Intended for healthcare professionals

Views & Reviews Between the Lines

Memories of lunar caustic

BMJ 2011; 342 doi: (Published 27 April 2011) Cite this as: BMJ 2011;342:d2533
  1. Theodore Dalrymple, writer and retired doctor

As every doctor knows, it is one thing to dry out an alcoholic and quite another to get him to stop drinking afterwards. Maybe it isn’t even the doctor’s role to do so: after all, are they their patients’ keepers?

In any case, some alcoholics have so destroyed their lives, and for so long, that they might as well go on. What will they do if they give up drinking? Malcolm Lowry (1909-57), author of Under the Volcano, seemed not to fall into this lamentable category. Strikingly good looking, he was only 47 when he died, a talented and famous author, and might have written many more books.

On the other hand, heavy drinking seems to have been so large a part of his experience of life that he had almost nothing else to write about. He started drinking when he was 14, and never gave up for long. He died having taken too many sleeping pills as well as drink, though whether deliberately or by accident no one knows for certain.

His novella, Lunar Caustic, was first published posthumously in 1963, but he had started writing it in 1937. It recounts his time in Bellevue Hospital in New York, to which he was admitted in 1936, probably in a state of delirium tremens. “Lunar caustic” is another name for silver nitrate used as a cautery or antiseptic; I remember using it early in my career in an attempt to stop persistent epistaxis. Was it his memory of his time in hospital or his alcoholism that he was trying to cauterise with it?

Lowry admitted himself to Bellevue voluntarily, his ward companions being a Jewish refugee and an innocent seeming adolescent boy who had cut the throat of a little girl with a broken bottle. “Gee, it was only a little scratch,” he said when asked why he had done it. No reason is forthcoming. I have known more than a few patients who broke their lover’s jaw or skull with “just a slap.”

The conditions in Bellevue are awful; it is a world of brutality, where the staff bark orders at the patients and therapy consists mainly of intermittent basket weaving. The doctor, Dr Claggart, recognises in Lowry an educated man, not frequently encountered among the patients, and singles him out for philosophical conversation.

According to Lowry, there is little difference between the staff and the patients. It is the world that is mad, not the lunatic. He says to the doctor: “You’re as resigned as your wretched patients, and you not only stand for it, but persistently your technique is to try and adjust them back to the system—just as you might imagine wounded soldiers being patched up to be sent back to fight by surgeons who had been smashed up themselves.”

This is R D Laing avant la lettre: the madman is simply one who has seen clearer and further than the so called sane.

Lowry is discharged from Bellevue, not because he is deemed fit to go but because, as a foreigner, he is not entitled to public assistance. Not that it makes any difference, for within minutes he is back to drinking, never having resolved to stop: “He was elated now, feeling the fire of the whisky.”


Cite this as: BMJ 2011;342:d2533

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