Rum Maniacs: Alcoholic Insanity in the Early American Republic by Matthew Warner Osborn (review)

Rum Maniacs, a satisfyingly concise text of accessible prose, is organized into six chapters, plus introduction and epilogue. Though “alcoholic insanity” has been applied with different meanings, Osborn’s use refers to delirium tremens, a condition that can occur after the sudden withdrawal of alcohol by heavy drinkers. Those afflicted may experience vomiting, tremors, anxiety, confusion, and vivid, often terrifying, hallucinations. The book’s subtitle is therefore in some ways a misnomer. Readers looking for the psychiatric treatment of those diagnosed with any one of the multiple terms for compulsive drinking or alcohol-induced psychological symptoms will largely be disappointed. Despite Osborn’s focus of Philadelphia, in 1752 the first American city to organize hospital provision for people considered to be mentally ill, there is little allusion to the impact this might have had on shaping physicians’ responses to drink. The introduction more precisely articulates the subject of the book: “how and why heavy drinking became a subject of medical interest, social controversy, and lurid fascination” in 1820s, 30s, and 40s America (p. 2). Yet this actually undersells Osborn’s ambition. He has gathered together a rich range of contemporary sources to explore alcohol, masculinity, class, financial hardship, temperance, and medical education and professionalization.

For Osborn, Philadelphian physician Benjamin Rush was Republican medicine; his preoccupation with alcohol influenced young medical men (chap. 1). Delirium tremens first appeared as a diagnostic category in Britain in 1813, the year of Rush’s death. Osborn persuasively argues that the newly named condition, colliding with Rush’s interest and leavened with the fashion for gothic tales, became part of medical and then popular imagination (chaps. 2 and 6). Using information from hospital, almshouse, and coroners’ records, Osborn asserts that the use of the diagnosis of “delirium tremens” was associated with men of means and not poor or black residents (chap. 3). Persuaded of the damage wrought by drink through new physiological medicine, and seeking legitimacy in a crowded medical marketplace, physicians were key to developing the temperance movement, which secured their professional standing (chap. 4). This public stage ensured that medical ideas pathologizing drink were assimilated into American culture. Popular lectures, magic lantern shows, magazines, newspapers, nostrums, and first-person narratives created an awareness of damaged drinkers and acceptance of specialized care (chap. 5). The fuse lit, the public imagination about delirium tremens was unbridled and fed by a rich diet of poems, stage productions, melodrama, and Edgar Allen Poe stories (chap. 6).

While many of Osborn’s arguments are supported by his array of primary sources, his central assertion—that economic contractions in the young Republic shaped responses to alcoholic ruin and linked it with failing masculinity—is on less firm ground. No separate bibliography is given, but it is clear that material is missing: about alcohol in medicine; scholarship on masculinity; and, for instance, histories of venereal disease, which would have offered comparators for gendered medicine. The epilogue, glimpsing alcohol and delirium tremens in the twentieth century, is an interesting idea but does not provide a robust conclusion and prompts queries about omissions (in particular discussions about hereditarians and eugenicists). Small slips are inevitable when the diagnostic labels and the terms explored are, well, slippery. But “intemperate” and “intemperance” were catch-all and often described excessive behavior, bad habits, or simply a lack of moderation; although coming close to fully interrogating meaning (p. 92), the author misses slightly and so some of the assertions (particularly in chap. 3) are not perhaps as definite as they seem.

Rum Maniacs contributes to the wider histories of alcohol, medicine, and professionalization, and begins to address the need in the historiography for studies of alcohol and insanity. But the real verve of the book develops our understanding of how medical ideas seep into culture (and vice versa) and lend validity to the tropes they create and come to, or wish to, leave behind. This...