IN THE WESTERN WORLD: A HISTORY
article appeared in the June 1998 issue of Scientific American.
Written by Bert L. Vallee, M.D., a Distinguished Senior Professor
at M.I.T., it is a fascinating historical look at the role
alcohol has played. It contains many surprises and puts current
thinking about alcohol into an historical perspective. I have taken the liberty
of editing this article slightly.]
Substances, like people, may have contradictory
aspects to their personality. Today, ethyl alcohol is a
multifaceted entity; it may be social lubricant, sophisticated
dining companion, cardiovascular health benefactor, or agent of
destruction. Throughout most of Western civilizations
history, however, alcohol had a far different role. For most of
the past 10 millennia, alcoholic beverages may have been the most
popular and common daily drink, an indispensable source of fluids
and calories. In a world of contaminated and dangerous water
supplies, alcohol truly earned the title granted it in the Middle
Ages: aqua vitae, the water of life.
The earlier societal relationship with alcohol
is simply unimaginable today. Consider this 1777 statement by
Prussias Frederick the Great, whose economic strategy was
threatened by the importation of coffee: It is disgusting
to notice the increase in the quantity of coffee used by my
subjects, and the amount of money that goes out of the country as
a consequence. Everybody is using coffee; this must be prevented.
His Majesty was brought up on beer, and so were both his
ancestors and officers. Many battles have been fought and won by
soldiers nourished on beer, and the King does not believe that
coffee-drinking soldiers can be relied upon to endure hardships
in case of another war.
Surely a modern leader who urged alcohol
consumption over coffee, especially in the military, would have
his or her mental competence questioned. But only an eyeblink ago
in historical time, a powerful head of government could describe
beer in terms that make it sound like mothers milk. Indeed,
that nurturing role may be the one alcohol played from the
infancy of the West to the advent of safe water supplies for the
masses only within the past century.
Natural processes have no doubt produced
foodstuffs containing alcohol for millions of years. Yeast, in
metabolizing sugar to obtain energy, creates ethyl alcohol as a
by-product of its efforts. Occasionally animals accidentally
consume alcohol that came into being as fruit spoiled
in the natural process of fermentation; inebriated birds and
mammals have been reported. Humans have a gene for the enzyme
alcohol dehydrogenase; the presence of this gene at least forces
the conjecture that over evolutionary time animals have
encountered alcohol enough to have evolved a way to metabolize
it. Ingestion of alcohol, however, was unintentional or haphazard
until some 10,000 years ago.
About that time, some Late Stone Age gourmand
probably tasted the contents of a jar of honey that had been left
unattended longer than usual. Natural fermentation had been given
the opportunity to occur, and the taster, finding the effects of
mild alcohol ingestion provocative, probably replicated the
natural experiment. Comrades and students of this first
oenologist then codified the method for creating such mead or
wines from honey or dates or sap. The technique was fairly
simple: leave the sweet substance alone to ferment.
Beer, which relies on large amounts of starchy
grain, had to wait until the development of agriculture. The
fertile river deltas of Egypt and Mesopotamia (todays Iraq)
produced huge crops of wheat and barley; the diets of peasants,
laborers, and soldiers of these ancient civilization were
cereal-based. It might be viewed as an historical inevitability
that fermented grain would be discovered. As in the instance of
wine, natural experiments probably produced alcoholic substances
that excited those who sampled the results. Before the third
millennium B.C., Egyptians and Babylonians were drinking beers
made from barley and wheat.
Wine, too, would get a boost from agriculture.
Most fruit juice, even wild grape juice, is naturally too low in
sugar to produce wine, but the selection for sweeter grapes
leading to the domestication of particular grape stock eventually
led to viniculture. The practice of growing grape strains
suitable for wine production has been credited to people living
in what is now Armenia, at about 6000 B.C., although such dating
is educated guesswork at best.
The creation of agriculture led to food
surpluses, which in turn led to ever larger groups of people
living in close quarters, in villages or cities. These
municipalities faced a problem that still vexes, namely how to
provide inhabitants with enough clean, pure water to sustain
their constant need for physiological hydration. The solution,
until the 19th century, was nonexistent. The water supply of any
group of people rapidly became polluted with their waste products
and thereby dangerous, even fatal, to drink. How many of our
progenitors died attempting to quench their thirst with water can
never be known. Based on current worldwide crises of dysentery
and infectious disease wrought by unclean water supplies, a safe
bet is that a remarkably large portion of our ancestry succumbed
to tainted water.
In addition, the lack of liquids safe for human
consumption played a part in preventing long-range ocean voyages
until relatively recently. Christopher Columbus made his voyage
with wine on board, and the Pilgrims landed at Plymouth Rock only
because their beer stores had run out. An early order of business
was luring brewmasters to the colonies.
Alcohol versus Water
Evidence arguing against a widespread use of
water for drinking can be found in the Bible and ancient Greek
texts. Both the Old and New Testaments are virtually devoid of
references to water as a common beverage. Likewise, Greek
writings make scant reference to water drinking, with the
exception of positive statements regarding the quality of water
from mountain springs. Hippocrates specifically cited water from
springs and deep wells as safe, as was rainwater collected in
cisterns. The ancients, through what must have been tragic
experience, clearly understood that most of their water supply
was unfit for human consumption.
the context of contaminated water supply, ethyl alcohol may indeed have been
mother’s milk to a nascent Western civilization. Beer and wine were free of
pathogens. And the antiseptic power of alcohol, as well as the natural acidity
of wine and beer, killed many pathogens when the alcoholic drinks were diluted
with the sullied water supply. Dating from the taming and conscious application
of the fermentation process, people of all ages in the West have therefore
consumed beer and wine, not water, as their major daily thirst quenchers.
Babylonian clay tablets more than 6000 years old give beer
recipes, complete with illustrations. The Greek term akratidzomai which came to
mean “to breakfast,” literally translates as “to drink undiluted wine.”
Breakfast apparently could include wine as a bread dip, and “bread and beer”
connoted basic necessity much as does today’s expression “bread and
The experience in the East differed greatly. For at least the
past 2000 years, the practice of boiling water, usually for tea, has created a
potable supply of nonalcoholic beverages. In addition, genetics played an
important role in making Asia avoid alcohol: approximately half of all Asian
people lack an enzyme necessary for complete alcohol metabolism, making the
experience of drinking quite unpleasant. Thus, beer and wine took their place as
staples only in Western societies and remained there until the end of the last
The traditional production of beer and wine by fermentation of
cereals and grapes or other fruits produced beverages with low alcohol content
compared with those familiar to present-day consumers. The beverages also
contained large amounts of acetic acid and other organic acids created during
fermentation. Most wines of ancient times probably would turn a modern
oenophile’s nose; these old-style wines in new bottles would more closely
resemble today’s vinegar with some hints of cider, than a prizewinning Merlot.
As the alcohol content of daily staple drinks was low,
consumers focused on issues of taste, thirst quenching, hunger satisfaction and
storage rather than on intoxication. Nevertheless, the “side effects” of
this constant, low-level intake must have been almost universal. Indeed,
throughout Western history the normal state of mind may have been one of mild
The caloric value of nonperishable alcoholic beverages may
also have played a significant role in meeting the daily energy requirements of
societies that might have faced food shortages. In addition, they provided
essential micro nutrients, such as vitamins and minerals.
Alcohol also served to distract from the fatigue and boredom
of daily life in most cultures, while alleviating pain for which remedies were
nonexistent. Today we have a plethora of handy choices against common aches and
pain. But until this century, the only analgesic generally available in the West
was alcohol. From the Book of Proverbs comes this prescription: “Give strong
drink unto him that is ready to perish, and wine unto them that be of heavy
hearts. Let him drink, and forget his poverty, and remember his misery no
more.” A Sumerian cuneiform tablet of pharmacopoeia dated to about 2100 B.C.
is generally cited as the oldest preserved record of medicinal alcohol, although
Egyptian papyri may have preceded the tablet. Hippocrates’ therapeutic system
featured wines as remedies for almost all known acute or chronic ailments, and
the Alexandria School of Medicine supported the medical use of alcohol.
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 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 a 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, to considerable profit. Throughout the Middle Ages, grain remained
the basic food of peasants and beer their normal beverage, along with mead and
home made 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 and opinion toward beer and wine remained remarkably unchanged. But a
technological development would alter the relationship between alcohol and
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 (http://www.gabarin.com/ayh/alcohol.htm#_ednref23)
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
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 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
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.
More info on
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