The essential in the treatment of the inebriate as we meet him, is upbuilding of body and character, which requires time, and in which drugs play only a small part.
Compulsory abstinence is of great value if we expect to care for a majority of the inebriates.
It would be wise for the State to undertake the custody, care and control of all non-criminal inebriates in one institution, provided adequate facilities for classification were available.
DISCUSSION
Dr. C. R. Ball (St. Paul): I have been very much interested this afternoon in this symposium on the treatment of fractures, the last word in obstetrics, and the inebriate, only it seems to me the Program Committee put the cart before the horse, and should have put the inebriate first, and the other things would naturally follow afterwards.
Dr. Freeman has splendidly presented his work and results at the Willmar institution. It is a subject to which I think medical men pay too little attention. I have more and more come to look upon the inebriate as a type of nervous disease and, in the great majority of cases, a functional nervous disease. It may be classified as we classify nervous diseases. We classify in one way functional nervous diseases as to their cause,—acquired, hereditary and acquired, or wholly hereditary.
The inebriate may be also classed in the same way. There are perhaps a few cases in which the habit of taking alcohol is absolutely acquired, but they are comparatively few. There are also a few cases of nervous prostration or functional nervous conditions from overwork, from a depleted condition, where the nervous condition comes on; and we may say it is acquired, and the prognosis in both of these cases is good. It requires but little effort to put them on their feet. Then we have that larger class of neurasthenic or functional nervous conditions, belonging to the second group, in which the nervous disease, as well as the inebriety, is partially acquired and partially hereditary. There is a large class here. They have an unstable nervous system, and whether they drink or break down depends a great deal upon the environment and physical condition. This type of inebriate must be treated along the same broad lines that we treat a person who is a neurasthenic, who is subject to repeated nervous breakdowns.
There is another type which, unfortunately, is rather large; and this is the wholly hereditary, and in this type we may classify the dipsomaniac. I have looked for a long time upon dipsomania as a periodical nervous disturbance, similar to periodical attacks of migraine or epilepsy, or periodical attacks of insanity. Often where a son is an inebriate we find a history of migraine in the mother. Very often there is insanity, and very often there is epilepsy, so that when we come to consider the dipsomaniac we have a tremendous problem. He does not drink for the fun of it, but chiefly because of mental depression, mental restlessness, which is so great that he turns to alcohol to buoy up his spirits and get rid of the feeling which rather than suffer with, he would often prefer to die. I have a man of that description who came to me, and said that at a certain time he became depressed and suspicious, began to hate himself, went along the back streets, absented himself from his usual associates, and always did this at the beginning of his drinking bout. That is the case with all dipsomaniacs. It is a disease similar to epilepsy, and our success in treating this type is just about as good as in treating epilepsy. It is not the alcohol: it is an inherited condition; it is a periodical nervous disturbance, just as epilepsy and migraine are.
We hear a great deal about the prevention of tuberculosis, and much is done to prevent it. I think we hear much more about the evil effects of syphilis than of alcohol, but, in my experience, I would place alcohol at the top of the list as being the most damaging both to the individual himself and to his offspring. We have heard a great deal about the effect on the offspring. In my clinic at the Free Dispensary I have many epileptic children, and I should say in sixty per cent of the cases one parent is an alcoholic. An address of Dr. Rogers, of Faribault, with reference to the ill effects of one intoxication, when a conception occurs during that time, put the subject of drinking before me in a new light. Much interesting experimentation has within recent years been done with rabbits and guinea-pigs to show the harmful effect of a single dose of alcohol given to either the male or female parent before conception, on the after-coming litter.
Not long ago I read an article by some man in New York in which he stated he had traced seven cases of epilepsy to the evil results of a single intoxication in seven different parents. That was something rather new to me, as I thought, in order to get the bad effects, on the descendants, of alcohol, it was necessary to be a chronic alcoholic, and I believe very few of the laity understand that, if conception happens to occur during one drunk, the parent being otherwise a temperate person, the ill effects may be visited on the offspring to as great an extent as if the parent were a chronic inebriate. These are some of the things which would do good if given publicity.