Background: The public health perspective on alcohol comprises two main tenets: (i) population drinking impacts on alcohol-related harm and (ii) population drinking is affected by the physical and economic availability of alcohol, where alcohol taxes are the most efficient measure for regulating consumption. This perspective has received considerable empirical support from analyses of contemporary data mainly from Europe and North America. However, as yet, it has been little examined in a historical context. The aims of the present article are to use data from tsarist Russia to explore (i) the relation between changes in the tax on alcohol and per capita alcohol consumption and (ii) the relation between per capita alcohol consumption and alcohol mortality. Methods: The material comprised annual data on alcohol taxes, alcohol consumption and alcohol mortality. The tax and alcohol consumption series spanned the period 1864–1907 and the mortality data covered the period 1870–94. The data were analysed by estimating autoregressive integrated moving average models on differenced data. Results: Changes in alcohol taxes were significantly associated with alcohol consumption in the expected direction. Increases in alcohol consumption, in turn, were significantly related to increases in alcohol mortality. Conclusion: This study provides support for the utility of the public health perspective on alcohol in explaining changes in consumption and alcohol-related harm in a historical context. We discuss our findings from tsarist Russia in the light of experiences from more recent alcohol policy changes in Russia.