Consequences and Behaviour Problematised: The Establishment of Alcohol Misuse as an Object of Empirical Inquiry in Late 18^th- and Early 19^th-Century European Medicine

Abstract

AIMS -This article discusses European medical thought on alcohol in the late 18th and early 19th centuries against the backdrop of concurrent transformations in the epistemological and social underpinnings of medicine at large. DESIGN -The article focuses on key medical works on alcohol written in the 1700s and early 1800s. The analysis draws on historical typologisations of medical practice and knowledge-formation (Ackerknecht, Jewson), and the notion of "working knowledges" (Pickstone). RESULTS -The defining feature of the era's medical thought on alcohol was that the issue began to be treated more rigorously in empirical terms. Doctors aspired to build an objective body of knowledge about diseases consequent on excessive drinking. The singling out of alcohol misuse as a special cause of diseases laid ground for viewing misuse itself as a phenomenon whose determinants and underlying dynamics were to be delineated in empirical terms. Remote causes of drinking were commonly traced to the socio-cultural sphere, which had a bearing on doctors' ideas on "alcohol addiction", too. CONLUSIONS -Earlier historiography has identified medical thought on alcohol at the turn of the 19th century as the starting point of individualising disease concept of alcohol addiction. The proper legacy of the era is rather the establishment of alcohol-related phenomena as objects of empirical inquiry, and the articulation of socio-cultural embeddedness of alcohol-related pathologies. AcknowledgementThis research was supported by the Academy of Finland (grant 118408) and the Finnish Foundation for Alcohol Studies.A material factor contributing to the growing concern with alcohol in Europe since the 17 th century was the increased availability and affordability of alcoholic drinks, Unauthenticated Download Date | 12/16/16 11:37 AM

Addiction: The dance between concept and terms

“…Thus Levine's paper has an epigraph from Foucault's work on this subject (1975) and its title pays homage to Rothman's book The Discovery of the Asylum (1971), concerning developments in the United States in this period. Though it is clear that British doctors' "clinical gaze" on "drunkenness" was discerning an element of compulsion already in the late eighteenth century (Nicholls, 2009, p. 59-72;Ruuska, 2013), Levine's dating of the first emergence of the concept as a common and accepted way of thinking about habitual consumption in the general North American culture, initially applied to alcohol, is still substantially apposite (Ferentzy, 2001). Corroborating evidence of a parallel phenomenon in Britain had been provided a few years before Levine's paper, in an analysis by McCormick (1969) of British fiction.…”

“…It was an Englishing of a Latin term, alcoholismus chronicus, put forward by a Swedish doctor, Magnus Huss, in a monograph originally published in Swedish (Huss, 1849-51). But Huss's meaning for the term was not in terms of the addiction concept, but rather, as the Medical Temperance Journal noted in 1882, was applied to "cases which come directly from the toxic action of alcohol" (quoted for "alcoholism" in the Oxford English Dictionary)-in other words, in what Ruuska (2013) terms the emergent "consequences problematic" as a medical view, rather than the "behavioural problematic" which included the addiction concept. Huss's meaning, oriented to long-term physiological consequences, persisted in medical nosology through the 1940s, so that, for instance, the title of a book edited by Jellinek (1942) early in his career as an alcohol scholar was Alcohol Addiction and Chronic Alcoholism, as two separate concepts.…”

The Italian “alcohol question” from 1860 to 1930: Two opposing scientific interpretations

“…In the 18th century, alcohol misuse and drunkenness became an object of study with the establishment of alcohol-related questions on the medical agenda (Room, 2006;Ruuska, 2013). However, the first concerns were not about alcoholism, but were associated with the threat that alcohol abuse posed to the 1 The introduction by Barrows and Room (1991) is recommended as further reading.…”

“…In the prevailing interpretation, alcoholism was "a progressive disease-the chief symptom of which is loss of control over drinking behavior, and whose only remedy is abstinence from all alcoholic beverages" (Levine, 1978, p. 293). During the 19th century, the medical approach was outlined ever more clearly in the writings of Trotter and Huss (Ruuska, 2013), and the treatment of alcohol-related problems was increasingly seen as falling within the purview of doctors and medical institutions (Barrows & Room, 1991).…”

“…moral and social order (Ferentzy, 2001;Nicholls, 2008), and physicians' explanations were not focused only on the patient's body, but also investigated the socio-cultural sphere (Ruuska, 2013).…”