The Pathologic Impulse to Drink 
==Alcohol as a Secondary 
Factor in Dipsomania. 
BY 
WILLIAM LEE HOWARD, M.D. 
REPRINTED FROM 
MEDICINE 
WILLIAM M. WARREN, Publisher 
February and March, 1898. THE PATHOLOGIC IMPULSE TO DRINK -ALCOHOL AS A SECOND- 
ARY FACTOR IN DIPSOMANIA. 
BY WILLIAM LEE HOWARD, M.D., Baltimore, Md. 
It is to be understood at the commencement that in the present 
paper the conditions I consider are not to be confounded with those 
of the common drunkard, the chronic alcoholic, or those found 
existing in individuals with defective moral sense or continuous 
unstable mental equilibrium. I shall study in this paper the 
unfortunate individuals suffering from a pathologic impulse to drink 
regardless of all effects or results-an impulse considered by many 
alienists a periodic insanity. 
The primary condition of the dipsomaniac is not caused by 
alcohol. The starting-point is a pathologic one; the impulse, the 
insatiate desire to drink, is due to this pathologic obsession - this 
paroxysm which has come over an otherwise lucid mind. A clinical 
picture of one of these dipsomaniacs will enable us to better under- 
stand the morbid states which we are to study. A man, with wife 
and children, holding a responsible position, upright and honest in 
his daily life, shunning coarse companions and avoiding drinking 
places, educated, refined, and domestic in his habits, who suddenly 
shows a disposition the very antithesis of his daily life, and after a 
short interval of abnormal existence returns to his quondam habits, 
offers an interesting psychologic and pathologic study. The sudden 
desire, the irresistible impulse, to drink enormous quantities of 
liquor, concomitant with palsy of the will and moral obmutescence, 
is rightly called dipsomania. 
A few days before the irresistible, savage, maddening, overpower- 
ing impulse to drink exerts its full force, the individual is restless, 
irritable, suffers from insomnia, or, should he sleep, is disturbed by 
mild but uncomfortable dreams. Slight muscular tremors may be 
noticed, and every act is accompanied by an uncertain or impulsive 
movement, physical as well as mental, showing that though up to 
this time no alcohol has been taken, and none perhaps for months or 
years, there exists a slight erethism of the cortex. The struggle, 
the painful demand for alcohol, the determination to control the 
crying yearning for some relief from this horrible restlessness, the 
knowledge of the fact that the higher centers are so disturbed as to 
make the carrying out of daily duties impossible, are too fearful for 
even a person perfectly conscious of the ultimate disastrous results 
to stand against. One drink only will he take to relieve the dis- 2 
THE PATHOLOGIC IMPULSE TO DRINK 
tressing restlessness. He steps into a saloon, an act which a few 
days ago he would have considered degrading. The one drink is 
taken, after which there does not appear to be any limit to the 
amount of alcohol he is capable of consuming. His thirst is savage, 
uncontrollable, unlimited. Now hours pass as minutes. The indi- 
vidual becomes voluble, boasting, egotistic, and self-contented; he 
delivers philippics and enters into polemical discussion with his bar- 
room companions, considering himself an oracle, the center of every 
movement. The amount of alcohol imbibed does not affect the 
motor or sensory centers to any marked extent, but the higher 
centers are completely in abeyance. No food is taken, and as mid- 
night comes he departs with his newly made acquaintances to some 
low, disreputable, all-night hole which is like a palace to him, the 
parasites being his willing knights. A short doze on a dirty sofa 
and the morning will find him without the physical or mental 
energy to leave the rum hole; and humored, flattered, cajoled and 
contented he will remain in this lycanthropic condition, dirty, filthy, 
and regardless of his personal appearance, until the nerve storm has 
spent all its fury. This storm, which approached with its undula- 
tions of fast-gathering tumults, its psychic murmurs, its sighing, its 
slow but insidious strength, finally bursts forth in all its horrible- 
ness and destructive fury, followed by rapid subsidence; leaving the 
hurtled flotsam, jetsam and moral wreckage to be gathered and 
dispersed by an interval of normal life. The duration of the storm 
from its first fitful gusts to its last sigh covers a variable period- 
generally about three weeks. During this interval but little food is 
taken, and that at irregular periods. The mental condition during 
this period is not the one of maudlin drunkenness, not the one of 
violent, inhuman, tiger-like brutality seen in alcoholic frenzy and 
pseudo-dipsomania, but one in which the speech is tenuous, light, 
airy, and teeming with idle gasconade. The ideas expressed are 
weedy, sedgy, spumy. There seems to be only a slight clouding of 
the mind as regards surrounding details; the whole mental condi- 
tion and attitude is in fitting with his companions and environment. 
He has not the drowsy, sleepy stare of the drunkard; nor does he 
have the appearance of being insulated in the gloomy umbrage of 
alcohol. Regarding his true life, his normal condition, there is a 
hazy, vague state of intellect if his attention is called to it; some- 
times total oblivion of his duties and responsibilities. The return 
to his former self is comparatively rapid, and after the recrudescence 
he will have but a slight recollection of the length of time passed or 
the places where he has been. Often close questioning and leading THE PATHOLOGIC IMPULSE TO DRINK 
3 
questions will throw a ray of light on some obscure act, but even 
then he is not fully convinced that the fact is not some phantasm, 
some dream, or idle banter of his questioner. He desires no liquor 
now, and has neither thought nor idea of ever wishing for a drop of 
alcohol. It is not the moral determination of the drunkard never 
to drink again, not the sickening, repulsive, abhorrent feeling of 
the inebriate for alcohol due to temporary excess, but a condition 
of psychical contentment. Such is a general outline of this patho- 
logic condition which is demonstrated by the craving for drink. 
There are naturally many various minor phases of this condi- 
tion, many clinical units, but they can all be reduced to the same 
psychical elements. This craze for drink must not be considered 
a distinct disease, but as a secondary symptomatic condition, as 
are other impulses in abnormal mental disturbances. Although 
one attack of dipsomania is generally followed by another, such 
is not always the case. 
I have had many opportunities to study these cases throughout 
their course, having had them under close observation from the 
prodromic period to convalescence, during which no liquor in any 
form was given. These cases exhibit a mental disorder character- 
ized by great depression, anxiety, and restlessness; inability to apply 
themselves to the simplest reading or games, an indefinable horror 
of some impending danger, and discoordinated psychic faculties. 
They soon become indolent and apathetic, though keeping up an 
incessant walk around the room and a conversation consisting 
mostly of lamentations regarding their inability to ever return to 
their business or profession. Insomnia is persistent, and anorexia 
so pronounced that often the taste of food will bring on an attack of 
vomiting. There is often spasmodic gulping down of food, and 
unsuccessful attempts to swallow, exhibiting an aura as character- 
istic as the epileptic aura. Frequently the sensation of precordial 
anxiety will be observed. In a day or so comes the impulsive, 
uncontrollable desire for drink. Large draughts of water are taken 
-hot one minute and a vehement demand for cold the next. The 
relief is only temporary, and soon the demand for alcohol asserts 
itself in pleading, cursing, and argumentation, sometimes ending in 
a frenzy-the delire emotif of Morel. During this period, which will 
last several days, the throat is parched, the skin hot and dry. The 
pulse varies from 85 to 100. Although large quantities of water are 
consumed, comparatively little urine is voided, and that is heavily 
charged with phosphates. At the height of the attack there is a 
passionate, desperate demand for alcohol - alcohol in any form. THE PATHOLOGIC IMPULSE TO DRINK 
4 
They plead, clamor, pray and struggle until, exhausted, they sink 
into a temporary consciousness of the impotency of their will and 
mental demoralization. This condition lasts for a short time, when 
the craze for alcohol again commences. With the subsidence of the 
cortical irritation comes great physical weakness and moral depres- 
sion, or the oppression of inexpiable guilt, apparently much greater 
than in the cases which have succumbed to the passionate demand 
for alcohol. In fact the latter cases recover their physical health in 
a few days; the former suffer from weakness and mental depression 
for some weeks after. This mental depression is probably due to a 
better recollection of the sad state they have been in and the fear 
and anxiety of future attacks (jnelancolie imptilsive ou anxieuse}. 
The cases which yield to the impulsive demand for alcohol are 
little troubled by introspection, as the alcohol has paralyzed the 
higher centers and the memory of events is too vague and hazy to 
give these individuals those afflicting, dismal thoughts which cause 
so great apprehensiveness to the cases which go through the attacks 
without obtaining alcohol. The cases under strict surveillance and 
not allowed to have any alcohol last much longer than do those 
who exhaust themselves by excesses. In these latter cases the 
abatement of the cortical irritation takes place more rapidly. There 
is no demand, desire, or physiologic craving for alcohol in these 
subjects when the nerve storm is over. Alcohol in any form is 
repugnant to them-a radical difference from the inebriate or drunk- 
ard. There are few if any symptoms of alcoholism. 
Of all the phenomena of which the life of the neurotic is replete, 
this one of dipsomania requires conscientious study by the medical 
profession. It is not an isolated phenomenon, but a syndrome. Its 
force, fury, sudden onslaught and periodicity demonstrate that we 
are dealing with a mental disturbance. For the sake of humanity, 
science and sociology we should do our utmost to bring it out from 
the dark chaos in which it is confounded with vicious habits and 
drunkenness, and place it among those psychoses which the science 
of medicine studies and treats as mental and nervous diseases. 
Too great importance has been attached to the alcohol habit in 
connection with dipsomania. Alcoholism never leads to true dipso- 
mania, although alcoholism and pseudo-dipsomania are allied, and 
the error has arisen in confounding the latter with dipsomania. 
The line between the drunkard and the pseudo-dipsomaniac is not 
an incised one, the conditions being those of correlation. The 
pseudo - dipsomaniac is an intermittent drunkard. He will drink 
to excess whenever opportunity occurs, and at no time does he have THE PATHOLOGIC IMPULSE TO DRINK 
5 
that repugnance for or fear of alcohol which possesses the dipso- 
maniac during his lucid intervals. The pseudo - dipsomaniac will 
enjoy an opportunity to drink to excess, but ceases with the oppor- 
tunity. The dipsomaniac knows no halt, no restriction; he must, 
he will, he does, succumb to the impulse to drink to the extent of 
causing total oblivion of all honor, respect and fealty due himself, 
and all duties, obligations and responsibilities due others. 
It was this confounding of dipsomania with pseudo-dipsomania 
that caused Hutcheson, Bucknill, Hack Tuke and others to divide 
dipsomania into several varieties. 
That which distinguishes dipsomania from various alcoholic hab- 
its and conditions is the impulse. Its periodicity causes Kraft- 
Ebing to consider it a periodical insanity, a variety of hereditary 
alienation. Magnan admits that the impulse is a syndrome met 
with in individuals with a hereditary incubus (les syndromes de la 
folie des hereditaires). 
It is evident from what has been said that the victim of dipso- 
mania is born with defective mental equilibrium; that this unstable- 
ness is a profound one, and increases from infancy to full growth, 
and exists throughout the life of the individual. 
Rabid impulsiveness is a phenomenon demonstrating peculiar 
mental states. This impulsiveness may take various forms and 
phases, but whatever its form it diminishes organic and psychic 
resistance. 
(Second Paper.) 
The aim of all scientific research is to understand cause and 
effect. No one individual can grasp more than a general idea of the 
widely diversified scientific thoughts and movements to-day. But 
few of us succeed in even getting a general view of the ever- 
changing phases of single special branches. The effective power 
of scientific research depends upon the subdivision of labor; the 
mutual dependence of any subdivision upon the others, and a har- 
monious and truthful relation among all. In my last paper I 
considered and described the condition of individuals suffering from 
the periodic craving for alcohol - a symptom - complex known as 
dipsomania. Whether we consider this hyperkinesia as a periodic 
insanity or as a latent unstable equilibrium of the cells of the cortex 
aroused by peculiar environment, fatigue, or by one of the numerous 
rhythms which are continually taking place in the central nervous 
system, or, as I believe it is sometimes, due to autointoxication, the 
effects and ultimate results vary but little. 6 
THE PATHOLOGIC IMPULSE TO DRINK 
Berkley,1 Andriezen,2 Bevan Lewis3 and others have given us 
excellent reports on the conditions existing and changes taking 
place in the cortical and central cells of individuals suffering from 
acute and chronic alcoholism. These studies have been useful as 
far as they go; but what is needed is a thorough understanding of 
the conditions existing in the central nervous system which cause 
certain individuals to have an uncontrollable impulse for alcohol- 
the condition prior to any alcoholic indulgence. I admit that to 
attempt any such studies appears rather fatuous, from the obvious 
difficulties which arise. 
There are various hypotheses, speculations and provisional 
statements put forward to account for the periodic attacks of dip- 
somania-statements referring to heredity, environment, predisposi- 
tion, the inability to control impulses, and many other vague and 
unsatisfactory reasons. That there is always a morbid weakness of 
control is evident. There is also the fact of transformed modes of 
nervous energy temporarily bursting the bonds of the individual's 
will; and the function of the brain, the mind, temporarily loses its 
normal mediating power. Bad social conditions, unfavorable envi- 
ronments, a predisposition for alcohol through heredity, faulty 
training and neglect of moral education, will cause lawlessness, 
drunkenness, and its concomitant vices; but aside from the vexed 
question of heredity, we have none of these conditions existing as 
the cause of true dipsomania, but only as the effect during the 
attack. The unfortunate victims of this form of hyperkinesia are 
generally those whose surroundings are of the best, individuals of 
genial and honest natures, educated, bright, and highly intellectual; 
many have been the most brilliant of their time. Hence we must 
seek for some inherent cause in the nervous system which produces 
this unfortunate rhythm in an individual otherwise normal in all 
his acts. 
Dipsomania is a symptom of defective inhibition. Defective 
inhibition may show itself in multitudinous forms of impulsive acts 
- from slight exhibition of temper to atrocious crimes. As the 
majority of individuals suffering from attacks of dipsomania are 
those who live at a high nervous and mental pressure-physicians, 
lawyers, litterateurs, and business men-exhaustion of nervous energy 
is frequent and often continuous, and the reserve brain power is soon 
used up. Exhaustion of nervous energy always lessens the inhibi- 
tion. The cells of the cortex become exhausted by long and 
1 Johns Hopkins Hospital Reports, vol. vi, 1897. 
2 Brain, 1894. 
s Text-book of Mental Diseases, p. 528. THE PATHOLOGIC IMPULSE TO DRINK 
7 
continued expenditure of energy; the individual resorts to alcohol to 
relieve his uneasiness, his restlessness, the result of this cell exhaus- 
tion, and which prevents him from attending to his ever-pressing 
duties. It is then that the defective inhibition is shown, and the 
uncontrollable impulse breaks the bounds of reason and judgment. 
What the pathologic condition of the cells is in these unfortunates is 
unknown. I consider it analogous to the hypothetic pathology of 
hysteria.1 That there is a physiologic similitude between the mild 
hysteric attacks of a woman who tries to control her actions, but is 
not able to do so, and the impulse to drink, which the dipsomaniac 
is aware of, but generally tries to resist, seems evident to me. 
The protoplasm of the cells of the cortex becomes used up by 
continued work without the necessary rest needed for recuperation, 
and while in this vacuolated state they are unable to function their 
parts; a small amount of alcohol rapidly cuts the higher centers 
off from the lower, and the result is a disorganized condition of the 
general nervous system in which the inhibitory power is lost, normal 
volitional potentialities reduced to mere atoms, and impulsive acts 
directed by the stimulation of the lower centers. Starting with such 
conditions it leads one to the hypothesis that a continuance of these 
would result in some organic changes, or at least in such changes 
that each attack leaves the connection between the higher and lower 
centers less active, with a lessened amount of functional force in the 
cortical cells, all of which changes are exhibited in the force, fre- 
quency and duration of dipsomaniacal attacks. 
Some cases of dipsomania can be directly traced to the absence 
of early education in not correcting uncontrollable impulses in early 
childhood, but even here we will invariably find the child has inher- 
ited a richly neurotic soil; demonstrated by uncontrollable impulsive 
acts. In some cases there seems to be an interruption of develop- 
ment in certain centers, as is demonstrated by these impulsive acts 
of childhood. This condition must be understood when training or 
correcting the child. As Donaldson2 aptly puts it: "No amount 
of cultivation will give good growth where the nerve cells are few 
and ill nourished, but careful culture can do much where there are 
those with strong inherent impulses towards development.'' 
The following case well illustrates the disastrous results following 
the neglect to develop the cells of the higher centers by careful and 
intelligent training and instruction: 
A patient, aged 40, was referred to me last year by his family 
1 Hysteria and Allied Conditions, Preston, 1897. 
2 Donaldson: The Growth of the Brain; London, New York, 1896. 8 
77/A PATHOLOGIC IMPULSE TO DRINK 
physician. His social position was of the best; and in his lucid 
intervals, which generally covered a period of four or five months, 
his environments were those of cultivation and refinement. During 
his attacks he was an individual of the type described in my last 
paper. In childhood he was wilful, disobedient, and exhibited a 
temper beyond all self-control. His mother told me that so furious 
would he become over trivial matters that his screaming and violent 
actions would frequently terminate in epistaxis. In one of these 
outbreaks he attempted to stab his mother with a carving knife. 
He would drive the servants out of the house as he grew older, by 
his violent threats and uncontrollable temper. Ordinary mild per- 
suasion and admonition had no effect on him, and thus he grew up 
with defective inhibitory power. He developed extraordinary busi- 
ness capacity, and rapidly rose to prominence in business matters. 
When about 25 years of age the defective inhibition began to show 
itself in dipsomaniacal attacks, which, on account of his value as a 
business man, were overlooked for years, until they became so fre- 
quent and prolonged as to make him useless in any capacity. His 
mother is a neurotic, and displays slight defective inhibitory powers. 
One sister I strongly suspect of being addicted to the morphine 
habit; a brother is a "ne'er-do-well," an aunt died insane, while a 
grandfather on his mother's side was a steady drinker. 
While in' this case we have a history of a neurotic soil, I believe 
that had his training been such as to have compelled him to control 
his morbid impulsiveness, or in other words, had the early signs of 
his defective inhibition been recognized and corrected, we should 
now have a valuable member of society, instead of what his acquaint- 
ances consider a degenerate. There is no degeneracy in such 
cases. The condition is simply one of inherited defective inhibition, 
which can, in most cases, if early recognized, be greatly modified if 
not corrected. As pointed out by Crandall,1 heredity and degen- 
eration are two totally different phenomena. One is an inheritance 
of tendencies or qualities possessed by the ancestors; the other is 
a loss of those qualities. The one produces a condition similar to 
that of the progenitor; the other, a condition dissimilar. The one 
is always transmitted; the other may be transmitted or acquired. 
The victim of dipsomania, like the sexual pervert,2 is one gen- 
erally born of ancestors whose central nervous systems have been 
on an exhaustive strain throughout life. Many men in this country, 
in the last decade, have not married until they have rushed through 
1 Archives of Pediatrics, December, 1897. 
2 William Lee Howard: Psychical Hermaphroditism, Alienist and Neurologist. April, 
1897. THE PATHOLOGIC IMPULSE TO DRINK 
9 
the best portion of their life in the hurry, push and excitement of 
an early business or professional career. They bequeath to their 
progeny the dregs of a former vital and equilibriated cell proto- 
plasm, and the natural result is an unstable nervous mechanism 
which the heir is unable to adjust. 
In these cases the law of heredity prevails, but between the laws 
which are to act and the indefinite variety of forces and circum- 
stances upon which those laws may operate is a vast stretch of 
uncertainty. 
There is another large class of dipsomaniacs whose history shows 
the early disturbance of the cortical cells (in using the word cell I 
refer also to its appendages) during their developmental periods. 
These are the cases which in infancy have been given by " the old 
nurse" alcohol in some form. If one carefully investigates he will 
be surprised to learn what a large number of individuals were early 
quieted by doses of gin and brandy. I have one case on hand with a 
history of gin being given to him daily from birth up to the age of 
two years. I am not referring to the low, ignorant class among 
whom this habit is not unusual, but of a class which consent and 
courtesy calls intellectual. In these cases it is not surprising that 
we find an absence of harmony and lacunae of function rhythmically 
appearing when cell fatigue has exhausted all reserved force. That 
these conditions may exhibit it in phases of the various neuroses other 
than dipsomania is evident; but I am now only speaking of some of 
the causes of this particular symptom of defective inhibition which 
shows itself in the impulsive action to drink alcohol in any form and 
regardless of the consequences. 
I have referred to the favorable social conditions generally sur- 
rounding the victims of dipsomania. It is necessary to accentuate 
this factor so as to bring out more distinctly the neurotic origin of 
this symptom-complex. As Donaldson1 says: ''The central nervous 
system, whatever its natural perfection, must be extremely respon- 
sive to surrounding social conditions, and thus growth processes in 
it be modifiable in no small degree, hence the conditions which 
social states imply." 
Among the other causes producing this dynamic disturbance of 
the central nervous system is autointoxication. As this is a subject 
by itself I merely mention it here. 
A peculiar condition sometimes met with is the coexistence of 
chronic alcoholism and dipsomania. Generally such cases terminate 
rapidly. What original inherent strength the brain had is soon 
1 Op. cit. 10 
THE PATHOLOGIC IMPULSE TO DRINK 
weakened by disease or tissue degeneration due to the chronic 
alcoholism, and a few dipsomaniacal attacks cut off the individual 
in early life. In these cases we generally find a true dysthymia, and 
the end is often by suicide. Two cases in my practise terminated in 
this manner last year. 
In taking up the subject of prophylaxis and cure we must con- 
stantly bear in mind the somatic cycles by which many of our 
unconscious actions are governed. These physiologic rhythms are 
habits of organic activity. I believe that the long rhythms in nutri- 
tion and heat regulations of the body are factors in augmenting and 
aggravating the periodicity of dipsomania. Under pathologic con- 
ditions such as hypothetically exist in this psychic explosion, its 
intervals appear to be governed by the organic cycles, including the 
monthly rhythm of the female with its concomitant changes,1 and 
which in this sex, at this time, is often marked by slight attacks of 
dipsomania. 
It is evident from what has been said about the uncontrollable 
impulses of childhood that the prevention of these analogous attacks 
in adults is in the early training of the child, and a thorough under- 
standing of the heredity of the child. When physicians and parents 
fully realize the meaning and ultimate disastrous results of the 
passionate, paroxysmal, and violent outbreaks, a veritable faire le 
diable a quatre, then will many an individual bless the day that he was 
compelled to control the outbreaks and by such training throughout 
the developmental stage reach manhood with a nervous system work- 
ing in harmony the balance of his life, and able to adjust itself to 
the various circumstances and rhythms as they occur. 
If we have cells controlling inhibition they are dormant in the 
cases where the child shows uncontrollable impulses. Education 
cannot cause any fundamental changes in these cells, but it can 
vastly strengthen them. In all functional activities a tendency to 
the formation of habit occurs, and it makes all the difference 
between happiness and sorrow when by habit we rouse these dor- 
mant cells into constant activity. 
The treatment of dipsomania offers such a perplexing chaos of 
conditions to deal with that I approach the subject with hesitancy. 
The result of studious, laborious and earnest work on one of these 
cases may result in such complete failure as to cause the general 
practitioner to consider them hopeless, and often to ignore or refuse 
to treat them. Only a short time ago a young man came to me with 
pleading aspect and anxious appearance and all the other psychic 
1 Havelock Ellis: Man and Woman, London, 1894. THE PATHOLOGIC IMPULSE TO DRINK 
11 
and somatic appearances of an approaching attack of dipsomania. 
He had been to his old family physician, who gave him the sound 
advice not to take a drink, not realizing for a moment that the 
young man needed intelligent and immediate assistance to follow 
this advice. 
The conditions existing in dipsomania are so different from those 
in inebriety that confinement in an institution offers many difficult 
problems. It is impossible in the early years of the dipsomaniac to 
foretell the time and frequency of an attack. The individual may 
go for a year or more without any symptoms of the dangerous 
psychic mine hidden in the soma, or give any indications when that 
mine will explode. The best we can do is, after getting a complete 
history, past and present, of the case, to educate the dormant cells, 
and as closely as possible correct the defective inhibition. Sugges- 
tion, with or without hypnosis, is of considerable value at this point. 
Everything possible must be done to prevent the exhaustion of 
nerve force, and efforts made to store up reserve material. The 
physiologic rhythms must be watched, and when we see the 
approach of the ebb of these rhythms the patient must be care- 
fully guarded. The rhythm which is particularly apt to be danger- 
ous is the daily one occurring in the afternoon about three o'clock, 
although there is one occurring about eight in the evening which 
also needs to be remembered. It is at these hours that I have my 
patients come to me, giving them an hour or two rest, through sug- 
gestion, thus tiding over an anxious and perilous period, while also 
allowing the necessary recuperation of the cells of the central sys- 
tem. Success greatly depends upon aborting a few attacks. The 
patient feels greater confidence, sees hope ahead, strives with 
strengthened desires, and anxiety is lessened - all of which con- 
tributes to the ultimate psychic result needed, control over morbid 
impulses. It is not desirable to keep these patients restricted or 
confined; they require the mental work and exercise of their daily 
vocations, and the idea of daily treatment is to compel them to give 
the cells of the central system a much needed rest, which they would 
not get, or be incapable of getting, without the moral and material 
assistance given them by one whose heart and mind is devoted to 
these unfortunate and much misunderstood victims of this fin-de- 
siecle period.1 Strychnine is of great value in these cases if used in 
large doses and for a long period. It is surprising how tolerant 
these cases are to strychnine. I often give one-twentieth of a grain 
1 Wm. Lee Howard: Alcoholic Maniacal Epilepsy, Quarterly Journal of Inebriety, 
July, 1897. 12 
THE PATHOLOGIC IMPULSE TO DRINK 
hypodermically every two hours during waking hours, while the 
restlessness, the mental irritation and the other prominent signs of 
an approaching attack continue. I prefer the nitrate of strychnine, 
and keep my patients on it for two years or more. During an 
attack of dipsomania strychnine should not be given. When the 
normal mental condition begins to return it may be used in small 
doses, as the object is to keep the cerebellum as quiescent as pos- 
sible; hence considerable judgment must be used at this period in 
giving strychnine. Under no circumstances should chloral be used 
at any stage in dipsomania. Chloral lessens the inhibitory power of 
the brain. It is scarcely necessary to more than mention the fact 
that all the rational methods used in functional neuroses must at 
one time or another be utilized as adjuncts in the treatment. The 
diet calls for careful supervision and judgment. The amount of 
proteids must be regulated, for it should not be overlooked that an 
exclusive proteid diet causes the formation of excessively large 
quantities of soluble peptones and albumoses, which have an excit- 
ing action on the nervous system and constitutes a favorable basis 
for the development of the multitudinous neuroses. 
There are several important and interesting medico-legal ques- 
tions to be considered in dealing with uncontrollable impulses. 
Rigid lines should be drawn for the courts to recognize between the 
responsibility for acts committed by the inebriate and those com- 
mitted by the dipsomaniac. 
It is to be hoped that teachers, parents and physicians will per- 
ceive in the child the basis for a useful or useless life according to 
the understanding of the heredity, and thus prevent an increase 
of uncontrollable impulse which so often leads to the distressing and 
ruinous neurotic disease, dipsomania. MEDICINE 
* * ♦ 
EDITOR-IN-CHIEF: - HAROLD N. MOYER, M.D., 
Adjunct Professor of Medicine, Rush Medical College; Neurologist 
to the Cook County Hospital, Chicago. 
♦ * ♦ 
DEPARTMENT EDITORS: 
Medicine: James B. Merrick, A.B., M.B., Adjunct Professor of 
Medicine, Rush Medical College; Attending Physician to Cook County 
Hospital, Chicago; and Bertram W. Sippy, M.D., Professor of 
Medicine in the Chicago Post-Graduate School. 
Surgery: Weller Van Hook, A.B., M.B., Professor of Surgery in the 
Northwestern University Medical School and in the Chicago Policlinic; 
Surgeon to the German Hospital. 
Pathology and Bacteriology: Arthur R. Edwards, A.M., M.B., 
Professor of Therapeutics, Northwestern University Medical School; 
Professor of Practise of Medicine and Clinical Medicine, Northwestern 
University Woman's Medical School; Attending Physician to Cook 
County and St. Luke's Hospitals; Pathologist to Wesley Hospital. 
Therapeutics: N. S. Mavis, Jr., A.M., M.B., Professor of the 
Principles and Practise of Medicine and of Clinical Medicine, North- 
western University Medical School, Chicago. 
Gynecology and Obstetrics: Henry P. Newman, A.M., M.B., 
Professor of Clinical Gynecology in the College of Physicians ana 
Surgeons, Chicago; Professor of Gynecology in the Post-Graduate 
Medical School; etc. 
Pediatrics: Isaac A. Abt, M.B., Professor of Diseases of Children, 
Northwestern University Woman's Medical School; Attending Physician 
Diseases of Children, Michael Rerse and Provident Hospitals. 
Neurology and Psychiatry: Hugh T. Patrick, M.B., Professor of 
Neurology in the Chicago Policlinic; Consulting Neurologist to the 
Illinois Eastern Hospital for the Insane. 
Laryngology and Otology: W. E. Casselberry, M.D., Professor of 
Laryngology and Rhinology in Northwestern University Medical School; 
Laryngologist and Rhinologist to St. Luke's Hospital; Laryngologist 
to Wesley Hospital; etc. 
Bermatology and Syphilology: W. L. Baum, M.D., Professor of 
Dermatology and Syphilology in the Post-Graduate Medical School, 
Chicago; Fellow of the Chicago Academy of Medicine. 
Ophthalmology: C. P. Pinckard, A. B., M. B., Professor of 
Ophthalmology, Chicago Post-Graduate Medical School; Attending 
Ophthalmologist, Michael Reese Dispensary, 
Genito-Urinary Biseases: G. Frank Lydston, M.B., Professor of 
Surgical Diseases of the Genito-Urinary Organs and Syphilology in the 
Chicago College of Physicians and Surgeons. 
Climatology and Public Health: Norman Bridge, M.B., Los 
Angeles, Cal., Professor of Clinical Medicine and Physical Diagnosis, 
Rush Medical College; and Joseph M. King, M.B., Los Angeles, 
Cal. 
Forensic Medicine: M. B. Ewell, M.B., LL.B., Dean of the Kent 
College of Law, Chicago. 
We are endeavoring to place before physicians a journal that shall 
contain strictly scientific matter, equally interesting to members of the 
profession in all parts of the country. All matters of a personal or con- 
troversial kind are excluded; also society news, and items of local impor- 
tance only. MEDICINE shall be kept abreast of the times, but matters 
which, as yet, do not admit of an authoritative opinion will not be ex- 
tensively considered. 
HAROLD N. MOYER, M.D., Editor.