History of Medicine

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.

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

Andrew Volstead (Wikipedia)

alcoholic beverages if they believed “that the use of such liquor...is necessary and will afford relief to [the patient] from some known ailment”.

     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.

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. 

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:

     https://www.law.cornell.edu/supremecourt/text/272/581

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.