Reprinted from The Medical and Surgical Reporter, October 21,11893. 
Medical Treatment of Inebriety. 
/ 
T. D. CROTHERS, M. D. MEDICAL TREATMENT OF INEBRIETY.* 
T. D. CROTHERS, M. D.f 
The medical treatment of inebriety ap- 
pears first in pictorial representations 
found in the ancient tombs of Egypt. 
Here can be seen the states of stupor, 
nausea, vomiting, administration of drugs, 
showering by water, massage, flagellation 
and attempts to counteract the narcotism 
by external stimulation, also inunctions of 
the body, convalescence, and restoration, 
all faithfully outlined on these old tombs 
whose origin is lost in antiquity. 
Fragmentary records of early Greek 
physicians contain references to the treat- 
ment of excessive wine drinkers. 
The great philosopher and physician, 
Hippocrates, clearly recognized the disease 
of inebriety and left some very sensible 
rules of treatment. 
From time to time, for the past twenty 
centuries, the question of the disease of 
inebriety and its treatment has come into 
prominence at intervals, then died away. 
Finally, at the close of the last century 
and the beginning of this, Dr. Rush of 
this country and several eminent European 
physicians affirmed the fact of disease, 
and laid down lines of treatment. But it 
was not until 1864 that the scientific 
treatment of inebriety became a practical 
reality, in the asylum at Binghamton, 
N. Y. From this time the rational study 
and treatment of inebriety begins. 
Unlike other great medical topics, 
public sentiment has gone on in advance 
of scientific knowledge of this subject in 
its demands for means of treatment that 
shall control and cure the victim. In 
meantime, all rational study and treat- 
ment of inebriety has been obstructed by 
false theories and delusive misconceptions, 
that cling tenaciously as fogbanks along 
the shore. 
Notwithstanding all the evidence, based 
on facts and experience, against the pres- 
ent methods of treatment, they still con- 
tinue. 
Temperance revivalists still boast of the 
number of pledged and converted as cured. 
As an evolution from this comes the 
empiric, with his secret specifics, boasting 
to have first affirmed the theory of disease, 
and claiming equally astonishing results 
with unknown drugs. 
While the question of disease and treat- 
ment is passing through the period of 
renaissance, there are landmarks and 
clearly defined facts to guide all future 
studies. 
Some of these outline facts grouped 
may help to clear away the errors that 
cloud the present conception of this sub- 
ject. 
The disease of inebriety, like other dis- 
eases of the brain and nervous system, 
follows a uniform movement, controlled 
by laws of dissolution, and conditions and 
causes that can be determined. 
In the question of treatment, the first 
inquiry is, What is the present condition, 
the organic and functional derangements 
■(•Superintendent Walnut Lodge Hospital, Hartford, 
Conn. 
*Read before the Mississippi Valley Medical Asso- 
ciation, October 5, 1893. 4 
of the brain and nervons system, also 
nutrition and digestion? 
Second: What are the special effects of 
alcohol on the nerves and brain? 
Third: Is the use of spirits a symp- 
tom of other brain states? or is it an 
active factor in the causation? 
Fourth: What neurosis and conditions 
of heredity are the active and latest fac- 
tors in the history of the case? 
From a study of these questions the 
lines of rational treatment will ap- 
pear. Take a common case as an illus- 
tration. You are called to a case of gas- 
tritis. The man has drunk spirits for a 
long time and taken but little food; both 
digestion and nutrition are seriously im- 
paired. Alcohol has affected the sensory 
and motor nerves, it has made the brain 
unstable, and lessened power of control, 
with evident hypersemia. If the treat- 
ment is based on these symptoms alone 
but little can be expected. If we go back 
and find that the use of spirits began 
after some severe strain or state of ex- 
haustion, or following as an entailment of 
some disease or traumatism, either physi- 
cal or psychical, or originated in contag- 
ious surroundings and faulty conditions 
of living, new lines of treatment are indi- 
cated. If further inquiry shows a neu- 
rotic inheritance, direct as from alcoholic 
ancestors, or indirect as from insane,con- 
sumptive, epileptic,or any other neurosis, 
new indications appear. 
The treatment of a case which checks 
the brain and nerve irritation by narcot- 
ics and, by the withdrawal of spirits and the 
use of eliminatives relieves the functional 
disturbances, is only partial. If at this pe- 
riod the pledge or conversion fills the 
mind by auto-suggestion with confidence 
that cure has taken place, or if the sys- 
tem is kept saturated with narcotics until 
the dominant idea of cure prevails or the 
mind is buoyed up on the delusive hope 
of final and permanent cure, the results 
are accidental and uncertain. Should 
final restoration follow the use of these 
means, the real causes of cure are un- 
known and belong to the realm of psycho- 
therapeutics. Cases which recover after 
these psychical remedies are those in 
which the drink craze or symptom dies 
out or becomes exhausted, through the 
operation of inherent forces, and not by 
the last means or remedies used. 
The medical treatment of inebriety 
must depend on the causes and conditions 
of the case. Without this knowledge all 
remedies are empirical. From such a 
clinical knowledge the physician may 
point out the lines from which a return 
to health may be expected. He can fore- 
see the oncoming insanity of which the 
drink impulse is a clear symptom; or the 
paresis with this stage of exaltation and 
spirit excess; the acute delirium, the mel- 
ancholia, the masked epilepsy in the dip- 
somaniac, and many other conditions that 
can be anticipated and studied. Many of 
these cases, in which to a superficial ob- 
server only the drink symptom is promin- 
ent, are found to have a uniform line of 
progress and termination. Take a hun- 
dred cases of inebriety and from a careful 
study of heredity, present condition, and 
the action of alcohol, etc., etc., a progno- 
sis can be made that will be verified in 
ninety per cent, of all cases. The first 
question to be determined in a given case 
is the physical condition of the patient. 
As a rule all inebriates suffer from degrees 
of paralysis, both vaso-motor, sensory, 
and functional. Sub-acute inflamma- 
tions and reflex irritations are common. 
The heart's action is variable, and the or- 
gan is enlarged. The liver is also en- 
larged and frequently the seat of lotv 
grade of inflammation. The stomach 
also suffers from both organic and func- 
tional derangements. Neurites are very 
common and of all degrees, usually called 
alcoholic rheumatisms and neuralgias. 
These are only the most general and 
prominent symptoms and call for general 
eliminative treatment. There is present 
in all these cases defective elimination of 
waste matter, also chemical changes of 
both cell and tissue, due in part to the 
direct action of alcohol and its indirect 
action on the nervous mechanism. As a 
result ptomaine poisonings, new soils for 
the growth of bacteria, also new centers 
of congestion and irritations occur. The 
bath corrects these indications by stimu- 
lating the cutaneous surface. Hot air 
baths or hot water baths, with rubbing 
once or twice a day, are the first essen- 
tials in treatment. Following this should 
be given what is termed internal lavage, 
or washing based on the same principle. 
This is best secured by saline and mercur- 
ial cathartics, with copious draughts of 
warm or acid waters. The patient should 
be placed in conditions where a certain 5 
amount of control over his habits and 
conduct can be obtained. Either at 
home, under the charge of a trusted 
nurse, or in an institution where all the 
surroundings can be guarded. 
All spirits should be removed at once, 
and a careful watch of the case be main- 
tained to ascertain any organic or other 
diseases which may be masked by the use 
of spirits. Epilepsy, tuberculosis, paresis, 
hysteria, and other affections often come 
into great prominence when spirits are 
abandoned. The remedies most valuable 
following the removal of spirits and baths 
are the cinchonia bark infusions, nux- 
vomica preparations, together with the 
bromides, codeia, sulfonal, and other 
narcotics for the control of the nervous 
irritations. Strychnia is inferior to nux- 
vomica in my practice. Choral is unsafe 
and uncertain in many cases. All 
narcotics should be given in large 
doses for a short time and changed fre- 
quently and discontinued. Beef tea, hot 
milk, hot acid drinks, are often very 
effectual as narcotics, allaying nervous 
irritation. Rest and frequent massage 
with the baths, mild tonics, salines, and 
good foods are often all the means essential 
for restoration. In many cases the drink 
craze disappears from the use of these 
means alone. In a certain number of 
cases the origin of the drink symptoms 
is associated with syphilis and bad living, 
or the advent of syphilis has been followed 
by excessive use of spirits. In these 
cases mercury, arsenic, and the iodides 
should enter very prominently into the 
treatment. In a certain number of cases 
unusual states of stupor and delirium 
follow each other with explosive violence, 
unusual to ordinary alcoholic intoxication. 
A suspicion of specific poison followed by 
mercurial treatment gives the strongest 
confirmatory evidence in the good results 
from such means. 
When inebriety is traceable to head in- 
juries, from blows, heat, shocks, sudden 
emotional strains, etc., etc., sub-acute 
inflammation and degenerative cell and 
functional changes present are noted in 
the impulsive exhaustive drink symptoms. 
Both the prognosis and treatment should 
anticipate grave brain troubles. 
Direct heredity, noted by inebriate 
ancestors, demands in the treatment total 
change of life and long periods of brain 
and nerve rest. Where the heredity is 
indirect, coming from allied states of brain 
degeneration, such as insane, idiotic, 
criminal, pauper, epileptic, and other 
profound brain diseases, the medication 
should be directed to lessen and favor 
return to states of health. In some of 
these cases the action of spirits varies 
widely. The insanity of the drink symp- 
toms and the organic degeneration is so 
pronounced as to suggest various causes. 
These are the cases which become drug- 
takers of all kinds, and the cure or sub- 
sidencr of one drug addiction is followed 
by another. These are the cases which 
appear in every community as shining 
examples of cure by "• gold specifics," by 
prayer and pledge, and who very often 
secretly use opium or other narcotic drugs. 
The hysterical confidence in permanent 
cure by unknown measures in a brief 
time is always open to grave suspicion of 
hysterical credulity or duplicity. 
In neurotic cases where alcohol is 
quickly followed by intoxication, especially 
in young persons, a grave prognosis is 
present. The treatment should be a 
radical change of life and also include all 
the constitutional remedies found valua- 
ble, such as baths, tonics, foods, and 
mineral drugs. 
In cases where cell and brain exhaustion 
from imperfect rest and food are present, 
the treatment must be nutrient and hy- 
gienic, rather than by drugs. Dyspepsia 
and the various disturbances of the 
stomach and liver, which are relieved by 
spirits concealed in bitters, are always 
grave troubles. Faulty or no mental con- 
trol and unstable brain equilibrium, with its 
irregularities and exhaustion in inebriety 
require long persistent treatment. Many 
of these neurotic cases are benefited by 
mental treatment. There is a realm of 
psycho-therapeutics in which the medical 
man can foster dominant ideas and direct 
the activities of the brain along hygienic 
lines of living. Hypnotism has been tried 
in this way with indifferent success, so 
far. New surroundings, with change of 
thought and impulse, have been very 
patent in some cases. A primary condi- 
tion in all these cases is exhaustion of the 
central brain structure. In most cases 
full restoration never occurs. The drink 
craze dies out, but the weakness and 
lowered vitality remain. In periodic 
cases the explosive character of the brain 
energy accumulating and discharging at 6 
intervals suggests a line of treatment 
which will afford an outlet for this abnor- 
mality. In some cases restraint by drugs 
at the period of discharge is valuable ; in 
others baths, exercise, cathartics seem to 
divert the energies and relieve the par- 
oxysm. In one case a prolonged hot air 
bath, with severe massage, avails ; in 
another, a long trampin the country, with 
dog and gun, and severe exercise ; in 
another, cessation of all work and rest in 
bed, assisted with bromides ; another case 
abstains from food at this period, and in 
other cases eats to excess for two or three 
days, and thus avoids the paroxysm. 
Various measures to control the drink 
paroxysm in these cases will depend on a 
study of the case. The premonitory 
symptoms are often very clear, and means 
of prevention can be provided. Where 
the case is in an asylum the application 
of means are more positive, but when the 
case is not under control greater skill is 
required. Many of these periodic cases 
drink only on holidays, or days of general 
rejoicing. If they can be carried over 
these periods they remain sober until 
similar occasions recur again. For many 
years I treated a case who never drank 
except during the holidays. A week 
before the approach of this season he was 
given mineral waters, nux-vomica, bro- 
mides at night, severe exercise and hot 
baths, with sharp rubbing, every day. 
This was continued for two or three weeks, 
then discontinued, and the drink craze 
was averted. In one case a man never 
drank except when on the seacoast ; 
change of residence to the mountains was 
followed by perfect abstinence. States of 
contagion are very patent causes in some 
cases, and when recognized can be reme- 
died. A form of hypnotic influence pre- 
vails, in which men drink to excess in 
certain surroundings and in certain com- 
pany, and abstain where conditions are 
removed. Asylum care and study reveal 
many very curious facts along this line. 
Often pronounced cures follow from a 
careful study and recognition of these 
symptoms. The tendency to epilepsy, 
suicide, dementia, and other grave dis- 
eases should always be considered in such 
cases, and both local and constitutional 
remedies be persistently applied. 
The continuous drinker, either in mod- 
eration or excess, has always the strong 
possibility of paresis, dementia, and cere- 
bral hemorrhage before him. The con- 
tinuous action of spirits is that of a 
paralyzant, disturbing and breaking up all 
the chemical and vital processes, either 
slowly or rapidly. The condition to be 
treated, after the removal of the active or 
apparent causes, is that of brain anaemia 
and profound central exhaustion, and 
degeneration of all the vital processes. 
Institutional care and treatment of 
these cases are obviously the most impor- 
tant and practical. In the near future, 
when the disease of these cases is recog- 
nized, their early treatment at home by 
the family physician may be practical. 
His knowledge of the family history and 
surroundings will enable him to apply 
preventive means and measures that are 
impractical later on. 
Public sentiment permits these cases to 
grow up in every community under the 
impression that all excess of spirits is 
simply moral weakness, within control of 
the victim. Thus, the period of curability 
is passed, and only when the disease and 
insanity of the victim is unmistakable are 
rational means applied. In an experience 
of seventeen years in asylums for these 
cases, I have rarely seen recent cases of 
inebriety coming for treatment. As a 
rule, all persons admitted to asylums are 
those who have exhausted every other 
means for relief, and who have used spirits 
until both the brain and organism are 
obviously diseased. To expect cure or 
permanent restoration in a few weeks from 
any form of treatment in such cases is 
impossible, or cure even from long 
medical care in any very large 
number of cases cannot be reasonably 
expected. Yet, the most reliable statistics 
show that fully thirty per cent, are re- 
stored from institutional medical care ex- 
tending over ten or twelve months. I am 
sustained by the best authorities in assert- 
ing that the inebriate is more curable than 
the insane, but the treatment must be 
based on his actual condition and extend 
over a long period of time, and be founded 
on general principles of rest and organic 
restoration. 
The restraint and care of an asylum is 
of more value for its control of the sur- 
roundings, and the facility for the appli- 
cation of exact methods of treatment, than 
for its removal and restraint from alcohol. 
Rest and building up of brain and nerve 
tissue takes away the demand for alcohol 7 
more positively than locks and barred 
doors. 
The central object of all treatment is to 
remove the causes which demand spirits 
for relief. To silence this craze for 
alcohol is not curative any more than the 
narcotism of opium removes the cause of 
pain. 
While the use of alcohol will create gen- 
eral organic degeneration, the demand for 
its use is always symptomatic of grave 
central irritations and lesions. 
Locks and bars, pledges, chemical re- 
straint by drugs, appeals to diseased 
higher brain sections, appeals to the cred- 
ulity and disordered senses and emotions 
by "gold cures," or specifics, are all em- 
pirical. Yet, excepting imprisonment in 
jail, all these measures claim to be cura- 
tive, and refer to examples whose condi- 
tions can be explained by othei' and more 
rational causes. The drink symptom is 
in many cases self limited and will change 
and disappear as a natural dissolution pro- 
cess, sometimes merging into organic dis- 
ease of the stomach, heart, liver, kidneys, 
nerves, and brain. Cerebral hemorrhages, 
organic diseases of the lungs, kidneys, 
and nerves are very common entailments 
following the excessive use of spirits. 
The examples of cure by specifics or moral 
means are as a rule diseased, and the 
change of the drink symptom is followed 
by other concealed or pronounced organic 
lesions. The breaking up of the drink 
craze by narcotics and other powerful 
drugs will of necessity increase the degen- 
eration, and directly predispose to insan- 
ity. 
Another central object of all treatment 
is to restore the organism so that the nar- 
cotic effect of alcohol or other drugs will 
not be demanded. This is a brief outline 
of some of the more prominent facts in the 
treatment of inebriety. It will be evident 
that we have scarcely touched the subject. 
Only in the most general way have the 
real facts and principles of treatment been 
recognized. The noise and confusion of 
empirics and specific vaunters are only 
foam bubbles on the surface, whose only 
significance is the agitation and movement 
that presages the oncoming truth. No 
question of practical medicine appeals 
more strongly to physicians in every com- 
munity for solution. What shall we do 
with the inebriates is answered to-day by 
quacks, pietists, politicians, and reformed 
inebriates. The mystery, credulity, and 
dogmatism of their answers is " confusion 
worse confounded." 
From scientific studies by medical men 
the correct answer must come. They are 
the real teachers of the nature and treat- 
ment of inebriety, and yet to-day nearly 
half a million politicians, empirics, re- 
formers, clergy, temperance men, and re- 
formed inebriates are talking, writing, 
and teaching what inebriety is and how to 
cure it, and not a single score of physi- 
cians in this country have given the sub- 
ject anv study. What a startling reflec- 
tion this is on medical science and medical 
men. Some of the facts which may be 
considered as starting points in the study 
and treatment may be outlined as follows: 
The treatment of inebriety extends far 
back to antiquity. Public sentiment is 
to-day far in advance of any real knowl- 
edge of the nature and treatment of in- 
ebriety; hence, the armies of specific 
vaunters and temperance revivalists who 
claim such remarkable results. The dis- 
ease of inebriety, like all other diseases, 
follows a uniform line of events, from 
certain special causes and conditions. Its 
treatment must begin from a knowledge 
of the present condition of the case and 
the effects of alcohol on the system; how 
far the use of alcohol is the symptom of 
other diseases and what heredity and 
neurosis enter into the case. A study of 
these and other conditions point out the 
lines of rational treatment. 
The prognosis and treatment depend 
altogether on a clear apprehension of the 
case. The first thing is to place the 
patient in the most favorable conditions 
for cure, where all the surroundings can 
be helpful, and the best means applied to 
build up and restore his brain and nervous 
system. This may be done in an institu- 
tion or at home under the care of a nurse. 
The withdrawal of spirits and the use 
of baths and massage daily, with brain 
rest, are essential. Remedies such as the 
bitter tonics, mineral salts and acids, 
nux-vomica, and often the bromides and 
the iodides are valuable. The use of 
nutrients, with rest and baths, fulfill most 
all the demands of each case. Recon- 
struction of cell and tissue is the object 
to be sought. 
Specific poisons such as syphilis, or 
injuries to the head, starvation, and other 
conditions require special lines of medica- 8 
tion. Heredity and all its allied neuroses 
are constitutional states of degeneration, 
to be treated on general principles; change 
of living and surroundings, with appro- 
priate medication to build up the entire 
organism, must be applied in all cases. 
Restraint, protection, liberty, and the 
application of means to meet all the de- 
mands and abnormalties must be applied. 
The public treatment of the pauper in- 
ebriates must be in military hospitals, 
especially organized for this class. The 
treatment for those able to pay can be 
more completely carried out in special 
hospitals, which will combine all the best 
appliances of science to meet the wants of 
each one. 
The entire subject must be studied from 
a higher level, and along the line of ac- 
curately observed facts.