The history of alcoholism: Brühl-Cramer's concepts and observations.

In 1819 the German-Russian doctor C. von Brühl-Cramer published one of the most important books in the history of alcoholism. He coined the term Trunksucht (which was translated as dipsomania by Hufeland), and he defined it as a physical disease. He discussed aetiology (assuming the consumption of spirits as the main occasional cause and annoyance or depressive feelings as other causes), and pathogenesis (suspecting that repetitive or noxious stimuli provoke a craving for continued intoxication). His recommendations on therapy were influenced by the contemporary ideas on treatment by the laws of chemistry and by concepts of excitability. He offered a classification in terms of continuous, remittent, intermittent, periodic and mixed forms of dipsomania. He described different sequelae, including neuropathy (in which the paresis began at the most distant parts of the limbs), dementia, suppression of the immune system and fetal alcohol syndrome (considering the typical features as proneness to diseases, mental retardation, hyperactivity, facial dysmorphism, incomplete growth). He examined ethnological factors based on his observations in multi-racial Russia. Passages of his work are presented. Relations with works of his contemporaries (especially with Trotter) and influences on later concepts of alcoholism are discussed.