761

THE LANCET.

LONDON: SATURDAY, MARCH 1/, 191l.

Legislation for Inebriates.THE report of the inspector under the Inebriates I

Act for the year 1912 differs from its recent pre-decessors in being not merely a record of workduring the particular period to which the reportnominally refers, but rather a general survey of thewhole question of the legal control and treatment

of habitual drunkards. As Dr. R. W. BRANTHWAITE

points out in his introductory letter, such a reviewof the problem is peculiarly opportune at the presentmoment, when further proposals- are being broughtforward to strengthen and extend the applicationof the principle of restraint as a curative methodin dealing with the inebriate ; and in the discussionof these proposals the concise account of previouslegislative experiments given in the inspector’sreport should prove useful and convenient.

Dr. BRANTHW AITE very rightly lays much stresson the importance of following the guidance ofscience in framing practical measures for the treat-ment of the inebriate ; and with this considerationin view he devotes the first part of his report to astatement of the theoretical conceptions regardinginebriety which, in his opinion, are most generallyaccepted by those who take a scientific interest inthis question. In substance, his view is that theinebriate-a term which he uses as synonymouswith habitual drunkard, chronic alcoholic, or dip-somaniac-is an abnormal being,

"

the victim of a

psycho-neurotic fault that implies a defective powerof resistance to the action of alcohol or drugs, inexactly the same sense as tubercular tendencyimplies impaired resistance to the specific infectionof that disease." We need not stop to consider howfar the parallel which this quotation suggestsbetween intolerance of alcohol and susceptibilityto microbic infection may be open to criticism;it is sufficient to note that the criterion of

inebriety adopted by Dr. BRANTHWAITE is a psycho-neurotic peculiarity shown in the tendency to

react abnormally to alcohol. As a similar tendency,however, is met with in most conditions of nervousinstability, and as there is no adequate clinical

evidence to show that, when observed in drunkards,it presents any special characteristics, or that itever occurs in such patients without other indica-tions of defect or deviation, it is difficult to see anyreason for regarding this sort of inebriety as

anything more than a symptom of mental de-

ficiency. No one will be disposed to questionthis conclusion so far as it applies to a certain

category of inebriates, and more particularly to Ithe large majority of individuals committed to

reformatory detention under the Inebriates Actof 1898. But it would be an obvious fallacy,and a fallacy pregnant with very serious con-

sequences in practice, if it were to be assumed

that this narrow definition of inebriety covers allthe cases of alcoholic intemperance which comewithin the purview of medicine and for which

there is need of a State system of institutional

care. As a matter of fact, pathological drunkardsof this special type are relatively few in number,compared with the more normally constitutedindividuals in whom intemperance has developedas a result of environmental conditions; and,moreover, it is to these latter cases of environ-mental alcoholism that institutional treatment canbe applied with most prospect of real and per-manent effect. It is the more necessary to bear

this fact in mind because there is at present an un-doubted tendency to adopt the view that inebriety,the inebriety which has been made the subject ofspecial legislation, is essentially an expression ofan adherent defect in mechanism. There is alwaysa temptation to apply to bio-social problems theeasy hypothesis of a specific innate tendency and toexplain crime, or inebriety, or prostitution, by acriminal, or an inebriate, or a libidinous, diathesis ;and in the case of inebriety this spirit of a priorispeculation has been so strong that it has mouldedthe character and influenced the administration ofthe legislative measures designed to deal with thehabitual drunkard. As a result, the operation ofthe Act of 1898 has been almost entirely confined toindividuals of the defective and degenerate class;and by a species of vicious circle the observationof such cases in inebriate reformatories and homesis now taken as a basis of argument, and has beenaccepted as giving an a posteriori proof of the

original assumption that an inherent morbid

tendency is the essential cause of alcoholic excess.What makes this point of practical importance

is that it goes to the root of the whole prin-ciple of State control of the inebriate. If inebrietyis merely a manifestation of mental defect, thenthe inebriate is a proper subject for detention inan institution for the feeble-minded; the casual

predominance of a single symptom-and that isall that inebriety means in such cases--can hardlynecessitate treatment in a special reformatory,more particularly having regard to the small

prospect of real gain, whether to the individual orto the community. On the other hand, a speciallyorganised system of institutional care may reason-ably be advocated for cases of environmentalalcoholism. Such cases are certainly curable in

the early stages of the alcoholic habit; theyrequire special and individual treatment, and theexpense of such treatment is justified by therestoration to society of useful citizens. Up to thepresent the legislation for inebriates has almostentirely failed, so far at least as its compulsoryprovisions are concerned, to reach this class of

environmental alcoholics, and to this fact is

largely due the public scepticism with regard

762

to the utility of restraint as a . curative measure.How limited the operation, of the Act of

1898 has been in this respect is strikinglyevident from the figures given in Dr. BRANTHWAITE’Sreport, from which it appears that during the 14years the Act has been in force the total number of

persons committed to reformatories has amountedto no more than 4280 ; and of this number only756 were males, though alcoholism, and more

particularly industrial alcoholism, is notoriouslyfar more prevalent amongst men. The analysisof the different offences committed by these

criminal inebriates is equally- instructive from

this point of view. To quote one illuminatingexample, we find that homicidal crime, theform of delinquency most characteristicallyrelated to alcoholism, was the ground of com-

mittal under the Act in exactly six instances in14 years.The conclusion to which the foregoing considera-

tions must lead us is fairly obvious. The time has

come for modifying very largely the direction andmethocs of the State control of the inebriate. The

scope of legislation to that end should no longer berestricted to the congenital defective in whom

inebriety is but one of many symptoms of debilityand for whom there now exist other and more

suitable methods of control; it should be directedto reach the chronic alcoholic whose organicdisorders are the consequence of his intoxicationand not the primary cause of his habit. These are

the inebriates who. are capable of reform, and theyare also the inebriates whose intemperance repre-sents the greatest positive and negative danger tosociety. But if legislation is to reach this class

there must be some readjustment of our ideas onthis question, and it will be necessary for those whoare responsible for framing and administering thelaw with regard to inebriates to take a wider viewof the problem, and not to answer all criticismswith such phrases as the " specific drink crave "and the " inborn tendency to inebriety."

Infantilism and ArrestedDevelopment.

IN all ages philosophers have tried to satisfyman’s curiosity about himself by providing answersto his queries, Whence came I ? Whither do I go ?Lately man has begun to ask further questions,and the medical profession has been gettingready to answer him. He wants to know,amongst other things, why and how he growsfrom infancy to man’s estate, a problem whichclearly belongs to the domains of science rather

than to those of philosophy or of religion. As

yet science can answer but few of the conundrumswhich the phenomena of growth and development,witnessed throughout the animal kingdom, pro-vide for solution. But certain rays of light havepenetrated lately the darkness of our ignoranceupon these matters, and a survey of what has beendisclosed thereby is exceedingly valuable at this

stage of progress. In his Hunterian lectures onInfantilism Mr. HASTINGS GILFORD draws attention

very appropriately-for we know that JOHN HuxTERwas deeply, interested in gigantism and similaranomalies-to certain pathological aspects of

growth and development in the human race. The

study of these is most important for the rightunderstanding of the normal processes. There

are two main avenues of scientific advance

which have provided ways of access to these

recondite mysteries. One is that which has been

opened up by the study of eugenics, and espe-

cially by the labours of Professor KARL PEARSOXand his school. The other is that provided byresearches into the functions of the ductless

glands, and into hormones, internal secretions,and similar bodies. The result of these investiga.tions, and of the interest now taken in problemsof growth, is that Mr. GILFORD has been able topropound a somewhat elaborate classification of

infantilism, and to indicate the leading featureswhich distinguish the different classes and stib-classes from one another. It is quite probablethat a good deal of this classification mayhave to be reconsidered, perhaps even aban-

doned, in a few years’ time ; but for the present it

is a distinct step in advance simply to possess atentative system by which the study of infantilism

and allied disorders can be furthered, and by whichdifferent workers can correlate their observationsmade under varying conditions.

Mr. GILFORD begins with a very clear and neces-sary definition of infantilism and of the differencebetween it and dwarfism. The latter word impliesmerely conspicuous relay or arrest of growth,the former a similar imperfection of development.One, as he justly remarks, is purely quantitative;the other, qualitative. General infantilism usually.but not necessarily, connotes dwarfism also, andmany dwarfs are infantile in some respects. But theconditions are distinct, and need not be coexistent.The complete classification of infantilism now.

put forward begins by separating off evolutionaryor phylogenetic infantilism, which is that of im-

mature or degenerate races. DeueloprruentaL infan-tilism is the other _main genus, and can be

divided into the infantilism of cells, of organs,and of the individual as a whole. It is

the latter which possesses the greatest interest,and requires further subdivision. Mr. GILFORD

begins his classification of individual infantilism byexplaining the difference between a fluctuationand a mutation. The former is a lesser degree ofvariation from the normal than the latter, which

, corresponds rather to what breeders know as a

,

"

sport," and which has been made familiar to us,

all .by recent work in biology, and heredity. The,

difference is quantitative rather than qualitative ;,

and since there is no hard-and-fast distinction, it is,

evident that borderline cases must exist. Classifica-

: tion is further complicated by Mr. GILFORD’S un.

: proved assumption that a fluctuation.is a variation

1 THE LANCET, Feb. 28th, 1914, p. 587 ; and March 7th, p. 664.