The Psychology of Alcoholism

GEORGE B. CUTTEN

7^3 .CLARKE Co ^ iRsELLL^STATlONERS 26&28TREM0NJST.& 30 COURT SQ..BOSTON.

THE PSYCHOLOGY OF ALCOHOLISM.

THE PSYCHOLOGY OF ALCOHOLISM

BY

GEORGE B. CUTTEN

B.D, M.A, Ph.D. (Yale)

THE WALTER SCOTT PUBLISHING CO., LTD,

PATERNOSTER SQUARE, LONDON, E.C.

CHARLES SCRIBNER'S SONS,

153-157 FIFTH AVENUE, NEW YORK.

1907.

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TO MY WIFE MINNIE W. CUTTEN, B.A.

WHO HAS ASSISTED IN THE PREPARATION OF THIS WORK NOT ONLY BY SYMPATHY AND ENCOURAGE- MENT BUT BY MANY HOURS OF PAINSTAKING AND SCHOLARLY LAEOUR

THIS BOOK IS AFFECTIONATELY DEDICATED

INTRODUCTORY PREFACE.

The study of alcoholism from the psychological point of view which the author now brings before the public, may be said, I think, to have considerable scientific value, and no one interested in humanitv will be inclined to dispute the value of whatever practical suggestions may be derived from the same study for the relief of the victims of this physical, mental, and moral disease. In even larger measure than most pathological conditions, the phenomena of alcoholism suggest lines for investigating almost all the inquiries which concern the general relations of body and mind ; they also raise and illustrate certain more specific problems connected with the mental life of memory, imagination, and the emotions.

With regard to the physiological and psycho- physical conditions and laws of the first two of these three classes of psychoses, little that is suggestive of new views seems to be connected with the study which Dr. Cutten has made of the subject. In a word, the effects of the excessive use of alcohol upon memory and imagination, through the histological and functional changes which it works in the central nervous system, are, in the main, such as might be a priori anticipated. In respect to the emotional peculiarities of the victims of alcoholism, however, the case seems to me not to be precisely the same.

v

vi INTRODUCTORY PREFACE.

This study contributes something of importance towards establishing the truth that disturbed central conditions are the determining causes of the changes which occur in the habitual feelings of the alcoholic patient; and that the "reverberations" of the peri- pheral organism, such as are brought about by a degenerate musculatur, disordered centres of the sympathetic system, etc., are of only secondary, although real importance. From the physiological, as well as from the more purely psychological point of view, then, the profound nature of the disturbances which alcoholism effects in all the emotional life, higher and lower, — passions and affections, and also moral, artistic, and religious sentiments, — is more readily comprehensible. The poison is subduing the physical citadel of the higher life, — of those motives which inspire, elevate, and sustain the spiritual nature in its struggle against the lower, animal nature.

Turning now, for a moment, to the more practical side of this investigation, it is no surprise to find that the suggestions looking toward the relief of the sufferer from alcoholism are almost entirely of the psychological order. General sanitation is, without doubt, here as everywhere else in the field of patho- logical conditions, of great and indisputable value. But it is doubtful whether the beneficial effect of administering drugs is not chiefly, if not even wholly, due to their psychological rather than to their primarily physiological value. Almost certainly the same must be said — and said a fortiori — of all hypnotic practice in the case of alcoholic patients. And, really, from every point of view, theoretical and practical, physio- logical and psychological, the most interesting and astonishing of all the phenomena are those connected with the cure of alcoholism by religious conversion.

INTRODUCTORY PREFACE. Vll

The indubitable facts of experience upon which Dr. Cutten dwells in some of these chapters, and which show the remarkable results that follow from abrupt and decided changes in the life of feeling through religious ideas and influences, are deserving of an even more detailed and critical treatment than he has been able to give them in this book. The confessions and actual performances of reformed alcoholic debauchees require, and are worthy of, a much more thorough discussion from the point of view of psychology, and by the methods of the trained psychologist, than they have as yet ever received.

It is for these and other reasons, which have regard both to the advancement of science and to the im- proved welfare of humanity, that I take pleasure in introducing Dr. Cutten's investigation to the entire public of readers.

GEORGE TRUMBULL LADD.

Yale University, New Haven.

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PREFACE.

In 1902 there was presented to Yale University by the writer, in partial fulfilment for the degree of Doctor of Philosophy, a thesis under the title of The Psychology of Alcoholism. Portions of Chapters II., III., V., VI., VIII., and XL of this work were there included. The following year, in partial ful- filment for the degree of Bachelor of Divinity at the same university, Chapter X. of this work was presented as a thesis, in very nearly its present form. In July 1902, the former thesis was among those selected for publication in 1903, by a committee of the faculty appointed for that purpose. Owing to some interruptions, the enlarged study was unfinished at that time, and it was thought best to defer publica- tion until it was more nearly complete. This patho- logical study is now presented to the public in the hope of its filling a need among thoughtful men and women who wish to know the relation between the use of alcohol and mental states.

In the preparation of this work willing and valuable assistance has been rendered by Professors Ladd,

Ferris, and Mendel, and Doctors McAllister, Defen-

ix

X PREFACE.

dorf, Ailing, and St. John — all of Yale University; and Dr. T. D. Crothers and Mr. Fred L. Emmons, as well as many others, to all of whom indebtedness is acknowledged and gratitude expressed. I also wish to tender my thanks to the authors and publishers who have so kindly allowed me the use of illustrations for this volume.

G. B. C.

January 1907.

CONTENTS.

PAGE

Introductory Preface by Professor Ladd . . v Preface ix

CHAPTER I.

INTRODUCTION.

Historical and present use of alcohol — Awakening regard- ing alcohol — Former attack on alcohol almost wholly of a religious character — The awakening among differ- ent classes of people — Men of science — Physicians — Anti-alcoholic congresses — Legislators — Society — The economic phase — Cost in different countries — Pauper- ism— Attitude of business — Death rate — Disease — Purpose and plan of the following chapters i

CHAPTER II.

PHYSIOLOGY.

Relation of mind and brain — Chemical affinity for and action of alcohol on the nervous tissue — Theories re- garding the physiological action of alcohol — Stimula- tion— Paralysis — Different effects upon the various parts of the nervous system — Injury to the neurons — Condition of the cerebrum — Dendrites — Cell body — Axis-cylinder — Spider cells — Neuroglia — Cerebellum — Spinal cord — Peripheral nerves — Changes in the vas- cular system — Effects on the different walls of the arteries — Injury to the brain on account of changes in the vessels — Spinal cord — Effect of alcohol on the quality of the blood — Pathological growth — Relation between the different lesions — Quantity and quality of the blood — Direct effect of alcohol on the nervous system — Difficulty of investigation — Effects of large and small doses vary — Results differ according to conditions — These differences augment our problem . 14

xi

Xll CONTENTS.

CHAPTER III.

MEMORY.

PAGE

Memory fundamental — Various disorders of memory brought about by alcohol — Amnesia — Cases cited — A case of hypermnesia — Paramnesia — Histological evi- dence— The three factors of memory — Relation to perception — Conditions of perception — Retention — Reasons for faulty retention — Disorganization of brain one cause — Effect of pathological growths — Distinction between retention and reproduction — Reproduction — Effect of disorders of other faculties on reproduction — Fatigue — Hypermnesia — Recognition — No local physi- cal basis — The usual fault of recognition — Localisation — Paramnesia — Classes and explanation of paramnesia — Memory declines in chronological order — Reasons for this order — Order of decline of contents of mind — Emotional memories — Effects of loss of memory . . 55

CHAPTER IV.

INTELLECT (NOT INCLUDING MEMORY).

The importance of the intellectual faculties — Imagination — Effect of alcohol — Primary stimulating action — De- pendence of imagination upon other faculties — Kinds of imagination — How each is affected — The result of the brain injuries — Thinking — The alcoholic weak- minded — No initiative — Less effect on habitual nature — Lack of judgment — Moral judgments especially affected — Unfitted for social intercourse — Theory of Dr. Everts — Experiments at Bonn — Experiments by Kraepelin, Smith, and others — Small doses at first heighten and quicken mental processes — Later effect is retarding — Alcoholic judges incorrectly concerning his actions— Higher and lower intellectual faculties — Effect of the decline of other faculties — Physical basis of the intellect — Influence of pathological changes in the brain 83

CHAPTER V.

WILL.

Does will depend on the physical ? — Freedom of the will — Abnormal condition of the will — Physical basis — Order

CONTENTS. Xlii

PAGE

of decline regarding movements — Inverse order of de- velopment— Influence of other faculties — Memory — Intellect — Affective nature — How alcohol affects the different factors of will — Ideals — Deliberation — Lack of inhibition — Control — Impulse — Fixed and insistent ideas — Four possible situations given by Stout — Lack of control by lessening nervous energy — Effect of injury of the vascular system — Choice — Desire — Effort — Examples of lack of effort in alcoholism — Delusion of free will — Inability for sustained effort — Influence of the physical — Theory regarding will and the blood supply — Lack of nourishment — Fatigue — Experiments of the writer — Tap-time — Ergograph .... 104

CHAPTER VI.

EMOTIONS.

Emotional degeneration — Influence of bodily health as a whole — Description of alcoholic emotional states — Results of experiments on dogs — Suspicion — Selfish- ness— Loss of the higher emotions — Perversion of the affections — Fear examined as an example — Fear absent in intoxication — A characteristic symptom in delirium tremens — Application of the rule of degeneration — Emotional decline — Order of the acquisition of the emotions by the race inverse to the decline — Lack of nervous energy causes a mood which accompanies the lower emotions — Influence of bodily organs — Fatigue — Influence of memory — Writers earliest memories of an emotional character — Cases cited — Influence of blood supply — Quantity and quality of blood both im- portant factors — Why joyous emotions of youth do not reappear with the sad ones — Emotional peculiarities have effect upon drinking — Dependence of emotions upon all other faculties — Different theories of emotions stated — Facts of alcoholism favour that of centrally initiated feelings ........ 141

CHAPTER VII.

SENSES.

Importance — Exaggeration of some senses — Sight — Both peripheral and central causes of the disorders —

xiv CONTENTS.

PAGE

Atrophy of the optic nerve and its terminations — Change in the pupil — Eye catarrh — Amblyopia — Amaurosis — Methyl and ethyl alcohol affect differently — Nystagmus — Results of experiments — Ridge, Krae- pelin, and Reis — Effect on expert shooting — Disorders of sight in alcoholic insanity — Central disturbances — Psychic and sensorial blindness — The intellectual element in all sight — Lack of accommodation — Unity of mental processes and the effect of the other faculties — Hearing — Little local disorder — Illusions — Direct effect — Meningitis and central disturbances — Experi- ments— Smell and taste — Perversions are dangerous symptoms — Not very frequent — Results of experiment — Touch — Hyperesthesia — General disorders — Re- sults of experiments — Muscular sense — General con- siderations— Experiments 166

CHAPTER VIII.

MORALS.

Moral equipment — Questions discussed — The moral life of the alcoholic — Relation to physical conditions — Con- duct and the weather — Result of the deterioration of the different mental faculties — Memory — Judgment — Emotions — " Ought " feeling — Sexual feelings — Will — Senses — Lying — Why the morals are so soon affected — The alcoholic as a criminal — Statistics and com- putations— Responsibility — Is the alcoholic responsible when drunk? — Conditions of responsibility — How far is the alcoholic responsible when approximately sober ? — Is he responsible for his present condition ? — Heredity — Nutrition of the foetus — Imbecility and alcoholic parents — Hereditary alcoholism — Facts certain whatever our theories — Statistics — Atavism — Dr. Sollier on heredity and alcoholism — Degenerates among the offspring of alcoholics — Faulty citations — Predisposition checked — Mother's influence more powerful than father's — The alcoholic mother — In- fantile acquired alcoholism — Lactation — Responsibility further discussed — Effect of other diseases — Effect of struggle for existence — Sorrow — Sociability — A drunk- ard responsible to a certain extent — W. James on the drunkard 189

CONTENTS. XV

CHAPTER IX.

INSANITY.

-n i • • • PAGE

Relation of insanity and alcoholism — Reciprocal— Alcohol as a direct cause undoubted — Statistics — America — Great Britain — The Continent — Different forms of alcoholic insanity— Chronic alcoholism— Case— Alco- holic somnambulism — Different names — Description — Change of personality — Intoxication a severing of consciousness — Further description — Cases — Alcoholic epilepsy — Alcoholic amnesia — Dipsomania — A periodic insanity — Description — May be one of a pathological series— Length of periods— Symptoms— Case— Onset very forceful — No desire for alcohol between attacks — Dipsomaniacs frequently men of great ability— Aborting an attack— Delirium tremens — Cause— Poison like that of bacterial origin — Diseased kidneys a factor — Alcohol an antidote — Symptoms— Hallucinations — Length of attack— Treatment by alcohol— Case— Pathological in- ebriety— Mania a potu — Alcoholic delusional insanity — Onset— Description— Egotistical— Case— Alcoholic paranoia — Very suspicious, especially of spouse — Various hallucinations — Religious delusions in un- married — Case — Alcoholic paresis — Similarity to general paresis — Prognosis unfavourable— A factor in general paresis — Case 231

CHAPTER X.

RELIGIOUS CONVERSION AS A CURE.

Alcoholism a sin— Inadequacy of drugs— Dr. Starr's opinion — Reformed drunkards in all churches— Recognized value of religious influence— Statistics— Difficulty of investigating the subject— Divine element— Nature of data — Reasons why religious conversion is so effi- cacious—A desire for reform— Associations are changed — An emotional substitute provided — Types of con- version— Definitions of conversion— Religion concerns the whole man— The process — The sense of sin — Escape from physical misery— Conversion while drunk —Desire for cure— Divided self or conviction— Self- surrender— Physical causes— Case of Jerry McAuley— The climax— Faith— The change— Feeling of newness — Selfishness changed to altruism— Revival of courage and hope— Self-confidence— Change sudden and per-

XVI CONTENTS.

I'AGE

manent — Part played by the will — The divine element — The sub-consciousness — Elements which determine the kind of conversion — Interaction of consciousness and sub-consciousness — Hypnotism and conversion — Jesus and the apostles — Conversion by divine power is consistent with the facts 277

CHAPTER XL

HYPNOTISM AND OTHER CURES.

Cure — Physical treatment — Defining the disease — Differ- ence between the disease and its results — Sanitation —Surgery — The taste for alcohol — Specifics — Secret cures — Dr. Thacher's method — Any help welcome — Hopeless cases — Influence of friends — Hypnotism — Success attending the treatment — Hypnotism a help only — Results by different operators — Conditions necessary for treatment — An actively willing subject — Two cases — Alcoholics easily hypnotized — Persons difficult to hypnotize when intoxicated — Success of the writer — Physical conditions of hypnosis — The blood supply a factor in the solution — Local anemia — Chemical theory of sleep — Method used by the writer for inducing hypnosis — Suggestions given — Auto- suggestion— In hypnotism, reform is easier than de- basement— Voluntary action in hypnosis — Three cases by the writer — Case of John Kinsel . . . .318

Index of Names . . . . . . . 351

Index of Subjects 355

LIST OF ILLUSTRATIONS.

i. Scheme of Lower Motor Neuron .

2. Dendrites affected by Alcohol

3. Nerve Cells affected by Alcohol

4. Granular Degeneration of Nerve Cells

5. Nuclei affected by Alcohol .

6. Degeneration wrought by Alcohol Elements ....

7. Changes in the Deepest Layer of the

Cortex

8. Changes in Neuroglia Cells .

9. Moniliform Swellings

10. Chromatolysis from Alcoholism

11. Diagrammatic Representation of Arteries

12. Section of Record of T. D.

i3- „ ,, J- C.

M. P. M. C. F.

C. C. D.

F. M. W. B.

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16.

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on Brain

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THE PSYCHOLOGY OF ALCOHOLISM.

CHAPTER I.

INTRODUCTION.

Historical and present use of alcohol — Awakening regarding alcohol — Former attack on alcohol almost wholly of a religious character — The awakening among different classes, of people — Men of science — Physicians — Anti-alcoholic con- gresses— Legislators — Society — The economic phase— Cost in different countries — Pauperism — Attitude of business — - Death-rate — Disease — Purpose and plan of the following- chapters.

The use of alcohol is universal, and is coeval with the history of the race. The earliest Egyptian, Babylonian, and Hebrew writings show drunkenness to have been common, and from this we infer that it existed long before the art of writing was known. Some form of intoxication has always been found by the investigators of the most primitive people, and it was also discovered that the early races were ex- cessive and violent drinkers, their debauches ac- companied by uncontrolled excitement, rather than steady and habitual imbibers. The warnings found in early Egyptian and Hebrew writings show that the danger of drunkenness was apparent over three thousand years ago. With the boasted wisdom and intelligence of our advanced civilization, when we clearly recognise the ever-increasing danger, we seem as powerless as they to prevent the increase of the use of alcohol.

2 PSYCHOLOGY OF ALCOHOLISM.

In addition to the increase of its consumption, the effects upon the body seem to be getting more in- jurious and to be developing new forms and types. Moderate drinking has rarely been carried out successfully, for it almost inevitably develops into excess; but to-day there appears to be less and less control, the moderate drinker passing very quickly into the impulsive, violent consumer. It has been stated, evidently on sufficient historical basis, that the nations which have longest used alcoholic drinks have become partially immune to their effects, the Jews and the nations of Southern Europe being pertinent examples. It seems hardly necessary, and certainly not profitable, for any people which is seeking its own highest development, to go through this process in order to be able to drink alcohol with comparative impunity.

What the solution of the problem will be is un- certain, but with safety we may predict that with the great number of men and women now devoting thought and energy to the subject, some lessening of the abuse must come, especially when we con- sider that it is a battle for the highest good of both individual and race. The proportionate increase of drunkenness seems to be greatest among women, and England has the disgrace of furnishing the greatest pro- portion of female inebriates of any country in the world. There the women drunkards equal or exceed the men in numbers. In America the drinking is largely con- fined to males; the proportion in continental countries falls somewhere between these extremes. The Com- mittee of Fifty computes that in America not more than 20 per cent, are abstainers, and on the other hand the percentage of excessive drinkers is only placed at 5. The latter figure is not too large.

Within the past few years there has been a great awakening on the subject, and the reasons for this awakening we wish to consider in the remainder of this chapter. The nature of the attack upon alcohol was formerly of a religious character. Drunkenness

INTRODUCTION. 3

was regarded as a sin, and dealt with from that standpoint only, so that clergymen, the more religious of the church members, and those who suffered most from its effects — the wives and children of the drunkards — were the principal opponents. The character of this movement was largely of an emotional nature, gross and exaggerated statements being made, which were easily refuted. The more recent allies have contributed much of a scientific and solid nature, many very prominent physicians and other able investigators adding valuable know- ledge concerning the subject.

It has not been on account of any particular principle at stake, or to uphold any theory, that these men have assembled to the anti-alcoholic cause; but because their observations showed them the injury which alcohol is doing, and their scientific desire for the sway of truth compelled them to warn the people, and in other ways endeavour to decrease the use of alcohol as a beverage. The attitude of the physician has changed so greatly that it is especially noticeable. In the days of Dr. Ford, in England, alcohol was almost universally prescribed for every disease; to-day the bill for alcoholic liquors at some hospitals is almost zero, and it is difficult to find a physician who orders it to his patients to any great extent.

The British Medical Temperance Association numbers about six hundred, and, in addition, over four hundred students belong ; this is evidence of the awakening among the physicians. The International Medical Manifesto on Alcohol would have been an impossibility a few years ago, but it met with en- couragement on every hand with scarcely a dissenting voice to be heard. The physician should be, as he is, the greatest enemy of alcohol, because he, more than any other, comes in contact with its disastrous physical and mental effects. As Sir Victor Horsley so well says, " We think that the (British) nation ought to refrain from spending ,£179,000,000 per

4 PSYCHOLOGY OF ALCOHOLISM.

annum on drink. The medical profession, more than any other, sees the working of that expenditure of ,£179,000,000. It sees more than any other profession the working of physical laws and conditions on the morals and on the welfare of the nation; . . . but whether under one guise or the other, the medical profession knows well that it is a potent cause of disease, crime, poverty, and death." The significant words of Dr. Lorenz, the eminent Austrian surgeon, when declining wine at a banquet tendered to him in New York, would indicate the position of many physicians. " I cannot say that I am a temperance agitator, but I am a surgeon. My success depends upon my brain being clear, my muscles firm, and my nerves steady. No one can take alcoholic liquors without blunting these physical powers, which I must always keep on edge. As a surgeon I must not drink."

Viewed from the standpoint of a half-century ago, one of the wonders of the twentieth century was the Eleventh International Anti-Alcoholic Congress, held at Budapest in September 1905, which was attended by 1400 members, composed of some of the greatest scientists, most noted physicians, and men and women of repute from all the countries of Europe and America. The Anti-Alcoholic Congress of France, which convened in Paris during January 1 904, is another example of the awakening. Attending this were about five hundred representatives, including pastors and priests, officers in the army, university and lycee professors, judges, physicians, and others from the leading and influential circles. With a place for the sale of liquor for every eighty-one inhabitants, France has become aroused, and it is the purpose of this congress to educate the people to the dangers, as well as to restrict the sale by legislation. Professor Foulet, of Lille, began a scheme of education by posting large placards all over his town to warn the people of their danger, and to acquaint them with the scientific facts concerning

INTRODUCTION. 5

the action of alcohol on the body. When the writer was in Paris in 1903, the same scheme was in evidence there. Large placards on all the billposting boards were very conspicuous, and must have inevitably attracted the attention of all classes. Some Danish physicians have lately formed a total abstinence society, and have posted warning notices in railway stations and other public places so that they can be read by every one.

It is not only the men of science, but also the legislators who are awakened on this subject, and in all countries we find political parties or sections of parties endeavouring to restrict or prohibit the manufacture and sale of alcoholic liquors. In the Anti-Alcoholic Congress of France, just referred to, the Social Democrats participated, with the pro- nounced statement that they owed it to the welfare of the working man. In some sections a prohibitory law has been enacted, and has been enforced for years, and not petty politicians, but leaders in legisla- tion are considering the question of alcohol. Note the forceful words of Lord Rosebery : " I view the uncontrolled condition of the liquor traffic as a serious danger. . . . No one can deny that there is a great deal too much drink in this country; and that much of the crime, much of the pauperism, and almost all the degradation prevalent in this country are attributable to the curse of drink. ... If the state does not soon control the liquor traffic, the liquor traffic will control the state."

The German Emperor appointed a commission to inquire into the drinking habits of his subjects. This commission has recently reported to him, and the results of the investigations were a revelation to both Kaiser Wilhelm and the people. The know- ledge thus gained will probably be the occasion of restricting legislation. The Russian and other European governments are also aroused. There comes the report that the Imperial Russian Minister of Finance has offered a prize of 50,000 roubles

6 PSYCHOLOGY OF ALCOHOLISM.

($25,750) to the person or persons who will invent some way of making alcohol undrinkable. Pamphlets giving the exact requirements governing the competi- tion have been printed in the French language and sent to the Russian consulates in foreign countries. In Canada and Australia, India and Ireland, Europe and America, all over the world there seems to have been a spontaneous awakening, the laws of the land proclaiming the progress which has been made, and acting as harbingers of a public restriction of the manufacture, sale, and use of alcoholic beverages.

The changed attitude of society during late years, concerning alcohol and the alcoholic, is another form in which we notice the awakening. No longer is the inebriate tolerated ; no longer the admiring onlookers proclaim the staggering drunkard to be "as drunk as a lord." While drinking still flourishes, it is with less public encouragement, less manifestation of noisy revelry, and with less pride in drinking as an enviable accomplishment than in the days of our fathers. Public sentiment is reflected in the words of King Edward, " An officer does me as much honour in drinking my health in water as by using wine." How unthinkable these words would have been a few years ago. For the sake of civilisation we may well be pleased that the man who made his boast that he could "drink his companions under the table," is a relic of the past, and the society which could tolerate such a man is dead and buried. The excuse of necessity has now been abolished, for experiments in the French army show that under all circumstances the French soldier is 40 per cent, more efficient when subjected to a regime of total abstinence. Generals Roberts and Kitchener in Africa have made very practical demonstrations of the same fact with the English army. The labouring man who used to feel the necessity of having his dram regularly in order to do his work and do it well, now knows that he was formerly deceived, and that he is the better workman without it.

INTRODUCTION. 7

The economic phase of the alcoholic question has attracted much attention, and has had a great in- fluence on the recent awakening. Look at the United States, which is far less drunken than some European countries. It was estimated that in 1905 the sum of $1,325,439,074 was spent directly for alco- holic beverages. This estimate was made from government excise statistics, but if one adds to this the additional amount which the consumer pays for adulteration, and the product of illicit stills, the amount would probably approach nearer $1,500,000,000. The indirect expense must also be counted. It has been computed that 1,500,000 men and women are daily either mentally or physically disabled for work as the result of drinking. In addition to this, let us compute the public expenses for the extra number of the judiciary, the police force, the jails, the prisons, the poorhouses, and the insane asylums. The value of grain wasted, and the labour used in the manufacture and sale of alcoholic beverages, although already included in the annual drink bill, should again be added, inasmuch as it would increase the wealth of the country if put into some useful business. The total cost of alcohol to the United States, directly and indirectly, cannot be less than $3,000,000,000 per year.

The commission appointed by the German Em- peror, which lately reported to him, estimated the annual drink bill of Germany to be 3,000,000,000 marks ($720,000,000). This great sum is one-eighth of all the German people earn, and is four times the amount which Germany spends yearly for her immense army and navy, under which the people are supposed to be greatly burdened. Add to this the indirect cost and we have another great sum, the worst feature of which is that of this amount there has been a direct increase of 800,000,000 marks during the last five years. Sweden for defence spends annually 35,000,000 kroners; for alcoholic beverages 80,000,000. Denmark's military bill is 17,000,000

8 PSYCHOLOGY OF ALCOHOLISM.

kroners ; her alcoholic bill amounts to 63,500,000 kroners. With a population of only three million, Switzerland spends 264,000,000 marks per year for liquor. In regard to England, the Rev. John Watson says, "It is calculated that an average English working-class family spends six shillings per week in drink, or about one quarter of their wages." The drink bill for the United Kingdom for 1905 was com- puted to be no less than ^"164,167,941 ($797,856,193); computing the population of the United States at 86,000.000, Britain's bill is comparatively larger. James D. Whelpley, writing in The Saturday Evening- Post on the terrible destitution in England, says : " It is at these times that the terrible evil of drink, the curse of Great Britain, comes prominently to the fore. The liquor bill of England and Wales amounts to about twenty-two dollars per capita. It is all incurred, however, by about one-half of the population, and over two-thirds of the amount by people whose incomes are less than $750 (^152) a year."

The enormous sum of money spent for alcohol must inevitably cause much poverty. The amount of drunkenness caused by poverty cannot be esti- mated, but the amount of poverty caused by drunken- ness can approximately. The replies to questions sent to every almshouse-keeper in the United States show that at least 51 per cent, of the inmates of almshouses became paupers through drink. To put this into statistical form, about 1,530,000 persons who have come to poverty through drink are dependent upon the taxpayers of the country. Warden Roberts, of the New York almshouse on Blackwell's Island, told the writer that he considered nine-tenths of the inmates, of whom he then had 2,593, came there through drink. Mr. Tudor Trevor says that 70 per cent, of the paupers of England, costing the nation ten million sterling annually, are the result of alcoholic drinking. Japan, with practically the same poor laws as Great Britain, has only 24,000 paupers, while Great Britain has 100,000. A Japanese states-

INTRODUCTION. 9

man, being asked to explain this difference in results, replied: "The Japanese drink tea; the British drink alcohol."

Large business concerns have discovered the danger and economic loss in employing drinking men. This increasinsr demand for sober and reliable men is destined to be a great reformatory force. Railroads all over America, large railroads — as, e.g., the Northern Pacific — have prohibited the use of alcoholic liquors by their employees at all times. Only a year or two ago the French Governor-director of Railroads said that all the Government roads had agreed to discharge all employees who persisted in using spirits and wine while on duty ; all persons who continued to drink should be dropped from the pension rolls of the company, and would not participate in the endow- ment funds in case of an accident. Restaurants on the road were forbidden to sell spirits to workmen. The Cliristian Endeavour World is authority for the statement that the marine insurance companies doing business in New York city now offer a reduction of five per cent, in rates to ships on which no ardent spirits are drunk during the voyage. It may be the economic loss, rather than the physical or moral, which will be the occasion of the remedy.

Leaving out all other considerations, and counting the cost only in dollars and cents, the price we pay for alcohol is astounding. If the alcohol were manu- factured and poured into the sea, the world would be much poorer because it was made; but how much better it would be than, in addition, to pay for it in the lives of men, sickness and disease, misery and Sorrow — this is the greatest price which we pay, this price which cannot be expressed in terms of money. Matti Helenius, in a thesis presented to the University of Copenhagen, Denmark, in 1902, as a partial fulfil- ment for a degree of Doctor of Philosophy, estimated that during the last thirty years 7,500,000 persons died in Europe from alcohol-drinking, this number being greater than the total of all who died as the

10

PSYCHOLOGY OF ALCOHOLISM.

result of wars during the nineteenth century. He further states that in Denmark one out of every seven of the men who die between the ages of thirty-five and fifty-five die of alcohol-drinking. Further com- putations have been made by him concerning other European countries. He computes the annual num- ber of deaths from alcohol to be as follows: —

Great Britain .

Belgium and Holland

Russia

France

Germany .

Scandinavia and Switzerland

40,000 20,000 100,000 40,000 40,000 20,000

260,000

Dr. T. D. Crothers computes that 10 per cent, of all mortality is due to the abuse of alcohol, and 20 per cent, of all disease is traceable to this cause. Dr. Carter, of Liverpool, says that the mortality from almost every disease has fallen in England, but that from alcohol is an exception. The direct death-rate has risen from 45 per 1,000,000 of those living in 1878 to J J per 1,000,000 in 1897. Dr. Charles Macfie, of Edinburgh, says that there are yearly 60,000 deaths from consumption and the same number from alcoholism ; many place the latter at 100,000, and both of these are preventible complaints. These figures must be largely matters of opinion, as the death certificates show only the cases where alcohol is the direct cause. As Whiteing well says, " Half the certificates we write are mere anodynes for the public conscience."

The following suggestive figures are taken from Temperance, August, 1905:

The experience of the Sceptre Life Assurance Society, Limited, for the twenty years from 1884 to 1903, inclusive, gives the following figures: For abstainers, expected deaths, 1,440; actual deaths, 792; being 55 per cent, of the expected. Non- abstainers, expected deaths, 2,730; actual deaths, 1,880, or 79 per cent, of the expected.

The experience of the Scottish Temperance Life Assurance

INTRODUCTION. II

Company, Limited, for the twenty years from 1883 to 1902, inclusive, gives the following figures : Abstainers, expected deaths, 936 ; actual deaths, 420, or 45 per cent, of the expected. Non-abstainers, expected deaths, 319; actual deaths, 225, or 71 per cent, of the expected.

In another company they have kept the figures for over sixty years, and the results are as follows :

N071- Abstainers, Male Lives.

Total number of years of exposure to risk, all ages - 466,943

Expected deaths by Om table - - - - 8,911

Actual deaths - . - - - - - 8,947

Per cent, of actual to expected - 100.4

Male Lives j Abstainers j Whole Life Policies; " Transfers To" Excluded.

Total number of years of exposure to risk - - 398,010

Expected deaths by Om table - 6,899

Actual deaths - - - - - 5,124

Per cent, of actual to expected - 74.3

The non-abstainers are not all drunkards, but include all persons who take alcohol in any quantity.

The evil effects are shown in disease as well as in death, both in the drunkard and his offspring. This Oliver Wendell Holmes expressed a number of years ago as follows: — "When nature has made up her mind that she has had enough of a particular stock, and that its room is better than its company, the work of patching up the constitutions of its offspring and keeping them sober is one of the most desperate tasks assigned to the healers of men." So many men think that there is no harm in drinking so long as they never get drunk. The business man at the close of the day must have his "bitters," and thinks that only good comes from his temperate indulgence; but Dr. W. H. Riley has made the statement that he " has seen scores of cases of paralysis caused by alcohol in those who never became intoxicated. Man does not need to be so intoxicated as to dethrone his reason in order to have the drug do him harm."

It is well known that injuries, which to other people would be but slight, are apt to prove serious even in

12 PSYCHOLOGY OF ALCOHOLISM.

moderate drinkers, and the risk of death is much greater in surgical operations. The direct relation of alcohol to disease can be seen in the words of Dr. Alexander Lambert, when he said, " Of the 24,300 patients in Bellevue Hospital (New York) in 1900, over one-quarter went through the alcoholic wards." Indirectly we know the very close relation which alcohol bears to fatal cases of consumption, pneu- monia, and many other diseases. It has been found that out of every one hundred alcholics attacked by pneumonia seventy die, while out of every one hundred non-alcoholics so attacked only twenty-three die. In addition to these facts already mentioned, the great prevalence of crime and insanity as a result of alcohol-drinking has contributed to the awakening. On account of the awakening concerning alcohol, of which we have just been speaking, and the interest in the subject as a result of this, it was thought that a treatise on the relation between alcohol and the mental states would be beneficial, especially as nothing of this kind has come to the notice of the writer, and no author has treated the subject except in an incidental way. In this work only the more permanent mental effects have been treated, and .hence only the effects of a continued use of alcohol. In using the title The Psychology of Alcoholism, we mean it to be an account of the mental changes brought about by the continuous and excessive use of alcohol, and an attempted explanation of the changes. Added to this, in the latter part of the book will be found two chapters on the effect of the mind upon this condition as far as cure is concerned. In treat- ing the mental effects it is necessary to approach through the physical and examine the effect upon the brain. To this Chapter II. is devoted. The whole of this chapter may not be perfectly clear to the lay mind, but an attempt has been made to put it in form so that it might be comprehensible. It is difficult to find terms which will convey the idea without using technical ones. Chapters III., IV., V., VI., and VII.

INTRODUCTION. 1 3

deal with the more strictly psychological aspects of the subject, with attempted explanations based on the results