Published online by Cambridge University Press: 08 February 2018
Almost 125 years ago Addison (1836) suggested the existence of a causal relationship between alcoholism and cirrhosis of the liver and more than 100 years ago Rokitansky noted accumulation of fat as the earliest effect on the liver of over-indulgence in alcohol (cited from Connor, 1938). Though the relative importance of infective hepatitis and alcoholism as aetiological agents in liver cirrhosis may vary a great deal in different countries, “alcohol and infective hepatitis are at present the only two unequivocal aetiological factors” (Annotation, Brit. Med. J., 1957). It is usually accepted that over-indulgence in alcoholic drinks often produces liver dysfunction—maybe in an indirect manner—which though reversible at first, tends to become irreversible as over-indulgence is continued and prolonged (Leevy, Cunniff, Walton and Healey, 1954). The terminal phases are characterized by cirrhosis, hypertrophic at first and then contracted, with ascites and eventual death. When individuals whose drinking habits lead them to this state need hospital treatment, they seem to find their way into general hospitals rather than into mental hospitals. Among them may be alcoholics of the type described by a World Health Organization Expert Committee as “habitual symptomatic excessive drinkers” (W.H.O. Rep., 1952) or “non-addictive alcoholics”, and those excessive drinkers whose alcoholism manifests itself in their “inability to stop” continual daily drinking in the face of dangerous consequences (W.H.O. Rep., 1955).
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