CHAPTER XIV

RELATION OF DRUGS AND ALCOHOL TO INSANITY

The habitual drug-taker and the confirmed alcoholic are puzzles that baffle the alienist. The man with the "wet brain" is a contradiction of all the rules of normality. In many criminal trials men have been adjudged insane who were merely in abnormal states due to the habitual use of drugs or alcohol, of which, without proper treatment, they have been suddenly deprived.

In one of the largest hospitals in the United States I once ran across an old woman crooning while she rocked an imaginary baby. She had been formally and legally adjudged insane by the State's experts. As a matter of fact, she was suffering only from an hallucination due to alcoholic deprivation. I suggested definite medical treatment for this case when I discovered that she was about to be transferred from the alcoholic ward to the insane pavilion. In two days after the administration of this treatment she had lost all her hallucinations, and on the third day was dismissed from the institution. Not long ago I observed a similar case in a foreign hospital.

It is my belief that commitments for insanity in the United States might be decreased by one third if in every case where insanity was suspected, but where an alcoholic or drug history could be traced, the patient should be subjected to the necessary medical treatment before the final commitment was made. The sudden deprivation of drugs and alcohol which follows the imprisonment of alcoholics and drug-users upon disorderly or criminal charges has produced thousands of cases of apparent insanity sufficiently marked for the subjects to be placed in insane asylums. There, as in the prison, no intelligent note is made of their condition, nor is any proper treatment applied, the result being that they become really insane--insane and hopeless. If we had any means of securing accurate knowledge of the number of such incurable maniacs who are now confined in our asylums, we should find in it a startling evidence of the lack of knowledge on the part of the medical world of what deprivation means to the habitual victim of drugs or alcohol.

GENERAL IGNORANCE OF THE RELATION OF ADDICTION TO INSANITY

The necessity for educating the public in regard to the very definite relation between alcoholism and insanity should no longer be overlooked. There lies a public peril of unappreciated magnitude in the fact that mere deprivation, the only method so far followed, has been, and if it is not corrected, will continue to be, one of the principal feeders of our insane asylums. Alcoholism will lead to insanity eventually even without deprivation.

The case is somewhat different with drug victims. Ordinarily they will not become insane unless deprived of their drug, although in the final stages of the habit they are likely to become incompetent and subject to certain hallucinations, imagining the existence of plots against them, suspecting unfairness on every hand, taking easy offense, exhibiting, in fact, a general distorted mental condition. It is true, indeed, that in some instances the drug victim who is deprived of his drug may become definitely insane, but death is the more frequent result.

I have before me a clipping from a newspaper published in Columbus, Ohio. There, after the enforcement of restrictive legislation, the authorities found it necessary to ask the governor for some special procedure which would authorize them to supply drug victims with their drugs until proper medical treatment was provided. This did not relate to those victims who had come exclusively from the under-world, but referred specially to those habitual drug-users whose habits had been acquired through illness. It can scarcely be expected that restrictive legislation will entirely prevent the sale and use of drugs in the under-world any more than restrictive legislation has been able to prevent the practice of burglary or any other type of crime or lawlessness. It is highly probable that the under-world will always be able to get its drugs; but it is nevertheless true that the passage of restrictive legislation and the enforcement of such laws will tend to prevent the descent of many into the criminal class.

Even this is comparatively unimportant. Those who suffer most are those who have been given the habit by physicians. These are honest drug-users, and to them at this writing no helping hand is anywhere held out save in New York State. I have been somewhat disgusted--I am sure that is the word I wish to use--by the continual outpouring of sympathy and constant manifestations of anxiety on the part of good people in regard to the under-world, when these same good people regard with indifference or classify as criminal the involuntary victim toward whom the most intense and understanding sympathy should be extended.

MENTAL ATTITUDE OF THE DRUG-TAKER AND THE ALCOHOLIC

The victim of drugs psychologically differs very materially from the victim of drink. Until his trouble has reached an acute stage, the alcoholic feels little interest in any of the methods advertised as remedial for alcoholism. Many men deny to their friends and even to themselves that they are alcoholics until they have reached a point akin to hopelessness in their friends' eyes and their own. The drug-user, on the other hand, knows that he is a victim as soon as he becomes one; in ninety-nine cases out of a hundred he is immediately filled with an intense longing to be relieved of his habit. Thousands of alcoholics will defend their vice. A library might be filled with books, fictional and other, glorifying alcohol and the good-fellowship and conviviality that it is supposed to promote. One might search a long time for a victim of any drug habit who would speak with affection of the material which has enthralled him. No poet has ever written any song glorifying morphine. There is no drug-user in the world who would not hail with joy any opportunity that might lead to his relief. The drug-victim investigates every hint of hope with eager interest, reading, intelligently questioning, experimenting. He shrinks from publicity with a horror that is backed by an acute consciousness of his condition, while the victim of alcohol becomes so mentally distorted or deadened that he takes no thought of consequences, cares nothing for publicity, and finds himself unable to avoid public exhibitions of a kind that put him into the hands of the police. Public hospitals do not tempt the drug-user for, having investigated them, he knows that they are not competent to give him real relief.

EXPEDIENTS OF DRUG-TAKERS

Nothing but really enforced restrictive legislation, fashioned after the model of the present New York State law, will bring to light the drug-victims in any community. The New York law uncovered thousands of them, and within two weeks forced Bellevue and other hospitals to devote many beds to sufferers from drug-deprivation. Similar restrictive legislation would uncover every sufferer from drugs in the country and thus accomplish more good than could be achieved by any other similarly simple means. No man on earth is more pitiably affected than the drug-taker; no suffering is more intense than his when deprived of his drug. The fact that rather than undergo such suffering men and women will resort to the most desperate expedients has been proved a thousand times. When confronted by the terrible prospect of deprivation, they invented plans worthy of the mental agility of the most famous fictionist. Drugs were smuggled into prison hidden in the heels of visitors' shoes. One wife who knew the agony her husband must endure if deprived of his regular morphine dosage took to him clean linen which was admitted to the prison without question, but which, as an accident revealed, had been "starched" with morphine. Another ingenious wife or sweetheart devised the expedient of sending in to a prisoner oranges from which the juice had been cleverly extracted and which had been filled hypodermically with a morphine solution.

If there is no length to which a drug victim will not go rather than find himself deprived of his drug, there is no length to which he will not go in order to obtain relief from a habit the existence of which fills him with horror. This has often been illustrated in the course of my practice, but perhaps never more strikingly than when I learned of the experiences of a certain judge in Jacksonville, Florida. This far-sighted, merciful, and progressive jurist had come in contact with one or more pitiable cases of the drug habit to which he wished to give relief. He communicated with me, and I was very glad to cooperate in aiding with definite medical relief several drug-victims taken before him. This procedure was commented upon in the public press, and presently the judge found himself importuned for help by those who had committed no crime, but expressed themselves as quite willing to be sent to prison as the only way in which they could get the treatment that was being administered under his auspices.

DRUG-TAKING MORE OFTEN THE CAUSE THAN THE RESULT OF CRIMINALITY

A careful study of the histories of drug-takers who upon one charge or another find themselves caught in the meshes of the law will reveal that in most cases, or at least in many cases, the drug habit has led to crime rather than the reverse. If an efficient treatment for the drug habit were established in a prison almost anywhere in the United States where such a treatment did not elsewhere exist, it would result, I am sure, in the actual commission of crimes by a certain number of people willing to endure the misery and disgrace of incarceration for the mere sake of securing treatment for their affliction. Any drug-user will tell you that no punishment recorded in the course of human history, no torture visualized by the most inventive imagination, can compare with the unspeakable agony of deprivation.

FALLACY OF IMPRISONING DRUG-TAKERS

That imprisonment should rarely, if ever, result in freeing a person from the drug habit can mean only one thing: that drugs are obtainable in every prison. Guards and other employees in such institutions are of a low class, for men and women of a high type are unlikely to seek such employment. I fear that this fact will prove one of the most serious stumbling-blocks in the path of those who are endeavoring to make a success of inebriety-farm experiments. In the first place, they will not be able to find men of a high type anxious to serve in the subordinate positions provided at such places; and in the second place, even if such men can be found, they will be unlikely to obtain positions because persons of an inferior type will be certain to be pushed forward by political influence. Such places would be used as means wherewith to pay political debts, and this would be more or less complacently tolerated, because society has always underrated and still underrates the terrific complications of the task of working for the reclamation of, or even caring for, the down-and-out. Such work is not employment for the saloon-keeper, the ward heeler, or the ex-prize-fighter, and of such is the personnel of most prison staffs made up. The reclamation of the alcoholic wreck means far more than physical rehabilitation. It means moral and psychological regeneration, and such work can be done only by people of understanding and delicate sensibility. The alcoholic from the city who has been perhaps an office employee or a professional man and who is sent to an inebriate farm will find there nothing curative save deprivation. Even if outdoor work will harden his muscles, it must be admitted that the surroundings in which this is accomplished may well ossify his brain.

PSYCHOLOGY OF THE DRUG HABIT

Nothing could more clearly indicate the popular ignorance concerning the drug habit than the general belief that it is usually accompanied by moral deterioration. Where the habit is an accompaniment of life in the under-world, moral deterioration of course exists, though this is due rather to the under-world than to the drug habit. In the thousands of histories where the habit has been acquired by the administration of drugs by physicians it results in moral deterioration no more than drinking tea does. As a matter of fact, that portion of society which holds a drug victim blamable is woefully mistaken and inhumanely unmerciful, the truth being that the man or woman who is not taking drugs is lucky.

THE NECESSITY OF DEFINITE MEDICAL TREATMENT IN DEALING WITH ANY FORM OF ADDICTION

It is impossible for me to conclude this book without discussing further the question of treatment for those afflicted with habits or addictions.

My taking up this work in 1901 was due almost entirely to an investigation into the methods employed to restore those who had lost control through the use of habit-forming drugs, whether they had acquired the habit through dissipation or from the administration of the drug by a physician on account of illness or injury. At that time such cases were supposed to be hopelessly incurable, and the victims only drifted from bad to worse until they had been accounted for either in a mad-house or in the morgue.

I found, on making inquiries from some of the leading medical men who had been dealing with the various types of mental and nervous diseases, that they were virtually unable to name any case of a confirmed drug-user who had been permanently benefited by institutional or any other means of treatment. This was very difficult to understand, particularly in the case of drug-users who had acquired the habit through the administration of the drug by a physician, and who earnestly desired to be freed from the habit. It seemed incredible that a skilled physician could not eliminate the craving or desire for the drug, or restore these unfortunates to the point where their systems would not demand or feel the need of it.

I soon found out why this was so. My investigation showed me that the drug habit is a mental as well as a physical condition; that the physiological action of an opiate is to tie up the functions, resulting in a deterioration of the vital organs when the victim has taken the drug sufficiently long to set up a definite tolerance.

The medical world had apparently been unable or had not attempted to bring about a definite physiological change, and to place such patients where they would not crave drugs and where their systems would not demand them. To my further surprise, I found that the medical world had been depending entirely on deprivation as a means of treating such cases. They would immediately send patients to an institution where they were put under surveillance and guarded by attendants, or they would attempt by gradual reduction of the dosage to eliminate the habit.

CURE BY DEPRIVATION IMPOSSIBLE

This investigation led me into some very interesting discoveries. I found that old, confirmed subjects of the drug habit were sent to such institutions. Where they were taking large daily doses of opiates the institutions were able to reduce these people, when there was no underlying physical disability, within a few weeks or a few months, according to the temperament of the patient, to a very small daily dosage, often as low as one half or one eighth of a grain a day. When they had reached this dosage it was often found absolutely impossible to limit them further. In some cases where the patient was confined and finally deprived of the drug entirely I found that when he had reached this minimum dosage he would suffer just as much physical discomfort in the end as if he had been suddenly deprived of a very much larger quantity of the drug taken daily. This led up to the further interesting fact that even where patients were finally deprived of the drug and lived through the horrible suffering inevitably accompanying the deprivation, although they outlived the tremendous depression and lassitude which followed, and for long periods of weeks and months after that time had the best of care and attention until they showed marked improvement in their physical condition, nevertheless, with too few exceptions, they never lost the desire for the drug. Always the need of some stimulant returned, and on the slightest excuse or opportunity they were taking their drug again. My investigation finally proved to me that deprivation did not remove the cause of the drug habit, because it did not remove the physical craving for the drug. No matter how long a period the deprivation had been, the needed physical and mental change had never taken place.

EFFICACY OF THE AUTHOR'S TREATMENT

During the first two years of my work, after finding in various ways patients from the under-world to use as subjects for demonstration, I was finally able to treat any case of drug habit which came to me unless it was complicated by underlying physical disability. After a period of from three to four days these patients would not feel the slightest craving or desire for any form of opiate, whether their addiction had been cocaine, alcoholic stimulants, or tobacco.

When the efficacy of this treatment was assured, it began to attract the attention of some of the best-known medical men in the country--men who were interested in this line of study. They followed carefully the medical administration of the new treatment of these cases.

It was only a matter of time before the value of the work was thoroughly established and became a medical fact. After hundreds of definite clinical histories had been recorded, the formula was publicly announced, first, at the International Opium Conference at Shanghai in 1909, and a month later to the medical world. Since the complete information concerning my work has been given to the medical profession, and after all these years of study and investigation and medical comment, I have never yet had from any physician an entirely satisfactory explanation as to why or how we were able successfully to unpoison these cases in this short period. At present this treatment is, so far as I know, the only one known to medical science that will bring about this definite physiological change.

The intelligent beginning of help in these cases is to unpoison the patient, put him physically on his feet, where he does not want drugs or drink, and where he does not feel the slightest desire or craving for them, and has no dread of ever drifting into these habits again. When you have brought about this definite physical change, you are invariably able to get a definite mental change. You cannot hope to get the mental change until you have first cleared the system of poison, for in this state the patient is in a most responsive condition to deal with. If physical building up, change of environment, change of surroundings in any way whatever are necessary, they can then be taken up intelligently.

LEGISLATIVE EFFORTS

The knowledge I gained from dealing medically with those afflicted with habits and addictions led me to take up personally the movement to bring about definite legislation with a view to subordinating as much as possible the traffic and consumption of drugs to legitimate medical needs; and to put an end to the criminal negligence by which such drugs have been permitted to be imported, manufactured, and distributed.

In contact with the afflicted of this class, I discovered the laxity with which drugs were dealt in, and began in 1912 to try and bring about some restrictive legislation with regard to the evil before the New York legislature. I had first found that in the medical use of the drug the principal evil had sprung from the knowledge of what would ease pain, and that the principal means used for this purpose was the hypodermic syringe. At that time there was no restriction placed upon the sale of this instrument; it could be bought in any drug store just as easily as a package of chewing-gum. The department stores that carried drug supplies advertised hypodermic outfits as low as twenty-five cents. A physician's instrument permitted to be manufactured and sold in this way! Through the bill which was introduced in the New York legislature in 1912, for the first time in the history of the medical world it became possible to purchase this instrument only on a physician's prescription.

In 1913 I was the author of a drastic law regulating the sale of habit-forming drugs in New York State, but because of severe pressure brought by physicians and druggists, I was unable to put it through. In 1914 I tried again, and after a hard fight I was able to have enacted a bill, which was introduced by Senator John J. Boylan, and which bears his name. For the first time there was put upon the statute-books of a State real restrictive drug legislation. Other States are taking up this matter, and, as the intention was, the New York bill has been the means of establishing a legislative precedent.

I regret very much that the aim and purpose of Federal legislation has been largely defeated by the powerful drug interests, but I predict that it is only a matter of time before public sentiment will defeat this powerful drug lobby, as it has always defeated other lobbies of a similar kind, and that the country will be largely freed from the illegal habit-forming drug traffic.

Until there is some international understanding between the countries that produce these drugs and the countries that consume them, we shall have to submit to more or less smuggling of these drugs into our country. Smuggled goods rarely, if ever, find their way into channels for legitimate medical needs, and for that reason it is only the under-world that would be affected by their use and abuse.

It is only a matter of time before the commissioners of health for the various States will be given authority enabling them to issue rules and regulations governing the health of the people that will wipe out the quacks and charlatan venders of all common advertised fake medicine cures.

THE NEED FOR REGULATING THE ADMINISTRATION OF DRUGS

I have been told that to require a consultation of physicians before the administration of a habit-forming drug would put upon the patient a financial burden which he should not be asked to bear. No fallacy could be more complete. There is in the United States to-day not one victim of the drug habit who, knowing as he does the intense suffering it entails, would not rather have given up ten years of his life and been forced to put a mortgage on his soul than to have had this habit fastened on him. Money? Money is nothing! The cost of a consultation is a small price to pay for the possible difference between life-long thralldom and free manhood or womanhood. And let me add in regard to the physician who objects to the legal establishment of a danger-point in drug administration that the physician who feels big enough to accept personally the responsibility of creating a drug habit is too small to be intrusted with that power.

PERCENTAGE OF THOSE TO WHOM THE PERMANENT ADMINISTRATION OF DRUGS IS A NECESSITY

The percentage of sick people to whom the administration of habit-forming drugs is a necessity for the preservation of life or comfort is smaller than is generally supposed even by the medical profession. When I was drafting my restrictive bill to be introduced into the New York legislature, I was asked by my lawyer to enumerate those physical troubles which demanded the constant use of habit-forming drugs. I found this to be impossible. I have known many instances in which to deprive of drugs patients suffering incurable illness would have been little less than criminal. This alone enabled them to live in comparative comfort.

I have known of many cases of drug habit which have grown out of the administration of morphine for recurring troubles, such as renal colic. Such a disorder as this, however, should never give rise to a drug habit, because those suffering from it are subject to such brief periods of pain that a physician could administer the necessary drug without their knowledge. I have had many cases of women who, acquiring the habit through the administration of drugs at the time of their monthly periods, became habitual users, although each recurrence of the pain lasted only three or four days. When this problem is thoroughly understood, such cases will be impossible, for legislation will not only prevent the layman from securing habit-forming drugs, but will prevent the doctor from the indiscriminate administration of them.

Of course the general reader may think this book merely a clever advertisement. In it I state that it is wrong to stop the use of morphine and alcohol unless the victims can be treated for the habit, and next I condemn doctors and sanatoriums for their useless methods of treatment, while lauding my own. Naturally, my reader may assume that my only motive is the selfish one of money.

Well, one may suppose what he likes, but the truth is that I urge every city and State to establish places that will drive me out of business. I urge physicians to take up this treatment and cure their own colleagues. I have no secrets. My methods have been published, and I am now devoting most of my time to legislative work from which I do not profit a cent.

APPENDIX

THE RELATION OF ALCOHOL TO DISEASE

BY ALEXANDER LAMBERT, M.D.

Visiting Physician to Bellevue Hospital; Professor of Clinical Medicine, Cornell University

Author of "Hope for the Victims of Narcotics"

In the simple heading of the subject-matter of this article there are contained such possibilities of facts and fancies, truths and errors, and wide differences of opinion, that it seems wise to define not only its meaning, but some of the words themselves. What is disease? To many people it is a definite, concrete thing which seizes one in its clutches, holds one captive or possesses one for a second time, and then if overcome releases its grip and one is free and in good health again. But disease is not an entity, even though some agents, as bacteria, are living organisms. It is the lack of some processes which these agents overcome, and others which they set in motion, as manifested by disturbances of various functions of different organs in the body that make up some of our diseases. Our bodies are often in a state of delicate equilibrium, and if some one gland fails to secrete, or secretes too abundantly, the resulting condition may become a disease. As health is a harmonious relationship between the various functions of different parts of the body, so disease is a disturbance of this harmony. The question of the relation of alcohol to disease becomes a question as to whether or not this narcotic if taken into the body can react on the various tissues and organs of the body to such a degree as to disturb the equilibrium of health. And, furthermore, can this disturbance of healthy equilibrium be permanent and the body acquire a lasting diseased condition?

HOW IT AFFECTS DIFFERENT MEN

Alcohol is classed here as a narcotic and not a stimulant, because we shall see later that alcohol is rather a paralyzer of functions, even when it seems to stimulate, than a producer of increased output from any organ. The time honored idea that alcohol is a stimulant and that, if used in moderation, it is a tonic, is so ingrained in the average mind that it is with the greatest difficulty that men can be made to realize that even in what seems moderate doses it may injure them. This is especially true as one sees men who all their lives have indulged moderately in alcoholic beverages from which seemingly no harm has resulted. The truth, perhaps, is best summed up by the old adage that what is one man's meat is another man's poison, and there is no question that the effects of alcohol in small or moderate doses is vastly different from its effects in large doses, or in long continued, excessive use. Different human beings react differently to similar amounts of alcohol, and conversely, identical amounts of alcohol will affect different individuals in different ways, even when it poisons all of them. For instance, if alcohol sets different processes in motion which bring about damage to the individual, we find that in some persons it has injured the heart and arteries, in others it has affected the liver or stomach, leaving the brain and nervous tissues free from damage, while in still others the body in general seems to be untouched and the brain and nervous tissues suffer the injuries. It is not uncommon to see a man who has partaken freely of alcoholic beverages all his life with neither he nor his friends conscious that his intellect has suffered or deteriorated thereby, to find suddenly that his circulatory and digestive systems are seriously and permanently damaged. On the other hand, many a drunkard has become a burden to his family and the community, with his personality deteriorated, his intellect rendered useless, while his circulation and digestion remain unimpaired, and he lives long years a nuisance and a burden to his environment.

Since I have made the distinction between moderation and excess in the use of alcohol, it will be well to define what is regarded as excess, and what moderation, in order that the effects of both may be considered. Physiologic excess, it seems to me, has been best defined by a brilliant Frenchman named Duclaux, who says that any one has drunken alcohol to excess who one hour after he has taken it is conscious in any way of having done so. If after a drink of any alcoholic beverage has been taken, wine, whiskey, or whatever it may be, an hour later we feel ourselves flushed, tongue loosened, or if we are heavy and drowsy, or, if we find our natural reserve slightly in abeyance, if the judgment is not as sternly accurate as before partaking of the beverage, if the imagination is unusually active and close consecutive reasoning not as easy as before, if we think we do our work much better, but next morning realize we haven't accomplished quite as much or done it as well as we expected, then we have shown a physiologic excessive intake of alcohol, and an amount which if continued will produce damage somewhere in the body. Moderation in the use of alcohol means that it be taken in amounts of which one remains unconscious. This may seem a narrow and hard line to draw, and may seem to confine the amount of alcohol that may be consumed to much less than many people wish to indulge in. How much in actual amount this should be with any given individual depends upon that individual alone, and no one can be a law to any other individual than himself. If a man be engaged in severe manual labor or muscular exercise, he can consume more alcohol without detriment than when leading a sedentary life, although the character of the work that he will do may not be as good as if no alcohol were taken.

THE MODERATE USE OF ALCOHOL

The above definition, however, must suffice. We must fix some standard between moderation and excess, and the more accurately we define moderation, the more narrowly do we confine it. Judge by the above standard, alcohol taken in moderate doses does not seem more than to stimulate the digestive processes of the stomach, increase the flow of blood through the heart, increase the circulation in the periphery and skin, dilate the capillaries, and make it easier for the circulation to complete its cycles. When absorbed into the body in such doses, it can act as a food, and, in fact, as much as is burnt up by the body does act as a food, although it differs from other foods in that it is never stored up. It can replace in energy-giving properties sugars or fats, and being burnt up by the body can give out the equivalent of sugar and fat in muscular energy, and heat generated and given out by the body. Its effect is similar to that obtained by sugar and fats which are taken up by the body when needed and in the amounts requisite to the body at the moment, and it seems to be treated as far as can be seen as other foods for fuel. But it is not an economical fuel because the human organism does not perform its work as well as when there is no alcohol in the ration. Simultaneously when being consumed as food it is exerting its drug action. In this process it is the more easily available, and thus the sugar and fats are stored up while the alcohol is burnt up; it spares the fat consumption, often causing an increase of bodily weight through the putting on of fat. To those who are accustomed to its use, it seems also to spare the protein consumption of the body, but to those unaccustomed to its use it has the opposite effect, increasing the destructive breaking down of proteins.

DANGER SIGNALS UNHEEDED

Moderate indulgence in alcoholic beverages adds to the pleasures of existence with a great many men, and while it seems to increase their pleasures and broaden the extent of their mental experiences, it cannot be said to increase their powers of accurate mental activity, though it temporarily increases the imaginative flow of ideas. It relieves the feeling of both body and mental fatigue for the time being, an effect which may be an advantage or may be a distinct disadvantage, for fatigue is Nature's warning when to stop, and if we dull ourselves to this feeling and leave the warning unheeded, we may easily go on to harmful excesses of overwork and overexertion. It is doubtful if the moderate drinking of alcohol, as we have defined moderation, sets in motion processes which may so disturb the equilibrium of the body as to cause disease.

Broadly speaking, the excessive use of alcohol injures the body in two ways. It injures the functional cells of the different organs for alcohol is distinctly a cellular poison, and it further disturbs the nutrition of the organs by its injurious action on the blood vessels which supply nutrition to the various parts of the body. Whether to replace the destroyed cells or as a result of the congestion there is also an increase in the connective tissue framework of the various organs. The action of alcohol on the circulation is one of the earliest effects which is shown after it is taken into the body. The flushing of the skin is a beginning paralysis of the minute capillary blood vessels. If habitually indulged in, the effect is a continuous dilatation of the vessels, although it seems for a while in the early stages that there is a toning up of the circulation. Yet excessive indulgence brings with it always a lowering of the blood pressure and finally the chronic congestions in the internal viscera. The action of the heart at first is to make it beat fuller and stronger, but if continued, the effect is also one of paralysis of its muscle and a diminution of the output of work done, and finally it is a paralyzer of the heart's action. In some persons, through its injury to the cardiac blood vessels and intrinsic muscle of the heart, it sets in motion those morbid processes which result in angina pectoris.

Beginning with the stomach, we find that when alcohol is taken in excess it not only disturbs the processes of digestion that are then going on, if it is taken in greater amount than five per cent. of the stomach content, but it also acts directly on the mucous membrane, producing an irritant action. We have formed here a chronic congestion of the mucous membrane which produces swollen cells, and the digestive glands of the stomach produce an excess of mucus which interferes with digestion, and the resulting congestion interferes with the gastric secretions. It ends in producing a swollen, inflamed mucous membrane, often with hemorrhages. These processes may go on to an atrophic form of gastritis, in which the mucous membrane may be so atrophied that it is unable to secret sufficient gastric juice. The acid of the gastric juice, combining with certain substances in the intestine, is one of the stimulants which causes the production of the pancreatic secretion. The pancreas not alone digests the meats and other proteids, but it changes starch into sugar, and also has a fat splitting ferment. Thus we see that pancreatic digestion is a most important function, and does much more in the digestive work than the stomach. When therefore the acids of the gastric juice are lacking, there is an insufficient stimulus to the pancreas to pour out its complex juices and complete digestion.

THE ATTACK UPON THE LIVER

Alcohol is so rapidly absorbed from the stomach and the upper intestine, that it does not as a rule produce much change in the small intestines. The absorption of the digested food from the intestinal tract by alcoholics when recovering from a debauch is greater than normal, provided they have ceased from their alcohol. The absorbing powers of the intestine remain a long time, and is the reason that so many alcoholics appear so well nourished. The acids of the gastric juice also stimulate the excretion of bile from the liver, and combining with the same ferment, the secretion, being taken up by the blood, stimulates the liver to an increased secretion of bile. If therefore one has so injured the stomach with the taking of alcohol that the mucous membrane is unable to secrete a proper gastric juice, it is readily seen that the proper stimulation to the liver and the pancreas are lacking, and the equilibrium of the entire digestive process of the body is upset. The blood from all the intestines goes directly to the liver, the circulation of this organ being so arranged that the blood must filter through and bathe the liver cells before it is gathered into a central vein and returns into the general circulation. In fact the liver is the great chemical laboratory of the body, and the complex processes that go on there are as yet but little understood. The processes which I have described as generally characteristic of alcohol are seen to a very marked extent in the liver. There is a chronic congestion, and there is very frequently various forms of degeneration in the hepatic cells, and in many cases an increase in the connective tissue to such an extent as to cause the disease known as cirrhosis of the liver.

Alcohol may also under certain circumstances produce such excessive fatty degeneration in the liver, as in itself to be a menace to existence, for if the liver ceases to do its proper work, the whole minute nutritive chemistry, the metabolism of the body, breaks to pieces. The liver stands an enormous amount of use and abuse, and it is one of the last organs to give way under great strain, but when its functional processes do break down, the existence of the individual is not much further prolonged. The liver can consume and break down a certain amount of alcohol, but when more is poured into it than it can assimilate, some of it must go through into the general circulation and over the body, flowing to the brain and poisoning this organ, and the other nervous tissues.

The action of alcohol on the nervous tissues constitutes, in the eyes of the majority, the main injury that alcohol does to a human being. Certain it is that the action of alcohol on the brain does more to distort and pervert a man's relationship with his environment than any other action which alcohol has on the body. It is through the poison of this organ that the personality of the individual is so changed and so poisoned that a degeneration of the individual in character and morals is brought about. It is here, too, that the widest differences of tolerance and intolerance to alcohol are shown. Some men may consume enormous quantities and their mental balance apparently remain intact. Other individuals cannot take a single glass of wine without being distinctly affected by it, or rendered unmistakably drunken. The gross injuries found in the brain of those dying from the effects of alcohol are partly due to the effect of alcohol on the circulation and the injury to the blood vessels, thus diminishing the nutrition of the brain and injuring the brain tissue itself, and besides, as we have seen in other viscera, to the increase in connective tissue.

It is not necessary here to go into the details of the minute formation of the cells, how each cell is formed of a cell body and many branches, as one may conceive, growing like a tree or bush with the many branches stretching out and touching other branches of related and adjacent cells. When these dendrites or branches are in contact, there is an interrelationship between the processes of the two cells. Alcohol causes a retraction of the tiny branches one from another and the cells are dissociated, so that the mental processes become dissociated from each other, and the cells themselves degenerate and are unable to carry on their functions; thus we see the functions of memory and of the reproduction of images by memory prevented, the inability of the mind to reason, through the inability of the mind to call up former experiences, feelings and ideas, and a weakening of the power of each cell to take in impressions.

Every person who drinks alcohol to excess will not show every form of mental deterioration that may be produced by excessive indulgence, and the degree of deterioration in intelligence which goes to make up the sum total of mentality varies greatly in different individuals. All who drink alcohol to excess, however, show some diminution in their judgment. Judgment means the power of recalling various memories of perceptions through the senses, which have come in from the outside world, memories of ideas, memories of emotions, and all the complicated association of ideas that these bring up, and in the recalling of them weigh each one with the other and judge of the value between them. This also means reasoning and decision for action. This power of reasoning and judging is weakened in the alcoholic, and in any brain long poisoned by alcohol it is an impossibility to exercise it. Memory itself is also weakened. There is excessive forgetfulness of the recent past, and in some cases of advanced alcoholism there is absolute forgetfulness of wide gaps of years; a man may be unable to remember anything from the last five minutes back for twenty years, and then remember back to childhood. The memories of childhood are more easily stamped on the brain than are those of adult life, both because it takes less to impress a child, and because there is not the complexity of ideas crowding into the brain, nor the complexity of association of ideas to be recorded. Therefore memories of childhood make a deeper impress and last longer, and so the complex memories of the adult are the first to be forgotten in the alcoholic, and those of childhood remain.

EFFECT UPON MEMORY AND JUDGMENT

Besides the absolute forgetfulness, there is another form of forgetfulness in the alcoholic which often produces a ludicrous result. This is a perversion of memory. The person may be in a perfectly strange place and meet strangers, and yet be convinced that he has seen the place and met the strangers before, and greet them as old friends. This feeling of having been there before occurs in normal, healthy people, and may be simply the expression of momentary fatigue, or proceed from some unknown cause; but it is grossly exaggerated in the alcoholic, and cannot as easily be straightened out as in the normal mind.

The imaginative faculties of the mind are at first heightened by alcohol, and this often produces bright, witty remarks in those who have taken enough alcohol to have their imaginations stimulated and their judgment slightly inhibited, so that their ideas crowd readily to their minds and their tongues are loosened. Often, however, they say things which though bright and witty had better be left unsaid, and this is an indication of the beginning paralysis of their judgment. The imaginative faculties, however, are not constructively increased by alcohol, and it does not conduce to reproduction and creative ability, which requires memory and constructive thought. In this connection Kraeplin's experiments have shown that alcohol makes easy the liberation of movements from the cortical areas of the brain, that is, the transformation of ideas and memories of movements into deeds, but no real mental power is given; for while a man may feel that he is doing things better with than without alcohol, as a matter of fact he is not doing them so well. This sense of self-approbation is very characteristic of the alcoholic. His judgment is gone, not only in regard to his mental processes, but very essentially regarding himself, and it may be truly said that while alcohol shrinks the judgment, it swells the self-conceit. This abnormally good opinion of his diminished abilities renders the alcoholic exceedingly complacent; he is persuaded that at any time he can give up drinking if he chooses, and he is unable to appreciate the rapid deterioration of his intellect. One cannot separate the will of an individual from his personality, and the weak-willed individuals, while they may possess many other agreeable characteristics, are lacking in the progressive force which strong characters possess. Alcohol weakens the will, causes the personality itself to deteriorate, and there is a lack of initiative; there is the ever ready specious explanation why nothing is ever done; there is a boastful conceited estimation of what can be done. With the judgment perverted the alcoholic cannot act at the proper time in the right way, no matter how much he may be willing to admit the necessity for correct action, and on the other hand he is equally powerless to prevent wrong action on his part, especially when such action has anything to do with a further indulgence in his alcohol.

The emotional side of the personality shows the same deterioration from the higher to the lower, as do the other intellectual processes. It is the same story that the last to come are the first to go, and the first to come are the last to go. All emotions of refinement, those of the esthetic development, disappear the earliest. The sense of affection and moral responsibility, duty to family and friends deteriorate and vanish. There is nothing left but the consideration of what affects the self, and an alcoholic is the most studied, selfish soul that exists. The remaining emotions of anger, fear and nutritional reaction for food and drink remain to the last, as these are the most primitive of the emotions. With the weak will preventing action, and with the loss of memory and inability for continuity of thought, we find the emotion of fear predominating to a very noticeable extent. This is true whether the alcoholic be delirious or not, for in all forms of alcoholic delirium, fear is a very predominant symptom. In some forms of delirium tremens, the intensity of the fear is a fair criterion of the degree of the poisoning. The various senses of sight, hearing and taste are dulled, because the cells producing the mental perceptions are equally poisoned with the rest of the mind.

WEAKENING THE MORAL FIBER

With the inaccuracy of sense perception and loss of memory and diminished judgment, one cannot be surprised to find that alcoholics are notoriously inaccurate, unreliable and untruthful. They cannot tell the truth even with assistance. But often what is credited to them as untruthfulness is mere inability to perceive things accurately, to remember accurately, and therefore to state things accurately. With the deterioration of the personality, that is, of the will, one would naturally expect that the deterioration of morals would go hand in hand. One cannot remain moral or virtuous without sufficient will to do so, and without sufficient will to make a struggle for self-control, and this is so in the case of a mind poisoned by alcohol. I do not claim that lack of morals is a disease, but moral development has appeared late in the development of the race, and such racial development is expressed by the individual. With the deteriorated mentality of the alcoholic, we must expect that the characteristics of late development will be the first to go, and for this reason we must realize that alcoholism naturally tends to immorality and crime. As a matter of fact, it is claimed that fifty per cent. of the crimes in France and forty-one per cent. in Germany are due to alcoholism, and no doubt in England and America the percentage is equally high. As might be expected, the offenses are principally those of disregard of the rights of others, contempt of law and order, assault, disturbances of domestic peace and robbery, and to all these crimes the habitual drunkard is particularly prone.

But it is not my purpose to discuss the effect of alcohol in any way except as it pertains to the human body, nor to go into the reasons why men so poison their bodies as to bring about these deleterious results. The deterioration that we have been considering, when occurring in the mind, would naturally cause one to infer that insanity must also be common in those who are addicted to alcohol, and such is indeed the case. In New York State alone I believe it can be safely said that fully ten per cent. of the women and thirty per cent. of the men confined in the state asylums are there through forms of insanity caused by alcohol. It will not profit us to go into the various forms of alcoholic insanity, but when we realize that one-third of the men in the insane asylums to-day in New York are there because of excessive indulgence in alcohol, and also that the State spends annually over six million dollars to care for them, we realize both the terrible ravages that alcoholic poison has made on the mentality of men and the enormous cost that it entails upon the community.

As to the alcohol circulating in the blood, there is an endeavor naturally to get rid of it as with all poisons, and the kidneys in this endeavor show the same processes that are elsewhere seen, of destruction of the specific cells, congestion, and increased connective tissue growth. Whether it is that these cells are destroyed in an endeavor to eliminate various substances for which they are not fitted and break down under the strain, or whether they are directly poisoned by the alcohol itself, the resultant factors are those best understood in the lay mind as acute and chronic Bright's disease. Whether or not alcohol produces these various processes in the kidneys which result in these diseased conditions, there is no question but that certain of these diseased conditions appear more frequently in alcoholics than in others. Besides the destructive processes about which we have been speaking in the various viscera, there are certain results of alcohol that may be said to affect the general condition of the individual. By this I mean the general resistance to bacterial infection, the resistance to injury to the body, and the ability to repair such injuries. Alcohol diminishes the power of the body to resist bacterial infection. The alcoholic is more prone to acquire bacterial diseases, and when these are acquired he is infinitely less able to resist them. In Bellevue Hospital in 1904 there were 1,001 patients with lobar pneumonia. Of these, 667 gave a history of alcoholism; 334 were non-alcoholics, which means that there were twice as many alcoholics suffering from this disease as non-alcoholics. Among the alcoholics the mortality was fifty per cent., and among the non-alcoholics, 23.9 per cent. Here again the mortality among the alcoholics was more than double that which prevailed among those who had not taken this narcotic. The same is true of other infectious diseases. When injuries occur to the body, such as broken legs or arms, there is a very wide difference in the picture produced in those who have drunk to excess, and those who have been sober. The shock produced in these instances is greater in the weakened nervous system of the alcoholic, and among those who have habitually taken alcohol there is a very great tendency after broken bones to develop delirium tremens, and when this occurs in these patients, the outlook is always very grave. A broken leg or arm does not bring with it any such danger to those who have led sober lives. The process of recovery from disease and accident, owing to the deteriorated nervous system and the poisoned circulatory system, is much slower in alcoholics than in others.

WEAK WILLS INHERITED

Unfortunately, the injury which alcohol does, and the processes of deterioration which it sets on foot, do not end with the individual. Alcohol poisons and injures the germ cells of both sexes, and the offspring of those addicted to its use may inherit a weakened and injured nervous system. The taste for alcohol, the craving, so called, is not inherited. This idea that, because a man has an alcoholic father or mother, he inherits the taste for alcohol, is a superstition that has been used by the weak as an excuse both for overindulgence in alcohol, and as a further excuse why no attempt should be made to check their indulgence. What is inherited is a weak, unstable intellect and personality, prone to excesses in all things, one that is weak-willed and weak in resistance to temptation, and one more easily affected by alcohol than the ordinary normal individual. There is also often inherited a lack of moral perception and moral sense, causing the individual to do things which make one doubt his sanity; yet he can not be called insane, but really wanders in the border line between mad and bad, which is often worse than insanity itself. Alcoholic inheritance does not stop at instability of the nervous system or weakness of the personality, and one is rather staggered to realize the high percentage of imbecile, epileptic and weak-minded children that may be born to alcoholic parents. A detailed study of the imbecile school-children throughout all Switzerland showed that fifty per cent. of them were born in the days nine months after the periods of greatest alcoholic indulgence, such as the New Year, the Carnival, and the grape harvest, and that the births of the other half of the imbeciles were evenly scattered through the remaining thirty-eight weeks of the year. It has been shown that in France, Germany, Poland and Switzerland, from twenty-eight to seventy per cent. of the epileptics in some of the institutions were the descendants of alcoholics. Demme, in comparing the results of the health and death rates between ten alcoholic families and ten non-alcoholic families, found that in the alcoholic families out of fifty-seven children, twenty-five were still-born or died in the first month of life; twenty-two were designated as sick, and ten as healthy--while in the non-alcoholic families, five were still-born or died early, six were sick, and fifty were healthy. Thus only 17.5 per cent. in the alcoholic families were healthy, while eighty-two per cent. in the non-alcoholic families were healthy, and only eighteen per cent. not healthy. The percentages, therefore, were almost exactly reversed. These statistics mean that not alone may the chronic alcoholic bequeath his poisoned nervous system to posterity, but from the statistics in Switzerland of the imbecile children, we must realize that even a temporary debauch may leave a curse upon the innocent child; they also mean that alcohol produces those processes in the individual which tend to the degeneration of the race, and tend after a few generations to extinction, and thus does Nature benefit the race by turning a curse into a blessing through the extinction of the degenerate.

Footnote:

[1] I have heard of a New Yorker who gave up his attendance as a member of the executive committee of a prominent and very useful reform association because, though an occasional smoker, he could not endure the tobacco-laden atmosphere of the room where the committee met.

To this day his associates probably think him a very lukewarm worker in the cause!

Transcriber's Notes:

Passages in italics are indicated by _italics_.

Punctuation has been corrected without note.

The following misprints have been corrected: "merly" corrected to "merely" (page 156) "dangerout" corrected to "dangerous" (page 199) "coedine" corrected to "codeine" (page 216)

Other than the corrections listed above, inconsistencies in spelling and hyphenation have been retained from the original.

End of Project Gutenberg's Habits that Handicap, by Charles B. Towns