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W.D., New York, N.Y.
Record, April 21, 1937
allergic nature of true alcoholism has been postulated in
a previous paper (1). We there endeavored to show that alcohol
does not become a problem to every person who uses it, and
that the use of alcohol in itself does not produce a chronic
alcoholic. Of those who are able to drink with impunity,
however, a certain number will sooner or later develop this
anaphylaxtic condition, in which the tissue cells are sensitized
to alcohol. We believe that the alarming increase in such
cases may be directly attributed to the failure of the medical
profession to recognize the true alcoholic pathology and
to treat the condition as a somatic dysfunction rather than
as a combined physical condition and a psychological maladjustment.
But before instituting treatment, it is essential to determine
whether a case is acute or chronic; that is, allergic.
present all the minutiae of the treatment of allergic alcoholism
in the space of one article is, of course impossible. It
is necessary, though, first to divide these alcoholics roughly
into two groups; namely, first, those who have reached an
acute crisis and, therefore, require hospitalization either
to avoid the crisis and prevent delirium tremens, or to
bring the patient safely through such a crisis: and, second,
those whose condition is such that, with proper treatment,
no danger crisis exists. Practically all the cases would
be in the second category if the patient’s condition was
recognized and the proper treatment started promptly. However,
through failure of the patient to reach the physician in
time, or through failure of the physician to provide treatment,
many do reach the crisis stage.
is, therefore, necessary to recognize three phases of treatment.
The first phase applies only to those in the first category,
referred to above, which ordinarily should have been avoided.
The last two phases apply to both categories since they
are necessary regardless of whether or not the patient had
to go through the first phase. We might define these three
phases as follows: 1, Management of the acute crisis; 2,
physical normalization and cell revitalization so that craving
is eliminated, and 3, mental and normal stabilization, which
naturally involves some “normal psychology.”
OF THE ACUTE CRISIS
of the fact that such a stage is usually avoidable, it is
not avoided in many instances, and, hence, its existence
must be recognized, not only so that it may be properly
treated, but also so that it may be avoided in a larger
percentage of cases. If the physician has kept abreast of
current developments in the handling of this problem, such
a crisis exists only because it was there before the patient
came to the physician. This being true, prompt and thorough
measures must be taken before any body cell normalization
is undertaken. In other words, with a crisis, a negative
treatment is first required. We firmly believe that most
such acute cases should be hospitalized, but, in selected
cases, and where hospitalization is impossible, home treatment
may be undertaken.
the most serious complication of acute alcoholism isacute
delirium, the first consideration of the attending physician
must be to determine whether or not this is imminent. The
imminence of delirium tremens can usually be recognized
within a few hours; its onset is recognized by:
A persistent rapid action of the heart (pulse rate to
A rise in temperature to 100 F. plus.
Persistent insomnia not yielding to sedatives.
Increase in the tremors, which may include the muscles
of the face, and progress to an ataxic gait.
Profuse perspiration (present in over half our cases).
The general picture of progressive alcoholism, although
the patient is receiving practically no alcohol.
In the presence of the
foregoing symptoms, the alcohol must not be abruptly discontinued.
From our experience in thousands of cases, we believe the
average patient properly treated without deprivation of
alcohol will seldom develop delirium tremens. The patient
must be adjusted to a controlling dose which is physiological
for him - say one ounce every four hours, with an occasional
ounce between, if symptoms increase.
relieve the pressure in the brain and spinal cord (unless
spinal puncture is contemplated), dehydration must begun
at once. Unless contraindicated, we begin with a large dose
of physic, preferably a cathartic to be followed by a saline
purgative. The chief contraindication is enlargement of
the liver. If abdominal distention is present, catharsis
must be discarded and high colonic irrigations of warm saline
should be substituted. On the next day, if the abdomen is
no longer distended, the cathartic can be administered advantageously.
In patients who are obtreperous and uncooperative, these
warm saline irrigations have a somewhat sedative action.
The dehydration is continued for from three to four days,
depending on the strength of the patient.
alcoholic gastritis, vomiting is common following the administration
of saline purgatives by mouth. This simply amounts to a
saline lavage, and the saline should not be repeated until
it is retained. Acidosis is frequently present in these
cases and should be recognized and treated by the usual
that we are still dealing with the acute stage and considering
only the negative treatment, we must recognize that sleep
must be induced. This is a prime necessity in view of the
insomnia which is universal with these cases. Morphine should
be avoided if at all possible, as it increases brain congestion
and frequently leads to a fatal issue. Before a sedative
is administered, the physician must ascertain whether one
has been previously been given and action is delayed. The
cumulative action of an additional dose is sometimes most
serious. We have seen a number of instances in which a dose
of morphine fired a whole train of sedatives that had been
given previously with no effect, with promptly fatal results.
If the patient contrives to get more alcohol than has been
prescribed and large doses of sedatives must be administered,
the depressant action of the alcohol, combined with the
sedation, may culminate in a state of mental confusion leading
about the fourth day the alcohol can be entirely withdrawn,
as by this time the crisis has been avoided or safely passed
through and, hence, the patient is in the second phase of
the treatment (which should have been the first stage in
most cases, as previously noted). The following is typical
of a patient who had to go through the first phase:
I (Hospital No. 17). - Mr. M., aged forty-one. His family
history was Negative.
history: The patient had been a moderate drinker for ten
years, with no apparent interference with his work, which
was exacting, or his family life, which was normal. The
picture then changed over a period of a few months, so that
alcohol became an immediate problem. He would abstain entirely
for a week and then, on taking one drink, would again have
to continue for a number of days, sometimes weeks. he could
not understand this development in his case, believing it
due to some lack of will power, and finally falling back
on other alibis.
examination was negative as regards organic disease. The
heart was rapid (pulse rate 120); blood pressure 180 -100.
Generalized tremors were present. The facial expression
was anxious and there was a general sense of apprehension.
No food had been eaten for the previous three days and insomnia
Immediate detoxication was initiated by means of free catharsis
and the cerebral pressure automatically relieved. He was
allowed a moderate amount of alcohol, varied according to
his condition. Sedatives were given in moderation, but not
enough to cause a sudden “knock-out.” Following three days
of this treatment, alcohol and sedatives were discontinued,
and the patient, still being nervous and finding difficulty
in sleeping, we decided to try an especially prepared combination
consisting of an orthocolloidal iodine complex and an orthocolloidal
gold. In one week’s time, there was a return to entire normalcy
as regards the physical condition and the treatment was
continued for a period of three weeks.
NORMALIZATION AND CELL REVITALIZATION
this phase are included all allergic patients who have either
been kept clear of the acute crisis or who have been safely
passed through that phase by hospitalization. Therefore,
in this phase we are able to start to deal with alcoholism
as a manifestation of an allergy. We have established to
our satisfaction that this allergy is the result of the
body cells becoming sensitized to alcohol. It naturally
follows that the proper treatment is one which will desensitize
the cells, restore them to normal, and add to their defensive
mechanism by activating them and re-energizing them. Without
such a corrective of the constitutional condition, neither
the ordinary allergic patient who has not had a crisis,
nor those who have passed through the crisis as a result
of the negative treatment described above, can be benefited
to any lasting extent.
this body cell condition is a colloidal phenomenon, the
logical treatment in the restoration to normal, physiologically,
is the administration of an appropriate colloidal preparation
such as that referred to in the case previously described.
This particularly appeals to us in that our experience demonstrates
that it relieves the necessity for the use of sedatives
which often produce disastrous results, retard recovery
and lead to various habit formations, and in addition, the
danger of “let-down” is obviated, as illustrated with the
II (Hospital No, 431). - A man of thirty-six just returning
from China, where he had been drinking heavily for five
or six months, presented himself for treatment, with the
usual history. Following the standard method of detoxication,
a tremor, of the intention type, persisted, which we were
unable to relieve with the usual means of sedatives or physiotherapy.
we then use the special colloidal iodine complex and colloidal
gold, and, in about a week, there was a marked dimunition
in the tremor. After two weeks of further treatment, the
condition was scarcely noticeable and the craving for alcohol
has not returned.
III (Hospital No. 981). - A young man of twenty-eight had
suffered severe attacks of migraine since the age of 14.
He had been said to be allergic to many forms of food and
had eliminated most type of food as a consequence. He had
for some time been using morphine and hyocine for relief
of the attacks of pain. For the last few months, he had
been living in a room from which all light had been eliminated,
believing that was of further benefit to him. His weight
was eighty pounds. His mental attitude was one of despair
and he had practically lost all interest in the general
affairs of life. Following our detoxicating treatment, we
decided, along with our usual procedure in such cases9 to
try the special colloidal iodine complex and colloidal gold
preparation (previously referred to as being appropriate
with alcoholics). The result was that in the next two weeks
he had gained fourteen pounds, was able to endure his attacks
of migraine, which were much milder in character, was eating
a mixed diet, moving about daily, and is talking of resuming
these patients are still in the second phase of the entire
condition, and elimination of the phenomenon of craving
that follows the treatment does not constitute a cure. In
some cases, desire never returns. In others, relapses occur,
but it is noteworthy that the intervals between debauches
are lengthened, and the sprees, when they do occur, are
not prolonged. As in the case of any other allergy, the
body can not usually be exposed again to the sensitizing
agent without danger. In these patients, therefore, there
can be no compromise with alcohol. The final cure rests
with themselves. What we can do is to give them a sound
physical basis on which to build the intelligently controlled
mental attitude which is essential to their complete restoration.
This however will be discussed when we outline the third
phase of treatment. We must utter a word of caution here,
however, which is that measures designed to contribute to
the physical rehabilitation of the patient are not indicated
while delirium tremens is imminent, but only when the crisis
has been brought under control or where no such crisis exists.
of these allergics are above average in intelligence and
become worthwhile members of society when freed from alcohol.
In some, constitutional psychopaths, manic-depressives,
and those in whom alcohol has produced a degenerative condition
of the brain cells, the prognosis is bad; with these, temporary
improvement is obtained but relapse is the rule. By this,
we do not mean that, where the prognosis is bad, the alcoholic
should be cast aside into the psychopathic scrap heap without
any attempt at reclamation. Frequently, a patient with a
seemingly complete mental breakdown shows a remarkable transformation
after his system has been detoxicated and re-normalized.
In other words, it is usually is impossible to predict whether
there is anything left worth saving and on which to build,
until he has been normalized by the treatment and medication
described. When this has been done, then, for the first
time, we can see what material we have to work with in trying
to restore a normal attitude toward life.
allergics with physical ailments or deformities the prognosis
is good, especially if during hospitalization the other
condition can be remedied. But the largest group comprises
individuals as normal as the rest of us except that they
have become allergic to alcohol. They must be given an intelligent
conception of their anaphylactic condition.
approach is somewhat as follows: We endeavor to impress
upon the patient that his condition is physical and not
mental as regards the drug; that the reasons he gives for
drinking (social and financial problems, escape from a feeling
of inferiority, etc.) are but alibis. He has a medical problem
to face, that a law of nature is working inexorably in his
case as in a diabetic. We define allergy and interpret its
characteristics, until we are sure he has grasped the fundamental
nature of the case. He can then appreciate that only by
entirely avoiding the toxic factor, alcohol, can he avoid
an “attack” of alcoholism.
we can bring our detoxicated and cell normalized patient
who has lost his craving for alcohol, to this viewpoint,
he will be in a position to make a decision to forego its
use. Without quibbling over words, we wish to differentiate
between a decision and a resolution, or declaration, of
which the alcoholic has probably made many. A resolution
is an expression of a momentary emotional desire to reform.
Its influence lasts only until he has an impulse to take
a drink. A decision on the other hand, is the expression
of a mental conviction, based on an intelligent conception
of his condition. After a resolution is made the individual
must fight constantly with himself; the old environmental
forces are still arrayed against him, and he finally succumbs
to his old means of escape. However, if he has made a decision,
through understanding of facts appealing to his intelligence,
he has changed his entire attitude. He can go back to his
former environment, mix with his drinking friends (without
concern, because his craving has been counteracted), and
meet his worries and disappointments as a normal person:
he is free from all the emotional restrictions that formerly
activated him to drink. No will power is needed because
he is not tempted.
have seen this reasoning operate successfully in many cases,
even as we have seen many failures following what we term
resolutions or declarations.
believe that this decision is in the nature of an inspiration.
The patient knows he has reached a lasting conclusion, and
experiences a sense of great relief. These individuals,
introverts for the most part, whose interests center entirely
in themselves, once they have made their decision, frequently
ask how they can help others.
III (Hospital No. 993). - A man of thirty-eight, who had
been drinking heavily for five years, had lost all of his
property and was practically disowned by his family, was
brought to the hospital with a gastric hemorrhage. His general
condition was typical of allergic alcoholism and apparently
he was mentally beyond hope. Following through elimination
and medical rehabilitation, he made a satisfactory physical
return. He then took up moral psychology and, in two years’
time has entirely recovered his lost fortune and has been
elected to a prominent public position. On meeting this
patient recently, we experienced a strange sensation; while
we recognized the features, a different man seemed to be
speaking, as if a self-confident stranger had stepped into
this man’s body.
IV (Hospital No. 1152). - A broker, who had earned as much
as $25,000 a year, and had come, through alcohol, to a position
where he was being supported by his wife, presented himself
for treatment carrying with him two books on philosophy
from which he hoped to get a new inspiration: His desire
to discontinue alcohol was intense, and he certainly made
every effort within his own capabilities do to so. Following
the course of treatment in which the alcohol and toxic products
were eliminated and his craving counteracted, he took up
moral psychology. At first, he found it difficult to rehabilitate
himself financially, as his old friends had no confidence
in his future conduct. Later he was given an opportunity,
and is now a director in a large corporation. He gives part
of his income to help others in his former condition, and
he has gathered about him a group of over fifty men, all
free from their former alcoholism through the application
of this method of treatment and “moral psychology.”
such patients we recommend “moral psychology,” and in those
of our patients who have joined or initiated such groups
the change has been spectacular.
Silkworth, W.D. Alcoholism as a Manifestation of Allergy,
Medical Record, March 17, 1937.
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