20 JUNE 1987, Page 41



Dying for a drink

Myles Hams

There is nothing good to be said for alcohol except that it is enormous fun.

i People complain of the remorse and guilt it produces the next morning but even that can be turned to good account. To do this I recommend the purchase of the Oxford Dictionary of Medicine. It comes in two heavy volumes clad in a menacing and funereal blue, its endpapers the colour of dried blood. The next time you lie broken- ly in bed after a heavy night take down a volume and slowly read. I have been a lifelong hypochondriac and this exercise. has given me some of the most satisfying frights in my life. At the outset I should perhaps mention one disadvantage of this practice. Really comprehensive medical textbooks have Your most worrying symptoms on every Page- This makes it hard to look up a particular disease, because so many chap- ters, tastefully highlighted with sinister eponyms, clamour for the neurotic's atten- tion. Who for instance, could easily pass a description of the Creutzfeldt Jacob syn- drome — not one of Beethoven's lesser known sonatas but a disease that so robs the victim of all movement it is impossible to tell his state of consciousness or even if he is still alive — an affliction that adds new interest to the slight weakness of the ankles you have been experiencing for the past week. It takes about half an hour of reading before a compulsion to check up on your symptoms (we doctors call them signs) Overwhelms you. For this I advise a poor light and a badly cleaned mirror. It makes things look much worse. I will assume you have managed to fight your way past the more exotic descriptions of such things as Kum and Pulseless Disease of Takayasu and are concentrating on the effects of drink. The first thing we will be looking for is Jaundice, a yellowing of the eyeballs. Turn down the lower eyelids. Among the tortuous red vessels of last night's excess You should, if you are lucky, spot a tinge of yellow. It can be a sign that the liver is about to hand in its cards. Back to bed and the Oxford Dictionary. Jaundice is listed in it just below Jackso- nian seizures, the details of which I won't detain you with There are 31 causes, most of them deadly. There is the jaundice of alcoholic liver disease, of pancreatitis acute and chronic, jaundice after blood transfu- sion, in cirrhosis, associated with breast- milk, obstructive, jaundice with or without gall stones; the list ends appropriately at `Jaws — wiring of. By now yours should be so open with horror they will need it.

As you read on, notice how, compared with the sordid details of biliary disease, the horrifying Creutzfeldt Jacob syndrome is becoming almost respectable, even dis- tinguished. Creutzfeldt — one is soon on first name terms with an imaginary afflic- tion — is, you start to feel, the sort of thing a Viennese professor of philosophy might contract after a lifetime's study of Serbo- Croatian manuscripts. But jaundice has a comical almost Irish flavour about it. Each paragraph of the section on alcohol and the liver reeks of priestly admonitions, pious retreats and faint images of Matt Talbot and his wretched hair shirt. Section after section is studded with arresting headings that could easily be used as texts for sermons on temperance. Here we have `Fulminant Hepatic Failure'. 'A disease', reports the Fulminant Hepatic Failure Surveillance Study Unit (inevitably from Boston), 'with a mortality of 80 per cent even in the best hands'. I try to imagine what it would be like to work for such a unit. What would you answer to the question 'Had a nice day at the office dear?' The early signs of FulHer , con- tinues the text — how quickly the Amer- icans lapse into acronyms — 'include euphoria, flapping tremor of the hands, persistent sleeping, incoherent speech and marked confusion. Spiders may be pre- sent.'

Spiders are not, as you might think, the signs of early delirium tremens but skin blemishes with angular arms like spiders' legs. They are formed by dilated, tortuous blood vessels and are common in liver disease. But God has not forgotten the hypochondriac's pleasure. Normal people can have them too; but no more than eight.

Any more and your physician is entitled to treat your denial of alcohol with a very large pinch of salt. Spiders can grow to enormous size but are not to be confused with grog blossoms, those red excrescences I used to see so frequently on the noses of the local farmers during Somerset child- hood, the victims of rough cider in immod- erate quantities.

Fear by now will have blanked your memory, but not enough to remove a recollection of the major signs of the Korsakoff psychosis, essentially a disease of forgetting, but of a very peculiar kind brought on almost exclusively by a truly heroic application of alcohol to the exclu- sion of any other form of food. It results in the victim remembering everything before his illness but being unable to retain new memories, even of the simplest kind. The last case I saw was in a home for the forgetful. He was a middle-aged Irishman in a cheap black suit sitting on a chair between two amiable old dements. They had brought him in like that three years ago, wearing the same suit of clothes.

From under a large peaked cap two puz- zled eyes filled with Irish sentimentality stared at two amnesics dancing to the sound of a loud television. Now and again he would put his huge red hands on his knees as if to rise, forget what it was he was about to do, sigh and sink back. For him the phrase 'my memory fails me' had assumed a cosmic reality.

If you can't afford the £40 or so for the Oxford Medical Dictionary you can always make do with the papers. But they lack the innoculating effect of a good medical text, and as you read them you begin to feel there is something unconvincing, over- stated yet rather squeamish about their reports. Besides, a whole edition might go by without a really frightening anti-alcohol story. However, today I read that women who drink even very moderately increase their chances of developing cancer of the breast by 60 per cent. While another paper reports that the Royal College of Phys- icians in their book A Great and Growing Evil lists, with statistics to prove it, over 30 diseases from cancer of the liver. to high blood pressure which they say are caused by or contributed to by drink. All of them we are told are rapidly increasing.

At this stage I am beginning to recover my courage. In Victorian times, when the only pleasure for the poor was frequent sex and a yearly trip to the seaside, doctors rose in their hundreds to denounce both.

Statistics proved, they thundered, that syphilis was caused by high-speed travel. If this were not so why was it that sailors, commercial travellers, stage-coach and en- gine drivers were so excessively prone to the disease? Experts agreed. The figures


confirmed what they had always thought, that syphilis, a well known cause of mad- ness, was due to a press of air rushing up the unfortunate traveller's nostrils.

Do I still drink? Of course I do. Health is desirable but it can be a trap, a prison door held open by those who want to service our fears. But fear of the effects of drink has never been much of a deterrent, quite the opposite. Lack of control in drinking is the key that opens the door to alcoholism and is something that lies in the victim's che- mistry rather than his soul. Moreover, far fewer people than the temperance lobby would have us believe are so affected as the cases in the Oxford textbook.

In fact for most people alcohol repre- sents a moderate risk to the health which is worth taking. And fear after all is the salt of pleasure. Alcohol does curtail life ex- pectancy, but abstinence curtails enjoy- ment, so the question is really the one that Frederick the Great put to his troops in 1757 when they showed signs of retreating under fire: 'Rascals, would you live for ever?'