| Popis: |
Numerous publications have been devoted to elucidating the question of whether long continued ingestion of alcohol will cause, or at least predispose to, the development of morbid changes in the liver. Most of these studies have been concerned with autopsy material, animal experiments or with the type of patient peculiar to charity hospitals. While the evidence arising from these studies often has been contradictory and, particularly as concerns animal experiments, open to various criticisms, it has nevertheless tended to create in the physician's mind the suspicion that most alcoholics suffer from some degree of portal cirrhosis. An approach to the problem by the study of chronic alcoholics from the better walks of life might yield a quite different opinion for several reasons: 1) study of autopsy material deals principally with those alcoholics who have developed cirrhosis and does not take into consideration the many alcoholics expiring from other causes who did not develop cirrhosis. Autopsy histories frequently indict as having been alcoholic any subject who was not a teetotaler if cirrhosis is perchance to be found. 2) alcoholic patients in charity hospitals are of an older age group and are often admitted principally for the treatment of complications of alcoholism such as nutritional deficiencies and decompensated cirrhosis. The patients of such a series would naturally exhibit a higher percentage of serious liver disease th::m would a like number admitted to a private institution for the treatment of alcoholism. 3) such factors as differing nutritional states, quality and type of alco~olic beverage consumed, hygienic conditions and general health may be important in conditioning different types or degrees of liver disease in indigent patients in charity hospitals as compared to those encountered in private practice. Accurate knowledge of the incidence of liver disease in private patients who are alcoholic is important in order to assign proper importance to this element of the history. An efficient screening procedure is desirable in order to detect reliably the presence of early and minimal liver damage in these individuals. Finally, a group of liver function tests capable of indicating the type of liver damage present (whether fatty degeneration or portal cirrhosis) is necessary for prognosis. So far as may be determined no such study on a large series of chronic alco |
