In the winter of 1858, at the age of sixty, Hawkins toured Vermont, refusing to allow bad weather to prevent him from speaking on 107 days in succession. When he died later that year, his son estimated that he had traveled over 200,000 miles, spoken at more than 5,400 meetings, and addressed 1.5 million people.43
The Washingtonians deserve great credit for what they accomplished. They showed the country that drunks had not ceased to be human, that many desired sobriety, and that at least some could achieve it. This would inspire new efforts to help alcoholics in the years ahead. The long journey of John Hawkins was not in vain.
CHAPTER THREE
Discovery of the Disease
J. EDWARD TURNER was an irresistible force. In 1843, with the Washingtonian excitement near its peak, Turner sailed to Europe to interrogate the world’s leading medical authorities about the problem of drunkenness. He was only twenty-one, but the young doctor already held strong opinions. During his medical studies and first two years of practice, he had cared for an alcoholic uncle who was given to periodic binges. His uncle’s case convinced him that alcoholism was a disease, and he hoped that he would find support in Europe, which had pioneered the creation of institutions for the treatment of insanity. He spent two years in Edinburgh, London, and Paris, but he found little sympathy at a time when Europe was largely untouched by the temperance movement.
On his return to the United States, Turner resolved to gather facts to prove his theory. Abandoning his medical practice, he spent four years conducting surveys of doctors, clergymen, judges, and coroners. At first, he met indifference. During the first three years, 3,000 letters to doctors received just 134 replies. But the Washingtonians were making Americans reconsider their views. More than a third of his correspondents responded in 1848. “[E]very year thereafter there was an increased interest manifested by those addressed,” Turner wrote.1
Turner was making progress, but he was still many years away from achieving his dream of curing alcoholism. He returned to Europe to study the design of insane asylums and hospitals in Germany, Italy, and France. Back in America, he conducted an intense lobbying campaign in the New York State legislature that finally secured a charter for an institution to be called the “United States Inebriate Asylum.” Even then, he had trouble getting anyone to serve on the board of trustees, and the men he found failed completely in their efforts to sell stock in the institution. The construction of the asylum only became possible after another lobbying campaign forced the legislature to part with some of the money that the state collected in taxes on the sale of liquor. It took him sixteen years to get that far. He estimated that there had been seventy thousand meetings.
Turner spent years perfecting the design of his asylum. He envisioned an immense institution, measuring 1,453 feet across the front of five attached buildings. There would be ten wards with twenty beds in each. He adopted a grand style to match its great size. Simple brick structures would never do for Turner. He had developed a taste for Gothic architecture during his tours of Europe, and the facade of his building would feature towers surmounted by turrets, cathedral windows, and buttresses studding the entire length of the roof. Everything was to be faced in limestone drawn from local quarries. The amenities inside would be equally lavish:
A spacious dining hall; a reading room and library with shelving capacity for 20,000 volumes; a chapel with stained-glass windows and seating for 500 worshipers; a stage for lectures and dramatic entertainments; three expansive reception parlors; lavatories “furnished with all the appliances of the Russian bath”; numerous industrial workshops as well as diverse recreation facilities, including bowling alleys, a billiard room, and a gymnasium (patients could also go rowing on the river or riding on the grounds), a kitchen and a bakery; and a conservatory or winter garden to accommodate 100,000 plants.
Turner didn’t omit a single detail.2
Construction of the renamed New York State Inebriate Asylum began in 1858 on a hill overlooking Binghamton, a picturesque city of eight thousand located at the confluence of two rivers in upstate New York. Five of its leading citizens arranged for the city to donate 250 acres of land. They may have seen it as a solution to the frequent drunkenness of canal boatmen who had settled in town following the completion of a local canal. They may also have believed that being the home of a pioneering medical institution would be a source of prestige. At the very least, it would encourage commerce and provide jobs. But in the beginning, it was just a source of speculation. The asylum wouldn’t open for another six years.
Doctors had recognized the danger of alcohol almost a century before Turner had begun to dream. One of the first was Dr. George Cheyne, who knew the problem of addiction from the inside. Cheyne was born in Scotland in 1671 and attended the University of Edinburgh. He enrolled at the Royal College of Surgeons, which had recently been established in Edinburgh, and was such a successful student that he became a protégé of Archibald Pitcairne, one of the most celebrated doctors of his day. Pitcairne was also a somewhat scandalous figure in Edinburgh, which was under the stern eye of the Presbyterian Church. He was known as a hard drinker who wrote sometimes ribald verse satirizing the Scottish ministers. Cheyne, too, loved to drink, and his hands began to shake in the mornings while he was still a medical student.
Things got worse after Cheyne moved to London to establish a practice. He sought his clients in taverns where he spent most of his time, eating and drinking so much that his health soon failed. His weight ballooned to over four hundred pounds, and he fled to the country to avoid further temptation. His old friends appeared to forget him. “Being thus forsaken, dejected, melancholy, and confined in my country retirement, my body melting away like a snow-ball in summer, I had a long season for reflection,” Cheyne recalled. In his search for guidance, he began to purchase and study religious books recommended by a clergyman he admired. He also committed himself to temperance in both food and drink. After his return to London, Cheyne wrote extensively about health and had a lot to say about the role of food and drink.3
In 1724, Cheyne warned that drinking was dangerous. The process usually began innocently with someone prescribing a little liquor to deal with depression caused by misfortune. But the drinking soon became compulsive:
A little Lowness requires Drops, which pass readily down under the Notion of Physick; Drops beget Drams, and Drams beget more Drams,’ till they come to be without Weight and without Measure; so that at last the miserable Creature suffers a true Martyrdom, between its natural modesty, the great Necessity of concealing its Cravings, and the still greater one of getting them satisfied some how.
“It has very often raised in me the most melancholy Reflextions, to see even the Virtuous, and the Sensible, bound in such Chains and Fetters, as nothing less than omnipotent Grace or the unrelenting Grave could release them,” Cheyne said. The doctor had advised patients again and again that they were killing themselves with drink. But it was no use. “They were deaf to Reason and Medicine, to their own Experience, and even to the express Words of Scripture, that says, the Drunkard shall not inherit the Kingdom of Heaven,” he said.4
The first American doctor to notice the problem of alcoholism was Benjamin Rush, who had also studied at the University of Edinburgh, receiving his medical degree in 1768. Rush was an unusually ambitious young man with a high, domed forehead and piercing blue eyes. His evenings were devoted to reading and writing, which sometimes lasted until the early hours of the morning. He was one of the most active correspondents in the American colonies, writing friends on both sides of the Atlantic. By the time he was twenty-seven, Rush had already written more articles and pamphlets on medical subjects than almost any physician in America. “Many, many times have I heard the watchman cry 3 o’clock before I had put out my candle,” he said.5
Rush was also a rebel. He rejected the medical theory embraced by most Philadelphia doctors and did not hesitate to insult them. Unfortunately for Rush’s patients, the new theory he embraced cont
inued to employ the traditional remedy of bloodletting. When he was establishing a practice in Philadelphia, he wrote a pamphlet attacking slavery, even though many of the people he hoped would become clients owned slaves. For years, Rush’s friends had warned him to be more discreet in revealing his opinions. But he was undeterred, even as the number of visits to his office fell in the months after the publication of his pamphlet. Prudence “is a rascally virtue,” Rush said.6
The young rebel was also an ardent believer in American independence and played a key role in bringing Pennsylvania into the revolution. He suggested to Thomas Paine that he consider writing a pamphlet and even came up with the title: Common Sense. Rush’s efforts were rewarded by election to the Second Continental Congress shortly after the adoption of the Declaration of Independence. He took his seat in time to participate in the signing. As the Congress members waited for their turn, one joked that they might be signing their own death warrants.
However, Rush was no politician. His gift for cultivating friendships was undermined by his quick temper and lack of discretion. He supported George Washington for commander in chief and joined him in a small celebration when he won the job. Rush visited Washington in the field on Christmas Eve, 1776, when the war was going badly, and the commander was “much depressed.” The next day, Washington led his troops across the Delaware and won an important victory at Princeton. However, more reverses followed, and Rush began to lose confidence in Washington. With the troops suffering at Valley Forge, Rush criticized Washington behind his back. His friendship with the father of his country ended when Washington found out what he had said. Rush, who was a surgeon general in the army, also challenged his direct superior and was forced to resign his commission.7
After several years of attending to his practice, Rush began to return to public life by writing anonymous articles about a variety of issues, including a piece, “Against Spirituous Liquors,” that was published by the Pennsylvania Journal in June 1782. The article was a brief argument against the custom of serving hard liquor to farmworkers during the harvest. He did not know it at the time, but he was about to declare another war.
Rush was well aware that drinking could be harmful. At Edinburgh, he had learned about the relationship between drinking and the abdominal swelling caused by cirrhosis of the liver. He had patients who died from alcohol abuse. But it was a ten-day trip to western Pennsylvania in 1784 that convinced Rush that he must attack whiskey, rum, and other distilled liquor. During the journey, he was struck by the contrast between neat and well-ordered German farms and the usually rundown condition of those owned by Scotch Irish families. Rush thought that the explanation was that so many of the Scotch Irish farms included a still. “The quantity of rye destroyed and of whisky drunk in these places is immense, and its effects upon their industry, health and morals are terrible,” Rush said.8
Back in Philadelphia, Rush began writing about the problem of alcohol abuse. Just two weeks later, he completed An Enquiry into the Effects of Spirituous Liquors on the Human Body, And Their Influence upon the Happiness of Society. Only eleven pages, the pamphlet was not a scientific treatise. Rush merely noted that since the invention of distilled spirits with high alcoholic content, “physicians have remarked that a number of new diseases have appeared among us.” He described them briefly: a stomach sickness “known by tremors in the hands, insomuch that persons who labour under it, are hardly able to lift a tea cup to their heads”; “an universal dropsy” or swelling of the limbs; obstruction of the liver; “madness,” “palsy,” and “apoplexy.” There was no need to elaborate because “the danger to life from the disease which have been mentioned is well known,” Rush wrote.9
The solution to the problem was obvious: people must stop drinking hard liquor. Rush proceeded with his customary optimism to challenge the nearly universal view that liquor was essential and to offer a variety of alternatives. The common arguments for the use of liquor were that it staved off the effects of both extreme cold and heat and that it made hard labor easier. A drink might warm you, but it did not have nearly the lasting effect of a full meal, Rush said. The idea that fiery liquor could have a cooling effect was “absurd.” “Half the diseases which are said to be produced by warm weather, I am persuaded are produced by the spirits which are swallowed to lessen its effects,” he said. Rush did not expect people to stop drinking all alcoholic beverages. He considered beer healthful and supported removing the tax on it to encourage people to switch from rum and whiskey. He was also enthusiastic about wine. With such good substitutes available, why wouldn’t almost everyone prefer them once they understood the dangers of liquor?10
Rush recognized that people who were addicted to alcohol would not find it easy to switch. None of the authors who had written about alcohol abuse had much hope for the “habitual drunkard.” Rush was not so gloomy. He had known alcoholics who had quit drinking and were “restored to health, to character, and to usefulness to their families and to society.” His suggestion to those who wished to quit drinking was that they quit “suddenly and entirely.” “No man was ever gradually reformed from drinking spirits,” he said. He even suggested “a few glasses of sound old wine every day” to help alcoholics with the side effects of withdrawal. Nevertheless, Rush recognized that some compulsion would be helpful to his cause. He wanted to see higher taxes on distilled liquor. It might also be necessary that “some mark of publick infamy” should be “inflicted by law upon every man convicted . . . of drunkenness.”11
Over the next two decades, Rush’s knowledge about alcoholism deepened. In 1804, he published an expanded version of his pamphlet that provided a detailed description of the symptoms of acute and chronic drunkenness. Rush also provided a more detailed list of diseases caused by drinking, noting that postmortem examination had revealed that the bodies of drunkards exhibited differences from those of nondrinkers. “[E]ven the hair of the head possesses a crispness which renders it less valuable to wigmakers than the hair of sober people,” Rush wrote. While retaining the strong, propagandizing tone of its predecessor, Rush’s new Inquiry made an important contribution to the medical knowledge about excessive drinking.12
The boldest scientific claim was that drunkenness was a disease with its own symptoms and stages of progression. The key symptom was the loss of control: both men and women felt compelled to drink until intoxicated, even knowing the damage they were doing to their loved ones and that death was near. A few years later, Rush would characterize the loss of control as “a disease of the will” and quote a drunk to drive home his point. “Were a keg of rum in one corner of a room, and were a cannon constantly discharging balls between me and it, I could not refrain from passing before that cannon, in order to get at the rum,” the drunk said. Most people believed that drunks were morally weak. But Rush insisted that the loss of control was involuntary—the final stage of a process in which a person experiences drunken “paroxysms” with increasing frequency. It was not moral weakness that made people drink: it was the disease of drunkenness that made them morally weak. Anyone could be a victim—husbands, wives, judges.13
Rush observed that alcoholism also appeared to be hereditary. “I have once known it to descend from a father to four out of five of his children,” he wrote. “I have seen three, and once four, brothers who were born of sober ancestors, affected by it.” Rush could not explain this phenomena, but he thought it was significant enough to issue a warning. “These facts . . . should not be overlooked by parents, in deciding upon the matrimonial connexions to their children,” he concluded.14
As Rush learned more about the disease of intemperance, he began to pay closer attention to its victims. What he discovered made him increasingly hopeful. The title of his 1804 pamphlet is An Inquiry into the Effects of Ardent Spirits: An Account of the Means of Preventing, and of the Remedies for Curing Them. It contains a new section that describes a dozen “religious, metaphysical and medical” ways in which drunks had regained their sobriety. “Example
s of the divine efficacy of Christianity for this purpose have lately occurred in many parts of the United States,” he wrote, apparently referring to the fact that Quakers and Methodists were urging their members not to drink. People stopped drinking because they felt guilt; Rush knew one man who recovered after he attacked his beloved wife in a drunken fit. Others were shamed into stopping by their children or their servants. A farmer was brought to his senses when his favorite goat, which had accompanied him to the tavern and got as drunk as his master, refused to follow him across the same threshold on the following day.
While Rush was willing to recommend things that had worked in the past, he was also suggesting something new. Religious cures and moral appeals were obviously inadequate to stop an epidemic. What was needed was a medical approach. Rush told how he had cured “a negro man,” probably his slave, by putting tartar emetic in his rum, causing him to vomit so much that he could no longer stand the smell or taste of liquor. He also urged doctors to make “frequent representations . . . to drunkards, not only of the certainty, but of the suddenness of death from habits of intemperance.”15
By 1810, Rush had become convinced that the best way to cure drunkards was to establish a separate institution where they could receive medical treatment. Rush’s “Plan for an Asylum for Drunkards to be called Sober House” does not appear to have ever amounted to more than a rough draft that was found in his papers. Nevertheless, it was a bold plan that authorized county courts to inquire into the behavior of heavy drinkers to determine whether they were a danger to themselves or others and to confine drunks until they were cured. A Sober House was not to be a jail. Each inmate was to have his own “apartment.” “Such diet, drink, and employments and means of moral and religious instruction should be contrived for them as are calculated to promote their reformation,” he wrote.16
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