INSANITY FROM ALCOHOL.
[Footnote: Read at the late meeting of the National Association for the Protection of the Insane and translated for the American Psychological Journal by Carl Sieler, M.D., of Philadelphia.]
By A. BAER, M.D., of Berlin, Germany.
The benevolent efforts of your society diverge in two different directions, which have totally different aims and purposes, and which require different means in order to attain lasting success. Since the number of insane has increased alarmingly within the last few years, in all civilized countries, so that the responsibility of the proper charge of them occupies continually not only the community, but also the State; and since the public as well as the private asylums are filled almost before they are finished, it becomes necessary to rid the institutions, as soon as possible, of those patients which have been cured, as well as of those which are improved. Patients of this kind are, as early as possible, returned to the unrestrained enjoyment of liberty with the expectation that the new scenes and surroundings may have a beneficial influence, besides having the advantage of relieving the overcrowded institutions. Unfortunately, however, it has been frequently found that the hut suddenly restored mental and emotional equilibrium is not of sufficient stability to withstand the storm of conflicting interests. Frequently it happens that the but recently discharged patient returns to the institution, after a short lapse of time, because the "rudder" (steuer) of his intelligence was soon shattered in the turmoil of life. How can, for instance, the indigent and poor patient, after his discharge from the institution in which he has found a shelter and the proper care, stand up in the struggle for existence and the support of his family? Is it not to be expected that a large proportion of those who have been discharged as improved, or even cured, cannot withstand the ever-moving sea of the outside life and bear up under the turmoil which constantly stirs mind and soul?
Starting with the recognition of this fact, societies of benevolent people have been formed in all countries in which true civilization and humanity are at work, to diminish or abolish social evils, whose object is to assist the restored patient who has been discharged from the institution, at a time when he is most in need of help and assistance. Switzerland has taken the lead of all countries by her brilliant example, and there these societies found the greatest encouragement. It should be looked upon as a good sign of the spirit of modern times, that the seed of true humanity, with astonishing rapidity, found its way, far and wide, for the benefit of suffering mankind. Everywhere, in all European countries, and also on the American continent, has this branch of a truly noble thought become acclimated, and many societies have been organized for the purpose of assisting cured insane patients, by aiding them in obtaining suitable occupations, or by direct donations of money, etc., with a view of preventing, if possible, a relapse of the disease. May this portion of the work of your society be an ever-flowing fountain of joy and satisfaction to your members!
Of much greater importance is the best portion of your work, namely, the prevention of insanity. It is nevertheless true, and cannot be doubted, that in all civilized countries insanity increases in a manner which is out of proportion to the increase of the population. Much thought has been given to the cause of this phenomenon, and physicians as well as moralists, national economists as well as philosophers and philanthropists, have endeavored to fathom the connection between this fact and the conditions of modern social life. According to all observations, it is certain that the cause of this phenomenon is not a single etiological condition, but that it is the sum of a number of influences which act upon the human race and produce their travages in the mental and moral life of our patients. The conditions which give rise to this increase of insanity may be looked for in the manner in which modern civilization influences mankind, in its development and culture, in the family and in the school-room, in its views of life and habits; also in the manner in which civilization forces a man to fight a heavier and harder battle for pleasure and possessions, power and knowledge, and causes him to go even beyond his powers of endurance.
More than even civilization itself, are at fault those pernicious abnormities, rare monstrosities, which are transmitted from generation to generation, or are also often newly developed and appear to belong to our civilization. If we want to prevent the increase of insanity, we must endeavor to do away with these monstrosities and eccentricities from our social life which remove mankind more and more, in a pernicious manner, from its natural development and from the normal conditions of moral and physical life; we must endeavor to kill these poisonous offshoots of pseudo civilization, which are the enemies of the normal existence of man. It is necessary to liberate the individual, as well as the entire society of modern times, from the potentiated egotism which spurs man on in overhaste, and in all departments of mental and physical life, to a feverish activity, and then leads to an early senile decay of both body and mind; from that terrible materialism which causes the modern individual in every class of society to find satisfaction in over excited taste and ingenious luxury. It is necessary to strengthen more than has been done heretofore the young, by means of their education, in their physical development, and at the same time to diminish, in proper proportion, the amount of mental over-exertion; and finally it is necessary to fight against, to do away with, those habits of modern society-life which have a pernicious influence upon the physical as well as the mental and moral organization of man. And of these latter, there is none so lasting in its effects, none so harmful to the physical as well as moral life, as the abuse of intoxicating liquors.
Intemperance is an inexhaustible source of the development and increase of insanity. It demands our undivided attention, not only on account of its existing relation, but particularly because intemperance, among all the factors which aid in the increase of insanity, can best be diminished, and its influence weakened, through the will of the single individual, as well as of society as a whole. The relation between intemperance and insanity is so definite and clear, that it is not necessary to adduce proofs of this fact. I will not refer to the writings of the older authors, such as Rush, in America; Hutchison, Macnish, Carpenter, and others, in England; Huss and Dahl, in Sweden; Ramaer, in Holland; Esquirol, Pinel Brierre de Boismont, Morel, and others, in France; Flemming, Jameson, Roller, Griesinger, and others, in Germany. I could name a much larger number of the greatest modern authorities on insanity, who are all unanimous in their opinion that the increase of intemperance (alcoholism) produces a corresponding increase of insanity. Of especial interest is this fact in those countries in which the consumption of concentrated alcohol, and particularly in the form of whiskies distilled from potatoes and corn, has only in later years become general. Thus Lunier has shown the number of alcoholic insane increased by ten per cent. in those departments in which more whisky and less wine is consumed.
In Italy a similar result has been reached by investigation; and in that country (according to Kanti, Sormani, Vesay, Rareri, Castiglione, Ferri, and others) the frequency of insanity caused by the abuse of alcohol stands in an unmistakable relation to the consumption of alcohol in certain provinces of Italy.
In a discussion at one of the meetings (1876) of the London Medico-Psychological Society, the general opinion of the members was, that intemperance is the most fruitful source of the increase of insanity, even when no other etiological element could be found, and alcohol had to be looked upon as the sole cause of the mental disease. Maudsley laid especial stress upon the observation, that intemperance, without hereditary predisposition, was one of the most powerful agencies in the production of aberration of the mind. Even Beckwith, who could not coincide with others as to the great importance of intemperance as an etiological element, says distinctly, that intemperance was, by far, the most potent of all removable causes of mental disease.
In comparing the number of drinking saloons in the different provinces of the kingdom of Prussia with the number of insane, both in public institutions and in private families, as gleaned from the census report of 1871, I was enabled to show conclusively, that everywhere, where the number of drinking places, i.e., the consumption of alcohol, was greatest, the number of insane was also largest. Without doubt, to my mind it is in alcohol that we must look for and will find the most potent cause of the development and spread of mental diseases.
As is well known, alcohol acts as a disturbing element upon the nerve centers, even if it has only once been imbibed in excessive quantity. In consequence of the acute disturbance of circulation and nutrition an acute intoxication takes place, which may range from a slight excitation to a complete loss of consciousness. After habitual abuse of alcohol, the functional disturbances of the brain and spinal cord became constant and disappear the less, as in the central organs degenerative processes are more and more developed, processes which lead to congestions and hemorrhagic effusions in the meninges and in the brain itself, to softening or hardening, and finally to disappearance of the brain substance. These degenerations of the nervous system give rise to a progressive decay of all intellectual and also, more especially, of the ethical functions, a decay which presents the phenomena of feeble mindedness, complicated with a large number of sensational and motor disturbances, and gradually ends in complete idiocy.
The number of those mental disturbances which are caused by alcohol intoxication is a very considerable one. We do not err if we assert that from 20 to 25 per cent. of all mental diseases stand in a direct or indirect relation to the evil consequences of intemperance in the use of intoxicating liquors. This is the opinion of a large number of authorities on mental diseases in all countries. Habitual intemperance leads to severe (psychical?) lesions (of the nervous system) which may show themselves in the different forms of insanity, but express themselves chiefly as mental weakness, not only in persons whose nervous system was weakened through inherited or acquired defects, but also in those whose mental organization was intact. In many other cases we see less complete forms of insanity and more indistinct psychological disturbances and neuroses, and among the latter epilepsy demands particular attention.
An investigation among the patients in the insane department of the Berlin Charite Hospital, in charge of Prof. Westfahl, which was lately carried on by Dr. T. Galle (Uber die Beziehunger des Alcoholismus zur Epilepsie. Inaug. Dissert. 1881, Berlin), showed that among 607 patients who had entered the ward as epileptics or epileptic insane, 150 = 24.7 per cent. had been addicted to drink; 133 before, and 17 after the disease had shown itself; further, that of 1572 patients with delirium tremens, alcoholism, alcoholic dementia, and ebrietas, 243, or 15.4 per cent., were epileptic; and that in 221 intemperance was present before the outbreak of epilepsy; finally, that among 2679 patients which entered the department in six and a half years, 393, or 18 per cent., were inebriates and epileptics. Among 128 epileptics which I had occasion to note in the receiving institute, Plotseurie, 21 per cent. were drunkards and 20 per cent. were the offspring of intemperate parents.
If the list of injuries which intemperance, as we have seen, does directly to the mental life of man is a very considerable one, the baneful effect which is produced indirectly, by the intemperance of parents, upon the mental constitution of their progeny is surely just as great and disastrous. The children of intemperate parents frequently become drunkards themselves; they have inherited a degeneration of the vitiated constitution, and carry the stamp of this degeneration within themselves. The offspring of drunkards are not only weakly and sickly, and die early, especially of diseases of the brain, but, as Dahl, Morel, Howe, Beach, and others have shown, they are frequently born idiotic, or show early signs of insanity. Under the influence of alcohol, the individual constitution of the drinker becomes lowered and depraved, and, according to the law of inheritance, is transmitted through the progeny to the race.
Prof. Bollinger, the latest writer on inheritance of disease (Stuttgart, 1882--Cotta--Uber Dererbung von Krankheiten), names alcoholism among the transient abnormal conditions which, during conception, exert their influence, so that children of intemperate parents acquire pathological, and especially neuro-pathological, dispositions. Intemperance, says this author, in its acute, as well as in its chronic form, causes frequently pathological changes in the nervous system, and thus may the pathological differences in children of the same parents be partially explained. On account of the inheritance of a depraved and pathological constitution, the children of intemperate parents frequently suffer from an abnormal psychical organization. As in the progeny of insane, epileptics, suicides, and criminals, so also among the children of drunkards, do we see cases of congenital idiocy and imbecility, of neurasthenia and inebriety, of psychical and somatic degeneracy, also of depraved morality, of vagrancy and crime.
Mr. President and Gentlemen: In the light of the enumerated facts, nobody will dispute that intemperance is a fruitful as well as inexhaustible source for the increase and development of insanity; and that every effort toward diminution of the frequency of insanity, toward the prevention of mental diseases, must be directed against this widespread evil, intemperance.
May your noble society succeed in confining this torrent of evil in a narrower growing bed, and to deliver mankind from a curse which cannot be too much contended with.