Alcoholism in America: From Reconstruction to Prohibition

1 Disease Concept(s) of Inebriety

C H A P T E R O N E Disease Concept(s) of Inebriety On the eve of the U.S. Centennial, the American Medical Association convened in Philadelphia, where founder of the American temperance movement Benjamin Rush had signed the Declaration of Independence. It was 6 June 1876, and members of the AMA Section on Public Hygiene and State Medicine gathered at the Horticultural Hall of the Centennial Exposition in Fairmount Park to discuss, among other concerns, the disease status of inebriates and the necessity of inebriate hospitals. Only five months earlier, at its own annual meeting, the Association of Medical Superintendents of American Institutions for the Insane (AMSAII) had passed several resolutions recommending: first, that each state establish an inebriate asylum; second, that laws be modified to commit inebriates to these institutions just as the insane are committed to state hospitals; and third, that the treatment of the inebriate in hospitals for the insane was not beneficial to either population.1 It was now time for the AMA to declare their own views on the issue. At the meeting of the Section on Public Hygiene and State Medicine that same day, Dr. B. N. Comings, a Civil War surgeon from Connecticut, introduced two resolutions that brought the AMA in line with the official opinion of the AMSAII. The first declared that inebriates should not be treated at public asylums for the insane. The second observed that “inebriety being both a disease and a vice—a vice as related to man’s normal nature, and a disease of his physical organization—special treatment in institutions adapted to the purpose is required for the inebriate, and it is the imperative duty of each Commonwealth to establish and maintain public institutions for the treatment of inebriety.”2 Comings’s interest in inebriety derived from his recent charge to explore the topic for the Connecticut State Medical Society and from his unease about committing alcoholics to the state hospital for the insane at Middletown. The Section on Public Hygiene and State Medicine adopted Comings’s resolutions , but not without some heated discussion. John Shaw Billings, who found Comings’s explanation that inebriety was both vice and disease taxing, declared: “The vice is the disease. They are the same thing.” Comings responded to Billings by clarifying his position. In doing so, he revealed the holistic , moral-medical perspective on inebriety that many of his contemporaries shared. The clergy, Comings insisted, recognized inebriety as a vice only, and not a disease, while the medical profession treated inebriety as a disease alone, not a vice. “The consequence is, both fail,” he concluded, adding “I desire therefore to recognize it as both a vice and a disease, that the combined influence of the clerical and medical professions may be brought to bear upon its treatment.” Hardly the position of a medical imperialist, Comings’s interpretation of inebriety won the acceptance of his colleagues, who passed the resolution forthwith. Thus, the AMA recognized inebriety as a hybrid medicomoral affliction.3 Defining intemperance as a disease was an essential step in the early campaign to medicalize the condition, for most people were accustomed to viewing habitual drunkenness as a moral failing or petty crime. Indeed, describing the disease of inebriety was an ongoing process during the fifty years that followed the AACI’s formation, a process that reflected much more than the state of medical knowledge about the condition. As physicians and reformers proposed new frameworks for understanding this very old problem, their terminology revealed their opinions about a host of other important issues of the day. This chapter examines the evolution of the terms used to describe habitual drunkenness between 1870 and 1920: a linguistic continuum that began with intemperance, moved from there to dipsomania and inebriety, and ended with a 26 Alcoholism in America diagnosis that is familiar to twenty-first-century readers: alcoholism. Although historians have emphasized the inconsistency of the terms used by inebriety physicians and the ways that this lack of consensus may have hampered the disease concept’s acceptance both within and outside the medical profession, these terms also reveal much about the particular cultural and medical moments in which they were employed. Dipsomania, for example, emphasized the connections between habitual drunkenness and hereditary forms of insanity , at once releasing drunkards from responsibility for their condition and implicating physicians as their natural caretakers. Admittedly...