In regard to the treatment: I can fully agree with Dr. Freeman in everything he has said. There is certainly no specific when you come to consider the nature of the trouble. The treatment must be carried along the same general lines of physical and moral upbuilding as those we seek to follow in functional nervous disease.
Dr. W. A. Jones (Minneapolis): I wonder how many members of the State Association have visited the hospital for inebriates at Willmar. I would like to ask all those who have, to hold up their hands. Five or six of this audience, representing the twelve hundred doctors belonging to this Association. That gives one a fair estimate of those familiar with the State farm for inebriates. I should like to know further how many members of the legislature have visited this institution, and how many have tried to condemn it or perhaps to take it for a tuberculosis hospital. That is what they will do unless we physicians stand by Dr. Freeman and the institution.
There is too much sentiment, too much sympathy among friends, relatives, courts, juries, and charity workers, as to the inebriate; but once he gets to Willmar and is under a proper regimen, his attitude changes totally toward himself and toward the world. After one has watched the treatment at Willmar and has seen the benefit these patients derive, he wonders why so many women and so many men are sent to quack institutions for inebriety and drug habits. Willmar costs the patient practically nothing, except a small per capita borne by the State. The average quack institution charges $150.00 for a cure, so called, whether the cure lasts for three days, or, as in some of the more conservative (?) quack institutions, the period is extended to ten days, and in the notoriously drink-habit cures, to thirty days. This ought to appeal to a doctor forcibly, inasmuch as all these claims of cures made by quack institutions are limited to thirty days at the outside, an absolutely absurd statement, and, for that reason, if for none other, we should all support and entertain anything that tends to increase the efficiency of the State farm for inebriates at Willmar.
One thing which Dr. Freeman wants to emphasize is the necessity at times of forcible restraint in a building especially constructed for detention cases. There is a small class of people who are, perhaps, suffering from a disease state, who are irresponsible. Most of them are common drunkards, who create all sorts of disturbances and who really need discipline—who need to be detained forcibly for a sufficient length of time to enable them to recover their normal physical tone, and until they recover something of their natural mental tone. If this could be incorporated in the rules and regulations of the governing body of the inebriate farm it would make a great increase in the total number of improvements and recoveries.
Dr. Freeman has emphasized the necessity of getting the physical condition up to a high point. He has said all that is really needed on the subject. I believe drugs and drink should be reduced rapidly in almost every case. If you look over some of the literature of some institutions that take these people, you will find they reduce the morphine down from fifty grains to forty, and then to thirty-nine, until, finally, after a period of so many weeks or months, they cut it down to the two-hundredth of a grain, and give it hypodermically. You can readily see the absurdity of that treatment. The average man can have the total reduction made within thirty-six or forty-eight hours.
I hope you will take more interest in the inebriate farm, and see that your legislator is interested as well.
Dr. Haldor Sneve (St. Paul): I have listened with a great deal of pleasure to Dr. Freeman’s paper, and especially because there are some statistics as to what can be accomplished in such an institution even in a comparatively short time. Personally, I think that six months as an average time to stay in this institution would be too short. It will be found, however, in time, whether this is true, but just now the institution is in the experimental trial stage.
A great many legislators are, as Dr. Jones said, trying to convert this institution either into an insane asylum or a tuberculosis sanatorium; and it is up to the profession of the state to back up the establishment of this institution for the treatment of a class which is growing.
Personally, I think drink is a vice and not a disease, and until we can eradicate from the minds of the laity and from the minds of some physicians the idea that a man who drinks is some sort of a nervous invalid, the sooner we shall get better results in the handling of this question. Even the dipsomaniac has periodic brain-storms, which Dr. Ball has likened to attacks of migraine; that is a good simile, they do not always take to drink, but go off in other ways.
I have treated from twenty to fifty cases of delirium tremens at the City Hospital every year for twenty years, and I have had considerable experience in institutions; and yet I cannot find anything to criticize about the principles of treatment that Dr. Freeman has put forth here today. The idea in the minds of the laity is that inebriety is a disease, and they want drugs for it to make them well, and that is one reason why so many patients go to Keeley cures and get well. They go there because they find a drug that cures disease. I find that the Towne-Lambert treatment is an excellent mental treatment for the inebriate in private practice. It can be used in the institution at Willmar, as well as in private practice, and putting a patient upon the Towne-Lambert treatment satisfies his desire to cure the disease he is suffering from.