The Modern Treatment of Alcoholism and Drug Narcotism
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b9 10m LIBRARY OF THE SCHOOL OF ft MEDICINE <s From the Medical Library of w Dr. Alexander Lambert B.A. I884 M JRj ti*l/?ij <JRJ*V> *3P «JR.J«.> iJ*l,/*\_> GIFT OF DR. LAMBERT'S NEPHEWS Dr. Adrian Lambert BA. 1930 Dr. John T. Lambert B.A. 1935 Dr. Samuel W. Lambert Jr. B.A. 1919 Dr. Dickinson W. Richards Jr. B.A. 19 17 YALE UNmIVERSITY PUSHING/WHITNEY THE MODERN TREATMENT OF ALCOHOLISM AND DRUG NARCOTISM THE MODERN TREATMENT OF ALCOHOLISM AND DRUG NARCOTISM C. A. McBRIDE, M.D., L.R.C.P. & S.(Edin.) NEW YORK REBMAN COMPANY 1123 BROADWAY All Rights. Reserved RC 5<5£ \C\\Q PREFACE For some years past I have been entreated by colleagues and friends to write the impres- sions and experiences gained during my thirty years' treatment of alcoholic and drug inebriates. From a literary point of view, I knew myself incapable of producing a satisfactory work, but when it was pointed out to me that there was no book published dealing fully with the special method of treatment which I had used with more than ordinary success during all those long years, I felt I ought to place my experiences on record, no matter how imperfectly it might be done. Throughout the book I have written for two classes of readers, namely, those of my own pro- fession who may be interested in the treatment of inebriety, and those of the laity interested in the subject. The book therefore is written in the simplest style possible, the only exception to this being the chapters on pathology and treat- vi PREFACE ment. It is impossible to transmit to paper the skill acquired during long years in the application of any line of treatment, but short of this I have endeavoured to make the book as practical as possible, and sincerely trust it may prove to be so. 30 New Cavendish Street, Harley Street, W., October 19 10. CONTENTS CHAP. PAGE I. What is Inebriety I II. Pathology .... IO III. The Causes of Inebriety 47 IV. Forms of Inebriety . 104 V. Treatment 162 VI. Ether Inebriety, Etc. • 299 Index 374 MODERN TREATMENT OF ALCOHOLISM CHAPTER I WHAT IS INEBRIETY? The View of the Ancients The superiority of the human race to the remainder of the animal world is said to be in the power of reasoning. It is also a matter of popular belief that sheep are the most stupid of all animals, and any one rash enough to com- pare the human race to a flock of sheep would call down upon his head a terrible storm of in indignation and abuse ; yet some matters, and more especially in the matter of inebriety, it is open to grave doubt whether we superior beings have not justified the comparison. How- ever this may be, let us take a rapid survey of the history of inebriety and see how the facts would bear out such a statement. i a 2 MODERN TREATMENT OF ALCOHOLISM The ancient Egyptians have left many proofs of their great advancement in civilisation in various departments of life, and it is therefore not astonishing to find that they recognised the truth regarding inebriety, namely, that it was a disease, and treated it as such, using such remedial measures as lay to their hands. Among these were purgatives, rubbings or applications to the head and spine. Herodotus wrote five centuries before the birth of Christ that " drunken- ness showed that both body and soul were sick." Diodorus and Plutarch assert " that drink mad- ness is an affection of the body which hath destroyed many kings and noble people." Many of the Greek philosophers recognised the physical character of inebriety and the hereditary in- fluence or tendency which was transmitted to the next generation. Greek laws were enacted forbidding women to use wine and restricting young boys. Frequent reference is made to the madness which sought solace in wine and spirits, and those so afflicted are called upon and urged to give more diligent care to their bodies— distinct hint of the physical origin of inebriety. Let us now pass on to the Christian era. In the first century we find St. John Chrysostom emphatically stating that inebriety was a disease like dyspepsia. In the next century, Ulpian, the WHAT IS INEBRIETY ? 3 Roman Jurist, referred to the irresponsible character of inebriates, and the necessity of treating them as sick men. His views were embodied in some laws which referred more distinctly to the physical nature and treatment of inebriety. Many of the Roman writers referred to the physical nature of the disorder. Now comes a considerable gap in the history, and nothing further is recorded of this great truth until the thirteenth century, when a Spanish king enacted laws fully recognising inebriety as a disease, lessening the punishment of crime committed when under the influence of spirits. One of these laws provided that when murder was committed during intoxication, the death penalty should be remitted and the offender banished to some island for a period not less than six years. After a further lapse of three centuries we find France and^some of the German States recognis- ing inebriety as a disease, and enacting laws regulating the punishment of crime accordingly. In 1747, Condillac, a French philosopher, wrote clearly on the subject, asserting inebriety to be a disease, and urging proper provision for its treatment. He stated that the impulse to drink was like insanity, an affection of the brain which could not be reached by law or religion. 4 MODERN TREATMENT OF ALCOHOLISM Fifty years later, Dr. Rush of Philadelphia asserted the same truth, and supported it by a long train of reasoning. In two essays, entitled ." The Influences of Physical Causes upon Moral Faculties," and " An Enquiry into the Effects of Ardent Spirits upon the Human Body and Mind," he described the disease of inebriety, dividing it into " acute " and " chronic " forms, giving many causes, among which heredity was promi- nent. He urged the necessity of treatment in hospitals for the purpose. To Dr. Rush belongs the honour of giving the first clear statement of how the disease should be treated. During the early part of the nineteenth century four eminent continental physicians, Dr. Cabanis of Paris, Dr. Salvator of Moscow, Dr. Esquirol and Dr. Buhl Cramner of Berlin, urged the true nature of the disease, and by their writings placed the subject upon a scientific basis, paving the way for a proper study of the disease. Since then many writers have touched upon this matter, recognising inebriety as a disease, and recommending its treatment as such. The present-day idea of inebriety is interesting in view of what has been written upon the sub- ject, but is one not altogether creditable to us as a profession. In spite of the recorded beliefs of the ancient Egyptians, Greeks, and Romans WHAT IS INEBRIETY ? 5 and the spasmodic recognition here and there throughout the long centuries of the true nature of inebriety, it is only within comparatively the last few years that English physicians have adopted the view of inebriety being a disease. This is the more astonishing when one considers the multitude of cases open to study, and the fact that every physician of even moderate practice must have met with numerous cases. I think I may venture to state that there is still a deplorable number of physicians in this country who stoutly refuse to believe inebriety to be a disease, and as firmly refuse to credit its curability. If this is so, and I base the state- ment upon the beliefs expressed to myself by many medical men during the last fifteen years, one cannot wonder at the views of the laity. The following incident will illustrate how the question is looked at by, I am sorry to say, far too large a proportion of the populace of this country. A lady friend of mine once related to me the drunken habits of a neighbour of hers, and when I ventured to suggest the question of its being a disease, she became very angry, and looking at me with flashing, indignant eyes, said, " Don't talk such rubbish to me about such a beast. If he were my husband I would horsewhip him or have him placed in prison." I am sorry 6 MODERN TREATMENT OF ALCOHOLISM to say the same lady later on became a prey to the disease herself. It is unnecessary to em- phasise further this point, as every physician probably knows it as well as myself. On this question I have only one view, namely, that inebriety is a disease, and, curiously enough, although I have spent the greater part of my professional life in the treatment of inebriety, the truth was revealed to my mind long before I was a student of medicine. I had been accustomed as a boy to look upon inebriety as a vice, and either laughed at or pitied the victims as the circumstances moved me, but one night I was making my way to the house of a relative, and amused myself treading in the zigzag tracks made by some intoxicated person in the newly fallen snow. My interest in these tracks in- creased when I found that as I turned corner after corner they were always before me, and as I knew the various residents in the road where my relative lived, finding them in this road also, I tried to guess who the delinquent could be ; but my boyish heart received a great shock when I discovered the footprints led me through the very gate of the house I was visiting.