Reprinted from the New York Medical Journal 
for November 28, 1885. 
ALCOHOL IN THE 
TREATMENT OF ACUTE AND CHRONIC 
FORMS OF ALCOHOLIC MANIA. 
By LEWIS D. MASON, M. D., 
CONSULTING PHYSICIAN TO THE INEBRIATE HOME, FORT HAMILTON, N. Y. 
While in certain forms of neuroses, occurring in cases 
of alcoholism, alcohol in any form would be injurious, nev- 
ertheless there are conditions in which the judicious use of 
alcohol is not only beneficial, but curative and indispensa- 
ble, and its place can not be taken by other drugs. The 
assertion that alcohol is only and always a poison, and must 
not be tolerated in any condition, especially where the ine- 
briate is concerned, is not carried out by our experience in 
the class of cases to which we shall presently refer. The 
indiscriminate and therefore injudicious and harmful use of 
alcohol is not here indorsed ; we now speak of its careful 
administration, where the quantity and form used are regu- 
lated by a competent practitioner. An asylum experience 
of over nineteen years, embracing the cases of several thou- 
sand inebriates, has given us ample opportunity to test the 
relative value of sudden and complete abstinence from all 
alcohol, and the plan of gradual reduction, or what is known 
as the “ tapering-off ” system. And just here it is legiti- 
mate to reason from analogy. Our experience has also era- 2 
ALCOHOL IN THE TREATMENT OF ACUTE 
braced many cases of the opium and morphine habits. In 
a few of the earlier of this class of cases under our treat- 
ment the drug was left off abruptly. The terrible suffering 
and collapse that ensued demanded the immediate restora- 
tion of his full dose to recover the patient from a state of 
suffering, if not peril, and the endeavor by some other and 
less severe method to relieve him of the habit. 
The same holds true in degree in certain cases in regard 
to alcohol. The inebriate, whose nervous system is broken 
down by his excesses, is suddenly deprived of his accustomed 
stimulant. Some hours may pass and nothing worthy of 
note happen; but in time the symptoms of deprivation mani- 
fest themselves, and he pleads for his usual draught, and will 
resort to all kinds of deceit or force to obtain it. lie fails 
by reason of his environments, and then mental aberration, 
muscular tremor, insomnia, and the familiar symptoms of 
delirium tremens are established. This is the common ex- 
perience of the hospital surgeon. The habitual inebriate, 
struck down by some accident, is brought into the hospital 
ward. He is thus suddenly deprived of all stimulants, and 
the necessity for administering the same is not recognized. 
A few hours pass, sleeplessness ensues, and a case of deliri- 
um tremens, associated with surgical injury, is established. 
And the hospital surgeon could not meet with a worse com- 
plication, especially in certain forms of injury, such as frac- 
ture, where perfect rest is so essential to secure proper 
results. 
During the first few years of our experience at the Ine- 
briate Home at Fort Hamilton the “ cut-off plan ” from all 
alcoholic stimulants was conscientiously adopted. Recogniz- 
ing the great evil that alcohol had done, we did not desire 
to place it on record as of any use at all; and, further, the 
popular cry that inebriate asylums “ were nothing more than 
hotels for the accommodation of a certain class who desired AND CHRONIC FORMS OF ALCOHOLIC MANIA. 
3 
to continue their evil habits ” influenced us somewhat to 
adopt this plan. 
Cases of delirium tremens were common. Hardly a 
person entered the asylum but he was expected to pass 
through his attacks of acute delirium. At present this is 
an exception to the rule. If a patient enters the asylum, 
and is at all tremulous, especially if he has had a long, tire- 
some journey, and the experience of a sleepless night and 
deprivation from his accustomed stimulant, he is regarded 
as on the verge of an attack of delirium tremens, and the 
judicious administration of a few bottles of ale, or its equiva- 
lent in some other form of alcohol, given at proper intervals, 
will not only quiet him, but tone up his nervous energy and 
arrest a condition rapidly tending to delirium. 
Many enter who do not need such treatment. The peri- 
odic dipsomaniac who is on the tail-end of his spree and 
is ready, after a day or two of rest, to again enter upon 
his sober interval, will probably not need such stimulant. 
The person most likely to demand it is the habitual inebriate, 
because, of the two, the nervous system of the latter is the 
most shattered, and because, also, he is accustomed to a 
daily stimulant. It must not be inferred that, in our asy- 
lum, alcohol is improperly, indiscriminately, or irregularly 
given. On the contrary, it is dispensed with as much care 
and caution as other drugs. A record of the quantities 
given, and the periods at which they are administered, in 
each case is kept, as well as the effect upon the pulse, tem- 
perature, and general condition of the patient. As a pro- 
phylactic or abortive treatment for delirium tremens, I 
know no remedy so safe and so potent as alcohol properly 
administered. I believe that insomnia is more readily over- 
come, and the end desired more promptly attained, than if 
we attempted to secure the same result by large doses of the 
bromides, chloral hydrate, or other hypnotics, and the risk 4 
ALCOHOL IN THE TREATMENT OF ACUTE 
that attends the use of these drugs avoided. If we have 
occasion to use these drugs also, less will be necessary, so 
that the quantities used may be administered in safer doses. 
I do not hesitate to assert that, by the too free use of these 
drugs in cases of delirium tremens, in the effort to overcome 
the persistent insomnia, the convalescence of the patient has 
been greatly retarded, and life has been put in jeopardy and 
even sacrificed. 
The method, then, of administering alcohol should be 
regulated by the condition of the patient. On the first 
appearance of sleeplessness, mental aberration, muscular 
tremor (and these should be watched for in all cases sub- 
mitted to our care), a bottle of Bass’s ale may be given 
every two, three, or four hours, lengthening or shortening 
the interval as the case demands, and then, after sleep is 
obtained and the patient reacts from his mental irrationality 
and physical depression, the use of the stimulant be sus- 
pended. 
The use of a stimulant may be necessary for a day or 
so, or longer periods. We find it rarely necessary to con- 
tinue it longer than a week or ten days, gradually decreas- 
ing the quantity, and at the end of that time total abstinence 
may be safely practiced for an indefinite period. I have 
seen several instances, both in private and asylum prac- 
tice, where the judicious use of ale alone, without other 
medication, has arrested in a few doses the tendency of the 
patient to acute delirium, and restored him to a safe condi- 
tion of sleep and mental soundness. And, even in cases 
where the delirium was marked and the insomnia persistent, 
the judicious use of stimulants has put the patient on the 
road to recovery. Ale will often succeed where whisky or 
other forms of alcohol do not answer. After a night or two 
of rest, the mental and physical condition of the patient 
meanwhile improving, we may begin reduction and carry it AND CHRONIC FORMS OF ALCOHOLIC MANIA. 
5 
on as speedily as the case seems to warrant, and in a few 
days the patient will be convalescent. If the case is one 
accompanied by severe injury, it may be well to continue 
the stimulant until the period of debility or shock has passed, 
or the exhausting drain on the system has been arrested. 
In chronic alcoholic dementia—a low type of mental 
alienation occurring in alcoholics—the patient is anaemic, 
listless, and full of delusions; hears voices, and holds conver- 
sation with imaginary persons; appears to have sane moments, 
but readily relapses into his old delusions ; his appetite is ca- 
pricious, his sleep irregular, and his physical strength poor ; 
he moves about in a waking nightmare, he walks in a land of 
dreams and shadows. The judicious use of stimulants in 
these cases, a glass of ale at each meal and at bed-time, con- 
joined with tonic treatment, proper diet, and regular exer- 
cise, will do much good. The use of bromides and chloral 
to overcome the insomnia will only add to the already pro- 
found mental disturbance and still further lower the physic- 
al tone. I have already referred to the fact that the too 
free use of the bromides and chloral and other depressing 
drugs in the acute forms of alcoholic delirium may plunge 
the patient into the more protracted forms of mental aliena- 
tion to which the inebriate is particularly prone. I have 
endeavored to be cautious in presenting my views; but our 
experience at the Fort Hamilton Asylum will not permit 
me to indorse the idea held by some practitioners—viz., that 
no harm can result from leaving off at once alcoholic stimu- 
lants in any case, and that no good can result from continu- 
ing them in any case of alcoholism; that their use is not 
only productive of mischief to the patient, but is, besides, a 
great shock to the moral sense of the community. I main- 
tain, however, that, if, by the judicious use of alcohol in such 
quantities and at such times as we may direct, we can arrest 
the onset of an attack of alcoholic delirium, or abbreviate 6 
ALCOHOL IN THE TREATMENT OF ACUTE 
the duration of the more chronic forms, the result of the 
treatment certainly warrants its adoption. In order that 
my statements need not be misapplied or misconstrued, it 
may be necessary to state that there are many persons who 
drink alcohol in some form habitually, but never to excess 
or intoxication, and who have not passed through the terri- 
ble ordeal of delirium tremens, chronic alcoholism, or chronic 
alcoholic mania, and who have not yet been convulsed with 
alcoholic epilepsy. To such my remarks do not apply. 
These persons are not inebriates in the true sense of the 
word. Immediate and abrupt cessation with them means 
nothing more than the leaving off of a very pernicious 
habit, which, if continued, will carry them into the terrible 
precincts of the inebriate. All such I most earnestly advise 
to leave off alcohol at once. Total and immediate absti- 
nence is their only safety. 
Nor do we hold that all patients entering the Inebriate 
Asylum demand the treatment herein indicated. But I wish 
to impress the fact that a certain class of cases require alco- 
hol in some form as a part of their treatment, and that in 
these cases it is especially indicated. We all recognize the 
moral side of the question ; but, when a life is wavering in 
the balance, we must use the means which experience has 
proved to be the best. 
One of the best and most conservative authorities in 
this special department of medicine indorses the judicious 
use of alcohol, if not directly, at least indirectly, and comes 
somewhat to our aid on this point. Speaking of digitalis 
and its effects in large doses in the treatment of delirium 
tremens—doses of half an ounce or an ounce of tincture 
of digitalis—he writes: “ The patient must have received so 
much proof spirit; ” and he is puzzled to account whether it 
was the alcohol or digitalis that effected the good result, 
and, although opposed to alcohol, says the favorable issue AND CHRONIC FORMS OF ALCOHOLIC MANIA. 
7 
was either due, probably, in the large number of suc- 
cessful cases, to a spontaneous favorable termination of the 
disease, or was slightly helped by the alcohol which is 
contained in the tincture ordinarily employed. The “ cut- 
off” plan is also considered by the writer; but he says 
it is more difficult to carry out this plan with older patients 
. . accustomed to depend for a long time on strong 
drink as a large part of their nutrition. “ But still,” 
he writes, “ we ought to try less harmful drugs—opium, In- 
dian hemp, etc.—before resorting to so doubtful a remedy 
as alcohol.” Again: “ Alcohol, also, in diminishing doses 
does seem to aid in the cure of feebler cases. If a man 
has been drinking a quart of whisky daily up to the time 
of his attack, a pint or quart of ale or porter will be to 
him only a mild tonic beverage, aiding his digestion.” 
And, finally, the author is forced to this admission : “ The 
popular idea of tapering off is not altogether devoid of 
scientific, as well as clinical, foundations.” * 
Another point to note, and of some value in gaining the 
confidence and sustaining the courage of the patient in the 
ordeal that he is to pass through, is the fact that his stimu- 
lant will not be immediately “ cut off ” if it is necessary to 
administer it. 
I have no doubt that many persons desirous of entering 
a special asylum for the treatment of their diseased appe- 
tites would do so if they did not dread the sudden depriva- 
tion from their accustomed stimulant. When a patient is 
brought to our asylum, his first and only question often is, 
“ Will they cut me off at once ? ” This thought is upper- 
most in his mind, intensifies his desire, and aggravates his 
nervous apprehensions. 
If we can, by the judicious use of a stimulant, carry 
* Dr. Francis Edmond Anstie (Reynolds’s “ System of Medicine ”). 8 
ALCOHOL IN ALCOHOLIC MANIA. 
him over the first few days of his asylum experience, quiet 
his fears, secure to him rest, and gain his confidence, we 
have brought him successfully over the first part of his 
treatment, and, in all probability, arrested a train of nervous 
phenomena that would, if allowed to go unchecked, have 
precipitated him into an attack of acute delirium, or per- 
mitted him to drift into the more chronic form of alcoholic 
mania.