[From the Journal of Inebriety, April, 1889.] 
HOW SHALL WE DEAL WITH THE INEBRIATE?* 
By L. W. Baker, M.D., 
Member New York Medico-Legal Society, of American Neurological Association, 
N. E. Psychological Society, Superintendent Family Home for 
Mental and Nervous Diseases, Baldwinsville, Mass. 
It is estimated that there are at least 500,000 individuals 
in this country to-day who are addicted to the excessive use 
of stimulants and narcotics. Representing all classes and 
conditions of society, they are a constant source of anxiety 
and danger in the community, not only as a present evil, but 
also from the transmission of diseased and defective organ- 
isms to a succeeding generation. 
It is of the utmost importance that this vast army, scat- 
tered all over the land, should be provided with care and- 
treatment based upon a thorough understanding of its con- 
dition, as thereby the evils of pauperism, insanity, and crime 
attendant upon its presence in the community will be largely 
diminished. 
The evil which we have to deal with is a present one, and 
in this brief paper I shall not refer to any of the causes, 
hereditary or otherwise, which lead to the excessive use of 
stimulants or narcotics; neither shall I discuss legislation in 
its relation to the manufacture and sale of intoxicating 
liquors. On this latter subject there is a wide difference of 
opinion, even among those who are equally desirous of di- 
minishing the evils which follow the abuse of alcohol. 
You may banish the destructive agent from the land if 
you choose, but you will still have to deal with thousands of 
defective nervous systems craving artificial stimulation or 
sedation. 
If it were possible in a single day to sweep every drop 
* Read before the American Association for the Study and Cure of Inebriety, 
Dec. 4, 1888. 2 
How Shall zve Deal with the Inebriate ? 
of alcohol from the face of the earth the suffering which 
would ensue among its devotees would be indescribable, 
while it is very probable that the inventive genius of man- 
kind would soon supply its place, and it is possible that the 
latter evil might be even worse than the first. 
In the meantime we are confronted by the fact, explain 
it as you choose, that the use of stimulants and narcotics is 
steadily increasing, while the existing provisions for in- 
ebriates are totally inadequate for their proper care and 
treatment. 
The popular methods of the past have been based upon 
a misconception of the subject. Regarding the inebriate 
solely as a moral delinquent, or as the victim of a vice or 
crime which was within his unaided powers of self control, 
with no attempt to investigate his condition from a scientific 
standpoint, or with scarcely a question as to the truthfulness 
of its conclusions, popular opinion has for generations ignored 
all elements of disease in the inebriate and held out to him 
the hope of cure by moral means alone, or punished him by 
fines or imprisonment when he has failed to control his de- 
sire for intoxicating drinks. 
For convenience we may divide the users of alcohol into 
four classes: 
First.- The occasional drinker, who indulges in the use 
of alcohol once in a while for social or sensual gratification 
only, now and then becoming intoxicated. 
Second.- The habitual drinker, who uses alcohol more or 
less constantly, not necessarily to excess, but the system 
is under its control in a greater or less degree nearly all of 
the time. 
Third.- The confirmed inebriate, who has lost the power 
of self-control, and oblivious of the claims of home and 
society drinks to excess whenever he has an opportunity. 
Fourth.- The dipsomaniac, who is the victim of a neu- 
rosis characterized by intense craving for stimulants occur- 
ring periodically, and preceded by certain premonitory 
symptoms. During the intervals of these outbursts of per- How Shall we Deal with the Inebriate? 
3 
verted nerve force the individual has little, if any, desire for 
alcohol, but when the paroxysm occurs the morbid craving 
for intoxication overcomes all power of self control. 
The first class is liable to merge into the second, and the 
second into the third by reason of frequent indulgence, the 
voluntary drinker thus often becoming the involuntary ine- 
briate, but the members of these two classes are usually 
more amenable to treatment by moral means, at least in the 
early stage of the disorder, than are those belonging to the 
remaining classes, and it is really with the confirmed ine- 
briate and dipsomaniac that we have to deal in the present 
inquiry. 
That some provision is needed for the treatment of these 
unfortunates different from that now provided there can be 
no question. 
We can no longer regard the inebriate solely as a moral 
delinquent: we must also recognize the disordered physical 
condition, which is either the result or a cause of the exces- 
sive use of stimulants or narcotics. Inebriety, whether it be 
inherited or acquired, is a physical disorder, and as such re- 
quires physical rather than moral means alone for its relief. 
In some respects the confirmed inebriate resembles the 
lunatic, while the analogy between dipsomania and insanity 
is closer still. Both are diseased, both have lost the ability 
of controlling certain actions through the power of the will. 
The existence of even a single delusion is often sufficient to 
incapacitate the individual for the active duties of life, and 
necessitate medical treatment and loss of personal liberty 
for a longer or shorter period of time. Why should we re- 
fuse equal assistance for the inebriate who cannot control 
his desire for a drug which benumbs the mental faculties, 
interferes with the healthy action of the brain, and renders 
the individual incapable of controlling his thoughts and acts. 
No brain can act normally while under the influence of a 
deleterious drug; the inebriate is thus at least temporarily 
insane, while the structural cerebral changes produced by 
the continued use of alcohol lead to an impairment of the 4 
How Shall we Deal with the Inebriate? 
mind which may include all degrees of mental derangement 
and degeneration. 
Inebriety should be studied from the same standpoint as 
insanity, and equal provision should be made for the inebriate 
and for the insane, varying of course with the different re- 
quirements of each class. Institutions for the treatment of 
insanity have multiplied with the demands made upon them, 
yet notwithstanding the fact that inebriates largely outnum- 
ber the insane, and furnish at least ten per cent, of all cases 
of insanity, public institutions for the treatment of inebriety 
are almost unknown. 
The evils of alcoholism are, unfortunately, not limited to 
the inebriate's own person : if they were the matter would 
be much simplified, for the individual would sooner or later 
reap the legitimate harvest of his excesses and pass out of 
existence, but to the second and third generation descend 
the destructive influences of inebriate parentage The 
amount of suffering thus entailed is enormous, while its 
effects of idiocy, insanity, and criminality are matters of the 
most common observation. The ranks of the defective 
classes are daily being recruited by the victims of alcoholic 
heredity, while the expense for their maintenance is already 
excessive. For this reason, if for no other, it is not only the 
right but it is also the duty of society to demand that this 
source of increase shall be checked at its fountain head. It 
is fully time for decisive action in this matter, which, while 
it shall be just to the inebriate, dealing with him according 
to his true condition, shall also provide his family and the 
public at large with a guarantee against the disastrous con- 
sequences which follow the excessive use of alcohol. Civil- 
ized society must always bear the burden of its unfortunate 
and defective classes, but it has a perfect right to insist upon 
measures which will reduce that burden to a minimum, and 
it seems to me that this will be lightened as institutions 
shall be established and fully equipped for the special care 
and treatment of the inebriate. These should always be un- 
der medical care, and should have all the legal powers of de- How Shall we Deal with 'the Inebriate? 
5 
tention and control possessed by our best asylums for the 
insane, for the patient must be kept from the use of alcohol, 
and this cannot be done if he is allowed full personal liberty. 
Public asylums for inebriates are also needed; these should 
be under State supervision, with strict discipline similar to 
that of the best prison reformatories, and should possess all 
necessary industrial appliances for the compulsory employ- 
ment of their inmates. To these institutions, rather than to 
the county jails or insane asylums, should the inebriate be 
legally committed for at least one year, when he may be re- 
leased on parole during abstinence from the use of alcohol. 
Upon the occurrence of a second offense he should be re- 
committed for two years, then given another trial, and if 
found unwilling or unable to control himself, then restrain 
him for an indefinite period of time. Inebriety, like insanity, 
is confined to no class or condition of society; it numbers 
its victims among the high and the low, the rich and the 
poor, the educated and the ignorant, and varying provision 
must be made for all of these classes. Some regard must 
also be paid to the former social position and surroundings 
of the inebriate in providing him with asylum treatment. I 
have had patients under my care who were formerly in 
larger institutions, and have known of their dislike for un- 
congenial company and surroundings. The wealthy will 
always exact different from those provided 
for the poorer classes. These are of course furnished in 
private asylums, but private rooms will also be needed in the 
larger institutions for patients preferring such accommoda- 
tions, and who have not been committed by the courts. 
Asylums for the inebriate should resemble those pro- 
vided for the insane in being under medical care; and in pos- 
sessing equal powers of detention and control, they will differ 
from insane asylums in their stricter discipline and in the 
constant employment of their patients. 
Generally speaking, the inebriate is insane only while un- 
der the influence of alcohol, or during an attack of dipso- 
mania: it is therefore unjust te commit him to an insane 6 
How Shall we Deal with the Inebriate? 
asylum, which our laws now permit, unless there is a strong 
probability that his insanity will become permanent. What 
he really needs is a prolonged residence and treatment in an 
institution especially arranged for his peculiar requirements. 
In this way the confirmed or periodic inebriate may be 
prevented from further injuring himself, his family or society, 
while at the same time he will be placed under the best pos- 
sible conditions for speedy recovery, or if found to be in- 
curable, will be provided with a permanent asylum home, 
which will at least prevent the transmission of the insane or 
inebriate diathesis to a succeeding generation. 
We humanely provide asylums for the permanent care of 
the chronic and helpless cases of insanity in self protection ; 
if for no other reason, must society furnish equal provision 
for the incurable inebriate. 
This in briefest outline is a plan with which you are all 
familiar, and which has again and again received the sanc- 
tion of this society, and also that of the American Medical 
Association and the Association of Medical Superintendents 
of American Institutions for the Insane. For its best suc- 
cess, however, it must receive the hearty cooperation of the 
patient. The desire to be cured is of the first importance. 
Unless this can be secured, and the individual is willing to 
assist the physician to the full extent of his ability, the 
chances of a permanent cflre are not so encouraging. We 
have then to choose between allowing the inebriate to con- 
tinue his destructive course unchecked, or placing him un- 
der conditions of permanent restraint. 
Scattered here and there, all out of proportion to the evil 
with which they have to contend, a few asylums, mostly pri- 
vate, offer medical care and treatment to the inebriate based 
upon a careful study of his mental and physical condition. 
But the victims of alcohol are slow to seek medical advice, 
unless some intercurrent disease compels them to do so. 
The number who voluntarily place themselves under proper 
medical treatment for the disease of inebriety is surprisingly 
small. This is largely due to a popular misunderstanding of How Shall we Deal with the Inebriate ? 
7 
the nature of inebriety, and a consequent disposition to deal 
with it as a moral rather than as a physical disorder. The 
first and most important step to be taken in dealing with 
the inebriate is a recognition of his diseased condition. 
Suitable methods of care and treatment will soon follow as 
a natural result. j RIVERVIEW '[ 
A FAMILY HOME FOR THE TREATMENT OF 
Mental and 
Nervous Diseases, 
AND THE OPIUM AND ALCOHOL HABITS. 
Private Medical Home consists of two spacious 
cottages, closely adjoining, heated by steam and provided 
with modern improvements. It is pleasantly situated, about 900 
feet above the sea level, in the village of Baldwinville, 70 miles 
from Boston, at the junction of the Fitchburg and Ware River 
Railroads, and combines the privacy and comforts of a quiet, 
country residence, with the special care and treatment required 
by this class of patients. 
For further information, address the Superintendent, 
L. W. BAKER, M.D., 
BALDWINVILLE, MASS. 
REFERENCES BY PERMISSION. 
Boston : S. G. Webber, M. D., C. J. Blake, M. D., Frank B. Sanborn, 
Esq., Mrs. Kate Gannett Wells, Miss E. S. Tobey. New York: C. L. 
Dana, M. D., Clark Bell, Esq. Chicago : Miss Frances E. Willard, Melrose, 
Mrs. Mary A. Livermore. Hartford : T. D. Crothers, M. D.