Archive note: This continuous medical-session recording includes Bill W. followed by medical professionals Dr. Nelson Bradley and Dr. I. J. Brightman. Their addresses are also available separately in the 1960 convention collection. This is a combined edition of existing performances. Bill W.; Dr. Bradley; Dr. Brightman.
Audio
Transcript
Source: Unidentified Historical Recording – Bill W Candidate Identity Review BW0205 – Date Unknown.mp3 File: bill-w-aa-hospital-work-bill-w-and-medical-professionals-aa-1960-archive-19120.mp3 Duration: 00:57:40
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Thank you, sister, for bringing us this story of the beginning of AA hospitalization in your community. You remember she spoke of Dr. Bob's New England accent, and one of the strange ways which God works is that he selected two men from Vermont to found our group. The governor of Vermont, taking notice of this, has declared a national or a statewide celebration. Now, whether this is to celebrate the founding of AA or the departure from Vermont of our founders, no one is quite sure, but in any event, one of them is here and would like to respond very briefly now, because he has to go on to Sister Ignatius' talk.
We all know that AA is a quest for sobriety, therefore it is a quest for freedom. We all know that there is no freedom except as we banish the blocks of fear and pride of all of their consequences. And then a wider freedom in all of our affairs puts in its appearance. We make ourselves worthy under God's grace. Now then, for such a pursuit, we obviously need high ideals and high examples of those ideas, people who demonstrate in their own lives true greatness of spirit and greatness of action.
You have heard and seen, and have no doubt felt through the language of the heart which Sister has spoken, that we are in the presence of not only one of our greatest benefactors, but in the presence of a person who is to test our greatness of spirit and the greatness of action that seldom will any of us achieve. I'm going to talk more about Sister tonight, but I wanted to say this much because it will bear repeating over and over.
And this effecting resurrection of the memories of our pioneering times stirs me beyond description as I see it has you, I'm sure. There were others in this hospital field, and you have heard the son of one of them who carries on the tradition of his father. I came in just as Ed finished. I regret that I didn't hear it all. The drunk even in the hospital clearly needs something more than physical treatment.
He needs those around him who understand, who minister not only drugs, but confidence and greatness in action and spirit. Ed was such a one, is such a one, and so is his father. And I might remind you, if I forget it tonight, that it was Ed's father, in a very early and uncertain time of this society indeed, who invited us back to visit patients in his hospital. And when the proposal for the book Alcoholics came along, and no money was to be seen, he put it on the line.
And the day we took the garbled manuscript of the printer at Cornwall and checked into a hotel and ran up a bill, I had to go back to New York and ask Ed's father for enough dough to get us out of the hotel. This is going quite a ways beyond just hospitalizing drunks.
[00:05:07]
So we have with us this pioneer, Ed's father, and the succession in Ed, and there was also another man, my doctor, Dr. Tiltworth. God knows how this man was possessed of greatness in spirit and action. As somebody once aptly titled a grapevine's face, this was the little doctor who loved drunks, and he loved them so much that for a long season his life was a failure measured in any ordinary terms. They never claimed in the early days to cure drunks up at Ed Pound's place, and there Dr.
Tiltworth resided, and now and then one would get it, and always the little man came along to each case as though it were a fresh opportunity. And I think in his lifetime pre-AA, he had ministered in all his eagerness and dedication to some 20,000 drunks, all or nearly all, who proceeded to succumb. And he, with them and their relatives, had to walk the last mile. This is the kind of dedication, greatness in spirit and action.
And then after AA, more recovery, and before Dr. Tiltworth passed on to his reward, he and our nurse, A. Nurse Teddy, down there had processed something like 10,000 with a good batting average. So these were the first examples of hospital facilities, plus people of goodwill, that were offered to us. And the speakers to follow are here because they are men who want to carry on in that tradition of the pioneers, and I thank God for their interest.
For there is no singular, there is no single thing that AA needs beyond improved communication with the millions who don't yet know, than it is appropriate hospitalization. Anything which is used steep, if it is to be effective, goes far beyond just medication. What rising young doctor cares to medicate some drunks to sober them up so that the butcher, the banker, and the plumber comes in to sober them up permanently?
This is not a career. But some doctors are dedicated to this sort of thing nevertheless, and more are becoming dedicated, and others are looking into our minds to see where the hidden springs are broken, and others are looking into test tubes to see what ails us physically. For all these folks, God bless them all. I am so happy to be here to say, even for a minute, the things that are in all of our hearts.
And I regret that I'm hedge-hopping to the next meeting. See you. We have heard a discussion of a program for alcoholics in a proprietary hospital, as Colonel Towns has described. We've heard Sister Ignatius speak of the work in a voluntary, what we call a church-related hospital. There's also work being done in governmental agencies. Our next speaker, Dr. Bradley, is listed in our program as being connected with the Lutheran
[00:10:03]
General Hospital in Des Plaines, a suburb of Chicago, which is true. This is a position to which he's recently come. He's going to talk to us out of his experience of having worked with a Minnesota state hospital in therapy programs for alcoholics. Dr. Bradley. I'd like to start by stating on what a privilege I felt it was to be invited to speak on this auspicious occasion. I didn't realize that I would be on the same platform with so many auspicious people.
I like to think of myself as an old-timer. I've been collaborating intimately with AA for some twelve years now, but listening to Colonel Towns and Sister and Bill, I feel very young. Numerically, I can almost compete with them. We have put through about 12,000 alcoholics, a little over 12,000, in the ten years at Willmar. I want to disagree with the Colonel, in spite of his experience and background.
I hope we are on the threshold of being able to treat alcoholics in any kind of hospital. Modern mental hospitals, the hospital I left, was 1,400 patients and just two wards away from being a completely open hospital, which is more than you can say for most general hospitals. Usually maternity and some of these wards are closed. I am on the start of a new career in a very ambitious new hospital. The reason to be for this hospital is that we are somewhat concerned in the treatment of all illness, that we treat patients too much as numbers or entities in diagnosis.
We are calling our approach, for the want of a better name, the ecological approach to illness, and we hope to join all the medical resources with the psychiatric and with the spiritual in treating the total man. And I think it is real significant that I was pulled out of Minnesota to this place because of my experience with alcoholics, and certainly here is a person whose whole life needs treatment, not just his physical disability.
I was assigned the topic of what has AA contributed to institution. I am going to dismiss our program. American Medical Association, American Hospital Association, American Psychiatric Association, we have all officially stated that alcoholism is a disease and alcoholics are sick people. We still have a long way to go. As a matter of fact, I honor those institutions and those doctors who do not treat alcoholics, who still consider them bums, as much as I do those who treat them because we still are doing so poorly in general in the management of this illness.
There is absolutely no excuse today for not treating a drunk in any type of medical facility, and a well-run alcohol ward should, by choice, be the quietest ward on any hospital. The institution or the physician who says he can't handle alcoholics is now just admitting his ignorance in this area. What has AA contributed to institutions? I would say that quite to the fact that I have worked with some 12,000 alcoholics now, the bulk of what I understand in the field of alcoholism and the alcoholics I have learned from members of AA.
I have intimately known.
[00:15:00]
That's a large number of AA, but I've known a great number of them, and some of them have been close, my closest friend, for the last 12 years. This isn't always an advantage, I can tell you. It's very flattering for me, professionally, to be considered a member of AA. It has cost me a good number of eyeballs in my day. And I know I have been overlooked in certain parties, in certain circles, not maliciously, but just because I couldn't drink.
It's not true. What we forget, and which is still extremely pertinent, is the greatest, the first, not the greatest, contribution that AA has made to institutional care of alcoholics is to make obvious what was obviously not possible, the fact that alcoholics are treatable. It's when we start having the town drunks, making, as the sister said, like respectable citizens, that this was a great challenge to people and institutions, that these people were not untreatable, that they were definitely treatable.
Does this tenement still hold? There are many times that, and I wish that the depth of my feelings towards alcoholism, alcoholic alcoholism, would be only as deep as the sisters, and I could have said, my dear, or oh my dear, was that right? I sometimes felt more strongly than that. But quite often you were talking to a guy who had been just as incorrigible as the person who you were thoroughly disgusted with at the time.
This living example of the possibilities of treatment is a great responsibility, and one that you must continue to sustain, that alcoholics are treatable. AA has been said that the great contribution that AA has made to medicine, psychiatry particularly, is that it's a great experiment in group therapy, and that it most certainly is. With our AA meeting, it is a great experiment in group therapy, but not particularly by our modern understanding of the mechanics of the group phenomena, and we know a great deal about this now, professionally.
AA rates very poorly. As a matter of fact, in Willmar, we experimented, did a very serious scientific experiment on group therapy, where one of the groups was a general discussion, and we had made it an AA meeting. We had analytically orientated groups. We had two-factor learning groups, and we had client-centered groups, and we tape-recorded all these sessions and did factor analysis of them. And as we predicted, the AA type of group therapy was the least effective of all our groups.
There are a lot of lousy AA meetings, as far as being exquisitely accurate and effective in encouraging this real treatment phenomena in group interaction. It is a great experiment in group therapy, and it's still the backbone of AA, but it's not as good as some scientifically run group therapy. Another thing we said about AA is that you must take the drunk to help a drunk. But the great advantage of AA is that this is a group of people who really know the drunk.
The drunk can't fool them, because most of the tricks they thought of themselves. And this is true. It makes the AA member a very effective tool in contacting a drunk. There are lots of physicians now, and I include myself. I've got two or three psychologists on my staff.
[00:20:03]
Dr. Fox, Dr. Teedboo. Heavens, we've forgotten more about alcoholism and alcoholics than most AA's will ever know. Now, and it's a great help to us. People like Dr. Teedboo and I have been very effective because of their great experience and great knowledge. So that it takes a drunk to understand a drunk is extremely significant. It isn't the whole reason for the effectiveness of AA. Another very pertinent defective over Wilmer.
They had been admitted to the hospital. They had no program. They had a lot of lousy rules. It was not a criticism. They were very able people running that hospital, but they were run that way, and they knew not what else to do. And so what do we do in taking over a place like that? I had already been associated with some top drawer AA men for several years before I went there. Is that we just went to AA and borrowed their entire program.
And we made that our treatment program at Wilmer. And it's a great respect I have for AA. We've modified it considerably. And we've kept a core there of four AA counselors. We've done a tremendous and I think also be considered among the real pioneers in this movement. We have a well-organized state organization. 236 official contact men. The groups are booked for months in advance to come twice a week.
We run about five evenings a week that were AA orientated. But if you start talking about the organization of AA, brother, you're stepping on shaky ground. If there ever was a group that was poorly organized, it's AA. Heavens, you send a patient to one group and they say, we don't want no part of it. You've got to be ready. He's got to come to us. We don't want you interfering. And then we don't send an alcoholic to the next group and say, what the heck?
How can we help you if you don't let us know he's coming, if you don't bring us down? This has been so serious that there have been state programs built around AA organization and they've fallen flat on their face because they were so poorly organized. Now it's still fabulous. And I've said many occasions that it is ridiculous to conceive an institution program or a state program without a close liaison with AA and without making AA the predominant factor in any program, whether it's private or state or outpatient clinics or what have you.
But certainly the autonomy of each AA group doesn't make them an easy organization to cooperate with. I would count among the richest experiences in my life the many hundreds of hours I have spent with AA, either as individuals in their home or mine or in meetings or seminars. And it's always a tremendous inspiration to me. There's one thing I have never enjoyed about AA, and this is their medical lore.
I'm not against the allergy series, except I am when it's expounded by a member of AA. And the drugs and the vitamins and the this and the that. And this has not been a great contribution of AA to the institution, as your knowledge of the pathology and upset physiology and the upset psychology that occurs in alcoholics. The most significant thing early in the game that intrigued me about AA was the first step.
They had to be ready, and we still follow this tenet with modifications, as I've said. We jumped from 8% volunteer admission in our hospital because of the first step and because of the dogmatic statement that an alcoholic must be ready, up to 82% of our patients were volunteers.
[00:25:01]
And after following these people up, we found out the volunteers didn't do any better than the legally committed. So now we're down to 50-50, and we just assume they come in committed as volunteers. This is a national experience, and I think a great credit to those institutions that are working with alcoholics. It means that your program is working. It doesn't matter much what their attitude is when they come to a good program.
But there's much more depth to the first step than they have to be ready. Admitting that I am powerless over alcohol. Now this, I think, is the big difference between a professional behavior pathologist, a psychiatrist, or psychologist, who, and there are many now, who can effectively work with alcoholics, and there are many more who can effectively not work with alcoholics, is that those people who do succeed treat the alcohol addiction rather than the basic problems underneath.
Dr. Colonel Towns doesn't think that alcoholics are crazy, but we again did a research. As a matter of fact, a very extensive research in Wilmer took us four years, and we found them nuttier than a fruitcake. If we classify, psychiatrically speaking, the alcoholic, and we had to force a little into our psychiatric entities, about 70% of them fall into the more serious psychiatric diagnosis. Now there's more to this story than that.
If we took the Lions Club, we would find the Chamber of Commerce very much the same. For an alcoholic to deny that there isn't a basic psychological defect, of course, is quite foolish. But to treat this primarily is equally foolish. Once you get to know AA and alcoholics, you'd like to drop this alcohol and make the first step. Just admit that my life is unmanageable. Then it takes on, me, real serious and soul-searching connotations.
This admitting, this has been the most gracious thing that a decrepit, drunk, physically sick, behaviorally sick, cold-blooded, tattered, no job, no family, and this desperate denial and this desperate effort that he makes to deny that his life is unmanageable. This is still, even the modern treatment of alcoholism, the basic problem. To get this person who it is painfully obvious, I imagine even to that horse, that this life is unmanageable, and to get them to admit it.
And once they admit it, you're on the way. To this, I, this concept that I now apply to all types of behavior problem, I am extremely indebted to the many hours that these shrewd people in AA spent with me trying to get across this idea to me. I am extremely indebted to Dr. Jelnik and his surrender, or his collapse of the alibi system, and to Dr. Tidbu, who went much deeper into this complete surrender phenomenon.
These are extremely significant statements, and I hope that it's the basis of practice in our new hospital in Test Plains. This admitting that you're nothing, that you're just a physical shell, or an intellectual shell, or an emotional shell, absolutely nothing, until you can turn your life over, your life and your will, over to a power greater than yourself. This is the real impact of AA on institutions.
Medical institutions, or institutions such as the science of medicine and the science of psychology, or hospital administration. This surrender phenomenon, this admission of our absolute nothingness, and our absolute omnipotence, if we are willing to turn our life and our will.
[00:30:00]
over to a power greater than itself. Now, we've done work on this, too, done a lot of research at Wilmer. I've studied my colleagues. I would love to have met Dr. Silkworth. He evidently was not a practicing churchman, let's say. I am absolutely sure from the number of professionals that I have studied who are either very effective or very ineffective in working with alcoholics that here we had a deeply spiritual man.
Without any exception so far in my observation, I have noticed that those professionals who can work with alcoholics are those who are comfortable in the spiritual area. There ever was a group of people who are not in a position to ask the question, and it was asked, it's AA, are not in a position to ask the question, Lord, when saw we thee hungered and fed thee, or thirsty and gave thee drink? When saw we thee alone and a stranger and took thee in?
When saw we thee naked and clothed thee? When saw we thee sick and in jail and in prison and visited thee? If you really believe the first step and the third step, this organization, twenty-five years old, now I guess the estimate is about 250,000, this is magnificent. If we compared it to other movements, we should be impressed with the strength and the accomplishments of AA in twenty-five years. We should even be impressed with the inroads we've made on the other disciplines in public education.
But if you really believe the first step and the third step, I'm sure that Dr. Bob and Bill are not the least bit more able or more effective than any one of the 250,000 of you. And if we really believe in these twelve steps, we shouldn't be talking about 250,000, we should be talking about two or three million. And this is the real impact of AA on institutions. Your medical lore, your experiments in group therapy, your organization, these are all wonderful, fabulous.
But I call them the tricks of AA. The real essence of AA and the real impact you have and continue to have on the professional organizations is that you really and should really put into action that you are your brother's keeper. Thank you. Thank you, Dr. Bradley. Our final speaker represents another very important group in medicine, the public health field. Dr. I.J. Brightman is Assistant Commissioner for Chronic Disease Services of the New York State Department of Health.
He will speak from the viewpoint of AA relationships with the public health programs of our states and communities. Dr. Brightman. Mr. Chairman, fellow speakers, and you stalwarts who have the courage to stay to the end of a meeting of this nature, you can't all be last speakers following me. I would like to be very kind to you and say I'm going to reduce my remarks for about five minutes, but I can't really, because after all, you have paid my expenses out here from Albany to New York, and I simply have to give you something to account for this.
The chairman has to account for it, and if I ever return to my own family after four days away for part of a holiday and attend this meeting and say I never got a chance to give it, this would be unexplainable. And then, of course, what my secretary would say after typing up this speech about two weeks ago, which was never given, so you'll have to bear with me a little bit, and I will be kind and only read certain parts and ad lib where ad libbing can save some time.
And of course, some of this has been covered by other speakers, which is fortunate, and
[00:35:02]
this can be omitted. So if you see me turning pages, you'll understand why. But fortunately, as a physician looking upon it a little different from other speakers during the day, and as a public health physician with a little different viewpoint from my colleagues who are treating patients continuously, there is not too much repetition, I believe. Now, you got from the chairman that my title was Assistant Commissioner for Chronic Disease Services, and it is as a chronic disease that we become interested in alcoholism, quite a different viewpoint than yours.
But here is where we have to begin to work together. It is expected that as a physician and a public health officer, I am interested in alcoholism as a chronic disease which, because of its high prevalence, its seriousness, its financial grade upon the community, and its requirement for a multitude of professional services beyond the ordinary ability of the afflicted individuals to provide, is a public health problem.
But as any chronic disease, it has social, psychological, and emotional and economic overtones, all of which must be evaluated and controlled if the patient is to be helped through treatment and rehabilitation. And in alcoholism, we must use the word rehabilitation in a very broad sense, implying not only the return to a job, but increase in self-respect, maintenance or regaining of satisfactory family relationships and increased independence in all areas of personal and social activities.
Now, that Alcoholics Anonymous has developed an approach to alcoholism through its extraordinary twelve-step approach is beyond question, and this requires no further elaboration by me, rather my purpose shall be to point out how we must work together, sometimes as a team, other times individually, though along parallel lines, always ready to call upon one another as necessary. Now, if alcoholism is a chronic disease with acute manifestations, then the alcoholic should be seen by a physician, we think, as early in the course of his disorder as possible.
At least an initial medical evaluation should be made. It would be very bad medical practice for us physicians to indicate that early excessive drinking is primarily a social or a behavioral manifestation, and that a physician's concern is only with the physical and the mental complications. There is convincing evidence that compulsive drinking is associated with various physical and mental abnormalities, which, as indicated before, occur in many other people who never become afflicted with addictive drinking, and these may lie in the biochemical, the endocrine, or the psychologic areas.
Certainly, the alcoholic patient warrants a complete medical evaluation to identify what physical and mental aberrations may underlie his alcoholic disorders. The alcoholic and other behavioral patterns determine how his nutrition has been affected by the drinking so far, diagnose early or late evidences of liver involvement or disorders of the peripheral nerves. Many discovered abnormalities require continued medical treatment and observation.
In addition, the recent development of the effectiveness of tranquilizing drugs, even though Dr. Downs has had some unfortunate experiences with it, these drugs and the management and control of the alcoholic make medical care essential for those persons who can profit by this approach. However, the physician, no matter how expert in the management of alcoholism, readily recognizes he cannot do this job by himself.
This is a matter of simple logic. The physician sees the patient in his office for relatively brief periods of time on a scheduled basis. Even if the schedule provides for several visits a week during the early periods, and if the medical care is a form of extended consultations, it cannot be expected by itself to have a very great carryover into the person's everyday experiences. The doctor recognizes the need for supportive services, to a certain extent he may call upon the wife and other family members to assist.
Certainly these persons must have adequate understanding of the problem, and the physician can help in providing this. He can refer the person to family agencies or the clergy, depending upon the person's background and preferences. But the experienced physician has recognized that Alcoholics Anonymous is in the best position to provide the necessary supportive service on a frequent and continuing basis, in a form the alcoholic patient is often willing to accept and be most effective in assisting in building up the patient's motivating forces.
But this must be a reciprocal arrangement. Alcoholics Anonymous must recognize the benefits to be gained by continuing medical care, and should encourage their newer members at least to seek such care or to continue it if they already are under medical supervision. Any attitude on the part of Alcoholics Anonymous that they alone have the answer to alcoholism
[00:40:00]
and should not encourage parallel medical care may be due irreversible harm to any of its members. Obviously, as a physician learns by experience, that referral to AA results most commonly, and a loss of that patient before optimal effects of medical care have been achieved, his dealings with AA may be expected to cease quite abruptly. It is recognized that the alcoholics who have abstained for long periods of time and have maintained satisfactory adjustment with the help of the AA program may need no more medical care or periodic examination than the average person.
Likewise, many persons suffering with problem drinking may do well under the care of an individual physician without referral to AA. However, it seems probable that a significant number of persons who are having an alcoholic problem will respond both to the joint services of these two approaches. Now we know that doctors have been quite reluctant at times to admit patients to their practice. This is often on the basis that alcoholics do not pay their bills very readily, often on the basis that they make a nuisance of themselves in the office.
But most often, and I think quite sincerely, doctors feel that they have not had good results with alcoholics, and this gives them a rather bad reputation. I think more and more doctors are beginning to take an interest in this field, and it can only be by working with such organizations as this that they can obtain a complete approach to this problem. But obviously the doctor cannot take care of alcoholics entirely on an ambulatory basis.
He must put this patient in the hospital very frequently. Now hospitalization, we feel, should not be only for patients who are intoxicated. Hospitalization should be available for persons in between periods of intoxication when tensions are being built up, and the physician can hospitalize a patient when he can really study him, analyze his tension, do a complete physical, and bring any medical disorder under treatment.
And the patient should not leave the hospital until there is a generally planned program for his carry-on thereafter, not only under medical supervision, but through the Alcoholics Anonymous program and any social service program that must be indicated. And this applies not only to the patient coming in for a general work of analysis of a general status, but for the person coming in because of intoxication.
To put a person through a drying-out period, through an inflexible five-day period as was used in pioneering days very nobly, but now recognized to be too inflexible, and discharging him just because his period of days are up, or because the number of days that have been paid for are up, is a rather serious business. There's a great deal to be learned about a person. When Alcoholics Anonymous groups are formed in hospitals, and we certainly believe that they should be formed in hospitals, there must be sufficient time to form the contact and let the patient leave the hospital, under the doctor's care, under AA care, knowing that there is a group on the outside to whom he can return and who will stay with him, his sponsor and the other members, and give him a different approach to life than he has had up to this period of time.
Now unfortunately, not only have doctors failed to recognize their responsibilities, but hospitals have failed in this respect to a great extent. In New York State, our State Department of Health, working with the Hospital Association and other departments, thought we'd look into this a little bit, and see just how bad the situation was. A study had been done in the New York Academy of Medicine back in 1945, presenting a rather dismal picture.
We wanted to know just how much our teachings, in reference to the handling of alcoholism, had simmered down. And we found a very mixed picture. And let me quote a few of these findings to you, because I think this is something you'll have to work with in your own communities. Of the 315 general hospitals replying to our questionnaires, representing about 85 percent of all patients served, about 20 percent indicated that they admit patients with alcoholism.
These are general hospitals. Eighty percent stated they did not. If you divided this up into public hospitals, you've got to have had a certain higher figure of 35 percent, and your voluntary hospitals dropped to about 15 percent. It's rather extraordinary that our municipal public hospitals, only 35 percent of them do admit alcoholic patients. Now we do know that many alcoholic patients are admitted to hospitals under other diagnoses.
This is the way that private physicians often get their patients into the hospital. But the fact that, on the record, the figures are this low is still rather serious. About 50 percent of the hospitals not admitting alcoholic patients stated that their regulations precluded their doing so. This reason was given by 75 percent of the public hospitals refusing alcoholic patients, which is rather enlightening in the wrong direction.
On the other hand, the voluntary and proprietary hospitals not admitting alcoholic patients more frequently gave such reasons as lack of facilities, lack of personnel, availability of other facilities in the community, troublesomeness of alcoholics. But one very interesting finding was that among the hospitals admitting alcoholics, 60 percent said that they were not troublesome, and 40 percent said that they were not.
[00:45:00]
indicated they were somewhat troublesome, but with the use of the tranquilizing drugs, their disturbances were quickly brought under control and treatment could follow thereafter. These findings have been published, and I'm not going to go into any further detail. I think it has already been mentioned that our professional associations have taken a great interest in alcoholism. The American Medical Association and the American Hospital Association have both issued statements and are working through their own state associations, trying to get their professional groups to take a greater interest in this particular problem.
Now one particular problem in public health comes to mind here in a very special sense, and that is the relationship of alcoholism and tuberculosis. You know that the case rates and death rates from tuberculosis have fallen drastically over the last ten years particularly, and one thing that we are having reported from all of our state and local tuberculosis hospitals is the fact that a very high percentage of the tuberculosis patients now in the institutions are patients who have a complication of tuberculosis and alcoholism, and this is a double problem for both diseases, because from the viewpoint of tuberculosis, these patients are the ones who will sign out of the hospital readily and public health laws rarely are executed to keep them in because of infectiousness, and they will not take care of the TB and they will have to return to the hospital after the tuberculosis has advanced to a more serious state.
In other words, they go through a revolving door as far as the tuberculosis is concerned, and obviously as far as the alcoholism is concerned, because they have an illness, because they can't get jobs on the outside, the revolving door of alcoholism is kept twirling a little faster. The fact is that in tuberculosis control, we may hit a plateau beyond which we may not go because alcoholism is serving as a double jeopardy here, and until we control one, we can't control the other, and which one comes first is difficult to say.
We frankly have to approach both. There's been a rather interesting experiment in Rochester where the TB SAM, where they had a new administrator come into the picture, and he recognized that a good percentage of his tuberculosis patients were going off to the local bars at night and coming back that night or the next night a little bit under the weather, and this was definitely interfering with his treatment program.
Some of them never returned at all, and they were patients who certainly needed intensive treatment for their tuberculosis. So what he did, and he was the kind of fellow who didn't know better than to do the direct thing, to really handle a problem, and he said, if these tuberculosis patients get out and it's not good for them, let's make it so that they can't get out, and he had one cottage there which he didn't need for any other purpose, which held about 20 persons.
He put 20 of his worst offenders, from the viewpoint of alcoholism, into this place, and he erected around it a barricade of wire fencing about 8 feet tall, topped by some really pointed material which he could not possibly scale. He worried about this a little bit, but the health office was very much interested, and he said he would sign out a warrant that these persons were dangerous to the public health and should be confined.
Both of them were really very much worried about this. They expected lawyers to be coming in at them, saying they were locking these persons up without good reason. They expected the wives to be coming in and complaining that the husbands were being deprived of civil rights, and they expected quite a squawk from the patients themselves. Peculiarly, this didn't happen. The alcoholics, being told they couldn't get out, said, well, we can't get out, so we'll sit down here.
And I think there was only one person who got out, and he got a hold of a shovel someplace, or somebody had made use of a shovel, and dug a hole underneath the fence and crawled out at night. And he went to town, had a ball for himself, came back at 2 o'clock in the morning, climbed a hammering to wake up the gatekeeper and be let in again, because he couldn't find the hole he had dug at 2 o'clock in the morning.
That's the moral of the story, if you dig a hole, remember where it is. But we are attempting some demonstration programs in this field to try to solve this, and certainly this is a place where Alcoholics Anonymous has to get into. I don't think you have made too much of an inroad into the tuberculosis hospital situation. There isn't a tuberculosis hospital in the country that isn't facing this problem today.
They've always recognized it as a problem, but when they had lots of tuberculosis patients, it was just one part of the problem and was considered, well, this is a hard call, we've got to take care of the soft call patients. Now that this hard call patient is becoming a very important person percentage-wise, they are more interested in it, they recognize they have to approach it, and I think that they need your help and you should offer this help to them very directly by establishing your AA chapters in these institutions.
I think you will be welcomed. Now one last thing I want to talk about is the role of medical education and alcoholism, and I have found a very interesting relationship with Alcoholics Anonymous in my teaching program at the Albany Medical College. We've often heard it said, quite justifiably, that the reasons doctors aren't interested
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in alcohol is because they never learn alcoholism in their undergraduate or even their graduate days. We are trying to teach alcoholism, and some speaker has indicated the important steps that the American Medical Association has introduced into the schools. But if we're talking alcoholism from a public health viewpoint, we like to make it clinical and in most of our other studies we bring patients in from the wards, and we've tried this with alcoholism, but you can recognize quite quickly that this doesn't work.
You can get a man with a fractured leg and he'll tell you exactly how he got that fractured leg and you can believe him. When you bring in an alcoholic from the hospital ward who's just coming out of the situation, this was absolutely hopeless. You can't believe what he said, if he said very much at all, some actually denied that they were drinking at all, which ruined the history completely. So about five or six years ago we got the idea of calling up the local AA chapter and asking them to send one of their men down to talk about alcoholism as a personal experience and incidentally to tell the group about AA, though that was a secondary rather than a primary approach.
And we have had some extraordinary experiences when the student, he's a third-year student, quite sophisticated by this time, calling him to the doctor by now, see this person walk in who may be a local banker or a local industrial executive or a housewife, they think this is another one of our consultants and we're always throwing at them. When the person is introduced as a patient who's going to tell their experiences with the problem of alcoholism, you see a lot of eyes popping here and this is really extraordinary to watch, and they really learn alcoholism not as a skid row problem, not as a jail problem, but as a community problem affecting people in everyday walks of life, and it is one of our most successful clinical teaching experiences.
The word of research came up a few times this morning, this afternoon, and it said that you can't bother with research because you have an immediate problem to take care of. Yet we know that the people who support research are the people who are affected by a problem. At the North American Association of Alcoholism programs last September, the statement was made that there had been no major breakthrough in our understanding of alcoholism on the development of preventive or curative techniques as a result of research, and this is still true.
Obviously, if we could learn something about the causes of alcoholism, we could make much further progress, thought as control. There is no question that we need funds and we need trained personnel for research. The work that has come forth to date has been confusing as it has been enlightening. We are told of certain personality types which are characteristic of alcoholics, and then we are told that there is no such thing as an alcoholic personality.
Metabolic tests yield conflicting and confusing results. We are presented with a series of psychological and perceptive tests on alcoholics which are considered to be characteristics of a high percentage of them, and then wonder how many patients in other diagnostic categories may have the same such findings. Little has been developed that we can utilize in our alcoholics program today. Public health and research programs require money, and while there have been notable advances in many state and local public programs, the funds are still too meager.
Legislators too often express the attitude that some alcoholics can be helped by AA and others cannot be helped. AA recognizes the need for improved medical and public health techniques. This must be made known to the public in general and to our lawmakers in particular. I think you recognize this or you would not have arranged this session this afternoon. In other words, you see, as a public health administrator I use every opportunity to get people to talk to legislators and point out problems and see if the necessary funds can be appropriated.
But in doing so you must have very specific ideas in mind because legislators are not usually too ready to appropriate money in these particular days despite so-called prosperity. Now, in concluding this program presentation, I've talked about the need for doctors, physicians, and AA to work together. And it was rather interesting to me to note that in the current issue of the New York State Journal of Medicine, there appears an editorial entitled, Congratulations to AA.
I don't think you'll find this in too many medical journals, and I'd like to quote from this editorial, which I happen to see in the draft form at the time I was drafting this paper. It says, This month marks the 25th anniversary of a social movement which has been of incomparable importance to medicine, business, and industry, but above all to human understanding and well-being. We regret to say that the medical profession up to now has shown little initiative in dealing with alcoholism.
Many of our community hospitals refuse to accept the acute alcoholic patient for treatment. Even our public hospitals are reluctant to admit them. While government is beginning to realize its responsibility in setting up the psychosocial facilities necessary to deal with alcoholism, the appropriations have been pitifully small and the plans often unrealistic. By implementing the recommendations of the American Medical Association's Council on
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Mental Health and those of the Medical Society of the State of New York's Subcommittee on Addiction to Alcohol, physicians can demonstrate their willingness to cooperate in the therapy of alcoholism. AA has pointed the way by removing the social stigma of the conditions and by forging a new instrument of social action, one based on the kinship of common suffering. To Alcoholics Anonymous, we give our heartfelt congratulations on this 25th anniversary and sincere best wishes for a long and increasingly useful life.
We propose a third A be added to your name, an A for achievement. Thank you. On behalf of all of us, I think I can assure you, Dr. Brightman, that you can thank your secretary for typing this speech, your wife and children for letting you come, and you yourself for its delivery because you have been a superb anchorman to a fine program. Thanks to Colonel Towns, Sister Ignatia, who's gone, and to Dr. Bradley.
I couldn't help but thinking as the doctor was speaking as a public health man of what happened to a colleague of his who moved from Albany to Syracuse. His little girl was sent off to school and her mother waited with some trepidation the child's return. On her first day, she came back laughing and smiling. Everything had gone well. And the mother said, well, tell me about it. He said, well, he introduced me around and I told him my name and where we lived and daddy's name and your name.
And she said, what else did they ask? He said, well, he wanted to know what daddy did. And the mother said, well, what did you tell him, dear? She told him that he was a public health doctor who was responsible for all of venereal disease in Western New York. This is a reminder to all of us, I hope, that we have enormous responsibilities that continue to the sick and suffering alcoholic. These hospital administrators and medical men have told us ways in which we have been helpful but have pointed many other ways in which we can and must be increasingly helpful, willing to give our time and our knowledge and our devotion in ways which hospital administration and medical science can make our program even more effective.