After one year from the ratification of this article the manufacture, sale, or transportation of intoxicating liquors within, the importation thereof into, or the exportation thereof from the United States and all territory subject to the jurisdiction thereof for beverage purposes is hereby prohibited.
-- 18th, or Prohibition, Amendment to the U.S. Constitution
When the 18th Amendment banning beverage liquor became effective on Jan. 16, 1920, the nation's physicians were given enormous power to prescribe medicinal alcohol.
Indeed, the Volstead Act that implemented the amendment stipulated that " . . . no one but a physician holding a permit to prescribe liquor shall issue any prescription for liquor."
The law was very specific that liquor only be used for medical purposes and limited the "dose" per patient. As it read:
"And no physician shall prescribe liquor unless after careful examination of the person for whose use such prescription is sought, or if such examination is found impracticable, then upon the best information obtainable, he in good faith believes that the use of such liquor as a medicine by such person is necessary and will afford relief to him from some known ailment. Not more than a pint of spirituous liquor to be taken internally shall be prescribed for use by the same person within any period of 10 days and no prescription shall be filled more than once."
But the medical provisions were hardly enforced. From 1920 to 1926, the federal government's enforcement arm, the Bureau of Prohibition, issued on average liquor-prescribing permits to 64,000 physicians but only revoked an average of 170 licenses to practice per year.
Considering the 11 million prescriptions written yearly by doctors through the 1920s, keeping check on wayward writers was an unequal task for the bureau, which had only a handful of agents on the doctor watch (the ratio of agents to physicians in New York City, for example, was one for every 300). By law physicians had to keep careful records, but by 1921 abuse of medicinal liquor privileges, either by physicians or druggists who filled orders, was a widespread problem.
So much so that Congress was pressured by prohibitionists to pass the Emergency Beer bill of 1921, formally known as the Willis-Campbell law. The legislation outlawed the writing of a prescription for beer; wine with more than 24 percent alcohol got the boot, and the one-pint-per-10-days limitation on liquor was cut to a half-pint. Most significant, each licensed physician got only 100 alcohol prescriptions every 90 days from the bureau. More would be issued if the doctor could prove "that for some extraordinary reason a larger amount is necessary."
Little wonder that the American Medical Association lobbied against the bill as "an indictment of the integrity of the whole profession, in that it is assumed that many of its members, unless restrained by law, will pander for gain to the While the skirmishes over medicinal liquor were being fought, bootleggers were smuggling booze worth an estimated $40 million annually. people's desire for drink." The American Therapeutic Society, founded in 1900 to promote the continuing education of practicing physicians, was equally outraged, stating that "no legislative body or enforcement authority should limit or hamper a doctor in the legitimate practice or exercise of his functions as a physician."
But the AMA and ATS were no match for the powerful Anti-Saloon League, which saw to it that both houses enacted the legislation by wide margins, 250-93 in the House, 39 to 20 in the Senate.
While the skirmishes over medicinal liquor were being fought, bootleggers were smuggling booze worth an estimated $40 million into the United States annually. In addition, domestic manufacturers produced nearly a billion gallons of legal near-beer from 1920-1925, which first had to be made as alcoholic beer, and much of which was sold, in the words of bureau head Lincoln C. Andrews, in its "high-test" state.
But doctors, who were supposed to be different from bootleggers and brewers, had more legal loopholes. For example, after the 1921 legislation a physician was limited in the kinds and amounts of alcohol that could be prescribed from his office. But if he attended a patient in a hospital, bureau regulations stipulated that prescriptions for medical alcohol "need not be written on official forms, but may be written in a book provided therefor by the institution." Moreover, a physician could get six quarts of alcohol yearly for administering to patients in his office, with additional amounts available on request, provided records were kept on individual consumption.
By April, 1933, the American Medical Association won regulations that permitted its members to write medical liquor prescriptions according to patient needs, without other restrictions. "While this places a greater responsibility on the physicians," said Dr. James M. Doran, chief of the Industrial Alcohol Bureau, "I do not believe that the privilege will be generally abused."
But such talk was moot. Less than eight months later, the 21st Amendment to the Constitution repealed the 18th.
Thomas V. DiBacco is a historian at American University.