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Benjamin Rush—patriot, physician, intellectual, and professor of medicine—was among the first influential Americans systematically to illustrate the negative aspects of alcohol in the late 1700s. Indeed, prior to that time alcohol was thought to be a healthful tonic and effective panacea. In the absence of opiates, which were not much used at that time in America, alcohol was about the only painkiller available to both doctors and laypersons. Rush was reacting to a large growth of drunkenness that followed the American Revolution. Old verities and authorities had fallen by the wayside after the war, and the use of spirituous liquors rose precipitously. For example, whiskey was used as currency in the backcountry, and taverns were full of common workers and artisans, many of whom customarily drank to excess on a daily basis. This, coupled with the almost universal practice of employers giving alcohol to apprentices and journeymen as part of their wages, led to a besotted working class. In fact, for many workers there were two drinking breaks during the workday until the 1830s. After work, men frequently repaired to neighborhood taverns, preserves of masculinity where they were encouraged to gamble and consort with prostitutes; there they continued drinking to excess and squandering their substance. Violence, riot, and crime in the city streets were often alcohol-fueled, and drunken gangs ranged urban streets well into the late 1850s. Farmers typically supplied alcohol to workers during harvest and that harvest time often degenerated into drunken affrays in rural areas, as well. Elections were periods of high drunkenness; politicians plied voters with copious amounts of liquor and punch. The upper classes also partook of large amounts of spirituous liquors, as writings of the day reveal. For example, 55 delegates to the Constitutional Convention at a party in 1787 drank 114 bottles of wine, 34 of beer and porter, eight of whiskey, eight of hard cider, and seven bowls of alcohol-laced punch. The use of spirituous liquors and wine was seen as a normal accompaniment to the business of the day and was frequent at festivals and celebrations of all types. However, for people of all classes, excessive use of alcohol frequently resulted in disease, dissipation, and financial ruin.

Rush and the early temperance advocates noted this and proposed that among some people chronic drunkenness had more in common with a disease than merely being a manifestation of lack of character or stamina. By the 1820s, a movement promoting temperance—which at that time meant refraining only from drinking spirituous (hard) liquor—came into being. The word temperance simply means moderation, and the hope was to change drinking habits from imbibing hard liquor to drinking moderate amounts of less harmful beer and wine. However, as soon as the movement gathered momentum, the focus shifted, and temperance came to mean abstinence from all alcoholic beverages, or teetotalism. Many of the founders of the early movement were members of the Federalist aristocracy.

They were appalled by the rise of the common man as exemplified by Jeffersonian and Jacksonian democracy. To many in the movement, temperance meant encouraging the lower orders to modify their behavior and manifest more middle-class norms of moderation and reputability. Temperance was a way of asserting real and symbolic control over the behavior and aspirations of the lower classes.

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