PROHIBITION AND THE
PRESCRIPTION OF ALCOHOL
In January, 1919, a bewildered nation woke up to
a hard fact: the eighteenth Constitutional Amendment had just been ratified,
prohibiting the manufacture, sale, transportation, importation, or
exportation (but not possession) of alcoholic products “for beverage purposes”. In one year it would take effect. Those who
could afford it quickly stocked up on booze (this included outgoing President
Woodrow Wilson and incoming President Warren Harding). Those on the lower economic scale
made do with cheaper, sometimes dangerous, substitutes.
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| Poster for popular Prohibition song (Wikipedia) |
Since the Amendment
applied to intoxicating liquors “for beverage purposes”, doctors (and patients)
immediately asked about consuming liquor as a medicine. Wasn’t this permitted? In fact, physicians frequently
prescribed whiskey, wine, or beer for health reasons. Perhaps more important, was not the prohibition of prescribing alcoholic liquors interference in the practice of medicine by Congress?
Congressman Andrew Volstead, chairman of the
Judiciary Committee, headed the drafting of the “Volstead Act”, to create rules
for enforcement of the Amendment. “Intoxicating” beverages were defined as
containing over 0.5% alcohol. Regarding physicians (Sect. 7), they could
prescribe
alcoholic beverages if they believed “that the use of such
liquor...is necessary and will afford relief to [the patient] from some known
ailment”.
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| Andrew Volstead (Wikipedia) |
What did physicians
really think about prescribing alcohol? The AMA sent questionnaires out to
53,900 physicians and received answers from 58%, representing 21.5% of all MDs
in the country. The primary question was whether the respondent considered
whiskey, beer, or wine “a necessary therapeutic agent in the practice of
medicine” (following language in the Volstead Act). For whiskey, 51% said yes, 32%
for wine, and 26% for beer. Whiskey was used most commonly in pneumonia,
influenza, other acute infectious diseases and diseases of old age. Beer was
recommended for lactation, convalescence, debility, etc. Urban MDs prescribed
more alcohol than rural ones. Several commented on seeing adverse effects from
moonshine brews, and many felt that alcohol prescriptions should be placed in
the same category as narcotics, controlled under the Harrison Act.
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| Prescription for whiskey, 1924. "Use as directed" is written (Wikipedia) |
Instead of a survey,
Dr. Charles Rosewater quoted from recent literature. William Osler wrote in his
1906 text: “I should be sorry to give up the use of alcohol in the severer
forms of enteric fever and pneumonia.” Abraham Jacobi, the “father of
pediatrics”, wrote in 1918: “Cases of young children in sepsis would improve
immediately when 3 ounces of whiskey was increased in one day to 12 ounces.” He
also noted that alcohol “need not make you strong, but it makes you feel
strong.” Many other professors advocated alcohol in their writings.
Volstead planned a
“Supplemental Prohibition Bill” to prohibit beer prescriptions and narrow other
alcohol uses. This brought matters to a head. The Prohibition Commissioner in
Washington (under the Treasury Dept) was bombarded with requests from
physicians to prescribe beer. He deferred to the Attorney General, Mitchell
Palmer, who issued the opinion that the Volstead Act did not apply to medicinal
uses, including the prescription of beer. He stated that physicians should
determine what type and what quantity of alcoholic beverage was prescribed.
Then he left office as the new Harding administration moved in.
Volstead, head of the
Judiciary Committee, and the drys, were not to be thwarted. Believing that
non-alcoholic beer would do just as well, they pushed ahead with the
Supplementary Bill. Alcoholic liquors could be prescribed if they did not
exceed 24% alcohol, prescriptions did not exceed 100 per month per doctor or
one pint per 10 day period per patient. Beer was out. The Act (known as the
Willis-Campbell Act) passed by a large majority. A vocal opponent was Senator
Henry Cabot Lodge who fumed over the attack of Congress on the autonomy of the
physician. The press generally seconded him.
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| Budweiser ad for alcohol-free beer (Wikipedia) |
The medical
community’s response also focused on government intrusion. Samuel Lambert, dean
of Columbia University’s medical school and leader of a group of prominent
physicians opposed to the Act, sued Edward Yellowley, Prohibition Director in
New York City, claiming interference with medical practice. The court ruled for
Lambert, saying that since the Act allowed prescription of some alcoholic
beverages, excluding beer was arbitrary and contrary to the sense of the
Volstead Act. In the first appeal the decision was unanimously reversed, the
court deferring to the legislature. The doctors appealed to the U.S. Supreme
Court, but by a 5/4 decision they lost. The decision resembled that of Jacobson v Massachusetts (see last month’s
blog) in that the Court deferred to the legislature, noting that regulating
medicine fell under the “necessary and proper” clause of the Constitution. “There is no right
to practice medicine which is not subordinate to the police power of the
States, and also to the power of Congress to make laws necessary and proper for
carrying into execution the Eighteenth Amendment” is a quote from the Lambert opinion.
Lambert v Yellowley
was the first instance in which congressional legislation regulating medical
practice was enacted in opposition to the medical community. It would
not be the last.
SOURCES:
Appel, Jacob.
“Physicians are not Bootleggers: The Short, Peculiar
Life of the
Medicinal Alcohol Movement.” 2008; Bull
Hist Med.
82: 355.
“The Referendum on
the Use of Alcohol in the Practice of
Medicine: Final Report”. 1922; JAMA 78: 210.
“Lay Comment on Alcohol Resolution”. JAMA 1922, 79:63-4.
Gage, Beverly. “Just What the Doctor Ordered”. Smithsonian
Magazine, April 1, 2005.
Lambert v
Yellowley opinion, found at:
Rosewater,
Charles. “Alcohol as Medicine: Abstracts from the
Writings of Eminent
Authorities” 1919. J Med Soc New
Jersey;
16: 274.
Okrent,
Daniel. Last Call: The Rise and Fall of
Prohibition. 2010;
Scribner.
