Dipsomania
116 Art. IX.? Attention has again been drawn to the prevalence and increase of dipsomania in England, and the following letter and circular has lately appeared in the medical journals :?
DIPSOMANIA.
Sir,?It is now more than twelve months since I was urgently entreated by a former patient to try to establish a Home in the environs of London for the treatment of intemperance in the upper and middle classes. I set myself the task, therefore, of ascertaining whether such an institution would be desirable, whether it would receive the countenance and aid of my medical brethren, and whether it could be made self-supporting. On all these points the evidence was conclusive and in the affirmative. That an institution devoted exclusively to this class of patients, and this only, was desirable seem proved by the fact, within my own knowledge, that many dipsomaniacs of the above classes,, who would gladly avail themselves of such a Home, did one exist, are now disposed of either as inmates of lunatic asylums or of hydropathic establishments, or in the families of medical men or of clergymen, in none of which can they be treated as their case demands. The desira- bility was also attested by all those leading physicians and psychologists to whom I applied for information and advice on the subject, and who have kindly attached their names to the document accompanying this letter. Further testimony was met with in the ” Report of the Select Committee on Habitual Drunkards.” Dr Forbes Winslow, in his evidence, expresses his belief that ” if establishments were organised for the reception of persons addicted to chronic habits of intemperance, hundreds would avail themselves of these institutions, and voluntarily surrender themselves for a time to control and treatment. Such insti- tutions are to my mind one of the great and crying wants of the age.” Dr Druitt expressed his opinion that inebriate asylums were quite as much required as lunatic asylums, and that 11 they would be the salva- tion of many.”
That the Home I propose to establish would receive the countenance and aid of my professionaljbrethren, I have every reason to believe’from the letters I have received from members of the profession in different parts of the country, and from the promised support of those eminent men who have signed the accompanying letter. I am aware that many take a less sanguine vieAV than myself of the amount of good likely to^ be achieved, and consider it essential that there should be a legal power of detention, and it is well known that the late Mr. Donald Dalrymple gave up his practice and entered Parliament for the express purpose of inducing the legislature to grant this power. Admitting the desirability of getting such a law passed, and the increased success in treatment that would result, yet I maintain, both from personal experience and from the reports I have received of the working of similar institutions in America, that much more might be done than is actually accom- plished, were a more systematic method of treatment pursued than has hitherto been attempted in this country; and this brings me to the last point of my enquiry, Whether the institution could be made self- supporting ? On this subject I have ascertained that, provided the establishment be conducted on a sufficiently large scale, little or no risk will be incurred. To assist me in raising funds for the purpose, the Earl ?of Shaftesbury has kindly consented to preside at a meeting to be held in Willis’s Rooms, on Thursday, the 11th of February, at three o’clock in the afternoon, and I earnestly entreat all those of my medical brethren who are interested in the subject to attend and support his lordship. Several eminent members of the three learned professions have promised to take part in the proceedings.
Yours &c. Carsten Holthouse. London: January 1875. To Carsten Holtliouse, Esq., 3 George Street, Hanover Square. We, the undersigned, fully alive to the prevalence of this disease, and to the great want of an institution specially devoted to its treatment, are of opinion that such a one as you propose?which shall afford to its inmates the comforts of a home and the pleasures of society, while at the same time they are protected from temptation?would be a great boon both to the patients and to their families, and is well entitled to our recommendation and support. George Burrows, M.D., F.R.S., C. B. Radcliffe. President of the Royal College Henry Munro, M.D. of Physicians. William Wood, M.D. Thomas Watson, M.D. H. Maudsley. Chas. J.B.Williams, M.D.,F.R.S., G. Fielding Blandford, M.D. President of the Royal Medical William Fergusson. and Chirurgical Society. James Paget. William Jenner, M.D. Prescott Hewett. William W. Gull, M.D. Henry Thompson.
J. Russell Reynolds. T. Harrington Tuice, M.D. Although we agree with Mr. Holthouse that a ” Home ” for inebriates is very desirable, at the same time we are of opinion that the scheme will prove a failure unless it receives the support of the legislature. It is impossible for any institution to be established upon a sound footing, in which such persons may voluntarily place themselves for any specified time, except some measure is passed by Parliament empowering us to deal with this variety of disease.
A person suffering from dipsomania cannot be confined in an asylum under certificates, and it is absurd, except in cases where the mental faculties are disordered, to attempt to place a dipsomaniac under legal restraint. It is only where mental disorder follows as a result of dipsomania, and evident signs of insanity are evinced, that any interference can be placed on a patient. When alluding to the subject, the Commissioners in Lunacy observe:?” We have considered that a Lunatic Asylum is not a place for the permanent detention of persons who have recovered the use of their reason, and are not obnoxious to the charge of unsoundness of mind otherwise than on account of the liability to run into their former excesses when restored to liberty.”
Dipsomania is a disease which for many years has been attracting the attention of Government, but we regret to say without any success, and no measure enabling us to deal with this form of mental disorder has as yet been adopted. In 1834 a Committee of the House of Commons was ordered to enquire into the prevalence of drunkenness, and again in 1872, but notwithstanding a large amount of valuable and useful informa- tion was gathered together, they failed to lead to any result. In Scotland, Ireland, the United States of America, and other countries, Dipsomaniac Institutions exist, which are recognised by the various Governments, but in England, we regret to say, no such establishment is to be found. Ordinary intemperance is quite distinct from what is understood by Dipsomania, by which is meant an irresistible yearning for intoxicating drinks, existing, we regret to say, to a frightful extent in the present day among all grades of society, females being, as a rule, more prone to it than males, especially young married ladies. In Scotland there is a provision in the “Lunacy Act 1866 ” which enables persons to place themselves in an asylum on their own written application, having obtained the sanction of the Commissioners in Lunacy. This is a very good provision, and the patients have an opportunity of thus obtaining proper treatment, and we most sincerely regret the absence of a similar provision in our own law.
In England a person can place himself voluntarily in an asylum, provided he has been a certificated patient any time within five years from his application to be admitted as a boarder. This provision is of little use as regards dipsomaniacs, who, beyond the insane and irresistible desire for drink, cannot be pronounced as being legally of unsound mind.
In 1865 “An Act for the better Regulation and Discipline of the New York State Inebriate Asylum” was passed, and in Section 4 we read: ” Any justice of the Supreme Court, or the county judge of the county in which any inebriate may reside, shall have power to commit such inebriate to the New York State Inebriate Asylum upon the production and filing of an affidavit or affidavits by two respectable practising physi- cians, freeholders of such county, to the effect that such inebriate is lost to self-control, unable from such inebriation to attend to business, or is thereby dangerous to remain at large; but such commitment shall be only until the examination now provided by law shall have been held, and in no case for a longer period than one year.”
No patients are received for a less period than three months, and all are bound to observe the regulations of the institution. Any person entering the above institution voluntarily must sign a bond agreeing to abide by the rules.
The Select Committee of the House of Commons, appointed in 1872, to enquire into the general management of habitual drunkards, sat from March 8 to May 10, at intervals; and during this time many very important witnesses were examined as to their experience on the subject, among whom we may mention Dr J. Cricliton Browne, Medical Superintendent, West Riding Asylum, whose great experience among the insane is proverbial, and who is one of our greatest authorities on insanity ; the late Dr David Skae, formerly Medical Superinten- dent of the Morningside Asylum; Dr Peddie; Dr John Nugent, Commissioner in Lunacy for Ireland; Dr Mitchell, Commis- sioner in Lunacy tor Scotland ; Mr. Balfour Browne, author of ” Medical Jurisprudence of Insanity,” and other works on the subject; Dr Dalrymple, M.P., Chairman of the Committee; Dr Forbes Winslow ; Dr Christie ; Dr Parrish, Superintendent of the Pennsylvanian Sanitarium, &c. &c.
The late Dr Forbes Winslow for many years urged on the profession and legislature the necessity of establishing Dipso- maniac Institutions; and in a small treatise on ” Uncontrollable Drunkenness,” he says, ” I have for a period of seventeen years edited the Quarterly Journal of Psychological Medicine, and have unceasingly endeavoured to impress upon the public and medical mind the importance of establishing in this country asylums or hospitals for the reception and treatment of those who have unfortunately become addicted, as the effect of some form of cerebral disease, to uncontrollable or uncontrolled habits of intemperance.”
We think, as the question relative to legally dealing with dipsomaniacs is now brought prominently before the public, it is desirable to give the verbatim evidence of the late Dr. Forbes Winslow, when examined before the Select Committee of the House of Commons in 1872.
Dr Forbes Winslow called in and examined. The Chairman : I believe you have had very long acquaintance with insanity and intemperance amongst the upper and upper middle- classes more especially ??I have for the last thirty years of my life. I propose to confine the questions which I am going to put to you to that class only: I am not proposing to take you into the lower stratum of the subject we have to deal with. In your long intercourse with these classes, have you found insanity resulting from intemperance to be of frequent occurrence ??In the upper classes of society, the insanity which can be clearly traced to habits of intemperance, of course, is not so great as in the lower stratum of society. It is very often associated with a morbid disposition to take stimulants to excess; but the actual insanity itself is not so easily traceable to habitual intemperance as among the lower and pauper classes of society. But amongst the upper and the upper middle-classes with whom you have had to deal, you have come frequently in contact with those forms of insanity resulting either from or produced by intemperance ??In the middle class of society certainly a good many cases of insanity which have come under my observation and treatment have been clearly traceable to habits of intemperance.
I believe that for some very considerable time past you have enter- tained views upon the necessity of legislative dealing with this particular form of social trouble ??I have.
I think it will save time if you will, in your own way, communicate to the Committee what your views upon the subject are.?My opinion has been that if establishments were organised for the reception of persons addicted to chronic habits of intemperance, hundreds would avail themselves of those institutions, and voluntarily surrender them- selves for a time to control and treatment. Such institutions are, to my mind, one of the great and crying wants of the age. The class of cases to which I refer are not admissible into the ordinary lunatic asylums, as they cannot be legally certificated to be of unsound mind, .according to the strict letter of the law. Medical men who have to certify as to the mental unsoundness of the person prior to his being placed under legal restraint, have to state what they themselves observe as to his insanity or mental unsoundness; and unless they can detect some aberration of intellect, evidenced by hallucination, delusion, or clearly manifested disorder of the brain, such as general paralysis or softening, and unless they can insert in the document that the patient is suffering from some aberration of intellect, specifying what its form is, or detect symptoms of diseased brain, such as softening of the brain or general paralysis, they cannot legally sign the certificate. The fact of a man or woman being an habitual and violent drunkard is not suf- ficient to meet the requirements of the statute test, and therefore there are numerous cases which one would gladly place under restraint, and which ought to be under restraint, not only for the protection of their own lives, but for the protection of the lives of others, which cannot be dealt with. It has often happened that these cases have ?come before me, and I have said, it is a very sad thing to see them without having the legal power of placing them under restraint. I went down to see a nobleman not very long ago, who had been in a state of intoxication for four or five weeks; he had not been sober during (that time for one day; but I could see nothing in his mental or physical condition to justify me in advising him to be placed in a lunatic asylum. I was satisfied that the man was killing himself, and ought to be under restraint. This is a type of case which I think should be dealt with by the legislature. Where you can establish habitual drunkenness, and the patient is not inclined voluntarily to put himself in an asylum, I think the fact of his being proved to be in this condi- tion should be sufficient to justify confinement. There are many cases of this, kind that you cannot deal with. I know numbers of ladies, moving in very good society, who are never sober, and are often brought home by the police drunk. They are wives of men in a very high social position. I have been often consulted about those cases; my hands are tied; I could not legally consign them to the asylums; I have no doubt there is the insanity of drunken- ness in them, but it is not the insanity which comes Avithin the strict letter of the law. The legislature does not recognise habitual drunkenness as a form of insanity, although medical men do. Of course it is very difficult to draw the line of demarcation between what I should term normal drunkenness and abnormal drunkenness; of course there is normal drunkenness, as there is normal forms of any other vice. It is very difficult to deal with drunkenness as a vice; but when it passes the boundary line, and ceases to be a vicious propensity, whatever form it may assume, then the depraved morbid craving for stimulants is clearly traceable to the mental condition, and of course under these circumstances you may deal with the disease, or you ought to be able to deal with it. There is a morbid craving for stimulants which is clearly traceable to a brain condition; it is a form of insanity, although it is not recognised by law. A man who has had ample opportunity of observing these cases, and studying them, is able to diagnose pretty accurately the difference between normal drunkenness and abnormal drunkenness. But you may have, as I said, ordinary licentiousness, which you may see manifest in all parts of London in the public streets; that is a vice which is very difficult to deal with, except by the police; but that vice sometimes passes from the normal into an abnormal state, and the exaltation of the instincts becomes a disease, or mania. There are very many forms of insanity springing out of the indulgence of the passions.
I gather thus far from your evidence, that you do not consider the ordinary lunatic asylum the proper place in which a person should be put who is labouring under insanity the result purely of intemperance? ?I think myself, in the absence of any other kind of institution, we have no other means of dealing with these cases, but I think it is a form of insanity which ought not to be associated with ordinary cases of lunacy. If we have institutions distinct and apart from ordinary lunatic asylums, and placed under a distinct course of direction, and perhaps with a different class of inspectors and directors, they would, I think, tend very much to diminish the amount of drunken insanity. And it would tend to lessen the number of the inmates of the asylums as they now stand ??Undoubtedly, because for a certain time a man may show a morbid and a diseased craving for drink without any other symptom of mental aberration, or without any other symptom of disordered brain; but if it goes on unchecked and untreated, it must pass into actual insanity. If we could deal with those cases in the early stage in which you have morbid, irresistible, and uncontrollable desire for drink, if you could check it in that stage, by placing the patient under strict control, and deal with him as you would deal with any other form of disease in its incipient stage, you would arrest the development of incurable forms of disordered brain. These terminate either in chronic aberration of the mind or in chronic brain disease.
Is it not the fact that as regards the dietetic treatment of the ordinary insane and of the habitual drunkard, a person drunk from an excessive indulgence in liquor, there is a difference made?that is to say, is it not the fact that a person suffering from ordinary insanity may require a considerable quantity of stimulants ??In some cases.
Whereas, where it arises from indulgence in drink, it is a great mistake to give drink ??It must not be given ; it is a great mistake to suppose that injury arises from stopping the drink; it is poison that is imbibed, and you must stop the poison, and you may do so with perfect impunity.
The dietetic treatment is not the same ??No, it is not; of course there are certain forms of insanity associated with a considerable amount of vital depression, in which cases you must give stimulants. How far do you believe that, if private institutions provided with legislative power to retain patients for an adequate period of time were established, they could be made for the upper and middle classes to pay their way, our object being of course to separate those which could be provided by the State in some shape or other from those which could be provided by private enterprise ??I believe such institutions would be a national blessing, and in many cases, I believe, they wrould be self- supporting. 1 am satisfied that I could have had under my care some thousands (I am speaking within bounds) of cases of morbid drunken- ness?I might say, of insane drunkenness?which I could have placed under restraint if I had had an opportunity of doing it. I have seen the most frightful amount of loss of life, poverty brought upon families, grievous, dreadful, and dire domestic distress and sorrow, and families wrecked and ruined by not being able to deal with those cases. In fact, as I have often said, “Your husband or wife is committing suicide, and requires as much to be controlled as if they were taking belladonna, or opium, or any other form of poison.” I look on alcohol as a poison. Every means should be had recourse to to limit or restrict the sale of a poison, as you interfere with the indiscriminate sale of opium, prussic acid, or arsenic. Alcohol is not a necessary of life; it should be dealt with by the legislature as a poison. A person goes into a dram shop and takes his rum or whisky ; he imbibes a poison. After a time his nervous system becomes saturated with it, and the brain itself becomes surcharged with alcohol; and, as is the case very often with chronic drunkards on examination after death, if you apply a light to the fluid in the ventricles of the brain, it ignites into a flame. You can actually distil alcohol from the brain of chronic drunkards; the brain is so saturated with the spirit, and of course the whole source of vitality becomes poisoned.
Are you of opinion, with regard to these institutions destined for the inebriate and the asylum proper, that there should be no confusion between the two, either in the public mind or in the legislative mind ?? I should keep them quite distinct. I believe that if sanatoria were established on a broad basis, and the inmates of those institutions were allowed a certain amount of rational enjoyment, and subjected to the minimum amount of restraint, and that not an offensive restraint, and had all the reasonable indulgences of life brought within their reach, thousands would go into those institutions; how long they would remain is a very different question.
Have you at all formed an opinion as to under whose control or inspection such establishments should be, because you would, of course, desire that they should be both controlled and inspected ??I think they should be subjected both to legal and medical inspection. I question very much whether, considering how overworked the* present Commis- sioners in Lunacy are, you could fairly put under their control and supervision any institution of the kind. 1 think that there should be a distinct and separate board for the supervision of those institutions. The boundary between vice and disease which Dr Mitchell has so accurately drawn, is one which might be left to the educated mind, but which could not be left to the ordinary inexperienced person ??No ; I think that a medical man who has had practically to deal with these cases has very little difficulty in coming to a right conclusion as to whether the boundary line has been overstepped; in other words, whether the condition is that of normal or abnormal drunkenness; whether it has passed from one stage into another, just as he can distinguish eccentricity in one man from eccentricity Avhich has passed into actual insanity in another. Experience gives him an additional sense, and enables the physician to come to a right conclusion; he ought rarely to commit a mistake in his diagnosis. I am referring to the judgment of an experienced physician. There are certain symp- toms that clearly indicate dipsomania, in which the morbid craving for drink springs from a disorder of the brain, and there is a craving for drink which is to be considered as a vice. I have had in my own institution a great many patients who have come voluntarily and placed themselves under treatment. Perhaps there has been a little undue straining of the law to receive them, but there has generally been some physical symptoms which you could lay hold of, such as, perhaps, general paralysis, or symptoms of some other form of organic disease of the brain, such as loss of memory and faint scintillations of aberration, so that if he can get hold of these facts, the medical man is justified then in certifying, but without that he cannot do so.
In the event of institutions such as these being established, you would of course give a power of detention for what might be deemed an adequate length of time by parties who had the control and super- intendence of the institution ??I am certain that nothing good could be done for these cases unless they were kept for a considerable time under control; it is difficult to say the amount of time they should be detained under supervision; I should say twelve months, at least, would be a fair test of recovery, and even then I am not certain whether the habit could be eradicated. A man places himself under control, and is thoroughly conscious of his sad and lamentable condi- tior.; he feels the necessity for restraint; he knows that he, by his habit of intoxication, is ruining himself and beggaring his family. He says, Here I am, take charge of me; I will remain any time you like under restraint; I surrender my free agency into your hands; and in the course of perhaps a fortnight or three weeks he is apparently well; the poison in the shape of stimulants is kept from him, and he loses the craving for it, and is apparently in possession of his senses; the ?craving for drink perhaps returns; perhaps it has been in existence during the whole time he has been under restraint, but has been kept in subjection. He says I feel quite well, and I want to go out; I want my liberty. You cannot restrain a man under those circumstances, unless you are legally authorised to do so; if he signs a document and says, I voluntarily surrender my freedom, and place myself in your institution for six or more months, that document would have no legal force if the man, when he was apparently restored to his senses, were to say, I will remain here no longer; I want to go. If you say to him, You signed a pledge to remain here for six months, he would say, I do not care for that document; and would tear it up just as a man would tear up his will. But if any legislative enactment provided for a con- tingency of that kind, we might say, You think you are well, but we do not think so, and we cannot allow you to leave until we are satisfied that this dreadful habit has been eradicated; but how to discover when the morbid desire for stimulants is really cured is a problem I cannot attempt to solve, for in the majority of cases of habitual drunkenness there is associated with it a disordered state of the brain which you do not cure; there is a disordered appetite which you do not eradicate. Although you keep the patient from drink, the craving for it is sure to return. There is no class of affections which, viewing them as mental affections, are so liable to relapse as drunkenness; you apparently extinguish other forms of mental disease, but with regard to this un- happy propensity, you never feel safe that the habit is crushed.
Mr. W. H. Gladstone : I understand you to say that you would not advocate compulsory detention until the habit passes the bounds of mere vice, and assumes the nature of a disease ??I would not until the craving for or the indulgence in stimulants was clearly symptomatic of a mental or brain disease, or a disordered condition of the mind or brain, manifesting itself principally in a craving for stimulants; there is no doubt a form of disordered brain in which the craving for stimulants is the prominent, and very often the only symptom.
Should you say that the ordinary drunkenness among the lower classes is of that character ?-?Certainly not; there is an enormous mass of drunkenness in the lower classes which cannot be traced either to mental or brain disease in the right acceptation of these words. The habit of drunkenness so in many cases eventually passes into mental alienation and brain disorder, and in thousands of instances it does. The county asylums of this country are filled with such cases. And you do not consider the term habitual drunkards includes that class ??No, I do not; I think there are habitual drunkards as well as there are habitual prostitutes, and persons who habitually indulge in any other form of vice. It is their natural and normal state. Mr. Mitchell Henry : Did I understand you to say that the fluid in the ventricles of the brain of an inebriate patient could be ignited ? ?Yes, there have been cases upon record where the serum in the ventricles of the brain of a chronic drunkard has actually been ignited. Have you ever seen that ??I have never seen it myself.
Have you ever seen anybody who has seen it ??No, I have not; it is so recorded by experienced authors; some German authors, and some French authors, have referred to it.
It has never come within your own experience??I have never tried the experiment.
Mr. Akroyd : Were you alluding to cases of spontaneous combus- tion ??No, I was not.
Mr. Mitchell Henry : Do you believe that the evidence is of such a character that we can believe it ??It appears to come from very good authority. I do believe, in habitual drunkards, that the whole nervous structure, and the brain especially, becomes poisoned by alcohol; all the mental symptoms which you see accompanying ordinary intoxication result from the poisonous effect of alcohol upon the brain ; it is the brain which is mainly affected. When a person takes stimu- lants to excess and becomes inebriated, it is in consequence of the brain being poisoned. In temporary drunkenness, the brain becomes in an ab- normal state of action, and the mind in an abnormal state of alienation, and if that habit is persisted in for years, the nervous tissue itself be- comes permeated by the alcohol; and organic changes take place in the nervous tissue of the brain, producing that frightful and dreadful chronic insanity which we see in our county asylums, traceable entirely to habits of intoxication, lou will never diminish the amount of pauper insanity until you deal with the great question of alcohol, and by legislation prohibit as far as you can its improper sale. I look upon public-houses as great centres for the distribution of poison. There would, no doubt, of course be great difficulties in practically dealing with this question. I should, by legislative enactment, put as many restrictions upon the sale of the various kinds of alcohol as I should restrict the sales of ordinary poisons; I think alcohol should be both dealt with as a frightful source of moral and physical deterioration. The human race, morally, mentally, and socially, is, I believe, dete- riorated by that poison; drunkards have drunken children. I was reading some statistics of idiots in the State of Massachusetts, where actually half the idiotic children were traceable to drunken parents; and it is the case that a large percentage of frightful mental and brain disturbance can be traced to the drunkenness of the parents, recognising the great physiological law, that ” like begets like.” I was looking at some statistics the other day in a list of criminals; there was ” a father a drunkard, grandfather a drunkard, grandmother an idiot,” and in the whole line there figures that family; they were drunkards, they were criminals, they were idiots; all the forms of vice were hereditarily transmitted.
Mr. Birley : What is the effect upon an habitual drunkard if he is suddenly and absolutely cut off from his accustomed stimulants??. There is a degree of vital and mental depression.
But no serious injury to the constitution itself??I do not think sof I have never seen it.
Under what authority would you propose that an habitual drunkard should be detained in confinement in such asylums as are contemplated ?, ?If there is a legislative enactment dealing with these institutions, I do not think there would be any difficulty in carrying it practically into effect.
Upon medical certificates, and the authority of a magistrate??Yes. And then I suppose you would have those asylums under the control of the Government Inspectors or Commissioners??Yes, certainly; and there is another provision of the law which I should like very much to see carried into effect, and it has been carried into effect with great success in some of the American States, that if you can establish a case of habitual drunkenness against a man, and prove that he is ruining his family and squandering his property, although he may not be in a -condition of mind to justify his being placed in a condition of legal restraint, in certain States of America the relatives have the power of representing to a judge in the State, ” This gentleman is drunk several times a week, or chronically drunk; place him and his property under the protection of the law “; and that is accordingly done.
Are you aware whether that power is abused very much ??I cannot answer that question, but I think that is a very wise provision; and I have seen in my own experience families perfectly ruined and beggared by the head of the family being a drunkard, and not being able to be dealt with. I always thought what a blessing it would be if there could be a mild provision of the law recognising the condition of recklessness or improvidence caused by drink, under which property is being squandered; and that upon the receipt of proper evidence the judge be authorised to say, I take from the control of this habitual drunkard the management of his estate, and place it under the care of persons appointed by the court, until he shows that he is fitted to manage it himself. Of course I refer to persons who are habitual drunkards, and whose mental powers are evidently impaired by drink.
The great object for us to pursue in the general management of dipsomaniacs is to endeavour to establish in them a power of self-control by firm but judicious treatment for a consider- able period; and we must again contend that, for any per- manent good to result from such treatment, the patients must be submitted to legal restraint in an institution recognised by law, and we do not anticipate, whatever the motive may be, any good resulting from the establishment proposed to be opened by Mr. Holthouse.
If in England institutions were established in which dipso- maniacs could voluntarily place themselves under restraint, they would still be free agents, at liberty to leave when they wished, and to do what they pleased whilst resident in the institution, and they could not be legally subjected to restraint. The withdrawal from all stimuli is the chief part of our treat- ment, and this cannot be effected if the person is a free agent. We must regard all dipsomaniacs as cunning in the extreme, artful, and generally unable to speak a word of truth; we cannot trust to their honour in desisting from drink, for they have none. Public opinion is against the deprivation of a dipsomaniac’s liberty, and states that any person is permitted to get drunk if he likes to do so. We have lately had an opportunity of seeing the evil resulting from our inability to deal legally with dipsomaniacs in several cases where the property has been squandered, and the family reduced to the utmost extremity of ruin and despair.
We now propose to consider the legal relations of drunken- ness and dipsomania.
With regard to the legality of restraining drunkards, we contend that any person who is in a state requiring forcible detention, from whatever cause it occurs, becomes amenable to be dealt with by law. In signing a medical certificate, we are called upon to certify in the 8 and 9 Vict. c. 100, ” That the said is a person of unsound mind, and a proper person to be taken charge of and detained under care and treatment,” &c. A man who is in a state of raving mania, brought on by drink, is certainly a proper person to be placed under legal restraint until the attack subsides.
The medical certificates justifying the admission into the asylum do not allow of the detention after the attack has passed away. In order to give the patient an opportunity of recover- ing, a statement is sent to the Commissioners in Lunacy of the mental and bodily condition of the patient; the examination for this must not be made until the patient has been in the asylum for two clear days, or more than seven. The patient, though raving from drink on his admission, may recover in the two days previous to the examination for ? statement,” and may consequently be discharged. In making the above re- marks, we are conscious that we are doing so in opposition to the general opinion, but we must contend that, taking the Act ipsissima verba, we are empowered so to act.
Dr Taylor, in his valuable and world-renowned work on ” The Principles and Practice of Medical Jurisprudence,” draws our attention to some important medico-legal enquiries relating to this matter. In the case of Scott v. Waken, the defendant5, a medical practitioner, was sued for damages for causing the plaintiff to be restrained, who was at the time suffering from delirium tremens. In consequence of his violence and excite- ment, it was found necessary to send for a medical man. The defendant, who found the plaintiff in a most excited state, with loaded pistols in his hands, threatening to shoot his wife, and to prevent this two men were holding him. He was in a fit of delirium tremens, in a dangerous state, and quite unfit to be at large. The defendant placed a man in the house to watch him during the night. The plaintiff, so restrained and unable to obtain any more drink, recovered from his attack next morn- ing, and brought an action for damages against the medical man for illegally restraining him. Baron Bramwell, in charging the jury, stated that, if the medical man knew that at the time the plaintiff was a dangerous lunatic, and as such likely to do mischief to himself* or others, restraint would be justified, not only at the moment, but until the danger had entirely subsided.
Notwithstanding the evidence given at this trial, the plain- tiff obtained a verdict. We have read the facts of the case carefully through, and we must express ourselves astonished at the verdict. A physician finds a patient raving mad from drink, forcibly held down by two men to prevent violence, with two loaded pistols in his possession, sends an attendant to protect not only himself but his wife from disgrace, injury, and probably murder, and, as a consequence of the prompt action of the medi- cal man, an action-at-law is brought against him. We are of opinion that the judge would have been justified in instructing the jury to non-suit the plaintiff, for in England delirium tremens is regarded and recognised as a form of insanity, and its legal relations are the same, and restraint is legally allowed, for in delirium tremens the brain is functionally disordered, and the person so afflicted insane for the time and dangerous and unfit to be at large.
Any act committed by a person whilst in a state of ordinary intoxication is valid, and it has been ruled that drunkenness is an aggravation of the offence. Sir Edward Coke remarked that ” a drunkard who is voluntas-dcemon hath no privilege thereby, but what ill soever he doth his drunkenness doth aggravate it.” Most of the frightful crimes and atrocities we read of are com- mitted by persons whilst under the influence of drink, and this is often pleaded by counsel as a mitigation of the offence. It is very difficult to draw a distinction between a violent attack of drunkenness and delirium tremens, yet the law makes a great difference in dealing with them.
In this case the wife denied that she had given any authority for interference, and so her evidence was conflicting with that of the defendant. A medical man who is called in to a case is surely allowed to use his own discretion where evident danger is imminent. A person maniacal from drink is quite as dangerous as if suffering from acute mania, and restraint is, in our opinion, quite justifiable ; and we consider that any practitioner who did not insist upon it would be liable to great censure. Cases are frequently brought under our notice of persons suffering from delirium tremens, who have attendants placed with them to prevent any harm incurring from violence. We remember being consulted in the case of a gentleman who had an attack of delirium tremens, and upon arrival at the house we found him in a state of maniacal excitement from drink. It was late in the evening, and the sole other occupant in the house was the wife. The patient was in such a dangerous state, with razors in his possession, threatening to destroy his wife, that immediate restraint was recommended, and we remained in the house until an attendant could be procured. The next morning the patient recovered, and restraint was removed; but it is our decided opinion that if immediate restraint had not been used, fatal results would have ensued from the violence of the patient. We will follow the history of the above case a little farther, as a proof of what we have stated. A few weeks sub- sequent to this, a second attack came on, medical certificates were obtained, and the patient was sent to an asylum; he recovered in a month, but his wife, contrary to the urgent advice of the medical officers, decided upon taking him home, the result being another violent attack, during which he killed his wife.
Such, then, would, in our opinion, be the result of most cases of delirium tremens accompanied with violent symptoms, if restraint were not resorted to ; by restraint we mean the super- vision of an attendant.
Another case, Symna v. Fraser and Andrews, tried at the Court of Queen’s Bench, seems to us as being a positive contradiction of the verdict given in the first-mentioned case. The plaintiff was a woman who had an attack of delirium tremens for two years previous to the trial.
The defendants were called in to attend her professionally. A nurse was placed with her, and acted according to the instructions laid down by the medical men. The action was for placing her under personal restraint. From the symptoms mentioned in the case, restraint was justifiable; and from a careful examination and consideration of them, we are of opinion that it was a case requiring legal restraint, especially when we read of a person with the following symptoms:?A distrust and dislike of all around her, a disposition to talk incessantly, rambling speech, attempts to get out of the win- dow, violence towards people, and a tendency to delirious delusions. The Lord Chief Justice Cockburn, who tried the case, drew a distinction between the assumption of authority and the instructions given to the attendant, and urged that the medical men would be responsible for the restraint used by nurses or attendants who were in attendance on their cases. This is no doubt true with regard to mechanical restraint used in an asylum, where none is allowed to be used without the knowledge and sanction of the medical officers; but we cannot see in what way a medical man can be responsible for the acts committed by an attendant. In this case the plaintiff was non- suited, the jury expressing an opinion that the restraint was necessary, and that no more was applied than what was abso- lutely required. This trial lasted five days.
At the commencement of the present year we read of another murder, committed by a person whilst suffering from delirium tremens. Here is a case where, if restraint had been used, no such murder would have been committed.
{Before Mr. Justice Denman.) Shocking Case of Murder.?James Hayes, 40, leather dyer, was charged upon ail indictment, and also by the coroner’s inquisition, with the wilful murder of his female child, aged 14 days.?Mr. Ribton pro- secuted, and the prisoner was defended by Mr. Straight and Mr. Gill.?? This case was one of a very painful and distressing character, and although the prisoner was placed upon his trial, as it could not be proved that he was at the present moment unable to understand his position, or in such a state of mind as not to be competent to plead to the charge, still there was no doubt that he was in a state of raving madness at the time the terrible act was committed. He resided with his wife at No. 17 Page’s Walk, Bermondsey, and it appeared that he had been very ill for some time previous to the 11th of December. His mind was no doubt affected. On the night mentioned he was in bed, when he suddenly seized the child, and dashed its head against the wainscot, inflicting injuries which caused its death. An alarm was raised and several of the other lodgers rushed into the room, when the prisoner rushed at his wife, and would, no doubt, have done her some serious mischief if the bystanders had not prevented him. It was proved that before this occurrence the prisoner had been a good father and husband. He appeared remarkably fond of the child in question and his other children, and it was clear that at the time the act was committed the prisoner was in a state of raving madness, and quite unconscious of what he was doing. He was so violent that it required the united exertions of five men to restrain him, and he exclaimed that he would have killed his wife and his other children, and par- ticularly one favourite child, Bobby,” if he could have got at them. The prisoner said he knew the back-way to Scotland, and should get there if they would let him, and he addressed the wainscot, and said there was a policeman there, although this was an entire delu- sion. Although more quiet, there was no doubt that the prisoner was still insane. Mr. Justice Denman, after some evidence had been given, said he had no desire to interfere with what was undoubtedly the province of the jury; but it appeared to him to be abundantly proved that the prisoner was insane at the time he committed the act of which he was accused. He at the same time told the jury that whether the insanity was from delirium tremens or any other cause in law made no difference. The jury said they were perfectly satisfied, and they at once returned a verdict of Not Guilty, on the ground of insanity, and the prisoner was ordered to be detained during Her Majesty’s pleasure. During the proceedings he did not exhibit the slightest emotion.
The prevalence ancl nature of uncontrollable drunkenness is pernicious to domestic happiness, prosperity, and to success in any profession; and in order to check the rapid progress of this horrible national calamity, we must urge expediency on the present Government to pass a Bill this session relative to the matter in question.
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