Alcohol in\Testern Sfi

The role of alcoholln 'Western

changed dramatically during thisOur current medical interpretatioas primarily an agent of disease

A more complex historical r

by Bert L. Vallee

substance, like a person, mayhave distinct and even conua-dictory aspects to its person-

ality. Today ethyl alcohol, the drinkablespecies of alcohol, is a multifaceted en-tity; it may be social lubricant, sophisti-cated dining companion, cardiovascu-lar health benefactor or agent of de-struction. Throughout most of 'Western

civilization's histor5 however, alcoholhad. a far different role. For most of thepast 10 millennia, alcoholic beveragesmay have been the most popular andcommon daily drinks, indispensable

portation of

&

zs

amount ofcountry as a

Majesty was

Many battles

Surely a

mental

sources of fluids and calories. In aworld of contaminared and dan-

gerous water supplies, alcoholtruly earned the title granted

it in the Middle Ages: aquauitae, the "water of life,"

Potent evidence existsto open a window intoa societal relationshipwith alcohol that is scribe beer in

Natural

for millions of

WESTERN CIVILIZATION hasfor nourishment and hvdration d10,000 years. Before the

"oy rece

pure water, alcoholic beverages mayliquids to drink.

ldIization has

'llennium.

of alcoholmes afteronsbip

simply unimagi ble today. Considerthis statement. i in 1777 by Prus-sia's Frederick

notice the inc in the quantiry ofcoffee used by y subjects, and the

that goes out of the. Everybody is

using coffee; this ust be prevented. Hist up on beer, and

so were both his rs and officers.been fought and won

by soldiers nouri on beer, and thethat coffee-drink-King does not beli

ing soldiers can relied upon to en-dure hardships in of another war."

cohol consumptileader who urged al-over coffee, especial-

ly by the militarS ld have his or herquestioned. But oniyn historical time, a

t could de-that make it sound

nomic strategyGreat, whose eco-

s threatened by im-: "It is disgusting to

d indeed, that nur-one alcohol played

the West to the ad-ies for the mass-

an eyeblink agopowerful head of

like mother's milk.turing role may befrom the infancyvent of safe wateres only within the century.

have no doubtproduced foodstu containing alcohol

Yeast, in metabo-lizing sugar to energy, creates

e and beer to thankmost of the past

availability of clean,been the only safe

in the Western World

$,' ethyl alcohol as.a bylroduct of its ef- vexes, namerg how to provide inhabi-forts. Occasionally animals accidentally tants wirh enough.l.;i ;;;;;;;;;i;consume alcohol that came into being - sustain their coisrani *Ja r". prrfri"_T l:y- -rl"iled"

in the.natural pro..ri :,logical lya."tio". ii. .ot,riio.,, ,rr,ritot termenration; inebriated birds and the 19th century, was nonexistent. Themammals have been reported. HumanS . warer s.upply o(

^ny g.oup of p.oft.

have a gene for rhe enzyme alcohol de- ' rapidry #;;.;"rd.ir.iili rt.o *"*.hydrogenase; rhe presence of this gene products

""a ,fi.r.ly a";g;i-";,;;

1]:,Tl l.t*s.the conjecture that 6ver iatal, to drink. How mrnf of ou, pro_

evolutlonary time animals have en_ genitors died anempting to quench theircountered alcohol enough to have ihirst with water can n".u.r=u. known.evolved

? yay to metabolize it. Inges- Based on current *oria*ra. crises oftion of alcohol, however,.was uninien- dysentery and infecdous disease wroughttional.or haphazard for humans untir by unclean *"t., ,uppr..,

" ,"f. b.t is

som,e 10,000 years ago. rhat a remarkably large fortio" of o,.,,About that time' some Late Stone Age ancesrry s,rcc,rmbed ,Jr"irr"J *"r.r.

g?y.T""9probablvtastedthe.ont.nis In aidition, ti,. r".koi-uq"ids safeot a )ar of honey that had been left un- for human consumption prayed a partanended longer rhan usual. Narurar fer- in preventing ro"g-;d; J.-Jn uoyig.,mentation had been given the opporru- uniil relativ"ely i...,itly.

--hrirropt .,nity to occur, and rhe rasrer, Fnding the corumbus

-"h. *, uoi"*.-riirt *i.r.effects of mild alcohol ingestion pr&o.- o., bo"rJ,

"rd ;h; p;#ii, L"a.a ,,ative, probably replicated the.narural ex- plymouth Ro.k ontyi.'.* ih.i, b..,periment' comrades and students of this stores had ,un our. eo ."riy-ora., offirst oenologist then codified the meth- business was luring b..r.n"J,.., to tfib-.od for creating such mead or wines colonies.

from honey or dates or sap. The tech-nique was fairly simple: leave the sweer Alcohol versus Watersubstance alone to terment.

.,"!::.ili;,1,1:5:ffi 'ilff iT,?,T:N;::ffi ;:,:::..?ffi :,';:?il1,-1origin and development of agricurture: i^g can be iound r'p.ro.ui oirhe BibleThe fertile river deltas- of Egypt and ani ancient Greek te"ts- Both the oldMesopota.mia

-produced huge ciops of and New Testaments "..

uiriu"tty d.-wheat and barley; the diets of p.rr"ntr, void of ,.f.r..r.., to ;;;.;;, a com_laborers and soldiers of thesi ancieni mon human beverage. Likewise, Greekcivilizations were cereal-based. It might writings m"ke sca.ri.eference to waterbe viewed as a historical. inevitabiiity drinking, with the.,ot"bt.."..ption ofthat fermented grain would be discov- positive staremenrs regarding the quali-ered' As in the instance of wine, natural iy of water f.o.n

-"o.rrrt"i.. spri.rgs.

;1leri1ents probably produced alco- Hippocrates specifically .ir.d *"r..

nollc substances that aroused the inter- from springs and deep wells as safe, asest- of those who sampled the results. *". ,"i.r*"1.r coilected in cisterns. TheBefore the third millennium n.c-, Egyp- "n.i."*,

through *il"i -"ri

h*.

it::: 11 B.ibylonians were driniing been tragic expiie.,..,.t..riy ur,_

scious applicatiprocess, peoplehave thereforenot water) asquenchers.

Babylonian

major daily thirst

y tablers more than6,000 years old ive beer recipes, com-plete with ill tions. Tlre Greek ak-ratidzomai, w came to mean "tobreakfast," li lly translates as "todrink undiluted wine." Breakfast ap-

of the fermentationall ages in the STestumed beer and wine,

beers made from barley and wheat. "

d..rtooi;h;il;:;';#;"

{/in5, too, would get a boost from ter supply was unfit f- h;;""agriculture. Most fruit juice, even wild consurnption.grape juice, is naturally too low in sug- In this context of contam-

Xr to produce wine,

.but the selection inated warer ,rpply;;hyifor sweeter grapes leading to the domes_ alcohol

-"y i,rd..i- hrrrl

tica.tion of particular grape stock even- been mother's milk to atually led to viniculture. The practice of nascenr 'western

civiliza-growing grape strains suitable for wine tion. Beer and wine wereproduction has been credited to people free of pathoger;. LJ;;living in what is now Armenia, ai"bout antisepiic p&er of alco-5000 B.C., although such dating is edu- hol, ai weli as the naturalcated guesswork at best.

._ The creation of agricultufe led to killed many p"thogerrs

tood,surpluses, which in turn led to whenthealcoholicdrlnksever larger groups of people living in were diluted *ith th..,ri-close.quarters, in vilJages or cities. These lied water supply. Datingmunicipalities faced a problem thar still from the t"-;ng

"nd .o;l

t+ ,.r,

E

N

s

6

eni

o

9

I

z

EGYPTIAN PAINTINGS show alcohol as integral to the lives of the nobiliry. This de-piction of wines being blended is from Amanemhat's Tomb, circa 1400 B.C.

parently could include wine as a breaddip, and "bread and beer" connoted ba-sic necessity much as does today's ex-pression "bread and butter."

The experience in the East differedgreatly. For at least the past 2,000 years,the practice of boiling water, usually fortea, has created a potable supply of non-alcoholic beverages. In addition, genet-ics played an important role in makingAsia avoid alcohol: approximately halfof all Asian people lack an enzyme nec-

essary for complete alcohol metabolism,making the experience of drinking quiteunpleasant. Thus, beer and wine tooktheir place as staples only in'Western so-cieties and remained there until the endof the last century.

The traditional production of beerand wine by fermentation of cereals andgrapes or other fruits produced bever-ages with low alcohol content com-pared with those familiar to present-dayconsumers. The beverages also contained

satisfaction andintoxication. Ne

to distract frombing boredom of

daily life in most Itures, while allevi-ich remedies wereating pain for

nonexistent, T people have a pleth-ora of handy cho agalnst commonaches and pain. t until this century.the only analgesic ally avallable inthe'West was a . From the Book

tion. Most winesably would turn

ancient times prob-modern oenophile's

nose; those old wlnes rn new Dot-tles would moreday's vinegar, wit

closelv resemble to-some hints of cider.

than a prizewinni merlot.As the alcohol

drinks was low,tent of daily staple

nsumers focused onissues of taste. thi quenching, hunger

age rather than onrtheless. the "side ef-

fects" of this nt, lowJevel intakemust have been most universal. In-deed, th 'Western history thenormal state of ind may have beenone of inebriati

The caloric va of nonperishable al-coholic beveragesa significant role

y also have playedn meeting the daily

energy requi of societies thatshortages. In ad-might have faced

essential micronu-trients, such as vi mins and minerals.

large amountsorganic acids <

Alcohol alsothe fatigue and

of Proverbs"Give strong

acetic acid and otherted during fermenta-

this prescription:unto him that iswine unto themready to perish,

that be of heavy rts. Let him drink.and forget his rty, and remember

E

{so

o

z

INEBRIATED REVELERS have accompanied the presence ofalcoholic beverages for millennia. This painting from Khety'sTomb, circa 2100 8.C., shows guests being carried away from a

64 ScrrNrrrrc Ar'lrnrcaH lune 1998

banquet after too much wine. Although to excess was,tiry of water 4,100taking.

and is, an unsafe practice, drinking anyyears ago was probably a much riskier r

in the \Yestern World

j . .

-::1':rhis misery no more.' A Sumerian cune-iform tablet of a pharmacopoeia datedto about 2100 B.C. is generally cited asthe oldest preserved record of medicinalalcohol, although Egyptian papyri mayhave preceded the tablet. Hippocrates'therapeutic system featured wines .asremedies for almost all acute or chronicailments known'in his time, and theAlexandrian School of Medicine sup-ported the medical use of alcohol.

Religion and Moderation

T-h. beverages of ancient societiesI nray have been far lower in alcohol

than their current versions, but peopleof the time were aware of the potential-ly deleterious behavioral effects of drink-ing. The call for temperance began quiteearly in Hebrew, Greek and Romancultures and was reiterated throughouthistory. The Old Testament frequentlydisapproves of drunkenness, and theproplret Ezra and his successors inte-grated wine into everyday Hebrew ritu-al, perhaps partly to moderate undisci-plined drinking custom, thus creating areligiously inspired and controlled formof prohibition.

In the New Testament, Jesus obvious-ly sanctioned alcohol consumption, re-sorting to miracie in the transformationof water to wine, an act that may ac-knowledge the goodness of alcohol ver-sus the polluted nature of water. His fol-lowers concentrated on extending mea-sures to balance the use and abuse ofwine but never supported total prohibi-tion. Saint Paul and other fathers ofearly Christianity carried on such mod-erating attitudes. Rather than castigat-ing wine for its effects on sobriery theyconsidered it a gift from God, both forits medicinal qualities and the tranquil-izing characteristics that offered relieffrom pain ar.rd the anxiety of daily life.

Traditionally, beer has been the drinkof the common folk, rvhereas wine rvasresen'ed for the more affluent. Grapewine, however, became available to theaverage Roman after a cenrury of vine-yard expansion that er.rded in about 30B.C., a boom driven by greater profits forwine grapes compared with grain. Ulti-rnately, the increased supply drove pric-es down, and the common Roman couldpartake in wine that was virtually free.Roman viniculture declined with theempire and was inherited by the Catho-lic Church and its monasteries, the onlyinstitutions with sufficient resources tomair.rtain production.

Alcohol in the Western World

For nearly 1,300 years the Church

.. operated the biggest and best vineyards,-go considerable profit. Throughout theMiddle Ages, grain remained the basicfood of peasants and beer their normal'beverage,

along with mead and home-made wines or ciders. The fewEltics ofalcohol consumption were stymied bythe continuing simple fact of the lack ofsafe alternatives. Hence. despite transi-tions in political ,yrt.-r, reiigions andways of life, the West's use of and opin-ion toward beer and wine remained re-markably unchanged. But a technologi-cal development would alter the rela-

I

tionship between llcohol and humanity.After perhaps 9f000 years of experi-

ence drinking relEtively low alcoholmead, beer and pine, the rffest wasfaced with alcohol in a highly concen-trated form, than(s to distillation. De-veloped in about 4.D. 700 by Arab al-chemists (for whqm al kohl signifiedany material's bas[c essence), distilla-tion brought about the first significantchange in the modp and magnitude ofhuman alcohol corisumption since thebeginning of WestErn civilization. Al-though yeasts prodrice alcohol, they cantolerate concentratidns of only about 16

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DISTILLATION created alcoholic drinks of unprecedented potency. lThis distillationapparatus appeared in Fliercnymus Brunschwig\ Liber de arte dislillandi, the firstbook published on the subiect, in A.D. 1500. The book featured thes[ claims for dis-tilled alcohol: "It causes a good colour in a person. It heals baldness j... kills lice andfleas....It gives also courage in a person, and causes him to have a gofd memory."

Sclrxtrrtc Aurntcerq iune 1998 65

TFIERMOMETER ANALOGY was anattempt by physician and political figureBenjamin Rush to illustrate the effects ofalcohol. Even after realizing that alcoholabuse was a disease, Rush did allow fofthe benefits of moderate drinking, seen inthe "Temperance" section of his chart-.

percent. Fermented beverages thereforehad a natural maximum proof. Distilla-tion circumvents nature's limit by tak-ing advantage of alcohol's 78 degreeCelsius (I72 degree Fahrenheit) boilingpoint, compared with 100 degrees Cfor water. Boiling a water-alcohol mix-ture puts more of the mix's volatile al-cohol than its water in the vaoor. Con-densing that vapor yields l iquid wirh amuch higher alcohol level than that ofthe starting liquid.

The Arab method-the custom of ab-stinence had not yet been adopted byIslam-spread to Europe, and distilla-tion of wine to produce spirits cclm-menced on the Continent in about A.D.1100. The venue was the medicalschool at Salerno, Italy, an importantcenter for the transfer of medical andchemical theory and methods fromAsia Minor to the West. Joining the tra-ditional alcoholic drinks of beer andwine, which had low aicohol concen-tration and posirive nutritional benefit,rvere beverages with sufficient alcoholIevels to cause the widespread problemsstill with us today. The era of distilledspirits had begun.

Knowledge of distillation graduallyspread from Italy ro northern Europe;the Alsatian physician HieronymusBrunschwig described the process in1500 in Liber de arte distillandi, the fustprinted book on distillation. By the timeBrunschwig was a best-selling author,distilled alcohol had earned its split per-sonality as nourishing food, beneficentmedicine and harmful drug. The wide-spread drinking of spirits followed close-ly on the heels of the 14th cenrury's boutswith plague, notably the Black Death ofi347-135 I. Though completely inef-fective as a cuie for plague, alcohol didmake the victim who drank it at leasrfeel more robust. No other known agentcould accomplish even that much. Themedieval physician's optimism relatedto spirits may be anributed to this abili-ry to alleviate pain and enhance mood,effects that must have seemed cuite re-markable dur ing a medical cr is is thatsaw perhaps two thirds of Europe's pop-ulation culled in a single generarion.

Economic recovery following the sub-

66 Scrrxrlrlc Auenrcnu Iune 1998

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sidence ofthe plague throughout Europegenerated new standards of luxury andincreased urbanization. This age wit-nessed unprecedented ostentation, glut-tony, self-indulgence and inebriation.Europe, apparently relieved to have sur-vived the pestilence of the 14th century,went on what might be described as acontinentwide hnder. Despite the obvi-ous negative effecs of drunkemess, anddespite attemprs by authorities ro cur-tail drinking the practice conrinued un-til the beginning of the 17th cenrurSwhen nonalcoholic beverages made withboiled water became popular. Coffee,tea and cocoa thus began to break alco-hol's monopoly on safery.

In the lSth cenrury a growing reli-gious antagonism toward alcohol, fu-eled largely by Quakers and Methodistsand mosdy in Great Britain, still lackedreal i:ffect or popular support. After all,the Thames fuver of rhe time was asdangerous a source of drinking water asthe polluted streams of ancient cultures.Dysentery cholera and ryphoid, all us-ing filthy water as a vehicle, were maiorkillers and would remain so in the I(est

as recently as the end ofthe 19th centu'ry, rivaling plague inl mass destrucrion.

Only the realizatidn that microorgan-isms caused disease hnd the institutionof filtered and trea{ed water suppliesfinally made water a Eafe beverage in theWest. Religious antlalcohol sentimentand potable water wpuld cornbine withone other factor to r{rake it finally pos-sible for a significand percer.rtage of thepublic to turn away fLom alcohol. -fhat

other factor was the recognition of al-cohol dependence as pn illness.

Diseases of Alcohol

f hroughout the 19th century the ap-I plication of scientif ic principles to

the practice of medicine allowed clini-cal symptoms to be categorized intodiseases that might thpn be understoodon a rational basis. Alcohol abuse rvasamong the earliest medical problems toreceive the attention bf this approach.Two graduates of thq Edinburgh Col-lege of Medicine, Thomas Trotter ofBritain and BeniaminlRush of the col-onies and then the U.5., made the 6rst

: : : : ' : : : ' ' : t . .

Nantshmcltq

Gellovs

Alcohol in lhe Western \Yorld

WOMEN'S AUXILIARY of the KielevLeague supported Keeley,s ..Gold Cure,i.which claimed to cure alcoholism at the :end of the,last cenrury. Dr Leslie Keeleyannounced that gold salts effectively end--ed an alcoholic's cravings for drinft. Histalent was in fact marketing. not biochem-istry. The Women's Auxiiarv mav hivebeen responsible for whatever iuccess Kee-Iey had, as- they provided a social supportnetwork for alcoholics struggling-withtheir addiction. Keeley died in 190b, andhis cure soon met its demise.

important contributions to the clinicalrecognition of alcoholism as a chronic.life-threatening disease. The influence ofmoralistic antialcohol Methodism mayhave driven their clinical research. buitheir findings were nonetheless sound.

In an 1813 essay on drunkenness,Tiotter described alcohol abuse as a dis-ease and recognized that habitual andprolonged consumption of hard liquorcauses liver disease, accompanied byjaundice, wasting and mental dysfunc-tion, evident even when the patient issober. Rush published similar ideas inAmerica and to greater effect, as he wasa prominent member of society and asigner of the Declaration of Indepen-dence. His personal fame, behind hiscorrect diagnosis of a societal ill, helpedto create viewpoints that eventually cul-minated in the American Prohibition(1"919-1933).

Nineteenth-century studies detailedthe clinical picture and pathological ba-sis of alcohol abuse, leading to today'sappreciation of it as one of the most im-portant health problems facing Ameri-ca and the rest of the world. Alcoholcontribures to 100,000 deaths in thiscountry annually, making ir the thirdleading cause of preventable mortalityin the U.S. (after smoking and condi-

The Autbor

BERT L. VALLEE received his M.D. from New' York Universi ry in 1943 and held positions at theMassachusefts Institute of Technology before join-ing the faculry of Harvard Medical Sihool in 1945.He is currently that institutiont Edgar M. Bronf-man Distinguished Senior Professor. Valleet prima-ry research has been in zinc enzymology, a field heis credited with establishins. His wo.k'o.r alcoholdehydrogenase, a zinc enzy-me, led to his interest inthe history of alcohol. The author of more than600 scientific publications, Vallee is a Fellow of theNational Academy of Sciences and holds numer-ous honorary degrees and professorships.

: i . :

Ff

ial to treatment.ical terms, has onlyand accepted as a

oping with the his-al of concentratedhaving been made

inuing researchon to produce

broader. Perhaps 40 percent of Ameri- new and more treatments basededge of the phys-and of addictive

t of history istime, as trapped

cits associated with full-blown fetal al- tions and atritudes ocohol syndrome; thousands more suffer individuals then livilesser effecs. Pharmaceutical treatmenrs them to the consider

Yol. 372, pages 281-294; 199 S.

for alcoholism remain impractical and Alcohol today is a srinadequate, with total abstinence still of relaxation, celebrethe only truly effective approach. ly, mass destiuction.

Society and science are at the thresh- having been a primaold of new pharmaceutical and behav- ,,elopirent of an entioral strategies against alcoholism, how- jolting, even offensever.As with any other disease, wheth- goodlhysician, holrer of the individual or rhe sociery, a iy before anempring

H. Jrirnvall, U. Rydberg, L. Terenius and B. L. Vallee. Birkhdland.1994.

Tnr Arconor. Dr.HyoRocrNRse Sysrrlr. H. Jrirnvall, O. .q,uist, BaPersson-and J. Shafqat in Aduances inbxperimental

Further Reading

DnrNrrNc rN AMERTcA: A Hrsrony. Mark E. Lender andPress (Macmillanl, 1,987.

Tovano a Morscuran Besrs or.ArcoHor Use erp Arusr. by B. Jansson,

The mores, tradi-an era inform the

often blindingof alternatives.

primarilyion and, tragical-To consider it asagent for the de-culture may beto some. Any

ver, takes a histo-cure. q

K. Mart in. Free

r Verlag, Switzer-

B. Hielm-and Biology,

NTIDIPSOTROPIC

47, No. 4, pages

ld in Nearbruary 26,'1.998.

Kuozu Roor: AN ANcnNr CHtvrss Souncs or Monrnu}::ry::Y.M. Keung and B. L. Vallee ii phytocbemistry,yol499-506; February 1998.

Parnvrs wrn Arconor pnonrnus. p. G. O'Connor and R. S. IEngland lournal of Medicine,Vol.338, No. 9, pages 592-402;

SctrNtrrrc AurnrcnN I Iune 1 998Alcohol in the Western World