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<h2>INSANITY FROM ALCOHOL.</h2>
<p>[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.]</p>
<h3>By A. BAER, M.D., of Berlin, Germany.</h3>
<p>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?</p>
<p>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!</p>
<p>Of much greater importance is the best portion of your work,
namely, <i>the prevention of insanity</i>. 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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
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