Chapter 7

"Some phthisical sufferers, of whom there are here, alas! too many, were now admitted from time to time into St. Vincent's Hospital. They were admitted in all stages, from an early one to the most advanced. On each admission the case was carefully examined; the history, symptoms, and physical signs were exactly noted; and the patient was weighed on a stage balance with great accuracy. The patient was put as much as possible on the mullein treatment only. For obvious reasons, no cod-liver oil, koumiss, or other weight producer was given; the patients got the diet suitable to such sufferers; and, if the special symptoms became troublesome, received appropriate treatment. As much as possible, however, they were left to the mullein--a proceeding which was entirely satisfactory to themselves. In addition to the admission weighing, they were carefully weighed every week, and care was taken that this should be done as nearly as possible on the same day and hour, with the same clothes, and, in fact, as much as could be under the same conditions. In securing this the patients anxiously co-operated; and it was frequently amusing, but sometimes painful, to watch the satisfaction or chagrin with which the weekly result was received. I must here tender my acknowledgments to our zealous, attentive, and accurate house surgeon, Mr. Denis P. Kenna, by whom this important, but tedious, duty was discharged."

Dr. Quinlan then refers to several cases, in which the mullein plant has been tried as a remedy for consumption, and remarks that these cases, although too few to justify any general conclusion, appear to establish some useful facts. The mullein plant boiled in milk is liked by the patients; in watery infusion it is disagreeable, and the succus is still more so. The hot milk decoction causes a comfortable (what our Gallic neighbors call _pectorale_) sensation, and when once patients take it they experience a physiological want, and when the supply was once or twice interrupted, complained much in consequence. That it eases phthisical cough there can be no doubt; in fact, some of the patients scarcely took their cough mixtures at all--an unmixed boon to phthisical sufferers with delicate stomachs. Its power of checking phthisical looseness of the bowels was very marked, and experiment proved that this was not merely due to the well known astringent properties of boiled milk. It also gave great relief to the dyspnoea. For phthisical night sweats it is utterly useless; but these can be completely checked by the hypodermic use of from one-eighteenth to one-fiftieth of a grain of the atropia sulphate; the smaller dose, if it will answer, being preferable, as the larger causes dryness of the pharynx, and interferes with ocular accommodation. In advanced cases, it does not prevent loss of weight, nor am I aware of anything that will, except koumiss. Dr. Carrick, in his interesting work on the koumiss treatment of Southern Russia (page 213), says: "I have seen a consumption invalid gain largely in weight, while the disease was making rapid progress in her lungs, and the evening temperature rarely fell below 101° Fahr. Until then I considered that an increase of weight in phthisis pulmonalis was a proof of the arrest of the malady." If koumiss possesses this power, mullein does not; but unfortunately, as real koumiss can be made from the milk of the mare only, and as it does not bear traveling, the consumptive invalid must go at least to Samara or Southern Russia. In pretubercular and early cases of pulmonary consumption, mullein appears to have a distinct weight-increasing power; and I have observed this in several private cases also. Having no weighings of these latter, however, makes this statement merely an expression of opinion. In early cases, mullein milk appears to act very much in the same manner as cod-liver oil; and when we consider that it is at once cheap and palatable it is certainly worth a trial. I will continue the research by careful weighings of early cases; and will further endeavor to ascertain whether the addition of mullein to the cultivating solution prevents the propagation of the phthisical bacillus.

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ACTION OF MINERAL WATERS AND OF HOT WATER UPON THE BILE.

Lewaschew and Klikowitch, from experiments upon dogs, conclude that the use of ordinary alkaline mineral waters was to increase the quantity of bile and to make it more fluid and watery. This increased flow is beneficial in clearing out any bile stagnating in the gall-bladder. A subsequent increase in the quantity of bile indicates a greater flow of bile into the gall-bladder, and this also is of service in emptying out any stagnant bile, and restoring the normal condition when this is disturbed. Artificial solutions of alkaline salts were found to have a similar action to the natural mineral waters, and, as with them, the action varies according to the concentration of the solution. Bicarbonate of sodium has a quicker, more powerful, and more lasting effect on the composition of the bile than the sulphate of sodium, and weak solutions than strong ones. Vichy was more efficacious than Carlsbad water. Hot water was found to have an effect on the bile much like that of the mineral waters.

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VIVISECTION.

Although Magendie is rightly considered the true initiator of experimentation upon living beings, the practice of vivisection is as old as science itself.

Galien, the physician of Marcus Aurelius (in the second century of the Christian era), dissected living animals, and yet he is regarded as having merited his name (_Galenus_, "gentle") from the mildness of his character. Five centuries before him, under the Ptolemies, Egyptian experimenters had operated upon condemned persons. So, then, vivisection is not, as usually thought, a diabolical invention of modern science.

In all ages the necessity has been recognized of operating upon animals that are nearest allied to man, such as the monkey, the hog, and the dog, and who share with the king of creation the privilege of eating a little of everything. Claude Bernard, however, had another way of looking at things. It is true that he especially made researches into the general laws of physiology, the secret of the vital functions, and the operation of the various organic systems that constitute living matter, but his immediate object was not to furnish weapons for the art of curing. He left to physicians and surgeons the care of drawing conclusions from his great work in biology, and of acting experimentally upon animals allied to man in order to found a rational system of therapeutics. So he preferred to operate upon beings placed low in the animal scale--the frog especially, an animal that has rendered him greater service than even man himself could have done. Cold-blooded animals offer, moreover, the advantage of being less impressionable than others, and the experiments to which they are submitted present more accurate conclusions, since it is not necessary to take so much account of the victim's restlessness. And then it is necessary in many cases to choose subjects that possess endurance. The unfortunate frog, so aptly named "the Job of physiology," becomes resigned to living under most dreadful conditions, and when, through sheer exhaustion, he has succumbed, his twitching limbs may still he used as an object of experimentation for twenty-four hours. Thanks are due to nature for giving so extraordinary a vitality to the tissues of a modest batrachian! We owe to it the famous experiment of Galvani that led Volta to the discovery of the pile and what followed it, the astonishing conquests of electricity and those more marvelous ones still that are now in their dawn. Science is much indebted to the frog, and may the homage that we pay him help to alleviate the sufferings that have been imposed upon this brave animal!

The simple fact that we have just enunciated pleads loudly enough for the cause of vivisection to make it useless to defend it. No one, however, has risen to ask for an absolute proscription of it, but it is only desired that the abuse of an abominable practice shall be curbed. Does the abuse exist? That is the question, and it may be answered in the affirmative. Yes, we do sometimes impose useless sufferings upon animals. It is a culpable folly, a beastly cruelty, to constantly repeat barbarous experiments with the object of exhibiting a well known physical fact, a hundred times verified and always the same, when it would only be necessary to enunciate it. But this is not the place to expatiate upon the subject. After proclaiming the utility of vivisection, we give it as our opinion that the practice of it should be confined within narrow limits. It is not too much to ask that it be confined to the privacy of laboratories, with the exclusion of visitors, and to require from students a diploma guaranteeing their knowledge and giving a programme of researches to be made. It is useless to seek in the living what a study of the corpse reveals in all its details.

And now, after these preliminary remarks, we present herewith a series of cuts representing the various apparatus used in the practice of vivisection, which are taken from a recent work by Claude Bernard. Fig. 1 shows the mode of muzzling a dog with a strong cord placed behind an iron bit. Fig. 2 shows a method of tying a dog. Fig. 3 is a vessel in which hares or cats are placed in order to anæsthetize them. Fig. 4 shows the mode of fixing an animal on its side, and Fig. 5 the mode of fixing him on his back. Fig. 6 shows a dog fixed upon the vivisecting table, and Fig. 7 a hare secured to the same. Fig. 8 exhibits the general arrangement of a vivisecting table, properly so called. Fig. 9 shows (1) an anæsthetizing muzzle applied to a dog, and (2) the extremity of the apparatus in section. Fig. 10 shows how the muzzle is applied for anæsthetizing, and gives the details of construction of the chloroform box. Fig. 11 exhibits the arrangement of the apparatus used for holding the animal's jaws open upon the vivisecting table.--_L'Illustration_.

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INSANITY FROM ALCOHOL.

[Footnote: Read at the late meeting of the National Association for the Protection of the Insane and translated for the American Psychological Journal by Carl Sieler, M.D., of Philadelphia.]

By A. BAER, M.D., of Berlin, Germany.

The benevolent efforts of your society diverge in two different directions, which have totally different aims and purposes, and which require different means in order to attain lasting success. Since the number of insane has increased alarmingly within the last few years, in all civilized countries, so that the responsibility of the proper charge of them occupies continually not only the community, but also the State; and since the public as well as the private asylums are filled almost before they are finished, it becomes necessary to rid the institutions, as soon as possible, of those patients which have been cured, as well as of those which are improved. Patients of this kind are, as early as possible, returned to the unrestrained enjoyment of liberty with the expectation that the new scenes and surroundings may have a beneficial influence, besides having the advantage of relieving the overcrowded institutions. Unfortunately, however, it has been frequently found that the hut suddenly restored mental and emotional equilibrium is not of sufficient stability to withstand the storm of conflicting interests. Frequently it happens that the but recently discharged patient returns to the institution, after a short lapse of time, because the "rudder" (steuer) of his intelligence was soon shattered in the turmoil of life. How can, for instance, the indigent and poor patient, after his discharge from the institution in which he has found a shelter and the proper care, stand up in the struggle for existence and the support of his family? Is it not to be expected that a large proportion of those who have been discharged as improved, or even cured, cannot withstand the ever-moving sea of the outside life and bear up under the turmoil which constantly stirs mind and soul?

Starting with the recognition of this fact, societies of benevolent people have been formed in all countries in which true civilization and humanity are at work, to diminish or abolish social evils, whose object is to assist the restored patient who has been discharged from the institution, at a time when he is most in need of help and assistance. Switzerland has taken the lead of all countries by her brilliant example, and there these societies found the greatest encouragement. It should be looked upon as a good sign of the spirit of modern times, that the seed of true humanity, with astonishing rapidity, found its way, far and wide, for the benefit of suffering mankind. Everywhere, in all European countries, and also on the American continent, has this branch of a truly noble thought become acclimated, and many societies have been organized for the purpose of assisting cured insane patients, by aiding them in obtaining suitable occupations, or by direct donations of money, etc., with a view of preventing, if possible, a relapse of the disease. May this portion of the work of your society be an ever-flowing fountain of joy and satisfaction to your members!

Of much greater importance is the best portion of your work, namely, _the prevention of insanity_. It is nevertheless true, and cannot be doubted, that in all civilized countries insanity increases in a manner which is out of proportion to the increase of the population. Much thought has been given to the cause of this phenomenon, and physicians as well as moralists, national economists as well as philosophers and philanthropists, have endeavored to fathom the connection between this fact and the conditions of modern social life. According to all observations, it is certain that the cause of this phenomenon is not a single etiological condition, but that it is the sum of a number of influences which act upon the human race and produce their travages in the mental and moral life of our patients. The conditions which give rise to this increase of insanity may be looked for in the manner in which modern civilization influences mankind, in its development and culture, in the family and in the school-room, in its views of life and habits; also in the manner in which civilization forces a man to fight a heavier and harder battle for pleasure and possessions, power and knowledge, and causes him to go even beyond his powers of endurance.

More than even civilization itself, are at fault those pernicious abnormities, rare monstrosities, which are transmitted from generation to generation, or are also often newly developed and appear to belong to our civilization. If we want to prevent the increase of insanity, we must endeavor to do away with these monstrosities and eccentricities from our social life which remove mankind more and more, in a pernicious manner, from its natural development and from the normal conditions of moral and physical life; we must endeavor to kill these poisonous offshoots of pseudo civilization, which are the enemies of the normal existence of man. It is necessary to liberate the individual, as well as the entire society of modern times, from the potentiated egotism which spurs man on in overhaste, and in all departments of mental and physical life, to a feverish activity, and then leads to an early senile decay of both body and mind; from that terrible materialism which causes the modern individual in every class of society to find satisfaction in over excited taste and ingenious luxury. It is necessary to strengthen more than has been done heretofore the young, by means of their education, in their physical development, and at the same time to diminish, in proper proportion, the amount of mental over-exertion; and finally it is necessary to fight against, to do away with, those habits of modern society-life which have a pernicious influence upon the physical as well as the mental and moral organization of man. And of these latter, there is none so lasting in its effects, none so harmful to the physical as well as moral life, as the abuse of intoxicating liquors.

Intemperance is an inexhaustible source of the development and increase of insanity. It demands our undivided attention, not only on account of its existing relation, but particularly because intemperance, among all the factors which aid in the increase of insanity, can best be diminished, and its influence weakened, through the will of the single individual, as well as of society as a whole. The relation between intemperance and insanity is so definite and clear, that it is not necessary to adduce proofs of this fact. I will not refer to the writings of the older authors, such as Rush, in America; Hutchison, Macnish, Carpenter, and others, in England; Huss and Dahl, in Sweden; Ramaer, in Holland; Esquirol, Pinel Brierre de Boismont, Morel, and others, in France; Flemming, Jameson, Roller, Griesinger, and others, in Germany. I could name a much larger number of the greatest modern authorities on insanity, who are all unanimous in their opinion that the increase of intemperance (alcoholism) produces a corresponding increase of insanity. Of especial interest is this fact in those countries in which the consumption of concentrated alcohol, and particularly in the form of whiskies distilled from potatoes and corn, has only in later years become general. Thus Lunier has shown the number of alcoholic insane increased by ten per cent. in those departments in which more whisky and less wine is consumed.

In Italy a similar result has been reached by investigation; and in that country (according to Kanti, Sormani, Vesay, Rareri, Castiglione, Ferri, and others) the frequency of insanity caused by the abuse of alcohol stands in an unmistakable relation to the consumption of alcohol in certain provinces of Italy.

In a discussion at one of the meetings (1876) of the London Medico-Psychological Society, the general opinion of the members was, that intemperance is the most fruitful source of the increase of insanity, even when no other etiological element could be found, and alcohol had to be looked upon as the sole cause of the mental disease. Maudsley laid especial stress upon the observation, that intemperance, without hereditary predisposition, was one of the most powerful agencies in the production of aberration of the mind. Even Beckwith, who could not coincide with others as to the great importance of intemperance as an etiological element, says distinctly, that intemperance was, by far, the most potent of all removable causes of mental disease.

In comparing the number of drinking saloons in the different provinces of the kingdom of Prussia with the number of insane, both in public institutions and in private families, as gleaned from the census report of 1871, I was enabled to show conclusively, that everywhere, where the number of drinking places, i.e., the consumption of alcohol, was greatest, the number of insane was also largest. Without doubt, to my mind it is in alcohol that we must look for and will find the most potent cause of the development and spread of mental diseases.

As is well known, alcohol acts as a disturbing element upon the nerve centers, even if it has only once been imbibed in excessive quantity. In consequence of the acute disturbance of circulation and nutrition an acute intoxication takes place, which may range from a slight excitation to a complete loss of consciousness. After habitual abuse of alcohol, the functional disturbances of the brain and spinal cord became constant and disappear the less, as in the central organs degenerative processes are more and more developed, processes which lead to congestions and hemorrhagic effusions in the meninges and in the brain itself, to softening or hardening, and finally to disappearance of the brain substance. These degenerations of the nervous system give rise to a progressive decay of all intellectual and also, more especially, of the ethical functions, a decay which presents the phenomena of feeble mindedness, complicated with a large number of sensational and motor disturbances, and gradually ends in complete idiocy.

The number of those mental disturbances which are caused by alcohol intoxication is a very considerable one. We do not err if we assert that from 20 to 25 per cent. of all mental diseases stand in a direct or indirect relation to the evil consequences of intemperance in the use of intoxicating liquors. This is the opinion of a large number of authorities on mental diseases in all countries. Habitual intemperance leads to severe (psychical?) lesions (of the nervous system) which may show themselves in the different forms of insanity, but express themselves chiefly as mental weakness, not only in persons whose nervous system was weakened through inherited or acquired defects, but also in those whose mental organization was intact. In many other cases we see less complete forms of insanity and more indistinct psychological disturbances and neuroses, and among the latter epilepsy demands particular attention.

An investigation among the patients in the insane department of the Berlin Charite Hospital, in charge of Prof. Westfahl, which was lately carried on by Dr. T. Galle (Uber die Beziehunger des Alcoholismus zur Epilepsie. Inaug. Dissert. 1881, Berlin), showed that among 607 patients who had entered the ward as epileptics or epileptic insane, 150 = 24.7 per cent. had been addicted to drink; 133 before, and 17 after the disease had shown itself; further, that of 1572 patients with delirium tremens, alcoholism, alcoholic dementia, and ebrietas, 243, or 15.4 per cent., were epileptic; and that in 221 intemperance was present before the outbreak of epilepsy; finally, that among 2679 patients which entered the department in six and a half years, 393, or 18 per cent., were inebriates and epileptics. Among 128 epileptics which I had occasion to note in the receiving institute, Plotseurie, 21 per cent. were drunkards and 20 per cent. were the offspring of intemperate parents.

If the list of injuries which intemperance, as we have seen, does directly to the mental life of man is a very considerable one, the baneful effect which is produced indirectly, by the intemperance of parents, upon the mental constitution of their progeny is surely just as great and disastrous. The children of intemperate parents frequently become drunkards themselves; they have inherited a degeneration of the vitiated constitution, and carry the stamp of this degeneration within themselves. The offspring of drunkards are not only weakly and sickly, and die early, especially of diseases of the brain, but, as Dahl, Morel, Howe, Beach, and others have shown, they are frequently born idiotic, or show early signs of insanity. Under the influence of alcohol, the individual constitution of the drinker becomes lowered and depraved, and, according to the law of inheritance, is transmitted through the progeny to the race.