Moonshine consumption often has been considered a backwoods activity in small, Southern towns, yet as School of Medicine researchers at Grady Hospital recently discovered, moonshine use is surprisingly common in urban Atlanta.

In a study conducted in the Grady emergency department and published in the September 2003 issue of Annals of Emergency Medicine, lead author Brent Morgan, assistant professor of emergency medicine and director of the Medical Toxicology Fellowship Program, reveals that a group of patients who admitted drinking moonshine were more likely to have elevated lead levels in their blood than patients who did not.

The paper is based on a study that began at Grady in April 2000, after four adult patients arrived at Grady with potentially lethal lead poisoning. Of the four, three presented with seizures and one with abdominal pain. All four admitted drinking moonshine and had blood lead levels well above the normal limits.

The study, completed in conjunction with the Georgia Department of Health and the CDC, was designed to estimate the prevalence of moonshine consumption among the urban population at Grady; to identify predictors of moonshine consumption; and to measure the relationship between self-reported moonshine consumption and blood lead levels.

The study was conducted in two phases: a prevalence phase, in which Morgan and other researchers assessed how many people in Atlanta are drinking moonshine, 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.

“Frequently, when we think of moonshine consumption, we think of the middle of Appalachia, but we didn’t know that this phenomenon was also here in the inner city of Atlanta,” Morgan said. “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 drinking moonshine within the past five years. Of those patients, 26 percent had consumed it within the previous week. Moonshine drinkers were more likely to be men between 40–59 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 hospital’s 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 also termed 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 it from north and south Georgia.

Moonshine is manufactured using corn along with a mixture of yeast, which 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 also were collected to measure the relationship between moonshine use and elevated blood lead levels.

“To our knowledge, prevalence rates of moonshine consumption have never been characterized,” Morgan wrote. “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 levels.”