IV. Pharmacopsychoses (the Alcohol, Drug, and Poison Group)

Pathological intoxication.

Case 86. (Boucherot, 1915-6.)

A Territorial infantryman, aged 37, was in the habit of drinking a good deal without getting drunk, and at the front drank a good deal of bad brandy. He had just taken a considerable quantity when his regiment got the order to charge. The charge was hardly over when the man became greatly excited and hallucinated. He thought he was surrounded by Germans and tried to transfix his comrades with the bayonet. Howling and struggling he was carried to the rear.

He was soon brought to the asylum at Fleury after howling all night and seeing the Boches and animals fighting among themselves. His hands and tongue were tremulous and there were cramps in the calves of his legs. On the 6th he expressed astonishment to find himself in hospital and was found to have but slight memory of what had happened. He remembered, however, that he had tried to kill his comrades. With the deprivation of alcohol he became rapidly normal and was sent back to the dépôt in a few days.

Re alcoholism under army conditions, Lépine remarks that alcohol has played in this war a rôle analogous to that of malaria in the epidemiology of some countries. Many of the victims are, to start with, unbalanced subjects and détraqués who are hereditary alcoholics. Alcoholism, according to Lépine, dominates the pathology of the interior and has a marked bearing upon conditions at the front. In fact, alcoholism would have been disastrous in France had not measures been taken against it; measures still insufficient (1917). More than one-third of 6000 cases studied by Lépine during three years have shown alcohol as a sole or, at all events, principal cause of the difficulty. It would be within reason to state, according to Lépine, that if we throw in cases in which alcoholism was a partial factor, more than half, or even more than two-thirds, of the mental cases had been strongly influenced by alcohol. Lépine thinks there may be effects like those of anaphylaxis. Certainly, the startling and sudden effects in so-called pathological intoxication, as in Case 86, suggest the critical and vehement effects seen in the sensitized anaphylactic subject.

Chart 4 Phases of War Psychiatry in France

I. Antebellum phase of Psychiatric Neglect: Groundless fear that recruiting would be disorganized by psychiatric sifting processes.

II. Phase of Alcoholism of Mobilization: Hospitals unprepared.

III. Phase of the Marne: Alcoholism restrained by law; psychoses few; psychiatrists optimistic.

IV. Phase of Trench Warfare: Overemotionality; and of High Explosives (January, 1915); now psychiatric services were systematically established along evacuation lines.

V. Phase of Systematic War Psychiatry: Filterwise system of management (a) near trenches, (b) in main body of army, (c) on evacuation lines, (d) special hospitals.

Chiefly from data of Chavigny, 1915.

Pathological intoxication: criminal prosecution stopped.

Case 87. (Loewy, 1915.)

An orderly, in private life a teacher, one day about noon-time, when going on duty, called the commanding officer to account because he (the orderly) had had to wait. He said he had been ordered to come at two o’clock and it was already long thereafter! He was severely reprimanded but addressed a number of the officers present with questions having no relation to military service. In fact, he seemed to have forgotten entirely that he was on military service.

This was the more remarkable as the teacher-orderly had many times distinguished himself upon dangerous patrol expeditions and in critical situations, winning the confidence of his superiors and the likelihood of promotion to corporal. He had been a discreet, earnest, and clever soldier.

Loewy observed him during this affair and noticed that he did not by language or movement suggest intoxication or hilarity but merely a certain excitement. He was entirely oriented for time, place and person, and his outward behavior was correct enough except for his military rank.

Sent to his quarters near by, he gave the impression to his immediate superior officer of deep drunkenness. He murmured something and soon fell into a deep sleep. After waking, he had an almost complete amnesia, knowing only that something disagreeable had transpired. He remembered that he had been offered several little glasses of cognac brandy by a comrade, and that he had drained them off quickly before going on duty. He said that he had never drunk cognac before, and in fact had drunk nothing for a long time.

The diagnosis of pathological intoxication was made, and the soldier was thereby cleared of his dangerous situation; a criminal prosecution was not instituted. He thereafter behaved with entire sobriety and modesty, and he achieved his corporalcy and later became file leader.

Desertion in alcoholism may deserve the term “pathological.” Case of fugue.

Case 88. (Logre, July, 1916.)

A “deserter” said: “I went because I drank a glass. I just went, comme ça, without any motive.” He was somewhat feebleminded and, in explaining the impulsivity of his act, he added: “I went like a broken-down beast. I walked straight ahead, without knowing where I was going and if I had been going to be killed, it would have been all the same to me.” He could not that afternoon remember very well; but next morning, after having slept, he regained full consciousness. He said that he then found himself in a field near a cemetery. He had carried his gun and equipment with him, but had lost them somewhere, and from a military point of view, his desertion was complicated by loss of effects. On coming to, he said to himself, “Where am I? How foolish after fifteen months in the line! Probably I have deserted again.” In fact, he had a month before left his post under exactly the same conditions in the midst of a period of alcoholic excitement.

This alcoholic fugue is typical: drunkenness, impulsive and subconscious ambulatory automatism, with partial amnesia, disorientation, with mislaying of objects, followed by sleep and immediate return to normality.

Re fugue, see discussion under Cases and . The French military code cannot excuse victims of fugue even though executed in a quite unconscious state, if the fugue is due to alcohol. There was a certain procursive suggestion in the fugue of Case 88, who went “like a broken-down beast,” straight ahead, without knowing where he was going.

Alcoholism: Amnesia experimentally reproduced.

Case 89. (Kastan, January, 1916.)

February 15, 1915, a German soldier drank beer in the canteen and at roll-call appeared tipsy. He then went to bed, but rose an hour later to go to town. A quarter of an hour later, he went to a clerk’s house and asked for paper, on the ground that the next day he was going to march to Warsaw. The clerk gave him no paper, which he then tried to get by force. A policeman arrested him and he said, “You just wait, lame dog!” Upon examination he denied that he had ever been guilty of any crime but had been in institutions on account of delirium. In point of fact, this man had grown up in very bad surroundings, amongst quarrels and disputes of his parents, who kept a disorderly house. At 19 he had been convicted of incest. He finally admitted having been convicted for rape. It was found that he had once run out into the front trenches; had been removed by an advance guard to a stable, and then wondered why he was not in school. He described a number of attacks of delirium although he had not drunk more than moderately.

He was given an experimental dose of 50 c.c. of alcohol, and in ten minutes became excited, tried to get out of bed, attacked other patients without reason, and was able to speak neither spontaneously nor in response to questions. In a period of two hours he became clear and asked what the trouble was. He knew only that he had taken alcohol.

Re the experimental excitement produced in Kastan’s case by the exhibition of alcohol, it is of note that Bérard has been much impressed by the agitation that surgical cases of alcoholism undergo when anesthetized. It may be that the anesthetics act similarly to the experimental alcoholism of Kastan’s case. According to Bérard, these phenomena of the anesthetized wounded (who are men recently evacuated from the front and other hospital cases) are of larval alcoholism brought out by the anesthesia. Bérard wonders whether rum issues at the front are at all responsible therefor.

Desertion, drunk. Contributory factors.

Case 90. (Kastan, January, 1916.)

Gottlieb S. left the barracks, January 25, 1915, met friends and drank with them, remaining all night in the railway restaurant and waiting room. He was promptly arrested.

According to the patient, he had always drunk a good deal and had once fallen from his horse in the campaign, and become unconscious. After this fall, he said he had been able to stand less alcohol than before.

There is doubt as to the syphilis of Gottlieb. He said he had been infected once, but his further statement that he had six relapses is, of course, questionable. As to the hypothesis of feeblemindedness, it appears that in childhood he had learned badly and had been a stammerer. He had been a herdsman, and after that a laborer. He finally became a travelling man for a specialty photographer.

He had previously been convicted of an embezzlement, brawling, and breach of the peace.

As to his military crime, he said he had been celebrating the emperor’s birthday the last three days, being urged on by acquaintances and drinking whiskey. He was, in fact, on a spree and did not eat properly. He had met a student in the railway station and had forgotten all about his military service. He remembered having spoken with the waiter, remembered telling the student that he was going to commit suicide, and the student had drunk seltzer with him. January 29, he for some reason drank no more, and then it occurred to him that he ought to go back to duty. He remembered that he was easily led astray. He had once thought of becoming a tanner but had been dissuaded from the trade because of its bad smell.

The analysis of this case must consider, first, syphilis. Supposing, however, that this hypothesis is not substantiated by laboratory findings, the hypothesis of feeblemindedness might well be raised. It seems possible, if not probable, that this patient was in the subnormal group, lying between normality and feeble-mindedness proper. The value of mental tests would here be extreme. There seems to be no evident epilepsy, and the majority of the phenomena can perhaps best be explained by alcoholism. Possibly the case is one of so-called pathological intoxication. The patient’s own story that, although he had been always subject to drink, he had been less tolerant of alcohol since a fall from his horse, seems to be entirely consistent with the post-traumatic history of numerous cases, so that it would hardly be wise to consider that alcohol accounts for the whole story. We must raise then in succession the hypothesis of syphilis, feeblemindedness, alcoholism, and coarse brain disease, bearing in mind also early stammering. As to the utilization of such a man, it would appear that a supervision of him with absolute countermanding of alcohol in view of the decrease in tolerance of alcohol since the fall from his horse might perhaps preserve this man for some form of military service.

Re German and French war alcoholism, Soukhanoff remarks that the conditions in these countries were in strong contrast to those in Russia. In Russia there was a great decrease in the number of cases of acute alcoholic psychosis; particularly at the time of mobilization, there were few cases of alcoholic psychosis. He says that during the Russo-Japanese war, alcoholic psychoses constituted a third of all the mental cases observed. This figure corresponds with that quoted above from Lépine (see under Case 86). Soukhanoff, writing in 1915, had not observed personally a single case of alcoholic psychosis. Incidentally, the number of cases of psychosis in the Russian army had remained in general small.

Desertion by mild alcoholic dement.

Case 91. (Kastan, January, 1916.)

Emil S. made a number of statements when he came for examination. He had once had a treatment by injections. Both his mother and his grandmother had been insane. He said that his brother was an officer in the navy, but this statement was found to be false.

According to his story, he had lost touch with his troop at the end of September, 1914, and had lived in several lodgings in T—— up to October 19, when he was arrested. He said that he did not know that a man who had lost touch with his troop had to report.

A week after his arrest, S. entered a shop and asked for coffee, saying that he had a furlough of 24 hours and wanted cake for his comrades. He said he was the owner of an estate and would send a roebuck for the cakes. The shop-man gave him cakes to the value of one mark. Bystanders said that he had been lodging in T—— for about two weeks. It seems that he had told his landlady that a city official had quartered him upon her and that he was on furlough. He went away in the morning and came back in the evening. He had written to a bank of which he had once been a representative, asking for money. One night he had lodged with another landlady, being given a meal, and he had there stated that he was in the City of T—— on duty and that his horse was in the barracks. He offered a thousand marks for his board and lodging.

At another lodging he had given himself out as a courier. In fact, the letter to the above-mentioned bank had been signed “Otto S., Land-owner, at present, courier.”

“If I do not revoke this in person or by writing on January 1, 1915, I beg you to pay to Mr. and Mrs. M. of T——, one thousand marks and deduct it from my balance.

“This is to be considered as my last will. As witness: present: Joseph B.”

The letter was addressed “To the direction of Commercial-Counsellor P——.” There was no stamp on the letter.

A second letter reads:

“Honored Sir, Commercial Counsellor:

I beg you to send by return mail to the address given below 1000 marks, and deduct this amount from my account. I have been in Russia. Well, things are moving now. Thank God, we have reached the point we have. Write me please more in detail about my property and estate and give me your very valuable advice.

With best regards to your esteemed wife, I remain

Sincerely and respectfully yours,

Otto S., at present courier, otherwise, land-owner.”

As for this Commercial-Counsellor P., P.’s son stated that his father had been dead for three years and a half.

S. gave himself out in T—— as a land-owner, falsifying his name, asking for beer to the amount of a mark a day, borrowing from his landlady ten marks, paying nothing, but remaining on friendly terms with the landlady and her women lodgers, making a contract with a superintendent ostensibly for his estate, and borrowing money from him.

Observed in the clinic, he said he was a bank representative and had been very nervous since being divorced in 1911. The divorce was due to his wife’s adultery. Sometimes he would not know really what he was doing, once even tried to shoot himself, and again once threw a burning lamp into his wife’s face without knowing it.

He had gone to the City of T—— without furlough in October because others used to, too. Only five days later had he noticed that his troop was no longer there; and upon inquiring about the troop he could find nothing as to its whereabouts.

He had been a heavy drinker and was always somewhat intoxicated, which, according to the patient, made him forget everything. He had drunk 20 glasses of beer and liquor daily. He wrote to P. because he knew his father.

As for the frauds, he said he knew nothing about them. He did not know even the baker from whom he had gotten the cakes. In fact, he had been drunk the whole day long.

He said that he had learned badly in school and had not passed any examinations. In active service he had already been convicted of drunkenness once. Referring to his treatment by injections, he said he would rather be dead. He had only sought diversion in looking over estates. Both his ability to reckon and his memory had suffered greatly. He and another patient eloped from the clinic one day but were captured a few hours later.

Remarks: Details are lacking as to the physical and laboratory side of this case. On the whole, there appeared to be no convincing features of paresis or cerebrospinal syphilis. The phenomena are very possibly in part alcoholic. There appeared to be no sensory disorders, and in particular no hallucinations. The intellectual disorder is chiefly amnestic. There is little or no evidence of emotional abnormality. The curious conduct seems hardly to indicate a primary disorder of will. The main feature psychologically appears to be amnesia coupled with an inability to reckon. To be sure, the letters are written externally in sufficiently good form; the amnesia does not appear to extend to details. It is a question of whether the disorientation which one suspects is not merely amnestic. On the whole, however, it would appear that there must have been at various times disorder of consciousness, as indeed is indicated by the patient’s own account of his ignorance of the cake-roebuck episode.

Dismissing the hypothesis of a syphilitic dementia, we might cling to that of alcoholic dementia more or less punctuated by acute alcoholism. Yet it is also possible that the patient was actually somewhat feeble-minded; this would be consistent with his own statement. The question might arise whether this soldier could have been excluded by careful psychiatric examination before entering service. It would seem that a knowledge of the insanity of the mother and grandmother, and an inspection of school records, if available,—to say nothing of the episodes which may or may not have been accurately related, between himself and his afterwards divorced wife—would have sufficed to throw doubt upon the military effectiveness of this man. We know also that he had already been convicted of drunkenness on military service before the episodes mentioned.

Desertion by alcoholic. Contributory factors.

Case 92. (Kastan, January, 1916.)

Carl B. was a soldier about whom the captain thought that his intellectual power had been weakened by drink. An inquiry after arrest showed that he had been odd also at home. He had once been sued for perjury, but the suit had been stopped for lack of evidence. He had been several times convicted of drunkenness. It appears that on March 30, 1915, after mounting guard, he said nothing and went home, remaining at home until the next day and then returned to the guardhouse in the street-car. He declared, this time, that the non-commissioned officer had given him permission to leave, although this statement was not correct.

Again, on April 6, B. was about to leave the quarters, but the surgeon, finding him drunk, kept him back. He did not go home that night, and the next day when he was wanted at the hearing, he could be found only in the afternoon. He replied confusedly and somewhat irrelevantly to the questions asked. On arrival at the clinic he was in tears and much depressed. Given 50 grams of alcohol, he became somewhat livelier. Upon examination, his perceptions were found diminished; he felt, he stated, a cracking and crackling in his neck. In his cell he had felt as if sparrows were roosting in his face; he had heard voices and seen pictures, and had not known what he was doing. He asserted his innocence, blaming his imprisonment for all his troubles. He had been in the habit of drinking three liqueurs and two glasses of beer a day. He had been drawing a pension since a fall from a scaffold.

A sister had suffered from continual headaches. The patient himself had three sickly children and ten of his children were dead; there were also two premature births.

The analysis of this case would clearly show the benefit of considering, first, the hypothesis of syphilis. Not only is the history of his children suggestive, but the impairment of mind noted by the captain as due to alcohol may very possibly be syphilitic in origin. Examples in division he could not solve, and it is a question whether his leaving guardmount is not in part related to disorientation for time. There appears to be no evidence of feeblemindedness and none of epilepsy (though a sister suffered from continual headaches). Alcohol may account possibly for the entire picture and is particularly consistent with the false voices and figures, the sparrows in the face, and the sensations in neck and the tickling in the ears. It is possible, also, that intolerance to alcohol had set in since the fall from the scaffolding for which a pension was being received. It does not appear necessary to consider any further of the groups of mental disease. Syphilis, alcohol, and a post-traumatic brain condition, all may play a part. Alcohol is able probably by itself to produce a number of these symptoms, and these alcoholic symptoms would be probably the more readily produced in virtue of the post-traumatic intolerance that we may assume.

A disciplinary case: Alcoholism.

Case 93. (Kastan, January, 1916.)

A German soldier, brought up for examination for disobedience and insubordination with intoxication, was found already to have been convicted 33 times of a variety of crimes. Once he had drunk a bottle of shoemaker’s polish, evidently with suicidal intent.

In the canteen he had assaulted superior officers and tried to strike a sergeant. He said he had been attacked by the sergeant and pushed into a cell, whereupon he had lost his mind.

He came from a family of drunkards, and had been himself very alcoholic formerly. On the day in question, however, he had drunk very little. According to his account, he had fits of this sort if any one injured him. He was amnestic and had forgotten his previous convictions. Anything he might have done, he said, had happened a long time ago, in his youth. For example, concerning a theft, he said that it was merely that he had fallen into some Christmas trees and stuck fast there, and no one wanted to be paid. Tremors of hands, feet, head. Analgesia of thorax.

Re alcoholism and disciplinary cases, we find alcoholism bulking large in Lépine’s account of military delinquency. Fugue subjects are not infrequently alcoholic. Minor disobedience is also often alcoholic. Acts of violence are characteristically alcoholic, or executed by subjects with hereditary alcoholic taint. (Such acts were in France especially common before the anti-absinthe law in 1915.) Alcoholic episodes and impulses often culminate in arson. No doubt, espionage employs alcoholism for a portion of its technique, though delusional mystics and subnormal hypersuggestibles are more often the purveyors of information to the enemy. The theft list, also, shows its share of alcoholics. Alcoholics are less common amongst those who, contrary to rules, assume shoulder-straps or other decorations. Here the sub-normals and victims of imbalance, as well as the drug cases, are more likely to figure if the matter is psychiatric at all.

Remarks upon an atrocity.

Case 94. (Kastan, January, 1916.)

April 15, 1915, a German soldier went with three comrades to a farm, to select a sheep for slaughter; they were obliged to go to three farms. The man carried a revolver and cartridges in his pocket. He threatened the farmer that he met with this revolver, and desired to rape the farmer’s daughter. He was very drunk, and said to the non-commissioned officer who was called in at the time, “You have served only a year longer than I have.” He staggered, struck violently with his hand at the sergeant, and gave insolent replies.

He had already choked the peasant’s daughter, scratched her face, and bitten her fingers, hand and arm. She could not run away as she was lame. The soldier held the revolver to her face and shot it off several times, offered sex assault, scratched her feet with his spurs, and tried to twist her neck. The non-commissioned officer threatened to shoot him, and he then became still. He said to the first-lieutenant before whom he was taken, that he would do anything but allow himself to be beaten, and at this moment moved his arms about in the air, and bloody foam came from his mouth. The first-lieutenant previously had always thought him to be normal except for a strange flicker and unrest of the eyes. There was a history that he had already once attacked a servant girl. The man had amnesia for the affair, only remembering how the non-commissioned officer had come on a white horse. He remembered nothing about the peasant and the girl. He said that he had been given to earache on the right side in winter. There was a history of his having fallen from a tree in childhood, becoming unconscious. He had been a sufficiently good scholar up to the second class in school. He had been an excellent soldier.

Alcoholism: Atrocity.

Case 95. (Kastan, January, 1916.)

September 15, 1914, a German soldier was missed. He had said that he wanted to get to the enemy quickly, and that he was going to march alone against the Russians. A shot was fired that night by this soldier, on the ground that he had been insulted by a civilian, although no civilian was present.

September 21, a farmer in a wagon reached a farm, where he found the soldier aiming at a woman. He fired, wounded the woman severely, and jumped on the farmer’s wagon and rode off with him. It seems that the soldier had come to the farm at noontime and accused the woman of treachery, ordering her to come with her husband to a certain farmhouse, where she should be placed against the wall and be shot. The soldier had shot her and wounded her husband also. According to the woman, the idea was to take revenge because she had denounced certain persons as spies.

He was arrested during the night, and told how he had left his troop because he could not get at the enemy. He had been informed that there were spies who ought to be shot; there had been talk in a certain inn about it. He did not know he had wounded the husband, and he only wanted to give that dangerous woman a piece of his mind.

After wounding the woman, he had given himself no further thought about her, but had gone to partake of the holy sacrament at the pastor’s. He then had drunk another glass of beer and gone to bed. He was, in fact, still drunk at the time of arrest. He had not been aware that he would be punished for the crime of going alone against the Russians.

Some days later, he wrote that he did not intend to kill the woman, that he had been drunk at the time and was always a bad man when drunk; that he had other times when he absented himself from home for days when drunk. He had had, he said, a number of attacks of delirium, in which he had seen animals. At one time, he had fallen on his head. On the day in question, he had drunk 1½ litres of liquor. He was remorseful for his deed.

A disciplinary case: Alcoholism; amnesia.

Case 96. (Kastan, January, 1916.)

A German soldier, New Year’s Eve, 1915, got away from his company, drank whiskey, and came back drunk. He bothered his comrades so that the non-commissioned officer had to call for help; whereupon the soldier said, “A man who comes on late and hasn’t been in much, hasn’t much to say. If it is a non-commissioned officer, I shall hit him in the snout.” The officer kept talking to him kindly but he cried “Halt’s Maul, you crooked …!” He staggered up to the lieutenant without saluting, but at a slight push fell prone into the straw.

It transpired that the man had not been intoxicated enough to lose all control of himself. He did not remember anything about what he had done; he had drunk a half-bottle of rum during the evening. There was a demonstrable lack of memory. He did not know the German provinces, and thought that Bismarck had once been war minister. There was a tremor, hypalgesia of the left leg and analgesia of the left arm and left shoulder.

It was found that he came from a strongly tainted family, with two insane sisters and three insane cousins. He had been a good soldier during his service, but had accused his father of alcoholism baselessly. He had always been difficult to manage when drunk and had been convicted nine times: five for dangerous assault and battery. He drank up to 1⅓ litres of whiskey a day if he got time, and also took ether. For some ten years he had been amnestic for what he did while drunk; nor, according to his wife, had he been able recently to stand so much alcohol. He said that he had had a fall from a wagon in 1911 or ’12, after which he had been unconscious.

Antebellum, run over by an automobile; intolerance of alcohol; episodes of amnesia after moderate alcohol.

Case 97. (Kastan, January, 1916.)

A German soldier was advanced in rank February 26, 1915, and in honor thereof drank six or seven glasses of beer. On his way home, he met a captain and failed to salute him. When called to account, he said he could not see, and made remarks about regrettable behavior. He refused to go along with the officer. Afterwards he remembered that he had been stopped by an officer but had forgotten subsequent happenings.

March 24, he was riding in an electric car with a lieutenant. He said to the lieutenant who had unbuckled his sabre, “It is a piece of insolence and improper to unbuckle the sabre.” He repeated the phrase on questioning. He was then asked to give his name, and replied, “I know my name but what is your name, Mr. Lieutenant?” He looked drunk at the time but afterwards remembered nothing.

Physically he was tremulous and showed blepharospasm. His face grew red on bending over.

This man had been run over by an automobile in 1910, after which he had become excitable, slow-thinking and forgetful. The spinous processes were painful on pressure, as was also the hip joint. The history showed that he had been convicted six times of various crimes, such as disturbing the peace, embezzlement, and the like. Since this accident he had not been able to work effectively. He had gone into the army in a spirit of enthusiasm.

Adventure with a stranger in Paris.

Case 98. (Briand and Haury, 1916.)

A soldier had seven days’ leave in Paris, beginning December 27, 1915, and the first day drank a good deal of wine with another man on leave. They met, in some place that the patient had forgotten, a well-dressed man whom they did not know, and all three fell to drinking. The stranger told them he knew a trick to prolong the leave to 3 or 4 weeks. “All I have got to do is to prick you, and it will cost only 100 sous.” The operation was done at the café after payment in advance. The operation was a puncture with a needle between the middle and ring fingers of the left hand. Next day there was a phlegmon of the dorsal surface of the hand, and he was put into hospital saying that he had gotten a barbed wire prick in the trenches. The surgeon who opened the phlegmon was surprised at its gummy appearance, gangrenous odor, and greenish tint. In point of fact, petrol had been injected.

Morphinism: Tetanus.

Case 99. (Briand, 1914.)

Mdm. L. was a morphinist. After the outbreak of the war, she went to a general hospital to recover from morphinism, but was too excited to be kept there. Accordingly, she had to be sent to Sainte-Anne, but upon arrival she developed distinct signs of tetanus.

It seems that Mdm. L. was the widow of a Colonial who had given her the first injections ten years before, for dysentery. She tried several times to stop. Daily dose 1.5 grams.

She was in a cachectic state, and according to her mother, took no care of her syringe, trailing it about everywhere. Her thighs, arms, and anterior aspect of the body were covered with scars. There were small phlegmons in places. Did she inoculate herself with bacillus tetani from an infected needle? In any case, she died of tetanus.

Medicolegal question concerning a morphinist.

Case 100. (Briand, 1914.)

A man worked in Paris on the ’Change, where there are a number of syringe victims. He had been brought up in Paris but was not a Frenchman. Enthused by his friends and the prey of deep emotion, he enlisted. He was of an introspective nature and himself wondered whether the morphine did not have something to do with his enlisting. He said, “I had been unnerved for a number of days by reading the papers, and after a number of heavy injections, I went to a recruiting station and signed on.” In his regiment, he continued the injections, but shortly found that he would be unable to replenish his diminishing stock of drug. He explained his unhappy fate to the corps physician, and was sent to Val-de-Grâce. He asked to be retired, alleging that he was under the influence of a poison when he went to the recruiting office and had therefore committed an illegal act.

Social effects of the war on two drug addicts.

Cases 101 and 102. (Briand, 1914.)

Fernand and Emilienne were two recidivists in morphinism. Although neither was over 22 years of age, both had been several times convicted of shop-lifting. They stole only if they had no money for morphine. Prostitution served to care for Emilienne, while Fernand was at times a cocaine seller, and at times made money in devious ways at Montmartre. Emilienne’s patronage scattered with the war, and it was the same with Fernand’s. Accordingly, there was no money for either morphine or cocaine. Moreover, the shops being not crowded were easier to watch. As Emilienne did not care to be arrested and sent off as an undesirable, she presented herself at the hospital for the insane at Sainte-Anne. Fernand shortly joined her there.