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Roundtable of AA History
January 10, 1998
DUNCAN SILKWORTH, MD (1873-1951)
Mike O., of The Just Do It Big Book Study Group of Alcoholics
Anonymous, DeBary, Florida.
William D. Silkworth, called, "the little doctor who
loved drunks", began an indispensable contribution
to Alcoholics Anonymous during the early 1930's from his
position as medical director of Charles B. Towns Hospital,
293 Central Park West (89th street), New York, N.Y. Towns,
founded in 1901, was well known then as a rich man's drying-out
place; a rehab for the wealthy, and it served a worldwide
clientele. American millionaires, European royalty and oil
sheiks from the middle east walked its halls, side by side:
brothers in humiliation in bathrobes and slippers.
was Dr. Silkworth who told Bill Wilson, during the summer
of 1933, of the nature of alcoholism: that, in his opinion,
the problem had nothing to do with vice or habit or lack
of character. It was, he said, an illness with both mental
and physical components. Silkworth is quoted widely as calling
the illness a combination of "---an obsession of the
mind that condemns one to drink and an allergy of the body
that condemns one to die" or go mad if one continues
to ingest alcohol.
Silkworth was not the first highly respected authority to
write about alcoholism. Solomon, considered the wise man
of his era, wrote about it in Proverbs, Chapter 23, and
Verses 29 through 35. Solomon's Biblical words seem an accurate
description of the alcoholic of today.
Benjamin Rush, one of the signers of The Declaration of
Independence, was the first member of the medical community
to write about alcoholism and suggest it might be an illness.
In a medical paper he wrote in 1784, Dr. Rush said he thought
alcoholism was "-a disease process." He offered
no further clinical evidence. So: Dr. Silkworth, it appears,
was the first medical person to detail alcoholism, in writing,
as an illness.
thus, disagreed with his employer, Charles B. Towns. Towns,
who had once claimed to have a "cure" for alcoholism,
believed firmly in a physiological, medical model of addiction.
But, he denied that alcoholism, per se, was a disease. Silkworth
argued that certain individuals were "constitutionally
susceptible to sensitization by alcohol" and that drinking
sparked an allergic reaction. This, he insisted, made it
physically impossible for an alcoholic ever to tolerate
alcohol. Moreover, he said, that problem drinkers would
have to learn and accept this fact as part of their treatment.
played a major role in many of the early recoveries from
active alcoholism, particularly those in New York. It's
estimated that he treated forty-thousand alcoholics during
his career. The introduction to his writings in the book,
"Alcoholics Anonymous" says early AA members considered
the Brooklyn-born Silkworth no less than a medical saint.
Silkworth advised Bill Wilson to stop preaching at the drunks
he was trying to help by telling them about his powerful
spiritual experience. Silkworth urged Wilson to begin, instead,
by telling each of the alcoholics that his condition was
hopeless, a matter of life-or-death. Only then, Silkworth
believed, would the drunks be willing to listen to a story
about a spiritual remedy.
no fault of the doctor's, there is disagreement about parts
of his professional history and about his birth year. In
Silkworth's biography in the book, "Dictionary of American
Temperance Biography: From Temperance Reform to Alcohol
Research, the 1600s to the 1980s," the historian Mark
Edward Lender lists Silkworth's date of birth as July 22,
1877. All other sources used in this compilation, which
contain a date of birth for Silkworth, including his New
York Times obituary, agree that Silkworth's birth year was
agreed, generally, that Silkworth graduated from Princeton
University (A.B. 1896) and that he took his M.D. degree
from New York University-Bellevue Medical School (1899).
But, two principal sources, "Pass It On," published
by Alcoholics Anonymous, and, "Not-God," researched
and written by the widely respected historian Ernest Kurtz,
Ph.D and published by Hazleden, offer differing versions
of his career path thereafter.
It On," (p. 101) reports Silkworth became a specialist
in neurology, a domain that sometimes overlaps psychiatry,
and entered private practice in the 1920's. It says Silkworth
invested his savings in a stock subscription for a new,
private hospital. "Pass It On" says Silkworth's
investment came with the promise of a staff position when
the hospital was built. But, the report says Silkworth lost
everything in the stock market collapse of 1929. And,"Pass
It On" quotes Bill Wilson as saying that Silkworth,
in desperation, went to Towns in 1930 for compensation of
about forty dollars a week, plus board.
(p. 22) reports that after he received his medical degree
NYU, Silkworth began a coveted internship during 1900 at
Bellevue Hospital, 462 First Avenue (27th. Street), in Manhattan.
It says that in 1924-after completing specialty training
as a neuro-psychiatrist---Silkworth became medical director
of Towns. "Not-God" notes that Dr. Silkworth estimated
his patients' rate of recovery, until Bill Wilson came along,
at "approximately only two percent."
"Pass It On" and "Not-God" show a six-year
difference in Silkworth's arrival date at Towns.
third source offers a wider time differential but more information
about Silkworth. The respected Journal of Studies on Alcohol,
published monthly by The Center of Alcohol Studies at Rutgers
University, New Brunswick, New Jersey reports Silkworth
arrived at Towns in 1932. An article by Leonard Blumberg,
(Professor of Sociology, Temple University, Philadelphia
Vol. 38. No. 11, 1977, "The Ideology of a Therapeutic
Social Movement: Alcoholics Anonymous") says Dr. Silkworth
worked at Towns from 1932 until his death in 1951.
entire career had a psychiatric emphasis. He was a member
of the psychiatric staff at the US. Army Hospital in Plattsburgh,
New York, for two years (1917-1919) during World War I.
Silkworth also served as associate physician at the Neurological
Institute of Presbyterian Hospital in Manhattan from 1919
to 1929. He had also been connected with Broad Street Hospital.
Blumberg article leaves room for speculation about the circumstances
under which Silkworth left the prestigious Presbyterian
Hospital in 1929. It concludes that he probably was laid
off during a staff reduction following the stock market
crash of that same year. The article does not attempt to
fill the time vacuum of approximately three years until
it says Silkworth went to Towns.
of his starting date at Towns, Wilson said Silkworth's arrival
there was the turning point in the doctor's life. Nearly
all sources agree that he worked there approximately nineteen
Dr. Silkworth was a major influence in persuading the management
of Knickerbocker Hospital in upper Manhattan to set aside
a small ward, beginning in 1945, for the treatment of alcoholics.
Knickerbocker was the first general hospital in New York
to do so. (This is significant because many general hospitals
at that time would not admit alcoholics as alcoholics. Their
doctors had to admit them under false diagnoses.) Dr. Silkworth
served six years at Knickerbocker as director of alcoholic
treatment, attending an estimated seven thousand alcoholics.
Teddy R., a nurse who was an AA member, ran the alcoholism
ward. Figures as to costs at Knickerbocker are unconfirmable.
But, the fees and other expenses there were much less than
at Towns, where patients paid $125.00 for one week of treatment,
during the early and mid-1930's. At Knickerbocker, drunks
off the street with no financial resources were de-toxified.
Duncan Silkworth died Thursday morning, March 22, 1951 of
heart attack at his home, 45 W. 81st. Street, New York.
He and his wife, Marie, had lived in Manhattan during their
later years. But, it's known that he commuted for part of
the time he worked in New York from a home in Little Silver,
New Jersey. Today, there's a train station about one block
away from that house, which-as of this writing -- is still
standing. But, it's unclear whether the train station was
there at the time Silkworth lived in Little Silver.
noted previously, the book, "Alcoholics Anonymous,"
reports that early AA members considered Dr. Silkworth a
"---medical saint." It was never a secret that
his personal relationship with Alcoholics Anonymous was
both deep and emotional. He was called, "-the little
doctor who loved drunks" because he genuinely cared
for and experienced communion with alcoholics. And, they
loved him. An in-depth explanation can be found in, "Language
of The Heart," (p. 176).
an article he wrote years later for The Grapevine, Bill
Wilson noted that Dr. Silkworth treated some 40,000 alcoholics
during his career. Wilson added, "He never tired of
drunks and their problems. A frail man, he never complained
of fatigue. During most of his career he made only a bare
living. He never sought distinction; his work was his reward.
In his last years, he ignored a heart condition and died
on the job--among us drunks, and with his boots on."
All but one of the AA historians who influenced this writing
believe that Dr. Silkworth held positions at both Towns
and Knickerbocker Hospitals at the time of his death. But,
it should be noted that the respected AA historian and author
Mel B., who wrote much of "Pass It On," the official
AA biography of Bill Wilson, mentions only Silkworth's affiliation
with Knickerbocker Hospital at the time of the doctor's
showed his gratitude to Silkworth in 1950 and '51, when
he and some associates tried to raise enough money to allow
"Silkie" and Marie, to retire to New Hampshire.
The doctor was going to be medical director of the treatment
center, Beech Hill Farm, near Dublin, New Hampshire. But,
Silkworth died before it could happen. So: Bill, noting
Mrs. Silkworth's strained financial circumstances, raised
$25,000 for a Silkworth Memorial, to supplement the widow's
Silkworth's death was announced to the Fellowship in the
April 1951 version of the AA Grapevine. And, the article
indicates AAs of that time considered Silkworth more than
a "medical saint." To those AA's who knew him,
William Duncan Silkworth was a hero. The April 1951 Grapevine
article notes, "He freely risked his professional reputation
to champion an unprecedented spiritual answer to the medical
enigma and the human tragedy of alcoholism." Historians
point out that he might have been laughed out of the American
Medical Association for holding such a view. Obviously,
that did not happen.
who previously had referred to Dr. Silkworth as "-AA's
first and best friend" eulogized Silkworth in the May
1951 Grapevine. And, his affection and sense of personal
loss is expressed in a notation on a copy of the appeal
for funds (found in the archives of the General Service
Conference of A.A.) It says, "Thank Heaven we started
this before Silkie went."
Wilson article, written especially for The Grapevine, concludes
with two questions: "Who of us in AA can match this
record of Dr. Silkworth's? Who has his measure of fortitude,
faith and dedication?".
The AA publications: "Alcoholics Anonymous", "Pass
It On", "The Grapevine" and "Language
of The Heart"; the Archives of the AA General Service
Office; "Not-God" by Ernest Kurtz; "The Journal
of Studies on Alcohol 1977" which contained "The
Ideology of a Therapeutic Social Movement: Alcoholics Anonymous."
by Leonard Blumberg: published by The Center of Alcohol
Studies, Rutgers University); "Dictionary of American
Temperance Biography: From Temperance Reform to Alcohol
Research, the 1600s to the 1980s" by Mark Edward Lender;
"Lois Remembers" by Lois Burnham Wilson; "My
Search For Bill W" by Mel B.; Yale University; New
York University and private conversations with AA's who
knew Dr. Silkworth.
I'm grateful for the above sources. Any errors are my own.
Researched/written for: The Round Table of AA History by
Mike O. (Michael O'Neil), of The Just Do It Big Book Study
Group of Alcoholics Anonymous, DeBary, Florida. Updated/revised:
1999, 2000, and 2001.
to main Dr.
Silkworth index page.
Silkworth Grapevine index | Grapevine