1882.; 
The Management of Chronic Inebriates. 
493 
>The Church has no traditional likeneafroi Jesug; 
taught the old paintapj#*to 
a face beauty,soNjluse the art 
divined the the 
Michel “ the frail and 
weary weed ” whiCT^Truthjj^flii^l^^M^puts on, in pity fox- 
human weakness. BmjjjHjfn we any state in the 
infinite future, of aj#ru a t egjUffgffie eternarltejgs, when Truth 
will not For is beauty 
resolvable j//rfo will, 
transceuir the imaffm of the two. than oe!!&||Lfry 
THE MANAGEMENT OF CHRONIC INEBRIATES ' 
AND INSANE DRUNKARDS.* 
In approaching a question of such magnitude as the pres- 
ent one, certain facts which have been proved by the expe- 
rience of the past must be touched upon as a fundamen- 
tal necessity to any intelligent discussion of the subject. 
Among these are the following. 
It is a recognized fact that the peoples of to-day are 
different in many respects fi-om their native ancestors, or 
from the peoples of those countries from which they may 
have emigrated. These gradual changes have long been 
observed, but in later years they have progressed with ac- 
celerated rapidity. This result is not confined to one lan- 
guage or continent, but is distributed in varying degTees of 
development throughout the whole civilized world. The 
changed condition is noticeable in many ways, principally, 
however, in features relating to the nervous system,— that is, 
in those departments of the human ox-ganization controlled 
or specially influenced by the great central ganglia, the 
brain and spinal cord. 
The most prominent evidences of such a change consist in 
an increased excitability, an abnormal activity of all the 
*Read at the Annual Meeting of the Social Science Association at Saratoga, 
Sepr. 6, 1882, by 494 
Management of Chronic Inebriates and 
Dec. 
cerebral and nervous functions, a restlessness and nervous- 
ness, a precocity which is not the healthy development of 
normal powers, but is a strained and overwrought activity 
resulting from unnatural and disordered excitability. This 
condition, if developed suddenly in any individual, is con- 
sidered indisputable evidence of disease, and is quite as 
properly reckoned a diseased action when its march is slow 
and insidious, so that its progress is unnoticed by the 
individual affected. 
The expression of increased nervous excitability is ob- 
served in nearly all the ordinary walks of life and in all 
conditions of people. Within the memory of most of us 
there have been such changes within the limit of personal 
observation to verify the truth of this assertion. The 
ground was well covered by the remark of a gentleman 
with whom I was recently conversing, who said, “ I would 
prefer to live seventy years in thirty rather than to con- 
sume seventy years in living thirty.” 
The causes of the generally elevated tension in which we 
live are manifold, and reach into almost every avenue of 
life. They invade the most humble home and intrude into 
the drawing-rooms of our modern palaces. It is impossible 
to enumerate all, or nearly all, the influences which have 
united to produce such a baneful effect upon our popula- 
tion; but a few of the more potent causes may be briefly 
touched upon. Among these may be mentioned, as one now 
acting most powerfully in this country, the modern science of 
politics, by which I would not be understood as alluding to 
the science of true statesmanship, but the petty, miserable 
abortion of statesmanship, in which personal ambition 
usurps the place of principle, and private advantage con- 
trols those acts which should be directed to the public 
good. 
The abolition of principle, which is to the mind what the 
pole-star is to the mariner, is one of the most fatal accidents 
which can befall any individual. Its absence leaves the 
mind without a proper degree of rectitude, without that 188*2.] 
Insane Drunkards. 
495 
necessary steadfastness of purpose and consistency of 
method which are essential to healthy and vigorous men- 
tal activity. Weakness and debility of the mental func- 
tions must as surely follow its loss as physical infirmity 
succeeds the loss of any material condition of animal life. 
The cumulative result of this defect is continually aug- 
menting, like that of the opium habit or any other profound 
and growing influence operating upon the foundatio-ns of 
being in the individual. 
The recent great mania for speculation, which has swept 
like a cyclone over this country, has been another powerful 
agent in disturbing the mental equilibrium of very many 
people in the past few years. The insatiable desire for 
wealth, the excitement attending the fluctuations of values, 
the anxiety regarding the favorite investment, the giddy 
exhilaration produced by sudden riches, and the despair at 
the shipwreck of the labors of a lifetime,— all exert a most 
powerful influence in unsettling the mental balance of many 
individuals, thus exposing them more easily to the effects 
of accidental influences, by which their debilitated mental 
and moral natures may now become more or less profoundly 
disturbed. 
The rapid dissemination of intelligence from one part of 
the world to another, thus bringing the events of distant 
localities to our earnest attention, with the added elements 
of exaggeration and sentiment, with almost the same force 
as those affecting our personal relations, must act as a con- 
stant excitant or spur to the emotional and sympathetic 
parts of human nature, and operate to strain these qualities 
of the mind to an unusual and harmful degree. In fact, 
one of the most dangerous forms of mental disease at this 
time is the so-called “ emotional insanity,” produced, or at 
least developed and perpetuated, by great and prolonged 
excitement of these mental faculties. The “ inspiration 
theory,” with its frequent deeds of horror, comes under this 
class of mental disease, of which we have had several most 
pitiable examples. 
Another potent factor in the increased mental vulnera- 496 
Management of Chronic Inebriates and 
[Dec. 
bility of our recent population is the changes in the private 
and domestic life of the people. There is an increased ten- 
dency toward aggregation in large communities, and all 
large cities are overcrowded. The natural result is, that 
much of the home life, if indeed not all, with its quiet 
restraint and peaceful influences, is lost upon those natures 
which most need them. The young of both sexes are thus 
thrown into the whirlpool of modern town life, and de- 
prived of the most necessary means of protection from its 
contamination. 
Is it to be wondered at if irretrievable damage i, done 
the mental and moral natures of inexperienced or susceptible 
individuals, which, like a slight deviation from a straight 
line, becomes further and further removed from its proper 
course ? 
When we add to all these the harmful practices associated 
with club life, now unfortunately becoming so popular 
among all classes, which pander to all the foregoing evils 
but counteract none of them, and supplement all these with 
late hours and their associated dissipations, the lack of 
friendly advice, the perils of gaming and the other social 
dangers, we surely have ample cause for the weakened 
and debilitated moral sense, and the overstrained and excited 
emotional nature of a large and increasing proportion of our 
young and middle-aged people. 
If, now, these unfortunate individuals become the slaves 
to passion or appetite, in any specific form, their bondage 
will be more oppressive from the lack of a powerful will to 
resist and a firm principle to guide; and the danger from 
encroachments of other vices will be augmented, owing to 
diminished power of self-control due to degeneration or 
abolition of standard mental qualities. 
At this point, one of the prime evils of our present sys- 
tem of living becomes evident, in connection with the facts 
mentioned a moment ago. Human nature cannot indefi- 
nitely support the increased strain to which a continually 
enlarging number of individuals are exposed. Natural food 
and natural rest will not provide for unnatural and superhu- 497 
1882.J 
Insane Drunkards. 
man exertion. There is a limit to all healthy energy. Be- 
yond this limit, labor is accomplished only at the expense of 
vitality. In this extremity, which is exactly the condition 
in which a large number of our people find themselves, the 
use of artificial stimulants is necessary, in order to follow 
an irrational and insane ambition. The constant mental 
toil, the unceasing anxiety, the sleepless nights and overbur- 
dened days, gradually produce a degree of exhaustion, in 
which the individual is forced to one of two measures,— 
either to relax the strain under which the system is laboring 
or to endeavor to support the failing energies by the use of 
some form of artificial stimulus. There is little need to add 
that the latter is the measure usually adopted at the present 
time. . . . There is a sensation of exhaustion which impera- 
tively demands the aid of a stimulant, and is temporarily 
relieved by its employment. The individual is led to think 
that the remedy has been found, and continues the use of 
an agent which has afforded such marked benefit. 
It is easy to conceive that any article which thus becomes 
necessary to the performance of daily labor may gradually 
acquire such power over the individual that the force of 
habit, combined with the physiological action of the sub- 
stance, may at length render all efforts at its abandonment 
entirely futile. . . . 
The cumulative effect of prolonged over-stimulation is 
twofold: first, the action upon the nervous system, as a 
spur, by which an extra amount of energy may be tempo- 
rarily evolved, with a gradual encroachment on the normal 
powers of the organism, until no extra energy can be 
awakened except from the effect of stimulation; and, sec- 
ond, a change in the physiological and organic relations of 
the structural elements composing the nobler functional or- 
gans, with gradual degeneration of the higher mental and 
moral qualities, so that the foundations of character are un- 
dermined and the powers of reason are perverted, while 
the emotions and sympathies are excited to increased activ- 
ity ; and the unfortunate individual becomes a slave to sud- 
den and irresistible impulses, the consequences of which may 
be disastrous to himself or others. 498 
Management of Chronic Inebriates and 
[Dec. 
Probably, many unsuspected cases which claim our atten- 
tion in their care and treatment are the direct result of an 
attempt to prevent exhaustion of the vital powers by the 
use of artificial stimulants. One of the most careful writers 
of our day says that “ cerebral exhaustion, however caused, 
more often leads to irresistible drink-craving than is gener- 
ally supposed ”; and Dr. Myers states that “ there is no 
form of nervous exhaustion more severe in its character 
than that which is induced by the abuse of stimulants.” 
The organic effect of prolonged over-stimulation upon the 
brain may be of two varieties: first, to dry up, so to speak, 
and to a certain extent solidify the tissues, with the symp- 
toms of a greater or lesser deviation from mental soundness, 
sometimes amounting to mania; often followed, second, by 
softeniug of the cerebral structure, accompanied by a grad- 
ual blunting of many, if not all, the mental faculties, at times 
resulting in actual imbecility. 
Dr. Sankey, in his lectures, traces the close parallel be- 
tween the gradual degeneration of brain and degradation 
of mind in the drunkard and the insane person, and shows 
that these processes exactly correspond in some cases, and 
that the cerebral changes are almost identical. ... It is safe 
to say that no person can employ alcoholic stimulants for 
any length of time continuously without impairing the in- 
tegrity of some, or all, the great organs of life, and vitiating 
their functions. With this result once induced, the neces- 
sity is felt for continued use of the harmful agent; and the 
weakened mental faculties are powerless to oppose the de- 
mands of an abnormal and depraved appetite. Thus, the bad 
habit is fostered and perpetuated, and the chronic inebriate 
stands before us. The uncontrollable appetite, the dimin- 
ished mental vigor, the complete subjection to the obnox- 
ious substance, are the essential factors which constitute 
the chronic toper, whose progress is now invariably from 
bad to worse. Dr. Bucknill considers this conditioi\_to be 
a form of emotional or moral insanity. He says, “ The prom- 
inent nature of this propensity is its irresistibility.” 
The second class which claims our attention at this time 1882.] 
Insane Drunkards. 
499 
is that other element of society, which is subject to alcoholic 
influence, and which presents a series of phenomena utterly 
different from those we have previously considered. These 
unfortunate persons are generally (so far as my observation 
has enabled me to judge) those who are Originally in some 
way constitutionally defective, or are, to a greater or lesser 
degree perhaps, congenitally “ weak-minded,” or, in the words 
of Dr. Fisher, “ those who inherit an unstable, nervous con- 
stitution from drunken, neurotic, or insane ancestors.” 
They are oftener found among the more illiterate ranks of 
society, or, if they belong to an elevated walk in life, they 
are inferior to their position, and are generally regarded 
as deficient in some essential qualities. This group of 
persons does not generally become addicted to the use of 
alcoholic stimulants from an original necessity for them, 
but from inherited vicious propensities, pandered morbid ap- 
petites, and depraved mental constitution. In them, the 
results which obtain in the chronic inebriate are less fre- 
quently observed, organic changes in the various animal 
structures are more rare, and the principal deleterious effect 
is to be noticed in the department of the higher cerebral 
functions. 
The nervous system in these unfortunate individuals 
seems to be so constituted that the effect of any powerful 
stimulant is developed at once, and particularly in these 
structures. A person who has taken but a very moderate 
amount of a common stimulant may present no outward 
sign of intoxication : the step may be firm, the face not 
flushed, the pulse but slightly accelerated; but the mental 
organization of the individual may be completely over- 
turned. There is often not the violent aspect of mental 
derangement which accompanies delirium tremens, but a com- 
plete suspension of normal cerebration. The general tend- 
ency of this state is one of personal exaltation, of unlimited 
resources, of gigantic enterprise, of assured success in most 
extraordinary undertakings. Although not generally in- 
clined to be violent, there is complete disregard of the pro- 
prieties of the person or property of others, which, coupled 500 
Management of Chronic Inebriates and 
[Dec. 
with the fact that any effort at restraint is at once resented, 
is often the occasion of the development of a state of fury 
in which life is often imperilled and sometimes sacrificed. 
In this state of maniacal rage there is no consistent selec- 
tion of means, nOr any consideration of the results which 
may ensue, but the unrestrained passion of the moment 
leads the individual to the most violent demonstrations as 
4 
the result of interference with the delusions which tempo- 
rarily possess the mind of the insane drunkard. Dr. Fisher, 
who has devoted much thought to this subject, says: 
“Under the influence partly of an uncontrollable impulse 
and partly of intoxication, they will perform truly insane 
acts. Closer investigation of their mental state will usually 
disclose the fact that they are liable to periodical recur- 
rences of causeless exultation and bursts of self-confidence 
on trifling occasions.” 
A case is now in my mind in which an amount of alcohol, 
not usually followed by any appreciable result other than a 
slight exhilaration, is in this patient the cause of uncontrol- 
lable rage, during which his room-mate, who is his dearest 
friend, becomes the object of the most malignant fury, and 
is in momentary danger of death from any convenient 
means. This impulse to violence toward others alternates 
with a powerful inclination to jump from the window, which 
is the only expression of any suicidal tendency in this pa- 
tient. Some days are required for the re-establishment of 
his disturbed mental equilibrium, though the bodily func- 
tions are at no time seriously deranged. The effect of 
stimulation in this and similar cases seems to be primarily 
and chiefly exerted upon the nervous system, and is particu- 
larly developed in the cerebral lobes, where its action is 
expressed by disordered mental action as the disturbed 
function of these organs. 
With each repetition of so dangerous an interference with 
these important structures, the tendency to diseased action 
is increased, so that the aberration of the intellect is each 
time more prolonged, and its character perhaps changed. 
The diseased condition may be produced by a lesser amount 1882.] 
Insane Drunkards. 
501 
of the stimulant, and the impression upon the whole organ- 
ism may become more pronounced, until at length reason 
may be permanently impaired, and the patient become the 
object of continuous apprehension or perpetual restraint, as 
a protection to himself or his surroundings or both. 
Dr. Blandford regards persons of inherited or acquired 
weak mental constitution, who are impelled to periodical 
drinking, by which indulgence the mental impairment is 
increased and perpetuated, as insane, thus expressing exactly 
the condition which we have endeavored to describe. 
From the foregoing, it becomes at once evident that the 
victim of drink may become a charge to society in either of 
the ways described. As such, he should not be regarded in 
the light of a voluntary offender or a hardened criminal, but 
as a sick and diseased individual, who is in need of humane 
and considerate treatment, and who is perhaps susceptible 
to recovery from his disordered condition and to restoration 
and cure of his infirmity. The cause of his present condi- 
tion, whether intemperate indulgence of vicious propensities 
or any other reason, is not now a subject for consideration. 
The mental and physical requirements of the patient are to be 
chiefly regarded. Dr. Bodington, at a recent meeting of the 
British Medical Association, says, “ For my part, I look 
upon all habitual drunkenness as a disease, and I would 
boldly call it dipsomania.” And the American Association 
for the cure of Inebriates takes the broad ground that “in- 
temperance is a disease.” 
Here, our greatest need in the proper care of these unfor- 
tunates becomes strikingly manifest. We have continuously 
in our midst a class of patients of deficient will-power, or 
nervous force, or principle, as we may choose to call it, who 
become the subjects of public care, and are daily becoming 
such in increasing numbers. 
Their existence as a class has been recognized, and their 
needs partially expressed. But I believe I am right when I 
say that in all our broad land there is not an institution or 
an establishment properly adapted to their reception for 
remedial or curative treatment, or for their care, if incur- 502 
Management of Chronic Inebriates and 
[Dec. 
able. I have yet to learn of the resort so arranged as to be 
applicable to their needs or so conducted as to be of practi- 
cal service to this element in our society, which the public 
must care for. 
From the nature of things, it is generally among the 
poorer people that these patients are met with, and there- 
fore among those least able to properly care for them, and 
least likely to appreciate the fact that they are really sick, 
and deserving treatment rationally addressed to their con- 
dition. 
The fact that they are frequently, and indeed generally 
brought to our notice through the commission of some act 
which calls for the intervention of the civil law, should not 
blind our eyes to the equally evident' fact that accounta- 
bility and moral responsibility may be more or less defi- 
cient or entirely wanting in the subject of the misdemeanor, 
and that he is precisely in just this degree incapable of the 
commission of a crime or amenable to its penalties. 
The only provision which has thus far been made for the 
treatment of these unfortunate creatures is of two varieties: 
first, those conducted by private enterprise as a means of 
accumulating money or from charitable motives, and those 
controlled by the municipal or State government. 
The first of these is defective in many ways. There is, as 
a prime objection, the fact that in these resorts the patient 
is a boarder, and as such is retained only so long as the 
means for keeping him there can be provided; and, upon 
the failure of the pecuniary provision, he is dismissed with- 
out regard to his physical condition. While in these re- 
treats, he is only a voluntary inmate, he is not constrained 
to remain until his condition is relieved, but often, ands per- 
haps always, the restraint proves so irksome that the pa- 
tient leaves the institution before he is in fit condition to do 
so, and consequently derives little or no benefit from his 
residence in it. 
Dr. Fisher says: “If able to pay and willing to go, such a 
patient might be kept for a short time in the Washingtonian 
Home or some similar establishment on the voluntary plan. 1882.] 
Insane Drunkards. 
503 
But this kind of temporary detention only restores and 
strengthens the confirmed inebriate for renewed indul- 
gence. . . . The disease has a deep root in the nervous 
constitution of the individual, which cannot be eradicated in 
this way.” These institutions are also often administered 
upon certain dogmatic religious or hygienic ideas, which 
may essentially impair their usefulness as curative asylums. 
The only institutions recognized by the State or municipal 
government for the reception of this class of patients are of 
two kinds: first, the various prison institutions for the con- 
finement of felons, thieves, murderers, etc., into whose com- 
panionship the mentally and physically weakened victim of 
alcohol is introduced, and which can objectively and sub- 
jectively act only as an aggravation to his infirmity, and 
from whose walls he emerges cursed with the moral stigma 
of its indelible associations. 
The second and only other resort to which a patient may 
be referred by judicial authority is the mad-house, with all 
its horrors, of which words can often convey no adequate 
conception. 1 quote again the words of Dr. T. W. Fisher, 
when speaking of Massachusetts: “ There is no provision 
anywhere for the treatment of delirium tremens but in the 
almshouse at Deer Island or Tewksbury. Cases of mania 
from drink, if likely to prove of short duration, are sent to 
the former place for observation, subsequently to be trans- 
ferred to an asylum, if the insane condition seems to war- 
rant it.” To the lunatic asylum, the insane drunkard may 
be committed with the same degree of rigor as to the 
prison; and too often his case is fully as much a mat- 
ter of routine in one place as in the other. The over- 
crowded condition of our public insane asylums, the lack 
of careful discrimination which I fear often prevails, with 
absolutely inadequate facilities or official staff for the hu- 
mane and kindly treatment of so many sufferers, effectually 
prevents this resort from being of service to our subjects. 
The confinement with maniacs, the constant association 
by day and by night with those in whom the power of 
reason is perverted, and whose every act and word is the 504 
Management of Chronic Inebriates and 
[Dec. 
expression of a diseased mind, is a cruelty and an inhu- 
manity toward the weak and the helpless. We have, and 
shall continue to have among us, a certain definite class of 
invalids, who are, and will continue to be, a burden to the 
public, and must be cared for at the public expense. It is 
certainly no proper argument that, because they must be 
supported at the public charge, they may as well be main- 
tained in prisons and asylums as anywhere else. We must 
not forget that we owe to these unfortunates a degree of 
humanity in their treatment which should endeavor not only 
to relieve their present distress, but to restore them, if 
possible, to the full exercise of their previous faculties. 
That is to say, the treatment of these individuals should 
have, for its ultimate object, the cure of the disease. This 
beneficent result is surely not to be attained by incarceration 
in a prison with the most hardened and desperate characters 
of our heterogeneous communities, nor is it to be hoped for 
behind the bolts and bars of our great and crowded insane 
asylums. Dr. Fisher expresses the same idea in these words : 
“ Insane drunkards would be undesirable inmates of our 
insane hospitals, if there was no difficulty in retaining them. 
They need little medical treatment, but require prolonged 
restraint, varied employments, and moral discipline. The 
private retreats for inebriates and insane drunkards are, so far 
as my experience goes, quite powerless to accomplish "any 
result, further than is in harmony with the will of the 
patient, and are on the whole of doubtful benefit for this 
class of cases.” 
As an instance of the working of two of the above-men- 
tioned institutions, I would cite the following cases, which 
occurred within my own personal knowledge. A gentleman, 
who had long been a hotel proprietor, met with sudden 
reverses and suffered considerable pecuniary loss. Always 
of active temperament and usually of sober habits, his present 
mental distress was very acute, and he became addicted to 
drink. I have never seen this man in the least degree 
affected in speech, gait, or other physical manner, nor to a 
casual observer would he excite attention as being intoxi- 1882.] 
Insane Drunkards. 
505 
cated. Yet, in this state, lie is a dangerous man, and his 
family have often suffered violence at his hands; and with 
each succeeding debauch there is a decided change in his 
mental condition, which is gradually approaching a state of 
homicidal mania. 
On more than one occasion, this patient has been placed in 
a private institution for inebriates, which has a very imposing 
name and a wide-spread fame, in the hope that he might be 
reformed, and again become a useful member of society. 
Each time, however, after a residence of a few days in the 
institution, this patient has called for his clothes, and has left 
the retreat to again indulge his diseased propensities. 
For such subjects as can be influenced by purely moral 
persuasion, these institutions may be of service, as those 
patients do not require restraint; but, for the uncontrollable 
manifestations which accompany the action of alcohol upon 
many persons, such resorts are total failures. They have not 
the judicial authority to aid their work, they are powerless 
to restrain the turbulent subject, and are quite useless as a 
means of reformation or cure in any excepting mild cases. 
An example of the opposite form of treatment also re- 
cently occurred within my observation. The patient was 
brought before the court, and was adjudged an insane drunk- 
ard and as such was judicially committed to one of the State 
Insane Asylums. After a time, he was released on a motion 
from the court, and thus describes his experience while 
under treatment: “ The doors were barred, and kept con- 
tinually locked. There was no privacy, hardly the oppor- 
tunity for the exercise of decency in personal toilet. Even 
during the day, the forced restraint was distressing, but at 
night it became much more so. The shouts and yells of ex- 
cited patients in neighboring wards were painfully audible, 
and disturbed sleep. The other occupants of this room 
were one patient who was constantly endeavoring to take 
his own life, one who feared that some one was seeking to 
kill him, one who was confined on account of homicidal 
tendencies, and one who was constantly striving to kill 
the others. The ward went by the cheerful name of the 506 
Management of Chronic Inebriates and 
[Dec 
‘ suicides’ room.’ ” The patient remarked that, “ even if a 
person were sane, on being confined here he might easily 
become insane from such surroundings,” — an opinion in 
which I am inclined to concur. 
Another disadvantage attending the present management 
of insane drunkards is the uncertain length of time during 
which the patient is retained for treatment. Upon this 
point, I cannot do better than quote from the valuable 
monograph of Dr. Fisher, who says: “ Great as is the task 
of getting an insane drunkard committed to an insane hos- 
pital, the difficulty of keeping him is still greater. This 
arises from the transient character of the prominent symp- 
toms, which are only brought out under the paralyzing in- 
fluence of alcohol. As one writer has said, the dipsomaniac 
is only sane while in the hospital. Although in his extrem- 
ity, under arrest for disturbance of the peace, and perhaps 
suffering mentally and physically from the immediate effects 
of drink, he acquiesces in his commitment, in a surprisingly 
short time he is on his feet, under perfect control, looking 
around for a lawyer to help him swear that his confused 
recollection of the circumstances of his commitment is the 
true version. No hospital can hold him, a moment against 
his legal protest, and he is discharged as a matter of course.” 
In view of the existing facts in relation to the manage- 
ment of chronic inebriates and insane drunkards, I think we 
are safe in asserting that no wise, humane, and practical plan 
has yet been inaugurated for this object, which shall insure 
the protection of society at large, and work no injustice to 
the individual. It is comparatively easy to see the defects 
of existing methods, but it is by no means easy to suggest 
a remedy. VVe may, however, perhaps learn something con- 
cerning the direction in which our efforts may be most 
profitably exerted, with the hope that in the fulness of time 
the desired result may be obtained. 
What conditions, then, would be most favorable for the 
restoration or cure of an individual wrecked by drink and 
a burden to society? This is the question which in one 
form or another must really underlie any earnest and sin- 1882.] 
Insane Drunkards. 
507 
cere endeavor for the practical relief of this unfortunate 
class of people. ... For its solution upon any plan, one 
thing must evidently be premised as an essential condition, 
which is that there shall be a suitable disposition of authority 
ivhich shall place these people within the control of some 
restraining force. Without this indispensable provision, no 
effort for their benefit can be successful. With such power 
guarded by wise restrictions, it might be possible so to influ- 
ence the life of th.e drunkard that his diseased tendencies 
and abnormal inclinations might be eradicated, and mental 
and physical health be restored to him. 
If we consider what elements of treatment would most 
conduce to recovery from the state in which we find these 
patients, we shall not fail to recognize the great importance 
of two conditions, namely: a judicious amount of physical 
toil, which will induce a certain degree of bodily fatigue, 
with a consequent inclination to natural repose; and a life 
as much as possible in the open air; a diet composed of 
strong, nutritious food, but of plain, non-stimulating char- 
acter, regularity of habits, and provision for abundance of 
undisturbed sleep. 
By the present methods of dealing with the two classes of 
patients of which we are speaking, neither of these essential 
conditions is secured. The associations which now accom- 
pany their treatment are of the most unfortunate character, 
and cannot but be detrimental to the well-being of any 
person exposed to their influence. A mind congenitally 
defective, or unsettled by overwork or over-stimulation, or 
a character depraved by the long-continued indulgence of 
vicious tendencies and pernicious appetites, will certainly 
not be benefited by the companionship of those with whom 
one is necessarily brought into contact in a prison or a mad- 
house. The treatment to which these patients are at pres- 
ent subjected cannot be properly called curative. It cannot 
possibly operate to relieve them to any such degree as it 
might do, if these features could be eliminated. 
How this may best be accomplished, and how those per- 
sons addicted to the habitual use of intoxicants, and those 508 
Management of Chronic Inebriates and 
[Dec. 
rendered insane by the same means, may be most advanta- 
geously treated both for their own good and for the good of 
society, I regard as among the most serious problems of our 
day. I doubt if our people are ready at this time to seri- 
ously consider it with that degree of candor and disinterest- 
edness which the subject demands ; nor will they do so, 
until a purer and more healthy spirit pervades our govern- 
ing power, and a more rationally humane and truly charita- 
ble disposition is evinced by the people. 
The suggestions which I have to make may not be the 
wisest or most desirable; but they are the best I can 
advance at this time, and are presented not as a basis for 
any present action, but for the sake of eliciting discussion 
and inviting more practicable suggestions from the members 
of this distinguished society. 
The fact must be constantly borne in mind that these indi- 
viduals, whatever their former condition or ability, generally 
degenerate physically, morally, and financially, until they 
become dependent upon private charity or require the 
official care of the State or municipality. Now, if the public 
can assume control of these unprofitable members of its 
body and institute a judicious treatment of their infirmities, 
treatment based upon careful and considerate study of their 
diseased condition and needs, these patients will not only 
be better cared for than they now are, but they will experi- 
ence the added benefit that the result of such treatment will 
tend toward their radical cure. Such a plan would premise 
that the municipal authority should be in some way enabled 
to include within its limits those persons, not yet criminals 
perhaps, but intellectually weak and depraved, and possibly 
unconscious transgressors against laws they do not compre- 
hend. The protection of society from the violent acts of 
drunkards, sane and insane, is a matter of vast importance, 
when we consider the frequency of such occurrences. The 
public is shocked at each new victim of insane violence, 
and shudders at the unending procession of suicides, but is 
strangely insensitive to the existence of potential homicides 
and suicides, who meet us at every turn. If these people 1882.] 
Insane Drunkards. 
509 
could be properly oared for, their indulgence iu intoxicants re- 
strained, good and sufficient food be given them instead, and 
they be made to employ their bodily powers in some muscular 
activity, graduated to suit the requirements of each individual 
case, with enforced regularity in regard to repose, I am sure 
that a short time would be amply sufficient to turn the tide 
in many cases from disease to health, and from the progres- 
sive degradation of the insane drunkard to the light and 
liberty of a free, sane, and competent man. 
How this desirable result may be best achieved in America 
at this time, under our present system, or rather lack of 
system, I am not prepared to say. One thing, I think, is 
true beyond question. None of the so*called “ Inebriates’ 
Homes,” “retreats,” or asylums, as at present conducted, 
have proved to be of much service in the real treatment of 
habitual drunkards and particularly of insane drunkards. It 
is not in their nature to accomplish this result, as they are 
entirely without authority to exercise judicious and needed 
restraint in those cases in which it is absolutely required. 
They are essentially little more than temperance boarding- 
houses, where inebriates can remain by paying a certain sum 
of money and conforming to the regulations of the institu- 
tion. Probably the majority of those patients who are ben- 
efited by a residence in these establishments would be quite 
as well able to reform under favorable conditions without 
residence in any asylum. 
But it is not this class of cases alone which we are called 
upon to consider. It is also the poor and the helpless whose 
circumstances do not allow them to enjoy the luxury of 
prolonged abode in these retreats, and who have not the moral 
strength to forsake their vicious habits. These also require 
attention and care. For their treatment, the exercise of judi- 
cial restraint is absolutely necessary. They must be assisted 
to overcome a diseased tendency, for the control of which 
they do not possess the necessary strength. Here is where 
all present institutions are found wanting. The inmate 
cannot be legally detained within their care one hour 
beyond his own desire, He can thus at any time defeat all 510 
Management of Chronic Inebriates and 
Dec.] 
such efforts for his reformation. Dr. Fisher remarks that 
“ an insane drunkard with homicidal propensities is more 
independent of legal restraint than any other person in the 
community.” 
The manner in which a legal supervision is to be exercised, 
so as to secure the humane and curative treatment of the 
mental and physical condition in the various classes of 
drunkards in our midst, it is not the province of this paper 
to discuss. If the views herein advocated receive the 
approbation of this society, some plan for their practical 
application will not long be lacking. A few hints from 
practical experience may, however, not be without interest in 
this direction. Some years ago, while making a foot tour 
through a portion of Germany, I passed through a section of 
country of considerable extent which had been a barren, 
cheerless waste, but which was in some parts at that time 
occupied by extensive plantations of regularly set and 
cultivated spruce or other evergreen trees in varying stages 
of growth. Upon making inquiries, I was told that, in several 
neighboring municipalities, the penalty for the less serious 
violations of law was transportation to this wild region, and 
a forced detention there until a certain number of trees had 
been properly planted or other forestry labor performed, 
when the offender was at liberty to return to his former 
home. I was told that drunkenness and its minor accom- 
paniments were among the more frequent causes of this 
temporary banishment and enforced labor. 
I was forcibly struck at the time by the much better 
circumstances for the moral and physical reconstruction of 
the subjects of alcohol there than in our own country, 
where they are often confined in hot, overcrowded, un- 
wholesome rooms, at unhealthy occupations, in company 
with those much worse than they are, who must exert a 
harmful influence upon them. 
In another part of Europe, I was told that the greater 
part of the prepared stone for the building and repairing of 
the magnificent post-roads in that part of the country is the 
result of labor sentences as the penalty for minor transgres- 1882.] 
Insane Drunkards. 
511 
sions against the civil law. Certainly, no one can doubt 
that occupation in the open air, of purely muscular charac- 
ter, and not so laborious as to occasion too great a degree of 
fatigue, with proper restraint and supervision, would be the 
very best means for counteracting the effects of over-stimu- 
lation in our inebriate population. 
We have, in all large cities, certain commissions or de- 
partments of the municipal service which are so limited 
and circumscribed as to make it possible to exercise com- 
plete supervision. Such is the care of the city stables, in 
which one overseer could easily observe the movements of 
a number of employes. The paving and sewer departments 
usually control large enclosed areas, in which considerable 
numbers of men might be employed. The care of the 
public parks, and the labor in landscape gardening, now so 
commonly seen in every town of even moderate pretensions, 
might be performed by these wards of the public, who 
would thus accomplish two important ends: 1. Their own 
improvement and final recovery in a much larger proportion 
of cases than under our present treatment of drunkards. 
2. They would, as a class, become self-supporting, instead 
of becoming and remaining the subjects of public mainte- 
nance. In many other ways, which will readily suggest 
themselves to any thinking person, these individuals might 
be employed, and carefully guarded from temptation until 
nature might effect a cure, and so reclaim her own. 
Some may consider these suggestions as too visionary 
and too ideal ever to become a reality. They may not be 
practicable at this time; but they certainly are possibilities, 
as has been demonstrated by the experience of the Lintorf 
Asylums for Inebriates, near Diisseldorf, in Prussia. Here, a 
system similar in its general character to the one I have 
outlined has been in operation, if I am not mistaken, since 
1851, and is productive of very gratifying results. The 
life of the inmates is carefully regulated, and strict compli- 
ance with the rules of the establishment is required. A 
large majority of the inmates remain for a period longer 
than six months, and are treated by means of good food, 512 
Management of Chronic Inebriates and 
[Dec- 
medical care, labor, kindness and sympathy, recognizing in 
inebriety a disease more than a vice, and treating it as such. 
The reports state the proportion of cures to have been 
from twenty-seven per cent, to thirty per cent, of all cases, 
a figure far beyond anything yet approached in our country. 
The objection may be raised to the views advanced in this 
paper, that they are inexpedient, or, in other words, that 
the man or woman who is degraded to such a degree as to 
indulge in intoxicating drinks has thereby merited the full 
measure of disgrace and suffering accompanying the pun- 
ishment for their acts while drunk, or their treatment if 
sick. In reply to such objection, it can only be said that, 
in a former age, the same spirit was evinced by the world 
toward many other physical and mental disorders with 
which frail humanity is afflicted ; but I think the time is 
fully come when any such unjust and unsubstantial reason- 
ing should be superseded by a mode of treatment more 
nearly in accordance with the advanced knowledge of a 
more enlightened century. And, in addition to this is the 
important fact that, in the majority of cases, the individual 
afflicted is really no more responsible for his condition than 
is the victim of syphilis, the slave of opium, the subject of 
epilepsy or intermittent fever or many other misfortunes 
which might be mentioned. 
It would certainly now be regarded as inhuman to allow 
patients with leprosy to die uncared for in the fields, and it 
is no longer considered necessary to burn inoffensive luna- 
tics. It is fully as great a cruelty to confine persons, really 
the subjects of mental disease, in the same place with the 
vile and desperate element which one finds in our crowded 
prisons and houses of correction. It is inhumanity beyond 
expression to subject the insane drunkard, perhaps only 
temporarily diseased and quite susceptible of care, to the 
daily and nightly companionship and uninterrupted associa- 
tion with furious maniacs, epileptics, suicides, maudlin bab- 
blers, and imbeciles. Experience demonstrates that the 
fatal influence of only occasional exposure to such diseased 
surroundings often shows itself in mental derangement of 513 
1882.] 
Insane Drunkards. 
those who have been connected with the care of the insane; 
and I am informed that a surprising number of the phy- 
sicians and nurses connected with our asylums and other 
institutions of a similar character either become subjects 
for their protection and care, on account of positive mental 
derangement, or are maintained by their friends in domestic 
seclusion rather than in a public institution. Thus, mental 
disorder sometimes seems to be acquired by the healthy 
individual from occasional contact with the subjects of dis- 
ease ; and, if this be true, how much more liable to the 
same danger an individual must be, whose nervous system 
is already temporarily shattered by over-stimulation, whose 
intellectual powers are already unsteady, if not positively 
deranged, and who requires treatment for weeks or months 
suited to the necessities of his condition, among the more 
essential elements of which are freedom from excitement, 
rest and peace of mind. I think the wonder is that insane 
drunkards who are placed in asylums under the present 
system ever escape permanent mental impairment from 
their unfavorable surroundings. 
The practicability of this, or any similar plan of treatment, 
will always depend upon two principal factors: first, the 
ability of the public to realize that it is as easy to support 
an insane drunkard in some asylum arranged for his partic- 
ular care as it is to support him in an institution designed 
for the legitimate needs of another and a different portion 
of the public burden, in which the indispensable conditions 
for his appropriate treatment and care do not and cannot 
exist, and from the restraints of which he can at present 
always effect a legal escape at a time when he is in immedi- 
ate danger of a relapse upon any exposure, with a certainty 
of rendering each subsequent period of treatment less hope- 
ful than before. One such case, the record of which is 
preserved by a friend and colleague, has been committed to 
the house of correction four times, and has been an inmate 
of the lunatic hospital seventeen separate times, from the 
recurrence of a diseased condition, which, by appropriate 
treatment, might perhaps have been easily and permanently [Dec 
514 
Bancroft's Constitutional History. 
cured in its earlier stages, instead of becoming a chronic 
state, which is truly a “second nature,” and often justifies 
the remark that “ the insane drunkard is only sane while in 
the hospital.” 
Second. The other factor which must be present to 
render this or any similar method of treatment possible is 
that alluded to a moment ago, a dispensation of authority in 
such a manuer that this large and increasing class of our 
community may be reached b}r its provision, and benefited 
by its practical application. 
It may be claimed that the views here advanced are con- 
cerned not with the cause of drunkenness, but only with 
its effects, and that any attempt to benefit drunkards should 
be directed to the prevention of the evil rather than to its 
cure, when the evil is already wrought. This criticism is 
very true, but it must not be forgotten that the subject of the 
prevention of drunkenness is still one of the purely specula- 
tive questions of the day, in the solution of which abso- 
lutely no essential advance has been made, notwithstanding 
the fact that the ingenuity of a generation of philanthropy 
has been devoted to its study; but the products of the evil 
are continually around us, and are constantly demanding 
some practical relief at our hands. 
BANCROFT’S CONSTITUTIONAL HISTORY.* 
Several months have passed since the first appearance of 
these volumes. That we have waited several years for 
the pleasure of their perusal may, in some sort, excuse the 
tardiness of our review. In outward form, they correspond 
with the octavo edition of the author’s History of the United 
States. A considerable part of each volume is taken up 
with original documents, letters and papers of many differ- 
ent kinds, illustrative of the events recorded in the body of 
the work. To these documents there is an index; but there 
is none to the body of the work, a very serious defect, 
* History of the Formation of the Constitution of the United States of America. 
By George Bancroft. In two volumes. New York : I). Appleton & Co. 1882.