Alcohol is the oldest and still probably the most widely used drug today. Some consider alcohol as an opponent but many consider it as an ally. Moderate amounts stimulate the mind and relax the muscles, but larger amounts impair coordination and judgment, finally producing coma and death. It is an addictive drug leading to alcoholism. Alcohol is known since antiquity to have some therapeutic value. Opium and alcohol had long been used as analgesics. Greek medicine had employed wine and vinegar in wound care (1). Now we know that alcohol is a good antiseptic. Alcohol has other values in modern medicine such as pain relief, delay labor, raising HDL level, etc. Dr. Sigwart describes a new therapeutic benefit of alcohol in this issue of Heart Views. He injected alcohol in a septal artery of the heart to induce a small basal septal infarction as treatment in patients with symptomatic hypertrophic obstructive cardiomyopathy. Pure alcohol is needed for such injection in vivo. Pure ethanol is a colorless, flammable liquid (boiling point 78.5? C). Ethanol, produced by fermentation as in wine or beer or by synthesis, is a dilute solution and must be concentrated by distillation for making other alcoholic beverages or pure ethanol for injections.

        This article will review the origins of alcohol and its many uses throughout history.


Alcohol in antiquity (2)


       Since antiquity, alcohol-containing beverages played a vital part in the daily lives of ancient people. Beer, from fermented barley, is the earliest known alcoholic drink to man. Beer was an integral part of their religious ceremonies and mythology. Early civilizations found the mood-altering properties of beer supernatural, and the newfound state of intoxication was considered divine. Beer, it was thought, must contain a spirit or god, since drinking the liquid so possessed the spirit of the drinker. Remnants of this belief persist to modern times. We still refer to alcohol and alcoholic beverages as “spirits”.

      “The mouth of a perfectly happy man is filled with beer”, is an ancient Egyptian proverb. Indeed, numerous ancient Egyptian inscriptions and documents show that beer, together with bread, was a daily food. Beer was an important offering to the gods, and was placed in tombs for the afterlife. An inscription in the tomb of Ramses II (c. 1200 B.C.) reads: “And thou shall give me to eat until I am satisfied, and thou shalt give to me beer until I am drunk.”

     The ancient Greeks called beer “zythos”, which was derived from the Egyptian word “zythum”. The Romans brewed and drank “cerevisia”, named after Ceres, the goddess of agriculture. The Romans had a god Dionysus, or Bacchus, the god of wine, who they worshipped in bouts of alcoholic frenzy. The hangover plagued mankind. It was a top medical priority in the days of ancient Egypt. Cabbage juice was the Pharaoh’s remedy. For many hundreds of years we have looked upon this “old wives” tale with amusement. However, recent scientific studies have shown that cabbage juice can chelate some of alcohol’s byproducts after the liver has detoxified it.

      Ancient cultures brewed beer for religious ceremonies as well as for their own enjoyment. Drinking beer was the principal means by which worshippers achieved religious ecstasy. Beer occupied a major role in ancient literary repertoire. For example, the Finnish poetic saga, Kalewala, has 400 verses devoted to beer but only 200 were needed for the creation of the earth. According to the Edda, the great Nordic epic, wine was reserved for the gods, beer belonged to mortals, and mead [an alcoholic drink of fermented honey and water] to inhabitants of the realm of the dead.

     Although beer and brewing was known in many ancient cultures, the oldest proven records of brewing are about 5,500 years old and can be traced to Mesopotamia [ancient Iraq]. A vast repository of cuneiform writings from the area depicts beer and brewing, hence the Mesopotamians are credited with the first beer. The earliest account of barley is found on an ancient Sumerian engraving describing beer making. Beer made people feel “exhilarated, wonderful and blissful.”

     The Royal Cemetery of Ur, one of the most spectacular discoveries in ancient Mesopotamia, contains mid-3rd millennium BC tombs of kings and queens of the city of Ur. One of the tombs belonged to Queen Pu-abi who was buried with her servants. Among the hundreds of gold and silver items found to accompany her to the afterlife was a five-liter silver jar, her daily allotment of barley beer.

     Hammurabi, who decreed the oldest known collection of laws, established a daily beer ration. This ration was dependent on the social standing of the individual. For example, a normal worker received 2 liters, civil servants 3 liters, and administrators and high priests 5 liters per day. In those ancient times beer was not sold, but exchanged for barley. As beer brewing was a household art, it was also women’s work. Hammurabi once ordered a female saloon-keeper drowned for serving low quality beer.

     The importance of beer to early man is highlighted in Gilgamesh, the great Mesopotamian Epic and written in the 3rd millenium B.C. It is the oldest literary epic in the world. Enkidu, the bestial primitive man, “drank seven cups of beer and his spirit loosened and his heart soared. In this condition he washed himself and became a human being.” Thus, Enkidu, the wild-man, evolved from primitive man to “cultured man” after tasting beer.


The archaeology of beer


     Archaelogists have identified the first chemical evidence of beer. An organic residue from inside a pottery vessel dated circa to 3500 to 3100 B.C. found in western Iran, tested positive for oxalate ion. Calcium oxalate is a major component of “beerstone” and settles out on the surfaces of fermentation and storage tanks of barley beer (2).

     In an attempt to trace the spread of agriculture and hence civilization, archaeologists and anthropologists have unearthed and dated pottery. The earliest dates they find forms a spreading pattern from the Middle East outward suggesting an expansion from that point from 10,000 BC to 5,000 BC. Some theorized that the pottery was a means of transmitting grains for transport. But what has intrigued them is that many of the pottery shards appear to have beer residue and were thus used for containing beer, not food. This implies, they say provocatively, that the desire for beer may have been the driving force for our hunter-gatherer ancestors to settle and cultivate grains (2).


Alcohol and the Arabs

      
      “The oldest alcoholic drinks were fermented beverages of relatively low alcohol content, that is, the beers and wines. When the Arabs introduced the then recent science of distilling into Europe in the Middle Ages, the alchemists believed that alcohol was the long-sought elixir of life. Alcohol was therefore held to be a remedy for practically all diseases, as indicated by the term whisky (Gaelic: ‘water of life’)”(3).

    The concept of an elixir or life-giving potion originated from the writings of Jabir ibn Hayyan (8th century AD) and al-Rahzi (9th century AD) and known to the West as Geber and Rhazes respectively (4). They were the most important scientists in the history of chemistry and chemical technology in Islam. Their works exerted a dominating influence on later generations of Muslims and Europeans.

     The most important of the great chemical discoveries in the Middle Ages were alcohol and mineral acids, and the key to finding them was through the process of distillation, which the Arabs developed and mastered. Distillation was one of the most important processes in Islamic chemical technology and was employed for both medicinal preparations and a variety of other technological and industrial uses, including the preparation of acids and the distillation of perfumes, rosewater and essential oils (4).

    Several great Muslim chemists clearly described the distillation of wine using specialized distillation equipment. Al-Rahzi, in his book Kitab al-Asrar (The Book of Secrets) described the process of distillation and the apparatus used. He used distillation to concentrate alcohol, which was then taken as an anesthetic. Al-Kindi (9th century AD), describes distillation and the apparatus in his book, Kitab Kimya’ al-‘itr wa al-Tas-idat (Book of Perfume Chemistry and Distillation). Al-Kindi says: “In the same way, one can distill wine using a water-bath, and it comes out the same color as rosewater.” In Spain, the Arab surgeon Aub al-Qasim al-Zahrawi, (d.1013 AD), known to the West as Albucasis, described the distillation of vinegar in an apparatus similar to that used for rosewater, adding that wine could be distilled in the same way. He described using alcohol as a solvent for drugs. The flammable property of alcohol was noted by Jabir (Geber): “And fire which burns on the mouths of bottles [due to] . . . boiled wine and salt, and similar things with nice characteristics which are thought to be of little use, these are of great significance in these sciences.” The flammable property of alcohol was utilized for various applications in Arabic military and chemical treatises of the 12th and 13th centuries. Many Arabic manuscripts describing the chemical recipe for alcohol eventually found their way into 12th and 13th century European works and attributed to various European authors (4).

     Clearly, the Arabs were the first to distill alcohol and used it for medicinal purposes.

    From the Arab world, knowledge of distillation spread to Europe and European alchemists began experimenting with the distillation of many items, but medicines were still mostly given as infusions or decoctions of single herbs. Arabic writings in Spain began to influence Christian schools of medicine in Italy and France. The 13th century Spanish alchemists, Arnold Villanueva and Raymond Lully, introduced wine spirits, which they called aqua vitae (water of life) as a solvent into European medicine. This later became known as brandy, shortened from the German term for “burnt wine.” Brandy was used as medicine by itself for various diseases and later became popular as a recreational drink as well. In the 16th century, the Swiss physician Paracelsus popularized the use of distilled alcohol as a solvent to prepare tinctures from herbs and chemicals (1).

History of alcohol abuse

     
     The harmful effects of alcohol have been known since ancient times. The first known description of death from alcoholism appears on an ancient Egyptian tomb inscription circa 2800 BC: “His earthly abode (body) was torn and broken by beer. His spirit escaped before it was called by God” (2). Intoxication was known and understood in ancient Egypt. The abuse of beer was discouraged. In the papyrus Sallier, a father tells his son: “Whoever smells beer is repulsive to all; the smell of beer holds people at a distance, it hardens your soul . . . you think it proper to run down a wall and to break through the board gate; the people run away from you . . . If you then talk, so from your mouth comes nonsense” (2).

     Greek literature is full of warnings against intemperance – they were well acquainted with the health and social implications of excessive drinking. Overindulgence was frowned upon in the Jewish religion and although beer was part of Jewish rituals, it was under strict social control because of its ceremonial importance (2). Islam forbids drinking alcohol.

     From the eighth through the tenth centuries A.D., Vikings spread terror throughout the civilized world. In a state of ale-induced “berserk” they raped, burned and pillaged their way through North Africa, Holland, England, Ireland, Wales, France, Germany, and Italy (2). Historians say that the excessive thirst for strong liquors often urged the barbarians to invade wine-producing lands. Interestingly, it has been suggested that the slave revolt against the Romans led by the gladiator Spartacus, a beer-drinking barbarian, might have been due to bad beer (2). Clearly, it seems that drunkenness, in a less civilized state of mankind, was sometimes capable of inciting man to battle, a war, or a revolution.

     From antiquity to the present, alcohol abuse has remained a major problem. Alcohol is the most frequently abused drug throughout the world. Alcohol related injuries are a major cause of morbidity and mortality. Acute alcohol intoxication, which is common in both social drinkers and alcoholics, profoundly impairs cognitive function and motor skills, often while paradoxically enhancing the drinker’s sense of mastery. Other types of fatal accidents including fires, falls, and drowning are caused by drunkenness. In addition, alcohol is implicated in most homicides, many suicides, and domestic violence (5).


Harmful effects of alcohol

       
     The long-term harmful effects of alcohol abuse on the body are also great. Fifty percent of chronic liver disease is caused by alcohol abuse. Alcohol is also associated with many other diseases, including pancreatitis, cardiomyopathy, peripheral neuropathy, dementia and other central nervous system disorders, and the fetal alcohol syndrome. Alcohol abuse is associated with cancers of the alimentary and respiratory tracts and possibly with breast cancer. High amounts of alcohol or long-term ingestion increase insulin resistance, triglyceride levels, blood pressure and all-cause mortality. Binges may result in arrhythmias. Alcoholics have elevated levels of plasma homocysteine, which has been linked to premature vascular disease (5).


Beneficial effects of alcohol


       There is no doubt that when used appropriately, alcohol has many medicinal uses, as mentioned earlier. Beer was used as anesthetic since ancient times and was a common component in ancient prescriptions in Mesopotamian, Egyptian, and Greek medicine (6). Since many recorded ancient prescriptions contain many ingredients, it is often difficult to determine which is the active component. Many powerful drugs must have been administered unintentionally, for the wisdom behind many folk remedies rests on the accumulated weight of empiric experience through the millennia. One of the fascinating finds of medical archaeology is the detection of the antibiotic tetracycline on a thin section of bone from Roman Egypt (6). It is thought that tetracycline was formed in the brewing process as a result of contamination with an airborne streptomycete, and then ingested with the beer (6). Beer, therefore, might have been an unintentional vehicle for the delivery of powerful antibiotics in those early times. Since beer was a fundamental food staple, a constant intake of this antibiotic might have influenced the pattern of bacterial infection. It is possible that the well-known great bacterial resistance to tetracycline today maybe due to bacterial exposure to it since antiquity.
© 2000 Hamad Medical Corporation


References:


References:

1. Porter R. The greatest benefit to mankind: A medical history of humanity from antiquity to the present. London: HarperCollins Publishers, 1997.

2. Nummer BA. The art, science, and history of beer. Food Science and Technology 2020, University of Georgia, USA. http//www.arches.uga.edu/~athbrew

3. Goodman and Gilman: The pharmacological Basis of Therapeutics, 4th edition. London: MacMillan Co., 1970.

4. Al-Hassan AY, Hill DR. Islamic technology. An illustrated history. Paris UNESCO: Cambridge University Press, 1986:133-141.

5. Lieber CS. Medical disorders of alcoholism. N Engl J Med. 1995; 333(16): 1058-1065.

6. Nunn JF. Ancient Egyptian medicine. London:British Museum Press, 1996.