Alcohol in \Testern Sfi ld

Theroleof alcoholn 'Western Iization has l

changed dramaticallyduring this 'llennium. Our currentmedicalinterpretatio of alcohol asprimarily an agentof disease mesafter A more complex historical r onsbip
by Bert L. Vallee

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substance, like a person, may have distinct and evenconuadictory aspects its personto ality. Today ethyl alcohol, the drinkable species alcohol, is a multifaceted enof tity; it may be sociallubricant,sophisticated dining companion,cardiovascular health benefactoror agent of destruction. Throughout most of 'Western civilization's histor5 however, alcohol had.a far different role. For most of the past 10 millennia,alcoholic beverages may have beenthe most popular and common daily drinks, indispensable sourcesof fluids and calories.In a world of contaminared and dangerous water supplies,alcohol truly earned the title granted it in the Middle Ages:aqua uitae, the "water of life," Potentevidence exists to open a window into a societal relationship with alcohol that is

simply unimagi ble today. Consider this statement.i in 1777by Prussia's Frederick Great, whose economic strategy s threatened by importation of : "It is disgusting to notice the inc in the quantiry of coffee used by y subjects,and the amount of that goesout of the country as a . Everybody is usingcoffee;this ust be prevented. His Majesty was t up on beer,and so were both his rs and officers. Many battles beenfought and won by soldiersnouri on beer,and the King doesnot beli that coffee-drinking soldiers can relied upon to endure hardshipsin of anotherwar." Surely a leaderwho urged alcohol consumpti over coffee,especially by the militarS ld havehis or her mental questioned. oniy But an eyeblink ago n historical time, a powerful head of t could describe beerin that make it sound like mother'smilk. d indeed,that nurturing role may be one alcoholplayed from the infancy the West to the advent of safewater iesfor the massesonly within the century. Natural have no doubt producedfoodstu containingalcohol for millions of Yeast,in metabolizing sugar to energy, creates

WESTERN CIVILIZATION has

for nourishment and hvdration d 10,000 years. Before the rece "oy pure water, alcoholic beverages may liquids to drink.

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ethyl alcohol as.a bylroduct of its ef- vexes,namerg how to provide inhabiforts. Occasionally animalsaccidentally tants wirh enough.l.;i ;;;;;;;;;i; consumealcohol that came into being sustaintheir coisrani *Ja r". prrfri"_ -

T termenration; ot l:y- -rl"iled" inebriated birds and the 19th century, was nonexistent. The mammals have beenreported.HumanS warer s.upply . o( g.oup of p.oft. have a genefor rhe enzymealcohol de- ' rapidry #;;.;"rd.ir.iili ^ny rt.o *"*. hydrogenase; presence this gene products rhe of ,fi.r.ly a";g;i-";,;; ""a conjecture that 6ver iatal, to drink. How mrnf of ou, pro_ 1]:,Tl l.t*s.the evolutlonary time animals have en_ genitorsdiedanempting quench to their countered alcohol enough to have ihirst with water can n".u.r=u.known. evolved yay to metabolizeit. Inges- Basedon current *oria*ra. crisesof ? tion of alcohol, however,.wasuninien- dysentery and infecdous disease wrought tional.or haphazardfor humans untir by unclean*"t., ,uppr.., ,"f. b.t is som,e 10,000yearsago. rhat a remarkablylarge " of o,.,, About that time' someLate StoneAge ancesrrys,rcc,rmbed fortio" ,Jr"irr"J *"r.r. g?y.T""9probablvtastedthe.ont.nis In aidition, ti,. r".koi-uq"ids safe ot a )ar of honeythat had beenleft un- for humanconsumption prayed part a anendedlongerrhan usual. Narurar fer- in preventing ro"g-;d; J.-Jn uoyig., --hrirropt mentation had beengiven the opporru- uniil relativ"ely i...,itly. ., nity to occur,and rhe rasrer,Fnding the corumbus *, uoi"*.-riirt *i.r. effectsof mild alcohol ingestionpr&o.o., bo"rJ, -"h. ;h; p;#ii, L"a.a ,, ative, probably replicated "rd the.naruralex- plymouth Ro.k ontyi.'.* ih.i, b.., periment' comradesand students this stores had of ,un our. eo ."riy-ora., of first 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 datesor sap.The technique was fairly simple:leavethe sweer Alcohol versus Water substance aloneto terment.
origin and development agricurture: i^g can be iound r'p.ro.ui of oirhe Bible The fertile river deltas-of Egypt and ani ancient Greek te"ts- Both the old Mesopota.mia huge ciops of and New Testaments uiriu"tty d.-produced wheat and barley; the diets of p.rr"ntr, ".. void of ,.f.r..r.., to ;;;.;;, a com_ laborers and soldiersof thesi ancieni mon human beverage. Likewise,Greek civilizations were cereal-based. might writings m"ke sca.ri.eference It to water be viewed as a historical. inevitabiiity drinking, with the.,ot"bt.."..ption of that fermented grain would be discov- positive staremenrs regardingthe qualiered' As in the instanceof wine, natural iy of water f.o.n spri.rgs. probably produced alco- Hippocrates specifically.ir.d -"o.rrrt"i.. *"r.. ;1leri1ents nollc substances arousedthe inter- from springsand deep that wells as safe,as est-of those who sampled the results. *". ,"i.r*"1.r coilected in cisterns.The Before the third millennium n.c-, Egypthrough *il"i h*. "n.i."*, B.ibylonians were driniing beentragic expiie.,..,.t..riy -"ri ur,_ it::: made from 11 " beers barley and wheat. d..rtooi;h;il;:;';#;" too, would get a boost from ter supply was unfit f- h;;"" {/in5, agriculture.Most fruit juice, evenwild consurnption. grape juice, is naturally too low in sugIn this context of contamto produce wine, the selection inated warer ,rpply;;hyi Xr .but for sweetergrapesleadingto the domes_ alcohol i,rd..i- hrrrl tica.tionof particulargrapestock even- been mother's -"y milk to a tually led to viniculture.The practiceof nascenr'western civilizagrowing grapestrainssuitablefor wine tion. Beer and wine were production has beencreditedto people freeof pathoger;. LJ;; living in what is now Armenia, ai"bout antisepiic p&er of alco5000 B.C., althoughsuchdating is edu- hol, ai weli as the natural catedguesswork best. at The creation of agricultufe led to killed many p"thogerrs ._ tood,surpluses, which in turn led to whenthealcoholicdrlnks ever larger groups of people living in were diluted *ith th..,riclose.quarters, vilJages cities. in or These lied water supply.Dating municipalities faced a problem thar still from the t"-;ng .o;l "nd

in the.natural pro..ri :,logicallya."tio". ii.

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scious applicati of the fermentation process, people all agesin the STest have therefore umed beerand wine, not water) as major daily thirst quenchers. Babylonian y tablers more than 6,000years old ive beerrecipes, complete with ill tions. Tlre Greek akratidzomai, w came to mean "to breakfast," li lly translatesas "to drink undiluted wine." Breakfast ap-

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large amounts acetic acid and other organic acids < ted during fermentation. Most wines ancienttimesprobably would turn modernoenophile's nose;thoseold wlnes rn new Dottles would more closelv resemble today's vinegar,wit some hints of cider. than a prizewinni merlot. As the alcohol tent of daily staple drinks was low, nsumersfocusedon issuesof taste.thi quenching,hunger satisfaction and age rather than on the intoxication. Ne rtheless. "side effects" of this nt, lowJevel intake must have been most universal.In'Western history the deed, th normal state of ind may have been one of inebriati alThe caloricva of nonperishable coholic beverages y alsohaveplayed a significant role n meeting the daily energy requi of societies that In might have faced shortages. admicronuessential EGYPTIAN PAINTINGS showalcoholasintegralto the livesof the nobiliry.This detrients,suchas vi mins and minerals. piction of winesbeingblendedis from Amanemhat's Tomb, circa 1400B.C. Alcohol also to distract from the fatigue and bing boredom of parently could includewine as a bread essary completealcohol metabolism, daily life in most Itures,while allevifor dip, and "bread and beer" connotedba- making the experience drinking quite ating pain for of ich remedieswere sic necessity much as does today's ex- unpleasant. Thus, beer and wine took nonexistent, peoplehavea plethT pression"bread and butter." their placeasstaples only in'Westernso- ora of handy cho agalnst common The experiencein the East differed cietiesand remainedthere until the end achesand pain. t until this century. greatly.For at leastthe past 2,000 years, of the last century. the only analgesic ally avallablein the practiceof boiling water, usually for The traditional production of beer the'Westwas a . From the Book tea, hascreateda potablesupply of non- and wine by fermentationof cereals this prescription: and of Proverbs alcoholicbeverages. addition, genet- grapesor other fruits producedbever- "Give strong In unto him that is ics playedan important role in making ages with low alcohol content com- ready to perish, wine unto them Asia avoid alcohol:approximatelyhalf paredwith thosefamiliar to present-day that be of heavy rts. Let him drink. of all Asian peoplelack an enzymenec- consumers. The beverages contained and forget his also rty, and remember

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INEBRIATED REVELERShave accompanied presence the of banquet after too much wine. Although alcoholic beverages millennia. This painting from Khety's and is, an unsafepractice,drinking any for Tomb,circa21008.C.,shows guests beingcarried awayfrom a yearsagowasprobably a much riskierr 64 ScrrNrrrrc Ar'lrnrcaH lune1998

was, to excess

tiry of water4,100 taking.

in the \YesternWorld

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I his misery no more.' A SumeriancuneFor nearly 1,300 years the Church tionship betweenllcohol and humanity. -:: 1':r iform tablet of a pharmacopoeia dated .. operatedthe biggestand bestvineyards, After perhaps9f000 yearsof experito about 2100 B.C. generallycited as -go considerableprofit. Throughout the ence drinking relEtively low alcohol is the oldestpreserved record of medicinal Middle Ages,grain remainedthe basic mead, beer and pine, the rffest was alcohol,althoughEgyptianpapyri may food of peasants and beertheir normal facedwith alcohol in a highly concen'beverage, havepreceded tablet. Hippocrates' the along with mead and home- trated form, than(s to distillation.Detherapeutic system featured wines .as made wines or ciders.The fewEltics of velopedin about 4.D. 700 by Arab alremediesfor almost all acuteor chronic alcohol consumptionwere stymiedby chemists(for whqm al kohl signified ailments known'in his time, and the the continuing simplefact of the lack of any material's bas[c essence), distillaAlexandrian School of Medicine sup- safealternatives. Hence.despite transi- tion brought about the first significant ported the medicaluseof alcohol. tions in political ,yrt.-r, reiigionsand changein the modp and magnitudeof ways of life, the West'suseof and opin- human alcohol corisumptionsincethe Religion and Moderation ion toward beerand wine remained re- beginning of WestErncivilization. Almarkably unchanged. But a technologi- though yeasts prodricealcohol, they can beverages ancientsocieties cal development of would alter the rela- tolerate concentratidns only about 16 of T-h. I nrayhavebeenfar lower in alcohol than their current versions,but people of the time were awareof the potentially deleterious behavioraleffects drinkof ing. The call for temperance beganquite early in Hebrew, Greek and Roman culturesand was reiteratedthroughout history.The Old Testament frequently disapprovesof drunkenness, and the proplret Ezra and his successors inte: i: :: gratedwine into everyday Hebrew ritu- *,i*i ,=j., al, perhapspartly to moderateundisci- i:.nti,::ill' i'l': plined drinking custom,thus creatinga rul .- ' t- i :. religiously inspired and controlled form !:,',j:,ii.; .' '.. of prohibition. .,-.i In the New Testament, obviousJesus ly sanctioned alcohol consumption,re- ;' - ,i.r r f: sorting to miracie in the transformation l" tl j: r .' of water to wine, an act that may ac- : ; +' -: ,, knowledgethe goodness alcoholver- i;'=i;i of *i-:Fi. susthe polluted nature of water.His followersconcentrated extending on measuresto balancethe use and abuseof wine but neversupported total prohibition. Saint Paul and other fathers of early Christianitycarriedon suchmoderating attitudes.Rather than castigating wine for its effects sobrierythey on considered a gift from God, both for it = o its medicinalqualitiesand the tranquilizing characteristics that offered relief c from pain ar.rd anxietyof daily life. the = Traditionally,beerhas beenthe drink of thecommonfolk, rvhereas winervas ; resen'edfor the more affluent. Grape }. ; r ': i i wine, however,became availableto the ;i,:tt,,. ..: I average Roman after a cenruryof vineyard expansionthat er.rded about 30 ftiC.rr"{ in B.C., boom driven by greaterprofits for a wine grapes comparedwith grain. Ultirnately, increased the supplydrovepricj.r!:!t o esdown, and the commonRomancould i partakein wine that was virtually free. lf*lL.'t; Roman viniculture declined with the DISTILLATION created alcoholic drinks of unprecedented potency. lThis distillation empireand was inheritedby the Catho- apparatus appeared in Fliercnymus Brunschwig\ Liber de arte dislillandi, the first lic Church and its monasteries, only book published on the subiect, in A.D. 1500. The book featured thes[ claims for disthe institutionswith sufficientresources to tilled alcohol: "It causes good colour in a person. It heals baldnessj... kills lice and a mair.rtain production. fleas....It givesalso couragein a person,and causes him to have a gofd memory."

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Alcohol theWestern in World

Sclrxtrrtc Aurntcerq iune 1998

65

TFIERMOMETER ANALOGY was an attempt by physicianand political figure Benjamin Rushto illustrate effects the of alcohol.Evenafterrealizing that alcohol abuse was a disease, Rush did allow fof the benefits moderate of drinking, seen in the "Temperance" section his chart-. of
ad lfcte,

percent.Fermented beverages therefore B,n, had a naturalmaximum proof. DistillaadP.gt7y, tion circumvents nature'slimit by tak::::' :: :' ':t .. ing advantageof alcohol's 78 degree Nantshmcltq Celsius(I72 degree Fahrenheit) boiling point, compared with 100 degreesC Bccr, for water.Boiling a water-alcohol mixture puts more of the mix's volatile ali .' , r, ., I ,. :4 . - ,'i. -: cohol than its water in the vaoor.Con.tti ,:::..1 .: nffEUffnA}lCf.,,. ,|, ' densing that vapor yieldsliquid wirh a ,' l much higher alcohol levelthan that of yrc!'r. ''.. ',. alrrlsrl. P U Il st. , , .l the startingliquid. , ..1......:: ,..1 :... t rtstttt: The Arab method-the customof abstinencehad not yet been adopted by nddsardBsgn-,, of thc han ;nul, lpccvirb: l$ffil' lTrcmonofthc harxlg Islam-spread to Europe, and distilla_ _-:1- ncin lf aeet-. lthe moming, pu lthg- mgmmg' PuLiDs wtJ Wa-lquarrillirrl bloatednear.tion of wine to producespirits cclmtcft lFishtian -llonilncd cycl, rcd lrtRtrtrBRr llnlamco cYGs lrc mencedon the Continentin about A.D. FATud *^,0, lfi* $lm$, lHortc-Rr.l endfacc.' I cinr. lSorc end sscUed 1100. The venue was the medical schoolat Salerno, Italy, an important o!.Gqr,Atadg,p.alq$-&ling in thchrrdr, and center for the transferof medical and R@4 k thc aoraizi,Sthdlfigl lDfopry,Epiltpsy, tcnriro chemical theory and methods from foi Lifa Asia Minor to the West. Joiningthe trat4doy-tlttlght, Gellovs lMuderi ditional alcoholic drinks of beer and wine, which had low aicohol concentration and posirivenutritional benefit, rvere beverages with sufficientalcohol Ievels cause widespread to the problems still with us today.The era of distilled sidence ofthe plaguethroughoutEurope as recentlyasthe end ofthe 19th centu' spiritshad begun. generated new standards luxury and ry, rivaling plagueinlmassdestrucrion. of Knowledge of distillation gradually increased urbanization.This age witOnly the realizatidn microorganthat spreadfrom Italy ro northern Europe; nessed unprecedented ostentation, glut- ismscaused disease the institution hnd the Alsatian physician Hieronymus tony, self-indulgence and inebriation. of filtered and trea{ed water supplies Brunschwig describedthe processin Europe,apparentlyrelievedto havesur- finally madewater a beverage the in Eafe 1500 in Liber de arte distillandi,the fust vived the pestilence the 14th century, West. Religiousantlalcohol sentiment of printed book on distillation. the time went on what might be described a and potablewater wpuld cornbinewith By as Brunschwigwas a best-selling author, continentwidehnder. Despitethe obvi- one other factor to r{rakeit finally posdistilledalcoholhad earned split per- ous negative its effecs of drunkemess,and sible for a significand percer.rtage the of sonalityas nourishingfood, beneficent despiteattemprsby authoritiesro cur- public to turn away fLom alcohol.-fhat medicineand harmful drug. The wide- tail drinking thepractice conrinued un- other factor was the recognition of alspread drinkingof spirits followedclose- til the beginningof the 17th cenrurS cohol dependence pn illness. as ly on the heels the 14thcenrury's of bouts when nonalcoholic beverages madewith with plague,notablythe BlackDeathof boiled water becamepopular. Coffee, Diseases Alcohol of i347-135 I. Though completely inef- tea and cocoathus beganto break alcofectiveas a cuie for plague,alcohol did hol's monopoly on safery. hroughout 19thcenturythe apthe f make the victim who drank it at leasr In the lSth cenrurya growing reliI plicationof scientific principles to feelmore robust. No other known agent gious antagonism toward alcohol, fu- the practiceof medicineallowed clinicould accomplish eventhat much. The eledlargelyby Quakers and Methodists cal symptoms to be categorizedinto medievalphysician'soptimism related and mosdyin GreatBritain,still lacked diseases might thpn be understood that to spiritsmay be anributedto this abili- real i:ffector popular support. After all, on a rational basis.Alcohol abuservas ry to alleviatepain and enhance mood, the Thames fuver of rhe time was as among the earliest medicalproblemsto effectsthat must haveseemed cuite re- dangerous sourceof drinking water as receivethe attention bf this approach. a ma rka b ledur ing a m edi c a c ri s i sth a t the polluted streams ancientcultures. Two graduatesof thq Edinburgh Coll of saw perhapstwo thirds of Europe'spop- Dysenterycholeraand ryphoid,all us- lege of Medicine, Thomas Trotter of ulationculledin a single generarion. ing filthy water asa vehicle,were maior Britain and BeniaminlRush the colof Economicrecoveryfollowing the sub- killers and would remain so in the I(est oniesand then the U.5., made the 6rst

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ScrrxrlrlcAuenrcnu Iune1998

Alcohol in lhe Western \Yorld

WOMEN'S AUXILIARY of the Kielev ..GoldCure,i. League supported Keeley,s which claimedto cure alcoholismat the : end of the,lastcenrury.Dr LeslieKeeley announced that gold saltseffectively end-ed an alcoholic'scravingsfor drinft. His talentwasin fact marketing. biochemnot istry. The Women'sAuxiiarv mav hive beenresponsible whateveriuccess for KeeIeyhad, astheyprovideda socialsupport network for alcoholics struggling-with their addiction.Keeleydied in 190b, and : i. : his curesoonmet its demise.

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important contributions to the clinical recognitionof alcoholismas a chronic. life-threatening disease. The influenceof moralistic antialcohol Methodism may have driven their clinical research. bui their findingswere nonetheless sound. In an 1813 essayon drunkenness, Tiotter described alcohol abuseas a diseaseand recognized that habitual and prolongedconsumptionof hard liquor causes liver disease,accompanied by jaundice, wasting and mental dysfunction, evident even when the patient is sober.Rush publishedsimilar ideasin America and to greatereffect,as he was broader. Perhaps40 percent of Ameria prominent member of societyand a signer of the Declaration of Independence.His personal fame, behind his correctdiagnosis a societal helped of ill, to createviewpoints that eventuallyculminated in the American Prohibition (1"919-1933). cits associated with full-blown fetal alNineteenth-century studies detailed cohol syndrome;thousandsmore suffer the clinical picture and pathological ba- lesser effecs. Pharmaceutical treatmenrs sis of alcohol abuse,leadingto today's for alcoholism remain impractical and appreciationof it as one of the most im- inadequate, with total abstinencestill portant health problems facing Ameri- the only truly effectiveapproach. ca and the rest of the world. Alcohol Societyand science at the threshare contriburesto 100,000 deaths in this old of new pharmaceuticaland behavcountry annually, making ir the third ioral strategies againstalcoholism,howleadingcauseof preventable mortality ever.As with any other disease, whethin the U.S. (after smoking and condi- er of the individual or rhe sociery, a

new and more

ial to treatment. ical terms,has only and accepted a as oping with the hisal of concentrated having beenmade inuing research on to produce treatmentsbased edgeof the physand of addictive

t of history is
time, as trapped The mores, traditions and atritudeso an era inform the individuals then livi often blinding them to the consider of alternatives. Alcohol today is a sr primarily of relaxation, celebre ion and, tragically, mass destiuction. To considerit as having beena prima agent for the de,,elopirent of an ent culture may be jolting, even offens to some. Any goodlhysician, holr ver,takesa histoq iy beforeanempring cure.

TheAutbor
BERT L. VALLEE received M.D. from New his ' York Universi in 1943 and held positions ry at the Massachusefts Instituteof Technology beforejoining the faculry of Harvard Medical Sihool in 1945. He is currently that institutiont Edgar M. Bronfman DistinguishedSeniorProfessor. Valleet primary researchhas beenin zinc enzymology,a field he is creditedwith establishins. His wo.k'o.r alcohol dehydrogenase, zinc enzy-me, to his interestin a led the history of alcohol.The author of more than 600 scientificpublications, Valleeis a Fellow of the National Academy of Sciences and holds numerous honorarydegrees professorships. and

Further Reading
DnrNrrNc rN AMERTcA: Hrsrony. Mark E. Lender and A (Macmillanl,1,987. Press H. Jrirnvall,U. Rydberg,L. Terenius and B. L. Vallee.Birkhd land.1994. Tnr Arconor. Dr.HyoRocrNRse Sysrrlr. H. Jrirnvall, O. . q,uist,BaPersson-and Shafqatin Aduancesinbxperimental J. Yol. 372, pages 281-294; 199S. K. Martin. Free by B. Jansson, r Verlag, Switzer-

Tovanoa Morscuran Besrs or.ArcoHor Useerp Arusr.

B. Hielmand Biology,

Kuozu Roor: AN ANcnNr CHtvrss Souncs or Monrnu NTIDIPSOTROPIC Keungand B. L. Vallee phytocbemistry,yol47, No. 4, pages ii }::ry::Y.M. 499-506; February 1998. Parnvrs wrn Arconor pnonrnus.p. G. O'ConnorandR. S.I ld in Near England lournal of Medicine,Vol.338, 9, pages No. 592-402; bruary 26,'1.998.

Alcohol in the Western World

SctrNtrrrc AurnrcnN I Iune 1998