Emergency Room Doctors Find Moonshine Drinkers in Downtown Atlanta
ATLANTA -- Moonshine consumption has often been considered a backwoods
activity in small, southern towns, yet as Emory University School of
Medicine researchers at Grady Memorial Hospital have recently discovered,
moonshine use is surprisingly common in urban Atlanta as well. In a
study conducted in the Grady Memorial Hospital emergency department
and published in the September 2003 issue of the Annals of Emergency
Medicine, lead author Brent W. Morgan, MD, assistant professor
of Emergency Medicine at Emory and director of Emoryís Medical Toxicology
Fellowship Program, reveals that a group of patients who admitted consuming
moonshine were more likely to have elevated blood lead levels than patients
who did not drink moonshine.
The paper is based on a study that began at Grady in April 2000, after
four adult patients with potentially lethal lead poisoning arrived at
Gradyís emergency care center. Of the four, three patients presented
with seizures and one with abdominal pain. All four admitted to consuming
moonshine, and had elevated blood lead levels well above the normal
limits. The study, done in conjunction with the Georgia Department of
Health and the Centers for Disease Control and Prevention (CDC), was
designed to estimate the prevalence of moonshine consumption among the
urban population at Grady; identify predictors of moonshine consumption;
and measure the relationship between self-reported moonshine consumption
and blood lead levels.
The study was conducted in two phases: a prevalence phase, in which
Dr. Morgan and other researchers assessed the prevalence of moonshine
use; and a nested phase, in which they studied a subset of patients
in more detail to examine associations of moonshine use with risk factors
and blood lead levels.
Dr. Morgan says the study was important because it documented the prevalence
of moonshine consumption.
"Frequently, when we think of moonshine consumption we think of the
middle of Appalachia, but we didnít know that this phenomenon was also
here in the inner city of Atlanta," he says. "We also wanted to see
how prevalent moonshine consumption is in this area, and how it affects
blood levels of those who drink moonshine. What we found was that moonshine
use is fairly common in Atlanta, especially among those who drank any
alcoholic beverage five to six times per week. They were more likely
to be the ones who used moonshine, as opposed to people who only drank
once a week or less."
Of the 581 patients studied, 8.6 percent reported consuming moonshine
within the past five years. Of the patients who admitted to consuming
moonshine, 26 percent had consumed it within the previous week. Moonshine
drinkers were more likely to be men between the ages of 40 and 59 and
were heavy alcohol users. Moonshine consumption was highly associated
with elevated blood lead levels, particularly among recent drinkers.
Eighty-eight percent of the patients in the study were black; 11 percent
were white; and 1 percent were of other races.
Patients were screened every other day on a 24-hour basis during a two-week
period in the two major treatment areas of the Grady Emergency Care
Center. All patients who came to the hospitalís emergency department
were screened to determine eligibility for the study.
Moonshine is defined as any illicitly distilled liquor or whiskey. In
the Atlanta area, it is termed "moonshine," "street gin," "corn liquor,"
"white lightning," or "unbranded whiskey." Some patients in the study
received their moonshine from stills in the metro Atlanta area, while
others obtained moonshine from north and south Georgia. Moonshine is
manufactured by using corn along with a mixture of yeast. The yeast
ferments the corn and produces alcohol. The mixture is then heated.
Since alcohol boils at a lower temperature than water, the bootlegger
will collect the steam that is produced at a temperature lower than
the boiling point of water. Lead can be introduced into the moonshine
as the steam is collected and condensed in either lead soldered pipes
or an automobile radiator.
According to the paper, patients who said they had drunk any amount
of moonshine in the past five years were deemed moonshine drinkers.
They were questioned about potential past environmental and occupational
lead exposures. Other potential sources of lead exposure included hobbies,
history of gunshot wounds, and whether the bullet was removed. Blood
samples were also collected to measure the relationship between moonshine
use and elevated blood lead levels.
Dr. Morgan says that moonshine use is more prevalent than some may believe.
"To our knowledge, prevalence rates of moonshine consumption have never
been characterized," he writes. "It is widely thought that moonshine
use is rare particularly in urban communities. This misconception is
simply due to a lack of news reports in recent years about moonshine-associated
lead toxicity and other adverse health effects. Our findings confirm
that moonshine consumption is still associated with elevated blood lead
Since moonshine consumption is such a pervasive problem among the urban
population that Grady serves, Dr. Morgan recommends that similar studies
be done in other urban and rural communities to determine whether moonshine
consumption and associated elevated blood lead levels are an isolated
problem or more widespread than presently realized. He also recommends
health care providers inquire about moonshine consumption in areas where
it is manufactured; that patients who acknowledge drinking moonshine
be evaluated for lead exposure and educated about the risks of moonshine
consumption; and that both law enforcement and health care sectors be
alerted when contaminated moonshine is discovered. He and other researchers
conclude by recommending lead testing of all moonshine that is confiscated
by law enforcement personnel.
"Our study shows that the days of lead toxicity and moonshine are not
over," Dr. Morgan concludes. "We must therefore renew efforts to increase
understanding of this issue, educate health care providers and the public,
and work closely with law enforcement personnel to effectively address
and prevent adverse effects of moonshine consumption."