Medical Society of the State of North Carolina. An.

Transactions of the Medical Society of the State of North Carolina [serial] (Volume 62 (1915)) online

. (page 11 of 58)
Online LibraryMedical Society of the State of North Carolina. AnTransactions of the Medical Society of the State of North Carolina [serial] (Volume 62 (1915)) → online text (page 11 of 58)
Font size
QR-code for this ebook


tendants — in fact, a place where the inmates could just rest, rest, and
enjoy themselves. We would not have to wait long to have such an
institution full and keep it so, and of course we would never have any
cases to relapse and come back to such a place.

But what now is the outlook, seriously and honestly, to the convicted
drug fiend ? He has the necessities of life and not the luxuries when
on the county roads. He is fed a plain, well balanced ration; is given
systematic employment for the exercise of his muscles, so that he needs
no tonic in the way of a stomachic for increasing his appetite. He has
regular hours for his meals, for work, for rest, and for sleep. Each case
is cared for as to his drug as an individual, and certainly not as a class.

This work or business of being a convict is certainly not what a
normal individual would aspire to, but if you are going to sentence
them — and you must sentence them in order to control them — it does
not make much difference one way or another as to where they serve



' MEDICAL JUKISPRUDEXCE AND STATE MEDICINE. 83

their sentence. One man will say that to place them with the regular
criminals you will make him a criminal, and another will say that as
he improves in physical stamina he will improve morally and will exert
a favorable influence over his fellows. So there you are.

To control an unfavorable condition you must first ascertain the cause
or causes, and once this has been clearly understood a long step forward
has been made towards a final solution of the problem.

These drug habitues are victims, yea, more than victims. They are
both slaves and victims. But they are not such from choice, nor are
they what they are from luxury, but are results of circumstances. There
has been in almost every case one or more contributory causes ; for, and
with many, this cause has been due to some genuine pathological con-
dition and frequently followed a major or minor surgical operation.
Following such operation it has been necessary for the surgeon to give
some form of opium. This has, of course, produced the effect, that of
allaying pain and producing sleep, the two conditions most desired by
the patient. In a few days the physician or surgeon ordered the panacea
discontinued, and the patient, who is far from a normal individual, both
mentally and physically, and who, knowing the great surcease from pain
and insomnia that he had obtained from the preparation, calls lustily
and persistently, pleading on account of the pain — pain that is more
imaginary than real, and which is greatly magnified by his weakened
and subnormal brain — to be given the dose, that he may have only one
more night in peace and quiet. This is not the exception, but the rule.
Fortunately, a very large per cent of these cases cease calling for their
potion; but some do not, and continue to call for and receive it as long
as they are confined to bed or in the house or hospital, as the case may
be. These cases then become one class of our drug habitues.

Then there is that class of cases in which the habit has fastened its
fangs in a slow and very insidious manner, and, we might say, almost
from accident, certainly on account of the ignorance of the individual.
These are cases occurring in neurasthenic and hysterical women, in the
majority of instances. They are cases wherein a physician has been
hurriedly called, probably in the middle of the night, and has given a
prescription containing opium or some of its alkaloids. This relieves
the case. The next time one of the so-called attacks come on the in-
dividual resorts to the former prescription, and of course the spells in-
crease in frequency and apparent severity, and as they become ac-
customed to the drug, more is required. In time the individual becomes
a confirmed habitue. Then out of the kindness of her heart she recom-
mends her cure-all to not only her neighbors, but to all of her friends.



84 NORTH CAROLINA MEDICAL SOCIETY.

acquaintances, and to some even whom she does not know. But these
cases will be almost nil in the future, for the Federal Antinarcotic Law
prevents the refilling of prescriptions, and without an original order
from the physician she cannot now obtain the drug.

State and especially local county laws have not been able to handle
the situation. There have been special laws as to the dispensing of
opium and other narcotic drugs on our statute books that have not been
complied with because the physicians have not been informed of the
law. Then there are some laws that are so far from being in any way
reasonable that they are absolutely ludicrous — laws daddied by some old
maid who wears breeches and votes, and suckered by a sissy who wears
skirts and also exercises indirectly the right of franchise — acts that
clearly put the profession in disrepute and laws which attempt to say
how much a physician shall prescribe of a certain preparation. But I
see I am not sticking very close to my text, so I Avill call a halt and
follow another line of cause.

I have now considered my own profession, and have endeavored to be
honest in my presentation, viz., that many cases of drug addiction have
been due to the carelessness of physicians; that the Federal law has
called a stop to this, and is protecting the physician and the patient.

If you desire to obtain favor with a man, say something in praise of
his dog; but if you want his everlasting condemnation, criticise his
church or creed. Now, I have never knowingly criticised any church
or creed, for I have ever felt that certainly in such matters every one
should be left severely alone as to their opinions, for it is a question
for each to decide by himself and for himself ; so I am now not going to
diverge from that which has been my custom; but I do want to have
something to say of things of a religious nature in general.

We have all denominations and creeds. You pay your money and
you take your choice. We boast of our high ideals, of our large and
important memberships, and we fight for the kneelers at the mourner's
bench. We erect large and magnificent edifices, have excellent music
rendered by paid choirs with the assistance of expert musicians. The
congregations and book membership of our churches are large. There is,
of course, the necessity for a church magazine. Of this I do not ques-
tion the fact, but I do seriously question the necessity for these maga-
zines being made the goat and dumping ground of fake and quack ad-
vertising. The ads. in many of these church magazines are simply
wolves in sheep's clothing, and simply because they appear in the church
magazines to the unitiated every word is the truth. These magazines
will refuse to carry a whiskey advertisement because it is whiskey, but



MEDICAL JURISPRUDEXCE AXD STATE MEDICINE. 85

will solicit it under such a name as Peruna, and they not only solicit,
but elders, deacons, wardens, stewards, and pillars of the church — yes,
even the ministers — Avrite testimonials stating, not in so many words cer-
tainly, yet nevertheless as emphatically, that they do not care for their
whiskey straight, but prefer a few barks and herbs mixed with it and to
pay about ten prices for the poor adulterated brand received. Why and
wherefore are patent medicines? Are they on the market for suffering
humanity ? Yes — for those cases which are like a drowning man grasp-
ing at a straw. The secret in all is some drug that is either a stimulant
or a narcotic, and which, of course, is habit-forming, so that one bottle
calls for another, and thereby the coifers of the self-styled philan-
thropists are filled.

Were it possible for the shades of Ananias and Sapphira to return to
earth and read some of these patent medicine advertisements in the re-
ligious press I am sure they would again fall down and give up the
ghost, for the shock would be too great for even a shade to withstand.
They would see that they were far surpassed and had lost all claim to
the title for which they had thought themselves famous.

Here, then, is the past and the present recruiting station for the drug
habitues, and will be the future unless something is done to stop it. The
religious press, I do not think, means to be bad, but, on the other hand, it
does not intend that the filthy lucre to be had from these advertisements
shall slip through its fingers. The leading papers and periodicals of the
secular press of today refuse to accept, not only patent medicine, but all
fake advertising, and why not the religious press ?

Here, then, are our causes, and here, also, ai^e the results of these
causes clamoring for their drug or demanding some relief from the
severe suffering consequential to its withdrawal. Some are even crimi-
nal or become so in their effort to get their dope. What are you going
to do with it? That's the question. My answer is, I do not know,
unless you send them to the county roads and give them humane treat-
ment.

Dr. G. T. Sikes, Grissom : Mr. President and members of the society,
I do not expect to add anything new to what has been said in these
papers, but I am exceedingly happy to mark the advancing information
that is coming to the medical profession of !N"orth Carolina upon the
subject of drugs. I see a very marked change since I have been a mem-
ber of this society in the nature of the papers on this subject, and I might
say more than that, but I will not. We are very glad that this informa-
tion is coming to the medical profession. But it is necessary that it go
farther than this. The fact that Ave know these things is a source of very



86 NOETH CAROLINA MEDICAL SOCIETY.

great consolation to us, and it places us in a position where we may be
of very great service to mankind. But the fact that struck me while
these gentlemen were reading their papers w^as that it might be very nice
if we could devise some j^lan by which this information might be spread
out over the country so that the laity might pick it up. If other people
can pick up the information we have as to the painful effects of these
drugs and alcohol, then we will be lauded in days to come for what we
have done in our day and time ; and while I do not know the proper plan,
yet it does seem to me that there might be some Avay that some of these
excellent papers might be published either in the newspapers or in
pamphlet form and distributed to the laity over the country, in order that
they might have an opportunity to see what the medical profession of
North Carolina is doing and that they might see the marked advance
upward of the great medical profession as they saw last year when this
body put its foot down on the use of alcohol. They may see that in the
future we are anxious to do even greater things, if they can comprehend
what we are doing.



A STUDY OF SOME STATISTICS AND REPOETS OF THE
INSTITUTIONS FOR THE INSANE.



Dr. Thomas M. Jordan. Raleigh.



That I may not be called upon to apologize for the message I am
about to bring you, let me say in the outset that until recently doctors
in annual convention have felt sufficient was their work when they had
discussed the properties of some drug or instrument for the treatment
of certain diseases, or had outlined the various and peculiar symptoms
of disease and the application of remedies thereto ; but I come to invite
you into a new and larger field of endeavor, and through you to call to
the attention of our fellow-citizens throughout our Commonwealth the
work of the more economic handling of and the prevention of insanity.

I know there will be found among us those who will say, ''Shoemaker,
stick to your last," and there may be without our iianks those who will
argue that enough for us is the duty of attending the sick, and the col-
lection of our bills — the former a most worthy and the latter a most
arduous work; but a large majority of the populace will bid us God-
speed, and not a few among the number are looking to us to do such
work, as you will readily infer from the following conversation. I asked
a prominent lawyer not long since to answer the question, the relation



MEDICAL JURISPKUDENCE AND STATE MEDICINE. 87

of the inebriate to the State and the State's duty to him, to which he
replied by saying that that is more a question for the doctor than for
the lawyer to solve. I do not agree with him unless he is willing to
admit that the medical profession is more philanthropic than the legal
profession, and because I think that lawyer reflected the opinion held
by a great many is my reason for calling your attention to some statistics
and facts showing the great need for this undertaking.

In discussing this subject I wish especially to emphasize the fact of
increase in insanity in our State out of proportion to increase of popu-
lation ; to the enormous and increasing cost of caring for the insane, and
the fact that in spite of both the increase of the insane and the larger
expenditure in caring for the same, out of proportion, too, to the increase
in the insane population, that our State is doing little or nothing to
prevent insanity; notwithstanding the fact that as much as 50 per cent
of the cases, due precaution having been used, might never have been.

The National Committee for Mental Hygiene says that the number of
insane people in the United States exceeds the number of students in the
colleges and universities of America, and it is also greater than the total
number of officers and enlisted men in the United States Army, the Navy,
and the Marine Corps. One-fourth of this number went crazy or were
born crazy as the direct result of alcoholism. (Add to this number that
other large per cent of insanity due to syphilis, and you will be safe in
the position that 50 per cent of the cases are preventable.)

The cost of caring for the insane exceeds the cost of any other single
item of expense in a State except for education, and it costs per capita
$175 annually to care for the insane of the country. Insanity in the
United States, as the result of alcoholism, costs $73,000,000 annually.
These are the statistics of Government reports, and bear directly upon
the question before us here in North Carolina.

But we must get nearer home. A study of the census for our State
shows that for a decade the State had an increase of population of I6V2
per cent. Studying the report of the State Hospital, Raleigh, N. C, for
the same decade, we find an increase in population of that institution
of not quite 200 per cent. Studying the report of State Hospital, Golds-
boro, we find that in 1904 124 patients were received, that in 1914 311
were received, a gain of 187 patients, giving an increase of about 150
per cent for the tenth year over the first year of a given ten-year period.

On November 30, 1904, the population of the Morganton Hospital
was 1,002. On November 30, 1914, ten years later, there was a popula-
tion of 1,359, a gain of 357 patients, representing over 35^/^ per cent;
and which most likely represents the real increase in the population of



00 NORTH CAROLINA MEDICAL SOCIETY.

our insane. But during the biennial term covered by the last report
of that institution there were admitted 359 patients, while 328 failed of
admission, a total of 687, or more than 50 per cent increase in the number
remaining at the beginning of said biennial term. J^ow, I do not pre-
tend to argue that any of these calculations give the true ratio of in-
crease of our insane population, and I regret that at present we have
no means of obtaining such information — it would seem there should be ;
but I cite these figures for the purpose of emphasizing the fact that
it is manifest that there is a considerable and rapid increase of insanity
in this State.

A study of the report of the State Treasurer and the acts of the Gen-
eral Assembly will reveal to you that the amount for the support of
our insane has increased from year to year until now more than one-sixth
of the State's net income is spent for the support of the insane, not to
mention amounts for permanent improvements, the expenditure for sup-
port alone reaching the sum of $469,535 annually. In 1904 our ex-
penditure for support was $259,530; and in 1914 $469,535, in ten years
almost doubling the amount. If the 35% per cent increase given in a
decade for the Morganton Hospital is nearer the correct increase for the
insane j)opulation of the State, then it would seem that the amount
expended in the decade for supj)ort being nearly 100 per cent increase
is out of proportion to increase of the insane population.

In introducing the subject before medical men, it is not that I think
more of the duty of correcting these evils devolves upon them than
upon the average citizen, but because, judging the future by the past,
it is here I may expect more sympathetic listeners in an effort to bring
about preventive legislation; for that will be the means through and by
which these ends may be attained; and upon your brows, my fellows,
should a wreath be placed for what statutes now exist upon our books
for disease prevention ; and it is to you we look for help to handle the
man who by abuse of self transmits to posterity disease in the shape of
insanity. It was not until the good year 1914 that doctors in convention
assembled went on record against alcohol; and by that resolution we
took a long step in placing our profession in the vanguard of those who
know what life is and love their fellowman. May we at no distant day
crown ourselves chiefest among ten thousand by standing together for
statutes that would prevent the drunkard, the dope fiend, and the
syphilitics from encumbering society with their defectives, filling our*
asylums with the insane, our prisons with criminals, and our almshouses
with incompetents and invalids !



MEDICAL JURISPRUDENCE AND STATE MEDICINE. 89

Even now in North Carolina, under the two quarts per month statute,
in my limited practice, even this very week, I am consulted by a man
who, though up and going about his business from day to day — and he
has a good business — has soaked himself until now he tells me frequently
that he is watched, that wherever he goes he is watched by different
people. J^ow, all the time we have known that unless he abstained, this
would be the inevitable; but we have had no statute by which he could
be restrained. Again this week : another long-time combination whiskey,
dope, and cigarette fiend, the father of more than a half-dozen children
by a good woman, has acted so inhumanly toward those nearest and
dearest to him that his wife asks confidential advice of her next best
friends, the preacher and her physician; and yet there has been no
law upon the statute books by which he might be restrained; prevented
is our medical term, and it is a good term in these instances.

Let us get ourselves together for life protection. I hope to see our
statutes carrying the command that whenever the syphilitic comes under
our observation and treatment his case shall be accorded the same noto-
riety as the man with smallpox or the child with scarlet fever, for he
is a thousandfold more a menace to the community, to life, and to all
that goes to better mankind. If not tagged with the quarantine card as
in diseases mentioned, doctors should be required to report to a county
record such cases, and before such person shall be permitted to further
propagate his kind he should be required to produce a certificate that
he has been cured. And so with the dope or whiskey fiend ; before they
may go unrestrained again, let some recorded authority be given them.
Dealing openly and directly with such cases is the only means of com-
pletely eradicating them. Let those who commit the acts be the dis-
graced, and not their posterity. The day has passed when the doctor
can wink at, and not condemn, the young man when he goes astray. By
such a course only can we hope to remedy these evils.

This is not too much to expect the noblest profession among mankind
to stand for, to work for, and to achieve; and when achieved the prob-
lem of increasing insanity, increased cost of caring for same, will then
be solved.



90 NORTH CAROLINA MEDICAL SOCIETY,

PEEVENTION OF INSAI^ITY BY THE PEOPER TREATMEI^T
OF WHISKEY AND DRUG HABITUES.



Dr. Albert Anderson.



We have a large crop of people so naturally endowed and so nurtured
by the effects of whiskey and drugs that we must recognize the problem
of heredity and solve it in every possible way if we expect to eradicate or
modify these avoidable causes of insanity.

Our parents and grandparents were reared at a time when it was the
polite custom universally observed to treat their friends with the de-
licious mint julep in their homes and vie with each other in hospitality
in the barroom. These customs have produced a large per cent of our
hospital population today, through heredity. These customs in the
South are no longer in vogue, and their decay seems to be spreading
with astonishing rapidity not only in this country, but wherever full
efficiency must be had in service of war or peace. Whiskey or its
equivalent, and opium or its equivalent, are done to the death overnight,
as may be illustrated in Russia and China. After their total abolition
it will take generations to remove the last vestige of this hereditary cause
of insanity ; but after one generation its good effects will be pronounced
as proven in those States which have had prohibition for a generation.

The patients admitted to our hospitals suffering from the use or abuse
of alcohol are drunkards who get well or return to an apparent normal
condition when they get sober. This class of patients from the direct
influence of whiskey are few compared to those types of insanity whose
drinking is only an expression of a psychopathic constitution that finally
develops into dementia prsecox, manic-depressive insanity, epilepsy, the
feeble-minded, etc. The free use of whiskey by former generations has
produced a generation with a weakened nervous system, whose nervous
constitution is so frail that it succumbs to the slightest strain brought
about by disappointment, hard work, worry, insomnia, and of the strenu-
ous life of modern society and business competition.

For the treatment of the whiskey class who cannot be controlled out-
side of an institution I understand the Belgian plan is feasible and works
well. It is this : The chronic alcoholics are colonized and made to sup-
port not only themselves, but another class of dependents, namely, the
pauper tubercular class. This segregation w^ill prevent offspring with
inherited natures for the above diseases and at the same time afford a
living for the indigent tubercular.



MEDICAL JURISPRUDENCE AND STATE MEDICINE. • 91

Sterilization or the prevention of marriage will be hard to enforce
until that educational day shall come when all the people will know what
only the alienists now know, namely, that whiskey drinking produces a
condition in parents that transmits psychopathic natures or traits in
children we find among our epileptics, feeble-minded, and various types
of insanity. When these traits are inherited, whatever is done to pre-
vent must be done during the early years — a period over which ignorance
has hitherto ruled in the home, in the school, and in society. These de-
linquents must be found early to eradicate or modify these congenital
tendencies during the formative period of early childhood.

Enough has been determined to lead us to find these children in
families whose parents beget offspring naturally endowed with qualities
which science teaches us to expect. Every seed brings forth its kind ; but
it is possible to change every type by education, and this is our only hope.
What has been said of whiskey drinkers can be largely affirmed of drug
habitues. The habit itself indicates in a large majority of cases a de-
fective psychopathic constitution, and unless discovered in early child-
hood and educated with the knowledge of eradicating and modifying
these traits of nature, they will grow to be misfits in homes, schools, and
society life. When they have grown to years of physical maturity and
have the freedom as well as the responsibility of citizenship, they will
run into excesses or an irregular life — drinking, taking drugs, and giving
free rein to their passions.

They are incapable of adjusting themselves to the demands of business,
to social requirements, or to a moral life. This class must be controlled
for the safety of themselves and society.

The eugenic department of the New Jersey State Village for Epilep-



Online LibraryMedical Society of the State of North Carolina. AnTransactions of the Medical Society of the State of North Carolina [serial] (Volume 62 (1915)) → online text (page 11 of 58)