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The British Journal of Inebriety THE NORMAN KERR MEMORIAL LECTURE.* BY T. D. CROTHERS, M.D., Professor of Mental and Nervous Diseases in the New York School of Clinical Medicine ; Superintendent Walnut Lodge Hospital, Hartford ; Honorary Secretary of the American Medical Society for the Study of Alcohol and Narcotics; Editor of The Anrevican Quartevly JOil?'~~of Inebriety. I BRING you the warmest thanks and assurances of the high appreciation of my associates in the American Medical Society for the Study of Alcohol and other Narcotics and of myself for the distinguished honour of being called to give the first Norman Kerr Memorial Lecture. Of necessity the prospective for such a study must be made at long distance, largely from the printed page and many records of his work. Fortunately this can be supplemented by a warm personal correspondence extending over a period of nearly twenty years, and intensified by the pleasure of several personal inter- views. While it is hardly possible to make an exhaustive study of Dr. Norman Kerr and his work without a real knowledge of the surroundings and influences which were prominent in his life, still, in the general field of science, there are certain con- ditions which are the same among all English-speaking peoples. All pioneers have much the same experience, meet with the same obstacles, and have to cross the same bridges. It is the common observation that each advance of science and every effort to extend the borders of the known by the acquisition of * Delivered in the Lecture Hall of the Royal Medical and Chirurgical Society House, Hanover Square, W., on Tuesday, October 10, 1905, at 8 30 p.m. T. I). CROTHEKS, 8.1.D. To face p. 105. I 06 The British Journal of Inebriety new facts and principles are guided by two distinct classes of leaders. In the first class are those who go out beyond the range of the present, taking advanced positions, and fortifying them- selves behind barriers of theories and statements which they vigorously defend. They announce facts and conclusions far beyond the current opinions of the day, and these are regarded with indifference, and denounced as the fallacies of fanatics and paranoiacs. Such persons make only a few converts among the generation in which they live. They are literally so far beyond the present that another generation must come before their views can be understood or appreciated. The literature of every age contains regrets, apologies, and explanations of why the great leaders and teachers of the past were unknown and neglected. A second class of pioneers includes those who make researches and studies on the frontiers of the present or just beyond it, but always in close touch and never far away from the accepted theories of to-day. Such resemble officers beyond the picket lines of advancing armies, pointing out new ranges of facts with new applications and fresh means of approach. Like the first class, they are unrecognised except by a few advanced thinkers, who follow the lines of research along the paths which the pioneers have laid out. Such men have a following, but they are the leaders of the few, and always ignored by the majority. They are practical organizers, gathering up truths that have passed unobserved, and fitting them for the actual service of to-day and the needs of to-morrow. Dr. J. Edward Turner of America was a most conspicuous example of the first class. He organized and put in operation the first inebriate asylum in the world, where the advantages of treatment by medical means were ably demonstrated. After a period of indifference, intense opposition, and misrepresentation he died, and now the present generation are beginning to realize the importance and value of his efforts to cure and eliminate the great evil of inebriety. Dr. Norman Kerr was an equally marked example of the second class of pioneers, who propounded new truths and organized scientific means to combat this evil beyond the fron- tiers of the present without antagonizing the theories of the times: he sought to direct them into new and more practical The British Journal of Inebriety 107 channels, and suggested more exact means and measures for correction. In this way new facts were grafted on to the scien- tific growths of that day, and new applications of old theories came into service. Work of this kind attracts little attention at the time, but later its value becomes prominent. Many examples of both these classes are seen in every advance and evolution of science. Dr. Turner went out beyond his day and generation, and marked out territories and pointed out lines of research which are yet to be taken up. Dr. Norman Kerr gathered and grouped facts, showing applications and possibilities from the physical treatment of inebriety which have not been reached. Both of these classes of leaders grew out of distinct evolutions and conditions which forced them into positions of leadership. It was no chance or accident that sent Dr. Turner far out beyond his day and generation, or placed Dr. Kerr in the position to interpret and make known some great neglected truths of science, but the result of conditions which may be seen and pointed out. Our present effort would naturally suggest a study of some of the conditions which influenced Dr. Kerr to take up the study of the physical character of inebriety, and investigate the possibility of its cure and prevention. The view that inebriety is a disease is a very ancient one. The cuneiform writings on the buried tombs in Egypt distinctly stated this fact in some detail many thousand years before the Christian era. Theories regarding the disease of drunkenness were mentioned by philosophers and physicians during the succeeding centuries, but they attracted no attention. They simply floated down through the thought and literature of the ages, repeated here and there, and probably were considered as mere random theories and speculations, just as at present one may hear strange theories and assertions of facts which will in the next generation, or in the future, become the working theories of the world. A historical chapter of fascinating interest is yet to be written on the early notices and conceptions of the physical character of inebriety down to the close of the eighteenth century. About this time Condilac, the French philosopher, in one of his essays discussed inebriety, and pointed out some of the possibili- 10s The British Journal of Inebriety ties from future study of this subject. In America Dr. Rush took up the views of Condilac and elaborated them in an essay, published in 1809, giving distinct outlines of the malady, and urging its medical study. A few years later Salvator, of Moscow, published a little work describing the different forms of the disease and the possible methods of cure. Other writers at intervals wrote on this subject, but in a timid, hesitating way, which failed to create any interest. The English Lunacy Commission, in their report for 1844, declared inebriety to be a disease to be studied and treated along the same lines as insanity. Among the few medical men who repeated this declaration and urged its practical character, Dr. Alexander Peddie, of Edinburgh (still living and a vice-president of your Society), took the most advanced ground, and persistently repeated it in many excellent essays and lectures, beginning with an essay on “Delirium Tremens” in 1857, but the theory of inebriety being a disease was regarded as impractical and extreme. In America several distinct events brought this subject into the field of science. The first of these was the Washingtonian Reform Movement, which began in 1840, and in less than ten years had secured the signatures and pledges of nearly 5,000,000 persons for total abstinence. This great reform wave brought into prominence lodging-houses and temporary homes, where the pledge-signer could be protected and cared for until he had secured sufficient strength to enable him to carry out his pledges. One of these early homes evolved through a long series of years into the present Washingtonian Home of Boston, Mass., one of the oldest institutions in America, and probably in the world, for the physical treatment of inebriates. It was the practical necessity for doing something more than the mere pledging of the inebriate that was recognised in the public mind, and prepared the way for the next great event. This was the projection and organization of an inebriate asylum at Binghampton, in the State of New York. The founder, Dr. J. Edward Turner, a Maine man, as the result of his early experience, became imbued with the idea of the need of an asylum for the care of inebriates. For nearly twenty years he The British Journal of Inebriety pressed this subject constantly before the general and medical public, and finally was able to make a practical test in a magni- ficent hospital built for this special purpose and opened in 1863. This institution began on a grand scale, with nearly a hundred patients, taken largely from the incurable class, and with a full board of officers and directors all without experience. The expectation and enthusiasm at the beginning soon reacted in conflicts and disappointments, The attempt to control and give proper physical care to incurables of this class even under the best conditions was a most difficult matter, but as an experiment it ended in bitter conflicts, during which the founder was driven out. Then followed a period of twenty years, in which eight different superintendents attempted to conduct the affairs of this institution and control its inmates, and finally it was changed by politicians into an asylum for the insane.

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