I KNOW MY FATHER DIED OF DRINK. I WATCHED HIM.

My father died from chronic alcoholism but I cannot prove it. I cannot prove
that in July 1982, when my father had been in intensive care for three days
and the plug was pulled on his life, alcohol was the cause of his death. I
cannot prove it because nowhere on his death certificate is alcohol even
mentioned.

My father's death is not included in the statistics of alcohol-related
deaths in England and Wales for 1982. In that year, the official number of
alcohol-related deaths in England and Wales was put at the very low figure
of 2,624. Those statistics are not going to put alcoholism very high up on
anybody's agenda, or shock the nation for that matter, but those statistics
are wrong.

Alcohol is no respecter of persons, of internal organs or of bodily
functions. But although research has improved since 1982, and official
statistics have risen, there still exists a web of denial, ignorance and
confusion in assessing the true picture of alcoholism, illness and
mortality. Difficulties in collection of data, collusion between families,
individuals and the medical profession which incorporates the stigma still
associated with the word "alcoholic" are factors in masking the problem's
real nature. If someone dies from alcohol-related causes, it is unlikely to
appear on the death certificate.

The debate within the medical profession - and within society as a whole -
about the effects of alcohol abuse is based on poor understanding fuelled by
inadequate research; an area as murky as the dregs in the bottom of a bottle
of inferior plonk.

How do I know what killed my father? Because I was there. I was there for
years. I brought him his last bottle of strong liquor. He was not eating
then. He could not. He was in terrible physical and mental pain. I witnessed
his physical and mental decline over a period of years as he drank his way
through a minimum of two bottles of Scotch a day. He never mentioned
suicide, but his life was ebbing away pitifully each day. It was not just
the physical disintegration but also the mental degeneration that was so
horrific. His spirit was atrophying.

In the two years before his death, my father's body was bloated, and his
skin a greyish colour. His face was jowly and ill-kempt. His eyes were
bulbous and yellow. He could not walk without extreme pain in his legs. He
smoked, but this was not all to do with smoking. It is known that chronic
alcoholism causes polyneuropathy - tender calf muscles, discomfort in
walking, numbness, weak legs, tingling in feet and hands and can lead to
paralysis of the legs.

His name was William, and he had once, some 30 years before, been a fit and
wiry fitness instructor in the RAF. At the age of 45 he was made redundant,
and dealt with his anxiety and disappointment in life with drink. He moved
the family to a house next door to a pub and when he was not drinking there,
he was brewing up pear wine and consuming it before it had fermented. It was
the kind of stuff you used to get under the counter in the Gorbals.
Moonshine. 100 per cent proof that could also be used as paint stripper.

The violent mood swings, such a consistent pattern in the early years of his
drinking, in the later stages, changed to an all-enveloping depression. As
his body and his mind weakened he withdrew into a space few could penetrate.
He spent most of his last days in a council bungalow, staring into the
middle distance. His memory came and went.

He began to believe that he had fought in the Second World War, when in fact
he had not been old enough to do so. This type of confabulation is
documented. Extreme cases are known as "Korsakoff's Psychosis".

On a hot July day in 1982, my father was found by a friend of the family who
was passing by his home. He was sitting naked and shivering on a kitchen
chair. He had removed all his clothes for they, like every sheet and towel
in the house was covered in a foul bloody liquid, which he was passing from
his bowel and mouth. The family friend recalled the look of abject fear on
my father's eyes as the ambulance took him to hospital.

That was the last time anyone saw him conscious. Soon after arrival at the
hospital his oesophagus ruptured and his stomach erupted. His brain was
monitored in intensive care. It had been severely damaged. He was 56 years
old when he died.

In the Liver Unit of King's College Hospital, it is the nurses who witness
most of the agonising death throes of the alcoholic patients; the foaming at
the mouth in alcohol-induced epileptic fits, the swelling of the brain from
inflammation. If the patient survives then he or she may become one of those
placed in a psychiatric hospital, the so-called "wet brains" who do not know
who they are or where they have come from, and whose brain damage is
irreversible. For those with chronic liver disease who are in physical
agony, a painkiller may not always be administered because death may be
caused by the drug itself.

All death and its details make grim conversation but there is a particular
aura of shame and taboo which surrounds the subject of alcoholic death.
Moreover, the medical terminology used to describe physical states leading
to death shrouds the subject further with clinical objectivity, and removes
the emotional shock from a general public who might wish to avoid hearing
about the gruesome details. The horrific nature of the alcoholic death -
from cerebral atrophy or liver disease for example - is confirmed by Dr
Sarah Jarvis of Alcohol Concern's medical committee. "It is, without doubt,
one of the most unpleasant deaths imaginable," she says. "Of course it is
the hardened alcoholic who ends up in hospital - the hopeless case - and I
think this gives doctors a very distorted view of the whole subject of
alcoholism in our society."

But why is it the case that accurate statistics are so hard to come by? Dr
Peter Anderson of the World Health Organisation says: "There is reticence on
the part of the medical profession to put alcoholism down as a cause. This
is perhaps partly to do with a certain ambivalence in the profession,
because of the way alcohol is used by the profession itself. There is also
the added desire to protect the family afterwards from the associated social
stigma."

Dr Jarvis agrees and says that collusion has meant it is hard to come up
with accurate statistics. Researchers have had to develop systems of
analysis of an epidemiological nature, by looking at the relationship
between drink and ill health or accidents related to alcohol consumption.

"A lot of death certificates are written out in the primary health care
setting where the doctor will have known the family. The truth might strain
the doctor-patient relationship." There may also be financial reasons. Lucy,
is an example of what often happens. Her husband died in a London hospital
at the age of 29. He had fought a battle with drink for nine years.

Lucy accepted he was dying of alcoholism, but it did not appear as the cause
of death. If it had, it may have jeopardised the life insurance which
enabled her to pick up the pieces of her shattered life after his death.

Statistics do matter. 100,000 a year is the figure for smoking-related
deaths. But Drs Jarvis and Anderson agree it is easier to assess
smoking-related illness, and even with changes in attitudes, there is not
the same social stigma associated with smoking oneself to death. Part of the
problem is recognising early signs in the pathology of the patient. Many
illnesses caused by alcohol could have been caused by something else.

Despite the commonly held belief that the consequences of alcohol misuse are
well understood, expert evidence suggests this is not true. Figures vary
between 4,000 and 40,000 deaths per annum in England and Wales. Dr Anderson
quotes a figure of 28,000 deaths (Lord President's Report, Action on Alcohol
Misuse, 1991).

It is these statistics, of course, which when waved in front of Government
Health Departments influence the importance assigned to any particular
health problems.

Since the University of York's Centre for Health Economics report in May
1992, which put the annual alcohol-related mortality rate at between "8,700
and 33,000", there has been no change in the statistical data. But more
recently the Government has proposed, in its Healthier Nation White Paper, a
strategy designed to tackle the whole issue. Alcohol Concern is in the
process of developing a body of work which will help to inform that
strategy. Perhaps the key statistics here are financial. Alcohol misuse
costs British industry an estimated UKP2bn per annum; and alcohol-related
crime costs an estimated UKP50m a year.

It is to be hoped that financial considerations will influence strategy in
such a way that death and alcohol become a more transparent subject. We must
overcome our squeamishness and shame. It is the tragic human consequences of
such illness and death which needs to be revealed if more lives are not to
be wasted.

Checked-by: Don Beck