I. COVID-19
The designation of liquor stores as “essential business” with a scarcity of vodka coincident with shelves emptied of hand sanitizer is one of the more fascinating observations of the COVID-19 pandemic. There is more here than simply fodder for a social media joke.
II. LISTERINE
Allow me to make a connection. Anyone who does emergency medicine for any length of time knows that a person desperate to fulfill their craving for alcohol who cannot go to a liquor store, may resort to buying Listerine over the counter and drinking it.
Listerine is an antiseptic mouthwash with 27% alcohol, making it 54 proof (beer is 3-7%; wine is 12%). Listerine has “specially denatured alcohol” qualifying it as a “non-beverage alcohol,” allowing it to be sold over-the-counter without an ID; but it does not deactivate its effects. Hand sanitizer is more than 60% alcohol and is also a “non-beverage alcohol” (and yes I have also seen persons addicted to alcohol drink sanitizer).
Antoine Van Leuwenhook discovered microbiology in 1675, making this discovery perhaps the greatest medical paradigm shift in history. What many people do not know is that one year later, he discovered that vinegar
destroyed some of these “animalicules.” You could say he discovered the first bacterial disinfectant!
Pasteur’s work in understanding the role of bacteria in fermentation and putrefaction (1860) was followed by Joseph Lister’s use of antiseptic (carbolic acid) in surgical settings (1865). Lister publicly praised two men working to modernize surgical practice: Robert Wood Johnson (founder of Johnson & Johnson) and Dr. Joseph Lawrence.
In 1879, Dr. Joseph Lawrence, from St. Louis, MO, created LISTERINE in honor of Dr. Joseph Lister. Listerine was an alcohol-based mouthwash, in addition to being an antiseptic for wounds. In the book Freakonomics, Levitt and Dubner tell us, “Listerine was invented as a surgical antiseptic. It was later sold in its distilled form as both a floor cleaner and a cure for gonorrhea.”
In 1895, it was marketed to dentists for oral care. In 1914, Listerine mouthwash became the first prescription product in the U.S. to be sold over-the-counter, marketed as an oral germ killer. In the 1920’s, the company owning Listerine renamed bad breath “halitosis,” and sales sky-rocket as “halitosis” became a new social disease. From 1921-1970’s, Listerine was marketed as a prevention and remedy for colds (20% of colds are coronaviruses). In 1976, the Federal Trade Commission declared this as false advertising (but may have been true if Listerine had contained more than 60% alcohol?). Listerine reminds us that alcohol that is drunk is not different than alcohol that disinfects.
III. Alcohol as a Disinfectant & Antiseptic
Definition of Terms
- Disinfectant: destroys the cell wall or outer layer of microbes
- Antiseptic: destroys microorganisms on living tissue
- Sterilization: kills all life (“biocide”)
- Sanitizer: a weaker disinfectant that cleans
- Antibiotic: destroys microorganisms inside the body
- Detergent: an agent that cleans by linking water to dirt
Types of Disinfectants
- Alcohols : Ethanol (EtOH); 70 % isopropyl alcohol (“rubbing alcohol”)
- Aldehydes: Formaldyhde (used in embalming)
- Oxidizing Agents: Chlorine (used to sanitize water); Hypochlorite (bleach); Hydrogen Peroxide
- Phenolics: Carbolic acid used by Listerine
- Inorganic compounds: Chlorine, Iodine, (Betadine), sulfur, silver, etc.
- Quaternarium Ammonia Compounds (QAC)
- Other: Acids (vinegar = acetic acid); Bases (alkaline); lye=potassium hydroxide; ammonium hydroxide; terpenes (pine oil, lemon oil); UV light; etc.
“Mr. Smirnoff, Tear Down these Walls”
Stated in a grossly oversimplified way, bacteria (many different kinds) have cell walls that are built with lipid (fat). Viruses also typically have a lipid covering (“envelope”) which protects them. The “slats” of their fatty fence make up the wall and membranes of microbes (bacteria and viruses) and are oriented in such away that the “fence” is held together by electrical forces preventing water from rupturing its integrity. One side of the fence is hydrophilic (loves water) and the other side of the fence is hydrophobic (repels water).
Put very simply, alcohols, like most disinfectants and antiseptics, tear down the cell wall of a bacteria or disrupt the lipid layer of a virus. The alcohol is “amphiphile”
– it loves water and it loves fat. Due to that love for both sides of the wall or membrane, it pulls and breaks the “fence” apart by electrical forces, thereby making alcohol both bactericidal and viracidal.
It is also the fat-loving and water-loving properties of alcohol that allow it to sneak past the very difficult blockade of the “blood-brain barrier.” The brain is essentially fat, and this is where alcohol induces its initial calm euphoria, followed by loss of judgment, and then its sleep into “drunkenness.”
IV. Alcohol and the Modern American Ambivalence
Today, we may smirk when someone says they are going to make hand sanitizer from vodka to protect against infection of COVID-19. The truth is, it would work; but only if the vodka contained more alcohol! (i.e., more than 60%). And when we hear of people drinking Listerine to get drunk, or that an alcohol-based mouthwash was used for wound care, we are equally shocked.
Perhaps you have a memory of a grandfather who would sit down with a shot of whiskey. Or perhaps you have a memory of the smell of rubbing alcohol, the cotton ball from the chrome-covered glass jar, and the shot of the nurse’s syringe in the doctor’s office. But maybe you have never put those “shots” together? Maybe you have never thought of alcohol as being fundamentally medicinal, at least historically.
This is a very difficult idea, especially for Americans today. We readily acknowledge that most celebrations, social events, and home get-togethers in the U.S. include the offering of alcohol. We also acknowledged that alcohol plays a prominent secondary role in domestic violence, rape, homicide, suicide, and motor-vehicle deaths; as well as a primary role in alcoholism, GI bleeds, pancreatitis, and liver failure.
As a society, we are sharply dichotomous and strangely ambivalent between alcohol as a recreational social lubricant and alcohol as the “demon rum.” The inability to shake the vilification of alcohol is a very recent 19th and 20th century “post-temperance” view that is not expressed in the ancient cultures that preceded our Judeo-Christian heritage, nor in our Christian Churches’ legacy, and not even in our own puritanical American roots.
V. Alcohol in History as Fundamentally Medicinal
Ancient Cultures
“Bio-archeologists” claim that intentionally fermented beer was found in primitive jugs 10,000 years ago during the Stone Age. Egyptian pictographs from 4000 B.C. provide depictions of wine. Wine was the principle drink of the Israelites; even slaves were given a daily ration. It was kept inside the Temple with a regular “first fruits” libation offering. Wine, beer, and mead (like a “honey-beer”) were the center of community and religious gatherings throughout the majority of cultures of the world.
Ancient Romans were some of the first to describe alcohol as a “medicine” apart from any religious or social context. In a treatise written around 400 B.C., Hippocrates described a medicine he had created from alcohol to treat stomach worms. We should be reminded that until just a few decades ago most of our modern medicines were made with an alcohol base. Of course the ancients knew nothing of alcohol’s disinfecting or antiseptic characteristics or its “amphiphilic” chemical properties. Nothing was known about bacteria and viruses. Even a basic understanding of how water was contaminated or if a disease could be transmitted from one person to another was incomplete, or just absent. Without knowing any of that, alcohol providentially saved millions, possibly billions of lives. This is one reason why the ancient toast with alcohol to the community was proclaimed, “Drink to health!” “Salud!”
Christian Legacy
This is one reason why the Jewish blessing is made with alcohol, as is the Christian Eucharist. It’s why Jesus’ first miracle is the making of wine. And it’s why the Good Samaritan has wine and oil poured in his wounds. It’s also why, during His crucifixion, Jesus is offered a mixture of vinegar and wine as an anesthetic. Wine and alcohol for the early Christian was a daily drink of health for everyone, an antiseptic, a medicine, and an analgesic for everyone. It was a gift given by God.
The Didache, one of the earliest manuscripts of the Christian Church instructs Christians to give a portion of their wine
in support of a true prophet or, if they have no prophet resident with them, to give it to the poor.
There are prohibitions in almost every religion, including Christianity, about drunkenness; but this is not a condemnation of the alcohol. Instead, it’s a denunciation of a person’s inability to control impulses.
St. Clement of Rome, a famous Bishop of the Church in A.D. 100, writes:
It is fitting, then, that some apply wine by way of physic, for the sake of health alone, and others for purposes of relaxation and enjoyment. For the first wine makes the man who has drunk it more benignant than before, more agreeable to his boon companions, kinder to his domestics, and more pleasant to his friends. But when intoxicated, he becomes violent instead.
So when St. Ignatius, a Bishop from Antioch who writes letters on the way to his death in the 2nd century, says that the Eucharist is “the medicine of immortality,” he is not simply being poetic—he is speaking a truth about wine as medicine already imbedded in the Jewish, Greek, and Christian culture. There were groups in the second century that advocated abstinence from alcohol, and they were condemned as heretical. St. John Chrysostom in the 4th century proclaimed that immature Christians “blame the fruit given by God” by saying there should be no wine, but that is blaspheming” against the use of wine.
Early Protestant American Views
In the Middle Ages, monasteries became responsible breweries to ensure a safe drink to the populace and a means of support to the Church and to the poor. Women who brewed in dirty pots and made people sick were called “witches” and their ale was called “witchs’ brew.” This charitable view of alcohol did not change with the Reformation. Luther was a strong advocate of alcohol and strong ale. His wife was a brewer who used the funds to support the church and feed the poor.
Neither did this view change with the Puritans. They drank freely and regularly. When traveling on the Mayflower, the most important person on the ship was the ale-maker, the brewer. Without beer on the ship, the passengers would perish. They didn’t stop at Plymouth due to divine vision, or unfortunate storm, but because they had run low on beer. From the Mayflower logbook of 1620, we read:
"Our victuals being much spent, especially our beere." I must have missed the day in class when the teacher told us that the Mayflower stopped on Plymouth Rock to pick up some more beer! But it’s a historical fact that the first thing they did upon landing was to commission the ale-maker to go about and make more beer.
There was apparently never a time when alcohol (mead, beer, wine) was not viewed as medicine. There were explicit precautions and condemnation against drunkenness, but this is not to immaturely “blame the fruit given by God.” Think of a pharmacist, who hands you the medicine and says, “Please take as directed, or it can be harmful.”
V. Alcohol as “Sour Grapes”
So where do we Americans acquire our “distaste” for a positive therapeutic view of alcohol? The short answer is the “temperance movement” that had its fledgling beginnings around the turn of the 19th century. A social response for moral reform, it was led by Christian religious groups largely composed of women. John Wesley (founder of Methodism), many Calvinist ministers and evangelical reformers of the second Great Awakening (1820-1830) joined the ranks of “moderation” in response to a growing overindulgence in alcohol resulting in abuse and disintegration of the family in America.
In the mid-1800’s, a Reverend B. Parsons wrote an essay entitled “Anti-Bacchus” in which he is the first to promote the theological theory of “two wines.” He asserts that whenever Jesus drank wine, it was unfermented; but when drunkenness is condemned, the wine is fermented. Dr. John MacLean, President of Princeton, responded to Parsons in 1941. Shredding Parsons’ logic, he argued the following: 1) Hebrew and Greek only have one word for wine; 2) unfermented wine left out in the middle-eastern heat would ferment; and 3) the Apostle Paul condemns the Christians who were drinking the communion and getting drunk.
But the temperance movement had gained too much steam. U.S. Sailors were no longer given a daily ration of a half-pint of rum (1862). The Methodists required unfermented communion in 1864. Dr. Welch, a minister and a dentist, discovered how to make wine that is unfermented to use in communion. In 1893, this would become the “Welches Grape Juice Company.”
What began as “moderation” became abstinence as Prohibition began with the 18th amendment on Jan. 16, 1919, and continued until 1933. Alcohol divided the nation on strictly moral and legal grounds. It is from this very recent American historical ground that alcohol has become such “sour grapes.” It is also from this historical shadow that we have such ambivalent guilt without even knowing that it follows us.
VI. Alcohol put Back into the Old Wineskin
By making alcohol about morality, it is inimical that the “alcoholic” often drinks because he feels guilty. When a person is asked, “How often do you drink?”, there is an implicit American judicial trap being set. If you say “never,” you are prudish or “puritanical” (however inaccurate that adjective is here)— “You do not know how to have fun.” And if you were to say “daily,” there would be immediate alarm bells going off that maybe you need group counseling at A.A. Alcohol is viewed only
through a moral lens. And this lens is so microscopic it limits what you see. Vodka and hand sanitizer are not on the same shelf. They are not even in the same store.
How different this would be if we viewed alcohol through a medicinal window, as it has consistently been viewed throughout history. What if we put the meaning of wine back into its old wineskin? If it were a medicine given by God used to prevent contamination, to clean a wound, to calm a mind, to provide analgesia for a “cut” (surgery was performed with alcohol as the primary anesthetic)—as well as being the central substance of health, the communion of the religious community? What if we more naturally thought of vodka as a hand sanitizer long before we ever considered it to be something that could get you drunk? What if we thought of the whole process of making alcohol as a proverb (truth is often poetic)? Consider the yeast or sugar that ferments in bread or honey. By decomposing itself—even controlled putrefaction of itself—it produces an alcohol which then disinfects everything around it. The sacrificial bread becomes the medicine of immortality.
Mark Mosley
has done emergency medicine at Wesley Medical Center in Wichita, Kansas for over 25 years. He is boarded in Internal Medicine and Pediatrics. He received his M.D. from the University of Oklahoma. He earned his Master’s in Public Health in nutrition from Tulane School of Public Health and Tropical Medicine. He is married to his wife Jane and has five children. He attends Saint George Orthodox Christian Cathedral.
