Religion and Moderation
The beverages of ancient societies may have been far lower in alcohol than their current versions, but people of the time were aware of the potentially deleterious behavioral effects of drinking. The call for temperance began quite early in Hebrew, Greek, and Roman cultures and was reiterated throughout history. The Old Testament frequently disapproves of drunkenness, and the prophet Ezra and his successors integrated wine into everyday Hebrew ritual, perhaps partly to moderate undisciplined drinking, thus creating a religiously inspired and controlled form of prohibition.
In the New Testament, Jesus obviously sanctioned alcohol consumption, resorting to a miracle in the transformation of water to wine, an act that may acknowledge the goodness of alcohol versus the polluted nature of water. His followers extended measures to balance the use and abuse of wine, but never supported total prohibition. Saint Paul and other fathers of early Christianity carried on such moderating attitudes. Rather than castigating wine for its effects on sobriety, they considered it a gift from God, both for its medicinal qualities and the tranquilizing characteristics that offered relief from pain and the anxiety of daily life.
Traditionally, beer has been the drink of the common folk, whereas wine was reserved for the more affluent. Grape wine, however, became available to the average Roman after a century of vineyard expansion that ended in about 30 B.C., a boom driven by greater profits for wine grapes compared with grain. Ultimately, the increased supply drove prices down, and the common Roman could partake in wine that was virtually free. Roman viniculture declined with the empire and was inherited by the Catholic Church and its monasteries, the only institutions with sufficient resources to maintain production.
For nearly 1300 years the Church operated the biggest and best vineyards, with considerable profit. Throughout the Middle Ages, grain remained the basic food of peasants and beer their normal beverage, along with mead and homemade wines or ciders. The few critics of alcohol consumption were stymied by the continuing simple fact of the lack of safe alternatives. Hence, despite transitions in political systems, religions, and ways of life, the West’s use of an opinion toward beer and wine remained remarkably unchanged. But a technological development would alter the relationship between alcohol and humanity.
After perhaps 9000 years of experience drinking relatively low alcohol mead, beer and wine, the west was faced with alcohol in a highly concentrated form, thanks to distillation. Developed in about A.D. 700-750 by Arab alchemists (for whom “al kohl” signified any material’s basic essence), distillation brought about the first significant change in the mode and magnitude of human alcohol consumption since the beginning of Western civilization. Although yeasts produce alcohol, they can tolerate concentrations of only about 16 percent. Fermented beverages, therefore, had a natural maximum proof. Distillation circumvents nature’s limit by taking advantage of alcohol’s 78 degree Celsius (172 degrees Fahrenheit) boiling point, compared with 100 degrees C for water (212 degrees F). Boiling a water-alcohol mixture puts more of the mix’s volatile alcohol than its water in the vapor. Condensing the vapor yields liquid with a much higher alcohol level than that of the starting liquid.
The Arab method – the custom of abstinence had not yet been adopted by Islam – spread to Europe, and distillation of wine to produce spirits commenced on the Continent in about A.D. 1100. The venue was the medical school at Salerno, Italy, an important center for the transfer of medical and chemical theory and methods from Asia Minor to the West. Joining the traditional alcoholic drinks of beer and wine, which had low alcohol concentration and positive nutritional benefit, were beverages with sufficient alcohol levels to cause the widespread problems still with us today. The era of distilled spirits had begun.
Knowledge of distillation gradually spread from Arabia to Italy to northern Europe. Alsatian physician Hieronymus Brunschwig described the process in 1500 in Liber de arte distillandi, the first printed book on distillation. Distilled alcohol had already earned its split personality as nourishing food, beneficent medicine, and harmful drug. The widespread drinking of spirits followed closely on the heels of the 14th century’s bouts with plague, notably the Black Death of 1347-1351. Though completely ineffective as a cure for the plague, alcohol did make the victim who drank it at least feel more robust. No other known agent could accomplish even that much. The medieval physician’s optimism related to spirits may be attributed to this ability to alleviate pain and enhance mood, effects that must have seemed quite remarkable during a medical crisis that saw perhaps two-thirds of Europe’s population culled in a single generation.
Economic recovery following the subsidence of the plague throughout Europe led to new standards of luxury and increased urbanization. This age witnessed unprecedented ostentation, gluttony, self-indulgence, and inebriation. Europe, relieved to have survived the pestilence of the 14th century, went on what might be described as a continent-wide bender. Despite the negative effects of drunkenness and attempts by authorities to curtail drinking, the practice continued until the 17th century, when beverages made with boiled water became popular. Coffee, tea, and cocoa thus began to break alcohol’s monopoly on safe beverages.
In the 18th century, a growing religious antagonism toward alcohol-fueled largely by Quakers and Methodists and mostly in Great Britain still lacked real effect or popular support. After all, the Thames River of the time was as dangerous a source of drinking water as the polluted streams of ancient times. Dysentery, cholera and typhoid, all using filthy water as a vehicle, were major killers until the end of the 19th century, rivaling plague in mass destruction.
Only the realization that microorganisms caused disease and the institution of filtered and treated water supplies finally made water a safe beverage in the West. Religious anti-alcohol sentiment and potable water would combine with one other factor to make it finally possible for a significant percentage of the public to turn away from alcohol. That other factor was the recognition of alcohol dependence as an illness.
Diseases of Alcohol
In the 19th century, the application of scientific principles to the practice of medicine allowed clinical symptoms to be categorized into diseases that might then be understood on a rational basis. Alcohol abuse was among the first medical problems approached this way. Two graduates of the Edinburgh College of Medicine, Thomas Trotter of Britain and Benjamin Rush of the colonies and then the U.S., published essays on drunkenness in the early 1800’s. They saw alcoholism as a chronic, life-threatening disease and recognized that habitual and prolonged consumption of hard liquor causes liver disease, accompanied by jaundice, wasting, and mental dysfunction, evident even when the patient was sober. The influence of moralistic anti-alcohol Methodism may have driven their clinical research, but their findings were nonetheless sound.
As a prominent member of society and a signer of the Declaration of Independence, Rush’s writings carried great weight. His personal fame and correct diagnosis of a societal ill helped to create viewpoints that eventually culminated in the American Prohibition (1919-1933).
Nineteenth-century studies detailed the clinical picture and pathological basis of alcohol abuse, leading to today’s appreciation of it as one of the most important health problems facing America and the rest of the world. Alcohol contributes to 100,000 deaths in this country annually, making it the third leading cause of preventable mortality in the U.S. (after smoking and conditions related to poor diet and a sedentary way of life).
The overall alcohol problem is far broader. Some 40% of Americans have been intimately exposed to the effects of alcohol abuse through a family member. And every year some 12,000 children of drinking mothers are robbed of their potential, born with the physical signs and intellectual deficits associated with full-blown fetal alcohol syndrome; thousands more suffer lesser effects.
Society and science are at the threshold of new pharmaceutical and behavioral strategies against alcoholism. In historical terms, it has only just been understood and accepted as a disease; we are still coping with the historically recent arrival of concentrated alcohol. The diagnosis having been made and acknowledged, continued research can be counted on to produce new and more effective treatments based on the growing knowledge of the physiology of alcohol abuse and of addictive substances in general.
Humanity at any moment of history is inevitably caught in that time, as trapped as an insect in amber. The mores, traditions, and attitudes of an era inform the individuals then living, often blinding them to the consideration of alternatives. Alcohol today is a substance primarily of relaxation, celebration, and tragically mass destruction. To consider it as having been a primary agent for the development of an entire culture may be jolting, even offensive to some. Any good physician, however, takes a history before attempting a cure.