[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.
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