Alcoholism in America: From Reconstruction to Prohibition.

Alcoholism in America: From Reconstruction to Prohibition. By Sarah W. Tracy (Baltimore: Johns Hopkins University Press, 2005. xiii plus 357 pp. $48.00).

Historians who have investigated the history of alcohol use and abuse in United States history have traditionally focused on the rise and fall of National Prohibition. Their studies of the period between the Civil War and Prohibition have dwelled on the activities of such groups as the Woman's Christian Temperance Union (WCTU) and the Anti-Saloon League. Few historians have looked at the other major story concerning alcohol, the challenge of dealing with alcoholics and alcoholism. The purpose of Sarah W. Tracy's book is to address this often-neglected subject, concentrating on the years between the founding of the American Association for the Cure of Inebriates (AACI) in 1870 and the formal beginning of National Prohibition in 1920.

Tracy takes as her point of departure the post-Prohibition formulation of Yale University physiologist E. M. Jellinek and others that alcoholism should be described and treated as a disease, in opposition to traditional thinking that perpetual drunkenness was a reflection of flawed character. Tracy argues that Jellinek's disease construction, which began to be articulated in the 1940s and still dominates alcohol treatment today, was actually not all that new. Rather, the AACI, back in the 1870s, was a leader in "[d]efining intemperance as a disease," which the author calls "an essential step in the early campaign to medicalize the condition." (p. 26). She goes on to show, rather convincingly through an impressive array of evidence, that the disease concept was taking firm hold well before National Prohibition presented the false hope that drinking problems would forever cease to exist.

Through the meticulous analysis of such words as dipsomania, inebriety, and alcoholism, Tracy discusses social and legal changes that moved drunkards out of jails and mental institutions and into private and state-supported facilities devoted to the curing of inebriates. Along the way, she touches on many other subjects of interest to social-medical historians. With respect to physicians of that era, Tracy views them as trying to expand the base of their cultural authority as society's healers by asserting "their professional expertise" in the treatment of alcoholics. (p. 52) (1) As for the WCTU, she offers a softer interpretation than some historians. She states that even though Frances Willard and other WCTU leaders "clung to an older vice-crime perspective" in regard to alcoholism, they also came to accept "habitual drunkenness" as "a medical condition" because of their "'do everything'" approach to eliminating the familial and social destruction associated with alcohol abuse. (p. 81) Concerning matters of gender, Tracy characterizes the goal of medical treatment for men as re-establishing the "the middle-class virtues of sobriety, personal responsibility, fiscal independence, and civic duty"; and for women as a return to respectability, especially in light of assumptions about alcohol's role in promoting promiscuous sexual behavior. (pp. 76-77)

On the other hand, Tracy does not always follow through on important subjects. While she discusses in some detail the well-known huckster Leslie E. Keeley and his bichloride of gold cure for inebriates, certainly an example of patent medicine quackery at high tide, she does not devote much space to medically-based recovery therapies of the pre-Prohibition era. More than once Tracy touches upon eugenics but does not fully discuss how concerns about racial purity, especially among pre-Prohibition Anglo-Saxon physicians, may have served to undergird the movement toward medical interventions for alcoholics. In the quest to establish state-supported inebriate asylums with a primary purposes of helping drunkards, the author mentions but does not demonstrate how party-based politics affected the actual policy making process in the creation, maintenance, and closing of such institutions. Additional clarity about these kinds of issues would have made this very useful volume even more commendable.

From this reviewer's perspective, the author's most compelling presentation appears in the chapter on the "Foxborough Experiment," a case study involving the twenty-six year history (1893-1919) of a state-run inebriate hospital in Massachusetts (pp. 147-95), and in the section analyzing commentary about published recovery narratives (pp. 228-42) and private letters from patients after leaving the Massachusetts treatment facility (pp. 242-69). This material "convinced" Tracy that therapeutic approaches, whether medical, moral, or some combination thereof, were not as important to curing problem drinking as were the willingness of patients to act as "allies in the fight for sobriety" and the continuing interest and support of their physicians after treatment. (p. 270). Modern researchers, still searching for answers, would no doubt agree. Any person interested in the social history of drinking, the problems associated with problem drinking and chronic alcoholism, and the rise of modern medicine and medical care will surely benefit from the careful consideration of the contents of this valuable work.

James Kirby Martin

University of Houston

ENDNOTE 

1. In support of this argument, Tracy relies on Paul Starr's The Social Transformation of American Medicine (New York, 1982).