both precedes and follows its use. 
 
 The controversy over the physiological action of al- 
 cohol becomes a general question, not only to be settled 
 in the laboratory, but from clinical study at the bedside 
 
 * See note on p. 38.
 
 38 INEBRIETY. 
 
 and in institutional care. What the particular effects are 
 on the organism, and what contributing causes provoke 
 its use and lead up to the profound degenerations, are the 
 fields to be explored and traced. The International Anti- 
 Alcoholic Congress held at Stockholm in July, 1907, gave 
 unmistakable evidence of the recognition of a new era of 
 the scientific study of the problem. 
 
 The various meetings of the friends of temperance, 
 called congresses, held in different parts of Europe for 
 over a quarter of a century, have been devoted to the 
 moral and hygienic side of the subject. Few scientific 
 papers were presented, and the whole subject was consid- 
 ered a great educational, moral problem. The Swedish 
 government, by inviting all the countries of the civilized 
 world to participate in this congress, gave expression to 
 the sentiment, which has been growing for years, that in- 
 ebriety and the alcoholic problem must be studied from 
 the scientific side, and that it was a question of facts and 
 their meaning, not of old theories and prejudices, which 
 have prevailed too long. 
 
 The congress held in 1909, in London, brought out 
 this fact more prominently than ever, and indicated that 
 the scientific study of the subject precedes every other 
 consideration. There can be no question that work in this 
 direction will indicate means and measures for effectually 
 stamping out inebriety, and preventing the evils which 
 follow from it, as is done in other diseases. 
 
 Note. Two works which have a very marked Influence in 
 popular scientific literature should be mentioned as most sug- 
 gestive studies along allied lines, viz.: Alcohol and the Human 
 Body by Sir Victor Horsley and Dr. Sturgis and the Psychology 
 of Inebriety by Rev. Dr. Geo. B. Cutten. These are most com- 
 mendable scientific works.
 
 CHAPTER IV. 
 FORMS AND CLASSIFICATIONS OF INEBRIETY. 
 
 Synopsis. The term inebriety and alcoholism. What they 
 mean. Illustrations of their meaning. The conditions present. 
 Effects of spirits on healthy persons. The neurosis and psychosis. 
 Three general classes of inebriates. First, with a long preliminary 
 period of drinking. Second, persons who use spirits irregularly. 
 Illustrations. Third, periodic drinker. The impulsiveness of their 
 use of spirits, resembling insanity. Illustrations. The influence 
 of saloons developing this class. States of degeneracy from 
 heredity. The psychopathic inebriate. Influence of tuberculosis. 
 General paralysis. Class of inebriates following injuries. Per- 
 sons who take spirits for intoxication. Inebriates with obsessions 
 and insane impulses. Inebriates with criminal impulses. Their 
 treatment in the police court. Delusional drinkers. Magnan's 
 classification. Other efforts to arrange them in classes. Associa- 
 tions with dyspepsia. Illustrations. General considerations. 
 
 The term inebriety appears to be the most accurate in 
 describing the continuous or occasional impulse or crav- 
 ing for spirits or drugs. The late Dr. Norman Kerr 
 called it narcomania, a desire or impulse for relief from 
 discomfort, unrest and pain. 
 
 Alcoholism means accurately, a state of poisoning by 
 alcohol and some special conditions due to this toxic state. 
 Inebriety includes this and indicates earlier and more 
 pronounced active causes. Thus, a man previously temper- 
 ate is injured, and suffers from shock or some obscure 
 injury, and without any preliminary use of spirits, be- 
 comes an inebriate at once. Such a person could not be 
 strictly called an alcoholic. If he began the use of spirits 
 in great moderation at first, and then gradually increased 
 up to a time when he became evidently poisoned from its 
 effects, the term "alcoholism" would properly describe his 
 condition. Both of these terms "inebriety" and "alcohol- 
 ism" represent degrees of neurosis and psychosis at the 
 beginning. 
 
 39
 
 40 INEBRIETY. 
 
 Probably two conditions, namely, brain instability and 
 hypersensitivcness to pain are more commonly present 
 than any other. Where spirits are used in small quan- 
 tities, by persons previously healthy, a demand will be 
 created for their increased and continued use. This is a 
 pathological hint of states of depression and deranged 
 functions which call for relief, found most readily in the 
 narcotism of alcohol. 
 
 There are innumerable classes of drinkers, and the 
 effort to divide them is beset with difficulties, for the 
 reason that the causes of the desire for spirits and the 
 resistance of the body to spirits are at present largely 
 unknown. Practically three general classes are apparent 
 in a general study. First, those who have a long prelim- 
 inary period of moderate drinking; beginning with cider, 
 beer, wine and then later taking stronger spirits and using 
 the latter to great excess at times ; there appears in this a 
 gradual growth and cultivation of the drink impulse. 
 Second, persons who use spirits infrequently and become 
 intoxicated ; the causes are usually accidental, and the 
 effects may be usually pleasant or the opposite. If the 
 intoxication is the culmination of some physical or mental 
 condition of excitement or depression, the recurrence of 
 these conditions will suggest and stimulate the use of 
 spirits up to the point of stupor, as upon former occa- 
 sions. Thus a number of persons, who are total abstain- 
 ers in all other conditions of life, drink to excess at some 
 special times or upon certain occasions. One man never 
 drinks, except at the seashore ; another only drinks on the 
 occasion of some great sorrow or death in his family, and 
 then abstains, until another similar event occurs. A num- 
 ber of old soldiers are perfectly temperate at all other 
 times, but on occasions of army reunions, when they are 
 frequently intoxicated. The drink craze is uncertain, 
 and due to special exciting causes, which are largely un-
 
 FORMS AND CLASSIFICATIONS OF INEBRIETY. 41 
 
 known. A third class may be called "periodic drinkers," 
 who, at times, drink to great excess, with or without 
 any apparent cause, irrespective of conditions or circum- 
 stances ; their distinct drink storms resemble epilepsy ; 
 after the narcotism of the drink has died out, they be- 
 come total abstainers and have free intervals of indefinite 
 length. The first class are the trained and cultivated in- 
 ebriates. The second are the unknown, erratic, explosive 
 inebriates, and are the most mysterious and unexplain- 
 able. 
 
 Often the person will give elaborate explanations of his 
 condition, describing it as the result of certain special 
 causes, but like the third class, it may terminate abruptly 
 when the system becomes saturated and profoundly nar- 
 cotized. The third class of periodic drinkers may be di- 
 vided into numerous sub-classes, one of which includes the 
 dipsomaniacs. This, fortunately, is not a very common 
 condition. It is marked by an insane overpowering im- 
 pulse which is a veritable mania for the time being, and 
 when the full narcotism of spirits comes on, the impulse 
 subsides. 
 
 In another chapter, varieties of this form will be de- 
 scribed. The periodic drinker appears to be very largely 
 dependent on his surroundings, mental condition, and de- 
 gree of health, for the time of the return of the drink 
 impulse ; hence all conditions of exhaustion, starvation, 
 severe strain with brain and body fatigue, furnish fertile 
 soil for the development and growth of periodic inebriety. 
 In this class are also included the inebriate who drinks 
 from contagion and emotional causes. 
 
 There can be no doubt that the presence of saloons 
 and club-houses give increased activity to states of in- 
 herited degeneration, and furnish sources of temporary 
 relief to hyperasthetic conditions, that could be diverted 
 into normal channels by proper hygienic means.
 
 42 INEBRIETY. 
 
 Many persons have been greatly puzzled to explain the 
 presence of inebriety in persons living in surroundings 
 that were antagonistic to the use of spirits, but reference 
 to carefully recorded and studied histories of other cases 
 indicate a range of natural causes which have escaped 
 attention before. 
 
 It will be shown later that inebriety and conditions of 
 degeneracy transmitted from the parents will explain 
 many of these mysterious outbursts of inebriety. There 
 is another class of inebriates that are undoubtedly becom- 
 ing more numerous. They may be termed the "psycho- 
 pathic class." In them inebriety is simply another phase 
 of existing disease, thus in tuberculosis the acute symp- 
 toms often subside when the patient uses alcohol to excess ; 
 when the alcohol is withdrawn, the inflammatory condi- 
 tions of the lungs start up again. 
 
 The general paretic always passes through a stage of 
 excessive use of spirits. The epileptic may have a drink- 
 ing spell in the place of the paroxysm. Quite a large 
 class of inebriates have a history of injury in early life, 
 such as contusion, broken bones, or severe inflammatory 
 fevers with a long protracted stage of invalidism and an 
 apparent recovery. Another class give a history of nu- 
 trient disturbances, either overfed or underfed. One au- 
 thor has made a division of the latter class, calling them 
 dyspeptic inebriates in which the digestive disorders are 
 the most prominent symptoms. 
 
 The late Dr. Parish described a class of psychical in- 
 ebriates in which the causes are unknown and confined to 
 the realm of the psychic. The patients never use spirits 
 except at midnight and then only for a brief time. This 
 class, termed the "solitary midnight drinkers," are total 
 abstainers at all other times. Dr. L. D. Mason noted a 
 class of persons who drank a few months before death 
 and who were total abstainers xip to this period. For
 
 FORMS AND CLASSIFICATIONS OF INEBRIETY. 43 
 
 some unknown reasons they would begin to use spirits to 
 produce continuous intoxication and in a short time 
 Bright's disease or acute pneumonia would cause death. 
 Other observers have noted similar facts and traced them 
 to an overwhelming loss of vitality and premonition of 
 death showing itself in the drink impulse. 
 
 The late Dr. Wright called this "senile inebriety" and 
 described cases of persons, whose previous life had been 
 temperate, who suddenly began to use spirits, giving no 
 reason, except that of exhaustion, and dying in a very 
 short time. Another class, which appears to be growing 
 more prominent every year, includes persons generally 
 actively engaged in business and professional work, who 
 suddenly disappear, go into seclusion and drink several 
 days to great excess ; then return and resume their work 
 as usual. Such patients never explain these attacks and 
 regard them as spells. In reality they are obsessions and 
 insane impulses, which are only satisfied by profound 
 narcotism from spirits. 
 
 There are many remarkable divisions of these insane 
 inebriates whose drinking resembles nerve explosions, and 
 often becomes epileptic in form. One of these classes is 
 that of the secret drinker, who never appears to be under 
 the influence of spirits, and whose drinking is only recog- 
 nized in the sudden changes of character and conduct. 
 The use of spirits is always denied and his conduct be- 
 comes more secretive, and attempts to find out what he is 
 doing, are repelled with great indignation. Many such 
 persons die suddenly and then the secret drinking becomes 
 known. The effects of alcohol vary in different persons, 
 but there are certain mental changes and degenerations, 
 whose uniformity cannot be mistaken. 
 
 Another very prominent class of inebriates is noted by 
 criminal conduct when under the influence of spirits. Al- 
 cohol seems to provoke intense selfishness and irritability,
 
 44 INEBRIETY. 
 
 with delusions of persecution, and lack of respect for law 
 or order. In the police courts they are termed vicious 
 and treated with severity. Morell, the French specialist, 
 described them as moral paralytics, without any ethical 
 notions of responsibility or duty. They are often seen 
 in the wealthier classes, and are called dishonest, tricky 
 and unreliable. There can be no question as to their 
 physical defects, whether this is due to alcohol or to some 
 inherited weakness is not clear. Probably both conditions 
 are active as causes. 
 
 There is a class called delusional drinkers, which are 
 very large, and in some respects prominent among all in- 
 ebriates. They are noted for extreme optimism, never 
 recognizing any possible danger from the use of spirits in 
 any form, and show much ingenuity in explaining erratic 
 conduct as due to other causes. Such persons pose in the 
 papers and among their friends as examples of the good 
 effects of spirits when taken for years, and are always 
 boastful of what they can do, and how unlike others they 
 are. In reality, they are often most diseased and irre- 
 sponsible and the appearance of sanity is a very thin var- 
 nish. Attempts to classify these cases are hardly possible, 
 except in a general way. 
 
 While the general symptomology is more or less uni- 
 form, there are so many variations and diversities of 
 defects, and peculiar manifestations of thought and con- 
 duct, that it is difficult to group them in any particular 
 classes. Magnan, of Paris, divides all alcoholics into two 
 classes, namely, the constant and periodic drinkers. The 
 first he describes as senile and demented. The second as 
 maniacal and explosive. Dubois calls all inebriates de- 
 ments and maniacs from toxic causes. Other authors 
 make a distinction of moral and functional cases at the 
 beginning, and then organic and insane farther on.
 
 FOEMS AND CLASSIFICATIONS OF INEBRIETY. 45 
 
 Delirium tremens is a special toxic stage in the terminal 
 period of drinking. Many divisions have been made and 
 described with great minuteness, but it is doubtful if these 
 distinctions are anything more than mere external symp- 
 toms from local causes. This will be discussed in another 
 chapter. 
 
 There is a sub-class in which delusional egotism is a 
 very prominent symptom; the patient never acknowledges 
 his condition, but always asserts that other causes than 
 alcohol are responsible. The disordered egotism is a com- 
 mon symptom in nearly all the classes, and where it as- 
 sumes great prominence, it is associated with other pro- 
 nounced degenerations, which are so apparent, that this 
 particular symptom cannot be designated as special. It 
 is a common observation that many of the symptoms are 
 due specifically to alcohol. This is only partially true. 
 The patient, who, after drinking, becomes hilarious, and 
 has delirium of exhaltations has a peculiar nervous organ- 
 ization, particularly sensitive to the rapid circulation of 
 the blood through the brain. Often these symptoms re- 
 semble nerve spasms and are marked by great depression. 
 The opposite class, who are suddenly depressed and mel- 
 ancholic from the action from alcohol, possess a different 
 degree of sensitiveness, and a brain resistance to the tox- 
 ins. In one there is extreme activity. In the other 
 marked depression.
 
 CHAPTER V. 
 
 INEBRIETY IN AMERICA AND ITS PECULIARITIES. 
 
 Synopsis. The general effects of alcohol the same all over 
 the world. More distinct in America. The moderate drinking per- 
 iod short. Men seldom use spirits regularly beyond a limited 
 time. Spirits are used impulsively. More periodic drinking than 
 in other countries. Due to the brain strain and intensity of liv- 
 ing. General neglect of rest and quietness. Inebriety in America 
 associated with delusions of wealth and power. The American In- 
 ebriate is not a wife beater, but a delirious reformer. He sel- 
 dom commits brutal crimes, but is a swindler and promoter of 
 great schemes. He dies of heart, kidney and lung diseases. In- 
 ebriety moves in waves and currents. Women drink less than in 
 other countries. Spirit drinking more concealed. A distinct form 
 of brain and nerve psychosis. A form of insanity due to the in- 
 tensity of living. The atmosphere is psychic and distinct factors 
 seem to provoke its growth. More distinctly inherited. Depend- 
 ent on extremes of temperature, also on foods. Tobacco a grateful 
 narcotic and promoter of inebriety. The American inebriate is 
 a bar drinker and not a club drinker. He drinks at night to 
 promote sleep. He drinks in the day time for new vigor and 
 strength. He has less descendants because of the profound de- 
 generation and nerve injury. He is curable under certain con- 
 ditions. He is susceptible and wants relief more quickly. Has 
 less power to resist pain. More pronouncedly diseases. 
 
 While the effects of alcohol and the conditions which 
 demand spirits for relief are practically the same in all 
 climates and conditions, there are many well marked pe- 
 culiarities which distinguish inebriety in America from that 
 of other countries. Thus the period of moderate drink- 
 ing is shorter, and spirits are rarely taken regularly with 
 meals more than a few months or one or two years. 
 Spirits are used in great quantities and impulsively, and 
 the effects are sought for with precipitate haste, and the 
 diseases and mortality which follow are more pronounced 
 and marked. 
 
 Many authors have recognized the fact that few persons 
 in active life drink spirits in so-called moderation in this 
 country. The attempts to pattern after the customs of 
 
 Europe, in having wine at the table and spirits at regular 
 46
 
 INEBRIETY IN AMERICA AND ITS PECULIARITIES. 47 
 
 intervals, ends disastrously, either in excessive use, or some 
 form of disease and invalidism. In active business circles 
 the excessive drinking and sudden collapse of men previ- 
 ously supposed to be temperate, are examples of the fail- 
 ure to drink moderately. 
 
 It is noted that business men with a reputation for con- 
 servatism and reliable conduct, who suddenly become 
 speculators and erratic in their judgment, are often found 
 to be moderate drinkers. Such persons have delusions of 
 immediate wealth, power, and political achievement, and 
 very soon break down from the excessive use of spirits. 
 Evidently, drinking has destroyed their good sense and 
 judgment. Among the reasons explaining this inability 
 to use spirits in small quantities for any length of time, 
 are the intensity of living, the constant excitement, and 
 the rapid changes in both business and social circles, and 
 the constant strain of every energy of the body to adapt 
 itself to the varying conditions. Associated with this is 
 the neglect of the ordinary functions of the body, par- 
 ticularly those of rest, sleep and nutrition, states of ex- 
 haustion follow for which alcohol is taken to give relief 
 and rest. The average drinker, in the psychical atmos- 
 phere of America, finds the necessity and occasion for 
 using spirits at any time, for their effects; and if they 
 are not sufficiently potent more is taken until the system 
 becomes saturated. 
 
 If this saturation becomes a marked intoxication, he is 
 likely to be disgusted and abstain for a short time; and 
 then start again, with a determination not to exceed a 
 small quantity at regular intervals. Sooner or later 
 this amount is exceeded and another intoxication follows. 
 Thus the average business man, who tries to imitate the 
 European in taking wine at meals, or small quantities of 
 spirits at fixed intervals, finds it impossible and becomes 
 an irregular and spasmodic drinker.
 
 48 INEBRIETY. 
 
 The foreign born resident who continues his former 
 customs of taking wine and beer, after a few years be- 
 comes nervous and suffers from some form of neurosis and 
 dies suddenly ; while his brother abroad, using spirits in 
 substantially the same way, seems to suffer less. The 
 effects of American life is thus marked in the character 
 of the derangement which follows from the use of spirits ; 
 the vast majority of persons are unable to drink small 
 quantities for any length of time and soon become im- 
 pulsive and excessive drinkers at intervals. 
 
 The average American inebriate is peculiar for the de- 
 lusions of egoism and ambition to acquire wealth and 
 power. He seems to be alert to seize opportunities to 
 lead in great schemes for his own welfare and that of 
 others. He is rarely a wife-beater or an avenger of per- 
 sonal wrongs, but joins mobs and all new efforts to break 
 up some supposed wrongs that are blocking the wheels of 
 progress. The records of courts contain few examples of 
 brutal crimes committed by native born inebriates. Their 
 offenses are frauds, swindles, schemes of deception, or 
 revolutions for profit and social reform ; often they be- 
 come strikers and redressers of wrongs, or promoters of 
 some new projects in politics, religion or business, and 
 like Colonel Sellers, "buoyed up with the hope that there 
 are millions in it." 
 
 The American inebriate, even in the submerged class, 
 seldom commits suicide, but dies from hemorrhage or acute 
 inflammation, and in the hospital or workhouse they have 
 little or no resisting power and succumb to any adverse 
 causes or conditions. Dr. C. H. Hughes has declared that 
 the use of alcohol in America is a distinct form of brain 
 and nerve psychosis, which in many ways resembles gen- 
 eral paresis, also that the use of alcohol in America is far 
 more dangerous and fatal than in any other country. 
 The excessive mortality from diseases of the lungs, heart
 
 INEBRIETY IN AMERICA AND ITS PECULIARITIES. 49 
 
 and kidneys noted among inebriates in this country is a 
 very strong confirmation of the above statement. 
 
 From a great variety of evidence there are many rea- 
 sons for believing that inebriety in America is controlled 
 by some unknown psychological wave movement. Some 
 of the facts gathered from different studies indicate such 
 a movement with a duration of from twelve to sixteen 
 years. This is based on the records of towns and cities 
 where it would seem that the arrests for drunkenness slow- 
 ly increase up to a certain point, and then decrease in a 
 sort of an ebb and flow current. These waves are noted 
 by an unusual interest in temperance work, and great 
 efforts to control and diminish the sale of spirits. After 
 a while they culminate in some high point of intense ac- 
 tivity, in society, churches and organizations, then they 
 subside for a while, and in a few years start up again, 
 reaching a certain high point and then declining. Several 
 very marked examples have been traced in the various 
 crusades to diminish inebriety. Thus a high tide of in- 
 creased alcoholic drinking is followed by intense opposi- 
 tion and wide efforts to check it, public sentiment is 
 alarmed, and moral suasion and other efforts are intense- 
 ly active to check its growth. Apparently they succeed, 
 and the use of spirits diminishes. Then in a few years it 
 reappears again. The late Dr. Beard wrote that wide- 
 spread financial disasters and depressions in business al- 
 ways bring to the surface a new crowd of inebriates, who, 
 after a more or less ineffectual struggle to recover, die. 
 
 It has been noted that political revolutions, such as pro- 
 nounced changes of parties and public policies are followed 
 by an increased number of inebriates in the higher walks 
 of life. This is readily explained by the failure of a 
 large number of neurotics and moderate drinkers to adapt 
 themselves to the new conditions of life forced on them, 
 and this creates an intense depression and exhaustion for
 
 50 INEBRIETY. 
 
 which spirits brings the most ready relief. In this there 
 seems to be evident a very close connection between wide- 
 spread disasters and high tides of alcoholic drinking. An 
 example like the following is not unfrequently seen. In 
 a certain town, without any special reason, an unusual 
 number of saloons were opened and the sale of spirits in- 
 creased to great proportions so that crimes, pauperism 
 and loss became very prominent. Public sentiment re- 
 acted and a great temperance wave followed, which ended 
 in driving out the saloons and a vote of no-license. A few 
 years later, the failure of a very large mill and greatly 
 depressed financial conditions was followed by the reap- 
 pearance of saloons with crime, pauperism and misery, 
 and again a temperance wave swept over the town, and 
 once more no-license and no saloons prevailed. There is 
 in this a distinct intimation of some great psychological 
 movement sweeping over cities and states and controlling 
 the rise and fall of inebriety. With farther study and 
 more exact knowledge, this subject of psychical wave 
 forces controlling inebriety, opens up a most fascinating 
 field for future discovery. Thus the temperance revivals 
 and crusades and social and political efforts to stamp out 
 and diminish inebriety are not chance and accidental oc- 
 currences, but evidences of some great laws which regulate 
 and control the evolutionary movements of the race. 
 
 While there is much conflicting evidence in regard to 
 the extent of inebriety in America, there are many rea- 
 sons for believing that it is slowly diminishing. The sale 
 of beer is increasing, while that of strong drink in some 
 sections is less or remains about the same. There can be 
 no question that there is a sharp decline in the use of 
 spirits among native born Americans. The use of alcohol 
 among American women is also disputed, some asserting 
 that it is increasing, others that it is growing less. While 
 it is more concealed in this country, and is less apparent,
 
 INEBRIETY IN AMERICA AND ITS PECULIARITIES. 51 
 
 some authors have asserted that the demand for narcotics 
 among American women is increasing, but this fact is only 
 sustained by some local statistics, and in all probability 
 does not apply to the masses. The general fact, which 
 all authorities concede to be correct, is that the use of 
 spirits is gradually declining and that social drinking is 
 less prominent. 
 
 Persons of foreign birth still cling to the old customs 
 of beer and spirits at meal time, and a certain class of 
 imitators, who believe that wine and spirits are luxuries 
 continue their use without any special reason. It is evi- 
 dent that the same general causes which regulate the use 
 of spirits among men in active life are influential with 
 women, with this addition, they are more sensitive to the 
 effects of wine and are more active to escape from its in- 
 juries. Narcotics and substitutes for spirits are undoubt- 
 edly in great demand in certain sections, but it is doubtful 
 if this demand is greater among women than men. Care- 
 ful studies of persons in particular sections of the coun- 
 try show a marked diminution in the use of spirits or 
 narcotics for any purpose, and this undoubtedly is true 
 in a general way for the entire country. 
 
 The psychic influences which seem to be active in the 
 spread of inebriety and its control have been the subject 
 of many essays. Dr. Bowditch, of Boston, Mass., called 
 attention to an apparent isothermal belt crossing the con- 
 tinent marking the center of the most active use of spir- 
 its. From this point each way there appeared to be a 
 decline in the use of spirits. A later study indicated 
 other causes than that of climate and pointed to some 
 psychic current and wave, starting from certain centers 
 and spreading along lines difficult to trace, but apparently 
 responsible for the excess and diminution of spirits. An- 
 other author asserted very prominently that the presence 
 of inebriety in the community was always followed by a
 
 52 INEBRIETY. 
 
 certain immunity in the next generation. Several authors 
 have endorsed Dr. Reid's studies of heredity and conclude 
 that immunity in families and communities and nations 
 always follows the excessive use of spirits. More extend- 
 ed studies of the facts show that these theories are not 
 well supported and that always in the next generation the 
 lowered vitality, increase of disease and mortality and 
 hypersensitiveness to spirits is most commonly noted. In 
 another chapter this subject will be presented in some de- 
 tail. 
 
 It has been pointed out that the extreme of heat and 
 cold are active as causes in the production of inebriety. 
 Several essays have been written on this topic, but the 
 conclusions are not in accord with the general facts that 
 are known. While it is true that stronger spirits are 
 sought for in the cold climates and lighter wines in the 
 warm belts of the country, the effects of all these drinks 
 are practically the same, irrespective of heat or cold. 
 
 The consumption of tobacco has furnished themes for 
 many studies, showing a connection between it and the 
 growth of inebriety. Many startling examples have been 
 presented, but the facts are not numerous enough, or 
 sufficiently studied to support any positive conclusions. 
 
 There can be no doubt that the largest factor deter- 
 mining the peculiarity of American inebriety is the con- 
 tagious excitement and continuous nerve strain, which 
 pervades all societies and business circles, and the result- 
 ant exhaustion which follows, is influential in the develop- 
 ment and duration of this malady. Thus the average 
 American in all circles is restless and always seeking new 
 conditions of life, changing incessantly with every new 
 prospect of gain ; business and work of all kinds are done 
 under a pressure and excitement that gives little chance 
 for proper nerve rest. The emigrant soon catches the 
 contagion of change and, if he is a young man, all his 
 habits of life become keyed to the same incessant strain.
 
 INEBRIETY IN AMERICA AND ITS PECULIARITIES. 53 
 
 The American inebriate drinks at the bar, standing 
 up, and then hurries out. The club-house and beer- 
 garden have no attractions for him. All attempts to form 
 beer-gardens for working men to sit down and drink in 
 are failures. The pressure of business opposes it. There 
 is no time to spend in such places. If a man wants beer 
 he takes it to his home. The club-house is a visiting 
 place where business and plans are discussed and projects 
 of how to take advantage of the present and future and 
 not for daily relaxation and comfort. The saloon for the 
 poorest classes is practically the same kind of place. 
 The patrons drink standing, plan strikes or talk political 
 topics and questions of profits and more lucrative work. 
 
 Tobacco, like spirits, is used for its narcotic effects. 
 Coffee and tea are taken in the same impulsive precipitant 
 way. This intensity of living calls for the relief and 
 narcotism of alcohol, which actually covers up the ex- 
 haustion and draws on the reserve strength of the body 
 and mind; thus the American inebriate is constantly dis- 
 counting his future vigor and strength, and lives on the 
 borders of physical and mental bankruptcy. Often he 
 realizes this in the uncertain changeable way in which 
 different varieties of spirits are used. For a time he is a 
 moderate drinker. Then abstains and drinks at intervals, 
 then uses drugs for substitutes, going from one to the 
 other in a vain attempt to escape the inevitable effects. 
 As a total abstainer and promoter of temperance he is 
 very emphatic and pronounced ; as an advocate of spirits 
 he is equally dogmatic. The tendency to go to extremes 
 and settle the whole matter at once, in excess of effort of 
 mind and body, is very apparent. 
 
 The average American who begins to fail in strength 
 at the summit of his success, goes off to Europe in quest 
 of health, claiming to be overworked and needing rest and 
 change. He rushes from place to place, becoming more 
 fatigued than at home, and finally returns, bringing with
 
 54 INEBRIETY. 
 
 him a new conception of the medicinal value of wine at 
 meals. Later he is found drinking to excess, and so dies. 
 The young man or woman who, from residence abroad, 
 gets the same conception of the value of wines and liquors 
 at meals, or as tonics, finds after a few years of trial in 
 this country, a degree of invalidism and incapacity, 
 which he or she rarely attributes to the true cause. These 
 are common examples which show that inebriety in Amer- 
 ica is a mania, a form of paranoia and degeneration that 
 differs from that in other countries. The causes are very 
 complex and include everything which stimulates brain 
 and nerve activity to its highest point of endurance. 
 
 In efforts to check and cure inebriety the same in- 
 cessant movement is apparent. As an inmate of the 
 hospital, he calls for continuous efforts to do something, 
 forgetting that rest is nature's best assistant; when sick 
 at home different remedies and measures for relief are 
 demanded, with a morbid impulse that indicates grave 
 central disturbances. Recovery sometimes takes place in 
 the same extraordinary, unusual way. Quacks that 
 promise cure by mysterious drugs are popular at once, 
 because of the excessive credulity of the victim. Patent 
 medicines and drugs containing narcotics become popular 
 in proportion, as they quiet the nerve irritation and 
 exhaustion of the victim. 
 
 It is evident, from a variety of facts, that the use of 
 spirits and drugs can not be taken safely in America, 
 especially in our present revolutionary stage of society 
 and its evolutions. 
 
 In business circles this fact is becoming important 
 through the increasing efforts to drive out the use of 
 spirits as a beverage ; and also the recognition of the 
 business incapacity of users of spirits, their susceptibility 
 to disease, and their incompetency to endure the strains 
 of business life.
 
 CHAPTER VI. 
 GENERAL SYMPTOMOLOGY AND DEVELOPMENT. 
 
 Synopsis. Three distinct periods in the symptomology. De- 
 scription of each period. In the third period patients "come under 
 observation. Their symptoms are so prominent. Efforts are made 
 to abstain, or limit the use of spirits. The first stage one of great 
 indifference. The last stage marked by delirium and delusions. 
 Insane reasonings. Exaggerated egoisms. Persons with good 
 reasoning on other matters, are literally insane concerning the 
 use and effects of spirits. So-called moderate drinker is incapable 
 of judging of himself. Examples. Persons living lives of great 
 excitement never realize their danger. Moral palsy common in 
 this stage. Defects of the senses very noted. Emotional depres- 
 sions common. Muscular control enfeebled. Beer drinkers have 
 nutritive degenerations with enlarged hearts and fibrinous de- 
 posits. Muscle workers have low vitality and are able to adapt 
 themselves to changes. Active brain workers have peculiar 
 symptoms, particularly of confusion of purpose and object in life. 
 Many of these persons die from other acute diseases. The face 
 registers these changes. Physical defects. Whitened hair. 
 Blanched face. Feeble muscular power. The display of brutal 
 qualities when drinking. Wide variations of character. Skepti- 
 cism and pleasure in condemning. Destructive criticism. A hint 
 of an alcoholic mind. Examples. General considerations. 
 
 The general symptomology of inebriety may be traced 
 and studied in several distinct stages. The first, extend- 
 ing over months and years, is one of occasional and ir- 
 regular use of spirits and beer. During this period 
 spirits may be taken to produce stupor and intoxication; 
 this may be followed by disgust and long periods of 
 abstinence. Then spirits are used again and the former 
 aversion does not appear. A second stage is marked by 
 the continuous use of spirits in small quantities, often 
 at meals. The patient justifies his use of them as neces- 
 sary and medicinal, while toxic conditions may follow 
 they are unnoticed, and supposed to be accidental. A 
 third period begins with an attack of delirium, or some 
 very unusual act or course of conduct which alarms his 
 
 friends. An effort is then made to either abstain alto- 
 
 55
 
 56 INEBRIETY. 
 
 gether or to limit the use of spirits to a moderate quan- 
 tity. At this time he may come under medical obser- 
 vation, and is found to be suffering from organic changes 
 with delusional mental states concerning his condition, 
 and relation to others. The first and third periods are 
 very often closely related. In the second stage, a pre- 
 liminary period of wine and beer drinking may continue 
 for a long time, with only the occasional use of spirits, 
 which at long intervals may culminate in acute intoxica- 
 tion and recovery, going back again to beer or wine. 
 The first stage, in nearly all cases, is one of great indif- 
 ference to the danger and possible ill effects from the 
 use of spirits. The patient is always confident of his 
 ability to stop, and considers his situation and use of 
 spirits as largely due to trivial circumstances and con- 
 ditions, over which he has full power. In the later 
 stages delusional confidence in his will power to stop in- 
 creases with the gravity of the symptoms. Often dif- 
 ferent forms of delirium and delusion growing out of the 
 use of spirits are realities to him, and are so positively 
 fixed in the mind that they can not be overcome. 
 
 In many instances the most ingenious reasons are given 
 to confirm and sustain his confidence in their reality, and 
 no pressure or advice by friends can make any impression 
 or indicate the real character of his mental condition. 
 Persons with good judgment on all other matters will have 
 the most delusional impression of their own conditions, and 
 assert with great confidence that outside influences and 
 undue anxiety and annoyance by friends are active causes 
 of his present stage. This peculiar egotism is a species 
 of general paralysis, particularly of* the higher brain 
 centers. It literally means a progressive anesthesia of 
 certain areas of the brain with unconsciousness of the 
 real condition.
 
 GENERAL SYMPTOMOLOGY AND DEVELOPMENT. 57 
 
 The moderate user of spirits, or one who takes a 
 stated amount regularly for years, has a very imperfect 
 conception of his condition and little ability to judge of 
 himself. The use of alcohol to great excess is followed 
 by a demented condition in which the brain is bewildered 
 and unable to act from any clear, rational point of view. 
 Often a moderate drinker will use spirits to great excess 
 and have an attack of delirium, and recover and with it a 
 decreasing consciousness of what has taken place and 
 of the feebleness of his brain power. 
 
 In a certain number of cases where spirits have been 
 taken at very long intervals in great moderation, and 
 the person claims to be practically a total abstainer, sud- 
 denly he begins to use spirits to excess. A progressive 
 paralysis, with a rapid decline in both the mental and 
 organic activities appears. The following is an example. 
 An active business man who, at long intervals, had taken 
 wine in moderation at banquets and never for any toxic 
 action, and was considered a temperate man, began to 
 drink to excess. He became intoxicated every night, vis- 
 ited clubs and saloons, giving no explanation, or making 
 no effort to abstain. This continued for a few months, 
 when he was finally found dead in his bed. Cases be- 
 longing to this class, although not so prominent, have 
 frequently been noted, and the physical effect of the 
 drink craze is beyond all question. 
 
 Many persons with highly developed nervous system, 
 living lives of great stress and strain, after some par- 
 ticular shock or disease begin to use spirits. With this a 
 special moral palsy or general failure of the ethical 
 recognition of duty, obligation and consciousness of right 
 and wrong appears. Delusional conditions and perver- 
 sions of reasoning are early symptoms, and with these, 
 marked defects of character, which constantly increase, 
 are noticed.
 
 58 INEBRIETY. 
 
 In other persons sensory defects are among the most 
 prominent early symptoms. 
 
 The defects of the eye and the constant change of 
 glasses ; the faults of hearing, taste, touch and in the 
 recognition of odors, are symptoms of palsy of the 
 senses which are recognized by friends, and are among 
 the first symptoms. In other persons melancholia and 
 unusual depression, without any apparent cause or sus- 
 picion of wrong-doing, are noted first. Other persons 
 show feebleness of the muscular centers and power of 
 control. Such persons stumble easily, can not hold things 
 in their hands, are easily exhausted and seem to have 
 some form of muscular palsy. 
 
 Another class exhibit early derangements of nutrition, 
 particularly marked digestive troubles. Foods and liquids 
 are used impulsively, and produce great disturbance. 
 Later local inflammations and various functional disorders 
 occur. Beer drinkers are often subject to these neutra- 
 tive degenerations and the excessive anxiety to find rem- 
 edies for their relief and the obscurity and complexity 
 of such disturbances point clearly to alcohol as a spe- 
 cial cause. 
 
 The vigor of the brain is very early impaired in such 
 cases, and its faulty activities reflect the poisoned and 
 paralyzed conditions. The muscle workers who use beer 
 and spirits regularly are particularly degenerate, and 
 physically have very low vitality are unable to adapt 
 themselves to changes of environment, and succumb 
 quickly to acute inflammation from any cause. Active 
 brain workers who use spirits steadily, have many symp- 
 toms that are peculiar. Thus the delusion of exaltation 
 and egoism is prominent, and the unusual optimism con- 
 cerning themselves is very marked. Many of these per- 
 sons have symptoms of paresis, and it is difficult to
 
 GENERAL SYMPTOMOLOGY AND DEVELOPMENT. 59 
 
 determine how far alcohol is the active exciting cause, 
 or the desire for it a symptom of some previous degenera- 
 tion which is developing. Many of these obscure cases 
 have been the subjects of great confusion in the diagnosis 
 and treatment, but in all there is a continuous anesthesia 
 and paralysis of both the brain and organism. Some of 
 these cases go on to pronounced paresis. Many of them 
 die of intercurrent disease and are not considered inebri- 
 ates, but the excessive use of spirits is a marked symptom 
 of the history of the case. 
 
 In other cases, the eyes and face register the degenera- 
 tions more clearly than any other part of the body. 
 The voice is another symptom of the palsy from the 
 use of spirits. Many authors have referred to the 
 symptoms of premature old age in comparatively young 
 men. The hair becomes white. The face is blanched or 
 congested, the eye is dull and watery, the speech is slow 
 and broken, and the tones are nasal and feeble. The 
 muscular powers are diminished. Nutrition is disturbed, 
 and such persons are irritable, stupid and childish. These 
 are all pronounced symptoms of inebriety. 
 
 The oft-repeated statement that the action of alcohol 
 reveals the real man and his purposes is not true. The 
 sudden display of coarseness and brutality in one who 
 when sober is genteel and kindly, is not uncovering the 
 predominant traits of character. It is simply putting 
 to sleep the higher faculties and allowing the lower ones 
 to control. Instances are noted of persons who become 
 excessively religious when under the influence of spirits, 
 and on recovery this feeling disappears. Persons who 
 are selfish and grasping, when under the influence of 
 spirits, are often most kind and generous. Others are 
 extremely skeptical, pessimistic and bitter while drinking, 
 and when sober are credulous and optimistic in the highest 
 degree.
 
 60 INEBRIETY. 
 
 A noted writer whose stories have been widely read, 
 when under the influence of spirits described the suffer- 
 ings and miseries of persons in the most wretched con- 
 ditions of life with great minuteness ; when sober such 
 descriptions are rarely attempted, and always treated with 
 brevity. Another symptom, peculiar to the so-called 
 moderate drinker, and particularly so to the one who 
 drinks steadily both beer and strong spirits, is the unrea- 
 sonable criticism and intense pleasure in condemning and 
 discovering bad motives for all sorts of conduct. This 
 is a kind of pessimism that takes intense pleasure in 
 destroying and retarding everything considered sacred or 
 correct by others. It is asserted that bitter criticisms, 
 which are destructive and unreasonable, are indications 
 of an alcoholic brain. This is confirmed by many striking 
 instances. Very interesting studies are to be made along 
 this line. In the future pages this idea will be 
 brought out.
 
 CHAPTER VII. 
 
 PECULIARITIES OF CONDUCT AND THOUGHT TRACE- 
 ABLE TO INEBRIETY. 
 
 .Synopsis. Inaccuracy, mistakes and failures prominent symp- 
 toms. Carelessness. Childish explanations and inability to adapt 
 oneself to the condition symptomatic. Examples. Bankrupts, 
 previously honest and careful business men. Traceable to the 
 use of spirits. Sensory derangement and defects of the reason 
 more common in this country than elsewhere among inebriates. 
 Emotional changes significant. Great variations in style and 
 clearness in literary work, point to alcohol, insomnia and nervous- 
 ness, catarrhal troubles and other conditions traceable to this 
 cause. Neuritis a common sequel. Dr. Kerr's drama of three 
 acts, in the history of inebriety. Great changes in muscular 
 output. Extreme skepticism of the honor of others. Imperfect 
 work, faulty expressions and neglect of important matters com- 
 mon symptoms. Delirium common in so-called moderate drinkers. 
 Examples of concealed drinking. Malaria used to describe it. 
 Many symptoms complex, but all follow distinct lines which may 
 be studied and understood. 
 
 Another symptom is the subject of considerable com- 
 ment, and noted in the carelessness, inaccuracy and in- 
 creasing mistakes and errors in thought and conduct. 
 Men and women previously exact and accurate in their 
 use of words, careful in recognition of duty, and of 
 scrupulous conduct, show great changes in carelessness 
 and failures to maintain their former character in conduct 
 and thought. Thus persons engaged in work requiring ac- 
 curacy and strict observance of details show this very 
 clearly. For this reason banking, railroading and engi- 
 neering projects reveal the alcoholic brain in the mistakes 
 of the persons who are doing the work. 
 
 Many supposed temperate men exhibit this peculiar 
 symptom of carelessness and inaccuracy that is traced to 
 their use of spirits. They are discharged, and soon 
 after their drinking becomes prominent. The explana- 
 tion given is the depression from loss of position and 
 
 61
 
 62 INEBRIETY. 
 
 supposed persecution by friends. In reality, they have 
 been concealed inebriates, and the change of environment 
 and position reveal the real condition. An example which 
 was the subject of much notoriety occurred in a clergy- 
 man, whose faults of memory, inaccuracy of statements 
 and neglect of duty became notorious. The physician 
 diagnosed it as brain fatigue and neurasthenia, and sent 
 him on a tour of travel. This ended in pronounced in- 
 ebriety and death a few months later. The question in 
 dispute was the diagnosis concerning the possibility of 
 his concealed use of spirits being an exciting or pre- 
 disposing cause, or a symptom of the final collapse. In 
 another instance a banker exhibited very unusual and 
 careless conduct in his affairs. The medical man failed 
 to recognize the alcoholic causation, and ordered tinc- 
 tures and wines as tonics and stimulants. Within a few 
 weeks he became wildly intoxicated and died a few 
 months later. 
 
 Many instances have been noted of bold and reckless 
 speculation by men previously conservative, followed by 
 bankruptcy, the excessive use of spirits and death. These 
 cases are so numerous that mercantile agencies rate very 
 low persons who are known to be moderate or occasional 
 drinkers of spirits. Experience shows that such persons 
 become bankrupts more frequently, and are more uncer- 
 tain in their health and vigor. It is stated that these 
 defects, particularly of the senses and reason, are more 
 pronounced in this country than elsewhere. As a sum- 
 mary, it may be stated that the absence of caution and a 
 degree of recklessness in the common affairs of life, par- 
 ticularly in persons previously conservative and sane, is a 
 very significant hint of alcoholic anaesthesia ; also that 
 unusual buoyancy and unreasonable faith in his own 
 capacity, and credulity of the statement of others, is an 
 additional confirmation. Again, emotional changes from
 
 CONDUCT AND THOUGHT. 63 
 
 boasting garrulity to timidity and stupor are additional 
 symptoms. 
 
 Many persons exhibit the effects of alcohol in a bright, 
 flashing eye and loud bronchial voice, also assertiveness 
 and absence of dignity bordering on the offensive. Pub- 
 lic speakers exhibit these symptoms, and the critical stu- 
 dent discovers that they have used spirits to give them 
 additional force and power. In reality, the effects are 
 just the opposite. The clearness of the thought is ob- 
 scured and the consciousness of the effect of his language 
 and manner is diminished. A revivalist whose dogmatic, 
 assertive manner and delirious expressions attracted great 
 attention, would have periods of great depression and 
 exhaustion after his platform work. A sympathetic 
 doctor prescribed spirits as a tonic, and very soon after- 
 wards he retired to a hospital to be treated for brain 
 fatigue. The actual condition was one of inebriety, and 
 the symptoms were the delirium of intoxication. 
 
 In some persons the unusual buoyancy following the 
 use of alcohol manifests itself in word delirium. Such 
 persons tell or write stories that are notorious for their 
 detailed descriptions, but exhibit faults of plan or pur- 
 pose. A number of literary men use spirits to give 
 fluency and supposed clearness to their work. They 
 rarely realize the unevenness and the purposeless trend 
 of the thought they express ; brilliant sentences, high- 
 sounding figures of speech that express nothing and 
 lead nowhere. Many books written by persons when 
 under the influence of alcohol, indicate the mental con- 
 dition and the alternate exhilaration and depression due 
 to spirits. The plot of a book may be very clear at 
 the beginning, but when drawn out by an alcoholic mind 
 it will vary widely from the original. 
 
 Insomnia is often a very significant symptom, and 
 profound debility, resembling collapse coming on sud-
 
 64 INEBRIETY. 
 
 denly, indicate toxic conditions, of which alcohol is a 
 common cause. 
 
 There are evidently less congested and red faces 
 among inebriates in America than among foreigners. 
 Many inebriates have a blanched appearance. The action 
 of alcohol after a brief period of flushing the facial 
 arteries and veins, produce constriction and marked pallor. 
 The muscles become paralyzed and a listless, dull expres- 
 sion follows. The emotional changes do not show in the 
 play of facial muscles, and the voice becomes bronchial 
 from the congestion of the mucus membrane. 
 
 Frequently for the catarrhal states that follow from 
 the use of spirits, cocaine is prescribed and a new addic- 
 tion is provoked. This remedy gives new buoyancy, and 
 not unfrequently spirits are abandoned, but this is of 
 short duration. The constant drinker always suffers 
 from changes in the membranes of the nose and throat. 
 This in vocalists and professional men who use the voice 
 freely, develops into aphonia. Obstinate bronchial and 
 catarrhal troubles are effects from alcohol in many in- 
 stances. When the spirits are taken away the disap- 
 pearance of these diseases is very marked. 
 
 So-called rheumatic pains of the lower extremities, 
 with cramps and numbness, are always significant symp- 
 toms of an alcoholic origin. In the so-called moderate 
 and constant drinkers, it is clearly neuritis of a toxic 
 origin. In many cases this is not recognized, and patients 
 supposed to have acute rheumatism, particularly marked 
 by palsy of the lower extremities, are given alcohol as a 
 remedy. In many instances the toxic effects of alcohol 
 seem to concentrate most prominently on the sensory and 
 motor nerves of the extremities. 
 
 The late Dr. Kerr divided the symptoms of inebriety 
 into what he called a drama of three acts. The first 
 was that of exhilaration, in which the face was flushed,
 
 CONDUCT AND THOUGHT. 65 
 
 the eye was flashing, the heart beat rapidly and a feeling 
 of extreme optimism and satisfaction gave the patient 
 the appearance of new vigor and health. The second 
 stage, the flushed face became more intense and the eye 
 became duller and the previous excitement passed away. 
 The imagination and impulsiveness had dwindled away. 
 The thoughts that were formerly clear became confused, 
 and the posing for effect passed off. The former bold- 
 ness disappeared. A complete change in conduct and 
 appearance is noted. If his work is automatic it will 
 be slower and more mechanical. A marked depression 
 and departure from the normal is evident. If in the first 
 stage he was unusually confidential and credulous, he now 
 becomes suspicious and hesitates. Finally, the last stage 
 of the drama is marked by sleep, stupor and general un- 
 consciousness of his condition and the surroundings. This 
 is practically a form of progressive paralysis, beginning 
 with excitement and general disturbance of the emotional 
 system, extending to the reason and conduct, and finally 
 ending in stupor and coma. In many persons these three 
 stages are clear and well defined. In others they are 
 somewhat obscure. The first stage of exhilaration may 
 be very prominent or almost entirely absent, as far as 
 symptoms would indicate, but the second and third stages 
 are always present. In persons who have become chronic 
 the period of exhilaration is brief and rarely noticed, but 
 the languor, comfort, rest, and finally sleep, are always 
 present. 
 
 Persons engaged in active work use spirits to give 
 steadiness, and put them in the second stage with appar- 
 ent power of control. The anaesthesia of this stage is the 
 one that approaches the ideal in the estimation of the 
 victim. The first stage of excitement and the last stage 
 of stupor are conditions to be avoided.
 
 66 INEBRIETY. 
 
 The supposed effect of alcohol to give additional force 
 and power is the most delusive. Any work done in this 
 stage is markedly imperfect and faulty, and this is noto- 
 rious in every department in business and social life. 
 This second stage is prominent for delusions that are 
 more or less peculiar, thus excessive egotism and extreme 
 confidence in capacity to meet every emergncy of the 
 present is common. 
 
 Another delusion is that of skepticism of the honor of 
 others, and belief of the infidelity and treachery of his 
 family and associates. This later is so marked as to be 
 regarded as almost pathognomonic. It is the materializa- 
 tion of this delusion, and the effort to correct the sup- 
 posed wrong which often ends in homicide. The inebriate 
 who believes his wife and other members of his family 
 untrue, and that they are plotting his ruin, has reached 
 a chronic stage which demands prompt recognition to 
 avert, and, if neglected, will be followed by crime. 
 
 Another delusion is that of wealth and ability to influ- 
 ence and command capital and control others. This 
 should be regarded as a paretic symptom, and very often 
 terminates in general paralysis. 
 
 Another delusion or symptom that is very common is 
 that of ability to conceal the use of alcohol and explain 
 the symptoms as due to other causes. They never ac- 
 knowledge what is so apparent to others, and can never 
 be persuaded that their use of spirits is known, or in 
 any way impairs or diminishes their strength and vigor. 
 This particular delusion is seen in certain circles where 
 persons go away and remain secluded for an indefinite 
 period, and then return, giving full explanations of what 
 they have done. Many instances like the following have 
 greatly puzzled both the family and the physician. A 
 lawyer who goes to Europe every year for rest will dis-
 
 CONDUCT AND THOUGHT. 67 
 
 appear from London for one or two weeks, then return 
 with voluminous explanations of his absence. He will 
 appear pale and nervous and much weakened. In another 
 instance an active man goes on what appears to be a 
 hunting tour, then disappears from all observation. He 
 returns with the same voluble explanations and debili- 
 tated appearance. 
 
 Another significant symptom has been noted in the 
 sudden aging and premature senility of active business 
 men, thus within a brief time and without any special 
 causes, the hair becomes white, the face blanched, the 
 eyes watery, the muscles trembly, and the mind becomes 
 feeble and uncertain. Such persons are known to be 
 moderate drinkers, and perhaps have periods of secretive 
 visits to the country or elsewhere for the restoration of 
 health. The diagnosis of exhaustion and the prescrip- 
 tion of spirits and drugs always precipitates the fatality 
 of such cases. 
 
 It has been observed that many so-called moderate 
 drinkers are extremely susceptible to delirium, which ap- 
 parently breaks out from the slightest causes. Thus a 
 blow on the head, a fall, or some sort of a shock or fit 
 of anger develops delirium. In common language, the 
 man is considered crazy in his reason and conduct, but 
 the early recovery fails to sustain the theory. Such per- 
 sons very soon develop neurotic disease, in which the 
 excessive use of spirits is a very pronounced symptom. 
 
 Another fact should be recognized in persons who are 
 known as moderate drinkers, namely, that of sudden ex- 
 treme prostration and exhaustion without any sufficient 
 cause. 
 
 These unusual collapses may often be the result of 
 concealed use of spirits, and strangely are treated by 
 spirits as a stimulant. In some instances an explanation
 
 68 INEBRIETY. 
 
 is given that this condition is due to poor whisky and 
 inferior alcohols, or to some particular event of minor 
 importance. Malaria is a term used to explain the 
 phenomena of exhaustion that is clearly due to the 
 toxaemias from spirits. 
 
 Persons who have long before suffered from malarious 
 fever, delude themselves with the idea that their present 
 condition is due to some entailment of the former condi- 
 tion, and not to the secret or open use of spirits. Many 
 persons who use spirits have profound toxic stages marked 
 by chills and fever. In one instance a man of unusual 
 ability and strength, after a period of intense activity 
 and excitement, suffered from what was called malaria. 
 The usual remedies of quinine was supplemented with hot 
 spirits and the case ended fatally. In another instance 
 profound nervous collapse appeared in a previously active 
 man. He was treated with spirits in great excess and the 
 patient became a chronic inebriate, blaming his physician 
 for causing inebriety. In reality, he was a secret drinker 
 before. 
 
 Thus the symptoms and effects of inebriety are not 
 only complex and variable, depending upon the person, 
 the surroundings, the condition of life and other factors 
 which should be recognized, but is a distinct neurosis that 
 involves toxicity and constitutional susceptibility. 
 
 Delirium tremens will be described in a separate chap- 
 ter, but it must be remembered that muttering delirium 
 and muscular tremor are very significant symptoms of an 
 alcoholic origin. A periodicity of collapse symptoms and 
 unusual mental conditions should always suggest a pos- 
 sible alcoholic origin. There can be no question that the 
 symptoms from the action of alcohol on the body and 
 mind, cither in early or later stages, follow distinct lines 
 of degeneration, and, while complicated, are peculiar and
 
 CONDUCT AND THOUGHT. 69 
 
 stand alone in many ways. In the later stages there is 
 little question of the meaning of these symptoms, but in 
 the early stages the finer depressions and changes of char- 
 acter, conduct, reason, habits of work, ambition and pur- 
 poses are all significant of degenerative processes which 
 should be discovered.
 
 CHAPTER VIII. 
 
 PERIODIC INEBRIETY AND ITS SYMPTOMOLOGY. 
 
 Synopsis. Great obscurity concerning- the causes of these con- 
 ditions. Found to resemble epilepsy. Various theories which do 
 not accord with the facts. Patients very emphatic in their ex- 
 planation of the causes, also confidence of ability to control them. 
 Premonitory symptoms very marked in some cases. In others ob- 
 scure. Theories of alcohol. Rythms in functional activities of 
 the body. The word habit. Two forms of periodic drinkers. One 
 with irregular free intervals, very common. The other with reg- 
 ular free intervals. The first impressions from the use of alcohol. 
 The future use depends upon this. These impressions powerful In 
 later life. Examples. Hereditary tendencies. Drink craze neu- 
 tralized by certain conditions. Often periodic drinkers are highly 
 developed nervous persons. Midnight drinkers. Club drinkers. 
 Relation to pneumonia and consumption. Examples. Curious 
 facts. Confusing groups of cases. Difficult matter to form them 
 into any connected whole. Such cases should be studied. The 
 subsidence of the drink craze is followed by other neuroses. 
 Some of them very severe. Examples. Periodic drinkers are very 
 seriously affected. The possibility of restoration not so good. 
 The drink craze may subside, but the tendency of the system to 
 take on periodic explosions, very marked. Examples. Farther 
 studies needed. 
 
 The man who drinks steadily, with apparent self-con- 
 trol, attracts little or no attention, but the one who uses 
 spirits to great excess, then abstains for a period, is more 
 noticeable. There is some mystery about this form of 
 periodic drinking, and the impression prevails that these 
 drink impulses are under the control of the victim, and 
 are literally moral lapses which he should and could pre- 
 vent. 
 
 The sudden cessation and total abstinence from all 
 use of spirits is explained by the victim with great exact- 
 ness, and this is often accepted as evidence of his will- 
 power. 
 
 The various theories offered in explanation of why 
 
 persons suddenly drink to excess and then stop with equal 
 
 70
 
 PERIODIC INEBRIETY AND ITS SYMPTOMOLOGY. 71 
 
 abruptness, are very numerous among the victims, and 
 are accepted by the public as accurate descriptions. 
 
 When the phenomena of these attacks are studied scien- 
 tifically, they are found to resemble those of epilepsy 
 and other convulsive explosions of nerve energy, with 
 distinct physical causes and conditions not under the con- 
 trol of the will. The assertions of free will and ability 
 to control the drink impulse and to stop at any mo- 
 ment, are not confirmed by the repeated attacks, hence the 
 inference that there are other causes unknown in the 
 production of these paroxysms. Theories offered in ex- 
 planation do not explain the condition, and are con- 
 tradicted by the facts. 
 
 Careful studies of persons subject to these drink storms 
 indicate distinct physical and psychical strains that have 
 some connection, and precede the outbreak, and, in some 
 instances, they are distinct premonitions of the drink 
 excesses. 
 
 In some cases the patient is unconscious of the sig- 
 nificance of these physical and mental perturbations pre- 
 ceding the use of spirits. In others, he is clearly conscious 
 of the coming drink attacks. In the latter case he will 
 often conceal these early symptoms, or explain them as 
 due to other conditions, and in some instances make prep- 
 arations and talk about drinking and the effects of al- 
 cohol as if fully aware that he is to have a period of 
 drinking. 
 
 In a certain number of instances persons have distinct 
 premonitory symptoms which always precede the drink 
 attack, whether they are conscious of it or not. If con- 
 scious, they conceal it, but probably they minimize and 
 overlook the significance of these oncoming symptoms. 
 
 One of them is loss of appetite, and great nerve ten- 
 sion, with irritability and unusual excitement. Another
 
 72 INEBRIETY. 
 
 is gormandizing, and inordinate appetite, eating large 
 quantities of food, drinking tea and coffee to excess, etc. 
 Another symptom is intense activity and prolonged work, 
 neglect of rest, unusual excitement and anxiety about his 
 work, family and other surroundings. 
 
 Thus a previously lethargic man will become intensely 
 active, and manifest great energy, quite unusual, then 
 suddenly drink to great excess. A previously healthy 
 man sleeping well, will have insomnia for a few days, 
 and then begin to drink, or he will show unusual anxiety 
 of some oncoming serious disease and consult various 
 physicians, and then drink to great excess and forget all 
 his previous symptoms. 
 
 To the friends these great irregularities of thought and 
 conduct are not often recognized as premonitory to the 
 drink attack. In such cases there is undoubtedly present 
 some condition of hypersesthesia of the nerve centers, or 
 profound anaemia and the nervous organization is de- 
 pressed to a painful degree. 
 
 Then the thought of spirits and its narcotic action 
 comes like an obsession which is irresistible. The mystery 
 of the periodic forms of these states occuring at regular 
 intervals has not been explained satisfactorily. It would 
 seem very much like the gathering of toxins in the brain 
 centers, and their explosion calling for relief. 
 
 Alcohol used up to the point of stupor is followed by a 
 complete subsidence of all the symptoms, as well as the 
 desire for drink. Then recovery follows. Later the same 
 symptoms recur, with the same ending, and the free in- 
 terval is marked by the rigid abstinence and disgust for 
 spirits and its effects. 
 
 There must be some condition of exhaustion and de- 
 rangement for which spirits act as a most grateful relief. 
 This relief is only complete when profound narcotism 
 follows.
 
 PERIODIC INEBRIETY AND ITS SYMPTOMOLOGY. 73 
 
 The very common theories that alcohol is a stimulant, 
 bringing new force and power, are very influential in 
 suggesting and promoting its use at these periods, and 
 the anaesthesia and narcotism which follows confirm the 
 theory. Thus the senses and power of reasoning are 
 deceived by its effects, interpreting the anaesthesia as 
 stimulation and new force. The more spirits used, the 
 more obscure the actual condition and the consciousness 
 of the effects become. 
 
 The word "habit," describing certain acts and conduct 
 which seem to be under the control of the will to do or 
 not to do, fails to indicate the conditions of the periodic 
 drinker. 
 
 While there are certain acts of automatism and distinct 
 rhythmic uniform movements of the functional activities 
 of the body, it is not certain that they are under control 
 of the will, and can be regulated by reason or judgment. 
 The periodicity of the drink attacks of the inebriate, par- 
 ticularly when they occur at exact intervals, open up a 
 new field of explanations and theories that are not clear 
 or satisfactory. 
 
 It is very evident that much of this phenomena is be- 
 yond the control of the will. Whether this is the result 
 of conditions which could have been controlled is un- 
 certain. 
 
 There appears to be two classes of periodic drinkers. 
 One in which the drink period and the free interval are 
 irregular, uncertain and changeable. In the other, the 
 drink attack is always the same, and the free interval is 
 distinct in length of time as well as the period of drinking. 
 
 The former are by far the most numerous and prom- 
 inent. The drink attacks in these cases are irregular, the 
 length of the attack differing and the free interval 
 variable, sometimes lasting years, but recurring again in 
 about the same way and under the same conditions.
 
 74 INEBRIETY. 
 
 The free intervals continually become shorter as the 
 disease progresses, and often this form of drinking dis- 
 appears and the patient becomes a regular drinker. 
 
 There is a sub-class of this form of drinking that 
 may be termed accidental, contagious, environmental 
 drinkers. These terms refer particularly to causes. Thus 
 one will only drink accidentally on meeting certain boon 
 companions. The contagion of good company brings on 
 the attack, and its duration depends on the same surround- 
 ings. 
 
 Others drink in certain particular surroundings, and on 
 certain occasions, and are temperate in all other condi- 
 tions. They are periodic drinkers, but their drinking and 
 periodicity is uncertain, subject to conditions that are 
 unknown, and may vary widely in different surroundings. 
 
 Often the length of these attacks seem to be controlled 
 by the effects of the spirits on the organism. Thus in 
 one instance a few hours of toxic poisoning from spirits 
 is followed by reversion. In others, many days of ex- 
 cessive drinking occurs before the paroxysm dies out. 
 
 Great varieties of brain instability, physical and 
 psychical exhaustion occur both preceding and following. 
 This is manifest in the diseased, emotional, unreasoning, 
 fitful activities, with changing ambitions and ideals of 
 life, showing much confusion of the reason and loss of 
 control. 
 
 Such persons begin the use of spirits, with or without 
 any particular temptation, and not unfrequcntly in con- 
 ditions and surroundings that are adverse and repulsive 
 to all use of spirits. There are in many communities per- 
 sons who have used spirits to stupor and become so 
 thoroughly disgusted with the effects, both physical and 
 mental, that they seldom if ever drink again. 
 
 Some physical antagonism to the effects of spirits has 
 been roused in the organism, and the thought of it is
 
 PERIODIC INEBRIETY AND ITS SYMPTOMOLOGY. 75 
 
 painful. Such persons are emphatic in their explanations 
 of the ability of everyone to stop the use of spirits at 
 will, and often this emphasis is so pronounced as to be 
 unreasonable, and suggest a weakness that is manifest in 
 many ways. 
 
 Often persons who are so very emphatic in the con- 
 demnation of the weakness of drinking, suggest a per- 
 sonal experience and realization of the effects of spirits. 
 Frequently they are secret drinkers themselves, who use 
 spirits at irregular intervals, recover and show an in- 
 temperate zeal in condemning others who use spirits. 
 The physical and psychical repulsion for spirits from a 
 toxic state may last a lifetime, growing with the years, 
 or may die out any time and be forgotten. 
 
 It is always a question of great clinical importance to 
 find out the first impressions on the mind of the patient 
 from the action of spirits. If this has been very pleas- 
 ing, satisfactory and impressive, it will always be more 
 or less permanent, no matter what the distress and dis- 
 gust may be which follows the subsidence of the drink 
 craze. If the first impressions have been pleasing, there 
 are reasons for believing that spirits will be taken again 
 in later life, but if they have been painful and distressing, 
 that is, after the first excitement, both body and mind 
 have been depressed with pain and uncomfortable feelings, 
 immunity may be expected in the future. 
 
 This is only a general rule, to which there are many 
 exceptions. Thus persons who have been disgusted with 
 the flavor and odor of spirits, or persons in whom the 
 effects of spirits have been depressing have been able to 
 overcome this. Later these effects change, and new physi- 
 cal conditions call for the renewal of spirits, regardless 
 of its distaste or pleasure. 
 
 There are certain persons who on occasions of great 
 emotional excitement and depression use spirits and be-
 
 76 INEBRIETY. 
 
 come quickly intoxicated from a very small quantity. 
 In such instances there is no particular desire for spirits 
 that precedes the act. It comes on suddenly and without 
 reason. In the treatment of these cases, the early im- 
 pressions suggest how far possible treatment by mental 
 measures can be depended upon to build up resistance to 
 its farther use. 
 
 There are always wide differences in the physiological 
 action of alcohol on the organism. These are to be con- 
 sidered in an early study. Where remedies are given 
 for the purpose of producing revulsion and distaste, or 
 dread of the effects of alcohol, the results have not been 
 satisfactory and can not be, unless the previous history 
 of the patient is known. 
 
 If the organism has repelled the effects of alcohol with 
 suffering and pain, a mental impression may be produced 
 that will increase this repellant power, and the recogni- 
 tion of this fact is a very practical aid in the treatment. 
 
 In one instance, a business man who had drunk in early 
 life and been profoundly disgusted, then abstained for 
 many years, was advised by the physician to use spirits 
 for debility. Very soon he was profoundly intoxicated, 
 and the exhaustion and mental disgust which followed were 
 very intense. From that time on, the odor of spirits 
 produced nausea, and if he was in a company of persons 
 who were drinking, this produced vomiting. The early 
 impressions became a dominant antagonism to spirits. 
 
 Often persons find the effect of spirits pleasant at 
 first, and while the odor may not be very agreeable, the 
 sedative effect is pleasing. In this there is a constitu- 
 tional predisposition and a bias to use it for its imme- 
 diate effects. Many of these persons become periodic 
 drinkers, and have distinct periods of intense fascination 
 and pleasure for the effects of spirits, and then periods 
 of repugnance.
 
 PERIODIC INEBRIETY AND ITS SYMPTOMOLOGY. 77 
 
 In this way a medical prescription containing spirits 
 may awaken some latent tendency, which quickly develops 
 into inebriety. Common examples are noted of men who 
 during their college career have been intoxicated, and at 
 the time seem to enjoy the effects of spirits. They either 
 become abstainers or moderate drinkers. If of the first 
 class, they are likely under conditions of great strain and 
 mental excitement to drink to great excess and become 
 intoxicated, and soon become periodic drinkers. 
 
 If of the latter class, they may continue to drink in 
 great moderation and become literally alcoholics. Such 
 men often reason that it is a safe use of spirits to take 
 it in small quantities at regular intervals. In reality 
 these persons frequently drink to great excess, and do 
 not seem to realize that the moderate drinking has any- 
 thing to do with it. 
 
 There is one class of moderate drinkers in which the 
 free interval is very uniform and exact as to time. The 
 following are examples. 
 
 A lawyer with a neurotic history, who began to drink 
 in college at intervals, has now, after a period of thirty 
 years, distinct drink attacks every ninety-one days, and 
 three or four hours. These come on very suddenly, irre- 
 spective of surroundings and conditions, and last from 
 four to five days. 
 
 They are followed by acute gastritis, mental and 
 physical exhaustion and recovery. No efforts on his part 
 have succeeded in breaking up the attacks or preventing 
 their return. 
 
 On two occasions he was locked up, and became acutely 
 maniacal. This mania was only quelled by the use of 
 spirits. He now goes to a sanitorium or hospital on the 
 approach of the drink storm. He is given small quanti- 
 ties of spirits and watched carefully, and is thus able to 
 recover in a shorter time, with less debility.
 
 78 INEBRIETY. 
 
 He is perfectly temperate during the interval, and 
 suffers from intense disgust from the smell of spirits or 
 the sight of drinking men. A number of cases have 
 been noted where the free interval was marvelously exact 
 as to time, and no prophylactic treatment could check it. 
 
 A second case was that of a business man who never 
 drinks except on Thanksgiving Day. He is a neurotic 
 and used spirits in early life occasionally, but for many 
 years he has been abstinent except on these particular 
 days. He will attend church, dine with his family, seem 
 to be perfectly well, then suddenly the desire for drink 
 will come over him so impetuously that he will go to 
 his room and drink to intoxication for twenty-four hours 
 or more, and then recover. 
 
 A third case is that of a physician with an insane 
 ancestry, who for the last five years has drunk on the 
 Fourth of July, and at no other time. He suggests that 
 the noise and excitement provoke a desire for drinking, 
 and that this desire does not occur at any other time. 
 
 A brother of his has for years drunk to great excess 
 every second year on the anniversary of his marriage. 
 The time between the drink storms he is perfectly tem- 
 perate, and even on off years he says he thinks of drink- 
 ing on the return of the period, but is able to control 
 himself. 
 
 The next year the period for drink arrives, and with 
 it an intense desire which he is unable to overcome. A 
 number of cases have been noted of occasional drinking 
 men, who at certain definite periods drink to great excess. 
 At all other times they seem to have full control. 
 
 There is in these examples both a psychical and physi- 
 cal abnormality, which gathers and breaks like a storm 
 in the clear sky. In all probability the eccentric acts 
 and strange conduct of prominent men arc due to con- 
 cealed periodic inebriety.
 
 PERIODIC INEBRIETY AND ITS SYMPTOMOLOGY. 79 
 
 Many business men suddenly disappear, going to some 
 secretive place with very unsatisfactory explanations and 
 frequently without any ostensible reasons, and return 
 pale and feeble after a week or more, and calling in the 
 physician, are treated for malaria or some other condition 
 of nerve exhaustion. The real cause, periodic drinking, 
 is unrecognized. 
 
 Some of these persons seem to be aware of the ap- 
 proach of the attack, and make extraordinary efforts to 
 conceal it and prevent all inquiry or possible anxiety from 
 their efforts. They often show great activity in business, 
 providing for possible emergencies and obligations. In 
 reality, setting their house in order before they go. After 
 an uncertain interval they return and explain their ab- 
 sence with unusual statements. This resembles a reasoning 
 mania, and is only noted because of its unusual character. 
 
 Another class of periodic drinkers show no apprehen- 
 sion or anticipation of the drink impulse, which comes on 
 so suddenly as to overwhelm them at once. One man will 
 disappear suddenly, and will return in two or three days, 
 and be unable to explain where he was or what he did. 
 
 An instance of this kind was that of a banker who 
 after an interval of fifteen months will suddenly disappear. 
 Apparently he will disguise himself, take a drink, walk 
 out of town, take a way train, go to some obscure hotel, 
 stay two or three days, and be constantly stupid. Then 
 wake up and return, and be very indignant if anybody 
 inquires concerning his acts during this period. 
 
 Another man will stop in the middle of his work, buy 
 a quart of whisky, rush off to the woods and conceal 
 himself and drink to continuous stupor. This quantity 
 of spirits generally lasts him two days or more. Then 
 he will return, and, when pressed for an explanation, say 
 that it was his crazy spell.
 
 80 INEBRIETY. 
 
 A number of very sensational disappearances of prom- 
 inent men, who later are found in distant places, are ex- 
 amples of this class. Very curious explanations are 
 given, but the real facts are concealed. Often the person 
 is known as a temperate man, or perhaps a total abstainer. 
 At all events, above all suspicion of being an inebriate. 
 
 An event of this kind was the subject of considerable 
 comment a few years ago, and it appeared that this par- 
 ticular act was one of many which had been known to 
 only a small circle of friends. He was a man of very 
 startling oratorical capacities, and a temperance lecturer 
 of unusual magnitude. In the middle of one of his 
 lectures he became pale, stammered, asked his audience to 
 excuse him, and in the excitement of the occasion dis- 
 appeared so completely as to excite the most startling ap- 
 prehension. In reality, he disguised himself and went to 
 an obscure farmhouse in the country, where he remained 
 intoxicated for several days. He then recovered and 
 under disguise went to a distant town and appeared. He 
 was a periodic inebriate in which the drink periods came 
 on suddenly at long intervals. 
 
 A number of persons have been noted who did not dare 
 to attend certain festive occasions, such as college or 
 other reunions, or banquets where wine is served. The 
 obsession to drink on such occasions is so strong that 
 they become intoxicated. 
 
 There are both physical and psychical conditions pres- 
 ent, which are roused into activity, demanding the nar- 
 cotism. 
 
 The late Dr. Parrish described instances of persons who 
 never drank except on moonlight nights, particularly in 
 the fall months. At all other times in the year there was 
 no impulse, but rather a repugnance to the use of spirits. 
 
 Instances have been mentioned of persons who never 
 drink except after midnight. The rest of the time they
 
 PERIODIC INEBRIETY AND ITS SYMPTOMOLOGY. 81 
 
 have no desire. Another class use spirits in the early 
 morning. If they remain sober during these periods there 
 is no danger of the return of the drink paroxysm until 
 the same time the next day. 
 
 The periodic drinker is always a neurotic and psycho- 
 asthenic, and these peculiarities of time and place which 
 recur with such startling uniformity are due to brain 
 conditions unknown. 
 
 Explanations given by themselves or their friends are 
 so obviously unreal as to be unworthy of notice. Nearly 
 all these persons are secretive in their drinking, and show 
 great adroitness in explaining their conduct as due to 
 other causes. 
 
 There is not unfrequently traceable a certain ebb and 
 flow in the nerve energy of certain persons, noted by 
 exaltation or depression, and registered by obsessions for 
 spirits. It should be remembered that these drink cycles 
 and periodic obsessions may change into other abnormali- 
 ties. Such persons may frequently become drug-takers, 
 or show marked disturbance of the brain and nervous 
 system. 
 
 Emotional changes are characteristic. Thus intense 
 excitement over trivial things or depression without any 
 sufficient cause, may frequently culminate in the stupor of 
 intoxication, and after this is over melancholia may come 
 on, and perhaps suicidal impulses. A man may at inter- 
 vals of a year or more become profoundly depressed and 
 drink to great intoxication unless controlled. Then the 
 depression passes off and with it all desire for spirits and 
 another year intervenes. 
 
 In a certain number of instances these drink storms 
 break up, and their recurrence is marked by other symp- 
 toms of mental perversions. Sometimes suicide follows, or 
 wild periods of speculative mania or extreme suspicion of 
 his associates, and doubt of the integrity of those about
 
 82 INEBRIETY. 
 
 him. Several cases have been noted where a man pre- 
 viously a periodic drinker, suddenly develops startling 
 symptoms of collapse, and concealed manias, which puzzle 
 the physician, and are often the subject of anxious con- 
 sultations. The patient recovers in a few weeks, and no 
 one traces any connection between these obscure physical 
 states and his previous drinking. In all probability it is 
 only another phase of periodic drinking. 
 
 A noted officer in the Civil War drank to intoxication 
 with the yearly reunion of his comrades, and at all other 
 times he was temperate. He moved away where it was 
 impossible to meet his old comrades as before, and for 
 many years afterwards, during the month of September, 
 he suffered from obscure neurosis and psychosis for two 
 or three weeks at a time. 
 
 These disorders took on various phases of profound 
 exhaustion, symptoms of Bright's disease, malaria poison- 
 ing, paralysis of the lower extremities, insomnia, loss of 
 appetite and high fever. He recovered from all of these, 
 and for the following year would continue in good health 
 and spirits, a perfect abstainer in every particular. 
 
 A patient under our care many years ago, who made a 
 good recovery, returns regularly once a year in the month 
 of April, complaining of mental disturbance and depres- 
 sion, sometimes suffering from severe dyspepsia, always 
 from insomnia, and alarmed at his condition. The symp- 
 toms arc very startling, but pass away after four or five 
 days of rest and quietness. 
 
 He is a total abstainer and in a half conscious way 
 fears that his debility will lead up to the drink craze, and 
 hence comes for assistance. There is in this a very marked 
 psychical clement, controlled by his general physical de- 
 rangement. 
 
 The periodicities of the drink craze are exceedingly 
 complex, and take on very strange forms, so much so that
 
 PERIODIC INEBRIETY AND ITS SYMPTOMOLOGY. 83 
 
 there can be no classification or grouping that will apply 
 to any large number of persons. An instance of a very 
 prominent banker, who, after a very serious failure, drank 
 to excess and was placed in an insane asylum. A few 
 months later he recovered and resumed business again, a 
 thoroughly temperate man in all his thought and habits. 
 Years after he failed again and drank as before, recov- 
 ered; and the third time he failed, drank to stupor and 
 died. In this there was a curious return of the drink 
 impulse under similar circumstances. Several cases have 
 been noted of periodic drinkers, whose drink periods 
 were well defined, contracting consumption on the return 
 of the drink craze. 
 
 Two cases of this class drank every six months for 
 many years, on or about the 1st of July. Both of them 
 were taken with acute tuberculosis at the time the drink 
 craze should have appeared. One went to the North 
 woods, recovered, and the following year the same symp- 
 toms appeared and soon after he died. The second case 
 went under the care of a quack and was given large quan- 
 tities of whisky, recovered, in part, but continued drink- 
 ing moderately and finally died of the disease. 
 
 Pneumonia is a very common acute inflammatory con- 
 dition which is likely to occur at the time for the return 
 of the drink paroxysm. 
 
 The connection between the return of the drink im- 
 pulse and acute inflammation of the lungs is seldom 
 traced, but undoubtedly it is very close; a local form of 
 paresis starts up in the terminals of the pneumogastric 
 nerves, and this is not uncommon in other inebriates, not 
 necessarily occurring only in those who drink periodically. 
 
 Verv interesting studies have been made of the period- 
 icity of nerve energy, both in health and disease, and there 
 is evidently a very wide field of facts that are now prac- 
 tically unknown. It may be assumed that the periodic
 
 84 INEBRIETY. 
 
 inebriate has developed organic changes in the brain cen- 
 ters that are very serious, and although largely unknown 
 are very pronounced in their symptomology. 
 
 It has been stated by good authorities that only verj 
 highly nervously organized persons drink at intervals. 
 The coarser and more demented nervous organizations 
 demand spirits continuously. This has some basis in fact, 
 but has not yet been worked out. There is a very close 
 connection between periodic drinking and epilepsy. 
 
 Frequently the drink period merges into a muscular 
 paroxysm and a regular epileptic convulsion. The so- 
 called alcoholic epilepsies resemble this, although there 
 are often very confusing details. While the use of al- 
 cohol will certainly produce epilepsy, a periodic drinker 
 who has distinct intervals is evidently on the road to this 
 condition, although it may not break out in this partic- 
 ular form. 
 
 All such cases should receive the very closest study, 
 and the paroxysms should be regarded with the greatest 
 interest.
 
 CHAPTER IX. 
 CONTINUOUS DRINKERS. 
 
 Synopsis. The regular drinker more diseased than any other 
 class. The form of diseases. Comparisons with total abstainers. 
 The accumulative action of alcohol. Effects slight at first. Sat- 
 uration from spirits dangerous. Effects on the psychic centers 
 show derangement of mind. Changes of conduct and appearance. 
 The senses are always disturbed. The surface of the body de- 
 ranged. Nutrition is seriously effected. Diseases appear ascribed 
 to different causes. Examples of injury from spirits. Mortality 
 greater in moderate drinkers. Stories of long life, fictions. Beer 
 drinkers examples of degeneration. Prognosis bad. Statistics 
 confirm this. Delusions in common life. 
 
 The man who uses spirits regularly even in so-called 
 moderation, is literally paralyzed, although he does not 
 realize it. This paralysis is the direct result of con- 
 tinuously taking toxins into the system from the alcohol, 
 and consequent cell starvation. 
 
 Very interesting studies have been made of so-called 
 moderate drinkers, who claim to be in good health, and 
 in every instance defects and degenerations have been 
 recognized of great gravity. 
 
 Dr. C. H. Hughes has repeatedly called attention to 
 the fact that the moderate or continuous drinker of spirits 
 is more diseased and degenerate, notwithstanding his ap- 
 pearance of health, than one who uses spirits at intervals 
 and recovers. 
 
 Dr. L. D. Mason has made many studies of this class, 
 and pointed out the low vitality and feeble power of re- 
 sistance and extreme susceptibility to disease, noted in 
 such persons. The increased action of the heart is always 
 marked by high tension, and with this comes lack of 
 precision and muscular control, faults of memory, slow- 
 ness of thought and inability to act quickly. 
 
 85
 
 86 INEBRIETY. 
 
 There are evidently two classes of continuous drinkers. 
 One, who after a time becomes excessive users of spirits, 
 either periodic or spasmodic, at irregular intervals. The 
 other class develops various diseases of which neuritis, in- 
 flammation of the kidneys and liver are most common. 
 
 They are not called inebriates, and yet the diseases 
 from which they suffer are traceable to the use of spirits. 
 Frequently they suffer from mental troubles that are ob- 
 scure and difficult to understand. 
 
 Eminent authorities, in all departments of medicine, 
 have called attention to the pronounced disease, both of the 
 brain and nervous system, in persons who used spirits 
 regularly. Recent text-books assert very positively that 
 in certain diseases all use of alcohol must be discontinued 
 in the treatment. 
 
 The cumulative action of alcohol, when used in small 
 doses, is unrecognized and yet all persons who are mod- 
 erate drinkers have a great variety of defects, which 
 they ascribe to other causes. In another chapter these 
 effects are presented in some detail. The effects prob- 
 ably begin with deranged circulation, increasing and di- 
 minishing the action of the blood, and the oxygen-carrying 
 properties of the red blood corpuscles. 
 
 These changes are slight at first, but later the use of 
 spirits prevents the readjustment of the disordered con- 
 ditions. The minute capillaries fail to convey the blood 
 uniformly to all parts of the brain. The nutrient plasma 
 is diminished. The toxins increase, and diminished force 
 and vitality follow. 
 
 When spirits are taken to excess, a point of saturation 
 is reached in which spirits are exhaled by the lungs, and 
 there is a pronounced form of circulatory derangement. 
 There must of necessity be very serious disturbances 
 when the alcoholic ethers accumulate to such an extent 
 as to be exhaled through the lungs.
 
 CONTINUOUS DRINKERS. 87 
 
 When the first effects of spirits pass away, there is a 
 sense of suffering and consciousness of low vitality that 
 calls for a renewal of the drug, and in this way the de- 
 lusion of strength and vigor is created. Clinical com- 
 parisons and studies of persons who use spirits daily and 
 those in the same condition who are abstainers, show very 
 striking differences. 
 
 In the moderate drinker there is exaltation of the ego, 
 unusual confidence, and unreasoning faith in his strength 
 and ability. This may not be very prominent at first, 
 but grows with the increased use of spirits. His conduct 
 and work become more automatic and mechanical, and less 
 original ; he is more incapable of change and adaptation 
 to new conditions. 
 
 His pride of appearance and integrity changes. Soon he 
 will suffer from defective eyesight and troubles of hearing 
 and catarrh, will begin to wear glasses, will visit the nose 
 and throat specialist, and be disturbed about chills and 
 drafts. Later he will complain of digestive disturbances, 
 and perhaps change the form of spirits, or combine it 
 with milk or some other substance, increasing the amount 
 and shortening the periods between the times of using it. 
 
 Then he will show anxiety and unusual zeal to defend 
 its use and claim its tonic and medicinal powers as seen 
 in his own experience to be very valuable. This reason- 
 ing is often marked by inconsistency, of which he is 
 oblivious. 
 
 Very soon the face and skin show congestion and 
 palsy, literally vasomotor paralysis of the capillaries 
 seen in the face, and associated with this are pains along 
 the track of the large nerves, called rheumatic. 
 
 Insomnia comes on and the physician diagnoses neu- 
 rasthenia, brain exhaustion, or perhaps night-sweats and 
 chills suggest malaria and catarrhal and bronchial trou-
 
 88 INEBRIETY. 
 
 bles give hints of incipient tuberculosis, and the patient 
 is sent to another climate. 
 
 Together with this there is irritability, emotional 
 changes and other prominent symptoms. The moderate 
 drinker sooner or later becomes an invalid, and patron of 
 physicians, both regular and irregular. His credulity and 
 skepticism suggest all sorts of means and measures, which 
 invariably fail to bring relief. 
 
 Then comes proprietary medicines, and should they 
 happen to contain opium, the improvement of the symp- 
 toms are so marked that he becomes an enthusiast in the 
 hope of recovery. 
 
 In all this search for health there is no thought of the 
 moderate use of spirits as a primary cause. His increas- 
 ing weakness and complex symptoms suggest different 
 kinds of spirits which he uses with great eagerness and 
 confidence. 
 
 One fact impresses itself on the mind of the patient 
 that he is unable to do what he did formerly, and that 
 he is gradually becoming weaker. His low vitality and 
 profound exhaustion after mental and muscular activity 
 and the slow power of repair from injuries attract the 
 physician who ascribes it to other causes. A sudden chill 
 and acute pneumonia end fatally in a few days. 
 
 The diagnosis of Bright's Disease is sometimes made, 
 and the advice to stop the use of spirits is followed by 
 depression and so-called collapse that forces him to resume 
 its use again. 
 
 After a time the constant user of spirits, even in great 
 moderation, will show some disturbed states or defects and 
 degenerations of some particular class or of some par- 
 ticular organ of the body. Thus, in one case a moderate 
 drinker exhibited emotional changes, was excitable, suspi- 
 cious and angry without cause. This was very unusual
 
 CONTINUOUS DRINKERS. 89 
 
 in his conduct. Another man was indifferent, stupid and 
 neglectful of common every-day duties. His former cau- 
 tion and conservatism changes to the other extreme and 
 he becomes a speculator, is visionary and unwise in his 
 thought and conduct. 
 
 Probably the derangement of nutrition recognized in 
 capricious appetite is the most common disturbance. A 
 great variety of nutrient disturbances occur that resist all 
 treatment. 
 
 In practical, every-day life where exact, uniform work 
 is required, the moderate drinker becomes more and more 
 incapable. Men working on the railroad or in positions 
 where exactness of work as to time and accuracy are re- 
 quired are very soon discharged as incompetent. 
 
 This inability is due to faulty sense perceptions and 
 feeble reasoning powers, with uncertain memory and in- 
 ability to act rapidly and with clear judgment. Em- 
 ployers of coarse muscular-labor workmen recognize that 
 the daily output of work is greatly diminished in persons 
 who use spirits constantly. 
 
 Thus groups of Italians who use spirits daily arc un- 
 certain, and their muscular output is unreliable, particu- 
 larly in emergencies. Injuries of any kind also are more 
 serious, with a slower convalescence than in others who are 
 abstainers. 
 
 The steady beer-drinker is a very marked example of 
 progressive degeneration. The delusive appearance of 
 health noted in the workmen about breweries, and par- 
 ticularly on the docks at Liverpool is contradicted by the 
 high mortality and frequent fatal results from insig- 
 nificant injuries. 
 
 A large percentage of beer drinkers die before middle 
 life, or are invalids and taken to hospitals to pass the 
 remaining years.
 
 90 INEBRIETY. 
 
 It is a curious illustration of popular ignorance that 
 the moderate use of spirits and beer is thought to favor 
 ideal health and longevity, and that if the user could con- 
 tinue its moderate use the best results would follow. 
 
 Repeated stories in the daily press of persons who use 
 spirits in small quantities regularly for long periods of 
 time, and not only do not suffer, but are better for it, 
 are often found to be mere myths ; for while it is pos- 
 sible for some persons living in quiet surroundings, with 
 little or no mental strain or activity, to use small doses 
 of spirits regularly for a period of years, experience 
 shows that they are the exceptions to the rule. Careful 
 studies of moderate drinkers show that they always de- 
 velop some chronic disease, and become broken down in a 
 very few years. 
 
 Dr. Mason, in a recent study, showed that both beer 
 and spirits taken in moderation always develop diseases, 
 and are followed by a shortened life and complex degen- 
 erations from which there are few if any exceptions. 
 
 Many studies have been made of persons of this class, 
 with a view of determining their freedom from disease and 
 their average mortality, but the results have always been a 
 confirmation of the statement that all persons who drink 
 in moderation suffer more or less from degenerations, 
 either acute or chronic. 
 
 In business circles the moderate drinker is regarded with 
 suspicion, particularly as to his capacity, reliability and 
 stability. Pie may be tolerated, but he is regarded as a 
 doubtful factor in the hard, grinding struggle of trade. 
 
 In the social and scientific world many men are known 
 as moderate drinkers, and there is very little question 
 about their mental impairment, and yet after a time a 
 strange, unusual will is revealed at death. Their affairs 
 become involved in strange financial difficulties. Their
 
 CONTINUOUS DRINKERS. 91 
 
 credulity and unusual conduct are marked in some start- 
 ling way. 
 
 An example was that of a noted statesman who sud- 
 denly exhibited a most extraordinary course of conduct, 
 and a short time after he suddenly died. The fact of 
 his moderate drinking explained this sudden lapse of 
 good judgment. 
 
 Many instances are prominent where all unexpectedly 
 changes of religion, occupation, conduct, judgment, cau- 
 tion and all other conditions which have marked the pre- 
 vious career occur, and are traceable to the cumulative 
 degenerative action of alcohol, which has been used for 
 years in so-called moderation. 
 
 It may be stated as a fact, the exceptions to which 
 only prove the rule, that the moderate and steady user 
 of spirits is always diseased and degenerate, whether we 
 recognize it or not. He may do his accustomed work, 
 but it will be automatic. His mental and muscular vi- 
 tality is impaired. His resistance to disease is diminished 
 and his susceptibility increased. 
 
 He is not only aged, but his vitality is reduced to the 
 point where restoration is more and more uncertain. The 
 drink craze may die out, and he may be a total abstainer, 
 but how far he can recover is an open problem. It has 
 been stated elsewhere that moderate drinking in this 
 country is far more serious than in Europe. This fact is 
 founded on statistics. Recent studies of the beer drinker 
 and the user of wines and spirits in Europe show the same 
 conditions, only less marked. 
 
 Thus in Munich, the home of the supposed finest qual- 
 ity of beer, heart and kidney diseases prevail to an alarm- 
 ing extent, and circulatory diseases constitute one of the 
 largest factors in mortality, and these, more and more, 
 are traced to the toxaemias due to alcohol.
 
 92 INEBRIETY. 
 
 It is a curious fact not recognized that the constant 
 drinker suffers from delusions concerning himself. Where 
 he is an active brain worker it is absolutely certain that 
 he can not continue the use of spirits any great length 
 of time without marked impairment, and yet he never 
 realizes this, but is constantly deceiving himself with the 
 faith that he is able to do as much as ever and with the 
 same skill and vigor. 
 
 The muscular worker has the same faith and confi- 
 dence in his ability, but actual measurements of his out- 
 put prove the delusion that he is laboring under. The 
 evidence of the impairment of the moderate drinker is 
 accessible, can be studied in every community. 
 
 In institutions the effort to restore such persons is at- 
 tended with great difficulty and prolonged invalidism.
 
 CHAPTER X. 
 
 INEBRIETY A FORM OF MORAL INSANITY. 
 
 Synopsis. What moral insanity represents. An accurate scien- 
 tific term very common in inebriates. Marked following inebriate 
 ancestors. Indicating' arrested development. Can be acquired. 
 Examples frequently noted. Symptoms common to chronic in- 
 ebriates seen in persons at the beginning of inebriety. Alcohol de- 
 stroys the moral sense first, in some persons very prominently. 
 Examples given seen in both extremes. In the supposed Intel- 
 lectual and wealthy classes and in the lowest and most defective. 
 Should be recognized in the study and treatment. A particular 
 form of degeneration going through successive stages. A form 
 of insanity not recognized in the books. One that is more or less 
 common in certain circles of society. When convicted of 
 crime cannot be defended by any known symptoms of insanity, 
 hence are punished as responsible. A new field for psychical study 
 that will occupy a very large place in the future. 
 
 The term moral insanity represents a condition of the 
 brain in which all sense of right and wrong, duty and 
 obligation is feeble or wanting. Recent exhaustive stud- 
 ies of the brain and mental phenomena indicate a loss 
 of the ethical sense, and the consciousness of the right 
 relations to others, in many persons who otherwise seem 
 to be normal, but whose truthfulness, honesty and respect 
 for law and the feelings of others seem to be entirely 
 wanting. 
 
 The term moral insanity has been used to describe this 
 condition, and in a general way it may be considered 
 fairly accurate, because it describes a condition which 
 exists, although but little known. It should be studied 
 more, for no real reform in public or private life is pos- 
 sible until the causes are removed. 
 
 In inebriety these symptoms of moral defect are com- 
 mon, no matter what the conditions and standing of the 
 persons may be. It seems to follow the poisoning from 
 
 alcohol, and in some cases very markedly. Two classes 
 
 93
 
 94 INEBRIETY. 
 
 appear prominently one hereditary, and the other ac- 
 quired. Wherever there is a marked history of heredity, 
 of alcoholic parents, or of neurotic degenerate ancestors, 
 a feeble or deficient consciousness of right and wrong is 
 found. 
 
 Alcohol used continuously retards growth, diminishes 
 vitality and prevents development. Drinking parents 
 have deficient vitality and are unable to transmit to the 
 next generation full normal vigor. The last and highest 
 formed element of brain power is the first to suffer from 
 alcohol. 
 
 Hence drinking parents seldom' have children with nor- 
 mal consciousness, sensibility and ethical growth. This 
 faculty will be wanting or very feeble in development. 
 This is the rule to which the exceptions are rare. The 
 defect may be associated with much intelligence, intel- 
 lectual capacity and power to conceal this condition. 
 
 A man prominent in the political world acts in private 
 life as if devoid of all sense of justice, of right and 
 wrong, and duty to others. He is untruthful and dis- 
 honest, and when his own interests are concerned will 
 sacrifice any person or principle to gain his ends. His 
 parents were wine dealers and drinkers, both of them 
 waiting on customers over the bar. 
 
 Only one child grew to manhood who entered politics 
 as a trade. He is temperate, but a moral paralytic, or a 
 moral maniac, with capacity to conceal his condition. 
 
 A man who became one of the greatest swindlers and 
 forgers of his day, was able to keep out of prison by 
 intrigue and cunning, came from drinking parents. To 
 his associates he is known as being without any sense of 
 duty and obligation to any one, and is a literal brigand. 
 
 That these conditions are due to inheritance is ap- 
 parent from the following:
 
 INEBRIETY A FORM OF MORAL INSANITY. 95 
 
 A boy with parents who drank excessively was taken in 
 infancy and educated in a most careful way; all the 
 higher faculties were cultivated to an unusual degree, 
 and he entered the church as a brilliant clergyman. He 
 was found to be untruthful in regard to himself, suspi- 
 cious of others and grasping, even up to the border of 
 theft in many matters. The collections in church had to 
 be kept out of sight, and always suffered if they passed 
 through his hands. 
 
 He became involved in spreading scandal, and seemed 
 oblivious of the danger of such conduct, and broke up 
 one church by his irregularities. For ten years, until his 
 death, he was in continual trouble with every church he 
 was associated with. Here the evidence was clear that he 
 had inherited defective conscientiousness, which defect no 
 training or surroundings could overcome. 
 
 In cases where inebriety has been acquired by acci- 
 dent, such as contagion of surroundings and conditions 
 of living, these moral insanities vary widely and are not 
 so general. 
 
 In one instance excessive untruthfulness and dishonesty 
 in all business relations was associated with sympathetic 
 tenderness to associates. In another, intense suspicion 
 and doubt of the honesty of others was associated with an 
 extreme desire to be truthful personally. 
 
 Another individual was intriguing, secretive, treach- 
 erous, and uncertain in his talk, and yet lived otherwise a 
 moral, upright life. 
 
 These are examples of a class almost infinite in 
 variety and manifestation, and all show profound changes 
 in the moral faculties. The more common forms are 
 illustrated in this case : A. B., a business man of good 
 reputation and standing in the community, began to 
 drink after a protracted illness from typhoid fever. Two 
 years later he became an inebriate. His mind continued
 
 96 INEBRIETY. 
 
 bright and clear, but his character changed. He was de- 
 ceitful, suspicious and slanderous, and thought his sons 
 and clerks were robbing him, and that his wife was in 
 league with them. 
 
 He had his books examined by an expert, and was still 
 in doubt when they were found correct. He told false- 
 hoods about his business and family, and grew more and 
 more egotistical about his mental capacity to grasp and 
 decide all matters. He was harsh and tyrannical to his 
 wife at times, lost all pride of character in the com- 
 munity and sense of obligation to others. 
 
 He was exacting in everything done for his own 
 interests, and oblivious of others' feelings and tastes. As 
 a patient he was intensely selfish and grasping, even to 
 theft, was fawning and obsequious, promising everything 
 and doing the opposite. 
 
 In the summary of the common symptoms following the 
 use of alcohol, untruth fulness, or a low respect for their 
 word, is most prominent. A man who previously took 
 pride in the correctness of his promises and statements, 
 will become indifferent to his word, whether true or false. 
 
 A man previously honest and trustworthy will be found 
 doing dishonest things, cheating persons, taking advan- 
 tage in little matters, and failing to act fairly in the 
 interests of himself or others. Then follows suspicion of 
 motives and conduct, doubting the honesty and purity 
 of persons. 
 
 This deepens into delusions of intrigue and deception 
 of others, extreme pessimism and doubt of everything ; 
 or a state of mind follows in which the distress of others 
 is pleasing. 
 
 Recklessness in the use of money, throwing it away 
 without motive or purpose, or extreme parsimony to 
 hoard it, and grasping selfishness, equally unreasonable, 
 are common. As in other insanities, exaltation of the
 
 INEBRIETY A FORM OF MORAL INSANITY. 97 
 
 ego follows, and intense confidence in themselves, their 
 power of reasoning and their ability to do anything pos- 
 sible is present. 
 
 Many persons who exhibit all these symptoms appear 
 to be but little changed in other respects. They carry 
 on business, seemingly make good plans and execute them, 
 and appear to casual observers the same. 
 
 These insanities seem to concentrate into particular 
 lines or ranges of thought. In one case an inebriate 
 lawyer doubted the honesty of everyone and thought no 
 one was pure or had good motives, and yet he acted 
 rationally on all other matters. In another case a teacher, 
 who had drank many years, became a secret thief, pur- 
 loining everything which he fancied, and when likely to 
 be detected restored them in some mysterious way. 
 
 He appeared honest and talked honestly, and yet when 
 not observed took every opportunity to appropriate any- 
 thing that came in his way. A number of cases of in- 
 ebriates have been reported where this kleptomaniac im- 
 pulse took on certain peculiar forms. Thus, one man 
 while drinking stole Bibles; another jewelry, and when 
 discovered gave them up freely. One man stole wash- 
 tubs. A woman inebriate always took aprons and towels ; 
 another man stole soap, and so on. 
 
 The most unusual and unreasonable things are taken, 
 concealed and given up freely without any sense of the 
 nature of the acts. One class of inebriates exhibits this 
 insanity in malicious slander, another in extreme suspicion, 
 others in vindictiveness to resent real or imaginary evils, 
 others in immorality and impurity of act and thought. 
 Many of the chronic cases exhibit all these phases in one. 
 
 The oft-repeated statement that "inebriety is criminal- 
 ity," is true in a general sense, when criminality is under- 
 stood as a course of conduct in which duty, right, and 
 obligations to others are ignored. The inebriate has
 
 98 INEBRIETY. 
 
 physically defective senses; he is not able to adjust him- 
 self to the outside world correctly, because his knowledge 
 of its relations is imperfect. His power of reasoning is 
 also deranged, because the impressions from without are 
 faulty and the integrity of the normal action of the 
 nervous system is impaired. 
 
 The coarser physical lesions in the inebriate are well 
 recognized and can be traced in all cases. Beyond these, 
 conduct indicates the higher moral defects and changes. 
 Mental changes, as loss of pride, of character, of honor, 
 respect for the truth, of duty to others, low motives or 
 no motives, extreme pessimism, are the first and common 
 changes wrought by alcohol which lead up to criminal 
 acts. 
 
 The paralyzing action of alcohol is first seen on the 
 moral brain in the dullness and defective workings of its 
 higher functional activities. The change observed when a 
 man is under the influence of spirits is vaguely called the 
 removal of the restraint of reason and the dominance of 
 the animal impulses the brute triumphing over the real 
 man. In reality it is palsy of the consciousness, a cut- 
 ting off of some part of the higher brain, and conse- 
 quent management by the lower brain and its workings 
 on animal levels. 
 
 Impressions are vague, the meaning confused and ob- 
 scure ; the higher relation of events and conditions of 
 life are unrecognized. It is asserted that three per cent, 
 of all persons born are without normal consciousness of 
 right and wrong. They have retarded brain development. 
 The part of the brain which determines moral control, or 
 consciousness of the higher duties is wanting or unde- 
 veloped. 
 
 Such persons are defectives, and insane in the general 
 meaning of that word, and like dements, are incapable 
 of normal, healthy adjustment to the relations of life.
 
 INEBRIETY A FOEM OF MORAL INSANITY. 99 
 
 In cases where an apparently normal state of this 
 brain function has existed and then a great abnormality 
 follows in thought, word and conduct, disease is present. 
 Comparisons of the conduct and character of inebriates 
 before their use of alcohol and after they become regular 
 drinkers, bring out some startling facts that are yet un- 
 recognized. 
 
 From the lowest type of the demented inebriate at the 
 bottom, to the moderate drinker and fashionable club- 
 man at the crest, there is a distinct relation and chain of 
 cause and effect. The clear moral insanity of the one is 
 traceable up to the other without any sharp dividing lines. 
 The moderate drinker and clubman, who proves to be a 
 defaulter, or one who is involved in conduct that is crim- 
 inal, or who becomes a principal in crime, is suffering 
 from disease differing only in degree, but not in kind 
 from the degenerate inebriate tramp. 
 
 Moral insanity is a very prominent phase of inebriety. 
 Its absence in any given case is an exception to the rule. 
 A man with a high moral development, usually after he 
 becomes an inebriate, may return to the form and externals 
 of his previous character. He may be more emphatic in 
 his display of some qualities such as religious observance 
 and duty, and yet in business or social matters be ob- 
 livious of all obligation. 
 
 One such man who prayed for inebriates and lectured 
 on temperance carried on an intrigue and sold his influence 
 to the highest bidder. Another man acted as an agent 
 for the sale of stolen goods, and at the same time carried 
 on a great reform revival ; and another was engaged in 
 gold mine swindles, while lecturing every night for gospel 
 temperance. The moral insanity was called hypocrisy, 
 and, in legal phrase, was malicious, criminal and vicious. 
 
 In reality it was degeneration and disease, the breaking 
 down of one part of the brain while the others remained
 
 100 INEBRIETY. 
 
 apparently clear. In our Civil War a noted general 
 drank to excess at times. Previously he was noted for his 
 hearty frankness and honesty, but was found unreliable, 
 intriguing and failed when needed most. He showed 
 petty weakness and untruthfulness, with malice that was 
 unknown before in his conduct. He finally died a moral 
 wreck, after the war was over, having become almost crim- 
 inal in his thoughts and acts. 
 
 A clergyman became a secret inebriate and later became 
 involved in a low intrigue and was turned out of the 
 pulpit. He was insane ; his consciousness became palsied, 
 and for a time he taught ethical truth automatically. 
 The possibility of one part of the brain being affected 
 and the rest doing normal work, and this condition being 
 concealed, is a reality which experience frequently con- 
 firms. 
 
 The inebriate who has lost pride of character and 
 sense of duty and obligation, truthfulness and honor 
 may seem to be the same in many ways for a long time, 
 but sooner or later this diseased moral condition will 
 spread, and his whole organism show degeneration. The 
 following are the notes of some cases which have occu- 
 pied public attention and been the topic of much bitter 
 discussion. 
 
 CASE 1. John Blank. His father was a strolling 
 actor of irregular character and an inebriate. He mar- 
 ried a woman of average ability from a good family. 
 The father died before John was born, and two years 
 later his mother married again. John was brought up 
 with great care and tenderness. His later education was 
 of the best character. He was the leader of his class as a 
 scholar and an athlete. To his mother and intimates he 
 displayed an intense selfishness, putting his interests and 
 desires above those of all others, and had no consideration 
 for pain and distress that he caused to those about him.
 
 INEBRIETY A FORM OF MORAL INSANITY. 101 
 
 He was cruel in his conduct to anyone who was in the 
 way of his achievement of any purpose or desire. He 
 finally became a lawyer, and was thoroughly unscrupulous 
 in money matters, although not miserly or avaricious. 
 As a politician he was without honor or pride of char- 
 acter and would stoop to anything to accomplish his 
 purpose. 
 
 He married a rich woman and soon after swindled his 
 father-in-law, and possessed himself of a large property. 
 Then he drank and began to live a fast life. Had a 
 mistress and attended horse races. Wherever he went he 
 swindled and falsified, and was feared by everyone who 
 had any dealings with him. He went into stock gambling 
 and was swindled and swindled others. He was cruel and 
 violent in his conduct toward his wife and children. After 
 a period of excessive use of spirits he killed his wife and 
 made no effort to conceal it or run away. 
 
 On trial his schemes for deception and fraud were re- 
 vealed to the astonishment of everyone. Truthfulness, 
 honor, duty and all the qualities which go to make char- 
 acter were absent. He was convicted of murder, but the 
 sentence was commuted to life imprisonment. 
 
 In this case the moral idiocy was inherited. The higher 
 part of the brain was undeveloped and beyond the reach 
 of culture and education. Without education he would 
 have sunk to a low tramp criminal and burglar, and 
 been a pauper degenerate, dying early. With education 
 he became a high-grade criminal, because he was unable 
 to appreciate ethical truth or moral relations. He was 
 insane from birth ; alcohol intensified and developed this 
 condition. The insanity was of the higher ethical brain, 
 and concealed, except to those who knew him intimately. 
 
 CASE 2. The second case came from a good family, 
 and was normal in all his relations to others ; was truth- 
 ful, honest and seemed generous and very kind. After a
 
 102 INEBRIETY. 
 
 severe attack of typhoid fever, during which he was given 
 large quantities of spirits, he began to use alcohol daily. 
 His father died and left him in charge of a large business 
 interest. His character changed. His regard for his 
 work was lost. He was suspicious of his mother and 
 brothers, and took money out of the business and con- 
 cealed it. He left his home for a hotel, and when drink- 
 ing excessively, wrote violent, scandalous letters to his 
 family and employees. He associated with low women, 
 but treated them harshly, refused to give them money 
 and was constantly in trouble. No public exposure dis- 
 turbed him. He was frequently in court for petty 
 swindles, and refused to pay unless forced to. His busi- 
 ness declined and was finally taken out of his hands, and 
 he became a low blackmailer and beggar, drinking at all 
 times and places. He was examined for lunacy and 
 decided to be sane. No symptoms of insanity were 
 found; nothing but wilfullness and vicious cunning was 
 the opinion of Philadelphia experts. Finally he was 
 convicted as an accessory to murder and incendiarism and 
 sent to prison for life. This was clearly moral insanity, 
 acquired and intensified by drink. His family and early 
 history showed no trace of defective conscientiousness or 
 moral weakness. 
 
 His parents were temperate, moral people, church 
 members, above all suspicion. In his early life he at- 
 tended church and Sunday-school, and had a lovable, at- 
 tractive character. He began his business career with 
 his father, and seemed in every way honest and honor- 
 able. He displayed excellent judgment, and was en- 
 trusted with large business interests, which he faithfully 
 executed. During his illness with the typhoid fever his 
 father died, and on his recovery he was put in charge of the 
 business. A total change of character which followed his 
 recovery might have been due to the spirits given, or to
 
 INEBRIETY A FOBM OF MOBAL INSANITY. 103 
 
 the injury to some brain centers from the fever. At all 
 events, the use of alcohol intensified and fixed this con- 
 dition. In both of these cases a great deal of mental 
 vigor and apparent sanity was associated with his low 
 morals and brain force. In the latter the experts could 
 find no impairment of reason or memory, and concluded 
 that his conduct was simply vicious. 
 
 These facts describe conditions and symptoms that are 
 not well known, but exist in a certain proportion of all 
 inebriates and persons who use spirits. The change of 
 character and the failure of the last-formed faculty of the 
 brain, termed the "ethical sense" of right and wrong, is 
 characteristic of the action of alcohol. 
 
 In addition to this, there is a class of persons in whom 
 this ethical sense is wanting or very feebly developed 
 before alcohol is taken. In such persons the use of 
 spirits would simply intensify and increase the previous 
 degeneration ; and it is persons of this class which fur- 
 nish the largest number of recruits of low criminals. 
 
 No matter what the previous condition has been, in- 
 ebriety signifies a special and pronounced damage of the 
 ethical sense which may be termed moral palsy. 
 
 Studies of drinking men bring out this fact, and show 
 that no matter what the other forms of degeneration are, 
 this peculiar defect is always present. Whether this is a 
 transient palsy due to physical changes or whether it is a 
 permanent cutting-off and breaking down of some func- 
 tional activity, is disputed. Many authors consider it an 
 inherited condition and seen only in persons whose an- 
 cestors have been diseased. 
 
 The practical character of this phase of inebriety comes 
 out in the question of responsibility for crime and con- 
 duct that is unusual and antagonistic to law and order. 
 Many interesting questions call for an answer; thus, is it 
 possible for one to use alcohol either as a constant or
 
 10-i INEBRIETY. 
 
 periodic drinker, and retain his former consciousness of 
 duty, obligation to himself and others? 
 
 In pronounced toxic states from spirits this conscious- 
 ness is evidently wanting. Is it possible to recover fully 
 this ethical sense of right and wrong after repeated toxic 
 states? These are some of the questions which can only 
 be answered by a study of accurately observed facts, and 
 not from theories or opinions. 
 
 So far, the moral palsies, so common in all inebriates, 
 are very significant symptoms that should be recognized 
 and studied in every effort towards prevention and cure.
 
 CHAPTER XI. 
 
 GENERAL CAUSES AND FAVORING CONDITIONS. 
 
 Synopsis. Explanations of the causes very numerous. Each 
 patient feels competent to explain the causes in his case. Ego- 
 tism a common symptom. Loss of pride and character another 
 symptom. Physical exhaustion often precedes the drink stage. 
 Heredity a very active cause. Nervous diseases indigenous. Al- 
 cohol most grateful remedy. Children given wine in early .life 
 have a predisposition later to use spirits. Persons with bad train- 
 ing. The alcoholic impulse is grown and cultivated. It may ap- 
 pear suddenly. It may break out in middle life from causes that 
 are dormant. It may appear any time from some change in the 
 brain. Obscure conditions may be active causes. Diet important 
 and active as an exciting cause. Periods of life when it is more 
 likely to break out. Shock of the first intoxication leaves an 
 entailment. Symptoms of drink neurosis. Psychic symptoms. The 
 demand for alcohol and relief which it brings. Danger of using 
 alcohol as a remedy. Unknown vitality and resisting power. Early 
 physical impressions continue in after life. Examples. Alcohol 
 dangerous in aged. General considerations. 
 
 It is a curious fact that the inebriate and his friends 
 have unusual confidence in their ability to explain the 
 causes which impel men to drink, and explain the reasons 
 why spirits were first taken. This is one of the few 
 disorders in which almost everyone has an opinion and 
 feels very free to express it, at all times and upon all 
 occasions. 
 
 In a work on "Drunkenness," published some time ago, 
 the author made very prominent the causes and the exact 
 reasons why spirits are taken. Among other things were 
 mentioned heat, cold, hunger, thirst, weakness, anger, 
 sorrow, loss, success, death, birth, overwork, no work, 
 want of sleep, and so on ; covering nearly every condition 
 of life and occupation. 
 
 The author was so impressed with the accuracy of his 
 studies that he seemed to fairly revel in details and ex- 
 planations of how and why the drink impulse developed. 
 
 105
 
 106 INEBRIETY. 
 
 He was very confident that the judgment of a large num- 
 ber of inebriates furnished the most accurate data in the 
 study of causes and motives which impelled the drink 
 craze. 
 
 His book, like many others, contained evidence that the 
 author himself was a victim, and was simply enlarging 
 his experience. If the study of insanity was based on 
 the opinions of insane men, and their motives and con- 
 ceptions, it would be very confusing and doubtful, and 
 the explanations of the causes would vary with each in- 
 dividual. 
 
 In much the same way the inebriate who describes with 
 minuteness how the first use of spirits began, and the 
 conditions which favored its continuance is not likely to 
 be accurate. Literally, very few inebriates can give any 
 rational reason why spirits were used at first, although 
 afterwards, while under the influence of spirits, they are 
 very profuse in their reasons and explanations. 
 
 On recovery these are forgotten, and the patient ac- 
 knowledges his inability to tell why, or give any clear 
 explanation as to how, he first began to use spirits. 
 
 Occasionally a person is conscious of intense pleasure 
 from the effects of the spirits, and of his inability to resist 
 its use. Many persons take spirits for the first time 
 without any thought of its danger, which they never real- 
 ized fully until in later stages when an effort is made to 
 give it up. 
 
 Most inebriates have a very faint idea of the danger 
 from the use of spirits, and the struggle to abstain is a 
 mere matter of promises ; words with a delusive confidence 
 in their ability to control the desire. 
 
 The explanations offered by the inebriate, of how he 
 became addicted and how he can escape, are most unreal ; 
 and yet they are accepted by his friends and associates 
 as practical facts.
 
 GENERAL CAUSES AND FAVORING CONDITIONS. 107 
 
 The egotism of inebriates is one of the first signs of 
 degeneration. This occasionally merges into mania or 
 slight forms of melancholia. It has been stated by many 
 authors that all inebriates are both maniacal and melan- 
 choly, and the evidence on which this is based is strikingly 
 confirmed in many instances. 
 
 In a study of a large number of inebriates, there ap- 
 pear to be two distinct ranges of causes prominent; one 
 of general physical and psychical exhaustion that has 
 preceded and follows from the use of spirits; the other, 
 some distinct constitutional degenerations and defects due 
 to heredity or physical and psychical causes existing long 
 before spirits are taken. 
 
 A large number of persons in the first class exhibit a 
 history of distinct physical disorders, particularly dys- 
 pepsia, bad nutrition and exhaustion from unhygienic 
 methods of living. Persons who are burdened with care 
 and worry, and who suffer from continuous nerve and 
 muscle strain, are marked examples. 
 
 Thus speculators, merchants, mechanics, artisans, farm- 
 ers, and workmen who are struggling for bread and 
 wealth, and endeavoring to accomplish some particular 
 purpose, and find great difficulties in adapting themselves 
 to the changing conditions ; also persons who carry great 
 loads of care and responsibility, or men with limited in- 
 comes and large families ; who are perpetually strained 
 to provide for the necessities of life, and whose constant 
 thought is the fear of failure. Ambitious men, who are 
 straining every nerve to attain their desire ; and avari- 
 cious men, struggling to pile up money ; and so on, 
 through the list of almost every condition of life, with its 
 burdens and responsibilities ; there are states of exhaus- 
 tion and debility which call for relief from some source. 
 The effects of this constant strain and struggle is marked
 
 108 INEBRIETY. 
 
 by exhaustion, irritability and general weakness, both 
 muscular and mental. 
 
 Alcohol, of all other drugs, gives the most delusive 
 relief, through its narcotic action; and this is interpreted 
 as permanent help, and so, in a short time, the remedy is 
 used continuously. 
 
 Its accumulative action not only covers up the exhaus- 
 tion, but develops toxic states for farther and more pro- 
 found debility. 
 
 There is another class in this country whose life and 
 training prepares them for inebriety and drug-taking. 
 They are persons who suffer from idleness and hyper- 
 nutrition and become poisoned and debilitated. They are 
 persons without occupation and without exercise, who 
 overeat, and from the toxaemic states from food find relief 
 in spirits and beer. 
 
 Opium, when taken to relieve pain, is sometimes con- 
 tinued unless its effects are disturbing, but spirits are the 
 most common remedies which give relief and cover up the 
 toxic conditions. 
 
 Another class because of unhygienic surroundings, badly 
 ventilated rooms, workshops, factories and homes, suffer 
 from states of starvation and cell poisoning, which are 
 the favorite soil for the growth of inebriety. 
 
 Occupations that require incessant readjustment of 
 those engaged, to accommodate themselves to the new 
 conditions, often produce the same effect. Alternations 
 of heat and cold and continuous changes, experienced by 
 traveling men and persons engaged in steamboating and 
 railroading ; or occupations where fear is always dom- 
 inant and continuous emotional strain is present, always 
 react in exhaustion and distress, from which inebriety 
 follows most naturally. 
 
 It must not be inferred, that these very general condi- 
 tions of exhaustion which depress and lower the vitality
 
 GENERAL CAUSES AND FAVOBING CONDITIONS. 109 
 
 of the body, always end in an intense desire for alcohol, 
 or in inebriety. It is only intended to show that a large 
 number of persons who drink to excess do so from 
 physical exhaustion, which precedes the use of spirits. 
 
 This number is so large that these causes can be ra- 
 tionally considered as most frequent in both predisposing 
 and exciting inebriety. Of course, there is always a cer- 
 tain number of persons to whom alcohol is distinctly re- 
 pellant and painful, and with whom it does not act as a 
 narcotic at first. That this condition can be overcome by 
 its continued use is sustained by experience. 
 
 An English author wrote at some length to show that 
 the first effects of alcohol, increasing the circulation of 
 the blood in the brain, was painful and depressant and 
 that its narcotic action was exceptional. He argued from 
 this that the use of alcohol had to be cultivated, and no 
 previous condition would make it attractive from the first. 
 This has not been confirmed by experience. 
 
 It is safe to assume that the narcotic action of alcohol 
 is certain to be pleasing and attractive where conditions 
 of exhaustion prevail, hence these may be called causes. 
 
 A second range of causes may be grouped under the 
 term hereditary, constitutional conditions, which will be 
 discussed in some detail in other chapters, but at present 
 will be merely outlined. Thus, in a large and variable 
 percentage of cases in which inebriety is present, there 
 is a distinct neurotic and psychopathic condition, which is 
 traceable to the ancestors, and is clearly transmitted to 
 the next generation. 
 
 In this class there are very marked histories of nutrient 
 disorders in childhood, physical defects, infantile diseases 
 which are particularly serious and followed by serious en- 
 tailments. 
 
 Infantile diseases, in the children of inebriates, are 
 always more severe; and inflammatory conditions, from
 
 110 INEBRIETY. 
 
 the slightest causes, are prominent. Frequently the men- 
 tality of the child is marked by great extremes, either of 
 precosity or dullness, or the child may seem very irritable, 
 and excessively sensitive and impulsive. 
 
 At puberty many complex symptoms appear which are 
 confusing, and attended with low vitality, hyperasthesia. 
 It is at this time that alcohol is found to be a most sooth- 
 ing medicine, no matter in what form it may be given ; 
 and later it becomes a beverage, and then, a train of de- 
 generation begins, which ends in inebriety. 
 
 It often happens that children of neurotic and mod- 
 erate drinking parents are given wine and beer in child- 
 hood, often as a medicine, on the theory that it has some 
 food elements. This fixes the inebriate tendency, and 
 develops a predisposition, which is almost certain to break 
 out in later life, with or without any visible exciting 
 causes. 
 
 Children of this class, who are subjects of intense solici- 
 tude and overcare by parents and who are trained to 
 depend on drugs and medicine to overcome discomforts 
 and suffering, are being prepared for inebriety, which 
 in all probability will break out in the future. 
 
 Proprietary medicines, given in childhood, particularly 
 tinctures and narcotic compounds, have the same effect 
 in preparing the soil and making it possible for inebriety 
 in the future. 
 
 Common examples are seen in almost every community, 
 where nervous, feeble children from neurotic and mod- 
 crate-drinking parents are the subject of continuous 
 medical care, and who are taken to Europe, and travel 
 about the country for the purpose of securing more 
 vigor and strength ; practically overfed and always over- 
 dosed. 
 
 Such children, when they grow up and pass through 
 college, as a rule, become inebriates. Wine drinking for
 
 GENERAL CAUSES AND FAVORING CONDITIONS. Ill 
 
 strength and exhilaration, and then for sociability, quickly 
 develops into pronounced inebriety. In this class are in- 
 cluded persons who are supposed to be trained as total 
 abstainers, and yet hygiene of the nervous system has 
 been utterly disregarded in their education. 
 
 The boy who has been trained a rigid abstainer, may be 
 a psychopath, and suddenly, under any circumstances, be 
 overcome by a drink impulse, and use alcohol to great 
 excess. Frequently such cases are the wonderment of the 
 friends, who suppose that simply temperance training in 
 early life would secure an immunity from an alcoholic 
 breakdown in the future; the heredity is not understood. 
 
 Some very interesting instances have been noted of the 
 breaking out of the drink impulse at most unexpected 
 times and places. 
 
 It appears in some cases that there must be some con- 
 ditions that may be atmospheric or electrical, and, at all 
 events, controlled by forces entirely unknown, which bring 
 on this drink impulse at the sea level or in the mountains. 
 
 A number of cases have been noted where these heredi- 
 tary neurotics drank only at the seashore or at some high 
 mountain levels. At other places they were able to con- 
 trol the desire and be free from all use of spirits. 
 
 Often indiscriminate education applied without ref- 
 erence to a neurotic and nervous organization develops 
 psychopathic degenerations, which lead up to spirit and 
 drug taking. This is a very frequent history of many 
 cases who are very highly trained along lines that favor 
 exhaustion, bad living and irregular development, and 
 this is almost sure to end in this way. 
 
 It is this sort of education and training, outside of 
 natural adaptation and capacity and without reference to 
 hereditary entailments, that results in a poor doctor, a 
 weak minister, a feeble lawyer, and a slack business man ;
 
 INEBRIETY. 
 
 whose entire life is a failure, with inebriety and drug 
 taking as a frequent possibility. 
 
 In such persons there is continual disappointment, in- 
 evitable, from their ill adaptation to the circumstances; 
 and, as a result, there is low vitality, insomnia and va- 
 rious conditions that naturally call for a narcotic, of 
 which spirits is the most prominent. 
 
 Many writers have called attention to the influence of 
 diet in early life, as an active cause for the use of alcohol 
 later. 
 
 The late Dr. Wright traced this condition in a large 
 number of instances, and concluded that the inebriety of 
 middle life was very often traceable to faulty nutrition 
 in infancy. 
 
 The late Drs. Parker, Parish and Wilson, from long 
 experience with the wealthy classes, reached the same con- 
 clusions. In such cases there are clearly over-stimulation 
 in infancy and childhood ; the diet, excessively rich in 
 proteids and albumenoids, soon breaks up the metabolic 
 equilibrium, which is never fully restored. 
 
 Thus, toxic poisonings, beginning in infancy, go on 
 through various stages ; and the balance between waste 
 and supply is disturbed, and the perversions and derange- 
 ments become more intense and organic. For these dis- 
 turbances, drugs are used, and alcohol is the most prom- 
 inent sedative. 
 
 On the other hand, where nutrition is defective and 
 poor in quality, or from some peculiar notions special 
 foods are used, similar results follow, of which mal- 
 nutrition and starvation are prominent. There is no 
 doubt that both classes, those who suffer from an alcoholic 
 heredity, and those who have no entailment of this kind, 
 are largely influenced by the nutrition of childhood. 
 
 It is an interesting question, on which authorities differ, 
 namely, how far tea and coffee, used in early life, favor
 
 GENERAL CAUSES AND FAVORING CONDITIONS. 118 
 
 depressions and perversions, which finally lead up to the 
 drink impulse. There can be no doubt that they are 
 causes, both active and predisposing, in a certain number 
 of cases. 
 
 A great variety of evidence has been published, show- 
 ing the influence of tea and coffee in early childhood, 
 and its special predisposing tendencies to the use of al- 
 cohol in later life. Dr. Mason has given some striking 
 examples in his studies of cases treated at the Fort Ham- 
 ilton Inebriate Home, particularly of persons, who after 
 the use of spirits in infancy 7 , were total abstainers until 
 middle or later life, and then became inebriates. 
 
 One example was a boy who was treated with spirits 
 and wine for several months in early childhood and grew 
 up a total abstainer until about thirty years of age. 
 Spirits were given for insomnia at first. In later life a 
 severe attack of pleurisy came on, and with it an inpulse 
 to use spirits which he was unable to resist. 
 
 Another example was a boy, who from some heat stroke 
 in early life, was given wine or spirits. He was a total 
 abstainer until after forty years of age; then, while con- 
 valescing from typhoid fever, a craze for spirits began, 
 which continued until his death a few years later. 
 
 These and other cases mentioned showed distinct con- 
 nections between the early and later use of alcohol which 
 are more than accidents. 
 
 The late Dr. Parish reported a case of a very eminent 
 man who was treated with spirits for an attack of typhoid 
 fever when a boy. He became a famous teacher of 
 medicine and was a temperate man in every way, and yet 
 whenever exhausted the impulse to use spirits was very 
 pronounced. Later in life he gave way to this, and it 
 was found that he became profoundly stupid from a 
 small quantity of spirits ; at other times spirits were re- 
 pugnant. The later years of his life were a continuous
 
 11 4 INEBRIETY. 
 
 struggle to avoid exhaustion, and thus abstain from the 
 use of spirits. 
 
 Belonging to the same range of causes, and illustrating 
 the wide diversity of conditions which precede the drink 
 craze, are the following examples. A young man without 
 hereditary predisposition became profoundly intoxicated 
 at a college banquet. Later, when a clergyman, whenever 
 dining with a large company, he suffered acutely from 
 an impulse to drink and with the horror and vivid im- 
 pression of the first attack. He finally was obliged to 
 keep away from all public banquets for fear he should 
 become intoxicated. 
 
 A very temperate, vigorous man, who became wealthy 
 suddenly, drank to stupor with his friends in celebration 
 of this event. For years afterwards every success and 
 special exaltation at his attainments was followed by an 
 intense desire to use spirits. 
 
 Another example, showing the opposite effect, was of a 
 strong business man, who, though thoroughly temperate 
 in every way, yielded to the solicitations of his friends 
 and became intoxicated on a certain occasion. He was 
 intensely nauseated and suffered from a low fever for 
 several days after. Later, the odor of spirits was fol- 
 lowed by nausea and intense disgust, and the rest of his 
 life he was unable to attend dinners where wine was 
 used, or to stay in the company of persons who were 
 drinking, and, when obliged to do so, went home and 
 suffered from a low form of fever. 
 
 A lawyer, who drank heavily during his colleg3 ca- 
 reer, suddenly developed the utmost horror and exhaus- 
 tion from the sight and smell of spirits, and had to go 
 to bed whenever he came in contact with drinking men 
 for any length of time. 
 
 There was in this something more than a mental obses- 
 sion. There was both a psychological and psysiological
 
 GENEEAL CAUSES AND FAVORING CONDITIONS. 115 
 
 aversion, which depressed him in a remarkable way. Fa- 
 miliar illustrations are those of persons, who, after pro- 
 found fatigue and weariness, are given alcohol medici- 
 nally, and the pleasing effects leave an impression on all 
 later life. 
 
 Such persons frequently become intoxicated on the re- 
 currence of any special fatigue. In the meantime, they 
 are total abstainers and abhor the condition which follows 
 from fatigue. Persons who have had unusual toxic effects 
 from spirits are often noted for the intensity of their 
 efforts to help others avoid similar conditions. 
 
 Examples like the following are not uncommon: An 
 inebriate, after years of drinking, becomes restored, and 
 at intervals he makes herculean efforts to help others who 
 are in like condition. He will leave his business and 
 family and follow the poor victim with an intensity that 
 is unexplainable, to bring him back to sobriety again. 
 
 A noted business man, after the arduous work of the 
 day, spends his evenings in conducting temperance re- 
 vivals in the slum districts until after midnight. When 
 not holding such meetings, he is visiting the homes of 
 drinking men and begging them to abstain. 
 
 A young lawyer of great promise suddenly stops all 
 business and becomes a reformer. Years afterwards he 
 explains his motive by saying that if he had not gone 
 into the work of helping others he would have died a 
 drunkard. The obsession to drink was so powerful that 
 the only way he could control it was by striving to help 
 others. 
 
 These causes are so complex that it is impossible to 
 give more than an outline of them. Cases like the fol- 
 lowing are met. Drinking men who develop neuritis and 
 palsy, stop the use of spirits and become demented or 
 maniacal ; or inebriates, who have cerebral hemorrhage
 
 116 INEBRIETY. 
 
 and stop using spirits show a degree of mental vigor 
 never noticed before. 
 
 Persons who abstain after years of continuous drink- 
 ing become paranoics and wild reformers. In another 
 chapter we shall mention tuberculosis as a very common 
 sequel of excessive inebriety. Why alcohol develops neu- 
 ritis in one man, dementia and profound mental weak- 
 ness in another, gastro-intestinal disease and organic de- 
 generation in a third, and in the fourth presents little or 
 no evidence of disease, except general debility, is yet to 
 be studied. 
 
 Why total abstainers, or men and women who have 
 lived practically temperate lives, should suddenly develop 
 inebrietry without any active or exciting causes, is equally 
 mysterious. 
 
 There are evidently laws of degeneration which control 
 the cases, and there are clearly effects from the action of 
 alcohol that are acute and accumulative that will be dis- 
 covered in the future.
 
 CHAPTER XII. 
 
 SPECIAL CAUSES or INEBRIETY. 
 
 Synopsis. Occupations among the special causes. Alcoholism 
 caused by inhalation. Some examples. Great susceptibilities in 
 certain surroundings. Barometrical conditions are often pre- 
 disposing causes. Saloons made attractive to stimulate thirst. 
 Travel and excitement dangerous causes. Moderate use of beers 
 and other beverages lead up to this condition. Neglect of physi- 
 cal care. Imperfect diet. Tea, coffee and tobacco often influential. 
 In the treatment they should be studied carefully. Cigarette 
 smoking dangerous. Meat eaters more liable to drink. Depressed 
 conditions encourage the use of spirits and beers. Children im- 
 perfectly nourished find great relief in spirits. Some interesting 
 statistics. Examples and bad training frequent causes. 
 
 It seems best to try and group the great variety of 
 causes which are active in inebriety under different head- 
 ings, so as to give the reader a better conception of their 
 complexity and afford an opportunity to discriminate in 
 future studies. 
 
 While there are evidently exciting and predisposing 
 causes, there are other conditions which contribute, give 
 shape and form to the degenerate influences. One of 
 these is the question of occupation. 
 
 Some studies recently made have shown that persons 
 engaged in the manufacture and distribution of spirits 
 furnish a large number of inebriates. Various explana- 
 tions have been given, but beyond the fact that drinking 
 persons are more or less attracted by such employment, 
 the causes are not clear. 
 
 The better class of manufacturers and dealers dis- 
 courage and try to prevent, if possible, the use of spirits 
 among persons engaged in the traffic. This is no doubt 
 a matter of business, for the reason that the users of 
 spirits are found most incompetent and unreliable, and, 
 therefore, give poor service. 
 
 117
 
 118 INEBRIETY. 
 
 There can be no question that persons working in the 
 manufacture of spirits, and its sale and distribution, neces- 
 sarily inhale a certain amount of spirit ethers which, after 
 a time, impress them and produce toxic states of exhaus- 
 tion for which spirits are craved as a relief and as a 
 medicine. Instances are mentioned of persons working 
 in distilleries suffering from continued impulses to take 
 spirits. 
 
 On going out into the open air they recover, and the 
 impulse dies out. The same is noted in breweries where 
 persons drink beer, but do not drink elsewhere. Often 
 retail dealers and workers manifest intense disgust while 
 handling spirits, and have no desire to use it in any 
 way, but later, when away and not engaged in the work, 
 have pleasure in it and desire to drink. 
 
 Both of these conditions are very marked. One, of a 
 distaste while working in contact with it, and the other, a 
 fascination for it and a desire to use it, which are not 
 present later. Probably a majority of persons working 
 in the spirit business use it as a beverage or as a medi- 
 cine, without regard to the external circumstances. 
 
 Formerly, in the retail business, the efficiency of the 
 bar-keeper was determined by his ability to drink in 
 moderation, and encourage others about him to do the 
 same. 
 
 Latterly, the value of a bar-keeper turns on his total 
 abstinence, and his ability to remain sober and take ad- 
 vantage of the weakness of others. It is a boast of many 
 men in the business that they are able to drink in mod- 
 eration and never to excess, but experience shows that 
 such men are the most degenerate of all classes of drink- 
 ing men. 
 
 Experience also shows that the dealers in spirits suffer 
 from rheumatism, gout, dyspepsia and organic inflam-
 
 SPECIAL CAUSES OF INEBRIETY. 119 
 
 mations of the stomach and kidneys, and are health-seekers 
 to a larger degree than persons in other occupations. 
 
 Some very interesting cases have been published in The 
 Journal of Inebriety of "Alcoholism from Inhalation of 
 Spirit Odors," in persons who have been total abstainers. 
 One instance was that of a clerk with a wife and family 
 of four children who lived in an apartment over a room 
 where spirits were mixed for sale. 
 
 His wife and family suffered from headaches, stupor, 
 insomnia, faulty nutrition and general invalidism. All 
 treatment was ineffectual. Finally they moved to another 
 apartment and recovered. It was clear that the odors 
 from the spirits below penetrated through the ceiling and 
 became a constant source of poisoning. 
 
 This was confirmed by the fact that the wife and 
 children suffered more than the husband, who was out 
 during the day, and during the winter, when the doors 
 were closed, they were worse than at other times. Exam- 
 ples of persons who were strong and healthy, doing busi- 
 ness in warehouses where spirits were stored, suffering first 
 from headache, derangement of the stomach, nervous de- 
 pression and a great variety of complex symptoms, which 
 gradually led up to the use of spirits, have been noted 
 in many journals. 
 
 Some of the palatial bar-rooms, where there are foun- 
 tains of perfumed water and spirit odors pervade the 
 air, it is noticed that they create the sensation of thirst 
 and desire to drink in those in whom it did not exist be- 
 fore. The retailer has studied this art of appealing to 
 the sense of smell by filling the air with spirit odors, and 
 sometimes scattering it on the street in front of the saloon 
 to arouse a desire in the minds of the persons who are 
 passing by. 
 
 There is no doubt a hypersensitiveness to spirit odors 
 in many persons, particularly in those who have used
 
 120 INEBRIETY. 
 
 spirits formerly. Thus the smell of wine at the com- 
 munion table, or its taste, has often been followed by an 
 intolerable desire to drink. 
 
 Instances are noted where persons, previously tem- 
 perate, have been attracted by the highly-flavored odors 
 of wine, and have drunk, ending in intoxication. It is 
 not clear that appeals to the sense of smell in this way 
 have caused inebriety in a previously temperate man, but 
 there are innumerable instances where these conditions 
 have preceded the use of spirits, and it is very certain 
 that the odors of spirits to men who have previously used 
 them to great excess is a special exciting cause. 
 
 The art of selling spirits has been developed to a very 
 high degree in the luxury and artistic attractiveness of 
 saloons. Appeals to the senses, particularly to the sight, 
 smell and hearing, in warm, attractive surroundings, may 
 be made to increase the thirst and provoke a desire to 
 drink. 
 
 Some very curious facts have been worked out, showing 
 that the traffic in spirits, both wholesale and retail, has 
 some peculiar psychical degenerative influences ; and that 
 men engaged in the business, not total abstainers and 
 called temperate, always suffer in the end from disease, 
 both mental and physical, that in some way seems to date 
 from the business. 
 
 Examples are cited of persons of good average mental 
 and moral vigor, conducting the business along rational, 
 common-sense lines, who not only become diseased in most 
 unexpected ways but suffer in some degree not common 
 to other occupations. 
 
 It is very evident from statistics that persons engaged 
 in the traffic have greater mortality and are more liable 
 to disease and inebriety than others. The commercial 
 traveler of former times suffered very largely from in-
 
 SPECIAL CAUSES OF INEBRIETY. 
 
 ebriety, and ranked next to the spirit dealer in liability 
 to this disease. 
 
 The causes, irregularity of work and rest, with con- 
 tinuous change, mental strain and habits of treating after 
 each sale, were very prominent. 
 
 There were always starvation and imperfect nutrition 
 from the irregular life of this work that found in alcohol 
 a most grateful relief. Fortunately, these conditions are 
 passing away, and the old-time, convivial commercial trav- 
 eler is disappearing, and the total abstainer is taking his 
 place. Still the business is marked by special exciting and 
 contributing causes, favorable to the growth and produc- 
 tion of inebriety. 
 
 Brokers and speculators belong to a class where con- 
 tinuous strain and irregularity of living, with forms of 
 mental shock and excitement, very naturally are followed 
 by depression and exhaustion, for which spirits are found 
 to be most grateful. 
 
 It is a fact of some interest that pneumonia, Bright's 
 Disease, and cerebral hemorrhage are very common in 
 persons of this occupation, particularly those who have 
 used spirits to excess. 
 
 Manias for wealth are always associated with sudden 
 and intense fears and hope, strains on the vitality and 
 shocks, breaking up the normal physiological equilibrium 
 of life. For the exhaustion which follows from this, 
 spirits are frequently used. 
 
 The same thing is seen in political circles, where am- 
 bitious men make great struggles for position and power, 
 and suffer from a constant drain on the emotions and 
 reasoning to attain some particular point. 
 
 Life with them becomes a mania. Here the same con- 
 ditions exist. Many examples are noted where previously 
 temperate men have entered into the political field, and
 
 122 INEBRIETY. 
 
 after a while became inebriates and died from acute 
 disease. 
 
 The general fact may be stated that all occupations, 
 associated with great irregularity and sudden strains and 
 drains, are active and contributing causes to the use of 
 alcohol, and only the most rugged, healthy brain power 
 can endure work of this kind. 
 
 We have elsewhere mentioned the fatal advice given 
 persons who show signs of exhaustion from these peculiar 
 occupations mentioned to travel abroad. The result is 
 always increased degenerations, particularly if wines and 
 spirits are used. 
 
 A very prominent writer declared that no neurotics or 
 exhausted professional men, suffering from overwork or 
 undue care, should ever go abroad for health. 
 
 The risk of contracting wine and beer-drinking addic- 
 tions is so great that no possible good could overbalance 
 it. Another fact has been stated by several authors, and 
 is evidently based on a very large observation, that many 
 young men, who go abroad to perfect their professional 
 studies, return with an alcoholic addiction which follows 
 them through later life. 
 
 The common use of beer and wine in the universities 
 of Europe furnishes a very dangerous soil for the growth 
 of drink and drug disease, especially in neurotics and 
 persons with a predisposition to exhaustion and debility. 
 
 One cause has been the subject of considerable litera- 
 ture, not at all conclusive, viz. : that the excessive use of 
 tea and coffee provokes spirit and drug taking. 
 
 It is a frequent observation that both tea and coffee 
 are used to great excess during the free intervals between 
 the impulses to drink, and they evidently supply some 
 need. There is considerable literature showing that the 
 excessive use of tea and coffee has been a premonitory 
 symptom of inebriety.
 
 SPECIAL CAUSES OP INEBRIETY. 
 
 Many authors are confident that the excessive use of 
 these beverages provoke toxic effects and degenerations 
 that favor the use of spirits. There is evidently a neu- 
 rotic basis and favorable soil for inebriety in persons who 
 use excessive quantities of tea and coffee, and very often 
 a craving for these is a pathological symptom of great 
 significance. 
 
 A study of many cases show that the free use of tea 
 and coffee has preceded the drink craze. Persons give 
 histories of having been great coffee drinkers, and from 
 the derangements following, found relief in the use of 
 spirits ; then gave up the former and used the latter. 
 
 Undoubtedly there are distinct physiological effects 
 from coffee, and also from tea, that produce favorable 
 soils for the growth of inebriety; and it may be safely 
 said that the excessive user of these is in danger of con- 
 tracting the addiction of spirits. 
 
 Tobacco is to be regarded very much in the same way. 
 Its effects are more pronouncedly narcotic and sedative, 
 and its excessive use favors exhaustion and depression, for 
 which spirits are a most grateful remedy. 
 
 An extensive literature on this subject has been pub- 
 lished, mostly addressed to popular readers, the central 
 facts of which are well attested, showing that the narcot- 
 ism from tobacco is particularly dangerous to neurotics 
 and active brain workers, not only from its direct pois- 
 onous action, but from its potent influence in increasing 
 the craving for spirits. 
 
 Studies of hypertension show that alcohol increases 
 this condition and tobacco diminishes it. Hence the grate- 
 ful feeling produced by smoking, in lowering the tension 
 coming from the use of alcohol. 
 
 The alternate raising the tension by spirits and lower- 
 ing it by tobacco is physiological but very quickly be-
 
 INEBRIETY. 
 
 comes pathological. The excessive use of tobacco is fol- 
 lowed by depression for which alcohol brings relief. 
 
 It is noted that cigarette smoking is the most danger- 
 ous form of all the methods in which tobacco is used. 
 The poisonous effects in excessive depression are more 
 pronounced than in any other use of tobacco. The evi- 
 dence from the history of many cases shows that excessive 
 cigarette smoking is followed by inebriety. 
 
 In the remedial treatment of inebriety cigarette smoking 
 is a very pronounced retarding influence, and experience 
 shows that unless the use of the cigarette is abandoned, 
 restoration is very slow and often impossible.* 
 
 Gormandizing and hypernutrition appear to be special 
 exciting causes, or conditions which have preceded the 
 use of spirits. In the history of many cases there is evi- 
 dence of excessive use of food, particularly meats and 
 proteids, and the deranged metabolism which follows from 
 this finds relief in spirits, which practically cover up the 
 disorder. In this way, proprietary drugs are responsible 
 for the development of spirit drinking, particularly in 
 persons who suffer from deranged digestion and forms of 
 dyspepsia that are not influenced by the ordinary medic- 
 inal measures. 
 
 It has been stated on good authority that any form of 
 spirits, in proprietary drugs or otherwise, is exceedingly 
 dangerous in persons who are dyspeptic, and who have 
 been gormands and excessive meat eaters. Records of cases 
 show that these conditions have so often preceded in- 
 ebriety as to be recognized among the causes. 
 
 A large number of persons, particularly brain workers, 
 and also manual laborers, suffer from a great variety of 
 
 These subjects are presented in my work on Morphinism and 
 Other Narcomanias, published by Wm. B. Saunders & Co., Phil- 
 adelphia, Pa.
 
 SPECIAL CAUSES OF INEBRIETY. 125 
 
 depressed mental and physical states, which seem to call 
 for stimulants or remedies to relieve them. Such persons, 
 acting on the theory that there are in nature drugs and 
 remedies, which, if known, would prevent disorders of 
 this kind, very quickly develop the craze for drink. 
 
 Their credulity in testing every new remedy offered, 
 prepares the way for the narcotism from alcohol. A de- 
 lusive faith in drugs and drug effects is always a pre- 
 curser of degenerations and a distinct intimation of se- 
 rious psychosis and the borderline of pronounced in- 
 ebriety. Elsewhere these facts are described at some 
 length. 
 
 Dr. MacNichol, of New York, in some studies on school 
 children whose retarded growths and faulty developments, 
 apparent in early life, were traced to the use of wine and 
 beer given by their parents, showed that starvation and 
 derangement was a very prominent factor in the etiology 
 of inebriety. 
 
 He indicated farther that these children, who were 
 practically starved and poisoned, would inevitably be- 
 come spirit takers in later life; and that this same condi- 
 tion would occur in the families of wealthy people, where 
 children are overfed and deprived of fresh air and 
 brought up under unfavorable unhygienic conditions, 
 and that these cases would end in the same way. 
 
 At the recent Anti-Alcoholic Congress in London, Dr. 
 Doczi, in a paper on "Alcoholism Among Children in 
 Hungary," brought out the same fact and showed that 
 all forms of spirits in early life were special exciting 
 causes of inebriety later. 
 
 Instances like the following are frequently seen. 
 
 A child was given beer and wine freely, as a medicine, 
 in infancy ; grew up healthy and was a total abstainer
 
 126 INEBRIETY. 
 
 until after fifty years of age. Then after a visit to 
 Europe for rest, he suddenly drank wine to great excess 
 and died an inebriate a few years later. 
 
 The facts which these and many other examples bring 
 into prominence are that the early use of spirits leave an 
 entailment and predisposition which are likely to break 
 out in later life from the slightest exciting causes; also 
 that children given spirits in early life suffer in much 
 the same way. 
 
 A noted writer made a study of persons who are 
 distinctly careless of the ordinary hygienic care of the 
 body, neglecting baths and proper exercise. This he 
 concluded to be an exciting cause of inebriety. He 
 showed from very well marked examples that defective 
 elimination was followed by toxaemias which provoked the 
 use of spirits. 
 
 There are many reasons for believing that this is true, 
 and the confirmation comes often from- the active treat- 
 ment of inebriates where elimination is made the prin- 
 ciple object. Many chronic cases of inebriates are prac- 
 tically cured by measures that produce drastic elimina- 
 tion, showing that toxaemia is an exciting as well as pre- 
 disposing cause. This will be presented under another 
 topic. 
 
 There are many persons who are very susceptible to 
 the surroundings. They are generally neurotics, and 
 while in fair health are very largely influenced by those 
 they come in contact with. This class of persons are 
 very strongly influenced by drinking men and follow 
 their example, simply from suggestion, and show feeble 
 power of resistance. 
 
 This is called contagion from example and contact, and 
 may be considered a distinct, exciting cause, and should 
 be considered in a study of individual cases. Numerous
 
 SPECIAL CAUSES OF INEBEIETY. 
 
 examples will occur to the reader in which a powerful 
 personality controls others and forces them to follow his 
 example and literally spreads inebriety broadcast. This 
 subject will also be treated in another chapter. 
 
 There are other causes, many of them prominent, which 
 are physiological and psychological forces that may prac- 
 tically be said to culminate in this disease.
 
 CHAPTER XIII. 
 
 INJURIES AND PSYCHOSES WHICH FOLLOW FROM 
 THE Toxic USE OF SPIRITS. 
 
 Synopsis. Toxic states from alcohol, very serious. Two 
 classes, one direct injuries following intoxication, the other ob- 
 scure injuries, from the same cause, breaking out later. Ex- 
 amples. All types of neuropsychoses, and psychopathies.' Early 
 profound intoxication, and subsequent degeneration, not uncom- 
 mon. Examples given. Intoxication, a concussion of the brain. 
 Imbecility and dementia. Common sequel;?. Phenomena of in- 
 toxication. That of irritation and paralysis. Symptoms following. 
 Recovery slow. Time of life makes a difference. Summary of 
 the important facts. 
 
 The history of many inebriates dates back to very 
 serious organic changes arising from concussions, blows 
 on the head, shocks from injuries, falls, heat and sun- 
 strokes, and syphilis. 
 
 Often the connection between these causes and the in- 
 inebriety which follows is very clear, and can be traced 
 with great distinctness. In other cases it is obscure, with 
 long intervals of sobriety, and apparent health. Then, 
 unexpectedly, very serious changes follow, in which in- 
 ebriety is a very prominent symptom. 
 
 Alcoholic intoxication, meaning the delirium or stupor 
 from the poison of excessive use of spirits, is the first 
 cause of an obscure neuropsychosis, and the future con- 
 tinuous use of spirits, although not often recognized, 
 dates from this event. 
 
 Familiarity with states of intoxication and the delusive 
 theories of moral causes have prevented any general study 
 of the first effects of the poisoning, and the relation be- 
 tween them and the subsequent toxic states which may go 
 on for years at long intervals ; hence, the etiology of the 
 
 delirious and stupid inebriates seen on the streets or in 
 128
 
 INJURIES AND PSYCHOSES. 129 
 
 the station-house is practically unknown, each case being 
 treated simply as a moral lapse. 
 
 There is a distinct psychosis of inebriety which may be 
 divided into various classes. First, persons with a his- 
 tory of injury, followed by debility, degeneration and 
 alcoholic poisoning; second, where some acute degenera- 
 tion followed from the first use of spirits. 
 
 As an example of the latter the following may be men- 
 tioned. A physician became intoxicated and his condition 
 was so alarming that many medical men were called in. 
 He was found to have drunk different kinds of wine at a 
 banquet, and immediately became convulsive and passed 
 into a stupor. 
 
 In his previous life he had been strong and healthy, 
 and a total abstainer, and expressed great dislike for the 
 taste and odor of spirits. This was his first intoxication. 
 He recovered in the course of a few days and complained 
 of great exhaustion and debility. Shortly after he began 
 to suffer extremely from dyspepsia, was anaemic and de- 
 pressed, ate to great excess, was frequently exhausted, 
 had attacks of insomnia and headaches, and his ordinary 
 practice was a great burden. 
 
 He was filled with morbid fears of mistakes and loss 
 of reputation. His condition was diagnosed as neuras- 
 thenia, and possible brain exhaustion and dementia, and 
 advised to take a change and rest. 
 
 He went abroad and came back with the wine-drinking 
 habit. He was morbidly introspective, and alarmed at 
 the possibility of a malignant disease of the stomach. 
 His anaemia increased. He ate to great excess for a 
 time and then abstained. 
 
 His wine drinking was of the same erratic character. 
 Various functional disorders frightened him so seriously 
 that he would go to bed and drink wine for days at a 
 time. Ke had a morbid fear of being intoxicated, and
 
 130 INEBRIETY. 
 
 whenever wine affected him in a very marked way, he 
 would abstain. This complex condition grew until finally 
 one day he drank large quantities of spirits and was 
 found dead. 
 
 Another example was also of a physician, who passed a 
 rigid examination for life insurance and who was con- 
 sidered a very healthy man, of good heredity, with no 
 history of using spirits or tobacco. He had never been 
 sick in his life, and was supposed to have taken unusual 
 care of himself. 
 
 On returning from a consultation he was caught in a 
 snow drift, and with great difficulty made his way to a 
 farmhouse, thoroughly chilled and exhausted. His con- 
 dition was so serious that he was given large quantities 
 of cider brandy. To the astonishment of everyone he 
 became delirious, and remained in this condition for two 
 days. He then recovered and went about his usual work. 
 
 From this time his manner changed. His former cheer- 
 fulness merged into silence and reserve. He seldom 
 laughed, and seemed absorbed in some mental preoccupa- 
 tion. He complained of insomnia, seemed very anxious 
 about foods and had a horror of baths. 
 
 Six months later his condition was much worse. He 
 walked as if partially paralyzed. Both digestion and 
 sleep were greatly impaired. He made no complaint, but 
 went about as usual. When asked to explain his condi- 
 tion, spoke of it as obscure nerve exhaustion. 
 
 Later night-sweats and chills were considered malaria, 
 and large quantities of quinine and tinctures of drugs 
 were given him. The diagnosis was brain exhaustion, 
 and the next two years of his life were an aimless strug- 
 gle passed at several different sanitoriums, during which 
 he drank some, but never to stupor. He steadily declined 
 in health and vigor until finally he died in some convulsive 
 condition.
 
 INJURIES AND PSYCHOSES. 131 
 
 The post-mortem revealed nothing unusual, and there 
 were no apparent conditions that would explain the cause 
 of death. 
 
 A third example was a clergyman thirty years of age, 
 in active charge of a large church. He was a strong, tem- 
 perate, athletic man, never using spirits or tobacco, and 
 with no history of heredity in his family. He became chilled 
 during a funeral service in a country cemetery in the 
 winter, and was taken into a neighboring house and given 
 quantities of brandy and milk. 
 
 The effects of this produced paralysis of the lower 
 extremities. He remained in bed for two days, in a semi- 
 stupid state and was unable to walk. He then recovered. 
 Soon after nutrition was disturbed, foods distressed him, 
 tea and coffee unduly stimulated him; then followed in- 
 somnia and palpitation of the heart. Influenza, malaria, 
 rheumatism and various forms of nervous exhaustion were 
 diagnosed. His mind became feeble, and he was emo- 
 tional and unable to do much work. 
 
 He gave up his charge and went to a sanitorium, where 
 his condition gradually grew worse until his death from 
 pneumonia, two years after the intoxication. 
 
 A fourth example was a farmer who was also a tem- 
 perate man, living in good surroundings, working regu- 
 larly every day, and apparently in very good health. 
 For reasons unknown at the time he drank champagne 
 and became stupidly intoxicated. A high fever followed, 
 and he was treated for incipient typhoid for several 
 months, making a very slow recovery. From this time 
 on he was an invalid, suffering from swelling of the 
 joints, acute and chronic pains in the extremities. Two 
 years later his condition was more serious, principally 
 neuritis and general exhaustion. 
 
 These examples are very marked t}^pes of injuries and 
 neuropsychoses, undoubtedly due to the toxic action from
 
 INEBRIETY. 
 
 spirits. In all probability many cases less prominent 
 occur in which the first use of spirits is not regarded as 
 an exciting cause, and is not recognized in the diagnosis. 
 
 Some of these cases use spirits afterwards as a medicine, 
 either as a proprietary drug or as some form of wine 
 or beer. In all there is no indication of how far the first 
 paralysis from spirits broke up the normal equilibrium of 
 nutrition and nerve force. 
 
 Persons who become invalids, exhibiting complex symp- 
 toms that are diagnosed by general vague terms, not un- 
 frequently give a history of intoxication and recovery, 
 and soon after these changes appear. 
 
 The first class, where a history of some injury preceded 
 the use of spirits, is more prominent and traceable, but 
 even here the theories of the causes of the use of alcohol, 
 so widely believed, cover up the real causes and give en- 
 tirely different impressions of the nature and character 
 of the events which follow. 
 
 Many persons begin to use spirits suddenly as a medi- 
 cine or for some frivolous reasons, and later become in- 
 toxicated, and then justify their use of spirits from 
 equally marked inefficient causes. A noted writer said 
 that every man has in himself the history of his family, 
 or rather of their entailments for many generations, and 
 the causes of moderate breakdowns in the use of alcohol, 
 may be referred to some remote ancestors, or to some 
 insignificant injury, either in his life or his parents', which 
 from the application of some exciting causes break out 
 suddenly. 
 
 A very prominent example occurred recently of a pre- 
 viously healthy man, whose eccentricities and genius at- 
 tracted great attention. Suddenly he became profoundly 
 intoxicated, and, on recovery, his condition was diagnosed 
 as locomotor ataxia. He remained in bed for a year,
 
 INJURIES AND PSYCHOSES. 133 
 
 drinking continuously until death. The diagnosis of 
 palsy was obscure. 
 
 In the clinical study syphilis seems to be a very com- 
 mon early history preceding the use of drink. Thus, a 
 man previously temperate began to use alcohol to cover 
 up the depression and debility following an attack of 
 syphilis. Then its use became steady and regular. Later 
 he died from dementia. 
 
 Young men in college, who contract syphilis, very often 
 begin the use of alcohol as a medicine to cover up neuro- 
 psychopathic symptoms, and afterwards become chronic 
 inebriates. 
 
 In the practical treatment of inebriates, where there is 
 suspicion of syphilis, specific treatment very often clears 
 up prominent symptoms and hastens recovery. 
 
 There can be no doubt that a certain number of cases 
 of inebriety date directly from the injury from lues, 
 and that the use of spirits afterwards is very largely 
 symptomatic, indicating exhaustion and deranged condi- 
 tions from this infection. 
 
 Inebriety dating from heat and sun-strokes appears in 
 a certain number of cases. In former times, when per- 
 sons were found unconscious on the streets suffering from 
 heat or sun-strokes, spirits were given as a tonic, and the 
 delirium which followed was exceedingly difficult and com- 
 plex to determine. 
 
 How much of it was due to alcohol or to the profound 
 changes in the brain circulation from the heat rays could 
 never be determined. In much the same way any state 
 of unconsciousness may be intensified and increased by 
 the use of alcohol to an extent not realized. 
 
 A prominent example was of two men walking on the 
 street, both became unconscious from the intense heat of 
 the sun's rays. Both were taken to the hospital. One
 
 INEBRIETY. 
 
 was given quantities of brandy to sustain the heart. The 
 other received no treatment other than cold water. The 
 first was delirious, and after a long serious convalescence 
 recovered. He continued the use of alcohol the rest of 
 his lifetime. 
 
 The second one recovered and was temperate. The 
 inference is that the effect of alcohol increased the in- 
 jury and fixed a distinct propensity for spirits which fol- 
 lowed him the rest of his life. The other escaped. This 
 is confirmed by the study of other cases, one of which 
 is the following : 
 
 Two firemen, both abstainers, were struck on the head 
 by a piece of falling timber. One became an inebriate 
 soon after, using alcohol as a medicine at first and then 
 to great excess at every opportunity. The other was an 
 invalid for the rest of his life, but did not drink. 
 
 Blows on the head, either from falls, direct or indirect 
 injuries, very often result in extreme psychic exhaustion 
 and crave for spirits. Sometimes this is seen very soon 
 after the injury. In others it appears at a later period. 
 It is considered dangerous at present to use spirits in 
 cases of this kind, for the reason that they are often 
 hypersensitive and show the toxic effects from a very 
 small dose. 
 
 In others little more than heart stimulation follows, 
 but with it more intense nutrient disturbance, which after 
 a while develops the same spirit thirst. There is a wide 
 field of psychic injuries and shocks to the brain which 
 end in inebriety, that have not been studied. Instances 
 like the following are not unusual : 
 
 Three men, all abstainers, in middle life, vrere pro- 
 foundly shocked by the sudden fear of death while on a 
 train which jumped the tracks and ran over the ties for 
 some distance. The windows were broken, the lights went
 
 INJURIES AND PSYCHOSES. 135 
 
 out and the passengers were thrown about, and there 
 was much confusion, although no one was seriously hurt. 
 
 One of these men was paralyzed from fear and had 
 to be carried out of the car. The other two walked with 
 great difficulty, and after taking their friend to a hotel, 
 all drank spirits. Two became stupid at once from a 
 single glass of spirits, and both of these men continued 
 to use spirits the rest of their lifetime. The third one is 
 now, years after, an invalid and drugtaker from the 
 exhaustion following this shock. Here the fear broke up 
 the brain equilibrium and the use of spirits provoked a 
 distinct drink neurosis. 
 
 Other examples are those of persons who are shocked 
 by electricity or a stroke of lightning, prostrated and 
 made unconscious, recovering afterwards and complain- 
 ing of excessive prostration and debility. Later they 
 begin to drink spirits, become intoxicated, and from that 
 time on they are powerless to restrain themselves and 
 abstain. Several very marked cases of dipsomania have a 
 history of similar causes. 
 
 It is also noted that persons working with electrical 
 appliances and in electrical business, who receive shocks 
 frequently, and later complain of profound exhaustion, 
 are very susceptible to the use of alcohol and likely to 
 continue its use, both as a medicine and beverage. 
 
 Another class of causes seems to precede inebriety with 
 great frequency, such as direct injuries from blows, re- 
 sulting in broken bones, strains, lacerated wounds with a 
 long, slow convalescence. In many of these cases there 
 is a history of moderate or occasional use of spirits pre- 
 ceding the injury. 
 
 In others the persons are perfectly temperate, and 
 have never used alcohol before the injury, and after the 
 injury they are possessed with a morbid impulse for its
 
 136 INEBRIETY. 
 
 use on all occasions. Undoubtedly all injuries that pro- 
 foundly affect the nervous system are more dangerous to 
 one accustomed to the use of spirits in moderation or at 
 long intervals. 
 
 In such persons there are physically greater feebleness 
 of reparative power, and greater resistance to means of 
 restoration. Psychically, there is an impression of the 
 possible relief which comes from the use of alcohol, based 
 on experience, and this greatly increases the difficulty of 
 recovery. Thus a moderate or excessive user of spirits, 
 when exhausted or depressed, turns to alcohol for relief 
 with a confidence based on experience which is very mis- 
 leading. 
 
 When a person who has no experimental knowledge of 
 the effects of spirits suddenly becomes possessed with the 
 idea of their great value, there must be some defect or 
 change in the brain to account for it. This impression 
 may be formed from observation on others, or suggestion, 
 and when it occurs in persons who have previously ex- 
 pressed great disgust and aversion for spirits it is sig- 
 nificant. 
 
 Some form of injury is undoubtedly the exciting cause, 
 provoking a new condition of functional activity or de- 
 veloping some old inherited predisposition. Thus, a 
 total abstainer and previously temperate man, who sud- 
 denly begins to use spirits, with a history of injury or 
 some form of shock preceding it, is suffering from a 
 distinct neurosis ; whether the connection can be traced 
 or not, it exists. 
 
 Where profound exhaustion follows from injury the 
 most natural suggestion would be some means or stimu- 
 lants to overcome this condition. It has not been recog- 
 nized to any great extent that the toxic action of spirits 
 used for this condition is far more severe than at any 
 other time.
 
 INJURIES AND PSYCHOSES. 137 
 
 When the person is exhausted the increased narcotic 
 action is very prominent. In surgical operations on in- 
 toxicated persons, anesthesia can be dispensed with in 
 many cases. Many of the older surgeons considered 
 alcohol of equal anesthetic value to chloroform, and opera- 
 tions were performed long ago with no other narcotic 
 than spirits. 
 
 Careful study shows that while the effect of alcohol 
 inhibits the sensory centers, there is an increased de- 
 pression following, noted in the greater mortality. Hence 
 alcohol is not considered a safe narcotic. It has also been 
 noted that in many of the modern surgical operations 
 where spirits were given for various causes there has been 
 slow repair of the wounds, and not unfrequently alcohol 
 has been used afterwards up to the point of inebriety. 
 
 Practical men of large observation realize that alcohol 
 in any form, given for any purpose to persons who are 
 injured, is dangerous; not only in lengthening out the 
 convalescence, but in producing an addiction afterwards. 
 
 Many cases have been reported of alcohol being used 
 as a medicine at first and finally becoming an addiction, 
 following a surgical operation. Evidently there is some 
 connection between the effect of the operation and the 
 drinking which followed. 
 
 Beer drinkers are particularly noted for their impulsive 
 use of strong spirits, following any shock or peculiar 
 stress or strain to the body. This is evidently due to the 
 ana?mia and toxaemic conditions following the use of beer, 
 furnishing a very fertile soil for the craving of strong 
 spirits ; and to greater susceptibilitv to pain, and in- 
 ability to disregard the discomfort and pain incident to 
 this condition. 
 
 We have noted elsewhere the frequency of the history 
 of concussions, shocks and general disturbance of the 
 system preceding the use of spirits, making it evident
 
 138 INEBRIETY. 
 
 that there are cumulative effects of injuries and poisons, 
 preparing the way for this condition. 
 
 It is also clear that every attack of intoxication, or 
 acute poisoning from spirits, increases the susceptibility, 
 and leaves a marked psychosis, from which recovery is 
 more difficult. 
 
 Some very interesting examples have been published of 
 moderate or excessive users of spirits, who, from injury 
 or disease, have suddenly developed an intense disgust and 
 repugnance to the taste and smell of spirits, and have 
 been total abstainers the remainder of their lives. 
 
 The drink craze and symptoms seem to have died out 
 at once. In one instance a moderate drinking man, after 
 becoming unconscious from sun-stroke, suffered intense 
 nausea, and vomited at both the sight and smell of spirits. 
 
 In another instance a man intoxicated was thrown out 
 of a wagon and badly injured. He became delirious, was 
 given spirits. The delirium was increased, and with it 
 came the delusion that the spirits had been poisoned. He 
 recovered, but had a profound impression that spirits were 
 poisonous, and exhibited the utmost horror and excite- 
 ment when invited to drink. 
 
 This aversion continued until his death. It frequently 
 happens that persons recovering from severe attacks of 
 alcoholic delirium or delirium tremens, manifest disgust 
 and repugnance for spirits for a long time, but this 
 wears away in most instances. 
 
 Empirics attempt to take advantage of this fact by 
 increasing the disgust and nausea from the effects of 
 spirits to secure an aversion and mental effect. In this 
 they are sometimes successful. The aversion to alcohol, 
 from injury or disease, is a pathological condition with a 
 tremendous mental effect that is yet to be studied. 
 
 Many cases appear where acute gastritis is followed by 
 an intense desire for spirits and their effects. Catarrhal
 
 INJURIES AND PSYCHOSES. 189 
 
 and bronchial troubles are frequently followed by the 
 same conditions. Diseases of the upper air passages 
 which are treated surgically very quickly develop spirit 
 thirst. 
 
 Railroad men in the transportation service, after 
 years of sobriety, suddenly use alcohol to great excess. 
 The explanation would be that the train service has pro- 
 duced a constant, steady succession of physical and 
 psychical shocks and strains, and this has brought on 
 exhaustion, derangement, and the use of alcohol. 
 
 The late Dr. Wright reported many cases of serious 
 exhaustion and diseases which profoundly affected the 
 organism in early life, and later in middle life inebriety 
 appeared without any special exciting causes. In these 
 instances there seemed to be an intense susceptibility to 
 the narcotism of alcohol which evidently had its basis in 
 early injuries. 
 
 Dr. Parish noted in the history of many cases two 
 distinct conditions following traumata, both physical 
 and psychical. One, mental degeneration, shown in in- 
 ebriety, drug-taking and various forms of psychosis ; the 
 other, a change in the habits, mentality and conduct of 
 the patient. 
 
 The influences following injury are always very potent 
 and to be considered in all studies of inebriety. While 
 not possible to point out the distinct connections and 
 causes, it is always wise to recognize them in the diagnosis 
 and treatment.
 
 CHAPTER XIV. 
 
 HEREDITY AND ITS INFLUENCE IN THE CAUSATION 
 OF INEBRIETY. 
 
 Synopsis. Inherited alcoholic defects a fact. Developing dif- 
 ferent conditions. Certain number of children apparently seem 
 to be immune from the effects of spirits, yet many of these from 
 special exciting causes develop the taste for drink. A psycholog- 
 ical susceptibility may be inherited and remain latent. The fact 
 of inheritance of inebriety was mentioned in an early age of the 
 world. Examples. Two forms of heredity. Direct and indirect. 
 Descriptions of cases which illustrate these forms. Wealthy and 
 very poor. Both furnish examples. Retarded development. 
 Feeble vitality. Great irritability, and mental instability are 
 symptoms. Instances illustrating the facts. 
 
 Notwithstanding the doubts and denials of the influ- 
 ence of heredity in inebriety, clinical evidence shows that 
 intemperate parents are almost absolutely certain to be 
 followed by descendants who have a predisposition and 
 are far more likely to become inebriates than others. 
 
 This does not prove that all descendants of inebriates 
 will use alcohol, but that in certain circumstances they 
 are more liable to find relief in spirits, and continue their 
 use ever afterwards. While it is true that a certain num- 
 ber of children of drinking parents seem to possess a 
 profound disgust for both the taste and smell of spirits, 
 experience shows that this is often overcome, and whether 
 they are more susceptible to change in this respect is 
 not clear. 
 
 This aversion for drink and its effects takes on many 
 different forms and phases. In one instance nausea and 
 excitement follow the sight of a drinking man, or the 
 odor of spirits. In another, indignation, anger and desire 
 to force the drinking man out of his condition. Many of 
 the most intolerant and extreme dogmatic reformers and 
 critics of inebriates come from alcoholic ancestry. 
 140
 
 HEREDITY AND ITS INFLUENCE. 141 
 
 To many men there is great confusion in the effort to 
 explain the repulsion for spirits and drinkers. In some 
 there is great toleration, up to the verge of fascination; 
 in others, there are wide variations in the effects of al- 
 cohol; in the children of drinking parents there are dis- 
 tinct degrees of susceptibility and immunity that often 
 follow uniform lines of progress. 
 
 In certain cases there is a peculiar physiological sus- 
 ceptibility, which may be developed or remain latent until 
 brought into activity by special causes. There is a 
 great deal of historic evidence, showing the hereditary 
 impulses to alcohol. In the early ages of the world the 
 drunkenness of children of drinking parents was ascribed 
 to inheritance by a great variety of philosophers, physi- 
 cians and writers. 
 
 Vulcan's lameness was said to be the direct result of 
 Jupiter's intoxication. Diogenes declared that stupidity 
 in children was the direct result of the drunkenness of 
 the parents. Aristotle presented a great variety of evi- 
 dence, showing that drinking women always bore children 
 who were feeble and drank. The legislation of Lycurgus 
 urged that drunkenness should be promoted and encour- 
 aged in vanquished nations, so that their patriotism could 
 be extinguished and longevity lessened, and in this way 
 their race would become degenerate. The Greek litera- 
 ture is full of references to the direct result of wine drink- 
 ing as sources of degeneration, damage and destruction 
 to the offspring. 
 
 These statements were based on observation and were 
 not theories, but were confirmed by experience of that 
 and later times. There appear to be two forms of 
 heredity ir.ore marked than others in the children of 
 alcoholics. 
 
 The first may be called direct heredity, in which the 
 same form of drinking appears in the next generation.
 
 142 INEBRIETY. 
 
 The conduct and acts of children are practically the 
 same as their parents. The same diseases occur and the 
 same manner and method of using spirits follow. 
 
 The second is called indirect heredity, in which alco- 
 holic defects of the parents appear in various widely 
 differing brain and nerve disorders. The following table 
 gives in an outline way the conditions which are very 
 commonly seen in the descendants of inebriates : 
 
 Heredity 
 
 T j. ... i Special 
 
 1 rcdisposition < _ 
 
 ( General 
 
 Defects 
 
 Physiological. 
 Psychological. 
 
 Physical Weakness. 
 Retarded Development. \ , , , , , , 
 
 f Mental Weakness. 
 
 It is a general observation, noted in every study, that 
 where one or both parents use spirits to excess, the off- 
 spring show marked predisposition to exhaustion and 
 degeneration, and give evidence of general defective and 
 retarded growth. 
 
 Often this predisposition occurs in one of two forms 
 called general or special. In the first the children will 
 be weakly, have feeble power of endurance of pain and 
 discomfort and seek relief from any source. Spirits pre- 
 scribed, either openly or concealed, seem very grateful 
 in the rapid relief of the conditions present. 
 
 Thus irritable, peevish children from drinking parents 
 are easily quieted by medicines of this character. Hence 
 patent drugs or any substance containing spirits, are 
 popular remedies in such families. Thoughtful parents 
 often notice this fascination for the effects of medicine 
 containing alcohol, and make strenuous efforts to teach 
 the horrors of its use.
 
 HEREDITY AND ITS INFLUENCE. 143 
 
 Children brought up and trained to abhor alcohol, 
 not unfrequently discover, in early manhood or woman- 
 hood, drugs containing spirits, which have a pronounced 
 soothing effect, and from this they sooner or later be- 
 come addicted to its use. 
 
 The following is an example: John Smith was an 
 inebriate, although the fact was concealed from his fam- 
 ily. His wife was a strong temperate woman, and each 
 of the five children born to her were feeble in early life, 
 and suffered severely from children's diseases. 
 
 They all manifested an intense satisfaction from any 
 form of alcohol given as a medicine. The mother rec- 
 ognized this inherited taste, and sought every means to 
 overcome it. Two of the boys drank during their col- 
 lege life, but later became devoted temperance men and 
 strong total abstainers. The third, a girl, became a 
 drug-taker, after the disappointment of an unfortunate 
 marriage. 
 
 The fourth was an erratic, feeble-minded child, that 
 died early. The fifth was an erratic preacher, whose 
 eccentricities were the subject of much comment. He 
 finally died a concealed inebriate. This example is quite 
 a common one, and can be duplicated from the experi- 
 ence of nearly every medical man. 
 
 It often happens that most unexpected results fol- 
 low the use of medicines containing spirits. In one in- 
 stance the effects are very obscure. In another, prac- 
 tically the same case, they are very pronounced, and the 
 quieting action from it is marked. Unreasoning physi- 
 cians ascribe this to different causes, but in many in- 
 stances it is found to depend entirely upon the alcohol 
 and the latent heredity of the patient. 
 
 Many persons are aware of the effect of a small quan- 
 tity of spirits given either concealed or openly. The 
 pleasing results following it show a special predisposi-
 
 INEBRIETY. 
 
 tion which, if cultivated, would make them inebriates in 
 a very short time. Such persons with ordinary caution 
 assert that they cannot take spirits, the real reason being 
 that its effects are so pleasing that it would lead up 
 to very serious results. 
 
 In others this predisposition is not recognized, and the 
 remedy is sought for and continued until finally it dawns 
 on them that it is the alcohol in it that is most agreeable. 
 Then they begin using it directly. This predisposition 
 to use alcohol for its grateful effects seems to follow 
 some general law which some authors have studied. 
 
 Thus, if the father is a drinking man, using spirits 
 to excess, the daughter will inherit this predisposition 
 more prominently than the son, and while the daughter 
 may not use spirits, there will be apparent some partic- 
 ular neurosis and psychosis due to alcoholic defects in 
 parents. 
 
 If the mother drinks, the predisposition breaks out in 
 the son, in more decided form than in the daughter, and 
 with little or no exciting cause. In the study of a large 
 number of persons, the inebriety of the grandfather on 
 the mother's side, appears very often in the boys. The 
 mother may have been a total abstainer, but failed to 
 live hygienically, hence the son manifests both the grand- 
 father's weakness and his mother's defects. 
 
 Women of the wealthy classes who use wine on the 
 table are very often followed by boys who drink to great 
 excess, while the daughters remain practically temper- 
 ate. Where both parents drink, this special heredity is in 
 tensified in complex forms of neurosis and psychosis, in 
 which some of the children will show immunity and 
 deterring horror of the use of spirits, and be strictly 
 temperate, and others will be fascinated by the effects 
 of spirits, and have no power to refrain from its ex- 
 cessive use.
 
 HEREDITY AND ITS INFLUENCE. 145 
 
 In both there is always present what may be termed 
 a general diathesis, or tendency to exhaustion, with ina- 
 bility to bear discomfort and constant efforts to seek 
 relief. Tuberculosis is a very marked form of defect 
 following in the children of alcoholic ancestors. The 
 same low vitality and feeble resisting power, which pro- 
 voke the use of spirits, manifest themselves in the early 
 breaking down of the lungs from acute inflammatory 
 trouble or bacterial invasion, and this is overcome with 
 great difficulty. 
 
 It is stated as a rule, observed by many authors, that 
 the descendants of alcoholic ancestors usually die of 
 tuberculosis or pneumonia. Of course, acute disorders 
 of nutrition and inflammations of the kidneys and other 
 organs are also prominent. 
 
 It is along the line of other observation that these 
 children show feebleness, general defects and entailments 
 from the parents, which manifest themselves in the con- 
 stant desire for relief and help. There is a great wealth 
 of clinical facts to be studied in this direction, and the 
 terms general and special heredity give some idea of the 
 outline forms of the laws that govern these conditions. 
 
 Why aversion and immunity, fascination and predis- 
 position to spirits and its effects should exist in one fam- 
 ily ; and in another extreme exhaustion, neurosis with 
 nutritive and organic feebleness ; and in a third circu- 
 latory diseases, or brain weakness, extending all the way 
 from genius to idiocy ; must be answered by further 
 studies. 
 
 The physical and mental defects seen in children of 
 inebriates are unmistakable signs of the decline of race 
 stock and vigor, even to extinction and death. This 
 is noted in the faulty, imperfect development of heads 
 and bodies of such children, together with other ab- 
 normalties, both physiological and psychological.
 
 146 INEBRIETY. 
 
 The instability of mental activities and functional 
 control is also marked. In the examinations for the army 
 and navy, and in life insurance work, these abnormali- 
 ties are very prominent, and are studied by insurance 
 men to determine their relations to longevity. One au- 
 thor believes that the inherited degenerations from alco- 
 hol are noted in the eyes, which are defective, and re- 
 quire glasses in early life ; stigmatic heads and faces, 
 ears, arms and legs are marked defects. Psychologically, 
 this is seen in the credulity, skepticism, impulsiveness, 
 selfishness and ungoverned instincts ; also in the erotic, 
 paranoic men and women, whose extreme defects of judg- 
 ment, reason and conduct are traceable to alcoholic 
 ancestry. 
 
 An army of such people live on the border lines, where 
 sanity and insanity unite, and they furnish at least 
 twenty per cent, of all the insane or persons pro- 
 nouncedly diseased mentally. In this same class can 
 often be traced geniuses, reformers, and sometimes great 
 pioneers in the world's work. Many of them are ab- 
 stainers. Others are periodics and impulsive users of 
 spirits. 
 
 Elsewhere more extended reference is made to these 
 classes. As examples of retarded development, due to 
 heredity, the following may be presented: 
 
 John Doe, a highly-trained lawyer, whose father was 
 a moderate drinker, and mother a neurotic society woman, 
 suffered from early life from extreme physical exhaus- 
 tion, particularly from any overwork or strain. He 
 would work for days with the greatest intensity, and 
 then have periods of depression in which he claimed to 
 be sick. 
 
 He passed through college and the university, work- 
 ing in this irregular, convulsive way, and as a lawyer 
 attained reputation for the great and spasmodic inten-
 
 HEREDITY AND ITS INFLUENCE. 147 
 
 sity of his mental activity. He was a total abstainer, 
 had a horror of spirits, but in middle life began to use 
 drugs for exhaustion, and then spirits. He died an 
 inebriate. 
 
 James Brown, from a similar ancestry, exhibited great 
 weakness at times, and while a man of ordinary judgment, 
 was very easily distressed and disturbed by the small- 
 est events in life. When excited he was almost an 
 imbecile in his conduct and talk, and after a rest would 
 fully recover. 
 
 He remained temperate all his life, but was feeble- 
 minded and melancholic during the last years. Both 
 of these cases had stigmata in face and ears, and were 
 abnormally developed in many ways. Instances will 
 occur to the reader of persons abnormal in appearance, 
 whose ancestors have been moderate or excessive users 
 of spirits, and whose lives and conduct have been irregu- 
 lar and unusual. 
 
 Criminals furnish marked examples of this class, and 
 drug-takers are very common. The recurrence of sim- 
 ilar conduct and acts at certain periods of life in sev- 
 eral generations point to laws of heredity that have not 
 been studied very well. 
 
 Thus, in one instance, the male members of the family 
 for three generations all drank spirits to excess between 
 forty-five and fifty years of age. Many of them were 
 total abstainers up to that time. Others had been mod- 
 erate drinkers. Their previous life gave no indications 
 of this outbreak which, in most cases, came on suddenly. 
 In this particular family, two persons, both exem- 
 plary clergymen and active reformers, began to use 
 spirits at this critical age, and died in insane asylums. 
 
 In the next generation, both a man and woman, one 
 forty-eight and the other fifty-one, began to use spirits 
 suddenly, and died within a couple of years. In the
 
 148 INEBRIETY. 
 
 third generation, three women and one man all drank 
 and took drugs at this time. Two lived many years. 
 The others died early. 
 
 In another family, the grandfather, father and two 
 sons of three generations were all strictly abstinent up to 
 thirty-five years of age ; then all began to use spirits for 
 various superficial reasons, and all died soon after. 
 
 In another instance, a man of fifty years of age, a 
 successful, temperate business man, began to drink to 
 great excess for no other reason than that he could not 
 help it. It was ascertained, although the patient did not 
 know it, that his father had been a total abstainer up 
 to that age. Then, after an alcoholic excess for a period 
 of a few months, he became insane.
 
 CHAPTER XY. 
 
 SOME OF THE NEUROSES FOLLOWING INE- 
 BRIETY IN PARENTS. 
 
 Snyopsis. The periodicity of the drink impulse. Very signifi- 
 cant symptoms. Its possibilities in other neuroses. Difficult to 
 explain it. Its appearance at certain stages of life and resem- 
 blance to epilepsy. Dipsomania a particular phase of degeneration 
 not common. Always dependent on hereditary defects. Genius 
 associated with it. Declining families. Efforts of nature to check 
 extinction. Borderline palsies. People who live on the border- 
 lands of insanity. Their strange conduct and acts. The effects 
 of marriage in changing the race march. Illustrated cases. The 
 Chinese law on heredity. A recognition of the uncertainty of in- 
 heritance. Opinion of Morell. Opinions of Maudsley. Lunier's 
 studies. Other studies of heredity. Influence of education, train- 
 ing and marriage. Possibilities of checking the transmission of 
 defects. Folly of theories. Appeal to facts. Illustrations. 
 
 The periodicity or recurrence of the drink impulse in 
 early life points clearly to some inherited defect which 
 gathers and explodes after a fixed cycle of years. 
 
 It is very difficult to explain the conditions which 
 provoke this desire and make it ungovernable at this 
 time. It is possible that it may have existed before, but 
 has been controlled and overcome, until finally it broke 
 all barriers and developed. 
 
 Illustrations of the duration and limitation of the 
 vital forces to certain distinct periods are seen in certain 
 families where death occurs about the same time of life. 
 Often the causes of death are similar, and break out 
 with or without any particular exciting causes. 
 
 Many instances are noted in which diseases of nutri- 
 tion appear at a certain fixed time of life in several gen- 
 erations. The excessive use of alcohol, terminating 
 fatally, has been noted in many such cases. The same fact 
 has been noted in families in which respiratory diseases 
 
 appeared after thirty, principally pneumonia and tuber- 
 
 149
 
 150 INEBRIETY. 
 
 culosis. Instead of these family diseases, inebriety would 
 apparently take their place, only it would progress with 
 great intensity to a more rapid termination. 
 
 Epilepsy is another form of convulsive degeneration 
 that frequently precedes and follows the use of alcohol. 
 This is a direct result from alcoholic ancestors. In a 
 number of cases there was distinct evidence that chil- 
 dren of alcoholic parents, who drank freely, developed 
 delirium more quickly than others without this heredity. 
 
 The term dipsomania describes a particular form of 
 mania for the use of spirits, which, in intensity, exceeds 
 all other impulses. This is frequently seen as a heredi- 
 tary entailment. Where the degenerative effects of the 
 continuous use of spirits manifest themselves in convul- 
 sions, which are called epileptoid, the same heredity will 
 be found in most instances. 
 
 Children of inebriates often exhibit a special neurotic 
 temperament in irritability, hypersensitiveness and un- 
 usual prostration from any particular exertion. Not in- 
 frequently such children exhibit precosity and unusual 
 mental development, which, after a time, declines and 
 leaves physical and mental feebleness. 
 
 The fact is established beyond all question that alco- 
 holic parents cannot transmit normal vigor and health 
 to their children. 
 
 All such descendants exhibit feebleness in resisting dis- 
 ease, less strength, lower vitality and greater difficulty 
 in adapting themselves to the exacting conditions of life. 
 In epidemics and infectious diseases such children have 
 greater mortality. 
 
 It is also noted that families with this heritage are on 
 the road to extinction, and that nature wisely hurries 
 on these defectives to death. Extinction can only be 
 prevented by union with a healthier race, in which the 
 tendency is checked.
 
 NEUROSES FOLLOWING INEBRIETY IN PARENTS. 151 
 
 Often a great effort is made to stop this downward 
 tendency by remarkable fecundity. Thus, in degenerate 
 families, a large number of children are born, exhibiting 
 all the defects of the parents, and usually dying early. 
 This is considered a hint that nature is making a great 
 effort to check this downward career. 
 
 It not unfrequently happens that some genius appears 
 among these descendants, who starts far above the level 
 of his ancestors, and does some great work, as an in- 
 ventor, reformer or orator. Then, after a short, brilliant 
 career, disappears. 
 
 He is the last member of a family that has been on 
 the descending path, and, like the flicker of a lamp, 
 bursts into full blaze before extinction. Where this 
 alcoholic heredity and degeneration is retarded or accel- 
 erated by the union with different families of varied 
 heredity, very strange products are the result. 
 
 While alcoholic defects may not appear in the next 
 generation, various grades of idiocy, criminality, pauper- 
 ism, tramps, and the most complex degenerations of mind 
 and body are traceable in the children. 
 
 Many of these degenerative descendants show defects 
 of consciousness and conception of duty, for which the 
 term moral paralysis is strikingly descriptive. Many of 
 them live on the very borders of insanity, and their 
 abnormalities are concealed until some occasion occurs 
 in which they break out with great distinctiveness. 
 
 Others seem to be hopelessly stranded in this border 
 region, between sanity and insanity, and their conduct 
 is puzzling. They are rated as great geniuses, orators, 
 reformers, and strange, erratic people, called by the 
 modern term paranoics, or persons with a mental twist. 
 
 Such persons are always enigmas, and their thoughts 
 and conduct are never along normal, rational lines.
 
 INEBRIETY. 
 
 One great fact, not often recognized, is that such 
 descendants have a lower moral sense and feebler concep- 
 tions of right and wrong. The fact mentioned before 
 is sustained by a great variety of evidence, that the use 
 of spirits has a particular paralyzing action on what 
 may be called the ethical brain, or moral consciousness 
 of right and wrong, this faculty being lowered and 
 paralyzed in different degrees in all persons who use 
 spirits to excess. 
 
 The additional fact, confirmed by strong evidence, is 
 that children of these alcoholic ancestors in a special 
 degree seem to inherit this particular moral defect, and 
 from the use of spirits this is greatly intensified until 
 a decided paralysis of the highest brain centers appear. 
 
 Many of the most dangerous criminals and persons, 
 whose lives are a continuous antagonism to law and order, 
 duty and obligation, are children of alcoholic ancestors. 
 
 This fact is illustrated, when persons with this heredity 
 occupy places of prominence in public opinion, become 
 possessors of wealth, often exhibiting unusual intelli- 
 gence and capacity, and then suddenly become default- 
 ers or criminals in most unexpected ways. 
 
 A study of the character and conduct of such persons 
 not unfrequently brings out depraved motives and pur- 
 poses, with skillful efforts to conceal and cover up their 
 real purposes. Very interesting studies along this line 
 have pointed out some very startling theories of degen- 
 eration that are practically unknown at present. 
 
 Another fact has been made prominent in some start- 
 ling examples where children from alcoholic ancestors 
 are given the highest possible culture and training along 
 unphysiological lines and without reference to their 
 hereditary defects. The results have been great abnor- 
 malities, extraordinary paranoics, egotists, with extrava- 
 gant exceptions of duties and relations of life, with a
 
 NEUROSES FOLLOWING INEBRIETY IN PARENTS. 153 
 
 feeble common sense and strange, unreasonable creduli- 
 ties. These persons are called by many authors mental 
 dyspeptics. 
 
 Such persons are seen in the professions, in business 
 circles and among the idle classes, and their erratic con- 
 duct and inconsistencies are the cause of continuous 
 wonderment. The Chinese law, enacted many thousands 
 of years ago, forcibly brings out some of the great 
 truths of heredity. Thus, when a criminal came before 
 the courts, they first asked, who and what his parents 
 were. If they were found to have had any of the traits, 
 manners or habits of conduct corresponding to the crime 
 of the prisoner, he was killed at once, and they were 
 severely punished. 
 
 His death ended all possibility of any transmitted 
 defects and criminal instincts, and their punishment was 
 supposed to stop all further propagation of the evils. 
 Parents who do not receognize the facts of heredity, par- 
 ticularly the possible damage from the use of alcohol, 
 that may be transmitted, are committing unpardonable 
 sins in rearing descendants who are crippled, and must 
 of necessity be unable to attain healthy growth and 
 development. 
 
 There are some very startling laws which govern 
 the degenerations of the race, particularly those starting 
 from spirit-drinking ancestors. These laws are often inti- 
 mately associated with other forms of disease, so that 
 it is difficult in the present state of study to indicate 
 their exact place. 
 
 Morell, a French alienist, has given the following table 
 of the lines of degeneration, which he has observed in 
 his study of inebriety from alcoholic ancestors : First 
 generation, alcoholic excess and general physical de- 
 pravity, with immorality, terminating in sudden death 
 from acute disease or violence.
 
 INEBRIETY. 
 
 Second generation, a craze for alcohol, either early or 
 late in life, or at the advent of some crisis. Spirit- 
 drinking is often maniacal, both in its use and the re- 
 sults following, and associated with nerve and brain 
 debility, disease, paralysis, and a great variety of de- 
 generations, ending in death. 
 
 The third generation is marked by idiocy, imbecility, 
 delusional homicidal tendencies. The excessive use . of 
 spirits is followed by most erratic conduct. Often ex- 
 treme horror of alcohol and great remorse are followed 
 by sudden death and extinction of the race. 
 
 Maudsley, a distinguished alienist, classifies heredity 
 in three distinct forms first, the appearance of the same 
 form of disease, particularly in children of drinking par- 
 ents ; second, that of allied forms of disease ; third, into 
 some form of neurosis and psychosis, in which the an- 
 cestorial defect is the evident cause. 
 
 He asserts that the parents transmit to their children 
 not only the family traits, but the individual character 
 and degree of health, and while these may be modified by 
 losses, sufferings, errors, achievements, degradations and 
 degenerations, they follow a uniform line, which is trace- 
 able in most cases. 
 
 From studies covering a very large number of cases, 
 the following general lines of descent seem to be most 
 prominent. The first generation from alcoholic ances- 
 tors will exhibit low vitality from infancy, with great 
 feebleness or precosity of mental activity, associated with 
 defects of control. Such persons may often be total ab- 
 stainers of a very pronounced type, or moderate and 
 excessive users of spirits. They appear to be particu- 
 larly prone to acute diseases. Convulsive and nutritive 
 disturbances appear in middle life. In the next genera- 
 tion, where spirits are used, very marked psychosis and 
 neurosis become prominent, and the mortality is increased.
 
 NEUROSES FOLLOWING INEBRIETY IN PARENTS. 155 
 
 In the third generation, criminality, pauperism, idiocy 
 and low grades of insanity end in extinction of the 
 race. 
 
 Often the race ends in the second generation, but 
 where marriage is contracted with vigorous stocks, the 
 tendency is checked, and degeneration may be neutral- 
 ized. Where marriage is contracted with equally de- 
 fective races, the alcoholic psychosis becomes fixed, and 
 the descendants die early, and are largely spirit and drug 
 neurotics. 
 
 The only hope for children of alcoholic ancestors, who 
 wish to continue the line of descent and prevent its 
 extinction, is to marry into strong families. Many inter- 
 esting studies have been made to determine how far 
 alcoholic heredity is a factor in mental disease. 
 
 Lunier, in a study of many thousand cases in asylums 
 for idiots and the insane, in France, decided that over 50 
 per cent of all cases were directly traceable to alcoholic 
 ancestors. Legraine, a noted specialist, made an ex- 
 haustive study two years ago in France, and concluded 
 that 60 per cent, of all mental diseases were due to this 
 cause. The late Dr. Wright made extensive studies of 
 the heredity in a large number of cases in this country, 
 and decided that at least 70 per cent, was traceable to 
 alcoholic degenerations of both patients and parents. 
 
 He confirmed Lunier's statements that more than half 
 of the mental diseases were traceable to alcohol. His 
 studies showed the following line of descent: Mental in- 
 stability, want of self-control, hypersensitiveness to pain, 
 low vitality, feeble resisting power, constant desire for 
 relief, defective nutrition, irritability, want of ambition, 
 selfishness, restlessness, perversions of reason, credulities 
 and egotism. 
 
 In the next generation, stigmata of the head, face, 
 ears, eyes and teeth appeared. Irregularities of the body
 
 156 INEBRIETY. 
 
 and external indications of retarded and defective devel- 
 opments. With this, pauperism, criminality, insanity 
 were common conditions, and, finally, the race was ex- 
 tinguished. 
 
 The late Dr. Kerr concluded, from a large number of 
 cases, that complex forms of insanity, as well as ine- 
 briety, were almost certain to appear in the second gen- 
 eration of inebriates. He claimed that insane parents 
 were followed by inebriate children, and inebriate parents 
 by insane children, using the term insanity in the broad- 
 est sense as describing all complex forms of neuro- 
 psychosis, and general defects and abnormalities of the 
 brain. 
 
 He said, "Any transmitted disease which increases nerve 
 susceptibility and exhausts nerve strength and power of 
 control, will positively appear in some form of defect 
 and degeneration in the next generation." Inebriety is 
 one of these diseases which will develop the same or an 
 allied disease in a large proportion of cases. 
 
 Dr. L. D. Mason, in an exhaustive study of 7,000 in- 
 ebriates, concluded that fully 60 per cent had alcoholic 
 ancestors, either parents or grandparents. In a later 
 study, he found that 50 per cent, of all mental and ner- 
 vous diseases were referable to this cause. 
 
 The late Dr. Day found that in 5,000 cases 70 per 
 cent, were traceable to alcoholic ancestors. The late Dr. 
 Parish, from a very large experience, urged that at least 
 50 per cent, of all inebriates were hereditary cases. He 
 claimed that 70 per cent, of all idiots came from this 
 cause, and that alcohol was either an active or predis- 
 posing cause in nearly all the degenerations that were 
 marked by criminality, pauperism and allied defects. 
 
 In a personal study of over 4,000 cases, over 60 per 
 cent, were traceable to this cause ; 20 per cent, were prac- 
 tically children of insane persons, or persons who were
 
 NEUROSES FOLLOWING INEBRIETY IN PARENTS. 157 
 
 mental defectives, as well as inebriates. The parents of 
 the others were more markedly inebriates, but presented a 
 great variety of neuro-psychopathic disturbances and 
 paranoic tendencies. 
 
 These are some of the conclusions reached by persons 
 of large experience and ample opportunities for study. 
 A very interesting question has been the subject of con- 
 siderable literature, namely, how far education, training 
 or marriage prevents or neutralizes the inherited defects 
 and tendencies to inebriety. 
 
 The answer opens a very wide field, with possibilities 
 that are startling. It is very evident that defective edu- 
 cation, bad training, as well as unwise marriages, may 
 intensify and develop the inheritance and destroy every 
 possible hope of recovery or normal life. 
 
 In some studies, recently made, the question is asked 
 in what direction do these transmitted defects appear 
 to be most prominent? The answer to this would often 
 suggest methods of treatment and forms of training 
 that would overcome this condition. The subject is 
 practically a great, dark continent, awaiting exploration, 
 and the few landmarks pointed out by many observers 
 only show how much there is yet to be studied. Prac- 
 tical men, working in institutions, have no patience with 
 theorists who deny the transmission of inherited defects. 
 They look forward with eagerness to advanced educa- 
 tional studies that will teach how to overcome and neutral- 
 ize these tendencies, and to parental training and culture 
 that will save the race from this downward march.
 
 CHAPTER XVI. 
 
 PSYCHIC PHENOMENA OF INEBRIETY TRACEABLE 
 TO HEREDITY. 
 
 Synopsis. Prominent defects noted in asylums. Traceable to 
 persons in whom symptoms of intoxication are present. To a 
 second class in which these symptoms only appear from special 
 exciting causes. In the first class the intoxication of parents is 
 prominent. Deformities of body and face appear. The mind 
 shows similar defects. In the second class mental symptoms ap- 
 pear when the person is excited. These symptoms are repetitions 
 of toxic states of parents. Illustrations. Morbid fears. Imbecile 
 conditions. Persons who when excited show symptoms of intox- 
 ication. Parents often periodic or moderate drinkers. Illustra- 
 tive cases. Instances of persons who when excited act as if 
 intoxicated. Pathological states probably present. These con- 
 ditions seen in other persons without Inherited predispositions. 
 The fascination of some men to hear of the sufferings of others. 
 Failures of temperance orators who use these methods. The toxic 
 states positive inheritances which take on different forms. A 
 condition not studied, but explaining many of the remarkable 
 conditions seen in this class. It may be concealed, and only 
 appear from the presence of certain exciting causes. 
 
 The special purposes of this chapter is to group cer- 
 tain facts and study their relation to causes which are 
 obscure ; also to present additional evidence of the tre- 
 mendous influence of heredity and its most intimate asso- 
 ciations in cases of inebriety which have never been 
 thoroughly studied. 
 
 Elsewhere it has been stated that the evidence from a 
 clinical study of these persons indicates a uniformity in 
 development, progress and termination, and laws of dis- 
 solution that are fixed and certain. 
 
 Two inmates of a deaf and dumb asylum exhibited 
 such distinct symptoms of acute intoxication as to become 
 the subject of special study. Both were boys, ages nine 
 and thirteen, and both walked with a staggering gait 
 and a peculiar muscular tremor. One had a demented 
 grin, and nodded continuously when he observed anyone 
 looking at him. 
 158
 
 PSYCHIC PHENOMENA OF INEBRIETY. 159 
 
 The other had a congested, blear-eyed appearance, 
 with a dull, vacant stare and expression of stupor. The 
 latter was very irritable and sensitive to observation, and 
 trembled with anger from any slight cause. The other, 
 after excitement, grew stupid and helpless. These and 
 other very distinct symptoms of alcoholic intoxication 
 had been noted from early life. 
 
 The parents of both of these boys were inebriates, 
 and the evidence showed that both were profoundly 
 intoxicated at the time of conception. Further inquiry 
 indicated that these particular symptoms were traceable 
 back to inebriate parents, which was by no means uncom- 
 mon, especially in hospitals for idiots and feeble-minded. 
 
 It was also evident that many of these persons did not 
 show such pronounced toxic symptoms continuously, but 
 only when excited and subject to some peculiar stimu- 
 lating influences. A number of these cases were grouped, 
 and seemed to divide into two classes one, in which the 
 symptoms of intoxication were present all the time; the 
 other, in which these symptoms only appeared from some 
 special, external causes. 
 
 In the first class, idiocy, imbecility and congenital 
 deformity were present, and the toxic symptoms seemed 
 to be special manifestations of this condition. The spe- 
 cial symptoms of drunkenness varied in many partic- 
 ulars. Thus, in one examination at a private school for 
 the feeble-minded, four children in fourteen had the 
 palsied walk, red eyes, leering expression, with a sus- 
 picious hesitancy of manner, and other signs almost 
 pathognomonic of intoxication. In the home of a former 
 patient was an idiotic girl, whose manner, walking, voice 
 and rambling utterances were a perfect picture of toxic 
 states from alcohol. 
 
 Other defects and deformities may predominate and 
 conceal some of these special signs of intoxication. In
 
 160 INEBRIETY. 
 
 the cases examined, most of the defects appeared soon 
 after birth. Others were slowly evolved with the growth 
 of the child, coming into prominence at or before 
 puberty. 
 
 The distinctness of the symptoms and their very close 
 resemblance to that of intoxication seen in the parents 
 suggest a direct causation. This was brought out in 
 the case of a lawyer, who was a periodic drinker, and 
 while under the influence of alcohol suffered from intense 
 delusions of fear and suspicion of injury from every one 
 with whom he came in contact. 
 
 When the paroxysm was over, this passed away. His 
 idiot son exhibited these precise symptoms, with or with- 
 out any exciting causes, so prominently as to indicate 
 the distinct inheritance. 
 
 In the second class these special alcoholic symptoms 
 appeared only from the action of some particular, pe- 
 culiar exciting causes, such as anger, excitement or, 
 sudden changes of condition or environment. In two 
 instances this was an exact duplication of the character 
 of his mother. 
 
 In another instance, these alcoholic symptoms were 
 only present when the child was taken away from the 
 home ; when quiet and still they did not appear. Per- 
 sons who have control of idiots and imbeciles realize 
 the danger of excitement, or anything startling, because 
 it develops all the weakness, delusions and delirium. 
 
 Hence the effort to avoid anything that will excite 
 or disturb the mentality of the child. Thus an imbecile 
 boy, if watched sharply, becomes confused, and acts and 
 appears as if intoxicated. When he becomes used to 
 the observation, these symptoms pass off, and he recovers. 
 
 The particular toxic condition due to alcohol is trans- 
 mitted to the children and develops into a like condition. 
 This is supported by the history of the parents and the
 
 PSYCHIC PHENOMENA OF INEBRIETY. 161 
 
 special appearance of the children. Thus, in one instance, 
 a father when intoxicated had intense muscular delirium, 
 in which he moved about incessantly, not being able to 
 remain quiet for a moment. His two children, who were 
 idiots, exhibited the same delirium and muscular agi- 
 tation from any sort of excitement. A woman, when 
 intoxicated, had hysterical fear of dogs. At other times 
 she was fond of them, and always had them about 
 the house as pets. She had two imbecile children, whose 
 fear of dogs was convulsive, and resembled the condition 
 of the mother when intoxicated. 
 
 Antenatal impressions made on the mother's mind, 
 which appear in the children, are well-attested facts, and 
 have been the subject of considerable literature. Two 
 instances bring out this fact in a different light. Thus, 
 an exceedingly nervous woman, who was a moderate 
 user of alcohol, was profoundly frightened by an intox- 
 icated soldier. A boy born soon after had all the symp- 
 toms of intoxication, both muscular and mental, when- 
 ever excited. 
 
 In the second instance a mother saw her husband 
 wildly intoxicated, and was very much alarmed. A boy 
 born soon after exhibited the same identical symptoms 
 of delirium, stupidity and convulsive toxic states. For- 
 tunately, there are other causes which neutralize and 
 prevent the special development of alcoholic delirium and 
 paralysis. 
 
 It is not clear why these conditions are not apparent 
 in all children whose parents were intoxicated at the 
 time of conception. It may be said that while this par- 
 ticular phase is not always present, there are other con- 
 ditions of defects and abnormalities which are traceable 
 in many ways. 
 
 There is another group of persons who grow up and 
 are recognized as average people with uniform health
 
 INEBRIETY. 
 
 and capacity, but who from particular, exciting causes 
 of exhaustion, debility and sudden shock or strain, ex- 
 hibit marks of alcoholic intoxication. 
 
 Many of these persons are total abstainers, reformers 
 and excellent men and women, who give no evidence of 
 using spirits in any form, and yet from some unexplain- 
 able shocks or disease, appear to be under the influence 
 of spirits. A careful study brings out the fact of alco- 
 holic ancestors, and, of course, an inherited, neurotic 
 weakness. 
 
 In one instance a man had extreme aversion for the 
 taste and smell of spirits, which produced nausea and 
 vomiting if forced to be in the company of drinking 
 men any length of time, or to breathe air filled with 
 spirit odors. On several occasions, when suddenly ex- 
 cited, this man became confused, staggered, talked in 
 an imbecile, boastful way, and gave all the signs of 
 profound intoxication. When taken to a room and 
 allowed to become quiet, he recovered and appeared normal 
 and sane. 
 
 Another example was that of a temperate man with 
 alcoholic ancestors, who showed great fear of intoxi- 
 cated men, and sought every possible means to keep 
 away from them, claiming that if he could not do so 
 he would be like them. In this instance he was nau- 
 seated and vomited, showing signs of extreme depression. 
 
 A group of cases, bringing out some very re- 
 markable facts, is presented, to show the mysterious laws 
 and forces which are potent in reproducing toxic states 
 in children of inebriates. Many of these cases were very 
 prominent at the time, and excited a great deal of 
 attention. One J. B., a man of character and wealth, 
 who had never used any kind of spirits, was greatly 
 excited and shocked by a runaway, in which he was 
 precipitated from the wagon and slightly bruised.
 
 PSYCHIC PHENOMENA OF INEBRIETY. 163 
 
 He could not walk. His face became red, his voice 
 jerking and husky, and his language impulsive and silly. 
 He was thought to be intoxicated, and after being taken 
 home recovered. Later, at a funeral of his child, he dis- 
 played these and other symptoms of intoxication, to 
 the great mortification, of his friends and family. 
 
 A year later another similar attack, only more pro- 
 nounced, occurred at the burning of some outbuildings 
 on his farm. A careful inquiry showed that he had not 
 used spirits in any way, although every symptom indi- 
 cated a toxic state. 
 
 His father was an excessive user of spirits, and his 
 mother died of consumption. He never could bear the 
 smell or taste of alcohol, and was greatly depressed 
 from being accused of drinking. 
 
 A second case was of a treasurer of a large manufac- 
 turing concern. He was strictly temperate, but a very 
 nervous, hard-working man. He suddenly appeared to 
 be intoxicated when accused of falsifying the books. He 
 was irrational, delirious and stupid. Was taken home, 
 and two days after recovered, and explained his affairs 
 to the satisfaction of all. After a period of invalidism 
 for several weeks, he seemed to recover. 
 
 During the next two years he had two similar attacks, 
 coming on from excitement and unusual strain. A physi- 
 cian called it congestion of the brain. In each instance 
 there was no evidence of any spirits having been used. 
 His father was a sailor, and died from the excessive use 
 of spirits. 
 
 A third case is of a merchant who had lost all his prop- 
 erty in a series of unfortunate speculations. He was 
 much depressed, and went to live with his brother-in-law, 
 a physician. He was a total abstainer and a healthy, 
 temperate man up to the time of his failure.
 
 164< INEBRIETY. 
 
 One day, on the receipt of a letter containing bad 
 news, he had, to all appearance, an attack of acute in- 
 toxication. A careful examination showed that alcohol 
 was not used, and the physician called it mind-intoxica- 
 tion. From this he recovered in a short time. 
 
 A few weeks later a similar attack followed, and during 
 the next five years he had many distinct periods of stupor 
 and delirium, each one lasting from two to four hours. 
 His ancestors were excessive drinkers of spirits. He died 
 from acute pneumonia. 
 
 A fourth case was that of a banker, an abstainer and 
 in good health. One day he received a dispatch, telling 
 of the sudden death of his daughter. In a very short 
 time he appeared like one wildly intoxicated. The physi- 
 cian declared that it was caused from alcohol. He was 
 taken home, and was an invalid for two weeks. 
 
 An opinion prevailed that he had drunk to stupor at 
 the news of the death of his daughter. There were no 
 spirits in his office, and no evidence that he sent out for 
 it, and while he denied having used spirits, he seemed 
 greatly confused and excited at his condition and the 
 accusations that were made. Both cf his parents drank 
 excessively, but there was no evidence of his having 
 used spirits. 
 
 An incident occurred during the late war, and was 
 the subject of much comment and speculation. A prom- 
 inent officer appeared intoxicated, riding up and down 
 the firing line, shouting parts of songs and orders with 
 wild exclamations. His conduct was so strange and un- 
 usual that he was ordered back, but not until he had 
 two horses shot under him, and was slightly wounded 
 himself. 
 
 In reality he was a total abstainer, and had not drunk 
 any spirits. The excitement of the occasion seemed to 
 have brought on a species of frenzy which resembled
 
 PSYCHIC PHENOMENA OF INEBRIETY. 165 
 
 acute intoxication. Surgeons have noted this strange 
 delirium and peculiar excitement in men under fire, so 
 exactly like intoxication, although it was impossible to 
 discover where the men had obtained spirits. 
 
 Several authors have mentioned similar incidents of 
 soldiers previously temperate who suddenly appeared de- 
 liriously intoxicated, and after the battle was over be- 
 came stupid and bewildered, and showed irritability and 
 other symptoms so common from the toxic action of 
 alcohol. 
 
 Instances are mentioned after periods of prolonged 
 strain and excitement, where large quantities of coffee 
 were given out. Many men showed unmistakable symp- 
 toms of drunkenness, which was termed "coffee drunks." 
 This was marked by excitement and frenzy, or stu- 
 pidity and unconsciousness of danger, which was not 
 bravado, but a sort of a delirious recklessness that fre- 
 quently ended in capture and death. 
 
 An author, in writing of a particular battle, men- 
 tioned that after giving out large quantities of coffee 
 to a certain division on an exposed position, the men 
 showed a recklessness and frenzy that was very marked. 
 The same facts have been observed in the navy where 
 men, subjected to protracted excitement, have become 
 wild and stupid, and the term "battle drunks" was used 
 to describe this condition. 
 
 Upon the advent of great disasters many persons are 
 shocked, greatly excited, act irrationally, do extraor- 
 dinary tilings, and seem to be practically drunk and 
 idiotic. 
 
 In a railroad accident the conductor of the train 
 appeared and acted like one intoxicated, although he 
 had never used any spirits. Two men, riding on a train, 
 talking quietly, were suddenly precipitated down an 
 embankment. The cars were crushed and manv were
 
 166 INEBRIETY. 
 
 killed. These two men were only slightly bruised. One of 
 them became stupid, excited and apparently intoxicated, 
 and his condition was the subject of a good deal of 
 comment afterwards. 
 
 These cases occur not unfrequently, but for want of 
 accurate observation and difficulty of obtaining the facts, 
 are seldom studied, but rather concealed, on the suppo- 
 sition that they would reflect on the character of the 
 person. The histories of all the cases which have so far 
 been studied indicate inebriate ancestors and a pronounced 
 entailment of heredity, which some special, exciting 
 causes have materialized into a form of apparent alco- 
 holic intoxication. 
 
 It is a reasonable inference where symptoms of intox- 
 ication in the general sense appear, and no active, excit- 
 ing causes can be found, to expect a similar condition 
 in ancestors. It is a fact based on a large experience 
 that inherited defects may pass down several generations 
 and be dormant, only appearing from the action of some 
 peculiar, exciting causes. 
 
 Another group of cases have come under observation, 
 in which persons who have previously been inebriates, or 
 who have drunk to intoxication, and then become total 
 abstainers, develop suddenly all the signs of intoxication 
 without having used any form of spirits. 
 
 Most of these cases show heredity and alcoholic ances- 
 tors one or two generations back. The following cases 
 seem to sustain this conclusion: A man of some prom- 
 inence, who drank during his college life, then became 
 a total abstainer, and for fifteen years afterwards lived 
 a temperate, healthy life, above all suspicion, became 
 engaged in marriage under circumstances of great 
 promise. 
 
 The day of the wedding the bride received a letter 
 of warning, saying that he was a secret drinker and a
 
 PSYCHIC PHENOMENA OF INEBRIETY. 167 
 
 bad man otherwise. This letter was sent to him. After 
 reading it he showed all the signs of intoxication and 
 went to bed, and for two days was under the care of the 
 physician. He asserted so positively his innocence that 
 medical examination of the facts was called for. This 
 showed no signs of the use of spirits, and confirmed his 
 assertion of not having used any alcohol or any similar 
 drugs. A history of moderate and excessive drinking 
 was noted in his parents. 
 
 A second case in which a clergyman had a marked his- 
 tory of heredity was taken to a hospital for inebriates. 
 A few months later, while still under treatment, he was 
 visited by a brother clergyman, who no doubt talked 
 very severely to him about the sin of drinking. He was 
 found a short time after apparently intoxicated, and 
 for two days he had all the appearances of one who 
 had been profoundly poisoned by alcohol. This case 
 was also the subject of very careful study, and his asser- 
 tions of not having had any spirits were sustained, and 
 the conclusion that the excitement precipitated a pathol- 
 ogical state resembling intoxication, was conclusive. 
 
 A third case was the subject of a great deal of con- 
 troversy. The facts were these: 
 
 A temperance lecturer in early life had drunk to 
 excess, but for over twenty years had been a total 
 abstainer and reformer. One evening while lecturing 
 he was handed a dispatch, announcing the fatal illness 
 of his only child. He drank a glass of water, attempted 
 an explanation, became confused, staggered and acted 
 like a man becoming intoxicated. He was led from the 
 stage, and laughed and shouted in a maudlin way. 
 
 The audience supposed that he was drunk. He was 
 put to bed and several hours later recovered. All cir- 
 cumstances showed that he had used no spirits, but was
 
 168 INEBRIETY. 
 
 suffering from some sort of a brain disturbance which 
 took on this peculiar form. 
 
 In another instance, an eloquent lecturer, who por- 
 trayed with great dramatic skill the conduct and manner 
 of an inebriate, and the terrible losses which follow from 
 his conduct, would be practically intoxicated at the con- 
 clusion of his lecture, and be taken away to some quiet 
 hotel room and kept from observation for several hours. 
 
 This man came from alcoholic ancestors, and drank 
 early in life, then abstained, and for many years has been 
 recognized as a very unusual speaker in the temperance 
 field, and is employed constantly. 
 
 The necessity of having him go to a room immedi- 
 ately after the lecture has been more and more prom- 
 inent the last few years. Phases of exhaustion, called 
 queer spells by his friends, and by others called intoxi- 
 cation, are very significant, and indicate a degenerative 
 neurosis that is increasing. 
 
 Another example was that of a clergyman of much 
 talent and genius, who drank during college life, then 
 abstained. At about forty-five years of age he became 
 subject to impulses to drink, which could be overcome 
 or restrained by preaching temperance sermons and seek- 
 ing opportunities to talk and plead with persons to 
 become total abstainers. 
 
 He finally gave up the pulpit and became a temper- 
 ance lecturer, exhibiting great power, enthusiasm and 
 dramatic skill in persuading people to abstain from 
 spirits. After giving a lecture his condition resembled 
 closely one who had been profoundly intoxicated. He 
 had to be put to bed and cared for as one who was ut- 
 terly incompetent to know and reason what he should do. 
 
 These were likewise called "queer spells." After the 
 meeting he was irritable and harsh, and wanted to be 
 taken away, and said in an undertone to his friends
 
 PSYCHIC PHENOMENA OF INEBRIETY. 169 
 
 that he wanted to get drunk, and must have some spirits, 
 unless they could take him away where it was quiet. 
 
 These examples indicate a wide range of facts which 
 may be studied in the temperance meetings of to-ddy, 
 particularly where conducted by reformed inebriates and 
 persons who have had serious experiences. 
 
 There is another series of pathological conditions 
 noted in what may be called unconscious, imitative ine- 
 briety, in which persons appear intoxicated from the 
 influence of contagion in the surroundings and from 
 personal contact with drinking men. 
 
 These cases have all a strong substratum of heredity. 
 That is, they come from inebriate ancestors, and have a 
 peculiar neuropathic diathesis. The following is an 
 example : 
 
 A lawyer, a delicate, nervous man, was employed in 
 the State Department at Washington, where a monoto- 
 nous, exact range of duties was performed for years. 
 He lived a temperate life, never having used spirits, al- 
 though his father was an inebriate. His evenings were 
 spent at the club, where he read a great deal, played 
 cards and appeared the same as others. 
 
 Suddenly it was noticed that he appeared like a 
 drinking man, particularly when in the company of 
 those who used spirits. If any of them became hilarious 
 or stupid, he would appear the same, although he did 
 not drink anything but water, and refused with firm- 
 ness all invitations to drink. 
 
 Sometimes he drank coffee or a mild cup of tea. As 
 the company grew intoxicated he appeared like them, and 
 sometimes would have to have a carriage to take him 
 home. The next morning he would complain of a head- 
 ache. These occasions increased in frequency, until 
 finally it was impossible for him to be in the company 
 of drinking men without appearing and acting like them.
 
 170 INEBRIETY. 
 
 His friends called him a "coffee drunkard." He could 
 give no explanation of his condition, and it was noticed 
 that he was not affected by the contagion of drinking 
 men who were strangers, but those whom he knew in- 
 fluenced him very markedly. 
 
 He affirmed that the sensation from the company of 
 drinking men was very pleasant, and that he followed 
 them, apparently enjoying their excitement and stupor 
 without realizing what it was until the party broke up 
 and he started for home. Then the palsy and stiffness 
 of the joints and general disgust appeared. This would 
 last until the next day, although he was not aware of 
 using any spirits himself. 
 
 He was the subject of a very careful study by two 
 medical men, who concluded that it was a pure case of 
 hypnotic influence and suggestion, and that he was a 
 perfect barometer of the surroundings and influences 
 of others, and that after a certain time he lost all memory 
 of what he was doing, or consciousness of the conditions. 
 
 This man left the club and recovered, but he was 
 very careful to keep away from all drinking men, be- 
 cause of the certainty of taking on their exact condi- 
 tions. 
 
 A second example was a farmer. He was a strong 
 temperance man, and was elected to Congress. He 
 formed a strong attachment for an impulsive, drinking 
 man in the same body, and associated with him freely, 
 although never using spirits of any kind. 
 
 It was noticed that he would stagger, talk wildly, 
 laugh and tell stories, and exactly reproduce many of 
 the manners of this man. Later he imitated conditions 
 of intoxication, and was hilarious and stupid. The only 
 thing that fixed itself on his mind was that he could 
 not use spirits. He was reported as intoxicated, and had 
 difficulty in making a reasonable defense.
 
 PSYCHIC PHENOMENA OF INEBRIETY. 171 
 
 Whenever in company with this man, where wine was 
 used, and the party was hilarious, he was considered in- 
 toxicated with the others. He was re-elected and his 
 companion died. After this his manner changed, and 
 he avoided the society of drinking men and dinners where 
 wines were served. 
 
 Both of these persons had an alcoholic ancestry, and 
 both were temperate men. Another group of examples 
 were reformed men, or persons who had previously drunk 
 and become abstainers, who showed the same signs of in- 
 toxication from contagion. 
 
 The following is an instance: A military man had 
 drunk moderately during. the war, but had been a total 
 abstainer for many years. While attending a dinner 
 with his old comrades, where most of them were intoxi- 
 cated, he suddenly became hilarious, made a wild, foolish 
 speech, settled back in his chair, evidently as drunk as 
 the others. 
 
 In reality he had not used any spirits, but simply 
 coffee and water, and yet he had all the symptoms of 
 intoxication, due to the contagion of the surroundings. 
 
 Another example was of a man who had been a total 
 abstainer for more than twenty years. He was elected 
 to office and gave a dinner in honor of this event. Many 
 of the company at the dinner became intoxicated, and 
 the host who drank nothing but water became boisterous 
 with the others, then stupid, and had every sign of in- 
 toxication. He was carried home in a semi-paralyzed 
 condition, and the next morning had only a confused 
 notion of what had occurred. 
 
 A physician who was present was able to make a study 
 of his condition, and declared that he had a mental in- 
 toxication, and that his condition was one of pure hyp- 
 notic contagion from the surroundings.
 
 172 INEBRIETY. 
 
 A third case was of a reformed man who had been a 
 total abstainer for twelve years. He went on a military 
 excursion, and most of the company became more or less 
 intoxicated. He appeared like the others maudlin, 
 wild and delirious although he drank nothing but 
 lemonade. 
 
 The event was the subject of comment and an occasion 
 of loss, socially and otherwise. A careful examination of 
 all the facts showed that he did not drink any spirits, 
 and that his condition was simply one of mental contagion. 
 
 These three examples were studied by most competent 
 authorities, and the conditions were beyond all question 
 and doubt. The previous examples were persons who 
 had never drunk, but exhibited a distinct pathological 
 inheritance. The latter cases show a materialization of 
 some previous pathological state. What form of brain 
 and nerve defects, either acquired or inherited, could be 
 made prominent by contagion or suggestion, is a ques- 
 tion for future studies. 
 
 In a less prominent way, similar conditions have been 
 noticed in club rooms and at banquets and dinners where 
 wines were very freely used. Men and women who are 
 not drinking spirits, not unfrequently show, with others, 
 very unusual symptoms of weakness and childishness, 
 resembling persons under the influence of spirits ; and 
 afterwards express regret and inability to account for 
 their acts or conduct. 
 
 There are some very striking psychological facts along 
 this line that explain many of the phenomena of ab- 
 normal or unusual mental states. It is said in theatri- 
 cal circles that actors who make the best representations 
 of insanity or inebriety have inherited some nervous 
 organization or peculiarities predisposing them to enter 
 into the spirit and condition of the character they 
 portray.
 
 PSYCHIC PHENOMENA OF INEBRIETY. 173 
 
 A single glass of spirits may awaken some latent 
 nerve defect which very quickly leads up to inebriety. 
 So the effort to imitate the manner and conduct of an 
 intoxicated person gives a certain impress and direction 
 to the functional activities of the body that sooner or 
 later become permanent. Actors who have been intox- 
 icated and who are moderate drinkers give a certain 
 realism to their representations of drunken men that 
 cannot be mistaken. 
 
 It has been said that persons of this class who rep- 
 resent intoxicated states are intensely depressed after- 
 wards, and claim that they feel worse than they do from 
 the real condition. In an instance where an actor daily 
 represented an intoxicated man for a season, he had to 
 give it up, because of its tremendous influence on his 
 character and conduct. He could not use spirits in the 
 play, for the reason that his memory would be disturbed 
 and his artistic sense impaired. 
 
 A temperance writer of great power and vividness of 
 detail said that in describing the effects of drink and 
 drinking men, he entered so deeply into the conditions 
 of exhaustion, pain, agony and joyousness, which he 
 described, that he had to go to bed, as he was prac- 
 tically intoxicated. 
 
 This man was strictly temperate. He had an inebri- 
 ate father, from whom he inherited a peculiar nervous 
 organization, which enabled him to realize the toxic 
 states from alcohol and describe them with vividness. 
 He gave up writing on this theme because it was so 
 intimately associated with his mental health. 
 
 Descriptions of drunken men in novels bring out 
 this fact very clearly. Either the writer has had some 
 personal experience or his ancestors before him have 
 impressed on his organism a vivid and intense concep-
 
 17-i INEBRIETY. 
 
 tion of the toxic states, or else their pictures are unreal 
 and mechanical word-settings. 
 
 Those who study inebriates carefully are continually 
 astonished at the reproduction of ancestral traits and 
 peculiarities, dating back two or three generations some- 
 times. One is also astonished at the psychological man- 
 ifestations and reproductions of previous mental condi- 
 tions in persons who are total abstainers. 
 
 For instance, reformed men, or those who have stopped 
 all use of spirits, are often very sensitive to the recital 
 of the struggles of others under the influence of drink. 
 Such narratives often take on the form of a mental shock 
 that have much to do in diminishing their strength and 
 vigor. 
 
 Temperance lecturers who expect, by drawing vivid 
 pictures of the horrors of alcoholic excess, to create a 
 similar sentiment in the minds of the hearers, often pro- 
 duce the very opposite effect, particularly in persons 
 who have inherited a defective nervous organization 
 from alcoholic ancestors. In much the same way, the 
 sight of intoxicated persons produces a dangerous sort 
 of excitement in the minds of defects and a species of 
 contagion, or rather fascination to imitate them. 
 
 The conclusion must be recognized that a pronounced 
 toxic condition from alcohol leaves a permanent impres- 
 sion on the organism which may be concealed for a 
 time, but is very likely to appear again on the appli- 
 cation of some special exciting causes. 
 
 There are evidently conditions of heredity, unknown 
 at present, which will be studied in the future. Two 
 facts seem to be clear. First, that symptoms of alco- 
 holic poisoning may occur when no alcohol has been 
 used. 
 
 Second, that the excessive use of alcohol leaves a per- 
 manent impression on the brain, both physiological and
 
 PSYCHIC PHENOMENA OF INEBRIETY. 175 
 
 psychological. This impression may go on down to the 
 next generation, and in some unforeseen way appear in 
 conduct and actions, and can be traced back to the orig- 
 inal cause. 
 
 The impression made of every event on the mind and 
 experience is exact and indelible, and when any sufficient 
 suggestion is made out of the unknown changes of the 
 past life, the old emotion, conduct and mental states 
 will appear, and their return is full of peril to the en- 
 feebled and weak ones.
 
 CHAPTER XVII. 
 PATHOLOGY OF INEBRIETY. 
 
 Exact changes difficult to determine. Under the 
 microscope confused wreckage of cells and nerves ap-parent. 
 First changes in the blood vessels. Many persons die of acute 
 inflammatory diseases. The pathology varies widely in these 
 cases. Vaso-motor paralysis a very common condition. Defective 
 nutrition with diminution of powers of elimination and accumu- 
 lation of toxins are common. Conclusions of the London Patho- 
 logical Society. Dr. Andriesen's opinions. Studies of Dr. Berk- 
 ley and Dr. Van Gieson. Derangement of circulation of the brain 
 an early symptom. Destruction of the protoplasm common. Dr. 
 Sims Woodhead's opinion. Thinks liver and other organs suffer 
 uniformally. Nutrition of the heart impaired. Every intoxication 
 a paralysis. Post-mortems show ruptures and occlusions. Dr. 
 Bevan Lewis points out congestion and shrinking of cells and 
 blood vessels as common. Psychic palsies leave marked effects. 
 Heredity, susceptibility and immunity conditions to be consid- 
 ered. The modern pathologist finds a great variety of degen- 
 erative changes. Other experts point out changes of functional 
 activity, sensory actions, structural pathology often mistaken 
 in their conclusions. Functional pathologists determine causes 
 very distinct. Conclusions. Much to be learned. Great problems 
 to be settled. 
 
 The pathology of inebriety is an obscure record of a 
 long series of shocks, injuries, degenerative changes and 
 explosive liberations of nerve energy, often beginning 
 with defective cells and growths, and going on for years. 
 
 Of necessity there must be great complexities of re- 
 sults from the innumerable causes and varied influences 
 which register themselves on the cells and tissue of the 
 body. 
 
 The brain and body of the inebriate under the micro- 
 scope often exhibit at the post-mortem a confused wreck- 
 age of cells and nerves and walls of blood vessels, thick- 
 ening and thinning of tissues, so that the pathologist is 
 unable to trace the exact causes which have produced 
 this or that result. 
 
 Usually degenerations most prominent are sclerosis 
 and calsification of the couts of the arteries, with atrophic 
 176
 
 PATHOLOGY OF INEBRIETY. 177 
 
 and hyperatrophic states of the organs, and other defects. 
 These are so common in inebriates that they are regarded 
 as pathologic and traceable to the excessive use of 
 alcohol. 
 
 In reality, a large number of inebriates die from acute 
 diseases which are local in their action. The post-mortem 
 reveals many organic changes which are commonly trace- 
 able to alcohol; yet there are many cases of pronounced 
 inebriates dying from acute inflammatory diseases where 
 the pathological changes are very indistinct, and might 
 be referable to other causes. 
 
 The more modern views of the action of alcohol indi- 
 cate that the first pathological changes are recorded in 
 the walls of the blood vessels, particularly in the capil- 
 laries of the brain and surface of the body. The well- 
 known action of alcohol on the vaso-motor centers, par- 
 alyzing and diminishing the muscular contractivity of the 
 arteries and capillaries obstruct and change the action 
 and uniformity of the blood current. This is followed 
 by defective nutrition, with accumulation of toxins and 
 a diminution of the power of elimination. 
 
 The conclusions of the London Pathological Society 
 have been sustained by all modern studies, and agree that 
 the first action of alcohol in the body is to check oxidiza- 
 tion by diminishing the oxygen-carrying properties of 
 the hemoglobin and retarding the elimination of carbon- 
 dioxide. 
 
 Another action is that of a corroding tissue poisoning 
 by the absorption of water at every point of contact 
 with the cells and tissues. 
 
 A third action is marked functional derangement, noted 
 in the depression, checking and retarding the natural 
 activities of the organism. The corroding effects on the 
 cells and nerves provokes inflammatory action with fibrin- 
 ous deposits, and these are very common.
 
 178 INEBRIETY. 
 
 Dr. Andriesen, the pathologist of the West Riding 
 Asylum, in England, concludes an exhausting study of 
 the injuries following the use of alcohol, as follows: 
 
 "There can be no doubt that alcohol taken into the 
 body has a specific influence over the nutrition of the 
 nerve cells, impoverishing and starving them, cutting off 
 and diverting the dynamic forces. This is followed by 
 shrinking and atrophy of both cell and nerve." 
 
 Dr. Berkley, of Johns Hopkins Hospital, has added 
 new studies of his own to these conclusions, proving that 
 alcohol has a special, corroding action on the cells, not 
 only paralyzing them, but abstracting the water from 
 them, and thus destroying their activity. This may be 
 confined to certain local centers, which later increases 
 until large areas of the brain become affected. 
 
 Dr. Van Gieson, late of the New York Pathologic In- 
 stitute, has described the altered conditions of the blood 
 cells and fibers following the use of spirits, reaching the 
 same conclusions that the corroding action of spirits is 
 apparent on the protoplasm and the nutritive activities 
 of the cells. 
 
 In support of these general statements a great variety 
 of studies have been made, not only confirming them, but 
 adding many new facts. One author believes that the 
 paralyzing action of alcohol on the capillaries breaks up 
 the uniform flow of the blood current, producing con- 
 vulsive, irregular activities, which is the first and most 
 pronounced " pathologic change. 
 
 The very apparent action of alcohol in increasing the 
 heart's action and flow of blood, is always followed by 
 a diminution of both the heart force and circulatory 
 power after a time. This may be so pronounced as to 
 cause great alternations of exhiliration and activity, fol- 
 lowed by depression and stupor.
 
 PATHOLOGY OF INEBEIETY. 179 
 
 It is from these conditions that nutrition is disturbed 
 and irritation encouraged, apparent in certain brain 
 tracts and in certain persons who are susceptible to 
 these influences. 
 
 The spasmodic activity of the heart from the use of 
 spirits varies widely in different persons. In one person 
 the beats will increase ten or fifteen a minute. In an- 
 other, after a brief time, the number will decrease, and a 
 decidedly sedative action will appear. In all cases there 
 is a lowering of the functional activity, and with it 
 increase of toxins and diminished nutrition. These con- 
 ditions may be caused by toxaemias of a gastro-intestinal 
 origin, and may be very active in producing similar re- 
 sults in susceptible persons. 
 
 The corroding action of alcohol may be intensified 
 by toxic products from various sources. Syphilis is a 
 degenerative poison, diminishing the resistive power of 
 the brain and stimulating acute organic degenerations. 
 All writers agree that the specific vaso-motor paralysis, 
 due to alcohol, is the beginning of organic changes in 
 the capillaries, and this is felt in the nerve cells. 
 
 The power of contraction and dilation, so prominent 
 in the heart, extends to the minutest blood vessels, and 
 is literally a force that controls the blood pressure, reg- 
 ulating the rythmic flow of the current, governed by 
 the influence of heat and cold, irritation, rest, nutrition 
 and other causes. 
 
 Hence, the disturbance of the heart is registered as 
 an impairment of the circulatory movement of the blood 
 in all parts of the body. This process impairs oxidiza- 
 tion, nutrition and elimination, and this finally is regis- 
 tered in fibrinous deposits and changes in the large and 
 small vessels.
 
 180 INEBRIETY. 
 
 Arterial sclerosis is a condition very common in in- 
 ebriates, and is a very natural result of diminished 
 elimination, defective nutrient plasm and desposits of 
 waste matters. The congested appearance of the face 
 in persons using spirits is a good index of the derange- 
 ment of circulation. 
 
 Both the vaso-dilators and the vaso-constrictors suffer, 
 and the blood current is interfered with, and finally per- 
 manent paralysis follows. The nutrition of the arteries 
 is changed, and the muscle cells are replaced by fibrinous 
 deposits, the channel is interfered with, and the supply 
 of nutrients deranged. 
 
 Dr. Sims Woodhead, the noted Cambridge pathologist 
 of England, says: 
 
 "I have been able to demonstrate that the walls of the 
 blood vessels are the first to suffer organic change from 
 the action of alcohol. Such changes occur, first, by a 
 thickening of the inner coat, followed by proliferation 
 of the endothelial cells. Then a thickening of the media 
 and the adventitia, also wasting of the muscular fibers. 
 This cellular increase is a veritable connective tissue group 
 of degenerations. First, it is a proliferation of the 
 endothelial and connective tissue cells, around the con- 
 nective tissue spaces, and, secondly, it is an accumulation 
 of waste products. 
 
 "This may go on slowly or rapidly. Often it attacks 
 the liver or the kidneys, always affecting the parenchyma- 
 tous tissues. These changes also affect the capillaries of 
 the brain, in the chronic form, the muscular coats of 
 the walls disappear, and fibrinous tissue take their place. 
 
 "The liver cells become atrophied, and fatty infiltration 
 with degenerations follow. This formation of fibrinous 
 tissues is particularly uniform in the heart, kidney, liver, 
 blood vessels and sheaths of the nerves. The lymphatics 
 are also affected."
 
 PATHOLOGY OF LNEBBIETY. 181 
 
 The spasmodic and convulsive activity of the heart 
 always deranges the nutrition of that organ. The cori- 
 nary artery is diminished in caliber and capacity to trans- 
 mit the blood current. Hence the increase action of 
 the heart is followed by exhaustion. This is registered 
 in the atrophic and hypertrophic conditions of the 
 heart. 
 
 Dilation of the heart results simply from deposits of 
 fatty cells in the place of the muscular fiber, whereby its 
 action and power of contraction is diminished. Both the 
 liver and kidneys suffer in the same way from increased 
 work and diminished nutrition. 
 
 The arteries and capillaries suffer in the same way, 
 by both thinning and thickening of the walls. In post- 
 mortems of drinking men the brain often shows occlu- 
 sions, ruptures and collateral circulation. These are the 
 direct result of spirits and the organic changes in the 
 walls of the arteries. 
 
 Every intoxication from alcohol is a paralysis, usually 
 spasmodic, or otherwise, of the arteries, with a diminution 
 of nutrition and other disturbances. This may be both 
 local and general. The stupor and coma, and the ex- 
 citement, delirium and delusions indicate physical de- 
 rangement. 
 
 It is also due to the irritant action of the toxins or 
 pressure of congested blood on certain centers. Other 
 poisons circulating in the blood may have a similar 
 action, producing contraction and tumefaction of the 
 cells and followed by increasing fibrinous growths. 
 
 Dr. Bevan Lewis has described this condition at length, 
 showing how toxins produce congestion and contraction, 
 and thus causing a shrinking of the cells in the blood 
 vessels. The serum infiltrations commonly found in the 
 brain of persons who use alcohol, together with the
 
 182 INEBEEETY. 
 
 fibrous arteries and sclerosis of the nerves and capillaries, 
 also of the liver and kidneys, constitute a distinct path- 
 ology, which is more or less common to all inebriates. 
 
 The older pathologists, whose experience was gained 
 from the cadaver, pointed out the uniformity of the 
 fibrinous deposits, serum infiltrations and calsification of 
 the arteries with foci of old hemorrhages as an unmis- 
 takable indication of alcoholic excesses. 
 
 Why one organ should suffer more seriously from or- 
 ganic changes than any other, and why the heart should 
 become hypertrophied and the liver and kidneys show 
 little change, except in their functional activities, and 
 vice versa, must be answered in the future. 
 
 Why inebriates show very little organic change with 
 great functional debility is another problem for the 
 future. There is evidently a pathology beyond the 
 microscopic power to determine ; that it is organic there 
 can be no question. 
 
 Another pathological view of what is termed psychic 
 causes, is far more common and uniform than specific 
 gross organic changes. It is uncertain whether these 
 psychic palsies follow or precede the organic changes in 
 the circulation and nutrition. 
 
 A very interesting chapter is yet to be written on 
 the palsies noted in inebriates, particularly of organic 
 and functional activities of the body. In many instances 
 psychic changes of character and conduct are traceable 
 to faulty nutrition and shocks, following sudden accumu- 
 lation, liberation and change of nerve energy. 
 
 The uniform paralysis and depression of the sensory 
 activities following the use of small quantities of alcohol 
 opens up a new field of psychological study. A study 
 of the normal man shows great variations of a similar 
 character, due to causes that may or may not be traced.
 
 PATHOLOGY OF INEBRIETY. 183 
 
 In the pathological study there is always a condition 
 of heredity and favorable organic states to be consid- 
 ered. Degenerations from the slightest exciting causes 
 are more likely to occur in some organs than in others. 
 
 Certain surroundings and environments and conditions 
 of nutrition have distinct pathological effects that are to 
 be recognized. It is an established fact that alcohol has 
 a specific depressing action on the psychic brain, or that 
 part which is termed character or consciousness of right 
 and wrong, duty and obligation. The explanation is that 
 this being the last formed in the growth of the brain 
 is the first to suffer and deteriorate. The modern patholo- 
 gist, with the new methods of staining and high power 
 microscopes, finds a great variety, but general uniformity 
 of degenerative changes. 
 
 The psychopathologist, with instruments of precision, 
 measuring the functional and organic activities of the 
 body finds a similar uniform palsy and depression. 
 
 The chemicopathologist concludes that the complexity 
 of the toxins of alcohol and other toxins growing out of 
 it produce a distinct change, which is traceable, and that 
 may be general or local in different parts of the body. 
 
 The anaesthesias following the action of various ethers 
 of alcohol on different parts of the body show very re- 
 markable changes that are scarcely yet known. 
 
 An attempt to mark out an exact pathology common 
 to all persons who use spirits, presents many difficulties. 
 One author of large experience asserts that sclerosis is 
 not a common sequela from drinking spirits ; another that 
 heart changes do not follow uniformly. 
 
 Their observations, of course, are limited, not in the 
 number of persons examined, but the narrowness of the 
 view taken. They fail to realize that alcohol, like syph- 
 ilis, has a peculiar variable virulent action on different
 
 INEBRIETY. 
 
 parts of the body, leaving other parts more or less in- 
 tact ; also, they fail to recognize the vast field of suscep- 
 tibility and immunity to these various poisons, and the 
 resisting powers of the body. 
 
 One fact is also not recognized, that the use of alcohol, 
 either in large or small doses, has a peculiar cumulative 
 action, both general and local, and this may be over- 
 looked and ascribed to other causes. It is evident from 
 the various studies that alcohol in the body is a tissue in 
 poison, both eroding and corroding, and that its effects 
 are ordinarily uniform and discernible. 
 
 The structural pathologist who decides on the absence 
 of any observable lesion that no disease is present, is 
 greatly mistaken. To assume that no disease exists, that 
 cannot be discovered by the present methods, is equally 
 faulty. 
 
 Many writers have concluded from this point of view 
 that inebriety has no pathology, but is a condition of 
 morals and weakness. Functional pathology is as evi- 
 dent and clearly defined as that of structural, and must 
 be recognized in all studies of pathology. 
 
 The disorders preceding, and associated with, periodic 
 paroxysms for drink and drugs, must of necessity date 
 from some specific change. The development of an al- 
 coholic craze or obsession must have a pathological cause 
 or causes, and it is evident that to this are added the 
 additional corroding influences of alcohol. 
 
 The later researches on arterial tension and obscure 
 exaltations and depressions show the same fact. A great 
 variety of very startling questions, yet to be answered, 
 suggest themselves. One, why alcohol should be used for a 
 long period of time without producing more serious and 
 decided pathological changes. Why persons who use 
 alcohol should suffer and die from germs or other diseases
 
 PATHOLOGY OF INEBRIETY. 185 
 
 in which peculiar symptoms appear; why the brain 
 and nervous system retains most of its vigor, while the 
 body would suffer acutely, and why the brain and nervous 
 system should succumb at the slightest exposure. 
 
 These and many other problems make the pathology 
 of inebriety a great dark continent in which only a little 
 exploration has been made.
 
 CHAPTER XVIII. 
 DIAGNOSIS OF INEBRIETY. 
 
 Synopsis. Diagnosis not a simple matter. Inebriates have a 
 mania to conceal and cover up the causes. They rarely realize 
 their real condition, but judge from their feelings. Symptoms 
 of neuritis are overlooked and the alcoholic cause unrecognized. 
 Moderate drinkers of wine and beer, ascribe these symptoms to 
 other causes. Midnight drinkers difficult to determine. Persons 
 who claim to be overworked are likely to be spirit drinkers. 
 Opinions of authorities. Diagnosis of persons found on the street, 
 supposed to be intoxicated. Illustrative examples. Common 
 errors. Diagnosis of women more difficult. Examples. Delirium 
 following trauma. Often misjudged. Delirium from fever may 
 come from alcohol. Psychic phase of intoxication very confusing. 
 Complications with syphilis. 
 
 It would appear to many that the diagnosis of in- 
 ebriety was a very simple matter. The common symp- 
 toms of flushed face, alcoholic breath and changed man- 
 ner, together with other symptoms, can hardly be mistaken 
 for another disease, and yet there are stages and states 
 of inebriety which require most careful study to dis- 
 criminate. 
 
 In a certain number of inebriates there is present a 
 literal mania to conceal and cover up the real causes of 
 their condition. This is manifest sometimes in unusual 
 skill and cunning, which baffles the most expert diag- 
 nostician. Elsewhere we have described the midnight 
 drinkers, or those who only drink in conditions of great 
 seclusion away from home, while to their friends and 
 associates they appear as total abstainers. 
 
 Such persons frequently appeal to medical men for aid, 
 and appear to be suffering from obscure conditions of 
 debility, mal-nutrition and exhaustion. Often business 
 men with obscure symptoms supposed to come from over- 
 work are treated with great minuteness, when in reality 
 
 the real cause is some form of spirits. 
 186
 
 DIAGNOSIS OF INEBRIETY. 187 
 
 Examples showing this difficulty are as follows: A 
 clergyman apparently anasmic suffered from insomnia, and 
 with so-called rheumatic pains in the lower extremities 
 made the rounds of eminent physicians, and was treated 
 for neuritis, disorder of the liver and other ailments. 
 
 All means seemed to fail until through an accident 
 of a broken leg he was obliged to remain two months in a 
 mountain village. His improvement was astonishing. On 
 resuming his regular work he became ill again, went 
 abroad and consulted eminent physicians. Finally he 
 died suddenly in a country village, where he had gone 
 for his health. 
 
 Then it was ascertained that his illness was due to his 
 secret use of spirits and the slow profound poisoning, 
 which was covered up by most unusual efforts. 
 
 Active business men frequently come under medical 
 care complaining of stiffness and wandering pains in the 
 feet and legs, with disturbed digestion, and many most 
 complex symptoms, which are diagnosed as rheumatism, 
 malaria or influenza. 
 
 These symptoms increase and are accompanied with 
 mental irritation, fatigue, general debility. Often med- 
 ical men prescribe alcohol in some form as a tonic, or 
 the patient uses proprietary drugs containing spirits. 
 This may go on a long time before the first cause, spirits, 
 is recognized. Opium may be given, and the patient will 
 apparently become addicted and the real cause never be 
 recognized. 
 
 Men and women living in centers of excitement and 
 subjected to great emotional strains, who complain of ex- 
 haustion and exhibit a variety of obscure symptoms that 
 seem unlike any known disease, should be regarded with 
 suspicion and an alcoholic origin of their difficulties 
 sought for.
 
 188 INEBRIETY. 
 
 Persons who use wine at meals and insist that they are 
 temperate should be suspected of spirit poisoning when 
 they complain of neurotic and obscure nutritive disturb- 
 ances. 
 
 An accurate diagnosis is often a matter of considerable 
 importance, and is determined by inference in a large 
 measure, particularly in college graduates and young 
 men about to enter business or professional life, who com- 
 plain of rheumatic pains, general obscure exhausted 
 states, with a feeble, irritable heart and symptoms that 
 are not clear or defined. 
 
 Anxious parents and friends, who are about to assist 
 them to become settled, call in the medical man, and the 
 diagnosis is exhaustion from overstudy and some very 
 vague causes. 
 
 The advice is travel and rest. If the travel is in 
 Europe, the symptoms increase, and the case becomes more 
 puzzling. Then it appears that spirits in some form 
 have been used and their condition is one of alcoholic 
 toxaemia. 
 
 Invalid college graduates who have used a great deal 
 of money during their college life and whose conduct 
 and habits have been bordering on the realm of extrav- 
 agance, are always to be regarded with suspicion, and 
 their symptoms of disease as possible indications of toxic 
 poisonings. 
 
 Many men in early life have drunk to excess and 
 then became abstainers and entered upon the active du- 
 ties of business or professional life, and after a long 
 period of temperate living suddenly become invalids. The 
 obscure symptoms and the absence of any special cause 
 should suggest the use of spirits and proprietary drugs 
 containing spirits as the active, exciting cause. 
 
 A noted man committed suicide and his friends believed 
 it to be the result of overwork and excessive study. In
 
 DIAGNOSIS OF INEBRIETY. 189 
 
 reality he was a spirit drinker in early college life, and 
 later this was concealed, but it continued with increasing 
 intensity until his final collapse. His family physician 
 had failed to discover the real causes. Many persons are 
 sent to private sanitoriums for complex forms of mental and 
 nervous diseases that are specifically due to spirit-taking. 
 
 This fact is discovered in their rapid improvement when 
 placed in surroundings where the opportunities for se- 
 curing spirits are difficult. Persons are often sent to 
 insane asylums suffering from mania, insomnia and de- 
 lirium that have never Been traced to any particular 
 causes. 
 
 The confinement and change of surroundings in the 
 hospital is followed by a rapid improvement. Sometimes 
 the real cause of spirits is determined, in others it is con- 
 cealed, and the hospital authorities consider recovery due 
 to the hygienic conditions and change, and not to the 
 removal of alcohol. 
 
 In criminal investigations, sudden impulses to commit 
 crime or do overt acts, foreign to all previous conduct, 
 have been traced to the secret use of spirits. Often 
 traveling men, speculators and active brain workers ex- 
 hibit startling symptoms of mental derangement, de- 
 veloping either criminal tendencies or displaying cred- 
 ulous stupidity, and the causes are unknown and untrace- 
 able. They are not known as drinking men, and often 
 claim to be total abstainers, yet after a time the use of 
 some form of alcohol appears to be the source of their 
 trouble. 
 
 The late Dr. Kcrr affirmed, as the result of a long 
 experience, that obscure and unusual neurotic and nutri- 
 tive troubles, marked by unusual conduct, should always 
 suggest an alcoholic origin; and if syphilis could be elim- 
 inated, the use of alcohol in some form would be found 
 as an active cause.
 
 190 INEBRIETY. 
 
 Many very prominent neurologists of this country have 
 asserted that quite a large proportion of neurotic and 
 psychopathic troubles were traceable to injuries from 
 spirits, and that no diagnosis was of any value that did 
 not consider the possibility of alcoholic poisoning as a 
 factor in the production of such diseases. 
 
 There is a prevalent theory among many classes that 
 alcohol in moderation or in small quantities can be taken 
 indefinitely without any harmful effects. This is not 
 sustained by scientific investigation, which shows that al- 
 cohol is cumulative in its degenerative influences, and in 
 some persons this cumulative action is very pronounced, 
 although not always traceable, except by very accurate 
 studies. 
 
 Instances like the following are common. Persons 
 pursuing a healthy, uniform, regular course of life, who 
 use beer or wine at meals, and on no other occasions, 
 suddenly become invalids, and there is no ostensible cause 
 for it. Not unfrcquently such persons apparently break 
 down and develop very unusual conduct and changes, ap- 
 parently resulting from business or social losses. Their 
 use of beer and spirits continues at the table, and no one 
 suggests the cumulative action of alcohol in producing 
 toxic poisonings. 
 
 Examples are common of men who suddenly contract 
 pneumonia that is fatal, or suffer from cerebral hemor- 
 rhage, or develop some acute organic trouble of the liver. 
 Their previous life has been comparatively healthy, only 
 wine and beer has been taken at the table in moderation. 
 
 The physician recognizes the unusual intensity of the 
 degenerations and the verv feeble resisting power of 
 nature and the remarkable weakness and protracted con- 
 valescence. The cumulative action of alcohol is mani- 
 fest in this. Very interesting cases are constantly coming 
 into prominence, bringing out this fact.
 
 DIAGNOSIS OF INEBRIETY. 191 
 
 Not unfrequently patients are found to be using pro- 
 prietary drugs, tincture of ginger, cinchona and other 
 medicines, both regular and irregular. The spirits con- 
 tained in them are the active causes, but do not attract 
 attention. The diagnosis at home by the family physi- 
 cian can often be made with great certainty where all the 
 habits and conditions of daily life can be studied. 
 
 The diagnosis of persons found stupid on the streets 
 with or without an alcoholic breath, often present most 
 obscure questions. Many instances of persons becoming 
 suddenly dizzy and faint on the street who have taken a 
 glass of spirits for relief and later fallen down uncon- 
 scious, have been diagnosed by policemen as intoxicated, 
 simply from an alcohol odor. 
 
 Such persons taken to the station-house have died, and 
 serious questions have arisen in which the officiousness of 
 the policeman in deciding on the nature of the case has 
 been condemned. 
 
 Heat or sun-stroke of persons on the street has pro- 
 duced conditions for which spirits were given as a stim- 
 ulant, and the same error of diagnosis has been made. 
 Dr. Mason has studied this question and presented in 
 some recent papers, many very startling examples of error 
 of diagnosis, resulting in death.* 
 
 The one fact should always be considered, viz. : that 
 the man found unconscious on the street may be suffering 
 from a hemorrhage, and a glass of spirits as a stimulant 
 to rouse him up is a most fatal remedy. The increased 
 heart's action widens the rupture and intensifies the hem- 
 orrhage, making it fatal. A physician called suddenly 
 to treat a case found unconscious should never permit 
 spirits to be used. 
 
 No diagnosis of the conditions can be accurate which is 
 based on the odor of spirits, or even on the dilated or 
 
 See paper in Virginia MerUcal Monthly, December 22, 1910, by Dr. 
 Mason on Diagnosis of Alcoholic Coma.
 
 INEBRIETY. 
 
 contracted pupils. Persons previously temperate, for 
 some sudden emergency, may be given spirits and the 
 effects may be so unusual and peculiar as to suggest in- 
 ebriety and alcoholism, which is an error. 
 
 Psychical changes of character and conduct that are 
 sudden, pronounced and prominent should suggest an 
 alcoholic origin, no matter what the previous character 
 of the patient may be. A remarkable case was of a 
 physician, for twenty years occupying a very responsible 
 position and having an unblemished reputation in his 
 community, who suddenly developed criminal practices 
 that sent him to prison under most distressing circum- 
 stances. 
 
 Then it finally became known that he had used spirits 
 in small quantities daily, and that their cumulative action 
 suddenly developed into palsy of the higher brain cen- 
 ters. This is a confirmation of the fact presented in 
 another chapter, namely, that the use of alcohol, either 
 in excess or moderation, seems to fall most heavily on the 
 ethical brain, destroying the consciousness of right and 
 wrong, and the conception of duty and obligation. 
 
 The diagnosis of inebriety in women is more difficult 
 because of the greater complexity of causes, and their 
 ability to conceal them. The use of spirits at the men- 
 strual period or at the menopause is more or less common, 
 and may become the starting-point of very complex neu- 
 roses and disorders that will baffle the skill of specialists. 
 
 Many very striking cases occur which are subjects of 
 great controversy and confusion of opinion. It may be 
 stated that the sudden appearance of unusual neurotic 
 symptoms should suggest a toxic poisoning. Slight 
 traumata, shocks and common social reverses and trou- 
 bles, followed by unusually severe nervous symptoms, 
 may have the same origin. Delirium from fever, of un- 
 usual proportion and intensity, has been traced in many 
 instances to the alcohol given as a remedy.
 
 DIAGNOSIS OF INEBRIETY. 193 
 
 The subsidence of the delirium on the removal of the 
 alcohol shows the connection between the two. A man 
 of wealth suffered from intense fatigue and depression 
 following a mild sun-stroke. His physician gave him a 
 preparation of brandy and milk. 
 
 The weakness of the heart seemed to call for increased 
 doses, and the delirium which followed was diagnosed as 
 meningitis. A number of physicians were called in con- 
 sultation, and very active measures were ordered, the 
 spirits being continued to sustain the heart. 
 
 The delirium grew more intense and also the exhaus- 
 tion. The patient was taken to his country home, and 
 by some accident the supply of spirits was cut off for 
 twenty-four hours. The improvement was so marked that 
 the nurse continued the withdrawal, and the recovery was 
 very prompt. No one had diagnosed the influence of 
 alcohol in the production of the delirium. 
 
 In old men the possibility of spirits in some form in- 
 creasing and complicating the conditions should always 
 come into the problem. The idiosyncrasies of persons, 
 either in great susceptibility to the toxic action of alcohol, 
 or in its local effect on particular organs, should always 
 be considered in the diagnosis. Elsewhere we hav2 re- 
 ferred to symptoms of intoxication which are largely 
 mental, and are not due to any form of alcohol but to 
 some defective condition produced by alcohol in the past. 
 
 The nervous system seems to reproduce the toxic con- 
 dition which was impressed upon it from alcohol by the 
 application of some unknown exciting causes. In making 
 a diagnosis of the presence of alcohol, this condition 
 should be considered as possible. 
 
 Where syphilis has existed greater complexities of 
 symptoms may obscure the real causes, but an active mer- 
 curial treatment will frequently clear up this obscurity. 
 In the ordinary diagnosis of inebriety a careful study of
 
 194* INEBRIETY". 
 
 the previous conduct and habits of the patient, and a 
 comparison of that and the present, will furnish unmis- 
 takable signs. 
 
 It is safe to assume that any use of spirits may pro- 
 duce results entirely unexpected, and out of all propor- 
 tion to the supposed causes. It also should be remem- 
 bered that alcohol is cumulative in its action, and that 
 some persons are peculiarly sensitive to its degenerative 
 action. 
 
 A study of heredity, occupation and surroundings will 
 often suggest possibilities of the use of alcohol which can 
 be asserted with as much certainty as practical knowledge. 
 The fact that alcohol deranges the senses and dimin- 
 ishes the reasoning power and lowers the capacity to 
 recognize duty and relation to others, is always to be 
 considered where these facts are prominent. In all the 
 varied neuroses and psychoses occurring after middle life 
 this factor should be recognized as possible, and one 
 that must be eliminated in an accurate diagnosis. 
 
 Delirium and delusional conditions often present prob- 
 lems that suggest alcohol as an exciting cause, thus the 
 delusion of infidelity on the part of the wife or husband 
 is so commonly noted in secret and open drinkers as to be 
 recognized as a diagnostic symptom. 
 
 Delirium of grandeur and strength and extraordinary 
 confidence in ability to accomplish the impossible is an- 
 other symptom with the same significance. As stated in 
 previous chapters, the sudden use of alcohol often covers 
 up the symptoms and draws attention to this alone, and 
 this may obscure the real conditions as in paresis, where 
 alcoholic and sexual excess are only symptoms. 
 
 Thus the problem of diagnosis widens and becomes 
 more complex, and often can be only approximately made 
 from a very careful study of all the symptoms.
 
 CHAPTER XIX. 
 PROGNOSIS OF INEBRIETY. 
 
 Synopsis. Differences of opinion about curability. Confusion 
 of opinions. Great variety of means used. The general principles 
 of treatment. Questions of prognosis. Compared to that of 
 other diseases, depends on heredity and predisposition. Exhaus- 
 tion and debility govern the prognosis. The prognosis bad when 
 spirits are used in infancy. Also bad in beer drinkers. The peri- 
 odic drinker most hopeful. The nerve storms point to some active 
 causes. Delusions of exaltation of doubtful prognosis. Prog- 
 nosis bad when other drugs follow the use of spirits. Persona 
 may relapse and drink again after years of abstinence. Con- 
 dition of the arteries important guide in the prognosis. Reasons 
 for this. Changes in the circulation of the brain create desire 
 for drink. Syphilis a complicating cause. About one-third of 
 all cases are curable. The prognosis in these cases is fair. It 
 depends largely on the conditions of the person and his sur- 
 roundings. 
 
 Curiously enough inebriates are very emphatic and 
 prominent in determining the prognosis of their individ- 
 ual cases, and physicians are often influenced by their 
 positive statements of ability to recover. 
 
 This side of the subject makes prominent the moral 
 side, and a voluminous literature has appeared, giving 
 reasons and explanations why the victim does not fulfill 
 his asserted predictions of ability to stop, and why he 
 does not recover from the use of spirits. The hopeful- 
 ness of the inebriate is characteristic, and becomes an 
 optimistic delusion that often increases with the degen- 
 eration of the person. The more pronounced his faith in 
 his ability to stop and confidence in his power of con- 
 trol, the weaker he is. 
 
 Often this delusional exaltation is an indication of 
 paretic changes that develop after a time. The con- 
 tinued failure to abstain, extending over years, makes no 
 impression on his judgment. The same assertions of his 
 ability to stop are made with the same confidence as before. 
 7 195
 
 196 INEBEEETY. 
 
 Notwithstanding these delusions, the general prognosis 
 of inebriety is very hopeful. Many persons, with or 
 without any special treatment, recover. It is asserted 
 that the disease marked by drink excesses is limited to a 
 period of not more than fifteen years. Thus, a person 
 who begins to drink to intoxication will die within fif- 
 teen years. 
 
 Of course, it is difficult to place any limit to the or- 
 ganic duration, because the causes are so complex and 
 varied. One fact is established from a great variety of 
 studies, viz. : that the craze for alcohol at times dies out 
 of itself from causes unknown. 
 
 Observation shows that a certain number of patients 
 who are confirmed inebriates, using spirits to excess, either 
 continuously or at long intervals, suddenly abstain and 
 remain temperate ever after. The explanation of this 
 sudden giving up of the use of spirits is usually ascribed 
 to the last means used. 
 
 This may have been a pledge, a prayer or conversion, 
 or a mere assertion of the will, not to drink any more. 
 These means were used many times before, and failed, but 
 now they succeed. Some religious men assert that the 
 former failures of inebriates to give up the addiction of 
 spirits was due to errors in their conversion ; that only 
 at the last moment, when the conversion was real and 
 true, did restoration follow. 
 
 Other persons sign the pledge under precisely the same 
 circumstances which they have done many times before 
 and keep it. The question is asked why this did not 
 happen before, and a great variety of explanations are 
 offered. 
 
 Thus, one man has signed the pledge ninety-nine times, 
 or professed conversion ninety-nine times, and failed on 
 every occasion. Then finally he stopped and the last
 
 PROGNOSIS OF INEBRIETY. 197 
 
 conversion and signing of the pledge was considered the 
 real cause of his success. 
 
 Many curious incidents and most unusual events, or the 
 use of drugs are given as reasons for the final cure and 
 restoration. Tansy tea and other bitter, nauseating 
 drugs, followed by a disgust for spirits, is supposed to 
 have caused it. The fact is overlooked that many of 
 these agents have been used before without any par- 
 ticular effect. 
 
 Patent medicines that are supposed to have some mar- 
 velous action refer back to such instances, and the fact 
 that they were followed by total abstinence is considered 
 evidence of their power. 
 
 The real fact is not often recognized, that in a large 
 number of cases there is a tendency of the drink craze 
 to die out or disappear with or without any special causes. 
 The craving for relief, for which alcohol is used, passes 
 away, and is followed by great disgust and aversion to 
 spirits. 
 
 The question whether this will return again is unknown, 
 but it is evident that medicinal means and restorative meas- 
 ures may so far build up the organism that the drink 
 impulse will never return. Observations of the temper- 
 ance reform movements and studies of the so-called cure 
 cases, show that the very means used preceding the final 
 cure were not new, but had been tried many times before. 
 
 Of the five million persons who signed the pledge of 
 total abstinence in the Washingtonian Movement from 
 1840 to 1845 a certain unknown number remained total 
 abstainers the remainder of their lives. In the same way 
 every great religious and temperance revival work is 
 marked by the restoration of an uncertain number of in- 
 ebriates, who never relapse again. 
 
 It is very evident that the same general causes do not
 
 198 INEBRIETY. 
 
 produce the same effects in all persons, and that restora- 
 tion and breaking up of the drink craze depends on some 
 unknown condition or change in the brain centers. Acting 
 on this general fact, it is clear that remedies addressed 
 to the physical and psychical, and to the development of 
 a more perfect organic functional activity will predispose 
 to this revolution or dying out of the drink craze and 
 favor it more positively than any other means. 
 
 The prognosis, therefore, is far more hopeful where 
 the best physical and medical appliances known are 
 used, and where every psychical and physical remedy can 
 be applied to build up and restore the disordered condi- 
 tions. Unexpected recoveries are constantly taking place 
 in conditions that are unfavorable, and certainly can not 
 be explained from any present knowledge. 
 
 Thus a person who has used spirits for over half a 
 lifetime and has become pronouncedly chronic, suddenly 
 stops and becomes an abstainer under the most adverse 
 conditions and from causes entirely unexplainable. 
 
 Another class of cases seems to date recovery from some 
 accident or injury or shock, or powerful mental emotion. 
 Cases are noted where a blow on the head, profound shocks 
 from disappointment, fright, or any powerful emotions 
 is followed by a disappearance of the drink craze for 
 ever after. 
 
 The following are illustrative instances. An army 
 officer who had drunk to excess for over thirty years was 
 reprimanded for some failure of duty. He stopped drink- 
 ing at once, and continued until death a sober, tenfperate 
 man. 
 
 A man with the history of a police court repeater, 
 who had been arrested several hundred times for drunken- 
 ness, suddenly begged for permission to sign the pledge, 
 and for many years afterwards remained thoroughly tem- 
 perate.
 
 PROGNOSIS OF INEBRIETY. 199 
 
 Another man, with a similar history, after being treated 
 for jaundice in the hospital became a total abstainer. A 
 quarrelsome inebriate, who was known to have a great 
 fear of drowning, while stupid was tied by a rope and 
 thrown into a river. The excitement and shock of rescu- 
 ing him was followed by perfect immunity from all use 
 of spirits for the rest of his life. 
 
 An incident worth recording, because the parties occu- 
 pied prominent places in society, was of a physician who, 
 while visiting a patient found her half-intoxicated hus- 
 band abusing her for the purpose of getting some money. 
 The physician gave the drunken man a severe pounding, 
 breaking his leg and making him unconscious. The man 
 recovered and never drank again. 
 
 These are only a few of examples that are more or 
 less common, showing the effects of violent emotion, im- 
 pressing the organism and producing some changes that 
 culminate in the disappearance of the drink craze and 
 aversion for alcohol ever after. 
 
 The inference must not be made that recovery always 
 follows from these traumata and shocks, but, on the con- 
 trary, similar injuries have been followed by a great 
 increase in the drink craze, and often such injuries have 
 been exciting causes. 
 
 Inebriety, associated with trauma, is a mysterious field 
 of cause and effect, with a very uncertain prognosis. In 
 a general way, where the causes of the drink craze are 
 distinct and readily explained, the prognosis is fair, be- 
 cause the remedies can be addressed more or less directly 
 to the removal of the causes. 
 
 The prognosis in inherited cases is uncertain, unless 
 the surroundings and conditions can be controlled, and 
 where mal-nutrition and mental contagion are present, the 
 application of remedies give great promise of relief. 
 Where the drink craze develops a distinct psychosis, with
 
 200 INEBRIETY. 
 
 well marked symptoms of insanity, great uncertainty 
 exists. 
 
 The most hopeful cases are those where inebriety ap- 
 pears to be the direct result of overwork, mental strain, 
 nerve exhaustion and neglect of the surroundings. Quacks 
 assert dogmatically that all persons are curable if they 
 use the proper remedies, which they, only, possess. 
 
 The moralists are equally certain that they possess 
 absolute curative measures to overcome the drink impulse. 
 The general practitioner notes that many chronic cases 
 recover both by quack methods, the appeal of moralists 
 and without any special means or remedies. He also 
 observes examples of cases whose cures are attributed to 
 a great variety of the most diverse means and measures. 
 
 It is very evident from this conflicting clinical experi- 
 ence that most profound ignorance exists of the real 
 causes, as well as the nature and progress of the disease. 
 The specialist, who makes a more exact study, finds more 
 examples of curability from the removal of the exciting 
 causes, and is able to make a prognosis based on certain 
 conditions that are more or less exact. 
 
 There are a certain number of persons in which spirits 
 are the pronounced exciting causes more so than any 
 other factors. When these are removed the future is 
 good. In other cases, where the constitutional defects and 
 inherited weaknesses are manifest in the symptom of 
 alcohol used for relief, the prognosis will be less favor- 
 able. 
 
 If the early life of the patient has been one of good 
 physical and mental training, there is a basis for de- 
 velopment and future restoration that is very favorable. 
 Where precosity and over-development have marked the 
 first part of life, the probability that the drink craze is 
 only a symptom of the profound changes and exhaustion, 
 makes the prognosis doubtful. Where wine and spirits
 
 PROGNOSIS OF INEBRIETY. 201 
 
 are used in early childhood, either as a beverage or medi- 
 cine, there would naturally be a very low resisting power, 
 and predisposition to seek relief from this source in later 
 life. 
 
 The early use of beer also makes the prognosis uncer- 
 tain. In periodic drinkers where after distinct free in- 
 tervals the drink impulse breaks out like a nerve storm 
 and is limited to a certain fixed period, the prognosis is 
 better, because it is always possible to discover the active 
 and predisposing causes and neutralize or prevent them. 
 
 Temperance reformers who are periodic drinkers, show- 
 ing extraordinary activity and interest to help others, 
 belong to this same convulsive class, and should be helped 
 with the application of exact means. The constant, 
 steady drinker has less favorable prognosis than the 
 periodic. 
 
 The man with hyperconfidence in his ability to stop 
 is always prominent, and, on general principles, should 
 be a very hopeful case if this delusion is not of a paretic 
 character. The patient who uses narcotics, smokes tobacco, 
 drinks tea and coffee and eats inordinately has not a 
 good prognosis. 
 
 The prospects of taking up spirits again are evident. 
 The toxasmic conditions from which he is suffering predis- 
 poses to this. 
 
 Among the great variety of conditions controlling the 
 prognosis, are unhealthy living, bad habits, bad sur- 
 roundings and general unhygienic lives. Unless these 
 are corrected, there is little hope for future change. 
 
 Physiologically, the patient with high arterial tension 
 and derangement of the nutrition has a doubtful future, 
 unless alcohol is withdrawn immediately. Specific poison- 
 ing is another complication making the neurosis more or 
 less uncertain. Slight cerebral hemorrhages are some- 
 times followed by a complete cessation of the drink craze,
 
 202 INEBRIETY. 
 
 and local palsies, showing organic changes, increase the 
 future uncertainty of the case. 
 
 The sudden disappearance of the drink craze if fol- 
 lowed by a radical change and removal of the general and 
 local exciting causes is very hopeful, but unless there is a 
 decided change in the habits of life, surroundings and 
 conditions of living there is less hope of the permanent 
 disappearance of the drink craze. Long continued con- 
 finement, as in a hospital or jail, unless associated with 
 pronounced physical restoration and mental growth is not 
 hopeful. 
 
 Many persons believe that the inebriate is hopeless and 
 his final cure is doubtful, but this is contradicted by 
 experience. The drink craze or drink symptom is almost 
 certain to disappear from the application of exact means 
 and measures. While the organic degenerations, of which 
 this is a symptom, may remain, this particular phase 
 passes away. 
 
 The prognosis may, therefore, be considered as promis- 
 ing as that of many other diseases, and it may be said 
 that there is a tendency to recover, particularly upon the 
 removal of the exciting causes. 
 
 This gives the greatest encouragement for increased 
 scientific care and study. The fact should not be over- 
 looked that a large proportion of all inebriates reach 
 chronic stages before they come under treatment. Hence 
 the difficulties are increased. When the disease is recog- 
 nized to the extent that the patient will seek medical care 
 from the family physician in the early stages, recovery 
 will be the rule, and not the exception, and the prognosis 
 should be very hopeful and promising.
 
 CHAPTER XX. 
 DELIRIUM TREMENS. 
 
 Synopsis. A distressing condition. Not well known, or care- 
 fully studied. A new type or form noted. Several distinct stages. 
 All leading up to profound delusions. Many of the cases aborted. 
 The withdrawal of spirits not followed by increase in the deli- 
 rium. A large mental element to be considered. Spirits to be 
 withdrawn according to this condition. A study of the physical 
 conditions explains many of the delusions. Often the delusions 
 are concealed. One a delusion of violent language in which the 
 patient does not utter audible sounds. Disorientation a common 
 symptom. Delusions having reference to events of the past equally 
 common. These are preceded by nutrient disturbances and tox- 
 aemic states. Often the delusions are contagious and imitative. 
 The symptomology very complex and diversified. Elimination is 
 the most essential in the treatment. Baths of all sorts called 
 for. Narcotics dangerous. Mortality is high when patients are 
 treated with narcotics. Restraint and liberty alternately valuable. 
 Quietness and rest. Nutrition should be limited, except in special 
 cases. No danger of collapse from want of food. Excitement to 
 be prevented. Instances of psychical treatment, by fear and shock. 
 Opium contra-indicated. Wide variations in the mortality. Il- 
 lustrative instances. Life insurance statistics. Diseases that fol- 
 low. After effects on the brain. The central facts to be ob- 
 served in the treatment. 
 
 Delirium tremens is one of the prominent and distress- 
 ing conditions which follow from the excessive use of 
 spirits. The text-books contain various descriptions of 
 what is called alcoholic delirium, mania a potu, and other 
 terms, signifying distinct forms of insanity, which are 
 due to the excessive use of spirits. 
 
 The old term delirium tremens was marked by exces- 
 sive muscular agitation and delirium, which after a few 
 days subsided with or without any special treatment. The 
 modern type of this form of degeneration from spirits 
 is marked by greater mental symptoms and less disturb- 
 ance of the motor activities. 
 
 In certain cases of inebriety there can often be traced 
 many distinct stages which precede the outbreak of the 
 delirium. First is a period of undue excitement and 
 
 203
 
 204 INEBRIETY. 
 
 anxiety concerning his own conduct and his relations to 
 his friends and surroundings. 
 
 Hysteric fears, alternating with unusual buoyancy 
 and confidence in his ability to understand and regulate 
 his conduct and control events about him. This may 
 last or three days. 
 
 A second stage begins with gastric disturbances, in- 
 somnia and periods of mental exaltation or depression. 
 The desire for spirits disappears for a time and then 
 returns with greater intensity than before. 
 
 Defects of sight and hearing appear with muscular 
 agitation and inability to remain quiet, and a continuous 
 use of spirits for the purpose of overcoming this con- 
 dition. This is generally a short stage. 
 
 Then a third period begins in which insomnia is in- 
 tensified and general muscular excitement with sense de- 
 ceptions fixed, and hallucinations concerning himself and 
 surroundings. 
 
 In this period there is a half -conscious recognition of 
 his condition and a struggle to overcome it. Finally a 
 fourth stage or period comes on, marked by great fear 
 and suspicion, with delusional reasoning, sometimes marked 
 muscular trembling; in others, very little muscular agi- 
 tation, except in attempting to overcome some particular 
 evil that is threatening. 
 
 Spirits are taken as a medicine and there seems to be 
 no craving for them, but only for their possible sedative 
 effects. Delusions of sight and hearing with insomnia 
 are common symptoms, and point at once to the inability 
 to co-ordinate the sense impressions. 
 
 Frequently they are confined to the night, and pass 
 away in the daytime. The withdrawal of spirits and a 
 sharp elimination is often followed by the disappearance 
 of the delusions, but where spirits are used for fear of
 
 DELIRIUM TREMENS. 205 
 
 them, they may be controlled temporarily, but always re- 
 turn with great intensity. 
 
 Muscular trembling in these cases is due to fear in 
 many instances and not to central irritation. At times 
 only delirium is present. At others, it is confined en- 
 tirely to sense delusions. When both delirium and delu- 
 sions are present, a careful study of the physical condi- 
 tion of the patient should be made. Thus gastritis, 
 neuritis and any particular local inflammation will be very 
 influential in the mental conditions. 
 
 A history of malaria or trauma from injury, shocks 
 or the sequela of fever or neglect of the ordinary hygienic 
 conditions, all have a very important significance in the 
 treatment. 
 
 When muscular trembling is pronounced from the be- 
 ginning, local irritations of the cords are present. Per- 
 sons who, after excessive use of spirits, develop sense de- 
 ceptions and hallucinations are often suffering from 
 toxarmic poisonings. Persons who have used spirits con- 
 tinuously for a long time, then develop deliriums and 
 delusions, are not only poisoned but suffering from some 
 organic change and irritation. Persons who drink peri- 
 odically and at the close of a drink paroxysm become 
 delusional, are no doubt suffering from both cell and 
 nerve poisoning. 
 
 Very curious studies have been made of the exact form 
 of delusions, tracing them to distinct local organic de- 
 rangements. Thus, delusions of small animals such as 
 frocjs, snakes and insects crawling over the face and 
 body, are often due to congestion of the retina, and dis- 
 ordered conditions of the pcriphcrial nerves. 
 
 When largo animals assume a threatening attitude, 
 and when persons with weapons try to do him injury, 
 there is no doubt both local irritation and congestion of
 
 206 INEBRIETY. 
 
 the nerve centers, and an almost infinite variety of de- 
 lirium and delusions appear in different persons, some of 
 them grotesque and humorous, others dangerous and ap- 
 palling. 
 
 All hallucinations in which the person hears insulting 
 words and holds conversations with imaginary persons 
 are dangerous, because concealed, and likely any moment 
 to materialize into violent acts. Delusions of persecution 
 and fear of injury or sudden assaults are also dangerous. 
 
 The profound pallor and profuse perspiration point to 
 concealed alarm and fear, and a state of tension that may 
 any moment concentrate into violent acts. It is prac- 
 tically impossible to tabulate, in any uniform groups, 
 these various delusional states and mental obsessions, but 
 their physical nature and causation should always be 
 studied and recognized in the treatment. 
 
 One of these curious conditions is the delusion that 
 the patient is uttering the most violent language, and 
 from word deafness and other causes he utters no audible 
 sounds. Such patients look about in astonishment that 
 the violent thoughts passing through their mind, sup- 
 posed to be spoken, do not seem to attract any attention. 
 
 In one instance, a man in a delirious state apologized 
 continuously for the wild, abusive talk, and expressed 
 great sorrow, saying that he could not help it and was 
 obliged to do this. Pie asserted positively that he was 
 using the most profane language and condemning all the 
 Saints and the Virgin, and cursing everything that was 
 good and true. While lying in bed or sitting quietly 
 in a chair he was profoundly impressed that he was ex- 
 pressing in audible tones these terrible thoughts. 
 
 In another instance, a lawyer in the delirious stage 
 posed and jesticulated with great energy many times 
 during the day. His lips moved, but there was no audible
 
 DELIRIUM TBEMENS. 207 
 
 sound. Then he would sit down exhausted. Then a 
 period of remorse and regret would come over him, and 
 apologies for his violent words. 
 
 In another case the patient was astonished that his 
 violent language made no impression on others, and when 
 told that his thoughts were not vocalized, was skeptical. 
 
 Disorientation is a very common symptom, particularly 
 at night. The surroundings are all confused and 
 changed, and the patient is unable to recognize anything 
 but his delusional conceptions. On the advent of day this 
 condition disappears. 
 
 In a certain number of cases the delusions have some 
 reference to some event of the past and its distressing in- 
 fluence at the present. Delusions of burglars and persons 
 who seek to injure them are very common, also of the 
 infidelity of others and their efforts to take advantage 
 of him. This, in many instances, is a very significant 
 symptom. 
 
 Changed personality is not uncommon. The persons, 
 acting as if they were in other surroundings and situa- 
 tions and reasoning with some sanity, often committing 
 acts that are rational in their new positions. Thus per- 
 sons believe themselves in danger of fire or drowning in a 
 building or boat, and will show discretion and judgment 
 in their conduct to prevent this. 
 
 In many instances a man using spirits to excess will 
 suddenly decide to stop, and give the most frivolous rea- 
 sons for this radical change. For a short time he will be 
 serene and hopeful, and express himself in the most ra- 
 tional way. Then all at once develop delusions and 
 hallucinations. 
 
 Sometimes these are preceded by acute indigestion and 
 insomnia. The delusions at first will be transient. Then 
 they become fixed. The common opinion is that this con-
 
 208 INEBRIETY. 
 
 dition is due to the sudden withdrawal of spirits, but 
 the return again to spirits makes little or no impression. 
 The delusive condition goes on just the same, only a little 
 more intense. 
 
 It is altogether probable that some pathological im- 
 pression suddenly materializes into repugnance for spirits 
 and desire to abstain ; later the toxsemic state centered in 
 delusions and delirium, which was but a continuation of 
 his former condition. 
 
 Practically such persons should receive very active treat- 
 ment for a time until the possibility of an explosion in 
 the form of a delirium has passed away. Persons who 
 come for consultation and give a history of sense decep- 
 tions and mild delusions, when told that these are symp- 
 toms of delirium tremcns are not unfrequently precipi- 
 tated into the very conditions they seek to avoid. 
 
 Thus, an inebriate who consulted a physician was told 
 that his symptoms meant an attack of delirium tremens. 
 His mind at once recurred to all that he had ever seen 
 or heard concerning this condition, particularly in the 
 symptoms and the conduct. Delirium tremens developed, 
 following exact lines and symptoms which he had observed 
 in others. 
 
 An instance in one family where a father, son-in-law, 
 and two intimate friends suffered from delirium tremens 
 at different times, the symptoms were identical, par- 
 ticularly in hallucinations of monkeys coming through the 
 windows, climbing over the beds and threatening them 
 at all times of the night. They had never seen or heard 
 of any other form of delirium associated with the vise 
 of spirits. Hence this symptom was classical to them. 
 
 In another instance, where a patient suffered from 
 hallucinations of elephants walking on tight ropes, cross- 
 ing back and forth over the bed, and threatening to fall
 
 DELIRIUM TBEMENS. 209 
 
 on him at any moment, these were reproduced in several 
 of his friends who had similar attacks. 
 
 In a certain hospital the particular delusions are those 
 of rats crawling over the beds and biting the extremities 
 of the body. In another hospital all the patients had 
 delusions of persons trying to shoot them through the 
 windows. 
 
 In the ward of another hospital, where a trolley car 
 passed close to the windows, the noise was interpreted as 
 gun shots, thunder bolts, and all the alcoholics made 
 tremendous efforts to secrete themselves. 
 
 Since the advent of the telephone, new forms of delu- 
 sions are coming into prominence. An active business 
 man who drank steadily was seen to have his telephone 
 covered up in the most careful manner. His explanation 
 of threatening voices indicated clearly the beginning of a 
 very serious delusion. 
 
 Thus, the symptomology of delirium tremens prac- 
 tically covers almost every form of mania, delirium and 
 obsession. The first effort of the medical man should be 
 to determine the physical causes and how far they are 
 influential in the promotion of these mental states. A 
 toxaemia from alcohol is to be recognized as the most 
 active exciting cause, and its removal is the most im- 
 portant step in the treatment. 
 
 If the patient has delusions of fear that its sudden re- 
 moval will precipitate a more dangerous condition, this 
 must be recognized, and the spirits withdrawn gradually. 
 
 Elimination through the skin by means of baths, and 
 by the bowels with salines, is the most prominent pre- 
 ventive means. A warm bath, or reclining in warm water 
 in a tub for two or three hours every day is invaluable. 
 
 The shocks of cold water on the surface, as in a 
 cold pack, follov.'ed by vigorous rubbing and general re-
 
 210 INEBEIETY; 
 
 -w 
 
 laxation, is a very excellent measure. Where baths and 
 showers can not be used with advantage, sponge baths 
 and frequent bathing of the body will accomplish the 
 same purpose. 
 
 The persistent insomnia is always self -limited, and the 
 attempt to control it by narcotics is full of danger. A 
 forced sleep by chemical measures still further deranges 
 the metabolism and lowers the vitality. The high mor- 
 tality following the use of narcotic drugs is the best 
 evidence of the danger of this method. In institutions 
 where hydropathic measures can be used, together with 
 electric light and the static breeze, this symptom is easily 
 controlled. In private homes tub baths, hot and cold 
 packs, warm showers and reclining, under the care of a 
 special nurse will accomplish the same purpose. 
 
 The diet should be restricted according to the patient. 
 Meat should be practically contra-indicated and used only 
 in small quantities and at long intervals. Nourishing 
 soups and foods easily assimilable are most valuable. Milk 
 and salines are to be given according to the conditions 
 present, and to meet the particular wants of the case. 
 
 Very little food should be given the first two days, 
 because of the toxsmic conditions of the body and the 
 impaired digestion. After that solid foods may be 
 gradually given at short intervals through the day, 
 supplemented by fruits and acids, according to the con- 
 ditions present. 
 
 Localized pains over the liver and abdominal organs 
 can best be treated by local applications of hot or cold 
 water. 
 
 The special treatment of delirium and delirious states 
 will vary largely according to the man and the direction 
 of the symptoms. If the delirium is destructive, during 
 which the patient tears and breaks everything around him,
 
 DELIRIUM TREMENS. 
 
 it is best to have him placed under a sheet and strapped 
 down on a cot in the middle of a floor, particularly at 
 night. 
 
 In the daytime this can be removed, and the patient 
 allowed to walk about with an attendant, and if in the 
 country, it is well to go in the open air. Where the 
 patient is a strong, muscular man, it is found practical 
 to allow him to exercise in the open air for an hour at a 
 time, until signs of exhaustion appear, or if the sur- 
 roundings excite him, this exercise should be in a room. 
 
 Warm showers, sponging or lying in a warm water 
 bath should follow this. If the delusions and delirium 
 are of a harmless character, having reference to grotesque 
 objects, or voices and conversations with friends, it is 
 well to allow the patient to have a good deal of liberty. 
 
 At night he should be put under a restraint sheet. An 
 improvised restraint can be made with sheets, passing 
 over the shoulders and arms, forcing him to recline. The 
 light should be turned down and the utmost quietness 
 prevail. Sometimes the person is more quiet where the 
 room is well lighted. 
 
 He should have no visitors and see only his nurse and 
 physician. The irregular heart's action should not excite 
 any apprehension, and no remedy should be given for 
 tliis purpose. The chief medication should be elimination 
 through the bowels, kidneys and skin. 
 
 The patient should be encouraged to drink water. If 
 he is fond of mineral waters, so much the better. Meat 
 juices and milk are in most cases disturbing. Digestion 
 should be allowed to rest, and no fears of exhaustion in a 
 person well nourished should be considered. No attempts 
 should be made to force sleep by narcotics. 
 
 The delirium and delusions are self-limited, and in 
 most cases disappear suddenly. After two or three days
 
 INEBRIETY. 
 
 of insomnia and restless activity the patient suddenly 
 sleeps, and recovery follows at once. After free move- 
 ment of the bowels, or after a prolonged hot water bath 
 the same results follow. 
 
 Placing patients in a padded room, unless such rooms 
 are well-ventilated, are open to many objections. If the 
 patient can afford to have the services of two or more 
 nurses, the duration of the disease may be greatly short- 
 ened. 
 
 In some of the charity hospitals well-ventilated strong 
 rooms are used, in which the patient, after a bath, is 
 placed. If his delusions are of a quiet form he is al- 
 lowed to remain on a cot in a ward, but when he be- 
 comes boisterous he is taken to the strong room. 
 
 It is noted that many patients after being placed in 
 the strong room exhibit a degree of restraint to keep from 
 being returned, showing a consciousness of their ab- 
 normal acts. 
 
 The fear of collapse and an effort to overcome this by 
 excessive nutrition and drug stimulation is not only 
 dangerous, but literally increases the mortality. 
 
 The general principle in the treatment should be to 
 remove the toxsemic conditions and the local irritations, 
 and restore the mechanical obstruction of the circulation. 
 In many cases there is effusion in the brain and tissues. 
 Metabolism is deranged, digestion is impaired, and actual 
 states of starvation and toxic irritation are present. It 
 will be evident that elimination and rest comprise the 
 best medical measures for restoration. During the de- 
 lirious period pneumonia and hemorrhage arc the most 
 common dangers. 
 
 The excitement of the patient may produce rupture 
 of the arteries which may be fatal, particularly if the 
 patient is given heart stimulants at this time. When this 
 occurs the patient should be forcibly restrained in a re-
 
 DELIRIUM TBEMENS. 213 
 
 clining position, and cold water applications to the base 
 of the brain be made. 
 
 Pneumonia, the result of paresis of the pneumogastric 
 nerve can not be anticipated, but can undoubtedly be pre- 
 cipitated by reckless and excessive diet. When it occurs, 
 hot applications over the surface by spraying with a luco- 
 descant light constitutes the very best treatment, in addi- 
 tion to the usual salines and eliminative measures. 
 
 After the delirium has subsided, the treatment should 
 be tonics with strychnine, iron, phosphorous and such 
 other remedies that have proven to be of value, each case 
 being very largely a law to itself. 
 
 The prognosis of delirium tremens is always good, 
 and institutional treatment, where it is practical, is the 
 best. In private homes, trained nurses are necessary, and 
 should be strangers to the patient. Members of the 
 family are not good nurses. 
 
 The very complex character of this poisoned state in- 
 dicates the very wide use of physical and psychical meas- 
 ures and is illustrated in the following instances: A 
 strong, vigorous man was attacked with wild delirium on 
 his yacht, and all efforts to restrain him were very diffi- 
 cult. A friend of his attached a rope to his body, and 
 by diverting his attention threw him overboard. The 
 shock of the cold water broke up the delusions, and the 
 fear of death dominated every other thought. He was 
 pulled in, vigorously rubbed and fell into a sound sleep. 
 A few hours later the delirium returned, and the same 
 remedy was applied. He recovered. 
 
 In another instance a fire broke out in the room of a 
 patient and the excitement of removing him broke up his 
 delusion, and he too recovered. 
 
 As a rule, fear has very little influence in such cases, 
 and unless it is associated with pronounced eliminative 
 measures, it is worse than useless.
 
 INEBEIETY. 
 
 Opium is contra-indicated. The wide variation in the 
 mortality, ranging from two to fifty per cent., indicates 
 the necessity for new and more exact studies and the 
 application of safe means and remedies. 
 
 A fact of considerable interest is, that, in many sections 
 of the country, delirium tremens is not regarded as a 
 grave affection. 
 
 A certain life insurance company found a large mor- 
 tality among the insured in a certain section. A special 
 agent found that these fatal cases had repeated attacks 
 of delirium tremens, and the local authorities and exam- 
 iners had regarded this affection as a temporary derange- 
 ment, and not at all impairing the longevity risk. 
 
 A very important question has been raised, whether an 
 attack of delirium tremens left a permanent impairment 
 on the brain and nervous system, and whether the person 
 should be considered strong and well after. This is an- 
 swered variously, according to the estimate of the physi- 
 cian. 
 
 It may be stated as a general fact that after such an 
 attack there is always feebleness, mental instability and 
 susceptibility to toxic states with lowered vitality. The 
 fact of having had delirium tremens is an important 
 factor in the history of the patient in disputed cases of 
 mental soundness. 
 
 A number of very interesting cases have been reported 
 of persons who, after an attack of delirium, entered upon 
 a career of crime, and showed a great moral weakness and 
 disregard of their ethical relations to the community. 
 Using alcohol again after such an attack is followed 
 by a more pronounced mental disturbance and graver 
 symptoms of disability. 
 
 Many instances are noted of tuberculosis following an 
 attack of delirium tremens. Pneumonia, without any spe- 
 cial exciting cause, is also frequently noted. Bright's
 
 DELIRIUM TREMENS. 215 
 
 Disease is another common sequela. In the two latter the 
 acute symptoms seem to be very rapid, terminating 
 fatally. 
 
 In tuberculosis a slower progress is common. Recovery 
 from the effects of delirium may be followed by extreme 
 susceptibility to the use of spirits, and an intense craze 
 for their use when debilitated and exhausted. 
 
 Often associated with this is a mental repulsion, which 
 is emotional in its manifestations, but is easily overcome 
 by fatigue and weariness. The fact that the man has 
 had one attack of delirium tremens is always to be re- 
 garded in the consideration of other diseases, and other 
 mental conditions. 
 
 He is far more likely to have a second attack from the 
 use of a smaller quantity of spirits than before, and the 
 second attack will be more intense in both the depression 
 of his vital forces and the irritation of his brain and 
 nervous system. 
 
 There is an instability of brain co-ordination that did 
 not exist before, and a distinct tendency to take on 
 delirious and delusional states from the slightest exciting 
 causes. Delusions of persecution and injury by others 
 never disappear entirely in some cases. 
 
 The later life of such persons is marred by want of 
 confidence and undue suspicion, no matter how temperate 
 they may live. There is lowered mentality and defective 
 sense impressions, with faulty reasoning of the motives 
 and purposes of others. 
 
 Many of these cases are undoubtedly seriously in- 
 jured by drug-taking, particularly narcotics, and forced 
 nutrition. Efforts to control the delirium and produce 
 chemical sleep are dangerous. The great central fact 
 to be made prominent is that these cases are self -limited, 
 and the best efforts of medical science are to eliminate the 
 toxzemic conditions and prevent the patient from injur-
 
 216 INEBRIETY. 
 
 ing himself, and keep him in the very best conditions and 
 surroundings. 
 
 Beyond this there must be treatment of local condi- 
 tions, dependent on the states present of the mind and 
 body, and the available surroundings.
 
 CHAPTER XXI. 
 
 FIRST CLINICAL EXAMINATION AND STUDY OF THE 
 PATIENT. 
 
 Synopsis. Condition of the patient on admission. What to ob- 
 serve. Distinct classes of symptoms. The paralysis and its sig- 
 nificance. Its disappearance after a short time. Physical symptoms 
 which remain. Mental symptoms of delirium and mania also of 
 delusions. Character of the delusions. Symptoms of the voice 
 and the use of language. First effects of the use of alcohol. The 
 conditions when first used. Diseases which have preceded it. 
 Heredity and its effects. Patients who have no fixed convictions. 
 Patients filled with delusions. Patients who are dependent and 
 who are called contagious cases. Patients without any psychic 
 conception of life. Patients who are introspective. Patients who 
 have concealed delusions and motives. Statements of patients 
 Paroxysmal drinkers. Steady users of spirits. Irregular and 
 accidental drinkers. Significance of the various early symptoms. 
 
 As a rule, patients coming under observation are either 
 intoxicated or in the period of remorse after the acute 
 symptoms have subsided. If in the state of intoxication, 
 either of stupor or delirium, a careful study of the 
 symptoms should be made. The degree of stupor, and 
 how far it is associated with muscular paralysis, par- 
 ticularly in walking. Observe whether the body sways 
 from side to side, or is projected forward, in irregular 
 angles. Observe the position of the head, the laxity or 
 rigidity of the muscles of the neck, arms and legs, and 
 also the fingers, and the spasmodic conditions. 
 
 Note the pallor or congestion of the face, the dryness 
 or perspiration, the warmth or chilliness of the hands 
 and feet, the eyes and the position of the mouth, and the 
 manner of expression ; also the tongue, and the ability to 
 protrude it. Inquire about the condition of the kidneys 
 and bowels, if the latter are relaxed or costive, the inco- 
 ordination and the changes of the heart's action on 
 lying down or sitting up. 
 
 217
 
 218 INEBRIETY. 
 
 The sound of the voice, when of stridulent character 
 or higher in tone, indicates defective hearing, and irri- 
 tation of the mucus membrane. A physical examination 
 at this time frequently reveals many very significant 
 symptoms, particularly enlargement of the liver, heart 
 and perhaps dilation of the stomach. 
 
 The urine may be loaded with albumen and phosphates, 
 as well as casts. The reflexes may be exaggerated or 
 diminished ; sensitive areas may be noticed in the spine. 
 Congestion of the retina may be present, and very high- 
 tensioned arteries. These symptoms disappear after a 
 time and are not to be regarded as of value except for 
 the purpose of comparison. 
 
 After three or four weeks' treatment nothing remains 
 but an enlarged liver, high-tensioned arteries and perhaps 
 an irritable heart. If the patient is delirious, the form 
 and direction of the delirium should attract attention. 
 The character of the delusions, whether concerning himself 
 or others, particularly his conception of his present con- 
 dition, and how much of it is due to the spirits taken, and 
 how much in his opinion is the result of mistakes of his 
 associates and surroundings, also his use of language in 
 describing this condition. His power of discrimination 
 in the use of words, and the use of violent expletives and 
 oaths ; also whether words flow in a continuous stream, 
 without much reference to the thought they express. Is 
 he voluble and garrulous in his statements, or reserved and 
 emphatic in the use of expletives? 
 
 Is the mania one of egotism, in which his conception 
 of power is exaggerated, and has he confidence in his 
 ability to do as much as other persons, or more ; or, is 
 his mania, while egotistical, fixed on delusions of per- 
 secution and revenge, for real or imaginary acts of others? 
 
 Is it concentrated on his stomach and dietetic wants, 
 or on his ability to discern the motives and purposes of 
 others ?
 
 FIEST CLINICAL EXAMINATION AND STUDY. 219 
 
 Three conditions must be considered. One, the stupor- 
 ous, paralyzed inebriate, who is entering upon the stages 
 of dementia; another, the wild, delirious egotism which 
 is a symptom of general paralysis, and the third, a 
 maniacal conception of his ability to overcome opposition, 
 which indicates mania. 
 
 These three conditions are significant. Where the use 
 of spirits is paroxysmal, with distinct free intervals, 
 neurotic and psychopathic symptoms are to be expected, 
 particularly in the free intervals, and their unexpected 
 manifestation in some strange symptom before the spirits 
 were taken. 
 
 If a long period of the so-called moderate use of spirits 
 has preceded the present condition, degrees of mental and 
 physical degeneration, evident in reasoning, conduct, acts 
 and irregularities of health, are to be expected. If the 
 use of spirits has followed injury, disease or some special 
 shock, either mental or physical, organic changes are to 
 be expected, and both local and constitutional defects will 
 be found. 
 
 A careful study of the effects of alcohol, with the first 
 glass or first intoxication, will point out a susceptibility, 
 immunity or some idiosyncrasy that will be very sig- 
 nificant in future studies. If the history shows that 
 alcohol exalted the sensory activities, and the depression 
 only followed as a second stage, this fact is to be noted. 
 
 If the first use of alcohol produced narcotism, general 
 stupor and profound derangement afterwards, this is 
 equally significant. Heredity is a very powerful factor, 
 and where it is possible, should be studied with care. 
 The children of alcoholic parents have always lowered 
 vitality and feeble resisting power, and are very liable to 
 profound and continuous exhaustion and hypersensitive- 
 ness to the effects of spirits.
 
 220 INEBRIETY. 
 
 In many instances spirits are repcllant and painful at 
 the start, but this may be overcome. Often the heredity 
 from grandparents develops in an unexpected use of 
 spirits and a fascination for its effects, with or without 
 any tangible causes. Where they are neurotics, and 
 psychasthenics, a study of the early life of the children 
 will indicate A r ery clearly much of the future. 
 
 The physical defects in growth of the body and the 
 history of prccosity or stupidity in early life, also the 
 hygienic training, dietetic and mental care are to be 
 studied. Often diseases of childhood, and their severity 
 and entailments, give unmistakable indications of the in- 
 ebriety in later life. 
 
 When the patient is in a remorseful stage, a careful 
 study of his own conceptions about his present and 
 future give very prominent signs of the injuries from 
 alcohol, and its neurotic basis. Oftentimes the ex- 
 aggerated conceptions of his present condition and his 
 reasoning of their causes point out changes in the 
 organism. 
 
 In this stage his credulity and anxiety to secure help 
 and to recover, his reluctance and skepticism of the 
 various means, and his hesitation about following advice, 
 are all most significant symptoms. When the egotism 
 of the patient, after recovery from acute symptoms, in- 
 sists on freedom from all restraint and the gratification 
 of every appetite, the condition is dangerous, and sug- 
 gests paresis. 
 
 When patients have no fixed convictions, and minimize 
 their present conditions, and enjoy the fact of having 
 used spirits, and talk of the possibility of moderate 
 drinking, the paralysis is profound. The delusion of 
 infidelity of relatives and friends and of the dishonesty 
 and intrigue of others, signify the same condition. Con- 
 cealed delusions are to be looked for in a study of the
 
 FIRST CLINICAL EXAMINATION AND STUDY. 
 
 disappointments, and diseases and strains which have fol- 
 lowed, also states of exhaustion and derangement, which 
 have accompanied and probably preceded the excessive 
 use of spirits, are also to be studied. 
 
 After the acute symptoms have passed away the psychic 
 conditions, both present and past, should be studied. In 
 many cases the patient is born without ability to act 
 alone, and without distinct personality to regulate his 
 life and conduct; he is dependent on the surroundings, 
 society and friends, and follows the personality of others. 
 
 Many patients, through overcare of their parents, have 
 never developed an initiative dependence on themselves in 
 the common every-day matters. They have been depend- 
 ent on others, and have grown up trusting to external 
 conditions, circumstances and surroundings. These are 
 very significant questions in the study of the case. A 
 study of diet, sleep, and exercise will point out many con- 
 ditions which explain the present state. 
 
 While the patient's conception of his own condition 
 should always be sought, it should never be followed, 
 except as a mere indication of the real facts; which must 
 be gathered from all sources and inferred as natural con- 
 sequences. The idea of the uniform action of laws of 
 dissolution and disease will become more and more prom- 
 inent from exhaustive studies. 
 
 The form in which alcohol is taken and the time and 
 the particular effects are by no means chance or accident- 
 al, and are not dependent on the capricious will of the 
 patient. Often the appearance of the parents or the 
 relatives of the patient furnishes confirmatory facts of the 
 race degeneracy, or the peculiarities. Patients who dwell 
 on the minute causes and conditions which provoke the 
 drink craze and the result of it are suspicious and should 
 be studied with great care.
 
 222 INEBRIETY. 
 
 Frequent examinations have a mental effect and often 
 disclose facts concealed before. The first effort should be 
 to secure the confidence of the patient, and have him talk 
 freely of his entire life, then take his statements under 
 consideration, recognizing them as biased and uncertain, 
 to be studied for confirmation and support by other facts. 
 
 On matters pertaining to themselves, the reasoning of 
 the patients may be very acute, or it may be misleading, 
 and the first examination will bring out this fact and in- 
 dicate what general line of causes have been influential in 
 producing the condition present, and the possible trend 
 and direction of these states.
 
 CHAPTER XXII. 
 
 GENERAL PRINCIPLES OF TREATMENT. 
 
 Synopsis. Certain general principles to be recognized in every 
 case. Particularly after the subsidence of the acute stages. Pa- 
 tients unconscious of their conditions. A suspicious egoism very 
 prominent. A delusional confidence in the will-power. The per- 
 iodic drinker recognizes the need of help. The moderate drinker 
 never. Theories of the causes are always misleading. The 
 patient's estimation of his condition should not be followed. The 
 diagnosis and prognosis always uncertain unless studied exhaus- 
 tively. Questions of rapid or slow withdrawal are misleading. 
 Treatment for insomnia, gastritis. Common early symptoms are 
 important. Studies to ascertain the exact causes both physical and 
 psychical essential. Studies to determine the acute exciting causes 
 very important. The removal of these is followed by restoration. 
 Examples of the acute causes. General treatment necessary, par- 
 ticularly on the subsidence of the active causes. Certain general 
 principles always to be recognized. Not theories, but prominent 
 facts supported by evidence. 
 
 In a study of the principles of treatment there are some 
 general facts which appear in nearly all cases which fur- 
 nish the groundwork or basis from which further study 
 and treatment must begin. One fact stands out prom- 
 inently, that the patients coming under treatment are 
 never in what is called the early stages of the disease, but, 
 on the contrary, they have reached a degree of chronicity 
 which has produced alarm and anxiety among their 
 friends and in themselves. 
 
 Commonly such treatment is for cases of acute intox- 
 ication. When this condition subsides the patient may be 
 convinced that he needs further help, particularly when 
 pressed by his friends, and may consent to receive medical 
 care and treatment. 
 
 In such cases he is very largely unconscious of his true 
 condition. He will reason that his danger is very slight 
 and insignificant and the symptoms which his friends are 
 anxious about are of little account, and that he has 
 
 223
 
 INEBRIETY. 
 
 full power to care for himself, if he should choose to 'ex- 
 ercise it. 
 
 This strange unconsciousness of the meaning of the 
 phenomena, direct or indirect, from the use of spirits is 
 common to nearly all cases. He may have drunk to ex- 
 cess in the past, acted strangely, done many insane 
 things, yet the passing off of these conditions brings 
 with it a delusional confidence that he will never drink 
 again, and that all these symptoms are transient. 
 
 The periodic drinker rarely acknowledges the need of 
 medical help, except at some particular period of his 
 drink paroxysm. Even then his confidence is only slight- 
 ly shaken in his ability to stop at will. 
 
 The steady drinker is more positive and continues to 
 believe that he has free will to stop at any time. When 
 asked to explain why he does not, refers to some slight 
 temporary external or internal causes, which seem to him 
 a sufficient reason. 
 
 In appearance the continuous drinker has more prom- 
 inent marks of alcoholic degeneration than the periodic 
 drinker. These are often seen in the eyes, face, walk, ab- 
 rupt manners and language. 
 
 There is a wide variation in the mental and physical 
 symptoms of inebriety ranging all the way from the man 
 with the slight alcoholic breath, up to the delirium of 
 intoxication and the stage of stupor. 
 
 One of the most prominent mental symptoms is a paretic 
 exaltation and egotistical confidence in his strength and 
 vigor. He will deny that he has ever taken any spirits 
 when the exhalations from his breath disprove it. He will 
 give the most absurd reasons in explanation of unusual 
 symptoms and believe that he has convinced his hearers. 
 
 A careful scrutiny will reveal muscular palsy, local 
 ticks and twitching of the nerves with a confused sensory 
 activity. These are in the early stages. Later, when
 
 GENERAL PRINCIPLES OF TREATMENT. 225 
 
 positive delirium and stupor comes on, they are recog- 
 nized. 
 
 Another symptom is very common to all persons who 
 use spirits, namely, inaccuracy of statement, faulty use of 
 words that have double meanings. This, with irritability 
 and disposition to be critical, minimizing their own con- 
 ditions and magnifying the opinions and judgment of 
 others. 
 
 Often a drinking man reveals his condition by his de- 
 lusional reasoning, concerning himself and others. This 
 is seen particularly in efforts to explain his condition and 
 the cause of his drinking. To persons not familiar with 
 this class, the excessive minute and dogmatic explanations 
 are very convincing and even his physicians accept his 
 statements of his own case without making special con- 
 firmatory studies. 
 
 Thus the diagnosis and prognosis of patients not de- 
 lirious and stupid are always misleading when based on 
 the statements of the patients and their friends. When the 
 toxic symptoms are prominent the inferences are more 
 positive and clear. 
 
 The intensely red or blanched face points to disorders 
 of circulation. The- dilated or contracted pupils indicate 
 pressure and change in the central organ. The acute in- 
 flammatory conditions and nutritional disturbances are 
 most significant of toxic and general derangement. 
 
 In most cases there is an intense demand for help, in 
 others great indifference and reluctance to receive any as- 
 sistance. Most patients seek relief when the drink craze 
 has subsided and a stage of remorse and depression brings 
 out an increased consciousness of the gravity of their con- 
 dition. 
 
 At this time there is mental feebleness and delusional 
 conceptions expressed in extravagant language concerning 
 themselves and their danger. This has great therapeutic
 
 226 INEBRIETY. 
 
 significance to the physician, suggesting localized de- 
 pressions and toxic poisonings which may deepen into 
 serious organic changes or pass away by the efforts of 
 nature. 
 
 It is at this time that the specific treatment with its 
 credulities and its extravagant expectations appeal most 
 vividly to the reason of the patient. 
 
 Physical and mental measures which attempt to increase 
 this sense of danger and the physical depression often 
 have the very opposite effects. Narcotics, emetics, and 
 other drugs act in this way and psychological measures 
 to deepen the mental impression are exceedingly uncer- 
 tain. 
 
 Efforts to shock the patient by exaggerating his fears 
 and increasing the magnitude of his danger are exceed- 
 ingly unsafe. This topic is referred to in another chap- 
 ter. 
 
 The appeal of the patient for relief should be followed 
 by pronounced eliminative measures, removing the active 
 and predisposing causes and placing the patient in the 
 very best conditions for restoration. 
 
 Then the questions of nutrition, elimination, environ- 
 ment and mental impressions become the subject of more 
 exhaustive studies. Where persons have used spirits for a 
 very long time, there is a delusion that unless its removal 
 is gradual, there is fear of collapse and heart failure. 
 
 Oftentimes the patient is so impressed with this idea 
 that the sudden removal of spirits must be considered in 
 the treatment. Where spirits are removed gradually, the 
 continuation of the poisonous effects must be recognized. 
 The mental impression that collapse will follow the with- 
 drawal of spirits must be met and neutralized according 
 to the conditions present. 
 
 A common custom of giving nitrate of strychnine with 
 every dose of spirits until the latter is painful has many
 
 GENERAL PRINCIPLES OF TREATMENT. 227 
 
 advocates. The freedom from danger of collapse is il- 
 lustrated in the number of intoxicated persons confined to 
 the station houses who are seldom given any spirits after 
 being locked up, and mortality is rarely traced to this 
 cause. 
 
 It must be remembered that there is greater peril and 
 danger in the slow withdrawal of spirits, states of con- 
 gestion, sudden palsies as of pneumonia, nephritis and 
 other local inflammations, suddenly starting up, are very 
 common. 
 
 Changing the form of spirits and combining them with 
 eggs or foods bring additional perils from autotoxic 
 causes, and rather protracts the trouble and increases the 
 fatality. 
 
 Extensive experience shows that the gradual withdrawal 
 of spirits in the treatment is followed by great complex- 
 ities of symptoms, prolonged convalescence with great ex- 
 haustion and slower recovery. 
 
 A study of many thousands of persons in whom spirits 
 were withdrawn at once has never indicated any deaths 
 from collapse that could be attributed to this cause. 
 
 Often sharp eliminative measures through the skin and 
 bowels with warm baths and rest in dark rooms bring out 
 a repugnance for both the smell and taste of spirits. 
 Acute gastritis and general hyperaemia, calling for relief, 
 suggesting spirits as the only possible remedy, is very 
 easily overcome by hydropathic measures, together with 
 appropriate mineral waters. 
 
 All the specific cures depend on the combined action of 
 atrophia and hyoscine to diminish the craving for spirits. 
 This is more or less perilous when applied without due 
 discrimination. Many of the vegetable bitters, particu- 
 larly in the form of infusions, have a revulsive effect in 
 breaking up the desire for drink. Elsewhere we have 
 noted this fact.
 
 228 INEBRIETY. 
 
 When the desire for drink has passed away, the condi- 
 tions due to the poisonous action of alcohol come into 
 prominence. Thus the faults of circulation and elimina- 
 tion, the local palsies, the unstable nerve centers with ex- 
 plosive tendencies, also the nutritional disturbances and 
 morbid impulses for foods and drinks are the conditions 
 which require recognition and therapeutic measures for 
 relief. 
 
 Insomnia is a very common condition. When treated 
 by narcotics, is often made worse. The forced sleep is at 
 the expense of vitality and nutrition with greater intensity 
 of the toxaemic states which may have been an active cause 
 in producing it. 
 
 The treatment of gastritis and insomnia by narcotics 
 has often ended fatally and the death certificate was heart 
 disease, when it should have been heart failure from drugs. 
 The remedies advised in the text books for these condi- 
 tions resulting from toxic poisonings are not to be relied 
 upon. In reality there is a very wide difference between 
 theory and practice here. 
 
 Authors are not familiar with the condition and write 
 from a theoretical point of view, giving very dangerous 
 advice. It is always a question in the treatment of acute 
 cases of inebriety and the acute inflammations which fol- 
 low, of avoiding the use of drugs which complicate and 
 increase the danger. 
 
 The subsidence of the active symptoms brings out new 
 questions of causes and conditions and suggests new meas- 
 ures of treatment which were not practical before. Thus 
 in some instances a most efficient remedy is a change of 
 environment and occupation. 
 
 In another it is a change of nutrition and exercise, sleep 
 and rest. In another it is nerve rest and quietness in a 
 sanatorium, or a home in the country. A long list of 
 very active and contributing causes should be studied and
 
 GENERAL PRINCIPLES OF TREATMENT. 29 
 
 removed. Then the progress towards recovery will be 
 rapid and positive. 
 
 Not imfrequently climatic conditions produce depres- 
 sion and irritation, which provokes the drink craze. When 
 these are changed restoration is rapid. Innumerable ex- 
 amples appear of apparently insignificant causes, which 
 when removed result in the restoration of the patient. 
 
 Such causes are generally toxaemic or have reference 
 to the toxaemic condition of the body. Thus, in one in- 
 stance, a chronic case was required to walk twice a day to 
 a spring for certain mineral waters, two miles away, and 
 drink certain quantities of the water. He recovered. The 
 muscular exercise in the open air was of more value than 
 the waters he drank. 
 
 In another example the treatment for hyperacidity of 
 the stomach with regulation of the diet and prolonged 
 rest in bed was followed by permanent restoration. These 
 cases indicate the possibilities of exciting causes, that are 
 unknown to the person, and only recognized by careful 
 study. 
 
 It is also evident that many complex psychoneuroses 
 exist which are not overcome by specifics or drug cures. 
 When they are removed, the progress towards recovery is 
 rapid. In every case there should be a general study of 
 the most prominent causes, or conditions that favor and 
 encourage the use of spirits. 
 
 At one time it may be contagion from example of oth- 
 ers, or it may be the contagion of surroundings. In one 
 instance a man never drank except at the club. In an- 
 other he could not resist the invitations of certain men to 
 join them in the social glass. To all others he could re- 
 fuse. Having taken one glass it was impossible to stop 
 until he had become thoroughly intoxicated. 
 
 Often conditions of starvation, both mental and phys- 
 ical, furnish very active predisposing causes for the drink
 
 230 INEBRIETY. 
 
 craze. Remove these and the person becomes an abstainer 
 at once. Very important questions occur as to the value 
 of drugs and chemical restraint, and how far it can be 
 used with safety. 
 
 To depend upon drugs alone is certainly perilous, also 
 to depend upon restraint. In much the same way mental 
 impressions are transient and by themselves alone are fol- 
 lowed by sad failure. It is only from an exhaustive study 
 of the conditions, both inherited and acquired, that the 
 therapeutic measures and remedies can be determined. 
 
 The fact should never be overlooked that the inebriate 
 is a most complex neurotic and that the mere use of spirits 
 is by no means the only cause. In reality it may be sec- 
 ondary and contributory, and these facts should be recog- 
 nized in the question of treatment. 
 
 The general principles of treatment include every pos- 
 sible degenerative influence, both physical and psychical, 
 and should not be based on any one set of facts to the 
 exclusion of others. While one cause may be more prom- 
 inent than another, their relations should be studied. 
 
 As an example, the subsidence of the acute symptoms of 
 tuberculosis is marked by an intense desire for spirits. 
 Traumata and shocks not unfrequently set up an alcoholic 
 craze. Reflex irritations are not infrequently apparent 
 in the same symptoms, and the treatment must necessarily 
 vary when these causes are recognized. 
 
 Hence, the general principles for treatment must be 
 understood at the beginning, and with this in view, ra- 
 tional means and measures can be applied.
 
 CHAPTER XXIII. 
 HOME AND OFFICE TREATMENT OF INEBRIATES. 
 
 Synopsis. The recent character of such treatment. Former 
 theories of intoxication obscure the need for treatment. A dis- 
 tinct business in the hotels of the large cities, also by charlatans 
 In certain centers. Question of how often one can be acutely 
 intoxicated and recover. Acute intoxication very serious con- 
 dition. Doubtful if full recovery ever takes place. The steady 
 drinker is much weaker and requires more careful study. Reme- 
 dies used to restore one who drinks steadily. Apomorphia has 
 some value. Opium extracts should not be used. Danger in 
 careless treatment of persons found intoxicated in the streets. 
 Three classes of persons commonly call physicians for temporary 
 relief. One in which intoxication is the direct result of spirit 
 poisoning. The other, when the toxic conditions come on suddenly 
 and without particular reasons. The third so-called temperate 
 persons who become intoxicated from causes other than spirits. 
 The general treatment of such cases. Danger in using the needle. 
 Value of water treatment. Conditions to be sought for. Nar- 
 cotics should not be used. Examples of cases restored by family 
 physicians. Office patients. Failure to recognize their conditions. 
 Disastrous results. Examples. Some remedies found valuable. 
 Number of patients calling for medical treatment increasing. 
 An unknown field of very great promise. Experience of em- 
 pirics shows possibilities of means and measures. 
 
 Up to a very recent period medical men were seldom 
 called to give assistance or prescribe for inebriates, ex- 
 cept in cases of acute intoxication and chronic conditions. 
 
 The apparent self -limited and transient nature of or- 
 dinary intoxication seems to require little or no medical 
 help, and the rapid recovery confirmed this impression. 
 
 The theory that inebriety is in its origin a moral dis- 
 order has discouraged the inclination to call for a physi- 
 cian, and with it an increased sense of humiliation after 
 the act and desire to conceal it. Only when intoxicated 
 persons become wildly delirious, or excessively stupid are 
 the family and friends alarmed; the physician is then 
 called. 
 
 The subsidence of these acute symptoms is not restora- 
 tion or cure, and yet the impression is that the patient 
 
 231
 
 232 INEBRIETY. 
 
 has recovered. In reality the injury to the organism is 
 very serious and complex, and far more dangerous be- 
 cause it is concealed. 
 
 During the last few years the medical treatment of the 
 acute stages of intoxication have become quite a distinct 
 and prominent business, especially by hotel physicians in 
 large cities, and also by charlatans and quacks who make 
 great pretensions of permanent cure. 
 
 Acute intoxication or alcoholism is marked by delirium, 
 coma, and general paralysis, following profound toxaemias 
 with marked symptoms of grave disturbance of both 
 the motor and sensory centers. There are always func- 
 tional changes and profound pathological disturbances 
 in the organism, which by repetition would become 
 permanent, and in all cases there are unknown degenera- 
 tions that may or may not pass away. 
 
 The question has been raised how far the organism, 
 particularly the brain and nervous system can endure 
 these toxic states, and preserve their normal integrity; in 
 other words, how many times may a person become deliri- 
 ous or stupid, and be intoxicated from the effects of spir- 
 its, and fully recover? 
 
 One observer thinks that few persons ever live to be- 
 come intoxicated more than 400 or 500 times. Others 
 estimate 300 as the extreme limit. The probabilities are 
 that few persons ever become profoundly intoxicated more 
 than 100 times and recover. General collapse, local in- 
 flammations and profound palsies and intercurrent dis- 
 eases take place long before the limit of 100 or more in- 
 toxications is reached. 
 
 It is evident that the modern man, particularly in this 
 country, is more sensitive to spirits and is less able to 
 throw off the profound toxaemias manifest in stupor and 
 delirium. It is also clear that other diseases spring up
 
 HOME AND OFFICE TREATMENT OF INEBRIATES. 233 
 
 more readily from this source and are more intense and 
 profound. 
 
 The condition of intoxication resembles that of a shock 
 and suspension of the normal activities, similar to that of 
 heat or sun stroke, or hemorrhage, in which local conges- 
 tion occurs. This, for the time being, is very intense, but 
 later passes off and the functional activities become nor- 
 mal again. 
 
 Careful studies of brain disease show that traumata 
 of all descriptions, both psychical and physical, produce 
 a permanent derangement from which recovery is never 
 certain. Many diseases occurring later are distinctly 
 traceable to brain injuries which were considered insig- 
 nificant at the time. 
 
 Intoxications from alcohol are both toxaemias and trau- 
 mata, in which poisoning and congestion are the pathologi- 
 cal conditions present. A study of many cases show distinct 
 physical degenerations dating from the first intoxication. 
 The inference is clear that this condition is by no means 
 trivial or of minor importance, no matter what the appear- 
 ance may be afterwards. The brain has suffered some de- 
 terioration from which it never recovered. Hence the 
 medical care and treatment of states of intoxications 
 are of very great significance and should require the most 
 careful study and remedial measures. 
 
 One of the questions which present themselves is, what 
 are the probable acute exciting causes, and how can they 
 best be removed. If the person is a continuous drinker, and 
 only occasionally poisoned to the extent of delirium and 
 stupor, the case is one of accumulated toxaemia. Here 
 the poisons are introduced from without and formed with- 
 in the body, and their removal is the very first effort in 
 the treatment. 
 
 If the person is a periodic drinker with distinct free 
 intervals of abstinence, the causes which precipitate the
 
 INEBRIETY . 
 
 drink storm are to be studied, anticipated and prevented. 
 Such studies indicate a great variety of conditions of 
 which poisoning, congestion, irritation, general and local 
 exhaustion are common. 
 
 This form of drinking is limited and controlled by 
 conditions, not always recognized. Removal of the ex- 
 citing causes will often be followed by a sudden cessation 
 of the drink impulse. 
 
 In certain cases the approach of the drink paroxysm 
 will be preceded by gormandizing and great irregularity 
 of living. In others, stupor, depression and melancholia ; 
 in others, profound exhaustion. These and other condi- 
 tions are to be recognized and treated by the remedies 
 which seem most called for. 
 
 In the continuous drinker whose toxic conditions create 
 alarm, profound elimination is essential. This can be ac- 
 complished by one-tenth grain doses of apomorphia, ad- 
 ministered at intervals of one or two hours, until relaxa- 
 tion, profuse perspiration, emesis and catharsis follow. 
 
 Warm boths with vigorous rubbing and reclining in 
 well ventilated rooms are essential to complete recovery. 
 Apomorphia should be used with caution because of the 
 depressant effect which follows. Sometimes this is so pro- 
 nounced as to contra-indicate its use. Where emesis is 
 called for, salt water and ipecac may be used in prefer- 
 ence, as safer and less depressing. 
 
 In other cases, smaller doses of apormorphia, one-twen- 
 tieth or one-thirtieth of a grain may be given for its 
 relaxing and sedative effects. These suggestions for treat- 
 ment have particular reference to cases cared for at home, 
 or calling at the office. 
 
 In an institution where the surroundings are under the 
 control of a physician, the medication may be practically 
 the same, but the condition and methods of treatment will
 
 HOME AND OFFICE TREATMENT OF INEBRIATES. 235 
 
 vary. Morphia and chloral are unsafe narcotics to over- 
 come the insomnia and the delirium which follow. Chlo- 
 ral should never be used because of its accumulative action, 
 and its depressing effect on the vitality, increasing the 
 delirium and prostration. Opium and its alkaloids, mor- 
 phia and others check secretions, and favor the growth of 
 toxins by increasing favorable conditions and soils. 
 
 Opium extract may be used after thorough elimination 
 has taken place to lessen the nerve irritation, but it should 
 be used with great care and discretion. Hydropathic 
 means and measures are by far the most valuable and safe 
 for the acute stages of intoxication and the conditions 
 which follow. 
 
 Thus persons found on the street in a state of coma, 
 exhaling a strong spirit odor, should never be given spir- 
 its, but should be treated with hot and cold water, botn 
 internally and externally. Water falling in a small 
 stream on the back of the neck and spine is a powerful 
 stimulant, starting up the heart and increasing the cir- 
 culation. 
 
 A warm bath is the most valuable restorative to the cir- 
 culation and the congestive conditions that are present. 
 Most of the cases calling for active treatment may be di- 
 vided into three classes, which require different measures, 
 particularly in the after treatment. 
 
 First, one in which the intoxication has followed the 
 drinking of large quantities of spirits in rapid succession, 
 as in the return of a drink paroxysm, or sudden obsession 
 with or without any particular motive. 
 
 Second, where spirits have been used in small quantities 
 extending over a long time, as for instance, in the so- 
 called moderate drinker, who suddenly becomes intox- 
 icated, or a person at a banquet who drinks lightly, then 
 suddenly becomes stupid and maniacal.
 
 236 INEBRIETY. 
 
 Third, persons who are called temperate, who from 
 some unknown cause, suddenly become intoxicated, or 
 from some known cause use spirits to great excess. 
 
 In the first class there is evidently some sudden depres- 
 sion and disturbance of the circulation, followed by intense 
 irritation and demand for relief. The excessive use of 
 spirits is simply to drive away psychical or physical pains. 
 
 There may be some motive or reckless abandon, but 
 there is always a mental element which should be recog- 
 nized. One of the most prominent remedies is apomor- 
 phia by the needle for its deterrent and eliminative ac- 
 tions. Then saline cathartics and baths and rest in the 
 best possible surroundings. 
 
 After the acute effects are passed, a cautious use of sul- 
 phate of strychnine in small doses, one-sixtieth of a grain, 
 and noting its effects and the toleration of the system, 
 will be found valuable, for the nerve irritation. Lupulin 
 in eight or ten grain doses is safe and has no depressing 
 effect. This with other mild sedatives, if required, will 
 answer the purpose. 
 
 In the second condition, where intoxication is the cul- 
 mination of continuous use of spirits, apomorphia should 
 be given. If its action is particularly depressing, it 
 should be used only at long intervals, or not at all. 
 
 Cathartics, diaeretics and sudarific may all be used at 
 intervals with excellent results. The object to be secured 
 is diversion and elimination. After the acute symptoms 
 have passed, various tonics can be given ; strychnine and 
 atropia in combination are two of the best drugs most 
 commonly used, one-sixtieth of the former and one-two- 
 hundredth of the latter, given at intervals of four hours 
 for two or three weeks. 
 
 If no toxic symptoms follow they should be withheld 
 for a week or two and then resumed again. This alterna- 
 tion may be continued for several months. Other means
 
 HOME AND OFFICE TREATMENT OF INEBRIATES. 237 
 
 and measures having reference to local conditions, par- 
 ticularly of the hydropathic class should be used. 
 
 In the third condition where intoxication is sudden, un- 
 usual and not clearly the result of any particular condi- 
 tions preceding it, hydropathic measures should precede 
 all others. Elimination by cathartics, and possibly mild 
 sedatives after the acute symptoms subside, may be found 
 useful. 
 
 It is always a question to be considered whether drugs 
 by the needle for these acute conditions are safe; also 
 whether they should not be abandoned at a very early 
 day for their mental effect. While the needle is a very 
 valuable method by which drugs may be given, there is 
 a psychical impression that should be recognized and con- 
 sidered in all cases. 
 
 Sedatives in these various conditions are only valuable 
 for their immediate effects, and should be of the mildest 
 class. The} 7 should be concealed from the patient largely, 
 and varied, and never continued any length of time. 
 
 Gastritis is a very common condition in these acute affec- 
 tions, and can be most successfully treated by hydro- 
 pathic measures. Packs and fomentations over the sur- 
 face and small quantities of water given internally, com- 
 bined with the lucodescant light are very effective remedies. 
 A great variety of means and measures have been urged, 
 among them narcotics which should be given with great 
 caution. 
 
 The use of spirits and milk, while sometimes checking 
 the irritation, is not safe, and should not be followed in 
 any routine wa} 7 . The absolute removal of spirits in any 
 form is the safest and most certain measure of relief. 
 The extreme thirst associated with gastritis, calling for 
 water and cooling substances is another condition requir 
 ing good judgment, and adaptation to the conditions 
 present.
 
 238 INEBRIETY. 
 
 Ice, lime, and bi-carbonated waters in small quantities 
 given every hour are grateful. Sometimes cold tea has a 
 sedative action. If to these various palliatives are added 
 hot and cold fomentations over the stomach and along 
 the spine, the acuteness of the symptoms subside. 
 
 The patient should be kept reclining in bed and given 
 no food for some little time. It is a mistake to suppose 
 that liquid foods, when retained, are healing in their 
 effects. The stomach needs rest and lavation by water 
 more than anything else. 
 
 The stomach symptoms are self-limited, and can be 
 easily overcome by water and natural means. With the 
 functional disturbances, there is high arterial tension, 
 anamia and nerve irritability. Strychnine has been used 
 at this time with very good effects occasionally. 
 
 Small doses of codein given by the needle are also 
 highly praised. Strychnine combined with small doses of 
 atropia are also valuable for their sedative effects, but 
 care should be exercised to discriminate any toxic action 
 which it may have. 
 
 The question of nutrition and the various tonics in- 
 dicated, of which forms of iron, phosphorus and soda are 
 most commonly used, must be decided with the conditions 
 of each case. Thus a patient who has been a gormand 
 and eaten irregularly and excessively should be restricted 
 to a very limited diet. One who has been abstemious and 
 underfed should require very carefully arranged foods 
 taken at short intervals, particularly foods that are easily 
 assimilated. 
 
 The deranged metabolism, so common in these cases, 
 must be recognized in the questions of diet, and not the 
 patient's appetite for food. An abnormal appetite after 
 the acute symptoms is very often the beginning of auto- 
 intoxication which will end in relapse.
 
 HOME AND OFFICE TREATMENT OF INEBRIATES. 39 
 
 Equal care of the diet as of that of typhoid fever, 
 should be given after the subsidence of the acute symp- 
 toms. No person should be considered cured on the sub- 
 sidence of gastritis and other toxic symptoms. The fact 
 that the patient is able to resume his customary work must 
 not be considered evidence of cure, but rather an indica- 
 tion of the possibility of future restoration by the use 
 of rational means and measures. The physician should 
 be very emphatic in urging further care with medical 
 means and measures. 
 
 Some examples will make these facts more clear. 
 Thus a man with an alcoholic heredity who was an ab- 
 stainer up to thirty years of age suddenly drank to grea* 
 stupor and delirium. The active causes were disappoint- 
 ment in business, and shock at pecuniary losses. The 
 physician, after giving thoroughly eliminative measures, 
 began a course of restricted diet with active hydropathic 
 measures, impressing the patient's mind with the extreme 
 gravity of his condition. 
 
 Bitter tonics were given at first, particularly cinchona 
 bark, for a few days, and then abandoned and taken up 
 again. He was able to resume business, but followed the 
 directions of the physician, who gave very active treat- 
 ment for over a year. 
 
 The treatment consisted of regular baths, exercise, 
 tonics, restricted diet and regulation of his work an:! 
 sleep. The recovery was complete, and although the phy- 
 sician was retained for many years and consulted on every 
 occasion, the patient continued temperate until his death 
 from an accident many years after. 
 
 Had this first attack of intoxication been treated with 
 the usual narcotics of which morphia, chloral and other 
 similar remedies are most common, then dismissed with 
 moral advice and warnings, relapse would certainly have 
 followed, and he would have died an inebriate.
 
 240 INEBRIETY. 
 
 A similar instance was that of a teacher, who at a ban- 
 quet was urged to drink various kinds of spirits and sud- 
 denly became acutely intoxicated. The physician was 
 called, and among other things made a very strong im- 
 pression on the patient's mind of the need of active treat- 
 ment and unusual care both in diet and hygienic measures. 
 
 The patient recovered, although he remained under the 
 care of the physician for a long time. In this case, had 
 the physician given the usual drugs and considered the 
 conditions very insignificant and transient the future 
 would have been doubtful. 
 
 After the subsidence of the acute symptoms a degree of 
 remorse may come, or the patient may have egotistical 
 confidence that the toxic state was of minor importance, 
 and was a mere accident from which recovery is absolutely 
 certain, and relapse will never occur again. 
 
 If the physician who is called will recognize this mental 
 attitude and impress on the patient's mind the serious- 
 ness of this event and the possible danger which may come 
 from it in the future, and insist that he come under med- 
 ical care and direction, the most gratifying results will 
 follow. 
 
 Persons who have been intoxicated several times, and 
 for some reasons unknown, call in the physician, should 
 be subjects of very serious inquiry and study. The pa- 
 tient's judgment of his own case should not be accepted 
 or recognized, but the fact of having drunk before up to 
 intoxication should be given the greatest prominence. 
 
 The delusion that having once recovered, he can do so 
 again, is a very serious bar to preventive measures. The 
 patient's ego must be overcome, and his delusions de- 
 stroyed, and in most cases this is very easily done. All of 
 these cases present evidence of the derangement of the 
 liver, kidneys, heart and arteries, and disturbances of the 
 digestion, which may be organic, and are certainly func- 
 tional.
 
 HOME AND OFFICE TREATMENT OF INEBRIATES. 
 
 A periodic drinker, during a paroxysm of intoxication 
 suffered from pericardial pains which greatly alarmed 
 him. The physician gave a very serious prognosis, and 
 impressed upon him the necessity of remaining in bed and 
 taking active treatment. After a time the restoration 
 came on and with it delusions of strength. 
 
 The physician and friends impressed upon him the 
 necessity of careful medication, hydropathic and nutrient, 
 which was continued for over two years, and resulted in 
 the complete subsidence of the drink paroxysm and his 
 final recovery. 
 
 In another example a lawyer, who after intoxication 
 sent for a physician, expecting temporary relief and res- 
 toration which had been received many times before. 
 The physician recognized the chronicity of his case and im- 
 pressed the idea that he was on the borders of a general 
 paresis in which his recovery was doubtful. 
 
 After a time the patient grew skeptical and doubted the 
 diagnosis. A consultation was called, and the first diag- 
 nosis was confirmed. Then he consented to follow the pre- 
 scribed course of treatment. After a time it was found 
 that he was using beer secretly. The physician gave him 
 apomorphia, the effects of which alarmed him, and from 
 this he continued for over two years, receiving medical 
 care, and following implicitly the directions laid down. 
 He recovered and was a total abstainer ever afterwards. 
 
 A very prominent congressman drank to great excess 
 at intervals and called in eminent professional men for 
 relief on every occasion. At one time he became intoxi- 
 cated at a hotel and called upon an obscure physician 
 who, after an elaborate examination, suggested the neces- 
 sity of making a will at once, and urged that every prep- 
 aration should be made in the possibility of sudden death. 
 
 The will was drawn and the patient was startled and 
 impressed with fears which the physician fostered in every
 
 INEBRIETY. 
 
 way. Very close attention with elaborate medication, 
 hydropathic and otherwise, with a careful study of every 
 symptom, and this was kept up for a month or more, be 
 fore the patient was allowed to go out and take up his 
 duties. 
 
 The physician continued his treatment and the patient 
 followed directions in the most conscientious way for two 
 years or more. His recovery was complete. This man is 
 now in the United States Senate, doing excellent work 
 and thoroughly temperate. Other physicians had treated 
 him for the drink paroxysms, probably with morphine, 
 chloral and bromide, with warnings and counsels, and had 
 recognized his own judgment concerning cure and re- 
 covery. 
 
 These examples indicate a very wide field in which the 
 family physician can give most substantial and valuable 
 help to a class of patients whose temporary toxic condi- 
 tions are never treated in a systematic scientific way. 
 
 Numbers of active business men are driven to the char- 
 latan and gold cure establishments with the hope of re- 
 ceiving some permanent help, where the family physician 
 has failed. 
 
 Office patients who come to the physician for the re- 
 lief of conditions following the toxic use of alcohol are 
 turned off with a prescription, with or without advice, and 
 are neglected, and in this way become incurable. They 
 should be carefully examined, studied and treated belli 
 physically and psychically, and made to understand the 
 gravity of their condition, and the statements of the 
 patient and their friends should not be the basis of a 
 superficial diagnosis preventing any further treatment. 
 
 All institutions for the treatment of inebriates present 
 examples of the failure of the family physician to under- 
 stand and give the first aid and assistance to these poor
 
 HOME AND OFFICE TREATMENT OF INEBRIATES. 243 
 
 wounded victims, who later become incurable, and theu 
 make most strenuous efforts to recover. 
 
 Often inebriates appeal to the physician for help in 
 the remorseful stage, suffering from the depression which 
 follows the drink paroxysm. Often they exaggerate their 
 symptoms and give most gloomy prognosis in the future, 
 and come to the physician's office, or send to him for 
 help. 
 
 Frequently they are among his friends and patrons, 
 and when not using spirits are most attractive, excellent 
 citizens. The office treatment consists usually of nar- 
 cotics, tonics and placebos with threats and warnings and 
 appeals. Often the appeal is for medicine to neutralize 
 or break up the drink craze which the physician is usually 
 powerless, or fails to do in a practical way. 
 
 If the physician should make a careful study of these 
 cases, and dismiss all thought of the moral theories and 
 the patient's ability to control himself, a new and most 
 fertile field of practice, and successful treatment would be 
 found. 
 
 The appeals for help to break up the drink craze are 
 very often touching. The coarse, crude efforts to break 
 up the drink craze often intensify the debility and while 
 stopping the craze for a time, cause it to return with 
 greater urgency than before. 
 
 The first means should be to eliminate the toxins by 
 catharsis with salines. Then insist that the patient shall 
 take highly concentrated solutions of quassia, or cin- 
 chona bark. The former is preferable, because it can be 
 concentrated by repeated boiling. Give two ounces of this 
 every two hours. The patient may use spirits or not ac- 
 cording to his inclination. 
 
 In a very short time the desire for spirits disappears, 
 and a repugnance to its taste and smell comes on. There
 
 244 INEBRIETY. 
 
 seems in this drug to be an antagonism making the ef- 
 fects of the spirits painful, and later followed by extreme 
 disgust. 
 
 If the patient will continue this quassia after the dis- 
 gust has appeared at longer intervals, and finally when- 
 ever the desire for spirits comes back follow it by an 
 ounce of quassia mixture, a temporary restoration is sure 
 to follow. Cinchona bark produces nearly the same ef- 
 fect, but it must be given in larger doses and always in 
 solutions. 
 
 Quinine can be used, but cinchonism comes on early 
 and with it little or no revulsive feeling. Apomorphia 
 may be used occasionally, but only in particular cases 
 where a profound relaxing action is called for. These 
 drugs, in most cases, will effectually break up the drink 
 craze for the time being, and enable the physician to de- 
 termine what further measures can be used to continue the 
 good effects and overcome the abnormal condition? which 
 demand the return of the use of spirits. 
 
 Examples of cases that have been permanently restored 
 by temporary office treatment are as follows: A noted 
 politician applied to a physician for help to prevent him 
 from drinking during an exciting convention that was io 
 occur the next day. 
 
 He was advised to take large quantities of concentrated 
 quassia solution the day before the meeting, and drirk 
 freely of mineral water. He was surprised to find thnt 
 all drink impulses were absent and in their place a strong 
 repugnance for the odor of spirits. 
 
 He was able to do his work with great satisfaction, ar.d 
 later came under the care of a physician for treatment 
 and became a total abstainer. 
 
 Another man equally noted applied for help to prevent 
 intoxication ,at the annual banquet of his college society.
 
 HOME AND OFFICE TREATMENT OF INEBRIATES. 245 
 
 The same treatment was given with the addition of oue- 
 two-hundredth of a grain of sulphate of atropia every 
 four hours for two days before the banquet. 
 
 His experience was so satisfactory that he placed him- 
 self under the charge of the physician and eventually be- 
 came a total abstainer. 
 
 A third case was that of a lawyer, who at the close of 
 a long exciting trial, when worn and exhausted, drank to 
 excess. So frequently did this occur that he went off to a 
 watering place and remained concealed until the drink 
 storm went by. 
 
 He was placed on the quassia treatment and was able to 
 overcome the impulse to drink. Then by baths and pro- 
 longed rest, recovered and was a total abstainer the rest 
 of his life. 
 
 A very interesting case is reported by a physician, of 
 a delusional inebriate who confided to the physician, that 
 during the drink paroxsym he was sorely tempted to kill 
 his wife, child and himself, and on several occasions was 
 only deterred from committing the act by a slight cir- 
 cumstance. 
 
 Later he was horrified at this insane impulse and ap- 
 pealed to the physician for help. After a dose of apo- 
 morphia, followed by baths and active treatment, he was 
 given strychnine and atropia, and urged to come to the 
 physician when he began to feel the drink impulse coming 
 on. He did so and was given large quantities of quassia, 
 which quickly overcame the impulse. This was repeated 
 several times during the course of the year and was fol- 
 lowed by a complete recovery. 
 
 The possibilities of relief and assistance in these par- 
 oxysmal drink obsessions are almost unlimited, and open a 
 new field of practice, that is at present practically un- 
 known.
 
 246 INEBRIETY. 
 
 Examples of failures of physicians to give this first aid 
 to the wounded or rather to assist the patient to over- 
 come the drink obsession may be noted in the following, 
 Avhich are common in the practice of almost every physi- 
 ician. 
 
 A banker appealed to his physician for help to over- 
 come the desire for spirits, which he feared was growing 
 and destroying his physical and business interests. The 
 physician gave bromides, chloral and various other seda- 
 tive remedies, together with the tincture of cinchona. 
 
 He failed to realize that cinchona as a tincture contain- 
 ing a large quantity of alcohol was a very dangerous 
 remedy. Finally, in despair, he sent the banker to a 
 quack cure. A few weeks later he returned buoyed up 
 with the faith that he was permanently cured. Later he 
 relapsed and became a secret drinker. 
 
 A few years afterwards he was convicted of forgery 
 and sent to prison for ten years. 
 
 A prominent clergyman who drank for exhaustion, real- 
 izing the danger, called in the family physician. A great 
 variety of remedies were used. Little or no attention was 
 paid to the real conditions. The patient failed to get 
 permanent relief. Later became a drug taker and finally 
 after a sensational exposure he committed suicide. 
 
 These cases might be multiplied to an almost indefinite 
 extent. It may be said that there are an increasing num- 
 ber of persons in every town and city who are becoming 
 alarmed at their inability to break up the drink impulse 
 and stop the use of alcohol. 
 
 They go to the family physician for help, and failing 
 to get any particular satisfaction or assistance, resort to 
 patent drugs and gold cures, and later, in desperation, go 
 to some hospital or sanatorium. They realize their dan- 
 ger and have a dim impression that something might be 
 done to keep them from growing worse. The physician,
 
 HOME AND OFFICE TREATMENT OF INEBRIATES. 247 
 
 who of all others, should be their best guide and counst 1 , 
 fails to realize the seriousness of their condition, and en- 
 courages the theory that it is a moral weakness which they 
 should overcome, and thus unconsciously drives the patient 
 away. 
 
 Office treatment of persons suffering from drink par- 
 oxysms, who are given morphia, chloral and other sedatives, 
 has many perils. The physician recognizing the present 
 symptoms without particular reference to their causes or 
 conditions, may give morphia or some other narcotic. 
 The patient goes home, uses more spirits and dies. 
 
 Should any question be raised, the prescription shows 
 that the dose was correct as to size, and other conditions 
 are supposed to account for the death. A number of 
 cases have come into prominence in which a small dose of 
 morphia or chloral has been fatal. 
 
 The depressed brain and nervous system were not rec- 
 ognized, and the narcotic given still further paralyzed the 
 vital centers. 
 
 A case of some prominence in which a paroxysmal 
 drinker was given a quarter of a grain of morphia, hypo- 
 dermically, and fifteen grains of chloral to be taken on 
 retiring. Death followed, and a legal contest grew out 
 of this. 
 
 The physician was sustained by the courts, but in all 
 probability a better acquaintance with the patient and 
 the conditions from which he was suffering would have led 
 him to give other drugs, and the patient would have lived. 
 
 Office prescriptions which are eliminative are safe, and 
 solutions of bitters and salts can be used with great effi- 
 ciency, but such patients should always be under the ob- 
 servation of physicians and never neglected, but seen 
 often. 
 
 Office and home treatment can be most successfully 
 carried on, if the physician can secure the hearty sym-
 
 248 INEBEIETY. 
 
 pathy and confidence of the patient and his family. 
 Where the inebriety is continuous, the conditions are more 
 complex and require more careful study. 
 
 If the patient is a periodic inebriate a great variety of 
 conditions must be understood, before exact treatment c,":n 
 be made successful. 
 
 In the numerous classes of drinkers, dependent on the 
 great variety of surroundings and active and remote 
 causes, there are always certain indications which will 
 show how far home and office treatment can be successful, 
 and when and where home and institutional treatment 
 should be substituted. 
 
 The empiric efforts to cure the chronic cases and these 
 who have reached terminal stages by reason of protracted 
 poisoning and degenerations extending over years, are 
 very startling in their temporary successes, and occasional 
 permanent restoration. 
 
 The methods used are exceedingly coarse and unscien- 
 tific, and yet the effects and impressions produced are 
 very marked. It is evident that there is a wide field of 
 therapeutic possibilities that is unoccupied at present, in 
 which both physical and psychical remedies can be con- 
 centrated to restore and permanently cure patients by 
 both office and home treatment.
 
 CHAPTER XXIV. 
 
 INSTITUTIONAL TREATMENT OF INEBRIATES. 
 
 Synopsis The hospital idea of treatment very old. The first 
 care on the Nile. The first efforts to protect drinking men. The 
 first hospital began in 1864, at Binghamton, N. Y. The advanced 
 methods promoted there. Controversy over these plans. First 
 inmates incurables. Mentally disturbed. Discussions over dif- 
 ferent methods. Four classes of hospitals. One doing Govern- 
 ment Work, taking- care of the incurables, struggling with the 
 same obstacles that confronted Binghamton Asylum. A second 
 class, both corporate and private, treating patients according to 
 the original plan of disease. A third class only recognize the 
 moral side and treat that alone. A fourth class claim specific 
 cures. The first class under the charge of the Government house 
 patients of all grades. The second class study patients scientif- 
 ically. The character of the patients which come to these hospi- 
 tals. The necessity of hospital treatment. The possibility of 
 recovery. This treatment precedes all others as a necessity in 
 their care and control. The whole subject is yet in its infancy. 
 It is impossible at present to do more than educate the public 
 and patients to realize the necessity of such treatment. 
 
 The idea of gathering inebriates in a certain place for 
 special treatment is a very old one. Ulpian, the Roman 
 jurist, after affirming that inebriates were diseased, de- 
 clared that they should be treated in special surroundings 
 and buildings. 
 
 Later one of the kings of Spain announced that inebri- 
 ates should be treated in special places as sick and d's- 
 eased. In one of the tombs of Memphis there is a state- 
 ment that the occupant had set apart a building for the 
 care of persons overcome by wine and beers, and that he 
 ministered to them such means as would relieve them from 
 the effects of spirits. This was practically a hospital 
 and was the first of which we have any record. 
 
 On another tomb is an inscription of a charitable man 
 who provided a place where the temple worshipers under 
 the influence of wine could be taken and protected until 
 they were able to go home. 
 
 249
 
 250 INEBRIETY. 
 
 From other sources the fact is stated that the temple 
 worshipers who became practically intoxicated, in par- 
 taking of the offerings given to the dead, were carried out 
 on the banks of the river Nile to sleep off the fumes of 
 the spirits. 
 
 This was found to be dangerous because of the croco- 
 diles which came out of the river and devoured them. 
 Laws were passed that persons who became stupid from 
 drink were to be put into separate places where they 
 could be protected. 
 
 Several references are made in those early records of 
 the need of taking care of the persons who were ov.r- 
 come by spirits. In the early part of the eighteenth cen- 
 tury hospitals and institutions were mentioned as giving 
 the best means for their care and protection. 
 
 It was not until 1864* that a distinct hospital was 
 opened for the medical treatment of inebriates at Bing- 
 hamton, New York. Lodging houses for drinking men 
 were opened in the earty part of 1850. Many of them 
 were rooms over saloons, and places in the neighborhood 
 of hotels where persons could be protected and cared for. 
 
 In London proprietors of saloons advertised very cheap 
 spirits and rooms with clean straw where persons over- 
 come by spirits could recline. The early temperance soci 
 eties, particularly after 1840, organized lodging houses 
 which were practically institutions for protection, care 
 and such treatment as was needed. There are several 
 references in the early history of the temperance move- 
 ment to the aid received from physicians in these places, 
 which was literally the first hospital care, or first aid to 
 the wounded. 
 
 Dr. J. E. Turner, the founder of the Binghamton as\ T - 
 lum, gave the first clear conception of the hospital work 
 and treatment of inebriates. He urged that inebriates 
 were in the first stages of dementia and paresis and that
 
 INSTITUTIONAL TREATMENT OF INEBRIATES. 251 
 
 nothing less than one year of absolute restraint and care- 
 ful medical observation and treatment would be of any 
 value. 
 
 The hospital at Binghamton was founded on this idea. 
 It required no pledges or promises, but simply insisted 
 that the patient should come under absolute control and 
 care, and all his surroundings be regulated on a fixed mil- 
 itary plan. 
 
 Drugs, baths, exercise, together with lectures and every 
 physical and psychical means known at that time were to 
 be used in the treatment. Work in shops and light farm 
 labor were given to all who accepted them as a means 
 of treatment. 
 
 This was so far ahead of the public sentiment of thac 
 day that the protests of the patients against the restraint 
 and the theory of disease were encouraged, and many 
 means were sought to discredit and oppose in every 
 way. From the very opening of the institution until it 
 was changed to an insane asylum sixteen years later there 
 was a constant conflict between the patients and the man- 
 agement, in which often the friends of the patients joined 
 with bitterness. 
 
 The founder, Dr. Turner, insisted that the inebriate 
 was diseased and needed long careful treatment with 
 restraint and exercise to become permanently cured. On 
 the other hand, the patients and friends urged tint 
 though disease might be present, it was transient and re- 
 covery depended largely upon freedom from restraint ar,d 
 every irritating cause, and appeals to the honor aiid 
 promises of the patients. 
 
 Many papers were written at that time showing the 
 disease was that of the will power in which manhood and 
 pride were more largely concerned, and that all restraint 
 was depressive and appeals to the honor were stimulating. 
 The various superintendents of the Binghamton asylum
 
 252 INEBRIETY. 
 
 who followed Dr. Turner attempted to find a middle 
 ground for treatment, in which the disease theory requir- 
 ing restraint, and the failure of the will power needing 
 freedom, and appeals to the honor and pride could be 
 combined. They all failed. Attempts to make the hos- 
 pital popular, not only increased the discontent, but 
 brought with it an element of personality which was de- 
 scribed as personal favors or persecution, and with this 
 came the political element which increased the discontent 
 and brought about a dismal failure of plan and pur- 
 pose. 
 
 The principle upon which the hospital was founded was 
 so combined with moral theories, and so impracticaliy 
 worked out, that the institution was finally declared a 
 failure. The dogmatism and intense ignorance of many 
 good men of that day illustrate clearly the obstacles 
 which every new truth must pass through, and the con- 
 troversy about the management of the hospital at Bing- 
 hamton sounds like the quarrels of little children at this 
 day. 
 
 Physicians, clergymen, politicians and editors wrote 
 and talked about the treatment of inebriates with a fa- 
 miliarity and confidence that was startling. Notwithstand- 
 ing the confusing efforts of the various managers to 
 please the public and the inmates of the institution, they 
 unconsciously exemplified and worked out many of the 
 facts which are now being recognized as the most ad- 
 vanced principles of treatment. 
 
 It is evident that the early work of this institution and 
 the theories of Dr. Turner will be studied with increasing 
 interest in the future. A number of institutions were 
 opened for the reception of patients in different parts of 
 the country, during the first ten years of the existence of 
 the asylum at Binghamton.
 
 INSTITUTIONAL TREATMENT OF INEBRIATES. 253 
 
 Nearly all of them grew out of the enthusiasm arrl 
 possibilities which the institution at Binghamton prom- 
 ised, and failed for want of knowledge of the character 
 of the patient and the correct principles of treatment. 
 Other institutions, founded on some special view of what 
 inebriety was and was not, were opened gradually chang- 
 ing and evolving or dying out. 
 
 At present there are four classes of institutions which 
 may be said to represent the infancy of the work. Fits! 
 and most prominent are the state and county institutions., 
 incorporated and receiving state aid, also fixed fees 
 per week, for the patients treated. Laws, giving power of 
 holding these persons, with efforts to furnish some occu- 
 pation, are provided. 
 
 The general principle recognized is that the inebriate 
 is diseased and to a degree irresponsible, and in that way 
 he is a semi-insane man. These institutions are strug- 
 gling with the same obstacles which the asylum at Bing- 
 hamton encountered. 
 
 The managers and superintendents are constantly 
 changing from political and other causes. Theories of all 
 descriptions and plans of treatment are urged and 
 dropped with startling frequency. There is no standard 
 to guide them, and no fixed principles, hence they belong 
 to a reformatory class. Happily they are steadily evolv- 
 ing towards a larger knowledge of the subject, and a 
 clearer conception of what is required. 
 
 A second class of hospitals, both corporate and private, 
 is struggling with the same problem. The management 
 is based on the theory that inebriety is half disease aiul 
 half vice ; that patients are irresponsible, to some degree, 
 while drinking, and at all other times are sane. 
 
 Some of these institutions receive mental cases and 
 persons who are eccentric and have feeble minds and
 
 INEBRIETY. 
 
 bodies. Most of the insane asylums have wards for the 
 inebriates, in which the disease is recognized and restraint 
 applied for temporary periods. Beyond that there is no 
 recognition of debility or disease. 
 
 A few private hospitals exist where inebriates are 
 treated exclusively as diseased, following the theories of 
 the great founder, Dr. Turner, in which remedies of all 
 grades and degrees are applied, and the patient is recog- 
 nized as both organically and functionally diseased, and 
 the treatment is a continuous effort to build up and restore 
 him to healthy living again. 
 
 A third class of hospitals formerly quite numerous, 
 now almost extinct, ignore all questions of disease, regard- 
 ing the patient as a moral dement, who happens to be 
 poisoned with alcohol, and when this is removed the real 
 remedy is the pledge, the prayer and appeals to his 
 higher will power. Some of these institutions have fur- 
 nished remarkable examples of suggestion, psychical im- 
 pressions and possibilities of treatment, along lines un- 
 known before. 
 
 A fourth class of hospitals which began in a small way 
 soon after the advent of Binghamton Asylum claimed to 
 have discovered some specific remedies and methods of 
 cure. They are promoted very largely by irregulars ard 
 men without training or reputation, and depend upon 
 their cxtraodinary pretentions and startling assertions. 
 
 A few years ago they attained great prominence, but 
 latterly they have declined. They require no laws of re- 
 straint and seem to depend entirely on the ability of the 
 patient to pay the fee charged. 
 
 These four general classifications describe the institu- 
 tional work for the treatment of inebriates at present. 
 The first class managed by the state and county officials 
 are the most hopeful and are probably doing the b?3t
 
 INSTITUTIONAL TREATMENT OF INEBRIATES. 255 
 
 work, although the inmates are almost altogether of the 
 chronic, incurable classes. 
 
 Their work of housing and controlling them gives an 
 opportunity for study which will be taken advantage of 
 in the future. The inmates committed by law are to some 
 extent provided with occupation and this appeals to the 
 taxpayer, not only in removing the patient from the 
 community, but relieving the burdens which fall upon the 
 family. 
 
 There is every reason to hope that these institutions 
 will make their inmates more or less self-supporting as 
 well as to restore a certain percentage to normal living 
 again. 
 
 The private corporate hospitals, depending upon the 
 income from patients for their existence, are stimulated to 
 discover and combine all means possible to bring about 
 restoration. Their particular purpose is to concentrate 
 all the known remedies and measures for curing the vic- 
 tim and preventing him from future relapse. 
 
 The most advanced study and work is to be expected 
 from these institutions, because of the stimulus and in- 
 centive to attract patients and produce permanent results. 
 The State of Connecticut has a most advanced law, 
 giving private incorporate hospitals legal control over 
 the inmates. Other States have limited restrictions which 
 will be greatly improved in the near future. 
 
 Hospitals and insane asylums with special wards for 
 the treatment of acute cases of this class are becoming 
 more and more available and give very substantial aid and 
 help. Much depends upon the attitude of friends and 
 relatives who permit the patient to go home long before 
 he is cured. 
 
 The egotism and irritation and evident dementia of 
 the patient after the subsidence of the acute symptoms
 
 256 INEBRIETY. 
 
 are not recognized. A very large class of persons who 
 come for treatment to hospitals are in the terminal in- 
 curable stages. They are credulous, emotional neurotics 
 who have tried all sorts of means and remedies without 
 success, and in the remorseful, period after the removal 
 of spirits, grasp at every new hope and new expectation 
 for permanent restoration. Later they consider them- 
 selves cured and are very insistent on returning to their 
 home life and circles again. When they relapse the 
 hospital and its management are considered responsible. 
 
 A certain percentage of these inebriates are moral 
 paralytics and create great expectation and enthusiasm, 
 among their friends, pertaining to their cure, and often 
 pose as examples of the extraordinary work done in the 
 institution, or by secret remedies. 
 
 Later, when they relapse, they seem to take malicious 
 pleasure in condemning the hospital and the means used 
 in their former treatment. Public sentiment is always in- 
 fluenced more or less by these relapsed patients whose vo- 
 ciferous declarations of failures or successes in hospitals 
 are regarded as evidence of the real condition. 
 
 In this class of hospital patients are the great army 
 of border liners, including the psychopaths, paranoiacs 
 and degenerates in the first stages of insanity. There is 
 another class of inmates becoming more numerous every 
 year, who frequent these hospitals. They are the brain 
 exhausted, practically worn out, men and women who use 
 alcohol as a narcotic to cover up the pains and discom- 
 forts from which they suffer, and to enable them, in some 
 slight measure, to continue amidst the changing conditions 
 of life. 
 
 This class patronize the quack hospitals largely, at- 
 tracted by the prctentions and promises of rapid per- 
 manent cure. Later they go to better organized institu-
 
 INSTITUTIONAL TREATMENT OF INEBRIATES. 257 
 
 tions and accept the restraint, receive scientific care and 
 utilize the methods offered, in a rational business-like 
 spirit. 
 
 Many such persons recover. After the subsidence of 
 the acute symptoms, the restraint of the hospital, of the 
 surroundings and the physical conditions, are accepted as 
 necessities and made available to the fullest extent. Such 
 persons never pose as examples of cures, but go back to 
 private life without making any reference to this treat- 
 ment or its necessity. 
 
 The impression prevails that it leaves a stigma to be 
 obliged to take such treatment, hence it is not mentioned 
 in later life. All well organized institutions, doing legiti- 
 mate work, have lists of persons restored, who never refer 
 to the institution or their treatment, for this reason. 
 
 Another class of patients are continuously extolling or 
 condemning such institutions, and referring to their ex- 
 perience with suspicious volubility. 
 
 There is another class to whom the hospital is a city 
 of refuge. Such persons recognize their need of help ar.d 
 go for treatment either openly or secretly. Some of them 
 are paroxysmal drinkers who go to break up the pai- 
 oxysm, for the correction of some local affection or 
 rest from certain nerve exhaustion. 
 
 The great hotel sanitoriums of this country and Eu- 
 rope have a very large number of persons who are moder- 
 ate or excessive drinkers and who realize in a slight degree 
 the danger of their present condition, and seek medics 1 
 help. Some of the more modern names of nervous dis- 
 eases are literally degenerations and disorders from al- 
 cohol. 
 
 At these institutions sanitorium methods and remedies, 
 such as baths, electricity and massage are very effective 
 and wise physicians recognizing the real causes urge
 
 258 INEBRIETY. 
 
 abstinence from spirits and other exciting causes. Most 
 of these patients come to organized hospitals after a time 
 and secure exact scientific care. 
 
 Institutional care of inebriates is thus built up slow 1 y 
 from sanitoriums and other places where seclusion and rest 
 can be had. Institutional care with its change of sur- 
 roundings and living, its military conditions of life, divu- 
 sions for the brain and nervous system, together with spe- 
 cial appliances for this particular condition, is a necessity 
 that is growing constantly. 
 
 The late Dr. Mott always referred to the inebriate as 
 one with a fractured brain and nervous system, requiring 
 the splint and bandage of an institution. This figure 
 describes in a very suggestive way many of the conditions 
 essential. Institutional treatment is literally placing the 
 patient in a condition where his malady can be studied 
 and better understood than elsewhere, and also where the 
 application of means and measures can be concentrated 
 and made to promote restoration with a degree of certain- 
 ty not possible elsewhere. 
 
 Experience has shown that a certain number of persons 
 find. in hospitals both a physical and psychical help which 
 cannot be obtained elsewhere. Many of the older institu- 
 tions have a class of patients who come regularly at inter- 
 vals for the security which the hospital offers. 
 
 They come suffering from excitement and exhaustior ; 
 often associated with the use of spirits or marked by an 
 intense dread and fear of drinking again. Common ex- 
 amples are that of a lawyer who many years ago drank 
 to excess ; then recovered. At irregular intervals he comes 
 to the hospital, takes baths, rests a few days and then 
 goes away. The relief which the institution gives him 
 and the psychical security of removal from temptation 
 brings about a rest and restoration.
 
 INSTITUTIONAL TREATMENT OF INEBRIATES. 259 
 
 A physician who has an obsession that if he drank 
 spirits he would kill his family and himself, comes to ail 
 institution to prevent him from drinking. He does not 
 drink, but he is frightened at the prospect of tempta- 
 tion. The moment he reaches the institution his fears 
 dissolve and later he returns, quiet and normal in every 
 way. 
 
 Other persons come to the institution after having 
 drunk and committed overt acts. They are filled with 
 the sense of danger, and are led to make tremendous 
 efforts to avert it. 
 
 The same conditions are noted in the better class of 
 Turkish baths in large cities. Here can be seen persons 
 recovering from drink paroxysms and others who are en 
 the verge of drinking, taking prolonged baths and be- 
 coming fully restored. 
 
 Sanitoriums at mineral springs have many persons of 
 this class, who drink largely of the waters, take the baths, 
 and not only expect but receive temporary help and resto- 
 ration. A certain hospital in one of the large eastern 
 cities has a number of rooms with barred windows, set 
 apart for persons who are in the delirious stage of 
 inebriety. 
 
 Many persons come from the higher walks of life, and 
 ask to be admitted and put under restraint so they can 
 overcome the delirious impulse to drink. Institutional 
 treatment does more than provide restraint and protection. 
 Where they are properly managed the patient can be 
 educated and taught to understand his condition, and to 
 know the danger signals, and provide for them in the 
 future. 
 
 He is trained to interpret correctly some of the 
 phenomena of his condition and to realize the particular 
 effect from distinct causes, and in this way he has a new
 
 260 INEBEIETY. 
 
 comprehension of his condition and the dangers which 
 beset him. In a well ordered institution this education 
 and mental training has a very pronounced value to most 
 patients. 
 
 In some of the larger institutions talks and experience 
 meetings are conducted by the patients, in which different 
 views are given and impressions made that are very help- 
 ful. Where the physician seeks to break up the delusions 
 of the patient by private talks or lectures, and calls atten- 
 tion to the facts of his condition and the needs of 
 clearer recognition, he is really giving treatment that has 
 a peculiar value, although not often recognized. 
 
 All the institutions doing scientific work should give 
 prominence to these psychical forces, and seek to direct 
 the patient along lines of healthy thought and living. 
 This, combined with other measures and means, consti- 
 tute the highest kind of scientific modalities that can be 
 used. 
 
 There can be no question that institutional treatment 
 of inebriates will occupy a very large place in the future, 
 also that home and office treatment will be preliminary or 
 furnish the after care so essential. The need of isola- 
 tion, change, forced rest and concentration of special 
 means and measures adapted for these psychoses, is be- 
 coming more and more recognized. 
 
 Some objectors claim that certain persons are impressed 
 that no help can be had outside of a hospital, and for all 
 sorts of mental and physical disturbances they turn to 
 the hospital for relief. This may be true in some measure, 
 but in the psychosis of inebriety it can never be an 
 abuse.
 
 CHAPTER XXV. 
 
 THE STATE CARE AND TREATMENT OF INEBRIETY. 
 
 Synopsis. Inebriates seldom recognized until they reach chronic 
 stages. Such persons are frequently dependent on their friends. 
 The state will not help them unless they have become dependent 
 and paupers. The assumption is that they have reached thie stage 
 by a wilful disregard of ordinary prudence. Insane and idiotic 
 are considered to have superior claims on the sympathy of the 
 public. The state tries to regulate the traffic by license. The U. 
 S. Court has decided that there is no inherent right to sell spirits, 
 because of the perils of the business. License and attempts to 
 control are giving a right to destroy one's self and then punishing 
 him for this. Great inconsistencies. No one has a right to destroy 
 himself. The state should enforce this. The present treatment 
 contrary to the teachings of science. Persons who use spirits 
 are poisoned and must be housed and controlled. The present 
 methods dangerous. Jails and station houses, schools of crime. 
 The state should organize work-house hospitals and control the 
 inmates. The incurables to have indefinite sentences. Others 
 shorter periods with parol. Almira Reformatory. An object les- 
 son in the principles of treatment. Laws of Conn., superior to 
 others. The practical treatment demonstrated in many ways. 
 English hospitals show the value of the work. The Binghamton 
 Asylum outlined the great principles. Hospitals in their infancy. 
 The principles which must be concentrated and applied are seen 
 in many institutions. 
 
 Inebriety is never recognized until the patient has 
 reached conditions that border on chronicity or incurable 
 stages. When such persons become dependent on their 
 friends and the state, then it dawns on the minds of the 
 friends that they are inebriates. 
 
 The State assumes that where distress and poverty are 
 apparently the direct result of neglect and wilful disre- 
 gard of ordinary prudence, there is no legal liability, ex- 
 cept in the extreme stages and then only the jail and alms- 
 house, and the most limited possible means of protection 
 should be given. This is founded on the theory that 
 inebriety is a moral disorder, and the victim is vicious and 
 wilful and could at any time, by the exercise of his 
 will, have prevented this condition. Hence this neglect 
 
 20 1
 
 262 INEBRIETY. 
 
 should be punished by suffering and deprivation of many 
 of the comforts of life. 
 
 The insane, idiotic and epileptic are considered to have 
 superior claims on the sympathy of the public, and hence 
 are entitled to protection and kindness, and more chari- 
 table legislation. The State assumes that alcohol is a 
 necessity, and that when they have passed laws to regulate 
 its traffic as a beverage, and by license and law keep 
 its sale within legitimate and rational bounds, they have 
 done their whole duty. 
 
 The United States Supreme Court has decided that 
 there is no inherent right given to any citizen of the 
 State or Nation to sell intoxicating liquors, because the 
 business is perilous and dangerous to individuals and the 
 community. Hence it may be prohibited by regulations 
 and laws that any state may determine. 
 
 The inconsistency of legalizing the business of selling 
 spirits and holding the salesman and consumer account- 
 able for the effects which are inevitable is very startling. 
 It is literally giving a man the right to become insane 
 and degenerate, and then punishing him for this con- 
 dition. 
 
 Many persons consider it wisdom to regulate the sale 
 of spirits and use the money obtained by the license for 
 the protection of those who are injured by it. This is 
 another inconsistency that it is difficult to understand. 
 The economic side of the license question shows beyond 
 all question a tremendous loss in the money received from 
 license funds and the amount paid out for police, hospital 
 and almshouse expenditures to take care of the victims. 
 It has been urged that wherever a city or town insists 
 on granting the privilege of selling spirits as a beverage, 
 it is in duty bound to provide homes and hospitals for the 
 care of the inebriate and persons made paupers from 
 using spirits.
 
 THE STATE CARE AND TREATMENT. 
 
 It is very evident that the state must recognize the 
 injuries which result from the free or licensed sale of 
 spirits, and should use every possible means to diminish 
 or permanently check the injuries which follow from it. 
 
 The great principle is that no one should have a right 
 to destroy himself and become incapable of doing his 
 duty as a citizen, nor should he be permitted to become a 
 burden or a source of loss and injury to others in the 
 community. 
 
 This principle is recognized in legislation concerning 
 public nuisances, sanitary evils and diseases from every 
 source which endanger the lives and homes of the com- 
 munity. Thus pollution of streams by sewerage, neglect 
 to remove dangerous infections or conditions which en- 
 courage disease, are punished as offenses and crimes of the 
 community. 
 
 The fact is well recognized that no one has a legal 
 right to so act and conduct himself as to peril the sani- 
 tary and healthful interests of others. By destroying all 
 sense of obligation and duty to others, and all conscious- 
 ness of others' interests, the inebriate becomes a source 
 of danger. His brain is bewildered and his reason is dis- 
 turbed, and he can not act or conduct himself with any 
 degree of certainty, hence he should be controlled, and 
 come under the class of infectious and contagious dis- 
 ease victims. 
 
 At present all inebriates are recognized as sane and 
 normal, and allowed to come and go with little or no re- 
 striction. When they fall down in the street stupid, or 
 when they commit assault or crime, they are taken to 
 hospitals and jails and the difficulty is considered only 
 transient. There is no recognition of their insane acts 
 and conduct in their homes, to their families and those 
 about them.
 
 264? INEBRIETY. 
 
 Science indicates clearly that every man, either as a 
 moderate or excessive user of spirits is dangerous, not 
 only to himself, but to others. He is infectious and un- 
 certain, and is likely any moment to become a burden and 
 loss to the community. He is not only insane, but he is a 
 criminal from the slightest exciting causes, and, more than 
 that, he is almost certain to transmit his disease and de- 
 generation to the future. 
 
 It has been said by good authority that no man has a 
 right to use spirits to injure himself and impair his con- 
 sciousness of the surroundings and his relation to otheis, 
 and it is the duty of the State to stop him, take away 
 his liberty and force him into conditions of normal, 
 healthy living. 
 
 This great principle applies and is becoming more and 
 more thoroughly recognized every year. The State does 
 license the sale of spirits, but it is its obvious duty to 
 recognize the inebriate as a source of danger and peril 
 to its best interests. The present methods of neglect, 
 and harsh means only at the last moment, when restora- 
 tion is practically impossible, will disappear in the near 
 future. 
 
 Every city and town should have hospitals and homes 
 for the control and care of inebriates, where the exciting 
 causes can be removed, and where the best conditions of 
 hygienic living and the appliances of science can be con- 
 centrated to bring about a radical restoration. 
 
 Such a work has already been tested, not only as prac- 
 tical and rational, but curative. The inebriate should 
 be sent to State farms and State colonies, restrained and 
 made self-supporting, and after a period under medical 
 care, during which he has nerve rest, restoration takes 
 place ; then he should be permitted to go out on parole 
 and return whenever relapses occur.
 
 THE STATE CARE AND TREATMENT. 265 
 
 If frequent paroles and relapses show a degree of in- 
 curability, the terms of commitment should be indefinite. 
 Every large city has a number of pauper inebriates, whose 
 frequent arrests for crime and intoxication are destruc- 
 tive to themselves and an increasing burden on the com- 
 munity. 
 
 The jails and station houses are schools for greater de- 
 generation and incapacity. They should be housed in 
 farm colonies for an indefinite time, and provided with 
 labor and occupation, and made self-supporting as far as 
 possible. The treatment in such places would be no exper- 
 iment. Already it has been demonstrated in many ways. 
 
 Some of the better class of jails, private hospitals and 
 reformatories and other institutions where there is sharp 
 military restraint, with obligation and the application of 
 persistent restorative measures, show beyond all question 
 what can be done. Thus, in one institution receiving the 
 most degenerate class of inebriates, where baths are given 
 daily, with good food and certain light duties, the changes 
 noted are almost marvelous. 
 
 Many of the patients when discharged give promise of 
 permanent restoration, and if this treatment could be car- 
 ried out for a sufficiently long time, the results would be 
 very promising. 
 
 An ideal institution, which is thoroughly practical and 
 will be positively attained in the near future, will be a 
 farm colony in the country, with every facility for farm 
 and garden work and light mechanical labor; small, in- 
 expensive dormatories, built about a central administrative 
 building, would permit classification and grouping of 
 people. 
 
 Full legal power of restraint covering years should be 
 given by the courts, and every patient should have an 
 opportunity to go out on parole when his restoration
 
 266 INEBRIETY. 
 
 warrants a resumption of natural, temperate living. The 
 patient should understand that restraint and control in an 
 institution depends entirely on his recognition of the rules 
 and regulations, and on his efforts to take advantage of 
 every means used to restore his body and mind. 
 
 If he fails in any particular, the restraint will be in- 
 creased and his liberty curtailed, and the duration of his 
 confinement lengthened. If he runs away, he will be re- 
 turned and will be held in more strict surveillance than 
 before. The institution will be conducted on a military 
 plan, in which baths, exercise, medicinal measures and duties 
 of every kind will be carried out with great exactness. 
 
 The muscle worker will be required to engage in out- 
 door employment on the farm or in the garden for a cer- 
 tain length of time during the day. The brain worker 
 and the mechanic will be given some lighter work in the 
 workshop, or at some occupation along the line of their 
 previous life-work. 
 
 If he refuses to take his part in these duties, his con- 
 finement will be more strict and his comforts diminished. 
 If he perform the duties cheerfully, greater liberty will 
 be allowed, more comforts and some returns for his serv- 
 ices, which may be used to increase the luxuries or to 
 help others who are dependent. 
 
 Occupation should be considered a remedial measure of 
 as great value as medicine, daily baths, electricity, mas- 
 sage, and such other measures as seem to be required by 
 the condition of the patient. In addition to this, the 
 evenings are to be occupied with lectures, concerts, musi- 
 cales, and every measure to stimulate and rouse up the 
 palsied brain. 
 
 In this way, both days and evenings would be a con- 
 tinuous medicinal hygienic culture school to control the 
 disordered impulses, strengthen the nerve energies and 
 divert the mind from the past, giving it new impulses and
 
 THE STATE CARE AND TREATMENT. 267 
 
 thoughts for the future. The removal of spirits and the 
 active treatment of disturbed conditions by every means 
 known to science would be the first objective point. Then 
 a re-education and materialization of military, medical 
 and psychical measures would restore the patient to a nor- 
 mal condition. 
 
 Such institutions should receive the chronic repeaters 
 and those found intoxicated on the streets, grading them 
 according to their conditions and capacity to live normal, 
 rational lives. The military restraint, severe at first, grow- 
 ing less as they show capacity to bear freedom. When 
 found incurable, they should be placed in a group by 
 themselves and treated according to the conditions present. 
 
 Another class less prominent, whose drinking is more 
 of the symptomatic and insane type, should be treated 
 by the same active measures, given alternate liberty and 
 restraint, held in strict accountability for the literal 
 fulfillment of every duty, and kept occupied during the 
 entire day, when not resting. 
 
 A third class, whose inebriety is of a very recent origin, 
 should have special accommodations and particular oppor- 
 tunities for rest in suitable surroundings. The first class, 
 the incurables, to a very large extent, would be kept in 
 such institutions for their lifetime. 
 
 They would become self-supporting in some measure, 
 and at all events the burdens would be lifted from the tax- 
 payers and their families, and they could be kept in 
 forced conditions of healthy living. 
 
 The second class would be restored after a longer or 
 shorter residence, and, going out on parole would very 
 likely take up responsible positions and live normal lives 
 for the future. The third class, the transient and tem- 
 porary inebriates could be checked and restored and sent 
 back to healthy, normal living. This latter class, to a 
 very large extent, could be cured and prevented from
 
 268 INEBRIETY. 
 
 becoming chronic inebriates or insane, and the work of 
 a colony for this class alone would be the highest practical 
 kind of preventive medicine. 
 
 The practical results of housing these three classes 
 and taking them out of their infectious degenerative 
 centers would be a matter of the highest economy to the 
 public and to the community, as well as to the homes 
 of many persons. 
 
 A colony of this kind would do work equal to an insane 
 hospital, not only by checking degenerative diseases at 
 the beginning, but preventing crime and pauperism, which 
 is certain to follow, as in the present conditions. 
 
 Of course, a large number of private institutions would 
 be organized with full legal power of control to treat 
 persons who are able to pay, and to give more individual 
 treatment, and these are already on the ground, only 
 lacking the power of restraint and the sympathy of the 
 public. The pauper and indigent classes that form so 
 large a burden on the tax-payers, and the homes in every 
 community would be lessened, and, by being grouped and 
 cared for in colonies, the sources of infection and injury 
 would be broken up and destroyed. 
 
 The great submerged class, that are going down and 
 carrying with them a vast tide of wretchedness and 
 misery, could be halted and many of them turned back. 
 
 Every inebriate hospital and every quack institution, 
 and every reformatory movement by church or society 
 furnishes evidence of the possibility of cure and restora- 
 tion, which could be enlarged and developed into grand 
 humanitarian work by state institutions and farm colonies. 
 
 The Elmira Reformator}-, under the direction of an 
 expert manager, demonstrated that juvenile criminals 
 could be restored and that crime could be checked by the 
 use of scientific means and measures. This institution
 
 THE STATE CARE AND TREATMENT. 269 
 
 literally has revolutionized many of the great subjects 
 of penology and pointed out new methods and possibili- 
 ties of treatment. 
 
 The state treatment of inebriates, including all classes, 
 can be equally successful along similar lines, and it will 
 be no experiment, but simply a question of judicious and 
 wise management. 
 
 Already institutions have begun in this direction, and 
 the magnitude of the problem has confused the managers 
 in some way, but their success under difficulties has shown 
 the possibilities of success in the future. One great diffi- 
 culty is in trying to follow theoretic lines, and not study- 
 ing the problem as original and peculiar. 
 
 Many years ago the State of Connecticut passed laws 
 giving legal power to confine and treat persons who have 
 become inebriates, for a definite length of time. This law 
 was fifty years ahead of public sentiment, and has never 
 been utilized except in a few private institutions. Of all 
 the legal enactments in the world, this is the highest and 
 most thorough in its power of control. 
 
 There should be no public sentiment or opposition or 
 fear of abusing personal liberty in the effort to establish 
 farm colonies. The great fact should be recognized 
 that no one should be allowed to destroy himself and im- 
 peril the interests of his friends and neighbors by using 
 spirits to excess. 
 
 He should forfeit his liberty and his free will, because 
 he shows no ability for self-control, and hence must be 
 cared for by others. There is no subject to-day more 
 vital to the interests of every community than that of 
 housing the inebriate and restraining him from suicide 
 and injuries to his friends and family. 
 
 The late Dr. Wright expressed this in the following: 
 "Restrain and control the inebriate, whether a millionaire
 
 270 INEBRIETY. 
 
 or a pauper, and you reduce crime, pauperism, criminality 
 and disease to a minimum." This is preventive medicine 
 and political economy of the highest type. The present 
 methods of allowing liberty and only applying restraint 
 when the evils and injuries are developed, is reckless ig- 
 norance. In this way, the very conditions for the growth 
 and development of inebriety are promoted. 
 
 There is no science, no economy, no sense in this. The 
 English Parliament, twenty years ago, recognized the 
 value of inebriate hospitals, and appointed an inspector 
 who should superintend their organization and control. 
 Over twenty institutions of this kind, both public and 
 private, have been organized and are doing good work. 
 Under the care of an able superintendent and inspector, 
 Dr. R. H. Brantwaite, very valuable and interesting con- 
 tributions have been made to the literature on the subject. 
 
 While the practical working and value of such insti- 
 tutions are established beyond question, there are many 
 difficult problems which are yet unsettled, and about which 
 considerable controversy exists. In this country, particu- 
 lar wards are put aside in all the large insane asylums and 
 reformatories, where special treatment and care of inebri- 
 ates is carried on. 
 
 While this is unsatisfactory, there is unmistakable evi- 
 dence that work of this kind can be done in farm colonies, 
 especially adapted for this purpose. The first inebriate 
 asylum at Binghamton distinctly outlined the need of 
 such work, and pointed out its value in general, educa- 
 tional, physiological and psychological training, and the 
 possibilities of restoring many persons, now lost by the 
 want of such treatment. 
 
 The State Asylum at Foxboro, Mass., has been doing 
 some excellent experimental work in housing and treating 
 the chronic inebriate. Their various reports reveal diffi- 
 culties to be overcome which a larger knowledge would
 
 THE STATE CARE AND TREATMENT. 271 
 
 put aside. The attempt to divide the inebriates into cur- 
 able and incurable, criminal and insane, and give sep- 
 arate treatment is beset with difficulties. 
 
 Several of the reports are marred by efforts to dis- 
 tinguish between the normal and abnormal inebriate, and 
 inebriates whose conduct is criminal and those whose con- 
 duct is not. If the energy spent in trying to differentiate 
 and mark out the classes, could be concentrated in labora- 
 tory measurements and clinical studies, many new facts 
 would appear. 
 
 Evidently the cases are not thoroughly studied where 
 the author spends time in the classifications of all persons 
 who drink to excess, and who may be practically classified 
 as chronic, require hospital treatment, and this treatment 
 has but two objective points, namely, restraint and train- 
 ing both mental and physical. 
 
 A well-appointed hospital will regulate this according 
 to the patients and the conditions. The state can not 
 discriminate, except in a very general way, and to call 
 one class curable and the other incurable, or one class 
 criminal and the other not so, and attempt particular 
 treatment adapted to each, assumes a degree of knowl- 
 edge of the nature and character of inebriety not yet at- 
 tained. 
 
 The temporary treatment of the inebriate in a few of 
 the older institutions on a general line of classifications is 
 certainly more practical, because it gives opportunity for 
 special means and measures in connection with other ef- 
 forts that could not be secured in other institutions. 
 
 A state institution at Knoxville, Iowa, is struggling 
 with the same problems. The frequent change of its 
 managers is a serious obstacle towards any permanent 
 work. Notwithstanding this, they have so far demon- 
 strated the reality of their work as to entitle them to 
 the very warmest indorsement and sympathy of all.
 
 CHAPTER XXVI. 
 
 TREATMENT BY HOT AIR, RADIANT LIGHT BATHS, 
 VIBRATION AND ELECTRIC CURRENTS. 
 
 . These various means of treatment becoming more 
 prominent In inebriety. Opinion of Dr. Shepard, and its con- 
 firmation. Public baths in different cities. Literally treating 
 inebriates in the acute stages. The physiology of this. The baths 
 in sanitoriums very essential. Effects of different kinds of baths. 
 Corn baths in the western countries. Their physio'ogy and prac- 
 tical value. Radium light baths. Their construction. Comparison 
 with hot air. Uniform good effects. Action of light on the body. 
 Greatest value when supplemented with other measures. Destroys 
 the desire for spirits, causing sleep. Some peculiarities of the 
 light bath introduced by Dr. Kellogg of Battle Creek, Mich. 
 Vibratory stimulation a valuable agent. Conclusions of the late 
 Dr. Pilgrim. Its effects on different organs of the body. Its 
 value increased in connection with other measures. Electric cur- 
 rents of great medicinal power. Static breeze valuable. Alternat- 
 ing currents. Auto-condensation currents. Some theories of their 
 action. Their value increased by other drugs. Some of these ef- 
 fects. These are so uniform as to give them a permanent place 
 among great remedies. Examples. Psychical effects. Subject 
 should be studied with care and discretion. Their great value 
 vrlll then appear. 
 
 The practical therapeutic value of hot air, steam and 
 radiant light baths, together with massage, vibratory exer- 
 cise by machines, and the electric current in the treatment 
 of inebriety calls for extended study and consideration. 
 These measures seem to occupy so large a place in the 
 treatment of these toxaemias as to become essential in all 
 therapeutic measures for relief. 
 
 Dr. C. H. Shepard, of Brooklyn, N. Y., who first in- 
 troduced Turkish baths in America, in 1864, declares 
 that this bath is more of a specific for the cure of in- 
 ebriety than any single therapeutic means. This state- 
 ment has been confirmed in many ways, and all authori- 
 ties agree that in connection with other measures it is 
 
 one of the most powerful agents now in use. 
 272
 
 TEEATMENT OF HOT Am, VIBRATION, ETC. 273 
 
 Strikingly confirmatory is the experience of modern 
 Turkish baths in large cities, where they keep open all 
 night and provide cots for patrons who come in under 
 the influence of spirits, and who after profuse sweating 
 and rubbing, sleep and go out in the morning restored. 
 
 Many of the baths in cities give such treatment 
 daily to a large number of persons, and they are literally 
 inebriate hospitals, giving the first care and treatment, 
 although not generally considered in this light. Periodic 
 and constant drinkers recognize their impaired condition 
 and resort to the baths for elimination and diversion of 
 the spirits from the blood to the surface, finding relief 
 in the profuse sweating and rubbing, and the sleep which 
 follows. 
 
 Periodic drinkers, at the beginning of the drink storm, 
 rush to the bath to overcome the obsession for drink and 
 succeed for a time. Others, who fear that their condition 
 from the use of spirits will impair their efficiency, go to 
 the bath for the purpose of sweating it out and starting 
 anew. 
 
 Thus the bath has become a fountain of healing to an 
 increasing number of persons. The physiological ra- 
 tionale is very evident. Thus the high temperature of 
 the room acting on the surface of the body increases 
 the circulation of the capillaries and causes are intense 
 determination of the blood to the surface of the body. 
 This causes intense perspiration, and is a literal flushing 
 of the body through the skin, in which the toxins and 
 waste products of cell and tissue are thrown off. 
 
 The sudden change in the surface circulation overcomes 
 the vaso-motor palsies of the capillaries, and in this way 
 congestion and pressure on different organs are removed. 
 It is very much the same as flushing the alimentary canal 
 with salines, driving off the waste material and accumu- 
 lating products.
 
 274 INEBRIETY. 
 
 The effect is very marked in subduing the excitement 
 and diminishing the stupor by relief from irritation. 
 The heart's activity is lessened, and the temperature of 
 the body is diminished. The blood pressure is lowered, 
 and with it a decided tendency to sleep. The toxins are 
 eliminated, and thus one's source of poisoning is lessened. 
 
 The derangement of the capillary circulation is over- 
 come, and the congestions and palsies so common are re- 
 moved. It not unfrequently happens that persons in the 
 Turkish baths do not perspire quickly. There are sur- 
 face congestions difficult to overcome, hence large quanti- 
 ties of water must be drank, and the persons taken out 
 and the skin softened with soap and massaged under a 
 hot shower. 
 
 In sanitariums, where the baths are used very freely, 
 the action of hot air on the skin of inebriates is studied 
 with some care. If perspiration is very intense from the 
 start, after a massage and rubbing, cold showers are given, 
 and the patient is wrapped up in a warm blanket until 
 reaction follows. 
 
 Where the perspiration is very tardy, massage of the 
 skin and hot showers precede the sweating. The effect 
 of profuse perspiration can be greatly increased by flush- 
 ing the alimentary canal and kidneys with warm or 
 mineral waters. After the bath and reclining in a dark 
 room, and a short sleep, if the skin becomes dry and hot, a 
 hot shower is given, and surface stimulation is kept up 
 by means of showers and steam baths. 
 
 If the patient complains of headaches after the hot air 
 bath, a steam bath may be given at intervals of two or 
 three hours. Where the patient has perspired freely and 
 the skin is in a hypersensitive condition, a steam bath 
 may be given with better effects than hot air. 
 
 Often persons delirious, perspiring freely, should be 
 given a hot shower, followed by a cold douche, then taken
 
 TREATMENT OF HOT AIR, VIBRATION, ETC. 275 
 
 to a steam bath for a short time, then to a cold shower 
 and wrapped up in blankets in a dark room. 
 
 In the western countries corn baths at one time were 
 frequently given with good effect and frequency. Large 
 ears of corn were boiled for a long time, then placed 
 around the patient's body and covered with blankets. The 
 heatd retained by the ears of corn produced a very high 
 surface temperature, and this stimulated the capillaries, 
 bringing about the same results as that from steam. 
 
 Diaphoretic drugs have the same effect with the addi- 
 tion of the depression from the untoward action of the 
 medicine. Stimulation of the skin is more safely secured 
 by external measures, of which hot air, steam and other 
 baths, are the best means. 
 
 The radiant light bath, which has recently come into 
 considerable prominence, should receive some considera- 
 tion. Up to this time its value has been very enthusi- 
 astically praised, and by many it is considered superior 
 to the hot air. The bath consists of a room four or 
 five feet square lined with tin, or painted, to give it a 
 radiating surface, over which are arranged a large num- 
 ber of incandescent lights. These lights may be supple- 
 mented by reflectors back of each one, intensifying the 
 rays. 
 
 The bath may be in the form of a cabinet, in which 
 the head projects and the body is surrounded by a large 
 number of incandescent lamps. Some of the baths are 
 lined with mirrors, which intensify the lights. 
 
 The patient sitting in this bath perspires very quickly. 
 While the temperature does not increase to more than 130 
 or 160 degrees, the perspiration is very rapid and in- 
 tense. The particular value of the bath seems to be in 
 its sudden profound stimulation of the capillaries. 
 
 The hot air bath requires from fifteen to twenty min- 
 utes to produce active perspiration. In the radiant light
 
 276 INEBRIETY. 
 
 bath the same effects, only more powerful, in from five 
 to ten minutes. The temperature remains about the same. 
 The patient is conscious of a decided sedative, soothing 
 action. The sensation of heat is less than in the hot air 
 bath, but the skin is more intensely reddened, and elimina- 
 tion is more profound. 
 
 In some instances a very marked odor from the oily 
 products of the skin is apparent. In others, all odors 
 seem to be neutralized. Areas of the skin that are hyper- 
 sesthetic and anesthetic are brought out with great dis- 
 tinctness. After a time the perspiration brings with it a 
 sense of exhaustion, and the patient is then placed under 
 a shower, after which a decided tendency to sleep follows. 
 
 These effects are so marked and uniform as to give it a 
 greater prominence than that of the hot air bath. Where 
 the skin is palsied and does not respond quickly, a warm 
 shower with soap is used to soften the skin and to increase 
 the surface circulation. 
 
 Then the light bath acts with great intensity. In the 
 hot air bath, there are often depression and a sense of 
 uneasiness and irritation, but in the radiant light bath 
 these effects are not noticed. 
 
 After one or two baths the skin seems to become very 
 susceptible to the action of light, and perspiration starts 
 almost immediately when the light is turned on. There 
 can be no question that the action of light has a more 
 profound physiological action on the surface than that 
 of hot air. 
 
 The light penetrates to all the tissues of the body and 
 is converted into heat waves, giving renewed activity to the 
 cells and circulation of fluids. It is practically a bom- 
 bardment of both heat and chemical rays, penetrating 
 through the surface into the tissues, destroying the toxins 
 and bacteria, and setting up activities anew.
 
 TREATMENT OF HOT AIR, VIBRATION, ETC. 277 
 
 The arc light is regarded as the most powerful, with 
 its ultra violet rays. Cabinets and rooms in which the 
 arc light is used have become more popular, and many 
 very interesting studies have been made showing their 
 superiority to the incandescent lamp. 
 
 In the treatment of inebriety, the radiant light bath, 
 to be most effectual, must be supplemented by showers, 
 massage, and various other measures, particularly adapted 
 to the case. After the bath has been used a few times, 
 the susceptibility to the stimulant action of light should 
 be recognized, and the duration of the bath diminished. 
 
 If the hot showers and massage afterwards are not 
 followed by a sedative action and sleep, a new study of 
 the conditions should be made. In some persons the sud- 
 den withdrawal of large amounts of water from the sur- 
 face is in the nature of a shock, producing irritation and 
 restlessness afterwards. In others, it is the opposite. 
 
 Warm or cold showers after the bath may frequently 
 correct this condition. This must be considered in the 
 after treatment. In some persons this bath is followed, 
 after the rest and sedation, by an increased desire for 
 spirits, but fortunately this can be overcome by any of 
 the bitter tonics, whose effects seem to be much more 
 active after the bath than before. 
 
 Where the desire for spirits is diminished accompanied 
 by an active impulse to overcome it, a repetition of baths, 
 of short length, will aid this impulse. Many very 
 curious, unexplained facts have been noted from the 
 effects of this particular remedy. Thus, in one instance, 
 a very nervous, excitable inebriate would fall asleep in 
 the bathroom and remain lethargic and dull, sleeping 
 and drousing for many hours after. All desire for spirits 
 disappeared as soon as perspiration began.
 
 278 INEBEIETY. 
 
 In another instance a steady drinker could not sleep 
 for many hours without restlessness and a feeling of 
 laughter. Later he would sleep very profoundly for a 
 long time. 
 
 In a third case it was necessary to take a bath early 
 in the morning, as its stimulating effects lasted all day, 
 taking the place of spirits, and enabling the person to 
 do without them. 
 
 In a fourth case the action of this bath was followed 
 by intense craving for food ; then sedation, sleep and 
 restoration. 
 
 In the acute symptoms of inebriety this bath is uni- 
 formly sedative, and this effect can be increased by warm 
 showers, carbonated waters, and reclining in a darkened 
 room. 
 
 Several authors have spoken about the particular good 
 effects of the radiant light bath, where the patients had 
 an opportunity to disport in a swimming tank and exer- 
 cise themselves. This, of course, would happen in those 
 who had used hot air or steam baths. 
 
 Experience has shown that where a person becomes very 
 sensitive to the light, the duration of the bath should 
 be confined to a very few moments, not going beyond sur- 
 face stimulation of warmth and moisture, then a warm 
 shower and reclining. 
 
 Another fact is of great significance, namely, that the 
 action of the drugs seem to be far more intense and 
 active after the bath. Thus sedatives, cathartics and 
 tonics, particularly of the vegetable class, are more pow- 
 erful, even in smaller doses. 
 
 In alcohol delirium the radiant light bath has proved 
 to be of almost specific value in many instances. Free 
 catharsis and warm showers softening the skin, and pro- 
 during increased surface circulation, then a prolonged 
 radiant light bath. This is followed by showers and re-
 
 TREATMENT OF HOT AIR, VIBRATION, ETC. 279 
 
 clining, and complete subsidence of the delirium for many 
 hours. 
 
 On its return a similar course was followed by pro- 
 longed narcotic effect and rapid recovery. It is still an 
 open question whether this treatment would be equally 
 efficient in all cases. In an institution where such baths 
 are in active service, the results will be different from 
 those in a private home. It may be asserted with great 
 confidence that any kind of a bath by which high heat 
 can be applied to the surface of the body will always be 
 found exceedingly valuable. 
 
 Dr. J. H. Kellogg, of Battle Creek, Mich., who first 
 introduced the radiant light bath, pointed out its great 
 value as an eliminant and sedative. He showed that it 
 not only acted on the arterial tension, reducing it, but it 
 had a powerful physiological action on irritation, and 
 was a germ destroyer. 
 
 He showed that its effects were not always explainable, 
 but like electricity, it presented some retarding forces to 
 diseased states, and gave some new power to the cell and 
 tissue. Clinical experience has brought a large mass of 
 confirmatory evidence both concerning this bath and that 
 of the hot air. 
 
 Thus persons exhausted from overwork, worry and de- 
 fective nutrition find in both of these baths relief and 
 sedation greater than from any other source. Thus, a 
 professional man suffering from periodical drink storms, 
 can overcome them by hot air baths at the beginning of 
 the period and in this way he has been able for many 
 years to prevent a drink excess. 
 
 In another instance an inebriate resorts to a bath in 
 his own house, taking two or more a day, followed by a 
 rubbings with oils and vigorous massage, and in this way 
 he has been able to keep from using spirits.
 
 280 INEBRIETY. 
 
 In one case an inordinate thirst which precedes the 
 drink storm is treated with hot air baths and salt rubs, 
 followed by a static breeze. The result is a complete 
 subsidence of the drink excess. 
 
 A physician reported a number of cases of chronic in- 
 ebriates treated in a jail by hot water douches and vig- 
 orous rubbing with a solution of salt. The results were 
 very good. A number of cases have been reported where 
 the insomnia following the inebriety was broken up by 
 the radiant light bath and salt showers. These, together 
 with other means, were followed by a remarkable recovery. 
 
 Up to this time the clinical evidence of the value of 
 this form of bath showed that it is one of the new modali- 
 ties that promise the very best results from farther use. 
 
 Another remedial measure is vibratory stimulation of 
 the muscles by delicately adjusted machines. This has 
 been found to be of great value in a large number of 
 cases. The following summary of its physiological action 
 by the late Dr. Pilgrim, outlines in a very satisfactory 
 way many of the facts which have been confirmed beyond 
 all question. 
 
 The action of vibratory stimulation on the body is : 
 
 1. Increasing the volume of blood and limph flow to a 
 given area or organ. 
 
 2. Increasing nutrition by stimulating secretion. 
 
 3. Increasing the muscular respiratory process and the 
 functions, and the general metabolism and the production 
 of heat. 
 
 4. Stimulating the excretory organs and the functions 
 of elimination. 
 
 5. Diminishing blood tension and relieving muscular 
 contractures. 
 
 6. Relieving engorgement and congestion.
 
 TREATMENT OF HOT AIR, VIBRATION, ETC. 281 
 
 7. Increasing the removal through the natural channel 
 of the lymphatics of exudates and other products of in- 
 flammation. 
 
 8. Inhibition and relieving pain. 
 
 Evidently these results and the need for stimulative 
 measures are called for in most cases of inebriety. Many 
 persons who drink both moderately and at intervals suffer 
 from contractions and impaired activity of both the 
 organs and glands, and frequently hand massage and so- 
 called osteopathic measures are followed by the best results. 
 
 Stimulation over the liver and along the lines of the 
 nerves, for cirrhosis and neuritis, and other muscular 
 palsies, together with abdominal muscular stimulation, 
 are all most practical and efficient measures to relieve 
 the conditions and assist toward healthy activity. 
 
 Several cases have been reported where the premonitory 
 symptoms of the drink craze have been overcome by vi- 
 bratory treatment and baths. Its use is indicated, par- 
 ticularly in so-called rheumatisms and sclerotic states fol- 
 lowing the use of alcohol, and when used in conjunction 
 with electric light baths and free showers, the very best 
 results will follow. 
 
 Persons who are overfed and underworked and who 
 use alcohol, should receive vibratory treatment. Persons 
 who are worn out from defective nutrition and continuous 
 poisoning from spirits, and persons with enlarged livers 
 or hearts should be given this treatment. 
 
 At first it should be light and brief as to duration, then 
 increasing the length of time, localizing the vibratory 
 activities over parts of the body that seem to be con- 
 gested. A mild vibratory treatment over the entire body 
 stimulates the capillaries and makes the electric light bath 
 much more active and in many ways seems to give power 
 to eliminated drugs by rendering the circulation more 
 active.
 
 282 INEBRIETY. 
 
 The vibratory machine, both before and after the 
 bath, is a very powerful aid and a remedial measure, 
 particularly in cases of muscular irritation and insomnia. 
 It may be called a mechanical sedative, and its effects 
 may be considered both physical and psychical. 
 
 Its use in barber shops, over the face and head, shows 
 that it is recognized as an agreeable stimulant as well as 
 sedative. In institutions where its effects can be studied 
 and applied with more or less exactness, it has become 
 a necessity, particularly to diminish nerve excitement and 
 muscular energy, and to bring with it a sense of relief. 
 
 Experience has shown that its value consists of its 
 scientific rational use, and that it is possible to increase 
 the very irritation and many of the difficulties which it is 
 found to remove by a careless use. 
 
 Electric currents from a static machine are very valu- 
 able remedial agents that are coming into increasing 
 prominence. High frequency currents, for their tonic 
 effect and after the removal of spirits, are very satis- 
 factory. The relief and rest in many cases is almost 
 specific. In others the effects are less marked. 
 
 The static breeze, given regularly, varying according 
 to the skill of the operator, and the form of current 
 which seems to be called for, becomes a very important 
 part of the institutional treatment of inebriety. 
 
 In a general way it may be said that the electric cur- 
 rent is either a stimulant or sedative. Sometimes one 
 effect is more pronounced than the other, and in all 
 cases the sedative effect is secondary, and is apparent in 
 all forms of treatment. 
 
 The alternating current aids and increases the assim- 
 ulation and digestion of the patient, and should be used 
 in all after treatment as a tonic of exceeding value. Oc- 
 casionally persons intoxicated are restored at once by the 
 action of the electric current. In others stupor and
 
 TEEATMENT OF HOT AIR, VIBEATION, ETC. 283 
 
 narcotism is intensified. In other cases, irritation and ex- 
 treme restlessness follow. It is found that the static 
 breeze, the alternating currents and the auto-condensation 
 currents are most effectual after the baths and hydro- 
 pathic measures. 
 
 The electric current seems to have a more intense ac- 
 tion on the cells and nerves after the radiant light bath. 
 The fact should be remembered that the effects of elec- 
 tric currents, in almost any form, differ very widely in 
 neurotic cases. In the complex conditions which mark 
 inebriety, these various effects are still more pronounced. 
 
 It has been asserted that there has been a distinct 
 antagonism between the palsy of alcohol and the stim- 
 ulating action of the electric current. In some cases this 
 is very evident, where the electric current was given for 
 the purpose of breaking up the drink craze. In some 
 cases this effect was very marked. In others it was the 
 opposite, showing that the facts are not well known and 
 the enthusiastic praise and bitter condemnation is the 
 best evidence of this. 
 
 It is the experience of a large number of observers 
 that the continued use of the alternating current is a 
 very powerful tonic for all forms of local and general 
 inflammatory conditions, following and associated with 
 the use of alcohol. 
 
 There are many curious clinical facts which arise from 
 the use of electricity in the treatment of inebriety that 
 have not yet been formulated into general conclusions, 
 and at present do not seem to have been studied with 
 any degree of exactness. 
 
 Thus the nausea following the withdrawal of spirits 
 is often completely overcome by the electric current. 
 Alcohol is not tolerated if given immediately before or 
 after the electric current is used. The effects are nausea 
 and vomiting.
 
 INEBRIETY. 
 
 The headache and oppression preceding or following 
 the use of spirits may be greatly increased or diminished 
 by the electric current. In a periodic drinker the drink 
 craze was preceded by gastralgia and fear of cancer of 
 the stomach, and the electric current over this region 
 broke up this impression and with it all desire for spirits. 
 
 In another instance a constant drinker suffered from 
 extreme revulsion from the effects and odor of spirits 
 after the use of the electric current. This lasted for 
 some months. A static breeze in some instances was used 
 to overcome the delirium with success. In others it 
 greatly intensified it. An enthusiastic man attempted 
 to treat acute intoxication by the galvanic current. His 
 claims of diminishing the toxic period and shortening the 
 period of restoration was not confirmed by other ob- 
 servers. 
 
 There is undoubtedly associated with the electric cur- 
 rent a psychical influence, which charlatans frequently 
 take advantage of. A number of persons are reported 
 in which the influence and shock of an electrical current 
 has overcome the intoxication, and produced an intense 
 revulsion for spirits which continued for the rest of life. 
 
 One man asserts at great length that the toxaemic 
 conditions which follow from the use of spirits intensify 
 the passage of electric currents, and that the man in this 
 condition is more susceptible, has lower vitality, and more 
 quickly succumbs to the disturbing influence of the cur- 
 rent. 
 
 There are many facts in the experience of reliable au- 
 thorities that make it evident that the tonic and stim- 
 ulant properties of the electric current are a very valuable 
 remedy in all forms of inebriety, particularly when sup- 
 plemented by other means and measures. 
 
 The psychic element of fear and expectancy concern- 
 ing this agent must always be considered and made use
 
 TREATMENT OF HOT AIK, VIBRATION, ETC. 285 
 
 of, not only to neutralize the obsessions and idiosyncrasies, 
 but to increase the faith and confidence of the patient. 
 Undoubtedly it is a medical agency of great poten- 
 tiality which will be understood in the future from 
 further and more exact study.
 
 CHAPTER XXVII. 
 
 MENTAL THERAPEUTICS AND SUGGESTIONS IN THE 
 TREATMENT OF INEBRIETY. 
 
 Synopsis. Suggestion a very powerful measure in treatment. 
 Different theories of its permanency. Gold cure system of sug-. 
 gestion. A blundering effort to utilize forces. Common illustra- 
 tions of suggestion in temperance meetings. Reasons why they 
 are not permanent. All cases must be prepared for suggestion by 
 removing toxins, and placing the person in favorable conditions. 
 A study of each case will show how suggestion can be applied 
 with advantage. Methods by which suggestion can be made ef- 
 fectual. Illustrations. Failures of other measures. Preparations 
 and use of means encouraging the growth of suggestion. Church 
 clinics and their methods, failures. How they could be made ef- 
 fectual. Summary and possibilities of this form of treatment. 
 
 Several writers have affirmed very positively that sug- 
 gestion and hypnotic influences are most valuable in the 
 cure of spirit and drug-takers ; also that more cures fol- 
 low from this measure than from any other. 
 
 It has been stated elsewhere that the inebriate is cur- 
 able by apparently very unusual means, and that in all 
 probability the cure depends on some change in the 
 brain, and not on the last means used. The fact that 
 recovery dates from the application of some peculiar and 
 commonplace measures does not prove that it is the direct 
 result of these means. 
 
 Cures following the pledge or conversion are very 
 pronounced, and why they do not always occur when 
 the same means are used is a mystery. Some literature 
 giving records of cases cured by suggestion is very 
 startling, but attempts to repeat these experiences are 
 attended Avith so many failures as to discourage further 
 efforts. 
 
 One writer asserts that seventy-five per cent, of all 
 
 inebriates can be cured by hypnotism or suggestion. 
 
 286
 
 MENTAL THERAPEUTICS AND SUGGESTION. 287 
 
 The cure, he declares, will fail in at least sixty per cent, 
 after five years, and that not more than four per cent 
 of this number will be permanently restored. This state- 
 ment is not based on very careful studies, and evidently 
 is an opinion, which in a very general way outlines the 
 facts that indicate what an indiscriminate application of 
 such measures might possibly bring about. 
 
 There is no question whatever about the powerful in- 
 fluence of the mind over the body, and the possibility of 
 overcoming diseased impulses, breaking up obsessions and 
 checking toxins. In all efforts to overcome disease the 
 element of hope and confidence on the part of the patient 
 is a very essential remedial measure, and without it the 
 results are not certain or permanent. 
 
 The gold cure craze, which has attracted so much at- 
 tention in the past, was literally suggestion and so-called 
 hypnotic influences made impressive by the use of drugs. 
 When the patient was told emphatically that spirits were 
 poisonous and injurious, the demonstration by the use of 
 spirits containing nauseating drugs proved it. 
 
 Then by the use of narcotics in small quantities, at 
 short intervals, the impression of health and perfect re- 
 lease from the drink craze was built up. A final test, 
 giving spirits with apomorphia and explaining the phe- 
 nomena afterwards as distinctly that of poisoning, and 
 evidence that the patient could not use it in the future, 
 so impressed itself upon the mind of the patient that he 
 was for the time being cured. 
 
 Later, when he recovered to some degree, an effort to 
 confirm the early impressions proved that they were not 
 real, hence he relapsed. This great empiric wave in a 
 most blundering stupid fashion brought out the fact that 
 psychical therapeutics contain possibilities of cure be- 
 yond any conception.
 
 288 INEBRIETY. 
 
 The inebriate, with his disordered mentality and func- 
 tional instability, is very susceptible to mental impres- 
 sions, but their permanency depends on a great variety 
 of conditions which must be controlled with scientific ex- 
 actness. 
 
 The common illustration of gathering the drink degen- 
 erates from the street and urging them to sign the pledge 
 and be helped by prayer and conversion, shows a degree 
 of susceptibility and credulity which should be utilized 
 along different lines. 
 
 The reform waves of pledge signing and temperance 
 revivals, in which large numbers of persons acting on 
 suggestion change the course of their life for the time, 
 and make an attempt to live normally, all indicate the 
 value of psychical therapeutics. 
 
 Evidently, impressions made at this time have little 
 or no basis in mental vigor to sustain them. It is also 
 clear that there must be a certain degree of normal vigor 
 on which to build up suggestion and rouse latent im- 
 pressions to overcome diseased impulses. The inebriate, 
 coming under medical care, is always starved and pois- 
 oned, and nothing can be done for him until these con- 
 ditions are in a measure removed. 
 
 We have outlined the possibility of this by hydro- 
 pathic eliminative measures, together with electricity and 
 other remedies found useful in a general restoration 
 of both body and mind. In the meantime, a careful study 
 will show the presence of some peculiar and special ob- 
 sessions, such as the fear of death, remorse at his condi- 
 tion, the suffering he has caused his family and parents, 
 or the failure of his ambition for position or wealth, 
 and other states which can be called practically obsessions 
 or impulses which seem to dominate and distress him. 
 
 If to this there is the suspicious egoism that he has 
 no responsibility in this, but is simply the victim of con-
 
 MENTAL THERAPEUTICS AND SUGGESTION. 289 
 
 ditions imposed upon him, which he could at any time 
 have changed, and that his effort to stop is more to 
 gratify others than himself, a more pronounced state of 
 degeneration is present. 
 
 These peculiarities or obsessions indicate the direction 
 which suggestion must take, and the form of the mental 
 therapeutics that is to be applied. At an opportune 
 moment after the patient has recovered to a certain 
 degree, and is in a moderately healthy state of mind and 
 body, he should be given a special treatment and told 
 that the object of this is to suggest to him some plans 
 and methods that will increase his future strength and 
 vigor. 
 
 If he has confidence in the physician he will enter into 
 this with great heartiness. He is then placed in a lux- 
 urious chair in a cheerful room and encouraged to relax 
 and open his mind to a confidential talk. Then in a 
 monotonous quiet manner the physician will repeat the 
 leading facts of his life, asking him to correct or restate 
 them, being careful not to dwell on any particular theory 
 which he may have formed. 
 
 The conversation going on in a quiet monotonous way 
 produces a degree of receptivity in which the physician 
 will suggest the destructive influences of alcohol and the 
 danger of its future use. This may be repeated over 
 and over, particularly having reference to the patient's 
 secret fears and sorrows, indicating how far he can over- 
 come these conditions and make them impossible in the 
 future. 
 
 Somnolence will appear after a time, and the patient 
 must be told to drowse or sleep, and during this quiescent 
 period the same idea should be reiterated over and over 
 again in clear, emphatic language. Then, if the patient 
 continues quiet, tell him to sleep and that you will 
 return in a few moments. The fact of sleeping is evi-
 
 290 INEBRIETY. 
 
 dence that the mind is influenced, and that the effect de- 
 sired is accomplished in some degree. 
 
 A day or two later give another similar treatment, 
 suggest the same line of thought, and encourage the pa- 
 tient to drowse or sleep. A very marked influence will 
 be noted after a few treatments of this kind. The pre- 
 vious conceptions of the patient will apparently change, 
 and a species of re-educating the mind and conscious- 
 ness will grow with each effort. 
 
 Where the patient does not fall into a sleep after these 
 suggestive talks, it is well to lay down the rules about 
 certain unimportant matters concerning diet, methods of 
 living and exaggerate their necessity, so that the mind 
 may be diverted from reasoning on what was said. 
 Where the patients are not actively receptive to these 
 influences it is well to find occasion for a warm bath, a 
 static breeze, with perfect relaxation before the treat- 
 ment, which should be at night so that the patient can 
 retire soon after. 
 
 In some instances it is wise to select a time of day in 
 which the patient seems to be most vigorous and anxious 
 to do everything that will assist towards his final cure. 
 In one instance a young man received a letter from his 
 mother in which she appealed to him to use every oppor- 
 tunity to make his recovery permanent; it was noticed 
 that this was the most favorable time for hypnotic sug- 
 gestion. 
 
 He was taken to his room and in a very short time, 
 after listening to the monotonous iterations of the physi- 
 cian, fell asleep ; then was given emphatic instructions 
 about what he must do. He was allowed to sleep until 
 he awakened naturally. Baths and soothing measures 
 were given in anticipation of the weekly letter from his 
 mother to make his condition more favorable for the
 
 MENTAL THERAPEUTICS AND SUGGESTION. 291 
 
 growth of powerful impressions. His recovery was per- 
 manent, and his life has been very exemplary for years. 
 
 In another instance an ambitious man who began to 
 drink in college life, and whose drinking had been a con- 
 tinuous obstacle to his promotion and success, came under 
 treatment in a condition of great despair. After a few 
 weeks of vigorous treatment he recovered and reached a 
 stage where he wished to get well to please his wife and not 
 for himself. 
 
 He was given vigorous outdoor exercise, then a static 
 breeze and warm bath and taken to a quiet room where 
 suggestive treatment, particularly enforcing the idea that 
 he should recover to save his wife from sorrow. This 
 was usually followed by sleep and great satisfaction after- 
 wards. The treatment was given every other day. Grad- 
 ually the suggestions widened with the fact that he could 
 not drink and that his future could be made brighter 
 than ever by abstinence from drink. The results were 
 very satisfactory, and his restoration was pronounced. 
 
 In another instance, in which a patient believed that 
 his drinking was due to failures of his friends to appre- 
 ciate his strength, various hypnotic treatments had been 
 tried with failure. He had been a college athlete and 
 had neglected to keep up his former exercise. On ad- 
 mission he was put in physical training, walked every 
 day, took vigorous baths with electrical treatment. In a 
 short time psychical suggestion was tried and found to 
 be very effective. He fell asleep quickly and the sug- 
 gestions made to him at this time produced a decided 
 change in his delusions. Every other day he was given a 
 suggestive treatment and was told that his delusions con- 
 cerning alcohol must disappear, and that his egotistic 
 opinion of his ability to control himself was wrong. His 
 future depended entirely on his use of means. It was
 
 292 INEBRIETY. 
 
 noticed that he was conscious in a measure of what was 
 said, but he affirmed that he had changed his mind and 
 was now going to live differently. He recovered. 
 
 In each case the object was to secure perfect relaxa- 
 tion and a degree of vigor that would respond and would 
 not in any way be interfered with by any physical 
 condition. Constipation from indigestion was treated and 
 overcome before suggestion was given, and every possible 
 means used to secure the best vigor of the body, so that 
 it would not interfere with the influence of the mind. In 
 one instance a drinking man had become practically in- 
 capacitated for all work. Christian Science healers made 
 very strenuous efforts to help him, but failed. It was 
 noticed that they paid little regard to his present con- 
 dition, but sought to overcome his obsession for drink 
 by suggestion and appealing to his fears. The result 
 was skepticism, doubt and despair. 
 
 Coming under treatment he was found to be very sus- 
 ceptible to the Turkish bath and fell asleep after reclin- 
 ing in the cooling-room. Sometimes this sleep lasted for 
 hours. During this period suggestion was given to him 
 of which he was not conscious afterwards, saying that he 
 did not remember of anyone talking with him. 
 
 Later a special suggestive conversation was begun 
 after the bath, and continued up to the time when he 
 went to sleep. After a few treatments of this kind he 
 announced most emphatically that he had lost all taste 
 for spirits, and would not under any circumstances allow 
 the idea to come into his mind. Evidently he outgrew 
 his old condition, and after a few weeks' treatment went 
 out cured. 
 
 Another instance brings out the fact in a more prac- 
 tical way. A business man, who drank every night to 
 procure sleep, was advised to go to the Turkish bath in
 
 MENTAL THERAPEUTICS AND SUGGESTION. 293 
 
 the early part of the evening, then go to his home and 
 be given a suggestive treatment while lying in bed. The 
 physician who gave the treatment followed it with strych- 
 nine and atropia tonics and very minute directions con- 
 cerning his living and work during the day. The bath 
 at night was to be followed by a warm shower. The 
 result was permanent recovery. 
 
 A physician who drank to great excess went to the 
 home of a quack, where the same practical treatment 
 was given, principally warm baths and massage, then 
 suggestion and sleep. He recovered and was most en- 
 thusiastic over the means used, although ashamed of 
 having been under the care of such a person. 
 
 A distinguished professor, who makes suggestion a 
 large element of treatment, refuses to do anything for a 
 patient who is using spirits, but urges that they become 
 sober, take a bath and attain some degree of normal 
 vigor before he will apply any suggestions. 
 
 In the various church clinics, where sleep is supposed 
 to favor the reception and permanency of the impression, 
 various drugs are used to produce conditions favorable 
 for this state. This seems very doubtful practice, and 
 open to serious objections. 
 
 A warm bath, an electrical breeze, or a lucodescant 
 light up and down the spine would furnish far more 
 favorable conditions for hypnosis. Partial or complete 
 drug sleep can not in the nature of things be a con- 
 dition where impressions from without can have any 
 permanency. Patients poisoned by toxins, either from 
 spirits or formed from conditions within, are in unfavor- 
 able conditions for mental treatment. 
 
 At one of the church clinics a gormand was very 
 anxious to be directed how to overcome the depression 
 and gloom which incapacitated him. The operator ad-
 
 294 INEBRIETY. 
 
 vised him to go to a sanitorium and take active treat- 
 ment, and then come to him for suggestion. This re- 
 sulted in recovery. 
 
 In an institution where the surroundings can be con- 
 trolled, and where the patient's habits of living can be 
 regulated, suggestive treatment can be made very prac- 
 tical, but it is always wise to be frank, and under no 
 circumstances deceive the patient as to the purpose and 
 object of the methods to be used. 
 
 If the patient possesses more than usual intelligence, 
 explain to him the use of mental measures and how far 
 they are dependent on physical conditions, and then in- 
 sist on every means to prepare his mind and body for the 
 reception of impressions that are given. 
 
 If somnolence follows, it should be encouraged, and 
 often the subsidence of consciousness opens greater fa- 
 cilities for impressing the subconsciousness. Sometimes it 
 is well to prepare the patient's mind by suggestions and 
 statements in advance, calling attention to certain results, 
 mental contagions, which follow directly, and then lead 
 up to an effort to use this as distinct medicine- 
 It is found that relaxation, both physical and mental, 
 are very largely essential in awakening the subconscious 
 and giving it a special power to control the organism 
 and its obsessions. In making impressions or suggesting 
 lines of conduct, it is quite necessary to bear in mind 
 the delusions or peculiar conceptions of the patient con- 
 cerning his own condition. Anything that antagonizes 
 these former impressions will excite rather than soothe. 
 
 Hence impressions must be along lines that direct the 
 mind out into other and better conditions. After a few 
 treatments a degree of confidence is established, then the 
 physician can suggest lines of conduct that at first would 
 not be favorably received. It is not necessary to have
 
 MENTAL, THERAPEUTICS AND SUGGESTION. 295 
 
 the patient in a sleeping state, although this is much 
 more favorable. 
 
 Efforts to produce sleep by colored lights passed over 
 the forehead, pressing the eyelids down, and other meas- 
 ures are all practical in certain instances, and should be 
 used according to the conditions of the patient and his 
 susceptibility. 
 
 In this general summary the facts to be made prom- 
 inent are these: Many inebriates cannot only be helped, 
 but permanently cured, by psychical therapeutics; but 
 they must be used along rational lines and in most fa- 
 vorable conditions. Every physician should be com- 
 petent to understand and use these psychical laws, and 
 make them contribute toward the restoration of the 
 patient. 
 
 It is altogether likely that suggestion, meaning by this 
 Avord, mental impressions of every kind, has a great deal 
 to do in the growth of inebriety, and it is absolutely 
 certain that the same forces, properly used, will be of 
 immense help in the prevention and cure.
 
 CHAPTER XXVIII. 
 
 HISTORY OF THE EMPIRICISM CONNECTED WITH 
 INEBRIETY. 
 
 Synopsis. Empiricism associated with every great truth. 
 Early efforts to cure inebriety by secret remedies. Work at 
 Binghamton Asylum. Cinchona bark cure. The first great 
 specific came from publication of The Journal of Inebriety. Its 
 accidental publicity. Methods of promoting- it. The interest and 
 excitement which followed. An expectancy in the public mind, 
 and failures to give relief by other measures prepared the way 
 for this means. Methods of promotion and efforts to keep the 
 scheme before the public. Appearance of rivals. One of the most 
 prominent and the methods used. Their activity and final fail- 
 ures. Physicians responsible, by indifference for the growth of 
 these schemes. A second great rival, promoted as a stock com- 
 pany. Methods used. Promissory notes of poor patients and re- 
 spectability of board of managers made a fortune for the pro- 
 moters. Efforts to extend the work to Europe, and the failures. 
 A suit In the U. S. Court, in which the early history of these 
 means became permanent records. Drugs were common and well 
 known. Contained nothing new. Certain number of persons 
 benefited. On this the claims of the institutions were supported. 
 Drug cures contained the drugs concealed. Physicians are often 
 deceived. Hospitals of the country show an increasing number 
 of persons who come for physical treatment. The chief promot- 
 ers of these schemes were victims themselves, and many of them 
 are dead from the very means which they claimed to have dis- 
 covered as specific cures. 
 
 A study of the various means of treatment used in 
 inebriety would be incomplete without reference to the 
 empiric methods and so-called specific remedies which have 
 attracted so much attention during the last few years. 
 
 Some details of these movements will be exceedingly 
 interesting as historic facts, showing that every advance 
 in science brings into prominence charlatans who seek to 
 secure some personal advantage from these movements. 
 
 As early as 1850 there appeared advertisements for 
 secret remedies for the cure of the drink craze. It was 
 evident that some one had caught the idea of physical 
 treatment by drugs, and customers were found. 
 
 During the war of the sixties the Binghamton institu- 
 tion appeared and drug treatment became a recognized 
 296
 
 HISTORY OF THE EMPIRICISM. 297 
 
 method of cure. The inebriety that followed the disband- 
 ing of the armies attracted a good deal of attention, and 
 quack curers came into greater prominence, but none of 
 them seemed prosperous. 
 
 In the early seventies a cinchona bark cure created a 
 great deal of interest, and was urged by physicians as 
 having a specific value. Extravagant claims were made 
 for it, but when subjected to scientific scrutiny and test, 
 were not confirmed. 
 
 Temperance work, both prayer and the pledge, were 
 pressed in all directions as giving the largest hope for 
 restoration. The unsatisfactory results which followed 
 from them, together with the desultory efforts of physi- 
 cians by special drugs or system of treatment, prepared 
 the public and created an expectancy that some time a 
 remedy would be found. 
 
 In the latter part of the seventies The Journal of In- 
 ebriety published a paper by a physician in Moscow, 
 Russia, which claimed very unusual results, for the treat- 
 ment of inebriety by the use of strychnine and atropia 
 given by the needle. 
 
 This attracted the attention of an advertising physi- 
 cian, who claimed to have discovered a specific cure for 
 epilepsy, and whose positive assertions were startling. A 
 correspondence followed between the editor of the Journal 
 of Inebriety and the physician, in which various sugges- 
 tions were offered, and possible effects from certain com- 
 binations of new remedies were proposed. Later this 
 physician announced the discovery of a specific with an 
 attractive name for the cure of inebriety and epilepsy and 
 other diseases. 
 
 After a time all other claims were dropped, and it was 
 announced that a specific for inebriety had been discov- 
 ered. For a time his assertions attracted no attention,
 
 298 INEBRIETY. 
 
 and his claims of cures by secret drugs seemed in no way 
 different from other empirics. 
 
 Then suddenly the pages of one of the leading news- 
 papers of the country were filled with the statements of 
 two persons who had been treated by this method and 
 fully recovered. Their experience and opinions were de- 
 tailed at length with more or less shrewdness. 
 
 This immediately attracted attention and a number of 
 inebriates made a test of the treatment, and they, too, 
 announced most enthusiastically the reality of the claims, 
 and the marvelous discovery of a new drug that would 
 destroy the drink craze at once. 
 
 The news spread far and near, bringing with it a 
 number of persons in all stages of the drink craze, who 
 after four weeks' treatment went out, proclaiming the 
 reality of the cure, and most enthusiastically urging oth- 
 ers to take the treatment. 
 
 The statement was published far and near that a new 
 discovery had been made, the evidence of which was the 
 statements of so-called cured patients. The public had 
 been prepared for this in many ways and a great number 
 of persons sought this new treatment. 
 
 The managers, while greatly surprised at the sudden 
 prominence and rush of patients, realized at once the 
 necessity of taking the golden tide at its flood, and 
 keeping the commercial side prominent. Large fees were 
 charged and patients were encouraged and paid to ad- 
 vertise the work, and prove its possibilities in every di- 
 rection. 
 
 Rights were sold to use the drug in certain sections of 
 the country, and open other institutions, for its adminis- 
 tration. The original institution was to supply the drugs 
 used and keep up the mystery, and no one was to know 
 what the drugs used were.
 
 HISTORY OF THE EMPIRICISM. 299 
 
 Appealing to both the philanthropic and commercial in- 
 stincts of the country and particularly to the great army 
 of inebriates and reformers, they succeeded in opening 
 institutions in almost every state of the union. Physi- 
 cians who were inebriates took the treatment and entered 
 with great eagerness into the work of curing others, ac- 
 cepting the statements of the promoters, regardless of 
 ethical principles or the want of exact knowledge. 
 
 A wave of the most extravagant credulous expectation, 
 exploited by duplicity and cunning swept over the coun- 
 try. The claims of a new discovery and new remedy, and 
 the evidence of it in the number of cured cases, were 
 pressed to the fullest extent, and all efforts to secure ac- 
 curate information concerning the means and the drugs 
 used, were suppressed. 
 
 Rivals appeared following the same lines, having new 
 and more perfect remedies, all making the same claims, 
 only differing in name and ways of promotion. One of 
 these rivals deserves a special mention for the shrewdness 
 and audacity displayed. 
 
 Instead of having a central home and requiring pa- 
 tients to come for treatment, they went out into the 
 streets and police courts, and gathered the most incur- 
 able cases, giving them treatment in hired houses, close by 
 their homes. When such persons had lost all desire for 
 spirits and were buoyed up with the faith that they were 
 permanently cured, they became agents and promoters to 
 bring in other patients, particularly those who could pay 
 a fee for treatment. 
 
 These reformed men were given a cash commission, and 
 visited every section, wherever patients were found, plan- 
 ning and studying how they could secure money enough 
 to take the treatment, and posing as examples of the 
 great power of the drug.
 
 300 INEBRIETY. 
 
 In a short time a large number of patients were under 
 treatment and the enthusiasm had reached a high level. 
 Then the managers would organize a company to carry 
 on the work, hire a prominent house and place it in 
 charge of some local physicians, they furnishing the drugs 
 instructing the managers how to conduct the work, and, 
 giving them the strongest assurances of its permanence. 
 
 Sometimes they organized companies and sold their 
 stock. At other times they sold out their rights to carry 
 on the treatment. In this way many institutions were 
 organized and philanthropists and business men wjpre 
 greatly interested. At one time it was claimed that there 
 were over 300 homes in different parts of the country, 
 giving secret drug treatment, particularly representing 
 the original promoter and the great rival. These local 
 institutions, as a rule, left to the business ability and 
 judgment of reformed patients, failed, and as time went 
 on relapses increased, and the number of patients fell off. 
 Then came bankruptcy and disappointment. 
 
 The managers adopted disreputable methods to keep 
 the work going, and this hurried on their final failure. 
 Physicians who joined these various efforts both for per- 
 sonal and pecuniary motives lost not only their reputa- 
 tion but their money, and philanthropists and investors 
 likewise suffered. Tremendous efforts to keep the work 
 going only brought into promimence the false claims and 
 pretensions. 
 
 A second great rival should be noted for its greater 
 shrewdness and dishonesty. Claims were made, particu- 
 larly among the wealthier classes of persons, that a new 
 combination of drugs had been discovered which were 
 far more certain than anything ever known before, and 
 that its application had proven this beyond question. 
 
 Some very shrewd promoters saw an opportunity for 
 wealth in this field, and a company was organized with an
 
 HISTORY OF THE EMPIRICISM. 801 
 
 enormous capital, and a board of managers, trustees and 
 officers of the highest respectability and commercial stand- 
 ing. The idea was pressed that at last a new reform 
 work had come which, while curative and beneficial to the 
 poor, who could be treated free, it would be made profit- 
 able by charging liberal sums to those able to pay. 
 
 It was the same secret drug given by the needle, ac- 
 companied with the most extravagant assertions and ex- 
 pectations, uttered in church and in public press, and 
 accepted as the last final discovery in the world of sci- 
 ence. 
 
 Promoters were sent to the poorer sections of the large 
 cities and drinking men of every grade were given four 
 weeks' treatment, and in return signed promissory notes. 
 These notes were placed among the assets of the company, 
 and used to show the enormous profits and promote the 
 sale of stocks. 
 
 Vast sums of money represented by these notes were 
 accumulated, while the actual income in cash was not 
 sufficient to pay current expenses. This the promoters 
 concealed and stock was sold to reformed patients and the 
 families of persons in which drinking men existed. 
 
 Business men and speculators interested in the problem 
 all took stock. The eminent men on the board of direct- 
 ors and the exceeding respectability and plausibility of 
 the whole scheme resulted in the sale of over a million 
 dollars' worth of stock. A large part of this was cash. 
 Then suddenly the promoters realized on the stock, sold 
 out and disappeared, and the board of directors who had 
 given their names and influence to the promotion of this 
 scheme withdrew in disgust, leaving only a few persons 
 who had invested all their capital in the company, to con- 
 tinue the work, and if possible get some returns from the 
 wreck.
 
 INEBRIETY. 
 
 This scheme is still extant and its managers are selling 
 the prescriptions of the company to physicians with 
 rights to treat persons in different sections. As in all 
 the other specifics the remedies used were secret, and the 
 managers depended largely upon enthusiasm, and asser- 
 tions, and when the tide of success began to ebb, they de- 
 serted, or used such extraordinary efforts to avert the com- 
 ing storm, that in reality hastened it. 
 
 Another fatal element was the management by re- 
 formed or cured patients. They lacked consistency and 
 persistency, and while showing some shrewdness, were 
 reckless and assuming and depended upon the element 
 of secrecy and appeals to the credulity. 
 
 Of all the various schemes for the specific cure of in- 
 inbriety, this was the most disastrous financially to a 
 large number of persons, and reflected very seriously on 
 the credulity of a number of respectable men. 
 
 The original specific curers, in their desperation to hold 
 their own interests, went into court to force a rival to 
 pay damages for infringing on their name and methods. 
 Two long suits followed in the U. S. Courts in which the 
 various remedies, means of treatment and methods of in- 
 fluencing the public were brought out in great detail. 
 
 The result was, the case was dismissed on the ground 
 that both plaintiff and defendant were unclean in the 
 eyes of the law and using disreputable means to pro- 
 mote their own interests. The records of this suit are a 
 most interesting psychological study, both of the men 
 who promoted them, and the remedies used, together with 
 the various means and methods to keep up the interests of 
 the public and attract the attention of patients. 
 
 The specific drugs which they claimed to have discov- 
 ered have been repeatedly analyzed and found to be 
 combinations of well known remedies, containing nothing 
 new or unknown to the profession, although the promoters
 
 HISTORY OF THE EMPIRICISM. 808 
 
 still insist that they have discovered new drugs and new 
 effects. Many of these cures are still advertised and 
 thoughtless physicians, without knowledge of the sub- 
 ject, have been more or less responsible by sending 
 patients to them, or permitting them to go, and thus 
 keeping the work alive. Many relapsed patients still go 
 to these places. The public, without any particular in- 
 formation, give a sort of a quasi-recognition of their 
 existence. 
 
 Out of these empiric efforts there has grown a wide 
 spread sentiment that inebriety can be cured by physical 
 means and methods. This is based not only on the result 
 of the empiric means used, but other evidence which is 
 accumulating in every direction. 
 
 All the large hospitals and various sanatoriums and 
 homes for nervous people receive such patients, and pro- 
 vide special wards for them, and relapsed cases go from 
 place to place with confidence and promise of restoration. 
 Many of the opium cures which have come up within 
 the last twenty years are merely different forms of opium 
 concealed in other drugs and offered as specifics. They 
 have never retained any prominence, although from the 
 advertisements, they are still patronized, but there is no 
 general endorsement of them. Repeated exposures of 
 their disreputable methods have very little influence, ex- 
 cept to advertise them. 
 
 Lists of opium takers are compiled and sold from one 
 institution to the other, and the army of repeaters going 
 from one place to another are very numerous. 
 
 Out of all these quack measures and means a few in- 
 stitutions have emerged claiming to do legitimate work on 
 ethical principles, using rational means and measures. 
 They are, as a rule, managed by a different class of men 
 from the early promoters.
 
 304 INEBRIETY. 
 
 On the continent, the empiric alcohol and drug curers 
 were forced by law to register the exact drugs used. 
 This was to be open and free for the observation of any 
 one. As a result they were not prosperous, although a 
 number of drugs are advertised, and some sent to this 
 country, with very pretentious claims. 
 
 The quacks in England had no restrictions, but the 
 conservatism of the country made it impossible to get any 
 prominent recognition. There are at least a dozen very 
 shrewdly named combinations of drugs, advertised to cure 
 the drink craze at home, and without any publicity. 
 They have repeatedly been analyzed and exposed, but 
 this does not seem to make any impression on their ap- 
 pearance in the public press. The empiric treatment of 
 inebriety is rapidly passing away, and the public have 
 lost confidence in anything that depends on secrecy and 
 pretention. 
 
 Yet the continued finding of new drugs and continued 
 pretensions of new discoveries show that the element of 
 credulity has not died out. It is a curious fact that 
 many of the great promoters of these different schemes, 
 particularly those who posed so prominently before tLe 
 public, died from the disease for which they claimed to 
 have found a cure. 
 
 Others disappeared and their loud pretentious claims 
 are matters of history. The future historian of the great 
 superstitions and empiric waves of the century will in- 
 clude the alcohol specifics, and the credulity and excite- 
 ment which followed from it, as among the great events of 
 the closing years of the century.
 
 CHAPTER XXIX. 
 
 CRIMINAL INEBRIATES AND MEDICO-LEGAL 
 SUPERSTITIONS. 
 
 Synopsis. Confusions of medical testimony concerning the 
 responsibility of inebriates. Constant conflicts between doctors 
 and lawyers. A summary of six different cases in which these 
 questions were settled on false theories and assumptions. These 
 examples represent a very large number of persons who are con- 
 tinually before the courts for crime committed while drinking. 
 The assumptions of the court and the strain to make the physi- 
 cians recognize these assumptions. The evident defects of the 
 brain from a spasmodic or continuous use of spirits. Crime the 
 natural result of the continuous or paroxysmal use of spirits, 
 resembling epileptoid paroxysms. No Inebriate can be regarded 
 as sane. No possibility of forming lines between sanity and in- 
 sanity. A matter of facts, not theories. Physicians should have 
 but one purpose in the court room, of presenting facts no matter 
 what the conclusions may be. He should act judicially and never 
 be forced into explanation, where only theories can be used as a 
 guide. Some of the delusions in a court room when questions of 
 responsibility are raised. General considerations and summary 
 of what is required. 
 
 The medico-legal relations of inebriates accused of 
 crime are most confusing. Theories both ancient and mod- 
 ern are reiterated with dogmatic confidence and both 
 judge and juries are hopelessly involved and have most 
 confused ideas of inebriety and its relations to responsibil- 
 ity and crime. 
 
 As an illustration of the conflicts between facts and 
 theories, records of six different homicides are selected, 
 where the questions of responsibility and the conditions 
 present were the subjects of some controversy. These 
 cases are in no way different from others which are con- 
 stantly coming under legal recognition. 
 
 In each of these examples the prisoner was convicted 
 and suffered the extreme penalty of the law. In each 
 there was a pronounced history of using spirits to excess 
 
 before and also at the time the crime is committed. The 
 
 305
 
 306 INEBRIETY. 
 
 defense in each case was insanity from inebriety and al- 
 coholism, with incapacity to judge of the nature and 
 consequence of the acts. 
 
 The prosecution urged that the use of alcohol in no 
 Avay lessened the responsibility of the prisoner, or dimin- 
 ished the average mental capacity to realize the nature 
 and consequence of the act. They also urged that the 
 use of alcohol must be considered as evidence of some 
 motive and not of impaired sanity. 
 
 The judges clearly sustained the verdicts of the jury 
 and congratulated them on the equity and justice of their 
 findings. One judge, in his sentence, predicted that when 
 inebriates realized the majesty of the law which would 
 permit no excuse, but hold them accountable, such crime 
 would be lessened. 
 
 Other judges were harsh or pathetic in their sentences, 
 all believing that the prisoner was accountable, and could 
 have controlled himself if he wished. The medical testi- 
 mony to the prosecution was a strange mixture of theories 
 and delusions concerning inebriety and the acts of per- 
 sons under its influence. 
 
 Nearly all the witnesses believed that a man, unless in- 
 toxicated was accountable, could reason wfsely and had 
 the power of control, and the legal conceptions of insan- 
 ity and inebriety were regarded as exact proofs which 
 science could and dare not deny, but must confirm. 
 
 The prosecution made very emphatic the theory that 
 intoxication under no circumstances could be an excuse 
 for, or urged in defense of, crime, and the medical wit- 
 nesses of the prosecution seemed to bring their facts down 
 to fit these conclusions. A grouping of some of the main 
 facts of each case will bring out more clearly the errors 
 and mistakes. 
 
 In the first case, as in all others, the physicians were 
 made to acknowledge that they knew the teaching of the
 
 CRIMINAL INEBRIATES. 307 
 
 law, that intoxication was no excuse for crime. Starting 
 from this point the great effort seemed to be to keep 
 down all testimony that conflicted with this dictum. 
 
 The facts in the prisoner's history were that he came 
 from a degenerate family in which insanity, inebriety, 
 pauperism and idiocy had appeared in many members. 
 He had been an inebriate tramp, had suffered from de- 
 lirium tremens, sun stroke and typhoid fever. 
 
 In occupation he was a gambler, a hotel manager and 
 a hack driver, and lived very irregularly. He drank 
 daily, but seldom to intoxication. One day after an al- 
 coholic excess he threatened to kill a man. The next day 
 while intoxicated he renewed that threat, and the third 
 day he sought and killed the man. 
 
 While drinking to excess continuously, he was seldom 
 stupid. At the trial two expert physicians swore that he 
 had full power of realizing the nature and consequence 
 of his acts. As he Avas driving a hack at the time, and 
 acted rationally, he could not have been insane or uncon- 
 scious of what he was doing. They called alcohol a 
 stimulant and doubted its paralyzing action, except in 
 excessive doses. In defense the prisoner was called an 
 alcoholic dement. 
 
 In the second case the prisoner killed his brother. He 
 claimed to have no recollection of the act, or what had 
 happened for a day or so before and only recovered his 
 memory after being in jail for forty-eight hours. He 
 was a periodic inebriate and had been drinking every 
 night for two weeks. 
 
 During this time he begged money and when refused 
 declared he would have it if he had to kill some one. The 
 next day his brother was found murdered, and he was in 
 possession of money. He had served in the army in 1864 
 and had drunk from that time, at intervals, living a very
 
 308 INEBRIETY. 
 
 irregular life. His father was an inebriate and his 
 mother died in an insane asylum. 
 
 On the trial, several physicians swore that he was of 
 sound mind and fully capable of knowing what he did, 
 even when under the influence of spirits. On the other 
 side, the medical testimony showed that he was insane and 
 delusional, and could not have been conscious of the con- 
 sequence of his act. 
 
 In the third case, a man of more than usual ability, 
 after an injury from a railway accident, became a low 
 inebriate, worked as a barkeeper, pawnbroker, drank 
 continuously, and was never delirious or stupid. 
 
 Finally he killed a low woman companion and ran 
 away. Minute evidence of his unchanged appearance, 
 both before and after the act, was presented, and the same 
 clash of medical testimony appeared. One declared him 
 sane and the other insane. 
 
 Case four was of a low drinking Italian laborer who 
 drank every night to a stupor, and worked during the 
 day time with apparent consciousness of surroundings. 
 He killed the barkeeper who refused to sell him more 
 spirits. The same testimony was offered by medical wit- 
 nesses for the prosecution and defense. 
 
 The fifth case was of an inebriate who murdered his 
 wife. He had been a periodic inebriate for many years 
 and lately had had delusions of his wife's infidelity, that 
 were never manifest, except when the man was drinking. 
 In the free intervals there was apparent sanity, but while 
 drinking he was suspicious, violent and intensely irritable. 
 The same conflicting testimony declared him sane and 
 insane. 
 
 The sixth case was a farmer, who drank cider brandy 
 continuously for years, and in a rage at his brother-in- 
 law, who was trying to help him, shot him. The history 
 showed a marked decline of both mind and body for a
 
 CRIMINAL INEBRIATES. 309 
 
 long time before the homicide, and on the trial he was 
 apathetic and stupid. 
 
 In three of these cases the medical evidence offered 
 showed the irresponsibility of the criminals who were more 
 or less exhausted, and yet the impression was created that 
 it was simply paid testimony and did not represent the 
 facts. 
 
 One medical witness declared that alcohol was always a 
 stimulant and could not be called poisonous except in 
 extremely large doses. The old theory of the right and 
 wrong test, and the capacity to control, with free will as 
 to the nature of the acts, was pressed to the fullest ex- 
 tent. 
 
 The assumption of capacity and responsibility was 
 based on the fact that the act was not performed in a 
 stupid wildly intoxicated condition, hence the person knew 
 what he was about. 
 
 The idea was prominent in many of the cases that a 
 defense of insanity must depend on the delirium, idiocy 
 or evident dementia of the person, and unless these symp- 
 toms are very pronounced, there could be no claim of ir- 
 responsibility. 
 
 The idea was pressed, although sharply denied by some 
 of the medical men, that a number of thoroughly insane 
 men exhibit a degree of mental acuteness and vigor, fully 
 equal to that of most sane persons. This idea was 
 treated as fiction. 
 
 In each one of these cases the evidence of irresponsibil- 
 ity was founded on a distinct chain of facts that could 
 have no other interpretation. Thus in the first case a 
 marked heredity and distinct psychosis, intensified by a 
 sun-stroke and the continuous poisoning of alcohol was 
 unmistakable. 
 
 In the second case a neurotic inheritance coupled with 
 explosive drink paroxysms and consequent failures to
 
 310 INEBRIETY. 
 
 reason accurately concerning the nature and conduct of 
 his acts was undoubtedly present. 
 
 In case three a distinct injury to the brain was followed 
 by a pronounced change of symptoms and character, and 
 the sequel showed a diseased brain. 
 
 The other three cases had equally pronounced symp- 
 toms of disease, only they were not studied. In all these 
 cases there was an automatic activity that was mistaken 
 for sanity. The principle fact of excessive use of alcohol 
 both as a cause and symptom of previous conditions, es- 
 caped the attention and was not considered. 
 
 It is a fair assumption that these six cases represent a 
 very large class of persons that are continually coming 
 before the courts, and are judged by theories and legal" 
 opinions that have no support in modern facts. To 
 assume the sanity of any person who uses spirits to excess 
 at intervals or continuously is not supported by the facts. 
 
 The continued depression and temporary exaltation of 
 the heart and functional activities must of necessity im- 
 pair not only the power of control, but the capacity to 
 reason from the impaired impression of the senses. 
 
 To assume that toxaemias from alcohol are a mere tem- 
 porary derangement of the same class as indigestion, ex- 
 haustion from muscular work, is untrue and dangerously 
 misleading. 
 
 The result of accurate experiments shows that very 
 small quantities of spirits have a measurable paralyzing 
 action on both the senses and functional activities of the 
 body. It is obviously impossible to continuously depress 
 all the vital functions of the mental and physical organ- 
 ism and retain health. 
 
 Beyond this there is a wide realm of favorable soils 
 and conditions which intensify the depressing action of 
 alcohol, and produce states of exhaustion which call for 
 relief for' which alcohol is the most grateful remedy.
 
 CRIMINAL INEBRIATES. 311 
 
 It has been shown elsewhere that in at least one-third 
 of all inebriates, the use of alcohol is a symptom of some 
 brain defect, either congenital or acquired, or some latent 
 tendency to exhaustion, which is manifest in the craze for 
 spirits. 
 
 Not only is it a symptom, but an acute exciting cause 
 of pronounced degenerations and defects. It is very evi- 
 dent that a man with defective heredity, or a distinct 
 neurosis, who begins to drink, has started on a career of 
 pronounced degeneration. 
 
 In addition to this, the well known fact, that in all 
 instances every small dose of spirits has a distinct meas- 
 urable effect en both the senses and reasoning, is almost 
 conclusive of the unsoundness of persons in this condi- 
 tion. 
 
 The continuous drinker is, of course, much more im- 
 paired than one who uses spirits at intervals with periods 
 of rest between them. The intoxicated man is clearly in- 
 sane. While this may apparently be transient there can 
 be no question of its profound impairment of the power 
 of sane thought and act. 
 
 Rational acts and conduct must be automatic, particu- 
 larly along accustomed lines. Outside of that the ca- 
 pacity of the brain to appreciate and judge of the condi- 
 tions is weakened. 
 
 The clinical facts do not sustain the assumption that 
 the effects from continuous or transient use of alcohol are 
 temporary and easily overcome. The question of how far 
 the person was unable to understand the nature and con- 
 sciousness of his acts, or if he did understand them had 
 the power of control, must be decided according to each 
 individual case. The recognition that alcohol paralyzes 
 the higher functions of the brain, particularly conscious- 
 ness and the recognition of right and wrong would seem
 
 812 INEBRIETY. 
 
 to make it one of the most positive agents known to pro- 
 duce conditions of insanity. 
 
 The depression of the senses is also another very sig- 
 nificant fact, suggesting delusions and hallucinations of 
 all descriptions. Amnesia is another most significant con- 
 dition. Thus physiologically the evidence would seem to 
 be very pronounced that all inebriates are impaired and 
 mentally unable to sanely comprehend the conditions of 
 surroundings and their relation to them. 
 
 Crime would be a most natural result, and this is found 
 to be the case. The more prominent the inebriety and 
 the longer its duration, the greater the incompetence of 
 the brain to act rationally and soundly. The effort to 
 find a dividing line where sanity and insanity joins, or 
 where persons in this condition realize their acts, and have 
 the power of control, is an absolute impossibility. 
 
 All crime committed by inebriates and persons under 
 the influence of spirits is the result of brain defects, brain 
 unsoundness and weakness. Delusions, illusions and hal- 
 lucinations with morbid impulses gathering and breaking 
 like storms in the sky are the common conditions, inevi- 
 table from this soil. 
 
 The fact that all persons who drink do not commit 
 crime is largely a matter of accident with very few ex- 
 ceptions. Such persons have most favorable conditions 
 and soils for the growth of criminal acts. The inebriate 
 who suddenly is exposed to temptation, falls with little or 
 no resisting power. 
 
 Thus a moderate drinker, whose conduct as a book- 
 keeper in a large bank was beyond all question, when 
 promoted to a cashier and exposed to temptation, acted 
 most insanely and became a defaulter. The conditions 
 were the same in both, only different kinds of temptation. 
 
 The adjuster of a large insurance company became in- 
 volved in criminal acts and bitter controvcrsv. He was a
 
 CRIMINAL INEBRIATES. 813 
 
 moderate drinker and an inebriate, hence his brain was 
 impaired. A total abstainer, taking his place, adjusted 
 the claims without the slightest friction. 
 
 In court no claim of insanity would have been allowed, 
 for the acts of this adjuster, and yet he was obviously 
 unsound. The man who, under the influence of spirits, 
 talks of homicidal acts, only needs favorable circum- 
 stances to execute them. The same man who acts in a 
 most unusual unreasonable manner against his own inter- 
 ests is on the verge of doing some of the most insane 
 things without consciousness of them. 
 
 In the disputed cases that come before the court a care- 
 ful study should be made of the explosive epileptoid char- 
 acter of his conduct. There is always the possibility of 
 masked epilepsy or insane conduct as explosions of nerve 
 force. 
 
 A careful study both before and after the act that is 
 questioned will indicate how far the brain is impaired and 
 unconscious at the time. The subsidence of the acute 
 symptoms and the change of the person's manner and 
 conduct are always to be regarded with critical interest 
 and not to be considered as evidence of perfect sanity. 
 
 The intervals between the epileptoid paroxysms may be 
 automatic sanity and reasoning. The same is true of the 
 inebriate. His mental impairment is very evident from 
 the sudden change of conditions and strain of unusual 
 circumstances and surroundings, and exhaustive study of 
 the criminal in the prison is very often misleading. 
 
 The fact that no evidence of unsoundness is present 
 gives no indication of mental soundness under other cir- 
 cumstances and conditions. It is a legal superstition to 
 overlook the conditions which lead up to the crime, and 
 to regard the thought and conduct of the criminal, long 
 after the execution of the act as evidence of his previous 
 state.
 
 314 INEBRIETY. 
 
 The physician who is called to give evidence in the 
 case of a criminal inebriate, has only two facts to de- 
 termine. One, that of the condition of the prisoner pre- 
 vious to the crime, particularly his hereditary history and 
 his use of alcohol; the other, the character and nature of 
 the crime. 
 
 Opinions and theories as to the present condition of the 
 person are insignificant and should be regarded as of 
 minor importance. In the cases mentioned the physicians 
 called to give testimony in the defense of the prisoner 
 were asked to explain the wide difference between his pres- 
 ent condition and the alleged insanity at the commission of 
 the crime. 
 
 They failed to give sufficient prominence to the drink 
 history and to show the impossibility of mental soundness 
 after the use of alcohol. The delusion that insanity could 
 come on like a fit of sickness without any special predis- 
 posing exciting causes and pass off leaving the patient 
 sane and responsible again was made the stumbling-block 
 in many instances. 
 
 The real fact that insanity and inebriety were diseases 
 with beginnings, development and termination, following 
 distinct ranges of causes, and uniform lines of growth 
 was ignored. In place of this inebriety was regarded 
 as a transient moral weakness, always under control, and 
 insanity only apparent by pronounced symptoms of 
 mania and delusions. 
 
 It is farcical for a medical man on a witness stand to 
 be drawn into an explanation of metaphysical theories of 
 inebriety and questions of responsibility. He should al- 
 ways refuse to give an opinion on presumptuous cases 
 which involve a mixture of half facts based on moral and 
 legal theories outside of all clear tangible evidence. 
 
 He should refuse to give any explanation of motives, 
 or determine the capacity of control of any person under
 
 CRIMINAL INEBRIATES. 815 
 
 the influence of alcohol, or on the commission of certain 
 distinct acts. He should testify plainly of the incom- 
 petency of all persons poisoned by spirits to act sanely 
 and wisely under given conditions. 
 
 He should never be drawn into details, but be allowed 
 to give probable facts and the general conclusions from 
 such facts. The central questions should be: Was the 
 prisoner an inebriate in the general sense of that word? 
 What was the history of his drinking before and at the 
 time of the commission of the act? What was the nature 
 of the act and the conditions which lead up to its perpetra- 
 tion? What conclusions or general facts did they sug- 
 gest ? 
 
 If these facts sustain the natural history of continuous 
 alcoholic degeneration and defective reasoning with sense 
 perversions they must be regarded as supporting the 
 probability of disease of the brain and the unaccount- 
 ability of the act. 
 
 There can be no possible boundary lines where sanity 
 and insanity join, or where responsibility and irrespons- 
 ibility unite. If the history shows that toxoemic poisoning 
 and neurosis and psychosis are associated, the physician 
 must reason on general principles and not on possible 
 exceptions. The prisoner cannot be normal and sane with 
 a history of continuous unsoundness and perversion long 
 before the act was committed. Every year the facts are 
 becoming more and more prominent that crime by persons 
 who use spirits to excess are insanities in the broadest 
 sense of that word, and that all legal treatment founded 
 on theories before modern science had established the phys- 
 ical basis for crime is unjust. 
 
 Physicians and expert witnesses make a serious mistake 
 in attempting to harmonize facts and theories and give 
 exact interpretation of motives and conduct according to 
 historic conceptions of insanity and inebriety. It is a
 
 316 INEBRIETY. 
 
 legal fiction and delusion to suppose that crimes commit- 
 ted while under the influence of alcohol are voluntary acts 
 of a conscious brain. 
 
 It is a delusion to interpret acts that indicate premed- 
 itation, particularly in inebriates, as evidence of the 
 sanity and consciousness of their nature. It is a delusion 
 to consider inebriety a mere transient condition in which 
 the victim chooses to poison himself for years and at all 
 times has the power of restraint, and is always sane and 
 accountable. 
 
 It is a delusion to consider alcohol as a stimulant when 
 all scientific study contradicts this. It is a delusion to 
 suppose that the man who is not wildly stupid or intox- 
 icated from the use of spirits is able to control himself 
 and reason accurately concerning his surroundings. 
 
 It is a sad delusion of the law when it insists on fixing 
 boundary lines of responsibility and irresponsibility, and 
 brings medical men into this penumbraeregion of sanity 
 and insanity to draw lines and indicate where human 
 justice should punish and where it should remit crime. 
 
 The medical man on the witness stand should be the 
 same as at the bed-side. The questions are those of facts, 
 not of the theories, but of present conditions and their 
 meaning. 
 
 The frequent criticisms of lawyers of the unreliability 
 of expert testimony grows out of the foolish efforts of 
 physicians to harmonize facts and theories and point out 
 in detail conclusions which could only be determined from 
 a very long and exhaustive study. 
 
 The physician in the court room should be a scientific 
 teacher with no other thought than the facts and their 
 sequences, irrespective of all antagonism to theories.
 
 CHAPTER XXX. 
 
 FORMS OF IRRESPONSIBILITY, ALCOHOLIC AMNESIA, 
 CLAIMS OF PRISONERS, ETC. 
 
 Synopsis. Statements of no memory in inebriates likely to be 
 true. Amnesia more or less common in inebriates. Often the 
 lapses of memory can be verified. Very commonly seen in alco- 
 holism, inebriety and epilepsy. Often traced to epilepsy, traumata 
 and shocks. Persons suffering from this condition act and talk 
 sanely, seldom giving evidence of no memory. They act auto- 
 matically. The condition is one of central brain paralysis. If 
 the patient has been insane in the past, and is degenerate and 
 suffering from neurotic disease this condition may be expected. 
 Some examples given. One of kleptomania. Third of homicide. 
 The fourth of forging. These examples were verified by ample 
 testimony. Examples of cases where the claim of no memory 
 could not be verified. Several classes of inebriates evidently 
 suffer from this form of palsy. One class marked by degenera- 
 tion, heredity, psychosis. A second class where the crime is ex- 
 plosive and maniacal. A third class where the crime is sudden and 
 precipitous. This resembles masked epilepsy. Some practical 
 questions to be considered. The claims of no recollection should 
 be the subject of careful study to verify or disprove. The im- 
 portance of the subject. The danger of such persons. A sum- 
 mary of the facts to be considered in a study of these cases. 
 
 The frequent statements of prisoners in court, that 
 they do not have any recollection of the acts or crime 
 they are accused of, is found from exact study to be both 
 a pathological and physiological fact. While the evidence 
 may be uncertain in many instances, it is unmistakable 
 in others, that crime is committed without a conscious 
 knowledge, or memory of the acts and conduct at the 
 time. 
 
 It is a well recognized fact that in certain states of the 
 brain that are not understood, memory is palsied, and the 
 mind fails to register the events for certain distinct peri- 
 ods. Like the somnambulist, a person may seem to realize 
 his surroundings and show a certain consciousness in his 
 acts and later be unable to recall anything which has hap- 
 pened. 
 
 317
 
 318 INEBRIETY. 
 
 These lapses of memory occur in many disordered states 
 of the body and brain, but are usually of short duration, 
 and seldom attract much attention. Often persons are 
 unable to recall what they did at such a time, but long 
 afterwards, the events are recalled very distinctly. 
 
 These memory blanks or amnesias have been noted more 
 commonly in cases of epilepsy, inebriety and alcoholism. 
 They evidently occur in many other conditions, and are 
 sometimes traceable to poisons, traumata and shocks. In 
 inebriety, they are always associated with the moderate 
 or excessive use of spirits. 
 
 Such persons go about, acting and talking sanely, 
 giving little or no evidence of brain disturbance, other 
 than that of mild stupor or excessive activity, and ap- 
 parently conscious of events and their surroundings. 
 Later they awake and deny all recollection of acts or 
 events for a certain period in the past. 
 
 This period to them dates from a certain point and 
 ends hours or days after, the interval being a total blank 
 like that of unconscious sleep. In the meantime automatic 
 brain activities go on as usual. The paralyzing action 
 of alcohol evidently centers on some brain areas, and later 
 passes away. In the meantime registration of events is 
 suppressed. 
 
 The claims of a criminal to have no memory or recollec- 
 tion of acts that he is accused of, should suggest the ex- 
 cessive use of spirits or some form of epilepsy or spasm 
 of the blood vessels of the brain, which may be inferred 
 from a variety of symptoms. 
 
 States of masked epilepsy are to be sought for in a 
 study of the causes. If a history of moderate or excessive 
 use of spirits can be made out, it is a reasonable inference 
 that the statement of the person may have some basis in 
 facts.
 
 FORMS OF IRRESPONSIBILITY, ETC. 319 
 
 If the person has been insane, in the past, and has re- 
 covered; or has been injured by sun or heat stroke; or 
 has been eccentric in conduct and thought, and is a neu- 
 rotic; amnesias are very likely to occur. 
 
 In determining the accuracy of the statement of the 
 person that he has no recollection of his acts, a very care- 
 ful history of his mental and physical condition is essen- 
 tial, and in most cases corroborative or disproving facts 
 can be brought out. 
 
 A clinical history of some cases will give a very clear 
 view of these amnesic states. The first example was that 
 of a man who was repeatedly arrested for horse theft. 
 He always claimed to be unconscious and have no memory 
 of the act. 
 
 The defense was regarded with ridicule by court and 
 jury, and more severe sentences were imposed after each 
 act, until finally he died in prison. The evidence brought 
 out in different trials in defense was this: 
 
 His father was feeble-minded and died of consumption 
 in early life. His mother was insane and died in an 
 asylum. His early life was one of hardships with lim- 
 ited education and great irregularities of living. At six- 
 teen he entered the army, suffered from exposure, sun- 
 stroke and fevers and began to use spirits. 
 
 At twenty he was employed as a hack driver and ten 
 years later became owner of a livery stable. He drank 
 steadily, yet attended to business, acting sanely, and ap- 
 parently conscious of all his acts, but often complained 
 that he could not recollect what he had done. 
 
 When about thirty-four years of age, his drinking in- 
 creased, and in a state of semi-stupor he would bring back 
 strange horses to his stables and claim he had bought 
 them. The next day he would claim no recollection, and 
 show considerable anxietv to find the owner of the horses.
 
 INEBRIETY. 
 
 Later the owner would appear and the horses would be 
 given up, with various explanations. 
 
 It appeared that after a certain time of excessive 
 drinking the sight of a good horse hitched up at the road 
 side, or apparently without an owner, created an intense 
 desire to possess and drive it. If driving his own horse, 
 he would stop and leave it in some secure place, then go 
 and take the new horse, and after a short drive take it 
 to his livery stable, then go and get his own horse, and 
 explain to the stable men that he had bought the new 
 one. 
 
 He would fall asleep and awaken without any recollec- 
 tion of where he had been and what he had done. On 
 several occasions he displayed cunning and shrewd rea- 
 soning in not taking the horses when the owners or drivers 
 were in sight. When once in possession of the horse he 
 displayed equal cunning in going about the back streets, 
 and concealing his identity, and bringing the horse to the 
 stable in the most secretive way. 
 
 Should the owner appear and demand his property he 
 would give it up in a confused, abstracted way. No 
 scolding or severe language made any impression on his 
 mind. Often if the horse seemed weary and worn, he 
 would take it to the nearest stable with strict orders that 
 it should have special care. 
 
 On one occasion he joined in a search for a stolen horse, 
 and found it in a stable where he had placed it many days 
 before. Of this he had no recollection. In another in- 
 stance he sold a horse which he had taken, but would not 
 take any money, making a condition that the buyer 
 should return the horse if he did not like it. 
 
 His horse stealing was all of this general character. 
 There was no particular motive, and sometimes no effort 
 at concealment, and on recovering from his alcoholic 
 excess, he showed great interest and anxiety in having the
 
 FORMS or IRRESPONSIBILITY, ETC. 321 
 
 property restored, and expressed regrets and payed very 
 freely for all losses. 
 
 His assertion of amnesia and unconsciousness of his 
 acts was sustained by a great variety of evidence, but his 
 automatic mental activity and cunning was made the 
 standard of his mental condition. This was a marked 
 case of amnesia and kleptomania which was not recog- 
 nized by the court. 
 
 The next example was that of B , who was ex- 
 ecuted for the murder of his wife. He asserted positively 
 that he had no recollection or consciousness of the act, or 
 of any event before or after. The evidence indicated that 
 he was a periodic inebriate of ten years' duration, dating 
 from a sun-stroke. His drink periods would last from one 
 to two weeks, during which time he drank large quanti- 
 ties of whiskey daily, was intensely excitable, active and 
 seldom stupid. He seemed sane and conscious of his acts 
 and surroundings, but was intensely suspicious and exact- 
 ing and irritable with all his associates. He would then 
 go to sleep, awaken in a few hours, and have no recollec- 
 tion of what had happened during this drink period. 
 
 When sober he was kind, generous and confiding and 
 seldom angry or irritable. While drinking his intellect 
 seemed more acute and sensitive. His business was con- 
 ducted with skill and great attention to detail. The only 
 peculiarity was, he would make no promises and sign no 
 papers, and refused to settle difficult questions of busi- 
 ness. 
 
 When sober, he was prompt and exact in carrying out 
 all his promises. His associates were very careful to put 
 down every item of business and obligation of the firm in 
 writing, for the reason that when he became sober, he 
 would deny and doubt the transactions. 
 
 On several occasions destructive manias appeared, in 
 which he showed violence without cause, and later had no
 
 INEBRIETY. 
 
 memory of it and was very penitent and sought in every 
 way to repair the injury. 
 
 Finally he struck his wife with a chair and killed her, 
 and awoke next day in jail. He disclaimed all knowledge 
 of the crime, was anxious to die, plead guilty and wel- 
 comed his execution. There could be no question about 
 the amnesia and the loss of memory, accompanied by 
 maniacal and homicidal tendencies, and yet the defense of 
 irresponsibility made no impression in the court. 
 
 The third example was that of a man of wealth and 
 character, who forged a large note, and went to a distant 
 city. He was arrested, tried and sentenced to state's 
 prison. The defense was irresponsibility, amnesia and 
 unconsciousness of the crime, by reason of excessive use 
 of spirits. Evidence showed that he had drunk to excess 
 at and before the crime, and yet his apparent rational 
 conduct and cunning in concealing his identity were re- 
 garded as sanity. 
 
 Both his parents were neurotics. He began to drink 
 in early years and was a moderate drinker for a long 
 time. Then he drank to excess at short intervals. He 
 complained of loss of memory after drinking heavily, and 
 doubted transactions that he had made while in this state. 
 Frequently he would make foolish purchases, discharge 
 valuable workmen and later take them back without being 
 able to explain the reason for his acts. His mental con- 
 dition at this time was reserved and one of acute con- 
 sciousness of his acts, and later he claimed that he had no 
 recollection of what he did. He forged many notes for 
 small amounts, and after denying that he had done so, 
 settled with great difficulty. 
 
 Finally he forged a large amount, drew the money 
 and invested it at once. When arrested he made a most 
 childish defense in foolish conflicting statements. This 
 was another case of alcoholic amnesia in which the his-
 
 FORMS OF IRRESPONSIBILITY, ETC. 323 
 
 tory of the prisoner's conduct, and his assertions of no 
 memory were verified by the facts and circumstances of 
 the crime. 
 
 The following case illustrates the difficulty of confirm- 
 ing the prisoner's statement of amnesia and unconscious- 
 ness of acts. An inebriate killed a man in a fight. He 
 was sentenced for life. His defense was, no memory or 
 recollection of the act. 
 
 When not drinking he was a very ordinary frank man, 
 acted with caution and reason, and showed good judg- 
 ment as to the consequence of his conduct. He was a 
 periodic drinker and drank in so-called moderation for 
 two or three months, then would stop. 
 
 During this drink period he showed great sensitiveness 
 about his condition and tried to conceal it and appear 
 sober. If anything happened he would display great 
 cunning in covering it up. When delirious and under 
 the influence of spirits he would grow sober at once, from 
 fear of exposure and publicity. He seemed to have the 
 power of control to act sanely on occasion and with 
 motives. 
 
 The crime was an accident, and at once he showed 
 great judgment in concealment and efforts to make it ap- 
 pear that he was not guilty. When arrested he claimed 
 unconsciousness of the act, but his previous conduct did 
 not reveal any facts that would indicate this condition. 
 
 On the contrary, he seemed to be acutely conscious, and 
 yet it is possible that he was unconscious. The exalted 
 delirium may have been followed by amnesia, but at the 
 time he acted with the most highly sensitive conscious- 
 ness of what he was doing. 
 
 In another case a man shot his partner in business while 
 both were intoxicated. He disp^ed unusual sanity and 
 cunning in concealing the crime and having the body sent 
 away. He made the same claim in defense. In a study
 
 INEBHIETY. 
 
 of his previous history there were no incidents that in- 
 dicated any times of marked loss of memory. In his 
 business relations, even while intoxicated, he was always 
 able to judge of his conduct and appeared as if more than 
 usually conscious of his acts and consequences. In all 
 probability this defense was fictitious and without support. 
 
 Of these cases where a defense of no memory of the act 
 is claimed, there are certain groups of common physical 
 conditions of degeneration that can be outlined with more 
 or less distinctness. Probably the largest number of in- 
 ebriates who claim loss of memory in defense of their 
 acts are chronic psychosis cases in which alcohol is both 
 a symptom and a very active cause. 
 
 The history shows excessive use of spirits for a long 
 period, either continuously or in paroxysms. This, with 
 bad training in early life, bad surroundings and bad 
 nutrition would, of necessity, result in great mental im- 
 pairment and liability to many and diverse brain defects. 
 
 If to this there is added a history of bad heredity, the 
 probability is much greater that their claims are correct. 
 Such persons have always impaired consciousness and de- 
 fective realization of their acts and conduct. They usually 
 are governed by the lowest and most transient impulses, 
 and act automatically in the ordinary relations of life. 
 
 Crimes of all kinds are generally accidents, depending 
 on the surroundings and conditions, and not on premedita- 
 tion or plan. They are incapable of reasoning sanely, 
 or of realizing the results of their conduct, and the crime 
 shows this, particularly in the marked indifference after- 
 wards. 
 
 Crimes of such persons are usually along lines of pre- 
 vious conduct and thought, and seldom in a sphere of 
 mental or physical activity unusual or outside of their 
 every-day surroundings.
 
 FORMS OF IRRESPONSIBILITY, ETC. 
 
 The claim of amnesia is very likely to be real, even al- 
 though it cannot be sustained by collateral evidence. 
 Mania is very rarely present. Concealed delusions and 
 morbid impulses of a melancholic type are common. The 
 mind resembles the body in exhaustion and feebleness, and 
 acts along lines of least resistance. 
 
 A second group of persons accused of crime who claim 
 to have no recollection of the acts, are those in whom the 
 crime was unusual, unforeseen and extraordinary. Such 
 persons are paroxysmal inebriates, periodic drinkers, dip- 
 somaniacs, who suddenly use spirits with or without any 
 cause, and drink to great excess, become prostrated, and 
 only stop when acute inflammatory conditions begin. 
 During this drink obsession their conduct and reasoning 
 is essentially maniacal, and while they appear to be con- 
 scious and to reason from cause to effect, it is a matter of 
 some doubt how far they are conscious or are governed 
 by accurate recollections and full consciousness of their 
 condition. 
 
 They are evidently unsound, unreasonable and inca- 
 pable of control. The claim of amnesia should always be 
 recognized as a possibility, and receive the most careful 
 consideration. No sane reasoning or conduct should be 
 considered as evidence per se of a clear registration of 
 events, and no conduct afterwards should be regarded as 
 conclusive evidence of memory, unless confirmed by other 
 facts. 
 
 A third class of criminal inebriates frequently claim as 
 a defense amnesia and want of memory. Many of the 
 pronounced symptoms of insanity seen in the second class 
 are absent. Not infrequently there is little or no his- 
 tory of alcoholic psychosis, imbecility, stupor and gen- 
 eral degeneration. 
 
 They are the so-called moderate drinkers, persons who 
 use beer and spirits in fixed quantities daily for long
 
 326 INEBRIETY. 
 
 periods of time, never seem intoxicated, never greatly in- 
 capacitated for the ordinary duties of life, and not in- 
 frequently occupying positions of responsibility, and ap- 
 parently doing the work of sane and responsible men. 
 
 Suddenly such persons commit crime with suspicious 
 coolness and indifference as to the consequences. The 
 crime is open, seldom concealed, and the conduct and ap- 
 pearance after gives little evidence of the realization of 
 the acts. In the defense the person will claim no recol- 
 lection, and the evidence in support of this is the unrea- 
 sonable act and the senseless conduct after. 
 
 A study of such cases opens a very interesting field of 
 dementia, concealed delirium and delusions, and claim of 
 no memory is very likely to be true. Other cases are 
 noted where the crime is committed, following great men- 
 tal irritation and depression, or a drink explosion; 
 
 riome condition of spasm resembling masked epilepsy 
 precedes the act, and there is a strong probability that 
 memory, consciousness and reasoning were all paralyzed 
 for the time, and that the conduct was automatic, im- 
 pulsive and maniacal. 
 
 In some studies of these cases there is a history of un- 
 usual suspicion, delusions and degrees of irritation and 
 perturbation, followed by a drink storm and unaccount- 
 able acts in which crime is committed, then follows a sub- 
 sidence of the acute symptoms and leaving amnesia and a 
 blank concerning the past. 
 
 This was called a trance state years ago, and perhaps 
 this term describes a sudden suspension of the registration 
 of events as clearly as local palsies can be marked out in 
 the extremities. That this blank is not always permanent 
 is true in many instances. 
 
 Many persons drinking to stupor are fully unconscious 
 of their condition at the time, but later they can recall the 
 events with considerable accuracy. Crime committed dur- 
 ing this period is always more or less automatic, follow-
 
 FORMS OF IRRESPONSIBILITY, ETC. 827 
 
 ing some previous lines of conduct, and showing a marked 
 failure to appreciate the relation of the surroundings. 
 
 Some governing center has suspended, and various im- 
 pulses may merge into acts any moment, regardless of 
 conditions and restraint. Evidently these blanks of mem- 
 ory are more or less common in persons who use spirits, 
 and they increase with the mental feebleness and de- 
 generations of the person. 
 
 The statement is often made that the person could 
 recall after an interval, the occurrences while under the 
 influence of alcohol. Later his memory became more and 
 more indistinct, until finally he was unable to remember in 
 any way what had happened during this period. 
 
 The practical question to be determined at a given case 
 is the general mental condition of the person who sets up 
 a claim of amnesia. The evidence must be based largely 
 on collateral facts and inferences supported by circum- 
 stances. The court should decide whether this defense is 
 of sufficient magnitude to require an expert examination 
 and study of the mental conditions of the prisoner. 
 
 The results of such expert study may show a large pre- 
 ponderance of evidence sustaining this claim. Then the 
 measure of responsibility will be modified, and their legal 
 treatment will vary. The great central principle should 
 never be minimized, that the inebriate of all these varied 
 classes, who claims to have been unconscious should be 
 recognized as insane, and incapable of realizing or con- 
 trolling the facts, and should be kept under legal and 
 medical surveillance for a long time. 
 
 Such men are dangerous and, like victims of contagious 
 disease, must be housed and treated. Alcoholic amnesia 
 is a veritable condition that should be recognized, and its 
 claim should not be regarded as a mere subterfuge to 
 avoid punishment, but should receive the same attention 
 and study that any claim of insanity calls for in self- 
 dofen^o.
 
 328 INEBRIETY. 
 
 This outlying view indicates a practical field of medico- 
 legal research that is largely unknown, but evidently is 
 more or less prominent. These cases appeal to us, and 
 the highest dictates of humanity and science call for an 
 accurate study and comprehension of their presence and 
 character. 
 
 The following summary may assist in grouping the 
 facts to be considered in these cases. First, amnesia is a 
 distinct central brain palsy, that exists beyond all ques- 
 tion or doubt. 
 
 Second, it is a particular state in which memory and 
 consciousness of acts and words are depressed, suspended 
 and cut off, and the patient goes about automatically with 
 little or no evidence of this change. The duration of this 
 palsy may last from a few moments to several days, and 
 the person appear conscious and natural along the line 
 of ordinary life. 
 
 Third, during this amnesiac period crime against per- 
 son or property may be committed without plan or mo- 
 tive. When accurately studied, the details and methods 
 of execution will lack evidence of premeditation and con- 
 sciousness of its nature and results. After the commission 
 of the act a certain indifference and want of recognition 
 of what he has done will also mark his conduct. 
 
 Fourth, when the question comes up in the court, and 
 the accused denies any recollection of the event in ques- 
 tion the facts to be settled are, whether statement is 
 a simulation or a reality, and what evidence may be 
 grouped to sustain or disprove his defense. 
 
 Fifth, the central question should be his drug psycho- 
 sis and the neurotic psychosis, tendencies and degenera- 
 tions which have come down. If this is clearly made out 
 there is a strong probability of this particular defect, and 
 when it is fully established, the legal irresponsibility of 
 the person should be the same as that of an insane man.
 
 CHAPTER XXXI. 
 
 MEDICO-LEGAL QUESTIONS OF INEBRIETY. 
 
 Synopsis. New field of study. Suddenly forced upon medical 
 attention. Great numbers of questions await legal solution. 
 Three views held. The ethical and moral view. The legal view. 
 The scientific and medical view. Assumption of knowledge that 
 does not exist. Urgency for a clearer view. Confusion noted in 
 two cases. Errors of medical men. It is a question of facts and 
 their meaning. Was the person an inebriate? What was his 
 mental condition at the time of the act? A study of the answer 
 to these questions necessary. Object of the legal treatment of 
 inebriates. Its failure. The reasons for it. The victims made 
 worse. The action of alcohol on the brain explains th:s. An in- 
 ebriate witness dangerous on the witness stand. He is not in 
 touch with the surroundings. His mind is confused and halting 1 . 
 He is a paralytic. Automatic acts cover up this condition. His 
 disability seen when called to do new work. A mental waif sub- 
 ject to the surroundings. A superstition to hold such a person 
 accountable. A question of facts not theories or rulings of judges. 
 
 The jurisprudence of inebriety is practically a new 
 territory, without boundaries and unexplored. The ques- 
 tion of the possible mental unsoundness and incapacity of 
 the inebriate to reason normally and act rationally, is 
 asked with increasing frequency in a great variety of 
 criminal and civil cases, where the question of motive and 
 purpose is raised. 
 
 The rapid advances in psychological study sustains the" 
 wisdom and necessity for scientific inquiry in this field. 
 The medical profession has been suddenly called to deter- 
 mine the facts and their meanings concernings the acts of 
 an inebriate and give advice as to his responsibility and 
 the means for prevention, and all this without precedent, 
 and the medical theories are often opposed by public 
 opinion and doctors are frequently forced into great dis- 
 credit and confusion. 
 
 As a result of lack of knowledge many wild and im- 
 possible theories prevail as to what inebriety is and is not. 
 
 329
 
 330 INEBRIETY. 
 
 Statements are made of moral and legal accountability 
 and responsibility, that presuppose a degree of psycho- 
 logical knowledge which is utterly impossible in the pres- 
 ent state of the study, and could only be acquired by long 
 years of accumulation and comparison of facts. 
 
 There are to-day many persons awaiting trial or sen- 
 tence for crime committed while under the influence of 
 alcohol. There are hundreds of business contracts dis- 
 puted and contested in law courts, contracts made when 
 the parties were intoxicated. There are many hundreds 
 of wills whose validity is questioned for the same reason. 
 Also there are innumerable divorce suits where the in- 
 ebriety of the parties is the vital question on which the 
 issue of the case turns. Grave questions concerning 
 pauperism, idiocy, criminality, degeneracy, all center on 
 the exact knowledge of the meaning and extent of ine- 
 briety. 
 
 These are some of the topics in this new medico-legal 
 field which must not be ignored by the profession, or 
 be answered by vague theories or dogmatic assertions. 
 Every year these questions become more urgent and 
 the profession must answer them on rational scientific 
 grounds. Already the attempts to answer them, although 
 complicated with vague opinions and wild superstitions 
 have divided into three distinct theories or points ot view. 
 First, the ethical and moral view which finds a full ex- 
 planation of inebriety from the teaching of Scripture and 
 the opinions of theolo gists and moralists. This view af- 
 firms that inebriety is a phase of moral depravity found 
 in some measure in every life, and one that is susceptible 
 of great growth and development by willful neglect and 
 gratification of passion and instinct. Theologically the 
 remedy is punishment, prayer, conversion and the ap- 
 plication of moral suasion and measures to awaken the 
 spiritual life.
 
 MEDICO-LEGAL QUESTIONS OF INEBRIETY. 831 
 
 A crime committed while under the influence of spirits 
 is a moral defect, a vice in which the victim is fully 
 responsible and always conscious of the nature and quality 
 of his act. 
 
 The second is the legal view which is literally a mate- 
 rialization of the moral theory. It assumes that inebriety 
 is a phase of savagery and inborn tendency to lawlessness, 
 and the indulgence of the lower passions, regardless of 
 law or order or the interests of others. The remedy for 
 this is punishment, suffering, on the principle that in- 
 dulgence of the lower nature followed by pain and suffer- 
 ing will rouse the higher brain to take control and throw 
 off the influence of passion and instinct. 
 
 If every act of drinking was followed by pain it would 
 be repelled and controlled. Three hundred years ago 
 Lord Coke, of England, held that inebriety was always an 
 aggravation of any offense committed, and this fact 
 should lead to greater punishment and never be consid- 
 ered an excuse. This has been the corner-stone of the 
 legal view of inebriety up to very recent times. 
 
 The third theory is the scientific and medical view. 
 This affirms inebriety to be a physical condition, both 
 acquired and inherited. This physical condition is always 
 a disease and an obscure or pronounced form of insanity. 
 The use of alcohol is a symptom and not a cause in many 
 cases. 
 
 This theory asserts that degeneration and disease is the 
 basis, and the use of alcohol, by disturbing the brain 
 circulation, causing congestion and paralysis, brings on a 
 degree of incapacity which should be realized and under- 
 stood. The inebriate is always defective in judgment. 
 The nature and character of his act is abnormal. His 
 power of control is enfeebled. Legally this theory re- 
 gards the inebriate as diseased and incapacitated to act 
 sanely, that his consciousness and control of his acts are
 
 332 INEBRIETY. 
 
 enfeebled and that he should not be regarded as competent 
 and sane. 
 
 The first two theories assume sanity and consciousness 
 in all cases of inebriety, and affirm that the only remedy 
 is punishment and strict accountability and suffering, to 
 enforce it. The third theory calls inebriety a physical 
 condition requiring scientific study and physical and 
 psychical remedies before the proper treatment can be de- 
 termined. 
 
 A compromise theory is urged, in which inebriety is 
 first regarded as a vice or a vicious phase and then later 
 a disease. At first prayer, pledges and punishment can 
 be used, and later medical care and treatment. It is 
 difficult to understand the degree of psychological knowl- 
 edge and ability necessary to discern where vice and 
 disease join, and where to apply punishment and suffer- 
 ing, and where to use medical means and measures. 
 
 Such a theory defended on the witness stand is a sad 
 reflection on the intelligence of the witness, particularly 
 if he is a medical man. The pressing character of these 
 cases frequently brings these different views into prom- 
 inence, but only end in confusion and injustice to all 
 concerned. 
 
 Lawyers and judges seek to clear up this confusion 
 by assuming that the law is absolutely accurate and just 
 in its basis and dictum. Curiously enough many medical 
 men form impressions from these dogmatic assertions and 
 re-echo them in the court room. This was very apparent 
 in a contested will case where five medical men testified 
 that a chronic inebriate who made a strange unusual will 
 was sane and knew what he was about, notwithstanding 
 the fact of his continuous intoxication. 
 
 The judge declared that he should act on his own 
 judgment, and decided the man was unsound and in- 
 capable of knowing his condition.
 
 MEDICO-LEGAL QUESTIONS OF INEBRIETY. 833 
 
 In another case a man set fire to a church. Three 
 physicians swore to his sanity ; notwithstanding the fact 
 that he was a chronic inebriate and had had delirium 
 tremens recently. The jury decided otherwise. In this 
 the medical men sought to determine the mentality of in- 
 ebriates, on previous theories of moral causation. This 
 was an error, for irrespective of all theories such facts 
 can only be determined from a physical point of view. 
 
 In disputed cases it should always be a question of 
 facts and their meanings. Facts of heredity, facts of 
 culture, training, development or dissolution. Facts of 
 disease, injuries, degenerations, surroundings, mentality 
 and so on covering the entire history of the case, physi- 
 ological, psychological and pathological. 
 
 It is only from this standpoint that any clear concep- 
 tion of inebriety, and the degree of responsibility can be 
 obtained. The general problems presented in all these 
 medico-legal cases, are, first, Was the person an inebriate 
 or one who drank spirits to excess at all times, or at in- 
 tervals? If this fact is established beyond question then 
 the basis for further studies into the degree of sanity and 
 mental capacity is formed from which comparisons and 
 conclusions can be drawn. A reasonable doubt or sus- 
 picion of the sanity and mental capacity may be enter- 
 tained. 
 
 Second. What was the mental condition and the cir- 
 cumstances of the person and his surroundings at the time 
 of commission of the act in question? Was the act 
 reasonable and just in its effects, consequences and exe- 
 cution? If not, the suspicion of insanity is strengthened 
 and insanity and mental feebleness must be assumed. The 
 legal theory should be reversed. The sanity must be 
 proved and not the insanit}'. 
 
 Third, the medical man must be acquainted with the 
 facts and have a reasonable assurance of their accuracy,
 
 334 INEBRIETY. 
 
 before he can point out conclusions which are naturally 
 sustained by them. The question is often one of pre- 
 ponderance of evidence, which if it indicates the ex- 
 cessive use of spirits with irregular conduct and evident 
 inability of control is most naturally the act of an im- 
 paired mind and a degree of insanity. 
 
 The efforts medico-lcgally are to check and prevent 
 the illegal acts of inebriates. Practical experience in 
 courts both in this country and in Europe agree that 
 capital punishment for murder never deters similar crime. 
 Notwithstanding this fact, inebriates are tried as sane 
 and responsible, and executed. In the lower courts fines 
 and imprisonment for illegal and criminal acts proves to 
 be not only worthless as deterrents, but to increase the 
 very condition which it aims to check. The physiological 
 reason which explains this is that legal penalties make 
 no impression on the intellect or higher judgment of the 
 man, because that part of the brain is palsied and so far 
 impaired as not to recognize the danger of, or be im- 
 pressed by, punishment. This will be made clear from a 
 brief restatement of the effects of alcohol on the brain 
 and body. 
 
 The increase of the heart's action directly due to spirits 
 produces alternate exhilaration and depression and this in- 
 terferes with the uniform nutritional and functional ac- 
 tivities and gives unsteadiness to the development, and 
 direction of the energy and course of the brain with les- 
 sened energy, and obscuration of the power of discrimi- 
 nation. 
 
 The senses become impaired and impressions are ob- 
 scured and this darkens knowledge and misleads judg- 
 ment. The facts from the outer world are imperfectly 
 communicated to the brain and imperfectly understood, 
 and the brain is weakened in its power to recognize and 
 correct the errors.
 
 MEDICO-LEGAL QUESTIONS OF INEBRIETY. 335 
 
 The constant repetition of the convulsive flow of the 
 blood to the brain, rising and falling, not only weakens 
 perception, but judgment and discrimination. Thus, the 
 fine shadows, the uncertainties, and the recognitions of the 
 value of conduct, acts and motives, escape the notice of 
 the inebriate because of his impaired senses and judg- 
 ment. 
 
 This he does not recognize. Often the more spirits are 
 taken, the less doubt and more confidence he has in his 
 judgment and ability to discern the actual conditions. 
 Delusions, delirium, egotism, and the idea of strength, 
 cover up the actual weakness. The false impressions 
 conveyed to the brain seem realities because of the inabil- 
 ity to discriminate. Thus, a man under the influence of 
 spirits is a dangerous witness of facts observed in this 
 condition, because of his impaired ability to see a reason 
 clearly, or a sequence and has a delusive idea of the ac- 
 curacy of his observations. 
 
 Dr. Wright wrote, that an inebriate witness testifying 
 to events and facts observed while sober is more reliable 
 than a sober witness testifying to facts and events ob- 
 served while intoxicated. We have elsewhere indicated 
 the anaesthetic condition of an inebriate manifested in the 
 voice and exaggerations of manner, also the sight, hearing 
 and smell and muscular disturbances. This is literally 
 paralysis extending all the way from the profound stupor 
 of intoxication back to the flushed face from the first 
 glass of spirits. 
 
 The irresponsibility of persons in this condition is 
 very evident in the extreme toxic stages, but the point 
 where the impairment of the judgment and consciousness 
 begins is impossible to determine. In much the same way 
 no one can determine where twilight begins, and where it 
 ends in night. Hence the responsibility of the inebriate 
 is impaired from the first glass of spirits and the first
 
 336 INEBRIETY. 
 
 paralyzing effect of alcohol and its increase and growth 
 is by stages differing widely in individuals, but always 
 present. 
 
 There can be no question of the inability of the 
 mind, and functional activities of the brain, to take cog- 
 nizance of facts and events exterior to it when the senses 
 are obscured and abnormal. Also when the higher opera- 
 tions of the reason are impaired by faulty nutrition and 
 toxins. In this case both the sense impressions and their 
 recognition are lowered and enfeebled and their value lost. 
 
 Alcohol, of all other drugs, lowers the consciousness 
 of right and wrong. Its paralyzing action obscures the 
 capacity to discriminate on questions of ethics, in brief, 
 the morale of the man is damaged first, and most perma- 
 nently. The inebriate, when intoxicated, exhibits con- 
 fused obscure ideas, and false beliefs of morals and duties, 
 and all his ethical sensibilities undergo a progressive de- 
 generation. 
 
 The coarser automatic and organic operations of the 
 mind and body may be but little disturbed, and the prom- 
 inence of the lower, more brutish and animal instincts 
 result simply from the palsy of the higher co-ordinating 
 centers of control. This is confirmed in so many ways 
 and yet the impression has been created that the use of 
 alcohol reveals the real man which has been covered up 
 before. In periodic drinkers the inebriate, when sober, is 
 often amazed at the wild insane conduct during his drink 
 attack, but in the continuous drinker there is no clear in- 
 terval by which he is able to review his previous thought 
 and conduct. 
 
 The condition is one of continuous and uniform paral- 
 ysis and dissolution. He may, before the use of alcohol, 
 have formed correct habits and rational conceptions of 
 life, which influence him automatically after the use of
 
 MEDICO-LEGAL QUESTIONS OF INEBRIETY. 837 
 
 spirits ; and thus he is able to act and appear along nor- 
 mal and rational lines of conduct. 
 
 He may, as a professional man or a mechanic, or 
 farmer or merchant, follow an accustomed line of business 
 while using spirits and appear to be normal and sane. 
 But should any supreme crisis intervene and drive him out 
 of his automatic range of life and thought, the palsied 
 state of the brain will appear. Such men are literally 
 waifs, subject to the surroundings and changing condi- 
 tions of life. The unexpected crimes and unusual acts 
 and insane confusions of motive and purpose appearing 
 in persons who have previously appeared rational, but 
 have been noted as spirit drinkers, furnish ample illustra- 
 tions of this condition. 
 
 The conclusion which must be drawn from these facts 
 is that all persons who use spirits are more or less un- 
 sound, and have entered into that penumbral region of ir- 
 responsibility and incompetence, and so are unable to act 
 rationally and normally ; also that it is grave supersti- 
 tion to assume that the use of alcohol is not only a volun- 
 tary act, but that it does not in any way impair the 
 judgment and power of control, and from this theory to 
 insist on a full measure of accountability where the ques- 
 tion of crime and illegal acts are raised.
 
 CHAPTER XXXII. 
 PREMEDITATION IN CRIMINAL INEBRIATES. 
 
 Synopsis. Premeditation considered proof of responsibility. 
 Where reason and judgment are evident, sanity is assumed be- 
 yond all question. In reality this is not true. Many persons ex- 
 hibit judgment, premeditation and reason who are literally ma- 
 niacs. This is sustained by a clinical history of cases. Drink 
 paroxysms, such as in periodic cases, furnish striking examples. 
 Criminal instincts very often follow from the paralysis of spirits, 
 and disappear when spirits are banished. Examples of such 
 cases. No question of responsibility should be based on these 
 symptoms alone. The continuous drinker is very dangerous as a 
 criminal, and is always more or less unconscious of the nature 
 and results of his conduct. Concealed delusions are very com- 
 mon. The present methods of punishment are destructive in many 
 instances, increasing the conditions which they are supposed 
 to correct. The use of spirits to give courage to execute crime 
 is not common, and always exhibits mental feebleness, which 
 suggests insanity. No apparent judgment and motives are safe 
 criterions from which to judge the mental condition of the crim- 
 inal. Morbid impulses, obsessions, concealed delusions are all 
 more or less common in inebriates who commit crime. 
 
 In the question of the sanity of inebriates who are on 
 trial for crime, evidence of premeditation is considered 
 strong proof of the responsibility of the prisoner. It is 
 assumed that there must be a degree of judgment where 
 purpose and motive are apparent, and this is normal. 
 
 If the motive be of sufficient magnitude and the facts 
 indicate distinct premeditation and design, there must be 
 some sanity in the prisoner, and the courts take this view 
 of it. When this reasoning is applied to inebriates there 
 are many exceptions, and it is very evident that it is not 
 true and can not be used as a general principle. 
 
 Many men obviously insane are capable of premedita- 
 tion and often display distinct motives and purposes. 
 The ordinary inebriate, who at the beginning has no in- 
 tention of carrying out any plan becomes obsessed the 
 more he drinks until he is profoundly intoxicated. 
 338
 
 PREMEDITATION IN CRIMINAL INEBRIATES. 339 
 
 He does not anticipate the final result, and is confi- 
 dent that he will always be able to control himself and 
 stop short of the toxic stage. In the periodic drinker, 
 premeditation and motive has no other purpose except 
 to provide for full gratification of the drink impulse. 
 That is the central thought, to gratify this impulse. 
 This is so overwhelming as to destroy all other motives 
 and be unnatural and insane. 
 
 Elsewhere instances have been noted of elaborate rea- 
 soning and preparation to conceal and cover up the drink 
 attacks and provide for any possible emergency that 
 might follow. Such persons may appear normal and 
 sane in other matters, but in this they are reasoning ma- 
 niacs without power of control and possessed by an 
 impulse which dominates all other thought or motive. 
 
 A typical case is that of a banker of excellent judg- 
 ment in all business and social matters. He would pre- 
 pare for a drink paroxysm for a week in advance, and 
 display great cunning to explain his absence. He would 
 send letters to be mailed to his family in the future, as 
 to his location, giving explanations that were reasonable, 
 so as to prevent any unusual efforts to verify or discover 
 his real condition. Then he would go on this imaginary 
 business and disappear for a week or two. On returning 
 he showed great activity to take up charity and temper- 
 ance work, and help others. On several occasions these 
 attacks were broken up by active treatment at home. 
 
 These periodic inebriates show such pronounced mental 
 unsoundness in these mysterious obsessions that it is 
 difficult to understand how they can be considered respon- 
 sible. Should a crime be committed during this period, 
 with evidence of premeditation, the courts will not consider 
 the question of insanity other than efforts to escape the 
 punishment for the crime.
 
 INEBRIETY. 
 
 The following case brings out this fact in a very vivid 
 light : A business man, after a period of moderate drink- 
 ing lasting several years, became a periodic drinker. 
 These periods were ushered in by one or two weeks of 
 continuous drinking then several days of profound in- 
 toxication, followed by recovery and intense remorse. 
 
 During the time of continuous drinking he carried on 
 his business in a sane and natural way, but to his confi- 
 dential clerk he displayed delusions of revenge. He elab- 
 orated the most skillful plans to injure a rival in busi- 
 ness by burning his property and exploding dynamite 
 under his office. These plans were remarkable for motive, 
 premeditation, cunning and judgment of the situation 
 and surroundings. 
 
 His clerk advised delay and urged objections, pointing 
 out the possibilities of failure, and in this way prevented 
 their materialization. After he became fully intoxicated, 
 these plans grew indistinct, and finally faded away. He 
 regarded them as crazy notions and seemed ashamed to 
 think that he had planned or talked about them. 
 
 The next drink period the same impressions came back, 
 and were more intense and his plans were more cunning 
 and skillful. Fearing that they might be put into execu- 
 tion he was given narcotics and made stupid, and in this 
 way the impulse was broken up. This delusion with the 
 slightest encouragement would have developed into & 
 criminal act, and in the court room no evidence of insanity 
 would have been considered. 
 
 The reasoning would have been that the act grew up 
 in his sane moments, and that the use of spirits was 
 for the purpose of giving him strength to execute it. 
 
 Another similar case was that of a moderate and 
 continuous drinker, who planned a bank robbery, and 
 spent much time considering and providing for any pos- 
 sible failures which might happen. He would visit dif-
 
 PREMEDITATION IN CRIMINAL INEBRIATES. 
 
 ferent banks, observe narrowly the conditions, make notes 
 of the position of the safe, counter, and the means of 
 exit. Then, by comparison with other banks, determine 
 that which promised the least risk. 
 
 He made a confident of his partner, who with him con- 
 ducted a grocery business, and gave him the notes and 
 papers on which all the plans and records were stated. 
 His partner considered them as mere drunken whims, and 
 advised him to stop drinking. He would abstain for a 
 while and then begin again. 
 
 Naturally, he was a very careful, sober, methodical 
 man of good judgment and was honest. The delusion was 
 very unusual, and foreign to his previous conduct and 
 thought, and yet he displayed most unusual skill in 
 calculation of possibilities and efforts to execute the crime 
 and conceal all traces of its author. 
 
 Here again was the same probability that with the 
 slightest encouragement he would have executed it. There 
 was undoubted insanity, notwithstanding the acute reason- 
 ing, judgment and apparent consciousness of the act. 
 To hold such a man responsible and judge him by other 
 standards of sanity would have been fallacious. 
 
 Some of these curious obsessions done under the influ- 
 ence of alcoholic narcotism show extraordinary judg- 
 ment and wisdom. In one instance a lawyer wrote a will 
 at a certain period when drinking. Later, under similar 
 circumstances, another will was executed, and so on for 
 several years. Each will was filed away with care as to 
 all the minutiae and details. He seemed to have no con- 
 sciousness of having written other wills, but clearly stated 
 his property and its conditions. 
 
 A man of wealth left a large fortune to an obscure 
 school for colored people in the South. This was written 
 on the eve of, or during, a drink paroxysm. The act 
 was a surprise to his friends, who had never heard him
 
 INEBRIETY. 
 
 express any interest in, or knowledge of, the work of any 
 Southern school before. 
 
 In the lower courts a great variety of criminal acts 
 by inebriates present degrees of reasoning, premeditation 
 and sanity that is unusual. In the evidence such persons 
 are not stupidly intoxicated and seem to be in possession 
 of their normal reasoning. The impression is that spirits 
 were taken to lessen the punishment of the acts, but this 
 is not confirmed by a careful study. 
 
 A number of persons who have been sober, free from 
 spirits, living normal honest lives, commenced to drink 
 moderately and enter upon a criminal career. Commonly 
 thev are sneak thieves, appropriating everything near 
 them, whether needed or not, robbing intoxicated men, 
 snatching parcels from boys and women, then running 
 away, showing very little cunning in the concealment or 
 effort to escape, but showing much skill and boldness in the 
 acts. They are kleptomaniacs, and in all probability this 
 is produced by the paralysis from spirits. 
 
 When such persons are about to be arrested, or are 
 discovered, they not unfrequently drink to great excess, 
 and the motive is not clear. The physical condition of 
 this is very evident in the history of a number of such 
 persons, who, after serving a sentence in prison, recover 
 and come out, leading correct lives afterwards. 
 
 Such persons have been known to act normally and 
 rationally for some time, but after some sickness or dis- 
 aster commence to drink and go back to crime again. 
 In all the criminal courts, person of this class appear 
 from time to time and are called "repeaters" of a high 
 grade. 
 
 No question of responsibility or mental feebleness is 
 ever raised. Their crime and intoxication are considered 
 as vicious and culpable, and the courts never recognize 
 the moral palsies, morbid impulses or concealed delusions,
 
 PREMEDITATION IN CRIMINAL INEBRIATES. 343 
 
 and hence continue to resentence them, fixing their crim- 
 inal status more pronounced than ever. 
 
 In this way the effort to prevent crime by fines and 
 imprisonments is destructive, and literally destroys the 
 sanity and normal mentality of such persons, training 
 them into criminal careers as well as increasing their 
 mental degeneration and disease. 
 
 A very common theory prevails that crime is often 
 planned and spirits are used to give courage to execute 
 it. This is confirmed by criminals themselves, but there 
 is much doubt about its reality. A criminal by training 
 and instinct seldom takes spirits for the purpose of com- 
 mitting a crime. Experience has shown that spirits 
 unfits him for the execution of the act, and that he needs 
 all the capacity and efficiency that he possesses, to be 
 successful and escape punishment. In reality, spirits 
 confuse and weaken the mind, and prevent the judgment 
 necessary. 
 
 Low brutal crimes committed by persons under the 
 influence of alcohol rarely show any motive or purpose 
 other than that of a demented person. Where the use 
 of spirits has been continuous and the brain is in a 
 semi-paralyzed state, criminal impulses may start at any 
 time, and materialize into acts that are clearly insane. 
 
 The very fact that the person has been using spirits 
 continuously is the clearest possible evidence of unsound- 
 ness. A theory prevails in the court room that when a 
 crime is committed by a drinking person and the con- 
 sequence and magnitude of the act are partially realized, 
 spirits are used to conceal the motive and lessen the con- 
 sequences. 
 
 It is very doubtful if this can be confirmed, for in 
 reality the general confused condition of the mind and 
 its control is so uncertain that any preconcerted action 
 is unlikely to occur. It would seem in certain cases
 
 INEBRIETY. 
 
 where persons drink to great excess after the execution 
 of a criminal act that there must be some motive, but it 
 is more likely to be a morbid impulse and delusional ob- 
 session of the same nature as suicide, and altogether 
 additional evidence of unsoundness and irresponsibility. 
 
 In all criminal acts committed by inebriates, it is safe 
 to assume that ethical notions of obligations, duties 
 and consequences are greatly confused or lost altogether. 
 No man under the influence of spirits can be normal and 
 have full self-control. Kleptomania, or the desire for 
 appropriating anything that the mind may fancy, is 
 only another phase of insanity, particularly when as- 
 sociated with the use of spirits. There may be motive 
 in this, and evidence of reason and judgment, and yet 
 the mind is obviously unsound. We have noted in previous 
 pages some striking examples of this. 
 
 A continuous drinker is more likely to develop crim- 
 inal acts and conduct and be the subject of morbid im- 
 pulses, and concealed delusions, and when the fact of his 
 drinking is made clear, the mental impairment and lim- 
 ited responsibility is of necessity present. The apparent 
 possession of judgment and sanity in inebriates who are 
 charged with crime should be made the subject of care- 
 ful study, and no evidence of premeditation should be 
 regarded as sanity or a safe guide upon which to base 
 degrees of responsibility and forms of punishment.
 
 CHAPTER XXXIII. 
 
 DISEASES AND NEUROSES ASSOCIATED WITH IN- 
 EBRIETY. 
 
 Synopsis. Both the inebriate and alcoholic turn to drug's for 
 relief. Drugs preceded the spirit taking and often follow it. 
 Very common in the history. Drugs taken for other purposes. 
 Examples. Drugrs cover up the symptoms, giving false impres- 
 sions. Opium most commonly used. Morphia very pleasing in 
 its effects. Complicated symptoms. Cannabis Indica, hyoscyamus 
 and concaine are used. For symptoms that indicate this condi- 
 tion. Hydrate of Chloral a common drug, combined with bromide 
 in proprietary medicines. Cocaine very fascinating for this pur- 
 pose. Some curious symptoms which follow. Belladonna another 
 drug used. Cannabis Indica with its peculiar symptoms. Chloro- 
 form and paraldahyde, to produce sleep, also gelsemine is used. 
 These drugs dangerous. Where spirits are prohibited, drug sales 
 are increased. Persons who recover without any suffering, to 
 be suspected. Medico-legal cases, in which persons are using 
 drugs secretly, to be recognized. Nicotine poisoning. Coffee and 
 tea are all to be recognized. Rapid recovery of persons supposed 
 to be incurable point to secret drug habit. Examples. Inebriates 
 are very susceptible to narcotic drugs. Their use should be rec- 
 ognized as dangerous. Possibility of producing a new addiction 
 more dangerous than the first. A new field to be studied. 
 
 The frequent references to drug addictions associated 
 with, and complicating inebriety, will naturally call for 
 a more detailed study of some of the more common forms. 
 This will enable the student to discriminate and in many 
 ways to more thoroughly understand the conditions pre- 
 ceding the use of spirits, and be better able to treat 
 them. Many of these conditions have been outlined in 
 previous chapters. 
 
 Both the inebriate and alcoholic very commonly turn 
 for relief to various narcotic drugs, either in regular 
 prescriptions or proprietary forms. When the effects 
 of these drugs are pleasant, they are used in the place 
 of spirits, and not unfrequently become a distinct addic- 
 tion. This may be for a brief time, until some disturbing 
 element occurs, or may become more or less permanent. 
 
 345
 
 346 INEBRIETY. 
 
 In the history of drug addicts a period of alcohol 
 taking, which has preceded the use of drugs, is very 
 common. This fact in itself will materially modify both 
 the diagnosis and prognosis, and should be considered in 
 the question of treatment. The history of these cases 
 show that alcohol has been used in various forms, particu- 
 larly beer or wine, for a long period. Then the patient 
 begins to suffer from some nutrient or nerve disturbance, 
 or insomnia. The family physician may be called in 
 and prescribe some drug containing a narcotic, that is 
 particularly agreeable and soothing in its effects, or the 
 patient may resort to some proprietary drug and receive 
 the same relief. In either case the drug will be repeated, 
 without any thought of its danger, and then finally, for 
 various reasons, an effort will be made to discontinue it, 
 which will be unsuccessful. 
 
 This is a very common history of a great many drug 
 addicts, and often in the struggle to escape from the 
 use of the drug, they will take up alcohol again, and 
 be astonished to find a peculiar susceptibility to it, which 
 did not exist before. The drug addict becomes quickly 
 intoxicated from alcohol, does strange things, and then 
 finally comes back to the drug from which he is trying 
 to escape. 
 
 This period is not unfrequently without the counsel 
 or advice of the physician and has been an accidental 
 circumstance of turning from one thing to another until 
 some drug is found that would apparently diminish the 
 pain and discomfort from which he suffers. 
 
 The physician who is called at this period, unless he 
 makes an exhaustive study of the patient, is very likely 
 to make mistakes and fail to recognize the original al- 
 coholic addiction, and the subsequent drug substitutions.
 
 DISEASES AND NEUEOSES. 847 
 
 The patient will very likely mislead him by giving a 
 history of malaria or rheumatism or some disorder of 
 the past, which in his mind has been responsible. 
 
 Thus a man, living in a southern country, who drank 
 spirits consecutively in so-called moderation, may have 
 had chills and fever, which to him was the unmistakable 
 evidence of malaria, but in reality it was a toxic disturb- 
 ance, generated in the system by alcohol. Acting on his 
 own supposition, he may have used large quantities of 
 quinine, with or without the advice of his physician. 
 This with alcohol has still farther increased the toxaemic 
 states, and culminated in some specific disorder, and to 
 cover up and conceal this, narcotics are particularly 
 valuable. 
 
 Other cases occur where obstinate constipation and 
 supposed congestion of the liver have been treated for 
 a long time with mercury, the alcohol being taken as 
 usual. The result is still greater disturbance and a 
 variety of symptoms which are relieved by narcotics, either 
 in the regular form or in some proprietary drug. 
 
 Other persons of this class occupying responsible posi- 
 tions, using spirits for their supposed tonic and stimulant 
 effects, have become insomniac, or have suffered from some 
 disturbing nutrient symptoms which have resisted all 
 treatment. Narcotics prove most attractive and they 
 become addicts. Then they give up the use of alcohol 
 and make great efforts to escape from their narcotic 
 addiction, but finally return to the use of both alcohol 
 and narcotics. 
 
 The number of persons in this condition is so large 
 as to attract attention, and require special study and 
 treatment. They are all practically inebriates and al- 
 coholics who have added to their troubles drug addictions. 
 The presence of extreme susceptibility to the use of 
 drugs, particularly narcotics and anaesthetics, can often
 
 348 INEBRIETY. 
 
 be determined with much certainty, and this fact is of 
 great importance in the study of the cases. 
 
 If the patients are neurotic by inheritance or from 
 neglect and exhaustion, the conditions are graver. These 
 facts should always be considered in the study of cases. 
 Quite a large number of persons will have a history of 
 wine drinking, beginning in college; then beer drinking, 
 with the result that fatigue and unusual exhaustion follow. 
 With this there will be associated gormandizing, high 
 living, neglect of sleep and continuous excitement. 
 
 This is the condition that narcotic drugs will effec- 
 tually cover up, giving the impression of cure; and if 
 the drug is resorted to repeatedly, its use becomes an 
 addiction. Opium, morphia and its other forms are the 
 most common narcotics taken, and sooner or later, become, 
 of all drugs, the most attractive and fascinating. 
 
 Opium, in the form of a tincture, is the most agreeable 
 of all and many alcoholics and inebriates boast of giving 
 up all spirits, but later are found to be dependent on 
 this drug. Often they are unaware of this. The ordinary 
 alcoholic cannot use the ticture of opium long without 
 producing some irritant effects on the stomach, and while 
 the narcotism is very pleasing, the nausea and vomiting 
 which follows are distressing. This occurs in many cases, 
 but not in all. 
 
 For this, not unfrequently, h} r perdermics of morphia 
 are substituted. The stomach regains its original vigor 
 and the patient has simply changed the form of the 
 drug. Many of the proprietary remedies contain opium 
 and its alkaloids. Hence it is safe to assume that the 
 pleasing narcotic action of drugs of this class are most 
 likely due to opium. 
 
 Many very interesting cases come under medical care 
 in which the patient has a variety of complex symptoms 
 and gives a history of having taken some proprietary
 
 DISEASES AND NEUROSES. 349 
 
 medicines for a long time, with increasing derangement 
 of the stomach and nutrient system, but with distinct 
 periods of rest and comfort. An early history of al- 
 coholic taking is not considered, and yet it is the begin- 
 ning and the present addiction is only another stage of 
 the same degeneration. 
 
 The patient asserts that opium was very irritating at 
 first ; that hyperdermics caused vomiting and nausea, and 
 that the drug which he has taken was originally distress- 
 ing, but finally it acted with great satisfaction and com- 
 fort. In reality his system has come to tolerate the 
 drug which was nauseating at first. What he is taking 
 is simply opium or its alkaloids. The attempt to with- 
 draw this drug is followed by grave depressions. 
 
 A case of considerable interest was that of a prominent 
 man who was said to have been very wild in his early 
 life, meaning that he drank a great deal of spirits, then 
 reformed and later became addicted to a certain remedy 
 which he used in large quantities. An attempt was made 
 to give up the remedy, but the effects were so distress- 
 ing that it was resumed again. 
 
 In early life, when recovering from alcoholic effects 
 morphine produced great depression and vomiting, and 
 the impression prevailed in his mind that this drug 
 could not be opium or its alkaloids, or it would have 
 produced the same effects which it did years before. 
 
 He became an invalid, and the remedy he was addicted 
 to was found to be morphia, combined with Cannabis 
 Indica. The physicians considered it wise to continue 
 this drug until his death, and also permitted him to use 
 alcohol for the supposed purpose of keeping up his heart's 
 action. Then came a very interesting question in the 
 contest over his will, whether he was able to sanely dis- 
 pose of his property. A great variety of medical testi- 
 mony was introduced, and the will was sustained, but
 
 350 INEBRIETY. 
 
 it was proven that his first use of alcohol and later that 
 of proprietary drugs which contained opium, had evi- 
 dently impaired his brain, and this with the blundering 
 effort to withdraw the drug, made him still more irra- 
 tional. The physicians in attendance and the experts 
 failed to realize the actual conditions, and the possibility 
 of help. 
 
 The diagnosis is a matter of considerable importance. 
 When an alcoholic or an inebriate suddenly stops all use 
 of spirits and has no symptoms of irritation or depres- 
 sion, but on the contrary rather boasts of his great 
 strength of will and ability to control himself, it may 
 safely be inferred that he is taking some concealed drugs 
 of which morphia or other forms of opium are the most 
 common. 
 
 Cannabis Indica, hyoscyamus, cocaine and other drugs 
 may be used in the place of spirits, but they cannot be 
 depended upon and are more or less uncertain. Morphia 
 in small doses is more likely to be taken secretly for 
 long periods without exposure than any other, and this 
 can seldom be discovered except by experts and critical 
 examinations. 
 
 Cases like the following are to be expected. An al- 
 coholic or an inebriate suddenly recovers and goes on 
 for a period of years, claiming to be a total abstainer. 
 During this time he will seldom call for a physician and 
 then only for some transient troubles. His manner and 
 air may become secretive as he grows older. His face 
 paler, and his eyes contracted and his sleep irregular, 
 broken but profound. Then suddenly he will drink 
 again, and the degree of depression and poisoning which 
 follows will be unusual and hardly explainable by the 
 amount of spirits taken. 
 
 Death will follow either from hemorrhage or acute 
 inflammatory conditions. In reality the man has been a
 
 DISEASES AND NEUROSES. 351 
 
 secret drug taker from the time of giving up the spirits, 
 until they were resumed again. He was able by the use 
 of some form of opium, to appear normal and healthy 
 and yet all this time he is becoming more and more 
 degenerate. Then on resuming alcohol his real con- 
 dition appeared which terminated in death. 
 
 It not unfrequently happens that an inebriate, at the 
 beginning or close of the drink paroxysm, finds pleasing 
 relief from the action of morphia, either by the needle 
 or by the mouth. This experience will be repeated and 
 the time will come when this drug will be taken to prevent 
 the obsession of spirits from controlling him. This may 
 be done secretly, although thoughtless physicians not 
 unfrequently give this drug at the beginning of the 
 paroxysm, telling the patient what they are doing and 
 thinking in this way they are breaking up the drink 
 craze. In reality they are cultivating another addiction 
 which is as toxic and dangerous as that from alcohol. 
 
 The efforts of quacks to cure such persons by opium 
 and its compounds and then attempt to withdraw these 
 drugs by substituting other narcotics is a vicious circle 
 from which there is little prospect of permanent restora- 
 tion. Irregular and thoughtless physicians lead spirit 
 drinkers on a round of different forms of opium and other 
 narcotics, and not unfrequently alternating with spirits, 
 claiming great results from each change, and yet leaving 
 the patient more and more incurable. 
 
 Frequently some irregular physician will attempt to 
 cure an inebriate by continuous use of morphia or some 
 of the alkaloids of opium. Then suddenly a collapse 
 follows and death, which is called heart disease, but 
 has really been toxic states overwhelming the vital forces. 
 
 Pneumonia is a very common sequela, is likely to occur 
 any time and is literally paresis of the pneumogastric 
 nerves. Opium smoking is another form of obtaining
 
 352 INEBEIETY. 
 
 relief, and this has perils peculiar to itself. In all this 
 there are unknown dangers and extreme liability to pro- 
 duce a more serious addiction, than that for which the 
 cure is attempted, and with it all the possibility of heart 
 failure or some unknown condition of collapse that is 
 given some name. 
 
 Instances are more or less common where the two 
 narcotics given both openly and secretly have resulted 
 fatally. The use of the needle, either with morphia or 
 cocaine, or other drugs, is both physically and psychically 
 dangerous ; first because the relief is very rapid and 
 pleasing, second, it creates an impression of perfect and 
 permanent cure, the memory of which remains. In reality 
 the derangement and depression is intensified and the 
 causes are not removed, but other causes are created. 
 There is no safety in the attempt to treat the alcoholic 
 or inebriate by narcotics. In many instances it is simply 
 changing the form of addiction and disease, leaving 
 the patient more seriously crippled than before. 
 
 Chloral is a drug that is frequently used in inebriety, 
 by itself or in compounds. In the ordinary inebriate and 
 alcoholic, where profound stupor and changing deliriums 
 occur, there are many reasons to believe that hydrate 
 of chloral is responsible for this. Numerous persons have 
 been observed in which, after the immediate effects of 
 drink, a peculiar delirium appeared. This did not resem- 
 ble the ordinary alcoholic delirium or delirium tremens, 
 but while being transient, was followed by curious inter- 
 vals of stupor. 
 
 A person who drank at intervals on public occasions 
 would the next day have very confusing states of delirium 
 with extreme depression. This was the subject of a great 
 deal of comment ; finally it was found that it was due 
 largely to hydrate of chloral, which was taken for the 
 purpose of producing sleep. It appears from a number
 
 DISEASES AND NEUROSES. 353 
 
 of histories that chloral taken after the stupor of alcohol 
 has subsided, will not only produce a short period of 
 sleep, but will leave the brain in a confused delirious 
 condition, which may be checked temporarily by another 
 dose. The subsequent symptoms will be increased and 
 more confused delirium will result. 
 
 Compounds of chloral and bromide in the form of 
 proprietary drugs is a frequent remedy given after the 
 use of spirits, and often results in symptoms that are 
 more or less confusing. While these associated disorders 
 are not very common they should be recognized and 
 understood. 
 
 Cocaine is another drug that has a peculiar fascination 
 in covering up the effects from spirits. The narcotism 
 from cocaine seems to fall on the higher mental processes 
 and not only cover up the irritation, but give an extreme 
 confidence in one's ability to overcome the physical disa- 
 bilities which naturally follow. The cocaine taker has 
 mental exaltations which rise above all remorse and 
 chagrin and consciousness of loss. All discomfort and 
 irritation passes away and the relief and consciousness 
 of health is so perfect and complete as to leave no doubt 
 in his mind. 
 
 The inebriate who after a drink excess shows great 
 serenity and confidence in himself and has no suffering 
 is very likely to be under the influence of cocaine. Not 
 unfrequently there will appear a certain garrulity and 
 word delirium in which the patient will talk on all sub- 
 jects and be perfectly happy and pleased. This suggests 
 cocainism more than any other drug. Later after this 
 period of delirium there will be a strange seclusion, ab- 
 stractness and period of suspicion. This also suggests 
 the same drug. 
 
 Another curious symptom pointing to cocainism is in- 
 tense literary activity. Persons will show an intense
 
 354 INEBRIETY. 
 
 desire to write and compose all sorts of literary products. 
 This occurs in quite a large number of cocaine addicts. 
 An example was that of a village doctor who after a 
 drink period would become a very voluminous contributor 
 to the village paper ; writing letters, poetry, giving advice 
 on all kinds of general and hygienic matters. After a 
 time this would subside and then a drink paroxysm would 
 occur again. Not unfrequently the alcoholic or inebriate 
 will exhibit very aggressive dogmatism, and a delirious 
 sort of reasoning, consisting of condemnation, strange 
 assertions and peculiar theories. Occasionally this cul- 
 minates in some overt act, which points unmistakably to 
 some other drugs and spirits. 
 
 Belladonna and hyoscyamus are found to be taken 
 very freely at this period. The narcotic effect is in some 
 way manifest in these peculiar symptoms. Cannibis 
 Indica is another drug whose peculiar effects are often 
 very marked after the first period of narcotism. Some 
 curious instances have occurred of inebriates who after 
 the use of Cannabis Indica became disoriented. Such 
 persons will fail to recognize the street on which they 
 live and make mistakes as to the location of their home 
 or office. This will be termed faults of memory, but in 
 reality it is the poisonous action of this particular drug. 
 
 A very good clergyman who had been a wine drinker 
 for years exhibited this fault to the alarm of his friends 
 and physicians. Finally it was discovered that he was 
 taking Cannabis Indica every night. The withdrawal 
 of this drug and the wine was followed by recovery. 
 Many persons suffer from insomnia, both preceding and 
 following the drink paroxysm, and often while using 
 spirits continuously. This symptom is sometimes very 
 distressing and is not easily overcome by increased doses 
 of spirits. Narcotics are often used.
 
 DISEASES AND NEUROSES. 355 
 
 A few cases are reported in which chloroform has been 
 given, and the results are most pleasing. In this way 
 an addiction is established. Fortunately this cannot con- 
 tinue long, owing to the peculiar odor which betrays 
 the victim. Chloroform addiction following the use of 
 alcohol is very serious. There are profound degenerations 
 of both sensory and motor nerves and the withdrawal of 
 chloroform is followed by obsessions that are frequently 
 suicidal. Many of the suicidal alcoholics have used chloro- 
 form and the peculiar derangement which follows from 
 its use lowers the vital resources and brings with it a 
 dread of suffering that seeks to avoid it through death. 
 
 Chloroform by inhalation produces a sense of relief, 
 the memory of which is very fascinating and vivid. Like 
 the effects of cocaine on the psychic centers, this impres- 
 sion is never forgotten, and no matter what the conditions 
 are, the temptation to secure it again is almost irresistible. 
 
 Paraldahyde is another drug used to produce sleep, but 
 its peculiar odor and taste makes it repellent. Some 
 cases have been reported of paraldahyde addiction, fol- 
 lowing the use of alcohol. 
 
 Gelsemin frequently has pleasing effects in such cases, 
 and has been used in proprietary compounds for the 
 relief of after symptoms from spirit taking. Quite a 
 number of drugs containing combinations of chloral, gel- 
 semin nux-vomica, atropia and opium are sold in Europe 
 to overcome the pain and depression following from the 
 excessive use of spirits. They are not very common in 
 this country. The peculiar effects following from them 
 have been noted in many instances. Coal tar derivatives 
 and opium compounds are more extensively used in this 
 country, together with strychnine and atropia. It should 
 always be remembered that the effects of these drugs 
 are to be considered from a study of these cases, and
 
 356 INEBRIETY. 
 
 their removal will reveal their special influence and pres- 
 ence. 
 
 Many of the obscure medical and surgical cases occur- 
 ring in inebriates have been traced to specific drugs or 
 narcotic prescriptions used to overcome the toxsemias. 
 Some investigations have indicated that in certain sections 
 of the country where the use of alcohol has been prohibited, 
 the demand for anaesthetics and narcotics is greatly in- 
 creased. Proprietary drugs of this class have had in- 
 creased sales in these sections. This is a clear indica- 
 tion of the physical causation of alcoholism and inebriety, 
 beyond that of alcohol. 
 
 While the facts are not yet clear, it is altogether 
 probable that the withdrawal of alcohol as a beverage 
 will create a demand for drugs of the anaesthetic class, 
 and this will continue for some time. The effects of these 
 drugs constitute a distinct phase or class of symptoms 
 which the physician should be competent to determine. 
 
 Reference should be made to medico-legal cases, oc- 
 curring in persons who have used spirits at some pre- 
 vious time and whose symptoms are so confusing as to 
 cause wide differences of opinions. Usually inebriety or 
 alcoholism has existed previously, and the patient has 
 recovered and claims to be a total abstainer. While his 
 symptoms of ill health have not attracted particular at- 
 tention or question, he suddenly commits an overt act, or 
 docs some strange things which is called into legal ques- 
 tion. A study of the symptoms shows considerable varia- 
 tion of strange conduct and reasoning, following the 
 withdrawal of spirits. This can not be called insanity 
 nor is it sane and normal in many ways. Alienists draw 
 different conclusions and usually assume that the state- 
 ment of the person that he has been a total abstainer is 
 true, but how to account for the irregularities both men-
 
 DISEASES AND NEUROSES. 857 
 
 tal and physical which follow is open to various theories 
 and explanations. 
 
 In all probability the withdrawal of alcohol was fol- 
 lowed by the secret use of some narcotic drugs for a 
 long period of time, and the extraordinary conduct and 
 criminal acts were due entirely to the degeneration of the 
 brain, which began with alcohol and was intensified by 
 drugs that were concealed. 
 
 The derangement has not reached the point of being 
 open and recognizable. Too much emphasis can not be 
 placed on this possible and probable fact, which is liable 
 to occur in a great many cases of criminal and insane 
 conduct. Tobacco when associated with and following 
 the drink addiction, is a poison that should be recog- 
 nized. The withdrawal of spirits is frequently followed 
 by the excessive use of tobacco and the result, nicotine 
 poisoning and its allied neurosis, is a prominent factor, 
 which should not be overlooked. 
 
 A number of cases have been noted where very prom- 
 inent physical and mental symptoms have appeared after 
 the spirits were withdrawn, that were interpreted as se- 
 rious organic derangements. A later study proved them 
 to be due to nicotine poisoning. 
 
 Statistics of the cure of patients sent to insane asylums 
 as paretics and dements bring out this fact very clearly. 
 Hospital treatment with abstinence of spirits and drugs 
 and with the ordinary limited measures, have restored 
 many persons that under any other circumstances were 
 supposed to be incurable. 
 
 A very pronounced case of general paresis was per- 
 manently restored in the New York Hospital in the course 
 of a few months. Both the family physician and the 
 alienist had failed to discover the use of chloral, cocaine 
 and bromides which the patient had taken for a long 
 time, following an alcoholic addiction.
 
 358 INEBRIETY. 
 
 Hyoscine is another drug used to quiet the mental 
 disturbances from alcoholism and inebriety that is very 
 likely to produce far more serious symptoms and degen- 
 erations than it is intended to correct. A periodic drinker 
 was given large doses of this drug which produced sleep 
 and finally terminated in a low form of delusion. He 
 was sent to an insane asylum and recovered after a few 
 months. A year later, he drank again, and this time he 
 was treated hydropathically. His recovery was complete. 
 This and other instances suggest that hyoscine on a 
 highly sensitive irritant brain may produce disturbances 
 and mental conditions of most serious character. Like 
 chloral the pleasing narcotism and sleep which follow may 
 develop congestions and irritations of a very serious 
 nature afterwards. It certainly is a very toxic drug, 
 and its peculiar action should be recognized in all con- 
 fused cases. 
 
 It is the opinion of many persons that tea and coffee 
 in excess after the withdrawal of alcohol are very likely 
 to predispose to states of exhaustion and toxaemia, that 
 will greatly retard the final recovery. There are many 
 reasons for believing that there are certain persons sus- 
 ceptible to various drugs ; of which caffein and thein 
 should be noted as complicating and encouraging diseases 
 following the use of spirits. 
 
 The associated diseases from drug narcotics in alco- 
 holics and inebriates are very numerous and complex and 
 we have scarcely indicated the principal ones and their 
 psychic influences. In reality, they constitute an un- 
 known field, that must be explored in the future. 
 
 The great fact should be remembered that the effects 
 of the use of spirits in inebriates and alcoholics prepare 
 a field for the growth, cultivation and development of a 
 great variety of neuroses and psychoses which should be 
 studied and traced in the questions of diagnosis and 
 treatment.
 
 INDEX. 
 
 PAGE 
 
 Alcoholic Congress, International, Anti 38 
 
 Alcoholism, the meaning of 39 
 
 Alcohol in America very distinct 48 
 
 The opinion of Dr. Hughes on 48 
 
 Alcoholism caused by inhalation 119 
 
 Barometrical conditions, causes of 118 
 
 Saloons an active cause of 119 
 
 Meat eating and cigarettes, active causes of 124 
 
 Examples of 126 
 
 Andrieson, Dr. Views on Pathology 178 
 
 Alcoholic Amnesia 317 
 
 Degrees and claims of 321 
 
 Some methods of discrimination 320 
 
 Binghamton Inebriate Asylum opened 31 
 
 The principles and purposes of 31 
 
 Changed to insane asylum 32 
 
 History of 33 
 
 Books on Inebriety and their authors 35 
 
 Beard, Dr. Opinions of 49 
 
 Bowditch, Dr. Views of, on Drink Neurosis 51 
 
 Beer addiction results in inebriety 122 
 
 And wine, the use of in Europe 122 
 
 Berkley, Dr. Opinions on the Pathology 178 
 
 Belladonna used after inebriety 354 
 
 Continuous inebriates 85 
 
 Two classes of 86 
 
 Opinions of authorities on 88 
 
 Symptoms peculiar to 89 
 
 Prevalence in business circles 90 
 
 Degeneration of 91 
 
 Coffee an active cause of inebriety 123 
 
 Clinical examination and study of inebriety 217 
 
 Charlatan efforts of treatment 296 
 
 Criminal inebriates 305 
 
 Examples 307 
 
 Can not be regarded as sane 311 
 
 Must be studies from facts 309 
 
 Alcoholic amnesia in 317 
 
 359
 
 360 INDEX. 
 
 Criminal inebriates Continued. PAGE 
 
 Different classes of 319 
 
 Variations in their history 324 
 
 Often moderate drinkers 325 
 
 Kleptomaniacs 324 
 
 Homicides 321 
 
 Premeditation, not a sign on sanity 338 
 
 Inherited instincts common 340 
 
 Examples 342 
 
 Irresponsible as a rule 343 
 
 Chloroform after inebriety 355 
 
 Cannabis Indica after inebriety 349 
 
 Chloral used after inebriety 352 
 
 Coffee and calfein after inebriety 358 
 
 Cocaine, a fascinating drug following inebriety 353 
 
 Some peculiar systems of 354 
 
 Davis, Dr. N. S 36 
 
 Day, Dr. Albert. His book 35 
 
 Drinkers, moderate 57 
 
 Delusional symptoms 58 
 
 Digestive disturbances 58 
 
 Delirium 57 
 
 Delirium Tremens 68 
 
 Word 64 
 
 Dipsomania, description of 150 
 
 Day, Dr. Albert. Studies of heredity 156 
 
 Diagnosis of inebriety 186 
 
 Delirium associated with inebriety 193 
 
 Diagnosis complicated in many cases 187 
 
 Of midnight drinkers 188 
 
 Of coma 191 
 
 Of women who drink 192 
 
 Examples of 193 
 
 Opinion of authorities on 189 
 
 Delirium Tremens 203 
 
 Different forms of 204 
 
 Some general symptoms of 204 
 
 Delusions of 205 
 
 Mortality from 206 
 
 Pathological conditions of 208 
 
 Toxsemic conditions of 209 
 
 General treatment of 212 
 
 Symptoms of other disorders associated 215 
 
 Examples of 214 
 
 Tuberculosis associated with . . .260
 
 INDEX. 361 
 
 PAGE 
 
 Diseases and neurosis associated with inebriety 347 
 
 Gelsemium following inebriety 355 
 
 Hughes, Dr. C. H. His opinions on inebriety. . . . .- 48 
 
 Heredity an active cause of inebriety 110 
 
 Xoted among children 125 
 
 Active in the causation 140 
 
 Historic references of 141 
 
 Two forms of 141 
 
 General symptoms of 142 
 
 Peculiarities of 144 
 
 Associated disturbances with 145 
 
 Examples of 146 
 
 Chinese laws relating to 153 
 
 Opinions of different authors 154-155 
 
 Hospitals, different classes of 253 
 
 Housing and controlling inebriates 255 
 
 Hospitals of the sanitorium class 259 
 
 Of the future 260 
 
 Of the workhouse class 258 
 
 Under state care 261 
 
 For the insane. Treating inebriates 262 
 
 Under the military plan 267 
 
 Under private management 268 
 
 Laws of 269 
 
 In England 270 
 
 Leading in this country 271 
 
 History of empiricism 297 
 
 Of different empiric efforts 299 
 
 Of the success of empirics 303 
 
 Of empiricism in England 304 
 
 Hyoscin after inebriety 358 
 
 Hydropathic treatment of inebriety 272 
 
 Inebriety 
 
 Antiquity of 13-17 
 
 In Babylon 19 
 
 In Grecian history, reference to 20, 21 
 
 Statements of Grecian philosophers on 23 
 
 Roman theories and conceptions of 24 
 
 Views of French physicians on 25 
 
 Writings of Americans on 25 
 
 J. E. Turner's views on 26 
 
 First International Congress on 26
 
 362 INDEX. 
 
 Inebriety Continued. PAGE 
 
 Discussions concerning 28 
 
 Theories concerning 30 
 
 First society for the study of 33 
 
 Journal of, its beginning 33 
 
 English society, for the study of 34 
 
 The meaning of the term 40 
 
 In America and its peculiarities 47 
 
 Moves in psychological waves 49 
 
 General symptoms of 56 
 
 Forms of moral insanity in 93 
 
 General causes of 106 
 
 Special causes of 118 
 
 Following from shock 114 
 
 Examples of 115 
 
 A clinical examination of 217 
 
 The diseases associated with 346 
 
 Kerr, Dr. Norman. His book 35 
 
 Symptoms divided into three acts 64 
 
 Studies of heredity 156 
 
 Kellogg, Dr. J. H 279 
 
 Le Graine, Dr. Studies of heredity by 155 
 
 Lewis, Dr. Sevan. Opinions of the Pathology 181 
 
 Medical Temperance Association. Organized 36 
 
 Name changed of 37 
 
 Mason, Dr. L. D. His description of cases 44 
 
 Magnan, Dr. His division of cases 44 
 
 Morell, Dr. Paralytics described by 44 
 
 Mason, Dr. L. D. Opinions of 85 
 
 Moral insanity forms inebriety 83 
 
 Examples of 86 
 
 Symptoms of 87 
 
 Types of degeneracy in 88 
 
 Forms of palsies in 100 
 
 MacNicholl, Dr. Study of defects in children 125 
 
 Morell, Dr. Studies of heredity 153 
 
 Mason, Dr. L. D. Studies of heredity 156 
 
 Studies of coma in inebriety by 191 
 
 Medico-Legal superstitions concerning inebriates 317 
 
 Examples of 320 
 
 Questions 329 
 
 Different views held . .331
 
 INDEX. 363 
 
 Medico-Legal superstitions concerning inebriates Continued. PAGE 
 
 Errors of medical men 334 
 
 A new field awaiting study 329 
 
 Automatism a common symptom 336 
 
 Some superstitions 337 
 
 Morphine following inebriety 348 
 
 Medico-Legal questions, after inebriety 356 
 
 Neurosis following inebriety 149 
 
 Associated degenerations 150 
 
 Dipsomania one of them 151 
 
 Marked by fecundity 151 
 
 Examples of 152 
 
 Table of symptoms 153 
 
 Types of cases 154 
 
 Stigmata 155 
 
 And its heredity 156 
 
 Narcotic drugs following inebriety 346 
 
 Opium following inebriety 348 
 
 Periodical drinkers 40 
 
 Classes of 41 
 
 Psychopathic causes of 42 
 
 Parish, Dr. His description of inebriety 42 
 
 Periodic inebriety, its symptomology 70 
 
 Premonitory symptoms 73 
 
 Periodic inebriates, different classes of 74 
 
 Psychical symptoms 75 
 
 Periodical drinkers, examples of 78 
 
 Psychoses of inebriety 128 
 
 Forms of 129 
 
 Symptoms of 130 
 
 Examples of 131 
 
 Traumas, an active cause of 133 
 
 Occupations active causes of 136 
 
 Diagnosis of, important 137 
 
 Parish, Dr. Studies of heredity 156 
 
 Psychic inebriety traceable to heredity 158 
 
 Symptoms and examples of 159 
 
 Pathological states 166 
 
 Impressions and obsessions of 166 
 
 Pathology of inebriety 176 
 
 Modern views of 177 
 
 Heart and blood vessels, effects on 180
 
 364 INDEX. 
 
 PAGE 
 
 Pathology, opinion of authorities on 178-179 
 
 Palsies, a common symptom 183 
 
 Pathology, structural 184 
 
 Pathology, functional 185 
 
 Prognosis of inebriety 185 
 
 General symptoms to be observed 186 
 
 Patent medicines and their influence 197 
 
 Predisposition a large factor in the prognosis 198 
 
 Pledges and prayers among the remedies 196 
 
 Prognosis depends on toxaemia and traumas 200 
 
 Prognosis good in most cases 202 
 
 Prognosis complicated 199 
 
 Prognosis, examples of 198 
 
 Premeditation in criminal inebriates 338 
 
 Examples 340 
 
 Inability to reason wisely 341 
 
 Impulsive, transient and uncertain 343 
 
 Paraldahyde following inebriety 355 
 
 Proprietary drugs common after inebriety , 346 
 
 Pneumonia frequent termination 351 
 
 Symptoms of inebriety 217 
 
 Changes first noticed 218 
 
 Disturbances of the stomach 219 
 
 Mental disturbances 220 
 
 Rapid changes 221 
 
 Careful studies necessary 222 
 
 Suspicious egoism 223 
 
 Psychical changes common 224 
 
 Shepard, Dr. C. H 272 
 
 Turner, Dr. J. B., founder of the asylum 30 
 
 The work and history of 32 
 
 Treatment, general principles of 223 
 
 Special questions to be considered in the 226 
 
 Conditions to be avoided 225 
 
 Remedies of general value 226 
 
 Complex conditions to be considered 229 
 
 Danger of depending on drugs 230 
 
 Home and office 231 
 
 Acute conditions to be overcome 232 
 
 Toxic conditions to be considered 234 
 
 Temperate use of spirits so-called 236 
 
 Treatment, examples of cure 242 
 
 Some drugs most practical 244
 
 INDEX. 365 
 
 Treatment, examples of cure Continued. PAGE 
 
 Empiric efforts 248 
 
 Institutional 249 
 
 Antiquity of 249 
 
 Hospital methods and means 251 
 
 By hot air 272 
 
 Radiant light baths 273 
 
 Vibration, electric currents 274 
 
 Treatment by hydropathic means 278 
 
 The effects of 281 
 
 Treatment, the psychical effects 282 
 
 Treatment by mental suggestion 286 
 
 By gold cures 287 
 
 Details of by suggestion 290 
 
 Examples of cure 294 
 
 By colored lights 295 
 
 Washingtonian movement 30 
 
 Home, the beginning of 30 
 
 Wright, Dr. T. L., book on inebriaism 35 
 
 Conclusions from studies 112 
 
 Studies of heredity 155 
 
 Woodhead, Dr. Conclusions on the Pathology .180
 
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 Inebriety; a clinical treatise... 
 
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