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In 1804 Thomas Trotter, a recently retired Physician to the Fleet, published his ‘Essay on Drunkenness’. This was the first ever book-length consideration of the phenomenon of alcohol dependence and its treatment.The aim of this paper is to explore the impact of that treatise on the evolution of relevant ideas over the years that have followed.A factual analysis of the content of the Essay is the starting-point, followed by an examination of sequential published appraisals on the significance, or lack of significance, of this work.To the modern reader, Trotter is likely to be seen as prescient, with his assertion that ‘the habit of drunkenness is a disease of the mind’, setting the scene for two centuries of debate. The literature, however, seems to suggest that Trotter did not, in fact, achieve much impact either on professional opinion or on the emergent temperance movement. It was Benjamin Rush's 1785 pamphlet on ‘Ardent Spirits’ which achieved iconic status. Rush and Trotter, although in some ways overlapping in their ideas, differed in other respects.