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Box 15-007 THE ARISTOCRATIC VICE: The Medical Treatment of Drug Addiction at the Homewood Retreat, 1883-1900. Cheryl L. Krasnick from "Ontario History, The Quarterly Journal of the Ontario Historical Society."
Dec 1 1983

THE ARISTOCRATIC VICE: The Medical Treatment of Drug Addiction at the Homewood Retreat, 1883-1900.

For most of the nineteenth century, drug addicts did not constitute a deviant social group but were simply indivivduals guilty of a specific moral transgression. By the 1920's, however, addicts were clearly social deviants, defined by both illness and by vice, and demanded institutional isolation.

In 1921, the "dope fiend" was portrayed as a "miserable, emaciated, furtive individual with pinpoint pupils, trembling hands [and] a sallow complexion." Yet in 1881, "opium eating" was viewed as "an aristocratic vice" [prevailing] more extensively among the wealthy and educated classes than among those of inferior social position... The merchant, lawyer and physician are to be found among the host who sacrific the choicest treasures of life at the shrine of opium.

What caused this transformation in attitudes? Improved technology and pharmaceutical advances produced more severe cases of addiction while diminishing the pool of potential opium addicts. Government regulation, which should be viewed as the culmination of the attitudinal shift, was produced at least as much by nativism as by a threat to public healthm and was responsible for curtailing licit supplies of narcotics. The most important factor in the creation of the modern public perception of drug abusers however was the definition of addiction as a disease by the medical profession. In Europe, the United States and in Canada from the 1870s to the end of the century, the medical profession was in the process of creating and defining a new disease and a new group of diseased. The Homewood Retreat of Guelph was the first asylum in Canada to treat the disease of drug abuse to any great extent. Homewood's patients were wealthy and cultured individuals, and typical victims of the "aristocratic vice." Through examination of the experiences of Canadian addicts, as reflected in their treatment at the Homewood Retreat, it is hoped that the naturem course and repercussions of the disease of addiction can be shown.

The first major historical work on drug addivtion was Terry and Pellens, The Opium Problem, published in 1928. Dr. Charles E. Terry, who founded an early government maintenance clinic in the United States, called for a rational rethinking of the coercive response to drug addiction by law enforcement agencies following the passage of the Harrison Act in 1914. American medical practitioners were in the forefront of the development of treatment for The American Disease. David F. Musto's work has been the standard text on American Drug addiction since its publication in 1973. Musto argued that the legislation of opiate ise resulted in the formation of a criminal class of addicts without solving the problem of addiction. With the growing interest in medicine by social historians, a number of recent studies on drug addiction have been published. H. Wayne Morgan's Drugs in America (1981) is an entertaining and informative account of popular drug use. David Courtwright's Dark Paradise: Opiate Addiction in America before 1940 (1982) is a response to Musto's thesis. Through an estimate of drug use both before and after tge Harrison Act, Courtwright argues that narcotics use was diminishing prior to government regulation, and he traces the decline to the medical model of drug abuse and alternative forms of chemical therapies. In Opium and the People: Opiate Use in Nineteenth Century England (1981), Virginia Berridge and Briffith Edwards blame the British Medical elite for shifting attitudes of drug abuse as part of the process of medical professionalization, and as the result of middle class hostility towards the free access to narcotics and stimulants for the working class.

In the first half of the nineteenth century, opium was the most important element of a physician's pharmacopeia. In raw gum form, as morphine, laudanum praregoric, opiates were as widely used as aspirins are today. They were prescribed by physicians, dispensed by pharmacists, and sold in general stores and by email-order houses. Opiates were contained in most patent medicines. Because of its exceptional qualities as an anodyne, Benjamin Rush termed opium "God's Own Medicine" and physicians described it for gastro-intestinal disorders, fevers, rheumatic and arthritic pain, hysteria, syphilis, smallpox, diabetes, cholera and cancer. Opium was invaluable in rural areas without easy access to physicians, or in regions with strong traditions of folk medicine.

The recreational use of opiates was pupularized by the Romantic authors. Coleridge, Keats and Poe were habituates and were popularly believed to have written many of their works "under the influence." The most important writer was Thomas De Quincy whose Confessionsof an English Opium-Eater was said to have inspired many to experiment with opiates. As one American Lawyer-addict lamented, the Confessions "kindled within me a desire to experience for myself the grand dreams to which the drug gave birth in him. Despite the publicity given to the famous literary addicts, Berridge has demonstrated that by the mid-nineteenth century, with easy access to opium, British addiction levels were stable and even falling, as the general populatin successfully regulatedits consumption of opiates.

With the introduction of the hypodermic syringe In the 1850's however, and its general use in private practice by the 1870's, the nature of opiate abuse was changing. Subcutaneous injection of morphine was at first heralded by the medical profession as being devoid of opium's side-effects, including addiction. The benign administration and swift dramatic effects of the hypodermic syringe also had great psychological appeal to the medical profession. Demoralized into "theraputic nihilism" by the public (and professional) rejection of "heroic" treatment (i.e. bleeding, cupping and purging) in the period prior to the advent of modern synthetic drugs, medical practitioners hailed the morphine injection as evidence that they could cure, or at least kill pain. In cases of severe and chronic pain, even a physician aware of the danger of addiction found it difficult or impossible to cut off the patient crying out for the needle, The logistics of a rural or widely-scattered practice also forced many physicians to teach patients and their families to administer morphine themselves, and the use of the hypodermic soon escaped the control of the medical profession.

The medical profession, in the process of organization, was concerned that so powerful a drug should be so easuly available to the public, and believed that opiate ise and abuse should somehow be a medical problem, despite the fact that no addiction "germ" could be found (since all diseases were believed to be organically based), and that addiction appeared to be a condition brought on voluntarily. The general population, however, accustomed to self-medication and often hostile to medicine's encroachment on hitherto public spheres, did not share this concern.

The breakthrough for the medical profession came in 1877 with the publication in German of Edward Lecinstein's The Morbid Craving for Morphia which was translated into English in 1878. Levinstein was the first to describe "morphinism" as a pathological state rather than a habit, but also as a "human passion" like gambling, drinking, or smoking. The treatment he recommended, however, dealt more with the moral failings than with the physical disease. It was, in fact, brutal- a session of "harsh, immediate withdrawl" with the patient isolated in a locked room for a week guarded by two mail nurses. If the patient lived through the ordeal, and levinstein described the symptoms of minor and complete collapse, he left the sanitarium cured. Relapse was viewed as the failure of the individual, not of the treatment.

Levinstein's treatment was modified in Britian and North America, but its underlying assumptions- of addiction as a disease and of the moral failing of the individual addict- were not. Dr. Norman Kerr, founder of the British Society for the Study and Cure of Inebriety, linked opiate abuse to alcoholism and incorperated it into the temperance movement. Kerr argued that intemperance in the use of alcohol or drugs was a "disease" of a "depravated, debilitated, or defective nervous organization." despite the facts that the vast majority of cases of addiction was caused by the misuse of hypodermic syringes by physicians, that habits were formed from chronic conditions rather than recreation, and that moderate cases of addiction did not of necessity preclude normal, every-day functioning, so long as supplies were maintained.

Kerr's views were controversial at the time, in part because the opium habituates physicians usually encountered were professionals and othersof "high social standing" who did not display "inferior moral intellect." The disease theory therefore had to be altered to suit the typical addict. T.D. Crothers, and American authority on addiction, modified George M. Beard's concept of neurasthenia, Neurasthenics were individuals whose nervous systems were rendered too delicate by civilization to deal with an excess of mental exertion. Crothers considered neurasthenics to be highly susceptible to opiate addition.

J.B. Mattison, the foremost American specialist, disagreed with Crothers, arguing that addicts were generally normal people who had become addicted through medical treatment. He also maintained however that addiction, once it occurred, was a disease requiring treatment in a controlled environment, Mattison advocated rapid reduction therapy, wherby the parient was weaned from the drug over a period of eight days to two weeks, and also stressedthe need to strengthen the patient's nervous system with tonics, hot baths and bromides.

In Canada, the first addiction specialist was Stephen Lett, superintendent of the Homewood Retreat, a private asylum founded in Guelph, Ontario in 1883. Born in Kilkenny, Ireland in 1847, Lett was educated at Upper Canada College. He became a member of the College of Physicians and Surgeons in 1870 and was appointed Assistant Medical Officer under Henry Landor at the Malden Asylum, which was encorporated into the London, Ontario Asylum in November 1870. In March 1875, Lett unsuccessfully applied for the position of Superintendent at London, recommended by inspector of Prisons and Asylums' John Woodburn Langmuir, but lost out to Richard Maurice Bucke. The two men took an instant and lasting dislike to one another. By March 1877 Bucke was complaining to the inspector of Lett's lack of courtesy (doubtless returned in kind), and it was decided that Lett be transferred to the Toronto Asylem. While in Toronto, Lett in 1878 received his M.B. and his M.D. the following year from the university of Toronto, He administered the Hamilton Asylum for six months in 1883 before being offered the position at Homewood (a corporation in which he was a major investor) by Langmuir. Assistant physicians sich as Lett found career advancement easier to attain through the private asylum system. Lett remained at Homewood until his retirement from illness in 1901; he died in 1905 at the early age of 58.

As was the case in Britain and the United States, Lett's treatment of addictino at Homewood was mmotivated by the imperative lives of the patient, the physician, the insitution and the medical profession. Lett fully embraces the medical model of addiction, labelling it "the opium neurosis" in his adress before the American Medical Association in 1891. He was an early proponent of the disease concept of drug abuse among Canadian practitioners. Addiction, he argued, should not be regarded as "only a vice, which the patient can at once abandon if he only wishes to do"; an opinion, he stated, which was held by "at least ninety percent of the medical men of (Ontario) who are not themselves victims of drugs." Lett's speech was sponsored by the Board of Directors of Homewood on the grounds that it would benefit the institution by bringing it wider renown and an increased clientele. The disease of drug addiction, which had neem termed a "medical growth area" of the 1880s, was the perfect vehicle by which Lett made his reputation. His role as head of a private asylum enabled him to obtain valuable clinical expereince in the treatment of opium and other "neuroses" and through the publication of a number of articles established himself as Canada's aithority on drug abuse.

Lett considered Levinstein's method, "abrupt and total withdrawl" to be a "barbarous, inhuman and dangerous procedure, involving, as it does, the most exquisite torture." Lett's treatment consisted of the gradual withdrawl of the opiate, effected by "decreasing the amount in fractions of a grain at each dose." When the point was reached where only one grain was consumed in twenty-four hours, Lett "usually employed from three to four weeks" untill the final dose would be 1/6000 of a grain. Following Mattison, Lett sustained his patients with tonics, bromides, and cannabis indica. Gradual reduction therapy was ideal for the private asylum for a number of reasons: it provided the least discomfort to the patients amd would therefore be a more attractive prospect; it reduced the risk of collapse; it required the active participation of a qualified practitioner; and it was only feasible in the controlled environment of an institution. It also required a lenthy and expensive stay.

Lett saw addiction as a disease in strictly physiological terms since, like Levinstein, he considered freedom of morphine from the body to be recovery, rather than recognizing a psychological component- even though, as he stated, "With very much broken down and highly nercous patients, I permit them to retain their syringe and morphia... it is a source of much comfort to them." Levinstein, Kerr, Mattison and Lett accepted and propagated the disease model of addiction, High rates of relapse and the frustrated attempts to discover actual physical manifestations of the disease did not deter them. Although their own therapies had helped to create the social problem, their failure to cure was viewed as the moral failure of the addict.

To test the validity of the late Victorian specialist's view of addiction, and to compare the narure of nineteenth century addiction with modern perceptions of it, the development of Canada's first addiction asylum, and the experiences of its patients--within and outside the institution--will be described. Homewood was founded by John Woodburn Langmuir after his retirement as Ontario's Inspector of Prisions and Asylums in 1882. Langmuir was the man most familiar with the potential market for an asylum for paying patients. As early as 1873, he was recommending that beds at the Provincial Lunatic Asylum at Toronto be converted for "pay patients." The "well-to-do" he argued, "were compelled to send their insane relatives to private asylums in the neighbouring States."

The private of "propriety" asylum, geared to accommodate the middle classes, was an increasingly important element in the treatment of the mentally ill in the late nineteenth century. In the United States between 1865 amd 1892, the number of private asylums uncreased 925 per cent. Proprietary asylums appealed both to patients and physicians since they offered more contact between doctor and patient, and more involvement, for the physician, in therapeutic rather than administrative duties.

The mentally ill were not the only potential clients for Ontario's private asylum. "Before the [Retreat] was many urgent applications for the care and treatment of inebriates were pressed upon the promoters that it was found necessary to admit this class of disease as well..." Six months after Langmuir's retirement, he engineered the amendment of Ontario's Private Lunatic Asylums Act to include provision "for the reclamation...of Habitual Drunkards" and consumers of "stimulating or narcotic drugs."

The inebriates who arrived in Guelph found themselves in a quiet community, sufficiently isolated to assure anonymity yet conveniently situated on the Grand Truck railway line, which provided access to both American and Canadian centres. In its early years, Homewood had little to do with the community, protecting its wealthy charges from the prying eyes of local inhabitants. Homewood was luxurious for an asylum. Located on the estate of Donald Guthrie, a prominent Guelph attorney and Member of Parliament, the asylum grounds included nineteen acres of wooded land which overlooked the Speed River. The building had a capacity of twenty-five male and twenty-five female patients. Each large room was well-ventilated and carpeted. The corridor connected to a drawing room "furnished with sofas, easy chairs [and] mirrors," a conservatory, billiard room, amusement hall and chapel. This was described by contemporary Daniel H. Tuke as lacking even the amenities of English county asylums. The basic fee rate was ten or twelve dollars per week although clients could pay as much as twenty dollars for the best suite, compared to $2.50 or less per week at public asylums.

Homewood's patients were affluent and urban. Senior civil servants and politicians, clergymen, lawyers, merchants and physicians comprised three-quarters of the patient population. Similarly, three quarters (78%) of Homewood's population for whom place of residence is known reside in urban centres, primarily Toronto, Montreal, Ottawa and Hamilton (table One). Patients also were brought from British Columbia, Michigan and New York State. This stood in marked contrast to public asylums, where the majority of patients were working class and often from rural areas. Significantly, the public asylum admitted almost no inebriates or drug addicts.

Homewood's patients were designated either Involuntary/Insane (and were admitted by medical certificate of Lieutenant-Governor's Warrant) or Voluntary/Sane-- "comprising those addicted to alcohol, opium, chloral, cocain and other drugs"-- who were admitted after signing an application of Voluntary Admission. (table two). Fifty-percent of Homewood's volunary patients admitted during the nineteenth century were alcoholics. For the purpose of this paper, however, the focus will be on the other fifty percent--the drug addicts.

By way of illustrating the experiences of Homewood's voluntary patients, a composite case will be presented: by his admission in 1893, Dr. M., a Toronto physician, aged thirty-five and married, had been addicted to morphine for six years. He first experimented with it in medical school, but refrained from drug use for many years until he resorted to morphine to relieve various complaints such as rheumatism, gastralgia and overwork. Because he had access to hypodermic syringes, his addiction was swift and severe. After four years of physical and mental degeneration, and a series of unsucessfull cures, he tried another drug touted as an antidote for opiate addiction--cocain, with, as Lett wrote, "the usual result": a double addiction, After an especially bad bout, Dr. M submitted to the urgings of his wife and colleague and signed an Application of Voluntary Admission. His wife added a note to "please keep the matter secret" and to allow him "a lamp to read at night." Dr. M. arrived by train, accompanied by a colleague, since his wife did not want to bear the blame of having him committed. Dr. Lett tested his urine for drug levels, discovering them to be much higher than the patient knew or admitted Dr. M. spent his first days in isolation, with Lett in constant attendance, administering morphia in minute doses to deternine how much was needed to "sustain" the patient. Lett did not administer cocaine, believing that withdrawal therapy could only be attempted with one drug, but M's withdrawl symptoms were so severe the first night that Lett was forced to send out for a supply of cocaine. M. was permittted to keep his hypodermic syringe for a week, until he was comfortable with his surroundings, then the morphia was administered orally in gradually reduced doses. During the first few weeks, M. was given chloral hydrate or Cannabis Indica to produce sleep. M. did "splendidly" until New Year's day when he went on a drunken binge, but soon recovered and reduction treatment was continued. Dr. M. amused himself by reading, playing chess, strolling the grounds and going to the races. He was released "in excellent health" one week after his last (minute) dose. He had been in Homewood seven months, Despite Lett's hopefull prognosis of the recovery rate of morphia addicts, Dr. M. returned eighteen months later. Physicians had a 64 per cent chance of relapse.

The nineteenth century has been termed the "dope fiend's paradise" and Homewood's patiends suffered from a variety of addictions apart from opium. Chloral hydrate, for example, was discovered to have therapeutic value in 1869 and within a year became a favourite sleeping potion in North America. Chloral, as it was called, was termed "unequalled" as a hypnotic, and was widely used in insane asylums in cases of mania or chronic insomnia. As Assistant Physician at the London Asylum, Stephen Lett had bee enthusiastic about the value of chloral, although his superior, Henry Landor, believed that a bottle of "the very best Scotch ale, or the best Dublin Stout" was "more pleasant to take" and "not less effective in its operation." Homewood's chloral addicts admitted between 1883 and 1900 were divided evenly between men and women (three cases of each) with one case complicated by alcoholism, and another by morphia taken to break the chloral habit. Cocaine, isolated from the coca leaf in 1855, found widespread popularity in the 1880s when Sigmund Freud and others attested to its value as a local anaesthetic and stimulant, and as a specific treatment against opiate addiction. Arthur Conan Doyle's experiences as a physician are reflected in Sherlock Holmes' struggle with addiction to cocaine. All eight of Homewood's patients who were stated cocaine addicts were male, seven of whom were also addicted to alcohol or opium. Other addictions included chloroform, bromides, chlorodyne, sulfonal and tobacco. One case of paraldehyde addiction, re-admitted four times over a four-year period, was considered by Lett to be unique enough to be reported in The Medical Times and Register (9 September 1893). It previously had been believed that the paraldehyde habit could not be formed, "owing to the disagreeable odor and taste of the drug."

Opium, of course, was the most common form of addiction. Of non-alcoholic addicts admitted to Homewood in the nineteenth-century, over one-half were opium addicts, comprising one-quarter of the total voluntary population. Homewood's patients took their opium in morphine injections, laudanum tonics, with whisky, cocaine or "other narcotics and stimulants."

The stated causes of addiction were varied but could be placed into several broad categories: physiological, social emotional, hereditary or prior addiction, Drugs other than alcohol overwhelmingly were taken to cure pain. In an age where symptoms, not diseases, tended to be treated, efficacious anaesthetics, analgesics, sedatives and hypnotics were disseminated rapidly, Patients cited epilepsy, rheumatism, bronchitis, asthma, bad teeth, peritonitis and Civil War wounds as the initial reason for taking opium. One retired druggist "went through the whole pharmacopeia" for relief of migraine headaches.

Peer pressure, especially in medical school, was deemed responsible for introducing medical practitioners to the use of alcohol and opiates. Emotional problems such as caused by business failure or family trouble, stress or overwork, drove many to drugs. Whisky was used to break off opium habits, cocain was used to break off morphia, and paraldehyde was taken to break the habit of chloral; this process invariably lead to multiple addictions. Finally, heredity was cited most frequently as the cause of alcoholism. Alcoholic causes were least likely to have causes mentioned other than heredity; the idea of alcoholic degeneration had taken firm hold by the 1890s. Alcoholic case files cited intemperate or insane by kin. In one case, alcholism was blamed on a wet nurse who was discovered, too late, to have been a drunk. Heredity was not seen as important in cases of drug addiction. This can best be explained by the association of drug addiction with the "better classes" in the nineteenth century. Habituates came from families whose accmplishments and social standing rendered them anything but "degenerate" and who themselves were the first to chastise the intemperate "other half."

Among the addicts admitted to the Homewood Retreat, two sub groups were noteworthy. William Osler wrote "The (opium) habit is particularly prevalent among women and physicians." and Homewood's statistics bore this out. One-half (49%) of female admission to the Inebriate Branch were addicted to opiates, while only one-fifth (20%) were so addicted. Women were susceptible to drug abuse since ipiates were specifics for the range of "female disorders." Mrs.J., a Homewood voluntary patient, was introduced to stimulants by a nurse, who had supplied her with them during her confinement..." Other patients used laudanum or morphine injections to relieve the pains of a "fibro-cystic growth," menstruation and menopause. There were also less tangible female aliments-depression, insomnia, "neurasthenia," "restlessness and hysteria"--psychological and psychosomatic disorders which drove many women to narcotics and stimulants. Mood-altering drugs, first introduced by physicians and drugists for physical complaints, became habits for women in need of emotional release, especially in a culture where saloons and alcohol were male preserves. Women who "never knowingly would touch liquor would drink it and opiates as 'medicine'." Mr. E., a middle-aged women and an opium addict, insisted she had not taken any drugs for some time, and her physician concurred. Lett, however, found significant levels of morphine in her urine. Upon further questioning, Lett learned that Mrs. E. had been "taking a tonic prescribed by her physician which she found having a wounderfully soothing effect and which she took with great regularity.

The other significant group of addicts were physicians and "paramedicals." including druggists, nurses and close relatives of physicians. This group contributed over one-third(36%) of all non-alcoholic addicts, Nurses comprised almost one-fifth (18%) of female morphia addicts. As in the case of physicians, access to hypodermic syringes was considered responsible for the severity of the addiction--the drug first being taken for problems such as "rheumatism" and then perhaps maintained by "trouble and unpleasant domestic relations." As would be expected, druggists had the most exotic addictions. The retired druggist suffering from migraine headaches mentioned above took a combination of "Soda Bromide, caffeine citrate and antipyrine," six glasses of brandy daily, "at times a little chloral and morphia every other night." Lett's paraldehyde case was also a druggist, a young man who first became addicted to chloral "through insomnia [from] the disturbed sleep attendent to his business." He suffered four relapses--one which was caused by "the dominion elections... he gave both his clerks leave to go out and.. the strain [of his business] was too much for himů" Physicians were highly susceptible to drug addiction and have remained so. In a modern study conducted at Homewood of physician-patients admitted between 1960 and 1067 (n.=93), one quarter (26.9%) were diagnosed with drug addiction and a further thirty-percent with alcoholism. The authors concluded that addiction was "almost an occupational hazard for the medical profession." The narcotics addiction rate among physicians currently is thirty to one hundred times that of the general population.

There are no precise statistics on the number of physician-addicts in Ontarion in the nineteenth-century, although in every year between 1883 and 1890 a few physicians entered Ontario's asylums as patients. The one designated case of addiction at the London Asylum in the 1870's was that of a physician who had beome "manic from morphia abuse and the strain of a 'hard country practice'." At the Homewood Retreat, one third (33%) of male addicts were physicians, who had easy access to the new "miracle drug" and apparently had most need of its qualities as stimulant and supposed cure of opiate addiction.

In the nineteenth century, alcoholism and "morphinism in medical men" was a serious concern of and embarassment to the medical profession. When Dr. T.D. Crothers of Hartford published a statement at the turn of the century that ten to twenty percent of physicians were "intemperate in the use of alcohol and drugs," The American Journal of Insanity was quick to denounce the "extremist." However, J.B. Mattison had earlier observed that of three hundred addicts whom he had treated, 118 cases were physicians. Mattison did not believe the high rates were due to "frequent handling of morphia" bit to "non-fatal disorders," "neuralgia" and the "anxious hours, the weary days and the wakeful night." Mattison also blamed the "careless curiosity" of junior physicians who dabbled in self-experimentation, and the "too frequent use of morphia" in general practice. Physicians were also guilty of ignorance or unbelief as to the... snarefull power of morphia."

Because of ease of access to pure drugs, overwork and unwillingness to seek professional help, physicians had the most serious addictions and were considered the worst patients, as is the case today. They tended to leave treatment early and suffer frequent relapses. The average patient took between two and four grains of opium on admission, Physicians had much higher levels. Dr. G. and S. required fifteen grains of morphia per day to sustain them. Dr. G. had been "out of it once or twice but always went back to work almost the day he took his last dose, consequently [he] was soon into it again." Dr. W., twenty-six years old, who first took morphia for "bad teeth" at the age of fifteen, used seventy grains of morphia "and as much cocain every twenty-four hours." He arrived with ulcers from injections on his arms and legs "about 5-6 inches long by about 3 inches broad." One year after admission, Lett wrote, "after a long and patient struggle both for himself and his physician, he is at last fairly righted and is sustained by 1 1/8 grain every four hours taken by the mouth, the syringe having been abandoned about ten days ago..." W. left in "excellent" health but was re-admitted twice in the next five years. Dr. M. arrived addicted to 45 grains of morphia and 75 grains of cocaine per day. Reduction treatment was physiologically sucessfull, but man has no mind above the gratification of his own personal comfort... I was oblidged during the later stages especially to keep him under lock and key... he is sure to return to it again. No good results could be expected from a person with so low an order of intellect."

Addicts submitted to many different cures both before and after treatment at Homewood. The believed benefits of fresh air and a change in environment sent many "to the seaside" or to European tours. Patients made the "asylum circuit" to retreats in New York," Michigan and Massachussetts, and were treated with chloroform, bromides, tonics and other substances--none of which had satisfactory results, the most heroic course was abrupt withdrawal either at an institution or at home, One woman suffered from hysterical paralyses after such a course, while another went "almost blind" Cures were rarely final in the treatment of druga addiciton. fifteen percent of Homewood's patients entered more than once. One-quarter of relapses entered more than twice. Given that Homewood was often not the first of the last asylum entered, the true relapse rate certainly was much higher. In some cases, there were no serious attemps made to stay off the drugs, as with the physician with the "low order of intellect" or the barrister who got drunk "immediately on his leaving his Guelph quarters." In other cases, however, re-addiction

1 Isaac McQuesten was addicted to alcohol and opium (chlorodyne and/or paregoric)and other stimulants (possibly morphia) and was receiving treatment for mental illness at Homewood Sanitarium at Guelph, Ontario from Dr. Flett. He died suddenly on March 7, 1888 after declaring bankruptcy--likely of an overdose of a combination of drugs and alcohol. His letter to his brother Dr. Calvin Brooks McQuesten clearly states his addiction to "stimulants" and his on-going treatment with Dr. Flett. See W2511 and footnotes. The children even as babies were given paregoric and other opium drugs to calm them. Also when Ruby was suffering from Tuberculosis she was being treated regularly with Calomel, a mercury compound, that was used as a purgative, and that she dreaded. The whole family took Calomel as a purgative. Mercury is known to affect the brain and to cause dementia. This may have contributed to the mental illness in several members of the family, which they thought was inherited.

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