Habitual drunkenness and insane drunkards

Preface

On the second reading of the Habitual Drunkards' Bill in the House of Commons, July 3rd, 1878, the introducer of the measure, Dr. Cameron, member for Glasgow, referred to the following articles in these terms : —

" The articles which had been written by Dr. Bucknill, the Lord Chancellor's Visitor, as the result of his visit to the United States, were marked by strong prejudice, as when he went so far as to say that he was ' out of all patience with maudlin sentimentality. In addressing the House he had endeavoured to abstain from that. (Cheers.) Dr. Bucknill suggested that the best thing that could happen was that the drunkard should ruin himself and his property pass into worthier hands. Dr. Bucknill's statements called forth the most conclusive replies. An institution that he reported closed through failure was closed simply because the State aid that had been expected was not forthcoming. It was said that Dr. Bucknill's reports were founded on superficial and limited information, and that he had not visited asylums the success of which had surpassed the wildest dreams of enthusiastic

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supporters. Careful inquiry showed that 60 per cent, of those who had passed through them continued to be sober persons. "

To this attack the author replied in the Times by the letter which will be found at page 98, and to Dr. Cameron's reply in the same journal by the letter which will be found at page 101, and, so far as the author is personally concerned, he deems those letters an ample justification. But, on reconsidering these articles thus impugned, the author is led to believe not only that they bear internal evidence that they were written without prejudice, but that they afford an unbiassed consideration of the social and medical bearings of drunkenness, which is not undeserving of being placed before the public in a collected form. Perhaps his opinions would have been better appreciated had they been recast into one connected paper ; but, under the circumstances, he has preferred to republish them, with all their faults, in the form and in the order in which they were written.

The author has not willingly entered upon this controversy : he has been drawn or driven into it. Interested as a mental physician in drunkenness as one of the great factors of insanity, in his visit to the United States in 1875, he made inquiries on the subject for the sole purpose of informing and satisfying his own mind on a most important matter closely connected with his business in life. His inquiries were made for the sole purpose of eliciting truth, and

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he ventures to affirm that none of the gentlemen of whom they were made will aver that they were either superficial or negligent. Others there were whose testimony he had been taught by their own countrymen to discredit, and of these he did not seek information. They have had other opportunities of giving it to the world, of which they have amply availed themselves ; but neither the author nor the public have any means of testing the accuracy of their statements. When lunatics are discharged from an asylum as cured, there is some probability that they are cured, at least for a time, as there is a certain ascertainable difference between a man who has been insane and is cured, and one who has been insane and is not cured. But, notwithstanding the information given to the House of Commons, that, with regard to a drunkard, " it could be known by the hands that all danger was removed, and a cure had been effected," it must be admitted that, with regard to propensities, men do not wear the heart upon the sleeve, or even on the hands, and it will be doubted whether the discrimination of the most acute observers can tell which of two sober men is likely to drink too much whiskey when he can get it. Not only did the author visit all the inebriate asylums and homes he could hear of in the eastern States of America, with the exception of one small private institution, but he made diligent inquiries of the numerous able and experienced physicians, by whom he was received with frank friendliness in that country ; and he also listened to

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and participated in a full and able discussion of the whole subject by the Association of Medical Officers of Asylums for the Insane, who in America, as in this country, are brought closely into relation with habitual drunkenness as a cause of insanity. His remarks on this occasion, reprinted from the Proceedings of the Association, will form a fitting introduction to this series of papers, and will prove to any candid mind how far removed he was from making his inquiries in any spirit of prejudice. There is indeed an underlined passage in these remarks which might even justify Dr. Cameron and his friends in claiming the author as a coadjutor in their cause. Nor would he refuse were the truthfulness of their assertions of cure substantiated, and their scheme of action not debased by the greed of private gain. But in this very debate, in which a great number of the most experienced mental physicians in America took part, no tittle of evidence was forthcoming that any considerable proportion of habitual drunkards were cured, while, on the contrary, Dr. John Gray, the Superintendent of the Asylum for the State of New York, asserted : — " I can recall some very remarkable cases of restoration from that habit, lasting eight, ten, or twenty years, that is, from the time of their discharge from the asylum to the present ; but / can count them all upon my fingers. The great majority of those who came through their own will, and seemed to have been strong when discharged, have in the main returned to drinking again." Dr. Conrad, the Super-

PREFACE. IX

intendent of the Maryland Asylum, said : — " We have one hall devoted to inebriates or dipsomaniacs. The experience I have had in the hospital has been confined to a class known as dipsomaniacs. Many have been confined to the hospital for several yeare, scarcely making an endeavour to withhold from

drinking for three days The subject of their

treatment is a matter in which I am interested, but I do not know of a single case where a cure has been effected by confinement."

Dr. Landor, the Superintendent of the Asylum for the Insane for the Province of Ontario, Canada, said : — " The Government of Ontario, more than two years ago, began to build an asylum for inebriates, which will be finished in the course of a few months and will hold a hundred people. The Government of Ontario doubts the efficacy of admitting patients into an asylum in this way, on account of the failure in tJie States. They have hesitated from what has been done in the States, by the discharge of men as cured, while many of those discharged have returned shortly, like the sow to the mire. Therefore our Government contemplates making this new institution into a hospital for lunatics instead of drunkards."

Dr. Walker, the Superintendent of the Boston Asylum and the Vice-President of the Association, said : " They [the Legislatures] have erected inebriate asylums and they have failed to cure the cases placed

therein We have two such institutions in

Boston, conducted by reformed inebriates, both of

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them honest, intelligent, and enthusiastic men. I asked one of them, ' What is necessary to reform these patients?' He answered me, 'Practical operative religion.' Without that they could do nothing whatever. In a few days after this, I went to one with Dr. Bucknill. They were opening the meeting by the singing of temperance songs and had religious exercises. Without this religion there is no hope for them. We know that both confinement and labour have failed ; both are good together, but alone without religion they can do no good whatever."

Dr. Kirkbride, the superintendent of the Pennsylvania Hospital for the Insane, the venerated chief of mental physicians in the United States, said : " From what has been said here, and what is said elsewhere, joined to many cases which have come under my own observation, I do not think it will be too much to say that these inebriate asylums have been failures. They certainly have not done what was expected of them when they were established. "

The superintendents of asylums for the insane in America have large opportunities of forming an opinion on the matters in question because, as the President of the Association stated, medical men all over the country freely give certificates of insanity, upon which inebriates are sent in considerable numbers to asylums for the insane.

The author heard opinions fully as strong expressed by private persons, and he cannot understand what, except ignorance, could have induced Dr. Cameron to

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have impugned his own moderate and unbiassed statements, which did not accuse these asylums of failure, but only of such a system of management observed by himself as appeared to give but little promise of success.

Ward's Island, indeed, has been given up to reprobation, and the reader will perhaps suspect from the words of Dr. Walker that there was more singing than work at Boston, especially as the religious and reformed inebriate who conducted this institution confessed that he had no means of preventing his inmates from getting whiskey, and that there was a spirit store next door. Binghampton, the great whiskey cure of New York State, has been a scandal from its inception, when an English philanthropist, whose name also was Walker, had collected a vast sum from the benevolent, which he had expended in a magnificent site and building, which he said was his own when the philanthropists wished to oust him, and Mr. Walker had to be paid for it a second time. Then came Dr. Dodge and Dr. Day, the other reformed inebriate whom Dr. Walker, of Boston, referred to, then Dr. Congdon, whom I examined, followed by Dr. Crother, who writes to Mr. Cameron that 60 per cent, of the inmates were cured in an institution where there was neither moral nor medical treatment, and where it was freely admitted that the inmates could get as much whiskey as they liked by walking to the outskirts of the town just outside their own grounds. So much inaccuracy of statement has xii PREFACE.

been made in this discussion by Dr. Cameron and his friends that we cannot at once accept the report of Dr. Crother as far as it goes, namely, that —

" Last year a careful examination was instituted into the history of patients who had been here for treatment over five years ago. Letters were addressed to their friends inquiring into their present condition, and the answers revealed the startling fact that over 60 per cent, of those who were under treatment here for four or five months, were sober, and continued reformed men." — Times, July nth.

But even if the friends of the Binghampton patients did so answer Dr. Crother's inquiry, it would not prove that their account was correct, and nothing could be accepted as a satisfactory verification of the astounding announcement that 60 per cent, of the inmates in this rotten institution were permanently reformed, except an independent inquiry into their subsequent history. Since Dr. Crother's communication, he also has been superseded at Binghampton, and by a gentleman who bears a reputation for honesty and ability. Would Dr. Kitchen undertake the trouble and the odium of making a real investigation into the statistics of this place which to many minds hitherto appears to rear its head with the moral attributes of London's tall column ?

After having inquired into the treatment of drunkards in America for the simple purpose of information, the

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Author owes it to himself, after the virulent attacks that have been made upon him, to describe how dispassionately and unintentionally he was drawn into controversy on the subject. He had not entertained the slightest intention of publishing his observations and opinions, but some time after his return from America, on attending at the annual temperance meeting at Rugby, he was induced to make some observations on the subject, the report of which came under the notice of Dr. Clouston, one of the editors of the Journal of Mental Science, and this gentleman was so struck with them that he addressed to the Author a letter containing a very fair and able criticism, to which the Author responded in the second article of this collection, which will be found to contain his opinions and the reasons on which he holds them stated frankly, but he trusts also clearly and calmly. He much wishes that the discussion; if it were to proceed further, could have been kept in this even tenor of argument, but unfortunately a slight reference had been made to a gentleman who was a red-hot partizan of the drunkard's legislation, who rushed in with an angry and illogical attack upon the Author, thus drawing upon himself the sharp rebuke of the third article, which the Author would willingly leave in the leaves of a specialist journal, had he not resolved in reply to Dr. Cameron's accusation, to republish all and the whole of what he has written on the subject.

The Author has no excuse to make for a passage in the fourth article, which has been repeatedly quoted xiv PREFACE.

against him, if it be not true. But if it be true, there can surely be no blame in stating forcibly a conclusion of social science, which is, that in these later ages the uncontrolled indulgence of men's propensities tends to eliminate the unfittest, and thus to preserve or improve the best qualities of the race. In the ages of personal conflict, it was the weak or the slow man who went down early in the struggle for existence ; in these times of peaceful conflict it is the foolish or the vicious who succumb ; and, now there seems to be no element of survivalism more potent than temperance. Let those who cannot disprove it forbear to sneer at the exposition of a most wholesome truth- In the fifth article the Author has been fortunate to escape from the atmosphere of controversy into which he had been dragged. Written hurriedly, on a sudden demand for a topic of scientific discusssion, he cannot but think that it is of value not only as an attempt further to define the relations of drink and insanity, but also as an early statement of the possible action of alcohol in averting disease. The views taken in this paper with regard to the atriptic action of alcohol in averting mental disease have recently been followed up by Dr. W. Farr in a letter to the Registrar-General on the possible action of alcohol in averting zymotic disease. For his article the Author was honoured by the Temperance Review with the title of the Apostle of Moderate Drinking which he is fain to set against Dr. Cameron's strictures on his harshness to drunkards, as another instance that zealots detest

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a man of moderate views far more than they do an opposite zealot. To the first they are antipathetic, with the other they are in the full swing of sympathy, however hostile they may be on the less important matter of opinion. If Dr. Cameron is right and drunkenness is a disease, the temperance movement is a cruel persecution of the innocent. If Sir Wilfred Lawson is right, the indulgent treatment of drunkards is an absurd and mischievous offence against society. The connivance of temperance men at the disease-heresy of drunkenness, is, however, confined to this country, for in America it has been earnestly and honestly repudiated.

The American Association for the Cure of Inebriates, propounds the broad principle that drunkenness is disease, and has, in support of this dogma, gone the length of rejecting the report of the best inebriate home in the whole country, because it was established for the reform, and not the cure of drunkenness. Dr. Cameron, however, has improved even upon the absurd idea of this general view, by asserting to the House of Commons that drunkenness is not only a disease, but that it is what is called an organic disease, in which there are " certain structural alterations, especially in the nervous system." "The result of these deteriorations of structure rendered the patient unable to resist that craving'' for stimulants, &C 1 And he

1 ' ' The evidence showed that there existed a very close analogy between habitual drunkenness and the various forms especially of mental disease.

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proceeds to affirm that these deteriorations of structure have been permanently removed in a certain hospital too remote for the statement to be verified, at the rate of 60 per cent, of the patients discharged.

Seeing the manner in which the author has spoken of inebriate asylums in his own country, he has been somewhat surprised at the acrimony with which he has been attacked for the statements he has made respecting the American institutions. He has visited six of these institutions in England and Scotland, and he has had every reason to believe that with much less pretence, much more earnest and good work is being done in them than in the American establishments. The only explanation which occurs to him is that these attacks come from members of the " Society for Promoting Legislation for the Control and Care of Habitual Drunkards," some of whose members are interested in procuring legal powers of detention which they have erroneously supposed to exist in America.

The English asylums for drunkards are private speculations, and, in default of powers of detention, they are said to be unremunerative. Give us — say members of this philanthropic society — power of

Prolonged indulgence in alcohol or other stimulants after a time — longer in some cases, shorter in others — brought about certain structural alterations, especially in the nervous system. The result of these deteriorations of structure were, first, a depression of vital force, giving rise to a craving for stimulants ; and second, a depression of the force of intellect and the will, which rendered the patient unable to re-ist that craving." — From Dr. Cameron's Speech; see the Times, July 4th, 187S.

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arrest and compulsory detention, and we shall keep our asylums full, and make them as profitable as private lunatic asylums. The Author has too plainly pointed out that in this agitation the angel wings of philanthropy are not long enough to hide the cloven foot of self-interest. Hence all these corrosive tears which have been shed upon him. That any society of which the Earl of Shaftesbury is president can make any permanent deviation from the paths of the highest philanthropy the Author does not for one moment believe, but that pecuniary advantage to individuals has been a prime motor in the minds of many leaders of this agitation cannot be doubted, seeing that some of them have had the courage to avow it publicly and in print. 1

That Dr. Cameron, entertaining the views he does about the curability of structural alterations of the nervous system, should differ from the Author, is not surprising ; but that he should single him out for attack in the House of Commons may perhaps also, to some extent, be accounted for by the manner in which the Author exposed the manifold follies and tyrannies of last year's Bill, when invited to meet Dr. Cameron for its discussion at the Metropolitan Branch of the British Medical Association, at which discussion he had the audacity to suggest that the Member for Glasgow might usefully employ his influence in promoting the execution of the existing law among

1 See Appendix to Bluebook on Habitual Drunkards, and report of discussions at Edinburgh meeting of British Medical Association.

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his constituents, to whom the Author described a visit of investigation in 1876 in company with the Sheriff of Lanarkshire, in which, on Saturday night and Sunday morning, he saw, with amazement and horror, a drunken population : the drink-shops and lodging-houses teeming, and the streets crowded with drunken men and women, and even children; the numerous police-cells occupied by comatose drunkards, and the police surgeon attending, through the long hours of the night, to drunken accidents; and — strange necessity! — the police constables taking no heed of simple drunkenness, and admitting, to the sheriff and his companion, that they never did interfere so long as the drunkard was peaceable, and could keep on his legs. When he fell helpless on the pavement they put him in a wheelbarrow stretcher and trundled him off to the cells. Dr. Cameron did not relish this description, and endeavoured to deny it ; but it may still be repeated by any one who will spend the last and the first hours of the week in the wynds of Glasgow. And Dr. Cameron was reminded that another observer had described the same orgie in almost identical terms in the Daily News, and that he had been insulted and threatened, and had been compelled to leave Glasgow, on account of his truthful audacity. As it is from the occasional drunkard that the habitual drunkard is manufactured, why does not Dr. Cameron attack habitual drunkenness at its source ? even at the risk of offending the bulk of his constituents.

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That remainder biscuit which is left to Dr. Cameron after his legislative voyage it would, perhaps, be cruel to cast away ; yet it is full of weevil, which may, perchance, contaminate sounder food. It is scarcely denied that, if there were no vested interests to consider, private lunatic asylums could not be permitted ; and yet this fragment of legislation would establish a new class of asylums, in which the liberty of the subject would be submitted to the determinations, biased by self-interest, of private adventurers, using that term in the sense in which it is employed to distinguish adventure schools from public schools. As the Spectator has pointed out, if such a private adventurer kept an alleged drunkard six or twelve months in his asylum when he ought to have been discharged in three, a grave injustice would be committed. And it must not be overlooked that the inebriate doctor who keeps an adventure asylum would have much greater opportunity of committing such an act of injustice than the mental doctor who keeps an adventure lunatic asylum ; for, while there is a marked distinction between the man who remains insane and the one who has recovered, there are no means of distinguishing the man who is still inclined to get drunk, from the man who has firmly and successfully determined not to do so.

Under this Bill an attesting justice or commissioner to administer oaths is to state in writing that the applicant understood the effect of his application, &c, that is, the surrender of his liberty ; but

b 2

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this a man might do while still incapable from the stupidity of a debauch. It ought at least to be attested upon medical examination that the man was sane and sober at the time when he is persuaded to take so important a step as to turn the key of a prison upon himself for a twelvemonth.

There cannot be a doubt that, unless stringent measures are taken to prevent it, these new asylums will be resorted to as places of detention for real lunatics ; and the Author is able to assert, from his own personal observation, that they are already resorted to for this purpose. Last year he examined one of these places by order of the Lord Chancellor, and, while entertaining doubts about the sanity of other inmates, he found one lady whose state of lunacy was obvious and unquestionable, and for whose detention without certificates the keeper of the asylum was prosecuted and punished.

The spirit of Dr. Cameron's legislative proposals is marked by the monstrous penalties which he proposes to attach to any offence against this statute.

If a lunatic escapes from an asylum there is no penalty on any one who harbours him, and if he evades recapture for seven days his certificates must be renewed. If even a felon escapes from prison, it is no offence to harbour him ; but if any person, the man's wife, for instance, should conceal or harbour an habitual drunkard who has escaped from his private gaol, that person will be liable to a penalty of twenty pounds, or to imprisonment, with hard labour, for six

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months. Could not Dr. Cameron bring a little of the repressive temper under which such penalties were conceived to bear upon the rampant vice of the town he represents? But the Bill can do little harm, because it is so small a measure ; at all events give this inch of legislation a trial. This is said to one side ; and to the other, it is urged, only let us get in the thin end of the wedge, and we shall eventually obtain all we desire. It is a good example of crocheteering legislation. An agitation ; an association ; a philanthropic balloon, with cordage of self-interest ; a grand promise, and an organised pressure upon members who keep their heads, but not their patience, and at last give way, like a certain judge, saying, "It is a small thing; let them try."

The great mistake which Dr. Cameron and his friends make is in refusing to recognise the obvious and undoubted fact that there are two distinct kinds of drunkards — the habitual and the insane drunkards — who must be dealt with by different methods ; the one form of drunkenness being a mere vice which may be reformed by moral methods, and of which we have seen in our own days a vast and sudden reformation under the influence of a devoted and eloquent priest ; and a more slow, but also more trustworthy, reformation still proceeding by various ways, of which the highroad of the temperance associations attracts the most notice. This kind of drunkenness is too widespread to be dealt with in asylums, or brick and mortar institutions of any kind. Neither can it be xxu PREFACE.

cured by any form of treatment, for it is not a disease. The other kind of habitual drunkenness is a morbid condition, and is, in fact, a form of insanity, and no one has described it better than Dr. Cameron himself, 1 his only grave error being the assertion that a large percentage of such cases can be cured. The Author is convinced that he speaks with the concurrence of all well-informed members of his profession when he asserts that a man who has be-

1 " He would not discuss the question whether dipsomania was a vice or a disease ; but there could be no doubt that habitual drunkenness closely approximated to insanity. The hereditary tendency to lunacy was also frequently the effect of excessive drunkenness. In some cases men who had hitherto been sober and steady became suddenly intemperate after a sunstroke or after receiving a blow or wound. There was a monomaniacal character about the offences committed by many drunkards in their cups. From 1844 to 1865 one woman was committed 137 times for being drunk, in which condition she invariably smashed windows, and at last she drowned herself. An old soldier who was wounded in the head stole nothing but Bibles, and was transported for the seventh theft. Another man stole spades, a woman shoes, and a man was transported for the seventh theft of a tub, although tubs had nothing to do with his occupation or prospects. In many cases lunacy was attributed to intemperance, and men were committed as lunatics. Deprived of drink, they speedily recovered and were liberated. Taking to drink again, they had to be locked up ; and these alternations recurred until they were no longer deemed sane, when their aberrations ceased and they were subjected to prolonged detention. This was done illegally now, and the fact showed in what direction cure was looked for. Still more did the proposal of the Scotch Commissioners in Lunacy, when the Criminal Lunatics Amendment Bill was before Parliament — that in cases where it was shown that lunacy had resulted from drinking, there should be power to detain patients for twelve months after their recovery. The proposal proved the belief of the Commissioners that habitual drunkenness depended to a large extent upon a diseased condition of the system, and that it required long and special treatment to enable the system to recover its tone and subdue the morbid craving for drink. When cases were treated on this theory, a large percentage of cures was effected." — The Times, July 4th.

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come a drunkard after a sunstroke or a blow on the head, his craving for drink being accompanied bysuch other indications of mental infirmity as Dr. Cameron has specified, and in whom Dr. Cameron is perfectly right in supposing that there are structural alterations of the nervous system, must, under any methods of treatment at present known to us, be looked upon as a lunatic, presenting an exceedingly small probability of permanent cure. But, curable or not, such a person cannot, and ought not to be dealt with by moral methods alone. He is a diseased person, needing medical care and treatment, for which purpose he must be subject to compulsory arrest and detention. That peculiarity of this malady which permits long remissions of the more marked symptoms renders the insane drunkard an inconvenient inmate of ordinary lunatic asylums, and therefore the proper method of dealing with such cases would be to establish public Hospitals for Insane Drunkards, with salaried officers under the control of Boards of Governors and the authority of the Commissioners in Lunacy. Much stress has been laid upon the value of classification within asylums ; that is to say, the classification of the different kinds of lunatics within the same asylum ; but a still more efficient and valuable form of classification would be to provide asylums of different character for lunatics of different kinds. The so-called Criminal Lunatic Asylum, for lunatics who by law are not criminals, and the Asylum for Insane Convicts who are criminals, xxiv PREFACE.