6

Debates over Wine Alcohol, Prussian Blue, and Sulphur Dioxide

1. Wine alcohol and cirrhosis of the liver The wine drinker needs a good liver and a steady supply of B vitamins, especially thiamine. Among the liver’s many functions are the making of ‘clotting factors and other vital proteins that go into blood serum’ and the metabolising of alcohol and other drugs. 1 The liver has several potentially deadly enemies, including hepatitis, cancer, and cirrhosis. In western countries cirrhosis or interstitial chronic inflammation of the liver ‘ most commonly results from chronic heavy intakes of alcohol’ rather than from a virus. 2 Though a description of the disease and its alcoholic etiology were given by Matthew Baillie in his work Morbid Anatomy ... (1793), the term cirrhosis was introduced in the early-nineteenth century by R. T. H. Laënnec; alcoholic cirrhosis of the liver is named after him – cirrhose de Laënnec.3 By the mid-nineteenth century there was an intense medical interest in cirrhosis. Some of the leading researchers and clinicians of the day did experiments, made observations, and cut out diseased livers to display to their colleagues in learned societies. 4 Lynn Payer pointed out that the crise de foie used to be the French national pathology. Not that the phrase means much any more, except digestive trouble. 5 As a direct factor in contemporary French mortality, cirrhosis of the liver produced by alcoholism puts on only a mediocre performance: in 1974 it stood fifth on the list of chief causes of mortality, causing 3.79 per cent of deaths. 6 Smoking was recently killing about 60,000 people per year, accounting for ten per cent of France’s mortality. Alcoholism is blamed for 40,000 deaths a year and costs the state about eighty billion francs annually. Two million people are hooked on the drug alcohol. Nor does the French paradox prevent heart disease from being the primary cause of death in France. Historians of medicine generally give short shrift to cirrhosis as they take the high whiggish road to topics such as Claude Bernard’s discovery of ‘ the glycogen-forming function of the liver.’7 But practising nineteenth-century doctors were much more concerned with cirrhosis than with the conversion of excess glucose into

165 Harry W. Paul glycogen as a food reserve. By the early-twentieth century the debate over types and classifications of cirrhosis had come to a confusing climax. As early as 1897 Desoil had despaired of agreement: ‘Each author creates his own cirrhosis: it’s anarchy.’8 Hepatology developed late as a medical science. Nearly a hundred years later, researchers are still seeing through a glass darkly on some aspects of the disease. 9 In his Clinical Lectures on Diseases of the Liver (1868), Charles Murchison noted that cirrhosis, or the so-called gin-drinker’ s liver ‘can almost invariably be traced to the abuse of strong spirits, and especially the habit of drinking them neat, and accordingly it is most common in those countries and towns where such a habit prevails.’ By contrast, chronic atrophy was elusive in etiology because it presented ‘ several diseases, which in their etiology and anatomical characters, are essentially distinct, but which often present symptoms so similar that it may be impossible during life to distinguish them.’10 Bichat’s old Parisian clinical program of opening up a few corpses still had its uses. In a later work on malfunctioning of the liver (1874), Murchison did not offer much comfort to pro-alcohol doctors. He attributed primary functional derangements of the liver principally to ‘errors in diet’ and ‘ various alcoholic drinks,’ including wines. In bourgeois Britain it could be claimed that many people were eating more food than needed to maintain the nutrition of the body. ‘There can be no doubt that the present system of living, and especially the consumption of even what are regarded as average quantities of rich food and stimulating drinks, contribute largely to derange the liver.’ Murchison identified alcoholic drinks as being ‘most apt to derange the liver.’ They did so in two ways. First, by causing ‘ persistent congestion of the liver’; even in healthy persons small amounts were capable of producing ‘ a temporary hepatic congestion.’ When alcohol is ‘taken in excess, or too frequently, the congestion of the liver becomes permanent and the functions of the organ are deranged.’ Long congestion could produce ‘structural disease.’ And doctors should remember that ‘ certain persons ... may ... have a constitutional intolerance of alcohol.’11 Unlike many French doctors, Murchison did not find that wines had any advantages over pure alcohol; quite to the contrary, they could be more dangerous. 12 Wines and other alcoholic drinks could ‘often cause derangement of the liver, which a corresponding quantity of pure alcohol would not produce.’ No blame could be placed on ‘any one ingredient of the offending liquid – neither by the free acid, the ether, the salts, gum, sugar, nor extractive matter.’ There was an 166