Sarah W Tracy, Alcoholism in America: from reconstruction to prohibition, Baltimore and London, Johns Hopkins University Press, 2005, pp. xxiii, 357, £32.00, $48.00 (hardback 0-8018-8119-6).

Abstract

With this book, Sarah Tracy has undertaken to revisit a subject that has already attracted considerable scholarly attention. Her main contribution to this vast and ramified historiography consists in a detailed analysis of the various, intricate, and by no means all-powerful processes subsumed under a seemingly straightforward set phrase: “the medicalization of intemperance”. While her “story highlights the failure of the medical profession to discover a specific mechanism that caused alcoholism (other than excessive consumption of ethanol)” (p. xvi) and to undermine definitively the religious approach to drinking, it nevertheless aims to go beyond the mere depiction of the “incomplete medicalization” of inebriety that prevailed at the end of the Progressive Era. In this perspective, Tracy investigates a series of transformations in the attitude towards drinking in the United States, from the second half of the nineteenth century to the passing of the Volstead Act. Instead of focusing solely on the (partly) conflicting views and strategies of medical activists, on the one hand, and temperance organizations, on the other, she favours a comprehensive inquiry into the developments at work at different levels. The investigation starts by highlighting the cultural characteristics of the Gilded Age and the Progressive Era that help to explain the status of alcoholism as the most dreaded peril of the time; then proceeds with an analysis of the competing theories debated within the medical profession, as well as the various kinds of institutions set up to take care of inebriates; and closes with an exploration of the views expressed by the alcoholics themselves on their disease, and the treatment they were subjected to. Three kinds of narratives are therefore intertwined in the fabric of the book. The first thread concentrates on the rising concerns about alcohol consumption, especially as regards the transmission of “inebriate diathesis” from one generation to the other. “The second narrative focuses on physicians' foray into the arena of social reform” (p. 18) with three complementary aims: to convince the public that drinking was too serious a problem to be left to the care of Christian temperance associations; to persuade state legislatures that the money spent on the construction and the running of either “inebriate asylums” or farm colonies (described as the only effective responses to the disease) would be well used; to regulate the trade of the many proprietary drugs against alcoholism advertised all over the country. Finally, the third layer of the story approaches patients' experience of the disease, and institutionalization through the study of their correspondence with physicians, relatives, or the courts, as well as autobiographies published by “reformed alcoholics”. The originality of the book resides precisely in Tracy's ability to build simultaneously on the contribution of the social history of medicine (great attention is paid to evolution in the very terms used by physicians with their underlying connotations), the history of state interventions in a contentious area, and cultural history of popular representations. Perhaps the most interesting aspect of the book is her analysis of the complex mix of medical and moral (i.e. overwhelmingly Christian) considerations that informed the approach to alcoholism over the period: notwithstanding their rationalist ethos, “physicians did not jettison their Judeo-Christian interpretations of behavior, free will, and appropriate social roles”(p. 19). To the point of taking it for granted that physicians' role in helping patients out of alcoholism was, first and foremost, to set the institutional conditions for their “medico-moral recovery”.