SECOND SESSION

Friday Evening, April 23, 1915

PROBATIONARY TREATMENT OF DRINK, DRUG AND OTHER INJURIOUS HABITS

MR. CHARLES L. CHUTE, SECRETARY, STATE PROBATION COMMISSION: I think all of us here last night felt we would have liked to have had more time for discussion, to get back at the speakers of the evening. The hour, however, was late and it seemed best to postpone the discussion until this evening and the other evenings that follow, when we will have plenty of time for discussion. In fact, we will give up these meetings almost entirely to discussion. We want to have you all speak on this important topic of the evening. We will begin without further introduction, and I will call on Dr. Charles F. Stokes, Medical Director of the Board of Inebriety, to tell you about his work and his experiences in the New York City Farm for Inebriates.

DR. CHARLES F. STOKES: I am very glad to have this opportunity to lay before you what I believe to be an absolutely new, original conception of the whole problem of drug addiction and alcoholic abuse. The literature on this subject is vague, unsatisfactory, unscientific, the treatment impractical, and the results attained are not understood oftentimes by those who employ the treatment.

To begin with, let us consider the human frame from a psychological point of view. As far as I can, I am going to refrain from indulging in anything in the way of technical description. The mind, the brain, is susceptible of all sorts of impressions. What we do with those impressions oftentimes depends on the activities of certain glands which until recently were very little understood. For example, the overwhelming and dominating emotion in all the animal kingdom, man and the animal, is fear. Fear supersedes everything else. Music may be going on in a theatre, yet at the cry of fire everything else vanishes; the animal impulse is to flee. In order that we may successfully flee and thus carry out the impulse or instinct of self-preservation, the heart action is

increased, and the brain action is stimulated. The muscles, in response to the brain messages, are called into activity. Now, the extent of that activity is determined by the secretions of three glands, one of which is the thyroid gland which you see enlarged in the neck in cases of goitre.

In the case of animals, for instance, the cat or rat, if you attempt to kill or destroy the cat or rat by aggression and strike them they will flee. It isn't as a result of thought; it is involuntary; it is hereditary; it is the result of the impress of generations, of centuries in this type of animal. The moment that animal flees, the rat toward a hole, the cat up a tree or elsewhere, they have secured safety, but suppose the cat or the rat are cornered. They realize that there is no avenue of escape. The glands that stimulate the heart and brain, that stimulate the muscles to activity, stimulate that cat and rat to turn and fight. In other words, in that lies their safety. Fight. They have forgotten all about flight.

Now, in the matter of cases of drug addiction, in cases of alcoholic abuse, we find men confronted with all sorts of difficulties in every-day life; there is no outlook for them in the way of promotion; there are certain deterrents; they are not given a security by their employers. They become fagged out through insanitary conditions; they worry; they fret; they fume; they seek flight, but their flight is in turning to drugs, in turning to alcohol, in turning to some one or other of the so-called narcotics. They attempt and believe that they do attain a measure of safety. At any rate, there is oblivion from their anxiety and worry, from all the conditions that are depressing and discouraging, but that shortcut is short-lived. By taking these drugs, the morphine or cocaine or alcohol, they blunt the impulse that comes to the brain normally to pour out these juices of the glands to stimulate an impulse to fight.

I don't know whether I made it clear or not, but that is my conception of the beginning of alcoholic addiction. Heredity may play a large part. Some authorities say 70 per cent of the addicts are addicts by reason of heredity. I do not mean that the child is born a drunkard, but the child is born with a kind of temperament that is restless and disturbed; it has longings, appetites, tastes

unsatisfied and unsatisfiable, until it comes to the age when it attains a measure of freedom and begins to reach out for something, it doesn't exactly know what. Along comes the heroin addict looking for a new pal. The child, the adolescent meet him; it has its first dose; it is initiated, joins the ranks, and so it is

with alcohol.

The youth at college cut loose from home restraint with these longings; there is some disturbance of balance in the secretions of these ductless glands. One stimulates brain activity. This thyroid gland in the neck is the monitor, the pacemaker; it holds in check these mental activities. If it were not for this monitor we would run wild through the stimulation of the other gland. On the other hand, if the brain, for instance, is lulled and dulled as it is by morphine, the stimulus that should go through the nerves of this gland is absent. We get none of that brain nutriment and muscular nutriment. Take away the drug and the man has collapsed physically and depleted mentally; he is a wreck. Without this stimulation or food that these glands produce, he cannot cerebrate originally. He lies; steals; he becomes a criminal and sometimes I feel we hardly should blame him for it. I see them absolutely depleted; I see them collectively; I see them individually. I tell them individually and collectively that I look upon them absolutely as beasts as they come to us. They are simply human machines; they have a so-called brain; they have a heart which blood through the vessels and nutrifies them in some cases fairly well. I tell them I take very little stock in what they say to me at the start. I ask very few questions, but I hold them

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strictly to account afterward.

The other day I dismissed a man for falsehood. To be sure there was an added offense of leaving the grounds, which are wide open, without permission. That made its impression upon the others. That dismissal doesn't mean a comfortable seat to New York, but walking for sixty-five miles. I did that for a specific purpose. This man falsified in seeking a position. I permit none 1 me with details. If anything goes wrong, and I am happy to say practically nothing of any account has gone wrong, it has to be presented in a straightforward, open way. There are no spies. We had one case of smuggling of liquor and I found out

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afterward that man had spent eighteen years in prison. He had been a drug addict and was a pretty worthless specimen to us there, at any rate.

I look upon the drug addicts and the alcoholic as the cat or the rat in the corner. They have sought safety in flight to their alcohol or morphine or heroin or cocaine. They are down and out and cornered. They realize there is no safety in that kind of flight, but they haven't the brain power, the will power to turn and fight back. By building them up physically, by building them up nervously, by stimulating their will power, by stimulating their self-respect, by self-denial, I tell each and every one individually and collectively, because we have an individual conscience and a crowd conscience. The individual conscience is the conscience that would prompt you to say what we think in the presence of others, of some individual. The crowd conscience holds it back. We are afraid of public opinion. So, as I say, I take them alone and collectively. These people are the cat and the rat in the corner. They are taught to fight back; they know what their enemy is, it is alcohol, it is cocaine or heroin or morphine. We talk about it freely there. All the distress I feel that has come to them; all the suffering and sorrow, poverty, sickness and distress that has come to their families, is pointed out clearly to them, so I stimulate them to fight their enemy. The probation officer dealing with these cases might follow that line of work or that mode of attack of this situation.

I build the men up physically, temperamentally and mentally and give them this conception of their duty toward alcohol and their former addiction so as to look upon it with abhorrence, to grapple with it and throttle it. I doubt very much if you can get that sort of aggression, that sort of spirit and the self-respect that comes with it by soft words, a pat on the back, condoning an offense and that line or that attitude toward these people. I should say that the probation officer should himself be above reproach. He should have tact, in that he should put himself, if possible, on the plane that these men are on and then look back and be guided by his higher conceptions in dealing with the individual before him.

The alcoholic has his brain stimulated to activity apparently. It is not a stimulation. The brakes are cut loose; he has all the

dangerous sensations without the deterrent worry, pain, anxiety, remorse or depression. At the moment of his indulgence things. look rosy and after a while there is a confusion of ideas, loss of co-ordination. We see the intoxicated man in the street; he stag gers and he makes grotesque motions. Oddly enough, he can maintain his equilibrium fairly well. Oftentimes, in the presence of the crowd he excites laughter; we watch him and laugh at him. Why? Because we are so used to him. He has been with us so many centuries; he is no novelty.

Now, can we logically in a treatment covering seven days, a week, two weeks or a month, expect results in cases of drug addiction or alcoholic intoxication which are chronic? The results that have come from the catch-penny cures or the much-advertised methods of cure are psychic. I mean, the man has had the horrors of the situation so impressed upon him that he seeks safety in flight. How can you expect a man who has been depleted, who has been poisoned for years by a drug or by alcohol, after a few days' treatment to cerebrate logically? How can he develop will power; how can he display judgment? He is all at sea.

The man who would kill; the man who would be one of our aggressive criminals under cocaine or alcohol becomes a deflated coward when his drug. or alcohol is taken away from him.

At Warwick, we aim first to build up the physical side; next we build up the mental, the nervous side. We aim to have self denial practiced. The men work and it is a curious thing they like to be governed, to be driven in a way and with precision. I was surgeon-general of the navy for four years and took up this work because I saw in it what I thought to be a big field. The psychic factor of having been surgeon-general has its impress on them. They think they are being governed in a military way. I told one the other day when our camp colony was established we were going to organize that camp precisely as we do our military camps in point of view of sanitation and all the rest, and I want you to be one of our watchmen; you will be responsible for the discipline and order, the cleanliness and all that sort of thing. At once he said, "I do not know anything about the military side of it; I cannot stand up straight." The other day one came in and called me "Admiral." That had been my rank. I told him this was not