In The Name Of Temperance

[Today’s post is sponsored by a new subscriber, Joseph Mason, MSW, MD, of Charlottesville, VA. Welcome!]

In addition to the federal constitutional amendment prohibiting the manufacture, sale, and possession of intoxicating spirits in the 1920s, a number of states enacted their own supplementary statutes. Many of them were strange and counterproductive to the original intent.

Take that bastion of common sense, South Carolina, for example.

In 1892, prohibitionists in Columbia had won a non-binding referendum calling for a ban on alcohol. The legislature then had tried to find a happy-medium between free-flowing booze and an outright drought. It subsequently created what came to be known as the South Carolina Dispensary, a government-owned and operated monopoly on alcohol sales – similar to today’s ABC stores. The dispensary system operated for about twenty years before the prohibition movement gained enough steam to end sales of liquor in the state altogether, and finally throughout the nation.

But even after federal prohibition ended in the 1930s, South Carolina retained its earlier and very restrictive approach. It still banned alcohol sales in restaurants as recently as the early 1970s.

Anyway, as with most laws, there are loopholes – in this case, BYOB. The law in effect in South Carolina starting in the 1930s prevented restaurant sales of alcohol, but patrons could bring their own. This lasted until 1973, when the restaurant owners’ lobby told the legislature that patrons drank way too much (and became rowdy in the dining establishments) because no one wanted to carry home half-filled bottles. So start chugging! The legislature, in its infinite wisdom, accordingly allowed restaurants to sell alcohol by the drink at last – but only if strictly pre-ordained amounts of hooch were used.

A 2004 article in USA Today explained, “South Carolina is the only state that does not allow bartenders to pour drinks from regular-sized bottles of liquor. Instead, for every drink, the bartenders have to open a 1.7-ounce bottle of spirits like the ones served on airplanes.” You see, 1.7-ounces was the legislature’s strictly pre-ordained amount of booze. The rule, effectively, put a cap on the amount of liquor in each drink, since few bartenders were going to open a second mini-bottle in order to add more alcohol to a single drink at the same price, and few patrons were willing to pony up additional cash for a second bottle in the same drink.

But the law also put a de facto minimum on the amount of alcohol used per drink. As bartenders had to open a new bottle for every drink, they made sure to use all of it… I mean, why skimp on the rotgut if it’s otherwise going down the drain?

The net result was that mixed drinks in the Palmetto State were all made with 1.7 ounces of firewater, or a multiple of that. Not more, not less. Critics of this foolishness pointed out that the drinks served in all other states almost always contained less than 1.7 ounces of the good stuff. In effect, South Carolina’s restrictions on free-flowing alcohol resulted in more tipple per drink, earning the state the reputation of having the strongest highballs in the nation… all in the name of temperance.

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[Copyright 2013 @ The Alienist’s Compendium]

Blowing Smoke

[Today’s post is sponsored by Sergei Chernikov, PhD, of Apex, NC. As a fellow employee of state government, I know that the (not so subtle) similitude of our shared bureaucratic experiences will not escape him]

Native Americans were known by early explorers to use tobacco in a variety of ways, including to treat medical ailments. European doctors quickly picked up on this – recall that tobacco was an exotic product at the time – and began to prescribe the noxious weed to treat everything from headaches to cancer, hernias to emphysema, and abdominal cramps to typhoid and cholera (all without much or any supporting empirical evidence).

For reasons lost to history, and though it was likely in practice earlier, a Dr Richard Mead in London first suggested in writing in 1745 that administering tobacco per anum was an effective way to resuscitate near-drowning victims.

Yes, you read correctly. Tobacco. Per Anum. Drowning.

This is how it worked in theory: upon pulling an unconscious victim from the water, a rubber tube was to be inserted in the rectum. The tube was to be connected to a fumigator/ bellows which compressed air and forced smoke into the colon. Sometimes a more direct route to the lungs could be substituted by forcing smoke into the nose and mouth, but most physicians of the period felt that the rectal approach was more effective. The nicotine in the tobacco was thought to stimulate the heart to beat stronger and faster, thus encouraging respiration. The smoke was also thought to warm the victim and dry out the person’s insides, removing excessive moisture from those waterlogged and near death.

from a medical textbook of 1776

from a medical textbook of 1776

[sidebar: this method was not recommended for the geriatric population, as it was believed that tobacco per anum dessicated the humours, made the brain sooty, and only exacerbated dryness in old people who were dried up anyway – I’m not making this up]

One of the earliest documented references to employing this treatment for resuscitation comes to us from the year following Dr Mead’s publication. In 1746, a man in Amsterdam pulled his unconscious wife from a canal. The absence of bellows notwithstanding, a passing sailor suggested that emergency tobacco administration might revive her, at which point the husband took his pipe filled with burning tobacco, shoved the stem into his wife, and blew hard. As one can imagine, hot embers of tobacco being blown up her rectum had the intended effect and she was, indeed, revived.

In the later 18th century, it was not uncommon to see bellows hung alongside major waterways, such as the Thames – much as we have defibrillators in public venues today – in case someone was found in the water and could be ‘saved’ by a timely tobacco intervention.

don't attempt this at home

don’t attempt this at home

In 1811, an English medical writer noted that “[t]he powers of the tobacco enema are so remarkable, that they have [captured] the attention of practitioners in a remarkable manner; of the effects and the method of [administering] the smoke of tobacco per anum, much has been written”; he then provided a long list of (peer reviewed?) European publications on the subject.

Eventually, artificial respiration was recommended by some practitioners for near-drowning victims… but only if the tobacco method didn’t work first.

By the second quarter of the 19th century, though, as medical science progressed, the practice of blowing smoke up someone’s rear finally became a thing of the past.

Figuratively, however, the practice remains alive and well.

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[Copyright 2013 @ The Alienist’s Compendium]

An Unusual Last Request

[Today’s post is sponsored by my dear friend and medical school colleague, David Harrison MD, of Salem, OR. It was good to visit with him this weekend, and as he enjoys these odd posts, hopefully he’ll like this one too]

On 19 September 1973, country-rock music legend Gram Parsons died in a California motel room of an overdose of morphine and tequila. A seminal figure whose work influenced everyone from the Rolling Stones to the Byrds, he had made a half-joking (?) drunken pact with his manager several months before his demise: if anything happened to either one of them, the survivor was to take the deceased to Joshua Tree National Park and cremate the remains.

Accordingly, Parsons’ manager, Phil Kaufman, grabbed a roadie named Michael Martin and commandeered Martin’s girlfriend’s old hearse – which had broken windows and no license plates – and headed to LAX, convincing the authorities that they were authorized to pick up Parsons’ remains (which were slated to be flown to Louisiana and buried there per his family’s wishes). Coffin onboard, the two men drove 200 miles through the Mojave Desert, stopping to get several containers filled with gasoline en route. Once at the national park, at the foot of majestic Cap Rock, they hauled the corpse out of the coffin in the back of the hearse, doused it with petrol, and lit the match.

Kaufman and Martin were arrested, but since burning stolen bodies was not actually a crime in California at the time (!!) they were instead fined $300 each, plus $750 for the coffin, which was somehow ruined during the trip. The twosome raised the money for the fines by holding a charity concert starring Bobby Pickett & the Cryptkeepers, who played their one-hit “Monster Mash” over and over to the enthralled crowd. And Parsons’ charred remains eventually wound up in New Orleans anyway.

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[Copyright 2013 @ The Alienist’s Compendium]

Six Degrees of Freud

Most people have heard of the parlor game called ‘Six Degrees of Kevin Bacon.’ It is a tongue-in-cheek morph on the concept of ‘six degrees of separation.’ Regarding the latter, it has been opined that any two people on Earth are six or fewer acquaintance-links apart. Kevin Bacon, the prolific character actor, then became the focus when movie buffs started to challenge one another to find the shortest path between a seemingly unrelated Tinseltown personality and Bacon. The game rests on the assumption that Bacon has been in so many different movies involving such a vast number of fellow thespians, producers, and directors that anyone in Hollywood is six or fewer films distant from him.

Example involving Actor X: “Actor X was in Movie A with Actor Y. Actor Y was then in Movie B with Actor Z. Actor Z appeared in Movie C with Actress Q. And Actress Q filmed Movie D with Kevin Bacon.”

See? Only four degrees of separation there. And the fewer degrees that can be shown, the more likely it is that the player will win the round and someone else will buy the drinks.

[sidebar: Kevin Bacon was reportedly so amused by this that he started a charitable foundation that he named]

Anyway, I was thinking back to my own career and remembering one of my learned former professors – JB – at the University of Virginia. Dr B was an esteemed and (to new residents) inscrutable presence in the psychiatric department. A man of short stature who spoke with the hint of a central European accent, he still then wore a long white coat after such had gone out of practice in most mental health circles. His usual modus was to peer silently from under huge Brezhnevian eyebrows at the dynamics of group therapies, saying little until, like the Sphinx awakening, he would utter a pearl of wisdom as everyone looked his way in awe.

JB was a bit of a mystery, as he never talked about himself with students and residents. Forced to escape his homeland when it was overrun by the Nazis, reliable sources said that after medical school in the UK, JB served as a medical officer in the Royal Army/ UN forces in Korea. It was in that setting that he first encountered POWs who had been subjected to extreme conditioning propaganda by their North Korean captors – what the rest of the world calls ‘brainwashing.’ JB apparently became interested in the psychological sequelae of such trauma. After his military service, he decided to return to residency and become a psychiatrist to pursue these interests. And later he came to the United States and settled into academia.

And that’s where it gets curious, because during his subspecialty training in London following his discharge from the army, JB was intensively supervised by arguably the preeminent psychoanalyst of that era – none other than Anna Freud, the sixth and last child of Sigmund Freud.

That means that I am only three degrees of separation from Sigmund himself, and a mere two from Anna.

For one in the mental health profession, this is heady stuff indeed. And it is far more compelling than any round of drinks won by connecting with Kevin Bacon!

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at]

[Copyright 2013 @ The Alienist’s Compendium]

Emperor Norton

Joshua Abraham Norton was born in 1818 in England, and when he was a toddler his family emigrated to South Africa, where his father owned and operated a successful ships’ chandlery. Unfortunately for Norton, his parents died when their only son was just in his 20s, leaving the younger Norton alone in the world but with an inheritance of $40,000 (a fortune at the time). As Norton was the type who craved adventure, he eventually decided to head to California for the Gold Rush.

By the early 1850s, a few years after arriving, Norton’s businesses – a warehouse, a ship, a cigar factory, a mill, and an office building – had increased his wealth to over $250,000 (about $6.5M today). However, he bet badly on rice futures and lost a ton of cash. By 1859, Norton was living in a working-class boarding house and living hand-to-mouth.

So Norton did what any other entrepreneurial person would do. He reinvented himself. With the Civil War looming, the Gold Rush flagging, and perceived graft and corruption all around, Norton told his friends that things would be far better if he were in charge.

Accordingly, on 17 September 1859, an unusual ad was published in the San Francisco Bulletin:

“At the pre-emptory request of a large majority of the citizens of these United States, I Joshua Norton, formerly of Algoa Bay, Cape of Good Hope, and now for the last nine years and ten months past of San Francisco, California, declare and proclaim myself the Emperor of These United States, and in virtue of the authority thereby in me vested do hereby order and direct the representatives of the different States of the Union to assemble in Musical Hall of this city, on the 1st day of February next, then and there to make such alterations in the existing laws of the Union as may ameliorate the evils under which the country is laboring, and thereby cause confidence to exist, both at home and abroad, in our stability and integrity.”

It would have been easy to disregard this as the ravings of a lunatic, but the Bulletin continued to publish his demands and edicts. The self-styled Norton I called for the abolishment of the Supreme Court. He put Congress on notice. He fired Virginia Governor Henry A. Wise for sending John Brown of Harper’s Ferry fame to the gallows without permission; as he couldn’t leave Virginia without a Governor, though, Norton replaced – through a notice in the paper – ‘former’ Governor Wise with John Breckinridge of Kentucky, who was actually then the Vice President of the United States.

In 1860, Congress convened against Emperor Norton I’s apparent wishes. In retaliation, he ordered the “General in Chief of the Armies… to clear the halls of [the legislature in Washington].” Then he decided to just abolish Congress and political parties altogether, and in their places institute an absolute monarchy. These proclamations were, as before, carried as news by the Bulletin.

As a ruler with no troops or money to back his decrees, the Emperor had no real power to fire governors, or dismantle Congress and the Supreme Court. However, he did gain power of sorts. Norton I quickly became a legend and was extremely popular among the people of San Francisco. Politicians were forced to humor him, because to show him disrespect was to lose votes.

Some examples of his ‘power’ include:

1. He was arrested once, not for advocating the overthrow of the government, but for vagrancy. There was such a hue and cry from the public and the media that he was released, charges were dropped, and the Chief of Police issued a formal apology.

2. After the vagrancy charges were dropped, the Chief also instructed his patrol officers to salute the Emperor when they passed him on the streets of San Francisco.

3. His rent at the boarding house never increased from fifty cents per night.

4. Shopkeepers gave him clothes so that they could then put signs in their windows that read, “Outfitters to His Imperial Majesty Norton I.”

5. He was given passes to ride free on all public transportation in San Francisco and, later, the entire state of California.

6. He rec’d free meals from many restaurants. free opera tickets, and passes to theatrical productions (he accepted box seats only).

7. When he needed some pocket change, he went to various businesses to collect the ‘tax’ that was due to him, and fans would always hand over some coins. At other times, he printed his own paper money, which was honored at most local retail establishments (or which he traded to enthusiastic souvenir-seekers for actual U.S. currency).

8. Dolls were made in his likeness and sold in shops throughout San Francisco.

9. It is even reported that he prevented a gang of ruffians from robbing a Chinese laborer whom they accosted on the street; Norton I stood before them and recited the Lord’s Prayer, making them sulk away in shame.

He became a local, and arguably a national, hero and mascot.

Unfortunately, after 21 years ruling these United States and later extending, by newspaper proclamation, his protection to Mexico, on a sad day in January 1880, the Emperor suddenly fell to the sidewalk during his evening walk. He died before he could be taken to the hospital. The Pacific Club of San Francisco raised funds for a rosewood casket and other funeral expenses, as Norton I died nearly penniless, having chosen to never overtax his subjects.

More than 10,000 people paid their respects, with some newspapers later claiming that as many as 30,000 people, or 13% of the population of San Francisco, had lined the streets. The funeral procession wound its way several miles from city hall to the grave site, and newspapers across the country reported the death of the Emperor. One newspaper, the Alta Californian, even dedicated 34 inches of print to a celebration of the life of Norton I. On the same day, that paper printed just 38 words from the inaugural speech of the new Governor of California.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at]

[Copyright 2013 @ The Alienist’s Compendium]

A Case Of (Geographic) Mistaken Identity

My son was visiting from college this week past; reminiscing with him about years past always brings back memories of West Virginia and why his birth certificate lists the Mountain State as his point of entry.

You see, in the autumn of 1991, I was preparing to finish my psychiatric residency at the University of Virginia. Accordingly, I had started to interview for post-residency positions. I went to several interviews – DC, Richmond, and Frederick all come to mind – but nothing really ‘grabbed’ me.

One day, I passed my faculty advisor in the hall of the psychiatric hospital, and after exchanging pleasantries, he asked how the search for employment was proceeding.

“Not too good,” I replied. “I’ve been on several interview trips, but I’m really lukewarm about what I’ve seen so far.”

He then mentioned that he had a good friend from his own days in residency who was actively recruiting for a psychiatrist “to join his practice in Charleston.”

Having spent vacation time at Kiawah Island as a resident, I jumped at this news.

“That’s great! I’d love to talk to your friend about his opening! And I love South Carolina!” I had sudden visions of palmettos, the beach, beautiful old homes, and balmy weather.

“Well, actually I meant West Virginia.”

[sidebar: our department chairman at that time was from West Virginia University, and when he had accepted the position as chair in Charlottesville, he had brought with him a number of his junior faculty. The attending to whom I was speaking was one of these transplants, and no sooner had I uttered “And I love South Carolina!” than I realized my faux pas]

Embarrassed, I didn’t want to then say, “West Virginia?!? Are you out of your mind?!? I wouldn’t be caught dead in that rural Appalachian backwater.” Though that’s how I felt.

Two weeks later, still embarrassed, I was driving to West Virginia for the job interview. Enticed by a good salary, the ticking clock, and a lack of viable alternatives, I accepted.

And my son was born there 18 months later.

Lesson to self: be careful of (geographic) mistaken identity. And if you do make the mistake, correct it as quickly as possible, and run.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at]

[Copyright 2013 @ The Alienist’s Compendium]