August 19, 2014 8:26:32 AM
It might be that the use of alcohol does us some good overall, but in my clinic day after day I am not able to see it that way, though it must be said that in the clinic I am more likely to see problems that alcohol brings rather than the gustatory treats and mood elevation other people value. I do not get to see people with delirium tremens, the agitation and hallucinations that come from withdrawal of alcohol; those cases are serious enough to get inpatient treatment. Alcohol does pose problems for people, but for a long while it was delirium tremens that was held to be its most dangerous, and most interesting, risk. In Rum Maniacs: Alcoholic Insanity in the Early American Republic (University of Chicago Press), historian Matthew Warner Osborn has explained the history of delirium tremens in America. It is a peculiar facet of American history, to be sure, but it is enlightening. Osborn says that his book "traces how and why heavy drinking became a subject of medical interest, social controversy, and lurid fascination in the early American republic. At the heart of that story is the history of delirium tremens and the 'fantastic terrors' that characterize it." As such, the book examines medical reports, newspaper stories, and novels and plays, showing alcohol taking its place in our society despite the madness it could bring.
The job of decrying alcohol in the New World fell to the preachers of the seventeenth and early eighteenth centuries, but taverns thrived and liquor laws became more permissive. Delirium tremens did not become a formal medical diagnosis until first officially described in 1813, but long before that doctors well knew that habitual heavy drinking could lead to insanity. Part of Osborn's book is an examination of why it boomed into an important medical diagnosis in America during the nineteenth century. Thoughts about the deleterious role alcohol might play in America were present right at the founding of the republic, in the efforts of Benjamin Rush, a prominent doctor in Philadelphia and signer of the Declaration of Independence. Rush's writings on the subject of alcohol might have been rooted in the teachings of European writers that drinking spirits posed a danger to the individual, and that such drink did not have the benefit touted in folklore that it was healthful in fighting cold weather or easing hard labor. The Founding Father Rush, however, went further: alcohol posed a threat to liberty. "A people corrupted by strong drink," he wrote, "cannot long be a free people." Drinkers would elect corrupt officials and thus endanger the republic. Although Rush thought that heavy drinking was a brain condition, he felt it was subject to improvement by such remedies as bleeding and purging. This was not, however, enough for a condition that so endangered the republic; drunkards, he taught, were to be forcibly committed to "sober homes," with little concern about due process. Drunkards were incapable of citizenship, and thus they could be denied civil rights. Rush was concerned with overall intemperance and had little to say about delirium tremens in particular.
As time passed on, fewer American physicians thought that the brain's moral faculty, including temperance, could be a subject of medical treatment. Instead, doctors became fascinated with the most dramatic and spooky part of alcohol abuse, delirium tremens. There are many colorful descriptions here by doctors who were impressed by the ravings of their patients who described ungovernable imaginings of grimacing animals, demons, ghouls, and worse. One doctor said that a patient would see "specters with gorgon heads, and bodies more hideous than those of the satyr or the fabled tenants of the lower regions, glower upon him with their eyes of fire, gnash their teeth in fiendish defiance, at length seize upon him, and he struggles with them in the full faith that he has encountered the devil incarnate." Delirium tremens was the new name given to an old condition, also known as mania a potu, mania a temulentia, delirium vigilans, delirium potatorum, or brain fever.
The impressive and scary symptoms had always been there, and Osborn tries to pin down why in the early nineteenth century there should have been such an upsurge in interest in delirium tremens. For one thing, seeing ghosts and demons was beginning to be understood as a fully mental phenomenon; no one could argue that such sightings by drunkards hinted at the supernatural. There was an increased emphasis on anatomy and dissection at the time, with Philadelphia becoming the center of American medicine and filling up with anatomy theaters and private anatomy instructors. The anatomists did find changes in the innards of drunkards: their stomachs were inflamed. The first theories about addiction to alcohol found it to be a stomach problem; one author asserted that delirium tremens resulted from repeated alcoholic stimulation of the organ, and this was also the cause of the vomiting to which inebriates were prone. Pictures of inflamed and obviously diseased stomachs became a staple of temperance lectures and were even distributed to school kids to scare them away from alcohol use, the way we use pictures of blackened lungs against tobacco.
Osborn finds a broader reason for the boom in interest in delirium tremens, however. He shows that doctors at the time participated in the economic and social atmosphere, and were likely to see a link between moral behavior and social and economic success. Delirium tremens in such a view was the most dramatic vision of a moral failing that would lead to financial and social catastrophe. Rush had seen that strong drink could corrupt voters and ruin the prospect of just government; the new physicians saw delirium tremens as a cautionary morality tale about masculine success. The lessons came at a time of financial uncertainty. They tied in nicely with the temperance or prohibition movements at the time, and physician involvement in such movements could avoid the accusations of class interest or priestcraft that labor activists might make against temperance efforts. Delirium tremens became specifically tied to the upper classes; if you had such vivid hallucinations, the thinking went, you had to have a rich mental life, some education, and thus some respectability.
Osborn includes many literary descriptions of alcoholic hallucinations, like the terrifying ones written about by Edgar Allan Poe, along with accounts of melodramas that had over-drinking as the flaw that drove the plot. The efforts of physicians and of temperance movements to spread awareness of the dramatic hallucinations meant that hundreds of drunkards on the page captured the attention of readers and theatergoers. It still goes on. Nowadays, there is an inpatient protocol to keep a patient with delirium tremens stable and undramatic, but Osborn shows that the condition played a dark part in films like The Lost Weekend, Days of Wine and Roses, and The Shining. Not all is as serious as it used to be. Osborn includes a few pages to Walt Disney's Dumbo, which "established pink elephants as the standard cliche for delirium tremens." There is also a Belgian beer called Delirium Tremens, and it has a pink elephant on the label. Perhaps the condition was taken more seriously in the good old days when there was no real treatment for it. It is just a medical condition that has been around for as long as people have had alcohol, but Osborn's book is an important academic study of how a scientifically-defined illness is nonetheless subject to changing social interpretation over time.