Victor Horsley (1857–1916) and the Temperance Movement

It was during his time as a medical student that Horsley developed an abhorrence of alcohol. He discovered that even a small quantity of wine interfered with his ability to concentrate and resulted in an unsatisfactory performance in written examinations, especially when the consumption had taken place the previous evening. As with all his other interests he embraced the cause of temperance with exaggerated enthusiasm.

Temperance is the wrong term to employ in his case; he regarded even a single glass of wine or beer as a sign of alcoholism and thus was an ardent advocate of total abstinence. This attitude could lead to social embarrassment. It is related ¹ that as a young man dining in 1887 at the house of Sir James Paget (1814–99), the senior surgeon of the day, he caused resentment by refusing wine with the meal. In later years with the agreement of his wife, Eldred, wine was not served to guests at his own table. Alcohol had been consumed in Britain since Roman times but it was not until the 1830s that the Temperance Movement took off, stimulated mainly by John Reed of Bradford and Joseph Livesey in Preston. ² Until the middle of the 19th century consumption of alcohol was almost universal and there were potent health and social reasons for this. Above all it was generally safe at a period when the water supply was suspect. Water-borne epidemics of cholera were a constant hazard (there were four major epidemics in the Victorian era (in 1832, 1848, 1854 and 1866) and typhoid, the other great water-borne disease, was endemic. ³ Socially, alcohol was an accompaniment of sporting activities among both the working class and aristocrats. In the Army and Navy the rum ration was thought to provide the stamina and confidence to the British forces that made them so feared by continental powers. Because drinking water was unsafe, alcohol was used as a thirst quencher and was given as such to patients in hospital; it was also prescribed as a painkiller to those undergoing surgery before the advent of anaesthesia.

The inn, the tavern and the alehouse fulfilled an important social role. ⁴ Before 1800 it was in such places that there was some mixing of social classes. Later, and especially after 1850, the middle and upper classes confined their drinking in the main to their private houses. With reduction of the tax on tea and coffee in 1805 and 1825, the afternoon soirée grew in popularity at the expense of alcohol consumption. Yet for the workingman the pub remained a place of refuge. It provided warmth, brightness, conviviality and relative spaciousness in contrast to the dark cramped conditions of the slums. Aside from this some public houses had an important place in the administration of local government. It was there that taxes could be collected, coroners' inquests held and the landlord might act as the local registrar of births and deaths. ⁵ Furthermore, any movement to abolish or reduce alcohol consumption faced an uphill struggle with the government since taxes on liquor were a significant contribution to national income – as late as 1879–80 alcohol provided 43.4% of all taxes. ⁶ Yet throughout the 19th century there was a decline in alcohol consumption associated with improved water supplies, increased tea and coffee consumption, and the exposure of the fallacy that alcohol was nutritious. Livesey in his Malt Lecture in 1833 claimed to demonstrate that the processes used in the production of beer and spirits destroyed their nutritional content.

Alcohol and the medical profession

The attitude of the medical profession was ambiguous. Often prescribed as a medicine or tonic to relieve mental or physical distress, it came to be realized that alcohol played a significant part in causation of cirrhosis of the liver and gout. By 1840 George Budd in his classical work Diseases of the Liver was citing excessive liquor drinking as the main factor causing cirrhosis. ⁷ He considered spirits especially harmful.

Horsley and a friend Walter Pearce debated the dangers of alcohol with their fellow medical students. ⁸ There is little evidence that his eloquence had any effect on that traditionally rowdy, beer-swilling body. Once qualified, Horsley started to speak on public platforms. Among his lectures was one to the St John Baptist Total Abstinence Society on ‘Is alcohol a food?’ He was there preaching to the converted but in 1892 he spoke at Exeter Hall on Alcoholic Disease that caused considerable annoyance to the grocery trade. Grocers had recently been permitted to sell alcohol – the so-called off-licence business – and Horsley spoke strongly against this. In The Alliance News, a trade journal, ⁹ he was reported as saying ‘I believe if you were to poll the medical profession tomorrow they would all vote for the abolition of the Grocer's Licences’. Here he was, as usual, overstating his case since a poll of the general public had not borne out this assertion; in any case, less than 5% of alcohol was retailed by grocers. His remarks occasioned a stormy response from David Barker, ¹⁰ Joint Secretary of the Off Licence Holders' Association, in a letter dated 21 June recommending that Horsley read a paper by a Mr Kingston entitled ‘Intemperance: its causes and remedies’. On 3 July Horsley replied brusquely that Kingston was not an authority on the subject. In objecting to such measures as off-licence sale of drink Horsley and the Temperance Movement had to contend with the brewery lobby in parliament that exerted increasing influence towards the end of the Victorian era. Several big brewers became members of the House of Lords, nicknamed the ‘Beerage’. Yet it was speeches such as the one at Exeter Hall that prompted the invitation in 1892 for him to become Vice-President of The National Temperance League.

A favourite forum for expressing his views was the session of the British Temperance League held during the annual conference of the British Medical Association (BMA). On 22 December 1896 he received a letter from JJ Ridge, Secretary of the League, ¹¹ inviting him to become their President. Previously he had declined such an invitation but now ‘it was the council's unanimous, independent and hearty expression of their wish’ that he accept and this he did. He claimed that his hospital and private practice limited the time he had available and the council agreed to relieve him of many of the routine duties by appointing a chairman.

Alcohol and children

Horsley's efforts to enlist support for the Temperance Movement among his medical colleagues met with variable success. Yet the profession was exercised by the physical state of the nation's children. In 1904 a petition, signed by 14,718 registered medical practitioners, ¹² was sent to every local Education Authority in the UK asking whether ‘it would be possible to include in the curricula of the Public Elementary Schools, and to encourage in the Secondary Schools, such teaching as may, without developing any tendency to dwell on what is unwholesome, lead all children to appreciate at their true value bodily conditions as regards Cleanliness, Pure Air, Food and Drink’. On 11 July 1904 a deputation in support of this petition called on Lord Londonderry, President of the Board of Education. ¹³ Those present included the leading medical men of the day among whom was Horsley. They compared the teaching in the Elementary Schools with that in the Army Schools where there was instruction on temperance, health and sanitation with especial reference to the deleterious effects of alcohol. It was also claimed that such teaching occurred in the USA, Canada and Australia. ‘Having regard to the fact that much of the degeneracy, disease and accident with which medical men are called to deal is directly or indirectly due to the use of alcohol, and that a widespread ignorance prevails concerning not only the nature and properties of this substance but also its effect on the body and mind,’ the petition urged that such teaching should be instituted forthwith. Londonderry was sympathetic but drew attention to the prefatory Memorandum to the Regulations for the Training of Teachers that had been issued on 29 June and which incorporated many of the suggestions in the petition.

Further support for Horsley and the profession came from the Interdepartmental Committee on Physical Deterioration ¹⁴ set up by the Duke of Devonshire. It contained a firm recommendation on alcohol: ‘The Committee believe that more may be done to check the degeneration resulting from “drink” by bringing home to men and women the fatal effects of alcohol on physical efficiency than by expiating on the moral wickedness of drinking. To this end they advocate the systematic, practical training of teachers to enable them to give rational instruction on the laws of health, including the demonstration of the physical evils of drinking. At the same time, the Committee cannot lose sight of the enormous improvement which has been effected in some countries, and might be effected in this country, by wise legislation.’ Alas, they do not particularize as to the precise nature of the practical demonstration they proposed. All these measures to educate the young on the dangers of alcohol were given impetus by TR Ferens, the Liberal MP for East Hull, who offered a prize for the best essays written on the subject by boys and girls in elementary schools. No fewer than 12,663 children wrote essays and 212 were awarded prizes. ¹⁵

In 1905 Horsley started a round robin letter for the press, deploring the taking of alcohol in any form and specifying its deleterious effects; but several who signed it had reservations. The attitude of Leonard Hill, Professor of Physiology at the London Hospital Medical College, typifies such reluctance. After appending his signature to the letter, he added ‘Nevertheless I hold that alcohol is a food and of value to many in small doses. It is, however, necessary to put the children against it for the sake of all this is worth having’. ¹⁶

Influential names still stood out. Sir Michael Foster, ¹⁷ a longstanding Secretary of the Royal Society, had claimed that alcohol was no more injurious than oxygen, distilled water or tea. On 10 March 1905 in a long letter ¹⁸ to the Marquess of Londonderry concerning the teaching of hygiene in schools, Foster's position was denied vigorously by 11 doctors, among them Broadbent, ¹⁹ Sims Woodhead, ²⁰ Leonard Hill and Horsley. The consumption of alcohol in schools greatly interested Horsley. On 27 March 1907 he wrote to the headmasters of public schools enquiring: (i) Is it the custom for the boys in your school to drink water or alcohol with their principal meal? (ii) If the use of alcohol is exceptional what percentage of boys take it? Replies were received from 93 schools. In 24, including such prominent institutions as Rugby, Malvern, Lancing, Stonyhurst, Marlborough and Eton, alcohol was allowed. ²¹

Politicians and alcohol

In 1909 Horsley accepted an invitation to become President of the International Association of Abstaining Physicians. In this capacity he wrote to all temperance leaders suggesting they unite. Clearly inspired by an evangelical enthusiasm for total abstinence and visualizing victory against the drinkers, he wrote ‘Sweet are the uses of advertisements, and once our big guns get going, the Armageddon of alcohol is near at hand – when the old serpent of intoxication will be chained in the pit of perpetual prohibition’. ²² His efforts were unsuccessful although from 1913 to 1915 he was President of the National Temperance Federation and in this role spearheaded their efforts to get legislation passed to restrict the sale of alcohol. The Federation wanted to send a deputation to various cabinet ministers and wrote letters asking to be received but all to no avail. ²³ Churchill replied that it was a matter for the Home Office, Mckenna and Lloyd George thought the Prime Minister, Asquith, should be approached – efforts that were laughable considering that all these men were well known as hearty imbibers. All this activity was stimulated by news that the liquor trade, reinforced by the brewers' lobby in Parliament, was sending a deputation to the government asking for longer hours at night for the sale of alcohol.

Medicinal alcohol

Before World War I medicated wines containing varying quantities of alcohol were widely advertised in newspapers and magazines as nutritive tonics; indeed, general practitioners prescribed some. Horsley and many other medical men condemned these potions as useless. As President of the National Temperance Federation he spoke out against these ‘wines’ and congratulated the editor of the British Medical Journal for refusing to carry these advertisements. The question was given further publicity as a consequence of a pamphlet published by a group of 50 doctors in Hull alleging that a product called ‘Meat Port Nutrient’ was of no medical value. The makers, Sutton Bendle and Company, sued for libel and the case was heard before Mr Justice Bray in June 1914. It was widely reported and Horsley appeared as an expert witness for the defence. ²⁴ His cross-examination by Sir Fredrick Low KC, Counsel for the plaintiffs, did not show him in an altogether favourable light. Instead of answering questions put to him, he embarked on a lecture on the dangers of alcohol. Low complained that Horsley was ‘trying to make points’ and avoid giving a direct answer. Yet there was laughter in Court when Counsel referred to Horsley's contribution to the publication of the 50 doctors as ‘interesting’ upon which Sir Victor remarked ‘Oh, I am so glad you find it interesting – perhaps you will become a convert’ – laughter that was repeated when Horsley offered to give the Judge a copy of the book which he and Mary Sturge had written entitled Alcohol and the Human Body and his Lordship hastily replied ‘Oh no’. Sutton Beale had asked for £5,000 in damages but won only £250.

Alcohol and the Human Body

Alcohol and the Human Body published in 1907 was considered a success; by 1915 five editions had appeared. ²⁵ Mary Sturge, his co-author, was a general practitioner in Birmingham where her family were prominent citizens – her father, a pacifist, had been Lord Mayor. A Quaker, she qualified at the London School of Medicine for Women. She met Horsley at the temperance breakfast held at the annual BMA meeting and their friendship was cemented when in 1903 he addressed the Medical Institute of Birmingham on ‘Alcohol and the Medical Profession’; it was perhaps on this occasion that they decided to collaborate on the book. A scholarly work, it treats the problem of excess alcohol consumption in a scientific and clinically impartial manner. They aimed to counter the prevailing public belief that alcohol was beneficial both as a food and as a restorative stimulant. Declaring it a dangerous drug, they maintained that as such it should be prescribed as any other remedy in the Pharmacopoeia. Stating that alcohol did not ‘aid the human economy’, they sought evidence that it damaged the structure and function of different organs. During the previous 40 years there had been a steady fall in the quantity of alcohol used in hospitals and they drew attention to its abandonment in surgery following the advent of anaesthesia and Lister's introduction of antiseptics. In medicine its use in typhoid fever had been discredited, as had its employment in cases of insanity. The popular belief that regarded ‘wine as the milk of the aged’ was dismissed as a superstition. Instead Horsley and Sturge emphasized the dangers of addiction.

Much of the cellular pathology described in the book is understandably primitive but the work on the function of the nervous system, involving damage to the intellect, emotions and motor mechanisms, remains true today. Having described the temporary exhilaration produced by alcohol, they emphasize that the subsequent depressant effect lasts much longer. Drunkenness resulting from imbibing large quantities of liquor was a frequent and well-recognized phenomenon. Yet it was the disturbing, and often unrecognized, effects of small quantities of beer and spirits to which they drew attention. The work of Kraepelin ²⁶ at Heidelberg was quoted showing that small doses of alcohol delayed both the quality and the speed of response to mental stimuli. Memory, especially for numbers, was impaired as was association of ideas and judgements. They mention the experiments conducted on compositors by Aschaffenberg ²⁷ in Germany who demonstrated that when small amounts of alcohol were imbibed fewer letters were composited than when alcohol was not drunk although men themselves believed they were doing better and quicker work. An important example of impaired judgement was the inability to recognize when it was advisable to stop drinking. These findings and opinions were supported by Horsley's own experience of surgical accidents that he attributed to ‘cerebral confusion’ or mental obfuscation produced by alcohol. His views were endorsed by evidence from Scotland where, according to AG Miller, a Consultant Surgeon at the Edinburgh Royal Infirmary, injuries due to mishandling of machinery were frequent on Saturday after pay day on Friday when the public houses were crowded with men spending their newly pocketed earnings. ²⁸ Such injuries were infrequent on Mondays as the public houses were closed on Sundays. These findings are undisputed today and reflected in severe penalties for those convicted of offences including driving a car after drinking.

The effect of alcohol on the emotions was of especial interest to Horsley and Sturge. By the time the first edition of their book was published evidence was accumulating that drink was a potent causative factor in suicide. At Keil Hillier, reporting on postmortem examination of 300 suicides, claimed that over half were alcoholics. ²⁹ In England Dr Sullivan, Medical Officer to the Prison Service, confirmed the prevalence of alcoholism among suicides ³⁰ but also found that of 200 men convicted of murder 60% were involved in alcohol abuse. The same was true with regard to the ‘painful subject’ of sexual crime where Sullivan found that ‘either chronic alcoholism or simple drunkenness is the causal condition’ in nearly half the cases.

The conflict with Karl Pearson

A matter of especial concern to Horsley was the influence of parental alcoholism upon their offspring. A potent factor in the aetiology of infant mortality, he maintained that it was also a serious cause in such children as survived, of mental deterioration with consequent insanity, idiocy, epilepsy and feeblemindedness, as well as physical underdevelopment. It was thus that with great indignation he read the memoir by Ethel M Elderton and Karl Pearson published in the Spring of 1910 that appeared to indicate that alcohol might have some beneficial effects on these children. ³¹ Karl Pearson was a distinguished mathematician and Golschmid Professor of Applied Mathematics at University College, London – in 1911 he was appointed to the Galton Chair of Eugenics. He is regarded as one of the founders of modern epidemiology and the application of mathematics to the study of biological problems. An inspirational teacher and lecturer, he was exceedingly difficult and intolerant of those who did not share his views. The controversial memoir he wrote with Ethel Elderton was entitled The First Study of the Influence of Parental Alcoholism on the Physique and Ability of the Offspring. It had been assumed for many years, and especially after reports including that of the Interdepartmental Committee on Physical Deterioration in 1904, that habitual indulgence in alcohol by the parents had a profoundly deleterious effect upon their children – a view embraced wholeheartedly by Horsley and the Temperance Movement. Elderton and Pearson decided to apply statistical methods to see whether this could be confirmed scientifically. Their results failed to confirm popular views on the subject. The study was a complex one and not easy for the layman to follow, involving a total of 3604 children – 585 boys and 477 girls in Edinburgh; 1433 boys and 1109 girls in Manchester. The children were from ‘ordinary respectable working class homes’ in Edinburgh but in Manchester they were selected from homes where at least one child was said to be mentally defective. The basic statistics were derived from two sources, the Report of The Edinburgh Charity Organisation Society and an account by Miss Mary Dendy ³² of the children in special schools in Manchester. This method of sampling was one of the main points of contention in subsequent discussion of the memoir. Their results were expressed in terms of correlation coefficients between drinking habits of the parents and the height and weight of the children, their health, intelligence, diseases, vision and infantile death rate (Pearson was responsible for the invention of some fundamental statistical techniques among which were the chi-square test for goodness of fit and the product moment of calculating the correlation coefficient). Their conclusions ³³ did not accord with popular belief and repudiated the belief that habitual indulgence in alcohol by parents had a profoundly deleterious effect on their children.

It was the finding that the children of alcoholics were if anything healthier, taller and heavier than those of non-alcoholic parents, together with the assertion that parental alcoholism was not the source of mental defect in the offspring, that especially angered those in the Temperance Movement. Yet they were slow to publish their objections. Instead the barrister and eugenicist Montague Crackanthorpe ³⁴ and the Cambridge economists Alfred Marshall ³⁵ and John Maynard Keynes ³⁶ all wrote criticizing both the methods used and the results obtained.

The objections raised by Keynes were published in a review only two months after the memoir appeared. ³⁷ He questioned both the trustworthiness of their data and the statistical methods employed. With regard to the first point it was unclear how and for what purpose the evidence they used had been collected and tabulated, namely details were not given as to how their samples were obtained. In addition, Keynes doubted whether applying sophisticated statistical methods, such as calculation of coefficients of correlation, were appropriate in samples of the size studied. He cited evidence presented to the Inter-Departmental Committee on Physical Deterioration where physiologists had drawn attention to the possibility of parental, especially maternal, alcoholism before the birth affecting the child ab initio. Furthermore the experience of social workers had shown it was likely that parental alcoholism after the child's birth was likely to injure its development. Elderton and Pearson had not addressed these distinctions. Keynes considered that before any contrary conclusion to generally held opinions was reached it was necessary to ensure that the experiment was on a considerable scale, that the classification, in this case alcoholic and non-alcoholic, had been skilfully and uniformly carried out and that its field was truly representative of the population at large. With regard to the second point Keynes was able to demonstrate that the districts selected for study were ‘thoroughly unrepresentative’. His concluding words were unsparing, and courageous for a relatively junior man commenting on the work of the premier national authority on the subject: ‘As a contribution to the solution of the general problem the memoir is almost valueless, and, from its failure to direct the reader's attention to essential facts, actually misleading. As a study in statistical method it is a salient example of the application of a needlessly complex mathematical apparatus to initial data’.

Crackanthorpe and Marshall wrote independently to The Times criticizing the selective method of sampling leading to bias, ³⁸ the lack of a control population and the inadequate definitions used for alcoholism. It was also pointed out that the study ‘had no regard to the latent potentialities or dispositions which, as a direct consequence of paternal self-indulgence, the adult years may disclose’. ³⁹ Finally the especial situation pertaining to maternal alcoholism when alcohol may pass to the fetus via the placenta or to the infant via the mother's milk was not considered by Pearson.

Horsley himself did not respond to the Elderton and Pearson memoir until 1911. Unsurprisingly, because he was not a statistician, in general terms he echoed the opinions of Keynes. During his address to the Society for the Study of Inebriety in January 1911, he declared that Elderton and Pearson had ‘arrived at their startling conclusions by reason of their disregarding facts and precautions against error; further, that these authors had, in a manner unknown in the scientific history of this subject, published imaginary statistical data where in reality none existed’. Afterwards he and Mary Sturge followed this up these strong words with a long paper in the British Medical Journal ⁴⁰ where, as well as criticizing the sampling technique as flawed and the definitions as inaccurate, they also referred to the Inter-Departmental Committee Report which concluded clearly that the foremost causes of physical deterioration were poor housing and drink.

Pearson did not take kindly to criticism. He condemned Horsley's position as ‘absurd to anyone with knowledge of the facts’. ⁴¹ He also demanded an apology; this he did not receive. He was excessively sensitive on such matters and anticipated that his views would not be well received. He claimed that those who disagreed with him were motivated by jealousy. It was, however, demeaning and ridiculous to assume that figures such as Horsley, Marshall and Keynes were envious of him. The question of inheritance and alcohol abuse remains of social importance today and is still not fully resolved. ⁴² Although environmental factors are of considerable significance, some studies have established that genetic influences are also important. It has been shown that adopted children of alcoholic parents are four times more likely to become alcohol dependent than those from non-alcoholic parents. ⁴³ Yet non-genetic familial factors, as demonstrated by observations on separated twins have shown, are probably of greater import.

Alcohol and the armed forces

The publication of Alcohol and the Human Body led to more invitations for Horsley to lecture on the subject. Some of his notes for these lectures survive, ⁴⁴ notably for one given at the Victoria Rooms in Bristol on 18 October 1907 and for an address to the Leeds Luncheon Club on 8 March 1915. In the former he covers much of the ground that appears in his book, describing the deleterious effect of alcohol on efficiency at work and emphasizing the benefits of abstinence. He also considered financial matters, claiming that £164 million was spent on alcohol; yet it was thought extravagant when Augustine Birrell, President of the Board of Education in the Liberal Government, asked for one million pounds to improve facilities in schools and universities. Horsley countered that the money spent on drink would ‘furnish our schools; it would pay our teachers a living wage; and it would establish our universities’. ⁴⁵

When he spoke at Leeds he was in the Army and concerned with the effect of alcohol on the war effort. He overstated his case in a combative and emotional manner. Calling the drink trade the most powerful ally of the Kaiser, he declared that ‘by the drink trade a man is being killed every ten minutes, and that is more than is happening to our men in Flanders’. He added ‘because of the drink trade you must count the wounded by the hundred thousand, where the German's war creates them by the thousand’. He further asserted that ‘the drink trade is controlling the State at the present moment’.

Crusading against the rum ration in the Army, he repeated these arguments with enthusiasm in an article in the Lancet. ⁴⁶ Describing the practice as pernicious, he declared that it reduced the soldier's efficiency, injured his health and was no substitute for real food. He thought it a serious evil but what incensed him most was that responsibility for giving the ration was placed on the medical profession. The issuing of rum was authorized by the Commanding Officer of a battalion on the recommendation of the Medical Officer. The rum ration was a tradition in the British Army dating from Marlborough's campaigns in Flanders at the beginning of the 18th century when it was credited with keeping the soldier ‘dry and warm when he had been chilled’. Horsley described this as dangerous nonsense.

It was widely assumed by army officers in the early part of the 19th century that drunkenness was inevitable among the common soldiers. Yet towards the end of the century opinion against drink had hardened and Kitchener and Roberts forbade it in the Egyptian Campaign and to a large extent in the Boer War. But his most telling anecdotal evidence came from Sir James McGrigor who served in 1801 as Superintending Surgeon to an army of both European and Indian troops in Egypt – he was later to become Principal Medical Officer of the Army Medical Service. He noted that the expeditionary force that engaged in a prolonged march in the desert ‘had no spirits delivered to them and not only did they not suffer from this, but it contributed to the uncommon degree of health which they at that time enjoyed’. This environment was vastly different from those in the sodden and chilled conditions on the Western Front in World War I. Here Horsley had a sound point because alcohol can aggravate the effect of low temperature by increasing heat loss as a consequence of dilation of skin vessels and by checking oxidation in the tissues, thus diminishing resistance to cold. He recommended that instead of rum the troops should be given hot milk, coffee, chocolate or soup.

Horsley's views were not widely accepted. Resistance was encountered not only from the drink trade but also from the Army and the politicians. In October 1914 as President of the National Temperance Federation he issued a memorandum urging that ‘the rum ration should be immediately abandoned and a ration of hot refreshing and sustaining food supplied in its stead’. Unfortunately, he followed this up by stating that the withdrawal of the British Expeditionary Force from Mons ‘would have been gravely endangered if rum rations had been issued to the troops’. But of course rum had been issued and Horsley's original biographer Stephen Paget ⁴⁷ quotes an officer in the Irish Guards, involved in the retreat, who declared that but for the rum ration the retreat would not have been accomplished successfully. Instead of acknowledging his mistake Horsley was unwise enough to dispute the evidence of those in the field and he continued to overstate his case. In fact rum was of value in alleviating the effects of the cold and dampness of trench life, so long as those receiving it were also given dry and warm clothing.

Horsley's strongest argument was that alcohol led to loss of efficiency in marksmanship, said by him to reduce accuracy by 40–50%. Influenced no doubt by incidents reported on the home front where there was much drunkenness, he decided too that excessive drinking resulted in ‘decadence of morals’. J W Astley Cooper, ⁴⁸ the Medical Superintendent of a sanatorium and with long experience of alcohol abuse, deplored Horsley's wholesale condemnation which he considered laid him open to ridicule and failed to achieve his purpose. While deploring excessive drinking, Astley Cooper declared that the two and a half ounces of rum that constituted the rum ration had never, in his experience, been harmful to morals or discipline; he also challenged Horsley's assertion with regard to accuracy in shooting. He agreed that alcohol was of no use as a food and that its value ‘in relieving the discomforts and incapacitating effects of cold was evanescent’. Yet he considered its use was justified, when hot food and hot non-alcoholic beverages were not available, ‘in bringing back to life benumbed and useless limbs and shivering bodies’. Dr Charles Mercier ⁴⁹ of Parkstone in Dorset, the author of a textbook on insanity, was less compromising in his attitude to Horsley's evangelical approach to temperance in the armed forces. He could find no evidence for ‘moral grousing, friction, disorder, drunkenness, decadence of observation and judgement’ and other defects in soldiers that Sir Victor attributed to alcohol. Deeply antipathetic to Horsley, he concluded his letter to the Lancet ‘The violence of a man drunk upon two and one half oz of rum, if that is possible, is unpleasant to witness, but I do not know that it is more distasteful than the verbal violence of a Habakkuk Mucklewrath, inebriated with the exuberance of his own fanaticism’.

Aside from his mania about the rum ration, Horsley was exercised by numerous advertisements, extolling the properties of whisky, in the popular press. He had attempted to have advertisements for liquor banned or at least severely curtailed when in civilian life and when in the Army he was disturbed to notice that Punch still carried them. He wrote from the 21st General Hospital in Alexandria to the editor, Sir Owen Seamen, in protest and received a sharp reply stating that ‘the Advertisement Department is not conducted by the Editor’. Seaman ⁵⁰ added for good measure ‘Anyone who brings a little consideration to the question of whisky advertisements in such a paper as “Punch” would understand that they represent a competition between firms, each desiring to persuade the public to choose a particular brand in preference to others. To suppose that the ordinary drinker is persuaded by these advertisements to drink more whisky is to suppose that the sight of an advertisement of tea or soap is likely to induce Sir Victor Horsley, for example, to drink more tea or wash more’. Sir Victor replied on 5 February 1916, barely five months before his death in Mesopotamia, that if advertisements did not induce people to drink whisky the producers would ‘not expend a penny on such appeals’.

Horsley's efforts on behalf of the Temperance Movement were only partially successful and alcohol continued to be consumed by men in the intolerable conditions in France during the war. This was despite the efforts of others, including Kitchener, to discourage alcohol drinking; even King George V announced he would not take any whisky until the conclusion of hostilities. ⁵¹ This was followed by widespread signing of the ‘Pledge’ organized by the Free Churches; one suspects mainly by those not involved directly in the fighting.