proprietary remedies for constipation, though it is in this department
of medication that the non-medical are freest with their advice.
First, the cheapest possible drugs are selected by the manufacturers
of such remedies. Secondly, those drugs especially are employed which,
while producing the desired immediate effect, are always followed by a
reaction which requires further use of the medicine. One finds
testimonials, however, from all classes of the community, even from
clergymen, with regard to such remedies, though at the last
international medical congress it was confidently asserted, by three
of the most prominent specialists in digestive diseases in the world,
that the modern problems in digestive disturbances are so much more
intricate than they used to be, and the affections which develop are
so much more difficult of treatment, because of the use of these
unsuitable remedies, and the consequent habituation to drugs, which
has been acquired during the prolonged period of their employment.
In recent years catarrh has become the word that is supposed to
attract popular attention most, and accordingly is the watchword of
the proprietary medicine manufacturer. A long time ago, that is, about
half a century ago, catarrh was supposed really to mean something in
medicine. Those were the days of humoral pathology, when disturbances
of secretion were supposed to be the basis of all disease.
Accordingly, whenever there was an excessive discharge from the nose,
a patient was said to be suffering from catarrh, and as the nasal
secretion was supposed to be connected in some way with the brain, it
is easy to understand how significant such a pathological condition
might well be thought. In more recent years, the word "catarrh" has
still been employed by physicians who thoughtlessly employ terms that
they think will be better understood by the laity, owing to their
familiarity with them, though they have been outlived in medicine.
From representing an affection of the nose, catarrh, as a consequence,
has come to be employed for an excess of secretion from any mucous
membrane. Accordingly we hear of catarrh of the stomach, catarrh of
the bladder, or catarrh of the {101} bile-ducts, and there has come to
the general public a notion that catarrh is an all-pervading affection
whose ravages must be prevented, at all hazards, and whose beginning
must be the signal for prompt medical treatment.
As a matter of fact, catarrh, when it means anything, means only that
stage of inflammation in which there is an increased secretion and
which represents an inflammatory condition so mild as often to be
described as only hyperaemic, that is, due to an increase of blood in
the part. It is rather easy to understand that if more blood flows
through a mucous membrane, there will be greater secretion from it
than would normally be the case. This is what happens in the
production of catarrh. As a rule, it is only a passing congestion
without any lasting changes in the tissue. Catarrh may, however,
continue to be present if the irritation, which originally caused the
congestion, be allowed to continue. It is this irritation, however,
which needs to be treated, and not the catarrhal inflammation, which
is only a symptom of it. The three most used words in popular
medicine,--catarrh, rheumatism, and gout,--when traced to their
etymological signification, mean the same thing. Catarrh means a
flowing down, rheumatism a state of flowing, both being formed from
the Greek verb [Greek text], to flow, while gout is derived from the
Latin word _gutta_, a drop, which hints at the excess of fluid that is
supposed to be the basis of the disease.
For these three diseases, however, the most varied remedies have been
proposed, and practically entirely without success, when tested, in a
large number of cases. As a matter of fact, under the two words
catarrh and rheumatism, there is grouped a series of affections very
different from one another, and requiring very different treatment.
The important thing is not so much the suggestion of a remedy as the
recognition of the particular cause which in one case is producing an
excess of secretion and in the other is giving rise to the so-called
rheumatic pain. When the exact cause can be found, it is usually not
so difficult to succeed in preventing the recurrence of the
troublesome symptoms. It is with regard to these two diseases,
however, that in non-medical circles even intelligent men are ready to
give advice. They constitute {102} the most puzzling problem that the
physician has to deal with, but the non-medical mind waives the
difficulty and suggests the remedy. In this matter one is forcibly
reminded of a famous expression of Josh Billings, who used to say, "It
is not so much the ignorance of mankind that makes them ridiculous as
the knowing so many things that are not so."
Clergymen, lawyers, members of Congress, and of various state
legislatures, all permit their portraits to appear, advertising the
merits of some trumped-up cure for catarrh or rheumatism. It is
interesting to realise, then, that in most cases, according to expert
testimony, the remedy they recommend so highly consists of nothing
more than diluted alcohol flavoured so as to taste like medicine. The
only real effect is the alcoholic exhilaration which follows its
ingestion and gives the sense of well being, because of which the
testimonials are provided. As one of the medical journals said
recently, it would be very interesting to make a list of the men and
women throughout the country who, by permitting their portraits and
recommendations to be used in the advertisements of various patent
medicines, have practically confessed that they like to take their
whiskey rather dilute but mixed with a little bitters. The whole
question illustrates the tendency of the proprietary medicine man to
exploit some phase of medicine long after it has ceased to be of
interest to the medical profession.
With regard to all of these things clergymen may do a great
humanitarian work by protecting the poor from the efforts of
advertising remedy-makers to get their hard-earned money. It is
sometimes said that long years have been spent in the preparation of a
remedy. This not only is never true, but never has been true in the
history of proprietary medicines. Some one who has an eye to business
gets hold of a prescription of which he knows nothing, but of which
his advertising agents are able to say much, and the result is
sometimes a fortune for the advertiser. There is always a pretence of
philanthropy, but it is the mask of heartless hypocrisy. Unfortunately
many of our religious journals are tempted by the promptly paid bills
of such manufacturing concerns to print their advertisements. They are
aiding in a {103} deliberate swindle, and if this were better
understood there would be much less suffering and fewer vain hopes.
The best-managed newspapers and magazines in the country are now
absolutely refusing all medical advertisements. This is the only
proper attitude in the matter, for there is a place to advertise
medicines, if they are worthy, and that place is the medical journals.
If the popular advertising could be reduced, we should soon have much
less of the proprietary medicine evil.
There are many ways in which clergymen by their example, their advice,
and their influence can be of great assistance to practitioners of
medicine. It is very sad, then, to find that some of them, having
elabourated theories of their own on certain subjects, or having taken
up with peculiar notions, are in opposition to the accepted medical
teaching of the world. Occasionally they are found among the ranks of
the anti-vaccinationists, though if there is anything that has been
demonstrated to a certainty, it is that vaccination has practically
eradicated smallpox, considering the frequency of the disease a
century ago, and that it would absolutely eradicate it, if the
practice could be made universal. Statistics are at hand to
demonstrate this beyond all possibility of doubt. There are a certain
number of people, however, who apparently, out of a desire for
singularity as much as anything else, refuse to accept the evidence.
It is very unfortunate to find clergymen among them, for it tends to
bring the clerical judgment into disrepute.
Nearly the same thing might be said of antitoxin for diphtheria.
Clergymen seem to consider it necessary for them to have their minds
made up as to whether the use of diphtheria antitoxin is advisable or
not. If they have once committed themselves to the expression of the
opinion that antitoxin is of no value, then no amount of evidence will
succeed in changing their opinion. Under these circumstances it
becomes extremely difficult at times for physicians to succeed in
having families permit them to treat their patients after the manner
in which they are convinced the treatment should be carried on. If
such clergymen would only realise that the clergyman has, as a rule,
much less right to express {104} opinions on medical subjects than has
the physician to air views with regard to theological principles,
there would be much less friction, and it would be better for patients
in the end.
There are certain sanitary regulations that clergymen should not only
not oppose, but endeavour, by every means in their power, to have
those who respect their opinions follow out as carefully as possible.
Such sanitary regulations have in the past twenty-five years
practically cut down the death rate of our large cities a half. There
is no greater source of alleviation for the physical evils, at least
those which afflict the lower classes, than the due enforcement of
modern sanitation. There are prejudices, however, that must be
overcome, and the clergyman should be found beside the doctor, helping
him rather than opposing him, as is sometimes the case.
JAMES J. WALSH.
{105}
VIII
SOME ASPECTS OF INTOXICATION
There are various drugs that, through acute or chronic poisoning from
their use, cause mental disturbance,--alcohol, chloral, cannabis
indica, somnal, sulphonal, paraldehyde, ether, chloroform, antipyrin,
phenacetin, trional, chloralamid, iodoform, atropine, hyoscyamus,
salicylic acid, quinine, lead, arsenic, mercury, opium and morphine,
the bromides, cocaine, and others. Of these intoxicants alcohol always
has been most commonly used by western nations, but the moral aspects
of alcoholism have not been shown with sufficient insistence. There
are many sots in human society much less reprehensible than to the
unskilled observer they appear to be; others are more blameworthy.
Morality, as far as the agent is concerned, apart from the nature and
circumstances of the deed, supposes, first, voluntary acts, or acts
that proceed from the will with a knowledge of the end toward which
the acts tend; and, secondly, free acts, or acts that under given
conditions may or may not be willed. If by unavoidable chance one
stumbles against a man standing at the edge of a wharf, knocks him
into the water, and drowns him, the act has no element of morality in
it, because it is not voluntary and free. If a mind is diseased, and,
impelled by a mad notion of persecution, it brings about a like
killing, there is no question of morality, because the agent is not
free, and when fully analysed his action is not voluntary.
An act is more or less voluntary and free, and therefore more or less
moral, as the agent is affected by ignorance, passionate desire, fear,
or disease. Ignorance, fear, and disease may be such as to remove all
quality of morality from an act. {106} Certain diseases or
pathological conditions, especially of the nervous system, can take
out of an act the elements of voluntariness and freedom that are
necessary to make the act moral or immoral, provided, however, these
pathological conditions are not brought on through the fault of the
subject in which they exist. If a man voluntarily becomes drunk with
alcohol, or some other drug, he is, of course, accountable for the
evil he may unconsciously do while under the influence of that drug,
and if he begets an idiot or a criminal imbecile in his drunkenness,
he must atone somewhere for the blinded soul of his child. Here,
again, there are certain extenuating circumstances, because very few
drunkards are fully conscious of the extent of the evil in alcoholism.
Apart from the other requirements that go to make an act moral, the
agent must be sane; that the act be immoral, he must be sane or
insane, either temporarily or permanently, through his own fault; that
it be devoid of morality an act must be a mere _actus hominis_, or it
must be the act of a person blamelessly insane. If a man knows that an
alcoholic is liable to beget a criminal imbecile solely because of the
alcoholism,--and most men are aware of that fact,--this father or
grandfather is more or less accountable for every larceny, rape, and
murder done by the imbecile. The law, therefore, should put the
imbecile into safe keeping, then seek out the father and hang him.
Insanity is a common condition, but it has not been satisfactorily
defined. It supposes an appreciable unsoundness of the will, memory,
and understanding, or of one or two of these faculties, but no
alienist has given a short differentiation of that unsoundness. Where
shall we draw the line between the weak but responsible will and the
insane will? What degree of opacity between intellect and the world
separates the ignorant man from the lunatic? The extremes of sanity
and insanity are readily recognisable, but the intermediate degrees
are not clear. There is no test to apply to all cases; each must be
diagnosed from its peculiar symptoms, but the will of an insane man is
always weak. It can not deny or defer the gratification of a desire,
nor can it keep up an effort. Even in its lightest forms insanity is
selfish and {107} impolite, because it lacks the force of will
necessary to take trouble. It foregoes great future benefit for slight
present gratification. The insane man is idle, or busy only in work
that he likes, in pleasurable activity. A marked quality of sanity is
the capacity for sustained work, and the man that shirks work merely
because he does not like it is gratifying himself dangerously.
These defects are found commonly in sane persons, but the lunatic can
not rise from them, and he adds to the defects of will a warped
intellect. He can not adjust himself to his surroundings, and the
fault is in himself, not in the circumstances. His intellect may be
brilliant, but it sooner or later shows a taint. The insane man is not
a free, rational agent.
Alcoholism readily passes over into unmistakable insanity, and it
almost always is the cause of nervous degeneration in the children
born within its influence. This, is a phase of the evil not
sufficiently insisted upon by those that plead for total abstinence.
Chronic poisoning by alcohol induces hardening and calcification in
the walls of the arteries, degeneration of the nerve cells and
dendrites, wasting or overgrowth of the heart muscle, and fatty
degeneration of the liver and kidneys. The nerve centres that control
the circulation of the blood are paralysed by it, and, as a sequence,
the arteries and capillaries are diminished in calibre. This state in
turn obstructs the flow of the blood, and the body is not nourished,
nor are the waste and poisonous results of metabolism carried off as
they should be. Alcohol prevents the haemoglobin of the blood from
doing its office, which is to supply oxygen and remove carbon dioxid.
It absorbs the necessary water from the tissues, and thus it acts as a
corroding poison. It is also a functional toxin, because it depresses
the activity of organs by injuring the innervation. The poison affects
the brain, and as the cerebral gray matter, especially its pyramidal
cells, are the physical instruments of thought, will, and memory, or
the means of communication between the soul and the outer world, the
exercise of these spiritual functions is checked or inhibited by it.
A tendency to excess in the use of alcohol commonly {108} manifests
itself before the thirtieth year, and in some cases it may be removed
at the alcoholic climacteric, which is from the fortieth to the
sixty-fifth year. Those that become drunkards are usually of a
neuropathic constitution, through inheritance or abuse. Severe
diseases, like influenza, syphilis, typhoid; injuries to the head,
sunstroke, shock, worry; the disturbance that may accompany puberty,
pregnancy, lactation, and so on,--cause a nervous depression which is
soothed by alcohol, and thus a habit is fixed. The reckless
prescription of alcohol by some physicians is another cause of the
habit, and the use of proprietary medicines is a still more prolific
source of drunkenness and the consequent misfortune.
Cider, beer, ale, and porter contain from 4 to 6 per centum of real
alcohol; light wines, red and white, and natural sherry, 10 to 12 per
centum; strong sherry and port, 16 to 18 per centum; brandy, 39 to 47
per centum by weight, or 46 to 55 per centum by volume; and whiskey,
44 to 50 per centum by weight, or 50 to 58 per centum by volume. The
effect of these liquors on the body is due primarily to alcohol, and
secondarily to ethereal derivatives of alcohol. Some owe a part of
their effect to non-volatile substances,--beer from which all alcohol
has been boiled can still affect the body in a marked degree.
The chemist of the Massachusetts State Board of Health (Document No.
34) gives the percentage of alcohol in the common proprietary
medicines, and these percentages will be found in the article on
_Social Medicine_.
The weakest of these compounds are twice as strong in alcohol as beer,
and they treacherously bring about the habit of drunkenness in
disposed persons who may be very desirous to avoid such a calamity.
Some men and women are quickly destroyed by alcohol; others resist it
more or less successfully for a lifetime, as far as mere existence is
concerned. Alcoholism is one of the commonest causes of insanity, but
it is often an effect of insanity. It may be an early symptom of
paresis, or a part of the maniacal stage of circular insanity. In
poisoning by alcohol the higher nerve centres are first affected and
the {109} lowest last. The sense of human dignity and of morality, the
exercise of the intellect, are more or less inhibited before the
motive muscles are affected.
The usual effect of alcoholic poisoning is boisterous exaltation of
mind, but there is a depressed type of drunkenness which weeps. Some
patients at once are subjected by hallucinations and delusions, others
are so depressed that they have a suicidal tendency, others may have a
maniacal frenzy that is destructive or homicidal. In these neuropathic
conditions muscular co-ordination is commonly well preserved--the
patient is "drunk in the head and sober in the legs."
In alcoholism the mental changes are gradual and progressive. The
intellect is blunted, the judgment becomes foolish, the moral sense is
dulled. The drunkard is always a liar. Delusions not infrequently
occur, and it is one of the common symptoms of alcoholic insanity to
suspect a wife or husband of conjugal infidelity. If a man that is a
drunkard accuses his wife of infidelity, the chances are fifty to one
that she is innocent and that he is in the first stages of insanity.
This symptom is characteristic also of cocaine intoxication.
Another mental disturbance of acute alcoholism is _delirium tremens_,
which is inexactly called _mania a potu_ by some writers. _Delirium
tremens_ is not a form of mania, but an acute hallucinatory confusion,
in which the consciousness is much more impaired than it is in a
mania. _Mania a potu_ is a real mania, and it is transient commonly,
although it may leave permanent mental weakness with delusions.
In chronic alcoholism a paranoid condition may occur, and this often
is incurable. This psychosis may come on suddenly or gradually. In
true paranoia the delusions are systematised, but in this alcoholic
pseudoparanoia the enfeebled intellect can not build up coherently
even a delusion. The alcoholic hallucinations are visual and auditory,
and we find delusions of persecution, especially of a sexual nature.
The patient hears all kinds of insulting remarks made by "voices."
These voices often come from his own belly. His enemies send poisonous
or foul odours into his room at night, and the groundless suspicions
of his wife's infidelity take most outrageous forms of expression. He
will swear {110} he has _seen_ her misdeeds. Often the baseless
suspicions of his wife begin before any other noticeable impairment of
intellect, and are not recognised as delusions. The first step a
priest should take in investigating accusations of conjugal infidelity
is to find out whether the accuser is a tippler or not.
The delusions of persecution lead to attacks on the supposed enemies
which often are homicidal. Occasionally alcoholic insanity takes on a
paretic form, or it may be epileptic. Ten per centum of alcoholics are
epileptic. When the children of alcoholics are epileptic, the
convulsions begin in these children about four years earlier than in
children that are epileptics from other causes. If epilepsy is latent,
alcoholism will start it into action.
Alcoholism sometimes produces a condition of waking trance followed by
amnesia (lack of memory). In such a state the drunkard may transfer
property, carry out complicated professional actions, commit crime,
take long journeys, travel for days, and so act that no one notices
his disordered mental condition. Then suddenly he awakens and he has
no recollection whatever of what has happened during this trance. He
appears to be conscious, but to have no memory of his consciousness.
There is another alcoholic amnesia, found especially in those that
drink much during the morning hours, where there is instantaneous
forgetfulness. If you ask one of these men to shut a door, for
example, he will forget between his chair and the door what he started
to do. This condition is difficult to cure even after the use of
alcohol has been relinquished.
Dipsomania is a form of impulsive degenerative insanity, and it is
probably epileptic in origin. After a few days of insomnia and loss of
appetite for food, there is an irresistible impulse to drink alcoholic
liquor and to indulge in other excess. The patient drinks until all
means of getting alcohol are exhausted. He will take crude alcohol,
bay rum, cologne, the alcohol that is about pathologic specimens in a
hospital museum. The attack lasts from one to two weeks, and is
followed by depression and a feeling of remorse. The onsets are
irregular in occurrence, and between them the patient may {111} be
temperate or have even an extreme distaste for alcohol. This form of
disease is not infrequent among professional men and clergymen, and it
is impossible to find out just how far the patient is responsible for
his condition. If bishops would investigate the alcoholic tendencies
of the _families_ of candidates for seminaries, and reject all that
have this taint, there would be much less scandal. It is a serious
error of judgment to ordain a seminarian that has even once been under
the influence of alcohol, and those seminarians that cover up the
tippling of a companion, because he is a good fellow, are guilty of
far-reaching crime. The fact is worth investigation whether or not a
liquor dealer who never drinks alcohol, but who lives for years in the
presence of volatilised alcohol, has much of the alcoholic degeneracy
and a tendency to beget neurotic children. Certainly the fumes of wood
alcohol have killed workmen that went down only once into a vat
containing these fumes, and other alcohols in the form of vapour
should have deleterious effects. Fere produced monsters in chickens by
exposing eggs to the vapour of alcohol.