The Sanitary Side of the Drink Problem. Read before the Section of State Medicine, at the Forty-third Annual Meeting of the American Medical Association, at Detroit, Mich., June 7, 1892. BY T. D. C BOTHERS, M.D., OF HARTFORD, CONN. "SUPT. WALNUT LODGE HOSPITAL, EDITOR JOURNAL OF INEBRIETY," ETC Reprinted from the ".Journal of the American Medical Association," October 8, 1892. PUBLISHED AT THE OFFICE OF THE ASSOCIATION. CHICAGO: 1892. The Sanitary Side of the Drink Problem. Read before the Section of State Medicine, at the Forty-third Annual Meeting of the American Medical Association, at Detroit, Mich., June 7, 1892. BY V T. D. CROTHERS, M.D., OF HARTFORD, CONN. " SEPT. WALNUT LODGE HOSPITAL, EDITOR JOURNAL OF INEBRIETY," ETC Reprinted from the "Journal of the American Medical Association," Octoher 8, 1892. PUBLISHED AT THE OFFICE OF THE ASSOCIATION. CHICAGO: 1892. THE SANITARY SIDE OF THE DRINK PROBLEM. BY T. D. CROTHERS, M.D., OF HARTFORD, CONN. Some conception of this problem may be obtained from the fact that in 1891 over eight hundred thou- sand persons were arrested in this country charged with being intoxicated and committing petty crimes. It may be fairly presumed that at least half as many more, using spirits to excess did not come un- der legal notice. If to this is added opium, chloral, and other drug narcotics-the number reaches enor- mous proportions. Practically this vast army of inebriates represents all classes and conditions who are literally with- drawn from the ranks of active workers and produc- ers, and become obstacles and burdens to sanitary life. They are centers of pauperism and progressive de- generation and the most unsanitary physiological and psychological conditions. This army literally follows a continuous line of re- trogression which antagonizes all evolution, growth and development, and seems to be governed by a uni- form law of cause and effect, marked by a beginning development, decline and extinction, the mystery of 4 which makes it the most absorbing scientific problem of the age. To-day over a million workers are waging a great moral crusade to break up this evil. Politics, relig- ion, education, the pulpit and press are combined in a struggle with this problem, approaching it exclu- sively from the moral side. Mediaeval superstition and moral theories are urged through the pledge, prayer, persecution and punishment to explain and check this evil. Above all this moral agitation and effort the voice of science appeals to physicians for help. This army of inebriates is increasing, and with it losses and de- generations both of individuals and the race. While inebriates are a part of the great army of the "unfit" that are "mustered out" and crowded out in the race march-there is yet unmistakable evidence that some can be halted, headed off, and returned to health. Already science has pointed out the possibilities of cure and prevention, that give promise of practically stamping out this evil in the near future. Some of the outline facts from the sanitary side will show its extent and the possibilities of cure from a larger and more accurate study of the subject. The great sanitary problem of to-day is the knowl- edge and removal of the causes of disease, and the placing of the victim under the best conditions for a return to health. To remove the conditions which favor and encour- age disease, and break up the breeding places of crime, pauperism and allied forms of degeneration is one of the future certainties of science. There are to-day over a million unrecognized inebriates who are the most defective, dangerous, and degenerate of all classes. They are centers of pauperism and sanitary evils that pass on into the next generation entailing mis- ery and loss beyond estimate. 5 The superstition of personal freedom with free will, permits this army of inebriates to go on year after year, destroying themselves, increasing the burden of their families, and building up veritable centers of physical and mental degeneration. Nothing can be more disastrous from a sanitary and scientific standpoint than the indifference which permits men and women to use alcohol and other drugs, not only destroying themselves but entailing all degrees of degenerations on their descendents. Sanitary science teaches that no one has a right to destroy himself and peril the health and comforts of others. The moderate and periodic drinkers are always sources of danger to themselves and others. To wait until they become chronic and degenerate into law breakers is to apply the remedy when it is too late. Public sentiment should not permit one to become an inebriate or tolerate him after he has reached such a stage. He should be prevented and forced to un- dergo treatment and should be regarded as danger- ous to the safety and welfare of the community and isolated until fully restored. In the near future science will demand that every inebriate have legal guardianship and restriction of personal freedom until he recovers. When these cases realize that such restrictions will be enforced, they will seek treatment in the early stages of their disease. The teaching of science demands that both the pauper and millionaire be seized at the very on- set of and forced into conditions of health and so- briety, and saved from becoming burdens on the community, and centers of ruin and misery. The saloon and the free sale of spirits from a sani- tary point is a source of extreme danger. Its influ- ence in any community is bad. It brings sanitary perils by destroying the physical and mental stabil- ity of its patrons and both directly and indirectly 6 favors the worst conditions of life. The saloon has no claim for recognition as a business. It is simply a parasite thriving on the decay and degeneration of the community. It is only tolerated by the dense ignorance and selfishness of its defenders. It should be classed with foul sewers, dangerous waters and unsanitary death-dealing forces, etc. Persecution as a moral evil keeps it alive, but ex- amination from the standpoint of science would be fatal to its perpetuity. The drink problem would be largely solved could the favoring conditions of saloons be changed. Unregulated marriage, now a mere matter of acci- dent and impulse is another source of danger perpet- uating the drink-curse. Inebriates, insane, and neu- rotics of all degrees are permitted to propagate and transmit their defects to succeeding generations. The result is a race of neurotics that develop inebriety, and all forms of insanity and idiocy, together with all associated conditions. The army of neurotics beyond all question reap- pears in succeeding generations with similar or inter- changeable diseases. The inebriates of this genera- tion who marry and raise up children are creating paupers, criminals and insane for the next. They are wrecking their descendents by crippling and in- capacitating them to live healthy lives. Every community illustrates this fact, and the drink problem is more complex and difficult of solu- tion on this account. We need scientific study and instruction on this point, and a public sentiment that will make mar- riage a question of sanitary science, then we shall have the means for practical prevention and cure of many present evils. The drink problem has another sanitary side in defective nutrition-bad ventilation and other con- ditions of an unhealthy character. 7 Build up the physique, relieve the condition of starvation-remove the defects of unhealthy living and in many cases the tendency of the drink craze is thwarted. Mental change-unrest and sudden change involv- ing a strain on the organism to adapt itself to the new conditions for which it is unfit, also overwork, underwork and diseased conditions, defective and retarded growths, and nearly every kind and degree of mental and physical defect enter into the drink problem, and must be recognized and studied. The present methods of dealing with this problem are followed by startling results. Of the 800,000 persons who were arrrested last year for inebriety not one per cent, were benefited. Over 99 per cent, were made worse, and confirmed in their habits. The station house and jail are active recruiting places, and the hosts of inebriates who are forced into them are transformed into legions of incurables which never desert or leave the ranks. Physically the short imprisonment of the inebriate simply removes him from spirits and leaves him less capable of leading a temperate life. Mentally he has lost a certain self respect and pride of character essential to recovery. The first legal punishment of inebriates is followed by a species of fatality seen in a constant repetition of the same or allied offenses. This fact is so apparent that these cases are called "repeaters" in the courts, and the number of sen- tences to the same person often extends to hundreds. In one thousand cases confined at Blackwells' Island, New York, 935 had been sentenced for the same offense, drunkenness, from one to 28 times. The first sentence was a regular switch point from which the victim was precipitated to a constantly descending grade, becoming more and more inca- pacitated for temperate living. 8 The system of fines is equally ruinous, because it falls most heavily on the families, making it more difficult to support themselves, thereby increasing the perils of pauperism, both to the victim and those who depend on him for support. It may be said, and the statement is sustained by many facts, that the legal treatment by the lower courts of cases of inebriety is fully as fatal as the saloons themselves where spirits are sold. The saloon and police court are literally the school and college for the training and graduation of classes of incurable inebriates that peril every sanitary interest in the country. The fault is not in the courts and their adminis- tration of the law, but in the laws themselves, and in that state of public opinion which urges that all ine- briates should be treated as wilful criminals, and arrested and punished as such. Thus, year after year this terrible farce of preven- tion of inebriety by fines and short imprisonments goes on and the incurability of the poor victims in- creases. Crime is increased, pauperism is increased, the most dangerous sanitary conditions are fostered, and the burdens of taxpayers and producers are increased. The inebriate is always debilitated, and suffers from impaired brain and nerve force-alcohol has broken up all healthy action of the body. In prison both the quality and quantity of food are ill adapted to restore or build up ' the weakened organism. The hygienic influences of jails and prisons are defective in every respect, and adverse to any healthy growth of body or mind. The psychological influences also are of the worst possible character. The surrounding and the asso- ciates precipitate the victim into conditions of men- 9 tai despair from which recovery is difficult, if not impossible. The only compensation to the inebriate is the removal of alcohol, and in this deprivation the State most terribly unfits him and makes him more and more helpless for the future. Thus, while civilization is one of the sources from which inebriety is produced, the blundering effort to remove it by penal punishment is an actual factor in increasing and intensifying the disorder. The treatment of inebriety from a scientific stand- point, has passed the stage of experiment and is sup- ported by a great variety of experience and collateral evidence that cannot be disputed. Probably the largest class of inebriates in this country are without means of support and may be termed the indigent and pauper class. This class, non-supporting and burdensome, should come under legal recognition and be committed to workhouse hospitals, built for this purpose, prefera- bly in the country, upon large farms and amid the most favorable environment. These hospitals should be training schools in which medical care, occupation, physical and mental training could be applied for years, or until the in- mates had so far recovered as to be able to become good citizens. Such hospitals should support themselves in part from the labor of their inmates, having been built from monies received from a tax imposed on liquor dealers, or a license fund, and be independent of the tax payer or of State support. These places would receive the classes who now are sent to jail, and that other class who are neglected until they have passed into the chronic stage and have become inmates of prisons and insane asylums. A very large proportion of these several classes could be made self-supporting while under treatment. 10 and in many cases be an actual source of revenue. The hospitals would naturally be divided into two classes. The first would receive the better, or less chronic cases; the second would have the incurables, and those whose recovery was deemed more or less doubtful. In one case the surroundings and disci- pline would be more adapted for the special inmates than in the other, but the same general restraint would be followed in each. In both recoveries would follow. A large class would be restored to society and become producers. In the second, cases would be housed and made to take care of themselves, which would be an immense gain to society in economy and safety. Private enterprise should be encouraged by legis- lation to provide smaller hospitals for the better class and those who would be unwilling, or whom it would be undesirable to compel to enter public asylums. Here the commitments should be both forced and voluntary, and the restraint combined with the fullest and latest appliances of science for the end to be accomplished, blending seclusion and good surroundings to build up and make recovery possible. The first step is to recognize the fact that the ine- briate, whether continuous or periodic, has to a greater or less degree, forfeited his personal liberty, become a public nuisance and an obstacle to social progress and civilization. Second, that he is suffering from a disease which affects society and every member of the community in which he lives, and from which he cannot recover without aid from other sources, making it absolutely necessary that he should be forced into quarantine on the same principle as the small pox or yellow fever patient. This is simply carrying out the primitive law of self- preservation. Naturally, the money to accomplish this shall come from the license revenue, on the prin- 11 ciple that every business should provide for the acci- dents and injuries which follow from it. Railroad companies and other corporations are required to pay damages for the accidents which follow their busi- ness, and this is conceded to be justice. But to-day the tax on the liquor traffic is used to support courts and jails where the inebriate, by fines and imprison- ment, is only made worse or more incurable. Thus, literally, the business of selling spirits is increased by the almost barbaric efforts of courts and jails, and every person so punished is made a permanent patron of that business. Against this all the teachings of science and all practical study utter loud protest. The practical success of workhouse hospitals for inebriates is demonstrated in every self-supporting jail and State's prison in the country where the obstacles are greater and the possibilities of accom- plishing this end more remote. This can also be seen in asylums for both insane and inebriates, in the various sanitaria and hospitals through the country where the capacity for self-support and the curability of these cases are established facts. More than that, these hospitals would relieve society of great burdens, of loss and suffering, the diminution of the number of the inebriates indeed become a practical certainty, the extent of which we can have no conception of at present. It is impossible at the present time to estimate the beneficial results that would follow a system- atized plan of thus housing and treating the inebriate, but there are positive indications that its effect would be felt in all circles. One of the great foun- tain heads of insanity, criminality and pauperism would be closed, and a new era would dawn in the evolution of science.