Volume 21, Number 1 PIVO AND POHODA: THE SOCIAL CONDITIONS AND SYMBOLISM OF CZECH BEER- DRINKING Timothy M. Hall, University of California/San Diego 2003 Timothy M. Hall All Rights Reserved The copyright for individual articles in both the print and online version of the Anthropology of East Europe Review is retained by the individual authors. They reserve all rights other than those stated here. Please contact the managing editor for details on contacting these authors. Permission is granted for reproducing these articles for scholarly and classroom use as long as only the cost of reproduction is charged to the students. Commercial reproduction of these articles requires the permission of the authors. "A Czech never says that he's going out to `have a few beers,' and he never counts the beers while he's having them. You go out for a beer. A beer is like a woman: when you're with a woman, you never think of women that you've been with before, and you never think of the next woman. It would be disrespectful. Iťs the same with a beer. You go out and you have one beer...and maybe, when the unfortunate time comes that you reach the end of your relationship with your beer, then maybe you'll have another."1 Such was my first introduction to the importance of ceské pivo, at the start of a long night of drinking and pub-hopping in Prague in 1998. As I learned, beer provides an entrée to many of the core features of Czech culture. Beer itself is an emblem of Czech national identity as well as a major mediator of sociality and a key element in recreation and leisure time. Beer and several Czech liqueurs (Becherovka and slivovice) play a key role in Czech folk ideas of illness and health, while the etiquette around bar behavior highlights Czech attitudes towards money, hospitality, and reciprocation, and also acts as a forum of contention between Czech and Slovak ethnic identities and values. The Czech word for beer, pivo, comes from the same root as the verb to drink, pít, and is cognate with the English word beverage (from Latin bibere, to drink). Beer is such a common beverage among Czechs that many do not consider it a form of alcohol: "iťs just beer." At the same time, it is a nearly sacred substance, which demands respect and must be handled in clearly prescribed ways. The normative values of heavy beer-consumption and lenient attitudes towards inebriation both demonstrate some basic Czech values, such as the importance placed on relaxation and comfort (pohoda; cf. Kuras, 1999: 19-21, 32-33), and contribute to the substantial medical and social problems caused by alcoholism. History and Economics Czechs themselves refer to their country as lying in the "heart of Europe" (srdce Evropy) but Benjamin Kuras' image is perhaps more accurate: a bridge between East and West, trod upon by both sides (Kuras, 1999: 9). Certainly the Czech people have existed in an ambiguous state, geographically at the center of Europe. The Czech lands (Bohemia, Moravia, and part of Silesia) were politically and culturally united during the Middle Ages under the Přemyslid and Luxemburg dynasties, but the Czechs lost their political independence to the Austrian Habsburgs beginning in the sixteenth century. After the Protestant Hussite defeat at the battle of White Mountain in 1621, most of the Czech intellectuals and much of the aristocracy went into exile (cf. Sayers, 1998: 45-50). By the time of the National Revival in the 19th century, the Czechs had nearly lost their linguistic and ethnic identity under centuries of Habsburg rule. Prague itself, the historic capital of the Czech lands, was called the city of three cultures: Czech peasants and bourgeoisie, German aristocrats, and Jewish intellectuals. When the country achieved independence in 1918, little remained in the cosmopolitan cities of Prague and Brno, or the Czech-speaking countryside, from which to build the symbols of a new Czech nation, and after the devastation of the Holocaust and the subsequent expulsion of the Sudetan Germans in 1945, two of the three cultures were gone. Aside from the specifically historic sites and the famously difficult language, one of the single bestrecognized Czech products abroad was beer. Beer-making has a long history in the Czech lands and the quality of Czech beer and hops are recognized by beer-drinkers around the world (Brewers Journal, 1903: 692). Czechs take their beer very seriously and have done so for a long time. In his history of Czech identity, sociologist Derek Sayer quotes a passage from Josef Pekář, one of the great Czech historians: "Writing to Ladislav Pohrobek after his coronation in 1453, the Pope suggests that the Volume21, Number 1 Czechs will not let their new boy-king go `until he masters Czech [language] -- and beerdrinking'" (Pekář, Žižka a jeho doba. Prague: Odeon, 1992, vol. 1: 265; cited in Sayer, 1998: 42). Most Czech beer is lager (ležák), as opposed to ale. Lagers are brewed at lower temperatures with yeast that lies on the bottom of the vat during fermentation. The product is usually lighter than ales, which are brewed at higher temperatures with a yeast that rises to the top. Czech lagers are generally highly hopped, which gives them a clean, bitter taste. They are slightly higher in alcohol than most western European and North American beers (especially the Czech 12° beers; see below), and are almost exclusively made with barley, as opposed to North American beers in particular which often have a high content of rice or corn. Two of the most popular types of beer in the world today originated in Bohemia and are still sought out by western tourists. The recipe for pilsner-style beers originated in the West Bohemian town of Plzeň (Pilsen in German) in 1842. The newly incorporated Burgeliches Brauhaus (now Plzeňský Prazdroj, A.S., a division of SABMiller, the worlďs second largest brewer) adopted a Bavarian style of lagerbrewing and modified it by increasing the content of hops and allowing it to undergo a secondary fermentation called krausening, which produced the foamy head desired by Czech beer drinkers (Brewers Journal, 1903: 692; Hernon and Ganey, 1991: 36). The Pilsen model was later copied by other brewers and exported from both Germany and Bohemia to western Europe and North America. It has now come to indicate any light, lager-type beer, and pilsner beers are among the most popular in the world. The town of Plzeň has been brewing beer at least since it received a charter from Václav II in 1290, and its Pilsner Urquell (the German form of the name, used for export, or Plzeňský prazdroj in Czech; both mean Pilsner Original Source) is the single most popular beer in the Czech Republic and the most recognized Czech beer abroad. The town of Ceské Budějovice in South Bohemia gave the world the original Budweiserstyle beer. Brewing in the town dates at least to 1265. By the mid-19th century, several breweries in the town had been producing a particular style of slightly sweet lager for a number of years, marketing it under the Czech name Budvar and the German name Budweiser and exporting it to western Europe and even to North America. The name in the United States, however, was first registered as a brand name by one Carl Conrad, an American importer of wine and liquor. In 1875, German-American immigrant and brewer Adolphus Busch bought the rights to the name from Conrad and began large-scale production. Anheuser-Busch ran into problems in 1907 when they attempted to trademark the name in the U.S.; they were challenged by a German brewer on the grounds that it was a geographical name and had originally been used in Europe. In 1911, Anheuser-Busch reached a settlement with both the German brewer and Budějovický Budvar, under which Anheuser-Busch received the rights to use the name in North America but agreed not to market their product in Europe; the Czech brewer retained the rights to sell Czech Budvar in the U.S. under the label "Imported Budweiser." In 1939, this agreement was modified and Anheuser-Busch obtained the exclusive right to market Budweiser in the United States (Hernon and Ganey, 1991: 35-38). Since the end of Communism in Czechoslovakia in 1989, the two companies have again been engaged in international trademark battles. The American version of Budweiser (including Bud Lite) is the single best-selling brand of beer in the world and one of the most recognized trademarks. It currently accounts for one fifth of the U.S. beer market. AnheuserBusch Companies is the single largest brewer in the world, with an output several times larger than that of all the breweries in the Czech Republic combined and nearly one hundred times that of Budějovický Budvar (Reuters, 2001). On the other hand, Czech beers are famous throughout Europe and many connoisseurs believe that Bohemia produces the best hops in the world. Anheuser-Busch has attempted to resolve the matter by purchasing a stake in Budvar, but the Czech government has thus far refused all offers. Budvar is one of the most profitable Czech companies and the government are understandably reluctant to sell it to a foreign investor and long-time competitor. The Czech government has petitioned the European Union to designate "Budweiser" and "Budvar" as geographically specific names, like "champagne" and "Roquefort", which would be the first time that a beer has been so recognized. The matter is still under consideration. Starting in 2001, Budějovický Budvar began marketing its beer in the U.S. under the name "Czechvar," a portmanteau of "Czech" plus "pivovar", which means brewery. Volume21, Number 1 Czech beer is measured by "degree" (stupeň), which tends to confuse foreigners. Degrees do not measure percentage of alcohol directly; rather, they indicate the amount of malt used in brewing.2 The degree does correlate with the amount of alcohol, a higher degree indicating a higher percentage of alcohol within the same brand of beer, but 12° beer from one brand can have a lower alcohol content than a 10° from another brand, depending on the strain of yeast and the brewing process. A higher degree beer also commands a higher price within a given brand of beer. The most common degrees are 10° (desítka) and 12° (dvanáctka), but the range goes from 6° to 19°. Czech brewers produce both light (světlé) and dark (černé literally, `black') beers, but the international repute comes from the light lagers. In Britain, Ireland, and North America, dark beers are typically more strongly flavored, heavier, more caloric, and are perceived to be higher in alcohol content -- typical men's drinks. Among Czechs, the gender stereotypes are reversed. Though the darker beers are still more caloric, they are much sweeter than the highly hopped lighter beers, and are often dismissed by men as "women's drinks." Beer is not only gendered, but also reflects ethnic differences. Bohemians, inhabitants of the northern and western twothirds of the Czech Republic, are the most prodigious beer-consumers in the world, and Bohemia produces some of the worlďs best hops. The climate, however, is generally too cool and damp, with too short a growing season, to boast much in the way of wine. Slovakia, on the other hand, produces and consumes more wine than beer, with Moravia, the eastern one-third of the Czech Republic, somewhere in between. One can often identify the Moravians and Slovaks in a pub in Bohemia by looking for the wine- drinkers. Under communism, Czechoslovakians enjoyed a higher average standard of living than the inhabitants of most other Soviet-bloc countries, continuing their previous position as the industrial heart of the former AustroHungarian Empire. While the inhabitants of the Baltic states were deported to Siberia or killed outright, Czechoslovakia was in part bought off with a tacit social contract. Although they were effectively forbidden to travel abroad or to purchase foreign-made consumer goods, and even staple foods were often of low quality or in short supply, Czechs and Slovaks could always count on inexpensive and available beer and liquor, and most Czech and Slovak families had a cabin or cottage (chata or chalupa) to retreat to on the weekends -- where the main forms of entertainment were hiking, playing games, singing songs, and drinking high-quality, government-subsidized beer. Bútora (1995) reports that beer prices in Czechoslovakia remained practically unchanged from 1955 to 1980. Even with the relaxation of the belated temperance campaign and the reduction of government subsidies in the post-Communist period, beer has usually been the least expensive beverage by volume in Czech bars and restaurants. In a society where free water is practically unknown except in a handful of tourist-oriented restaurants and where food prices are slowly but steadily increasing to approximate European Union norms, the continuing low price of liquor and specifically of beer demonstrates the governmenťs reluctance to end subsidies for such a culturally valued commodity. Beer and alcohol prices will rise over the next few years in preparation for joining the EU. It remains to be seen how the Czech public will react, but people are already complaining. Beer as the medium of sociality and leisure Czech men rarely socialize without beer and Czechs in general often relax with some form of alcohol. "Dáš si panáka?" -- "Will you have a shot?" is a common gesture of hospitality when visiting someone's home. However, Czechs' consumption of Becherovka or rum by the shot-glass does not match the Russian or Polish consumption of vodka. The most famous Czech opera by Bedřich Smetana (1824-1884), Prodaná nevěsta (The Bartered Bride) praises beer with the following lines: "Beer's no doubt a gift from heaven, it chases away worries and troubles and imparts strength and courage to men...Without beer we should cut a poor figure; there's so much trouble in the world -- that foolish is he who cares too much! (Smetana, 1866: Act II, Scene 1)." Czech drinking establishments are divided into several categories, some far more common than others. The most basic of these and central to Czech leisure time is the hospoda or pub, usually a fairly casual, neighborhood tavern whose customers drink mainly beer, though some may have wine or hard liquor. A basic hospoda serves some beer food as well, usually at least párky (steamed or boiled sausages like frankfurters), tatranky or oplatky (sweet wafer cookies with cream filling), pretzels Volume21, Number 1 and nuts. Many also have other traditional "beer foods": nakládaný hermelín (a brie-type cheese marinated in oil with onions, bay leaves, allspice and other flavorings), utopenci ("drowned ones" -- small sausages marinated in vinegar with onions and spices), or sekaná (slices of forcemeat, similar to baked or fried bologna). All of these are served with slices of brown rye bread flavored with caraway (kmín -- one can hardly escape the flavor of kmín in Czech cooking), and if you're lucky, the párky or sekaná will come with horseradish-enhanced mustard and a sweet gherkin. Higher quality hospody have more extensive offerings of food, though it tends toward the fairly basic: sausages, soups and goulashes, and the kitchen often closes long before the last call. At the upper end, hospody shade into low-end restaurace. Many of the traditional Czech bar foods are threatened by European Union (EU) regulations. Utopenci and nakládaný hermelín in particular are both marinated foods which are normally kept at room temperature. Even though both are cooked, and pickling is a traditional means of food preservation, they do not meet EU standards for food safety. New regulations passed in anticipation of EU accession require all establishments serving food to maintain certain standards, including refrigeration and a stainless steel food preparation environment. Most small pubs and even some restaurants cannot afford to purchase new equipment and retrofit their kitchens. In the end, many will probably stop serving food altogether or go out of business, while many others will probably attempt to bypass the regulations by removing the offending food items from the menu but still providing them to regular customers who know to ask for them. The typical hospoda is a ground-floor or basement establishment with a number of long tables and benches, occasionally having smaller tables and chairs. Ceilings are low and the air is smoky except in summertime when windows and doors are opened to admit cooler air. Regulations call for separate non-smoking areas in places that serve food, but this is rarely enforced and comes as news to most Czechs. Approximately 70% of the adult population smokes, and the others are more or less used to it. Seating, as in all but the fanciest Czech establishments, is more or less do-it-yourself. The pub world has a certain camaraderie and a certain Czech pragmatism: empty seats at one of the long tables are available to all comers, so long as they are not being saved or reserved. (An interesting and sometimes frustrating feature is that most Czech establishments count on only a single seating in a night, so places that accept reservations will keep a table empty for hours while awaiting a party who called ahead.) One asks whether the seat is available "Je tady volno?" and sits down. Accounts in most pubs are kept on tallies of paper (lístek or učet), usually left on the table. Beers are marked at the bottom of the tab with a "P" for pivo, and other items are listed at the top by their cost. At fancier nightclubs, one receives a konzumační karta or consumption card, which one pays before exiting. Waiters assume that men will have half-liters of the light beer, and usually only ask whether one wants 10° or 12°-- "desítku nebo dvanáctku?" Women will sometimes be asked if they want a one-third liter "small beer" (malé pivo) or dark beer. Most pubs have an exclusive contract with a single brewer for their draft beer, which provides them with a discount but restricts them from offering other brands; to order a pivo thus means a half liter of the draft beer from the brand that a given pub serves. Sometimes other beers are available in cans, but Czechs rarely order them and sometimes appear puzzled when foreigners ask for a non-draft beer. (Tourists, used to the wider range of offerings in western countries and hoping to taste the two best-known Czech beers, Pilsner Urquell and Budvar, often attempt to order them in cans or bottles. I was never able to determine why Czech pubs even stock beers in cans or bottles, except for the occasional non-alcoholic beer, usually the German near-beer Clausthaler, which no one would order in sufficient quantity to justify keeping on tap.) This exclusivity is changing slowly as the brewing industry is privatized and restructured. Some breweries have merged and their customers can now offer several brands of beer on draft, but a wide selection of beers remains the mark of a somewhat overpriced tourist bar. The camaraderie of the pub is somewhat mitigated by Czech conventions of exact payment, however, a point about which Slovaks occasionally complain. Ethnographers in Britain, Ireland, and North America (Cavan, 1966: 112-135; Scheper-Hughes, 1979: 54-55) have noted the practice of "standing rounds" or buying a round of beer for everyone at the table, everyone in the group of friends. Similarly, in singles bars, buying someone a drink is a fairly innocuous gesture of flirtation and buying drinks Volume21, Number 1 for one's friends is not that serious a statement of solidarity. In the practice of buying rounds, each person typically takes a turn, but in a larger group, not everyone gets a turn on a given night. Ordinarily, as long as no single person gets out of buying a round too regularly, no one minds. The Czech situation is rather different, however. Except between extremely close friends, or late in the night when someone is very drunk, or when someone is celebrating a birthday or name-day, Czechs rarely buy rounds of drinks for the table. This reflects a general pattern of precise accounting in restaurants and pubs, in which tabs are divided at the end of the evening down to the single crown (the unit of Czech currency, koruna). Buying a round for other than very good friends can engender some anxiety until the recipient has the opportunity to repay the buyer's largesse. Even switching pubs in the course of an evening can bring on some anxiety between acquaintances if one has bought a round of beers, because the beer in the next pub could cost more or less than the beers in the first pub, thus obviating exact repayment. Slovaks comment on this point quite unfavorably when the topic comes up. While Czechs are quite hospitable to their personal guests, hospitality holds a much higher ranking in the pantheon of Slovak values. Slovaks do each stand their round when drinking in a pub, and small items such as snacks or cigarettes are freely, even ostentatiously, shared among the drinking comrades. The greater Czech emphasis on individuality and account-keeping strikes the Slovaks as cold and calculating, and they often contrast it with Slovak generosity and warmth of feeling. At the end of the evening, one of the headwaiters (not a busboy) comes and tallies up the marks on the card. Individuals keep track of what they have, and waiters in pubs and more casual restaurants typically assume that customers will be paying separately, though they usually ask: "Dohromady nebo zvlasť?"Although people in pubs do not normally buy rounds for the table, each person usually drinks about the same amount, which makes keeping track easier. It is fairly unusual simply to divide the bill equally in a Czech pub, unless the parties involved are quite good friends or the bill involves many items and individuals all consumed roughly the same amount. Some of the tropes of the pub also reflect the pervasive discourse in Czech society about how things "ought" to be, a picture of an idealized past under Communism or in the traditional life of the village. As an example, one of my favorite pubs in Prague had a wall covered with a collage of different kinds of playing cards. When I asked why, people invariably answered that it is traditional to play cards in a pub, and so they fit the décor. In more than three years of fieldwork, often in bars and pubs, I may have seen a deck of cards in a pub on a total of one or two occasions in which I did not actively seek them out. The traditional Czech and Slovak card game is mariáš, which is played mainly by men and mainly in pubs. As a further example, though most of my informants agreed that mariáš was a traditional pub game, I only met one person under the age of forty who knew how to play, and he was from Ostrava, the least international of the larger Czech cities and the one whose population has most recently moved to an urban setting.3 Other types of establishments exist. In summer, many restaurants have outdoor seating (called a garden or zahrada, though often more like a patio or sidewalk seating). The Czech Republic does not have the sort of welldeveloped Biergarten culture that Germany has refined, but independent beer gardens operate in some of the larger parks during good weather. Other types of establishments include the vinárna or wine-bar (which sometimes advertises itself as "Moravian", presumably indicating better quality wine) and the vinný sklep (literally "wine cellar", usually smaller than a vinárna). A herna is a small gambling joint or casino, often open late or non-stop, with slot machines and possibly other games such as darts. A herna is rather seedier than a normal bar; while it may act as a neighborhood bar, it often serves as a stop-over for drunks whose bar has closed for the night. Beer in a herna is often only bottled or in cans, and comes with a higher price tag. The disco or diskoteka is a dance club, where people may drink beer but also wine, spirits, and mixed drinks. A kavárna is nominally a café, but nearly all of them also serve alcohol and a substantial number of men in a kavárna in the afternoon or evening will be drinking beer. All of these can be described as podníky or establishments. The one establishment that does not serve alcohol to most of its customers is the čajovna or tea room, which also provides one of the few smoke-free public venues in the Czech Republic. Čajovna patrons tend to be a younger, Volume21, Number 1 somewhat alternative crowd, who smoke pot and listen to various kinds of alternative music when not in the tea room. The čajovna scene itself represents the current Czech (and more generally Central and Eastern European) fascination with elements of "eastern" mysticism -- astrology, Ayurvedic and traditional Chinese medicine, vegetarian and other diets -- as a replacement for both Communist ideology and organized, western religion in a post-Communist, postCatholic world. The Etiquette of Beer Beer is a metonym of relaxation and leisure (pohoda), but it commands a certain respect and formality, and also points up a number of peculiarities in Czech drinking behavior. The general rules of beer-drinking all express respect for the beer and for one's companions. Beer is not wasted, it is not mixed, and the good feeling and even the next day's hangover mark a certain sense of communitas with one's drinking fellows. It is, in a sense, both a sacral drink and a medium of liminality. One of the first rules that you learn in the Czech lands is that you never leave a beer, though this is perhaps more a statement started by young men and carried into adulthood for some time, comparable to the "rule" among some young men in the United States that a party cannot end until the keg is finished. Nonetheless, to leave a beer glass with a noticeable amount of liquid in it is to say that something is wrong with the beer. Either it has gotten warm, or perhaps the glasses were not adequately rinsed and have been contaminated with soap. Either way, it is a statement that the beer was not up to par. Beer is treated differently than other beverages. If possible, beer is normally put on a coaster, usually provided by the brewer and bearing various advertisments for that brand of beer. Sometimes the coaster is left out if the beer will be placed on a tablecloth, but even then a coaster is typical. A half-liter of cold beer does generate a lot of condensation in a humid Czech pub, but so do other drinks not equivalently honored with a coaster (such as a half-liter wine spritzer -- vinný střík -- or even a cold soda). The first round of beer of an evening, or in a given establishment, normally calls for a toast (připítek). It also requires that one wait until everyone in the group is present and seated; to start without toasting or without waiting for someone else in the group is to show disrespect. To make a toast classically means to raise one's glass while looking into the eyes of one's companion, clink the glasses together lightly and say "názdraví" (to health). Rather more informally, one can simply use the various salutations, most commonly "čau" but also the old Sokol4 slogan "nazdar" which means much the same thing, or the informal greeting "ahoj." A somewhat humorous pun is to say "nádraží", which sounds like "názdraví" but means "train station." (Zíbrt, 1910: 65-71 et passim, describes a number of Czech toasts and drinking lore from the 16th through 19th centuries.) A few rules must be followed. One must look into the eyes of one's partner while clinking the glasses together, and clink the glasses one at a time rather than in a group. To do otherwise is to be insincere, not to give the other person the attention or respect they deserve (cf. Zíbrt, 1910: 49 for the antiquity of this custom), and is occasionally attributed to Germans, as this custom seems not to hold in Germany. Part of this general rule of toasting with a single person at a time, each in succession, states that one may not reach under or over another person's glass in order to clink glasses with someone else. (At the other extreme, Hungarians never clink when toasting. The clink of glasses during a toast was once the signal for a coup, and today no Hungarian patriot will touch glasses while toasting. Several neighboring cultures also require looking into one another's eyes while toasting: Austrians and Slovaks do, but Germans apparently do not. Neither is it required in Britain or the United States.) As is the case with many understandings of culture as prescriptive rules, many Czechs think that foreigners take some of the toasting a bit too seriously. Failure to look into someone's eyes directly while toasting is grounds for reproach, but Czechs sometimes say that foreigners concern for toasting with every last person is excessive. And then they proceed to do precisely that, and to express insult when they are overlooked. Among students and young men, there is a more elaborate form of clinking glasses. The simplest elaboration is to tap the glass on the coaster or a wooden table top after clinking glasses and before taking the first drink. A slight variation on this is to clink the glass additionally against an ashtray or any other glass or ceramic item on the table that is not a cup. The idea in this is that it makes a different quality clink than either the glasses together or the tap against the Volume21, Number 1 table, but clinking one's glass against another glass sitting on the table is either rude (to the person whose glass it is), or distasteful and in any case runs the risk, especially as the evening progresses and the tally marks on the tab increase in number, of breaking the target glass. The fullest variation is to clink the glasses together first top, then bottom, then angled to one side and the other, then to rub the glasses against one another, tap them firmly on the tabletop or coaster, and then to take a long drink. People see this as a deliberately humorous caricature of the toasting tradition and usually smile while doing so; as nearly a parody, it practically demands either the most formal "názdraví" in a tone of mock gravity or suppressed laughter, or something silly like "nádraží." A beer should always be treated with respect, and a sign of this is that a beer is never mixed or poured from one container to another. Czech beer is ideally served cold, with about two centimeters of foam on top. A holdover from the Communist era is that all glasses are marked with a measuring point which should be reached by the meniscus of the liquid.5 Bartenders can short their customers somewhat by serving greater amounts of foam; ideally, the beer should be level with the mark when the foam is nearly dissolved, and to fall short of this is to give bad measure. Bartenders learn a complex art of drawing beer from the tap in order to achieve the right amount of foam (pěna or smetana) on the beer, involving several glasses and pouring foam off from the main glass into others, where it will settle into a few centimeters of liquid beer which is then topped off from the tap to serve a later customer. This process is most necessary for the first several liters of beer to come out of a newly tapped keg. The bartender, however, like other handlers of sacred substances, is the only person permitted to mix beer or pour it from one glass to another. Once a beer has arrived in its final glass and been placed on the table, it should not be poured into another glass or mixed with anything. Neither do Czech pubs serve pitchers of beer; beer is always served in individual glasses straight from the tap (though sometimes people will carry home beer from a local pub in liter bottles if a party at home runs short -- essentially beer take-out). On my first trip to Prague, I discovered this rather painfully. I was sitting in a pub with a group of Czech men, drinking and talking. The waiter had already brought the next round of beers, though we were only about halfway through our half-liters, but he had brought small beers. I thoughtlessly poured the small beer into the large beer, to cool down the large beer and clear some space on the increasingly crowded table as I might do in a bar in Boston or San Diego. Conversation suddenly stopped and my companions looked at me as though I had spit into the beer. I have seen Czechs occasionally split beers or consolidate beers, but it usually occurs late in the evening, among close friends, and rather surreptitiously, as it is considered more than a little gauche. There do exist a couple of mixed drinks involving beer, but none are common, and some Czechs claim not to have heard of them. I have seen all of them served in bars at some point during my time in Prague. One is beer with Sprite, at a mixture of about half and half. Most informants responded that this sounded like an abomination and was probably a German drink. (Later research found that this is in fact a German and Austrian drink called a Radler, though some Czechs drink it on rare occasion and call it pivo se sprajtem.) Beer can also be mixed with Fernet or Becherovka, analogous to the Japanese-American "sake bomb", but this is equally rare. Czechs generally demonstrate disgust at mixing anything else with beer, like lemon slices in German Hefeweizen or lime wedges in Mexican Corona. Wine, however, which most Americans would balk at mixin, is often drunk mixed with soda or cola. There is one legitimate exception to mixing beer, and an exception to the rule that men do not normally drink dark beer. There exists so-called "cut" beer -- řezeno pivo or řezák -- which is a 50-50 mix of light and dark beer. This is not like a Black and Tan, in which Guiness is floated on a lighter beer, but is in fact blended. One is not supposed to mix beers from different breweries in making this drink, but given that most pubs have contracts with a single brewery, that concern is more hypothetical than practical. The heroine of Hrabaľs Cutting it Short describes quite lyrically: `Half-and-half,' I told myself into the can and then I sipped in and gradually, holding back the desire to pour down the whole measure at once, ever so slowly and sweetly I swallowed down that light lager mixed with dark garnet, that half-and-half, mutra the maltsters called it, I drank it ever so slowly and tenderly, just like when on a Volume21, Number 1 summer's evening out there beyond the brewery, on the margins of the fields of rye, someone sits sweetly... playing for himself his melancholic song (Hrabal 1976: 87). The Healing Powers of Pivo Beer and various Czech herbal liqueurs also play a major role in Czech folk medicine. Many Czechs swear by the healing powers of pivo. They say that it has "a lot of vitamin B" and that iťs very nutritious.6 The belief in alcoholic beverages as medicine extends to several liqueurs peculiar to the Czech lands and Slovakia which have reputations as "digestives" and "medicinal." When translated through the models of folk biology, this effectively states that they have herbs in them. Absinthe is a liqueur once popular across Europe but banned in most countries other than the Czech Republic, Slovakia, and Spain since the nineteenth century. It is a decoction of herbs in grain alcohol, prepared from a combination of wormwood (Artemisia absinthum), licorice, angelica, and other herbs, and has an alcohol content of some 70-80%. Less potent but still strongly herbal and fairly alcoholic are Becherovka, from the Jan Becher distillery in the spa town of Karlovy Vary (Carlsbad) in western Bohemia, and Fernet from the Stock Plzeň-Božkov distillery in Plzeň. Both belong to the same Central European family of herbal liqueurs as the German Jägermeister and the bitter Hungarian cordial unicum. Both Becherovka and Fernet are drunk straight as shots or mixed with tonic (beton is Becherovka with tonic, bavorák is Fernet with tonic). Also common with local variations throughout Central and Eastern Europe, slivovice or plum brandy carries a reputation for general but unspecified medicinal powers. (Less common variations are made from a number of fruits, including apples -- jablkovice, huckleberries or bilberries -- borůvkovice, pears - hruškovice, apricots -- meruňkovice; and even pine needles -- borovice). Czechs believe with almost superstitious fervor that "mixing" drinks -- in the sense of switching from one category of alcohol -- beer, wine, liquor -- to another in the course of an evening is bad. This does not stop them from doing it, of course, but doing so will often draw comment from someone in a group, especially if the sense is that the group is just out for a couple of beers. Some Czechs will actually show some nervousness -- as in warning that "you really shouldn't mix different kinds of drinks" -- and some will even comment on switching different brands of beer, if one is switching pubs. I have heard this given as a mild reason not to switch pubs -- presumably it was in fact being given as an excuse that was motivated by something else, but the fact that it could be given as an argument at all is suggestive. It was not that they disliked the brand of beer at the proposed pub, but rather that we had been drinking brand X all evening already and should not "mix" our drinks. Slightly more common is the comment, if changing between pubs with contracts to the same brewer, "Such and such a pub even has the same kind of beer, so we won't be mixing." A final consideration in the folk medical beliefs around alcohol strictly prohibits drinking while taking antibiotics. This warning is given in other countries of course, and has two major justifications from a medical viewpoint. Alcohol can increase the risk of various side effects of antibiotics, including toxicity and carcinogenicity. It also can increase clearance of the antibiotic from one's body and reduce its effectiveness, either by increasing urination or by stimulating metabolism of the drug by the liver. The Czech folk belief holds a peculiar horror for mixing alcohol with antibiotics, however, as distinct from all other categories of medicine which might have interactions with alcohol, and also distinguishes two categories for the Western category of antibiotic -- true antibiotics and "chemotherapeutics" (chemoterapie). Western medicine draws a technical distinction between bactericidal antibiotics, which actually kill bacteria, and bacteriostatics, which merely impede their growth and allow the body's own immune system to clear them, but this does not seem to be the exact distinction represented by that between antibiotikum and chemoterapie, and the absolute prohibition on alcohol consumption in the public consciousness is reserved for antibiotikum per se. The Dangers of Drinking: Alcoholism Czechs consume more beer per capita than anyone else in the world, and have consistently maintained one of the highest rates of general alcohol consumption over the last century. Total alcohol consumption has in fact increased nearly threefold since the 1930s, from 3.6 liters per person per year in 1936 to 9.9 liters per capita in 1999. Beer consumption has increased two and a half times over the last seven decades, from 64.8 liters per capita in 1936 to 165 liters per capita in 2002 (See Tables 1, 2 and Volume21, Number 1 3). Most authorities suspect that reported alcohol consumption underestimates the true numbers (ÚZIS 2001, 2002b). The World Health Organization numbers, for example (Table 3), are substantially higher than the estimates by the Czech Institute of Health Information and Statistics (ÚZIS). Many Czech thinkers have discussed the problem of alcoholism in their writings and speeches. Tomáš Masaryk stated that "a nation which drinks more will undoubtedly succumb to one that is more sober. The future of each nation and especially of a small nation depends on...whether it stops drinking. Each nation destroys itself by drinking and drinking injures everyone who does not resolve himself against it (Masaryk, 1905a; see also Masaryk, 1905b, 1912; Beneš, 1915)." Recognition by the general public, however, has been slow in coming. Bútora describes how the phenomenon of alcoholism, like many other social and psychological ills, was either hidden or caricatured under Communism. The communist press portrayed alcoholism as a degenerate behavior of the bourgeoisie, alien to the authentic, right-thinking, socialist Czechs and Slovaks (Bútora, 1995: 39-40; 1980a). The image of a wild-eyed, dissipated counterrevolutionary clearly did not fit the more insidious problems of ordinary Czechs: missing work or arriving late because of a hangover (kocovina), fights with spouses and neglect of children, or an untimely death from cirrhosis. As Nancy Scheper-Hughes comments on the status of alcoholics in rural Ireland, the existence of a notorious and well-known drunkard within a community or on its fringes reinforces the normality and acceptability of other community members's behavior. Only the one or two "town drunks" have a problem, and their flagrant dysfunction normalizes the less dramatic problems of ordinary people in the community (Scheper-Hughes, 1978: 83). Most Czech males begin drinking with friends in mid-adolescence, around the age of 15 or 16, and are regularly spending time with friends in pubs by the age of 18 or so. The drinking age is only loosely enforced, and 16and 17-year-olds are often served if they are with a group of older friends or are not obviously under age. A series of studies have found significant levels of alcohol consumption among Czech and Slovak adolescents: a 1995 survey of 26 European countries found that 91% of 10thgraders had consumed alcohol in the last twelve months and 54% had been drunk at least once during that time (ESPAD, 1997); a 1993 study found that 38% of 15-year-old boys and 18% of 15-year-old girls drink alcoholic beverages at least once a week (WHO, 1996); and another 1993 study found that 87% and 88% of 14-yearolds and 16-year-olds, respectively, had used alcohol in the past year (European Commission, 1995). The general acceptance and availability of alcohol as compared with many western countries appears to offer a protective factor against teen drinking, as alcohol is not forbidden and offers less allure. My informants reported that they initially disliked the bitterness of beer. Most Czech teenagers manage to overcome this initial distaste by the end of high school, however, and males in particular often socialize in pubs by the age eighteen when they can legally drink. Certainly by adulthood, drinking alcoholic beverages and especially beer has become the normal mode of socializing, and attitudes towards alcohol consumption and even frank inebriation are quite tolerant. Czech women drink substantially less than their male counterparts, though still a considerable amount. Women are more likely to drink wine than are men, are less likely to drink hard liquor, and drink smaller amounts in a single episode of drinking (ÚZIS 2002b). Women often drink with their male partners, husbands or boyfriends, but are less likely to go to a hospoda alone. The exception to this is that young women in the cities, especially single young women, do go alone or more often in groups of female friends to dance clubs, where they drink wine or mixed drinks. Women in cities also often go out dancing with their boyfriends, and will of course drink alcohol at parties. The pub, however, is gendered as masculine territory to the extent that one will only rarely see groups of women in a pub by themselves. The typical crowd in most pubs comprises groups of men, or in pubs which attract a younger crowd, groups of men and mixed groups of young men with their girlfriends. In fact, the advertising campaign in 2002-2003 for Staropramen beer bears the slogan "chlapi sobě" ("guys for themselves") and shows groups of obviously working-class men enjoying themselves with cold half-liters of Staropramen. (For further discussion of gendered aspects of Czech drinking, see Bútora, 1995; Hall, 2003; Kubička et alia, 1993, 1995; ÚZIS, 2002b.) Volume21, Number 1 Heavy drinking behavior and frequent consumption of alcohol are supported by cultural norms of drinking beer in most social situations and a concomtant tolerance for drunken behavior. Drinking beer on a morning "coffee break" at work does not raise eyebrows from coworkers, and the equivalent of the threemartini lunch -- the three- or four-beer lunch -- is fairly common. Alcohol is available in Czech cities twenty-four hours a day. There are no official closing times for bars. Although most pub owners do not find it profitable to stay open past 3:00 A.M. or 5:00 A.M. in the case of discos, small casinos are open near the central train or bus station all night long in the larger towns and cities. In the largest cities, such as Prague and Brno, kiosks on the main square or near the train station sell beer and liquor along with sausages and fried cutlets (řízek) through most of the night. Czechs can and do drink alcohol in public: there is no prohibition of alcohol in parks or at beaches, and it is the rare restaurant that does not have a license to sell beer at the very least. Even family-oriented establishments such as McDonalďs and KFC have beer on the menu and cafés offer a selection of liquor-infused coffees (Algerian with custardflavored egg-cognac, Irish with whiskey, African with coffee liqueur, Brazilian with rum, and others). In short, alcohol is easy to obtain and there are few if any sanctions for drinking alcohol in itself. Drunkenness and the effects of drunkenness are also treated with a fair degree of leniency. Czechs feel little guilt at calling in sick or showing up late to work when they have a hangover, and feeling under the weather due to heavy drinking the night before at one's own or a frienďs birthday or name-day celebration is fairly common. In contrast to the United States or Britain where intoxication is de facto evidence of culpability, Czechs consider that overindulgence in alcohol reduces one's responsibility for neglect of duties, at least up to a point. A colleague of mine spent a wintry weekend teaching English to businessmen on a study retreat at a hotel in the mountains. Both nights, the caretaker stayed up late drinking with some of the businessmen. As a result, he allowed the furnace to go out both nights, leaving the hotel cold and without hot water, and was too hung over to prepare breakfast. Not only did no one complain, but when my colleague remarked on this the second cold morning without breakfast, several of the businessmen defended the caretaker: "But he'd been up drinking all night." Similarly, several prominent celebrities and politicians are known to drink heavily on a regular basis, with minimal criticism in the press. A study by Kubička et alia (1985) of young males in Prague found that drinking five half-liter beers at a sitting was considered acceptable behavior by most respondents and 41% said that it was normal to drink 6-8 beers in an evening (3-4 liters of beer). Preliminary results from my own research showed that males who had drunk beer on their last night out reported consuming an average of five and a half beers (2.75 liters). This does not count other sources of alcohol; my data suggests that Czech men drink either beer or wine, but usually have a strong preference for one over the other. Both wine-drinkers and beer-drinkers often have shots of hard alcohol in addition to the beer, particularly if celebrating something or later in the evening. Actual rates of alcoholism, as of any psychiatric condition, are difficult to measure and in a cross-cultural situation particularly, must be considered against the prevailing social norms and the local effects of alcohol consumption. In her thoughtful study of alcoholism and depression among the Flathead Indians of Montana, Teresa O'Nell (1996) makes a case for the prosocial functions of heavy alcohol consumption and occasional bingedrinking in a Native American community. She argues that in the local community, drinking serves as a major mediator of social interactions among adult men, and a certain level of "excessive" or binge drinking is socially normative. In such a setting, teetotalling by itself was often a sign that healthy social relations were lacking and the threshold for diagnosing alcohol abuse or dependence should accordingly be raised above that which would obtain in a middle-class Anglo-American setting. This compares to findings by Shedler and Block (1990) that adolescents who experimented with marijuana and alcohol but did not use them to excess, were in fact healthier on several measures of intra- and interpersonal function than were either habitual users or total abstainers. Simple application of norms derived from other societies, particularly norms for pure consumption of alcohol which ignore social context, may not adequately detect dysfunctional or harmful levels of alcohol consumption in the Czech and Slovak Republics. However, it is clear even from the society-specific data that Czechs Volume21, Number 1 do experience relatively high rates of alcoholrelated problems. Table 4 presents data from the Czech Ministry of Health for hospitalizations due to alcoholism. Two patterns are apparent from the numbers: relative numbers of individuals hospitalized for alcoholism have increased over the last two decades among both men and women, and the number of women showing problems associated with drinking has increased at a faster rate than the comparable number of men. A consistent finding is that women's drinking patterns, particularly among younger, more educated, and urban women, are slowly but surely becoming more similar to those of their male counterparts (ÚZIS, 2002b). Other measures of alcoholism, such as the number of deaths from cirrhosis and alcohol-related liver damage, are also high in the Czech Republic. Bútora reports that the rate of cirrhosis rose 470% between 1950 and 1990, from 5.4 to 24.7 deaths per 100,000 population. WHO numbers show that the numbers have continued to rise throughout the 1990s (see Table 5). Overall, Czech and Slovak authorities have begun to recognize the deleterious effects of heavy alcohol consumption, but the general public still holds fairly tolerant views of social drinking and even of frank intoxication. Exact numbers, both in terms of consumption and in individuals dependent on alcohol, are hard to determine, but the presence of the problem is indisputable. A Culture of Beer We can see then that if any culture in the world qualifies as a beer-drinking culture, it is the Czechs. Images of beer and beer-drinking pervade Czech literature and film, from Hašek's drunken anti-hero Švejk or the brewery which dominates Hrabaľs Little Town Where Time Stood Still, to the scenes from the popular musical Stařci na chmelu (The old folks in the hops). Beer acts as a major mediator and occasion of sociality, and Czechs are among the greatest beer-drinkers in the world. This set of associations and values, however, has a dark side. Czechs have high rates of alcoholism and other health and economic consequences from their high alcohol consumption. So what happens now, as both Communist-supported temperence programs and government subsidies wither away, as young Czechs increasingly have opportunities to travel and study (cf. Nash, 2003), and the Czech Republic increasingly opens itself to European and international influences? Will the camaraderie of the hospoda go the way of mariáš lingering only in among pensioners in villages, or will beer and alcohol more generally maintain their hold on Czech social life? It remains to be seen what will happen to Czechs' relationship with their beer as the nation "returns to Europe." Acknowledgements This article would never have been possible without the help of Karel Vrbenský, my first guide to the world of české hospody and someone who takes his pivo quite seriously. Many thanks also to Vojtěch Kostiha, Dušan Quis, Bohdan Ševčík, Margaret Rance, and the staff of Stella bar, Alcatraz, and Angel. This article is based in part on my dissertation research in Prague, Czech Republic, which was supported by the Jacob K. Javits Fellowship, U.S. Dept. of Education; the MST Program at UC San Diego School of Medicine (NIH grant #5T32GM07198); a language training fellowship from The Rotary Foundation; the Center for Gender Studies and the Committee on Human Development at the University of Chicago; and the Melford E. Spiro Fieldwork Grant from the Dept. of Anthropology, UC San Diego. Timothy M. Hall is completing his M.D. and Ph.D. at the University of California - San Diego with a specialization in psychiatric anthropology. He can be reached at mccajor@post.harvard.edu. 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(Prague, Czech Republic: 7. 12. 1998) --------, 2001, Aktuální informace (AI) č. 41: Zdravotně riziková konzumace alkoholu v ČR (srovnání šetření HIS CR 1999, CIDI 1999 a studie SZÚ 1996) [Healthrisking alcohol consumption in CR (comparison of results of HIS CR 1999, CIDI 1999, and a study by the State Health Institute, Prague)]. (Prague, Czech Republic:10.7.2001) --------,2002a,Aktualní informace (AI) č. 57: Hospitalizování v psychiatrických lůžkových zařízeních ČR v roce 2001 [Hospitalization in psychiatric beds in CR in 2001]. (Prague, Czech Republic: 3.12.2002). --------, 2002b, Aktualní informace (AI) č. 9: Šetření zdravotního stavu české populace (EUROHIS 2001) Díl XI.: Spotřeba alkoholu [Results of the health status of the Czech population (EUROHIS 2001), Part XI: Consumption of alcohol]. (Prague, Czech Republic: 22.2.2002) WHO, 1996, Health Behaviour in School Children Study 1993/1994. World Health Organization Regional Office for Europe. Data supplied by Dr. Bente Wold, WHO Collaborating Centre, University of Bergen, Norway. Cited in: Moser, J., Memorandum to World Health Organization, (February, 1996). Geneva: World Health Organization. --------, 1999, Global Status Report on Alcohol. Geneva: World Health Organization. Volume21, Number 1 Zíbrt, Čeněk, 1910, Řády a práva starodávných pijanských Čechů a družstev kratochvilných v zemích českých (Přiloha časopisu ,,Sládek" neodvislého týdenníku pivovarského, ročník druhý). Prague: Knihtiskárna V. Kotrba. 1 Notes 1 Karel Vrbenský, hospoda U medvídků, Praha, June 1998. 2 The degree system was developed by Carl Joseph Napoleon Balling in England based on earlier research density measurements and saccharometry. It was introduced into British and German brewing in the 1840s. Each "degree" in the Balling scale represents 1% sugar content by volume (in the mash, for brewing contexts) at 14° R (63.5 °F or 17 °C). The Balling scale uses the Rankine temperature measurement, an absolute temperature scale using Fahrenheit degrees. The system has since been replaced in brewing by the Plato scale and in wine-making and confectionary by the Brix scale, which were developed later and calibrated to degrees Celsius (Brewers Journal, 1903: 48-49, 80-81; Goldammer, Ted. The Brewers' Handbook: The Complete Book to Brewing Beer. Herndon, VA: Apex Publishers, 2002). 3 Mariáš is normally a three-person game, though variants exist for four or two players. It ultimately derives from a French game called mariage and is related to other local games in Central Europe, such as the Hungarian ulti. The game is played with a special deck of 32 cards, which look more like Tarot cards than English playing card. There are four suits: hearts or red (červené), balls (kule), acorns (žaludy) and leaves or green (zelené); each of eight cards: ace (eso), king (král), over-knave (filek), underknave (spodek), and numbered cards 10, 9, 8, and 7. Mariáš is played in tricks, one player against the other two, with a trump suit. Scoring and bidding are quite complicated, which may partly explain why younger Czech men less often take the time to learn the game. The complexities of mariáš probably also explain why most Czechs who do not play cards regularly seem unable to name the cards or suits: the names of mariáš suits overlap partly but not completely with the names of suits in regular cards, which seems to generate some confusion. Information about a number of obscure card games including mariáš and its relatives can be found at www.pagat.com. Booklets of rules for Czech card games are published in the Czech Republic and sold in gaming stores. Cards are available in game stores and some pubs. 4 Sokol is an athletic organization which began in the nineteenth century and played a significant role in the Czech and Slovak nationalist movements. Nazdar! was one of its slogans and passed into the vernacular as a greeting. The organization still exists. 5 Ordinarily 0.33-liter or 0.5-liter glasses for most beers. Velvet, a relatively new beer with a wheat-beer taste, semi-opaque consistency and small, descending microbubbles like Guinness, is served in special 0.4 liter glasses. Some expensive tourist-oriented bars also serve beer in 0.4-liter glasses. 6 Beer probably constituted a relatively healthful beverage in a pre-industrial setting. Turning barley into beer preserves the calories through the winter, reducing the chance of spoilage or loss from mold and rodents, and also provided a source of sterilized liquid in an era when most water was probably contaminated with bacteria. Beer does contain small amounts of B-complex vitamins, but not of nutritional significance. Beer contains amounts of B-vitamins comparable to the vitamin C content of potato chips. Volume21, Number 1 Table 1: Total beer consumption per person per year, in liters of beer Year Czechoslovakia Czech Republic 1936 51.8 64.8 1955 79.1 89.2 1960 100.1 109.0 1965 130.0 140.7 1970 139.9 154.1 1975 143.4 157.3 1980 137.8 148.5 1985 130.8 146.9 1988 131.7 149.7 1989 131.8 151.0 1990 135.1 155.2 1995 --- 156.9* 2000 --- 159.9* 2002 --- 165 (Adapted from Bútora, 1995; Statistical Yearbook of Czechoslovakia; ÚZIS, 2002a; *Data directly from ÚZIS; Lidové noviny, 06.01.2003. Data for the Czech Republic was tallied separately within Czechoslovakia; the Czech and Slovak Republics separated in 1993.) Table 2: Total alcohol consumption per year, in liters of pure ethanol per person over 15 years of age Year Czechoslovakia Czech Republic* 1936 3.4 --- 1949 3.9 4.2 1955 4.3 4.5 1960 5.4 5.7 1965 6.7 6.5 1970 8.2 7.8 1975 9.0 8.3 1980 9.6 9.0 1985 9.4 9.0 1988 8.5 8.1 1989 8.7 8.2 1990 9.3 8.9 1999 - 2001 --- 9.9 (Adapted from Bútora, 1995; Statistical Yearbook of Czechoslovakia; ÚZIS, 2001, 2002a. *Data for Czech Republic before 1993 was provided separately by Czechoslovakian sources. Data for 1999-2001 provided directly by ÚZIS: same amount each year.) Volume21, Number 1 Table 3: Consumption of alcohol calculated as liters of ethanol per person over 15 years of age in the Czech Republic, WHO estimates. Year Liters of pure ethanol Liters of ethanol as beer Calculated liters of beer Liters of ethanol as wine Liters of ethanol as spirits 1961 10.04 6.36 141.3 2.34 1.35 1965 11.94 7.66 170.2 2.86 1.41 1970 13.58 7.99 177.6 2.60 3.00 1975 14.95 8.30 184.4 2.94 3.71 1980 15.54 8.10 180.0 2.84 4.60 1985 15.24 7.70 171.1 2.93 4.61 1990 15.73 8.89 197.6 2.64 4.20 1995 15.25 8.67 192.7 2.65 3.93 1999 15.33 8.62 191.6 2.74 3.97 (Adapted from WHO Global Alcohol Database. Data compiled from FAOSTAT - United Nations Food and Agriculture Organization's Statistical Database, World Drink Trends, regularly published by Produktschap voor Gedistilleerde Dranken [The Netherlands] and direct government data. Liters of beer calculated by the author using WHO conversion rate of beer as 4.5% ethanol by volume.) Volume21, Number 1 Table 4: Hospitalization due to alcoholism, Czechoslovakia 1980-2001. Absolute numbers hospitalized for alcoholism Hospitalizations for alcoholism per 100,000 population Year Men Women Total Men Women Total 1980 6,628 813 7,441 132.3 15.3 72.1 1981 6,785 968 7,753 135.9 18.2 75.2 1982 6,462 1,020 7,482 129.2 19.2 72.5 1983 6,711 1,224 7,935 134.0 23.0 76.9 1984 6,709 1,363 8,072 133.9 25.6 78.1 1985 6,586 1,394 7,980 131.3 26.2 77.2 1986 6,694 1,386 8,080 133.3 26.1 78.1 1987 6,920 1,471 8,391 137.8 27.6 81.1 1988 6,784 1,543 8,327 134.8 29.0 80.4 1989 6,970 1,811 8,781 138.4 34.0 84.7 1990 6,713 1,861 8,574 133.3 34.9 82.7 1991 5,473 1,720 7,193 109.4 32.4 69.8 1992 5,130 1,835 6,965 102.4 34.6 67.5 1993 3,915 1,278 5,193 78.0 24.1 50.3 1994 6,536 2,146 8,682 130.2 40.4 84.0 1995 6,821 2,340 9,161 135.9 44.1 88.7 1996 7,262 2,602 9,864 144.8 49.1 95.6 1997 7,564 2,624 10,188 151.0 49.6 98.9 1998 7,280 2,717 9,997 -- -- 97.1 1999 -- -- 9,511 -- -- 92.5 2000 7,082 2,896 9,978 142 55 97.1 2001 7,291 2,885 10,176 146 55 99.1 (Adapted from ÚZIS 1998a, 1998b 2002a. Individuals counted in this table received a diagnosis of Alcoholism: ICD-10 diagnosis F-10, and were treated in a hospital setting.) Volume21, Number 1 Table 5: Deaths from cirrhosis and chronic liver disease (ICD-10 diagnoses K70,K73-K74,K76), absolute numbers and number of deaths per 100,000 live births. 1994 1995 1996 1997 1998 M total 1192 1234 1188 1218 1314 F total 537 533 512 546 594 M / 100 000 23.1 24.6 23.7 24.3 26.2 F / 100 000 10.1 10.0 9.7 10.3 11.2 (Adapted from World Health Statistics Annual, Geneva: WHO.)