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An essay, medical, philosophical, and chemical on drunkenness and its effects on the human body
 9781315867168, 1315867168, 0415006368

Table of contents :
Content: Introduction --
Definition of drunkenness --
Phn?omena and symptoms of drunkenness --
In what manner vinous spirit affects the body --
The catalogue of diseases induced by drunkenness --
The method of correcting the habit of drunkenness, and of treating the drunken paroxyfin.

Citation preview

PSYCHOLOGY

REVIVALS

An Essay, Medical, Philosophical, and Chemical on Drunkenness and its Effects on the Human Body Thomas Trotter Edited with an Introduction by Roy Porter

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Psychology Revivals

An Essay, Medical, Philosophical, and Chemical on D ru n ken n ess and its Effects on the H um an Body

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An Essay, Medical, Philosophical, and Chemical on D runkenness and its Effects on the Hum an Body

T h o m a s T ro tte r

Edited with an Introduction by R oy P o rter

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Taylor & Francis Group*

LONDON AND NEW YORKI

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AN ESSAY M E D IC A L , P H IL O S O P H IC A L , A N D C H E M IC A L

ON DRUNKENNESS AND

IT S E F F E C T S O N T H E H U M A N B O D Y

Tavistock Classics in the History of Psychiatry G E N E R A L ED IT O R S:

W .F . B yn u m and R o y P orter Current interest in the history of psychiatry is growing rapidly both among the psychiatric profession and social historians. This new series is designed to bring back into print many classic documents from earlier centuries. Each reprint has been chosen for the series because of its social and intellectual significance, and includes a substantial introduction written by an eminent scholar in the history of psychiatry. L ifes Preservative A gain st Self-K illin g (1637) by Jo h n Sym (ed. M ichael M acD o n ald) Illustrations o f M adness (1810) by Jo h n H aslam (ed. R oy Porter) O b serv atio n s on M aniacal D iso rd e rs (1792) b y W illiam Pargcter (ed. Stanley W. Ja c k so n )

AN ESSAY M E D IC A L , P H IL O S O P H IC A L , A N D C H E M IC A L

ON DRUNKENNESS A N D ITS E F F E C T S O N T H E H U M A N B O D Y BY

TH O M A S T R O T T E R Edited, with an Introduction by

R oy Porter

I I RO UTLEDG E London and N ew York

First published 1988 by Routledge 11 New Fetter Lane, London EC4P 4EE 29 West 35th Street, New York, N Y 10001 © 1988 Introduction by Roy Porter Printed in Great Britain at the University Press, Cambridge All rights reserved. N o part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data Trotter, Thomas An essay, medical, philosophical, and chemical on drunkenness and its effects on the human body. 1. Man. Physiology. Effects of alcohol I. Title II. Series 615'.7828 Library o f Congress Cataloging in Publication Data Trotter, Thomas, 1760-1832. An essay, medical, philosophical, and chemical, on drunkenness and its effects on the human body/Thomas Trotter; editor with an introduction by Roy Porter. p. cm.—(Tavistock classics in the history of psychiatry) Reprint. Orginally published: London: Printed for Longman, Hurst, Rees, and Orme, 1804. Includes index. ISBN 0-415-00636-8 1. Alcoholism—Early works to 1800. 2. Alcohol—Physiological effect— Early works to 1800. I. Porter, Roy, 1946- . II. Title. III. Series. [D N LM : WM T858e 1804a] RC565.T76 1988 616.86'1—dc 19 D N L M /D L C for Library of Congress ISBN 0-415-00636-8

CONTENTS

PREFACE

vii

Introduction by R oy Porter ix

An Essay, Medical, Philosophical, and Chemical, on Drunkenness and its Effects on the Hum an Body by Thom as Trotter 1

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PREFACE

The Tavistock Classics in the H istory o f Psychiatry series meets a considerable need am ongst academics, practitioners, and all those who are m ore broadly interested in the development of psychiatry. Psychiatry as a discipline has always paid considerable heed to its own founders, its history, and emergent traditions. It is one field in which the relevance of the past to the present does not diminish. There is a high professional awareness o f the history o f the subject, and many aspects of this are now benefiting from fruitful dialogue with the now rapidly expanding investigations o f historians and historical sociologists. Yet two factors greatly hamper our grasp of psychiatry’s past. On the one hand, a considerable number of the formative texts on the rise o f psychiatry are exceedingly difficult to obtain, even from libraries. A s a small discipline in earlier centuries, many of the m ajor w orks were published only in short runs, and many, even o f the classics, have never been reprinted at all. This present series aims to overcome this problem , by making available a selection o f such key w orks. M ostly they are books originally published in the English language; in other cases where the original language was, say, French or Germ an, we are reprinting contem porary English translations; in a few cases, we hope to present entirely new translations o f classic Continental works. O n the other hand, in many instances little is com m only known o f the life and ideas of the authors o f these texts, and their works have never been subjected to thorough analyses. O u r intention in this series is to follow the model o f the now defunct D aw son series o f psychiatric reprints, edited and introduced by Richard Hunter Vll

P reface and Ida Macalpine, now, alas, both dead, and to provide substantial scholarly introductions to each volume, based upon original research. Thus the book and its author will illuminate each other, and one will avoid the dilemma of a text isolated in an intellectual vacuum, or simply the accumulation of miscellaneous biographical data. It is our hope that this series will break new ground in the history of psychiatry, and secure a new readership for a number o f illustrative works in psychiatry’s rich and fascinating past.

vm

INTRODUCTION R oy Porter

Through much of Europe and N orth America it was the first half of the nineteenth century which saw the dawn of modem society. Popu­ lation mushroomed at a hitherto unknown rate, leading to the emer­ gence of gigantic new conurbations. The demands of commercial and industrial capitalism brought into being in these manufacturing towns, mining areas and ports a concentrated proletarianised work force, typically uprooted from traditional social ties and patterns. And along­ side the metaphorical armies of navvies who built the canals and railways were the real armies and navies which fought the Napoleonic Wars and later served the military designs of the new nation states. M ass society was thus born; and one of its features - indeed, one of its terrifying problem s, as contemporaries never ceased to point out —was m ass drunkenness. There was, o f course, nothing new in the heavy consum ption o f alcoholic beverages, nothing new in drunkenness, as the lives of people real and fictional from N oah through Falstaff to Jam es Bosw ell make abundantly clear.1 In tradi­ tional rural society it was good housekeeping to brew or distil grain surpluses into ale or spirits; and given the impure nature o f the water supply, fermented beverages formed safe as well as warming, nourishing and convivial drinks. Ale houses and inns were the foci o f com m unity life (‘a tavern chair’, reflected Samuel Johnson, ‘is the throne o f human felicity’). The w ell-off marked their good fortune with the conspicuous hospitality o f the free-flowing bowl, while the poor forgot their troubles, their lives o f incessant grinding toil and poverty, in the Bacchanalian culture o f carnival, when, on May D ay, at H arvest H om e, or at Christm as and N ew Year, peasants were permitted to booze themselves into oblivion.2 IX

Introduction by Roy Porter Pre-industrial E urope abounded with warnings, religious, moral and medical, about the dangers of the demon drink: in tippling, as in everything else, moderation was the golden rule. But root-andbranch hostility to alcoholic liquor as such - as distinct from its abuses and excesses - was highly exceptional; there were few Malvolios, urging total prohibition in cakes and ale. After all, through the Eucharist, the taking of wine was validated within the ceremonial and sacramental rituals o f the Christian churches (contrast the fierce prohibitions o f Islam ), and as the great American puritan, Increase M ather, had put it, ‘drink is in itself a good creature of G o d ’. Similarly, traditional medical opinion, both learned and folk, regarded wine as a valuable cordial, a view spelt out at length in D r Peter Shaw ’s The Ju ice o f the Grape, or Wine Preferable to Water (1724). M any o f the tried-and-tested items o f the pharm acopoeia were alcohol-based, as also were the patent and proprietary nostrums which began to flood the medical self-care market during the eighteenth century.3 D ow n the centuries critics, of course, tiraded against tippling; but drunkenness was typically treated as a problem which was individual, local, and tem porary, confined to times o f feast and festivities, rather than a real threat to social survival itself. The solutions were thought to lie in personal discipline and in specific measures of social control (the suppression o f a rowdy fair, the closing of n otorious drinking-dens and so forth).4 Events, however, took a far more ominous turn during the eighteenth century. In certain regions of Europe, advances in capitalist agriculture were by then producing occasional huge grain supplies. The upshot was that great towns became flooded with really cheap spirits; during the ‘gin craze’ in London between the 1730s and the 1750s there were at one point 8,000 dram shops in the capital, and one could notori­ ously get drunk for a penny and dead drunk for twopence. Labourers who could never have afforded to get blotto on ale descended into constant stupefaction - and beyond, into the grave - on cheap gin. Some thirteen million gallons of gin were consumed in 1734; by 1742 the total was nineteen million. The demoralizing, indeed fatal, effects were all too visible on the streets. In its most acute aspects, the gin craze proved only temporary. Governments acted to raise duties and curb the gin-shops, while a steadily rising population quickly put an end to the grain mountain.3

Introduction by Roy Porter Nevertheless the gin craze - m ost fam ously depicted of course in H ogarth ’s print, ‘G in Lane’ - did mark the shape of things to come, registering the moment at which ardent spirits became the real menace, and brewing and distilling emerged as big businesses within market capitalism. Traditionally the rich had kept their cellars full o f wine and the lower orders guzzled their home- or village-brewed beer. D uring the eighteenth century, however, stronger liquors came into vogue. Port was brought in cheaply from Portugal, brandy was sm uggled from France; gin was adopted from H olland in the late seventeenth century; with the rise of the sugar plantations, rum (‘grog’) became a favourite drink of sailors and colonials, and homedistilled whisky swept N orth America. Potent, dangerous, and often extremely cheap, the spread o f ardent spirits raised the problem of drunkenness onto a new plane. Danger also lurked in the contem poraneous emergence of the great capitalist brewers - entrepreneurs such as H enry Thrale or Samuel W hitbread, who operated on a scale comparable to the greatest factory-owning cotton-spinner or mines magnate. C o m ­ mercial brewers naturally wished to mass produce. This meant developing types o f ales which would travel well and have a long storage life. The creation o f the heavy ‘porters’ answered this need. But ‘porter’ was certainly more intoxicating than the traditional lighter ales, and critics - Thom as Trotter was one o f them - com ­ monly alleged that such brewers adulterated their products with noxious additives used both as stabilizing agents and perhaps to create addiction. Thus by the close o f the eighteenth century, the alcoholic drinks available were more potent and perilous than previously.6 These developments o f course paved the way for the massive surge o f heavy drinking which ultra-rapid urban and industrial growth, with its ready money and social disruption, inevitably created in the nineteenth century. The new drink problem was a phenomenon tabulated by social statisticians, deplored by m oralists and preachers, and analysed by com m entators, who associated the evils o f the bottle with every m ode of vice and crime, above all with prostitution, violence and (mainly later in the century) physical and psychic degeneracy. Charitable organizations - the remote fore­ runners o f Alcoholics Anonym ous - sprang up to warn about the demon drink, to save the sot, and to provide alternative form s of XI

Introduction by Roy Porter recreation. F o r the first time, organized temperance movements were launched, aiming to win converts to the cause of complete abstinence, and, especially in the U SA , to prohibition. And, not least, the m assive new prominence of drunkenness, with all its attendant disorders, diseases and accidents, attracted the public alarm o f the medical profession for the first time.7 Building to som e degree on the w ork of precursors such as Erasm us D arw in, nineteenth century doctors set about investigating the pathology o f excessive drinking, exploring its associations with conditions such as dropsy, heart disease, cirrhosis of the liver (newly described by D r Matthew Baillie), nervous disorders, paralyses and, o f course, sudden and premature death. Habitual drunkenness w as shown to be critical in the aetiology o f particular diseases, such as apoplexy; and the emergent psychiatric profession underlined the causal links between chronic drunkenness and insanity (the vast Victorian expansion of lunatic asylum s, which readily filled up with inebriates, made such relationships crystal clear).8 From the early nineteenth century, particular syndrom es were newly labelled, ascribable to alcohol abuse, notably delirium tremens, first described by Th om as Sutton in 1813, and m ore fully discussed by Samuel Burton Pearson under the name o f ‘brain fever’.9 Th us doctors explored how heavy drinking caused disorder and disease. M ore challenging was the claim advanced frequently in the first half o f the nineteenth century that heavy and persistent alcohol consum ption was itself a disease in its own right, or at least a key sym ptom o f som e underlying disease. In other w ords, just as one w ould speak o f a consum ptive or an epileptic as someone suffering from a serious ailment, so the habitual drunkard was equally to be regarded as a diseased person, falling within the province o f medicine to diagnose and treat. Thus the drunkard - a wretch traditionally seen as suffering from m oral or religious weakness - came to be medicalized, and the ‘disease concept’ o f drunkenness was crystalized, leading by the mid-nineteenth century to the notion o f the disease o f ‘alcoholism ’ and of the ‘alcoholic’ as a suitable case for medical attention.10 It is im portant not to oversim plify the formulation o f the disease concept o f alcoholism . There was not one single concept but many, and the various approaches all had their insights and merits. O ne view point was advanced by the Germ an physician, C . von Briihlxn

Introduction by Roy Porter Cramer (d. 1821), who argued in his influential Uber die Trunksucht und eine rationelle Heilmethode derselben that the propensity to excessive drinking was a symptom of a physical disease (Trunksucht, or dipsom ania). Thus drinking to excess should be seen not as a vice, but rather as analogous to the pow er of fevers to create unslakable thirsts; Briihl-Cram er also suggested parallels with pica, the inordinate longings of pregnant women for peculiar food or drink. Regarding what he called ‘dipsom ania’ as a physical disease o f the whole nervous system , Briihl-Cram er recommended treatment with physical m edicines.11 A different viewpoint lay in treating excessive drinking essentially as a m ental disease, or m ore frequently perhaps as the symptom of mental disorder. The leading French psychiatrist, J. E. D . Esquirol (1772-1840), thus assimilated habitual drunkenness into his favoured category of monomania. Ju st as som e people, sane in other respects, had deluded perceptions and ungovernable appetites with regard to property, pow er or sex, so others were possessed by irresist­ ible impulses to drink. Esquirol noted the close affinities between drunkenness and insanity; but unlike m ost asylum keepers he was less concerned to blame drink as the cause o f madness than to point out how habitual drinking was a tell-tale sign o f underlying mental disturbance. E squirol’s interpretation has some similarities to that developed in the 1830s by the German physician, Karl Rosch (1808— 66), who regarded habitual drunkenness as typically the outcom e of the com bination o f psychological predisposition (inner tempera­ ment) with social circumstances (squalid housing, bad com pany, etc).12 Yet another approach was adopted by perhaps the m ost eminent investigator o f drunkenness, the Swede, M agnus H uss (1807-90), who was responsible for coining the term ‘alcoholism ’ in 1852. H u ss approached the problem primarily as a clinician. H e inves­ tigated sensory, m otor and psychic disturbances, and offered a particularly acute account of the neurological sym ptom s of the chronic alcoholic: nausea, convulsions, ringing o f the ears, vertigo, and so forth. H uss was sceptical about identifying underlying psychological causes o f alcohol habituation, and specifically denied the view, then being developed by ‘degenerationist’ psychiatrists such as M orel, that the alcoholic diathesis was in itself heritable.13 xiu

Introduction by Roy Porter T h o m a s T r o tte r and the H isto ry o f A lco h o lism The first half of the nineteenth century thus saw chronic drunken­ ness - eventually ‘alcoholism’ - firmly established upon the map as a medical disorder. Thomas Trotter’s traditional claim to historical fame is that he was the first to outline - albeit not finally to formulate - many of the viewpoints and strategies subsequently adumbrated in the writings o f Briihl-Cramer, Rosch, Esquirol, H uss and others. Brian Harrison, historian of the Victorian temper­ ance movement, has thus written, ‘Trotter was the first scientific investigator of drunkenness’ ;14 and it is significant that he has been credited with the ultimate accolade of a Garrison and Morton number (currently 2071.1), identifying him as the Colum bus of the medical study of drunkenness. There is no doubt that Trotter’s work made a splash; his major treatise, the Essay, Medical, Philo­ sophical, an d Chemical, on Drunkenness, published in 1804, went through further editions in 1807, 1810 and 1812; it saw an American version in 1813, and was also translated into German and Swedish. There is much truth in the traditional view that the Essay . . . on Drunkenness was a notable, original and pioneering work. Trotter quite explicitly, indeed aggressively, defines drunkenness as a medical prerogative, noting condescendingly that parsons and moralists have long had their crack at the drink problem, but it must properly be the labour of the medical profession to solve it.15 He categorically states that excessive drinking is a ‘disease’ ;16 indeed quite specifically a mental disease.17 A substantial part of his treatise is devoted to accounts of the symptoms and sequelae of the syn­ drom e; but T rotter was no narrow clinician, and he showed himself acutely attentive to the sociopsychological circumstances which favoured heavy drinking. His 200-page book effectively sketchmapped the field. Thus Trotter deserves attention as a major forerunner of nineteenth-century students of alcoholism. But he believed he had a grander claim to fame. For he regarded himself as the very first doctor to collar the problem of habitual drunkenness. H e informs us at the commencement of his book that when he was choosing the topic for his Edinburgh University M D dissertation, he was anxious to ensure that he would pick one which had ‘never been noticed by any form er graduate’ - one, indeed, ‘only cursorily’ dealt with in xiv

Introduction by Roy Porter the medical literature at large; and at numerous points in his text he trumpets his own originality: ‘I have not any precursors in my labours’.18 There is som e warrant for Trotter’s belief in his own novelty. Drunkenness had, of course, figured large in writings ever since Antiquity, and there was a sizeable body of serm ons, advice books, w orks of self-improvement and so forth, in English, on the subject. Various medical practitioners in Enlightenment England had written papers dealing with drunkenness, or had discussed drinking as part o f the wider questions o f regimen and diet, matters con­ tained within the traditional framework of the ‘non-naturals’. Bernard Mandeville, G eorge Cheyne and John Coakley Lettsom are am ongst the m ost eminent who examined the pathology of hard drinking, but the subject o f alcohol abuse was at least touched upon by scores of medical writers, as for instance William Buchan in his much-read Domestic M edicine.'9 M ad-doctors blamed drunkenness in their aetiologies o f insanity, and, not surprisingly, many prac­ titioners commented upon the evils o f the ‘gin craze’. Even so, T rotter’s treatise seems to have been the first book-length analysis o f drunkenness by a British doctor - though it should not be forgotten that the American, Benjamin R ush’s influential An Inquiry into the Effects o f Ardent Spirits Upon the H um an Body (1785), had already appeared, a work to which Trotter curiously seems never to refer.20 Trotter presents a forthrightly medical view o f the condition: ‘1 consider D runkenness, strictly speaking, to be a disease’, an idea he later refines into the province o f psychiatry (‘the habit of drunken­ ness is a disease o f the m ind’).21 The striking clarity o f this form ula­ tion is probably original. But it does not seem as if the ideas underlying it were really breaking new ground. For it was not uncommon for British practitioners earlier in the eighteenth century to construe drunkenness as a medical problem (rather than sim ply as a m oral, religious or legal w eakness), and the term ‘disease’ and its cognates had already been deployed in this context by physicians such as G eorge Cheyne and Anthony Fothergill. M oreover, T rotter’s perceptive grasp of the psychological underpinnings of habitual drunkenness - showing how the mind becomes enslaved to its own desires - was hardly so original as he thought. Very similar notions o f the form ation of chains of habits had already been xv

Introduction by Roy Porter outlined by his predecessors. Som e twenty years before Trotter, Jo h n C oakley Lettsom had offered a comparable vision o f the fatal dow nw ard spiral, leading from tippling for stimulus, relief or exhilaration, to low spirits, which were its inevitable after effects; which in turn could be obliterated only by further bouts of yet heavier drinking. Lettsom gave as an example22 those o f delicate habits, who have endeavoured to overcome their nervous debility by the aid of spirits: many o f these have begun the use o f these poisons from persuasions o f their utility, rather than from love o f them: the relief, however, being tem porary, to keep up their effects, frequent access is had to the sam e delusion, till at length what was taken by com pulsion, gains attachment, and a little drop o f brandy, or gin and water, becom es as necessary as fo o d ; the female sex, from natural delicacy, acquire this custom by small degrees, and the poison being admitted in small doses, is slow in its operations, but not less painful in its effects. Eventually, Lettsom argued, such dependence would set in that neither threats nor persuasions are powerful enough to over­ com e it, and the miserable sufferer is so infatuated, as in spite of locks and keys, to bribe by high rewards the dependent nurse, privately to procure the fatal draught. M oreover, som e fifty years before Lettsom , G eorge Cheyne had been advancing com parable ideas, showing how old soaks eventu­ ally succum bed to alcohol ‘cravings’ :23 They begin with the weaker w ines; These, by U se and Habit, will not d o ; They leave the Stomach sick and mawkish; they fly to stronger W ines, and stronger still, and run the Clim ax from Brandy to Barbados W aters, and double-distill’d Spirits, till at last they find nothing hot enough for them. Th us, as Cheyne saw it, the slavery o f ‘N ecessity upon N ecessity’ set in, m oving from ‘D rops to D ram s’, through which in time ‘D ram s beget m ore D ram s . . . so that at last the miserable Creature suffers a true M artyrdom ’.24 And before Cheyne, Bernard Mandeville had offered a graphic account o f the demon drink and the slide into alcohol addiction, xvi

Introduction by Roy Porter putting his version o f the ‘Sot’s Progress’ into the mouth o f a fictional character, ‘M isom edon’, who recounted how the drinker made rods for his own back. ‘M isom edon’ first praised the bottle go d :25 It has laid m y pains, appeas’d my Soul, made me forget my Sorrow s, and fancy over night, that all m y afflictions had left m e; but the next M orning, before the Strength o f the Charm has been quite worn off, they have in C row ds return’d upon me with a Vengeance and my self paid dearly for the deceitful Cure. ’Tis unspeakable in what Confusion and H orror, Guilt, Fear, and Repentance I have w ak’d, in what depth o f Grief, Fear, Anguish and Misery my Spirits have been sunk, or how forlorn and destitute o f all H opes and C om forts I have som e­ times thought m y self after the U se o f this fallacious remedy. It would be easy to multiply instances, from British and Continental physicians alike, o f an awareness of the interplay between psyche, habit and alcohol dependence before the appearance of Trotter’s w ork, for such perceptions were not unique to doctors but were part of com m on experience. F or instance, Samuel Johnson - at one stage a heavy drinker - became a total abstainer as the only way to avoid addiction, telling Hannah M ore, ‘ I can’t touch a little, child, therefore I never touch it. Abstinence is as easy to me, as temper­ ance w ould be difficult’ .26 Trotter’s Essay . . . on Drunkenness is a landmark in the history of thinking about drunkenness, alcoholism and addiction; yet precisely in which w ays and for what reasons remain open to question, for he was probably not quite the pioneer he thought himself to be. (O ne w onders why he nowhere refers to the discussions of the problem by Cheyne, Mandeville, Lettsom , Rush and others.) The remainder of this introductory essay will seek to ascertain the precise contri­ bution made by Trotter. It will not principally address the rather Whiggish issue of priority (was Trotter the first to adumbrate the modern idea of alcoholism ?). Instead, it will aim to recapture ex­ actly which elements of drunkenness fascinated Trotter as a welltrained, experienced and humane practitioner, and how he viewed drunkenness as a medico-social problem and a therapeutic challenge. It is first relevant to sketch his life. XVll

Introduction by Roy Porter T h e L ife o f T h o m a s T ro tte r, 1760-1832 We do not know whether Trotter accentuated or tried to suppress his Scottishness, but the fact that he was born in Scotland - at M elrose in Roxburghshire in 1760 - was o f immense importance in shaping his career and attitudes.27 A baker’s son - he sprang from the sam e class of society as the H unter brothers - Trotter went off at the age of seventeen to Edinburgh U niversity to study medicine. It is known that he took Alexander M onro Secundus’s class in anatom y and surgery. After two years he left, perhaps out of am bi­ tion, perhaps from poverty, and elected one o f the classic career options open to the young Scottish medical lad o f parts: he became a surgeon ’s mate in the N avy. The War of American Independence was then at its height, and Trotter alm ost immediately found himself on active service aboard the Berwick bound for the Caribbean. Caught in a dreadful hurri­ cane in which he lost his medicine chest, the ship limped back to England with a crew severely stricken with scurvy and dysentery (Trotter him self suffered badly from the latter). This youthful experience undoubtedly made a profound impact upon him. Through­ out his naval career, im proving the health o f sailors was to be his great priority. It was, in any case, as he noted, a matter o f military prudence: as he was to discover, the Royal N av y ’s victories at sea ow ed much to the fact that the French were saddled with sick crews. This initial trip also fixed his lifelong concern with scurvy, which he first discussed in print in his Observations on the Scurvy (1786). T rotter saw further active service, receiving public thanks for his exem plary treatment o f the wounded at the Battle of D ogger Bank in 1781, and being prom oted to the rank of surgeon in the next year. A t the close o f the war in 1783, Trotter found himself one o f those surgeons unfortunate enough not to be kept on at half pay. H e took em ploym ent instead on a Liverpool slave ship, the Brookes. It proved another harrow ing experience. The inhumanities of the slave trade appalled him, and he discovered that his elementary medical advice (for instance, for purchasing such antiscorbutics as fresh vegetables and fruit) was ignored by the callous and bigoted master, interested in nothing but economy. Trotter’s early experiences taught him two lessons. First, that the difference between a healthy ship and a disastrously disease-ridden one lay in the dedication and xvm

Introduction by Roy Porter authority o f the surgeon; and second, that immense resistance was to be expected from the traditionalism, stupidity or parsim ony of the officer class. Trotter next practised briefly at W ooler in Northum berland, before returning to Edinburgh, where he attended the lectures of William Cullen, Francis H om e, Jam es G regory and Daniel Rutherford, and, under the imprimatur of Jam es Gregory and the encouragement o f D r Charles Webster, wrote his M D dissertation, D e Ebrietate, Eiusque Effectibus in Corpus H um anum (1788).28 It was apparently warmly received by Cullen. Little is known in any detail about T rotter’s activities during his two spells in Edinburgh. It is clear, however, that he became caught up in the controversies surrounding John Brown and his Brunonian doctrines. In both the D e Ebrietate and in the later Essay . . . o n Drunkenness, Trotter drew on the Brunonian concept o f excitation, while taking issue with the Brunonians for holding too simplistic a vision of health as the m id-point between extreme sthenic and asthenic conditions.29 O n leaving Edinburgh, Trotter then resumed his career in the N avy medical service. Armed with his M D , he now became a naval physician, being appointed to the Barfleur in 1788. H e quickly attracted notice as an active and highly conscientious man, not afraid to voice strong views on the vital importance of cleanliness, ventilation and diet for maintaining health aboard ship. From 1793 to 1794 he served as second physician at H aslar, the vast naval hospital - it held up to 2,000 patients - just outside Portsm outh. W ithout being fixated upon pet theories, Trotter proved energetic in striving for improvements, in particular seeking to better the quality o f nursing care, spelling out his ideas in Rem arks on the Establishment o f the N a v a l Hospitals with Hints fo r their Im prove­ ment (1795). Even so, the resistance his agitations met grieved him. Although the reforms he aimed to introduce were relatively uncontroversial - such as a suite of baths and a vegetable garden - they met with mere inertia. In 1794 Trotter was prom oted to his highest appointment, physician to the Channel Fleet under L ord H ow e, with whom he enjoyed cordial relations. H is massive three-volume Medicina N autica: An Essay on the Diseases o f Seam en, published in 1797, 1799 and 1803, a medical history of the Channel Fleet from 1794 to 1802, affords a fascinating glimpse of his endeavours.30 H e encouraged xix

Introduction by Roy Porter record-keeping am ongst the ships’ surgeons, and placed great faith in the value in tabulating data o f epidemics, their duration, severity and outcom e. H e agitated for practical improvements in operating facilities and recovery beds, preferring to tend sailors aboard ship than to transfer them to hospitals on shore. N ot least, he campaigned to raise the pay and conditions o f naval surgeons. T rotter alw ays affected to despise theory and trust to experience. Yet he w as no blind empiricist. In assessing the aetiology of diseases aboard ship, he recognized a certain truth in the miasmatic theory: foul air and lack of ventilation bred diseases. Yet som e diseases were clearly spread by contagion, sm allpox in particular. F or that reason, he cham pioned inoculation throughout the navy, and quickly became one o f the m ost ardent supporters o f Jennerian vaccination (the Essay . . . on Drunkenness was to be dedicated to Jenner, and they became friendly correspondents).31 Though perhaps curiously ambivalent tow ards Jam es Lind (of L in d’s m ethods with scurvy, he w rote, ‘the plain truth is, his method of cure was imper­ fect’, and he disapproved of Lind’s passion for fumigation), Trotter w as a lifelong propagandist for the value o f citrus fruits, lemons above all, and o f fresh vegetables in preventing and treating scurvy; and he was fond of picturing himself, as physician to the fleet, personally scouring the markets and nurseries in and around ports, buying up the choicest apples and onions for his crews. Trotter was not specially concerned with the theoretical reasons why fruit and vegetables proved efficacious antiscorbutics, though in his Medical an d Chem ical Essays (1795), not one of his more successful w orks, he offered reasons for regarding them, in line with the new Lavoisierian chemistry, and particularly follow ing Beddoes’s pneumatic experiments, as providing the blood with an acidifying principle, oxygen being the principle of fighting disease.32 Trotter suffered a hernia in 1795, and this perhaps precipitated the early end to his naval career in 1802. O n leaving the service, he was aw arded no special honours or recognition, and not a penny above his regular pension o f £200 p.a. H is later writings indicate that he took this as an affront, believing that this rather shoddy treatment was the reward for his tireless badgering o f the naval pow ers-that-be on behalf of crews and surgeons. The Medica N autica m ay in part be read as a retrospective self-vindication, indicting the supineness of his naval superiors and o f such fashion­ xx

Introduction by Roy Porter able naval physicians as Sir G ilbert Blane; and the Essay . . . o n Drunkenness likewise abounds with barbs against the complacency o f those w hose duty was to improve the sailor’s lot, as well as celebrating his own achievements, as for example in securing a reduction o f the number o f gin shops in Plymouth from 300 to 100.33 Ju st turned forty, Trotter chose to settle as a medical practitioner in N ew castle, an obvious choice for a seafaring man, though an am bitious ex-physician to the fleet might have been expected to set up in London. In 1810, on the death o f his first wife, he remarried. H e played an active part in the intellectual and cultural life of the town, being prominent in the Literary and Philosophical Society and contributing to the local newspapers and journals. H is interests were both literary and scientific. H e published a play, The Noble Foundling, in 1812, and a volume of poem s, Sea Weeds: Poems Written on Various Occasions, Chiefly D uring a N a v a l Life, in 1829. But he also became embroiled in the controversy over the preven­ tion o f gas explosions in the deep pits of the N orthum berland and Durham coalfields. A s set out in his A Proposal fo r Destroying the Fire an d Choak-dam p o f C oal Mines (1805), T rotter’s solution lay in the use of an effective ventilation system - a view which surely reflects his years o f experience in keeping ships’ holds salubrious. F o r one who had risen to become chief naval physician, and who was to publish influential w orks in his forties, relatively little is known of the last twenty-five years o f Trotter’s life. H e continued as a medical practitioner in New castle till he was in his mid-sixties. Retiring from practice in 1827, he moved to a small estate in his native Roxburghshire, then briefly to Edinburgh, before finally returning to N ew castle, where he died on 5 September 1832. The last quarter century o f his life brought no further medical or scien­ tific publications. T rotter’s three chief productions all appeared around mid-life. These were the Medicina N autica (1797-9), the summation o f his experience in the navy, which will not be further discussed; the Essay . . . on Drunkenness (1804), which will be analysed below ; and the View o f the N ervous Temperament (1807). This was in many respects T rotter’s m ost wide-ranging and intellectually am bitious medical w ork - it is approxim ately twice as long as the Essay . . . on Drunkenness - constituting an attempt to diagnose the characteristic xxi

Introduction by Roy Porter sicknesses of the age, indeed, more specifically, to pinpoint precisely how the degeneracy o f modern society was itself creating a pro­ clivity tow ards sickness. The View o f the Nervous Temperament has been neglected. I shall attempt to show below how a grasp o f its key ideas is vital to an understanding of Trotter’s project in the Essay . . . on Drunkenness.

The Essay .. . on Drunkenness T rotter’s Essay . . . on Drunkenness (1804) is a quite complex literary production. F or one thing, it stands in a rather unusual relationship to his Edinburgh University M D dissertation, D e Ebrietate (1788). T rotter quotes from his M D in the original Latin,34 presumably as a w ay o f establishing the temporal priority of his ideas about the diseases o f drink. Yet he also treats the D e Ebrietate as the first edition o f the w ork of which the Essay . . . on Drunkenness is the ‘second’ (‘corrected and enlarged’). Thus we encounter the peculiar situation o f an author quoting from the first edition of his own w ork in the second edition! Trotter awkwardly terms his Essay a ‘com m ent’ on his M D thesis. This is just one sign amongst many that the Essay . . . on Drunken­ ness was having to serve a plurality o f purposes. After having spent twenty years in H is M ajesty’s Service, Trotter had newly set up as a physician in civilian life. Though his choice of N ewcastle may possibly m ark a decision for relative retirement, the fact that he was keen to make a name for him self as a medical author also suggests am bition. C iting his pioneering M D thesis may well have been part o f a strategy for establishing his credentials within the medical com m unity as an expert o f long-standing upon inebriation. Yet all the signs are that he was not primarily, or at least not solely, targetting the Essay at a professional, medical readership. Written in an entertaining and often personal style, and laced with anecdotes and asides, the w ork is far from being a dry handbook or technical treatise on habitual drunkenness, methodically detailing its diagnosis and treatment, and listing clinical case histories and therapeutics. F or one thing, as already mentioned, Trotter uses it as a vehicle to hit back against the ‘torpid indifference’ o f the naval authorities - sardonically referring in his dedication to Jenner to xxu

Introduction by Roy Porter ‘m y present obscurity’.35 F or another, he was clearly putting him­ self through his paces as a man of letters - an ambition eventually manifesting itself in his plays and verse: several chapters begin with epigraphs from Shakespeare, and extracts from H orace, Virgil, Jam es Thom son, R obert Burton and other literary lions are spliced into the text. It is noticeable that Trotter offers as his prime depic­ tion o f the characteristics of intoxication F alstaff’s paean to the qualities o f a ‘good sherries sack’ .36 Yet T rotter’s w ork is far from being ‘m erely’ a literary essay; nor is it intended to add to the genre o f do-it-yourself domestic health­ care books written primarily for the laity, for unlike these, Trotter does not dole out platitudinous advice upon the virtues o f temper­ ance. It w ould also be misleading to suggest that his Essay is just a mishmash, falling between many different stools. Perhaps the indi­ cations that Trotter had several different purposes in mind confirms that, as he claimed, he was indeed initiating a genre of writing about drunkenness, rather than contributing to a well-worn tradition. Above all, Trotter wants the medical identity o f his monograph to be established beyond dispute. It is surely significant that he chooses to dedicate it to ‘D r Jen ner’, thereby, by implication at least, playing off the medical benefactor o f mankind against the Admiralty top brass whom he might he expected to have sought as patrons. H e also takes an early opportunity o f slighting the efforts of the ‘priesthood’ and the ‘m oralist’ to rectify drunkenness: though such lay people have ‘meant well’, in the event they have done little good, because the key medical aspect - ‘the physical influence of custom , confirmed into habit, interwoven with the actions of our sentient system, and reacting on our mental part’ - has ‘been entirely forgotten’. Drunkenness must be recognized as the province of the ‘discerning physician’.37 And in pursuit of this he chooses to give his book a medical structure, or, as he puts it, ‘to treat my subject philosophically’ .38 The first chapter concerns itself with the ‘Definition of D runken­ ness’, and opens with the challenging and program m atic character­ ization of drunkenness as ‘strictly speaking . . . a disease’ .39 We must, o f course, be wary o f reading too much into this contention; for to a practitioner trained in the eighteenth century, the term ‘disease’ still carried general connotations o f ‘dis-ease’, disorder or distemper, rather than the very specific implications - the notion of xxm

Introduction by Roy Porter a disease as a distinct ontological entity, a vera causa - later to becom e com m on in the age o f bacteriology and germ theory.40 T rotter’s tactical aim was less to make the fine distinction between drunkenness as ‘disease’ and drunkenness as sym ptom , than to assert categorically that drunkenness fell within the medical dom ain. A s he goes on to explain, to label drunkenness a disease is a way o f identifying it as equivalent in status to other disease entities such as delirium, apoplexy or coma, with which of course it shares sym ptom s and to which it com m only leads.41 Thus, in Trotter’s definition, drunkenness is specified as the disease consequent upon ‘im m oderate use o f vinous liquors’, producing the sym ptom s of ‘imbecility o f intellect, erroneous judgm ent, violent em otions and loss o f sense and m otion’.42 Addressing the eminent professor, William C ullen ’s nosology, Trotter places drunkenness within the class o f the Vesaniae, i.e., the species of insanity; within this category it has the closest affinities to am entia (idiotism ), insania, and mania though melancholia is itself often the consequence of habitual intoxication.43 H aving arrived at his medical definition o f drunkenness, Trotter proceeds in his second chapter to investigate its ‘phenomena and sy m pto m s’ . The initial effects o f alcohol - the desired end o f drink­ ing - are to suffuse heat, stimulus, ardour, vigour; but when con­ tinued beyond moderation there follow s a descent from stimulus to ‘indirect debility’, ‘from pleasure to pain, from the purest percep­ tions o f intellect to the last confusion o f thought’, which ‘ends, by bringing [man] to a level with the brutes’.44 Trotter details the sym ptom s o f com m on drunkenness (‘the countenance looks swollen and inflamed, the eyes start and glare, vision is double’, he w rites, citing Boissier de Sauvages),45 but also describes the acute ‘paroxy sm ’, which triggers fever, delirium, apoplexy and even death. Therein lies the paradox at the heart of ‘vinolency’ (apparently an archaic term , revived by Trotter): prolonged potations prove counter-productive. M oreover, its use as a stimulant is subject to the law o f diminishing returns: ever greater quantities are successively needed to induce identical effects: ‘in short’, states Trotter in a com m ent that is m ore than just a truism, ‘like all human enjoy­ m ents, the exhilarating pow ers of wine lose their fine zest and high relish, by being too frequently indulged’.46 xxiv

Introduction by Roy Porter H aving defined drunkenness and examined its phenomena and effects, Trotter proceeds, in chapter III, to explore the pow ers of alcohol upon the animal econom y: through what chemical and vital processes does it produce its effects? T o resolve this, Trotter feels obliged to pose a much wider question, not confined to alcoholic beverages but encom passing the entire range o f ‘narcotics’ - in particular opium , bangue, hyosciam us (henbane), nicotiana and so forth. Should alcohol and other such substances be principally regarded as ‘sedatives’ ? O r should they rather be treated - as the Brunonian school insisted - primarily and essentially as ‘stimulant and exciting’, being only ‘indirectly sedatives’, once their stimulat­ ing pow er had been exhausted?47 Focusing upon the effects of opium , used medically and recreationally, Trotter contends that the latter is evidently the correct reading - after all, he stresses, no physician would prescribe opium for inflammatory or sthenic diseases such as pneumonia, which clearly require sedative treat­ ment. Hence, Trotter concludes, ‘all narcotics have more or less the same effect’.48 It may seem that Trotter is here making heavy weather o f an obvious empirical fact: that vinous spirits are a stimulant. But his ploy was designed to secure two larger points. O n the one hand, he was aiming to establish the affinity between consum ing alcohol and recourse to a multitude o f other stimulants, all seen as manifesta­ tions o f a com m on sociopathology - a point to which I shall return later. O n the other, by assimilating drinking within the use of ‘narcotics’ in general, he sought to provide a general formulaic answer to the problem o f the physiological effects o f alcohol. What is the nature o f the ‘operation o f vinous spirit on the b o d y ’ ? It is, he can now answer, ‘intoxicating’ .49 Trotter was aware o f the verbal sleight o f hand involved in this solution, to which he presumably resorted for want o f any detailed experimental physiological studies of the kind perform ed later in the nineteenth century. Possibly in a gesture o f self-exculpatory bravado for the rather Molierian quality o f the solution (alcohol makes people drunk because it is intoxicating), Trotter waves further inquiry aside as pointless: it is beyond our pow er to trace the pathways through which alcohol affects the fibres, nerves and brain, and ‘it w ould be an endless digression, and very little useful to the present investigation, to detail the various theories and conjectures xxv

Introduction by Roy Porter o f physicians and m etaphysicians on the connection between body and m ind’ .50 Instead, T rotter pursues som e o f the side-effects of intoxication. D runkenness suspends or distorts many regular vital processes and sensory-m otor chains. It has been alleged to offer protection against certain contagions (T rotter is non-com m ittal); it certainly provides a surprising im m unity against extreme cold and other painful sensa­ tion s; and not least it disorientates the senses, allowing Trotter to quote som e entertaining anecdotes out of Burton’s Anatomy o f Melancholy (1621) concerning drunkards’ delusions.51 Alongside its ‘intoxicating’ principle of action, alcohol also possesses a ‘chem ical’ pow er, which he regards, in a manner apparently in­ debted to Beddoes, as intimately connected with deoxygenation o f the blood. T rotter devotes full thirty pages of his text to exploring one particular manifestation of the chemical transform ations of chronic drunkenness: spontaneous com bustion, or, as he defines it, ‘the burning o f the human body without the contact of any substance in a state o f ignition’ .52 H e adduces a handful of apparently welldocum ented examples - m ostly fat old sottish women - in which, as w as said, the consequence of protracted heavy spirit-drinking was to turn the body fibres and fat into a kind o f highly combustible fuel. P ossibly with the aid o f an initial spark from a pipe, such p eop le, their bodies literally soaked and pickled, had caught fire and insensibly burned to death in their sleep. Trotter acknowledges the bizarreness o f these tales, but is disposed to accept them, believing them w ell-authenticated.53 They clearly support his more general proposition, that man is a creature comprehensively changed, m orally and physically, by his m ode of living - or, as he might have said, man is what he drinks. They also, of course, provide the m ost awful w arning:54 ‘M ay men never forget that the vine sometimes produces very bitter fruit, - disease, pain, repentance, and D E A T H !’ But burning to death is not the only dire fate awaiting the drunk­ ard, and T rotter devotes his fourth chapter to an exposition of the spectrum o f diseases which ‘temulency’ brings on. These divide into tw o kinds; on the one hand, those acute disorders specifically triggered while in a state o f high inebriation - and here apoplexy is the chief,55 though epilepsy, hysterics and convulsions are also discussed.56 O n the other, those which follow from ‘habitual intoxixxvi

Introduction by Roy Porter cation’ . These include inflammatory diseases (brain-fever, pleurisy, rheumatism, and assorted inflammation o f the stomach and the bowels),57 ophthalmia,58 carbuncles,59 hepatitis,60 gout,61 schirrus,62 jaundice,63 dyspepsia,64 dropsy,65 tabes and other form s of emacia­ tion,66 palpitations,67 diabetes,68 palsy,69 ulcers,70 m adness,71 m elancholy,72 im potence,73 and premature old age.74 Because, one imagines, of his unequalled experience of seeing the physical decline and fall o f heavy drinkers in the N avy, Trotter is insistent upon the prim e role played by excessive drinking in the aetiology o f all such serious diseases. D iscussing ‘dropsies, apo­ plexies, palsies, & c .’ he comments, ‘we must look to hard drinking as the principal agent in bringing on these maladies’.75 N o t least, Trotter stresses, drunkards may communicate their disorders to their children, primarily through the m other’s milk, which will all too readily set the baby off on the road to ruin.76 So where lies the solution? In chapter V (‘The Method of Correct­ ing the H abit o f Drunkenness, and o f Treating the Drunken Paroxysm ’) Trotter addresses himself to counter-measures. It is perhaps the m ost radical and original section in the whole work. Trotter abstains from droning the custom ary warning sermon, nor does he pretend that he has in his bag a surefire medical therapeutic - still less a nostrum - to redeem addicts. Instead his approach is to characterise alcohol-dependency as integral to, and one element o f many within, a wider contem porary problem of addiction to stimulants and narcotics. In his view, habitual drinking will be m isunderstood unless contextualized alongside the rampantly rising consum ption of opiates, tea, coffee, cordials, and (not least) medi­ cines, and the development o f other harmful habits. T o concentrate upon the individual sot w ould be to commit the error o f scapegoat­ ing; the problem was much wider, and would be intelligible only within the fram ework o f what we might anachronistically call a comprehensive historical sociology of health and sickness. Within the confines of a single chapter, Trotter can sketch in this framework only suggestively, merely through a variety of examples and anecdotes. The Ancients, he tells us, guarded themselves effect­ ively against this horrid habit o f intoxication; under one o f Solon’s laws, the Athenians put drunken magistrates to death; to excite horror o f tipsiness am ongst their children, the Spartans exposed drunken slaves before them; ‘am ongst the Rom ans, the vice was xxvu

Introduction by Roy Porter odious: the whole history of this republic does not mention such a phrase, as a habit of intoxication’.77 N ow adays, by contrast, he argues it is thought manly rather than shameful to have a name for being a heavy drinker, and - wagging a disapproving finger at politicians such as Fox and Pitt - in these degenerate times it is even thought proper that a statesman should be a three-bottle man.78 N or, Trotter implied, were the ladies any better, for in different ways they were no less addicted - albeit often secretively - to their brandy-based cordials, opiates and laudanum, to say nothing of their countless dishes of intoxicating hyson tea.79 So-called civilized Christians dub Red Indians and similar people barbarians, yet the Cherokees have absolutely prohibited the use of hard liquor;80 and so forth. It is easy to pick up the thread of the argument implied in such disparate remarks. But there is no need to strain at these hints, because Trotter spelt out his case more systematically and lengthily in his View o f the Nervous Temperament, which can profitably be read as an extended gloss upon, and contextualization of, the Essay . . . on Drunkenness.

D ru n k en n e ss and the N e rv o u s T em p eram en t The View o f the Nervous Temperament engages with the debate over the gains and losses of man’s emergence from ‘rudeness to refinement’ - Trotter himself picks up that famous phrase conducted throughout the Enlightenment, above all by Montesquieu and Rousseau in France and by Adam Ferguson, Adam Smith and John Millar in Scotland.81 Such ‘conjectural historians’, or philo­ sophical anthropologists, could broadly agree that history showed epochal transformations of human culture: man had developed the useful and the fine arts, and maximized his control over N ature; with greater technical and scientific powers, economic progress had multiplied wealth and leisure; social organization had become more sophisticated, manners and morals had grown more polite, refined and sensitive. Modern society seemed to abound in affluence, com­ forts and individual liberty, in enticing opportunities and higher expectations. What was fundamentally disputed, however, was the deeper XXV lll

Introduction by Roy Porter meaning of these developments for human nature and happiness, for man’s real well-being, psychic and physical. O ptim ists argued that as a result o f these advances man now lived in a safer, securer, more healthy environment, and could exercise greater control over his destiny. Education, urbanity and refinement, had increased his potential for happiness, and economic and technological progress had extended his capacity to realise that potential. Thus, at the close o f the third volume o f his Decline an d Fall o f the Roman Empire, Edward G ibbon could claim along these lines, with a flourish tinged with a hint o f scepticism, that ‘every age o f the world has increased, and still increases, the real wealth, the happiness, the knowledge, and perhaps the virtue, of the human race’.82 Trotter read G ib bon ,83 but advanced a clean contrary interpreta­ tion o f the implications o f this epochal transition. In a way more reminiscent o f Rousseau, Trotter looked back to the more basic civilizations o f Antiquity, and even to the barbarians as portrayed by Tacitus, and saw in them peoples marked by a noble ‘simplicity’.84 They were sturdy, independent and tough; they suffered few ills, precisely because they had few needs: ‘where the savage feels one want, the civilized being has a thousand’.85 It might be admitted of the ‘primitive’, Trotter conceded, that ‘his enjoyments are limited’ ; nevertheless ‘his cares, his pains, and his diseases are few ’.86 In T rotter’s evaluation, the march o f civilization, with its attend­ ant claustrophobic urbanization, indoors existence, ‘refined life’,87 and sedentary occupations (or none at all!)88 has proved little more than the advance o f discontents, generated by spiralling wants, opportunities and desires. The tide of progress has fermented a spirit of inquietude, a restless, insatiable quest for new experiences, new gratifications, new excitements. Greater wealth has brought idleness, indolence and consequent ‘low spirits’ ;89 these in turn have spurred fresh cravings for ‘debilitating pleasures’90 and ‘excessive stim uli’.91 Similarly, indulgence in luxury begat the evils of excess,92 and the cultivation of subtler tastes and exquisite sensitivities brought with them increased susceptibilities to pain. By consequence, alongside cravings for novel stimuli, fresh needs sprang up for sedatives, to deaden the pains o f the discontents of civilization - not least that ‘hypochondriacism ’ resulting from a com bination of unhealthy life-styles and ultra-febrile imagination.93 The civilizing process thus created insatiable needs for both ‘inordinate XXIX

Introduction by Roy Porter stim ulation’94 and for narcotics, all fired by the allure o f the new and the empire o f fashion. M ore specifically, the artifices o f m odish living - over-sophisticated diet, gluttony,95 stifling room s, pernicious fashions such as tight-laced corsets, late rising, lack of exercise and so forth - necessarily bred ill-health and disease, and so led autom atically (given the new supersensitivity to pain) to the sw allow ing o f ever greater quantities o f medicines; and because so many o f these were both harmful and addictive, they in turn further destroyed the stom ach and the nerves, causing fresh sickness, and so induced a descending spiral of yet more medicines to rectify the iatrogenic ailments. All in all, judged Trotter, the so-called growth of freedom in m odem society was all illusory. Pleasures rapidly wore out and trapped the voluptuary on a treadmill, for - to return to a sentiment expressed in the Essay . . . o n Drunkenness - ‘the exhilarating powers . . . lose their fine zest and high relish, by being too frequently indulged’.96 Thus modern man was enslaving himself to his own insatiable imagination, wants and expectations, to his vices and his self-created physical and mental weaknesses. We had degenerated, bem oaned Trotter, into a ‘nation of slaves’.97 In its currently m orbid manifestations civilization was itself a m ode o f disease. So civilized man grew unhealthy, suffering from that very ‘nervous tem peram ent’ which the civilizing process had created. T o revive his jaded appetites he resorted to such stimuli as ardent spirits; to ease his pains and deaden his jangled nerves, he swallowed sedatives; all these in turn only gave new twists to the screws of sickness. M edi­ cines proper had the same deplorable effects. And all the while, T rotter em phasized, implicitly drawing upon Lockean associationist theories of the formation of habit and character through educa­ tion and environment, these pathological facets of civilization were actually becom ing ingrained within human nature itself, em bossed upon the collective mind and passed down from generation to genera­ tion. For human nature was not a fixed entity, but the product of self­ development. And civilized man, a delicate, hothouse plant, was above all a ‘creature of habit’.98 In so far as he was a victim of the ‘nervous temperament’, this was precisely because he was the ‘creator of his own temperament’.99 As Trotter emphasized in his Essay, ‘in the present stage of society, human kind are almost taken out of the hands of N ature; and a custom called fashion . . . now rules everything’.100 xxx

Introduction by Roy Porter In individual, society, and race, the disposition to drunkenness was both a sym ptom and a spur within this process. The craving for drink was itself a mark o f an effeminate, decadent stage, for ‘natural appetite requires no such stimulants’ .101 Trotter was not such a primitivist as to debar stimulants entirely. But m ost - such as ardent spirits and hyson tea - he believed were essentially harm ful; and he deplored the fact that stimulants such as wine, which were safe if deployed w isely, had been turned into necessities, and that such substances as soda water, which ought to be used strictly medicin­ ally, had become habitual beverages. Tim es were bad when opium , G o d ’s greatest gift to the physician for the relief o f acute pain, had become an item in every fashionable lady’s reticule in the form of the laudanum phial.102 Thus, in both the individual and in the social m acrocosm , a descending spiral was in m otion. D raw ing upon the Brunonian analysis of excitability, Trotter asserted that each dose of artificial stimulant produced the required sensations, but only temporarily, and their pow ers to excite were quickly exhausted. They were then consumed in ever larger quantities, greater concentrations, or in adulterated form s - and here Trotter was particularly severe on the adulterating practices o f the great brew ers.103 Finally, more potent stimulants had to be found. Tim e was when the rich had satisfied their cravings in wine; now, enervated by ‘luxury and refinement’ 104 and racked by ‘diseased sensibility’, 105 they had taken to fortified liquors such as port and brandy. Form erly the poor had quaffed their ale; now they downed rum and gin, or, no less perniciously, ales adulterated by unscrupulous brewers who added addictive bitters and even opiates. Overall then, ‘polished society’ was so acting as to ‘bring on its own dotage’ and ‘dig its own grave’.106 There was nothing funda­ mentally original in T rotter’s interpretation of how the transition from ‘rudeness to refinement’107 had in reality proved disastrous for human nature. M any other critics looked back to a golden age when life was simpler, healthier, happier. Indeed such advocacy o f plain living was quite com m on am ongst doctors, from G eorge Cheyne’s English M alady, which urged a return to grains and milk, through to the late eighteenth-century sex therapist, Jam es Graham , who indicted oversophisticated civilization of causing impotence and depopulation, demanding an end to alcohol consum ption and a xxxi

Introduction by Roy Porter return to w ater.108 Cheyne had suggested that perhaps a third o f all the diseases o f ‘people of condition’ were nervous; Trotter, probably echoing him, judged that such diseases constituted no less than twothirds o f all modern disorders.109 Though T rotter’s account o f the diseases o f civilization was not, strictly speaking, original, what makes his formulation o f these ideas particularly telling is his stress on the sym biosis of physical and psychological dependency in the individual (increasingly hooked on his stimulants, be they alcohol or medicines), and indeed in that ‘a creature o f habit and imitation’,110 civilized man at large, was ‘wallow ing in wealth and rioting in indulgence’, 111 enslaved to the tyranny o f fashion, sensation, and novelty. Physical stimuli, such as alcohol, made their mark upon the senses; these in turn registered their effects upon the nervous system, producing the ‘nervous tem peram ent’ ; this temperament affected the psyche; and in turn the mind begat imagined desires which set o ff new chains of cravings. Th us Trotter could ask, rhetorically:112 ‘Are not habits of drunkenness m ore often produced by mental affections than cor­ poreal diseases? I apprehend few people will doubt the truth of this.’ Convinced thus o f this psychological enslavement, it was natural that T rotter should be the first analyst clearly to formulate the idea o f habitual drunkenness as a mental illness, for in his view it w as sustained by a w ider historical process of the corruption of the civilized mind. T rotter was never an out-and-out primitivist, advocating a return to N ature, as R ousseau seemed in som e o f his more provocative pronouncem ents. Indeed, he thought that certain pockets of hardy m anhood still survived relatively uncorrupted. A well-disciplined British warship, manned by doughty tars and commanded by con­ scientious officers, was one exception, and he was confident that Britain w ould defeat N apoleon, for the process o f cultural deca­ dence, the evolution o f the nervous temperament, had proceeded less in Britain than in effeminate France.113 Hence he was not m erely a lau dator temporis acti, and it was the abuses o f civilization, not civilization itself, which he deplored. H e did not call for the total abandonm ent o f medicine or alcohol, nor did he envisage the state passing any general liquor laws. What he recommended, rather, w as the tim e-honoured regime o f moderation. X X X ll

Introduction by Roy Porter In respect of alcohol, he was guided largely by considerations of health. N o healthy young man should require the stimulus of vinous spirits. At the age o f forty, a man might avail him self o f the cheering and cordial virtues o f good wine to the extent o f two glasses a day; at fifty, that might be extended to four, and at sixty to six. O n this Trotter cited Luigi Cornaro, the renowned Venetian writer on longevity who had lived to well over a hundred on such a regim e.114 The pursuit o f ‘temperance’ in the traditional sense - i.e., m oderation - w ould curb the insensate lust for sensation fired by the nervous temperament. But were remedies to hand in the case o f the individual sufferer? F or those actually in the throes o f the drunken paroxysm , Trotter suggested the standard drastic countermeasures to prevent possibly fatal apoplexy, above all, emetics and clysters. The habitual drunk­ ard was a different problem . F or those ‘addicted to ebriety’, 115 pursuit o f a sensible regimen o f ‘plain diet and water’ 116 was of course vital; and such expedients as visits to Bath might be useful. But on one point Trotter was insistent. Precisely because habitual drunkenness was a disease o f the mind, it m ust be cured not by drugs, but by mental discipline: ‘it is in vain to expect a cure from articles of medicine. The habit of drinking m ust cease, and moral arguments . . . m ust be speedily em ployed’.117 This would require the strict ‘ascendency’ o f the physician over his wayward and m orally perverse patient - Trotter’s formulation here echoes the ‘moral management’ techniques prominent in contemporary psychiatry.118 N o t least, because habitual drunkenness was a mental disorder, successful cures required that drinking should stop ‘at once’, rather than by gradual stages: it m ust be marked by an act o f will. Trotter surveyed the strategems widely advocated to wean sots off drink gradually - e.g., L ettsom ’s ruse of putting a drop of sealing-wax in the drunkard’s glass each day, so as slow ly and insensibly to reduce his intake.119 Trotter dism issed such ploys as ‘childish’ and psycho­ logically stupid. The drunkard, ‘addicted to the bottle’,120 w ould naturally drink a little, feel good on it, and persuade him self it was safe to take a little more. O n ly a sudden, decisive, complete break w ould w ork. It had all to be done ‘at once’ .121

X X X ll l

Introduction by Roy Porter C o n c lu sio n At first glance, T rotter’s Essay . . . o n Drunkenness may appear rather a strange book, both perceptive and pioneering, with its stress upon habitual drunkenness as a disease, indeed a disease o f the mind, yet puzzlingly anecdotal, short of specific clinical evidence, case studies and therapeutic experiments. It is certainly not a work in the m ould o f nineteenth century psychiatric discussions of alco­ holism, typically focused upon the data of alienism as taken from the lunatic asylum - an institution Trotter does not even mention. The proper integrity is, however, restored to his w ork if it is seen, in tandem with the View o f the Nervous Temperament, in the light of the emphasis placed by Scottish medicine, in particular Cullen’s school, upon the overwhelming importance o f the nervous system (and thus o f neurosis), and upon the role played by nervous organ­ ization in the interplay o f mind and body, consciousness and action. Trotter set this insight within the framework of a late Enlighten­ ment historical sociology of the evolution of human wants - and discontents. D raw ing upon a tradition of cultural criticism, he viewed the very civilizing process itself, with its quest for stimulus and its cultivation of refined sensibility, as uncorking a magnum of evils. Trotter made a pioneering contribution to the understanding o f alcoholism. T o understand this, it must be located in its historical context.

N o te s 1.

2.

For Boswell see K. B. Rix (1975), ‘James Boswell (1740-1795): “ No Man is More Easily Hurt With Wine than I Am’” , Journal of Alcoholism, 10: 73-7; for a general and rather anecdotal account of heavy drinking habits see A. L. Simon (1926) Bottlescrew Days. Wine Drinking in England During the Eighteenth Century, London: Duckworth. For the place of drinking within pre-industrial society, see J. A. Spring and D. H. Buss, ‘Three Centuries of Alcohol in the British Diet’, Nature, 219 (1977): 567-72; M. M. Glatt, ‘The English Drink Problem: its Rise and Decline Through the Ages’, The British Journal of Addiction, 4 (1958): 51-67; H. G. Graham (1969) The Social Life of Scotland in the Eighteenth Century, London: Black; Keith V. XXXIV

Introduction by R oy Porter Thom as (1971) Religion and the Decline o f Magic, London: Weidenfeld & N icolson: p. 17; P. Clark (1983) The English Ale House, London: Longman. Samuel John son ’s views are discussed in J. S. Maddan (1976) ‘Samuel Johnson’s Alcohol Problem’, Medical History, 11: 141-5. 3. For Mather see M. Lender (1973), ‘ Drunkenness as an Offence in Early N ew England’, Quarterly Jo urn al fo r Studies in Alcoholism, 34: 357. For medical approval of drinking see P. Shaw (1724) The Juice o f the G rape; or Wine Preferable to Water, London: W. Lewis. For religious tolerance see M. Screech (1979) Rabelais, London: Duckworth, and Screech (1983) Montaigne and Melancholy, London: Duckworth. Thom as Trotter himself complained about the lacing of nostrums with alcohol: see Trotter (1804) An Essay, Medical, Philo­ sophical, an d Chemical, on Drunkenness and its Effects on the Hum an Body, London: Longman, H urst, Rees & Orme. Similar points are made in V. Berridge and G . Edwards (1982) Opium and the People, N ew Haven: Yale University Press. 4. E. L. Bristow (1977) Vice an d Vigilance, Dublin: Gill & Macmillan; J . Sharpe (1977) ‘Crime and Delinquency in an Essex Parish 16401660’, in J. S. Cockburn (ed.) Crime in England 1550-1800, London: Methuen, pp. 90-109; M. J . Ingram, ‘Communities and C ourts: Law and D isorder in Early Seventeenth Century Wiltshire’, in ibid.; pp. 110-34; and, for America, I. Tyrrell (1979) Sobering Up, Westport, C onn.: Greenw ood Press. 5. For the gin craze see J. Watney (1976) Mother’s Ruin, London: Peter O w en; D. M. George (1966) London Life in the Eighteenth Century, H arm ondsw orth: Penguin; T. G . C offey (1966) ‘Beer Street: Gin Lane: Some Views of 18th Century Drinking’, Quarterly Jo u rn al fo r the Study o f Alcoholism, 34: 662-92; Lord Kinross (1959) ‘Prohibi­ tion in Britain’, History Today, 9: 493-9. 6. See the discussion in P. Mathias (1969) The Brewing Industry in England 1700-1830, Cam bridge: Cam bridge University Press. Trotter’s complaints can be found in his Essay . . . on Drunkenness, PP-41f. 7. For the temperance movement see B. Harrison (1971) Drink and the Victorians, London: Faber & Faber, and (1963) ‘D runkards and Reform ers; Early Victorian Temperance Tracts’, History Today, 13: 178-85; P. M acCandless (1984) ‘Curses of Civilisation; Insanity and Drunkenness in Victorian Britain’, British Jo urn al o f Addiction, 79: 49-58. 8. The views of eighteenth and early nineteenth century mad doctors on drink as a precipitant of insanity are explored in R oy Porter (1987) xxxv

Introduction by Roy Porter

9.

10.

11. 12. 13. 14. 15. 16. 17. 18. 19.

20.

21.

Mind Forg’d Manacles. A History o f Madness in England from the Restoration to the Regency, London: Athlone Press, pp. 198-201. See the excellent account in W. F. Bynum (1968), ‘Chronic Alcoholism in the First Half of the 19th Century’, Bulletin o f the History o f Medicine 42: 160-85, esp. p. 162; and John Romano (1941), ‘Early Contributions to the Study of Delirium Tremens’, Annals o f Medical History, 3: 128-39. For Erasmus Darwin see E. Darwin (1794—6) Zoonomia; or, the Laws o f Organic Life, 2 vols, London: Johnson. Darwin explicitly termed ‘drunkenness’ a disease (in his classification it was number 1.1.2.2, a disease of ‘irritation’). D octors have traditionally seen the advent of medicalization as pro­ gress, arguing that the recognition of underlying physical causes for what had traditionally been seen as sins, vices or crimes, freed patients from stigma. See H. W. Haggard and E. M. Jellinick (1942) Alcohol Explored, New York: Doubleday & Doran. Critics have argued on the contrary that it forms part of a strategy, conscious or unconscious, of medical imperialism (see T. Szasz (1975) Ceremonial Chemistry, London: Routledge & Kegan Paul). I am here indebted to the account in Bynum, op.cit. (note 9). Ibid., pp. 165, 174-5. Ibid., pp. 177-9. See Harrison, Drink and the Victorians, op. cit. (note 7), p. 92. Trotter, Essay . . . on Drunkenness (note 3), p. 3. Ibid., pp. 1, 8. Ibid., pp. 26,195. Ibid., pp. 1-2. William Buchan (1776) Domestic Medicine, London: W. Strahan. For writings about alcoholic drink since Antiquity see J.-C . Sournia (1986) Histoire de I’Alcoolisme, Paris: Flammarion. For Rush (1785), see An Enquiry into the Effects o f Spiritous Liquors on the Hum an Body, Boston: Thomas & Andrews; J. Hirsch (1949), ‘ Enlightened Eighteenth Century Views of the Alcohol Problem’, Journ al o f the History o f Medicine, 4: 230-6; H . G. Levine (1978), ‘The Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America’, Journal o f the Study o f Alcoholism, 39: 143-74, and B. Rush (1948), ‘Plan for an Asylum for Drunkards to be Called the Sober House. 1810’, reprinted in G. W. Corner (ed.) The Autobiography o f Benjamin Rush, Princeton: Princeton University Press, pp. 354—55. Trotter, Essay . . . on Drunkenness (note 3), pp. 8, 179. For similar formulations, see ibid., pp. 128, 182 (‘the habit of intoxication belongs to the mind’), p. 26 (drunkenness is ‘a species of insanity’), xxxvi

Introduction by Roy Porter

22.

23. 24. 25. 26. 27.

28.

29.

30.

31.

and p. 186 (‘are not habits of drunkenness more often produced by mental affections than corporeal diseases?’). For further discussion, see Roy Porter (1985), ‘The Drinking Man’s Disease: The “ PreH istory” of Alcoholism in Georgian Britain’, British Journal of Addiction, 80: 385-96. J. C. Lettsom (1787) ‘Some Remarks on the Effects of Lignum Quassiae Amarae’, Memoirs o f the Medical Society o f London, 1: 128-65, esp. 157-8. For Lettsom, see K. J. Rix (1976) ‘John Coakley Lettsom and Some of the Effects of Hard Drinking’, Journal o f Alcoholism, 11: 98-113; and compare also A. Fothergill (1796) An Essay on the Abuse o f Spiritous Liquors, Bath: Cruttwell, p. 19, and Thomas Beddoes (1802) Hygeia, 3 vols, Bristol: Phillips, vol. 2, essay 8, pp. 28-90. G. Cheyne (1724) An Essay o f Health and Long Life, London: G. Strahan, p. 49. Ibid., p. 53. B. Mandeville (1730) A Treatise o f the Hypochondriack and Hysterick Diseases, London: J. Tonson, pp. 373-4. J. Wain (1980) Samuel Johnson, London: Macmillan, p. 240. The best accounts of Trotter’s life, from which most of the following details are taken, are Ian Porter (1963), ‘Thomas Trotter, M .D., Naval Physician’, Medical History, 7: 155-64; Sir Humphry Rolleston (1919) ‘Thomas Trotter, M .D .’, in Contributions to Medical and Biological Research Dedicated to Sir William Osier, In Honour o f His Seventieth Birthday, by His Pupils and Co-Workers, New York: Hoeber, pp. 153-65 (perceptive yet unreliable on points of detail). Hardly any manuscript material seems to have survived. Thomas Trotter (1788) De Ebrietate, Eiusque Effectibus in Corpus Humanum, Edinburgh. A copy of this is to be found in Edinburgh University Library. The most comprehensive recent discussion of the contribution of Brunonianism to late eighteenth century medical debate is to be found in W. F. Bynum and Roy Porter (eds) (1988) Brunonianism in Britain and Europe, London: Medical History Supplement 8. Copious extracts from these works have been printed, with a brief commentary, in C. Lloyd (ed.) (1965) The Health o f Seamen. Selec­ tions from the Works o f Dr. Jam es Lind, Sir Gilbert Blane and Dr. Thomas Trotter, London: The Navy Records Society, pp. 217-316. See Paul Saunders (1982) Edward Jenner: The Cheltenham Years 1795-1823, Hanover and London: The University Press of New England, pp. 107, 255. xxxvn

Introduction by Roy Porter 32. 33. 34. 35. 36. 37. 38. 39. 40.

41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65.

See Kenneth Carpenter (1986) The History of Scurvy and Vitamin C, Cambridge: Cambridge University Press. Trotter, Essay . . . on Drunkenness (note 3), pp. 41, 49. Ibid., p. 187. Ibid., p. 170. Ibid., p. 20. Ibid., p. 3. Ibid., p. 6. Ibid., p. 8. For discussion of this point see O . Temkin, 'The Scientific Approach to Disease: Specific Entity and Individual Sickness’, in A. L. Caplan, H. Tristram Engelhardt, jr, and J. J. McCartney (eds) (1981) Concepts o f Health and Disease, Reading, Mass.: Addison and Wesley, pp. 247-64; C. Rosenberg, ‘The Therapeutic Revolution’, in M. Vogel and C. Rosenberg (eds) (1979) The Therapeutic Revolution, Philadelphia: University of Pennsylvania Press 3-25. Trotter, Essay . . . on Drunkenness (note 3), p. 8. Ibid., p. 10. Ibid., p. 11. Ibid., p. 16. Ibid., p. 25. Ibid., p. 29. Ibid., p. 33. Ibid., p. 37. Ibid., p. 42. Ibid., p. 42. Ibid., pp. 47ff. Ibid., p. 87. For discussion see John Rathbone Oliver (1936), ‘Spontaneous Combustion’, Bulletin o f the History of Medicine, 4: 559-72. Trotter, Essay . . . on Drunkenness (note 3), p. 93. Ibid., p. 98. Ibid., p. 105. Ibid., p. 109. Ibid., p. 110. Ibid., p. 111. Ibid., p. 113. Ibid., p. 114. Ibid., p. 116. Ibid., p. 117. Ibid., p. 118. Ibid., p. 121. xxxvm

Introduction by Roy Porter 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83.

84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 100.

Ibid., p. 122. Ibid., p. 123. Ibid., p. 124. Ibid., p. 126. Ibid., p. 127. Ibid., p. 129: intoxication is a ‘temporary madness’. Ibid., p. 132. Ibid., p. 134. Ibid., p. 135. Ibid., p. 139. Ibid., p. 136. Ibid., p. 140. Ibid., p. 165. Ibid., pp. 154, 174. Ibid., p. 141. See G ladys Bryson (1945) Man and Society: The Scottish Inquiry o f The Eighteenth Century, Princeton: Princeton University Press. Edward Gibbon (n.d.) The Decline and Fall o f the Roman Empire, J. B. Bury (ed.) London: Methuen, vol. iv, 169. Thom as Trotter (1807) A View o f the Nervous Temperament, A Practical Enquiry into the Increasing Prevalence, Prevention, and Treatment o f those Diseases Commonly Called Nervous, Bilious, Stomach and Liver Complaints; Indigestion; Low Spirits; Gout etc., London: Longman, H urst, Rees & Orme, p. 144. Ibid., p. viii. Ibid., p. 220. Ibid., p. 29. Ibid., p. 35. Ibid., p. 22. Ibid., p. 70. Ibid., p. 48. Ibid., p. 142. Ibid., p. 135; for context see J. Sekora (1977) Luxury, Baltimore: Johns H opkins University Press. Trotter, ibid., p. 39. Ibid., p. 31. Ibid., p. 24. Trotter, Essay . . . on Drunkenness (note 3), p. 29. Trotter, View o f the Nervous Temperament (note 83), p. xi. Ibid., p. 31. Ibid., p. 34. Trotter, Essay . . . on Drunkenness (note 3), p. 153. XXXIX

Introduction by Roy Porter 101. Ibid., p. 155. 102. Ibid., p. 38; Trotter, View o f the Nervous Temperament (note 83), p. 312. 103. Trotter, Essay . . . on Drunkenness (note 3), p. 103. 104. Trotter, View o f the Nervous Temperament (note 83), p.135. 105. Ibid., p. 90. 106. Ibid., p. 106. 107. Ibid., p. 143. 108. See H . R. Viets (1949), ‘George Cheyne, 1673-1743’, Bulletin o f the History o f Medicine, 23: 435-52; Roy Porter (1987) Mind Forg’d Manacles, pp. 83-85 (see note 8), and (1982) ‘The Sexual Politics of Jam es Graham’, British Journal fo r Eighteenth Century Studies, 5: 201- 6 .

109. 110. 111. 112. 113. 114. 115. 116. 117. 118. 119. 120. 121.

Trotter, View Ibid., p. 233. Ibid., p. 257. Trotter, Essay Trotter, View Trotter, Essay Ibid., p. 170. Ibid., p. 188. Ibid., p. 120. Ibid., p. 179. Ibid., p. 185. Ibid., p. 195. Ibid., p. 182.

o f the Nervous Temperament (note 83), p. viii.

. . . o n Drunkenness (note 3), p. 186. o f the Nervous Temperament (note 83), p. 153. . . . o n Drunkenness (note 3), p. 156.

xl

A P P E N D IX 1: B IB L IO G R A P H Y OF TH E W RITINGS OF TH OM AS TROTTER Trotter, T. (1786) Observations on the Scurvy: with a Review o f the Theories Lately Advanced on that Disease; and the Opinions o f Dr. Milman Refuted From Practice, Edinburgh: Charles Elliot & J. Robinson. (2nd edn, 1792) Trotter, T. (1797-99) Medicina Nautica; an Essay on the Diseases of Seamen; Comprehending the History o f Health in His Majesty’s Fleet Under . . . Earl Howe (with an Appendix Containing Communications on the New Doctrine o f Contagion and Yellow Fever, By American Physicians, etc.), 3 vols, London: Cadell & Davies. Trotter, T. (1800) Suspiria Oceani: a Monody on the Death o f Richard Earl Howe, K.G., Admiral o f the Fleet, etc., London: J. Hatchard. Trotter, T. (1804) An Essay, Medical, Philosophical, and Chemical, on Drunkenness and its Effects on the Human Body, London: Longman, Hurst, Rees, & Orme, 2nd edn. Trotter, T. (1807) A view o f the Nervous Temperament; being a Practical Enquiry into the Increasing Prevalence, Prevention, and Treatment o f those Diseases Commonly Called Nervous, Bilious, Stomach and Liver Complaints; Indigestion; Low Spirits; Gout, etc., London: Longman, Hurst, Rees, & Orme (2nd edn, 1807) [A third edition appeared in 1812]. Trotter, T. (1819) A Practicable Plan for Manning the Royal Navy, and Preserving our Maritime Ascendency, without Impressment. Addressed to Admiral Lord Viscount Exmouth, Newcastle and London: Longman, Hurst, Rees, Orme & Brown. Trotter, T. (1829) Sea Weeds. Poems Written on Various Occasions, Chiefly During a N av al Life, London: Longman.

xli

A P P E N D I X 2: T R O T T E R ’S MD T H E S IS : DE EBRIETATE

In 1788 Trotter defended and published his M D thesis, D e Ebrietate, Eiusque Effectibus in Corpus Hum anum. Typically of Edinburgh M D s of that vintage, it ran to some forty pages, amounting to perhaps about 8,000 words. It was written in a simple, though quite pure, Latin, and liberally sprinkled with quotations from literary sources, both Classical and English. Although no more than perhaps a tenth as long as the Essay . . . on Drunkenness, it is quite unambiguously the parent of the longer and later work. The verbal and stylistic similarities are great. For example, the dissertation begins ‘Homines semper studiosi voluptatem aegre inter mala recensuerunt quae ab luxuria orta sunt’, which, literally translated, becomes the first sentence o f the essay (‘Mankind, ever in pursuit of pleasure, have reluctantly admitted into the catalogue of their diseases, those evils which were the immediate offspring of their luxuries’). Already in the dissertation Trotter is proposing ‘ebrietatem quasi morbum tractare’ (to treat drunken­ ness as a disease). Above all, the structure of the thesis is remarkably repeated in the Essay. The thesis moves from 1. definition, 2. sym ptom s, 3. proximate causes, 4. original causes, to 5. therapeutics; and this ordering of materials is obviously closely reproduced in the later Essay, with much the same reliance upon identical authorities such as Cullen, Morgagni and Boissier de Sauvages. Certain details and anecdotes are present in the earlier work which have disappeared by the latter, not least, reports on drunken sailors on board his first ship, the Berwick. But there is very little indication that any of the views embraced in the De Ebrietate were later abandoned. Obviously there is much in the Essay without equivalent in the thesis, not least the entire discussion on spontaneous combustion. But there is also evidence of a general broadening of interest in the interim. The Essay is noteworthy for the scope of Trotter’s concern with the problems of habit and habitforming substances in general, within the context of (a) the analysis of a

xlii

Introduction by R oy Porter drug-consuming culture, and (b) the notion that drunkenness is a disease of the mind. Neither of these concerns had been crystallized in the earlier work. Thus it is fair to say that Trotter began with posing drunkenness as a medical problem ; only subsequently did he evolve his m ajor insight, the need to investigate the wider problem of habit and addiction as a whole.

xliii

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AN

E S S A Y , MEDICAL, PHILOSOPHICAL, AND CHEMICAL, on

DRUNKENNESS.

Piloted by A . Strata Printcrs-Strect,

A N

E S S A Y , MEDICAL, PHILOSOPHICAL, AND CHEMICAL, ON

D R U N K E N N E S S , AND

ITS EFFECTS ON THE HUMAN 2 0 DY.

By THOMAS TROTTER, M. D. S ATE

PHYSICIAN

OF

TO

A D M ' 11A L

«IS

EARL

M AJESTY'S HOWE, X . O . ;

FLEET AND

UNDER

TO

THE

THE

COMMAS*

X^UADRONg

C O M M A N D E D J3Y A D M I R A L L O R D U R i D T ’O K T , K . B . A D M I R A L EARL

* T. V I N C E N T , K . B. A N D

THE

HONOURABLE

ADMIRAL C 0 R N W A L U 3 ; MEMBER

OF

VIIE

ROYAL

MEDICAL

AN h l ! * ; > R A K Y M F M R E R O f OP

I DIKBUkOH, APKKPKCN,

OF OK

LiriR A K Y

SOCIETY

OF

EDINBURGH }

I Hi ' R O Y A L P H Y S I C A L S O C I E T Y

THE THE

MEDICAL

SOCIETY

PHILOSOPHICAL

OF

AND

S O C I E T Y OS N E W C A S T1

&c. & c.

O ! tiiou iovitibie fphit of wine, if thou h ifK io name to be ki«w\vu Ii-t Hi cull thee— Devil. S ’I a k s f e a r f ,

by,

L

O

N

D

O

N

:

P R IN T E D TOR T . N. LONGMAN, AND O. HEESj PA TERN O STER *RO \V.

1804 .

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DE DI C ATI ON T O

Dr. JE N N E R . MY D E A R SIR,

.A

fter

having addrefled you on the occa-

fion o f your G r e a t D i s c o v e r y from the firft medical ftation in the public fervice o f the country, which I had then the honour to hold, you will be the lefs furprifed to hear from me in m y prefent obfeurity.

In laying

the follow ing Eflay before the world I feel fo independent in motive and expe& aticn, that nothing but the patronage o f D r . Jen n er can fatisfy me.

I lhall thus efcape the common

accufation brought againft authors o f being flatterers.

T h e man whofe labours go the

Jength o f faving annually h alf a million o f his fellow-creatures, is as far beyond the sphere o f compliment as he has outftripped the

I

VI

)

the meafui'C of human gratitude, and can need 110 adulation from my pen. I have, therefore, to requeft that he will accept of all that, as a private man, I con offer him, which is to fay, that, with all fincevity, I am, my dear Sir, Your moft faithful friend, and Moft humble fervant, New'caftle-on-Tync, Dec. 20, 1803.

T . TRO TTER.

P R E F A C E .

w

h en

I became a candidate for the de­

gree o f Do£tor o f Medicine, in the U niverfity o f Edinburgh, I was rather anxious that the fu b jed o f my Inaugural

Diflertation

£hould be fomething that had never been noticed by any former graduate.

T h is was

a difficult p o in t; for fcarcely any thing re­ mained that had not been previoufly difcufled.

After much confuleration, however,

feveral obje&s o f inquiry prefen ted themfelves, and I fixed upon Ebriety.

But fome

doubts arofe in my mind whether fuch a thefis was proper matter for an academic exercife; and as foon as I was enabled to put it into a regular form it was fahmitted to the judgm ent o f the late worthy Dr. Charles Webiter.

T h e do£tor was delighted with

the work, and gave it as his opinion that it would be highly acceptable to the profelTors. W hen m y private examinations were finifhed, it became the tafk o f Dr. G regory, now Profeflbr

( vi» ) feffor in the Pra& ical Chair, to give it his fan& ion for being printed.

D r. G re g o ry p e -

rufed it with great pleafure, and encouraged m e to think o f it as a fubject w orthy o f future inveftigation.

In the public hall m y

venerable friend and preceptor, D r. Cullen, w as pleafed to introduce m y exam ination w ith fom e eic-gant ailufions to the th e fis; and after a few facetious rem arks on the author, in his ufual Jlyle, com m ended the defign, execution, w ork.

and im portance o f the

I w as fhortly after this honoured with

the thanks o f the H um an e Society, tran s­ m itted to me by D r. H aw es, the illuftrioua founder o f that inllitution.

D r. H aw es ob -

ferved, that, “ the inveftigation o f fo irnportw ant an inquiry,

in a

regular fcientific

“ m anner, w as never before thought o f : it *( w as a fubje£i left, happily left, to be inge** nioufly executed and am plified by

D r.

« T ro tter.” A fter fuch teftim onies from men at the fum m it o f the M edical Profeffion, it became a talk o f gratitude, as well as duty, v ith m e, to review the Diflertation.

From 1708 till

lately m y ftudies have been entiiely occupied 3

br

(

W

)

by naval affairs; and it is only within thefc few months that I began to compile the fol­ lowing Eflay, which may be confidered as a comment on the thefis, B e Ebrietate, ejufque Eff'e&ibus in Corpus humanum.

Ed in.

1788. T h e importance o f the undertaking will be generally acknowledged.

It is o f a nature

that muft intereft every friend o f mankind j and 1 truft it is demonftrated in thefe pages the fhare which the medical profeffion ought to take in checking the evil habit o f intoxi­ cation in fociety.

H ow far I am right in the

execution o f the plan others muft decide. fhall receive

I

every hint for improvement

with much fatisfa&ion ; and fhall corred m y errors, wherever they may appear, with equal pleafure.

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CO N TEN TS.

Dedication, Preface, Introduction,

-

V vii

.

.

.

Definition o f Drunkennefs,

1 8

Phaenomena and Symptoms of Drunken­ nefs, . . . .

*4

In what Manner Vinous Spirit affe&s the Body, . . . .

31

The Catalogue o f Difeafes induced by Drunkennefs, . . .

96

The Method of corre&ing the Habit o f Drunkennefs, and of treating the Drunken Paroxyfm, -

136

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O N D R U N K E N N E S S , ftk .

IN T R O D U C T IO N . —

D uke periculum eft,

0 Lernee ? fequi Deum Cingentem v i r i d i tem po ra p a m p tn o .

Ma n k in d ,

H or.

ever in purfuit o f pleafure,

have relu&antly admitted into the catalogue o f their difeafes, thofe evils which were the

immediate offspring o f their luxuries.

Such

a referve is indeed natural to the human m in d : for o f all deviations from the paths o f duty, there are none that fo forcibly impeach their pretenfions to the character o f rational beings as the inordinate ufe o f fpirituous li­ quors.

H ence, in the writings o f medicine,

we find drunkennefs only curforily mentioned am ong the powers that injure health, while the mode o f adtion is entirely neglected and left unexplained.

T h is is the more to be

wondered at, as the ftate o f ebriety itfelf exb

hibits

( * ) hibits Tome o f the m od curious and intereftin g phaenomena that are to be met with in the hiftory o f animated nature.

T h e potent

fHmulus o f vinous fpirit, as if by magical in­ fluence, fo difturbs, or operates on the animal functions, that new affe&ions o f mind, latent, or unknown before, are produced; and the drunkard appears to a£t the part o f a man o f deranged intellect, and altogether foreign to the ufual tenor o f his fober refle&ions. B ut a long train o f the moft dangerous difeafes are the certain confequence o f habitual intoxication : fufFer.

the body and mind equally

Sudden death, apoplexy, palfy, drop-

fy, madnefs, and a hideous lift o f mental difquietudes and nervous failings, prey upon the ihattered frame o f the inebriate, and prove fatal in the end.

Thefe fufficiently point out

the fubjeft as highly important in a medical view , and worthy o f the niceft inveftigation. B u t as I have not any precurfor in my labours, nor exam ple in the records o f phyfic, to direft m y fteps, I fhall need the lefs apology for the m anner I mean to p urfue; and muft claim indulgence where I appear fingular in m y method. M oft

(

3

)

M o ft inftances o f cafual or fudden death, and fuipended anim ation, h ave obtained rules fo r recovery ; w hile the drunkard, expofed in the ftreet and h ighw ay, or ftretched in the kennel, has been allow ed to perifli, w ithout pity and w ithout afliftancc ; as i f his crim e w ere inexpiable, and his body infectious to the touch.

O ur newfpapers give us too fre­

quent accounts o f this kind.

T h e habit o f

inebriation, fo com m on in fociety, to be obferved in all ranks and ft-:?icns o f life, and the fource o f inexprefiible afRi&ion to friends and relatives, has feldom been the obje£t o f m e­ dical adm onition and practice.

T h e priefl-

hood hath poured forth its anathem as from the p u lp it; and the m oralift, no lefs fevere, hath declaimed againft it as a vice degrading to our nature.

Both have meant w e ll; and

becom ingly oppofed religious and m oral ar­ gum ents to the finful indulgence o f anim al appetite.

B u t the phyfical influence o f c u f'

tom , confirm ed into habit, interw oven w ith the a& ions o f our fentient fyftem , and re a d in g on our mental part, have been entirely for­ gotten.

T h e perfeft know ledge o f thofe re­

m ote caufes which firft induced the propen b 2

fity

( 4 ) fity to vinous liquors, whether they fprung from fituation in life, or depended on any pe­ culiar temperament o f body, is neceflary for conducing the cure.

A due acquaintance

with the human chara&er will afford much affiftance; for the obje£ts o f our care are as diverfified as the varieties o f corporeal ftructure.

Pleafure, on one hand, prefents the

poifonous b ow l: low fpirits, on the other, call for the cheering draught.

There bu-

linefs and the duties o f office have plunged one man into frequent hard drinking; while cares and misfortunes have goaded on ano­ ther. The foldier and the failor get drunk while narrating the dangers of the battle and the ftorm : the huntfman and the jockey, by defcribing the jo y s o f the chace and courfe. Here genius and talent are levelled with the duft, in trying to forget, in wine, the outrages o f fortune, and the ingratitude o f the world ; while more ponderous and Itupid mortals, in attempting to feek in the bottle the feelings and fentiments o f exalted beings, gravitate to their original clay, or fink deeper into their parent mud. In

(

5

)

In treating thefe various defcriptions o f perfons and chara&ers, it will readily appear to a difcerning phyfician, that very different methods will be required.

T h e patient al­

ready knows, as well as the prieft and m oralift, that the indulgence is pernicious, and ultimately fa t a l: he is alfo aware, without the reafonings o f medicine, that the conftant re­ petition will deftroy health ; but it is not fo eafy to convince him that you poffefs a charm that can recompence his feelings for the want o f a grateful ftimulus, or beftow on his ner­ vous fyftem fenfations equally Toothing and agreeable as he has been accuftomed to re­ ceive from the bewitching fpiiit.

H ie labor,

hoc opus e jl: this is the difficulty; this is the talk, that is to prove your difcernment, pa­ tience, and addrefs. T h at little has been done hitherto with fuccefs, we may be affured, by very rarely meeting with a reformed drunk­ ard.

T h e habit, carried to a certain length,

is a gulph, from whofe bourne no trav eller re ­ turns ; where fam e, fortune, hope, health, and life perifli. Am idft the evils which flow from modern wars, is to be reckoned the vaft confumption B 3

of

(

6

)

o f fpirituous liquors. T h e tax on diililled fpilits form s fo large a part o f finance, and fills up fo great a chafm in the annual budget o f an y m iuifter, who m ay ftrive more to retain h is place than to reform the m orals, or check the difeales o f his countrym en, that we ceafe to w onder at its continuance.

A few years

ago, the crops o f grain were fo deficient over this ifland, that the diftillation o f fpirits from m alt were prohibited : and thus fcarcity, bor­ dering on fam ine, became a bleffing to the hu­ m an race. B ut no fooner had fruitful feafons, and the bounty o f Providence, covered the earth v. ith plenty, than the firft gift o f H e a ­ ven, abundance o f corn, was again , for the fake o f taxation, converted into poifonous fpi­ rits, by opening the ftillories.

M igh t not

other taxes be devifed that would be equally produ£tive ? and would it not be a virtuous a£t o f the Legiflature to abolifti the pra& ice for ever ? In order to treat m y fubje£t philofophically, and for the fake o f method, I propofe dividing it into the follow ing heads, viz. ift, Definition of D runkenncfs. 2 d,

C

7

)

2d, T h e Phenom ena, or Symptoms o f Drunkennefs. 3d, In what M anner Vinous Spirit affe£ts the living Body. 4 th, T h e Catalogue o f Difeafes induced by Drunkennefs.

And,

5 th, T h e Method o f correcting the H abit o f Drunkennefs, and o f treating the Drunken Paroxyfm. Into thefe heads I (hall occafionally intro­ duce fuch pra&ical remarks as may arife out o f the fubje£t; but which are too defultory for methodical arrangement.

chap.

(

8

)

CHAP. I. Definition o f Drunkettnefs. 0 ! thou Invifibk fpirit o f JVine, i f thou haft no name to be known by, let US call thee ---------- D e v il! Shakeshar.

I n medical language, I confider drunkennefs, ftriCtly fpeaking, to be a difeafe; produced by a remote caufe, and giving birth to actions and movements in the living body, that d is­ order the fu n dion s o f health.

T h is being the

cafe, befides the value o f an accurate defi­ nition for the fake o f fyftem, it may be o f fome practical utility to point out the affinity which the paroxyfm has with other affeCtions. In afiigning the character form erly, I was well aware o f the difficulty o f fixing on any fym ptom , or even concourfe o f fym ptom s, that are invariably prefent. For this reafon delirium feemed to be the moft certain, as it is the m oft prominent and general.

B ut objections

m ay yet be made to th is; for difference o f age, and varieties o f temperam ent and conftitution, influence the acceflion and progrefs of

( of

9

)

w avering intellect during

A g ain ,

although

evidently

intoxication.

the anim al functions are

deranged,

exhibited

by all

the

fhades and gradations o f delirium , fuch as im­ becility o f m ind or fatuity, erroneous ju d g ­ m ent, im aginary perceptions, falfe relations, violent em otions called raving, & c . yet at the fam e tim e, the paroxyfm is fo generally at­ tended with a partial or total abolition o f the pow ers o f fenfe and m otion, that it afium es very much the nature o f a comxtofe condition. Indeed the m oft frequent fatal termination o f the drunken fit is apoplexy.

It is certainly

no uncom m on occurrence to fee an inebriate w ho can neither w alk or fpeak, exercife fo confiderable a degree o f mental pow er, as to re co ile d every circumftance that pafies ; yet fo confcious o f his inability to move w ithout ftaggering, that he cunningly watches

the

opportunity, when unperceived by his com ­ panions, to take his leave.

T h e character o f

this difeafe therefore, partakes both o f deli­ rium and coma. T o avoid confufion, I take the remote caufe into m y definition.

D runkennefs is the de­

lirium occafioned by fermented liquors.

It is true

(

to

)

true that other narcotics, particularly opium and bang) produce nearly the fam e p h e n o ­ m ena, and their habitual ufe alm oft the fam e difcaies ; y et, for obvions reafons, the ch ief o f w hich is the com m on occurrence o f drun ken ­ nefs in this country, I am induced to feparate them here, and confider this fubjedt by itfelf. ------ O ur definition is briefly t h i s : P ost

V in u m

im m o d ice

assu m p tu m ,

D e l i r i u m e t C o m a . — W hich m ay be thus

tranflated :— ie Im becility

o f intellect, erro-

** neous ju d g m e n t, violent e m o tio n s; an d lofs “ o f fenfe and m otion after the im m oderate “ ufe o f vinous liquors.” T h e L atin w ord “ V in u m ,” has been pre­ ferred as bein g the m oft concife, and beft con vey in g the m eaning o f vinous fpirit, the product o f ferm entation, and on w hich the in ebriating pow er o f all ferm ented liquors d e p e n d s; fuch as w ine, m alt-liquors, cyder, perry , m um , m ead, koum ifs, & c . all o f w hich b y diftillation yield alkohol. T h e carbonic ac id g as., or fix e d a ir , w hich is evolved in great quantity during the vinous ferm en tation , that gives a fparkling and pun ­ gency to certain liquors, fuch as cham paign e,

bottled

( It ) bottled beer and cyder, is know n to produce a kind o f flupefattion refem bling intoxica­ tion, independent o f the fpirit.

T h is kind o f

ebriety is but m o m e n tary ; as the a£tion o f the gas on the nerves o f the ftomac^ is o f fliort duration.

V ery different are the effe&s

o f this g a s when breathed.

Brew ers have

frequently been fuffocated in taking out their ale or beer from the v?.t, as the air lies on the furface o f the ferm enting liquor.

N ay it has

fom etim es accumulated in iuch quantities in clofe cellars, as to prove fatal to feveral people before the caufe w as dete& ed, and the air expelled by ventilation.

In m ines, wells, and

the holds o f fhips, this vapour has often proved lethalic. D r. Cullen, in his order o f V efania, or m ental derangem ent, has given five genera : but the paroxyfm o f ebriety more particularly exem plifies the m ixed chara& er o f am entia, infanta et m ania, or ideotifm, agreeable em o­ tions,

and violent

emotions.

Oneirodynia,

difturbed fleep, w hich comprehends flaepw alking and night-m are, perhaps only occurs during the decline o f the drunken paroxyfm . A n d melancholia, melancholy, w ould appear 7

to

(

)

to be fufpended during the ftimulant pow er o f wine.

T h is dileafe is rather the offspring

o f habitual intoxication ; it is probably con­ fined to a peculiar temperament o f body, that is little difpofed to be excited, and can endure excefiive ftimulus without proportional a d io n , as well in the fu n dion s of the fenforium commune, as in the circulating fyflem. Th ere is a fpecies o f delirium that often attends the early acceffion o f typhus fe v e r, from contagion that I have known to be miftaken for ebriety.

A m ong feamen and

foldiers, where habits o f intoxication are com­ m on, it will fometimes require nice difcernment to d ecide; for the vacant ftare in the coun­ tenance,

the look o f ideotifm,

incoherent

fpeech, faultering voice, and tottering walk, are fo alike in both cafes, that the naval and m ilitary furgeon ought at all times to be very cautious, how he gives up a man to punifhment

under thefe

fufpicious

appearances.

N ay , the certainty o f his having come from a tavern, with even the effluvium o f liquor about him , are figns not always to be trufted : for thefe haunts o f feamen and foldiers are often the fources o f infedion .

In all doubt­ ful

(

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)

ful cafes o f this kind, let the members o f our profeflion be guarded in their opinions j it is fafe to lean to the humane fide. There is another fpccies o f intoxication that follows the inhalation o f inflammable fpirit, by the nofe and mouth, without being fwallowed.

T h is fpecies o f ebriety is com­

m on to coopers, porters, and other workmen employed in cellars and diftilleries.

The

moft volatile part o f the fpirit, or pureft alkohol, which arifes in pouring it from one veflel to another, probably a d s by diredly ftimulating the nerves o f the membrana Shneideriana

fpread about the nofe and frontal

fin ufes; and alfo the infide o f the mouth, trachea and lungs,and thus produces delirium. T h is ebriety is likewife tranfitory, and foon difappears when the patient is moved into the open air.

It frequently happens in fhips, in

pum ping fpirits from a large cafk into a fmaller, in the confined fpace o f a fpirit room : but the pradice is dangerous, as veflcls have often been fet on fire by a lighted candle touching the fp irits; and it is now ftrid ly forbidden in all well regulated fhips in his M a» jefty’s navy. CHAP*

( H )

CHAP. II. Phenomena and Symptoms o f Drunhennefs. Hue, Paler 0 Lenae, veni: nudataquc mujlo Tinge novo mecum correptis crura cothurnls.

T

he

V irg .

firft effe&s o f wine are, an inexprcf-

fible tranquillity o f mind, and livelinefs o f countenance : the power.-- o f imagination be­ come mure vivid, and the flow of fpirits more fpontaneous and eafy, giving birth to wit and humour without hesitation. enras edaces.

Dijjipat Evrius

All anxieties o f bufinefc, that

require thought and attention, are 'aid afide ; and every painful afTedion o f the foul is re­ lieved or alleviared.

Placed, as it were, in a

paradife oi pleafure, the being only contem­ plates delightful and agreeable objects; the moft prominent o f them are love and delire, ------------f;r.e Baceho friget Venus. T

er .

T h e man o f a lively fancy, who happens to be in love at fuch a time, fees beauties in his

(

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his miflrefs that he overlooked before ; and he culls every flower o f poefy that can add warmth to his emotions, or paflion to his feelings.

T h e delirium o f love may, there­

fore, be faid to begin firft. A n agreeable heat is diffufed over the whole b o d y ; mufcular ftrength is recruited, and the action o f the heart and arteries is manifeftly increafed. T h e vigour o f the circulation o f the blood, being thus augm ented, a fparkling o f the eyes may be obferved ; a flufh or rednefs is fpread over the face, and the whole appearance o f the countenance is brightened into a fmile. A painter, fuch as H ogarth, would find fine exercife for his talents in delineating the fhades and gradations o f feature that take place in particular perfons, from perfect fobriety to the laft ftage o f intoxication.

The

foul, as i f unconfcious o f its danger, looks with bodily organs that befpeak rapture to the deceitful bowl, which carries in its draught every degree o f fenfation, from pleafure to pain, from the pureft perceptions o f intellect, to the laft confufion o f th ou gh t;

which

raifes man above the fphere o f mortals, and ends

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ends, by bringing him to a level with the brutes. When the mind has attained the higheft degree o f pleafurable feeling from

vinous

ftimulus, it is wrapt in reverie, which may be called a boundary, between the agreeable fenfations o f fobriety, and the delirious tu­ mults o f thought, which uftier in complete inebriation.

T h e fyftem has been enough

excited to bring forth pleafurable fenfation, tofubdue pain,and fufficient judgm ent remains to analize the refle&ions which arife from condition o f life, fo as to fortify the prefent moment againft all the intrufive approaches o f care or forrow.

Did the giddy votaries

o f Bacchus but flop here, fome indulgence might be granted, that human nature fhould a while forget thofe ills which flefli is heir to. D uring this period, which I m ud beg leave to call the drunken reverie,

that difguife

which all mankind, more or lefs, carry about them, is in fome meafure thrown off.

The

grave philofopher himfelf, becomes convivial, lays afide his fevere demeanour, and applauds the jeft and the fong. ■Teuccr

( -—

*7

)

Teucer Salam ina patremque

Cum fuigent t.imen ud;\ L y x o T en ipora populea fercar vinxifie corona.

ITng forth children like unto them felves.” B u rto n A n a t. M el. I f thefe authorities, along w ith S ir Jo h n F a lfta ff’ s, can have any w eight, m ankin d have a (Ironger reafon ag ain fl intoxication, than has ufually been urged by m oral w riters. T h a t is the dread o f tran fm ittin g infanily to their offsprin g. D r . D arw in , in his reveries about generation, fpeaks o f the progeny receiving likeriefs o f form fro m the im agination o f the paren t. B u t i f im agination can have the pow er o f iinprefling the Jhape-eJs ens, how m uch m ore m uft the real condition o f the inebriate. T h e legiflators o f forue coun­ tries h ad fuch ideas o f the effc&s o f wine, as b .in g a poifon to the foul and a fom en tor o f vices, that th eir women were fubjefted to the fam e punifhm ent for drinking as fo r adultery. G el. lib. x. cap . 23. W hatever m ay be the tru th o f this doctrine, fobriety in hufband and wife m u d give the beft chance fo r a fober progen y. D r . D arw in even fay s, “ It is rem arkable that all the difeafes from drin king “ fpirituous o r ferm ented liquors are liable to becom e he“ reditary, even to the third generation, g rad u ally increaP“ in g, i f the caufe be continued, till the fam ily becom e* “ e stin tt.” B o t. G a rd . P a rt II. Note on V itls.

c 2

“ forgetive,

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forgetive, full o f nimble, fiery, and d eledil able flia p e s; which delivered over to the “ voice (the tongue), which is the birth, be“ comes excellent wit*

T h e fecond property

“ o f your excellent {herries is, the w arm “ in g o f the blood ; which before, cold and ** fettled, left the liver white and pale ; which “ is the badge o f pufillanimity and cow ardice: “ but the fherries w arms it, and makes it “ courfe from the inwards to the parts ex** treme.

It illumineth the face ; which, as a

“ beacon, gives w arning to all the reft o f this little kingdom m an, to arm : and then the u vital com m oners, and inland petty fpirits, “ mufter me all to their captain the h e a rt; “ who great, and puffed up with this retinue, “ doth any deed o f co u rage; and this valour “ comes o f (h erries: fo that fkill in the w ea“ pon is nothing without fack j for that fets “ it a w o rk ; learning a mere hoard o f gold “ kept by a devil, till fack commences it and u fets it in a d and ufe. H ereo f comes it that ** prince H arry is valian t; for the cold blood u he did naturally inherit o f his father, he “ hath, like lean, fterile, and bare land, m anured, hufbanded, and tilled, with excellent 4

“ endeavour

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“ endeavour o f drinking good, and good ftore “ o f fertile ih erries: that he is become very ** hot and valiant.

I f I had a thoufand fons,

“ the firft human principle I would teach “ them, fhould be,— to forfw earthin potation, “ and to addi& themfelves to fack.” Hen. iv. p a rt ii. a ft 4 . T h e fober pleafures o f Bacchus have now been detailed ; noify folly and ribaldry next appear : the fong becomes louder, and dan­ cing commences with the rude fqueeze, and every odd gefticulation;

chearfulnefs and

w it are changed into low hum our and ot>fcene jefts. --------- toiiitc barbarvun

Morem, verecimdumque Bucchum, Sanguineic prohibice risis.

H or .

T h e man is now drunk, and whatever he fays or does, betrays the errors o f the think­ in g principle.

T h is fcene is finely painted, by

T h om fon in his poem o f the Seafons ; and as it is far beyond the compafs o f medical or technical language, I (hall give it in his own w o rd s; C 3

— — B ut

(

22

}

--------But eruneft brimmingbowis 'L av «s e v e r y fl= « l, iJse v.ibio H e a tin g r m w d ,

A n ! p i'.'frnieat iidndcfs to >i;c in d J L d four. T Jiu ? ; ::.y tv.:-yi in v.: ' i fwil, :i;e zj.1

VjicL^1j'.ib .u oaicci*c*si iv.eutv ton jatj R e e l s f a d ir u u t t i i .i r i c : » i.h e :;;;:, h o s i i Iio rftfS ilx-jU iK i-j

T ; j cliu'.'cli c.r m iilr * . -, politics or g h o ii, .'in e n d l e J s m a z e s i 'H i u v .l e , p e r p l e x ’d .

M ean tim e, « it.h f u Jd '.a imervp.psion ’ ju t!, T i i ' im p a t ie n t c a tc h b a n t s ir o r u th e i» y o a s I i e .i r t ;

Th at moment touch’d iscv.ry kindred ib u l; A n d o p e n i n g in afi;l!-m nuken Ptirczyfoi. As the M ateria M d ^ a does net luppiy any thing as yet known for correiling th j inebriating power o f alkohoi, the cure c f ihz

paroxyfm wilt turn very much in evacuating it from the ftomach ; which muft be left done by throwing in quantities o f lukewarm water, and provoking vomiting. 7

Acids, it is tru e,

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true, have been faid to prove very efficacious in deftroying the flimulant power o f ardent ipirit by chemical union, thereby altering its nature. It has been a common pradtice to exhibit acids to obviate the effedt o f large dofes o f opium: but it is doubtful whether ever much good was done by their affiftance. I f this is at all a chemical queftion, it will not be eafy to explain the mode o f adtion o f thefe fubftanees W'ith opium. I would therefore, at all times, prefer the method o f dilution, and provoking vomiting, if poffible. It is re­ marked in a former part o f this eflay that death is fometimes fo fudden after the deglu­ tition o f a large quantity o f raw or undiluted fpirit, that no time is given to call in medical afiiftance.

Neverthelefs this pra&ice is fo

fimple as to be eafily carried into elfedl by any perfon prefent: but I am ignorant whe­ ther any rules on the fubjedt have been publifhed by the Humane Society. Should the drunken man have fo far loft the power o f lenie and motion as to be un­ able to help himfelf, he ought to be placed either in an armed chair, where he cannot fall, or laid in a bed with the head eredt, in c lin in g

(

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inclining a little to the one fide, for the purpofe of facilitating vomiting. The neckcloth ought to be taken oiT, and the collar o f the Ciirt unbuttoned. The doors- and windows o f the room ought to be thrown open, for a free ventilation; all viiitors beyond affiftants mu ft be excluded, and whatever may add to the heat o f the body is to be carefully avoided. If his face is much Iwoln, and unufually liulhed or bloated ; if his breathing is fterterous, with the eyes fixed and veffcls turgid, there is danger of an inftant fit of apoplexy. How far bleeding with the lancet, cupping the temples, or applying leeches, for the purpofe of relieving the brain, are to be depended upon, I cannot well determine. I have tried bleeding, and the patient has recovered that fit ; but in a few hours another one has carried him off. If, how­ ever, thefe means fhould be attempted, atten­ tion muft be paid to the ftrength and age o f the patient, and to the degree of comatofe lymptoms, fo as to regulate the quantity of blood necefTary to be taken away. Which being done the ftomach is to be quickly un­ loaded and as the delay in exhibiting erneo tics

(

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tics might be fatal, the beft means o f accomplifhing this is by introducing a feather or any fuitable fubftance into the mouth, ' . '3 tickling the fauces, till the contents ofc u ?' vifcus are all evacuated *. I am well aware that there are phyficians w h o may hefitate to direct vomiting in the manner which I have propofed.

Vom iting,

under an im pending apoplexy, has been confidered a dangerous pra&ice ; as during the inverted action o f the ftom ach, and the collapled ftate c f iuogs, b y a long inspiration, the blood is accumulated in the blood-vcflels o f the brain, and thus a greater hazard o f their diftsniion, rupture and effufion from them take place.

T h a t fuch things might

happen during the effort o f vomiting I do net mean to difpute : but I have long made the obfervaticn that ipontaneous vomiting is a certain relief when there is every fign o f inflant apoplexy.

I therefore conceive it fair

* Si ebrius qiiii'piam rcpcjite aplienius fiat, convulAi? m critu r, nii'i ftb re corripiatur, au t u!>i, ad h oram pervemerit, :1. De Med. 1. ii. c. 6.

to

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)

to imitate that effort by art. Indeed thoie gentlemen who have cavilled moft at this pradtice have produced no fadt to controvert i t : their diflike to it refts folely on theoretical opinions.

T o thefe opinions, fortunately, the

operations o f nature are not obliged to ben d: for if we are to fuppofe it dangerous to eva­ cuate the loaded ftomach o f the inebriate, i vomiting, at any time, muft be confidered as an operation not only inexpedient but to a certainty hurtful. T h e means o f exciting vomiting, I have faid above, are. fo fimple, that any perfon might accomplish. it, as in the following inftance: A gentleman returning home on a dark night {tumbled over lomething foft in the itrect, which induced him to examine what it was, when it proved to be a man

mo(t infenlibly drunk.

Not wifliing to leave

him to the hazard o f being trod upon by a fcorfe or carriage, he waited for the next paffenger, who kindly took him on his back. Th ey carried him to the firft light which they faw, which proved to be his own houfe, and where his mother was anxioufly waiting his ietum from a corporation feaft. o z

The m an w as

(

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)

was to all appearance dying : but one o f the gentlemen having perufed my thefip, thought, i f any thing could fuve him, it was by un­ loading the ftomach, which was eiTe&ec! by forcing down w arm w ater.

T h is timely e x ­

pedient brough t him quickly to his fenfes, and he was fnatched from the jaw s o f death. I firmly believe that many human beings m ight be faved w ere equal humanity exercifed for the recovery o f drunkards in fimilar conditions. I

w ould alfo recom m end the bowels to be

immediately emptied by glyllers. fait, to

Common

the amount o f two table-fpoon-

fuls, diffolved in a pint o f water, bloodw arm , can be cafty procured, and will adt quickly. Throughout the whole paroxyfm the ap­ plication o f cold water, reClified fpirit o f wine, or sether, to the head and temples, is proper. Although it may be difficult to explain the modus operandi o f thefe articles, I am well

convinced o f their u tility ; but the cold pro­ duced by their evaporation from the head, may in a great meafure account for their good effeCts.

T h e affufion o f cold water, or the

(

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the fhower-bath, when it can be procured, might be ft ill more beneficial. “ Senatoretn Britannicum celeberrimum, ** {non m agis fpe&abilem elegantia orarionis, “ quam frequentia ebrieratis,) fertur, gravem “ vino, manuie aqua frigida bene madefac“ turn circum caput conftringere, in ledulum “ fe recipere;

et mane expergefadtum ad

“ curiam pergere, mirabile di£tu! fine capitis “ dolore, vel langnore, vel laffitudine aut “ animi aut corporis, ad dicendum Temper “ p aratu m *.” A nalagous to the ufe o f the wet kerchief bound about the head, is the clay capy fome­ times tried in maniacal cafes.

W hatever

moderates the heat and velocity o f the cir­ culation in the brain, would feem to be beneficial in both difeafes. Sudden immerfion o f the body in cold water has often brought a drunkard to his fenfes.

I have frequently known this happen

in H is M ajefty’s (hips, where feamen, in

a

ftate o f ftupid intoxication, have fallen over­ board ; they are generally fober when picked up.

T h e cafe o f the miller mentioned in * Diflert, Dc Ebrietate, p. 4 1 . a form er

(

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)

a former part o f this Effay, fupports the opinion. Buffon fays, “ Among the favages “ in the Ifthmus o f America, the women “ throw their drunk hufbands into the rivers, “ in order the more fpeedily to remove the w effeds of intoxication This pradice among thefe favages was probably tried at firft as a punifhment, but having obferved its good effeds it was continued as a remedy. The cuftom o f ducking a drunken hufband, common enough in different parts o f this ifland, had moft likely a fimilar origin. It is much to be lamented that our fair country­ women do not exercife their privilege much oftener. But it is to be remembered, that there are limits to the practice of cold immerfion, whether local or general. The pa­ roxyfm o f ebriety is to be diftinguifhed by two ftages, each exhibiting yery different fymptoms. The firft ftage comprehends that train of fymptoms which fubfifts during the Ilimulant power of the wine, fuch as heat of body, full pulfe, fluflied countenance, &c. The fecond ftage includes thofe figns o f de­ bility which fucceed; the body is cold, the •* Chap. on Infancy, y o I,

u.

pulfe

(

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)

pulfe w eak, and the countenance pale.

To

the firft ftage, the cool regimen and eva­ cuating plan are chiefly to be confined; nay, it is likely thefe would do much harm when the debility commences, for expofure to cold, and

fleeping on damp ground

after in­

toxication, have brought on many mortal difeafes.

It is under thefe circumftances, I

think, that the inflammatory afFe&ions are produced;

the body being firft weakened

and chilled, and then improperly brought near great fires, or into warm rooms, is all at once plied with every thing heating. A n officer o f my own acquaintance having often heard that cooling the head would re­ lieve ebriety, when in the fecond ftage o f the paroxyfm, plunged his head into a bucket o f cold water, as being the moft effe&ual w ay, was foon after feized with phrenitis, or

brain fever as vulgarly called, o f which he died in a few days.

Cold water applied to

the head is not therefore a fafe remedy at all times for the head-ache o f drunkards. Perfons addicted to

eh;

iefy are often found

in the ftreets and highways, uad fometimes in thefe fituations expofed to the moft inclement weather.

( 200 ) weathet\

W ere they to remain long in that

condition in fevere frofts they muft run great hazard o f perifhing; for as foon as the fecond ftage o f the paroxyfm commences, the body becomes feeble, the circulation o f the blood languid, and the vital powers fo exhaufted that no great time would be required for the complete extin&ion o f the living principle. It is to be fufpe&ed that moft o f the tra­ vellers who perifh am ong fnow, are o f this defcription; fool-hardy, under the falfe cou­ rage o f dram -drinking, they fally out in the dark to explore their w ay, and quickly lofe the road, from the change o f obje&s, which falling fnow, or fnow already fallen, occafions. T h e dram in this fituation o f diftrefs only helps to accelerate death, it affifts in bringing on drowfinefs and deep, which leaves the body to be fooner weakened by the cold, and the

benighted traveller

never wakes

ag ain ! If, however, figns o f life appear when the perfon is found, great caution is necefTary,1 left, by attempting to recover him by ftrong fpirits, and carrying him too near a fire, you extinguilh the fmall remains o f the vital prin­ ciple.

( ciple.

201

)

H ere all the means and the pre­

cautions ufually taken for the recovery o f froft-bitten limbs will be neceffary.

The

hands, arm s, feet, and legs, may at firft be rubbed with m ow , or wafhed with cold water, then wiped dry, and the patient put to bed. T h e firft thing to be given by the mouth, m ay be a little warm milk, and as the heat o f the body increafes, fomething more ftirnulant m ay be added.

T h e great o b je d to be at­

tended to, is to cherilh the flender remains o f life by the gentleft ftimuli, for the ftronger would tend to deftroy them.

T h e future

ftrength o f the body is to be recruited by meafures fuited to the condition o f the fyf­ tem , whfch need not be detailed here. It m ight perhaps be confidered by fome as too great a compliment to in ftru d the drun­ kard how to corred m orning head-ache and fick ftomach. o f H orace

I have quoted before the lines which

apply to

this fu b je d .

Som ething relifhing is ufually ferved up on this occafion, fuch as falted fifti, ham , falted, or fmoke-dried meat, & c.

Kitchen fait is a

very grateful ftimulus to a ftomach weakened by excefs.

D r. Cullen, p

in

his L e d u re s on

(

202

)

on Dyfpepfia, ufed to fay, that he had found it prove anti emetic when every thing elfe failed. “

S i n o fh irn a tibi n o c eat p o tatio vini, “ E x eo d e m m an e b ib as, m e d icin a fu c r it.” S anctor.

A cid ity, gaftrodynia, & c . are to be relieved b y anti-acids and ftimulants.

D r. H om e

fays, “ Calor le d i, equitatio et elixir vitrioli, “ naufeam hefterni Ijacchi abigunt

T here

are, perhaps, fome who will prefer a m orning ride, or other kinds o f exercife in the open air, or the cold bath, to all kinds o f medi­ cine. I have certainly know n and heard o f inflat.ces o f cbriety bJ.nv quickly changed into fobricty by fear, danger, excefTive jo y or grief, acute pain, and probably by whatever means fudden im prdiions are nutdd on our fentient fyftem .

]>ut as thefe means cannot eafily be

imitated by our arc. it would tend to no ufeful purpofe to oiler any {peculations on the mode o f action. A s a ht o f ebriety leaves the body dull, languid, weak, and prone to numerous difPi Incipia Mcdiciinr.

eafes,

(

203

)

eafes, great caution ought to be taken in ex­ posing it in that ftate to marfli effluvium, to hum idity, cold, or any kind o f contagion, whether o f fever or others.

I

(hall now conclude this Eflay with the

following admonition : L e t all thofe perfons, whofe conftitutions have any predifpofition to the difeafes mentioned in the catalogue, be­ ware how they get drunk, or fall into the habit c f intoxication.

For this predifpofition

will haften the approach o f that difeafe, that muft in the end terminate their exiftence. Such perfons as Celfus finely advifes, “ Su f“ pccta habere fua bona debcre.” ----- Not poppy nor manclragcrn, Nor all the ilrawiy fyrups oi' the world, 8hal! ever med’eine thee to that Avcct fleep Which thou ow’ J i l yelicrday. S h akesh a k.

T H E

END.

BOOKS lately publifhed by thefame Author. i . M e d i c i n a N a u t i c a : A n EfTay on the Difeafes o f Seamen, comprehending the Hiftory of Health in the Fleet from 1793 to 1802. 3 vols. 11. 3 s.

3.

O b s e r v a t i o n s on S c u r v y .

3. M 3 s. 6d, 4.

edical

S uspiria

and

C hemical

O cean' ! :

Admiral E arl Howe, K . G .

Printed by A . Strahan, I’linters-Strcet.

2d Edition, E ssays.

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A Monody on the Death 2 s.

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