Detection of alcoholic liver disease.

Alcohol has been used in society over centuries and all over the world for its mood-lifting properties and taste. It is probably, however, the commonest drug of abuse world-wide and unfortunately causes considerable morbidity, mortality and social disruption. In 1990 the cost to the USA was more than $100 billion and 100000 lives[1]. The relationship between alcohol and mankind is well documented from the earliest times. Wine-making equipment was found in the remains of an early neolithic village in Northern Iran dated about 5000 BC[2]. In the Bible Noah 'planted a vineyard: and he drank of the wine, and was drunken'[3]. Beer was first produced in Ancient Mesopotamia, Egypt and Greece. There is evidence that alcohol was used for religious purposes and recreationally in Egypt around 3000. The Ancient Greeks worshipped the God of wine, Dionysius, and seem to have been the first to develop large-scale wine fermentation and production, with export to other countries. The Romans in turn worshipped Bacchus, their God of wine, and were significant wine producers, planting vineyards across Europe. It is not just wine production that has survived through the ages. Barley provided both bread and beer from the first agricultural communities, but mead, made from fermented honey, was the preferred choice for most of Western Europe until Tudor times. Beer, brewed with hops, was introduced later from Germany. Alcohol has long been an accepted part of human daily life, and throughout the centuries there has been evidence that, for both men and women, consumption gradually increased. This is due, at least in part, to the boiling of the water in the brewing process. An alcoholic beverage was well-known as an adjunct in the treatment of cholera. For example, in the seventeenth century the water supply for Nottingham, Great Britain, came from the sewage laden river Leen, but there was a plentiful supply of ale-houses (about one for every eighty people) thus ensuring some relatively clean fluid to drink[4]. However, there are long-term side effects and problems with excessive drinking. In 1726 the Royal College of Physicians in England issued a statement to the House of Commons asking for an increase in taxes on spirits to act as a disincentive to this 'great and growing evil'[5]. Concern for the effects of alcohol misuse continued and at the start of the twentieth century the British Prime Minister, Lloyd George, addressed factory workers during the first World War with 'we are fighting Germany, Austria, and drink; and, as far as I can see, the greatest of these three deadly foes is drink'[6]. As a result licensing laws were introduced in Britain limiting the hours during which alcohol could be served, and these are currently still in place[7]. Immoderate alcohol consumption may result in a broad spectrum of medical, psychiatric and social problems. These in turn are an expensive burden on any health service and society at large. However alcohol is also widely available and enjoyable so there have been attempts to identify levels of drinking at which alcohol-related damage occurs.