reached conclusive or almost conclusive results; in regard to other points one can only infer the facts with greater or less probability, because much is still obscure, so that for the present we can only discuss possibilities and bring forward more or less well grounded hypotheses-working hypotheses which may serve as points of departure for further investigations."

(The author emphasizes that in order to gain a clear conception of the pathological effects it is necessary to have a thorough knowledge of the physiological that is pharmacological effects. While the latter are outside the real field of the author's inquiry, he found it necessary to survey the most important. His work therefore falls into two main divisions: The first dealing with the general physiological effects of alcohol upon organism, and the second giving a survey of our present knowledge in regard to the general and specific pathology of alcoholism. He concludes the introduction as follows:)

"It is not a spirit of fault-finding which leads me to examine during the progress of my exposition several declarations contained in our popular text-books on 'Alcohology.' I do it because it seems to me timely to point out evident untruths which have sneaked into them and thereby helped on their removal from the text-book literature. Aside from this, the text-books seem to me of interest and must be given attention in an exposition like the present, since several other countries have them of the same kind and they thus have assumed an international aspect; also because they express the conception most generally adhered to by the great public, although apparently held also by a number of physicians. That the latter is the case is shown by the fact that two of our popular text-books are written by physicians, while two have been tested by physicians. In a preface to the 'Text-Book on Alcohol,' by Helenius, Professor Curt Wallis says that it is 'a deserving compilation of the most important knowledge which science hitherto has brought together relative to this question.' Under such circumstances it is quite natural that the text-books are regarded by a large part of the public. as an expression of the standpoint of medical science."

Chapter I

Some Words About the Formation and Occurrence of Alcohol in Nature

(The author refers to the universality of alcohol as an article of consumption and cites Hartwitch, who states that at the present

time the peoples who can be regarded as "alcohol free" are only certain remnants of the original population of Ceylon, Malacha and some Indians of South America. He describes the formation of ethyl-alcohol, the qualities and effects of which are the subject of his study. He refers to the occurrence of alcohol in healthy, normal organs, and the conclusion drawn by some investigators that alcohol is a substance which is regularly formed in the body (human) and therefore constitutes a substance not really foreign to the normal organism and its functions. He remarks, however:)

"Meanwhile, it is evident that even if the organism is able to consume and take into its service the alcohol formed under the normal processes of digestion, nothing is thereby decided in regard to the question whether and to what extent the body is able to render harmless the alcohol brought into the body from outside. How this matter stands, how the human organism reacts to the alcohol brought in from outside in larger or smaller quantities, belongs to the complex problem of the medical alcohol question, which again is conditioned upon a multitude of different questions belonging to the wide domain of medical science, and which I, in the following exposition, will try to illustrate from different points of view."

Chapter II

The Absorption of Alcohol by the Body and Its Circulation in the Organs (This is a solely technical exposition.)

Chapter III

The Consumption of Alcohol Within the Body and Its Influence Upon the Process of Digestion

"In the previous chapter we have learned that the alcohol taken is quickly absorbed sucked into the blood and thereby brought to all parts of the body, and that after several or few hours-according to the size of the dose- it has disappeared from the body. When large intoxicating doses have been taken the blood seems to become free from alcohol in the course of about twenty-four hours.

"We shall now in what follows study the relations of alcohol to the body and step by step follow the effects upon it which are peculiar to alcohol."

(Having examined a number of the more important investigations the author says:)

"From the above named explanations we thus conclude that alcohol is oxidized within the body in different quantities and under different conditions. As high as 98 per cent of the alcohol taken, or even more, can be oxidized when the dose has not been too great and additional circumstances have not been effective. But from this fact it does not follow that it has a nutritive value, for it may be assumed that digestion can take place to the same extent with, as without, alcohol, and that thus alcohol may be consumed without any use. In order to make this clear, experiments in digestion have been made, yielding results which I will briefly account for."

4

(The concept of the importance of alcohol as a nutritive substance has passed through many stages of development marked by the most contradictory views. What is "known" about the subject the author sums up in two sentences:)

"For the greater part alcohol oxidizes in the body.

"In the process of oxidation in the body alcohol is capable of conserving both fat and carbo-hydrate as well as albumen, and must therefore be regarded as a nutritive substance."

(After a thorough examination of the various investigations made of the subject, the author re-states the case as follows:)

“...

". . . The physiologists of our day thus regard themselves as bound from the physiological point of view to regard alcohol as a nutritive substance, and, more definitely stated, as a substance having a conserving value in relation to fat and carbohydrates as well as to albumen.

"Kassowitz has controverted this view, and as his formula of the view 'Alcohol is a poison, therefore not a nutritive substance,' has won many imitators in the popular temperance text-book literature, I wish to touch upon it in a few words. First and foremost it should be noted that the standpoint of Kassowitz is not determined by any new and experimental investigations undertaken by himself which disprove others, but so far as I have been able to discover his standpoint is fixed by the fact that he explains older experiments in a different way from other investigators, and by the fact that he starts with a definition of nutritious substances peculiar to himself. He believes that certain earlier experiments show that alcohol is a poison to albumen and, furthermore, he holds that only such substances are nutritious as are adapted to the formation of protoplasm or at least as

fat can serve as reserve substances. Since this surely is not the case with alcohol which quickly and immediately oxidizes, it must be denied all significance as a nutritive substance and labeled as poison. He therefore would not designate a substance as nutritive which had only a so-called conserving value, and his opposition is therefore directed against the general accepted definition of the concept of nutritious substance. . . . Thunberg shows that if the general theory of Kassowitz in regard to the effect of alcohol were true, it could never serve as a nutritious substance for any living being. Now it is undoubtedly true that alcohol is a nutritious substance for certain micro-organisms which produce vinegar from alcohol, and therefore the incorrectness of Kassowitz' standpoint is surely clear. And in regard to Kassowitz' contention that the poisonous effect of a substance excludes every nutritious effect: 'no substance can possibly assume the dual role of a nutritious substance and of a poison, and therefore alcohol can never have any nutritive but only toxic qualities,' it is, as already indicated, not in conformity with experience.

"But even if all the physiological experiments tend to the result that alcohol must be conceded as among nutritious substances on account of the manner in which it influences the process of digestion, at least the well person can get along without it. For such a one alcoholic beverages have their particular significance and use as articles of enjoyment, but by such alcohol should be taken, if at all, only in comparatively small doses on account of the poisonous effects which accompany the use of larger doses, especially when repeated.

"The conserving value of alcohol is thus acknowledged by physiologists. How far in the process of oxidation within the body it may furthermore serve as a source of energy in mechanical work or directly sustain this or that physiological function may be brought into question, but it is at least not yet thoroughly established. Certain experiments made by Hans Meyer seem to bespeak the probability that alcohol may yield immediate energy or muscular exertion. Even the investigations of Atwater and Benedict in regard to muscular work during an alcohol diet indicate a possibility of this. . .

"What relation has alcohol to the function of our nutrition? Thunberg answers in his explanation of the question as follows: 'It is quite clear that it cannot serve as building material; it is furthermore quite clear that it can serve as a source of heat, while

it is probable but not certain that it can serve as a source of energy for the work of the body. Its relation as a material for sustaining the processes which do not stand in the direct service of producing heat or working ability we know nothing of.'

"Alcohol must therefore, if we turn our attention to its influence upon the process of digestion, by no means be compared with albumen, which can meet all the particular demands of nutrition. In this respect furthermore it may not simply be placed on par with fat or carbo-hydrates partly because these to a certain degree are fat forming, partly because without question they can serve as a source of energy. This property can only be attributed to alcohol as a probability. To this must be added the condition that the body can produce fat and carbo-hydrates as reserve nutrition for future use in case they are brought to the body in greater quantity than needed. Alcohol, on the other hand, oxidizes immediately and cannot be conserved. If we view the question from other points that offer themselves it must be considered that alcohol, when it is taken into the body in larger quantities has a definite toxic effect. Alcohol is therefore not on par with any of the substances which from old are designated as nutritive substances. But while acknowledging that alcohol is not to be put side by side with other nutritive substances, physiology must nevertheless insist upon the concept that in smaller quantities it has a nutritive effect and therefore is properly classified among nutritious sub

stances.

Chapter IV

The Toxic Properties of Alcohol and Some Words in Regard to the So-called

Moderate Use of Alcohol

"In addition to its properties as a substance of nutrition which were discussed in the preceding chapter, alcohol possesses, when consumed above a certain quantity, undoubted toxic properties which manifest themselves by producing, according to circumstances, symptoms of acute or chronic poisoning; and sufficient quantities may even cause immediate death through alcohol poisoning.

"When we speak of the toxic effects of alcohol it should be borne in mind, as previously indicated, that the effect of a poison in the individual instance depends upon the magnitude of the dose in which it is administered. Hans Meyer, for instance, says: . . .