{105}
There are various drugs that, through acute or chronic poisoning from their use, cause mental disturbance,—alcohol, chloral, cannabis indica, somnal, sulphonal, paraldehyde, ether, chloroform, antipyrin, phenacetin, trional, chloralamid, iodoform, atropine, hyoscyamus, salicylic acid, quinine, lead, arsenic, mercury, opium and morphine, the bromides, cocaine, and others. Of these intoxicants alcohol always has been most commonly used by western nations, but the moral aspects of alcoholism have not been shown with sufficient insistence. There are many sots in human society much less reprehensible than to the unskilled observer they appear to be; others are more blameworthy.
Morality, as far as the agent is concerned, apart from the nature and circumstances of the deed, supposes, first, voluntary acts, or acts that proceed from the will with a knowledge of the end toward which the acts tend; and, secondly, free acts, or acts that under given conditions may or may not be willed. If by unavoidable chance one stumbles against a man standing at the edge of a wharf, knocks him into the water, and drowns him, the act has no element of morality in it, because it is not voluntary and free. If a mind is diseased, and, impelled by a mad notion of persecution, it brings about a like killing, there is no question of morality, because the agent is not free, and when fully analysed his action is not voluntary.
An act is more or less voluntary and free, and therefore more or less moral, as the agent is affected by ignorance, passionate desire, fear, or disease. Ignorance, fear, and disease may be such as to remove all quality of morality from an act.{106}Certain diseases or pathological conditions, especially of the nervous system, can take out of an act the elements of voluntariness and freedom that are necessary to make the act moral or immoral, provided, however, these pathological conditions are not brought on through the fault of the subject in which they exist. If a man voluntarily becomes drunk with alcohol, or some other drug, he is, of course, accountable for the evil he may unconsciously do while under the influence of that drug, and if he begets an idiot or a criminal imbecile in his drunkenness, he must atone somewhere for the blinded soul of his child. Here, again, there are certain extenuating circumstances, because very few drunkards are fully conscious of the extent of the evil in alcoholism.
Apart from the other requirements that go to make an act moral, the agent must be sane; that the act be immoral, he must be sane or insane, either temporarily or permanently, through his own fault; that it be devoid of morality an act must be a mereactus hominis, or it must be the act of a person blamelessly insane. If a man knows that an alcoholic is liable to beget a criminal imbecile solely because of the alcoholism,—and most men are aware of that fact,—this father or grandfather is more or less accountable for every larceny, rape, and murder done by the imbecile. The law, therefore, should put the imbecile into safe keeping, then seek out the father and hang him.
Insanity is a common condition, but it has not been satisfactorily defined. It supposes an appreciable unsoundness of the will, memory, and understanding, or of one or two of these faculties, but no alienist has given a short differentiation of that unsoundness. Where shall we draw the line between the weak but responsible will and the insane will? What degree of opacity between intellect and the world separates the ignorant man from the lunatic? The extremes of sanity and insanity are readily recognisable, but the intermediate degrees are not clear. There is no test to apply to all cases; each must be diagnosed from its peculiar symptoms, but the will of an insane man is always weak. It can not deny or defer the gratification of a desire, nor can it keep up an effort. Even in its lightest forms insanity is selfish and{107}impolite, because it lacks the force of will necessary to take trouble. It foregoes great future benefit for slight present gratification. The insane man is idle, or busy only in work that he likes, in pleasurable activity. A marked quality of sanity is the capacity for sustained work, and the man that shirks work merely because he does not like it is gratifying himself dangerously.
These defects are found commonly in sane persons, but the lunatic can not rise from them, and he adds to the defects of will a warped intellect. He can not adjust himself to his surroundings, and the fault is in himself, not in the circumstances. His intellect may be brilliant, but it sooner or later shows a taint. The insane man is not a free, rational agent.
Alcoholism readily passes over into unmistakable insanity, and it almost always is the cause of nervous degeneration in the children born within its influence. This, is a phase of the evil not sufficiently insisted upon by those that plead for total abstinence.
Chronic poisoning by alcohol induces hardening and calcification in the walls of the arteries, degeneration of the nerve cells and dendrites, wasting or overgrowth of the heart muscle, and fatty degeneration of the liver and kidneys. The nerve centres that control the circulation of the blood are paralysed by it, and, as a sequence, the arteries and capillaries are diminished in calibre. This state in turn obstructs the flow of the blood, and the body is not nourished, nor are the waste and poisonous results of metabolism carried off as they should be. Alcohol prevents the haemoglobin of the blood from doing its office, which is to supply oxygen and remove carbon dioxid. It absorbs the necessary water from the tissues, and thus it acts as a corroding poison. It is also a functional toxin, because it depresses the activity of organs by injuring the innervation. The poison affects the brain, and as the cerebral gray matter, especially its pyramidal cells, are the physical instruments of thought, will, and memory, or the means of communication between the soul and the outer world, the exercise of these spiritual functions is checked or inhibited by it.
A tendency to excess in the use of alcohol commonly{108}manifests itself before the thirtieth year, and in some cases it may be removed at the alcoholic climacteric, which is from the fortieth to the sixty-fifth year. Those that become drunkards are usually of a neuropathic constitution, through inheritance or abuse. Severe diseases, like influenza, syphilis, typhoid; injuries to the head, sunstroke, shock, worry; the disturbance that may accompany puberty, pregnancy, lactation, and so on,—cause a nervous depression which is soothed by alcohol, and thus a habit is fixed. The reckless prescription of alcohol by some physicians is another cause of the habit, and the use of proprietary medicines is a still more prolific source of drunkenness and the consequent misfortune.
Cider, beer, ale, and porter contain from 4 to 6 per centum of real alcohol; light wines, red and white, and natural sherry, 10 to 12 per centum; strong sherry and port, 16 to 18 per centum; brandy, 39 to 47 per centum by weight, or 46 to 55 per centum by volume; and whiskey, 44 to 50 per centum by weight, or 50 to 58 per centum by volume. The effect of these liquors on the body is due primarily to alcohol, and secondarily to ethereal derivatives of alcohol. Some owe a part of their effect to non-volatile substances,—beer from which all alcohol has been boiled can still affect the body in a marked degree.
The chemist of the Massachusetts State Board of Health (Document No. 34) gives the percentage of alcohol in the common proprietary medicines, and these percentages will be found in thearticleonSocial Medicine.
The weakest of these compounds are twice as strong in alcohol as beer, and they treacherously bring about the habit of drunkenness in disposed persons who may be very desirous to avoid such a calamity.
Some men and women are quickly destroyed by alcohol; others resist it more or less successfully for a lifetime, as far as mere existence is concerned. Alcoholism is one of the commonest causes of insanity, but it is often an effect of insanity. It may be an early symptom of paresis, or a part of the maniacal stage of circular insanity. In poisoning by alcohol the higher nerve centres are first affected and the{109}lowest last. The sense of human dignity and of morality, the exercise of the intellect, are more or less inhibited before the motive muscles are affected.
The usual effect of alcoholic poisoning is boisterous exaltation of mind, but there is a depressed type of drunkenness which weeps. Some patients at once are subjected by hallucinations and delusions, others are so depressed that they have a suicidal tendency, others may have a maniacal frenzy that is destructive or homicidal. In these neuropathic conditions muscular co-ordination is commonly well preserved—the patient is "drunk in the head and sober in the legs."
In alcoholism the mental changes are gradual and progressive. The intellect is blunted, the judgment becomes foolish, the moral sense is dulled. The drunkard is always a liar. Delusions not infrequently occur, and it is one of the common symptoms of alcoholic insanity to suspect a wife or husband of conjugal infidelity. If a man that is a drunkard accuses his wife of infidelity, the chances are fifty to one that she is innocent and that he is in the first stages of insanity. This symptom is characteristic also of cocaine intoxication.
Another mental disturbance of acute alcoholism isdelirium tremens, which is inexactly calledmania a potuby some writers.Delirium tremensis not a form of mania, but an acute hallucinatory confusion, in which the consciousness is much more impaired than it is in a mania.Mania a potuis a real mania, and it is transient commonly, although it may leave permanent mental weakness with delusions.
In chronic alcoholism a paranoid condition may occur, and this often is incurable. This psychosis may come on suddenly or gradually. In true paranoia the delusions are systematised, but in this alcoholic pseudoparanoia the enfeebled intellect can not build up coherently even a delusion. The alcoholic hallucinations are visual and auditory, and we find delusions of persecution, especially of a sexual nature. The patient hears all kinds of insulting remarks made by "voices." These voices often come from his own belly. His enemies send poisonous or foul odours into his room at night, and the groundless suspicions of his wife's infidelity take most outrageous forms of expression. He will swear{110}he hasseenher misdeeds. Often the baseless suspicions of his wife begin before any other noticeable impairment of intellect, and are not recognised as delusions. The first step a priest should take in investigating accusations of conjugal infidelity is to find out whether the accuser is a tippler or not.
The delusions of persecution lead to attacks on the supposed enemies which often are homicidal. Occasionally alcoholic insanity takes on a paretic form, or it may be epileptic. Ten per centum of alcoholics are epileptic. When the children of alcoholics are epileptic, the convulsions begin in these children about four years earlier than in children that are epileptics from other causes. If epilepsy is latent, alcoholism will start it into action.
Alcoholism sometimes produces a condition of waking trance followed by amnesia (lack of memory). In such a state the drunkard may transfer property, carry out complicated professional actions, commit crime, take long journeys, travel for days, and so act that no one notices his disordered mental condition. Then suddenly he awakens and he has no recollection whatever of what has happened during this trance. He appears to be conscious, but to have no memory of his consciousness. There is another alcoholic amnesia, found especially in those that drink much during the morning hours, where there is instantaneous forgetfulness. If you ask one of these men to shut a door, for example, he will forget between his chair and the door what he started to do. This condition is difficult to cure even after the use of alcohol has been relinquished.
Dipsomania is a form of impulsive degenerative insanity, and it is probably epileptic in origin. After a few days of insomnia and loss of appetite for food, there is an irresistible impulse to drink alcoholic liquor and to indulge in other excess. The patient drinks until all means of getting alcohol are exhausted. He will take crude alcohol, bay rum, cologne, the alcohol that is about pathologic specimens in a hospital museum. The attack lasts from one to two weeks, and is followed by depression and a feeling of remorse. The onsets are irregular in occurrence, and between them the patient may{111}be temperate or have even an extreme distaste for alcohol. This form of disease is not infrequent among professional men and clergymen, and it is impossible to find out just how far the patient is responsible for his condition. If bishops would investigate the alcoholic tendencies of thefamiliesof candidates for seminaries, and reject all that have this taint, there would be much less scandal. It is a serious error of judgment to ordain a seminarian that has even once been under the influence of alcohol, and those seminarians that cover up the tippling of a companion, because he is a good fellow, are guilty of far-reaching crime. The fact is worth investigation whether or not a liquor dealer who never drinks alcohol, but who lives for years in the presence of volatilised alcohol, has much of the alcoholic degeneracy and a tendency to beget neurotic children. Certainly the fumes of wood alcohol have killed workmen that went down only once into a vat containing these fumes, and other alcohols in the form of vapour should have deleterious effects. Féré produced monsters in chickens by exposing eggs to the vapour of alcohol.
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 circumstances 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 unchastity 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 sanctity. 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. Féré, as was said before, by injecting a few drops of alcohol beneath the shell 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 Bicétre, 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 sexual 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 class, 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 sexual appetite 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 cocainehabituécan 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 multitude 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, seeAllbutt's System of Medicine, vol. viii. p. 428 (The Macmillan Co.).
{118}
In Génicot'sTheologiae Moralis Institutiones, vol. i. p. 162 (Louvain, 1902), is the following passage: "Videtur licitum ebrietatem inducere ad morbum depellendum, si quando practicum 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 Génicot 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 isintoxication, 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 antitoxin, 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 antitoxin, 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 homoeopathy, 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 ÓMALLEY.
{120}
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 circumstances, at least, acquired characteristics were transmitted by heredity. That is to say, it has been definitely asserted 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 prone 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 chorea, 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 constitution 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 constitution.
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.
Often when in such cases there is no definite history of harelip, it is found that in either one of the parents there is a very high arched palate and a thin upper lip, showing that the normal occlusion of the cleft which exists here during foetal development is not quite perfect, and this peculiarity may be traced for several generations back, with an occasional occurrence of harelip as an exaggerated example of the faulty tendency not to produce sufficient tissue in this neighbourhood for the proper closure of the embryonic cleft.
An even more striking manifestation of a physical anomaly, as a family trait, is the condition known as hemophilia. This{124}tendency to bleed easily, so that a slight scratch, or the pulling of a tooth, may give rise to fatal hemorrhage, occurs, as a rule, only in males, but is transmitted through the female line. It is in the mother's male relatives that the history of its previous occurrence is found, and the tendency usually can be traced through several generations, until it is lost in vague tradition. It is no wonder, with such examples before them as six-toedness, harelip, and hemophilia, that physicians have been ready to accept heredity of qualities in the moral order, traits of character and disposition, and pathological tendencies to crime or passion or indulgence.
One of the most frequently discussed conditions of supposed pathological inheritance of this order is dipsomania. Everyone has heard it said, "Poor fellow, how can he help it; his father was a drunkard before him." As we have already said, in such direct cases inheritance is absolutely unproven. An alcoholic father may transmit a very weak physical constitution to his children, and this may prove inadequate to enable them to withstand the emotional strain and worry of modern great city life, and, as a consequence, they may take to alcohol for consolation until the habit is formed, and then the craving for stimulants supplies the place of any hereditary influence that may be supposed to be needed.
Of course there are cases of the drink habit in which, after a number of generations of family history of alcoholism, an individual seems to have the craving for stimulants born in him. In such cases it is not unusual to find that the patient, for such he must be considered, is able to avoid indulgence in liquor entirely, except at certain times. Every physician of any large experience has had under his care dipsomaniacs who had no difficulty in keeping away from liquor for weeks, or even months, but who had regularly recurring periods, sometimes as far apart as every three months, when they had an irresistible craving for stimulants come over them. The regularity of the interval in these cases is often very remarkable. Here, of course, we may be in the presence of some as yet not well-understood periodical law of cell life, with consequent depression, and then the irresistible craving for stimulation.{125}As a rule, however, it would seem that in most of these cases suggestion has great influence. As we have said elsewhere, with regard to suicide, when a man has constantly before his mind's eye the fact that a father, perhaps a grandfather, or other members of the family, have committed suicide, he is likely to be much more easily led to the thought of this way of escaping hard conditions in life than are other individuals. The man who knows that the fact that his father indulged too freely in stimulants will be looked upon by many as an excuse for his deviations in this matter is likely to be more easily led to take an occasional drink at moments of depression, or for friendship's sake, though he realises that it so weakens his will power over himself that he is likely to take too much before he stops.
The passage inJulius Caesar(Act. I. sc. 2) in which Cassius says:
"The fault, dear Brutus, is not in our stars, but in ourselves,"
illustrates one phase of the subject. There are, of course, many other things besides the drink habit, with regard to which men are prone to find excuses in heredity, and to consider that somehow their ancestral tendencies make them not quite responsible for actions commonly considered the result of malice or passion, rather than hereditary influence, and our great English poet, knowing men so well, has stated the truth forcibly.
InKing Learthere is an often quoted passage which properly stigmatises the opinion in this matter held by those who would find excuses for wrong-doing in hereditary qualities:
"This is the excellent foppery of the world, that, when we are sick in fortune,—often the surfeit of our own behaviour,—we make guilty of our disasters the sun, the moon, and the stars; as if we were villains by necessity; fools by heavenly compulsion; knaves, thieves, and treachers by spherical predominance; drunkards, liars, and adulterers by an enforced obedience of planetary influence; and all that we are evil in, by a divine thrusting on; an admirable evasion of whore-master man, to lay his goatish disposition to the charge of a star!"
{126}
One phase of the question of hereditary tendencies to inebriety is extremely interesting from a physiological and sociological point of view. As the result of carefully gathered statistics, there seems to be no doubt now that when children are conceived while the parents, or either of them, is in a state of drunkenness, the offspring is very likely to be of low-grade physical constitution and often of very neurotic tendencies. In France, particularly in the case of a number of insane children and idiots, histories of this nature have been obtained in confirmation of this unfortunate factor as an element in degeneracy. In general it may be said that about one-third of the admissions to homes for children of low intelligence, as well as to insane asylums, are due to this cause.
There is in this, of course, an added motive for temperance, and it would seem that parents should be warned of the danger to which they are subjecting their offspring by excessive indulgence in alcohol, when it may be followed by such serious and lasting results to the beings on whom their love and affection will be expended in the future. This phase of alcoholic excess has never been taught as insistently as its importance would demand, perhaps because of the delicacy of the subjects which it involves; but it is too significant a factor in making or marring progress in the development of the race to allow any pusillanimous motives to prevent the spread of precious knowledge. [Footnote 3]
[Footnote 3: The present conditions that obtain with regard to the celebration of marriages are very prone to have a certain amount of intoxication as their result. Perhaps, then, it is a fortunate thing, as has often been said, that the first child is not born until some considerable time after it might normally be expected. It has been said more than once, however, that first children are a little more likely to have certain degenerative defects than are others, and a connection has been found between certain abuses of stimulants and incidental exhaustion to account for this. One of the most amusing things to Li Hung Chang, on his travels through our country, was the curious publicity we give to everything connected with marriage, while presumably our Christian ideas should rather counsel a veiling of the mysteries, religious and physical, connected with it. Certain it is that the present tendency towards farewell dinners at clubs, and other festivities of various kinds, are not at all likely to result in benefit to the presumably hoped-for offspring.]
The only real light that has been thrown on the puzzling details of heredity has come from work in the same field in which Mendel made his ground-breaking observations.{127}De Vries, the professor of botany at the University of Amsterdam, has succeeded in showing that new species of plants may be made to arise by careful attention to certain anomalous plants which occur from generation to generation. These plants breed true, that is, maintain their own peculiarities. To begin with, they are quite different from the parent plants, and the difference is perpetuated by inbreeding.
So far the problem of the origin of species has been supposed to depend upon the normal variation that is noticed in plants and animals. All living things differ from one another, even though they may belong to the same species, and differ sometimes in remarkable degrees. This continuous variation was supposed to account for the origin of new species when it became excessive. It has become well recognised now, however, that such differences gradually disappear in the course of the normal multiplication of plants and animals. The tendency is much more towards the disappearance than the maintenance of peculiarities.
There are certain discontinuous variations, however—sports, as they are called—in plants which differ very markedly in some quality from others, and these have the tendency to perpetuate themselves. Just why these sports occur is not known, nor how. They occur in a certain small percentage of all normal plants, but may die out, though it takes but little encouragement to succeed in helping them to maintain themselves. It is this that De Vries has done, and thus has succeeded in raising what would be called new species of plants.
This same thing would seem to occur in human beings. Some definite variation occurs as a consequence of a peculiar embryologic process. This becomes stamped upon the genital material and appears in the subsequent generations. It does not occur as a consequence of pathological changes nor of mere embryonic faults; it is almost as if it were something introduced from without. Once having found an entrance, however, it affects the germinal material and thus perpetuates itself.
With regard to plants, it has been suggested that the only explanation available for the occurrence of sports is that there is a purposeful introduction of them as the result of the laws of nature, and that it is thus that evolution is intentionally{128}brought about. This is, of course, a scientific reversion to teleology once more, but the question of teleological influences has been discussed more seriously in the last few years in biological circles than ever before. Unfortunately for the coincident evolution argument involved in human beings, the peculiarities introduced, which become the subject of inheritance, do not make for the development, but rather for the degeneracy, of the race. Even such peculiarities as six toes can scarcely be said to add any special feature of advantage to man in his struggle against his environment.
It is agreed by many of our best authorities in biology, zoology, and botany, by such men as Professor Wilson of Columbia University, Professor Thomas Hunt Morgan of Bryn Mawr, Professor Castle of Harvard University, Professor Bailly of Cornell University, Professor Michael Guyer of the University of Cincinnati, Professor Spillmann, who is the Agrostologtst of the United States Government, and Professor Bateson of the University of Cambridge, England, that these principles of heredity enunciated by Father Mendel will undoubtedly revolutionise the modern knowledge of the subject. In the meantime, however, all the old theories are in abeyance. Darwin's work and Weissmann's brilliant theories and observations must give way, while the application of these new laws is being worked out to their fullest extent. While the influence of heredity can not be denied, there is undoubtedly a tendency to overestimate the influence on the physical being of the power of hereditary transmission, and, on the other hand, to underestimate the influence of this same force as regards disposition and character. There is no doubt now that the physical basis influences the exercise of the will, and that consequently responsibility is not infrequently modified by the hampering influence of unfortunate physical qualities. This truth makes for that larger charity in the judgment of the actions of others which enables physicians to realise how much men are to be pitied, while its failure of recognition by the "unco guid" not only causes suffering, but in the end adds to the amount of evil.
JAMES J. WALSH.