The story of addiction treatment in the late 19th and early 20th centuries is a fascinating story of a battle between medical dogmatism, pragmatism, and profiteering.
One of the most interesting aspects of the study of early addiction treatment is seeing that so many concepts which are believed to have been originated by AA and the modern disease theory were actually fully developed by the end of the 19th century. Another is that the battle between those who promote pharmaceutical treatments for addiction and those who promote spiritual solutions also dates back to the 19th century.
The story of addiction treatment in the late 19th and early 20th centuries is a fascinating story of a battle between medical dogmatism, pragmatism, and profiteering. Orthodox medicine of the 19th century promoted the dogma that the only possible treatment for alcoholism or other addictions was confinement in inebriate asylums for years at a time, where inmates could be remade through moral therapy. The inebriate asylum movement got its start in the mid-19th century with the founding of the Binghamton, New York Inebriate Asylum (opened 1864) and the Washingtonian Home in Boston (opened 1857). The inebriate asylum movement, led by orthodox doctors specializing in mental disease, held that pharmaceutical treatments for inebriety were an impossibility and that inebriates could only be treated by moral means such as work and religion. Their stance was that pharmaceuticals were only to be used during detoxification, and sparingly even then.
Then, in 1886, a Russian doctor named Nikolai M. Popoff published an article stating that when alcoholics were given injections of strychnine nitrate, they spontaneously stopped drinking in two to three days. The use of strychnine as a medicine may sound strange to 21st century ears; however, strychnine was an extremely commonly used medicine in the 19th century, one of its most common uses was as a cardiac stimulant.
An English-language summary of Popoff’s article was published in the May 1, 1886 issue of the British Medical Journal, and this summary was reprinted in countless English-language medical journals. Numerous other Russian doctors replicated Popoff’s experimental treatment, and these were also translated and published in many English-language medical journals. However, the Quarterly Journal of Inebriety, America’s only specialty addiction treatment journal during this era, pointedly ignored the Russian discovery and did not print a single word about it.
However, a railroad surgeon and patent medicine salesman named Leslie E. Keeley, who lived in the dusty little prairie town of Dwight, Illinois, heard about the Russian cure, and decided to give it a try. Keeley had already been selling a patent medicine which he called the Double Chloride of Gold Cure for alcoholism since 1880. The main ingredient in Keeley’s Gold Cure appears to have been tincture of red cinchona, and it is questionable how efficacious it was. It contained no gold. But when Keeley added the strychnine injections to his treatment regimen in 1886, he found that he had a miracle cure on his hands. Keeley found that calling his treatment the Gold Cure was a great marketing strategy, so he retained the name, although the treatment still contained no gold.
Keeley, of course, never gave any credit to the Russians for the discovery of the cure. Instead, Keeley marketed the cure as a secret formula which he had discovered through years of painstaking research and experimentation. It was a motif which Americans ate up: the simple country doctor who solved a medical problem which had baffled the great and learned doctors on the east coast. The stories of Thomas Edison and the Wright brothers are examples of this same motif.
At first, the news of Keeley’s miraculous Gold Cure spread by word of mouth, then, in February of 1891, Joseph Medill, editor of the Chicago Tribune, published an endorsement of the Keeley Cure in his newspaper, giving it national publicity. Medill had initially been skeptical of the Keeley Cure; therefore, he had sent several of the worst drunkards in Chicago to Dwight for treatment in order to test the efficacy of the cure. All had returned to Chicago unable to drink whiskey. The floodgates broke, and by the end of 1891, Keeley was treating nearly 1,000 patients a day at Dwight. Subsequently, 126 Keeley Institutes opened worldwide, and at least 300 imitators popped up, running institutes which claimed to offer a gold cure which was as good as or better than Keeley’s. By the time the Keeley Institute closed in 1966, half a million people had taken the Keeley Cure.
The members of the inebriate asylum movement hated the Keeley Cure. The inebriate asylum movement had never been a success, only a few were ever opened. Moreover, their cure rate was only about 20% to 30%. Dr. Keeley bragged that his success rate was 95%. Although Keeley was clearly exaggerating, it is quite clear that those who completed a 28-day course of injections at a Keeley Institute were unable to drink whiskey when they left the institute, although some made an effort to overcome their aversion and eventually resumed their drinking careers. Many others used the initial treatment as a springboard to permanent abstinence from alcohol. Keeley graduates also banded together to form a mutual support group called the Keeley League, which had over 30,000 members at the height of its popularity. The members of the inebriate asylum movement mounted vicious attacks on the Keeley Cure in medical journals and the popular press; these attacks were, however, filled with specious arguments and logical fallacies. Rather than engage in debate, Dr. Keeley simply ignored them and laughed all the way to the bank.
The Keeley Institutes began encountering some stiff competition when the Neal Institutes were opened in 1909. The Neal Institutes offered an early form of conditioned taste aversion therapy which paired an emetic with a drink of whiskey, causing the person to immediately vomit up the whiskey. Although vomiting when intoxicated does not create an aversion, vomiting while sober does. Later research at the Shadel Sanitarium in Seattle Washington in the 1940s would produce statistics which proved that this form of aversion therapy was highly effective for alcoholics. However, Dr. Benjamin Neal and the Neal institutes were satisfied in finding the treatment highly profitable. Whereas the Keeley Treatment took 28 days and required hypodermic injections four times a day, the Neal Treatment only took three days, and no injections were used. About 80 Neal Institutes were opened worldwide.
Treatment demand fell precipitously around the time the US became involved in World War One (1917 – 1918), and most of the proprietary cure institutes had closed by the advent of national alcohol prohibition in 1920, although a few managed to survive. After the repeal of prohibition in 1933, many new proprietary treatment facilities such as the Samaritan Institutions and the HALCO institutes sprung up; however, these new institutes all relied on aversion therapy with emetics, which was simpler and faster than the strychnine cure. The Gold Cure was available in only a few surviving Keeley Institutes and by the late 1940s, the Keeley Institute in Dwight had abandoned the Gold Cure in favor of 12-step treatment.
When I began researching the early proprietary cure institutes of the late 19th and early 20th centuries, I found that there were no detailed accounts of their history in existence. Most articles written about them had simply and uncritically repeated the diatribes attacking these institutes which had been published in the medical journals of the late 19th and early 20th centuries. Therefore, I felt compelled to write a detailed history of these immensely popular treatments. This required going back to primary sources, i.e., the newspaper stories, medical journals, pamphlets, etc. published during this era. A fascinating and previously untold story emerged which I have published in two books, Strychnine and Gold (Part 1) and Strychnine and Gold (Part 2). Each is over 400 pages in length, and they are available at Amazon.