THE UPHILL FIGHT AGAINST ALCOHOLISM By Quentin Reynolds

What is to be done for the thousands of his feet but he collapses. Delahanty goes to the Americans under sentence of death from this call box. scourge? Here is one city that is trying to find the The ambulance arrives quickly, and answer within 11 minutes the man is in the accident ward of Boston City Hospital, one of the three largest municipal hospitals in the country. Dr. The United States, according to available Maurice Constantin, an intern, gives the man a statistics, appears to be the alcoholic capital of quick examination. He has to decide whether the world – although pressed closely by France this is just an ordinary drinker who has been and Sweden. Since 1940 the rate of reported celebrating, or a man suffering from one of the alcoholism in this country has risen serious mental and physical illnesses which approximately 45 percent among men and 52 result from alcoholism. If he has one of these percent among women. In January the Yale illnesses, he will be treated with the same University Center of Alcohol Studies reported consideration and expert care that he would get that there are now 4,589,000 known alcoholics if he had heart trouble or double pneumonia. For in the United States. alcoholism, is a disease, and it is sternly Every major American city is faced with regarded as such by everyone at Boston City, the problem. Boston, Mass., although not the from Dr. John F. Conlin, superintendent, down to chief sufferer (the leader is San Francisco, with the newest intern. 16,760 alcoholics per 100,000 adult population), The warmth of the accident room revives nevertheless has the problem in serious the man; he is more responsive now; he says proportions. And because medical, religious and that his name is Dennis O’Toole. (the names of communal organizations in Boston are striving all patients in this article are disguised) Dr. desperately and intelligently to cope with the Constantin applies a stethoscope to the patient’s situation, I made a study of their program. This chest, takes his pulse and strips his trousers off. is what I found. He frowns when he sees that both legs are It’s a freezing January night. Officer badly swollen up to the thighs. He feels the soft James Delahanty and I are walking the Dover flesh just below the right rib cage, finds that the Street beat in Boston’s South End, the city’s edge of the man’s liver can be felt three finger- Skid Row. The saloons are emptying now, for breaths below the last rib. This enlargement is the law which forbids serving liquor after 1 a.m. strongly suggestive of a fatty or badly scarred is strictly enforced. Men are hurrying furtively liver. Obviously, Dennis O’Toole is not an and unsteadily along the dark street, many of occasional drinker; he is a really sick man. them with bulges under their coats which you Constantin learns that this is O’Toole’s know are bottles of whiskey or jugs of Sneaky eight visit to Boston City, that he had been Pete (a poor grade wine, 80 cents a quart). drinking hard for months, has eaten little during They’re looking for an alleyway or a friend’s this period. O’Toole answers all questions room where they can drink and blot themselves rationally enough, but his out-stretched hands out. are tremulous, and his breath comes in labored Delahanty’s practiced eye sees a gasps. Constantin notes particularly his eyes: shapeless something slumped against the side they can be made to deviate only slightly from of a building. He goes up to it, shakes it and center. He suspects at once that, no matter what says, “It’s a cold night. Better get inside or you’ll else is wrong with O’Toole, he is suffering from freeze your feet off.” A rasping, choking voice Wernicke’s disease, a disorder of the nervous gasps, “I can’t walk.” We try to help the man to system.

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Carl Wernicke brought this disease to the liquids low in salt content (in case of any serious attention of the medical profession in 1881. heart ailment). Today it is routine for a receiving intern to Dennis O’Toole, 42, unemployed, was examine a possible alcoholic patient for its getting the kind of attention that many could not presence. Wernick’s disease is caused chiefly afford. To the staff of Boston City he was not a by a lack of thiamine (vitamin B1). If not caught drunken derelict but a very ill patient whom it early, irreparable damage to the brain may was their duty to help. occur; if not treated adequately, death may Eight days later I sat with Dennis O’Toole result. Two other things about O’Toole indicate in a ten-bed ward. He proudly showed me his vitamin deficiency: his tongue is smooth and red; completely normal legs. I told him how a number his skin is dry and hangs loosely. of doctors had studied his case, and of the The intern rapidly records his preliminary various (and expensive) drugs which had kept diagnosis to guide the doctors on the wards: him alive. “Chronic alcoholic; possible Laennec’s cirrhosis; “They take pretty good care of you at rales, lower right lung field; peripheral edema; that,” he said complacently. Wernicke’s disease.” I asked O’Toole how much he drank. He “Get him up to Medical Three,” he tells evaded the question by saying he was just a an orderly. “Stop on the way for chest X ray.” social drinker – which is the stock answer I There is no alcoholic ward at Boston received from dozens of alcoholics. Sure, he City. Dr. Conlin and his staff feel that drank every day, he said, but you couldn’t really confinement in such a ward puts a psychological call him an alcoholic. burden on a sensitive patient. So Dennis How much whiskey did he drink each O’Toole is wheeled into Medical Three. day? A pint? Dr. Brendan M. Fox, the intern on duty, “A pint!” he exploded. “Mister, when I’m takes blood, urine and sputum specimens, and drinkin’, I spill more than a pint a day.” verifies Dr. Constantin’s findings. Now he tests Now that O’Toole is in fairly good O’Toole for the serious and tragically common physical condition, the staff concerns itself with mental component of Wernicke’s disease: his rehabilitation. A psychiatrist visits him daily Korsakoff’s psychosis, named for Sergei and tries to gain his confidence. But O’Toole has Korsakoff, one of Russia’s most brilliant talked with psychiatrists before; he listens with psychiatrists, who discovered it in 1889. apparent sympathy but with little understanding. The disease takes the form, mainly, of Father Laurence M. Brock, S.J., for ten loss of memory, particularly for recent events. years chaplain of Boston City, visits O’Toole Seen almost exclusively in alcoholics, its primary every day, and the patient obviously likes the cause is likewise nutritional deficiency. Often, by big, rugged priest. O’Toole even drops in to the the time it manifests itself, damage to the brain beautiful little chapel on the ground floor to hear is so great that the patient is committed to a Mass. But when you ask the priest if he has mental institution as incurable. made any progress, he shakes his head sadly. O’Toole is fortunate. Unlike nine out of “I never ask a man to sign the pledge ten patients with Wernicke’s disease, he is lucid. that he will never drink or even that he won’t Now Dr. Fox helps O’Toole to his feet take a drink for six months or a year,” he says. “I and asks him to walk across the room. O’Toole find that the pledge works only when the patient walks like a man on stilts, his feet far apart. Fox asks to take it. Very, very few of the Dennis notes the word “ataxia” – inability to coordinate O’Tooles ever make it. I phoned Alcoholics voluntary muscular movements – on the chart. Anonymous and they sent a man to see him. He Then he gives his patient as injection of promised to attend a few of their meetings. I chlorpromazine, a tranquilizing drug, and puts doubt he will. The rehabilitation of an alcoholic him to bed. has to come from within. O’Toole falls into a deep sleep. Fox “We have about 2000 beds here at the orders intravenous feeding of thiamine, plus hospital. If it weren’t for alcohol, we could get along with a lot fewer. Go over the accident

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cases; a great many are the result of drinking. me his alcoholic history and allowed me to visit And far too many other patients are here with him. because alcohol made them susceptible to Slocum had been an alcoholic for 20 disease.” years, and had taken a dozen “cures” at private Before Dennis O’Toole is discharged, institutions. During most of this time he had held Resident Dr. Stanley M. Silverberg has a long a good job as a sales director, but now he had talk with him. He pleads with him to return to come to the end of the road. I spent visit Dr. Iver Ravin’s out-patient clinic for considerable time with him but he never alcoholics. He tells O’Toole of the drug called remembered me from one visit to the next. One Antabuse, designed to help him overcome his time the doctor with me asked, “Do you know alcoholic habits. A pill is taken each morning, where you are Peter?” and if the patient then takes a drink, he is “At my sister’s home in Malden,” Slocum overcome by violent nausea. said in a soft, gentle voice. (Contrary to general “Doc, I don’t need any of them gimmicks opinion, few alcoholics are violent. Chaplain to stay sober,” O’Toole says earnestly. “I don’t Brock refers to them as “the gentle people.”) need no head doctor nor no priest or A.A. guy “He has no sister, nor any relatives in holding my hand. I got will power!” Malden,” the doctor said to me. We talked with And so Dennis O’Toole leaves Boston Slocum for an hour, but it was impossible to City Hospital. The institution has done establish any real communication. everything humanly possible to help him. But it Dr. Kermit H. Katz, visiting physician who can’t make him help himself. Even the most is chief of the 5th and 6th Medical Services at the skilled experts in medical, psychiatric and hospital, had investigated Slocum’s history spiritual counseling cannot make O’Toole admit thoroughly. “He was always good at his job,” Dr. that he has no control over alcohol. He is a Katz explained. “He was the man who took chronic alcoholic who refuses to believe that he clients out when they came to Boston. He’d is slowly committing suicide. drink with them at lunch and then drink with One cannot say that Dennis O’Toole is a another group at dinner. He did this for years, typical alcoholic, for there is no typical victim of until finally there came a time when he didn’t this disease. Nor does the scourge stalk only the merely want a drink – he needed a drink. He Skid Rows of the big cities. Less than 15 per never really liked the taste of alcohol, but to cent of our four and a half million alcoholics keep going he had to have a few eye-openers in dwell in the Dover Streets and Boweries of the the morning. Then came the final step: he had to land. drink constantly. “He’d go away and get straightened out If nature exacts its usual inexorable toll, temporarily, but he always had to return to the a tall, good-looking man of about 50 who is bottle. Now? We’ve tried everything science has registered at Boston City under the name of taught us. But I can’t see any hope. There is too Peter Slocum will be either dead or buried alive much organic damage. I wish that those who in a mental hospital within a short time. Slocum could still rehabilitate themselves could see was found stumbling across Boston Common Peter Slocum today.” talking incoherently. Reasonably well-dressed Certainly the example of Slocum is a with money in his pocket, he might just have had sobering one. Even more sobering is the one too many. But the intern on duty at Boston experience of listening to a patient in the grip of City needed only a few minutes to make the delirium tremens, the final stage of prolonged diagnosis: Korsakoff’s psychosis, in an alcoholism. Come with me to a private room in advanced stage. the 5th Medical Service at Boston City. A few days after Slocum was admitted, a Mrs. Rogers, age 36, once an attractive man came to the hospital in search of a missing brunette, is the patient. When I saw her she had brother. He found that the man registered as been in delirium tremens for five days. Usually Peter Slocum was indeed his brother. He told the symptoms abate within 72 hours. She lay in bed “in restraint” – her wrists and legs attached

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by cuffs to the side of the bed, but loosely tetracycline (an antibiotic). She had two electroenough to permit some movement. cardiograms, two chest and kidney X- rays, ten Her husband had brought her to the urinalyses, 11 blood counts, a Papanicolaou hospital in a state of coma after she had smear test (for vaginal cancer) and several suffered an alcoholic epileptic seizure. She blood cultures. made a partial recovery from the seizure and She was taken to the operating room on then had slipped into delirium tremens. She had two occasions, at which time she received the been a heavy drinker for 12 years. Her husband most modern (and expensive) anesthesia, and said that she drank beer steadily each morning had a complete gynecological survey. A sternal and then shifted to wine in the afternoon. He puncture was done, and the marrow was himself was a moderate drinker. Their home? cultured for bacteria. The state of her liver was The husband had finally sent their two children assessed by performing a liver biopsy (removal to relatives. He had only a deep and gentle pity of a small portion or the organ for microscopic for the woman who had been his wife for 17 examination). Visiting physicians held half a years. She was being given oxygen through a dozen conferences to determine the best way to nasal tube. Glucose, water and vitamins were treat her various physical and mental ills. being injected intravenously. I studied the complete medical and Her eyes were wide open, and she was surgical record of Therese’s three-month stay in carrying on an animated conversation, all of it the hospital. Included were reports from eight meaningless. When the doctor pointed to me internists, one gynecologist, two pathologists, and asked, “Mrs. Rogers, do you know this one general surgeon, five laboratory and X-ray man?” she said in what appeared to be a normal technicians, one heart specialist, two neurologvoice, “Yes, that’s my brother Steve. Where is ists and a specialist in lung disease. Therese Anne? Oh, here she is”-a white clad nurse had finally walked out of the hospital in fairly good entered the room. ”I like your brown hat, Anne, health. but it doesn’t go with that plaid skirt…Steve, the What did her treatment cost the water is running. Turn it off, Steve. Make him taxpayers of Boston? turn it off, Anne – it’s up to your ankles. Now it’s Dr. Katz looked puzzled when I asked up to your waist. You stay here if you want – I’m him that question, for at Boston City great going to the kitchen….” importance is placed upon the life of a patient The doctor said, “I’ve turned it off, Mrs. but much less on the cost of preserving that life. Rogers. It’s all right.” The patient seemed However, Dr. Katz went through the file and reassured. But in a few moments she was estimated that the cost to a paying patient in a babbling something equally fantastic. When we private hospital for the drugs, laboratory tests, left, she was talking animatedly about a little dog medical, surgical and nursing attention that she believed to be in bed with her. Twenty-four Therese had received would have been at least hours later Mrs. Rogers stopped talking forever. $5000. (It might be noted that Katz and 500 other visiting doctors and psychiatrists give their SOMEWHERE in Boston today there is a skill and time to Boston City patients with no girl named Therese, working as a waitress. She recompense at all.) came to Boston City in an alcoholic coma, more The budget at Boston City is 16 million dead than alive; the whole resources of the dollars a year. When you ask Dr. Conlin how hospital were regimented in an effort to save much of that is consumed in the care of her. She was in such grave condition that she alcoholics, he smiles, “Does it matter? They are was given a private room, and during her first just as sick as men and women who come here two weeks a nurse was with her 24 hours a day. with meningitis or cancer and, as you’ve seen, Some of the drugs given Therese during they are treated the same. Happily, both the the three months of her hospitalization were: profession and the public are finally beginning to penicillin, paraldehyde, chloral hydrate, an realize that alcoholism is a disease and not a extract of rauwolfia, chlorpromazine, thiamine, form of adult delinquency.” codeine, sulfisoxazole (a sulfa drug) and

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What can be done for the advanced For 47 of the 101, complete failure. For alcoholic? 22, partial recovery. (They still went on Alcoholics Anonymous, which has an prolonged drinking bouts two or three times a active membership of about 150,000, is still, year.) Twenty other patients remained sober for doctors believe, the most impotent of all forces the three years of the study, but each admitted for rehabilitating the alcoholic. But Boston keeps that he could maintain this immunity from trying to find other, even better answers. It is an alcohol only if he continued to live at the hospital uphill fight. under medical and psychiatric supervision. The Far out in Boston Harbor is a small island remaining 12 abstained from liquor, did connected with the mainland by a causeway. satisfactory work in their jobs, and finally This is the home of the Long Island Hospital decided that they could face life in the city (part of Boston City), an institution for sufferers independently, without reliance upon the of chronic diseases. Chronic alcoholics, of hospital. course, make up only a portion of the hospital’s “I try to keep in constant touch with these patients, but it is a discouraging portion. For 12 men,” Meyerson says. “Are they cured? We despite the heroic efforts being put forth, the can never use that word in discussing an number who can be classified as “cured” is so alcoholic patient. But they have apparently low as to be frightening. learned to live with their affliction. They all Dr. David Myerson, the hospital’s continue to attend AA meetings and to engage psychiatrist, recently completed a three-year in therapy we suggest. But if any of these men study of 101 alcoholics here. Fifty percent had ever takes one drink, he will have failed to attended high school. And some of these had overcome his problem. Alcohol to them is a once held good jobs in business or industry. destructive force against which they must carry Virtually all had lost all family relationships, and on an endless struggle.” for them had substituted the illusionary Of course, the alcoholic cases Dr. companionship found in local taverns. Myerson deals with are in the most advanced Each patient had entered Long Island stage. As in other illnesses, the chances of cure voluntarily, with an avowed desire to be are better if detection is earlier. Psychiatrist rehabilitated. Each to a great degree lost his David Landu believes that at least a partial sense of isolation, because at Long Island he solution to the problem lies in reaching the was a member of a group. (Once a week the “unrecognized alcoholic,” who has not yet dedicated members of Alcoholics Anonymous arrived at the point of no return. If such men and hold meetings here.) The hospital soon became women could be made to realize that it is merely a home for the patients, and when they a question of time before their minds and bodies improved, jobs were found for them in Boston. become scarred and, eventually, destroyed, they Each night they returned to the hospital in might escape the sentence of death which can buses. pass upon them. What is the result of Dr. Myerson’s treatment and study?

Source: Reader’s Digest, April 1956

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