material, however, cannot be obtained in the near future and the question therefore remains open for the present.'

"I am not capable of judging Andrae's criticism from the point of view of insurance technique. It seems to me, however, that in the present condition of the question one must reckon with the possibility that the sub-normality among absolutists, as pared with the others in the above named life insurance statistics, at least in part may be due to the dissimilar relation of both groups to the use of spirituous drinks. But for the reasons mentioned, I cannot find that the investigations show absolutists in general to be superior to the truly moderate in the matter of duration of life.

"Some non-European life insurance companies seem to show an experience different from the English, and to have reached results pointing in the opposite direction. Holitscher, from whom I have obtained the data, says: 'In compiling the material from a company in New Zealand, the absolutists were found to be somewhat worse placed; a similar result was gained by a company in Canada and one in the Cape Colony. If, in accordance with the experience of the English companies, it were a hard and fast condition that absolutists, solely because of their abstinence from spirituous drinks, might expect a duration of life greater by 25 per cent., it is striking that this does not appear from the last mentioned statistics, but quite the contrary.'

"Meanwhile, the statistics just referred to have not been so fully published that they permit a closer critical scrutiny, and it is therefore not possible to say anything final about the weight of the evidence. It has been objected that they concern too small numbers and too short a time to be taken into consideration. This would also seem to be true of the statistics from the Cape Colony which relate only to 865 insured absolutists and 2,792 insured non-absolutists. . . .

"Also from Sweden there is at hand a comparatively extensive investigation by Ekholm. In the Swedish Life Insurance Company the question has been asked applicants since 1897, ‘Are you an absolutist or not?' And thus it has been made possible to investigate separately the mortality among absolutists and non-absolutists.

"The statistics prepared by Ekholm cover the years 1897-1906 and relate to about 35,000 persons, of whom somewhat more than half were absolutists. The whole number of deaths was only

496, and 252 of them occurred among absolutists and 244 among the non-absolutists. The absolutists showed on an average 6 per cent less mortality than the rest. If the material is divided into four groups according to age and time of insurance, it appears that the difference in favor of the absolutists rises according to age and the length of the time of insurance. In the group containing persons under 44 years of age, the relative sub-normality of the absolutists was only 2 per cent., but among the older persons 26 per cent.

"Ekholm adds the following remarks to his analysis of results: 'One may argue about the hygienic significance of this result. To me the assumption seems entirely natural that the difference in favor of the absolutists is explained by their abstinence from alcoholic beverages. It seems to me, therefore, that the results indicate absolutism as a thoroughly healthful mode of life which has a certain significance when these absolutists are compared with a selection. of healthy and moderate non-absolutists. It is clear that at least a part of the latter have consumed more alcohol than is good for them. To many the results here related may seem to be sufficient proof that even a moderate use of alcoholic beverages is injurious to health. But a closer scrutiny of the question shows that it is not quite as simple as this, for in the end everything depends on what is understood by moderate use.'

"The investigations hitherto at hand are to this extent incomplete, that the life insurance statistics deal solely with two categories, absolutists and non-absolutists. But in order to solve the question completely it is also necessary to know how great the consumption of alcohol on the part of the individuals among non-absolutists has been. Ekholm relates that Swedish life insurance companies have already begun to collect statistics in order to determine this question more thoroughly, as those who apply for insurance are requested to answer the question, how much spirits they consume daily. On the basis of this, the insured are divided into different groups according to the magnitude of the daily consumption of alcohol. By this method of procedure it is expected that it will be possible to determine how large the optimum of alcohol consumption is, and to compare this with zero. Ekholm believes that the solution of the question in this way will require a long time, but that we must be patient, for there is no short cut which surely brings one to the goal."

Chapter XXI.

Personal Pathologic-Anatomical and Experimental Investigations

(Being a solely technical statement, this chapter is not adapted for a summary reproduction).

Chapter XXII.

Summary of the Principal Traits of the Special and General Pathological Anatomy of Chronic Alcoholism

(Necessarily the author repeats much that has been set forth in detail in previous chapters. It is enough to give the closing paragraphs :)

"We cannot as yet give an exhaustive explanation of the action of alcohol on the organism nor form a theory of general validity in regard to the pathology of alcoholism, as there is still so much, even as regards fundamental questions, which is unexplained. Much remains to be done before we can gain a clear picture of this difficult question.

"But when in the course of my studies I have found much conflicting with many of the current conceptions of the nature of the pathological effects of alcohol, I have expressed my doubts in regard to their correctness. At the same time I have adhered to another method of explaining some of the peculiar phenomena which are bound up with this interesting and difficult problem; the pathology of alcoholism.

"The attempts which have been made were founded upon the known investigations of the action of alcohol as a narcotic substance. In this property of alcohol we should, according to my opinion, seek the point of departure and we should not in pathology look away from the fundamental principles of the modern theory of narcotics, nor from the data which modern investigation has yielded in regard to the significance of the liquid substances in physiology and pathology. Much seems to indicate that alcohol with its natural attraction for these substances may act in the first instance upon these and not only in the acute but also in the case of chronic poisoning. And a further exposition of this question seems to me well adapted to furnish us the key to the explanation of the important question of the primary effects of alcohol on the cells which fundamentally is very important to the doctrine of the pathology of alcoholism.

"The opinion has been advanced that even moderate or small quantities of alcohol have an injurious action upon the organism, even upon the offspring. Meanwhile, the pathology does not yield us any proof of this assumption, and from a theoretical point of view it does not seem to me to be probable. We must regard the demonstrated fact that smaller doses quickly oxidize and that the energy thus generated is placed in the service of the organism as an effective protective measure of nature. Alcohol in this case assumes clearly the same relation as other nutritious substances. The poisonous action occurs first when a certain amount is exceeded. Where this limit for alcohol lies cannot be stated with exactness and must differ in the case of different individuals.

"In conclusion I wish to speak a few words about temperance education in schools.

"I have shown that the customary text-books in the so-called 'Alcohology' contain many incorrect and unreliable statements and assertions in regard to the pathology of alcoholism, and I therefore regard them as unsuitable as text-books; they should as soon as possible be supplemented by others. Here, as in other questions of enlightenment, one is justified in demanding that the statements in regard to the temperance question which are placed in the hands of teachers and children shall contain as correct and reliable data as possible and avoid all which can mislead.

"I wish to express it as my firm conviction that all pathologicanatomical special questions should be excluded from the temperance instruction. As a rule they are far too complicated and undetermined to be studied in the schematic and dogmatic manner which is now customary. Besides, they can hardly play a notable part in the conception of the social hygienic temperance question. which is the most important part of the alcohol question to the general public. To me the extreme pathologic-anatomical sketches which occupy a prominent place in the text-books, together with diagrams and figures, which are used to illustrate this part of the temperance instruction, seem to be exhibitions of a misdirected method of teaching. It is not necessary to seek after any anatomical bogy, there are sufficiently many such in actual life which show the unhappy consequences of a misuse of spirits.

"I cannot imagine a more unsuitable subject of instruction for

children than pathological anatomy. It would also be a relief to all school teachers to be exempted from the duty of instructing in questions relating to this which they themselves lack the necessary qualifications for handling in a competent manner. Both pupils and teachers have other subjects to devote their time to which are more useful and important to them. Aside from this it does not seem to me to be right that the so-called Alcohology is treated in the schools as a separate subject. It is a part of and belongs to general hygiene and should be considered as a part of it, as is done in some text-books. If one takes away the unnecessary parts of 'Alcohology,' which are as unsuitable for the instruction of children as for popular instruction generally, more time would be left for the other questions belonging to general hygiene. What it is important to impart is a knowledge in regard to the means of promoting popular hygiene as a whole. However far the misuse of alcohol reaches into the life of society at the present time, it is nevertheless not the only menace to public health. But there are alongside of it many other questions of hygiene which are worthy of attention and instruction."