Essays In Pastoral Medicine Part 11

In judging a drunkard, it must be remembered that in many forms of alcoholism, after the condition is well established, the patient has little more freedom of will than a brute has. If he is accountable for the habit, he is blamable for the crime that follows. If he is not accountable, and it is often very difficult to prove that he is, he is to be treated as a blamelessly insane man. In proper surroundings, and with skilful direction, a child born with a tendency, or more exactly a temptation, to dipsomania or other alcoholic neurosis can be saved, but commonly the circ.u.mstances of such a child's life are the worst imaginable. These children must never take alcohol, even as a medicine, and they must not be pushed in school to nervous exhaustion.

A tendency to unchast.i.ty can "run in families," like a disposition toward alcoholism, but the disgrace in yielding to this vicious bias keeps many such unfortunates clean. It is to be regretted that public opinion can not give the same aid in alcoholic predisposition.

A confirmed alcoholic should be prevented, if possible, from marriage, because his sins will be visited upon his posterity. {112} The first children of an alcoholic may be mentally sound, the younger children are more or less mentally weak, the youngest are not uncommonly imbeciles, or idiots, or under shock they grow insane. Fortunately many of the children of alcoholics die at an early age, and the family of a drunkard very seldom lasts beyond four generations. In the first generation moral depravity and alcoholic excess are found; in the second, chronic drunkenness and mania; in the third, melancholia, hypochondria, impulsive and homicidal ideas; in the fourth, idiocy, imbecility, and extinction of the family. The lower the social caste of the drunkard, the greater the liability of meeting these blights.

Priests should take a deep interest in societies established for the promotion of temperance, and the only temperance for most persons is total abstinence. No man knows what latent tendency to alcoholism he may have, especially in America, where great grandfathers are unknown and the climate and life are trying on the nervous system. The adulterated liquors sold everywhere at present make the danger greater than it ever was. Whatever may be the truth as regards heredity, there is no doubt concerning the strong influence of environment; therefore get into the temperance societies the children of alcoholic parents, of parents that are shiftless, hysterical, irritable. If a man has a violent temper or if he is unchaste, get him and his children into the society to check the downward drift. A bad temper is a neurotic taint, and it commonly is a first step toward alcoholism. Do not forget to warn the people against patent medicines that contain alcohol.

If you go over the list of the families in a parish, it is startling to find how few there are without one or more "black sheep." The human black sheep, in a good environment, is always physically imperfect, and never so black as the gossips paint him. He may be a powerful football player, but there is something wrong with his gray matter. He is morally deaf, he was born so, and he is to be excused if he can not always hear the still, small voice. This may sound like lax doctrine, but it is true, nevertheless.

We must recognise that moral weakness is very often, {113} partly at least, a physical defect, and there is no such state as "moral insanity" where the intellect is normal. Now, I do not wish to be quoted as holding that all moral depravity has a physical basis; most of it is the unalloyed stuff; the Lombroso criminal is not a scientific fact; but there is a moral condition very frequently met with which is largely physical in origin. Given so many grains of cocaine or morphine or so many ounces of alcohol, and you can make a liar of a man once on the way toward sanct.i.ty. Given an attack of hysteria in a holy nun, and she at once becomes a liar, an altogether blameless liar, but no influence that does not remove the physical cause will cure the lying.

The morally weak do not at present obtain enough religious instruction. Their religion is more a matter of inheritance and habit than of positive energy. It is "in the bones," sometimes in the fists, rather than in the soul. They prefer the Sunday newspaper to the Sunday sermon. The remedy here seems to be in making the Sunday school solidly interesting and its teaching impressive.

Alcoholism in the parents, especially drunkenness at the moment of conception, is one of the chief causes of idiocy in children. Fere, as was said before, by injecting a few drops of alcohol beneath the sh.e.l.l of hens' eggs, or by exposing the eggs to the vapour of alcohol, could produce monsters almost invariably. In 1000 cases of idiocy at the Bicetre, Bourneville found a history of alcoholism in 620, or 62 per centum: in the fathers of 471, in the mothers of 84, in both parents of 65; and in one-half of the remaining 38 per centum no history was obtainable--probably most of these also had the alcoholic taint. The administration of alcohol to infants, of gin and whiskey, of essences of peppermint and anise, to relieve colic or induce sleep, and the dosing with opiates like paregoric, are also well-established causes of idiocy.

The idiot is practically dead, except for the trouble he gives in caring for him; but another unfortunate, the imbecile, most commonly the offspring of alcoholics, is often capable of great mischief. The higher grades of imbeciles, those nearest the normal, are almost invariably criminals. Not all criminals, of course, are imbeciles, but a vast number of petty and brutal {114} criminals are imbeciles. We keep these unfortunates most of their lives in jail, while we fine their drunken fathers, the cause of the imbecility, "five dollars and costs."

Imbecility has grades,--from marked lack of intellectual power, a stage little beyond idiocy, up to the presence of a mind capable of fair education,--but in all cases there is real defect, either of intellect or of will. Sometimes, where the will is so weak that the patient becomes a criminal in spite of all training, the intellect is practically normal to the superficial observer.

The grades of imbecility can not be clearly marked off from one another, but, roughly speaking, there are three. The lowest grade of imbeciles understands simple commands, and has a slight manual dexterity. They express themselves by signs and in monosyllables. They can not concentrate attention upon anything, nor can they be taught to read or write. Careful training can advance them so far that they may do rough, menial work, and they are industrious when directed by a present superior. They are inclined to masturbation. If they are not teased, they are quiet; if annoyed, they may become dangerous.

Imbeciles of the middle grade can converse in a narrow vocabulary, and they commonly stammer. They may be taught to read monosyllables; they can not do even the simplest sum in addition, yet they show a certain shrewdness. They are irritable and quarrelsome, inclined to lying and stealing, and they have no sense of shame. They will not do any regular work, but change from one occupation to another. They may have s.e.xual instincts and cause trouble on that account. They are slow to understand, their memories are defective, and they are always very vain. Their belly and what they shall wear are the chief things in their lives. They are less criminal than the highest grade of imbeciles.

The third cla.s.s, the high-grade imbecile, is the most important, because he is commonly a criminal. His intellect is below the average, and his will is very flabby. He learns little at school, and what he does learn is acquired slowly. He reads and writes badly and he may be able to add simple {115} columns of numbers, but he can not multiply or divide. Sometimes such an imbecile has a remarkable facility in getting a speaking knowledge of two or three languages, and he may learn a trade. There is a high-grade imbecile that is cunning and shrewd, but he has no will, and he is a criminal. As imbeciles approach the normal in intellect they recede from it in abnormality of will.

Autopsies on imbeciles show an infantile development of the forebrain.

Imprisonment does no good in these cases. They are not taught anything in prison, not even a trade, because the labour organisations and the protected industries will not permit prison labour. They should be confined so that they will not pervert youth and propagate their kind.

It is impossible to say how far a given imbecile is morally accountable for what he does, but the accountability is not full in the best cases. A neurasthenic, however, is not to be mistaken for an imbecile. A neurasthenic person may have a tender conscience, an imbecile has no conscience. In imbecility the fault is in the will, rather than in the intellect, in the middle and highest grades. Many women, especially, that are hopeless fools intellectually have strong wills, but an imbecile never has a strong will except in the sense that stubbornness is strength. Stubbornness is perverted strength.

_Morphine and Cocaine Intoxication_,--Morphine, an alkaloid of opium, is used very extensively as an intoxicant. Since 1890 the importation of opium into the United States has increased fourfold, although physicians are now using less opium than they formerly did.

The insomnia, worry, moral distress, which bring on the alcoholic habit in some persons, lead to morphinism in others. Some physicians, by carelessly prescribing morphine for neuralgia, migraine, dysmenorrhoea, or any pain, make their patients slaves of this drug.

The degenerative effects of morphine are not so great nor so rapid as those of alcohol. It does not shorten life so much as alcohol does, nor are the children of a person addicted to the use of the drug so liable to idiocy and imbecility. The mind is enfeebled--slowly in some cases, rapidly in others. The patient will resort to almost any means to obtain the {116} drug, if he is deprived of it. Authorities hold that he will lie without reason, merely for the perverse pleasure in deceiving, that he is uncertain and treacherous, with a dull conscience and morbid impulses. There are exceptions to this in cases where the drug is easily obtained by the patients. Opium and morphine diminish the s.e.xual appet.i.te in males, even to impotence. The bodily changes are slow but profound.

When a user of morphine has been deprived of the drug for from ten to fifteen hours, he becomes so weak he can not stand; he gets diarrhoea with cramps; he sweats, trembles, and collapses. Later, mental disturbance comes on. He grows delirious, sees insects and small animals, as the delirium tremens patient does, and his suffering is very great. It is extremely difficult, and commonly impossible, to cure the morphine disease after it has been firmly established, and a deliberate acceptance of the habit is evidently a grave vice. Where a patient has become addicted to the use of the drug, through the fault of a physician, or through ignorance, the treatment from the social point of view of such a patient is commonly cruel.

Cocaine intoxication is much worse than morphinism. It is a new excess, which was unknown before 1886. Many users of morphine can carry on business, but the cocaine _habitue_ can not do so. He is always extremely busy doing nothing. He writes long letters which are never finished. He changes from work to work, and even his conversation wanders. His bodily weight decreases rapidly, even one-third of his whole weight may be lost within a few weeks. The skin hangs in folds and is of a dirty yellow colour, the facial appearance is that of extreme distress, and the muscles are feeble. Fainting, irregular cardiac action, sweating, and insomnia are other symptoms.

Insanity is an occasional sequence, with hallucinations, especially of hearing. Such a patient hears roaring noises and voices; his secret thoughts are shouted out, he thinks, to crowds; loud screams, shrieks of murder, and similar noises appall him. Again, he sees swarms of flies, ants, roaches, which cover him and crawl into his mouth, nostrils, {117} and ears. He feels bugs crawling under his skin, and he has a mult.i.tude of similar interesting experiences.

Such patients grow homicidal. Like alcoholics, they are jealous and suspicious of their wives, but, unlike the alcoholic, the cocaine user is commonly reticent; he is not willing to talk of his troubles.

The prognosis is always bad, even in the best cases. This drug can be withdrawn from a patient more rapidly than is possible in chronic poisoning from morphine, but a relapse is to be expected.

In dipsomania, morphinomania, and other drug habits, and in the cases of vicious and degenerate children, many encouragingly good results have been reported from the use of hypnotism. Forel, Voisin, Ladame, Tatzel, Hirt, Nielson, de Jong, Liebeault, Bernheim, van Eeden, van Renterghem, Hamilton Osgood, Wetterstrand, Schrenck-Notzing, Kraft-Ebbing, Francis Cruise, Lloyd Tuckey, Kingsbury, Woods, and others have undoubtedly cured dipsomania by hypnosis.

Wetterstrand alone cured 37 of 51 cases of morphinism by hypnosis. One of these patients had been using morphine for fourteen years and morphine with cocaine for an additional four years. All his cases except one were treated at home--they were not obliged to go to a hospital or sanitarium.

As to vicious children: Liebeault in 1887 recorded 77 cases, 45 of whom were boys and 32 girls. By hypnosis 56 of these were cured, 9 improved, 12 were not affected.

As to the so-called dangers of hypnotism in the hands of skilled physicians, there are none. Forel said: "Liebeault, Bernheim, Wetterstrand, van Eeden, de Jong, I myself, and the other followers of the Nancy school, declare absolutely that, although we have seen many thousands of hypnotised persons, we have never observed a single case of mental or physical harm caused by hypnosis." Travelling mountebanks that hypnotise in public can do harm, and they should be prevented from so doing. On the continent of Europe only physicians are permitted to use hypnosis.

For a bibliography of hypnosis as a curative agent, see _Allb.u.t.t's System of Medicine_, vol. viii. p. 428 (The Macmillan Co.).

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In Genicot's _Theologiae Moralis Inst.i.tutiones_, vol. i. p. 162 (Louvain, 1902), is the following pa.s.sage: "Videtur licitum ebrietatem inducere ad morb.u.m depellendum, si quando practic.u.m est, ex gr. ad typhum depellendum, vel ad coercendam vim veneni quod e serpentis morsu haustum sit (Sabetti. N. 149). Similiter, per se licebit sensus sopire ope ebrietatis ad magnos dolores levandos: nullum enim discrimen morale videtur inter hoc medium et alia, ex gr.

chloroformium, quae adhiberi solent."

That is, Father Genicot permitted alcoholic intoxication to cure typhus or typhoid (typhoid is called typhus abdominalis in Europe) and snake bite, or to quiet great pain, as chloroform is used, in his opinion. This doctrine would be correct morally if from a medical point of view alcoholic intoxication cured typhus, typhoid, or snake bite, but it does not. Alcoholic liquors are necessary in some stages or forms of typhus and typhoid, and they must be administered skilfully; but to induce alcoholic intoxication in any pathological condition is always to add a grave poison to the disease already at work. The very name of the condition is _intoxication_, poisoning. You can end a toothache by removing a man's jaw, but the practice is not to be encouraged.

In America, when a person is bitten by a rattlesnake or copperhead, the first aid to the injured is commonly a pint of whiskey. You might better rub milk on the patient's bootheels, because the milk is harmless, but the pint of whiskey is anything but harmless; and one is as good as the other as far as curing the snake bite is concerned.

Whiskey is popularly supposed to be a good medicine in all the ills of humanity. It is a good medicine in certain cases and a very bad medicine in others. A snake bite is a startling evil, and while far from a physician the early settlers gave the patient the only medicine they had, whiskey, and if a little is good a great deal is better. As the "bite" of the North American snakes is frequently not fatal, some early victims grew well in spite of the snake venom and the added whiskey poisoning; therefore a pint of whiskey cured them, _post hoc ergo propter hoc_. Thus the "cure" became fixed in the popular ignorance, and some moral theologians, without investigating the {119} matter, fixed it deeper. The venom of the East Indian cobra and of other tropical and subtropical snakes would not be affected in the slightest degree by all the whiskey in Kentucky. The only hope in such cases, is in Calmette's ant.i.toxin, administered within an hour or two after the poisoning.

Snake venom paralyses the muscles of respiration, and the patient ceases to breathe. A little whiskey may do good--whiskey pushed to intoxication is very injurious. Artificial respiration, if needed, as in a case of attempted resuscitation after partial drowning, with skilful stimulation by a physician, and the use of an ant.i.toxin, are the main parts of the treatment in snake poisoning; but to pour a pint of whiskey into the victim is cruel ignorance. Patients often come into dispensaries showing bitten wounds which are stuffed with hair from the dog that did the biting; whiskey causes a man to see snakes, therefore use "hair from the dog that bit you." This may be good h.o.m.oeopathy, but it is not medicine.

The making a man drunk with alcohol "to remove great pain" is a treatment not used by reputable physicians: there are many correct medical methods of removing pain, but a big draught of whiskey is not one of them. Even in a case where a physician can not be found, it is usually questionable whether the effect of alcoholic intoxication would not be worse than the irritation of the pain; and if it were not, where is the line to be drawn? Some male and female old ladies can work up "great pain" from a colic. The bigger and stronger a man is, especially if he has never been ill before, the greater his "agony" when he is having a tooth filled.

AUSTIN oMALLEY.

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IX

HEREDITY, PHYSICAL DISEASE, AND MORAL WEAKNESS

Heredity is a very vexed question, with regard to which most varied opinions are held even by those apparently justified in having opinions, so that it is evident we are as yet only crossing the threshold of definite knowledge and are not near anything like the clear view that many people have imagined. The most striking proof of this inchoateness of scientific knowledge of heredity is the fact that within five years the work of a monk in Austria, done about forty years ago, which has lain utterly unrecognised ever since, has come to be accepted as the most striking bit of progress made--almost the only real scientific knowledge with regard to heredity that was acquired during the whole nineteenth century. Father Gregor Mendel's work [Footnote 2] was done with regard to the pea plants in his monastery garden, and it revolutionised all the supposedly scientific thinking with regard to heredity that has been current in biology for half a century.

[Footnote 2: _See American Ecclesiastical Review_, Jan. 1904; Walsh, _A New Outlook in Heredity_. ]

This serves very well to show how far in advance of observed facts theories of heredity have gone. There is undoubtedly a very significant influence exerted over life and its functions by the special powers that are transmitted by heredity. How far this influence extends, however, and how much it may be said to rule details of existence, of action and in human beings, that complex of elements we call character, is entirely a matter of conjecture, and the {121} belief in its extent, or limitation, depends absolutely on the tendency of the individual mind to accept or discredit certain theories in heredity which have had great vogue.

Until within a very few years it was considered a matter of common experience and observation that under some circ.u.mstances, at least, acquired characteristics were transmitted by heredity. That is to say, it has been definitely a.s.serted as probable, and by many even intelligent people considered absolutely certain, that modifications of a living being undergone during the course of its existence might influence the progeny of that being in various but very definite ways.

It was not, of course, thought that if a man lost an arm and subsequently begot a child, the child would be born without an arm, but slighter modifications of the organism were somehow supposed to be transmissible; and, on the other hand, modifications which affect important organic structures of the body were somehow thought to have a definite effect, by transmission, upon corresponding portions of the progeny.

When this theory is stated thus baldly, very few people confess their belief in it, yet how many there are who find ample justification for such expressions as, "His father suffered from rheumatism and it is not surprising then that he should have it"; "Her mother had heart trouble and we've always been afraid she would suffer in the same way." We are only just beginning to get beyond the period in which consumption was thought to be directly and almost inevitably inherited. With regard to mental ailments this was frankly conceded by nearly every one. If the direct ancestry suffered from mental disease of some kind, then it is not considered surprising that the immediate descendants should be mentally affected in some way. Physicians are quite as p.r.o.ne as those without medical training to make loose statements of this kind.

Of course there is a reason for the confusion that exists in this matter. Oliver Wendell Holmes once said that he could cure any patient that came to him for treatment, if he but applied to him in time. For proper success, however, he considered that many of his patients would have had to come to him in the persons of their great grandfathers. As {122} a matter of fact, many of the supposed hereditary influences that are traced only to a father or a mother are family conditions that have existed many generations, and that were probably originally acquired, but the moment of whose acquisition cannot be definitely determined. We know that the Hapsburg lip has been a distinguishing feature, a persistently recurring peculiarity, in some of the members of the Austrian ruling family in nearly every generation for seven centuries. How much farther back than that it goes we have no way of determining. It is a family affair, a characteristic which became a matter of heredity perhaps ten centuries ago, but the mode of its original acquisition is a mystery.

There is no really great scientist in biology at the present moment who teaches the hereditary transmission of acquired characteristics.

Modifications of the organism that become matter for heredity have existed for many generations and we cannot tell just how they began.

There is no doubt that there is some hereditary influence, for insanity in the same family is likely to keep recurring in successive generations. More than this, affections of certain less important organs are evidently a common trait in certain family strains. There is no doubt that in some families stomach affections are the rule in successive generations. It is very hard to say, however, just when such defective organisation became a family trait. The tendency to nervous affections is undoubtedly a similar family affair. Certain affections have been hereditary traits for many generations. An excellent example of this is the so-called Huntingdon's ch.o.r.ea, which several generations of American doctors, of the name of Huntingdon, by following carefully the history of certain families on Long Island, succeeded in tracing through four generations.

The habits of life of a father or a grandfather may so weaken the physical const.i.tution of his descendants as to make them less capable of resisting infections in the physical order, or in the moral order of withstanding trials and temptations, and the allurement to abuse of nervous excitement to which they may be subjected. That some acquired pathological condition, however, as stomach trouble, or heart {123} trouble, or affection of the liver or of the brain, should be directly transmitted, is quite as nonsensical as that the loss of an arm should be a subject for hereditary transmission. On investigation it will be found that the pathological conditions of immediate ancestors are themselves only a manifestation of family traits that have existed for many generations. The possibility of inheritance must therefore always be borne in mind. We are utterly unable as yet to understand how such family traits are originally developed, since, in ordinary experience, at least, acquired characteristics are not the subject of inheritance or transmission, and consequently it becomes difficult to understand how they ever became impressed upon the family const.i.tution.

Notwithstanding this general principle with regard to heredity, there are a number of striking observations which show that even unimportant peculiarities may occur from generation to generation, though it is not always easy to decide where the peculiarity originated. The well-known example of the occurrence of six toes has already been mentioned, and is an oft-quoted bit of evidence as regards hereditary transmission. An extra finger on the hand, or some portion of an extra finger, at least, comes in the same category. Not long since it was pointed out that harelip is another of these peculiarities that readily lends itself to hereditary transmission. Recently there was the report of a family into which there were born four girls with harelip and cleft palate, and three boys not showing any trace of these deformities.