[CANCER RESEARCH 39, 2822-2829, July1979] 0008-5472/79/0039-0000$02.00 A Historical Overview of Alcohol and Alcoholism1

Mark Keller

The Center of Alcohol Studies, Rutgers University. New Brunswick, New Jersey 08903

Abstract primitive vessel or in the hollow of a rock. The sun and the action of invisible devilish creatures which we now call yeasts The product of natural fermentation was discovered by man have spoiled the fruit. They are a thick soupy mess. In modern in prehistoric time and was soon followed by deliberate pro technical terminology they are a mash. But a tired, hungry, duction of wines and beers from sugary and starchy plants. thirsty man returned from an unsuccessful elephas hunt, feeds Primitive alcoholic beverages served as foods, medicines, and incontinently on this mishmash. We can imagine the impact of euphoriants, in religious symbolism and social facilitation. They this fermentative accident. It not only satisfied his hunger and alsocausedsuch recognizedtroublesasdiseases(includingthirst but also made him feel exceptionally good all over: less alcoholism itself), accidents, and quarrels, and they came tired; less achy; and even less disappointed. Maybe even more: under early social regulation, but the benefits sufficiently out maybe he saw wondrous visions and felt full of divine courage weighed the costs that occasional attempts to banish them and demonic derring-do; he could talk back to his carping wife; usually failed. Records of peoples from all over the world reveal and he uttered words which, although not understandable, essentially the same repetitious history up to modern times. sounded inspired and portentous. Distillation provided a more potent intoxicant, a more efficient Perhaps this imaginative depiction of the discovery of alco anesthetic-euphoriant, and more dangerous pathogen; this in hol, the effect of natural fermentation of sugary plants, is more tensified but did not essentially change the problems surround poetry than history. It constricts too much into a single event. ing alcohol. A further intensification of problems occurred with It is safe to infer, however, that man discovered alcoholic industrialization and with frontier conditions in America. This beverages in prehistoric times. Primitive people were inventive. led to the growth of an organized political antialcohol movement It is likely that they advanced rapidly from depending on acci and to prohibition. As in several other countries, prohibition dent to deliberate manufacture of this magical drink-food that failed in America when large segments of the population per relieved fatigue, assuaged pain, evoked gaiety, enhanced bray sisted in resorting to illegal supplies of alcohol. The repeal of ery, promoted friendship, and even facilitated communion with prohibition was followed by new recognition of the scope of the invisible spirits that seemed to control mankind's fate. alcoholism and its associated diseases, including alcoholic Paleobotanists are uncertain about which plant the primitive encephalopathies, liver cirrhosis, a fetal alcohol syndrome, and gatherers first deliberately cultivated in starting the agricultural cancer of the aerodigestive tract. To enlist science in newer stage. It is likely that that first plant was Vitis, the ubiquitous attempts to cope with the problems of alcohol misuse, a multi grapevine, for its fruit could be eaten fresh, as grapes, and disciplinary Center of Alcohol Studies with a systematization of preserved, as raisins, and with little effort could be converted the knowledge about alcohol was founded; a National Institute into that heart-rejoicing drink of magical properties and po on Alcohol Abuse and Alcoholism as well as additional centers tency. The memory of this fateful event is apparently preserved specializing in research on alcohol have been established; and in the Biblical record of the flood-hero who, when he began to public health educational efforts aiming at prevention have be a farmer, first planted a vineyard.2 been launched. Few preliterate people failed to discover or learn how to produce wine or beer from fruits, berries, flowers, cactuses, This overview of the history of the use, misuse, and effects tree saps, honey, milk, and every sort of tuber and grain. In the of alcohol requires an exposition of some 50,000 years of case of starchy vegetation, the most primitive agriculturists history in less than 50 minutes. It is appropriate to begin, then, discovered how to convert the starch to fermentable sugar by with the paraphrase of a famous brief statement: adding the necessary zymase from their saliva. How gratifying In the beginning there was alcohol. early man found his wines and beers may be inferred from the It is hard to understand why the human liver should be fact, certified by the instructive myths and legends, that these endowed with enough alcohol dehydrogenase, the enzyme that drinks were not consumed without a price in troubles, and that catalyzes the first step in the oxidation of alcohol and does not they very quickly became the object of important social regu seem to have very much else to do, to metabolize a quart of lation. From the very beginning alcohol was a double-dealer whisky a day unless alcohol was amply present in the dietary with man. Yet, with few exceptions, man has preferred to pay of man, or of his ancestors, in remote evolutionary time. From the price. this suggestion, we must leap over eons to a period when homo The values that came to inhere in alcoholic beverages are is sapient, living in what the paleohistorians call the gathering evidenced by the multiplicity of customs and regulations that stage, but does not yet have alcohol. By chance, some fruits or developed around their production and use as reported from berries, quite possibly grapes, have been left unattended in a hundreds of preliterate societies (2, 15, 27, 43). They tended to become central in all significant personal and social occa @ Presented at the Alcohol and Cancer Workshop, October 23 and 24, 1978, sions: in religious ritual; in all rites of passage from birth to Bethesda, Md. A portion of this article is revised from Chapter 1 in W. Filstead, J. Rossi, and M. Keller (eds.), Alcohol and Alcohol Problems: New Thinking and New Directions. Boston: Ballinger, 1976. 2 Genesis 9:20.

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Downloaded from cancerres.aacrjournals.org on September 25, 2021. © 1979 American Association for Cancer Research. Historical Overview of Alcohol and Alcoholism initiation to marriage to funeral; in all public happenings; in of the hypochondrium, delirium, and incoherent speech. That compacts, feasts, conclaves, crownings, warmaking , and clinical picture should not seem unfamiliar to present-day phy peacemaking; in hospitality, magic, and medicine. sicians. The ancients were familiar with alcoholism and with its Archaeological records of the earliest civilizations, murals, effects. wall paintings, and vessels from all over the world, provide a Nor was alcoholism among the ancients strictly a masculine continuous line of evidence of the universality and importance phenomenon. More than 3000 years ago in Israel, when the of these beverages. The earliest written records are equally Priest Eli saw the gentlewoman Hannah leaning against the informative. There are the laws of the famous first recorded wall of the tabernacle and moving her lips without sound, he code by the Chaldaean King Hammurabi (14), the clay tablet mistook her for a hallucinating drunkard, showed no surprise, prescriptions of the Sumerian physicians (22), and later the but urged her to give up drink.5 The Greek Anthology tells this medical papyri of the Egyptians (25) and the cuneiform epics story (35) of the lady Bacchylis, unsympathetically character of the pre-Biblical northern Canaanites of Ugarit (13). The ized as ‘‘thespongeof Bacchic cups,' ‘whowhen she fell sick evidence in the classical literature is voluminous; the Hebrew made this vow: ‘‘IfIescape from the wave of this pernicious Bible is only one source. The Greeks and Romans too have left fever, then for the time of a hundred suns I will drink only fresh us a rich literary heritage (30, 31), and there is no lack of spring water and avoid Bacchus and wine. ‘‘But‘‘whenshe reference in the Vedas of India (36). What is important to bear was quit of her illness, on the very first day, she devised this in mind is the evidence not only of ubiquitous production, use, dodge: She took a sieve, and looking through its close meshes, and appreciation but also of trouble. saw even more than a hundred suns.― A tendency that keeps cropping up naively in the writings of What modern writer has more pithily described an alcoholic any period is to blame the alcohol-related troubles on ‘‘mod than with the epithet, ‘‘spongeofBacchic cups' ‘?(Aswhat em, ‘‘newlyrisen phenomena. Even the claimed recent bur modern alcoholic, swearing off booze when in distress, has not geoning of alcoholism among women (42) or among adoles in his next need for alcohol quickly found a crafty sieve for the cents (38) is pronounced a new phenomenon. This tendency absolution of his vow?) That was a lady alcoholic; women's betrays those who do not take account of history. All the libation is not a modern phenomenon. records, archaeological and literary, to which I have alluded, Neither is the mortality of drunken pedestrians (3). This is are filled with praises of the goodness and beneficence of the what a Greek orator said at the funeral of a drunkard (26). wondrous potions derived from wines and beers. ‘‘Winewill rejoice the heart of man,‘‘sangthe Biblical poet,3 while the I do not know whether to accuse the wine of Bacchus or the rain of poet of the Odyssey intoned that ‘‘Winesetseven a thoughtful Jupiter. For both jeopardizethe feet. This gravecontainsPolyxenos, man to singing, or sets him to softly laughing, sets him to who, returning from a country feast, fell from a slippery slope. Let every dancing, sometimes it evokes a word that was better unspo toperdreadrainypathsafter dark. ken' ‘(Ref.24, Book 14: pp. 464—466),andequally the poet of Nor is the accident proneness of the drunken anything so the Finnish epic, the Kalevala, praised the ‘‘goodbeer'‘that new as might be supposed from the recent statistic (9) that ‘‘set women to laughing, put men in a good humor, the right eous to making merry, fools to joking' ‘(28).The same litera alcoholics are 16 times more likely than others to die by falling. tures nevertheless recount the evils and illnesses and all sorts When Odysseus' companion Elpenor, ‘‘insearch of cool air, had lain down drunkenly to sleep on the roof of Circe's palace, of malign consequences arising from drinking those same winesandbeers. and when his companions stirred to go, he, hearing the tumult and noise of talking, started suddenly up, and never There is no question about the benefits of alcoholic bever ages that accrued from their use in moderation, and even from thought. . .but blundered straight off the edge of the roof, so established periodic festive bouts of drunkenness, which must that his neckbone was broken. . .and his soul went down to be classified as forms of social drinking, such as the drunken Hades' ‘(Ref.24, Book 10, pp. 554—560). These citations have adumbrated the earliest beginnings and fiestas among South and Central American Indians or the older religious debauches in the Near Eastern early civilizations, the reports of alcohol use, and of the consequences through classical times. There was socially integrative public drinking, Dionysian and Bacchanalian celebrations of the Greeks and Romans, and the festive intoxications of the Chinese and and private drinking for pleasure which was moderate and not Japanese. Along with these benefits, the antique and the apparently harmful. There was ceremonial, religious, and me ancient peoples knew a multitude of evils. It was not from ill dicinal drinking. In short, drinking was widely practiced nearly everywhere in the world, and drink was appreciated as a good, temper or misanthropy that the Proverbist warned: ‘‘Whohath often as a particularly divine blessing, so recognized in the Old woe?. . .who hath babbling? Who hath wounds, without cause? and New Testaments of the religions that have chiefly influ Who hath redness of eyes? They that tarry long at the wine. ‘“ That is an early description in the Bible of both mental and enced Western culture. There were also harmful overdrinking and pathological sequels common enough to attract the re physical illness attributed to excessive drinking. )lippocrates, peated condemnation of potentates, prophets, philosophers, the father of medicine, in describing certain febrile illnesses and physicians. There was alcoholism. The belief that it was noted that they began with heavy drinking (1). One of his alcoholism rests on the numerous evidences that many of those patients, made sick ‘‘bydrinkingand much venery, ‘‘exhibited who were given to gross, repeated, and self-injurious use of rigors, nausea, insomnolency, continued palpitation throughout alcoholic beverages obviously could not help themselves. They the epigastrium, a parched and tense skin, a softish distension wereaddicted.

3 Psalms 104:15.

4 Proverbs 23:29-30. S Samuel I, 1:13—15.

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So-called Western culture is rooted in a grandiose mix of Some brought a sylke lace/Some brought a pyncase,/Some her chiefly 3 cultures: Greek, Hebrew, and Roman. We inherited husbandes gowne,/Some a pyllow of downe/. . And all this shyfte they our alcoholic beverages and our drinking ideologies, along with make/For the good ale sake. much else, from this mix which occurred in the centuries immediately preceding and immediately following the beginning At least some of these women were obviously alcoholics with of the Christian era. We inherited not only drinking and its manifest signs of alcoholic disease. Skelton describes one rewards, but overdrinking and its punishments, and our ways thus: of reacting to the problems, from Christianized Europe. That history forms the backdrop for our history. . . .Lyke tan leather hyded:/She had her so guyded/Betwene the What happened as Christianity established itself in Europe? cup and the walI,/That she was there wythall/Into a palsy fall;/With that her hedshaked,/Andher handsquaked:/Herfaceglystrynglyke Alcoholic drinks were not unknown to the pre-Christian Euro glas;/All foggy fat she was;/She hadalsothe gout/In all her ioyntes peans. They had been making and drinking wine and beer from about;/Her breathwassourandstale/And smelledall of ale. remote times. The new Christian culture did not oppose drink ing. Indeed, some of the religious orders became the skillful Apparently, she had pellagra, an alcoholic encephalopathy manufacturers of the finest beverages. Of course, drunkenness with seizures, beriberi with edema, and probably cirrhosis of was condemned. It was, like gluttony, a sin; but a common sin, the liver with ascites. If she had cancer too, our poet had no everywhere indulged in by all classes. A few striking examples means of detecting it. are worth recalling from the historical record. Drinking, drunkenness, and alcoholism have been described In 12th-century Russia, a moving sermon by St. Basil the thus far from the days of wine and beer. We have arrived at the Great is titled, ‘‘Onhowit is seemly to refrain from drunken century when distillation became established in Europe. From ness' ‘(11). The date is centuries before the advent of vodka; the Elizabethan age, it is interesting to cite the writings of that country did not have to wait to discover its problem, neither Thomas Nashe, a contemporary of Marlowe and Shakespeare. for distillation, nor for industrialization, nor for communization. In his ‘‘PiercePenilesse'‘(33),an entire section is titled ‘‘The Moving westward, ‘‘Theoceancruise of the Viennese,‘‘bythe Complaint of Drunkennes. ‘‘Curiouslycontradicting Skelton, 13th-century satirist Der Freudenleere (17), gives a lively pic Nashe represents the English as a sober people until corrupted ture of bibulous high jinx on an early ship of fools. Nothing has by the Netherlanders. He says that it was in the Holland wars changed for the better in the depiction of ‘‘thehorriblevice of that the English soldiery were beguiled by the Dutch spirits (it drunkenness' ‘bySebastian Franck (12), published in Germany must have been the original gin). Nashe writes: in about 1531 . Franck, a follower of Luther, is by some re garded as a religious preacher and might be suspected of FromGluttonyin meates,let mediscendto supertluitiein drinke:a exaggerating. However, another depiction in the same century, sinne, that euer since we haue mixt our selues with the Low-countries, written in Latin for the learned by a self-proclaimed friend of is countedhonourable:butbeforewe knewtheir lingringwarres,was drink, Vincentius Obsopoeus, is equally informative. His poem heldin the highestdegreeof hatred.. . Now,heis nobodythatcannot on ‘‘theartof drinking' ‘(39)recommends a moderate cup with drinke super nagulum...quaffevpseyfreze cross.. . . He is reputeda one's wife at home. But ‘‘Ifbychance some private care pesauntand a boorethat will not take his licour profoundly.And you disturbs you—you are gloomy. . .there is no more certain rem shallhearea Caualierof the first feather,a princockes.. .frenchifiedin edy for cares than pure wine. ‘‘Asfor intoxication, it ‘‘is his Souldiers sute, stand vppon termes with, Gods wounds, you dis considered a fault, ‘‘butonly ‘‘afrequentfault is worthy of honourme sir, you do me the disgraceif you do not pledge me as reproach; an infrequent one is without blame.‘‘Thispoet, then, muchas I drunketo you. liberal enough to favor an occasional drunken carouse, thus describes the drinking customs of his time: Nashe then describes his famous eight species of drunken ness, including ‘‘Apedrunke' ‘and‘‘Liondrunke' ‘(thatone

No othervice nowso possessesgreathalls.. the leadingmendrip ‘‘flings the pots about the house, calls his Hostesse with constant drunkenness. . . . And what do the common people pursue whore. . .and is apt to quarrel with any man that speaks to but bacchanalia?Thesottishmoblovesfull cups. Drunkennessdoes him' ‘).Hedeclares, ‘‘Allthesespecies, I have seene practised not cease upon the whole globe; every land far and wide is full of in one Company at one sitting.― bibulousmen.. . . Anunnaturaldesireto drinkholdscompletesway.... That Nashe ignored the past and saw the drunkenness of his No one is a good fellow now.. unlesswhen he drinks he can make awaywith a lot of wine.. . . This is the ugly comedyof a bibulouslife. time as a bad habit newly learned from the Hollanders reminds Theatresfull of menmaybe seenplayingit everywhere. us that Sebastian Franck claimed that the Germans had learned the horrible vice of drunkenness from the French. The French, England is hardly different. John Skelton, who died in 1529, too, claimed to have learned it abroad, from the Dutch. Scape has left an entertaining description in verse of Elynour Rum goating is not new either. myng, an alewife whose brew was popular with lower-class As already noted, we have reached the era of distillation. people in the neighborhood of King Henry VIII's Castle None According to the still prevalent tendency to attribute the trou such (40). Her customers are described as bles that people experience with drink to whatever is new in society, distilled spirits were destined to become a scapegoat. all good ale drinkers,/That will nothyngspare,/But drynke tyll they That is why it was necessary to document the universality of stare.... drunkenness, alcoholism, and disease (and there were also all the social distresses accompanying them, which have hardly Skelton reports how some of the women customers been mentioned), all before the era of distillation. paid: Distillation, if it did not create or increase, could intensify

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Downloaded from cancerres.aacrjournals.org on September 25, 2021. © 1979 American Association for Cancer Research. Historical Overview of Alcohol and Alcoholism problems around alcohol. For now instead of beverages con preacher. ‘‘Hesays ‘‘Itsustainedthe sailor and the plowman, taming up to 14% alcohol, but usually less, people could drink the trader and the trapper. By it were lighted the fires of revelry dilute alcohol with strengths of 50% and more. Surely, at the anddevotion.‘‘Fewdoubteditwasa boontomankind.Sothe very least, it had become easier to become drunk and likelier rum trade flourished along with the slave trade. Later whisky to irritate delicate tissues or absorb invisible pathogens. from native grains was to replace the rum made from imported With what speed the spirit of wine conquered most of Europe! molasses. It is a testimonial to man's eager willingness or need to medi In the early colonial days, drunkenness was condemned cate himself with this drug. People must have wanted a faster, because it was an abuse of the ‘‘GoodCreatureof God' ‘(5), easier, and more potent alcoholic effect. It was inevitable that the good creature being not the drinker but the drink. magical-beneficent virtues should be attributed to the newly Reading some of the cases tried in New England, hardly found potion. Indeed, aqua vitae was a more potent medicine, after it was founded, in mid-i 7th century, with repeated con a swifter assuager of pain, a quicker dissipator of cares, a victions of the same persons (6), it is impossible not to be faster facilitator of fun, and a speedier inducer of longed-for reminded of recent cases known as Easter, Driver, and Powell euphoria. In many languages besides Latin, it was called the heard only yesteryear in our high courts. Some of the Puritan

‘‘water of life, ‘‘and in some countries that name still survives defendants convicted of drunkenness were women. The court for the most popular spirits, as in the Danish and Swedish could recognize the helplessness of the confirmed drunkard, akvavit and akkevitt, and, through Gaelic uisge beatha, in that it was dealing with ‘‘asinnrooted in him.‘‘Hardlyanyone English whisky. The Russians took to it as vodka, the little says ‘‘sin'‘nowadays.We apply different labels, such as al water, and clearly they mean the dear little water. coholism, problem drinking, or alcohol dependence syndrome, In England, at least, drunkenness was to become connected and different punishments or treatments to such people; but with distilled spirits, especially gin. On the threshold of the the descriptions of their behavior are remarkably similar as are industrial revolution the publicists depict gin as the instigator the public perceptions of the problem. A speaker before the of all private and public mischiefs, especially as the ruiner of General Association of Connecticut in 1776 declared (5): the lower classes. But it takes no profound research to discover that the alcoholism of the upper classes was merely better Many gross immoralities shockingly abound, which are become so masked and more politely ignored, even as in recent times. fashionablethat in the estimationof many they almostcease to be Besides, the better classes got drunk not on gin but on brandy Vices. Of this kind we may reckon Intemperance. How many wallow in and wine, and gin, invented by foreign devils, was the popular the morethanbestialsin of Drunkenness,andseekeveryOpportunity by the immoderateuse of Strong Drink to deprive themselvesof villain. The conditions are dramatically pictured in such artistic Reason,thatdistinguishingBadgeof Humanity,andreducethemselves works as Hogarth's Gin Lane (10), and Cruikshank's The to a level with the Brutes! Almost beyond Account have been the Bottle, The Drunkard's Children, and The Gin Juggernaut (19). Quantitiesof strong Drinkannuallyconsumedin this Colony;and the English writers of the 18th century blamed the blights of mournfulComplaintsunderthepresentScarcityshowwhata wretched London, the increase of diseases like dropsy and consumption, influence it hath acquired over us. an appalling rate of infant mortality, and a decline of population, on high consumption of gin (32). When the government at Could this be an exaggeration of conditions in America in tempted to put some limit on the gin flood by imposing a duty the year of the Declaration of Independence? But how reminis on imports and a license on sales the result was mob violence. cent it is of Obsopoeus in Germany or Nashe in England It is worth noting that in the depictions of drunkenness of those centuries earlier! Changing only the style of language, how up times there is no lack of women. Most of them are wretched to-date it would sound! paupers or nighthouse girls. Trevelyan (41) found it ‘‘hardto An awe-inspiring mutation was to occur, the Good Creature say whether the men of fashion or the rural gentry were the of God transfigured as the Demon Rum. The transmutation got worst soakers. ‘‘Itis hard to believe that the English ladies its start in the 18th century from the writings of 2 Philadelphi evaded all contamination by the universal custom. ans, the Quaker teacher Anthony Benezet (7) and the foremost It is time to migrate to America. The story of the bringing over physician Benjamin Rush. Both challenged the popular beliefs of alcoholic beverages and of drinking customs from Europe is in the health benefits of spirits. Rush's ‘‘Inquiryinto the Effects familiar. The Pilgrims landed at Plymouth partly because they of Ardent Spirits upon the Human Body and Mind' ‘(37)was were running short of beer on shipboard (8). In colonial times, reprinted in numerous editions well into the 19th century. He the tavern was the center of public life, the place to meet for is not only the first American medical authority on alcoholism business, for trade, or politics. Beer, cider, wine, and spirits but the father of the American public health movement. Those were consumed copiously. They were the popular refreshment who suppose it was the American Medical Association that on all festive occasions: a wedding; a housewarming; a chris discovered in 1956 that alcoholism is a disease should note tening; or the ordination of a clergyman (29). The usual prob that Dr. Rush explicitly referred to habitual drunkenness as a lems appeared. There was drunkenness. It is documented in disease and explicitly called it an addiction. laws, with their basis in old England (4), making it a punishable The influence set in motion by people like Benezet and Rush offense; in sermons condemning it; and in records of punish became a movement under the leadership of men like President ments meted out to named culprits, especially repeaters (6). Timothy Dwight of Yale College and the Reverend Lyman Drunkenness is better reported in Puritan New England than in Beecher. The latter finally denounced not only intemperance the Cavalier South; that may only show who cared more. Krout but any use of alcoholic beverages. He fathered not only Harriet (23) noted that rum not only relieved the sorrowful and dis Beecher Stowe, the reformist author of Uncle Tom's Cabin, but tressed but ‘‘gavecourage to the soldier, endurance to the also the reformist total abstinence movement. Gradually, the traveller, foresight to the statesman, and inspiration to the growing popular movement for voluntary temperance in the use

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Downloaded from cancerres.aacrjournals.org on September 25, 2021. © 1979 American Association for Cancer Research. M. Keller of spirituous liquors was taken over by the teetotalers, with less the land was that people acted as if there would be no more faith in the power of moral suasion and more in the efficacy of alcohol problems. Such a total disregard of history could hardly legislative clout, all history notwithstanding. In their attacks on be believed but that we witnessed it. There was a temporary alcohol, following the lead of Dr. Benjamin Rush, they heavily shortage of drink among those who had not laid up supplies. emphasized disease. Colorful charts of the drinker's roseate There was a reduction in arrests for drunkenness and in nose, flaming brain, decayed stomach, and shriveled liver were admissions to hospitals. Profitable sanitariums specializing in the visual aids at every temperance lecture. They did not alcoholism closed their doors and went out of business. Doc feature cancer or the fetal alcohol syndrome only because they tors stopped seeing alcoholics and stopped recognizing alco had not heard of them. holic diseases. The alcohol problems curve sank precipitously As America spread westward in the 19th century, drinking but immediately started to rise again. There was a demand for expanded simultaneously with the frontier and with industriali liquor and, promptly, a booming illicit business in supplying it. zation. Winkler (45) has detailed the drinking ways, and the Probably a lot less alcohol was consumed, on the average, by troubles engendered by them, of the explorers, soldiers, In the total population during Prohibition than before. But it is dians, trappers, hunters, miners, settlers, and cowboys. ‘‘In likely that much of the amount not drunk was not drunk by dian drinking' ‘wasmerely a pejorative synonym for blitz drink those whose drinking does not give rise to problems, moderate ing, a form of downing alcohol with the purpose and the effect drinkers to whom liquor was not important and who shunned of immediate gross intoxication and riotous bang-bang behav dealing with bootleggers. Still a lot of pressure developed to ior. The antialcohol movement, representing any drinking as have one's bootlegger and to have entree to speakeasies, and the problem, gained adherents. a college sophomore had no status without a flask on his hip. No doubt there were respectable neighborhood taverns with What happened to the obtrusive problems can be seen in benevolent free lunches. The saloon, as a center of all wicked the statistics of alcoholic admissions to hospitals as the years ness including thievery, gambling, prostitution, and political of the Prohibition era lengthened. They rose fairly steadily. chicanery, became the whipping boy of the antialcohol move During the first post-Prohibition decade, nearly every one of ment, which had preempted the title of temperance. In a stead the tens of thousands of alcoholics admitted to such hospitals ily mechanizing environment, industrialists realized the advan as the Psychiatric Division of Bellevue, in New York, had tage of abstinent employees; the temperance cause gained become an alcoholic during Prohibition (18). new sources of support. A natural reaction among many thoughtful people to the By the time of World War I, the antialcohol movement had repeal of prohibition was the fear of increased problems and the most skillful political leadership in its history, represented puzzlement over how they might be brought under control. especially in the Anti-Saloon League. Prohibition won legisla Strong appeals were written recommending the middle way, tive approval in most of the states. A wartime national prohibi with incomparable Sweden inappropriately held up as a model. tion was passed by the Congress. The 18th Amendment to the The new legislation adopted by the majority of states that Constitution was next adopted, followed by the Volstead Act. relegalized alcoholic beverages usually included a noble sen In 1920, the temperance movement celebrated John Barley timental preamble of purpose: to promote temperance. A small corn's funeral, but the corpse refused to play dead. sample of these laws reveals an inconsistent survival of the There was probably more popular support for prohibition need to make concessions to the old temperance cause, es than most of its opponents and denigrators have been willing pecially in restricting the availability of alcohol. Some states to concede. There was much hopeful, if naive, sentiment for thought temperance would be better promoted by a system of putting an end to the evils of the saloon and of alcohol by a private licensed distribution; others preferred a system of state national prohibition. The 18th Amendment had not been sub owned liquor shops. Some laws required that drinks could be mitted to popular referendums. It is doubtful that a popular served only together with food; elsewhere the provision of food national majority favored a total prohibition. The cause of in liquor-dispensing places was forbidden. Some laws required prohibition was lost within an insignificant time of its adoption. that the windows of drinking places by curtained from public Popular defiance again had its way; moonshine, smuggling, view; others required that they be uncurtained. Some laws bootlegging, and corruption flourished. Popular referendums forbade the presence of unescorted women in drinking places; reamended the Constitution and repealed Prohibition in 1933. others only forbade women to drink standing at the bar; seated This history, a bare outline, has been a necessary prolego at a table they might drink as heartily as any upright man. In menon to an important turning point. some respects, all the legislation agreed. The young must be Drunkenness with its accompanying disorders and alcohol barred from buying, and alcoholic beverages must yield reve sm with its associated diseases are not the only problems nues to the government. connected with the misuse of alcohol. Peace-loving churches A small group of thoughtful people had a brilliant idea. warred with each other over whether it is moral to drink, and Drinking and the associated problems had been around a long this sort of problem tears at the roots of a society. School time, and neither legislation nor inculcation of the fear of hellfire children were indoctrinated by legislative direction about the or disease had been effective in preventing or ameliorating evils of drinking, contrary to the customs of their home cultures, them. Were we not in the age of science? Could not the power and that sort of teaching is confusing to children and under of science at last be brought to bear on these problems? mines the educational process. The obtrusive problems that In the mid-i 930's, the Research Council on Problems of society was willing to recognize in some degree were drunken Alcohol was founded to seek funds to support scientific re ness and alcoholism. search on the problems. The members were predominantly A fantastic consequence of prohibition becoming the law of M.D.'s but there were also Ph.D.'s, Sc.D.'s and D.D.'s. The

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Council raised only insignificant amounts but did obtain confidence is now shaken. We could describe in understand $25,000 to support a review of the biological literature on the able terms the forms and some of the costs of particular sorts effects of alcohol on man. An executive was needed, and it of alcohol problems: poverty and crime; morbidity and mortal was for this that E. M. Jellinek (21) was lured away from ity; production losses and traffic accidents; religious conflict; schizophrenia research to alcohol research. and Wet versus Dry propaganda. We did not know and did not The literature review was conducted, beginning in 1939, at pretend to know the cause or causes of alcoholism. We could the New York Academy of Medicine, contiguous to its great and did display a lot of new sophistication in discussing alco library. Anyone who knew E. M. Jellinek could have predicted holism and personality or alcoholism and social conditions. We that the action would not remain confined to biology. Within a knew there were many forms and degrees of misbehavior with year, the problem was where and how to publish the volumi alcohol, and we spoke of inebriety and later problem drinking. nous reports that were beginning to come out. Dr. Howard W. Within this rubric, we included something we called alcoholism, Haggard at the Yale Laboratory of Applied Physiology founded and we were sure there was such a phenomenon, and we were the Quarterly Journal of Studies on Alcohol in 1940; next he sure it is a disease. We chose to emphasize alcoholism and its invited E. M. Jellinek to come to Yale to start what was to treatment because that seemed to be a magic key which, in become the Yale Center and eventually the Rutgers Center of the new era that was beginning, with the added value of the Alcohol Studies. It began with the recruitment of a multidisci popularization of Alcoholics Anonymous, would open doors plinary staff (21). and gain support for broader conceptions about research and Within a few years, the Center of Alcohol Studies had ac education. But we could only hold forth the hope and belief quired a psychologist, a sociologist, a jurisprudent, an educa that, given the chance to study with the skills of mutiple tionist, a documentalist, a psychiatrist, as well as a biometri disciplines, we and a growing cadre of scientists and profes cian. The Center proliferated not only a respected scientific sional colleagues everywhere could solve the fundamental journal but the beginnings of a systematic documentation of questions. Such study, Jellinek predicted, would contribute knowledge about alcohol problems, a summer school of alcohol ‘‘toward the prevention of inebriety' ‘(16). studies, public clinics for the treatment of alcoholics, and a Beginning in the 1950's and increasingly in the 1960's, the program for dealing with alcoholics in industry. It helped form National Institute of Mental Health became a major supporter the first volunteer health organization on alcoholism and the of the Center and of research on a broad spectrum of alcohol first association of educators about alcohol. It had an important problems. In the 1970's, the National Institute on Alcohol role in the legislative establishment ofthe first state commission Abuse and Alcoholism was established. From that Institute, the on alcoholism, which, like the clinics and the industry program, latest pronouncement is that alcohol problems are flourishing was to become a widely adopted and adapted model. It con (34). ducted interesting researches not only in its physiological So much for history. Now, is there a lesson in this history? biochemical laboratories but in law and legislation, in educa If we would believe popular current propaganda, we would tion, in psychology, in treatment, in epidemiology, in sociology, have to conclude that Jellinek's prediction was naive or that in anthropology, and even in police science. It projected to the scientific study is ineffective, for, 35 years later, we are being nation and to the world an image of science in action getting told that about 1 in 10 drinkers in the United States is an ready to solve the problems of alcohol. It called attention to alcoholic. The actual numbers claimed are in the neighborhood and did research in the problems of drinking as well as drun of 9, 10, or more millions which would represent an enormous kenness and alcohol as well as alcoholism. increase in the earlier estimated rates of alcoholism. These It is time to mention the second phenomenon that also recent gross numbers seem to have been derived by a new emerged in the mid-i 930's and burgeoned in the early 1940's, system of statwistics or mythematics. We have yet to develop Alcoholics Anonymous (44). The fame it got not only expanded a reliable epidemiology of alcoholism. There probably are sev its own capacity to help a growing multitude of alcoholics but eral million alcohol addicts among the more than 100 million also helped the Center of Alcohol Studies by reinforcing the drinkers in this country, and that makes a serious public health teaching that alcoholics were not all Skid Row bums and that problem. Moreover, these alcoholics, and some of the several they could be restored to health, family, and society. million heavy drinkers from whose ranks the alcoholics de Two questions need answers now. What was the state of velop, are at risk for all the well-known alcohol-related dis scientific knowledge in the early i 940's, and what did those eases, including increased risk of some forms of cancer. who had the knowledge propose? But a grave social problem also lurks in what may be pro We were confident that we knew a lot about the immediate jected by the concerned health agencies. Evidently, the most physical and psychological effects of various amounts of al common addiction in this country, smoking, has been reduced cohol. We were sure, although we no longer are, that any among some segments of the population since the knowledge amount of alcohol always acts as a depressant. We knew a lot of the malign health consequences of smoking, especially in about the effects of prolonged excessive drinking on health. relation to cancer, has been popularized. Yet at the same time, We could identify most of the alcohol-associated diseases, and in spite of the propaganda being aimed particularly at youth, we could even successfully treat most of them; most, but not smoking has become more prevalent among adolescents. It is all. Today we still do not know the whole truth about Korsakoff's as if what we are saying about smoking has a different effect psychosis or about liver cirrhosis, or how the recently often on different generations in the population. reported alcoholic cardiomyopathy comes about, or what the At the same time, we are confronted with many evidences of role of alcohol is in relation to cancer. We spoke with some an increased incidence of drinking, or at least drinkers, among confidence about the nonheritability of alcoholism, and this adolescents. The reports Qf a greatly increased prevalence of

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alcoholism among adolescents may be exaggerated. More 6. Baird, E. G. The alcohol problem and the law. Ill. The beginnings of the alcoholic-beverage control laws in America. 0. J. Stud. Alcohol, 6: 335— adolescents are drinking and perhaps drinking more often and 383, 1945; 7: 110-162, 1946. in more quantity than formerly. This at least raises the possi 7. [Benezet, Anthony.] The mighty destroyer displayed; in some account of the bility of more alcohol addiction in the future. dreadful havoc made by the mistaken use as well as abuse of distilled spirituous liquors. By a lover of mankind. Philadelphia: Joseph Crukshank, Is there something wrong with the messages about smoking 1774. and drinking? Are they having an adverse effect on youth? In 8. Bradford, W. Of Plymouth Plantation: 1620—1647. In: S. E. Morison (ed), the ‘‘education'‘aboutalcohol, are we falling into a false The American Past Series. New York: Alfred A. Knopf Inc., 1952. 9. Brenner, B. Alcoholism and fatal accidents. Q. J. Stud. Alcohol, 28: 517- propaganda trap by saying that alcohol causes liver cirrhosis, 528, 1967. alcohol causes cardiomyopathy, alcohol causes the fetal al 10. Coffey, T. G. Beer Street: Gin Lane; some views of 18th-century drinking (With 5 illustrations from William Hogarth). Q. J. Stud. Alcohol, 27: 669— cohol syndrome, alcohol causes cancer, when in fact only 692, 1966. gross alcohol intake over a long time is associated with these 11. Efron, V. (translator). Slovo svyatogo velikogo Vassilia o torn, kak podobayet sequels, whereas moderate drinking may be individually and vsderzhatsya of p'yanstva. [The sermon of St. Basil the Great, on how it is seemly to refrain from drunkenness. (Original 12th century).] 0. J. Stud. socially beneficent? Do public health authorities and educators Alcohol, 3: 663-667, 1943. owe to tell people the whole truth? 12. Franck, S. Von dem grewlichen laster der trunckenheyt (On the horrible vice The product of this workshop, after considering the relation of drunkenness). Ulm, Germany, 1531? 13. Gordon, C. H. Ugaritic textbook (Analecta Orientalia, No. 38). Rome: Pon ship of alcohol to health and especially to cancer, might easily tifical Biblical Institute, 1965. be a report solely in terms of adversity; there is ample evidence 14. Harper, R. F. The Code of Hammurabi King of Babylon (Sec. 108—111). of an association between alcohol intake and increased risk of Chicago: University of Chicago Press, 1904. 15. Horton, D. The functions of alcohol in primitive societies; a cross-cultural cancer. A public health institute has a responsibility to formu study. 0. J. Stud. Alcohol. 4: 199—320,1943. late its messages with the same caution that a physician must 16. Jellinek, E. M. Introduction to the curriculum. In: Alcohol, Science and Society, Lecture 1, p. 10. New Haven: Quarterly Journal of Studies on exercise in approaching a patient; first of all to be sure to do Alcohol, 1945. no harm. A public health institute has to determine how much 17. Jellinek, E. M. (translator). Der Wiener Mervart. (The ocean cruise of the alcohol over how much time entails what risks, and to take Viennese), by Der Freudenleere (pseudonym, before 1284). Q. J. Stud. Alcohol, 6: 540-548, 1946. account of and give expression to a holistic perspective. That 18. Jolliffe, N. Alcoholic admissions to Bellevue Hospital. Science, 83: 306— means that it has to take into account and give expression to 309, 1936. all aspects of effects of alcohol use including beneficent health 19. Keller, M. The evils of drunkenness as sketched by George Cruikshank; with @ reproductions of his etchings, The Bottle and The Drunkards Children. effects. No doubt some life spans are curtailed, some through 0. J. Stud. Alcohol, 5: 443-504, 1944. the development of cancer, because of the use of alcohol. Yet 20. Keller, M., (ed). Alcohol and health; second special report to the United States Congress. Chap. 4, Alcohol and Mortality. Rockville, Md.: National the totality of the epidemiological evidence suggests that mod Institute on Alcohol Abuse and Alcoholism, 1974. erate drinkers outlive abstainers as well as heavy drinkers (20). 21. Keller, M. Multidisciplinary perspectives on alcoholism and the need for If that is true, then what is the propriety of public health integration; an historical and prospective note. Q. J. Stud. Alcohol, 36: 133— 147, 1975. messages that would discourage people from drinking at all? 22. Kramer, S. N. From the tablets of Sumer. Chap. 9, pp. 56—60,Medicine:the History does hold valid and valuable lessons, and the reci First Pharmacopoeia. Indian Hills, Conn. : Falcons Wing Press, 1956. tation of the preceding history would be useless if we did not 23. Krout, J. A. The origins of prohibition. New York: Alfred A. Knopf Inc., 1925. 24. Latimer, R. The Odyssey of Homer. New York: Harper & Row, 1965. learn at least 5 things from it: (a), that the drinking of alcoholic 25. Leake, C. 0. The old Egyptian medical papyri. Lawrence: University of beverages is deeply integrated in human, including American, Kansas Press, 1952. society and entails some beneficent as well as harmful personal 26. Leslie, S. (translator). The Greek anthology, Book 7, No. 398. London: Benn, Ltd., 1929. and social consequences; (b), that negative propaganda about 27. Loeb, E. M. Primitive intoxicants. Q. J. Stud. AIc.. 4: 387—398,1943. alcohol, and especially legislative restrictions, do not stop most 28. Lónnrot,E.(compiler). The Kalevala (prose translation by F. P. Magoun. Jr.). Cambridge, Mass: Harvard University Press, 1963. people from drinking and are least effective with those who are 29. McCarthy, A. G., and Douglass, E. M. The historical background. In: Alcohol most endangered, those who are or who are on the way to and Social Responsibility, Chap. 1. New York: Thomas Y. Crowell Co., becoming addicted; (c), that we have yet to learn why some, 1949. 30. McKinlay, A. P. Ancient experience with intoxicating drinks; non-Attic Greek but not most, people drink so much as to harm themselves and states. 0. J. Stud. Alcohol, 10: 289—315,1949. why some of them become addicted, that is, the etiology of 31 . McKinlay, A. P. Roman sobriety in the early empire. Classical Bull., 26: 31— alcoholism; (d), that we have yet to learn how to prevent 36. 1950. 32. Morris, C. Observations on the past growth and present state of London. overdrinking and alcoholism; and (e), that until we learn how to London, 1751. prevent we need to study the adverse consequences of over 33. Nashe, T. Pierce Penilesse his supplication to the Divell (Original 1592). In: R. B. McKerrow (ed), The Works of Thomas Nashe. 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41 . Trevelyan. G. M. English Social History, Vol. 3. London: Longmans. Green. alcohol in preliterate societies. New York: College and University Press, 1944. 1961. 42. United States Senate, Committee on Labor and Public Welfare. Alcohol 44. W[ilsonj, W. The fellowship of Alcoholics Anonymous. In: Alcohol. Science abuse among women; special problems and unmet needs. Hearings, Sep and Society, Lecture 29, pp. 461 -473. New Haven: Quarterly Journal of tember 29. 1976. Washington, D. C.: U. S. Government Printing Office, Studies on Alcohol. 1945. 1976. 45. Winkler, A. M. DrInking on the American frontier. 0. J. Stud. Alcohol, 29: 43. Washburne, C. Primitive drinking, a study of the uses and functions of 413—445, 1968.

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