Notes and Comments. EVERTS. 1896. NOTES AND COMMENTS. ORPHEUS EVERTS, M. D. PROGRESS is the legend on every banner of the present epoch. It is the key-note of nearly every presidential speech, or general address in medicine or surgery, recently delivered. Self-gratulation and applause are char- acteristics of modern medicine, because of its accomplishments. That advances have been made by all branches of Science, by which medicine has greatly profited within the last half century, there can be no doubt. That every movement proclaimed as an advance was, or is. entitled to the appellation, may be questioned. Innumerable theories and practices, once vaunted as evidence of medical progress, are now relegated to the limbo of error from which they emanated. At all this, however, the experienced do not wonder, nor the philosophic grieve. It is in accordance with the order of all natural processions; the movements of which, when fully comprehended, are continuous and harmonious. That which we call progress is nothing more nor less than growth. Whatever grows carries with it from first to last, both materials and characteristics of that out of which it grew, and with which it is forever continuous, however distant its extremes. Later growths may bear but little resemblance to antecedent forms. Cultivation effects great changes. The finest flavored apple bears but little resemblance to its ancient crab ancestors. Neither does modern truth resemble ancient falsehood closely, although intimately related, and continuous one with the other. The fact is, the Universe is a unit, and there is nothing, strictly speaking, isolable, or original. We cannot think, rationally, of anything emanating from nothing. We can not imagine anything that is not a modifica- tion of something existing. Something, the ascent of which, 2 through infinite gradations, may be traced to an unknown, but not an original, antecedent. Without motion matter could not exist as it is. Motion implies change, and change implies mod itication of forms. That the modifications of some forms of matter are so slowly effected as to he imperceptible to our senses, does not invalidate the theory that all matter is being affected by motion as an unceasing condition. Of other forms of matter, some are so ephemeral as to elude our observation. How brief the term, even, of individual human existence! Vet how numerous the modifications of con ditions and characteristics incidental to an ordinary life-time! No man is to-day that which he was yesterday, in all particulars. Nor will he he to morrow that which he is to day, however simi lar. Every beat of his unceasing heart efleets some modification of his being. Every consecutive phase of feeling or of thought differs, somewhat from its antecedents. We can not repeat the experiences of life without some variations. Infancy, child- hood, youth, manhood, age, succeed each other without definite intermissions. All of which being true, as matters of fact, how idle is the boast of originality—of either thought, or speech, or mechani- cal invention.—Gladstone has had credit for originality as a phrase-maker. One of his most notable phrases “The unspeak- able Turk,” has become classic, as original. Three hundred years ago Erasmus used the phrase, “ Unspeakable Monks." Shakespeare modified, adapted, transformed, existing literature, by his wonderful genius, as ancient alchemists hoped, and endeavored, to transmute all baser metals into gold. That appears to us to be original the antecedents of which are over looked or forgotten. That every movement along the lines of human progress should be without obstruction or deflection, would be incon- sistent with facts, apparent, if not real. As in the process of erystalization of inorganic matter, impurities and defects are not always avoidable; as in the growth of plants and animals excrescencies and deformities sometimes obtain ; so in the gener alization of principles from facts, or the construction of coin- 3 plex formulas; religious, political, ethical; or the adoption of new theories and practices in medicine : eccentricities, exagera- tions, and defects of various kinds may be expected to disfigure, to some extent, otherwise harmonious developments.—That the transition from an almost universal supernaturalism to naturalistic views of everything comprehensible, now taking place in the realm of thought, is an advance of incalculable importance, no devotee of science fails to recognize. Were this transition without significance otherwise, the consequent withdrawal of man, in all of his relations to time and space, from a mystical and hypothetical position, and finding for him his true place in nature is alone sufficient to merit all possible commendation.—To read now the history of philosophy, or even the latest approved systems of Metaphysics, after an intelligent study of modern science, is like reading of other worlds and peoples, so hypothetical and fabulous it all seems. Yet, in the historical development of the human race, even Science is compelled to admit the important parts played by Supernaturalism, and metaphysical philosophy.—Criticise and condemn the past, as some pretentiously “advanced thinkers” seem disposed to, that which is, would not be as it is, had its antecedents been other than they were.—As man himself has grown up through innumerable gradations of animal existence —pre historic, savage, and barbaric, to present conditions of civilized life; so knowledge has grown out of, and through, suc- cessive degress of ignorance to present states of enlightenment. As well heap reproach upon Apedom for delaying human development as to berate ancestral ignorance and incapacity for obstructing the progress of knowledge, and the advent of mod- ern Science.—Humanity has grown fast enough. Greater rapidity might have destroyed its typical identity. Of the many incidents of change from supernaturalism to naturalism in our views of the Universe, that by which our notions of Insanity, and consequent treatment of the Insane, have been so extensively transformed, is, if not the most important, still very conspicuous. So long as man was recog- nized as a dual being—a natural, animal man, comparatively 4 short-lived and insignificant; at best but a mere “ muddy vesture of decay,” incapable of reasoning or volition—and an immaterial, supernatural, man, spirit, or soul; inherently immortal; and endowed with all the capabilities manifested by the phenomena of mind; dwelling temporarily within the natural man—subject to disturbance, or control, by other supernatural beings equally impalpable; gods and demons; insanity was rationally regarded as spiritual disorder effected by evil spirits taking possession of the helpless victim of supernatural malice, or pure deviltry. The Insane were treated in accordance with this theory of their condition, rationally indeed, as imp-obsessed, and devil-driven, outcasts, amenable only to exorcistic violence, as ineffectual as it was cruel. Now that man is being recognized as a natural being only; a specialization of matter effected by motion, and deter- mined by inherent qualities and the order of natural pro- ceed lire under given circumstances; inevitably, becoming conscious when organized as brain; manifesting all of the phenomena of mind when sufficiently developed ; such manifes- tations, corresponding to, and reflecting the capabilities thus organicly attained—Insanity is rationally regarded as the phe- nomenal reflection of disordered brain-mechanisms, and the Insane are treated as invalids suffering physical disease. Man is a rational being, under all circumstances, when not impaired, however misinformed. He believes and acts in accordance with such testimony as is before him, however erronious as a matter of fact it may eventually prove to be. To what extent the Insane have profited, incidentally, by this transition from supernaturalism to naturalism in our theor- ies and practicies, it would be difficult to accurately estimate. But when r/e consider the fact that a large proportion of the Insane are not entirely destitute of feeling and appreciation, and contrast modern hospitals for the Insane, founded and supported by States, as public benefactions, where they are not only housed, clothed, fed and protected, in a manner at once liberal and intelligent, but treated as invalids by skillful practioners of the healing art—with the prisons, dungeons, caves, and other places of refuge, that were formerly their por 5 lion; naked, ragged, starved, chained, whipped and otherwise neglected or tormented; the change seems to be almost incredi- ble.—Christianity has done much for the advancing races of mankind. When we think of conditions through which it has grown to he what it now is, out of Judaism through the rank molds of paganism, carrying with it something of the substance, types, and characteristics, of every antecedent; one can not but wonder and admire. Yet, Science has done more toward humanizing, and fraternizing, mankind than any or all relig- ions now extant. That modern ideas of Insanity and the Insane are not exempt from error may be confidently affirmed. The most con- spicuous disfigurement of modern growths of ideas respecting Insanity consists of misinterpretations of facts as related one to another, on the part of many earnest and well-meaning students of the subject. For example:—It is held now by a certain school of medical philosophers, that inasmuch as Insanity is a manifestation of cerebral disease, and disease of the brain is not a matter of volition on the part of the subject, therefore Insanity should be recognized as an unconditional excuse for criminal conduct on the part of the Insane. To which end appeals to, and denunciation of, law-courts, both British and American, are strenuously made. This position is an eccentricity of Science. The truth is that all conduct is definitely related to cerebral peculiarities, and conditions, influenced by environments. The true relation of crime to Insanity does not, therefore, differ in any essential particular from its relation to sanity, scientifically considered. Similar characteristics of thought, and methods of action, may obtain in both health and disease. Criminals, as a class, are of a low order, intellectually considered; undeveloped in the direction of the highest mental capabilities essential to com- plex perception of morals; and, as a rule, more or less impaired by intoxication, and other vices; occupying a plane of life recognized as distinct, and inferior. While the Insane—such as are capable of criminal conduct simulating t hat of ordinary criminals, have degenerated, by reason of disease, and reached 6 the same plane by descent that the ordinary criminal reaches by ascent, occupied by both for a time in common. Equally responsible? u Ah, there’s the rub!” We have carried over, with our new ideas of the Universe, generally, and of mankind particu- larly, old notions of responsibility, which throw our mental machinery somewhat “out of gear"’ when endeavoring to liar monize them. Hut a rational view of responsibility, seen in the light of present knowledge, relieves at once from this embarrassment. Responsibility, indeed, should be no longer regarded as personal, pertaining to the individual, of whatever condition, sane or insane, moral or immoral ; but as general, pertaining to society, from the necessities of which, alone, it springs, and which, alone, is interested in its existence. Were but one man living no question of responsibility could arise respecting his conduct.—An Irish lunatic entertained the delusion that the parish Priest was God. The reverent Father was called to dissipate, if possible, the error. He came, and assured the lunatic that he was not God, but a poor priest, only a common mortal, like himself, etc., etc. After his departure Pat was asked : “ Do you believe still that Father R. is God? ” “ Av coorse I do! Why not?” Said Pat, smiling. “Would God lie to you ? ” Was asked. “Avcoorse lie would ! Why not? He's no body to be responsible to but himself.”—was the quick and signitieent reply.—When two or more individuals associate for co-operative purposes, their common necessities requiring certain restrictions of personal liberty—the rights of society at once supercede the rights of individuals—and respon- sibility is imposed upon, instead of inhering to, individuals ; without reference to their capabilities, beliefs, knowledges, or physical conditions, of health or disease, if contraindicted by social needs. How. and upon whom, society imposes responsibility, for its own welfare, if not for existence; and by what penalties enforces it; are questions of human prudence. If society deems it prudent and humane to spare the life of an insane homicide because of obvious impairment of mental capabilities by which 7 ethical precept-ions may have been modified or obliterated; while it still executes murderers, common criminals, whose ethical perceptions are equally deficient, or obtuse; the matter pertains to Social Science, and not to Medicine. It is, indeed the punishability of individuals—a clear and simple proposition, rather than their responsibility—more vague and complex— that enlists feeling, and embarrasses judgment. Responsibility being an outgrowth of social necessities, imposed upon individuals without reference to their apprecia- tion, instead of an inherent, spontaneously responsive condition of individuals; and justifiable, only, to the extent of the necessi- ties from which it emanates—why should insanity exempt an individual from such imposition ? Is it not a necessity, and therefore a duty, of society to protect itself from the badness of a madman, as well as from the madness of a bad man? Why distinguish in favor of the madman? Is the liberty or life of a lunatic more sacred, or valuable, than is the liberty or life of an ordinary criminal, not insane? Is it because the one is supposed not to know right from wrong, or is not capable of refraining from doing wrong, because of his infirmity; while the other is presumed to know right from wrong, and to be capable of doing the one and refraining from the other?—What is right, and what is wrong? Society, when imposing respon- sibility upon its members, defines right and wrong by decrees, or statutes; and thereafter presumes every one to know what has been commanded; what shall be, or shall not be, done by individuals; regardless of facts, capabilities, or opportunities. But this presumption is often violent, and insupportable by facts. Beside, many, if not most, persons of the criminal class, notwithstanding some knowledge of the statutes, do not believe them to be “right.” They delight in certain lines of conduct that the statutes declare to be wrong; and it is above their plane ot comprehension to recognize that to be right which interferes with their pursuits of happiness. Believing, as the intermediately intelligent all do, in the false doctrine of natu- ral equality, and inalienable rights, of all men ; having been so taught by pseudo-philosophers, and political demagogues; they 8 look upon the pretensions, and conduct, of tin* law abiding as hypocritical and cowardly; and the statutes as made in the interests of the governing classes, in someway inimical to them- selves.—With Loan Brougham, when considering “knowledge of right and wrong" as a measure of responsibility, one may well doubt if any one has such knowledge, or if it is, indeed, knowable.—Many insane peisons have as much knowledge of the statuses as have ordinary criminals, and are as capable of obeying them.—To enter into judgment with individuals upon the basis of what we think they know, or do not know, is always presumptions; as we come into touch, one with another, by supertices only, not by interiors; and are not overly wise respecting ourselves. Let us relieve ourselves from all em barrassment, then, by shifting the matter of responsibility, or punishability, from the individual to society, where it belongs; and trust society to deal with criminals of all classes, sane or insane, according to its ascertained necessities, and all will lx* well. Another eccentricity developed in the course ot medical progress, becoming more and more conspicuous of late, is the pseudo-scientific inference, and affirmation, that Inebriety is a sequence of disease existing previous to, and independent of, experimental intoxication. That intoxication is disease, how- ever ephemeral or protracted, is beyond question. The presump tion that experimental intoxication, and unresisted impulsion to frequent repetitions of the experience, is necessarily, or usually, a sequence of antecedent disease, manifesting itself in no other way, conspicuously, is not rational; because not drawn from sufficient facts to justify it. The facts of heredity, so far as they are known to us, do not support the theory ; as only conditions of organization, or peculiarities of structure, consti- tuting the “ potentiality of disease, are transmissible from parents to offspring. Inebriates whose immediate ancestors were not drunkards are numerous; and the immediate descend ents of drunkards do not all, nor a large proportion of them, become inebriates.—The facts of history, ethnological, and ethological, show that an appetite for stimulants and narcotics is 9 organic—natural to mankind, ol* all races and ages, wherever found. Also, that peoples that have attained to the highest degree of cerebral and intellectual development have manifested this organic appetite most conspicuously, by the most liberal indulgence of it. Numbers of individuals of such peoples have, unquestionably, become inebriates; as men are neither born equal, nor achieve equality in the manifold struggles of life. It would be unreasonable to suppose, however, that the organic appetites of such exceptional persons differed, in any essential particular, from that which was common to their ancestors and their brethern, before disease effected by experimental intoxi- cation impaired their strength, and general capabilities.—To assume that an organic appetite common to the race and con- tinuing through the historical period of its development, is, or ever was, disease, would be to impeach Nature as incompetent,- or wanton and perverse. Pathological facts can not be depended upon to support this contention ; as no rational inference can be drawn from pathological appearances of brains, or other organs, discov- erable before experimental intoxication has obtained, that such appearances indicate the immanece of sequential inebriety. Such psychological facts as may be cited in support of this affirmation—the statements of Inebriates respecting their mental and physical experiences—are too untrustworthy for consideration as contributive to scientific knowledge—for reasons well known to all persons who have been long familiar with Inebriates as a class. The ascription to Inebriety to pre-existing disease should be classified as one of a group of pseudo-scientific errors, including all of the so-called “ Monomanias,” characterized by natural proclivities to certain vices; such as stealing, burning, killing, etc., etc., without other evidence of disease; and the once popular notion of a condition of. certain defective persons, attributed to hypothetical disease, known as “Moral Insanity” manifested by vicious propensities and conduct without general derangement of mind, or apparent physical disorder.—That the manifestations by character and conduct of persons consti- 10 tutionally below the higher planes of organic stability, and complexity of function, may closely resemble manifestations of persons impaired by disease, has been rationally inferred, and readily admitted. Why then distinguish, one from the other, as classes ( For the sake of truth, and the integrity, and dignity, of Science. There are, however, certain other reasons why this fadulent notion of Inebriety should be exploded. Of these reasons one is :—The false theory, seriously maintained, tends to excite undue, and unwholesome, sympathy for the Inebriate; and to release society from its obligation to impose upon him such restraints as are essential to, not only its, but his, well being. When we consider how intimately associated the vice of drinking is with all other vices, and evils—and nearly all crimes of public notoriety—more often than otherwise constituting the antecedents from which other vices, and crimes, flow as inevi- table sequences—is it not apparent that society, to be rational and consistent, as well as provident, should, when excusing the offenses of the Inebriate, excuse the vices of the otherwise defective, and demoralized, or naturally immoral i Another reason why this error respecting Inebriety should be corrected, is:—It begets false notions, and false hopes, representing the curability—not of Inebriety proper—but of the hypothetical disease of which Inebriety is supposed to be a sequence. Millions of dollars have been poured into the treas- uries of innumerable “ Cures,” called into being by notions thus instigated, and hopes thus inspired, bv the friends of Inebriates, within the past few years. With what results' Temporary suspension of intoxication in some instances, affected by other than medical influences; but for the most part, dissi- pated hopes, and disappointed expectations. Intoxication, and many phases of disease affected thereby, are, within certain limits, amenable to disciplinary treatment, aided to some extent by medication. The appetite for intoxicants, primarily organic and natural, but intensified by experimental intoxication, and consequent impairment of resisting capabilities, is not amenable 11 to medicine; nor to any other treatment other than absolute abstinence from intoxicants; which can be accomplished in but two ways. One of these ways is to place intoxicants beyond the reach of the victim; and the other is, to place the victim beyond the reach of intoxicants, and so keep him—not for a day, but indefinitely. How can this be done { By the authority of the State, only.—Twenty-seven years of my life having- been spent in close contact with defective persons, hundreds of whom were Inebriates, enable me to speak confidently and earnestly, while cautioning younger members of the profession against the somewhat persuasive literature now prevalent on this subject. It may require time and experience for States to become educated up to the point of action, in the exercise of necessary authority for the effectual suppression of Inebriety in its offensive forms. But let us as a learned and philan- thropic profession Ireat the matter fairly; and contribute our mite to such needful education. Cincinnati Sanitarium, January, 1896.