The doctors’ views on alcohol as medicine
In August 1917, the general secretary of the Norwegian Medical Association, the temperance advocate Rasmus Hansson (1859 – 1934), who was also co-editor of the association’s journal, wrote that there were «very few indications to prescribe spirits for medical use»
(7), and in another article in November of the same year he added that everybody would have to agree that the benefits of alcohol for curing diseases had constantly declined in importance (8).
It was not that simple, however. Norwegian doctors were concerned with issues associated with alcohol as a medicinal drug, and many attached decisive importance to people’s belief in the salutary effects of alcohol. In Norwegian medical journals, the abuse of alcohol and its effects were not on the agenda, unlike in the United States, where the doctors collaborated more closely with the temperance movement. The Norwegian medical community appears to have adhered to the notion of alcohol as a suitable form of medication for a longer period of time than in many other countries (
(4), p. 58; (5), p. 121).
In the autumn of 1917, Director of Health Michael Holmboe (1852 – 1918) endorsed a recently commissioned statement from Edvard Poulsson (1858 – 1935), Professor of Pharmacology, on the use of alcohol as medicine
(9). The professor was of the opinion that alcohol could occasionally be useful as a nutrient in case of diseases involving digestive problems. In case of serious forms of diabetes «alcohol is very valuable, both as a nutrient and as a means of making the monotonous, fatty diet more tasty.» Alcohol in small doses could also have a positive effect in case of various kinds of anorexia, as an appetite stimulant. Poulsson concluded his statement by saying that doctors were fully legitimate in prescribing «the accustomed digestive» alcohol to healthy, especially elderly, people who were accustomed to having a dram with their food, preferably with so-called «hearty diets», i.e. fatty, hard-to-digest food. Even this view was endorsed by the Director of Health (9).
Little was mentioned about the negative health effects of alcohol. The journal editor, Rasmus Hansson, and some others with him reacted to this assertion about a dram with food. Hansson referred to modern research, and countered Poulsson’s views. However, the views promoted by Poulsson and Holmboe met with little opposition in medical circles. Naturally enough, most doctors would rather listen to the signals from the Director of Health than to the admonishments from Hansson the temperance advocate.
Norwegian doctors were, however, more divided in their views on the salutary effects of alcohol than may be indicated by the absence of public debate up to this point. This became clear when the Spanish flu struck in the summer of 1918. The pressure put on doctors to prescribe alcohol appears to have increased dramatically over a short period of time. In an editorial on 16 July, the
Aftenposten daily claimed that there was at least one medicine that according to definitive experience would help and protect better than any other – cognac (10).
At the same time, three senior consultants at Ullevål Hospital came forward to warn against the use of cognac, which because of the epidemic was reported to have reached a hitherto «unprecedented use as a medical drug». Lyder Nicolaysen (1866 – 1927), Olaf Scheel (1875 – 1942) and Yngvar Ustvedt (1868 – 1938) were of the opinion that there could be no talk of a preventive effect from cognac. People would be better advised to protect themselves by washing their hands and face before each meal, and avoiding contact with infected persons. They were not as categorical about alcohol as a curative drug, but claimed that any directly positive effect on diseases had never been conclusively proven and remained highly unlikely
The reactions were not long in coming. Carl Stoltenberg (1865 – 1939) found the statement of the three senior consultants to be the right words at the right time. He had recently been visited in his surgery by an elderly gentleman who demanded cognac. Since the doctor, who was neither a temperance advocate, nor an adherent of the prohibition, could see no reason to write a prescription, the man exclaimed: «Would a doctor really endeavour to refuse a patient his cognac?!»
(12). Most of the contributions were negative, however. Dr. Bjarne Eide (1869 – 1929) proclaimed the Ullevål doctors’ statement to be «a presumptuous and arrogant impertinence to the Norwegian medical community» (13). Axel Holst (1860 – 1931), an influential professor of hygiene and bacteriology, pointed out that animal experiments with certain bacteria had proven that cognac might well have a preventive effect. «Why should there be no similar effect on the Spanish infirmity?» he asked (14) (Figure 2). Holst was joined by a number of his colleagues in this view of alcohol, which does not appear to have changed noticeably during the entire prohibition era.
Figure 2: Axel Holst (1860 – 1931) was Professor of Hygiene and Bacteriology at the University of Kristiania and head of the University’s Institute of Hygiene from 1893 to 1930. Holst was a skilful scientist, but was less critical in his views on alcohol as medication. Photo: Ludvig Forbech, University History Photographic Archives, approximately 1900.