1917 BMJ (Clinical Research Edition)  
of the Board of (Liquior) Control, dlelivered a lecture before tlle Royal Instittute of Public Healtlh, on Mlay 16th, on "Public lhealtlh and the control of the liquor traffic." The Problem of Alcoh olism. He miiaintained at the outset that tlhrougllout the whlole .course of public lhealtlh legislation in this country time significance of tlle liquor traffic as affecting., thle lhealtl aild plhysical well-being of the community had been neglected, a fact whiclh was the niore surprising because
more » ... surprising because it could not be attributed to ainy lack of knowledge of tlho results of a widespread prevalence of alcolholism. Even the most superficial student of social problemls was aware of the direct and indirect influence of alcoholic excess upon tlle incidence of disease and deatlh. Never-tlleless, Lord D'Aberiloni mainitained that ihitlherto these effects vere not genierally regarded in tlcir niatural relation to puiblic lhealtlh, but lhad been viewed rather as elements in a special and distinct-social problem belonging more to the splhere of morals than to that of medicine. In any case, little effort -seemiied to' have been made until quite recently to deal witlh thlese evils of alcolholism in tlle sort of spirit in wlieli a problem of preventive medicine would be approached, and to tlhiscircumstanice Lord D'Abernon mainly attributed the fact that the evils lhad continued urnchlecked. Very little, he said, could be done towards tlie practical solution of this question so long as tlle only policies in the field were those put forward by tlle more extreme sections of the liquor trade, and by the advocates of total prolhibitioln. The arguments on botlh sides of the conitroversy lhad tllis in common, that tley were botlh based upon a priori conceptions and not upoIn evidence, and both led in practice to the same result-iniaction. There still, lhowvever, remained open a tlhird anid radically different policy-a policy of moderate and reasoned restriction, witlh whlich, of course, the Board of Liquor Control lhad largely concerned itself. By reasoned restriction the lectuirer meant restriction directed specially to limiting tlhe conditions whiicl could be slhown by observatioii to lead to drunkenness, to alcolholic excess, and to clhronie alcoholismn. In framing restrictionis for this purpose two points received clhief consideration-tlle strenigtl of tlle alcolholic beverages, and the timries during whlielh their use was permitted. Tihus concurrently thle lhours of ,drinking liave been limuited, and the use of liquors of very' hligh concentration liave been prolhibited. A policy of restrictiou alona these lines lhas been tried in tllis country during time last twvo years, and Lord D'Abernon based -his argument upon the considerable amount of data already obtained regarding tlle effect of tlhis policy upon the health of thle population. Alcoholic Mortality in TVar Time. Thle first set of figures wlhiclh lie slhowed gave thle ninomrtality attributed to alcolholic *exccss in time years; 1913-16; and, allowing for tlhe fact that nmany deatlss whiiclh slhould be attributed eitlher directly or indirectly to alcoholism were not so certified, tllhy yet served as an inidex of the mnovernent of alcolholism duriug tthat period. As a clieck upon these figuLres the deatlhs from cirrllosis of time -liver were set out side by side witlm tlhem. In 1914 the deatlhs from alcolholism-botlh time deatlhs attributed directly to tllis cause and the deatlhs to wlliclh it .^was a contributory factor-slhowed a sliglht upward move-*nent. This was followed in 1915 by a movement in time opposite directioni, moderate in the case of women, more pronounced in tlle case of men. The policy of restriction brouglht about by meanis of orders issued by time Board of Control came into force in tlle second lialf of 1915. Making -allowance for tlle fact of enlistnment, wlicih witlhdrew a -large number of adultnmales, aud for otlher qualifying con--siderations, Lord D'Abernon attributed much, of time decrease in alcolholic mortality in 1915 to tlle influence of restrictioni. T'lle figures for 1916 strengthened hiis argument; restriction was in force during time wlhole of that year, and tlhrouglhout tlle greater part of the country. 'Concurrently time decline in deatlhsfrom alcoholism was enornmous, amounting to over 40 per cent. in the case of men, ancl to lnearly 50 per cent. in the case of women, as compared witlh the pre-war standard of 1913. The extent of tllis movemuent, and the fact that it affected women even more than men, indicated beyond all doubt tlle operation of a new and potent influence acting on tthC general popuilation, and Lord D'Abbrnon nmaintained that tllat iifluence could only be tlle restriction of drinking. Cirrlhosis of the liver being an essentially clhronic affection, it was to be expected that any effect of restrictive measuLres on tlle nlumilber of deatlhs frolmi that disease would be less marlked; and so it was. Whlilst admitting that it wotuld be of great assistance in tlle study.of this quiestion if we lhad a statistical index of alcolholism of more unequivocal value and givilng us a larger numerical basis, Lord D'Abernou defended the inference which lhe drew from tllese statistics thius: "Tlloughl standards may be very different in different areas, tlley appear, if we judge from the figures, to be tllorouglhly stable in thle sam-le area froii one year to anotlher, slhowing only m-oderate fluctuations over a series of years in wlhiel no unuisual influences are operative." Lim-nited statistics of deliriumn tremens, lhowever, were available, notably from-l the Poor Law infirnmaries of Liverpool. A return of the number of cases of delirium tremens treated in tlhese infirmaries duLirng the two twelvemontlh periods preceding, and one ssuch period following, the date when the policy of restriction came into force, gave striking corroborative evidence of tlle effect of restrictive measures in reducing alcolholism. Parallelism of Drinkecitness Statisties. This inference was further reinforced by tlle numiibers of convictions for drLunlienness in the sanie area during time same periods. Tl'lie statistical fluctuationis of )ublic -drunkenness, of delirium-l tremienis, and of deatlhs frolm alcolholie excess slhowv a close correspondence, from wlhlich the inference is drawn that tthe plhenomena are, in fact, closely correlated. In furtlher support of this concltusion, Lord d'Abernon produced a table slhowing tlle convictions for drunkenness in England and Wales in eaclh of tlle fouLr years 1913-16. Coomparing tllese figures witlh the statistics previously given of alcolholic mortality, lie slhowed that tlhe saime clharacteristics were to be noted-in 1914 a sliglht decrease alliong men and an increase am-lonlg woomen; in 1915 (during tIme latter moutlhs of whliich restrictions were in force) a decrease in the figures for botlh sexes, but mlluchl muore pronounced amonig males; anid in 1916 (tlhe period of full restriction) a very large fall. nearly 60 per cent. in the case of men, over 40 per cent. iin women, as comupared with tIme pre-war year 1913. From-l this striking parallelism lhe argued tllat statistics of dti-uikenness were a miuchll more reliable index of aleoloolic excess than was usually believed. Thle special value of statistics of dlelirium-ii tremiens was time index they futirnislhed of -tlhe less overt formiis of intemperance, tlhuLs servincg to clheck both tlhe accuracy and the significance of tIme official retur-ns of drunkenness. It was often alleged tljat witlh the decrease in public drunkenliess tllere liad beeni au increase of lhome or secret drinking since the wvar; agyainst tllis view Lord D'Abernon set the available figures for delirium tremens. The Advantages of Control. From tllc evidence wlhichl lie lhad obtained, and wllichi hie made the mnore telling by means. of diagramims, the lectuLrer concluded that muclh lhad already been doine to lim-it alcolholic excess by a policy of nmoderate rcstrictions on drinliing; notwithstanding thiat these miieasures lhad been imposed on the liquor trade by an outside autlhoritv, and] that public-lhouses, especially in inldustrial centres, were mnuch in excess of tlle reasonable needs of time population, and were often of a structural clharacter makinig proper supervision almost impossible. Two facts of grreat importances hle regarded as being definitely establislhed by tlhe experience of the last two years-that an enormousrnount of preventable injury lhad been done to the community by the absence of fitting regulation of tlle drink traffic, and --that, cbntrary to current belief, intenmperance could be diminished to a considerable degree by legislative and administrative action. -
doi:10.1136/bmj.1.2942.651 fatcat:hv7tmibonngehkscvwy6gj5gba