HX00024414 Columbia (BnitJer^^ttp t.i mtl)f€itpijflfttlork College of ^tpgictansi anb g)urseon£( ILibvavv GIFT OF Frederick S. Lee ^^^«lv^ .^^ Digitized by tine Internet Arcliive in 2010 witli funding from Columbia University Libraries http://www.archive.org/details/physiologicalasp01bill ©be liquor problem. THE LIQUOR PROBLEM IN ITS LEGISLATIVE AS- PECTS. By Frederic H. W.nes and John Koren. An Investigation made under the Direction of Charles W. Eliot, Seth Low, and James C. Carter, Sub- Committee of the Committee of Fifty to Invesfgate the Liquor Problem. With Maps, izmo, $1.25- ECONOMIC ASPECTS OF THE LIQUOR PROBLEM By John Koren. An Investigation made ""^er the Direction of Professors W. O. Atwater Henry W. Far- nam J. F. Jones, Doctors Z. R. Brockway. John Sam Brooks, E. R. L. Gould, and Hon. Carroll D. Wright, a Sub-Committee of the Comtn, ee of Fifty. w"h an Introduction by Prof. Henrv W. Farnam. i2mo, $1.50. SUBSTITUTES FOR THE SALOON. By Raymond CalI Is An Investigation made for the Committee of F^tty under the direction of Elgin R S. Gould Francis G. Peabody, and William M. Sloane Sul^ Committee. ,2mo, tuio. n.t. (Postage .3 cents.) THE PHYSIOLOGICAL ASPECTS OF THE LIQUOR PROBLEM. Edited by John S. Billings, M. D. An Investigation made for the Committee of Fifty under the direction of John S. Billings, W. O. Atwater, H ■ P. Bowditch, R. H. Chittenden, and W. H. Welch, Sub- Committee. . vols. 8vo, ?4.SO, «<. (Postage extra.) HOUGHTON, MIFFLIN AND COMPANY, BosTOM AND New York. PHYSIOLOGICAL ASPECTS OF THE LIQUOR PROBLEM INVESTIGATIONS MADE BY AND UNDER THE DIRECTION OF VV. O. ATWATER, JOHN S. BILLINGS, H. P. BOWDITCH, R. H. CHITTENDEN, AND W. H. WELCH SUB-COMMITTEE OF THE COMMITTEE OF FIFTY TO INVESTIGATE THE LIQUOR PROBLEM VOLUME I BOSTON AND NEW YORK HOUGHTON, MIFFLIN AND COMPANY ^hi tii'act0iiK prcil^, Cambri&se 1903 COPYRIGHT, 1903, DY JOHN S. BILLINGS ALL RIGHTS RESERVED Published, June, igoj ^■1 PRESENT ORGANIZATION OF THE COMMITTEE OF FIFTY. Mat, 1903. President. Hon. Seth Low, LL. D., New York, N. Y. Secretary. Prof. Francis G. Peabodt, D. D., Cambridge, Mass. Treasurer, William E. Dodge, Esq., 99 John Street, New York, N. Y. Executive Board. The above-named officees and — Dr. J. S. Billings, Astor Library, Lafayette Place, New York, N.Y. President Chakles W. Eliot, LL. D., Harvard University, Cam- bridge, Mass. Col. Jacob L. Greene, Hartford, Conn. Hon. Carroll D. Wright, A. M., LL. D., Commissioner of Labor, Washington, D. C. Membei's. Prof. Fells Abler, 123 East 60th St., New York, N. Y. Bishop Edw. G. Andrews, D. D., Methodist Building, 150 Fifth Ave., New York, N. Y. Prof. W. O. Atwateb, Wesleyan University, Middletown, Conn. Dr. J. S. Billings, Astor Library, Lafayette Place, New York, N. Y. Charles J. Bonaparte, Esq., 216 St. Paul St., Baltimore, Md. Prof. H. P. Bowditch, Harvard Medical School, Boston, Mass. Rev. Prof. Charles A. Briggs, D.D., 700 Park Ave., New York, N.Y. Z. R. Brockway, Esq., Superintendent State Reformatory, Elmira, N. Y. John Graham Brooks, Esq., Francis Ave., Cambridge, Mass. Hon. James C. Carter, 54 Wall St., New York, N. Y. Prof. R. H. Chittexden, Sheifield Scientific School, New Haven, Conn. Rev. Father Thos. Conaty, D. D., Catholic University, Washington, D.C. JohnH. Converse, Esq., Baldwin Locomotive Works, Philadelphia, Pa. Wm. Bayard, Cutting, Esq., 34 Nassau St., New York, N. Y. Rev. S. W. Dike, LL. D., Auburndale, Mass. William E. Dodge, Esq., 99 John St., New York, N. Y. iv ORGANIZATION OF COMMITTEE OF FIFTY. Rev. Father A. P. Doyle, Paulist Fathers, 455 West 59th St., New York, N. Y. President Charles W. Eliot, LL.D., Harvard University, Cambridge, Mass. Rev. Father Walter Elliot, Paulist Fathers, 455 West 59th St., New York, N. Y. Prof. Richard T. Ely, University of Wisconsin, Madison, Wis. Prof. Henry W. Farnam, 43 Hillhouse Ave., New Haven, Conn. Rt. Rev. T. F. Gailor, D. D., University of the South, Sewanee, Tenn. Daniel C. Gilman, LL. D., C14 Park Ave., Baltimore, Md. Rev. Washington Gladden, D. D., Columbus, Ohio. Richard W. Gilder, Esq., Union Square, New York, N. Y. Dr. E. R. L. Gould, 281 Fourth Ave., New York, N. Y. Col. Jacob L. Greene, Hartford, Conn. Dr. Edward M. Hartwell, 5 Brimmer St., Boston, Mass. Rev. W. R. Huntington, D. D., Grace Clmrch, 237 Broadway, New Y'ork, N. Y. Prof. J. F. Jones, Marietta, Ohio. Hon. Seth Low, LL. D., New York, N. Y. President James MacAlister, LL. D., Drexel Institute, Philadelphia, Pa. Rt. Rev. Alexander Mackay-Smith, D. D., Bishop Co-adjutor of Pennsylvania, Philadelphia, Pa. Prof. J. J. McCook, Trinity College, Hartford, Conn. Rev. T. T. MuKGER, D. D., New Haven, Conn. Robert C. Ogden, Esq., Broadway and lOtli St., New York, N. Y. Rev. Prof. F. G. Peabody, D. D., Cambridge, Mass. Rt. Rev. H. C. Potter, D. D., 29 Lafayette Place, New York, N. Y. Rev. W. I. Rainsfobd, D. D., 290 East 16th St., New Y'ork, N. Y. Jacob H. Schiff, Esq., 27 Pine St., New York, N. Y. Rev. Prof. C. W. Shields, D. D., Princeton, N. J. Prof. W. M. Sloane, Columbia University, New Y''ork, N. Y. Dr. Wm. H. Welch, Johns Hopkins Hospital, Baltimore, Md. Frederic H. Wines, Esq., Springfield, 111. Dr. P. M. Wise, N. Y. State Commission in Lunacy, 1 Madison Ave., New Y'ork, N. Y. Hon. Carroll D. Wright, A. M., LL. D., Commissioner of Labor, Washington, D. C. NOTE. The publication of the series of reports on various aspects of the Liquor Problem of which these volumes form the fourth was begun in 1897 with that on " The Liquor Problem in its Legislative Aspects," prepared under the direction of Pres. Charles W. Eliot, Pres. Seth Low, and Hon. James C. Carter, a sub-committee of the Committee of Fifty. Then followed in 1899, " Economic Aspects of the Liquor Problem," under the direction of Henry W. Farnam, Secretary of the Economic Sub- Committee, and in 1901, " Substitutes for the Saloon," under the direction of the Ethical Sub-Committee, consisting of Prof. Fran- cis G. Peabody, Dr. Elgin R. L. Gould, and Prof. William M. Sloane. Like its predecessors, this report is preliminary in its nature, and is published in accordance with a vote of the Com- mittee of Fifty passed January 10, 1896, by which " reports by its sub-committees to the whole body may be published by author- ity of the Executive Committee as contributions to the general in- quiry, but to all such publications is to be prefixed a statement that reports of sub-committees are to be regarded as prelimi- nary in their nature, and only contributory of facts upon which the general discussion may in the future be undertaken by the committee as a whole." CONTENTS OF VOLUME I. Report of the Sub-Committee on the Physiological and Pathological Aspects of the Drink Problem, presented to THE CoMiOTTEE OF FlFTY ix Report on the Present Instruction on the Physiological Action of Alcohol. By Dr. H. P. Bowditch and Dr. C. F. Hodge 1 The Influence of Alcohol and Alcoholic Beverages on Di- gestion AND Secretion. By Prof. R. H. Chittenden 137 Data relating to the Use of Alcoholic Drinks among Brain Workers in the United States. By J. S. Billings, M. D. . . 307 Relations of Drink Habits to Insanity. By J. S. Billings, M. D. 339 The Influence of Alcohol on Growth and Development. By C. F. Hodge, Ph. D 357 The Influence of Acute Alcoholism on the Normal Vital Resistance of Rabbits to Infection. By A. C. Abbott, M. D. 377 REPORT OF THE SUB-COMMITTEE ON THE PHYSIOLOGICAL AND PATHOLOGICAL AS- PECTS OF THE DRINK PROBLEM, PRESENTED TO THE COMMITTEE OF FIFTY. REPORT. At the meeting for the organization of the Committee of Fifty, held in April, 1893, the following named gentlemen were appointed a Committee on the Physiological and Pathological Aspects of the Drink Problem, namely. Dr. J. S. Billings, U. S. Army, Director of the Medical Museum and Library, Washing- ton ; General Francis A. Walker, President of the Massachu- setts Institute of Technology ; and Professor R. H. Chittenden, Director of the Sheffield Scientific School of Yale University. This committee was requested to report to the General Com- mittee as to what investigations should be made into the effects of alcoholic drinks upon the human body, in order to settle, as far as possible, the questions as to the nature and amount of such effects, and to lead to a sound judgment as to the merits of the widely divergent opinions with regard to the effects of the moderate use of alcoholic drinks which are at i^resent found among writers and teachers on this subject. In the following month. May, 1893, a report was presented to the committee, stating that investigations are needed upon the following subjects : — " I. The effects of each usual, or, as it might be termed, nor- mal constituent of various kinds of alcoholic drinks, including more especially malt liquors, the wines in ordinary use, whis- keys, brandy, rum, gin, and liquors or cordials. The constitu- ents referred to are ordinary or ethyl alcohol, various higher alcohols, such as amyl, propyl, butyl, etc., alcohol and their derivative ethers, extractive, bitter, aromatic, and coloring mat- ters, volatile oils, tannin, salicylic acid, and other preservar tives, etc. " II. The effects of certain unusual and abnormal substances which are at times found in alcoholic drinks, and which may be either purposely added or be accidental contaminations. " III. The effect of the various combinations of these normal and abnormal constituents which form the alcoholic drinks of commerce. xii REPORT. " IV. The effects to be observed may be divided into imme- diate, secondary, and remote. The immediate and secondary effects, such as those on body temperature, digestion, absorp- tion, secretion, the vascular and nervous systems, and especially on metabolism or nutrition in general, are to be ascertained by experiments on animals and on man. By secondary effects are meant those which follow within a day or two. This investiga- tion would chiefly be a matter for skilled experimental physiolo- gists to imdertake. " V. The remote effects are those due to the action for a con- siderable period of time of the substances in question, being manifested by changes in tissues, organs, and functions, together with the resultant influence on nutrition produced by a more or less habitual use of alcoholic drinks of various kinds. This branch of the inquiry pertains more especially to pathology, and requires a careful collection and comparison of records by com- petent observers. Experiment on this part of the question has but a limited field of usefulness, although the results bearing on nutrition may be of direct value. " VI. It is believed in a general way that the results of the habitual use of the different kinds of alcoholic drinks differ in different individuals, and also according to the form and amount of drink used. Thus physicians commonly believe that the habitual excessive use of malt liquors tends to produce fatty degenerations of various organs, more especially of the liver and kidneys ; that the habitual use of wine, more especially of bur- gundy, and the finer clarets and port, tends to produce gout ; that the excessive use of distilled liquors tends to produce exces- sive development of the inter-cellular tissue in jthe liver and kidneys, resulting in what is called cirrhosis ; and that the use of the cheaper kinds of spirits, and especially of those contain- ing the higher kinds of alcohols in the form of fusel oil, is especially likely to produce delirium tremens. At present, however, such statements as these are usually matters of indi- vidual opinion and do not rest uj^on any scientific statistical basis. One of the lines of inquiry would be to obtain positive data on these points, to compare the results observed in beer drinkers, for example, with those observed in spirit drinkers. "VII. Another branch of the inquiry into remote effects relates to the influence upon offspring of the habitual use of REPORT. xiii alcohol, or of its excessive use just, prior to fecundation and during^ pregnancy. Upon these points we have little definite and accurate information. Connected with this is the question of hereditary predisposition to alcoholism, and that of periodi- cal alcoholism or so-called dipsomania, in which the desire for alcoholic drinks is considered to be due to abnormal nerve struc- ture, and to be, therefore, a symptom of a particular form of disease. " VIII. In each of these lines of inquiry, the first steji should be to prepare a concise statement of what is known, carefully distinguishing facts reported by reliable experimenters and ob- servers and paying little attention to speculations and theories, except for the purpose of formulating definite questions with an indication of the possible soui'ces from which positive answers may be derived. This part of the work can probably be best done in the library of the Surgeon-General's office in Washing- ton, and it would occupy the time of a skilled man for several months." The general conclusions of this report were approved by the main committee. The Committee on the Physiological and Pathological Aspects of the Drink Question was continued, and Professor H. P. Bowditch of the Harvard Medical School, Bos- ton ; Dr. William H. Welch, Professor of Pathology in Johns Hopkins University, Baltimore ; and Dr. G. Alder Blumer, Director of the State Insane Asylum, Utica, N. Y., were added to the committee, which, somewhat later, was increased by the addition of Dr. W. O. Atwater, Professor of Chemisti-y in Weslej'an University, Middletown, Conn. The committee thus organized proceeded to enter on the following investigations : — I. A research on the influence of pure ethyl alcohol and some alcoholic drinks upon the purely chemical processes of digestion, carried out under the direction of Professor R. H. Chittenden ; II. A research upon the pathological effects on the tissues produced by the long-continued use of alcoholic drinks, made under the direction of Professor W. H. Welch ; III. A research on the influence of alcoholic drinks and of pure ethyl alcohol upon the growth and development of certain animals, made under the direction of Dr. C. F. Hodge, Pro- fessor of Physiology in Clark University, Worcester, Massa- chusetts ; xiv RErOKT. IV. The preparation of a bibliography of the most impor- tant literature ou the effects of alcoholic drinks, by Dr. Bil- lings ; V. The preparation and issue of schemes for the collection of certain data with regard to the use of alcoholic drinks. At the meeting of the Committee of Fifty, November 16, 1894, the Sub-Committee on the Physiological and Pathologi- cal Aspects of the Drink Question presented a report, showing that the various special researches above named were being carried on. The preliminary bibliography of the literature on the effects of alcohol and alcoholic drinks had been printed. It also called attention to the following facts : — " That the experimental researches which have been ordered or proposed, important as they are, will have only an indirect bearing upon some of the most important cpiestious to be con- sidered by the Committee of Fifty, such, for example, as the following : — " I. To what extent does each alcoholic drink in ordinary use, more especially wine, beer, and whiskey, jDroduce disease and shorten life in the United States, or in certain localities in the United States? " II. AVhat are the particular forms of disease which each class of alcoholic drinks specially tends to produce, and to what special constituent of the drink are these peculiar effects due ? " III. Is the regular consumption of a moderate quantity of wine, beer, or whiskey conducive to the maintenance of health and the working power in any class of men ? If so, what class, and what is the average quantity that is thus useful ? " IV. What is the quantity of whiskey, wine, or beer, which the average man in good health may consume daily, without special risk of injuring his health? Does this vary in connec- tion with variations of age, of climate, or of occupation, and, if so, what are these variations ? " The laboratory researches authorized or proposed by the com- mittee bear mainly upon question II. With regard to the other questions it proj)oses to attempt to obtain infoi'mation by the collection of statistical data, and for this purpose it proposes to undertake four lines of inquiry, as follows : — " I. To address a circular letter to a large number of men in various parts of the country who are above forty years of age. KEPORT. sv and are engaged in mental work of a high class, inclosing a form to be filled out embracing a series of questions with regard to the use of alcoholic drinks by, and their effects upon, the individual. " II. A second circular letter with inclosed forms is intended to be addressed to the leading family physicians of the country, to obtain information for each person thirty years of age and upwards under their charge, and with whose habits and physical and mental conditions they are acquainted, giving their habits as to alcoholic drinks and the present condition of their health. " III. A third line of statistical investigation proposed is to obtain from the large hospitals of the country reports with regard to the habits, use of alcoholic drinks, and the physical and mental condition of patients twenty-five years of age and upwards admitted to them for treatment, the object being to obtain statistics from the class which makes use of hospitals, to compare with those derived from the reports of private physi- cians. It has not, as yet, been j)rinted. " In connection with this a scheme has been prepared for a collective investigation of the pathological conditions found in the bodies of those dying while affected with acute or chronic alcoholism, to be sent to large municipal hospitals. " IV. A fourth line of investigation proposed is with regard to the influence of the use of alcoholic drinks ujjon the mental condition of those using them, with special reference to the possibility of hereditary transmission of certain mental and physical effects under their influence, and as a commencement of these inquiries it is proposed to gather the data called for from asylums and institutions for the care of the insane. It is believed that this particular branch of the inquiry might well be assigned to the American Medico-Psychological Association, which is composed mainly of superintendents of asylums for the insane, and, on consultation with prominent members of this Association, it is believed they will be willing to undertake it, and also the collection of data called for on the hospital blank form above referred to." In September, 1895, certain experiments relating to the influ- ence of alcohol upon the process of infection were commenced in the Laboratory of Hygiene of the University of Pennsylvania, by Dr. A. C. Abbott, — the first work relating thereto being on svi REPORT. rabbits under the influence of alcohol to the stage of acute in- toxication. The details of these experiments, with the conclu- sions, were given in a paper which was printed in the " Journal of Experimental Medicine," volume i.. No. 3, 189G, and in the " Transactions of the Association of American Physicians," vol- ume ii., page 421. At the same time, it was decided to have a corresponding series of experiments carried out on animals, to ascertain what effects would be produced on the immunity to certain infectious diseases by the long-continued use of alcoholic drinks, and these experiments were undertaken by Dr. Abbott, the animals employed being large monkeys. The Association of Superintendents of Institutions for the Insane was induced to take up the matter of statistical investi- gation of the relations between alcohol and insanity, as observed in these institutions. A schedule of questions was prepared and sent out to collect this data. In the report presented to the General Committee, November 19, 1896, it was stated that it was desirable to have a careful investigation in regard to the metabolism of alcohol and alco- holic drinks in the living human body, as bearing upon the question as to what extent alcohol is consumed in the living human body, thereby acting as a force pi-oducer and a food. This investigation was undertaken by Professor Atwater, acting in consultation with the whole committee. The preliminary report of the results obtained by Professor Hodge was printed in the " Popular Science Monthly " for March, 1897, page 594, and April, 1897, page 796. Dr. Blumer resigned from the membership of the Committee of Fifty in November, 1897, and his place was filled by the appointment of Dr. P. M. Wise of New York. At the meeting of the Committee on Ethics in 1896, a report by Mr. Walter A. Wyckoff, prepared under the direction of Professor W. M. Sloane, giving the results of an inquiry into methods of instruction with regard to the effects of alcoholic liquors, and especially the so-called " Scientific Temperance In- struction " formulated by a prominent temj^erance organization and embodied in various text-books, was, at the request of the Ethical Committee, referred to the Committee on the Physi- ological and Pathological Aspects of the Drink Question for report, and for the presentation of a scheme of satisfactory REPORT. xvii instruction. In considering this question it was aj^parent that the question as to whether alcoholic drinks are in any sense a food was one of very considerable importance, and one which did not appear to have received such a definite solution as would meet the general approval of scientific physiologists and physicians, although the prevailing opinion among leaders in physiological science is that alcohol is really a food. Just at this time the opportunity was offered to make a series of experiments upon this point by means of a recently completed calorimeter devised by Professors Atwater and Kosa of Wes- leyan University, and the committee, after examining this apparatus and the general plan of investigation proposed by Professor Atwater, were satisfied that in this way a more defi- nite answer to the question could be obtained, and, the necessary funds having been provided by the General Committee, the work was at once commenced and has been continued for some four years. The results were published in detail as a Memoir of the National Academy of Sciences (volume vili., Sixth Memoir, Washington, 1902), entitled " An Experimental In- quiry regarding the Nutritive Value of Alcohol," by W. O. Atwater and F. G. Benedict. The work which has been done under the general direction of the committee may be summed up as follows : — I. An investigation on the influence of alcohol and alcoholic drinks upon the chemical processes of digestion, by Professor R. H. Chittenden and Dr. L. B. Mendel. II. A further study of the influence of alcohol and alcoholic drinks upon digestion with special reference to secretion, by Pro- fessor R. H. Chittenden, Dr. L. B. Mendel, and Dr. H. C. Jackson. III. An investigation on the effects of long-continued doses of alcohol or alcoholic liquors in producing organic changes in certain tissues and organs of the body, made by Professor William Welch and Dr. J. Friedenwald. In this connection should be mentioned an investigation made by Dr. H. J. Berkley of Baltimore, on the lesions produced by the long-continued use of alcohol on the cortical nerve cells of the brain (" Brain," pt. Ixxii., 1895, pp. 473-496, plates), and also one by Colin C. Stewart, on the influence of acute alco- holic poisoning on nerve cells (" Journal of Experimental Medi- cine," vol. i., 1896, pp. 623-629). xviii REPORT. IV. An investigation as to the effects of alcohol and alcoholic di-inks on the growth, development, and reproductive powers of animals, by Professor C. F. Hodge of Clark University. V. An investigation on the influence of alcoholism on infec- tion and immunity, by Professor A. C. Abbott of the Uni- versity of Pennsylvania. VI. An investigation of the extent to which alcohol is con- sumed in the living human body, and its action as a force producer and a food, by Professors W. O. Atwater and F. G. Benedict of Wesleyan University. VII. An investigation on the relations between the use of alcoholic drinks and insanity, made by the American Medico- Psychological Association. VIII. A statistical investigation as to the relative prevalence of the use of alcoholic drinks among brain workers in the United States, by Dr. J. S. Billings. IX. An investigation of the opinions and teachings of lead- ing j)hysiologists and pathologists of the present day, with regard to the effects of alcoholic drinks, and a comparison of these with the teachings of text-books in use in the common schools of this country, by Professors H. P. Bowditch of Har- vard and C. F. Hodge of Clark University. This historical sketch of the development of the plans of research of the Physiological Committee has been given to show that it was clearly recognized that the field for investigation was a very wide one, and that there are many unsettled ques- tions with regard to the physiological and pathological action of alcoholic drinks upon the human body. With the funds that were available and the number of skilled experimental investigators whose services could be commanded for work of this kind, it was impossible to undertake anything like a complete series of experimental investigations, or reli- able and satisfactory statistical inquiries as to the effects pro- duced on man by the moderate use of alcoholic drinks. The committee did not consider it necessary to make special inqui- ries as to the effects produced on man by what is ordinarily termed an excessive use of liquors, since the evidence that such use tends to produce disease and shorten life has now so accu- mulated that detailed statistics on this point are unnecessary. REPORT. rix The object which the committee had in view was, as indi- cated above, to ascertain the effects of the occasional or habitual use of a moderate quantity of wine, beer, or spirits upon the health and working powers of man. As to the term " moderate quantity," the committee accepted the use of this phrase among English physicians as formulated by Anstie, viz., the equivalent of one and one half (l.]) ounces of absolute alcohol per day, or about three (3) ounces of whiskey, or half a bottle of claret or Khine wine, or four (4) glasses of beer ; it being understood that this is to be taken only at lunch and dinner, and that the whiskey is to be well diluted. CONCLUSIONS. As the result of their investigations and deliberations the committee have arrived at the following conclusions : — I. The effects of a moderate or occasional use of alcoholic drinks upon man differ greatly in different individuals, and depend ou constitutional peculiarities, age, occupation, climate, etc. Most of them, especially the ultimate effects upon health, cannot be ascertained with much accuracy by experiments upon animals or upon a few men for short periods of time. II. The residts of the many exjjeriments of this kind which have been made up to the present time appear to us to be fairly stated in the papers by Professors Abel, Atwater, Chittenden, and Welch, printed with this report. The committee agree upon the general and more important conclusions of these pajjers after careful examination and personal conference. III. We have no trustworthy data as to the proportions of total abstainers, occasional drinkers, regular moderate drinkers, and positively intemperate persons in the United States. From such information as we have, it seems to us probable that of the adult males in this country, not more than twenty per cent, are total abstainers, and not more than five per cent, are positively intemperate in the sense that they drink in such excess as to cause evident injury to health. Of the remaining seventy-five per cent., the majority, probably at least fifty per cent, of the whole, are occasional drinkers, while the remaining twenty-five per cent, might perhaps be classed as regular moderate drinkers. With the majority of these occasional drinkers, and with many of the regular moderate drinkers, such as those whose XX REPORT. drinking is limited to a glass of wine or two at dinner, no especial effect upon health seems to be observed either by them- selves or their physicians, but in some cases the drinking is certainly harmful, while in a few it is thought to be beneficial. IV. Among the leading brain workers of the United States, as indicated by the statistics in the table on page 313, vol. i., of this report, it would appear that about eighty per cent, use alcoholic drinks occasionally or regularly in moderation. The opinions of these men as to the effects of alcoholic drinks in general have little or no scientific value, but are of interest as showing that the use of such drinks to stimulate mental effort gives, on the whole, bad results. We believe that such occasional or moderate use is most likely to be harmful to young persons, and mainly because of the danger of its leading to excess ; and that the cases where it is useful, otherwise than iu disease, are mostly those of persons over fifty years of age and when the alcoholic beverages are taken with the last meal of the day. V. The special effects of alcoholic drinks are mainly due to the alcohol they contain, and, so far as these effects are harm- ful, the other substances are of comparatively small importance. Fine old whiskeys and brandies are nearly as likely to produce injurious effects as are the cheaper grades of the same liquors, if taken in the same quantities. Some wines appear to delay or check the digestive process by reason of other constituents than alcohol, as is shown by the experiments of Professor Chitten- den with regard to the effects of claret. In general the inju- rious effect of an alcoholic drink is in proportion to the amount of alcohol contained in it, which seems to be the chief reason why wine and beer are less injurious than distilled liquors. VI. The question as to whether a given alcoholic drink is a food or a poison is one which cannot be answered by any short comprehensive formula. In moderate quantities, beer, wine, and diluted whiskey are, in a certain sense, foods ; but they are seldom used for food purposes, but mainly for their peculiar effects on the brain. In large quantities, and, for a few persons of i^eculiar temperament, even in moderate quantities, they are poisons. VII. Alcoholic drinks in moderate quantities may be useful as restoratives in fatigue after the work is done, but they often REPORT. xxi produce a depressing and even harmful effect when used just before or during physical or mental labor. They are useless as preventives of infectious or contagious disease ; on the contrary, they appear to lessen the power of the organism to resist the effects of the cause of such disease. VIII. The report prepared by Dr. H. P. Bowditch of Boston, and Professor C. F. Hodge of Worcester, Mass., on the present instruction on the physiological action of alcohol, is believed to be a correct representation of the facts, and to justify the con- clusion that much of the methods and substance of the so-called scientific temperance instruction in the public schools is unsci- entific and undesirable. It is not in accord with the opinions of a large majority of the leading physiologists of Europe as shown by the statement printed on page 18 of volume i. of this Report. This appears to us to be a matter of grave importance. IX. It does not seem to this sub-committee desirable to at- tempt to give systematic instruction to all children in the pri- mary schools on the subject of the action of alcohol or of alco- holic drinks. To older children, and especially those in the high schools, it does seem proper that instruction should be given as to the principal facts known about the use and effects of alco- holic drinks, the sociological and especially the ethical relations of the subject, the means which have been tried to prevent the evils resulting from alcoholism — and the results, — the object being to enable them to form an intelligent opinion upon the whole subject, especially to distinguish between mere assertions and scientific evidence. X. This teaching should not be made a special, isolated mat- ter, but should be a part of some elementary instruction in physiology and hygiene, and all that is really useful and desir- able can be given in a brief time, equivalent to a few lessons of an hour each, following the lessons on food. In these lessons might be taught what the ordinary alcoholic drinks are, and of what and how they are made, the difference between simple fer- mented drinks, like beer and wine, and distilled liquor, such as whiskey, the natui-e of the so-called " temperance drinks," and the general effects of alcohol as a stimulant and as a narcotic. It might be taught that while in moderate quantities beer and wine may be, in a certain sense, a food, they are a very imper- fect and expensive kind of food, and are seldom used for food xxii REPORT. purposes ; that they are not needed by young and liealthy per- sons, and are dangerous to them in so far as they tend to create a habit ; that in certain cases of disease and weakness they are useful in quantities to be prescribed by physicians ; that when taken habitually it should be only at meals, and, as a rule, only with the last meal of the day, or soon after it, and that alcoholic drinks of all kinds are worse than useless to prevent fatigue or the effects of cold, although they may at times be useful as restoratives after the work is done. It should also be taught that alcoholic drinks are almost al- ways a useless expense, that their use in excess is the cause of much disease, suffering, and poverty, and of many crimes ; but that such use is sometimes the result, rather than the cause, of disease. It should not be taught that the drinking of one or two glasses of beer or wine by a grown-up person is very dangerous, for it is not true, and many of the children know by their own home experience that it is not true. Signed : JoHN S. Billings, Chaiitnan. W. O. Atwater, H. P. BOWDITCH, R. H. Chittenden, W. H. Welch. REPORT ON THE PRESENT INSTRUCTION ON THE PHYSIOLO- GICAL ACTION OF ALCOHOL. By dr. H. p. BOWDITCH and DR. C. F. HODGE. REPORT PRESENT INSTRUCTION ON THE PHYSIOLOGICAL ACTION OF ALCOHOL. Our sources of information for this report are the following : I^irst. Standard text-books in common use in colleges, uni- versities, and medical schools. Second. Letters received from prominent physiologists, both in this country and Europe, giving their opinions on this sub- ject. Tliivd. Text-books " indorsed and approved "' by the " De- partment of Scientific Temperance Instruction " of the Woman's Christian Temperance Union for use in the public schools. Foiirth. Answers of public school-teachers in reply to ques- tions as to fitness and value of the books and results of so-called " scientific " temperance instruction. We shall endeavor to treat data from these sources in the above order and in such manner as to show the present status of teaching of the subject. No attempt wiU be made in this report to harmonize conflicting opinions. I. STANDARD TEXT-BOOKS OF PHYSIOLOGY. We shall consider first the various opinions held by physiolo- gists upon the fundamental question of the food value of alco- hol and its influence upon the processes and organs of digestion, and shall make but little reference to recent investigations which have not yet found their way into standard text-books, these being fully considered in other reports. Although his views have not been embodied in a formal text- book, the name of Professor Fick has been long associated with opposition, on physiological grounds, to the use of alcohol.. 4 THE LIQUOR PROBLEM. Fick defines a poison as follows ; " We may unhesitatingly designate as a poison any substance which, introduced into the blood in comparatively small amounts, causes disturbances in the functions of any organ. That alcohol is such a substance cannot be doubted." ^ He goes on to explain that alcohol differs from other poisons which affect the nervous system in a way which has led to tlie eiToneous opinion (" irrige Meinung ") that alcohol is a food. This difference consists in the fact that alcohol is oxidized in the body. " It is, when introduced into the blood, oxidized like a nutriment, to carbon-dioxide and water, and this oxidation must of course, like the oxidation of albumen, fat, or sugar, produce heat." ^ But this, Fick main- tains, does not prove that alcohol can be rightly considered a food unless it be proven that the energy derived from its con- sumption may be useful to the body. This he does not think clearly demonstrated, and therefore concludes : " Although the relations of the oxidation of alcohol to that of the true nutri- ments in the animal economy have not yet received a complete physiological explanation, it is certain that alcohol, even when taken in moderation, cannot be classed among the useful nutri- ments." ^ Joined with the view of Schmiedeberg, that alcohol exerts only a soothing or narcotic influence upon the nervous system, this position has been adopted by a small group of physiologists, Drs. Gaule, Forel, and Bunge. We have quoted these some- what guarded statements of Fick, because they are the original 1 " Als ein Gift werden wir ohne Bedenken jeden Stoff zu bezeichnen haben, der, in verhaltnissmassig kleiner Menge dem Blute beigemischt, Stcir- ungen in der Verrichtung irgend welches Organs verursaeht. Dass der Al- kohol ein solcher Stoff ist, kann nicht bezweifelt werden." " " Er verbrennt nanilich, in das Blut eingefuhrt, wie die Nahrungsstoffe zu Koblensaure und Wasser, und diese Verbrennung muss naturlieh wie die Verbrennung von Eiweiss, Fett oder Zueker Warme erzeugen." ^ " Wenn auch die soeben beriibrten Beziehuugen der Verbrennung des Alkohols zur Verbrennung der eigenliehen Nahrungsstoffe im thierisehen Organismus physiologisch noch nicht vollstiindig aufgekliirt sind, das ist gewiss : zu den niitzlichen Nahrungsstoffen kann auch der miissig genossene Alkohol nicht geziihlt werden." All the above quotations are from the following : Adolph Fick, Die Alkoholfrage, 2d ed., Dresden, 1895, pp. 2-6. A further discussion of this question is given on pp. 20, 21, in connection with the opinions of Professors ' Kiihne, v. Voit, and Dastre, as expressed in their letters. PHYSIOLOGICAL INSTRUCTION. 5 sources from which the sweeping statements of the school text- books, to receive attention later, have been derived. Bunge's statement is almost identical with that of Fick. He says : — " We know that alcohol is mostly oxidized in our body. . . . Alcohol is therefore, without doubt, a source of living energy in our body. But it does not follow from this that it is also a nutriment. To justify this assumption proof must be furnished that the living energy set free by its oxidation is utilized for the performance of a normal function. It is not enough that potential energy is transformed into living energy. The transformation must take place at the right time and place and at definite points in definite elements of the tissues. These elements are not adapted to be fed with every sort of oxidizable material. We do not know whether alcohol can fui-nish to the muscles and nerves a source of euergy for the performance of their functions. ... In gen- eral alcohol has only paralyzing properties," etc.^ It will be noted that Bunge does not say that alcohol is not a food, but that it has not been clearly proven to be a food, two clearly distinct positions which are often confused. The above positions differ but slightly from the four which follow, viz., those of Professors Howell, Schiifer, M. Foster, and Tigerstedt, each one standing for the dictum of one of our best modern scientific writers of physiological text-books. Professor Howell says : — " Alcohol also, when not taken in too large quantities, may be oxi- dized in the body and furnish a not inconsiderable amount of energy. It is, however, a matter of controversy at present whether alcohol in 1 " Wir wissen, dass der Alkohol zum grtissten Theil iu unserera Korper verbrannt wird. . . . Der Alkohol ist also zweifellos eine Quelle der lebend- igen Kraft in unserem Korper. Daraus folgt aber docb nicbt dass er aueh ein Nahrungsstoff sei. Um diese Annahme zu begriinden, miisste zuvor der Nacbweis gefiihrt werden, dass die bei seiner Verbrennung frei werdende lebendige Kraft verwerthet werde zur Verrichtung einer norraalen Func- tion. Es ist nicht genug, dass chemische Spanukriifte iu lebendige Kraft sich umsetzen. Die Umsetzung muss zur rechten Zeit am reehten Orte vor sich gehen, an ganz bestimmten Puukten ganz bestimmter Gewebselemente. Diese Gewebselemente sind gar nicht darauf eiugerichtet mit jedera belieb- igen Brennmaterial gespeist zu werden. Wir wissen nicht, ob der Alkohol etwa in den Muskeln oder Nerven znr Verricbtmig ihrer Functionen die Kraftquelle abgeben kdnne. . . . Ueberhaupt hat der Alkohol nur lahmende Eigenschaften," etc. G. Bunge, Lehrbuch der physiologischen und paiholo- gischcn Chemie, Leipzig, 189i, p. 124. 6 THE LIQUOR PROBLEM. small doses can be considered a true food-stuff capable of serving as a direct source of energy and of replacing a corresponding amount of fats and carbo-hydrates in the daily diet." ' Professor Schafer says : — " The nutritive value of alcohol has been the subject of considerable discussion and not a few exjjerinients. Some of these tend to show that in moderate non-poisonous doses it acts as a non-proteid food in diminishing the oxidation of proteid, doubtless by becoming itself oxi- dized. Its action, however, in this respect, is relatively small and, indeed, a certain proportion of the alcohol ingested is exhaled with the air of respiration. " Moreover, in large doses, it may act in the contrary manner, in- creasing the waste of tissue proteid. It cannot, in fact, be doubted that any small production of energy resulting from its oxidation is more than counterbalanced by its deleterious influence as a drug upon the tissue elements, and especially upon those of the nervous system. " It is of interest, in connection with this subject, to point out that alcohol has been regarded by some physiologists as probably formed at a stage in the metabolism of carbo-hydrates prior to their complete oxidation, traces of alcohol having been obtained from fresh tissues by distillation with water." * Professor Tigerstedt says : — " That alcohol is chiefly oxidized in the body is quite certain. About 10 per cent, of the alcohol taken into the body leaves the body unde- composed. The rest is oxidized to carbon-dioxide and water. But whetiier this results in a saving of the substances composing the body is difficult to decide, for alcohol, even in comparatively small doses, has a decidedly poisonous effect, and we must therefore consider only those amounts of alcohol by which this effect is not produced. " If now alcohol is decomposed in the body without protecting other substances from decomposition the excretion of carbon-dioxide should naturally rise in proportion to the amount of alcohol decomposed. This, however, does not seem to be the case. At least, the experi- ments of Zuntz and Berdez and of Geppert show that the ingestion of a non-toxic dose of alcohol is not followed by any appreciable increase of carbon-dioxide excretion. " In the normal nutrition of man, however, alcohol can play but a very unimportant part. The amount of alcohol which a man unaccus- 1 Wm. H. Howell, American Text-Book of Physiology, Phila., 1896, p. 297. ■ E. A. Schafer, A Text-Book of Physiology, 1898, p. 882. PHYSIOLOGICAL INSTRUCTION. 7 tomed to alcoholic drinks can take without producing symptoms of intoxication is very small, i. e., about 16-25 grams which, reckoning the combustion warmth of alcohol at 7 Calories per gram, would pro- duce 112-175 Calories which amounts to 4.5-7 per cent, of the daily heat production of the body. Only in very exceptional cases can alco- hol have any practical importance as a nutriment. It is especially in the case of acute diseases accompanied by diminished digestive power that alcohol, independently of its action on the nervous system, seems to be able to serve as a valuable nutriment." ' Professor Foster says : — " For though observations show that thS greater part of a moderate dose of alcohol is oxidized within the body, and so serves as a source of energy, man has recourse to alcohol not for the minute quantity of energy which is supplied by itself, but for its powerful influence on the distribution of energy furnished by other things. . . . For the action of all these bodies of which we are now speaking, in contrast ' " Dass der Alkohol zum grossten Theil im Korper verbrannt wird ist gauz sicher. Vou dem im Magen aufgenommeu Alkohol werdeu etwa 10 fc unzersetzt vom Korper abgegeben, das Uebrige verbrannt zu Kohlen- saure uud Wasser. " Ob aber dabei die Kbrpersnbstanz erspart wird ist schwer zu entscheiden, denn der Alkohol iibt ja sclion iu verhiiltnissmassig kleinen Mengen eine entschieden giftige Wirkuiig aus, uud wir miissen daher nur solche Alko- holmengen in Betracht Ziehen, bei welchen jede derartige Wirkung ausge- sehlossen ist. " Weuu nun der Alkohol im Korper zersetzt wird, ohiie audere Substanzen vor Zerfall zu sehiitzen, so sollte natiirlich die COo Abgabe der Zersetzteu Alkoholmengen entspreclieud steigen. Dies ist aber nicht der Fall. Wen- igstens zeigen die Versuche von Zuntz und Berdez und von Geppert, dass nach Aufnahme einer nicht toxisehen Dosis vou Alkohol keiue nenueus- werthe Steigerung der CO™ Abgabe eintritt. " Bei der normalen Erniihrung des Menscben kann indessen der Alkohol nur eine ganz unbeteudende Rolle spielen. Diejenige Quantitat Alkohol, die ein an alkoholiscbe Getranke nicht gewohnter Mensch geniesseu kann ohne dass Vergiftungssymptome auftreten, ist nUmlich eine sehr geringe und betragt nur etwa 16-25 g. was bei einer Verbrennungswarme von 7 W. E. pro g., 112-175 W. E., d. h., bei einem taglichen Bedarf von 2500, W. E., ^.o-lfo des Stoffwechsels betragt. Nur in seltenen Ausiiabms- fiillen kann der Alkohol als Nahrungsstotf eine practische Bedeutung haben, und zwar vor allem bei akuten, von herabgesetztem Verdaungsver- mogen begleiteten Krankheiten. Bei diesen scheint er, unabhangig von seiner Einwirkung auf das Nervensystem, grade als NahrungsstofP von grossera Nutzen sein zu kounen." Tigerstedt, Lehrbuch der Physiologie, Stockholm, 1898, p. 97. 8 THE LIQUOR PROBLEM with the actions of the food-stuffs proper, is not only complex but vari- able ; so complex and variable that simple experience is at present a more trustworthy guide than speculative physiology." ' The reader should at this point refer to Dr. Foster's letter, see Appendix I., p. 68, which is in some respects a more ex- plicit statement than the one given in his text-book. This general direction should also be followed with reference to the other authorities whose letters we have been able to obtain. We have, thus, a group of physiologists at the one extreme who take grounds, more or less strongly, against any dietetic use or value of alcohol, even this group admitting that it is not fully proved that alcohol is not a food. We have a second group who are inclined to favor moderate dietetic use of alcohol, tending to class it with non-proteid foods, but still maintaining that its classification as a food is not clearly established. Among these we should also place Kirkes, whose only reference to alco- hol is as follows : — " Among these " (accessories to food) " must be placed alcohol, the value of which within moderate limits is not as a food but as a stimu- lant and aid to digestion." ^ A third group of physiologists and pharmacologists, whether they advocate or oppose its use, evidently consider recent discus- sions as to the food status of alcohol unnecessaiy quibbling. For them the evidence is sufficient to pronounce alcohol in mod- erate quantities a food. The following are citations from au- thors under this head : — Sir T. Lauder-Brunton says : — " The conclusion to which all the evidence points is that alcohol is a food, and in certain circumstances, such as febrile conditions, it may be a very useful food ; but in health, when other kinds of food are abundant, it is unnecessary, and, as it interferes with oxidation, it is an inconvenient kind of food." ° Professor M'Kendrick says : — " If oxidized even to a small extent, and the evidence as indicated points to the oxidation of by far the larger proportion of it (95 per 1 M. Foster, A Text-Book of Physiology, 5th ed., Lend., 1891, p. 837. 2 Ifirkes, Physiology, Phila., 14th ed., 1896, p. 625. ' T. Lauder-Brunton, A Text-Book of Pharmacology, Therapeutics, and Materia Medica, Lond., 1887, p. 768. PHYSIOLOGICAL INSTRUCTION. 9 cent.), alcohol must be regarded in the scientific sense as a food. . . . While, therefore, it must be classed technically as a food, it is in many respects an unsuitable food and its place can be taken with great ad- vantage by other substances." * Professor G. N. Stewart says : — " In small quantities alcohol is oxidized in the body, a little of it, however, being excreted unchanged in the breath and urine. It is therefore to some extent a food substance." '^ Professor Halliburton says : — " Alcohol is thus within narrow limits a food. ... It is, moreover, a very uneconomical food ; much more nutriment would have been ob- tained from the barley or grapes from which it was made. The value of alcohol within narrow limits is not as a food, but as a stimulant, not only to digestion, but to the heart and brain." * Professor H. C. Wood says : — '• According to Dupr^ one gram of alcohol oxidized in the body evolves 7134 units of heat, while the same amount of lean beef gives off only 1482 units of heat. It has been estimated that 9.5 ounces of lean beef, equal to about two ounces of alcohol, will supply the force necessary to maintain the circulation and respiration for one day. That is, four ounces of strong spirit will suffice for this purpose. . . . These considerations warrant the statement that in a certain sense al- cohol is a food, i. e., that it is capable of being used for the purposes of the organism." * Landois and Stirling say : — " Distilled spirits — brandy, whiskey, gin — have but a trifling re- tarding influence on the digestive processes ; and when one considers their action on the secretory glands, it follows that in moderate die- tetic doses they promote digestion." " About 95 per cent, of it [alcohol] is oxidized in the body, chiefly into carbon dioxide and water, so that it is in so far a source of heat. As it undergoes this change very readily, when taken to a certain extent, it may act as a substitute for the consumption of the body, especially when the amount of food is insufiBcient. (Hammond found that when he lived on an insufficient amount of food, alcohol, if given in certain 1 M'Kendrick, Physiology, Glasgow, 1889, vol. ii. p. 19. 2 Stewart, Manual of Physiology, 1895, p. 414. ^ Halliburton, Text-Book of Chemical and Pathological Physiology, 1891, p. 600. * H. C. Wood, Therapeutics, 1901, p. 284. 10 THE LIQUOR PROBLEM. quantity, supplied the place of the deficiency of food and he even gained in weight. If, however, sufficient food was taken, alcohol was unnecessary.) . . . " Alcohol in small doses is of great use in conditions of temporary want, and where food is taken insufficient in quantity. AVhen alcohol is taken regulaily, more especially in large doses, it affects the ner- vous system, and undermines the psychical and corporeal faculties, partly by the action of the impurities which it may contain, such as fusel oil, which has a poisonous effect on the nervous system, partly by the direct effects, such as catarrh and inflammation of the digestive organs, which it produces, and lastly, by its effects upon the normal tabolism." ^ Professor Lusk says : — " Alcohol in the stomach at first prevents the gelatinization neces- sary in proteid for peptic digestion, but this difficulty is of no great moment, because the absorption of alcohol is rapid and complete. . . . Alcoholic beverages coijibining alcohol and flavor promote gastric di- gestion, but often stimulate the appetite in excess of normal require- ment." ^ Finally we may quote the following passage from Konig : — " Alcohol in moderate doses is an important stimulant to digestion, and this explains the strong craving for brandy on the part of the la- boring class whose food consists of difficultly digested materials (po- tatoes, bread, etc.). . . . " C. A. Gluchinsky has recently investigated the influence of alcohol on digestion and has found that it is greatly slowed as long as alcohol is present in the stomach. Alcohol soon (after from one half hour to an hour) disappears from the stomach, however, and as soon as this occurs, acidity of the stomach increases suddenly up to two to three times the degree of acidity when alcohol has not been taken. Corre- sponding with this, digestion proceeds more rapidly and is completed in less time, in spite of the initial arrest. Hence a moderate amount of alcohol taken a short time before eating must exert a beneficial in- fluence on digestion." ' > Landois and Stirling, Text-Book of Human Physiology, Loud., 1891, pp. 348, 437. ^ Lusk, Am. Text-Book of Physiology, p. 979. 8 " Der Alkohol in miissigen Gaben genossen, bildet ein wichtiges Reiz- mittel flip die Verdauiigsthatigkeit und nicht ohne Grund tritt bei der ar- beitenden Classe, welche sich vorzugsweise mit schwer verdaulieher Nah- rung (wie Kartoffel und Brod etc.) eruahrt, ein starkes Verlaugen nach Brantwein auf. . . . PHYSIOLOGICAL INSTRUCTION. 11 lu concluding this topic we may cite a few more passages from standard authorities, placing side by side with them state- ments from the " indorsed and approved " public school text- books of physiology. While these books will be treated more fully in the pi'oper place, the following form of presentation may assist in making clear the great lack of coordination be- tween these different departments of our educational system. Stajstdard Text-Books. "It may, perhaps, be said with safety that in small quantities it (alcohol) is beneficial, or at least not injurious, barring the danger of acquiring an alcohol habit, while in large quantities it is directly in- jurious to various tissues." * " In practice we find that in many persons a small quantity of alcohol improves digestion ; and that a meal by its means can be digested which would be wasted." ^ " In attempting faii-ly to esti- mate the action of stimulants, es- pecially of alcohol, one point is of utmost impoi-tance to remember. It is this — alcohol is a food ! If alcoholic stimulants were mere dis- " Indorsed and Approved " Physiologies. '• Alcohol is universally ranked among poisons by physiologists, chemists, physicians, toxicologists, and all who have experimented, studied, and written upon the sub- ject, and who, therefore, best un- derstand it." ' '• Alcohol is not a food or drink. IVIedical writers, without excep- tion, class alcohol as a poison." * " IS alcohol a food ? " " What do you think about it ? (Question to the class.) ... Do you think your body would grow and keep well and strong if you " C. A. Ghichinsky hat ebenfals die Wirking des Alkoliols auf die Ver- dauung gepriift und gefunden, dass dieselbe stark geheuuiit wird, so lange noch Alkohol im Magen voihanden ist. Der Alkohol verschwindet iiidess bald (nacli ^1 Stmide) aus dera Magen und sobald dieses gescheben ist, steigt plotzlich der Sauregrad des Magens auf das 2-3 fache des Sauregrades ohne Alkohol. Dem entsprechend schreitet auch die Verdauung schneller vorwarts und ist, trotz der aufiinglich ungiiustigen Wirkung, in kiirzerer Zeit vollendet. Ein miissiger Alkoholgenuss einige Zeit vor dera Essen muss daher gunstig auf die Verdauung einwirken." J. Kdnig, Chemie der menschlichen Nahrungs- und Genussmittel, Berlin, 1889, p. 33. 1 Howell, Am. Text-Book, 189G, p. 298. ^ Fothergill's Practitioner^ s Handbook of Treatment, 11th ed., London, 1897, p. 34. ^ Quoted from Youmans in Blaisdell's, No. 2, p. 232. * Eclectic, No. 3, p. 67. 12 THE LIQUOR PROBLEM. engagers of static force, early ex- haustion would be the rule. But as alcohol is a readily oxidizable form of hydrocarbon, it is also a food as well as a stimulant. In fact it is one of the most easily as- similable forms of food, and very frequently it can be taken and util- ized when no other form of food is available. While it is a stimulant, an evoker of force, it also supplies to some extent that force in its readily oxidizable self. The ex- periments of the late Dr. Anstie and Dr. Dupr^ have placed beyond all question or honest doubt the fact of the oxidization of alcohol within the organism. If alcohol is oxidized in the body, then alcohol is a true food, or furnisher of force." " The question of the propriety of the daily use of alcohol by healthy men is at present a very serious one, involving so many moral and politico-moral issues that it cannot be fully discussed here. Suffice it to state as obvious inferences from our present know- ledge of the physiological action of alcohol, that the habitual use of moderate amounts of alcohol does not directly and of necessity do harm ; that to a certain extent it is capable of replacing ordinary food, so that if it be scanty, or even if it be coarse and not easily di- gested, alcohol, in some form or other, is of great advantage ; that in all cases it should be taken well diluted, so as not to irritate the ^ Fothergill, op. cit., p. 254. * Eclectic Series, No. 2, p. 31. * Authorized Series, No. 8, p. 58. used it instead of bread and meat ? No, indeed . . . We know tliat alcohol is not a food." " " It is important for you to re- member that alcohol is a narcotic poison." ' " This alcohol is a liquid poison, a little of it will harm any one who drinks it, and much of it would kill the drinker." ■* " It must be remembered that in whatever quantity, or wherever alcohol is found, its nature is the same. It is not only a poison, but a narcotic poison." ' "AJLCOHOL A POLSON." "A poison is any substance whose nature it is, when taken into the body either in small or large quantities, to injure health or destroy life. "In large doses, in its pure state, or when diluted, as in brandy, whiskey, rum, or gin, alcohol is often fatal to life. Deaths of men, women, and children from poison- ous doses of this drug are common. " In smaller quantities, or in lighter liquors, beer, wine, and cider, when used as a beverage, it injures the health in proportion to the amount taken." ' " This alcohol is poisonous. It is its nature, even in small quanti- ties, to harm any one who drinks it. It is capable of ruining the character — as well as the health ; 2 Health Series, No. 1, p. 30 £P. * Pathfinder Series, No. 1, p. 41. 6 Dulaney's Series, No. 2, p. 46 S. PHYSIOLOGICAL INSTRUCTION. 13 stomach ; and that wine or malt and if one takes enough it will liquors are certainly preferable to kill him." ' spirits" (p. 377). ..." As Lie- ben also found that this substance exists in the urine of dogs, horses, and lions, and as A. Kajewski ob- tained it from healthy rabbits, it must be acknowledged that our present knowledge strongly indi- cates that alcohol is formed and exists in the normal organism." ' In connection with this last statement of Dr. Wood, and as also bearing upon Schiifer's testimony, we should also cite the following from Hoppe-Syler.^ " Traces of alcohol are found in human organs, such as the brain, muscles, liver, not only after alcoholic indulgence, but, without this, they seem to be con- stantly present." Considerable space in all the public school text-books is devoted to various pathological processes which do not properly belong to the domain of physiology, and hence are rarely touched upon in the standard text-books. Among these obesity and fatty degeneration, especially of the heart, and sclerosis, partic- ularly of the liver, are treated as though alcoholic indulgence were practically the only cause. Landois and Stirling remark (§ 453) that fatty degeneration is apt to occur after severe fevers, or after artificial heating of the tissues, after poisoning with phosphorus and arsenic, and " in drunkards." Schmiede- berg makes the effects of chronic alcohol poisoning to consist chiefly in fatty degeneration and increase of connective tissue. But he concludes the topic by saying, " Moderate amounts of alcohol may be taken daily throughout a whole lifetime without producing these changes in the tissues." * ' H. C. Wood, Therapeutics, 1901, pp. 290, 284. - Union Series, No. 2, p. 33. ■■' " Spuren von Alkohol finden sioh in den menscblichen Organen, wis Gehirn, Muskeln, Leber, nicht allein nach Alkoholgenuss, sondern sie scheinen auch obne letzeren stets vorbanden zu sein." Hoppe-Syler, Handhuch der chemischen Analyse, Berlin, 1895, p. 40. * " Massige Mengen von Alkohol kbnnen taglich ein ganzes Menschen- alter hindiirch genossen werden, obne dass solche Gewebsveraiiderungen als Folgen auftreten." Grundriss der Arzneimittellehre, p. 41. 14 THE LIQUOR PROBLEM. II. LETTERS FROM PHYSIOLOGISTS. An important part of the data collected consists in letters obtained from physiologists, both in this country and abroad, giving their views upon this subject. A special effort has been made to secure the opinions of all the physiologists who have taken an active part in the movement to diminish the con- sumption of alcoholic beverages, and the letters from these authorities here presented contain the strongest arguments which science can furnish in favor of the total abstinence agitation. A number of these letters, representing all shades of opinion, are presented in Appendix I., and it is therefore necessary at present only to sum up as briefly as possible the general position of physiologists as set forth in this body of corre- spondence. At the outset circular letters of inquiry were sent first to all members of the American Physiological Society, seventy-two in number; second, to forty-five physiologists, hygienists, and spe- cialists in allied sciences, holding j3rominent positions abroad. In this way it was hoped to obtain valuable expert opinions from practically the entire scientific world. Below is a copy of the letter sent to American physiologists. The circular to foreign authorities was similar, except that it gave a brief de- scription of " scientific temperance instruction " as to text^ books and time requirements. (copy of circular.) Worcester, Mass., October 1, 1897. The Committee of Fifty has requested me to gather the testi- mony of physiologists upon two topics relating to the practical teaching of the physiology of alcohol. Your coojDeration is very respectfully solicited First, as to the facts at our disposal, will you please give a list of the points which you consider sufficiently well established and of essential importance to the education of medical and imiversity students ? We wish to learn your own view of the physiological value of alcohol as a food, condiment, stimulant, and medicine ; its influence upon the tissues, organs, and upon physiological processes. Please give also a list of the impor- PHYSIOLOGICAL INSTRUCTION. 15 tant points that you think are not sufficiently well proved to form a part of our teaching material, the points about which there is too much present difference of opinion. Second. To what extent do you think it wise to introduce alcoholic physiology into elementary public school courses ? I refer to the " Scientific Temperance Instruction " promoted by the W. C. T. U., viz., the requirement by law that the subject be given considerable prominence throughout the school course. Have you examined any of the " approved and indorsed " phy- siologies ? If so, what ones ? What is your opinion of them ? Finally, will you give a list of the arguments which seem most conclusive to yourself either for or against this method of pre- venting alcoholism ? It is desirable that replies be sent in by October 15, but, if that is not convenient, they may still be of value to the in- vestigation as late as December 1. Sincerely yours, C. F. HoDGE. Thirty members of the American Physiological Society re- plied to the circular ; nine of this number, however, did not wish to enter the discussion. Of those who expressed definite opinions on the subject, all but one. Ph. A. Levene, a recent accession to the ranks of American physiologists, who should possibly be classed among a small group of foreign scientists whose position will receive attention later, oppose the so-called " scientific temperance instruction " as it is now being promoted in the schools, the strong conviction of a number being that it is resulting in more evil than good. The following foreign authorities were consulted, the science pursued by each being indicated by abbreviations as follows : — Physiology Ph. Psychiatry Psych. Hygiene Hy. Pathology Path. Pharmacology Phar. E. W. Boyce, Path London, England. Sir T. Lauder-Brunton, Phar. . . . London, " Sir Michael Foster, Ph. .... Cambridge, " Francis Gotch, Ph Oxford, " 16 THE LIQUOR PROBLEM. W. D. Halliburton, Ph London, England. E. A. Schafer, Ph London, " C. S. Sherrington, Ph Liverpool, " T. S. Clouston, Psych Edinburgh, Scotland. J. G. M'Kendrick, Ph Glasgow, " Wm. Rutherford, Ph Edinburgh " T. Place, Ph Amsterdam, Netherlands. Sigmund Exner, Ph Vienna, Austria. Richard Freih. v. Krafft - Ebbing, Psych Vienna, " Nandor Klug, Ph Budapest, Hungary. Ferencz Tangl, Ph Budapest, " Vasilij Jakovlevic Danilevskij, Ph. . Charkow, Russia. Ivan Michajlovic Dogiel, Ph. . . . Kasan, " Nikolaj Jevgenjevic Vvedenskij, Ph. St. Petersburg, Russia. Kenji Osawa, Ph Tokio, Japan. Jiro Tsuboi, Hy Kyoto, " Sophus Torup, Ph Christiania, Norway. R. A. A. Tigerstedt, Ph Stockholm, Sweden. Ch. Richet, Ph Paris, France. Luigi Luciani, Ph Rome, Italy. Angelo Mosso, Ph Turin, " Gustave Bunge, Ph Basel, Switzerland. August Forel, Psych Zurich, " Justus Gaule, Ph Zurich, " Hugo Kronecker, Ph Bern, " A. Baer Berlin, Germany. Julius Bernstein, Ph Halle, " Adolf Fick, Ph Wlirzburg, •' Ditmar Finkler, Hy Bonn, " Carl Flugge, Hy Breslau, " Karl Frankel, Hy Halle, « F. L. Goltz, Ph Strassburg, " Rudolph Heidenhain, Ph Breslau, " Victor Hensen, Ph Kiel, " Ludimar Hermann, Ph Konigsberg, " Emil Kraepelin, Psych Heidelberg, " J. von Kries, Ph Freiburg, " Willy Kilhne, Ph Heidelberg, " Leonard Landois, Ph Greifswald, " Eduard Pflilger, Ph Bonn, " Karl von Voit, Ph Munich, « PHYSIOLOGICAL INSTRUCTION. 17 Of the scientists thus appealed to, only thirteen responded. Of these, five are from Great Britain, and they should be con- sidered somewhat by themselves, as standing for the present position of English physiologists. (See letters by Foster, Clouston, Halliburton, Schafer, and Lauder-Brunton in Ap- pendix I.) Of the other eight, seven — Baer, Dogiel, Fick, Forel, Gaule, Bunge, Richet — are more or less actively inter- ested in the cause of reform in the use of alcohol. They tend, therefore, to regard the subject from a sociological rather than a physiological point of view, and yet it is interesting to notice that, with the exception of Dr. Baer,^ a physician in a peniten- tiary near Berlin, no one of them is willing to indorse the " approved text-books." Even Forel, perhaps the most ener- getic and brilliant advocate of total abstinence in Europe, who goes so far as to maintain that alcohol in all doses is a poison, remarks, in speaking of educational methods : " I think that in America somewhat unwise methods have been adopted." ^ It must not be supposed that the letters of these seven for- eign correspondents represent the opinions of Continental physi- ologists in general. The letters in Appendix I., and the names appended to the statement prepared by Professor Foster, furnish sufficient proof to the contrary. The method of obtaining infor- mation and opinions by means of circular letters is objectionable on acccount of the varying degrees of interest in the subject felt by the persons addressed. The questions asked in our circular letter cannot be properly answered without devoting some little time to the subject, and the conclusion to be drawn from our attempt to gain information in this way is that those interested in alcohol reform are willing to take the time to answer. Those who are not have other woi'k which they regard of more impor- tance. In order to gain an expression of expert opinion fuller than that elicited by the above circular letter, the matter was brought before the members of the International Physiological Congress which convened in Cambridge in the summer of 1898. To facilitate the work Professor Foster drew up a moderate state- ' Even this solit.iry advocate of " Scientific Temperance Instruction " writes : " Personally, I do not practice total abstinence." - " Ich glaube dass in Amerika in dieser Beziehuug tbeilweise unrichtige Wege betreten worden sind." 18 THE LIQUOR PROBLEM. ment concerning tbe influence of alcohol which he considered to represent the views of physiologists generally. Those who were willing were then asked to sign the statement, either as it stood or with such modifications as each might wish to make. Certain names were obtained by special correspondence after the adjournment of the Congress, and in some instances this correspondence drew forth expressions of opinion which are published in their proper place in Apf)endix I., together with the letters received in reply to the circular. Dr. Foster's statement is as follows : — " The physiological efEects of alcohol, taken in diluted form, in small doses, as indicated by the popular phrase 'moderate use of alcohol,' in spite of the continued study of past years, have not as yet been clearly and completely made out. Very much remains to be done, but, thus far, the results of careful experiments show that alcohol, so taken, is oxidized within the body and so supplies energy like common articles of food, and that it is physiologically incorrect to designate it as a poison, that is, a substance wliich can only do harm and never good to the body. Briefly, none of the exact results hitherto gained can be ap- pealed to as contratlicting, from a purely physiological point of view, the conclusions which some persons have drawn from their daily common experience, that alcohol, so used, may be beneficial to their health." * The following is an alphabetical list of the signers of this statement, with the modifications desired by certain individuals given in the foot-notes : — S. von Basch, Director Lab. of Experimental Pathology, Vienna. J. Bernstein, Prof. Physiol., Halle. R. Boehm, Prof. Pharmacology, Leipzig. Arthur Biedl, Priv. Doc. Exp. Path., Vienna. T. Lauder-Brunton, Lect. Pharmacology, St. Barth's Hosp., London.^ P. J. Dear, M. A., Oxford. Delzenne, Prof. Agr^g^ Physiol., Montpelier. ^ With reference to this statement it should be observed that the last clause was intended as a protest against the absolute condemnation of al- cohol by the " approved " text-books, and is not to be regarded as an indi- cation that those signing it believe that the usefulness of alcohol as a beverage has been scientifically demonstrated. ^ Omitting " and so supplies energy like common articles of food " in the sixth and seventh lines, and inserting " in such doses " between " it " and "as " in tbe seventh line. PHYSIOLOGICAL INSTRUCTION. 19 M. Dufour, Prof. Agr6g4 Physique, Nancy. Eugene Dupuy, Paris. C. Eckhard, Prof. Physiol., Giessen. S. Exner, Prof. Physiol., Vienna. Ph. W. Engelmann, Prof. Physiol., Berlin. N. Floresco, Pr^parateur Physiol., Paris. M. Foster, Prof. Physiol., Cambridge, England. M. vou Frey, Prof. Physiol., Zurich. J. Gad, Prof. Physiol., Prague. Arthur Gamgee, Emer. Prof. Physiol., Owen's Coll., Manchester. W. H. Gaskell, Lect. Physiol., Cambridge, England. Fr. Goltz, Prof. Physiol., Strassburg. P. Griitzner, Prof. Physiol., Tubingen. W. D. Halliburton, Pi-of. Physiol., King's College, London. W. J. Hamburger, Prof. Physiol., Ecole de Med. Vet., Utrecht. V. Hensen, Prof. Physiol., Kiel. Geo. T. Kemp, Prof. Physiol., Univ. of Illinois. J. von Kries, Prof. Physiol., Freiburg. H. Kronecker, Prof. Physiol., Bern. M. Lambert, Prof. Agr^g^ Physiol., Nancy. J. N. Langley, Lect. Histology, Cambridge, England. L. Landois, Prof. Physiol., Greifswald. J. Latschenberger, Vienna. J. P. Langlois, Prof. Agr^gd Physiol., Paris. F. Laulanie, Directeur Ecole Vet., Toulouse. Frederick S. Lee, Prof. Physiol., New York. A. B. Macallum, Lect. Physiol., Toronto. Hans Meyer, Prof. Physiol., Marburg.^ N. Mislawski, Prof. Physiol., Kasan, Russia. K. Mitsukuri, Prof. Zoology, Tokyo, Japan. A. Mosso, Prof. Physiol., Turin. A. Moussu, Prof. Pathol., Ecole Vet., Alfort. H. Munk, Prof. Physiol., Berlin. Otto Nasse, Prof. Physiol. Chem. and Pharmacology, Rostock. H. Ohrwall, Prof. Physiol., Upsala, Sweden. D. Noel Paton, Lect. Physiol., Edinburgh, Scotland. William T. Porter, Prof. Physiol., Harvard Medical School, Boston. J. M. Purser, Prof. Physiol., Trinity College, Dublin. E. Wayniouth Reid, Prof. Physiol., Dundee. Sydney Ringer, Prof. Clin. Med. Univ. Coll., London. A. RoUett, Prof. Physiol., Graz. ' Makes sixth line read, "and so can supply energy," omitting "like common articles of food." Omit " poison, that is, a " in eighth line. 20 THE LIQUOR PROBLEM. Giorgio Rotondi, Assist. PhysioL, Genoa. H. Sahli, Prof. Therap., Bern.i F. M. Sandwith, Prof. Medicine, Cairo.'' E. A. Scliafer, Prof. PhysioL Univ. Coll., London. C. S. Sherrington, Prof. Physiol. Univ. Coll., Liverpool. L. E. Shore, Lect. Physiol., Camhridge, England. J. Burdon Sanderson, Prof. Physiol., Oxford. P. H. Pye-Smith, Lect. Guy's Hospital Medical School, London. W. H. Thompson, Prof. PhysioL, Belfast. Max Verworn, Prof. Pliysiol., Jena. A. D. Waller, Lect. Physiol., St. Mary's Hospital Medical School, London. G. Weiss, Prof. Agr^gd Physique, Paris. W. H. Wilson, Prof. School of Medicine, Cairo. N. Zuntz, Prof. Physiol. Landwirtschaftliche Hochschule, Berlin. Comment on the above list of names is unnecessary. It is interesting to notice that, with the exception of certain of the writers above mentioned as actively engaged in the tem- perance movement, none of the i^hysiologists whose letters are presented in Appendix I. desire to be regarded as advocates of total abstinence. This attitude seems to be quite independent of the opinion of the writers as to the nutritive value of alco- hol. Most of them consider the fact that the greater part of a moderate dose of alcohol is used up in the body, thus setting free energy in the form of heat, to be conclusive evidence of nutritive value, for this is what happens in the case of such recognized nutriments as sugar, starch, and fat. Others, how- ever, with the extreme caution of true science, maintain that " the oxidation of a substance in the animal body does not de- termine its injurious or its useful effects " (Kiihne), and that " a substance may be consumed by the body and liberate energy and yet be harmful " (v. Voit).^ Dastre proposes to recog- nize two groups of heat-producing substances, viz., " biother- mogens," including the true nutriments (proteids, fats, and starches) which produce heat in connection with the vital pro- cesses of the body, and "pure thermogens," including alcohol, glycerine, and certain organic acids, which simply produce heat ' In eighth line omit " poison, that is, a." 2 Add " with food " after " form " in first line. ' It will be noticed that this is the opinion held by Fiok, see p. 4. PHYSIOLOGICAL INSTRUCTION. 21 having no relation to vital processes and destined to be got rid of. The questions thus raised are of considerable theoretical interest and are suggestive of new lines of research, but at the present time it is, to say the least, doubtful whether a distinc- tion between useful and useless heat-production can be main- tained. Moreover, the question is of little practical importance, for the same writers who thus doubt the nutritive value of alco- hol maintain that light wines and beers are not only harmless but even desirable adjuncts to our diet. Thus Dastre writes: " I believe . . . that alcohol, used in weak and reasonable doses, in good wines, at meal times, is an excellent thing, very agree- able, and that it cannot do harm. ' Bonum vinum laetificat cor hominum.' " Von Voit expresses the opinion that " a moderate use of light alcoholic beverages, as for instance beer, is not in- jurious to health," and Kiihne remarks that " when one sees how many normal, hard-working people arrive at a ripe age, while using stimulants with discretion, among which I include the moderate use of alcohol, one does not find good reasons for total abstinence." UI. INDORSED AND APPROVED PUBLIC SCHOOL TEXT-BOOKS. Exactly what " scientific temperance instruction " is can be learned from this series of text-books, now twenty-five in num- ber ; but these books themselves are the embodiment of a move- ment for temperance instruction, and it may assist us to their better understanding if we study the movement itself for a mo- ment and attempt to discover its origin and estimate its general character. Scientific temperance instruction in the United States had its beginning in 1879, when Mrs. Mary H. Hunt presented to the National Convention of the Woman's Christian Temperance Union, held at Indianapolis, Ind., her scheme " for thorough text-book study of Scientific Temperance in public schools as a preventive against intemperance." ' In response, the conven- tion passed the following resolution : — " Resolved, That this Convention consider the introduction of Scien- 1 A history of the first decade of the Department of Scientific Temper- ance instruction in schools and colleges of the Woman's Christian Temper- ance Union, Boston, Washington Press, 383 Washington Street, 1892, p. 6. 22 THE LIQUOR PROBLEM. tific Temperance text-books into the regular course of study in our public schools as a most hopeful line of work. We therefore urge the various States here represented to take immediate action to secure this important study taught in the schools of their various localities." A standing committee, with Mrs. Hunt as chairman, was ap- pointed to " translate this resohition into action." The follow- ing year, 1880, the work was reorganized as a " Department of Scientific Temperance Instruction in Schools and Colleges," with Mrs. Hunt as a " National Superintendent " in place of the standing committee. Of this change she writes as fol- lows : 1 — " Here was a turning point in the early history of this movement where, guided by an unseen Power, we planned ' more wisely than we knew.' This unification, resulting from plans emanating from one source, to which all results are reported, has secured a unity of action, with ability to concentrate at desired points, that has been one great secret of success. A great army with battalions in every State and Territory, regiments and companies in all counties, with pickets at ever}' outpost, and all under the guidance of one head, is what this centralization foreshadowed." In 1888 this movement was incorporated as a department of the World's Woman's Christian Temperance Union, and Mrs. Hunt assumed the title " National and International Superin- tendent." "^ The work thus spread to " twenty different coun- tries besides the United States." In order to ascertain something definite regarding the " ap- proval and indorsement " of the text-books, some letters were interchanged with the Department of Scientific Temperance Instruction, and, while the desired information was not given, we learned one fact of importance, viz., the method of organi- zation of the " Advisory Board " which is supposed to have this matter in charge. The letter (April 13, 1897) states : " The names of the board of educators, reformers, physicians, and clergymen associated with Mrs. Hunt in this work were sug- gested by Mrs. Hunt and elected by vote of the Woman's Christian Temperance Union." We call attention to these things to make clear two points : First, the purely autocratic character of the movement. For 1 Loc. cit., p. 7. '■' Loc. cit., p. 101. PHYSIOLOGICAL INSTRUCTION. 23 its origination, for its policy, and for every development in its history, Mrs. Hunt is practically responsible. Second. That it was founded, from its very beginning, on the text-book theory of instruction, and has therefore had behind it the powerful influence of the text-book publishing firms through- out the country. The true character of the movement is well set forth in one of the publications of the Woman's Christian Temperance Union. " This is not a physiological, but a temperance movement. In all grades below the high school this instruction should contain only physi- ology enough to make the hygiene of temperance and other laws of health intelligible. Temperance should be the chief and not the sub- ordinate topic and should occupy at least one fourth the space in text- books for these grades." ^ The above platform expresses in few words the animus of the whole movement. It is frankly and honestly the total absti- nence reform, a movement in this country often connected with partisan jjolitics and with some denominations associated with religious work. As is generally the case when feeling and pre- judice run high, the temptation has been irresistible to either manufacture evidence or stretch it over points that it does not cover ; to call " scientific " everything that happens to agree with particular prejudices, and to relegate to the limbo of human error aU the evidence that appears for the other side. Another characteristic feature of this movement has been the flattery of authors who favor the views to be inculcated with such appella- tions as " greatest living authority," " foremost scientist," " the wise physician of to-day, who is abreast of the modern investi- gations concerning this di-ug," " author of great prominence," " most skilled in his profession," " eminent scholar," etc. These phrases are rarely, if ever, applied to persons who are recognized by men of science as authorities on this question. To give cfl^ect to this policy of compulsory " scientific tem- perance education," laws have been enacted in nearly all the States of the Union. This has usually been effected without much opposition, the excellence of the motive tending to disarm criticism. The present New York law, however, which is one 1 Science Temperance Monthly Advices, March, 1892, p. 4. 24 THE LIQUOR PROBLEM. of the most stringent that has ever been enacted, was placed upon the statute books in spite of the organized and strenuous opposition of the teachers of the State who were in entire sym- pathy with the general principle of temiierance instruction and who had done excellent work under the more reasonable law of 1884. The laws of the different States, most of which will be found in Appendix II., differ greatly as to their provisions. In their simplest form "■ Physiology and hygiene, which in both divisions of the subject shall include special instruction as to the effects of alcoholic drinks, stimulants, and narcotics on the human sys- tem " (Massachusetts law), are placed on the list of prescribed studies. Such laws have been obviously found insufficient to force the " approved and indorsed " text-books upon the public. Accordingly a text-book clause has been frequently added, com- pelling the use of text-books which contain a definite propor- tion, usually one fourth or one fifth, for graded schools, and twenty pages of temperance matter in books intended for high school use. A definite number of lessons, generally thi-ee les- sons per week for fourteen weeks each year from the primary to second year in the high school, has also been made compul- sory, and further, penal clauses, removal from office (District of Columbia law), or fines (New York law), have been incor- porated into a number of the statutes. The bill presented dur- ing the winter of 1898-99 to the Massachusetts legislature may be taken to represent the latest effort of the department of " scientific temperance education," and a brief account of the discussion to which it led may therefore be introduced in this connection. This bill ^ (see Appendix II.) defined more accurately than the existing law the amount of time to be devoted to temper- ance teaching and jjrovided a penalty in case of failure on the part of school committees to conform to the law. The committee on legislation of the Massachusetts Medical Society, acting under instructions from the society, appeared in opposition and presented a bill ^ providing for instruction in the action of stimulants and narcotics to such classes and in such manner as school committees may determine (see Appen- * Known as the " Morgan-Hunt Bill," Senate, 41. * Known as the " Myers Bill," House, 817. PHYSIOLOGICAL INSTRUCTION. 25 dix II.). In behalf of the former bill appeared three members of the " Massachusetts Central Committee for the Promotion of Scientific Temperance Instruction in the Public Schools," who introduced evidence which " may be roughly classified as follows : — " 1. Dissertations on the evils of intemperance. " 2. Certifications of Mrs. Hunt's uprightness of character and nobility of intentions coupled with broad insinuations that those who oppose her bills are in league with the liquor in- terests. " 3. Statements in regard to the beneficent effects of similar laws in other States as proved by a decrease in the consumption of beer and the good health of the troops during the late war." ^ Evidence belonging to the first and second classes required, of course, no answer ; that of the third class was easily shown in the hearing before the legislative committee to be entirely misleading. The latter bill was supported — 1. By a committee of the Massachusetts Medical Society, who presented the result of a canvass of school superintendents and teachers showing an overwhelming preponderance of opinion in favor of the bill and abundant evidence of the failure of the present law to accomplish the desired results.^ 2. By the Secretary of the State Board of Education, who testified to the efforts of the " scientific temjjerance " people to secure the dismissal of state emjdoyees suspected of not being sufficiently in sympathy with their own extreme views. 3. By the most prominent educators, physicians, and clergy- men of the community, some of whom had favored " scientific temperance " legislation in 1885. The fact that in a State like Massachusetts educators gener- ally united against more strenuous legislation and in favor of a less exacting measure is of great significance. After fourteen years' experience, the solid front of opposition presented by Massachusetts teachers and educators was decisive proof that legislation in this direction had gone too far. The reasons for this opposition must be sought wholly in the methods rather than in the object of this " scientific temperance " propaganda. ' Dr. G. W. Fitz, letter in Boston Transcript, March 31, 1899. ' For a fuller presentation of this evidence, see pp. 38-44. 26 THE LIQUOR PROBLEM. Among these reasons, tlie character of the approved text-books is probably the most important, as tlicse books embody the arbitrary and unpedagogical character of the movement. Dr. Fitz thus briefly states the case : — " The points of opposition can be summed np as follows : (1) The specification by law of the amount of physiology and hygiene to be taught in the schools and of the time to be devoted to it, a specifica- tion not made for any other subject ; (2) the impossibility, from scien- tific and pedagogic considerations, of teaching physiology and patho- logy to children ; (3) the irrationality of the idea that a frequent repetition of exaggerated statements develops character ; (4) the danger of familiarizing the children of Massachusetts, who in the large majority of cases have temperate homes, with the methods and effects of evil conduct; (5) the preposterousness of the attempt to force teachers and school committees to act contrary to their convic- tions : (6) the failure of the supporters of the Morgan-Hunt bill to consult the teachers or to study the school conditions in a way which would make it possible for them to devise rational methods of in- struction." After prolonged hearings, the Committee on Education gave the petitioners for the former bill " leave to withdraw " and re- ported that the latter bill " ought not to pass," thus leaving the existing law in force. Approved and indorsed public school text-books are com- monly published in series of three or four, adapted, supposedly, for primary, intermediate grammar, grammar, and high school use. The following list ^ gives the books in each series with publishers. It will be noted that there are in all twenty-three different books, i-epresenting seven different publishing firms. Excepting for the present. Dr. Martin's text-book, which will receive special attention later, they may all be treated together, since they are all constructed on the same lines. While this is essentially true, it should be specially noted that eight of the remaining twenty-two books are published anonymously. These are, Authorized Series, No. 1 ; Dulaney's Series, Nos. 1 and 2 ; Pathfinder Series, Nos. 1 and 2 ; and Union Series, Nos. 1, 2, and 3. None of these books are vouched for by any authori- tative writer's name. Still they have received unqualified " in- dorsement " of the Department of " Scientific Temperance In- » See p. 29. PHYSIOLOGICAL INSTRUCTION. 27 struction." For example, in the indorsement of the Pathfinder Series we are informed : — " The above are the series originally prepared (as their general title indicates) to supply the demand created by the laws for temper- ance instruction in public schools in the United States. They were written by experts under the supervision of the Scientific Department of the National Woman's Christian Temperance Union, published by the instigation of the same, and have been carefully revised from time to time, under the same supervision, to keep them abreast with the latest teachings of science. " Being both teachable and well adapted to grade, their educational value, as proven by school-room tests, is of the highest order. We therefore cordially indorse and highly recommend the Pathfinder Series for use in schools. Maet H. Hunt, National and International Superintendent of the Scien- tific Department of the Woman's Christian Temperance Union ; Life Director of the National Educational Asso- ciation. Advisory Board. Joseph Cook, William E. Sheldon, Albert H. Plumb, D. D., Daniel Dorchester, D. D." An indorsement of this general character is printed upon the back of the title-page of text-books approved by the W. C. T. U., and so extensive and so well organized are its brandies through- out the United States, and so effectively is the work of regulat- ing the character of the text-books done, that publishers have found it difficult at times to sell text-books which have not this mark of official approval or which, at any rate, do not teach doc- trines in conformity with those of the organization referred to. How far this supervision keeps the text-books " abreast with the latest teachings of science " a single example will suffice to show. Steele's " Hygienic Physiology " (No. 3 of the Pathfinder Series) contains on pp. 177-179 a clear statement of the doc- trine that alcohol is eliminated entirely unchanged. The sev- eral successive editions of this book contain the above-quoted indorsement dated, in the last edition, June, 1889. Now the weight of scientific evidence in favor of the oxidation of alcohol in the body is, as elsewhere set forth, absolutely overwhelming. Even Dr. Benjamin W. Richardson, of London (than whom no writer on the effects of alcohol is more often quoted in temper- 28 THE LIQUOR PROBLEM. ance publications), in one of his well known Cantor lectures on Alcohol,' delivered in 1874, declares that " while it is true that, under certain circumstances, alcohol taken into the body will pass o£E in the secretions unchanged, the quantity so eliminated is the merest fraction of what has been injected." In other words, fourteen years after Sir Benjamin Richardson had taken pains to show that this doctrine which the text-book teaches is utterly untrue, the indorsement signed by Mrs. Huut as superintendent and by four persons as members of the Ad- visory Board of the Scientific Department of the W. C. T. U. stated that the book had been revised to keep it abreast with the latest teachings of science, and this indorsement has re- mained in the editions up to the present time. In 1895 the attention of the Department of Scientific Tem- perance Instruction of the W. C. T. U. was called to this and other errors in this specific book as types of errors in the in- dorsed books generally. The only reply was a circular published a year and a half later purporting to be prepared at the instance of Christian churches and allied philanthroijic organizations, and stating that this and twenty other " approved " or " in- dorsed " physiologies had been carefully examined by a com- mittee of " eminent medical experts," " occupying the very first rank in their profession," and that " after minute and careful examination " " not a single member " " rejJorts finding them inaccurate, but exactly the reverse." With regard to these " eminent medical experts " it may per- haps be proper to remark that their names would not be likely to suggest themselves to physiologists as those of authorities in this particular subject, though some of them are eminent in other departments of medicine. 1 Lecture IV. On the Position of Alcohol as Food. See pages 107-111 of Ten Lectures on Alcohol, by Benjamin W. Richardson, M. A., M. D., F. R. S., National Temperance Society and Publication House, New York, 1880. PHYSIOLOGICAL INSTRUCTION. LIST OF BOOKS EXAJIINED, WITH THE ABBREVIATIONS WHICH WILL BE USED IN REFERRING TO THEM. ABBSETUTIOM. Authorized Physiology Series. American Book C'omiJany. No. 1. Health for Little Folks. Anonymous. Authorized Series, No. 1 No. 2. The Human Body and How to Take Care of It, by James Johonnot and Eugene Bouton, Ph. D. " " No. 2 No. 3. Anatomy, Physiology and Hygiene. R. S. Tracy, M. D. " " No. 3 Brands' Physiology, Hygiene, Narcotics. Leach, Shevvell & Sanborn. Good Health for Children (Primary). Orestes M. Brands. Brands, No. 1 Health Lessons for Beginners. Same author " No. 2 Blaisdell Series. Ginn & Co., 1896 and 1897. The Child's Book of Health. Albert F. Blais- dell, M. D. BlaisdeU, No. 1 How to Keep Well. Albert F. Blaisdell, M. D. " No. 2 Our Bodies and How We Live. Same author. " No. 3 Dulaney's Series. Wm. J. C. Dulaney Co., Bal- timore. Dulaney's Primer of Physiology. Anonymous. Dulaney's, No. 1 Dulaney's Physiology. Anonymous. " No. 2 Eclectic Ediicational Series. American Book Company. The House I Live in. Eli F. Brown, M. D. Eclectic, No. 1 Youth's Temperance Manual. Eli F. Brown, M. D. " No. 2 The Eclectic Guide to Health. Eli F. Brown, M. D. " No. 3 StoweU's Health Series. Silver, Burdett & Co., 1896. A Primer of Health. Charles H. Stowell, M. D. Health Series, No. 1 A Healthy Body. Charles H. Stowell, M. D. " " No. 2 The Essentials of Health. A Text-book on Anatomy, Physiology, Hygiene, Alcohol, and Narcotics. " " No. 3 Pathfinder Series. American Book Co. Child's Health Primer. Anonymous. Pathfinder Series, No. 1 Young People's Physiology. Anonymous. " " No. 2 30 THE LIQUOR PROBLEM. Lessons in Hygiene. Anonymous. Pathfinder Series, No. 3 Hygienic Physiology, by Joel D. Steele, Ph. D. " " No. 4 The Union Series. E. H. Butler & Co., Phila. Physiology and Health, No. 1. Anonymous. Union Series, No. 1 Physiology and Health, No. 2. Anonymous. " " No. 2 Physiology and Health, No. 3. Anonymous. " " No. 3 The Human Body and the Effects of Nar- cotics. Martin. H. Holt & Co. Quotations have already been given from a number of the approved books. A list of similar citations has been prepared containing one or more from each book. Since they are all so much alike, however, we shall now present only one qiiotation from each series, selecting these under the main topic of the food value of alcohol. " Alcohol a Poison. — The nature of alcohol is that of a poison. . . . It has often been urged that men have been known to drink alcoholic liquors for a long time and yet live. A great English j^hysician said concerning this, " The stomach and other organs of the body may be so hardened and changed by alcohol that it may seem to fit them for a long time, but the alcohol will all the while be doing its fatal work.' " ^ ^^ Alcohol as a Poison. — Any substance capable, when absorbed into the blood, of injuring health or destroying life, is a poison. Alcohol is capable of destroying life when taken in sufficient quanti- ties, as has been proved by numerous instances of death following the drinking of spirits on a wager, or a draught of brandy or gin taken in ignorance by a child. Remember this — alcohol is A poison." " " Alcohol a Poison. — A cat or dog may be killed by causing it to drink a small quantity of alcohol. A boy once drank whiskey from a flask he had found, and died within a few hours. His death was caused by the alcohol in the whiskey. Many people have been poi- soned by liquor containing alcohol. ... It is in the nature of alcohol to make drunkards." ' "Any drink that contains alcohol is not a food to make one strong; but is a poison to hurt, and at last to kill." (A category of crimes follows.) " You may say that all men who drink liquor do not do such terrible things. That is true. A little alcohol is not so bad as a great deal. But even a little makes the head ache and hurts the brain and nerves. ... A man who never drinks liquor will get well where a drinking man would surely die." * 1 Authorized Series, No. 2, p. 35-37. ^ Blaisdell, No. 3, pp. 84 ff. s Brands, No. 1, 19 fB. and 27. * Dulaney's, No. 1, p. 33 £f. PHYSIOLOGICAL INSTRUCTION. 31 " Alcohol is a colorless liquid poison. Its presence makes what was before good fruit juice a poisonous liquid " (p. 27). '• We now know that fermentation changes entirely the nature of the substance upon which it acts. In this case it changes a food to a poison. To attempt to drink fermented liquors moderately has led to the hopeless ruin of untold thousands." ' " We can find nothing about it [alcohol] that gives us any idea that it is a food. . . . Alcohol is not in any sense a food." " " It is not a food. We have shown that alcohol and all spirituous liquors are poisonous. For this reason alone we should not expect to find them valuable for food. . . . Then again, close observation of its effects on man does not warrant us in believing that it has any value whatever as a food." ' " Alcohol is not a food, for it cannot build up any part of the body. It contains no mineral substance and will not make healthy fat." * '• Alcohol not a Food. — You have learned that food supports life. Alcohol will not nourish or build up the body or any of its parts ; it is its nature to injure health and destroy life. Alcohol is not a food." ' The above may serve to demonstrate the character of these books as well as hundreds of similar passages which could be given. When these are compared with the standard authorities already referred to, it is clear how great is the disadjustment between this public school education and that in our colleges, universities, and medical schools. Moreover, school-children now have ready access to libraries, and there they may easily find statements which modify and even directly contradict the most emphatic statement of their books. It is little wonder that educators and teachers oppose " scientific " temperance. It is no part of our present purpose to discuss the truth or falsity of these statements. "We are endeavoring solely to present the teaching of alcohol physiology as it actually exists. Until scientific investigation is able to furnish more definite and uniform data, it would seem self-evident that compulsory educa- tion, especially in the form of text-book memorizing, could result in nothing but the widespread demoralization of our youth. They can hardly escape the conviction that an attempt is being deliberately made to deceive them for a special, sup- posedly moral, purjjose. 1 Eclectic Series, No. 1, pp. 27, 28. ^ Health Series, pp. 74, 75. ' Health Series, No. 3, p. 55. •* Pathfinder Series, No. 1, p. 14. ^ Union Series, No. 2, p. 67. 32 THE LIQUOR PROBLEM. The argument constantly advanced to excuse this lack of adjustment is that elementary physiology should not touch upon medical uses of alcohol. This is emphatically stated in the published " Standard for Temperance Physiologies," as fol- lows : — " This effort to disabuse the minds of the rising generation of the fallacies wliich lead to drink habits should purposely avoid reference to the medical use of alcohol. As by common consent its lay pre- scription is condemned, the question of its use as a remedy may properly be relegated to medical treatises, as out of place and mislead- ing in a school textrbook." But it must be generally admitted that there cannot be one truth for elementary schools, and truth exactly contradicting it for colleges and medical schools. There is but one science of physiology. And, furthermore, the use of alcoholic drinks has passed almost as completely beyond the control of the medical profession as has that of other common articles of diet. The statements already quoted, and we shall add a few more, seem to indicate that the text-books are written with a delib- erate purpose to frighten the children, the younger the better, so thoroughly that they will avoid all contact with alcohol, an attempt fraught with danger on account of the natural reaction of healthy children, boys especially, to such exaggerated state- ments. On no other theory, it would seem, can such statements as the following be explained : — " Alcohol sometimes causes the coats of the blood vessels to grow thin. They are then liable at any time to cause death by bursting." ' "Worse than all, when alcohol is constantly used, it may slowly change the muscles of the heart into fat. Such a heart cannot be so strong as if it were all muscle. It is sometimes so soft that a finger could easily be pushed through its walls. You can think what would happen if it is made to work a little harder than usual. It is liable to stretch and stop beating and this would cause sudden death." ^ " Many people are made crazy by the use of alcoholic liquors. In some asylums where these people are kept, it has been found that nearly one half of the crazy people were made crazy from this cause. Not all of these were drinkers themselves. It often happens that the ' Authorized Series, No. 1, p. 61. ^ Brands, No. 1, Good Health for Children, p. 69. PHYSIOLOGICAL INSTRUCTION. 33 children of those who drink have weak minds or become crazy as they grow older." ' " Do you remember what we said about beer making some people fleshy ? We said that the muscles became soft and filled with fat. Because the heart is a muscle, it, too, may become fatty from drink- ing beer. This makes it larger and at the same time softer and weaker. Physicians call this disease ' the fatty heart ' because there is so much fat in the muscles of the heart. At last the heart becomes so weak it cannot do its work, and suddenly death occurs. From this we learn that some alcoholic drinks may cause a disease of tiie heart which no physician can cure, and which may result in sudden death." ^ " Sometimes tlie stomach is so hurt by alcohol that the drinker dies." ^ '• There is one form of this disease, called alcoholic consumption, which is caused by alcohol. The drinker looks well, till suddenly comes a ' dropped stitch,' or a pain in the side. Then follows diffi- culty of breathing and vomiting of blood, then a rapid passage to the grave ; for medicine, food, change of air, all prove useless." * " A noted murderer confessed that never, but once, did he feel any remorse. Then he was about to kill a babe, and the little creature looked up into his face and smiled. " ' But,' he said, ' I drank a large glass of brandy, and then I did n't care.' " ° These are but a few citations among many that might be given. The books, especially those intended for the lower grades, fairly bristle with statements of a character to work upon the fears of the reader, and remind one in this respect of patent medicine advertisements. " Such a treatise as the New York law contemplates cannot be written by a scientific man." * This remark by Dr. Jordan applies to the whole machinery of scientific temperance text- book making. Speaking of those who are connected with the approval and indorsement of the text-books, he continues : — " Indeed, they have the efifrontery to demand of a scientific author in treating a certain scientific subject in the school courses that he 1 Idem. No. 1, p. 44. - Health Series, No. 1, pp. 47, 48. » Dulaney's, No. 1, p. 88. * Dulaney's, No. 2, p. 123; Pathfinder, No. 2, p. 91. ^ Dulaney's, No. 2, p. 186; Pathfinder Series, No. 2, p. 179. ' Popular Science Monthly, 1896, p. 351. 34 THE LIQUOR PROBLEM. shall introduce only so much of the subject as shall bear on a certain reform tliat they are advocating. Can even earnestness of purpose or the importance of the reform be a shadow of an excuse for such a course ? " In this connection it may be interesting to quote the remark of the author of an approved series of text-books to a member of this committee : " I have studied physiology," said he, " and I do not wish you to suppose that I have fallen so low as to believe all of the things I have to put into those books." That he had fallen low enough to put them in without believing them did not seem to disturb his mind. Among the writers of the text-books which we are consider- ing, Prof essor H. N. Martin is perhaps the only one who can be properly regarded as a professional physiologist of high stand- ing, and it is therefore interesting to compare the statements with regard to alcohol in his text-book for medical students with those which he puts forth when he is writing to satisfy the requirements of the Woman's Christian Temperance Union. These statements are here presented in parallel columns. MARTIN. Human Body, Elementaey.' Human Body, Advanced Coctrse. " Has alcohol a just claim to be " Alcohol. There are perhaps called a food ? Is alcohol a tissue- no common articles of diet con- forming food ? To this the an- cerning which more contradictory swer is certainly. No ; so far at statements have been made than least as useful tissue is concerned alcoholic drink. This depends (since it contains no nitrogen, upon their peculiar position : ac- etc). cording to circumstances, alcohol " Is alcohol a strengthening may be a poison or be useful ; food ? To this the answer is. No. when useful it may be regarded Does alcohol keep up the heat of either as a force regulator or as a the body ? To tliis question, also, force generator. It is sometimes the answer is No, though this may a valuable medicine, but it does no seem a strange view of the fact good to the healthy body. If not that a drink is often taken to more than two ounces (which ' warm one up.' " would be contained in about four Dr. Martin evades asking or ounces of whiskey or two quarts of attempting to answer the clear lager beer) are taken in the twenty- physiological question. Is alcohol four hours, they are completely oxi- ^ Indorsed and approved. PHYSIOLOGICAL INSTRUCTION. 35 capable of yielding energy to the dized in the body and excreted as body (as do carbohydrates and water and carbon dioxide. In this fats) ? and is enabled to con- oxidation energy is of course liber- clude : — ated and can be utilized. ... If " The study of alcohol as an ar- the facts lead us to conclude, tide of diet leads therefore to the against the extremists, that it is to result that it cannot fairly be re- a certain extent a food, it is never- garded as a food." ^ theless a dangerous one ; even in what we may call ' physiological ' quantities, or such amounts as can be oxidized in the body." ■ We feel obliged in this connection to call attention to the manner in which scientific authorities are misquoted in order to appear to furnish support to " scientific temperance instruc- tion." In the " School Physiology Journal," Mary H. Hunt, editor, November, 1897, an editorial occurs entitled " The Findings of Science." It reads in part as foUows : — " During the past two years two important papers containing ori- ginal investigations upon the effects of alcohol have been published in this country. In each case ' the writer had previously doubted the universal poisonous action of alcohol, and had openly expressed a strong belief in its food and stimulative value ' (from what authority this is quoted, we are unable to state). As results of these investiga- tions, however, Dr. Chittenden of Yale University finds that ' amounts of alcohol equal to five per cent, are markedly injurious and retard digestion,' and Professor Hodge of Clark University arrives at the conclusion that ' alcohol always lowers working power, and, in some degi-ee, interferes with growth.' " The paper first referred to is evidently Chittenden and Mendel's " Influence of Alcohol and Alcoholic Drinks upon the Chemical Processes of Digestion." We have not succeeded in finding the words purporting to be quoted from Chittenden, and they evidently completely misrepresent his position. The statement is, in fact, contradictory to his conclusion (pp. 10 and 81) : " First, it is plainly manifest that in the presence of small amounts of alcohol (one half of one per cent, of absolute alcohol) gastric digestion may proceed as well, or even better, ^ Martin, The Human Body. An Elementary Text-Book, etc., N. Y., 1894, pp. 141 £f. 2 Martin, The Human Body, N. Y., 1890, pp. 304, 305. 36 THE LIQUOR PROBLEM. than under normal circumstances." And on page 82, speaking of salivary digestion, he says : " With active saliva not greatly diluted, the presence of even five jjer cent, of absolute alcohol may lead to a slight increase of digestive power." In his con- cluding paragraph he again cautions against drawing any such sweeping conclusions as that intimated in the " School Physi- ology Journal," as follows : "■ The results recorded do not afford data for drawing any broad or general conclusions regarding the influence of alcoholic drinks upon digestion or alimenta- tion, since they throw no light upon possible modifications of secretion, absorjition, or peristalsis." With reference to the second purported quotation. Dr. Hodge is able to deny that it occurs in any of his published writings, or elsewhere, so far as he knows. He has certainly not drawn any such sweeping conclusion from his own experi- ments. Another illustration of the way in which the method of par- tial quotation of scientific authorities is emjjloyed to serve the purposes of the Woman's Christian Temperance Union is fur- nished by the use made of Liebig's statement as to the nutritive value of beer often quoted in the school physiology journals and similar publications. It reads as follows : — " We can prove with mathematical certainty that as much flour as can lie on the point of a table knife is more nutritious than eight quarts of the best Bavarian beer." This statement occurs in a rare edition of Liebig's " Chemical Letters," published in 1852, and in no previous or subsequent editions. It is well known that Liebig divided all food sub- stances into two groups, viz., nitrogenous or plastic foods and non-nitrogenous or respiratory foods. While we have not been able to see the edition in which this statement occurs, it is evident from what we have learned of it and from statements in the same connection in other editions, that Liebig, in mak- ing this statement, must have had in mind the nitrogenous ingredients of beer. To this group he attached the greater physiological importance, believing them to be the sole source of mechanical energy of the body, while the latter group served for the production of animal heat. This distinction cannot be maintained in the light of later investigations. That Liebig PHYSIOLOGICAL INSTRUCTION. 37 clearly had it in mind, however, in writing the above paragraph, is shown by the fact that he elsewhere mentions specifically alcohol, beer, and wine as " respiratory foods." It is, therefore, evident that to make the above statement accurately express Liebig's view, it should be altered so as to read, " contains more nitrogenous nutriment than eight quarts," etc. Taken by itself, it entirely misrepresents Liebig's position. E. O. Neumann calls attention to the above quotation from Liebig in an article on the " Significance of Alcohol as Food " in the " Archiv fiir Hygiene," 1899, vol. xxxvi. pp. 2, 3. He- gives the quotation in more detail as follows : — " As much flour as can be held on the point of a knife-blade is more nutritious than five (Bavarian) quarts of the best Bavarian beer. A man who should be in condition to drink daily five quarts of beer would tbus have in a year, under favorable circumstances, exactly as much nutritive material as in a five-pound loaf of bread or in three pounds of meat." A calculation based on the combustion warmth of starch leads Neumann to the conclusion that, in this estimate of the nutritive value of beer, Liebig has committed an error of over 8000 per cent. He notes, however, that, seven years later, Liebig, as the re- sults of his experiments in metabolism, reached the conclusion that alcohol, in its value as a respiratory food, stands nearest to the fats. IV. ANSWERS OF PUBLIC SCHOOL-TEACHERS. Teachers possess a vantage ground in opportunities for ob- servation and experience in educational matters held by no other class of the community. Certainly one of the weakest features of the jiresent plan of instruction in so-called scien- tific temperance has consisted in almost total failure to ade- quately recognize this fact. And it is safe to say that ulti- mately the form which this instruction shall take must of necessity be determined by the tact and wisdom of our teachers. It is also safe to predict that in so difficult and delicate a sub- ject there must be the greatest possible freedom of method. Each teacher must be allowed to work in his own way and adapt his teaching to needs of different classes of pupils and 38 THE LIQUOR PROBLEM. even to different individuals, if the greatest good and the least harm is to result. Four investigations have been made as to methods and re- sults of scientific temperance instruction in the schools. Each was made independently of the others, by different methods, and from differing points of view. The fact that they all converge upon much the same general result is significant. The first investigation was made by George H. Martin, Agent of the Massachusetts State Board of Education, by actually examining schools in which this instruction had been given. 1 Of the answers given by the pupils to his questions he publishes a sufficient number to demonstrate the futility of present methods. Since yearly repetition is so prominent a feature in the present plans of study, possibly the most sug- gestive result is that whether one year or six years are devoted to text-book work on the subject makes practically no differ- ence with the amount of a pupil's knowledge. He says on this point : — " Pausing to consider the schools where text-books are used for a longer or shorter time, the character of the papers presented seems to depend more on the general character of the school and the ability of the pupil than on the number of years spent in the study of alcohol. " If we select a number of schools in which the subject is studied from text-books one, two, three, or more years, we shall find the best papers presented will cover essentially the same facts in all the schools. On the other hand, the average papers, after one year's use of the book, may be better than other schools will furnish after five or six years' study." Mr. Martin draws the following conclusions, which we quote in full : — " 1. The phrase ' scientific temperance instruction ' sometimes ap- plied to this work is a misnomer. There is, and in the nature of things can be, no such instruction. The two essential elements of scientific study — observation and inference — are necessarily wanting ; neither the pupil nor the teacher can have first-hand information. " 2. That the outcome in accurate knowledge resulting from much of the work done is meagre and out of proportion to the time spent upon it. ' George H. Martin, " Physiology and Hygiene," Massachusetts State Board of Education, Fifty-fifth Annual Report, 1890-91, pp. 312-326. PHYSIOLOGICAL INSTRUCTION. 39 " 3. That many false impressions are left in the minds of the stu- dents. " 4. That physiological details are not suited to young children. " 5. That however defective the instruction may he, the sentiment of the school is sound, — the conviction that alcohol and tobacco are bad things to use seems universal. " 6. That the strength of this sentiment does not depend upon the amount of information acquired. " 7. That where exaggerated notions of the effects of stimulants have been acquired, there is danger of a reaction of sentiment in the light of after-knowledge." Mr. Martin also offers the following suggestions : — "1. That committees and superintendents give more careful atten- tion to work in this department, prescribing definitely its limits, and requiring the prescribed work to be done as well as work in other sub- jects, using the same means for judging its progress and results. 2. That teachers who are called upon to give oral instruction pre- pare themselves with great care for the exercise, and see that their statements are true, and by frequent tests, oral and written, ascertain that their teaching is intelligently comprehended by aU the pupils. " 3. That, when no text-book is used in any grade, the teachers pre- pare for the highest classes a summary of the effects of stimulants and narcotics upon the different systems of the body, aiming at clearness of statement and avoiding exaggeration. " 4. That the use of text-books be limited to the older pupils. " 5. That so much of explanation accompany the use of the book as may be necessary to guard against error, and insure exact knowledge. " 6. That, as far as possible, technicalities be avoided. " 7. That the pupils have frequent opportunity to express their know- ledge orally and in writing. " 8. That throughout the course the moral and social effects of the use of intoxicants be made prominent, and abstinence be inculcated from higher grounds than such as concern only the body." Dr. G. W. Fitz next investigated the condition of " scientific temperance instruction " in Massachusetts with a view to as- certain what difficulties attached to the present plan and what changes in legislation might be accejjtable to teachers. Letters of inquiry were sent to superintendents and principals through- out the State. Eighty-three (83) cities and towns were thus heard from. These represented 113,000 children and about 4000 teachers. These figures cover more than one quarter of 40 THE LIQUOR PROBLEM. the total mimbei- of children (409,000), and of teachers (12,- 000), in the State. Replies to some of these questions Dr. Fitz has tabulated as follows : — What are the results of this (temperance) instruction ? Excellent, if well taught 2 per cent. Good 11 " Medium 15 " Little 14 " None 55 " Bad 3 " This gives 28 per cent, who think the results are excellent, medium, or good, and 72 per cent, who consider them little, none, or bad. To the question " What value has the instruction in mental and moral discipline ? " the answers are : — Great 1 per cent. Good 16 « As much as other subjects 24 " Little 31 " None 28 " A somewhat larger percentage are thus seen to look with some favor u2)on the disciplinary value of this instruction, and still a considerable majority, 59 per cent., consider it to possess little or none. A continuation of Dr. Fitz's investigation consisted in gather- ing (1898-99) the votes of 288-4 Massachusetts teachers upon the question whether it was desirable to have more stringent legislation (represented in the Morgan-Hunt bill. Senate, 41) or less exacting laws (as embodied in the Myers bill, House, 817). Copies of both bills were distributed with all the letters of inquii-y, and are to be found in Appendix II. The result of this canvass, with the issue very definitely stated, showed 98.2 per cent, of the teachers in favor of the Myers bill. Only 1.8 per cent, favored the Morgan-Hunt bill. A modification of these bills rendered a second canvass necessary, but the opinion of the teachers on the bills in the new form remained unchanged.^ 1 For the nature of these modifications, see letter of Dr. G. W. Fitz, Sec- cretary of the Massachusetts Medical Society Committee, inclosing Mrs. Hunt's modified bill, Appendix II., p. 134. PHYSIOLOGICAL INSTRUCTION. 41 A third investigation was undertaken by Mr. Walter A. Wyckoff and the result presented to the Committee of Fifty by Professor Sloane. In this case an attempt was made to obtain the expert opinion of representative teachers in forty-eight States and Territories and in the District of Columbia. As a report upon this investigation will naturally form a part of the report of the Ethical Committee, it will be sufficient to say in this con- nection that the results agree with those above presented in find- ing overwhelming majorities of the teachers opposed to exacting legislation upon this subject, while practically all are agreed that the subject ought to receive a reasonable amount of atten- tion in connection with courses in physiology and hygiene. Our own study of the subject consisted in distributing 500 slips containing the questions given below among teachers. About 200 each were distributed in New York and Massachu- setts and 100 in Wisconsin. New York has the very exacting Ainsworth law, while Wisconsin and Massachusetts have mod- erate laws, though in Massachusetts it has been very strictly interpreted. The following is a tabulation of the questions with all the answers received. Do you approve the teaching of alcohol physiology as pro- moted by the department of scientific temperance instruction of the Woman's Christian Temperance Union ? Mass. : Yes, 26. N. Y. : Yes, 16. Wis. : Yes, 12. Totals : Yes, 54. Mass. : No, 56. N. Y. : No, 45. Wis. : No, 18. Totals : No, 119. Do you favor such instruction being made compulsory by state law? Mass. : Yes, 24. N. Y. : Yes, 22. Wis. : Yes, 11. Totals : Yes, 57. Mass. : No, 42. N. Y. : No, 43. Wis. : No, 19. Totals : No, 104. What do you think of the " approved and indorsed " school physiologies ? Mass. : Good, 19. N. Y. : Good, 15. Wis. : Good, 13. Total : Good, 47. Mass. : Bad, 28. N. Y. : Bad, 40. Wis. : Bad, 18. Total : Bad, 86. In your opinion, are results of the instruction now given good or bad ? Mass. : Good, 19. N. Y. : Good, 25. Wis. : Good, 15. Total : Good, 69. Mass. : Bad, 34. N. Y. : Bad, 35. Wis. : Bad, 15. Total : Bad, 84. 42 THE LIQUOR PROBLEM. Passing by answers to the first two questions, we will quote a few replies to the third which give the opinions of teachers as to the approved text-books. What do you think of the " approved and indorsed " school physiologies ? ANSWERS FROM MASSACHUSETTS. (Law liberal, but strictly interpreted.) 1. Not well adapted to work among the young children. 2. They are misleading, to say the least. 3. I disapprove of those I have examined. They seem often to be prejudiced and untrue. 4. I think them generally untruthfiU. 5. I think they contain many errors and false statements. 6. Emphasizing the evil effects is apt to fill the child's mind with such notions. A great many teachers with whom I have talked feel that better results could be obtained by teaching that emphasizes the normal rather than the abnormal. ANSVTERS FROM WISCONSIN TEACHERS. (Law lenient.) 1. They are ill balanced and often strongly prejudiced and false to fact. 2. I think they are too strongly colored with preaching. 3. I think that the temperance matter is overdone, so that the sub- ject-matter is likely to be neglected. 4. The printing, binding, and cuts are excellent. Most of the ma- terial is good. If not more than five per cent, of the alcohol para- graphs were introduced, — good. 5. They appear to be written to be " approved and indorsed," — to sell, and are really inferior books. 6. They are, as a whole, weak books " doctored," and made to pander to the demands of this society. 7. I think they have been made to sell, and that most of them are incorrect in statement and unscientific in treatment. ANSWERS FROM NEW YORK TEACHERS. (Law very stringent.) 1. Most of them are pernicious scientifically and ethically. 2. I find that according to our best authority, the successful phy- sician, they are inaccurate and unscientific. 3. Tliey are very much exaggerated. PHYSIOLOGICAL INSTRUCTION. 43 4. They are worse than useless. They defeat the very object for which the Woman's Christian Temperance Union labors. They en- tirely suppress the few beneficial effects of alcohol and unduly exag- gerate the evil effects. All youtlis pass through an age of unbelief, of cynicism, of agnosticism. This age generally comes during the latter part of tiie high school course. When they learn from authoritative sources of the benefits of alcohol, the reaction is marked. They im- mediately question the truth of the evils of alcohol, and term what the books teach "a lie." Such has been my experience. 5. In many cases they do not stand the search-light of scientific truth, besides containing disgusting details. 6. I should judge many of them to be extravagantly inaccurate as regards alcohol, according to the teachings of the University of . 7. So far as I have examined them, I believe them to be unscien- tific and in some instances ridiculous. 8. They are extreme, hence do not serve the purpose intended. It is unnecessary to quote from the briefer answers, " Poor," " Bad," " Good," which constitute the majority of the returns; for they tell us no more than appears in the table. Our re- turns, on the whole, tend to bear out Dr. Jordan's statement, " Just in proportion to his ignorance of the subject will be the teacher's willingness to undertake the teaching of the New York law," ^ that is, the teachers who give evidence of hav- ing reasoned and observed seem to have reached conclusions adverse to the " approved " text-books. The final question as to results is naturally most important. From letters of the Department of Scientific Temperance In- struction, we learn that it is considered too early to expect results. This is remarkable, since, at the time of our inquiry, the law had been in operation in some States as long as fifteen years. Dr. Jordan has answered the question in the following emphatic manner : ^ — " The whole ' scientific temperance ' movement is opposed to the movement for good schools through the choice of good teachers. It has been judged thus far mainly by its motives, which are good. It will come to be judged by its results, and these are bad." In addition to such simple answers as are tabulated above, 1 David Starr Jordan, " Scientific Temperance," Appleton's Popular Sci- ence Monthly, January, 1896, p. 352. ^ Loc. cit., p. 354. 44 THE LIQUOR PROBLEM. we may quote a few of the New York re]ilies which show the results of observation, and shed additional light on the subject. ANSWERS OF NEW YORK TEACHERS AS TO RESULTS OF SCIENTIFIC TEMPERANCE INSTRUCTION. 1. I have seen evil results. 2. Good, when untrammeled ; a failure, when hampered. 3. In my own judgment the effects of the teaching have been bad, for the reason that the manner in which the subject is treated kills the interest of botli teacher and pupil in a science that is naturally inter- esting. 4. Bad, generally, in that the pupil often sees that the statements of the book are not literally in accord with his daily experience (and perhaps home training), causing him to lose respect for the books and impairing the influence of the teacher. 5. Bad, especially where the law is followed to the letter. 6. If the teacher is honest enough to teach the beneficial effects of alcohol, the pupil will beUeve the evil effects ; then, and only then, are the results good. 7. The effect on the pupils seems to be that of regarding any men- tion of alcohol and its uses as a subject of ridicule. 8. Where a morally well-balanced instructor is allowed to use his discretion as to what to teach, — good. CONCLUSION. It is thus apparent that under the name of " Scientific Tem- perance Instruction " there has been grafted upon the public school system of nearly all our States an educational scheme relating to alcohol which is neither scientific, nor temperate, nor instructive. Failing to observe the distinction between the diametrically opposite conceptions of " use " and " abuse," some of its advocates have not hesitated to teach our children that the terrible results of a prolonged abuse of alcohol may be ex- pected to follow any departure from the strict rules of total abstinence. The success which has attended the efforts of the Woman's Christian Temperance Union to secure the desired legislation may be readily explained by the sympathy sure to be felt by all intelligent people for any sincere attempt to com- bat one of the most gigantic evils of modern times. There can be no doubt that the abuse of alcohol is a threat to our civili- zation, and any honest effort to diminish its consumption is PHYSIOLOGICAL INSTRUCTION. 45 certain to be welcomed without any very critical examination of the methods employed. That the originators of this educa- tional scheme were honest in their intentions there is no reason to doubt, but they have violated sound principles of pedagogy in forcing subjects upon the attention of children at an age when their minds cannot possibly be adapted to comprehend them, and have shown themselves absolutely indifferent to the demoralization of our educational system resulting from forcing teachers to give instruction in a way which their experience has shown them to be ill adapted to accomplish the ends in view, and from compelling children to memorize statements sure to be contradicted by the experience of their later lives. That the removal of this educational excrescence will be no easy task is evident from the result of the attempt in this direc- tion made in Massachusetts during the session of the legislature in 1899, and described on p. 24-26 of this report. When it is remembered that the bill introduced by the Woman's Christian Temperance Union related to the teaching of a physiological subject in our public schools, the almost unanimous opposition of both the medical and the teaching professions is a circum- stance of the greatest significance. The fact that after a series of hearings the Committee on Education made a report leaving the whole subject in statu quo shows that a prolonged struggle will be necessary to free our public school system from the incu- bus which rests upon it. In this struggle the Committee of Fifty should speak with no uncertain voice. APPENDIX TO REPORT ON THE PRESENT INSTRUCTION ON THE PHYSIOLOGICAL ACTION OF ALCOHOL. I. In this appendix will be found, alphabetically arranged in groups, specimens of letters from American and foreign physi- ologists, obtained partly in answer to the request printed on p. 14 of the committee's report and partly in response to a special request directed to certain teachers of physiology who either were not present at the physiological congress of 1898, or who were unwilling to sign the statement there presented. AMERICAN AUTHORITIES. Dr. H. G. Beyer U. S. N. Prof. H. P. Bowditcli Boston. Prof. R. H. Chittenden • . New Haven. Dr. F. W. Ellis Monson, Mass Dr. G. W. Fitz Boston. Prof. Theo. Hough Boston. Prof. W. H. Howell Baltimore. Dr. P. A. Levene New York. Prof. L. B. Mendel New Haven. Prof. H. Sewall Denver. Prof. G. N. Stewart Cleveland. Dr. Henry G. Beyer, New Bedford, Mass., October 9, 1897. In my experiments on the direct action of certain drugs on the heart and blood vessels, made at the Johns Hopkins Uni- versity, ten years ago, and, before mastering the various steps necessary in the successful operation for the isolation of the dog's heart, according to Martin's method, I made a few experiments with alcoholized blood on the heart and blood vessels. Assuming that the physiological organs, under experimenta- tion, were chiefly muscular, and, by carefully observing the doses, I should say positively that the first effect of alcohol PHYSIOLOGICAL INSTRUCTION. 47 stimulates, the next effect of alcohol paralyzes the muscular structures involved. The stimulating effect, however, is so slight and temporary that it is far outweighed by its subse- quent paralyzing effect : the heart is arrested in diastole and the blood vessels become dilated (when isolated from the central nervous system) beyond recovery, when the doses were large enough and continued long enough. The dilatation of the blood vessels is especially marked in the frog's web and can be directly measured under the microscope, when alcohol is used in proper dilution and injected into the lymph sac with normal salt solution. The fact that alcohol at first stimulates and then paralyzes, in other words, first increases, then decreases, blood pressure, or first causes temporary contraction and then a more prolonged relaxation of the muscular fibres of the heart and blood vessels, explains many of the phenomena in all the other organs, in which blood vessels are found and of which the temporarily in- creased mental activity is perhaps the more important. As regards the pharmacological side of the question of the administration of alcohol, it is not difficult to find pathological conditions in which the administration of alcohol is directly in- dicated, and in which, moreover, no remedy might answer as well as alcohol. In a perfectly normal animal organism, how- ever, I cannot understand any good effects pi-oducible by alcohol. In my opinion, alcohol is 7iot a food, nor even a condiment. It is a stimulant of value only in pathological conditions, and should be used, therefore, as a remedy only. The introduction of alcohol physiology into the elementary school courses is, in my opinion, an example of mistaken public benevolence which has nothing but the good motives of the originators to commend it, and which illustrates the dangers of people meddling with things they do not understand. The most perfectly cooked meal, on a most properly ap- pointed dining-room table, served by the best dressed pro- fessional waiters, while most attractive and beneficial for grown people, would be of no 'use for the starving suckling. The best established and most important biological facts cannot be comprehended by the infant or child-mind, nor 48 THE LIQUOR PROBLEM. properly assimilated, any more than a beefsteak can be di- gested by a suckling infant. I place the lowest limit of age for the beginning of the study of biology at fourteen years and that of elementary physiology at sixteen years. I agree per- fectly with the idea of the promoters of alcohol instruction that a knowledge of the pernicious effects of alcohol can only be obtained and thoroughly comprehended when engrafted upon a brain already cultured with a sound knowledge of phy- siology. The best that can be done in the primary and grammar de- partments is to warn children of the dangers of alcohol as we warn them of bad company, of swearing, of telling lies, or of the dangers of mad dogs, etc. In other words, teachers might begin by working on their sentiments in the absence of their understanding, but great care should be taken to avoid all un- truths and exaggerations with regard to alcohol and its effects. Nothing which could not later on be verified by the children themselves should ever jiass a teacher's lips. I have examined many of the so-called physiologies written especi-ally for alcohol instruction, and can approve of none. Martin's is, however, the best among them. Professor H. P. Bowditch, Boston, September 29, 1897. In reply to your letter of September 24 I would say that I have always taught that alcohol, since it is, in moderate doses, almost wholly used up in the body, must be regarded as a force producer or a food in the same sense that starch and sugar are foods, but with this important difference, that, while starch and sugar can be ingested in amounts limited only by the power of the system to digest and absorb, alcohol, owing to its peculiar action upon the nervous system, cannot in health be taken in an amount sufficient to render its nutritive value of any impor- tance. In certain pathological conditions, however, this action upon the nervous system seems to be held in abeyance, and we accordingly find cases of convalescence from exhausting dis- eases in which the system seems to tolerate large quantities of alcohol and to be not only stimulated but actually nourished by it. A most remarkable case of this sort is reported by Dr. S. L. Abbot of the Massachusetts General Hospital. It is that of a PHYSIOLOGICAL INSTRUCTION. 49 young woman suffering from double pneumonia who refused to take food and who seemed at the point of death. A teaspoon- ful of brandy and water, forced between her teeth, seemed to produce a beneficial effect, and orders were given to let her have all the brandy she would take. For the next seven days she lived exclusively on brandy and whiskey, consuming in all over a gallon of distilled liquor without showing any signs of stimulation. As she received no other food the conclusion that she was nourished by the alcohol seems almost irresistible. She finally made a good recovery. The action of the drug upon the nervous system is mainly that of a narcotic poison. The initial period of stimulation is perhaps a reflex phenomenon due to the contact of the drug with the mucous membrane of tlie alimentary canal, though the possibility of a direct stimulation of the tissues by the alcohol in the circulating blood cannot be excluded. Professor R. H. Chittenden, New Haven, Conn., October 5, 1897. Your series of questions pertaining to alcohol remind me of the pamphlets we are wont to receive from Washington on edu- cational matters, in which the list of questions is so broad as to be appalling. I will do my best, however, to answer a few of the questions contained in your letter. First : I believe that we have abundant evidence that alcohol has a certain food value ; that when fed under suitable condi- tions, i. e., in not too large amounts at one time, it is oxidized in the body, playing the part of a non-nitrogenous food. Like the latter it is capable of diminishing somewhat the amount of proteid food required by the body. Owing to its peculiar nature, however, i. e., its ready absorbability, it is rapidly eliminated from the body when taken in large doses, and as a result only a portion of the alcohol so ingested can be utilized. In such cases the food value which alcohol possesses is lost sight of in its more pronounced action as a stimulant. There is, I think, no doubt that this energy which comes from the oxidation of alcohol in the body can be utilized as a source of work, although it is doubtful if alcohol can be considered of great value in this direction since its stimulating action is so much more marked. Further, when taken in small doses heat unquestionably results from its oxidation, although at the same 50 THE LIQUOR PROBLEM. time it is to be remembered that there may be an increased loss of heat from the action of alcohol upon the cutaneous blood vessels. As regards its action upon metabolism, I believe that much dejjends upon the dosage and the personal idiosyncrasies of the individual, and that these two factors are in great part responsible for the ajjparent divergence in results attained by different investigators. That as a food it differs from oi-dinary non-nitrogenous food is shown by its specific influence in many cases, as upon the production and excretion of uric acid. Alcohol has a certain positive influence upon digestive action. In small quantities it increases slightly the digestive power of saliva and of gastric juice, or, to be more exact, it may do so if the digestive power of the secretions is uj) to normal. With larger quantities of alcohol the digestive power of saliva, gas- tric juice, and pancreatic juice is greatly inhibited, the extent of inhibition depending upon the relative strength of the secre- tion and the proportion of alcohol present. How far this inhib- itory action is counteracted by increased secretion under the influence of alcohol I do not think we know at present. Alco- hol certainly does increase the rate of secretion of gastric juice, at least in the dog, and it also has a marked influence in in- creasing the rate of absorption from the stomach of various dif- fusible substances, such as peptone, sugar, salts, etc. I believe we can safely say that alcohol in small doses is frequently use- ful as an aid to digestion, especially in certain semi-abnormal conditions. I also think we are warranted in the general statement that strictly moderate doses of alcohol, while not needed by the healthy individual, are not liarmful under ordinary conditions of life, and that small doses may even prove beneficial, at least under some conditions. Taken in large doses on the other hand, i. e., in excess, intoxication and even death may result, if the dosage is sufficiently large. Further, the long-continued use of large quantities of alcohol may without question produce marked lesions of the stomach, liver, blood vessels, brain, nerves, etc., the intensity of action depending much upon the quantities used and the personality of the individual. As a stimulant, alcohol is without doubt of great value in many acute diseases running a limited course where it is neces- sary to have recourse to something to keep up the patients' PHYSIOLOGICAL INSTRUCTION. 51 strength until the crisis of the disease is past, but unquestion- ably alcohol acts differently with different individuals. As Lauder-Brunton says, observation alone can tell whether the administration of alcohol — in fevers, for example — will be advantageous or not, but in many cases alcohol is certainly exceedingly useful both as a cardiac and a general stimulant. Second : In my judgment the introduction of " alcohol physio- logy " into elementary public schools is absolutely useless. The children are not sufficiently advanced to profit by the instruc- tion given, even if the latter is good. There is no propriety in teaching any form of physiology before the child has acquired some knowledge of chemistry and physics. To teach physiology to children who have not had this preliminary training is simply to present them with a collection of isolated statements which convey little or no meaning to their minds. They may memo- rize them, it is true, but lasting impressions wiU hardly be made. I have very little definite knowledge of the various physio- logies used in the schools ; two or three that I have seen have not impressed me favorably. One in particular contained sev- eral statements regarding the action of alcohol in producing diseases, such as cirrhosis of the liver, which I fancy would be hardly intelligible to the average child. Dr. F. W. Ellis, Monson. Mass., October 12, 1897. I fear that I cannot offer anything authoritative concerning the physiological effects of alcohol. Some years ago I made quite a careful stiidy of the subject, but at present I am not abreast of the newest work in this line. I am a believer in the therapeutic value of alcohol, although its use as a medicine is undoubtedly abused at times. I believe that it is nonsense to attempt to teach the physiology of alcohol in the public schools. I believe that the temperance cause is likely to be injured rather than advanced by such in- struction. I have not examined carefully any of the approved temperance physiologies, but I am confident that the time to write such books has not yet arrived. Until scientists are agreed as to the effects of alcohol on the animal functions, and until the subject has been clearly worked out by unprejudiced investigators, I think it will be a waste of time to endeavor to 62 THE LIQUOR PROBLEM. enlighten children in those matters. Few, if any, teachers in the public schools are qualified to teach any branch of physio- logy as it should be. I am certain that the average teacher will make a sad mess in attempting to impart instruction in the ob- scure subject of the physiology of alcohol. The temperance question, in its essence, is a moral and not a physiological question. I believe that any attempt to teach the physiology of alcohol in elementary schools is likely to induce the pupil to lose sight of this essential fact. Dr. G. W. FiTZ, Cambridge, Mass., October 30, 1897. As to the inquiries in your letter of September 28, I cannot now reply in full. Concerning the body of effects relating to alcohol essential to the education of medical and university students, I should consider it sufficiently well established that the use of alcohol as a beverage was harmful and that it is wiser for any one to avoid its habitual use. I doubt if the occasional use of moderate amounts has any particular effect, that is, amounts entirely physiological, showing no immediate toxic effect. As to the value of alcohol as a food I believe that in certain conditions it has a distinct food value, but its use should be limited to a physician's direction. As a medicine I believe it has undoubted value. As a condiment for sauces and similar articles of food, I believe it is a perfectly legitimate use, and if used in moderate amounts I see no reason why it should create an appetite for liquor ; I have no personal knowledge of any case where such has arisen. Its influence upon tissues, organs, and physiological processes I have no time to go into. I have not the time to go into the list of points claimed by the Scien- tific Temperance people which are not sufficiently well proven to form part of our teaching material. " They are too numer- ous to mention." I do not believe that the study of the physiology of alcohol should be introduced into any course below the high school. I do not believe it should be made compulsory by state law. So far as I have been able to observe the results of the instruction in physiology of alcohol, I believe that it is bad rather than good. The arguments against such teaching are (first) the PHYSIOLOGICAL INSTRUCTION. 53 children have no basis in chemistry and especially physiology for any study of the physiology of alcohol : therefore at once it has no educational value, as it is beyond their comprehension, so as a " scientific study " it is a misnomer and absolutely value- less. I believe that such teaching is unpedagogical and dis- tinctly bad for all the other studies, as it gives children the idea that they can study and reason about things which are entirely beyond their comprehension. Again, this study suggests possi- bilities of experiment with alcohol which may result in just what it is hoped to prevent. I believe that the strongest arguments should be the positive ones, that no one can afford to do any- thing that will not further his best life. Children can compre- hend the social effects of the use of alcohol, the economic and to a certain extent the hygienic aspects of its use, and the in- fluences of such observation and study have far stronger effect in shaping their lives than any amount of scientific study. When the child is taught that the use of alcohol as a beverage may lead to coarseness, brutality, loss of control, bring about unhappiness to the family, make the individual who might otherwise be helpful and kind a selfish brute who may do injury, even murder, and that the individual who does not use alcohol is brighter, happier, able to do more work and to be more help- ful in society, he has the main facts, and has certainly the chief stimulus to abstaining from its use. Professor Theodore Hough, Boston, October 4, 1897. I cannot pretend to an adequate acquaintance with the very extensive literature of the physiological effects of alcohol, but have seen enough of it to recognize that there is much unne- cessary confusion introduced by not distinguishing between the effects of pure alcohol and the effects of the various alcoholic drinks in common use. Among the points which seem to me " sufficiently well established " are : — 1. Its action in causing cutaneous dilation and so increased loss of heat from the body. This is probably the cause of its undoubted efficiency in the early stages of internal inflammation processes, such as colds or intestinal troubles. 2. It is oxidized within the body to a certain extent. I sup- pose the amount of oxidation varies to a certain extent with different individuals, but it has been more or less accurately de- 54 THE LIQUOR PROBLEM. termined in certain individual experiments. What is not oxi- dized is excreted through the lungs and the kidneys. 3. It seems to be in aU cases a strong diuretic, although the marked diuresis of some drinks, such as beer, must be due as much to the other substances which they contain as to the al- cohol. 4. It acts at times as a direct stimulant, although I am in- clined to think that many of its effects classed under this head are in fact due to other actions. Thus in the case of internal in- flammation — or, perhaps better, congestion — its medical value is probably due to the changes it produces in the distribution of the blood to the various organs of the body and the conse- quent changes of blood pressure or blood flow in the congested organs, rather than to the " stimulating " action, which " helps the organ affected to make an increased effort to meet the un- favorable conditions under which it is laboring." This has always seemed to me to be a very loose method of explaining such phenomena. Even with regard to its stimulating action on the nervous system, it seems to me to be an open question whether this is due to the direct action of the drug on the nerve cells, or to a rearrangement of the conditions of the organism as a whole. In fact, this whole subject of the relation of the vascular changes to the action of the drug on the nervous sys- tem has not received the attention which it deserves. For in- stance, what accurate experimental knowledge have we of its effect upon the cerebral circulation ? In short, it seems to me that the so-called stimulating action of the drug needs to be in- vestigated much more carefully than has been done in the past. 5. Certainly some of the alcoholic drinks when taken into the stomach dilate the vessels of the mucosa. Whether this is an aid to digestion or not is another question. Among the points which seem to me insufficiently proved to form part of any didactic teaching I should certainly include the whole question of its effect upon general metabolism, — the production of carbonic acid, for instance. Such experiments are so complicated that it requires a good physiologist to under- stand their significance, and often, I fear, the best physiologists can only be impressed with the confusion of the whole matter as it stands at present. After all, the practical point is not so much the effects of a PHYSIOLOGICAL INSTRUCTION. 55 single dose of alcohol as the ultimate effects of its long-con- tinued, moderate use. The pathological lesions resulting from excessive use are reasonably well known, we want more accurate information as to the regular use of small or moderate doses through long periods of time, and you have done us a great ser- vice in carrying out the experiments upon cats and dogs recently published. If similar experiments could be made which would extend your results to the effects on the various physiological functions, such as the more important reflexes, the activity of the digestive juices, etc., we might feel that we had a real practical physiology of the subject. But the labor of such re- searches would be almost superhuman. As to the second part of your question I can say that I do not believe at all in the so-called " Scientific Temperance In- struction," and that chiefly for three reasons : First, It is absurd to expect the teachers in our public schools to have that acquaint- ance with the results of scientific labor on the subject which alone would enable them to deal intelligently with the j)ractical question at issue. They cannot get this knowledge from our " temperance physiologies," the majority of which are written to supply the demand for a certain definite teaching and are evidently written by men (or women) with no real knowledge of the subject at issue. I have examined many of the " approved and indorsed " physiologies, and I have always ceased their perusal with feelings of pity for the conscientious teacher who is dependent upon them for information as to the physiological side of the problem. Only a well-trained physiologist is capable of stating the real facts, and in the nature of things the avei-age teachers in our public schools cannot be " well-trained " physi- ologists. Second. The great argument against the use of alcohol is the danger of contracting the habit. That is a moral question and does not need enforcement by any teaching of the physio- logical effects. I have nothing to say against some sort of temperance instruction in tlie schools with this feature promi- nent ; but I do not believe that if this fails of effect with the pupils, the so-called scientific teaching will do any good. In other words, as a matter of practical education, from the temper- ance standpoint, it is attacking the question in the wrong way. Third. From the standpoint of personal hygiene such teach- 56 THE LIQUOR PROBLEM. ing is one-sided. Only a certain amount of time can be given to the teaching of personal hygiene in our schools, and, as it is, that time is now taken up almost exclusively with the teach- ing of the effects of alcohol upon the system. I have yet to meet a student of our high schools who could give any account of muscular exercise, or sleep, or proper attention to diet, cloth- ing, bathing, or mental activity, as agents in the maintenance of health. Hygiene to them was only the " use and abuse of stimulants and narcotics." 1 believe it is possible to give such instruction in physiology and personal hygiene which shall be of real use to the pupils in the subsequent care of their health. But this is out of the question so long as the time necessary for such instruction is monopolized by temperance teaching. The whole is greater than the part, and we are to-day absolutely neglecting everything but one part, and, it may be added, we are doing that part in an utterly inefficient manner. Professor W. H. Howell, Baltimore, October 14, 1897. I do not believe that the physiological value of alcohol as a food has been either demonstrated or disproved — its value as a condiment and as a stimulant I believe is indicated by experi- ment and medical experience, to say nothing of the accumulated experience of mankind — provided always that the quantity used is not too great for the particular organism it is used upon. The points that seem to me unsettled are the precise effect of the alcohol in large and small quantities respectively upon digestion and metabolism. These points, I believe, cannot be settled otherwise than such j)oints are usually settled, namely, by the accumulated results of experiments from many ob- servers. As to the second point, I have at different times examined a number of the " approved and indorsed " temperance text- books. I am strongly of the opinion that this whole method of treating total abstinence is a mistake. The argument in my mind is simply this : About the excessive use of alcohol there is no division of opinion. About the fact that those who begin to use alcohol moderately incur the danger of becoming victims to its excessive use there can be no difference of opinion, but the physiological reason for this fact cannot be furnished. It PHYSIOLOGICAL INSTRUCTION. 57 is proved abundantly simply by the facts of human experience, and for the purpose of teaching temperance that is quite suffi- cient. The effects of a moderate use of alcohol, that is, the direct physiological effects, are not accurately known, and if the matter is discussed at all the evidence on both sides should be given. In my opinion tlie great objection to the books in ques- tion is that they assume that alcohol in all doses is injurious to the organism and treat this as a truth that is established by scientific experiments. They violate the fundamental principle of scientific inquiry in treating as proved what is still undeter- mined. My own feeling in the matter is this : If the commu- nity believes that it is the duty of the public schools to teach temperance, or rather total abstinence, — and as to this I have not wholly made up my mind, — then let the teaching be based not on a pseudo-scientific basis, but on the experience of mankind. Most men will admit that drunkenness is a bad thing, and that he who drinks is in danger of becoming a drunkard ; but to attempt to prove scientifically, in a form suited to the minds of the young, that he who drinks necessarily injures himself physi- cally is an impossibility. It can be made apparently successful as a logical argument only by violating the truth in the premises laid down. Dr. P. A. Levene, New York, November 13, 1897. I greatly regret that the state of my health does not permit me to answer the questions contained in your letter as fully as I should have liked to ; but I consider the subject of such impor- tance that I desire to add a few words to all the other answers received by you, in order to record one more vote against the too frequent administration of alcohol by the physicians of the U. S. A. As to the use of alcohol, there are two ways of its consumma- tion by individuals. One, as a food or a constant stimulant to digestion during meals (so to say its " chronic use "), the other as a stimulant in the course of acute diseases, such as fatigue, temporary indigestion, etc. (its " temporary use "). As regards the first, the views of men of science on the sub- ject are pretty harmonious — they are hardly favorable to the use of the too dangerous food, though it is largely advertised by practitioners. 58 THE LIQUOR PROBLEM. I do not wish to describe here fully the symptoms of chronic alcoholisms of the anatomical changes — the organs, etc., but I shall characterize them all in a few words, demonstrating at the same time the physiologic meaning of those changes. The chief aim of medicine is, in fact, to preserve the vigor of the organism, its strength for the struggle with unfavorable and frequently hostile surroundings, and every physician knows ■ that old age is the most unfavorable condition in our struggle with diseases. But can the age of the organism actually be measured by the number of years lived by a certain individual ? By no means. By age, as a factor in the struggle of the organism with the surroundings, we understand a certain condition of the tissues of the organs. My late great master, Professor Botkin, St. Petersburg, used to say that the age of a person is determined by the relative amount of connective tissue and specific elements (cells) in the organism. And no other remedy taken a la longue destroys so easily the various tissues, leaving in their place connective tissues, thus causing premature age of the individual, as does alcohol. This fact will be readily understood if we bear in mind the great osmotic power of alcohol in comparison with tonics and stimidants of a more complicated chemical composition (Overton). This result of chronic alcoholism is a long-established fact ; it is also a well established fact thait it is sufficient to consume but very small doses of alcohol, taking them regularly day after day, in order to belong to the legion of chronic alcoholics. And if, after all, medical men do prescribe alcohol, it is because they believe in its power to stimulate the appetite and digestion. It is unnecessary to enter into great detail as to that sup- posed property of alcohol. Suffice it to remark that no experi- ments on alcohol and its influence on digestion (Chittenden and Mendel, for instance) have ever disclosed any beneficial effect of it. And if we find a good many persons who cannot eat and digest without alcohol to their meals, that fact is to be explained chiefly by the pathological condition to which they have reduced PHYSIOLOGICAL INSTRUCTION. 59 their organism by constant use of alcohol. Such individuals actually do digest better using alcohol to their meals than with- out it, as was shown by a number of works in the clinics of St. Petersburg. But if many physicians who do see the danger of using alcohol as a food, and its irrationality, and who agree with the views on the use of alcohol so well expressed by Professor Bunge, wiU still adhere to the use of alcohol in acute diseases, I can only repeat all I said a little above about the influence of alcohol on the digestion. I mean to say that there are no research works j)roving the advantage of using alcohol in preference to other stimulants in the course of acute diseases, and, on the other hand, there are research works proving that the acute diseases take a much worse course with the use of al- cohol, — that the digestion, upset by the disease, is being still further harmed by the addition of alcohol to the toxiues devel- oped in the organism, and the digestion is one of the principal factors we have to care for during acute diseases. (I am sorry I cannot enumerate the authors of the researches mentioned, which were done about six years ago, as I am too far from my home and my little lil>rary, where I have the entire literature on the subject.) The question of the action of alcohol on the heart and kid- neys, especially in fever, is even less investigated than the influence of alcohol on the digestion in the course of acute dis- eases ; still we know that the issue of the disease depends on the condition of those organs more than on anything else. I do admit that the number of research works is very limited, that the difference of opinion on the question in dif- ferent countries is very great; still, to my mind, the student should be taught to prefer the use of remedies whose influence has been more carefully studied than that of alcohol. There is one other point I should like to answer, and that is, whether the study of the physiological influence of alcohol should be introduced into elementary schools, and within what limits. In fact, I hardly believe it possible to instruct a teacher as to how much of a certain truth he is to tell to his pupils, young as they may be. It is not a question of quantity ; it is a question of the form in which it is communicated. All we can 60 THE LIQUOR PROBLEM. tell to the student, we can also tell to the primary boy, if we know how. I shall also not dwell at any great length on arguments as to the efficiency of this method of preventing alcoholism, but shall only mention — 1. There is no better weapon in the struggle against evil than knowledge. 2. Of all we learn, we retain longest in our minds what We have learned in the days of our youth (on the principle of the law of reflexes). 3. If only one child out of hundreds shall be saved by this method from alcoholism, the work will be worth doing. By all that I do not mean, however, to say that the teaching of the influence of alcoholism on the organism is the only or best way of preventing alcoholism. I hope you will pardon the shortness and superficiality of my answer, as I am, I repeat, too ill to work up the question as fully as I should have liked to. As to the instruction on the subject in the elementary schools, it is certainly understood that the influence of alcohol as a food only has to be considered, i. e., its use in hygiene, and not as a medicine. Professor Lafayette B. Mendel, New Haven, October 7, 1897. In response to your invitation I offer my " testimony " con- cerning the topics suggested in your letter. I need not add that there is " much to be said on both sides." I. (a) Ethyl alcohol, introduced into the system in mod- erate doses, is burned up, only a small part being excreted as such. Comparative experiments on nitrogenous metabolism and respiratory exchange seem to show, on the whole, that the oxidative changes in the body are scarcely affected by moderate doses, i. e., such as do not interfere with the normal functions ; and in such quantities alcohol seems to behave precisely like a non-nitrogenous food stuff. Inasmuch as even moderately large doses of alcohol have certain peculiar disturbing effects upon the normal actions of the organism, alcohol can be assigned only a very limited importance as a food, and its use must be considered from other standpoints. (b) That alcoholic fluids (especially the weaker ones) form PHYSIOLOGICAL INSTRUCTION. 61 important condiments must, I think, be admitted. When it is remembered how largely the accessories to our diet determine the amount and character of the food ingested, and further- more, how universal is the use of condiments, it is eminently fair to compare the alcoholic drink with the other common accessories. They all agree — and here, again, when taken in ajjpropriate quantities — in exerting a more or less marked ac- tion on the nervous system, upon the digestive functions, upon psycho-physical states, e. g., weariness, etc. The alcoholics differ markedly only in one respect : the danger of excesses is decidedly greater. Considerable testimony of a definite charac- ter might be added regarding the action of alcohol on the digestive functions, a subject upon which Professor Chittenden and myself propose to present some experimental data at an- other time. (c) Alcohol — in physiological doses — is a typical stimu- lant and examples readily suggest themselves of its service as such. I am not inclined to agree with those physiologists (e. g. Bunge) who assign to it a depressing action exclusively. Its action is of short duration, and herein lies a danger. Further, its use must be modified in many instances, owing to pecul- iarities of the individual rather than the agent ; but in this respect again alcohol shares a quality common to the majority of substances employed like it. I cannot refrain from quoting a few words from O. Funke which always seem to me to be worthy of repetition in this connection. He wrote, — " It is foolisli and unjustifiable to put a stop to even tlie most moderate enjoyment of the aforementioned stimulus. One does not need to have recourse to the argument that the inclination to acquire it in some form or other is really the expression of an inextinguishable human instinct which has made itself felt in all ages and by all peo- ples. One needs only to ask : Must our machine, then, always work in the same monotonous, tiresome tempo as the pendulum of a clock ? What harm is there if from time to time it pumps somewhat more quickly under a higher pressure of steam if subsequently, during a pe- riod of slower work, it can make good this slight unnecessary expendi- ture of force by drafts from an abundant store of energy, and repair any small damage which its mechanism may have suffered ? It is certainly a fact that many a bright fruitful idea has been born from a large glass of fragrant Rhine wine which, perhaps, would never have 62 THE LIQUOR PROBLEM. come from the water jug of a vegetarian. Many a bitter heartache, which would have eaten deeper and deeper by drinking raspberry- lemonade, has been softened by a nice cup of coffee ; many a trouble, many a care, has disappeared in the smoke of a cigar, — and that is surely worth something in this poor human existence." i (d) With reference to alcohol as a medicine the clinician alone is entitled to speak with full authority. Every one knows what extensive lesions of various oi-gans excessive " doses " of "alcoholics" may give rise to. But the "physiological," therapeutical, and pathological properties of alcohol deserve as distinctive treatment as does, for example, the consideration of arsenic as a drug and as a poison. The preceding is intended to indicate very briefly what topics I consider sufficiently well established and important to present to the university student. The pharmacologist and pathologist will doubtless present other points of view. The majority of the better books wisely omit any discussion on those topics regarding which experimental data are largely wanting or unsatisfactory (e. g., comparative action of various alcoholic drinks on renal seci-etion or exci-etion). And in the university, at least, let us not make the mistake of some public-school enthusiasts in conceiving of physiology and the study of al- cohol as complementary oi* equivalent subjects. 1 " Es ist thoriclit und unbereehtigt audi den bescheidensten Genuss der genannten Reizmittel zu verwerfen. Man braucht sie nicht damit in Schutz zu nehmen, dass der Trieb sie in irgend welcber Form sich zu ver- schafFen, wiederum der Ausfliiss eines untilgbareii Menscheninstinctes ist, der sich zu alien Zeiten und bei alien Volkern geltend gemacht hat. Man braucht sich nur zu fragen: Muss denn unsere Maschine, wie das Pendel der Uhr, inimer in demselben monotonen langweiligen Tempo arbeiten ? Was schadet es ilir denn, wenn sie von Zeit zu Zeit mit etwas starker gespanntem Dampf etwas raseber pumpt, sobald sie nur in den darauffol- genden Intervallen bei langsamerer Arbeit die Kleine Luxusausgabe von Kraft aus dem geniigenden Vorrath wieder einbringen und etwaige Kleinere Defecte ilires Mechanismus wieder ausbessern Kann ? Wahrlich manche leucbtende fruchtbringende Idee ist sehon aus einem Rbmer duftenden Rheinweines geboren, welche vielleicbt nie den nuchternen Wasserkriigen der Vegetarianer entstiegen wiire ; mancb bitteres Herzweh das bei Himbeerlimonade tiefer und tiefer gefressen hatte, hat ein Schalchen KafPee geniindert ; manche Sorge, manche Grille hat sich mit dem Ranch einer Cigarre verfliichtigt, und das ist doch etwas werth in so mancher armseligen Menchenexistenz." PHYSIOLOGICAL INSTRUCTION. 63 II. I cannot uphold a system of instruction in physiology which leaves in the pupil's mind as the uppermost thought re- garding the function of the human hody : Avoid drink. I am in thorough sympathy with any justifiable movement to pre- vent the sjiread of alcoholism ; but I cannot uphold the farce of '' scientific temperance instruction " which has received the sanction of the law. Physiology and hygiene should be taught as such in our schools. The evils of intemperance may be treated by themselves, if necessary, along with habits that may become "bad" habits. Physiology should remain a true sci- ence, stating facts of observation and not those presumed or enforced by law. I am familiar with a number of the so-called " indorsed " physiologies (Steele's, Hutchinson's, Stowell's, Thatcher and Morrill's), the worst of which is perhaps the one " prepared by order of the General Assembly of Connecticut." Furthermore, the teachers are frequently incompetent to discuss the pharmacology of alcohol. Thus, one text-book prescribed for children of seven years states " that the subject is presented in language that can be rcaclUy understood by children, and in the form and order best adapted to objective teaching." In speaking of the effects of alcohol on the digestive system, the book has sentences like this : " The liver may become inflamed and permanently changed in its tissues, producing the diseased condition called cirrhosis with the resulting dropsy of the abdomen." A teacher using this book (prepai-ed in compliance with chap, cxxxix. 188G Conn.) was asked by me how she would illustrate the properties of alcohol as the physiology de- mands. " Burn some," she replied, with hesitation, " to show its inflammable qualities. It pi-oduces inflammation." It hap- pens that I myself was subjected to a course in temperance physiologj' at the age of twelve years. The instructor illus- trated the influence of alcohol by dropping the undiluted white of an egg into at least five or six ounces of strong rum, calling attention to the solid precipitate, and concluding that as the lining of the stomach is albuminous, therefore this coagulating action is repeated when liquors are ingested. Precisely such an illustration is to be found in Steele's " Physiology," on page 129, the author adding that " the brain is largely albuminous substance." Another book, widely used, says : " There is no such thing as a temperate use of spirits. In any quantity they 64: THE LIQUOR PROBLEM. are an enemy to the human constitution." Stowell's "A Healthy Body " begins with the chapter, " AVhat is Alcohol? " the keynote being : alcohol is a poison. A college student who had learned the alcoholic physiology in the New York city schools was asked what he understood the action of alcohol to be. He informed me that it served " princijjally to form fat, which is useful in the body." I speak of these examples to illustrate some of the unfavor- able results of the present methods. The commonest error consists in giving universal application to facts which apply to definite conditions alone. An untruth once discovered by an individual will make him doubly skeptical. The obvious ab- surdity of some of the text-book discussions is certain to bring harmful results and at the same time to injure the proper study of physiology and hygiene. Physiology must be upheld as a science : and every science aims at the truth. If " temperance instruction " cannot be made to conform to scientific methods, then it must create a department for itself. Finally, I can scarcely believe that the means and methods at present ado2)ted are justifiable, whatever the end in view. Man is by nature a temperate animal, and it is only by distinguishing between temperance and intemper- ance (i. e., use and abuse) that the evils of alcoholism can be combated. Present methods fail in this respect. Professor Henry Sew all, Denver, Colo., October 10, 1897. I am very glad to reply to your circular dated the 1st inst., not that I can give answers either pertinent or valuable, but at least that I may express appreciation of the work you have been doing, as evinced in the reprints sent me from time to time. I have at times formulated opinions regarding the mat- ters touched in your two eucyclopasdic questions, but the data on which my opinions would have to be founded are widely scattered. There is only one suggestion I feel qualified to advance, and that is in regard to the method commonly used in the ordinary " temperance " text-book of physiology in impressing the evils of alcohol, etc. In these works the truth, or what there is of truth, is presented with such partiality for total abstinence, with such magnification of the evils of any indulgence, so little PHYSIOLOGICAL INSTRUCTION. 65 discrimination between the effects of stimulants and narcotics employed in therapeutic and poisonous doses, that the idea given the pupil is necessarily delibei-ately false. I seriously believe that more evil will probably accrue to the next geuerar tion through this legalizing of lies than would result without direct effort for moral teaching. This is an opinion which has spontaneously asserted itself in me from time to time in look- ing over school physiologies ; I have tried to get a number of such books for more critical review, but they are not at hand. I do not by any means mean to make my strictures universal. One could hardly wish a sadder picture of, or more powerful plea against, the evils of intemperance than that to be found in the junior editions of Martin's "' Human Body." Professor G. N. Stewabt, Western Reserve University, October 10, 1897. I think the little I know about alcohol in its physiological relations stands very much as I put it in my "Manual of Physiology," pp. 413, 414. I believe it is unwise to attempt to teach ordinary school- children pharmacology. To attempt to teach the pharmacology of a single substance, whether alcohol or any other, without the sure foundation of adequate physiological knowledge, seems to me absurd ; and the manner in wliich the attempt is made in school " Physiologies " in this country further to be, as a rule, dishonest, or at least disingenuous. I believe that it is the office of parents, in the first place, and of clergymen and Sunday-school teachers, in the second, to warn the children of more mature age, on fit and not too frequent occasions, of the moral, social, and hygienic evils of excessive use of alcohol. Finally, I do not believe that it is the lack of knowledge of " the physiology of alcohol " which is responsible to any great extent for the existence of intemperance. Nor do I suppose that the amount of drinking in one of the most drunken parislies in the North, the habits of whose population have been intimately known to me for more than twenty years, would have been greatly lessened by any exposition of the histological or physiological changes produced by alcohol in the kidney, liver, or brain that an omniscient school-teacher could have 66 THE LIQUOR PROBLEM. given in the parish school. But an amelioration in the material condition of the people, due in part to wise legislation in re- gard to the tenure of land, the spread of education, the estab- lishment of libraries, and the efforts of temperance societies to provide entertainments that act as a counter-attraction to the public house, have brought about, within the period which my memory covers, a gradual but encouraging change for the better. ENGLISH AUTHORITIES. Sir T. Lauder-Brunton London. Professor T. J. Cloueton Edinburgh. Sir Michael Foster, K. C. B Cambridge. Dr. Arthur Gamgee Slontreux. Professor W. D. Halliburton .... London. Sir J. Burdon Sanderson, Bart Oxford. Professor E. A. Schafer London. Dr. P. H. Pye Smith London. Professor Sir T. Lauder-Brunton, London, October 22, 1897. My views in regard to the physiology of alcohol are expressed in my text-book on Pharmacology, but are also given at greater length in my article on " Stimulants and Narcotics " in Cassel's " Book of Health," as well as in the book on " The Alcohol Question," Contemporary Controversies Series, published by Strahan & Co., 34 Paternoster Row, London, which contains a reprint of articles by several authors from the " Fortnightly Review." I have also mentioned some views in regard to the prevention of drinking in " The Bible and Science," a copy of which I now send to you. I doubt very much if instruction to children in the physiology of alcohol would do them much good, and especially if repeated lessons would be of much bene- fit. I should think that more could be done to prevent their taking alcohol, by exciting their imagination and appealing to the fighting instinct by showing them that it was a brave thing to resist the temptation to alcohol, and a weak and cowardly thing to yield to it. Professor T. J. Clocston, Edinburgh, October 26, 1897. In reply to your letter of the 20th September regarding the Alcohol problem, I would, without attempting to cover the whole ground, briefly enumerate my views as follows : — PHYSIOLOGICAL INSTRUCTION. 67 1. Alcohol in small doses is a true stimulant to the mental cortex, increasing markedly the intellectual and emotional in- tensity in most persons. 2. The function of inhibition is always weakened, however, by it in any dose, lai'ge or small, and this constitutes its great- est danger. 3. Whenever there is a neurotic heredity or diathesis, the results of small doses of alcohol are especially dangerous from the intense feelings of pleasure it has the power of producing, and the strong craving for a repetition of the dose and for larger quantities it is apt to excite. 4. Therefore neurotics of every kind should especially be on their guard against alcohol. Most of them should be teetotal. 5. It causes in large and continued doses demonstrable and mostly inculpable changes in the brain neurons, the vessels, the lymphatics, and the neuroglia, — changes that are inconsistent with sound mental activity, with morality, and with average social conduct. 6. Alcohol is a food, and may in a diluted form be a very valuable adjunct to oi-dinary foods, by exciting appetite, by improving digestion, and by stimulating certain nutritive pro- cesses, e. g., the laying on of fat. 7. As a drug it is essential in medical practice. 8. As a luxury, a producer of subjective feelings of happi- ness and organic satisfaction, it seems to me to be perfectly legitimate if it is used in strict moderation and its dangers are kept in mind and avoided. Many human beings have none too many sources of happiness and are entitled to run some risks even in securing it. Burke hesitated to condemn the poor London gin drinker on this ground. 9. Human nature has in all its history never been content with mere " bread and butter," the " ale " was invariably craved for and got as soon as the " cakes " were secure. Prim- itive man whenever he had a " feast " introduced alcohol or some brain stimulant in some shape or form as an adjunct to feasting, and all his successors have done the same. 10. It is in my opinion at least an arguable point whether if all the pleasure given, all the stimulation to social instincts, and aU the drowning of care produced by alcohol in rich and poor were summed up and weighed and put in the scale on one 68 THE LIQUOR PROBLEM. side, and all the harm done by it put in the other scale — whether the result would not be in favor of the alcohol ; and if opium, tobacco, Indian hemp, tea and coffee, and cocoa were added, it seems to me clear that the vote must go for brain stimulants. 11. I think plain dogmatic teaching as to the risks and real uses of alcohol should be given by teachers, but not teetotal teaching. Especially the risks to unhealthy and nervous con- stitutions should be pointed out. It seems to me that twenty lessons a year would be overdoing the subject. No class of men are so apt to use opium, cocaine, chloral, chloroform, etc., and poison themselves thereby, as medical students and young doctors, who know best their risks and dangers. Knowledge and self-coutrol, like " knowledge and wisdom," far from being one, have ofttimes no connection. Sir Michael Foster, Cambridge, England, December 15, 1897. I have now received your circular of September 18, and can now write more to the point. 1. I give very little space to the question of alcohol in my Text-Book, because our evidence as to its action is so meagre, and in part so unsatisfactory, that it cannot be dealt with in the more or less dogmatic manner in which I treat all topics in my Text-Book. If I were to say more than I do say I should have to go into a detailed discussion, which would be tjuite out of place in my Text-Book. 2. With some reluctance Shore and I have added a brief statement about alcohol as a part of diet in the second (Amer- ican) edition of Foster and Shore. Since I have not a copy of this by me, I cannot call to mind what we do say. But I have no hesitation in stating that in my opinion it is perfectly ab- surd to devote any large space to a discussion of the physio- logical effects of alcohol in an elementary work, or indeed in any other than a quite advanced or special treatise. The phy- siology of alcohol is most difficult, and the little exact know- ledge which we possess can only safely be expounded to those who have a real knowledge of physiology. The guide to the use of or abstinence from alcohol is still, and must for a long time be, not physiology but common experience. The food of man as of other animals consists of two classes PHYSIOLOGICAL INSTRUCTION. 69 of material. In the one class the material contains potential energy, produces in the body actual energy, and is used for that purpose. So large a part of food is material of this class that this part alone is often spoken of as food. In the other class the material is of value, not because it supplies energy, but because it intervenes in the processes by which the energy pre- sent in the first class of material is set free, and, so to speak, directs the setting free of energy. This second class is no less necessary for the well being and indeed the life of the body than is the first. Some kinds of this material, such as water, sodium chloride, etc., possess no potential energy ; other sub- stances of this class, which are present in aU kinds of food, such as animal and vegetable, so-called " extractives," may con- tain a smaU amount of potential energy, but the value of these latter does not depend upon their energy being added to the sum of energy available for the use of the body ; they are of use because, like the material devoid of energy, they by their properties direct and govern the metabolic processes of the body. The substances of the second class play a physiological part in the working of the body, of the same kind as that of the so- called drugs ; the one distinction between the two, as between the action, for instance, of sodium chloride and morphia, is that the former in a certain quantity is necessary or of advan- tage under all ordinary circumstances of the body, in what we are accustomed to call health, whereas the latter is of advan- tage in abnormal circumstances only, in what we call illness or disease. It follows from the nature of the part played by the second class of food material that their value to the body is directly dependent on the quantity taken. In the case of each one of them, the proper action of the substance depends on a certain quantity being present in the tissues at one time. If too little or too much be present the metabolic processes are disai-ranged. Thus if too little sodium chloride be taken per diem the body suffers ; if too much be taken the body also suffers, the excess acts as what is called a " poison." And the same is the case with even water. The limit as regards quantity, beyond which the excess produces palpable injurious effects, becomes palpably poisonous, varies of course with different substances. A very great excess of water is needed to develop poisonous effects, 70 THE LIQUOR PROBLEM. but a very moderate excess of a potash salt readily develops them. Alcohol belongs to the second class of food material. Though it does contain potential energy, and indeed a relatively large amount, and though within the body it does yield up that energy and thus adds to the sum of actual energy of the body, this is not its important action when taken as part of food. Its value depends not on its being used as a substitute for an isodynamic quantity of starch or fat, but on its directing and modifying the metabolic processes of the body. Our knowledge of the exact manner in which the food mate- rial of the second class intervenes in the metabolic processes of the body is exceedingly scanty. Similarly, though we have ac- cumulated a large amount of information about the " action " of drugs and poisons in large doses, that is, in doses which produce obvious physiological effects, we know very little about the exact way in which doses of these substances which do not produce obvious " symptoms " affect the body. Our knowledge of the action of alcohol is at the present time in the same con- dition. We know something of the physiological effects of large, that is to say, poisonous doses, but we know very little concerning the exact physiological effects of doses of alcohol which produce no immediate palpable effects, in other words, of alcohol as an article of diet. The investigation of the pro- blems connected therewith are extremely difficult and complex. For instance, the question : Does alcohol aid digestion or the re- verse ? cannot, so far as I know, be answered physiologically at the present moment. Observations have been made as to whether the addition of alcohol (in such a dose as when taken by an individual would produce no decided obvious symptoms) to an artificial digestion mixture influences the digestion ; but these observations, whether they show retardation or accelera- tion of digestion, or neither, are not to the point. The effect of alcohol taken with food is not limited to its action on mix- tures within the stomach ; it may, and probably does, affect the whole act of digestion in many ways, some of them perhaps very indirect ; it may act on the secreting or absorbing mechanism of the stomach ; it may act on the vaso-motor system, and so on. Concerning all this our knowledge is at present insufficient. Hence it appears to me that no distinct physiological dicta PHYSIOLOGICAL INSTRUCTION. 71 concerning the usefulness or the opposite of alcohol as an arti- cle of diet can at present be enunciated. Any physiological opinion which may be given is of less value than the teachings of general experience. What physiology can state is that if a number of persons say that a certain quantity of alcohol per diem seems to them to be a means of keeping them in health and vigor, there is nothing in our present knowledge of physi- ology to lead one to doubt the validity of the conclusions thus drawn from experience. The fact that alcohol taken in a cer- tain quantity is obviously injurious is no argument whatever against a smaller quantity being beneficial, the exact limit vary- ing with individual features and various circumstances, for this dependence of the natvire of the effect upon the quantity is, as has been said, characteristic of food material of this class. Since we do not know the details of the action of alcohol, we cannot explain why it seems in the case of certain persons to be advantageous ; nor can we explain why A seems perfectly well without any alcohol at all, and B seems equally well with a certain quantity taken every day. So long as we are ignorant of the details of the action there is no reason why we should think B mistaken and A correct. Professor Arthur Gamgee, Montreux, November 15, 1898. The statement which you have sent me precisely expresses my opinion on the subject of the use of alcohol. I have on several occasions abstained from alcohol during a period of some weeks, and have found that my working capacity was thereby injuriously affected. The assertion that alcohol does not supply energy to the body is, as every one must admit, dis- proved by the experimental facts in our possession, and it must be admitted by all physiologists whose judgment is not tainted by blind prejudice that alcohol must, therefore, be classed among the articles of food. The only question which remains to be discussed is, therefore, whether it is a safe or expedient article of food. Subject to limitations as to amount and man- ner of consumption, it appears to me that alcohol is a valu- able constituent of the diet of man ; and personally I have no doubt whatever that a physician cannot properly discharge his duties towards his sick patients if he systematically and uni- formly eliminates alcohol from their diet. 72 THE LIQUOR PROBLEM. Professor W. D. Halliburton, London, October 20, 1897. I have i-eceived your letter of the 18th ult. re the alcohol question. My students are in the main medical ones, and I consider a brief statement on the subject, such as is contained in my text-books, is all that is necessary in lecturing to them. They have the subject much more fully set out in their lectures on Pharmacology, and can see for themselves the ill effects of excess in drink in the hospital wards during their clinical studies. I consider the large amount of space that Bunge devotes to the subject uncalled for. Bunge, however, is an enthusiast on this special question, and his statements have the bias usually seen in enthusiasts. With regard to lectures to elementary teachers, it is perhaps necessary that the evil effects of alcohol should be dealt with at somewhat greater fullness, as they have to teach a mixture of Hygiene and Physiology in their so-called Physiology classes. The proposal to devote a fifth of the text-books to the subject is to me preposterous. One might with equal justice devote another fifth to the opium question, another fifth to hashish, and I dare say one can find two other drugs to fill in the re- maining two fifths, and thus exclude all useful physiological teaching. If teetotal propaganda form part of a child's in- struction it should be labeled as such, and not called Physi- ology. Sir J. BuRDON Sanderson, Bart., Oxford, November 22, 1898. The statement about alcohol that you send me in an amended form so exactly expresses what I think, and should like, if the opportunity offered, to say, that I do not wish to add anything to it. I myself often experience the advantage of alcohol, and the more the older I become. I have also experienced the horror of an overdose, particularly when experimenting with whiskey in association with the late Dr. Anstie. I can think of nothing more disagreeable than the effort to make observa- tions on one's self when half poisoned. But I quite agree with you that, notwithstanding, alcohol is not a poison, as well as with your definition of a poison as a thing which can only do harm and never good. PHYSIOLOGICAL INSTRUCTION. 73 Professor E. A. Schafer, London, October 22, 1897. In reply to your queries I beg to state that the alcohol ques- tion is hardly touched upon in my course of Physiology : it is, I believe, treated in the course of Pharmacology. Beyond in- cidental references to its effect in large doses in reducing tem- perature and its value (?) as an article of diet, I do not deal with it. Personally, I do not doubt that it would be useful to insist, in elementary courses of instruction intended for the laity, upon the deleterious effects of over-indulgence in alcoholic drinks. Whether this would tend to increase or diminish abuse of alco- holic drinks can only be determined by careful statistics, and one's individual opinion is of little or no value : to assume the possibility of such instruction increasing their abuse seems to indicate a very definite belief in the asinine qualities of human nature. I should at least Ao/^e that the effect might be to di- minish their abuse. Professor P. H. PvE-SMrrn, London. I have signed the statement you sent me, and return it to you. One must assent to the general sense of such documents, for every man would use different phrases. The definition of a poison is not quite satisfactory. Arsenic and strychnine would be excluded, for they sometimes do good. Truly, everything depends upon the how, when, and in what dose. The value of alcohol as a food is in most cases small, and chiefly seen in ill- ness when no other food can be absorbed. But its dietetic value depends, like that of mustard, pepper, vinegar, tea, coffee (and tobacco), upon its sedative effect on the nervous system, and its stimulating effect on the glandular system, as well as on its effect on the heart and cutaneous vessels. Physiology as an experimental science not only has not, but I think never will decide whether the moderate use of alco- holics is good or bad. For many, perhaps for most, it is (phy- siologically) indifferent. But science can say it is (by defini- tion) a food, oxidized and so contributing energy, and it is not (so taken) a poison, i. e., injurious to health. Personally, I have a strong conviction that diluted spirits do more harm than good, and are only desirable in old age or in 74 THE LIQUOR PROBLEM. special cases, while wines and malt liquors for a large number Qjerhaps for most adults), when taken with meals, do more good than harm. The practice (or fashion) of ordering all dyspeptics to take whiskey and water with meals (for which I am afraid the late Dr. Andrew- Clark was to some extent re- sponsible) is to my mind a bad one. Temperance is much better than abstinence, and in England we ai'e certainly far more temj)erate than our grandfathers, as temperate as we were in the seventeenth century or in the Middle Ages. I am afraid in France intemperance is more common than it used to be. With us spirit-drinking is worse, I believe, in Glasgow and some of the Scottish towns and in our Colonies, j^articularly the Cape and Australia. I have never seen a drunkard, or one inclined thereto, among my Amer- ican patients, and do not remember to have seen intemperance (with one exception) in the United States. CONTINENTAL AUTHORITIES. Dr. A. Baer, Penitentiary, Plotzensee, near Berlin. Pro- fessors G. V. Bunge, Basel ; A. Dastre, Paris ; J. Dogiel, Kasan ; J. R. Ewald, Strassburg ; S. Exner, Vienna ; A. Fick, Wiirzburg ; A. Forel, Ziirich ; J. Gaule, Zurich ; P. Heger, Brussels ; H. Kronecker, Bern ; W. Kiihne, Heidelberg ; Ch. Richet, Paris ; C. v. Voit, Munich. Dr. A. Baer, Berlin, November 26, 1897. (Translation.) Concerning the most important question, whether I agree with the sentiment in the newspaper clipping which you sent me — which I herewith inclose and acknowledge as my own view — I am ready to answer in the affirmative in the fullest degree. According to the prevailing opinion of the great ma- jority of our experts, which is based upon the results of physi- ological experimentation and the observation of healthy as well as sick people, the facts in the approved and indorsed school- books on hygiene and physiology can be considei'ed as the ex- pression of modern science, in so far as they bear upon the use of alcoholic di-inks. With us as with you, now and then a voice is raised in favor of the opposite view ; this cannot, how- ever, greatly modify the above-mentioned opinion. In all ques- PHYSIOLOGICAL INSTRUCTION. 75 tions that come under scientific discussion there are dissenting and modifying views, but through tliem all there runs an under- lying opinion from which very few of the scientists differ ; and I believe I am not wrong in pointing out the statements in the letter which I have addressed to Mrs. Hunt as an opinion of this sort. The second question is whether I would recommend the in- troduction of this method of instruction into our schools in Germany. The manner and method of instruction on this question must of necessity accommodate themselves to the sys- tem of public instruction in general. If an instruction in this direction could be given, I would have exactly the same things taught which are regarded as the essential things in the books above referred to. Moreover, with us it is regarded by the ad- vocates of temperance as a very effective and justifiable method of work to acquaint the school-children with the true facts re- garding the value, use, and abuse of alcohol, i. e., of all alco- holic drinks. As the government and the school management have not thought yet of introducing such an official instruction, we have ourselves tried to come into relation with the teachers in a private way, and to give them instruction in this direction. Although we have not yet accomplished a great deal, our efforts are everywhere openly recognized by the highest school author- ities. Here in Berlin we are now trying to work out this prin- ciple in the form of health regulations, and to spread them among the school-children. I had hoped to be able to send you these rules, but unfortunately they are not yet ready. I cannot regard it as an argument against this sort of in- struction that the child, when thus taught in the school, may come into conflict with the lives of his parents. According to this pedagogical principle, one must not teach in the schools the fundamental doctrines of morality and religion, such as the decalogue and so forth, because unfortunately in many families these are actually and openly sinned against. Many children are said, as you allege, to be led to a liking for alcoholic drinks through this instruction. If such is actually the case, it is caused, in my opinion, only by a bad sort of instruction and by a very unfortunate method which the teacher himself chooses to employ. Only when the teacher, in the interest of truth and public welfare, puts this branch of instruction earnestly and 76 THE LIQUOR PROBLEM. wortliily before the young and makes it intelligible to them, can his work be successful in the highest sense. There is but one truth which the instructor can teach. If he is opposed to this principle and shows this opposition in his method of instruction, then he must do more harm than good. From a very thorough study of that excellent book, " The Liquor Problem, its Legislative Aspects, by the Committee of Fifty, 1897," I have seen how strongly legislation on the alcohol question has been influenced by politics and party conflict. Must not the party platform also influence the teacher, and through this make itself felt even in the instruction ? An impassionate, earnest, sensible teaching of these subjects, a truthful, rational instruction of the young about these facts, cannot possibly lead to an increase in the consumption of alco- hol. It can cause a decrease in the same only after genera- tions ; but the youth of the present day can be urged along the road to drink only when the instruction is imparted not in the highest sense of an honest love for truth, but in quite the con- trary spirit. Instruction on this question is already given in Belgium, Holland, and England. An effort is being made to introduce it in France, Germany, and Austria. Nowhere has such a criticism been made against this means of fighting alcohol. Were it possible that this great evil should arise, — granted that the method of instruction is the right one, — then I would be among the first to banish the instruction from the schools. At present an effect of this sort appears to me hardly possible.' ' Additional Testimony that the Indorsed Temperance Physio- logies ARE Accurate ; from the Royal Sanitary Commissioner in Berlin, Germany. — Dr. Baer, the foremost European specialist on the subject treated in these text-books, has recently subjected these same books to a rigid examination. We give below the result of his investigations : — Berlin, N. W., May 15, Rathenower atr. 5. National and International Department of Scientific Temperance Instruction in Schools and Colleges, represented by Mrs. Mary H. Hunt, Superintendent, 23 Trull Street, Boston, Mass. Honored Madam, — By your letter of March 15 you have done me the honor to request my opinion in regard to the "ap- proved and indorsed temperance physiologies " which have been sent me, and are now in jise in the public schools of most of the States of North America, as to whether the teachings of these school books, in regard to the value and effect of alcohol and of alcoholic drinks, are in harmony with the principles of modern science. PHYSIOLOGICAL INSTKUCTION 77 Professor G. von Bunge, Basel, October 22, 1897. (Translation.) Accept my grateful thanks for the esteemed invitation to share in the work of your Committee. As you write me that you are in possession of my text-book (edition III., 1894) I have nothing essential to add to what is therein expressed, and so send you my further publications upon the alcohol question. As to the second question, I consider instruction in the schools upon the alcohol question certainly very desirable. It is important to overcome prevailing prejudices before it is too late, that is, before the young people have become slaves to al- cohol. The number of such slaves is greater than is generally believed. It is a fatal mistake to suppose that slaves to alcohol are only those who lie in the gutters. There are numberless men who always drink one moderate glass. To this moderate glass, however, they cling quite as inveterately as the morphin- ist to his syringe. These men are, and remain, the unrelenting enemies of the abstinence movement. With regard to the number of hours, 250 hours seem to me to be a great deal certainly, yet I do not presume to contradict experienced abstinence leaders. We ought not to forget how many more hours the contrary is brought before the young. In order to ascertain the truth of the important question at issue, I have gladly undertaken the task, and have examined with strict impartiality the school books sent me [enumerating the text-books on the indorsed list]. On the basis of the examination I have made, I can assert that the above- mentioned school text-books, in respect to their statements regarding alco- holic drinks, contain and disseminate no teachings which are not in harmony with the attitude of strict science. Ideas and facts as to the actual value of alcohol as a food, as to the effect of its occasional or habitual use upon the body, upon the tissues and organs, likewise upon the brain and its activ- ity, are throughout represented correctly and clearly, and often with re- markable felicity adapted to the youthful understanding. Though personally I do not practice total abstinence, yet I consider the dissemination of the above teachings in the way of instruction in the schools wise and the most admirable and effective means of opposing and averting the serious evils which alcohol does both the individual and society, and of bringing about a complete change in the drink habits. Hoping for the best results of your efforts, I remain with much esteem, your obedient servant, Dr. A. B.wer, Geheimer Sanitatsrath, Chief Physi- cian of the Penitentiary, Plotzensee, bei Berlin. — The Union Signal of the National W. C. T. U., Chicago, July 15, 1897. 78 THE LIQUOR PROBLEM. More depends on the teacher, in my opinion, than upon the number of hours. But more important than all teaching is ex- ample. Verba docent, examjjla trahunt. Children are fine psy- chologists ; they pay little attention to what is said, but notice exactly what is done. Please remember me kindly to all fellow combatants. Professor A. Dastre, Paris, April 15, 1899. (Translation.) One can look at the alcohol question from the point of view of hygiene and from the point of view of physiology. 1. From the point of view of hygiene. I think, with you, that alcohol, taken in small and reasonable doses, in the form of good wine, with meals, is an excellent thing, very agreeable, and entirely harmless. Bonum vinum Icetificat cor hominum. But an excessive amount, its abuse between meals, its inges- tion in concentrated form, are harmful. One should not drink alcoholic liquors on an empty stomach or in excess. This is what we nearly all of us think in our country of France, which still produces some very good wines, rejoicing, strengthening, and comforting cor hommum. There are very few teetotalers among us. It is a rare species. 2. From the physiological point of view. I believe that alcohol is preeminently a nervous stimulant, that it is not, properly speaking, a food. Why do I hold this opinion ? For theoretical and for prac- tical reasons. When alcohol is ingested it is divided into three parts : — 1st. About Jq is fixed in the anatomical elements (Lallemand Perrin, Duroy, Rabuteau, etc.). 2d. -f-Q (?i, variable, unknown) is eliminated by the respira- tion and by the emunctories. 3d. -f^ is oxidized in the circulating blood and produces heat. Alcohol is then thermogenetic (1 gram is thermogenetically equal 1.66 gram of sugar, 1.44 gram of albumen, or 0.73 gram of fat). Most physiologists say: it is thermogenetic; it is therefore a. food ; it is useful. This reasoning is false in theory and in fact. I. It is false in theory. To understand this it is necessary to go back to first princi- PHYSIOLOGICAL INSTRUCTION. 79 pies and to inquire what is the function of heat in connection with vital processes. Heat is condition of the medium, nothing more. The mod- ern conception of biological energy shows that this condition may be useful, harmful, or indifferent according to circum- stances ; that it is not always useful. Heat is an excretion. There are two types of thermogenetic foods. 1. Bio-thermogens, true foods, carbohydrates, albumens, and fats. 2. Pure thermogens, false foods. Alcohol is a pure thermo- gen. It circulates with the blood. Only a tenth part, fixing itself in the anatomical elements, is a bio-thermogen, i. e., a true food. II. It is false in fact. The experiments of many authors, particularly Hammreich and Miura (my own have confirmed theirs), have shown that alcohol is not isodynamic with the carbohydrates. My own ex- periments have been principally upon malic, citric, and tartaric acids, which, with glycerine and alcohol, form a group — the jnire thermogens. I know as well as any one the difficulties of these experi- ments and the numerous sources of error to which they are sub- ject. There ai-e some physiologists, and among them perhaps your compatriot Dr. Atwater, who have obtained different results. It is for this reason that the agreement between theory and experiment has here a great value. I have greater confidence in the results of my own experiments and of those of Miura because they are in harmony with these theoretical views. It is not a case of absolute demonstration, but of a strong pre- sumption. Professor J. Dogiel, Kasan, December 18, 1897. (Translation.) You and Dr. Hodge have expressed the wish to learn my opinion upon the physiological importance of alcohol as a nutriment, as a relish, and as a remedy ; furthermore, upon the advantages which may be expected as a result of introducing the teaching of the physiology of alcohol into the schools. 80 THE LIQUOR PROBLEM. From my researches, which were undertaken principally for the purpose of investigating the physiological effect of spirits of wine, and which have been published at different times, I have reached the following conclusions : — 1st. The monotomic, saturated alcohols of the fat series have an essentially similar effect. The difference between them consists only in the intensity of their effect, which is dependent upon the number of the CH, group in their composition, so that methyl-alcohol (CH4O) can be regarded as the weakest, and amyl-alcohol (CjHuO) as the strongest, of the five first alcohols in this series. 2d. Ethyl-alcohol, or the spirituous drinks containing it, exercises a strong effect upon the animal organism and changes the physiological action of the organs of digestion and of circu- lation, of the nerve and muscle system, of the organs of secretion and excretion, and of respiration, into a pathological activity. 3d. Ethyl-alcohol can be regarded neither as a useful stimu- lant nor as a food material. 4th. If strong (ninety per cent.) or diluted (thirty per cent.) ethyl-alcohol can in certain cases be useful as a medicine, it nevertheless cannot be regarded as an indispensable remedy. 5th. Alcohol and spirituous drinks effect no heating of the body, but rather a cooling off. 6th. Muscular action is not increased, but is decreased, by alcohol and spirituous drinks. 7th. The effect of alcohol upon the heart, the distribution of blood, the rapidity of flow, and the formation of the blood, is shown as follows : in acceleration of the heart-action with gradual decrease of contractility on account of the change in structure, fatty degeneration of muscle in this oi'gan, through the continual use of spirituous drinks ; in the retarding of the blood-flow and decrease of blood-pi'essure, which depends on a change of structure of the blood vessels and on a similar change of the nerve elements of the brain, spinal cord, and heart. The composition of the blood undergoes a change under the influence of ethyl-alcohol which makes itself evident in the disturbed gas exchange in the organs, and in changes of the respiration. 8th. A structural change doubtless also takes place in the nerve-cells of the heart, of the retina, and of the brain, as a consequence of the continued effect of ethyl-alcohol. PHYSIOLOGICAL INSTRUCTION, 81 The diminution of the visual power caused by alcohol ap- pears in both eyes at once and with equal strength. With this is noticed a peculiar characteristic affection of color-perception for red and green light : all objects of these colors seem more or less intensely gray. This change in color-perception is one of the first symptoms of alcohol-poisoning : a further symptom of such an affection is the weakening of the power of accom- modation. In animals the influence of ethyl and amyl-alcohol upon the retina is shown in the degeneration of the nerve-fibres. 9th. Spirituous drinks predispose mankind to various ill- nesses. 10th. The use of spirits appears from a social and moral point to be extremely momentous. It lays the foundation for pauperism, insanity, and various crimes. 11th. A decidedly restricted sale of spirits, the prosecution of adulteration, the founding of hospitals for the care of alcohol-victims, — all these are desirable and certainly useful, but cannot binder the development of the propensity to use spirituous drinks. 12th. The effort to check the propensity to the use of al- cohol, to root out the passion for drink, is most assuredly no Utopian project. It lies within the limits of possibility. The inner consciousness provides the only means to this end, — a firm will, a strong character, — and is maintained only through a correctly guided education from earliest childhood. 13th. There can be no doubt about the influence of parents and the educators of youth upon the develojjment of character and will. 14th. An intelligent teaching of the injurious effect of al- cohol introduced in the schools would be very desirable and extremely advantageous ; indeed, therein lies the only way by which the development of the inclination for the use of alcohol can be combated. 15th. Such instruction as to the terrible effects of spirituous drinks could be given to young children by intelligent, cultivated women ; to youths of somewhat riper years by experienced pedagogues and persons who have made a specialty of re- searches into the physiological action of alcohol and spirituous drinks. 82 THE LIQUOR PROBLEM. 16th. As means for the forming as well as the improvement of character, and as most important influences against the habitual use of spirituous drinks, the following agencies deserve consideration : music, singing, various games and excursions, and finally traveling, — because these offer an entire diversion, acquaint one with his country, and with nature, etc. Inclosed I send you my article in Russian, " Spirituous Drinks as Predisposing Sources of Various Illnesses of Man- kind." This has been recommended by our clergy for the libraries of the middle-grade schools, seminaries, and institutes. I send you also my research " On the Influence of Music upon Men and Animals," in Russian. J. Rich. Ewald, Strassburg, December 13, 1898. (Translation.) The circular which you so kindly sent me contained nothing at variance with my opinion, and I would gladly have pleased you by signing it if I were not on principle in favor of the most stringent I'estrictions upon alcohol-drinking. Certainly, in small doses, alcohol is not harmful, but, as experience teaches, it very rarely stops at these small quantities, and we daily see the saddest consequences of excessive drinking of alcohol. Because tempei-ance is scoffed at, much drinking and drinking too much will be encouraged in every way, and in a certain sense will be rewarded. Since, therefore, a reaction against alcohol has at last set in, and the state, as well as so- ciety, is making a move against alcohol, it seems to me that this is an extraordinarily important advance from an ethical as well as purely practical point of view, and I would like to see it encouraged under all circumstances, even at the risk of over- stepping the mark in the first zeal and of giving up the small advantages which, under certain circumstances, alcohol may possess. Professor Sigm. Exnbr, Vienna, November 23, 1 898. (Translation.) As you see, I have signed your circular. I should have been more in sympathy with it, however, if the suggestion of using alcohol as a nutriment had been left out. For this purpose it is too expensive (combustion warmth in comparison with that of the material from which it is made) and too dangerous. Aside from this, I am in entire sympathy with your under- taking. PHYSIOLOGICAL INSTRUCTION. S3 A. P^CK, Wurzburg, November 3, 1897. (Translation.) From your valued letter dated October 4, 1897, I see that you have my little article upon the alcohol question. I know uothing essential to add to what is therein said with regard to the physiological action of alcohol. A publication of Ziehen's on the action of alcohol came to my notice a short time ago, but as it is not at hand just at this moment, I cannot give an exact reply to it. However, in Ziehen's article, as nearly as 1 can re- member, not a single indisputable argument for the usefulness of alcohol is brought forward. At most, I could agree with Ziehen that alcohol in the smallest possible amounts is not harmful to the health. Upon this subject I have already ex- pressed my views in my report on the alcohol question. In the mean time, there has also appeared an investigation by Frey in Bern, which is much discussed, and in which he claims that alcohol will strengthen fatigued muscle. It is my convic- tion that the apparent strengthening in Frey's experiments rests entirely on suggestion, of the jjowerful effect of which I have convinced mj'self in similar experiments. To your second Question I have to answer that I consider instruction upon the effects of alcohol very advantageous. I believe that this instruction must lay special stress upon the undeniable truth that alcohol is under no conditions and in no amount beneficial to the healthy body. Whether alcohol can act beneficially under morbid conditions of the body I do not consider proven. Naturally, I cannot pass judgment upon this question from my own experience. Professor A. Forel, Burgholzli, October 25, 1897. (Translation.) In my opinion the question of the value of alcohol as nour- ishment, stimulant, and particularly as part of the human diet, has been completely settled. Alcohol is a poison and not a food. Its claim to be of value in economizing the use of other food has been refuted thoroughly by Dr. Miura in von Noor- den's laboratory. But, even if there were anything in this idea, to the unbiased man of science it must be obvious that a sub- stance which in large doses causes such frightful toxic phe- nomena in all the organs as does alcohol (brain, liver, heart, etc.) excites the gravest suspicion that when, in small doses, it 84 THE LIQUOR PROBLEM. diminishes proteid metabolism, it does this at the cost of the normal functions and normal structure of our tissue. When one considei's objectively, and without prejudice, the ravages caused by alcohol-drinking, in the way of crime, death, suicide, physical and mental illnesses, hereditary malformations and degeneracies, it seeins utterly insane that humanity could use such a substance as an article of food and a relish. This only goes to prove that the primitive man, like the higher forms of monkey and pithecanthropi, was on the one hand excessively inquisitive and on the other hand quite scientific. They dis- covered fermentation, experimented with fermented liquors, found their narcotic properties agreeable, and, without further thought, the habit of alcohol-drinking was adojjted and con- firmed in the course of centuries. So long as the knowledge of primitive men taught them to produce fermented drinks only in small quantities, and did not show them how to store these products in large amounts, the evil remained comparatively localized, and could not threaten the progress of humanity, as it does to-day, when alcohol, produced in a thousand ways and extremely cheaply, brings in question the endurance of our race on the earth. The i^rejudice maintained for centuries through poetry, my- thology, religion, and history has rooted itself so deeply that it blinds men, and, unfortunately, medicine and science are also held captive by this prejudice. It is with this as it was with the pi-ejudice in favor of slavery in your country fifty years ago. This explains the tremendous difficulty in obtaining scientific moderation in judging the ques- tion of the use of alcohol. You would i-idicule me if I should put the question to you in aU earnestness if we ought not to introduce arsenic, atropia, or codeine as food or stimulant or relish in our daily diet, and yet scientifically regarded and used in dilute doses it comes to the same thing. I especially recom- mend to you the study of the recent experiments of Smith- Fiihrer, Aschaffenburg, and others in the laboratory of Pro- fessor Kraepelin at Heidelberg, upon the effect of small doses of alcohol on the mental activity, as well as those of Professor Destree (professor in the University at Brussels, rue de la Regence 41) upon the effect of alcohol on muscle-strength. From all these experiments it is clear that alcohol — in small PHYSIOLOGICAL INSTRUCTION. 85 as well as in large doses — paralyzes and disturbs the activity of the muscles as well as the concentration and the correctness of thought. Even 7-10 gr. is sufficient for this, and a certain brief stimulation of the motor apparatus is to be regarded as a reflex phenomenon due to nerve injui'y and not as an indication of increased power. I advise you to get the book by Destree as well as the Heidelberg works. You will not require me to describe alcoholic psychoses, alco- holic fatty heart, liver cirrhosis, — every physician understands them sufficiently ; allow me to say, however, that the social effect of wine and of beer, the mental enjoyment of society, is nothing else than intoxication of the brain. Through pure pre- judice this is commonly forgotten, and yet it is quite obvious. I hardly know what points shoidd be mentioned as " not yet sufficiently determined." The defenders of alcohol-drinking are not in a position to state a single reasonable ground which could be maintained against a serious scientific criticism. Their whole argument rests upon fashion and public opinion. I re- capitulate my views in the words that alcohol in all forms and doses is a poisonous substance which disturbs the human organ- ism and its functions, is extremely dangerous and injurious to individuals and to society, possesses not the slightest usefulness, and therefore should be absolutely excluded from human diet. Of course it is quite a different thing with regard to the use of alcohol as a medicine, for we have the right to temporarily employ poisons. Still, even here a monstrous abuse is prac- ticed, and the indications for the use of alcohol are very lim- ited : it almost never happens that I use it, for even a stimu- lating effect is problematical to my mind, because it is followed much too quickly bj- paralysis and depression. It goes without saying that alcohol is very useful in the arts as a preserving medium ; this question, however, does not come into consideration. For the sake of simplicity I send you with this letter in a newspaper wrapper my point of view and that of my col- leagues as expressed in some extracts from the " International Monatschrift zur Bekiimpfung der Trinksitten," published on the occasion of the founding of our German Temperance Medical Association. From these you can see our point of view still more clearly. 86 THE LIQUOR PROBLEM. The second question is more difficult for me to answer be- cause, unfortunately, central Europe is still inexperienced in this matter, and it is not scientific to theorize a priori upon matters which have not yet been tested. It seems to us urgently necessary that temperance shall begin in youth, for it is much easier not to take up a bad habit than it is to free one's self from an old habit. On that account we are very much in favor of total abstinence societies for the young, and up to the present time have had very good results. Mr. Denis has written a temperance manual for our youth (for sale at the agency of the Blue Cross in Bern) which seems to me very good. I think it is necessary that the young should be thor- oughly informed about this terrible destroyer of nations. On the other hand, it appears to me injudicious in treating of other sciences, such as anatomy and physiology, to treat these sciences from an anti-alcoholic standpoint. One ought as little to teach a religious or catholic anatomy or physiology, as to drag the anti- alcohol movement in where it has nothing to do with the sub- ject. I think that in this respect in America somewhat unwise methods have been adopted. It is only in connection with hygiene and chemical physiology that an energetic chapter on alcohol should be introduced, warning against the use of alcohol and stating clearly and scientifically the arguments for this point of view. I believe, so far as I can judge without any practical experience, that this would be the right way to in- struct the young on this subject. My humble opinion is there- fore briefly this : an anti-alcohol instruction is at this time needed, but this should not be connected with the other subjects of instruction except in so far as the alcohol question belongs to them. I hope, honored colleague, that I have conscientiously an- swered your questions according to the best knowledge. For me there is only one way to obviate the alcohol misery, and that is the complete withdrawal from human diet of all drinks con- taining alcohol. Professor J. Gaule, Pegli, near Genoa, October 27, 1897. (Translation.) I am greatly pleased with the intention of the Committee of Fifty to obtain the opinions of physiologists on alcohol, and am PHYSIOLOGICAL INSTRUCTION. 87 very glad to express my own. I value alcohol neither as a food nor as a relish. As a nutriment the calories contained in it cost too much and it has too many disagreeable results. Be- sides, it is possible, as the works of Kubner and Miura seem to prove, that this heat-production causes exactly the same amount of outgo as o£ income in the organism, and so no advantage is gained. Alcohol is not to be considered as a relish because it has very disagreeable after effects upon the organic cells. In this connection former observations are to be brought into pro- minence, — upon the production of catarrh of the bowels, af- fections of the liver, and of the central nervous system. Not less important are the more recent views upon the condition of the organs of circulation, resulting from excessive drinking of diluted alcohol (Munich Bier), the changes of the individual cells, particularly the germ cells, as brought to our knowledge by Raffael Dubois, and the influence of alcohol upon living cells (Overton). We must also pay attention to the influence of alcohol upon the rapidity of the various reactions of the nervous system as investigated by Smith and Fiihrer in Krae- pelin's Laboratory, and to the plasticity of the entire nervous system under the influence of small regiUar doses during growth, investigated by Hodge and others. These should all be brought to the knowledge of the growing generation. I must decline to speak of alcohol as a means of cure, as medicine, for that lies beyond my province as a physiologist. I must also say that I do not know at what age one can best begin to teach young people about alcohol. For that, the experience of a public school-teacher is necessary, and I do not possess this. It seems to me, however, that one must be careful not to produce a sur- feit of this theme. Professor Paul Heger, Brussels, December 24, 1898. (Translation.) I am sending you with this letter three copies of the syllabus of a popular course I have given this year. You will find on page 22 and in what follows the exact expression of my thought relative to the question on the subject of which you have de- sired my opinion. " It would be wrong to exclude beer and wine from a dietary under the pretext that these drinks contain alcohol : it is a well observed fact that alcoholism makes less ravages in countries. 88 THE LIQUOR PROBLEM. such as Norway, where the consumption of beer is very wide- spread, or Italy, which produces a great deal of wine, than in countries like ours, where alcohol is furnished cheaply to the poorer classes. " That which makes it necessary to prohibit anything is its abuse. With regard to alcohol and strong alcoholic drinks, it is necessary to absolutely prohibit them from food : the nutri- tive properties of alcohol are very uncertain, while the intoxi- cant properties are very evident." I agree entirely with the opinion of those physiologists who refuse to interdict the use of beer or wine : to prohibit beer because it contains a small dose of a poison which is called al- cohol would lead us in the name of pitiless logic to also prohibit tea because it contains a certain amount of poison, theine ; to prohibit coffee, which contains cafeine ; to prohibit even meat itself, which undeniably contains organic poisons. I only regret that the statement which you have submitted to me does not affirm at the same time the harmlessness of drinks containing small projaortions of alcohol and the harm- fulness of strong alcoholic drinks. Pure alcohol is injurious ; alcoholism is a horrible evil. I would like this not to be for- gotten when anything on this subject is said in the name of physiology. It is in these terms and with this sole reservation that I send you the expression of my assent. Professor H. Kronecker, Bern. (Translation.) I have still to thank you for your October letter in which, on behalf of the Committee of Fifty, you desire to know my ex- perience and view with regard to the influence of alcohol on the animal organism. You have the two works on this subject which were done under my direction : — In that of McGregor Robertson, " On the Effect of Ether on the Heart of the Frog " (Verhandlung der Physiol. Gesellschaft, Berlin, March, 1881, reprinted in du Bois-Reymond's Archiv of 1881) we furnished, in the essentials, the demonstration, which I believe important for the alcohol question, that the concentration, not the absolute quantity, of the ether determines PHYSIOLOGICAL INSTRUCTION. 89 its action. A one per cent, solution (in the blood) has always a stimulating action upon the frog's heart (increasing the fre- quency of pulsation) ; a two per cent, solution has a paralyzing effect even at the beginning of its action. In connection with given doses of alcohol whose effect upon vegetable and animal life of dogs Hodge has investigated with so much patience and skill, it would be interesting to consider also the degree of dilution in which the alcohol is administered. Hodge says (p. 11 of his excellent paper), " 6 c. c. alcohol in 405?) solution, and mixed with their hreakfast.^' This causes an additional dilution of uncertain amount. I remember very well in my student days at Leipzig that the " early cup " ^ is the most dangerous, while the a-vft-Troaiov after the Suttvov, as was cus- tomary among the Greeks, does not as easily intoxicate. There- fore the unadulterated light wines of 6-8fo alcohol can be taken in large amounts, while Italian, Spanish, and Greek wines, con- taining 20-21^ of spirit, come nearer to the distilled liquors of SO-SOji alcohol. The harmful effect of Bavarian beer, which contains only S-^fo alcohol (Heidelberg beer scarcely 2^) is really chiefly due to the quantity of liquid with which the body is filled. Oertel and Sch Wenninger (Bismarck's physician) have in- deed made wonderful cures by stopping the drinking of water. Milk is also considered dangerous in these days (Runipf) in diseases of the circulatory S3'stem because it contains too much water and lime. I believe that the pernicious effects of alcohol proceed more from the substances mixed with it (absinthe, fusel oil, etc.), and from the immoderate drinking of concen- trated solutions in badly ventilated rooms where frequently the entire atmosphere is saturated with alcohol fumes and tobacco smoke. It has filled me with astonishment that the movement against alcohol drinking could assume such large proportions amongst your nation, — which is free from prejudice. I was quite shocked when I read in Hodge's letter (of September 28) which he wrote at the request of the Committee of Fifty, that in the primary and middle grades every child from six to seventeen ' That is, alcohol on a comparatively empty stomach. 90 THE LIQUOR PROBLEM. years is instructed 250 hours in the physiology of alcohol. If I were to teach this subject five hours I should know of nothing more to say and should probably be discharged by the authori- ties as a stupid teacher. I consider that such narrow-minded methods of combat breed fanaticism. Wine-drinking is forbidden among the Moham- medans, and the Arabs have shown unquestionable moral vir- tue, bravery, shrewdness, inventive skill in technique, art, and science, but they have been utterly beaten at every point by the wine-drinking nations of the West. What great things have our apostles of abstinence accom- plished in comparison with the great friends of wine such as Byron, Goethe, Bismarck? Helmholz and Ludwig were also friends of a good drop. The Mohammedans make up for their deprivation of wine by the use of haschish and opium. Modern abstainers would take up morphine injections, cocaine, and other excitants, whereby maniifacturers of chemicals would gladly enrich themselves at the expense of the vineyard owner and the beer brewer. Let tobacco be given up, which ruins so many hearts and brains ; strong tea and coffee, which contain known poisons ; then let the sexual impidse be controlled, — the source of the most blighting diseases and weaknesses ; and all the moral errors, — race hatred, party passion, class prejudice, greed, purse-pride, etc. It is not by the prohibition of one or another error, but by the example of model lives that human happiness is to be secured. Professor W. KtfHNE, Heidelberg, December 16, 1898. (Translation.) I certainly agree with the first paragraph of the translation of your communication, but not with the second. For according to my view the oxidation of a substance in the animal body does not determine its injurious or its useful effect, just as, inversely, many a substance may be useful to life without contributing di- rectly to the jjroduction of kinetic energy. Indeed, I consider the second paragraph dangerous, as you will be understood to consider alcohol as a food and to recommend it as such. . . . If I am, as your letter permits, to express my views on the PHYSIOLOGICAL INSTRUCTION. 91 alcohol question in my own way, I must base my opinion only upon general experience which I do not find to be contradicted by any physiological or medical facts. Alcohol is one of the many stimulants or relishes discovered by man accidentally and used by him for ages empirically be- cause without these aids he simply cannot live. Judging from the bad results obtained from the most nourish- ing but tasteless prison fare, which, regarded simply as a food mixture is evidently far better than the food of so many free laborers, one cannot doubt that even the most perfect nutrition is insufficient without the assistance of some relish. But all these relishes which are necessary, even if the fare consists prin- cipally of meat, are harmful when taken in large doses. This can be affirmed even in the case of common salt and especially of all spices, coffee, tea, tobacco, etc., and yet no race does without them unless indeed for religious reasons, when the one takes the place of the other. When one sees how many normal, hard-working people ar- rive at a ripe age while using these stimulants with discretion, among which I include the moderate use of alcohol, one does not find good reasons for total abstinence. There is only one exception to be made, which, however, ap- plies not only to alcohol but also to other stimulants, i. e., the prohibition of its use to children and to adolescents. Certainly one should oppose the misuse of stimulants, but I do not think that it can be abolished by treating and judging the moderate and immoderate uses alike. Abuse and use are opposites. Much more could be said on the subject, but I think the pre- ceding wiU suffice, especially as you will have received many exhaustive treatises from other sources. Professor Ce. Eichet, Paris, France. (Translation.) In response to your letter here are some points relative to the physiology of alcohol which appear to me well and firmly es- tablished : — 1st. The use of alcohol is absolutely pernicious to young chil- dren : it is always injurious, but most particularly so for children less than fifteen to eighteen years of age. 2d. It has a bad effect upon the gastric digestion : where alcohol is used there is no more good digestion. People afflicted with dyspepsia have been cured by abstaining from alcohol. 92 THE LIQUOR PROBLEM 3d. It is believed that it gives strength, but this is a singu- lar illusion. It reduces muscular strength. The most vigorous workmen are those who do not take alcohol. 4th. The least dangerous alcohol is the alcohol of wine (C2HGO), or ethyl alcohol. Unadulterated wine (which is very rare) is without much of a disturbing element, though al- ways injurious even in small amounts. All other alcohols con- tained in alcoholic drinks (whiskey, gin, rum, brandy, kirsch, bitters, vermouth) are very intoxicant ; in equal quantity 3, 4, 5, or even 10 times more intoxicant than ethyl alcohol. In wine thei-e are very apt to be these intoxicant alcohols, as alco- hol made from grain is added to wine to keep it. 5th. Absinthe is the worst intoxicant of all, one of the most dreadful poisons known. I demonstrate in my course that one can give 500 times more absolute ethyl alcohol, very pure and highly rectified, than of absinthe. One or two drops of essence of absinthe produce terrible convulsions. 6th. Insanity, suicide, affections of the nervous system, follow a line exactly parallel to the consumption of alcohol. 7th. Alcohol, though an active poison, is an admirable medi- cine in certain cases. Those who are addicted to the use and abuse of alcohol cannot when they are unwell profit by the ad- vantages of its medicinal power. 8th. Two litters of dogs have been raised, some with alcohol and some without. At the end of a month the alcoholized pups were miserable and dying, the others were in perfect condi- tion. 9th. It is not yet known certainly whether alcohol burns in the organism or whether it is eliminated in breathing under the form of vapor of alcohol by the lungs, or of acetone or of ace- tate or of alcohol by the kidneys. This is a point demanding new investigations. In very small quantities it stimulates nu- trition, but a medium amount arrests it. I do not believe that this stimulation of the nutrition is a good thing. 10th. With regard to instruction in schools for children and youth, certainly an understanding of the dangerous quality of alcohol is of advantage ; but I imagine that the real remedy does not lie in that direction, and that society should defend it- self by prohibition or at least by an increase of the tax in such away that only the very rich could afford to be alcohol drinkers. PHYSIOLOGICAL INSTRUCTION. 93 Professor C. von Voit, Munich, December 11, 1898. (Translation.) You were so kind as to inform me of a movement which aims to calm the exaggerated agitation of the temperance question as well as to contradict certain unfounded physiological asser- tions. Many of the physiologists who were present at the In- ternational Physiological Congress in Cambridge have signed this document, and I should gladly also have done so had I agreed with certain of the less important points. I agree with you in the opinion that a moderate use of light alcoholic bever- ages, as for instance beer, is not injurious to health. I deem it therefore an exaggeration which may often lead to hypocrisy and to other bad results if the use of alcoholic beverages even in moderate quantities is prohibited. The same can be said of so many other articles whose use when exaggerated becomes in- jurious ; it is only this misuse which should be prevented. I agree to and indorse the first part of the paragraph which says : " The physiological effects of alcohol when consumed in diluted form and in small quantities have, notwithstanding the contin- uous researches of the last few years, as yet not been satisfac- torily demonstrated. Much remains still to be investigated in this matter." I do not, however, agree with the second part, as I consider that the views therein expressed have as yet not been clearly proved. It is here quite rightly said that alcohol is oxi- dized in the body, and that during this process it is changed into energy the same as other nutriments ; but if in consequence of this we assert that it is physiologically wrong to call alcohol a poison, i. e., a substance that can never have useful but only dangerous effects, we then claim something that has as yet not been strictly proved. A substance may be consumed by the body and liberate energy and yet be harmful. I am not of the opinion that alcohol consumed in the aforesaid quantities is only a poison with dangerous effects, but I know not as yet whether or not it is useful to the healthy organism, — for it might be possible that alcohol is consumed and produces energy, i. e., heat, but that this heat leaves the body by causing the blood vessels of the skin to expand. As to the third paragraph, I agree to it with the exception of the last five words, for I do not believe that healthy persons can find that the use of alcohol benefits them. I should, however, not object to the third para- 94 THE LIQUOR PROBLEM. graph if in it were said : " Judging from a purely physiological point no exact result can be mentioned which would oppose the views which many persons have drawn from their daily expe- rience, namely, that alcohol consumed in the aforesaid manner injures their health." I drink beer,not on account of the alco- hol it contains, which I could do without, but because I like its taste and because it quenches thirst in an agreeable manner. APPENDIX II. In the following pages will be found the Temperance Educa- tion Laws of the various States of the Union and the law of Congress ajjplicable to the Territories, the District of Columbia, and the special schools under the charge of the United States government. For the States of Illinois and New York two laws are given, passed at different dates, showing how the Woman's Christian Temperance Union has been successful in substituting special and stringent legislation for the general provisions of the earlier laws. For the States of Connecticut and New Jersey two laws are also given (the more recent ones passed since this Report was prepared), showing that a reaction against such stringent legislation has begun. This law may be regarded as the result of a compromise between the teaching profession and the total abstinence associations. These laws are followed by a " comparative table of requirements of Scien- tific Temperance Laws " and by copies of the bills brouglit be- fore the Committee on Education of the Massachusetts legis- lature in 1899, together with the letters used in the canvass of the schools as described in the Report. UOTTED STATES. 24 Statutes at Large, page 69. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled : — Sec. 1. That the nature of alcoholic drinks and narcotics, and special instruction as to their effects upon the human system, in con- nection with the several divisions on the subject of pliysiology and hygiene, shall be included in the branches of study taught in the com- mon or public schools, and in the military and naval schools, and shall be studied and taught as thoroughly and in the same manner as other like required branches are in said schools, by the use of text-book in the hands of pupils where other branches are thus studied in said schools, and by all pupils in all said schools throughout the Territories, in the miUtary and naval academies in the United States, and in the 96 THE LIQUOR PROBLEM. District of Columbia, and in all Indian and colored schools in the Territories of the United States. Sec. 2. Tliat it sliall be the duty of the proper officers in control of any school described in the foregoing section to enforce the provisions of this act; and any such officer, school director, committee, superin- tendent, or teacher who shall refuse to comply with the requirements of this act, or shall neglect or fail to make propei' provision for the in- struction required and in the manner specified by the first section of this act for all pupils in each and every school under his jurisdiction, shall be removed from office, and the vacancy filled as in other cases. Sec. 3. That no certificate shall be granted to any person to teach in the public schools of the District of Columbia or Territories, after the first day of January, Anno Domini eighteen hundred and eighty- eight, who has not passed a satisfactory examination in physiology and hygiene, with special reference to the nature and effects of alcoholic drinks and other narcotics upon the human system. Approved May 20, 1886. STATES. ALABAMA. Code of 1896. Sec. 3546. 1. Duties of the Superintendent of Education. ... 3. He shall make provision for instructing pupils in all schools and col- leges supported, in whole or in part, by public money, or under state control, in hygiene and physiology with special reference to the effects of alcoholic drinks, stimulants, and narcotics upon the human system. Sec. 3577. No certificate shall be granted hereafter to any new applicant to teach in the public schools of Alabama who has not passed a satisfactory examination in the study of the nature of alcoholic drinks and narcotics and of their effects upon the human system in connec- tion with the several divisions of physiology and hygiene. Sec. 3578. Every teacher shall give instruction as to the nature of alcoholic drinks and narcotics and their effects upon the human system, and such subjects shall be taught as regularly as any other in the pub- lic schools and in every grade thereof. [These laws in substance enacted February 4, 1891, found at page 350 of the Alabama laws of that year, amended a statute passed Feb- ruary 26, 1887, at page 129 of the annual laws.J ARKANSAS. Acts of 1899, act 52. Be it enacted by the General Assembly of the State of Arkansas : Sec. 1. That Pliysiology and Hygiene, which must in each division PHYSIOLOGICAL INSTRUCTION. 97 of the subject thereof include special reference to the effect of alco- holic drinks, stimulants, and narcotics upon the human system, shall be included in the branch of the study now and hereafter required to be regularly taught and studied by all the pupils in the common schools of this State. Sec. 2. It shall be the duty of the Boards of Directors and County Examiners to see to the observance of this statute and make provision therefor, and it is especially enjoined upon the county examiner of each county that he include in his report to the State Superintendent of Public Instruction, the manner and extent to which the requirements of section 1 of this act are complied with in the schools and institutions of the county. Sec. 3. After two years from the passage of this act no license shall be gi-anted to any person to teach in the public schools of this State who has not passed a satisfactory examination in Physiology and Hygiene witii special reference to the effect of alcoholic drinks, stimu- lants, and narcotics upon the human system. Sec. 4. That this act take effect and be enforced from and after the first day of July, 1899. Approved March 10, 1899. CALIPOBNIA. Act approved March 15, 1889. Statutes and Amendments, 1889, 189. Sec. 25. Section sixteen hundred and sixty-five of the Political Code is hereby amended so as to read as follows : — 1665. Instruction must be given in the following branches, in the several grades in which each may be required, viz. : . . . Elements of physiology and hygiene, with special instruction as to the nature of alcoholic drinks and narcotics and their effects upon the human sys- tem. . . . [The words after "Elements of .physiology " were first added by act approved March 15, 1887. Statutes and Amendments, 1887, 142.] Act approved March 15, 1887. Statutes and Amendments, 1887, 142. Sec. 2. Section one thousand six hundred and sixty-seven of the Political Code is hereby amended to read as follows : — 1667. Instruction must be given in all grades of public schools and in all classes during the entire school course, in manners and morals, and upon the nature of alcoholic drinks and narcotics and their effect upon the human system. 98 THE LIQUOR PROBLEM. COLORADO. 2 Mills' Annotated Statutes, pages 2125, 2126. Sec. 4043. The public schools of this State shall be taught in the English language, and the school board shall provide to have taught in such schools the branches specified in fifteen of said chapter, and such other branches of learning in other languages as they may deem expe- dient, including Hygiene with special reference to the effects of alco- holic stimulants and narcotics upon the human body. [G. L. 1877, page 835, sec. 2523 ; G. S. 1883, page 904, sec. 3073 ; as amended by L. 1887, page 401, sec. 37.] [Sec. 15. Includes physiology and the laws of health.] Sec. 4046. That the nature of alcoholic drinks and narcotics and spe- cial instructions as to their efllects upon the human system, in connection with the several divisions of the subject of physiology and hygiene, shall be included in the branches of study taught in the public schools of the State, and shall be studied and taught as thoroughly and in the same manner as other like required branches are in said schools, by the use of text-books, designated by the board of directors of the re- spective school districts, in the hands of pupils where other branches are thus studied in said schools, and by all pupils in all said schools throughout the State. Sec. 4047. That it shall be the duty of the proper officers, in control of any school, described in the foregoing section, to enforce the provi- sions of this act ; and any such oflicer, school director, committee, su- perintendent, or teacher, who shall refuse, fail, or neglect to comply with the requirements of this act, or shall neglect, refuse, or fail to make proper provisions for the instruction required, and in the manner specified by the first section of this act, for all pupils in each and every school under his or her jurisdiction, shall be removed from office, and the vacancy filled as in other cases. [The last two sections were an act approved April 4, 1887. Laws of 1887, 378.] CONNECTICUT. Connecticut Laws, 1893, ch. 157, sec. 5, repealed sections 2100 and 2141 of the General Statutes of 1888. Sec. 2100 is ch. 139, and sec. 2141 is ch. 116 of the laws of 1886. The 1893 law provides that : — Sec. 1. The nature of alcoholic drinks and narcotics, and special instruction as to their effect on the human system, in connection with the several divisions of the subject of physiology and hygiene, shall be included in the branches of study taught in the common or public schools, and shall be studied and taught as other like required branches, PHYSIOLOGICAL INSTRUCTION. 99 by the use of graded text-books in the hands of pupils where other branches are thus studied, and orally in the case of pupils unable to read, and by all pupils in all schools supported wholly or in part by public money. Sec. 2. The text-books used for the instruction required by the pre- ceding section for intermediate and primary pupils shall give at least one fifth of their space to the consideration of the nature and effects of alcoholic drinks and narcotics, and the books used in the highest grade of graded schools shall contain at least twenty pages of matter relating to this subject ; but when this subject is massed wholly or in part in a chapter or chapters at the end of a book, such book shall not be considered as meeting the requirements of this law. Act approved May 29, 1901. Public Acts, 1901, ch. 81. Sec. 1. The effects of alcohol and narcotics on health, and espe- cially on character, shall be taught in connection with hygiene, as a regular branch of study, to all pupils above the third grade in all graded public schools, except public high schools. Sec. 2. Suitable text-books of physiology and hygiene, which ex- plain the effects of alcohol and narcotics on the human system, shall be used in grades above the fifth in all graded public schools, except public high schools. Sec. 3. The provisions of sections one and two of this act shall ap- ply, in ungraded public schools, to classes corresponding to the grades designated in said sections. Sec. 4. All normal schools and teachers' training schools shall give instruction in the subjects prescribed in section one of this act, and in the best methods of teaching such subjects. Sec. 5. No certificate to teach in grades above the third shall be granted to any person who has not passed a satisfactory examination in the subjects prescribed in section one of this act. Sec. 6. If it shall be satisfactorily proven to the comptroller that any town or district, having pupils above the third grade, has failed to meet the requirements of this act, such failure shall be deemed suf- ficient cause for withholding, in whole or in part, school dividends which such town or district would be entitled to receive. Sec. 7. Chapter clvii. of the Public Acts of 1893, and sections 2100 and 2141 of the General Statutes, are hereby repealed. DELAWARE. Act approved May 12, 1898. Laws of 1898, ch. 67. Sec. IG. It shall be the further duty of each of said committees and Boards of Education to see that all the pupils in all the free schools in the district are instructed in physiology and hygiene, with special refer- 100 THE LIQUOR PROBLEM. ence to the efEects of alcoholic drinks, stimulants, and narcotics on the human system, and to see that all the said schools are sufficiently sup- plied with such text-books relating to such subjects as are furnished the district in the distribution of free text-books hereinafter provided. Any teacher in any of the free schools of the State, failing to so in- struct any pupils under his governance, shall, unless ordered to the contrary by a school officer having authority over him, be liable to a fine of twenty-five dollars, to be recovered before any justice of the peace of the proper county by any informer, and any school officer ordering a teacher under him not to instruct pupils as aforesaid shall be liable to light fine, recoverable as aforesaid by any informer. [An earlier law was passed April 12, 1887, found in vol. 18, ch. 69 of the Laws of Delaware, and amended in 1893 at 347 of the laws of that year.] FLORIDA. Revised Statutes, sec. 242. Each board of public institution is directed — ... tenth. To prescribe, in consultation with prominent teachers, a course of study for the schools of the county and grade them properly ; and to require to be taught in every public school in the county over which they preside, elementary physiology, especially as it relates to the efEects of alcoholic stimulants and narcotics, morally, mentally, and physically ; and all persons applying for certificates to teach shall be examined upon this branch of the study, under the same conditions that other branches require by law. [Law enacted June 8, 1889.] GEORGIA. This is the only State having no law on the subject. Act approved February 17, 1899. Session Laws, 1899, page 306. Sec. 8. Teacher's Certificates — Qualifications — Signatures. He shall grant certificates to teachers in such form as the state superin- tendent of public instruction shall prescribe, and to those persons only who shall have attained the age of eighteen years, who have attended the said public examination, and shall be found to possess good moral character, thorough scholarship, and the ability to instruct and govern a school ; but no certificate shall be granted to any person who shall not pass a satisfactory examination in orthography, reading, writing, grammar, arithmetic, geography, history of the U. S., civil govern- ment, physiology, and hygiene, with particular reference to the effects of alcoholic drinks, stimulants, and narcotics upon the human PHYSIOLOGICAL INSTRUCTION. 101 system, theory and Dractice of teaching, state constitution, and so much of the general school laws as relates to the duties and responsi- bihties of teaching. All certificates shall be signed by the county superintendent, and no person shall be considered a qualified teacher within the meaning of the school law. who has not a certificate granted by the said superintendent or other legal authority. Pro- vided : That all examination questions shall have been prepared as prescribed by law, furnislied under seal, and opened before the appli- cants for certificates on the day of examination. Provided : That first grade certificates shall be granted to all applicants who are otherwise qualified according to law, and who shall have passed all the branches required in this section, and algebra in addition thereto, with a general average of not less than ninety per cent., and with a minimum of not less than seventy-five per cent, in any branch, and all applicants who are otherwise qualified according to law shall be granted second grade certificates who shall have attained a general average of eighty per cent., and a minimum in any branch of not less than seventy per cent., and third grade certificates shall be granted to all applicants who are otherwise qualified according to law, who shall have attained a general average of seventy-five per cent., and a mini- mum in any branch of not less than sixty per cent. Provided, fur- ther: That each applicant for teacher's certificate under the provisions of this act shall pay the county superintendent the sum of one dollar, the same to be deposited by him in the county treasury to the credit of the institute fund, to be used in institute work in addition to the regular appropriation. ILLINOIS. Act approved June 1, 1889. Laws of 1889, page 345. 1. Be it enacted by the people of the State of Illinois, represented in the General Assembly : that the proper legal school authorities shall have power, and it shall be their duty, to have all pupils of suitable age in schools of Illinois, supported by public money or under state control, instructed in physiology and hygiene, with special reference to the effects of alcoholic beverages, stinmlants, and narcotics on the human sj'stem. 2. No certificate shall be granted to any person to teach in the public schools of Illinois after July, 1890, who has not passed a satis- factory examination in physiology and hygiene, with special reference to the effects of alcoholic beverages, stimulants, and narcotics on the human system. 102 THE LIQUOR PROBLEM. Act approved June 9, 1897. Laws of 1897, 294 (Kurd's Revised Statutes, 1899, sees. 362, 363). Sec. 1. Be it enacted by the people of the State of Illinois, repre- sented in the General Assembly : that " an act relating to the study of physiology and hygiene in the public schools : " approved June 1, 1889, in force July 1, 1889, be amended so as to read as follows : — That the nature of alcoholic drinks and other narcotics and their effects on the human system shall be taught in connection with the various divisions of physiology and hygiene as thoroughly as are other branches in all schools under state control, or supported wholly or in part by public money, and also in all schools connected with reform- atory institutions. All pupils in the above-mentioned schools below the second year of the high school and above the third year of school work, computing from the beginning from the lowest primary year, or in corresponding classes of ungraded schools, shall be taught and shall study this sub- ject every year from suitable text-books in the hands of all pupils, for not less than four lessons a week for ten or more weeks of each year, and must pass the same tests in this as in other studies. In all schools above mentioned all pupils in the lowest three primary years, or in corresponding classes in ungraded schools, shall each year be instructed in this subject orally for not less than three lessons a week for ten weeks in each year, by teachers using text-books adapted for such oral instruction as a guide and standard. The local school authorities shall provide needed facilities and defi- nite time and place for this branch in the regular course of study. Tlie text-books in the pupils' hands shall be graded to the capacities of the fourth year, intermediate, grammar, and high schools pupils, or to corresponding classes as found in ungraded schools. For students below high school grade such text-books shall give at least one fifth their space, and for students of high school grade shall give not less than twenty pages to the nature and effects of alcoholic drinks and other narcotics. The pages on this subject, in a separate chapter at the end of the book, shall not be counted in determining the minimum. Sec. 2. In all normal schools, teachers' training classes, and teachers' institutes, adequate time and attention shall be given to instruction in the best methods of teaching this branch, and no teacher shall be licensed who has not passed a satisfactory examination in this subject and the best method of teaching it. Any school officer or officers who shall neglect or fail to comply with the provisions of this act shall forfeit and pay for each offense the sum of not less than five dollars nor more than twenty-five dollars. PHYSIOLOGICAL INSTRUCTION. 103 Act approved March 14, 1895. Laws of 1895, page 375 (Burns' Annotated Statutes, Kevision of 1901, sees. 5984a, 5984b, and 5984c). 1. The nature of alcoholic drinks and narcotics and their effects on the human system in connection v^ith the subject of physiology and hygiene, shall be included in brandies to be regularly taught in the common schools of the State and in all educational institutions sup- ported wholly or in part by money received from the State ; and it shall be the duty of the Boards of Education and boards of such educa- tional institutions, the township trustees, the Board of School Trustees, of the several cities and towns in this State to make provisions for such instruction in the schools and institutions under their jurisdiction, and to adopt such methods as shall adapt the same to the capacity of the pupils in the various grades therein ; but it shall be deemed a sufficient compliance with the requirements of this section if provision be made for such instruction orally only, and without the use of text-books by the pupils. 2. No certificate shall be granted to any person on or after the first day of July, 1895, to teach in a common school or in any educational institution supported as aforesaid, who does not pass a satisfactory ex- amination as to the nature of alcoholic drinks and narcotics and their effects upon the human system. 3. Any superintendent or principal of, or teacher in any common school or educational institution supported as aforesaid, who willfully refuses or neglects to give the instruction required by this act shall be dismissed from his or her employment. Iowa Code, 1897. Sec. 2677. Physiology and hygiene shall be included in the branches of study regularly taught to and studied by all pupils in the school, and special reference shall be made to the eSect of alcoholic drinks, stimulants, and narcotics upon the human system, and the board of trustees shall provide the means for the enforcement of the provisions under this section and see that they are obeyed. Sec. 2736. The examinations shall include competency in and ability to teach orthography, and physiology and hygiene, which latter, in each division of the subject, shall include special reference to the effects of alcohol, stimulants, and narcotics upon the human system. Candi- dates for examination in special studies need be examined in such branches only ; but no special teacher shall be employed to teach any 104 THE LIQUOR PEOBLEM. study not included in the certificate. A record shall be kept of all examinations made, and the names, ages, and residences, with the date and result thereof. See. 2737. The superintendent shall revoke the certificate of any teacher who shall fail or neglect to comply with the provisions of law relating to the teaching of physiology and hygiene, and such teachers shall be disqualified for teaching in any public school for one year thereafter. 26 G. A. ch. 39 ; 21 G. A. ch. 1, sec. 3. Sec. 2739. The county superintendent shall annually, on the first Tuesday in October, make a report to the superintendent of public in- struction, giving a full abstract of the several reports made to him by the secretaries and treasurers of school boards, stating the manner in and the extent to which the requirements of the law regarding in- struction in physiology and hygiene are observed, and such other matters as he may be directed by the state superintendent to include therein, or he may thiiik important in showing actual conditions of the schools in his county. Sec. 2740. The county superintendent shall see that all provisions of the school law, so far as it relates to the schools or school officers within his county, are observed and enforced, specially those relating to . . . the introduction and teaching of such divisions of physiology and hygiene as relate to the effects of alcohol, stimulants, and narcotics upon the human system, and to this end he may require the assistance of the county attorney, who shall at his request bring any action neces- sary, to enforce the law or recover penalties incurred. Sec. 2775. [The board of directors] shall require all teachers to give and all scholars to receive instruction in physiology and hygiene, which study in every division of the subject shall include the effects upon the human system of alcoholic stimulants, narcotics, and poison- ous substances. The instruction in this branch shall of its kind be as direct and specific as that given in other essential branches, and each scholar shall be required to complete a part of such study in his class or grade before being advanced to the next higher, and before being credited with having completed the study of the subject. [For prior legislation, see act approved February 17, 1886. Laws of 1886, ch. 1.] Act approved March 4, 1885. Laws of 1885, ch. 169 (General Statutes, 1897, ch. 63, § 206). Sec. 1. No certificate shall be granted to any person to teach in any of the public schools of this State after the first day of January, 1886, who has not passed a satisfactory examination in the elements PHYSIOLOGICAL INSTRUCTION. 105 of physiology and hygiene, with special reference to the effects of alco- holic stimulants and narcotics upon the human system ; and provision shall be made by the proper officers, committees, and boards for in- structing all pupils in each public school supported by public money and under state control upon the aforesaid topics. KENTUCKY. Sec. 4383, Kentucky Statutes, 1899. Act approved July 6, 1893. The instruction prescribed by the board shall embrace spelling . . . physiology and hygiene. . . . After July 1, 1893, the nature and effects of alcoholic drinks and narcotics upon the human system shall, in all schools supported wholly or in part by the State, be taught as thor- oughly as other required studies to all pupils studying physiology and hygiene as a part of this branch. LOUISIANA. Act approved July 6, 1888. Acts of 1888, No. 40. Sec. 1. Be it enacted by the general assembly of the State of Lou- isiana, that, in addition to the branches in which instruction is now given in the public schools, instruction shall also be given as to the nature of alcoholic drinks and narcotics, and special instruction as to their effects upon the human system, in connection with the several divisions of the subject of relative physiology and hygiene, and such subjects shall be taught as regularly as other branches are taught in said schools. Such instruction shall be given orally from a text-book in the hand of the teacher, to pupils who are not able to read, and shall be given by the use of text-books in the hands of the pupils in the case of those who are able to read, and such instruction shall be given as aforesaid to all pupils in all public schools in the State to all the grades until completed in the high schools. Sec. 2. Be it further enacted, etc.. That the text-book used for the instruction required to be given by the preceding section shall give at least one fourth of their space to the consideration of the nature and effects of alcoholic drinks and narcotics ; and the books used in the highest grade of graded schools shall contain at least twenty pages of matter relating to this subject. Text-books on physiology in use in the schools at the time this act takes effect, which are not in accord- ance with the requirements of this section, shall be changed for books satisfying the requirements of this section, except when previous con- tracts as to such text-books are now in force. Sec. 3. Be it further enacted, etc., Tiiat no certificate shall be granted hereafter to any new applicant to teach in the public schools of Louisiana who has not passed a satisfactory examination in the 106 THE LIQUOR PROBLEM. study of the nature of alcoholic drinks and narcotics, and of their effects upon the human system, in connection with the several divi- sions of the subject of relative physiology and hygiene. Sec. 4. Be it further enacted, etc., That each teacher of any school in this State supported wholly or in part by public money shall, before receiving any remuneration for services rendered in said capacity, file a certificate with the person by whom such payments are authorized to be made, to the effect that such teacher has faithfully complied with all the provisions of this act during the entire period for which such payment is sought and in the manner specified in this act, and no money shall be paid to any such teacher who has not filed such a certificate. Sec. 5. Be it further enacted, etc.. That this act shall take effect from and after its passage, provided that section 3, referring to exam- ination of teachers, and section 4, to the payment of teachers, shall not take effect until on and after October 1, 1890. Chapter 267 of the Public Laws of Maine of 1885, approved Feb- ruary 19, 1885. Sec. 1. Provision shall be made by the proper local school authori- ties for instructing all pupils in all schools supported by public money or under state control in physiology and hygiene, with special refer- ence to the effects of alcoholic drinks, stimulants, and narcotics upon the human system. Sec. 2. No certificate shall be granted to any person to teach in the public schools of this State after the fourth day of July, 1885, who has not passed a satisfactory examination in physiology and hygiene, with special reference to the effects of alcoholic di-inks, stimulants, and narcotics upon the human system. MARYLAND. Public General Laws, art. 77, ch. 7. Sec. 40. The nature of alcoholic drinks and narcotics with special instruction as to their effects upon the human system, in connection with the several divisions of the subject of physiology and hygiene, shall be included in the branches of study taught in the public schools, and shall be taught to and studied by all pupils whose capacity will admit of it in all departments of the public schools of the State, and in all educational institutions supported wholly or in part by money from the State ; and the said study shall be taught to and studied by said pupils in said schools as thoroughly and in the same manner as other like branches are there taught and studied, with text-books in the PHYSIOLOGICAL INSTRUCTION. 107 hands of pupils, where other like branches are thus studied ; and said text-books must be published, printed, and sold in the State of Mary- land. Sec. 41. It shall be the duty of the boards of county commissioners, and of the boards of commissioners of public schools of Baltimore City, county examiners, superintendents of public schools of Baltimore City, and boards of aU educational institutions i-eceiving aid from the State, to enforce the provisions of the preceding section. [The above is ch. 495 of the laws of 1886.] MASSACHUSETTS. Revised Laws, ch. 42. Sec. 1. . . . [The public] schools shall be taught by teachers of competent ability and good morals, and shall give instruction in . . . physiology and hygiene. ... In each of the subjects of physiology and hygiene, special instruction as to the effects of alcoholic drinks and of stimulants and narcotics on the human system shall be taught as a regular branch of study to all pupils in all schools which are supported wholly or partly by public money, except schools which are maintained solely for instruction in particular branches. [So enacted in substance in ch. 332 of the Acts of 1885.] [See Acts of 1885, ch. 332, and Acts of 1898, ch. 496, sec. 1, which superseded it.] MICHIGAN. The people of the State of Michigan enact that section 15 of chapter 3 of act No. 164 of the Public Acts of 1881, entitled "An act to revise and consolidate the laws relating to public instruction and primary schools, and to repeal all statutes contravening the provisions of this act," approved May 21, 1881, as amended by act No. 93 of the Pub- lic Acts of 1883, approved Jlay 16, 1883, be and the same is hereby amended so as to read as follows : — Sec. 15. The district board shall specify the studies to be pursued in the schools of the districts, and in addition to the branches in which instruction is now required by law to be given in the public schools of the State, instruction shall be given in physiology and hygiene, with especial reference to the nature of alcohol and narcotics and their effect upon the human system. Such instruction shall be given by the aid of text-books in the case of pupils who are able to read, and as thoroughly as in other studies j)ursued in the same school. The text- books to be used for such instruction shall give at least one fourth of their space to the consideration of the nature and eifects of alcoholic drinks, and narcotics, and the books used in the highest grade of graded 108 THE LIQUOR PROBLEM. schools shall contain, at least, twenty pages of matter relating to this subject. Text-books used in giving the foregoing instruction shall first be approved by the State Board of Education. Each school board making a selection of text-books under the provisions of this act shall make a record thereof in their proceedings, and text-books once adopted under the provisions of this !u:t shall not be changed veithin five years, except by the consent of a majority of qualified voters of the district present at an annual meeting. The district board shall require each teacher in the public schools of such district, before placing the school register in the hands of the director as provided in sec. 13 of this act, to certify therein whether or not instruction has been given in the school or grade presided over by such teacher, as required by this act, and it shall be the duty of the director of the dis- trict to file with the township clerk a certified copy of such certificate. Any school board neglecting or refusing to comply with any of the provisions of this act shall be subject to fine or forfeiture, the same as neglect of any other duty pertaining to their office. This act shall apply to all schools in the State, including schools in cities or villages, whether incorporated under special charter or under the general laws. [This law was approved June 9, 1887, and is act 165 of the laws of that year. It may also be found in the Compiled Laws of Michigan, 1897. Act 108, laws of 1893, approved May 24, 1893, — sections 8426-8453 of the Compiled Laws of Michigan, — provides for the or- ganization of corporations to instruct in the treatment of disease and in hygiene.] MINNESOTA. Act approved March 1, 1897. General Laws, 1887, ch. 123 (Gen- eral Statutes, 1894, sees. 3892-3896). Sec. 1. It shall be the duty of the boards of education, and trustees in charge of schools, and educational institutions supported in whole or in part by public funds, to make provision for systematic and regular instruction in physiology and hygiene, including special reference to the effects of stimulants and narcotics upon the human system. Sec. 2. It shall be the duty of all teachers in public schools of the State to give systematic and regular instruction in physiology and hygiene, including special reference to the efilects of stimulants and narcotics upon the human system ; and any neglect or refusal on the part of such teachers to provide instruction as aforesaid shall be deemed sufficient cause for annulling his or her certificate by the county superintendent or other competent officer. Sec. 3. No certificate shall be granted to any person to teach in the public schools of this State after January 1, 1888, who has not passed a satisfactory examination in physiology and hj'giene, with special PHYSIOLQGICAL INSTRUCTION. 109 reference to the effects of stimulants and narcotics upon the human system. Sec. 4. It shall be the duty of the county superintendent of schools to report to the superintendent of public instruction any failure or neglect on the part of any board of education or trustees of a school or institution receiving aid in whole or in part from the State, to make pro- vision for the instruction aforesaid, and such failure or neglect being satisfactorily proven by the county superintendent or by other persons, it shall be sufficient warrant upon which the superintendent of public instruction may withhold the apportionment of the current school fund from such district ; provided, that not more than one fourth of said apportionment shall be withheld upon the first offense, one third upon the second, and one half upon any subsequent offense. Sec. 5. The superintendent of public instruction and the presidents of the normal schools of this State are directed to recommend some suitable text-book, and to furnish the same at cost to the several school districts of this State, for the study of physiology and hygiene, with special reference to the effects of stimulants and narcotics upon the human system. MISSISSIPPI. Annotated Code, 1892, ch. 119. Sec. 4019. The branches of study upon which teachers are required to be examined constitute the curriculum of the free public schools. Sec. 4022. To obtain a first grade license, the applicant must be examined on spelling, reading, practical and mental arithmetic, ge- ography, English grammar and composition. United States history, history of Mississippi, elements of natural philosophy, civil govern- ment, elements of physiology and hygiene, with special reference to the effects of alcohol and narcotics on the human system ; and to ob- tain a second grade license, the applicant must be examined on spell- ing, reading, mental arithmetic, practical arithmetic, elementary ge- ographj', elementary English grammar and corajjosition, and ])rimary United States history, and primary physiology, with special reference to the effects of alcohol and narcotics on the human system ; but a teacher qualified shall not be refused a certificate to teach for the next two years by reason of a want of sufficient knowledge on the subject of physiology. Sec. 4023. To obtain a third grade license the applicant must be examined on the subjects required for second grade, and must make thereon an average of not less than sixty per centum, with not less than forty per centum on any subject. 110 THE LIQUOR PROBLEM. Revised Statutes, 1899. Sec. 9798. No person shall be granted a certificate to teach in any of the public schools established under the provisions of this chapter ■who is not of good moral character, and qualified to teach . . . phy- siology and hygiene, with special reference to the efBects of alcoholic drinks and stimulants and narcotics generally upon the human system. Sec. 9799. Physiology and hygiene, including their several branches, with special instruction as to the effect of alcoholic drinks, narcotics, and stimulants on the human system, shall constitute a part of the course of instruction, and be taught in all schools supported wholly or in part by public money, or under state control. [See act approved April 2, 1885, Laws of 1885, 243; Revised Statutes, 1889, sees. 8023, 8024 ; and act approved March 19, 1897, Laws of 1897, 233.] MONTAifA. Act approved March 11, 1895, found at sec. 1861 of the Montana Political Code. All common schools shall be taught in the English language, and in- struction shall be given in the following branches, viz. : . . . physi- ology and hygiene, with special reference to the effects of alcoholic stimulants and narcotics on the human system, history of the United States, civics of the United States and of Montana. Attention must be given during the entire school course to the cultivation of manners, to the laws of health, physical exercise, ventilation and temperature of the school-room. NEBRASKA. Ch. 83, Laws of 1885 (Compiled Statutes, 1899, sees, 4760, 4761). Be it enacted by the Legislature of the State of Nebraska : — Sec. 1. Provision shall be made by tlie proper local school author- ities for instructing the pupils in all the schools supported by public money, or under state control, in physiology and hygiene, with special reference to the effects of alcoholic drinks and other stimulants and narcotics upon the human system. Sec. 2. No certificate shall be granted to any person to teach in the public schools of the State of Nebraska, after the first day of Janu- ary, 1886, who has not passed a satisfactory examination in physiology and hygiene, with special reference to the effects of alcoholic drinks and other stimulants and narcotics upon the human system. Sec. 3. All acts and parts of acts inconsistent with this act are hereby repealed. Approved March 5, 1885. PHYSIOLOGICAL INSTRUCTION. Ill Statutes, 1895, page 81, approved March 12 of that year. See. 4. The powers and duties of the board shall be as follows : First, to describe and cause to be adopted a uniform series of text-books in the princij)al studies pursued in the public schools, to wit : . . . ])hysi- ology and drawing. Special prominence shall be given in all public schools to the effect of alcoholic stimulants and of narcotics upon the human system. NEW HAMPSHIRE. Revised Statutes, ch. 92, sec. 6 ; as amended by ch. 40 (March 13) and ch. 50 (March 19) of the Session Laws of 1895. This law was passed in 1887. Ch. 52, sec. 1, of the laws of that year. The School Board, Duties of : — They shall prescribe in all mixed schools and all graded schools above primary, the studies of physiology and hygiene, having special reference to the effects of alcoholic stimulants and of narcotics upon the human system, and shall see that the studies so prescribed are thoroughly taught in said schools, and that well approved text-booka upon the subjects are furnished to teachers and scholars. . . . Candi- dates shall be examined in the studies prescribed by law, or by the school board in accordance with law. Ch. 94, sec. 2, of the Revised Statutes as amended by ch. 35 of the laws of 1895 : — The superintendent of public instruction . . . shall investigate the condition and the efficacy of the system of public education in the State, especially in relation to the amount and character of instruction given to the study of physiology and hygiene, having special reference to the effect of alcoholic stimulants and narcotics upon the human S}'stem, and shall recommend to the school boards what he considers the best text-books upon those subjects, and suggest to them the best mode of teaching them, and he shall pursue such a course for the purpose of awakening and guiding public sentiment in relation thereto as may to him seem best. NEW JERSEY. Public Laws of 1894, page 119, approved April 24, 1894 (General Statutes, page 3050, sees. 208-214). A supplement to an act entitled " An act to establish a system of public instruction." 1. Be it enacted by the Senate and General Assembly of the State of New Jersey, That the nature of alcoholic drinks and narcotics, and 112 THE LIQUOR PROBLEM. special instruction as to their effects upon the human system, in con- nection with the several divisions of the subject of physiology and hygiene, shall be included in the branches of study taught in the com- mon or public schools, and shall be studied and taught as thoroughly and in the same manner as other like required branches, with adequate tests of the efficiency of the teaching, by the use of graded text-books in the hands of pupils where other branches are thus studied, and orally only in the case of pupils unable to read, and by all pupils in aU grades of all scliools sujiported wholly or in part by public money. 2. And be it enacted. That the space in the text-books devoted to the consideration of the nature of alcoholic drinks and narcotics and their effects upon the human system shall be sufficient for a full and adequate treatment of the subject. 3. And be it enacted, That no certificate shall be granted to any person to teach in the public schools of New Jersey, after January first next, one thousand eight hundred and ninety-five, who has not passed a satisfactory examination in physiology and hygiene, with special reference to the nature of alcoholic drinks and other narcotics and their effects upon the human system. 4. And be it enacted. That in order to carry into effect the pro- visions of this supplement each district shall, in the manner now pro- vided by law, on or before the first day of July next, adopt a graded series of text-books in accordance with the provisions of this supple- ment. 5. And be it enacted, That the state superintendent of public in- struction shall, immediately after the passage of this supplement, notify all boards of education, boards of school trustees, or other bodies having charge and control of public schools, of the provisions of this supplement, and particularly call their attention to their duty in enforcing the same. 6. And be it enacted. That it shall be the duty of all city and county superintendents to report to the state superintendent of public instruction whether the provisions of this act have been complied with, as specified in the preceding sections ; and any refusal thus re- ported, or otherwise satisfactorily proven, shall be deemed sufficient cause for withholding the state appropriation of school money from sucli district or districts until such district or districts have fully com- plied with the provisions of this supplement. 7. And be it enacted, Tliat this act shall apply to all schools in this State supported wholly or in part by money received from the State, whether such schools are governed by the act to which this is a sup- plement or by any special law, or the provisions contained in the charter of any city, town, borough, or other municipality, and that this act shall take effect at the beginning of the next school year. PHYSIOLOGICAL INSTRUCTION. 113 Act approved March 23, 1900. Laws of 1900, ch. 96. Sec. 259. The nature of alcoholic drinks and narcotics and their ef- fects upon the human system shall he taught in all schools supported wholly or in part by public moneys as thoroughly and in the same man- ner as other like branches shall be taught, by the use of graded text- books in the hands of the pupils when other branches shall be thus taught and orally only in the case of pupils unable to read. In the text- books on physiology and hygiene the space devoted to the consideration of the nature of alcoholic drinks and narcotics and their effects upon the human system shall be sufficient for a full and adequate treatment of the subject. The failure or refusal of any district to comply with the provisions of this section shall be sufficient cause for withholding from such district the state appropriation. Sec. 260. No certificate shall be granted to any person to teach in the public schools, except to persons applying for special certificates to teach music, drawing, manual training, or other subjects not included in the usual school curriculum, who shall not have passed a satisfactory examination in physiology and hygiene with special reference to the nature of alcoholic drinks and narcotics and their effects upon the human system. NEW TOKK. Laws of 1884, ch. 30. See. 1. Provision shall be made by the proper local authorities for instructing all pupils in all schools supported by public money, or under state control, in physiology and hygiene, with special reference to the effects of alcoholic drinks, stimulants, and narcotics upon the human system. Sec. 2. No certificate shall be granted to any person to teach in the public schools of the State of New York after the first day of January, eighteen hundred and eighty-five, who has not passed a satisfactory examination in physiology and hygiene, vrith special reference to the effects of alcoholic drinks, stimulants, and narcotics upon the human system. Act approved May 26, 1896. Laws of 1896, ch. 901. The people of the State of New York, represented in Senate and Assembly, do enact as follows : — Sec. 1. Sections nineteen and twenty of article six of title fifteen of chapter five hundred and fifty-six of the laws of eighteen hundred and ninety-four, known as the consolidated school law, as amended by chapter one thousand and forty-one of the laws of eighteen hundred and ninety -five, are hereby amended to read as follows : — 19. The nature of alcoholic drinks and other narcotics and their 114 THE LIQUOR PROBLEM. effects on the human system shall be taught in connection with the various divisions of physiology and hygiene as thoroughly as are other branches in all schools under state control, or supported wholly or in part by public money of the State, and also in all schools connected with reformatory institutions. All pupils in the above-mentioned schools below the second year of the high school and above the third year of school work, computing from the beginning of the lowest primary, not kindergarten, year, or in corresponding classes of ungraded schools, shall be taught and shall study this subject every year with suitable text-books in the hands of the pupils, for not less than three lessons a week for ten or more weeks, or the ecjuivalent of the same in each year, and must pass satis- factory tests iu this as in other studies before promotion to the next succeeding year's work ; except that, where there are nine or more school years below the high school, the study may be omitted in all years above the eighth year and below the high school, by such pupils as have passed the required tests of the eighth year. In all schools above mentioned, all pupils in the lowest three pri- mary, not kindergarten, school years or in corresponding classes of un- graded schools, shall each year be instructed in this subject orally for not less than two lessons a week for ten weeks, or the equivalent of the same in each year by teachers using text-books adapted for such oral instruction as a guide and standard, and such pupils must pass such tests in this as may be required in other studies before promo- tion to the next succeeding year's work. Nothing in this act shall be construed as prohibiting or requiring the teaching of this subject in kindergarten schools. The local school authorities shall provide needed facilities and defi- nite time and place for this branch in the regular courses of study. The text-books in the pupils' hands shall be graded to the capacities of fourth year, intermediate, grammar, and high school pupils, or to corresponding classes in ungraded schools. For students below high school grade such text-books shall give at least one fifth their space, and for students of high school grade shall give not less than twenty pages to the nature and efi'ects of alcoholic drinks and other narcotics. This subject must be treated in the text- books in connection with the various divisions of physiology and hy- giene, and pages on this subject in a separate chapter at the end of the book shall not be counted in determining the minimum. No text-book on physiology not conforming to this act shall be used in the public schools except so long as may be necessary to fulfill the conditions of any legal adoption existing at the time of the passage of this act. PHYSIOLOGICAL INSTRUCTION. 115 All regents' examinations in physiology and hygiene shall include a due proportion of questions on the nature of alcoholic drinks and other narcotics, and their effects on the human system. 20. In all normal schools, teachers' training classes, and teachers' institutes, adequate time and attention shall be given to instruction in the best methods of teaching this branch, and no teacher shall be licensed who has not passed a satisfactory examination in the subject, and the best methods of teaching it. On satisfactory evidence that any teacher has willfully refused to teach this subject, as provided in this act, the state superintendent of public instruction shall revoke the license of such teacher. No public money of the State shall be apportioned by the state su- perintendent of public instruction or paid for the benefit of any city until the superintendent of schools therein shall have filed with the treasurer or chamberlain of such city an aiBdavit, and with the state superintendent of public schools a duplicate of such affidavit, that he has made thorough investigation as to tlie facts, and that to the best of his knowledge, information, and belief, all the provisions of this act have been complied with in all the schools under his supervision in such city during the last preceding legal school year ; nor shall any public money of the State be apportioned by the state superintendent of public instruction, or by school commissioners, or paid for the benefit of any school district, until the president of the board of trustees, or in the case of common school districts the trustee or some one member of the board of trustees, shall have filed with the school commissioners having jurisdiction an affidavit that he has made thor- ough investigation as to the facts, and that to the best of his know- ledge, information, and belief, all the provisions of this act have been complied with in such district, which affidavit shall be included in the trustees' annual report, and it shall be the duty of every school com- missioner to file with the state superintendent of public instruction an affidavit in connection with his annual report, showing all districts in his jurisdiction that have not complied with all provisions of this act, according to the best of his knowledge, information, and belief, based on a thorough investigation by him as to facts ; nor shall any public money of the State be apportioned or paid for the benefit of any teachers' training class, teachers' institute, or other school mentioned herein until the officer having jurisdiction or supervision thereof shall have filed with the state superintendent of public instruction an affi- davit that he has made thorough investigation as to the facts, and that to the best of his knowledge, information, and belief, all the provisions of this act relative thereto have been complied with. The principal of each normal school in the State shall at the close 116 THE LIQUOR PROBLEM. of each of their school years file with the state superintendent of pub- lic instruction an affidavit that all the provisions of this law applicable thereto have been complied with during the school year just termi- nated, and until such affidavit shall be filed no warrant shall be issued by the state superintendent of public instruction for the payment by the treasurer of any part of the money appropriated for such school. It shall be the duty of the state superintendent of public instruction to provide blank forms of affidavit required herein for use by the local school officers, and he shall include in his annual report a state- ment showing every school, city, or district which has failed to com- ply with all the provisions of this act during the preceding school year. On complaint by appeal to the state superintendent of public in- struction by any patron of the schools mentioned in the last preceding section, or by any citizen, that any provision of this act has not been complied with in any city or district, the state superintendent of pub- lic instruction shall make immediate investigation, and on satisfactory evidence of the truth of such comi)laint, shall thereupon and thereafter withhold all public money of the State, to which such city or district would otherwise be entitled, until all the provisions of this act shall be complied with in said city or district, and shall exercise his power of reclamation and deduction under section nine of article one of title two of the consolidated school law. Sec. 2. This act shall take effect immediately. NORTH CAEOLINA. Laws of 1891, ch. 169. Be it enacted by the Senate and House of Representatives of the State of North Carolina in Legislature assembled : — Sec. 1. That the nature of alcoholic drinks and narcotics, and spe- cial instruction as to their effects upon the human system, in connec- tion with tlie several divisions of physiology and hygiene, shall be in- cluded in the branches of study taught in the common or public schools in the State of North Carolina, and shall be studied and taught as thoroughly and in the same manner as other like required branches are in said schools by the use of text-books in the hands of pupils where other branches are thus studied in said schools, and orally in the case of pupils unable to read, and shall be taught by all teachers and studied by all pupils in all said schools supported wholly or in part by public money. Sec. 2. That the text-books used for the instruction required to be given in the preceding section in primary and intermediate grades shall give at least one fourth their space to the consideration of the nature and effects of alcoholic drinks and narcotics ; and the books PHYSIOLOGICAL INSTRUCTION. 117 used in the highest grade of graded schools shall contain at least twenty pages of matter relating to the subject. Sec. 3. That no certificate shall be granted to any person to teach in the public schools of the State of North Carolina, after the first day of January, Anno Domini eighteen hundred and ninety-two, who has not passed a satisfactory examination in ph3'siology and hygiene, with special reference to the nature of alcoholic drinks and other narcotics and their effects upon the human system. Sec. 4. That it shall be the duty of the proper officers in control of anj' school described in the foregoing section to enforce the provisions of this act ; and any such officer, school director, committee, super- intendent, or teacher who shall refuse or neglect to comply with the requirements of this act, or shall neglect or fail to make proper pro- visions for the instructions required and in the manner specified by the first section of this act for all pupils in each and everj' school under his jurisdiction, shall be removed from office, and the vacancy filled as in other cases. Sec. 5. This act shall be in force and effect from and after the first day of August, 1891. Ratified February 27, 1891. NORTH DAKOTA. Revised Codes of North Dakota, 1895. Sec. 750. Each teacher in the common schools shall teach pupils, when they are sufficiently advanced to pursue the same, the following branches : . . . physiology and hygiene, giving special instruction con- cerning the nature of alcoholic drinks, stimulants, and narcotics, and their effect upon the human system ; physiology and hygiene and the nature of alcoholic drinks, stimulants, and narcotics, and their effect upon the human system, shall be taught as thoroughly as any branch is taught, by the use of a text-book to all pupils able to use a text-book, who have not thoroughly studied that branch, and orally to all otlier pupils. When such oral instruction is given as herein required a sufficient time, not less than fifteen minutes, shall be given to such oral instruction for at least four days in each scliool week. Each teacher in the special school districts, and in the cities organized for school purposes under special law, shall conform to and be governed by the provisions of this section. Sec. 648. He [the county superintendent of schools] shall see that the pupils are instructed in the several branches of study required by law to be taught in the schools, as far as they are qualified to ])ursue them. If any teacher neglects or refuses to give instruction as required by law in physiology and hygiene, and the nature and effect of alcoholic 118 THE LIQUOR PROBLEM. drinks, narcotics, and stimulants, the county superintendent shall promptly revoke such teacher's certificate and cause him to be dis- charged. If the teacher so neglecting or refusing to give instruction in said branches holds a state certificate, the county superintendent shall immediately certify .such refusal or neglect to the superintendent of public instruction. [Laws of 1890, cli. 62, sees. 29, 130 ; approved March 20, 1890.] OHIO. Act passed April 13, 1888. 85 Laws, page 213. Sec. 1. Be it enacted by the General Assembly of the State of Ohio, Tliat the nature of alcoholic drinks and narcotics, and their effects upon the human system in connection with the subjects of physiology and liygiene, shall be included in the branches to be regularly taught in the common schools of the State, and in all educational institutions supported wholly or in part by money received from the State ; and it shall be the duty of the boards of education, and boards of such educational institutions, to make provisions for such instruction in the schools and institutions under their jurisdictions, and to adopt such metliods as shall adapt the same to the capacity of the pupils in the various grades therein ; but it shall be deemed a sufficient compli- ance with the requirements of this section if provision be made for such instruction orally only, and without the use of text-books by the pupils. Sec. 2. No certificate shall be granted to any person on or after the first day of January, 1890, to teach in the common schools, or in any educational institution supported wholly or in part as aforesaid, who does not pass a satisfactory examination as to the nature of alcoholic drinks and narcotics, and their effect upon the human system. Sec. 3. Any superintendent or principal of, or teacher in any com- mon school or educational institution supported as aforesaid, who will- fully refuses or neglects to give the instruction required by this act, shall be dismissed from his or her employment. Sec. 4. This act shall take effect and be in force from and after the first day of January, 1889. [Sees. 8092-33, 34, and 35 in Revised Statutes, 1890. See, also, sec. 4074 as to teachers' certificates ; and sec. 4020 as to the authority of boards of education as to studies and text-books.] Hill's Annotated Laws of Oregon, sec. 2649 (Statutes of 1885, 115, passed February 25, 1885). A teacher's duty while in charge of the school shall be as follows : PHYSIOLOGICAL INSTRUCTION. 119 . . . Third : To labor during school hours to advance the pupils in their studies ; to create in their minds a desire for knowledge, prin- ciple, morality, politeness, cleanliness, and the preservation of physical health ; and it is hereby made the duty of every teacher to give, and of every board of school directors to cause to be given, to all pupils suitable instruction in physiology and hygiene, with special reference to the effects of alcoholic drinks, narcotics, and stimulants upon the human system. PENNSYLVANIA. Act approved April 2, 1885. Laws of 1885, page 7. Sec. 1. Be it enacted, etc., That physiology and hygiene, which shall, in each division of the subject so pursued, include special re- ference to the effect of alcoholic drinks, stimulants and narcotics upon the human system, shall be included in the branches of study now required by law to be taught in the common schools, and shall be introduced and studied as a regular branch by all pupils in all departments of the public schools of the Commonwealth, and in all educational institutions supported wholly or in part by money from the Commonwealth. Sec. 2. It shall be the duty of county, city, borough superintend- ents, and boards of all educational institutions receiving aid from the Commonwealth, to report to the Superintendent of Public Instruction any failure or neglect on the part of boards of school directors, boards of school controllers, boards of education, and boards of educational in- stitutions receiving aid from the Commonwealth to make proper pro- vision in any and all the schools or districts under their jurisdictions for instruction in physiology and hygiene which, in each division of the subject so pursued, gives special reference to the effects of alcoholic drinks, stimulants and narcotics upon the human system as required by this act ; and such failures on the part of directors, controllers, boards of education, and boards of educational institutions receiving money from the Commonwealth thus reported or otherwise satisfactorily proven, shall be deemed sufficient cause for withholding the warrant for state appropriation of school money to which such district or educa- tional institution would otherwise be entitled. Sec. 3. No certificate shall be granted any person to teach in the pub- lic schools of tlie Commonwealth or in any of the educational institu- tions receiving money from the Commonwealth, after the first Monday of June, Anno Domini one thousand eight hundred and eighty-six, who has not passed a satisfactory examination in physiology and hygiene, with special reference to the effects of alcoholic drinks, stimulants and other narcotics upon the human system. 120 THE LIQUOR PROBLEM. RHODE ISLAND. Ch. 60, sec. 7, of the General Laws (ch. 415, sec. 1, of the Laws of 1884, passed April 24, 1884). The school committees of the several towns shall make provision for the instruction of the pupils in all schools supported wholly, or in part, by public money, in physiology and hygiene, with special reference to the effects of alcoholic liquors, stimulants, and narcotics upon the hu- man system. SOUTH CAKOLINA. Statutes at Large, vol. 22, sec. 27, at page 160 ; approved Mai'ch 9, 1896. An Act to declare the free school law of the State. Sec. 27. It shall be the duty of the county board of education and of boards of trustees hereinafter provided for to see that in every school under their care there shall be taught, as far as practicable, . . . morals and good behavior, algebra, physiology and hygiene, and es- pecially as to the effects of alcoholic liquors and narcotics upon the human system. . . . SOUTH DAKOTA. Act approved March 5, 1901. Session Laws, 1901, ch. 113. Ch. viii. sec. 14 (page 177). Instruction shaU be given in the common schools of the State in the following branches, in the several grades in which they may be required, viz. : . . . . physiology and hygiene, with special instruction as to the nature of alcoholic drinks and their effect upon the human system. ... [See chap. ii. sec. 4, of the same statute for the requirements for teachers' certificates. For earlier acts, see Session Laws, 1890, ch. 82, and Session Laws, 1897, ch. 57, ch. viii. sec. 13. See, also. Session Laws, 1901, ch. 113, ch. xi. sec. 30, for repeal of earlier acts.] TENNESSEE. Acts of 1895, ch. 180, sees. 1, 2, 3, taking effect January 1, 1896 ; approved May 14, 1895. Sec. 1. Be it enacted, etc.. That in addition to the branches in which instruction is now given in the public schools of this State, phj'siology and hygiene, with special reference to the nature of alcoholic drinks and narcotics, and smoking cigarettes, and their effects upon the hu- man system, shall also be taught as thoroughly as other branches. Sec. 2. That this shall be made a regular course of study for all pupils in all schools supported entirely or in part by public money. Sec. 3. No certificate shall be granted to any person to teach in the public schools of this State after the first day of January, 1896, wlio PHYSIOLOGICAL INSTRUCTION. 121 has not passed a satisfactory examination in physiology and hygiene, with special reference to the effects of alcoholic drinks and narcotics, and cigarette smoking upon the human system. [Code of Tennessee, Annotated, 1896, sees. 1455, 1456.] Revised Statutes, as amended by the twenty-sixth Legislature (Laws of 1899, 234, 326). Art. 3909a. All public schools in this State shall be required to have taught in them orthography, . . . physiology and hygiene, including the effects of alcoholic stimulants and narcotics on the human system, . . . Art. 3973b. Teachers' certificates authorizing the holders tliereof to contract and teach in the public free schools of this State shall be of three kinds, as foUows : A county certificate, to be valid only in the county in which it is issued ; a city certificate, to be valid only in the city in which it is issued ; a state certificate, to be valid in all counties and independent districts of the State. Art. 3974. An applicant for a third grade certificate shall be ex- amined in spelling, . . . elementary physiology and hygiene, and the laws of health, with special reference to narcotics, and school manage- ment and methods of teaching. (1) An applicant for a second grade certificate shall be examined in the subjects prescribed for a third grade certificate, and in addition thereto, in United States history, . . . physiology and hygiene, and physical geography. (2) An applicant for a first grade certificate shall be examined in the subjects pre- scribed for third and second grade certificates, and in addition thereto, in physics, . . . and the effects of tobacco and alcoholic intoxicants upon the human system. [See act approved May 20, 1893. General Laws of 1893, ch. 122, sees. 17, 65.] UTAH. Revised Statutes. Sec. 1829. It shall be the duty of all boards of education and trus- tees in charge of schools and educational institutions supported in whole or in part by public funds to make provision for systematic and regular instruction in physiology and hygiene, including special refer- ence to the effects of stimulants and narcotics upon the human system. [This section is a part of ch. 49 of the Laws of Utah, 1897. This act was approved March 11, 1897. A similar clause was enacted by the legislature of Utah Territory, March 13, 1890.] 122 THE LIQUOR PROBLEM. VIRGINIA. [In Virginia, although a regulation of the board of education re- quired instruction in physiology and hygiene, it was not until the winter of 1901-1902 that persistent effort has secured a law on the statute books.] Act approved January 24, 1900. Acts of Assembly, 1899-1900, ch. 132. In every public free school shall be taught . . . physiology and hygiene. ... In the teaching of physiology and hygiene approved text-books shall be used, plainly setting forth the effects of alcohol and other narcotics on the human system ; and these effects shall be as fully and thoroughly taught as other branches of said last-named subjects. VEEMONT. Statutes, 1894. Sec. 683. In every town there shall be kept for at least twenty- eight weeks in each year, at the expense of said town, by a teacher or teachers of competent ability and of good morals, a sufficient number of schools for the instruction of all the children who may legally attend all the public schools therein ; and all pupils shall be thoroughly in- structed in . . . elementary physiology and hygiene, with special reference to the effect of alcoholic drinks and narcotics on the human system. . . . Sec. 822. [Applies to school districts.] All pupils shall be thor- oughly Instructed in . . . elementary physiology and hygiene. . . . [For earlier legislation see Acts of 1886, No. 33, and Acts of 1888, No. 9, sec. 95.] WASHINGTON. Laws of 1897, ch. 118. [The basis of this law may be found in the General Statutes, 1891, at sees. 810, 854, and 855, approved March 27, 1890.] Sec. 58. It shall be the duty of all teachers to endeavor to impress on the minds of their pupils the principles of morality, truth, justice, temperance, and patriotism ; to teach them to avoid idleness, profan- ity, and falsehood ; to instruct them in the principles of free govern- ment, and to train them up to the true comprehension of the rights, duty, and dignity of American citizenship. Sec. 65. All common schools shall be taught in the English lan- guage, and instruction shall be given in the following branches, viz. : Reading, . . . physiology and hygiene with special reference to the effects of alcoholic stimulants and narcotics on the human system, his- tory of the United States, and such other studies as may be prescribed PHYSIOLOGICAL INSTKUCTION. 123 by the state board of education. Attention must be given during tlie entire course to the cultivation of manners, to the laws of health, physical exercise, ventilation and temperature of the school-room, and not less than ten minutes each week must be devoted to the systematic teaching of kindness to not only our domestic animals, but to all living creatures. Sec. 162. Upon complaint in writing being made to any county superintendent by any district clerk, or by any head of family, that the board of directors of the district of which said clerk shall hold his office, or said head of family shall reside, have failed to make provi- sion for the teaching of hygiene, with special reference to the effects of alcoholic drinks, stimulants, and narcotics upon the human system, as provided in this act, in the common schools of such district, it shall be the duty of such county superintendent to investigate at once the matter of such complaints, and if found to be true, he shall immedi- ately notify the county treasurer of the county in which such school district is located, and after the receipt of such notice, it shall be the duty of such county treasurer to refuse to pay any warrants drawn upon him by the board of directors of such district subsequent to the date of such notice, and until he shall be notified to do so by such county superintendent. AVhenever it shall be made to appear to such county superintendent, and he shall be satisfied, that the board of di- rectors of such district are complying with the provisions of said sec- tion of this act, and are causing physiology and hygiene to be taught in the public schools of such district as hereinbefore provided, he shall notify said county treasurer, and said treasurer shall thereupon honor the warrants of said board of directors. Sec. 163. Any county superintendent of public schools who shall refuse or fail to comply with the provisions of the preceding section shall be liable to a penalty of one hundred dollars, to be recovered in a civil action in the name of the State in any court of competent juris- diction, and the sum recovered shall go into the state school fund ; and it shall be the duty of the prosecuting attorneys of the several counties of the State to see that the provisions of this section are en- forced. WEST VIRGINIA. Acts of 1887, ch. 3. The nature of alcoholic drinks and narcotics, and special instruction as to their effects upon the human system, in connection with the several divisions of the subject of physiology and hygiene, shall be included in the branches of study taught in the common or public schools, and shall be taught as thoroughly and in the same manner as other like 124 THE LIQUOR PROBLEM. required branches are in the said schools, and to all pupils in all said schools throughout the State. Approved February 17, 1887. WISCONSIN. Statutes, 1898, sec. 447a. Ch. 327 of the Laws of 1885. Provision shall be made by the proper local school authorities for instructing all pupils in all schools supported by public money or under state control, in physiology and hygiene, with special reference to the effects of stimulants and narcotics upon the human system. The text-books used in giving such instruction shall have the joint approval of the state superintendent and the state board of health. Revised Statutes, 1889. Sec. 612. Physiology and hygiene, which shall include in each division of the subject special reference to the effects of alcohol and narcotics upon the human system, shall be included in the branches taught in the common schools of the State, and shall be introduced and taught, either orally or by text-book, in all departments of the public schools above the second primary grade, and in all educational institutions supported wholly or in part by the State. (R. S. 1887, sec. 3969.) Sec. 613. It shall be the duty of the several county and city super- intendents of schools in the State, and of the secretary of the board of directors of all other educational institutions receiving aid from the State, to report to the state superintendent of public instruction any failure or neglect on the part of the board of trustees of any school district, or the board of directors of any educational institutions receiv- ing aid from the State, to make proper provision for the teaching of the branches mentioned in the last preceding section in any or all of the schools or other educational institutions under their charge, or over which they have jurisdiction, and such failure on the part of the above mentioned officers, so reported and satisfactorily proven, shall be deemed sufficient cause for withholding the warrant for the district appropriation of school money to which such school district or educa- tional institution would otherwise be entitled. (R. S. 1887, sec. 3970.) Sec. 615. No certificate shall be hereafter granted to any person to teach in the schools of Wyoming who shall not pass a satisfactory examination in physiology and hygiene, with special reference to the effects of alcoholic drinks, stimulants, and narcotics upon the human system. (R. S. 1887, sec. 3972.) [See Session Laws of Wyoming Territory, 1886, ch. 35.] PHYSIOLOGICAL INSTRUCTION. 125 TERRITOKIES. ARIZONA. Revised Statutes, 1901. Sec. 2142. Every applicant for a first grade territorial certificate must be examined by written and oral questions in . . . physiology, hygiene, with special reference to the nature and effects of alcoholic drinks and other narcotics and stimulants upon the human system. . . . Applicants for a second grade certificate shall not be required to pass an examination in algebra or natural philosophy. Sec. 2214. Instruction must be given in the following branches, viz. : . . . elements of physiology, hygiene, including the nature of alcoholic drinks and narcotics, and special instruction as to their effect upon the human system. . . . NEW MEXICO. New Mexico has no such law. OKLAHOMA. Statutes of Oklahoma. Sec. 5817. Certificate of the first grade shall certify that a person to whom issued is proficient in, and fully qualified to teach, . . . physiology and hygiene. . . . Sec. 5818. Certificates of the second grade may be issued to per- sons . . . able to teach all branches prescribed for first grade certifi- cate. . . . [AU territories are governed by act of Congress given S7q)i-a.^ 126 THE LIQUOR PROBLEM. Comparative Table of Requirements of Scientijic Temperance Laws in the States of the Union, Compiled from the Laws as in force January 1, 189G. Alabama California.... Colorado Connecticut. . Delaware Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky . . . Lomaiana — Maine Maryland . . . • Massachusetts Michigan. . . Minnesota. . Mississippi . General provision similar to our '84 law. Same as other No law. No law. No law. Similar to N. Y. General provision. General provision. General provision. General provision. General provisi General provisi A8 a repula brauch in a] grades. General provision. Supt. to recom- mend suitable ones. One fifth. 20 pp. One fourth. 20 pp. Oral instruc- tion to pupils who cannot read. PHYSIOLOGICAL INSTRUCTION. Comparative Table of Requirements, etc. (continued). 127 Stats. Length of time study pursued. Text-book required. Percentage of matter in text-book. Oral instruc- tion of pupils who cannot read. hi III 111 Penalty. When patrons so desire in writing. No. Yes. General provision. No. None. No. Yes. None. General provision. Prescribed by State Board. No. Loss of pub- lic money. N. Hampshire General provision in all schools above primary. No. No. New Jersey . . Alt pupils. All grades. Yes. Full and adequate. Yea. Yes. Loss of pub- lic money. New York.... All pupils. Each year. 10 weeks, 4 lessons per week. Yes. One fifth. 20 pp. Yes. Yes. Loss of pub- lic money. N. Carolina .. As thoroughly aa other branches. Yea. One fourth. 20 pp. Yes. Yes. Removal from office. As thoroughly aa other branches. Yes. Yes. No. General provision. General provision. As a regular branch. No. Yes. Oregon PennBylvania. tion suffi- cient in all grades. No. No. Yes. Loss of pub- lic money. General provision. As thoroughly as other branches. No. So. Carolina.. When used in other branches. One fourth. 20 pp. Yea. No. Removal from office. So. Dakota. . . As thoroughly as arith. and geog. Yes. One fourth. 20 pp. Yes. Yes. Lossofpub- Uc money. As thoroughly as other branches. No. Yes. Texaa General provision. General provision. No general law. Local boards may introduce study. No. No. Virginia 'Washington . . General provision. No. No. Loss of pub- lic money. W.Virginia.. Aa thoroughly as other branches and in like manner. Except aa before stated. Yes. from office. Wsco sin General provision. Text-book to be approv'dbySupt. andB'dofHealth. No. None Wyoming — All schools above 2d primary grade. Optional, with oral instruction. Yes. lie money. THE LIQUOR PROBLEM. CIRCULAR LETTER USED IN FIRST CANVASS OF PUBLIC SCHOOLS.i To School Superintendents, Principals, Teachers, and School Com- mittees of Massachusetts. Your attention is called to the proposed legislation concerning in- struction in physiology and hygiene in the public schools of Massachu- setts. The texts are here given of — (1) The present law. (2) A bill introduced into the Senate, providing for the greatly in- creased stringency of the present law, with penalties for non-compli- ance with the same. (3) A bill introduced into the House to provide for such instruction in physiology and hygiene as has been concluded by a conference of teachers and physicians to be adapted to promote the cause of temper- ance and the best welfare of the schools. Appended is a statement of the grounds of the petition. The Present Law. Statutes of 1885, Chapter 332. Section 1. Physiology and hygiene, which, in both divisions of the subject, shall include special instruction as to the eilect of alcoholic drinks, stimulants, and narcotics on the human system, shall be taught as a regular branch of study to all pupils in all schools supported wholly or in part by public money, except special schools maintained solely for instruction in particular branches, such as drawing, me- chanics, art, and like studies. All acts or parts of acts relating to the qualification of teachers in the public schools shall apply to the branch of study prescribed in this act. Sec. 2. All penalties now fixed for neglect to provide instruction in the branches of study now prescribed by law shall apply to the branch of study prescribed in section 1. Sec. 3. This act shall take effect on the first day of August, in the year eighteen hundred and eighty-five. Bill of Charles L. Morgan and Mary H. Hunt, Senate, No. 41. [To accompany the petition of Charles L. Morgan and Mary H. Hunt for amendment of the law requiring physiology and hygiene to be taught in the public schools so as to more fully define the schools in which it shall be taught, the methods of instruction, and the char- acter of text-books ; to provide penalties for non-compliance with the requirements of the law ; to provide for the supervision of the in- ' See Report, p. 40. PHYSIOLOGICAL INSTRUCTION. 129 struction ; and to provide for the enforcement of the law. Educa- tion.] Commonwealth of Massachusetts. In the year One Thousand Eight Hundred and Ninety-nine. To amend the Law requiring Physiology and Hygiene to be taught in the Public Schools. Be it enacted by the Senate and House of Representatives in Gen- eral Court assembled, and by the authority of the same, as follows : — Section 1. Section one of chapter three hundred and thirty-two of laws of A. D. eighteen hundred and eighty-five is hereby amended so as to read as follows : — That the nature of alcoholic drinks and otlier narcotics and their effects on the human system shall be tauglit in connection with the several divisions of physiology and hygiene, as thorouglily as are other branches, in all schools supported wholly or in part by public money, including all evening common schools, and in all schools connected with reformatory institutions. All pupils in the above-mentioned schools below the second year of the high schools and above the third year of soliool work, computing from the beginning of the lowest primary year, or in corresponding classes of ungraded schools, shall be taught and shall study this sub- ject every year from suitable text-books in the hands of all pupils, in not less than three lessons a week for fourteen or more weeks of each year, and must pass the same tests for promotion in this as in other studies. In all such schools all pupils in the lowest three primary school years, or in corresponding classes in ungraded schools, shall each year be instructed in this subject orally in not less than three lessons a week for ten weeks in each year by teachers using text-books adapted for such oral instruction as a guide and standard. The text-books in the pupils' hands shall be graded to the capacities of the fourth year, intermediate, grammar, and high school pupUs, or to corresponding classes in ungraded schools. For students below high school grade such text-books shall give at least one fifth their space, and for students of high school grade, shall give not less than twenty pages to the nature and effects of alcoholic drinks and other narcotics. The pages on this subject, in a separate chapter at the end of the book, shall not be counted in determining the minimum. No text-book on physiology not conforming to this act shall be used in any public school except so long as may be necessary to fulfill the conditions of any legal adoption existing at the time of the passage of this act. 130 THE LIQUOR PROBLEM. In all normal schools, teachers' training classes, and teachers' insti- tutes ade(|uate time and attention shall be given to instruction in this branch and the best methods of teaching it. All acts or parts of acts relating to the qualifications of teachers in the public schools shall apply to the branch of study prescribed in this act. Nothing in this act shall be construed to apply to special schools maintained solely for instruction in particular branches, such as draw- ing, mechanics, art, and like studies. Section 2. The school committee of all cities and towns, the princi- pals of all normal schools, and the supervising officers in all schools connected with reformatory institutions shall annually provide a defi- nite time and place in the regular course of study for the given number of lessons in this branch and an adequate supply of text-books for the pupils' use as required by this act, and also for the teachers' use for oral instruction in primary classes, and shall cause the requirements of this act to be complied with in all schools under their jurisdiction, and shall file with the Secretary of the State Board of Education an affidavit that all the provisions of this act have been complied with. Any of the aforesaid officers who shall neglect or fail to comply with any of the provisions of this act shall forfeit and pay for each offense the sum of not less than five dollars and not more than twenty- five dollars. Failure to comply with all the provisions of this act on any school day to which it applies shall constitute an offense. At the opening of each school year it shall be the duty of the Secre- tary of the State Board of Education to send to all school committees, principals of normal schools, and supervising officers of all schools connected with reformatory institutions, blanks containing the follow- ing questions : — First. Have you provided a definite time and place in the course of study in the schools under your jurisdiction for three lessons per week for fourteen weeks per year in physiology and hygiene, which include the nature and effects of alcoholic drinks and other narcotics upon the human system as specified in section one of Act , and has that study been pursued by all pupils in all schools under your jurisdiction as specified by that act, with the same tests for promotion as in other studies ? Second. Have you provided text-books on the foregoing topics that are adapted to the several grades, and that give the specified space to the nature and effects of alcoholic drinks and other narcotics which the law demands ? The school officers to whom these blanks are sent shall return them at the close of the school year to the Secretary of the State Board of Education with answers filled out and an affidavit that they have made PHYSIOLOGICAL INSTRUCTION. 131 thorough investigation as to the facts, and that to the hest of their knowledge, information, and behef, these questions are truthfully an- swered, and that all the provisions of this act have been complied with in the schools under their jurisdiction during the preceding year. Any failure thus reported or otherwise satisfactorily proven shall be deemed by the Secretary of the State Board of Education to be suffi- cient cause to compel the payment by such delinquents of the forfeit- ure specified in this act. All penalties which apply to the failure of a city or town to make other returns or reports to the Secretary of the State Board of Educa- tion shall apply to failures to report as tpecified by this act. The Secretary of the State Board of Education shall cause all the provisions of tliis act to be enforced, and shall report annually to the legislature any failure to comply with the same. Trial justices, district, municipal, and police courts shall have juris- diction of offenses under this act. Section 3. This act shall take effect on the first day of August, in the year eighteen hundred and ninety-nine. Bill of James J. Myers, House, No. 817. House of Representatives, February 8, 1899. [Introduced on leave by Mr. Myers of Cambridge. Education.] Commonwealth of Massachusetts, in the year One Thousand Eight Hundred and Ninety-nine. An Act relative to Studies in the Public Schools, Be it enacted by the Senate and House of Representatives in Gen- eral Court assembled, and by the authority of the same, as follows : — Section 1. Section one of chapter three hundred and thirty-two of the acts of the year eighteen hundred and eighty-five is hereby amended by striking out in the fifth line thereof the words "all schools," and inserting in place thereof the words " the highest grade ^ of aU grammar schools and in one grade at least of all high and Latin schools," so as to read as follows : — Sec. 1. Physiology and hygiene, which, in both divisions of the subject, shall include special instruction as to the effects of alcoholic drinks, stimulants, and narcotics on the human system, shall be taught as a regular branch of study to all pupils in the highest grade ' of all grammar schools and in one grade at least of all high and Latin schools supported wholly or in part by public money, except special schools maintained solely for instruction in particular branches, such as drawing, mechanics, art, and like studies. All acts or parts of acts ' To be amended to read " the fifth and highest grades," etc. 132 ■ THE LIQUOR PROBLEM. relating to the qualifications of teachers in the public schools shall apply to the brancli of study prescribed in tliis act. Sec. 2. The following new section is hereby inserted after section one of said chapter, as follows : — Sec. 2. No text-book on physiology or hygiene shall hereafter be purchased for use in any public school unless it has been approved by the chairman and secretary of the state board of health and by the secretary of the state board of education. Sec. 3. The last two sections of the said chapter are hereby renum- bered. Sec. 4. This act shall take effect upon its passage. AlS' ANALYSIS OF THE BILLS NOW PENDING. Senate Bill No. 41. Mrs. Hunt's bill is an extremist's definition of the present law. Its purpose is " more fully to define (1) the schools in which physiology and hygiene shall be taught, (2) the methods of instruction, and (3) the character of text-books, (4) to provide the penalties for non-com- pliance with the requirements of the law, (5) to provide for the super- vision of the instruction, and (6) to provide for the enforcement of the law." The fundamental objections are : — (1) Schools (and Geades). Pupils in the primary and lower grammar grades are too young to grasp the anatomical and physio- logical details necessary for the comprehension of the physiological and pathological action of stimulants and narcotics. The moral effect upon pupils is lessened, if not destroyed, by the repetition of a comparatively limited number of statements which they have neither ability to understand nor opportunity to verify. (2) Methods. The true method of temperance instruction should emphasize the social and moral aspects of the question and avoid so far as possible physiological and pathological details unsuited to the comprehension of the pupils. (3) Text-Books. The text-books provided for by the proposed law devote too much space to the effects of stimulants and narcotics, while other equally important topics of hygiene, such as food, diet, sleep, clothing, cleanliness, and precautions against cold and wet are given too little attention. (4), (5), and (6) Penalties and Supervision. The penalties for non-compliance are too severe, and the conditions of supervision of instruction are unprecedented. An inquisitional system, subverting a wholesome relation between school officers and teachers, is inaugurated. PHYSIOLOGICAL INSTRUCTION. 133 House Bill No. 817. The bill introduced by Mr. Myers proposes (1) to have instruction in physiology and hygiene in the eighth grade ' of grammar schools and one year iu high schools, and (2) To have a commission consisting of the chairman and secre- tary of the State Board of Health and the secretary of the State Board of Education to examine the books used for the purposes of this teaching in the schools, with the provision that no book shall be used which has not received the sanction of this commission. (1) This provision for instruction insures that no pupil shall leave the schools without having the instruction ; at the same time useless and deading repetition is avoided. (2) The examination of the text-books insures good text-books, suitable because of accuracy of statement and adaptation to the intelli- gence of the pupil. It also protects the school officers and teachers against ill-considered local interference in the performance of their functions. Petition. We, the undersigned, because of our interest in the cause of tem- perance and of our belief that the failure of the present law is due to too much, rather than too little, teaching of the nature and effects of stimulants and narcotics, and too little emphasis on the moral and social aspects of the question, respectfully petition that House Bill No. 817 be enacted into law by the Senate and House of Representatives of the State of Massachusetts. A. Lawrence Lowell, formerly of Boston School Committee. Prof. W. T. Sedgwick, Mass. Institute of Technology. Prof. H. P. Bowditch, Harvard Medical School. Dr. H. P. Walcott, Chairman State Board of Health. Prof. G. W. Fitz, Harvard University. A Committee of the Massachusetts Medical Society to consider the instruction in Physiology and Hygiene in the public schools of the State. Alice Freeman Palmer, State Board of Education. Charles W. Eliot, President of Harvard University. William Lawrence, Bishop of Massachusetts. George Hodges, Dean of the Episcopal Tlieological School, Cambridge. George A. Gordon, Pastor New Old South, Boston. Frederick Edwards, Pastor Episcopal Cimrch, Maiden. Prof. Nathaniel S. Shaler, Harvard University. ' To be amended to read " in the fifth and eighth grades." 134 THE LIQUOR PROBLEM. Prof. Paul H. Hanus, History and Art of Teaching, Harvard Uni- versity. Prof. C. F. Hodge, Clark University. Dr. Samuel W. Abbott, Secretary of the State Board of Health. Supt. George E. Gay, President of the Massachusetts State Teachers' Association. S. T. Button, Supt. of Schools, Brookline. CIRCULAR LETTER USED IN SECOND CANVASS OF PUBLIC SCHOOLS.! CAMBRmoE, Mass., February 24, 1899. To Superintendents and School Committees of Massachusetts : — This blank is sent to you to get an expression of opinion regarding — (1) Mrs. Hunt's modified bill, which is inclosed. (2) Mr. Myers's bill, with the understanding that the instruction shall be given in the fifth and eighth grades of the grammar school and in one year of the high school, and that the text-books shall be approved as provided for. (3) ]Mr. Myers's bill modified to require the teaching of physiology and hygiene with special reference to personal hygiene, including the nature and effects of stimulants and narcotics on the human system, to every pupil in the schools, but leaving the decision as to when this instruction shall be given, and the choice of text-books, to the local authorities, so that they may make their programmes suit local condi- tions. G. W. FiTZ, M. D., Sec. of the Mass. Jledical Society Committee, Harvard University, Cambridge, Mass. MRS. hunt's modified BILL. For the use of the Committee on Education. [With reference to the petition of Charles L. Morgan and Mary H. Hunt for amendments of the law requiring physiology and hygiene to be taught in the public schools so as to more fully define the schools in which it shall be taught, the methods of instruction, and the character of text-books ; to provide penalties for non-compliance with the requirements of the law ; to provide for the supervision of the instruction ; and to provide for the enforcement of the law.] Commonwealth of Massachusetts. In the year One Thousand Eight Hundred and Ninety-nine. An Act relative to Teaching Physiology and Hygiene in the Public Schools. Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows : — ' See Report, p. 40. PHYSIOLOGICAL INSTRUCTION. 135 Section 1. Section one of chapter three hundred and thiity-two of laws of Anno Domini eigliteen hundred and eighty-five is hereby amended so as to read as follows : — The nature of alcoholic drinks and narcotics and their effects on the human system, shall be taught in connection with the several divisions of physiology and hygiene, as thoroughly as are other branches, in all schools supported wholly or in part by public money, including all schools connected with reformatory institutions. All pupils in the above-mentioned schools below the second year of the high schools and above the third year of school work, computing from the beginning of the lowest primary year, or in corresponding classes of ungraded schools, shall be taught and shall study physiology and hygiene, including the nature and effects of alcoholic drinks and narcotics, every year, with text-books in the hands of all pupils, not less than three lessons a week for ten or more weeks of each year, or the equivalent of the same each year. All pupils must pass the same tests for promotion in this, as in other studies. In cases wliere there are nine years below the high school, the study may be omitted in the ninth year, or in the first year of tiie high school, but not in both. In all public schools all pupils in the lowest three primary school years, or in corresponding classes in ungi'aded schools, shall each year be instructed in this subject orally in not less than three lessons a week for ten weeks in each year, or the equivalent of the same each year, by teachers using text-books adapted for such oral instructions as a guide and standard. The text-books in the pupils' hands shall be graded to the capacities of the fourth year, intermediate, grammar, and high school pupils, or to corresponding classes in ungraded schools. For students below high school grade such text-books shall give at least one fifth their space, and for students of high school grade, shall give not less than twenty pages to the nature and effects of alcoholic drinks and narcotics. The treatment of the effects of alcoholic drinks and narcotics shall be incorporated with each division of the subject of physiology and hygiene in all text-books used in compliance with this act. In all state teachers' institutes and in all state normal schools, the State Board of Education shall cause adequate instruction to be given in the best methods of teaching this branch as required by this act. Nothing in this act shall be construed to apply to special schools maintained solely for instruction in particular branches, such as draw- ing, mechanics, art, and like studies. ' Sec. 2. The school committees of all cities and towns, the county commissioner in control of all truant schools, and the supervising 136 THE LIQUOR PROBLEM. boards, trustees, or other officers in control of all schools connected with reformatory institutions, shall annually, at the beginning of the school year, provide a definite time and place in the regular course of study for the given number of lessons in this branch, and an adequate supply of text-books for the pupils' use, as required by this act, and also for the teachers' use for oral instruction in primary classes ; and shall cause the requirements of this act to be complied with in all scliools under their jurisdiction. The school committees of all cities and towns shall state in their reports to the Secretary of the State Board of Education, vfliether all the provisions of this act, according to the best of their knowledge and belief, have been thus complied with. Any member of a school committee or board, or any trustee, or supervising officer connected with a reformatory institution, who shall neglect or refuse to cooperate in securing compliance with any of the provisions of this act, after thirty days' notice and a continuance of such neglect or refusal, shall pay a fine for such neglect or refusal of the sum of not less than twenty-five dollars. It shall be the duty of the Secretary of the State Board of Educa- tion to send annually to all school committees, blanks containing the following questions : — First. Have you provided, during the last school year in the schools under your jurisdiction, a definite time and place in the coui-se of study for the required number of lessons for all pupils in physiology and hygiene, including the nature and effects of alcoholic drinks and nar- cotics upon the human system as specified in section one of Act [ ] and have you required that study to be pursued by all pupils in all schools under your jurisdiction as specified by that act, with the same tests for promotion as in other studies ? Second. Have you provided text-books on the foregoing topics that are adapted to the several grades, and that give the specified space to the nature and effects of alcoholic drinks and narcotics which the law demands ? Every school committee to whom these blanks are sent shall return them at the close of the school year to the Secretary of the State Board of Education, with answers filled out and an affidavit that these ques- tions are truthfully answered. The Secretary of the State Board of Education shall include in his annual report to the legislature a report concerning the compliance with the requirements of this act. Trial justices, district, municipal, and police courts shall have juris- diction of offenses under this act. Sec. 3. This act shall take effect on the first day of August, in the year eighteen hundred and ninety-nine. THE INFLUENCE OF ALCOHOL AND ALCO- HOLIC BEVERAGES ON DIGESTION AND SECRETION. By Dr. K. H. CHITTENDEN. DIGESTION AND SECRETION. DEFINITIOXS OF TECHNICAL TERMS AND EXPLANATIONS FOR LAY READERS. Physiologically speaking, digestion is a somewhat broad term including a variety of processes, all having for their ob- ject, however, the conversion of the several classes of foodstuffs into forms capable of being absorbed and utilized by the body. These processes are chemico-physiological in nature, involving not only the simple solvent or digestive action of the several di- gestive juices, i. e., the purely chemical processes, but also the purely physiological processes of secretion, absorption, peristal- sis, etc. The fluids most intimately concerned in digestion are the saliva, gastric juice, and pancreatic juice, while the bile and the succus entevicus, i. e., the secretion from the small intestine, are likewise valuable aids. The saliva is manufactured and secreted by three sets of glands known as the parotid, submaxillary, and sublingual glands, which pour their secretions into the mouth cavity, where they mingle with the secretion from the buccal glands, the mixture constituting the so-called mixed saliva. The gastric juice is secreted by the tiuy cells contained in the mucous membrane of the stomach, while the pancreatic juice is manufactured in the pancreatic gland and brought to the small intestine, when re- quired, through a small duct or tube. These secretions have their origin primarily in the blood ; that is, the blood brings to the glands nutritive material which the gland cells work over and eventually transform into the specific substances character- istic of the respective secretions. These various digestive fluids are secreted only under the in- fluence of stimulation, mainly reflex through the nerves going to and coming from the glands, although mechanical stimula- tion may likewise be effective in some degree, particularly with 140 THE LIQUOR PROBLEM. the saliva and gastric juice. Many circumstances combine to modify the extent and quality of the secretion furnished by these several glands, 1. e., the character and extent of the stimu- lation, so that constant fluctuation, within certain limits, may be expected in the volume and concentration of the fluids from day to day, and hence in their physiological activity likewise. Thus, influences which affect the volume and character of the blood flowing through the glands, local blood-pressure, etc., as well as the character and amount of the ingested food, all have an effect upon the volume and comj^osition of the secretions. The digestive power of these several secretions is dependent mainly upon the presence of specific ferments or enzymes, manu- factured in the glands, which, acting upon the foodstuffs under suitable conditions, render them soluble and diffusible and so capable of being absorbed. The saliva is a slightly alkaline fluid, and in virtue of the enzyme (ptyalin) it contains acts upon starchy or farinaceous foods, transforming them into soluble dextrins and sugars, — a process which commences in the mouth and continues for a brief time in the stomach, until the enzyme is finally destroyed by the increasing acidity of the gastric juice. This starch-digesting action of the saliva is fre- quently spoken of as amylolytic action, while the active agent may be described as an amylohjtic ferment or enzyme. The gas- tric juice is an acid-reacting fluid containing normally about two tenths per cent, of hydrochloric acid, the enzyme pepsin and a milk-curdling enzyme known as rennin. The main action of the gastric juice, in virtue of the contained pepsin-hydrochloric acid, is upon the proteid or albuminous foods transforming them into a number of products, chiefly proteoses and peptones, charac- terized especially by their solubility and diffusibility. This proteid-digesting power is described as proteolytic action, and the enzyme which accomplishes the transformation of the proteid is known as a p7-oteoIytic enzyme. When the acid chyme, 1. e., the semi-digested mass in the stomach, leaves the latter organ, it passes through the pyloric orifice into the small intestine, where it is exposed to the double action of the bile and pancre- atic juice. The latter is a powerful digestive fluid of sti'ong alkaline reaction, containing three distinct enzymes. One of these is an amylolytic or starch-digesting enzyme essentially identical with the enzyme of saliva and converts any unchanged DIGESTION AND SECRETION. 141 starch into soluble clextrins and sugar. The second ferment is a powerful proteolytic enzyme known as trypsin which in a neutral or alkaline-reacting fluid transforms proteid matter into a row of soluble products different in nature from those formed in acid gastric digestion. The third ferment is an adipolytic or fat-splitting enzyme which transforms at least a portion of the fats of the food into soluble forms. This threefold action of the pancreatic juice may continue for some time in the small intestine, but as the peristaltic or wave-like contraction of the intestinal walls tends to push the contents of the tube onward toward the large intestine, and as absorption is quite rapid at this point, the conditions gradually become unfavorable for further digestive action. From the foregoing, it is plain that digestion, broadly speak- ing, may be modified in a variety of ways, notably through the influence of agencies affecting the nervous system, thereby modi- fying the rate and character of the secretions coming from the digestive glands. Thus, agents introduced with the food, as well as the food itself, may after their absorption into the cir- culation lead to changes in the rate of flow and composition of the blood passing through the glands, modifying thereby the amount of material available for the manufacture of the several digestive secretions. Further, these agents may exert a spe- cific influence upon the nerves which directly govern secretion, thereby directly affecting the manufacture and flow of the in- dividual digestive fluids. Again, the mere presence of sub- stances introduced with the food may exert an influence upon the digestive or solvent action of the secretions, thus modifying the rate of digestion. For example, the presence of salt in the stomach-contents may lead to an acceleration of gastric digestion through a simple acceleration of ferment action, while larger quantities of the same salt in the stomach may retard gastric digestion through inhibition of ferment action. Obviously, the duration of this acceleration or retardation of gastric digestion would depend primarily upon tlie length of time the salt re- mained in the stomach, i. e., upon the rapidity of its absorption and consequent removal from the alimentary tract. Still again, the rate of digestion may be modified by agents which, absorbed into the blood, act upon the nerves, controlling the motor func- tions of the stomach and intestine. Thus, normally the latter 142 THE LIQUOR PROBLEM. organs are constantly in motion, producing a more or less con- stant agitation or churning of the respective contents which serves to intimately mingle the food particles with the digestive juices, thereby accelerating digestion. Hence, everything else being equal, anything which tends to accelerate peristalsis will in turn accelerate the rate of digestion, while, on the other iand, retardation of peristalsis may be accompanied by inhibition of digestion. Lastly, the rate of absorption from the alimentary tract exercises an influence upon the speed of digestion : con- sequently any agent which, for example, modifies the flow of blood along the gastro-intestinal tract, thus influencing the rate of absorption, may indirectly affect the speed of digestion. It is thus plainly evident that what we term digestion may be in- fluenced through a variety of channels, but the two more im- portant ways in which digestion may be modified are through changes in the rate of flow and composition of the digestive fluids, i. e., changes in secretion, and through changes (either acceleration or retardation) in the rate of digestive action caused by the mere presence of some substance in the digestive mix- ture, i. e., through a direct influence upon the purely chemical processes of digestion. Moreover, it is obvious likewise that a substance may exercise an inhibitory influence in one direction, as upon the chemical process of digestion, while leading to an acceleration in another direction, as on secretion. Further, a given agent may produce one effect on salivary digestion and quite a different effect on gastric digestion. Obviously, therefore, in studying the influence of alcoholic beverages on digestion, there are many lines of inquiry which must receive attention. n. GENERAL CONCLUSIONS AS TO THE INFLUENCE OF ALCO- HOL AND ALCOHOLIC BEVERAGES ON DIGESTION. As already indicated, digestion may be influenced by alcoholic fluids in several ways, notably by influencing the rate of secre- tion of the digestive fluid, either increasing or diminishing the rate of flow and thereby increasing or decreasing the volume of digestive fluid available, and also by modifying either favorably or unfavorably the chemical composition of the secretion. Fur- ther, the presence of the alcoholic fluid, in the stomach for ex- ample, may exercise a direct influence upon the chemical pro- cesses of digestion, either augmenting or retarding the natural solvent or digestive action of the secretion. Again, digestion may be influenced indirectly by the action of an alcoholic fluid upon the rate of absorption and upon the peristaltic movements of the intestine, since both of these factors exert an influence upon the rapidity of digestion. 1. Gastric Digestion. a. Influence of alcohol and alcoholic beverages on the secre- tion of gastric juice. The results of the experiments carried out by the writer and his assistants on the influence of alcohol and alcoholic beverages on the secretion of gastric juice lead to some very definite conclusions. The data obtained and presented in detail in the subjoined report tend to show that when alcohol and alcoholic fluids are taken into the stomach there is a marked increase in the flow of gastric juice accompanied by an increase in the content of the essential constituents, pepsin and hydro- chloric acid, as well as in the content of total solid matter. Moreover, this stimulating effect of alcohol and alcoholic bev- erages upon the secretion of gastric juice is not limited to a direct action dependent upon the presence of the alcoholic fluid in the stomach, but is exerted likewise indirectly through the influence of alcohol absorbed from the intestine. Thus, if the 144 THE LIQUOR PROBLEM. intestine is entirely shut o£E from the stomach by a ligature at the jjylorus, the introduction of an alcoholic fluid into the in- testine is followed by a stimulation of the gastric glands accom- panied by an outpouring of the gastric secretion. Whiskey, brandy, sherry, claret, beer, and porter, as well as pure alcohol, all agree in producing direct and indirect stimulation of gastric secretion, increasing both the rate of flow of the gastric juice and the concentration of the fluid. Of special importance in this connection is the fact, brought out by experiment, that when alcohol and alcoholic beverages are introduced into the alimentary tract there is a very rapid absorption of the alcohol into the circulation. The alcohol quickly leaves the stomach and intestine passing into the blood, this act being accompanied by an inrush of acid gastric juice in large quantity. Even from the stomach, where absorption is ordinarily comparatively slight, the absorption of alcohol goes on with considerable rapidity. Thus, the introduction of two hundred c. c. of thirty-seven per cent, alcohol into the stomach of a dog with the intestine ligated at the p3dorus may be followed by the nearly complete disapj)earance of the alcohol in three hours by absorption through the stomach walls into the blood. When the outlet from the stomach into the intestine is open, then the rate of absorption of alcohol is greatly increased. Al- cohol unquestionably disappears from the alimentary tract quite rapidly. Thus, in one experiment, fifty c. c. of twenty per cent, alcohol were introduced into the stomach of a dog with a gas- tric fistula, and on withdrawal of the stomach-contents half an hour later no alcohol whatever was found in the forty c. c. of fluid obtained. In view of this rapid disappearance of alcohol from the alimentary tract it is plain that alcoholic fluids cannot have much, if any, direct influence upon the secretion of either pancreatic or intestinal juice. Further, it is equally clear that the rapid removal of alcohol from the stomach by absorption must tend to diminish considerably any influence the presence of alcohol might exert upon the solvent or digestive action of the gastric juice in the stomach. The conclusion is therefore obvious that when alcoholic fluids are taken into the stomach there is first a direct stimulation, leading to the rapid secretion of a powerful gastric juice. This is followed by a more or less rapid absorption of the alcohol DIGESTION AND SECRETION. 145 accompanied in turn by an indirect or secondary stimulation of gastric secretion. These conclusions are in accord with many previous observations bearing upon this subject. Thus, in many of the older handbooks of physiology the statement is frequently found that '' alcohol is a strong stimulant of gastric secretion," and it has been a common practice to use alcohol as a means of obtaining gastric juice from dogs with gastric fistulae.^ Glu- zinski, in 1886, reported that when brandy and dilute alcohol were administered to men these fluids gave rise, after a brief preliminary period, to the formation of a very active gastric juice, rich in hydrochloric acid. Wolff, in 1889, found that cognac in small doses increased the secretion of hydrochloric acid. He reports in addition, however, that in larger quantity it decreases the acidity of the gastric juice. Klemperer, in 1890, observed that moderate doses of alcohol led to a very slight increase in the secretion of gastric juice, while in the same year Blumenau reported that the introduction of twenty- five to fifty per cent, alcohol into the healthy human stomach acts as a secretory stimulant, bringing about an increased flow of gastric juice with rise of acidity. Brandl, in 1892, experi- menting with fistulous dogs, found that alcohol — as contrasted with water — introduced with foodstuffs into the stomach brings about an unfailing, though not particularlj- large, increase in gastric secretion. Lastly, Haan, in 1895, with repeated and in- creasing doses of alcohol observed an augmentation in the acidity of the gastric seci-etion from the dog, followed after a few days by a diminution in the amount of secretion and a gradual decline in acidity. It is thus apparent that, in a general way at least, there is a perfect agreement between our observations upon this subject and the recorded observations of other physiologists. Further, there is no necessary inconsistency between the stimu- lating action of alcohol upon gastric secretion and the quite prob- able detrimental action of larger doses frequently repeated. As stated by both Heidenhain and Lauder Brunton, large amounts of alcohol are regarded as detrimental to the stomach, giving rise eventually to a pathological condition, a statement which is doubtless correct. It has been our aim, however, to ascertain the physiological action of alcoholic beverages upon gastric 1 The authority for these and some of the following statements will be found in the references on pages 251-253 of this report. 146 THE LIQUOR PROBLEM. secretion, and upon this point our conclusions are quite definite that they act as stimulants. 6. Injluence of alcohol and alcoholic beverages on the chem- ical 2}'>'occsses of gastric digestion. Our exjieriments upon this subject have been very numerous, and for the detailed re- sults reference must be made to the subjoined report. It will suffice here to state merely our general conclusions, bearing in mind, however, that these have to do simply with the action of various alcoholic fluids upon the chemical processes of gastric digestion, i. e., the influence of the presence of alcoholic fluids in the stomach upon the solvent or digestive action of the gastric juice on proteid foods. Pui-e ethyl alcohol, when mixed with the stomach-contents or with an artificial pepsin-acid solution, has little or no effect on pepsin-proteolysis when present in small amount, say one or two per cent, of absolute alcohol. Not until the digestive mixture contains five to ten per cent, of absolute alcohol is the action of the gastric juice materially interfered with. With these propor- tions of absolute alcohol, equal to ten or twenty per cent, of proof spirit, retardation of proteolysis becomes noticeable, while in the presence of fifteen to eighteen per cent, of absolute alcohol di- gestive action may be reduced one quarter or even one third. Especially noteworthy is the fact that the extent of retardation by a given percentage of alcohol varies greatly with the strength or activity of the gastric juice and with the digestibility of the proteid food. Everj'thing else being equal, the greater the strength or digestive power of the gastric juice, the less is the retardation ; while, on the other hand, the weaker the gastric juice, the greater is the inhibitory action of a given amount of alcohol. Normally, however, it is safe to say that until the stomach-contents contain ten per cent, of proof spirit, there is no appreciable retardation of the solvent action of the gastric juice. Strong alcoholic beverages, such as whiskey, brandy, rum, and gin, ordinarily containing from forty to fifty per cent, of ab- solute alcohol, have an action upon gastric digestion practically proportional to the amount of alcohol present. Thus, with a vigorous gastric juice, the presence of ten per cent, of whiskey results simply in a slight retardation of digestive action. With a weak gastric juice, the retardation is much greater. When DIGESTION AND SECRETION. 147 digestive action is fairly vigorous, the presence of small per- centages of whiskey causes practically no retardation. The detailed results of our experiments in this direction, given in the subjoined report, lead to the conclusion that pure whiskey, rum, brandy, and gin are no more deleterious to the digestive action of gastric juice than corresponding strengths of absolute alcohol, and that in the healthy individual these liquors can be considered to directly impede the gastric digestion of pvoteid foods only when taken immoderately and in intoxicating doses. The possible presence of so-called fusel oils in whiskey, as an impurity, cannot materially modify the action of this alcoholic beverage on gastric proteolysis. Our experiments tend to show that in small quantities the higher alcohols characteristic of fusel oils are prone to increase somewhat the solvent action of the gastric juice, and it is only when j)resent in large amounts, far larger than would be possible when introduced as an impur- ity in whiskey, that they show any decided inhibitory action. In considering the influence of wines upon the solvent action of the gastric juice, they may be divided for convenience into the two classes of heavy and light wines, i. e., those which con- tain a comparatively large percentage of alcohol, as shen-y, and those which contain a smaller amount of alcohol, as claret, and hocks. With such samples of sherry wine as we have experi- mented with — samples containing from twenty to twenty-one per cent, of alcohol — there is marked retardation of gastric proteo- lysis. The inhibition produced is out of all proportion to the amount of alcohol present. Indeed, the presence in a digestive mixture of five per cent, of sherry, equal to not more than one per cent, of absolute alcohol, has a far greater retarding effect on the solvent action of the gastric juice than even five per cent, of absolute alcohol. That the inhibitory action of the sherry is not due to the alcoliol or other volatile matters con- tained in the fluid is apparent from the fact that when the dis- tillate from tlie wine is added to an artificial gastric juice, in amount equal to ten per cent, of the original wine, there is distinct stimulation of digestive action. The retarding ac- tion is due, mainly at least, to the solid matters present in thfe wine, which in this particular sample amounted to 4.73 per cent. These conclusions are based upon experimental data which are seemingly quite definite. Doubtless, however, the 148 THE LIQUOR PROBLEM. natural variability in the amount and character of the solid matter contained iu wines of this class may lead to some varia- tion in the extent of the influence exerted on the solvent action of the gastric juice. With clarets, on the other hand, containing approximately ten per cent, of alcohol, small amounts (say one per cent.) added to gastric juice lead to an increase in the rate of digestion. Large amounts of claret have a distinct inhibitory action which, however, is not anywhere near so pronounced as with sherry. It is true that the content of alcohol in the claret is only half that of the sherry, but even six per cent, of claret is equal to only six tenths of one per cent, of absolute alcohol. The retardation, however, produced by the presence of five per cent, of claret is approximately equivalent to that caused by five per cent, of absolute alcohol, from which it is evident that the inhibition of proteolysis produced by the presence of large amounts of clai-et must be due to something other than the alco- hol present. This is unquestionably the solid matter and ex- tractives present. With white wines of the hochheimer type, con- taining about eleven per cent, of alcohol, small quantities tend to increase the rate of pepsin-digestion, while larger amounts, say ten per cent., have a slight retarding effect which is due al- most wholly to the solid matter present in the wine rather than to the alcohol or other volatile matter. Seemingly, white wines are far less active than red wines in inhibiting pepsin-proteolysis, due doubtless to the fact that they contain, as a rule, less solid matter than the red wines. That such retardation of digestive proteolysis as these various alcoholic beverages produce is due far more to the presence of extractives, etc., than to the alco- hol contained in them is plainly evident from a comparison of the relative action of a given percentage (say five per cent.) of rum, whiskey, brandy, sherry, hochheimer, and claret upon the digestive action of the gastric juice. Thus, in one comparative experiment of this character, it was found that sherry, with its high content of solid matter, had the greatest retarding action, while claret came next, followed by the hochheimer. Rum, whiskey, and brandy, with the highest content of alco- hol, produced the least effect. In other words, rum, whiskey, and brandy cause approximately only half the retardation of gastric proteolysis that the same percentage of claret will pro- duce, although the latter contains only one fifth as much abso- DIGESTION AND SECRETION. 149 lute alcohol ; five per cent, of absolute alcohol has no greater retarding action than the same percentage of claret with only- one tenth as much alcohol. With malt liquors, such as ale, lager beer, bock beer, stout, and porter, having a content of alcohol ranging fi'om 1.5 to 5.5 per cent., our experiments lead to the conclusion that in small quantities they are without any inhibitory influence on the digestive power of the gastric juice ; indeed, small amounts show a tendency to increase slightly the rate of digestion. In larger quantities, they give rise to an inhibition of proteolysis which is entirely unconnected with the small amounts of al- cohol present, but directly traceable to the comparatively large amounts of extractives they contain. When these beverages are consumed very freely with the meals, so that the digesting mass in the stomach contains from fifty to sixty per cent, of a malt liquor, then the retarding action upon the solvent or di- gestive power of the gastric juice must be very considerable owing to the influence of the extractives they contain. Taken in small quantities, on the other hand, these malt liquors are without any noticeable inhibitory effect upon the proteolytic action of gastric juice. As stated in the subjoined report, such inhibitory action as these fluids possess is to be compared to the inhibitory action of such beverages as tea and coffee, the retarding action of which is equally pronounced or even greater when the latter are consumed in large quantities. It is also to be noted that the extractives or solid matters ordinarily pre- sent in malt liquors are not especially peculiar in possessing this retarding action upon pepsin-proteolysis. It is, indeed, a pro- perty shared by many substances, and does not in itself neces- sarily constitute an evil of any great magnitude unless the retardation is very pronounced and liable to be long continued. Then it may become a serious evil, and one sufiicient'to con- demn the substance which causes it. Our results and the conclusions we draw from them are in close accord with the published statements of nimierous investigators in this direction. Thus, Sir William Roberts ^ found by artificial digestion experiments that in the presence of less than ten per cent, of proof spirit there was no ap- ^ The authority for these and some of the following statements is to be found in the references on pages 251-253 of this report. 150 THE LIQUOR PROBLEM. preciable retardation of gastric digestion. With twenty per cent, of proof spirit there was distinct, though slight, re- tardation. Klikowicz observed that five per cent, of alco- hol in a digestive mixture led to somewhat variable results, although, as a rule, slight stimulation of proteolysis was ob- servable. With whiskey, Roberts obtained results which led him to the conclusion that, " taking into account the quantity of whiskey commonly used dietetically with the meals, the amount so consumed is not sufficient to appreciably retard the speed of gastric digestion. For if the digesting mass in the stomach be estimated at two pounds, a wineglass (two ounces) of whiskey added thereto would only equal five per cent, of proof spirit (or 2.5 per cent, of absolute alcohol), an amount too small to hamper digestion to any appreciable ex- tent." In regard to the action of wines Buchner found, in agreement with our results, that the light white and red French wines retard gastric digestion far more than corresponding quantities of alcohol, and Sir William Roberts came to the same conclusion. Writing of the dietetic use of sherry, the latter authority concludes from his experiments that " as used dietetically, sherry must figure as having frequently an im- portant retarding effect on pejitic digestion. This wine is used with dinner by some persons very freely. Half a pint of sherry is no unusual allowance, and this in a total gastric charge of two pounds amounts to about twenty-five per cent., which the table shows to be a highly inhibitory proportion. In the more common practice of taking two or three wineglasses of sherry with dinner, we see probably a double action — a stimulating action on the secretion of gastric juice and on the muscular contraction of the stomach, and a slight retarding effect on the speed of the chemical process especially in its early stages." Again,' the same writer states, " If we consider the copious pro- portions in which hock and claret are used dietetically, it be- comes evident that their retarding effect on peptic digestion is often brought into play. A pint of claret or hock is a common allowance with dinner for robust eaters — and such a propor- tion, as the table shows, would not be without considerable effect. . . . On the other hand, the more sparing use of these wines, a glass or two with dinner or luncheon would evidently not produce any appreciable retardation of peptic action, but DIGESTION AND SECRETION. 151 would, like corresponding doses of sherry, act as pure stimu- lants." With these statements our results and the conclusions we are inclined to draw from them ai-e in close accord. c. Influence of alcohol and alcoholic beverages on gastric digestion as an entirety. — From what has already been stated, it is evident that alcohol and alcoholic fluids may act directly and indirectly as stimulants to the secretion of gastric juice, and judged from this standpoint alone, their ingestion in not too large quantities must tend to accelerate the digestion of proteid foods in the stomach. Coupled with this stimulating action upon secretion, however, we find that the presence of alcoholic fluids in the stomach, especially when present in large amounts, leads to an inhibition of the chemical process of digestion, i. e., causes a retardation of the solvent action char- acteristic of digestion. The question therefore naturally arises, how far these two diverse effects may neutralize each other? In other words, what is the result of this divergent action upon the process of digestion as it goes on in the living stomach ? In view of what has been stated regarding the rapid with- drawal of alcohol from the stomach by absorption, together with the action of the absorbed alcohol upon secretion, it would appear that the stimulating effect of alcoholic fluids upon gas- tric secretion would be far more lasting than the inhibitory action upon the chemical process of digestion, and thus lead to a marked increase in the rate of digestion. This point has been carefully tested by a long row of experiments upon dogs with gastric fistidae, comparing the rate of digestion of a given test meal to which water was added, with the rate of digestion of a corresponding meal to which alcohol or some alcoholic beverage was added. The results collectively indicate that the period of gastric digestion is not greatly varied under the influence of alcohol or alcoholic beverages. In some few of the experi- ments, the results indicate a slight acceleration of digestion in the presence of weak alcoholic beverages, while in others strong alcohol retards slightly the rate of digestion. Giving due heed, however, to the unavoidable errors which must of necessity at- tend this kind of experimentation, we believe that the results obtained justify the conclusion that gastric digestion as a whole is not materially modified by the introduction of alcoholic fluids with the food. In other words, the unquestionable acceleration 152 THE LIQUOR PROBLEM. of gastric secretion which follows the ingestion of alcoholic beverages is, as a rule, counterbalanced by the inhibitory effect of the alcoholic fluids upon the chemical process of gastric digestion, with perhaps at times a tendency toward preponder- ance of inhibitory action. The general conclusion that alco- holic beverages do not, as a rule, materially modify the ultimate result in gastric digestion is in perfect harmony with the ob- servations of Zuntz and Magnus-Levy ^ regarding the influence of alcohol (beer) on the digestibility and utilization of food in the body. Thus it was found by these investigators, fi'om a series of metabolic experiments on men with diets largely made up of milk and bread, and on individuals accustomed and unaccus- tomed to the use of alcoholic beverages, that the latter did not in any way diminish the utilization of the food by the body. 2. Salivary Digestion. a. Influence of alcohol and alcoholic beverages on the secre- tion of saliva. Our expei'iments as to the influence of alco- hol and alcoholic fluids on the secretion of mixed saliva in man and on the secretion of the submaxillary saliva in dogs lead to the following conclusions. When alcohol and alcoholic bever- ages are taken into the mouth, there is a direct stimulating effect upon the secretion of mixed saliva, increasing at once and in a very marked degTee the flow of the secretion. This acceleration of secretion, however, is of brief duration, the in- fluence passing off shoi-tly after the alcoholic fluid leaves the mouth cavity. The stimulating effect of alcohol is manifested not only by an inci'ease in the outflow of saliva, but also by an increase in the proportion of both organic and inorganic constit- uents, an increase in the content of alkaline-reacting salts, to- gether with an increase in the starch-digesting power of the se- cretion. In other words, human mixed saliva which is secreted under the influence of an alcoholic stimulant is characterized by greater digestive power upon farinaceous foods than the fluid secreted under normal conditions. This stimulating effect is in no sense peculiar to alcohol, but is precisely analogous to the action of many so-called stimulants, such as weak acids (vinegar), ether and chloroform vapor, etc. As stated above, the stimulating action of alcohol and alco- ' Archiv f. d. ges. Physiol., 1891, xlix. 438 ; and 1893, liii. 544. DIGESTION AND SECRETION. 163 holic beverages upon the secretion of saliva is a direct one, pro- duced only when the alcoholic fluid is in contact vi^ith the mouth cavity and passing off shortly thereafter. Thus, it has been found by experiment that alcoholic fluids introduced directly into the stomach in such a manner as to do away with any local action in the mouth produce no appreciable effect upon either the rate of secretion or the composition of the saliva. In other words, alcohol absorbed from the stomach and intestine into the general circulation is without influence upon the secretion of saliva ; hence, as already stated, the stimulating effect of al- coholic beverages upon the secretion of saliva is of a transitory nature. Our conclusions regarding the action of alcohol as a direct stimulant of salivary secretion receive confirmation from some recent work by Dr. Robertson,^ of Edinburgh. This investi- gator states, as the result of his experiments, that " in the form of brandy or whiskey, alcohol forms a powerful stimulating agent in promoting the flow of saliva. Even in weak solution it acts energetically ; but the stronger the alcohol the more powerful it is as a sialogogue." Bitter beer was also found to be a powerful sialogogue, while sherry did not appear to pro- mote the flow of saliva, although it did produce a more abun- dant secretion of mucus. h. Influence of alcohol and alcoholic beverages on the chem- ical processes of salivary digestion. In considering the in- fluence of alcoholic beverages upon the digestion of farinaceous foods by the saliva, it is to be remembered that the normal process of salivary digestion is a comparatively short one as contrasted with the longer periods of gastric and pancreatic digestion. The amylaceous foods are exposed to the action of the saliva in the mouth for a brief period only, and although salivary digestion is without doubt continued for a short time in the stomach, yet we have every reason to believe that the active enzj^me of the saliva is soon destroyed by the acidity of the gastric juice. To compensate, perhaps, for this shorter period of digestion, saliva is ordinarily very powerful in its ac- tion on starchy foods, a few minutes sufficing for the conversion 1 W. G. A. Robertson, " The salivary digestion of starch in simple and mixed diets : An Experimental Inquiry," Journal of Anatomy and Physi- ology, 1898, vol. xxxii. p. 615. 134 THE LIQUOR PROBLEM. of the available well-cooked starch into soluble products fitted for absorption. In view of these facts it is readily seen that retardation of amylolytic action may become a serious matter, and that even slight retardation of amylolysis may mean a loss of nutritive material to the body, or at least result in checking the utilization of the starchy foods until they are exposed to the action of the panci'eatic juice in the small intestine. Our experiments recorded in the subjoined report show quite conclusively that pure absolute alcohol has no very marked influence on the digestion of farinaceous foods by the saliva. With active saliva not greatly diluted the presence of even five per cent, of absolute alcohol, equivalent to about ten per cent, of proof spirit, may lead to a slight increase in digestive power. Larger quantities of alcohol cause retardation of amylolytic ac- tion, but even ten per cent, of absolute alcohol produces only slight retardation, hardly recognizable in the solvent action of the saliva, but showing in the amount of reducing sugar formed, i. e., in the secondary action of the saliva. With strong alcoholic beverages, as whiskey and brandy, salivary digestion is not materially retarded in the presence of five per cent, of the liquors, provided the saliva is not too greatly diluted. Indeed, there may even be stimulation of amylolysis under these conditions. When, however, the saliva is greatly diluted or very weak in its amylolytic power, then re- tardation is noticeable even in the presence of small quantities of these alcoholic beverages. Inhibition of amylolysis in these cases, our experiments show, is out of all proportion to the con- tained alcohol, and is to be attributed mainly to the slight acid- ity of the fluids. Rum differs from whiskey and brandy in having a somewhat greater inhibitory action, due simply to the greater acidity of this fluid, and not connected with the alcohol present. Large amounts of whiskey, brandy, and rum produce marked retardation ; a retardation, however, which is not closely connected with the amount of alcohol the fluids contain, but is more intimately associated with the presence of volatile, acid- reacting bodies. In conformity with this statement, we find that the solid non-volatile matters in whiskey tend to increase decidedly the starch-digesting power of saliva. Wines, as a class, show a very powerful inhibitory influence upon salivary digestion, an influence which is due almost en- DIGESTION AND SECRETION. 155 tirely to their acid properties. Thus, when the acidity of a wine is neutralized with some alkaline fluid, it loses completely its inhibitory effect on salivary digestion. Malt liquors like- wise have a verj' great retarding effect upon salivary digestion, especially when the saliva is quite dilute. When the saliva is less dilute, then the retarding action of the malt liquor is much less pronounced. In all cases, however, the retarding action is due almost entirely to the presence of acids or acid-reacting bodies. Consequently, as stated in the body of our report, we may conclude that the retardation of salivary digestion caused by ordinary alcoholic drinks is in character similar to the re- tardation which follows the use of vinegar, lemon-juice, or other acid fluids or mixtures, such as salads highly seasoned with vinegar, etc., the only difference being that the latter class are unquestionably more vigorous in their retarding action from their greater degree of acidity. We may indeed quei-y whether under ordinary circumstances in the body the retarding action of all these fluids, alcoholic or otherwise, is quite as great as some of our experiments would at first glance indicate. It must not be overlooked that the saliva is ordinarily alkaline, and with such an alkaline fluid, aided perhaps by alkaline food, a portion, at least, of the disturbing acid of the alcoholic bever- age, especially if the latter is not imbibed in too large quantity, may be neutralized and thus deterred from exercising any deleterious influence. Further, the widespread use of efferves- cent table waters, such as Apollinaris water and others charged with alkaline carbonates, as additions to wines of the claret and hock type, would likewise lead to a diminution of the danger in this direction. On the other hand, the acid alcoholic bever- ages, especially the sour wines and other liquors with pro- nounced acid reaction, must always be a menace to the thorough and vigorous digestion of farinaceous foods by the saliva. This obviously may be a matter of little moment to a vigorous per- son with abundant digestive resources, but to the weak and ail- ing individual with scant digestive powers it may be a matter of vital importance. The general tenor of our conclusions in this direction is in close harmony with the observations of Sir William Roberts. Thus, this investigator states that "both the stronger and the lighter wines show a powerful inhibitory effect on salivary digestion. Even so small a proportion as one 156 THE LIQUOR PROBLEM. per cent, of sherry or hock was found to paralyze saliva almost completely, and even one quarter of this proportion delayed the achromatic point appreciably. Claret and port wine behaved similarly. The inhibitory effect of wines is entirely due to the very considerable degree of acidity vehich they all possess. . . . When the acidity of wines is neutralized they lose entirely their inhibitory effect on salivary digestion." Further, in writing of the action of malt liquors, Roberts states, as the result of his experiments, that " malt liquors were found to hamper salivary digestion exactly in proportion to their degTce of acidity." Robertson,^ in his recent work on the salivary digestion of starch, reports that " wines have a very marked inhibitory in- fluence-on the digestion of starch by saliva, and this is almost wholly due to their acidity." Alcohol, he states, even in dilute solution, " retai-ds salivary digestion of starch, but the action is much less marked than in the case of infusions of tea." Lastly, the same author states that " beer promotes the salivary diges- tion of starch," a conclusion which our results hardly confirm. It should be mentioned, however, that the character of the re- sults to be expected in experiments of this kind must of neces- sity be influenced by the character of the beer employed, i. e., the extent of its acidity, while the reaction of the saliva must also be taken into account. 3. Pancreatic Digestion. While pancreatic digestion normally plays an exceedingly important part in the digestive process as a whole, the fact that the field of its operations is limited to the small intestine makes it very probable that alcoholic beverages as ordinarily consumed can exercise very little direct influence upon this phase of digestion. The main ground for this as.sumption lies in the fact, already explained, that alcohol is very rapidly ab- sorbed from the alimentary tract. Indeed, as previously stated, alcohol, unlike most other substances, undergoes rapid absorp- tion from the stomach, the results of our experiments clearly indicating that under ordinary circumstances, at least, alcoholic fluids taken by way of the mouth must lose the greater portion, if not all, of their contained alcohol before passing through the 1 The salivary digestion of starch in simple and mixed diets : " An Experi- mental Inquiry," Journal of Anatomy and Physiology, 1898, vol. xxxii. p. 615. DIGESTION AND SECRETION. 157 pyloric orifice. Further, such portions of alcohol as may reach the small intestine must undergo rapid absorption there, while the other constituents of the alcoholic beverages must also be rapidly diminished by absorption. In view of these facts, we think it quite plain that digestion in the intestine cannot be materially affected through any direct action of alcoholic bever- ages. On the other hand, it is possible that pancreatic diges- tion may be indirectly influenced through an action of the ab- sorbed alcohol upon the secretion of pancreatic juice and, indeed, upon the secretion of bile. This point, however, we have not attempted to determine, since there was little jiromise of results of any value for the present inquiry. For various reasons, however, it has seemed desirable to ascertain what effect alcoholic beverages might have, if present, upon the pro- teolytic action of the pancreatic juice, since this is one of the chief functions of the secretion. As to the influence of alco- holic fluids upon the amylolytic action of pancreatic juice there is no cause for special inquiry, since, as is well known, the amy- lolytic enzyme of the pancreas is essentially the same as the enzyme of saliva, hence what has been found true of the latter fluid will doubtless apply likewise to the amylolytic action of the pancreatic juice. Influence of alcohol and alcoholic beverages on the digestion of proteid foods hy jiancreatic juice. The conclusions to be drawn from our experiments under this head may be briefly summarized as follows : Pancreatic juice in its proteolytic ac- tion is more sensitive to pure alcohol than gastric juice. Re- tardation of digestive action is more pronounced even with small amounts of alcohol, the presence of even two to three per cent, of absolute alcohol being sufficient to produce a distinct re- tardation of proteolysis. Still, as in the case of gastric diges- tion, the exact amount of retardation is greatly dependent upon the digestive power or concentration of the pancreatic fluid. When the amount of absolute alcohol present in the digestive mixture is less than one per cent., the inhibition of proteolytic action is very slight, provided the ferment or enzyme is fairly vigorous in its action. Toward whiskey, brandy, rum, etc., the pancreatic enzyme is exceedingly sensitive, even small amounts of whiskey especially being detrimental to the digestive action of pancreatic juice on proteid foods. Further, the retarding action of a given per- 158 THE LIQUOR PROBLEM. centage of whiskey is greater than that of a corresponding percentage of pure alcohol, thus indicating the presence of an additional inhibitory substance which is apparently a part of the solid matter of the whisiiey and is connected in part with the acidity of the fluid. Brandy and rum likewise produce a retardation of proteolysis which is somewhat greater than that caused by a corresponding strength of alcohol. With wines, pancreatic digestion of proteids is more strik- ingly inhibited than by the stronger alcoholic liquors. This action, under ordinary circumstances, is almost entirely inde- pendent of the content of alcohol and is very closely connected with the acidity of the fluid. Thus, a strongly acid wine, like a claret with only ten per cent, of alcohol, has a far greater re- tarding action on pancreatic proteolysis than a sherry with twice that content of alcohol, but with less acidity. Malt liquors, as a class, likewise exert an inhibitory influ- ence upon pancreatic proteolysis, although far less pronounced than that exerted by wines. The retai'ding action is due mainly to the character of the solid or extractive matters present in the liquors, and is practically unconnected with the content of al- cohol. In this connection, it should be mentioned that many non-alcoholic beverages have an equally pronounced inhibitory action on pancreatic proteolysis owing to the presence of certain inorganic salts and other extractives. Tea and coffee are known to exei't such an influence, while, as our experiments show, or- dinary ginger ale may produce as great an inhibition of pancre- atic proteolysis as a corresponding proportion of lager beer or Bass's ale. Our general conclusions as to the action of alcohol in this direction are in close accord with the conclusions of Sir Wil- liam Roberts, who has studied experimentally the effect of food accessories on pancreatic digestion. He states that " alcohol liad a distinctly retarding influence when its proportion in the digesting mixture rose to five per cent, of absolute alcohol (ten per cent, of proof spirit), but the effect was comparatively slight. . . . When we consider how rapidly alcohol is absorbed from the stomach, it is obviously almost impossible that the chyme in the duodenum should ever contain anything like these proportions of alcohol, so that we may consider that alcohol as used dietetically never interferes with tryptic digestion." ^ ' Sir William Roberts, Digestion and Diet, London, 1891, p. 158. III. DETAILED REPORT WITH EXPERIMENTAL DATA. The foregoing general conclusions as to the influence of al- cohol and alcoholic fluids on digestion are based upon a large amount of experimental work carried out in the Laboratory of Physiological Chemistry of the Sheffield Scientific School of Yale University. The work has extended through several years, and has been rendered possible by the active cooperation of several of the writers' assistants, viz., Professor Lafayette B. Mendel, Dr. Holmes C. Jackson, and Dr. Alfred N. Eich- ards. The exjierimental work has come under three distinct heads, viz. : 1. A study of the influence of alcohol and alcoholic drinks upon the chemical processes of digestion. 2. A study of the influence of alcohol and alcoholic drinks upon digestion, with special reference to secretion. 3. A study of the influence of alcoholic fluids on the composition and amylolytic j)ower of human saliva. Since there has been much diversity of opinion as to the action of alcoholic fluids upon digestion, it has seemed wise to present all of the experimental results as well as the in- dividual data, and the methods by which the results have been obtained, and the writer would advise all persons interested in this subject to study carefully this portion of the report as the surest way of arriving at a true comprehension of the extent to which alcohol and alcoholic fluids modify the various processes of digestion. 1. The Influence of Alcohol and Alcoholic Drinks upon the Chemical Processes of Digestion.' In attempting any accurate and complete study of the influ- ence of alcohol and alcoholic fluids upon digestion, there must be a clear recognition of the fact that no single line of experi- ' The experiments here reported were originally published by R. H. Chittenden and Lafayette B. Mendel in the American Journal of the Medical Sciences, 1890, January-April. 160 THE LIQUOR PROBLEM. mentation can lead to full and concise results covering the whole ground of inquiry. For experimental purposes, therefore, the subject must be studied under several distinct heads, as (1) the influence of alcohol and alcoholic drinks upon the process of secretion ; (2) upon the process of absorption ; (3) upon peri- stalsis ; and (4) upon the purely chemical processes of digestion. It is the latter phase of the subject we wish to consider now, viz. : the influence of alcohol and a variety of alcoholic drinks upon the digestive action of the several digestive fluids and their contained ferments or enzymes. Such a study cannot properly be carried out on animals nor on human beings, since it would then be almost impossible to connect the results ob- tained with their true cause. We must at first exclude all of the accessory influences connected with secretion, absorption, and peristalsis if we are to learn the influence of alcoholic drinks upon digestive action, and this is best done by artificial diges- tive experiments in which saliva, gastric juice, and pancreatic juice are allowed to act under definite and constant conditions upon the several foodstuffs, and any variations in activity care- fully determined. In this way, and in this way only, in our opinion, is it possible to measure the exact influence of alcohol and alcoholic fluids upon digestive action ; i. e., upon the purely chemical processes of digestion. Before proceeding f urthei', we would call attention to the fact that in writing this report we have confined ourselves mainly to a mere statement of the results obtained in our work, with the obvious conclusions to be drawn therefrom. In only a few instances have we attempted any comparison with the results obtained by other workers in this direction, and, as a rule, we have refrained from generalizations other than those plainly warranted by the data which we ourselves have obtained. At the end of the report a short bibliography is appended giving the more important papers by previous workers. A. GASTRIC DIGESTION (l. E. PEOTEOLTSIS BY FEPSIN-HYDRO- CHLOKIC acid). The solvent action of gastric juice on proteid or albumi- nous foods is due solely to the presence of pepsin-hydrochloric acid, but the amount of both pepsin and acid in the natural secretion varies considerably with different states of the system. DIGESTION AND SECRETION. 161 The average amount of hydrochloric acid, however, is approxi- mately 0.2 per cent., while to the jjepsin no definite figui-e can be given, since as yet the chemist has not been able to isolate the ferment in a pure state. Further, it is quite certain that both ferment and acid are subject to great variation in the amount present in the secretion at different stages of digestion and under different conditions of health and nutrition. In view of these facts we have experimented under varying conditions in order that our results may have as wide an application as possible. The methods pursued were as follows : — (cf) Withjluid egg-albumin.^ The albumin solution was pre- pared after the method recommended by Schiitz.^ A quantity of undiluted white of egg was freed from globulin by the ad- dition of hydrochloric acid of specific gravity 1.12 (4.2 c. c. acid to 300 c. c. of albumin), the mixture shaken vigorously, and after standing some hours filtered through paper. The clear acid fluid was then made exactly neutral with dilute sodium carbonate, after which it is ready for use. Ten c. c. of this fluid contain a little less than one gram of coagulable proteid, the exact amount being determined by heat-precipitation, collecting the coagulum on a weighed filter and drying at 110° C. The digestive experiments were made in series, each indi- vidual mixture containing the same volume of the prepared albumin solution (10-20 c. c), together with the same amount of pepsin and acid. The albumin solution was introduced into a small flask of 200 c. c. capacity provided with a suitable stopper, water and alcohol, or alcoholic fluid, being added to make the volume up to 50 c. c. Lastly, 50 c. c. of 0.4 per cent, hydrochloric acid, containing a known amount of pepsin, were added, making tlie total vol- ume of each mixture 100 c. c, and the strength of acid 0.2 per cent. HCl. It is thus evident that the only variable element in the mixtures of a given series is the amovint of alcohol or alcoholic fluid present. The flasks were then placed in a water-bath, kept approximately at the body temperature (38- 40° C.) for a definite period — usually five to seven hours. At 1 See R. H. Chittenden, " Observations on the Digestive Ferments," Medical News, Philadelphia, February 16, 1889. * Zeitschr. f. pkysiol. Chem., ix. 581. 162 THE LIQUOR PROBLEM the end of the allotted time, the extent of digestive action was determined by simply heating the mixtures to boiling, neutral- izing the acid fluid by addition of an equivalent amount of sodium carbonate in a one per cent, solution, and collecting the precipitate of unaltered albumin or acid-albumin on a weighed filter, washing it with boiling water until free from chlorides, and then drying at 110° C. until of constant weight. The dif- ference between the weight of coagulable albumin introduced and the amount found at the end of the experiment gives the amount of soluble digestive products, i. e., albumoses and pep- tones, formed under the conditions of the experiment. In this way it is jiossible to measure accurately the extent of proteoly- tic action under varying conditions. (6) With coagulated blood-fibrin. Fresh blood-fibrin from the blood of oxen or sheep was washed with water until quite white, then boiled repeatedly with water, after which it was thoroughly extracted with cold alcohol, boiling alcohol, and, lastly, with ether. It was then ground to a coarse jDowder and passed through a sieve, so constructed that the particles collected were all approximately of the same size. The so prepared powder was then dried at 110° C. until of constant weight. The digestive experiments with this form of jjroteid matter were conducted as follows : A definite amount of alcohol or alcoholic fluid was introduced into each flask, water being added to make the volume 50 c. c. Then 50 c. c. of 0.4 per cent, hy- drochloric acid containing a known amount of pepsin were added, thus making the total volume of fluid 100 c. c. To this mixture two grams of the prepared fibrin were added. Thus, as in the experiments with fluid egg-albumin, all of the mixtures of a given series were exactly alike in containing the same volume of 0.2 per cent, hydrochloric acid, the same amount of pepsin, etc., but unlike in the percentage of alcohol or alcoholic fluid pre- sent. For comparison, one mixture of each series contained no alcohol whatever. When prepared, the mixtures of a given series were placed in a bath at 38°-40° C. for two to three hours, where they were kept under exactly the same conditions, being stirred or shaken to the same extent, etc. At the end of the given period the mixtures were heated to boiling to destroy the ferment, after which the undigested residue was collected on a weighed filter, washed with boiling water until free from all DIGESTION AND SECRETION. 163 soluble matter, then dried at 110° C. until of constant weight. The difference between the weight of the fibrin taken and the undissolved residue is a true measure of the digestive action under the conditions of the experiment. Action of Absolute Alcohol (99.5-100 per cent.). The laercentages of alcohol referred to are percentages by volume unless otherwise specified. The pepsin employed was a very active scale pepsin marked 1 : 4000. Experiment 1. Conditions : Proteid = fluid egg-albumiu (20 c. c). 20 c. c. albumin solution contain 1.6398 grams dry albumin. 0.03 gram pepsin ; 0.2 per cent, hydrochloric acid. Period of digestion 6\i hours at 38°^0° C. Alcohol. per cent. 6 Undigested albumin. 0.1850 gram. 0.2708 " Proteid digested. 88.8 per cent. 83.5 Relative proteolyti action. 1^ 100.0 94.0 12 0.5173 " 66.7 76.0 18 0.6703 " 59.2 66.6 Experiment 2. Conditions : Proteid =: fluid egg-albumin (15 c. c). 15 c. c. albumin solution contain 1.0522 grams dry albumin. 0.0024 gram pepsin; 0.2 per cent, hydrochloric acid. Period of digestion 5J hours at 38°-40° C. Alcohol. per cent. 1 3 6 Experiment 3. Conditions : Proteid = fluid egg-albumin (10 c. c.). 10 c. c. albumin solution contain 0.8199 gram dry albumin. 0.03 gram pepsin; 0.2 per cent, hydrochloric acid. Period of digestion 5^ hours at 38°-40° C. ' Expressing the relative extent of digestive action as compared with the action of the control experiment, the latter being taken as 100. Undigested albumin. Proteid digested. Relative proteolytic action. 0.4007 gram. 62.0 per cent. 100.0 0.4075 « 61.3 98.8 0.5146 " 51.1 82.4 0.6256 " 40.6 65.4 164 Alcohol. per cent. 1 3 5 8 10 THE LIQUOR PROBLEM. trace 0.0100 gram. 0.0130 " 0.0250 " 0.0699 " 0.0875 " 100.0 per cent. 98.5 97.0 91.5 89.4 Relative proteolytic action. 100.0 98.8 98.5 97.0 91.5 89.4 Experiment 4. Conditions : Proteid = fluid egg-albumin (20 c. c). 20 c. c. albumin solution contain 1.9198 grams dry albumin. 0.03 gram pepsin; 0.2 per cent, hydrochloric acid. Period of digestion 5^ hours at 38°— 10° C. Alcohol Undigested albumin. Proteid digested. Relative proteolyt action. per cent. 0.0887 gram. 95.4 per cent. 100.0 1 0.0740 " 96.1 100.8 5 " 0.2617 " 86.4 90.5 10 0.5373 « 72.0 " 75.5 15 0.5859 « 69.5 " 72.8 Experiment 5. Conditions : Proteid =r blood-fibrin (2 grams). 0.016 gram pepsin; 0.2 per cent, hydrochloric acid. Period of digestion 2\ hours at 38°-10° C. Alcohol. per cent. 1 3 5 The following five series of experiments were all made after the same plan, each mixture containing 2 grams of blood-fibrin, 0.016 gram pepsin in 0.2 per cent, hydrochloric acid, and warmed at 38°-40° C. for 21 hours : — Undigested fibrin. Proteid digested. Relative proteolj^ic action. 0.5834 gram. 70.9 per cent. 100.0 0.5727 " 71.4 100.7 0.6273 " 68.7 96.8 0.6493 " 67.6 95.3 per cent. 10 « Experiment 6. 0.3676 gram. 0.6970' " 81.7 per cent. 70.2 Relative proteolytic action. 100.0 85,9 1 Filtered very slowly and could not be washed thoroughly ; hence, the result is only approximately correct. per cent. 5 DIGESTION AND SECRETION. Experiment 7. Undigested Proteid fibrin. digested. 0.2013 gram. 90.0 per cent- 0.2601 " 87.0 " Experiment 8. Relative proteolytii action. 100.0 96.6 per cent. 6 per cent. 5 0.1759 gram. 0.2145 « 91.3 per cent. 89.3 Experiment 9. fibrin. 0.2027 gram. 0.2619 " 89.9 per cent. 87.0 100.0 97.8 100.0 96.7 per cent. 4 Experiment 10. Undigested Proteid fibrin. digested. 0.3881 gram. 80.6 per cent. 0.4118 " 79.5 Relative proteolytic action. 100.0 98.6 In the following three experiments the conditions were the same as in the preceding, excepting that the mixtures were warmed at 38°-40° C. for 2 hours instead of 2| hours : — Experiment 11. Alcohol. Undigested fibrin. Proteid digested. Relative proteolytic action. per cent. 0.5315 gram. 73.5 per cent. 100.0 2 0.5390 " 73.1 99.4 Experiment 12. Alcohol. Undigested fibrin. Proteid digested. Relative proteolytic action. per cent. 0.4630 gram. 76.9 per cent. 100.0 2 0.4583 " 77.1 100.2 Experiment 13. Alcohol. Undigested fibrin. Proteid digested. Relative proteolytic action. per cent. 0.1970 gram. 90.2 per cent. 100.0 5 0.2830 « 85.9 95.2 In the following three experiments the conditions were the same as in the preceding, except that the mixtures were warmed at 38°-40'= C. for 1| hours : — Experiment 14. Alcohol, per cent. 2 Undigested Proteid fibrin. digested. 0.50G8 gram. 74.7 per cent. 0.4970 " 75.2 Relative proteolyti action. 100.0 100.6 166 Alcohol. per cent. 5 Alcohol. per cent. THE LIQUOR PROBLEM. Experiment 15. Proteid digested. 89.9 per cent. 88.5 0.2032 gram. 0.2317 " Experiment 16. Proteid fibrin. digested. 0.32-17 gram. SS.* per cent. 0.355-1 " 82.3 Relative proteolytic actiou. 100.0 98.2 In the following two experiments the mixtures were warmed at 38°-40° C. for 1,1- hours: — Experiment 17. Alcohol. Undigested fibrin. Proteid digested. Relative proteolytic action. per cent. 0.3361 gram. 83.2 percent. 100.0 5 0.4040 " 79.8 95.9 Experiment 18. Alcohol. Undigested fibrin. Proteid digested. Relative proteolytic action. per cent. 0.3867 gram. 80.7 per cent. 100.0 5 0.4352 " 78.3 97.0 In the following experiment the conditions were apparently much the same as in the preceding experiments, although the results show a greater degree of retardation with like per- centages of alcohol : — Experiment 19. Conditions : — Proteid = blood-fibrin (2 grams). 0.02 gram pepsin ; 0.2 per cent, bydrochloric acid. Period of digestion 24 hours at 38°^0° C. Alcohol. Undigested fibrin. Proteid digested. Relative proteolyti action. per cent. 0.4536 gram. 77.32 per cent. 100.0 0.5 0.4688 " 76.56 99.0 1.0 0.4954 " 75.23 97.2 2.0 0.4958 " 75.21 97.2 3.0 0.5324 " 73.38 94.9 5.0 0.6031 « 69.84 " 90.3 A carefid study of all the preceding results makes it evident that we cannot define with mathematical exactness the action of a given percentage of absolute alcohol on pepsin-proteolysis, since variations in the attendant conditions, i. e., the relative amounts of pepsin, acid, and proteid, together with the period DIGESTION AND SECRETION. 167 of digestion, the digestibility of the particular proteid, etc., are proue to modify the final result. Thus, with a weak gas- tric juice, where the amount of ferment present is small and digestive action consequently slow, or where the proteid material used is difficult of digestion, the retarding effect of a given percentage of alcohol is far greater than when the digestive fluid is more active ; that is, when it contains more pepsin. (Contrast Experiments 1, 2, and 3.) Further, this difference of action is more pronounced the larger the percentage of alcohol present. Thus, in Expei'iments 2 and 3, where the difference in the amount of pepsin present is very great, the ac- tion of one per cent, of absolute alcohol is essentially the same ; but when the amount of alcohol is raised to three, five, or six per cent., then the difference in digestive action is very striking. Bearing in mind the possibility of these variations incidental to variations in the attendant conditions, and recognizing the possibility and probability of just such valuations in the human stomach, we may look at our results with a view to drawing some general conclusions. First, it is plainly manifest that in the presence of small amounts of alcohol (from one to two per cent, of absolute alcohol) gastric digestion may proceed as well or even better than under normal circumstances. In fact, many of our experiments show a slight increase in digestive power when the mixture contains one or two per cent, of absolute alcohol. This increased digestive action, though slight, occurs too frequently to be tlie result of mere accident, and apparently indicates a tendency for alcohol, when present in small quan- tity, to increase slightly the digestive action of pepsin-hydro- chloric acid ; or, in other words, to so stinnilate the ferment that it can accomplish somewhat more, under given conditions, than it otherwise could do. As the percentage of alcohol is raised, retardation or inhibition becomes more noticeable, al- though ordinarily it is not very pronounced until the digestive mixture contains five to ten per cent, or more of absolute alcohol. With from fifteen to eighteen per cent, of absolute alcohol, digestive action may be reduced one quarter or even one third, the exact amount of retardation, however, being especially de- pendent upon the strength or activity of the gastric juice and upon the natural digestibility of the proteid material. (See 168 THE LIQUOR PEOBLEM. Experiments 1, 3, 4, and 6.) It is to be remembered, however, that eighteen per cent, of absolute alcohol would be equivalent to thirty-six per cent, of proof spirit, so that if we should as- sume the contents of a human stomach at a given period to be one third proof spirit, it might perhaps be considered that diges- tive action would be retarded to the extent of from twenty-five to thirty-five per cent., provided the gastric juice present in the stomach was of fair strength and the proteid matter of ordinary digestibility. Such percentages of proof-spirit, however, ai'e not likely to be long present in the stomach, and it is perhaps idle to speculate on such hypothetical cases. We may in this connection, however, again emphasize the fact that the stronger the gastric juice and the more digestible the proteid food under- going digestion the less retardation will a given percentage of alcohol produce, while, on the other hand, the weaker the gastric juice and the moi-e indigestible the proteid the greater will be the inhibition caused by a given percentage of alcohol. In other words, those variations which must naturally exist in the stomach-contents of different individuals, both in health and disease, will lead to different degrees of retardation in the pre- sence of given percentages of absolute alcohol. It would, there- foi"e, be unwise to make a general specific statement regarding the action of a given percentage of alcohol. Under definite conditions, however, as our experiments plainly show, the pre- sence of a definite amount of alcohol always leads to essentially the same results. In order to prevent any misinterpretation of these results, we would again call attention to the fact that we are dealing here with only one of the four questions that need to be answered before we can hope to fully understand the influence of alcohol on gastric digestion as a whole. Thus, our results afford plain evidence of the influence of alcohol on the digestive or solvent power of the gastric juice, but we should not be justified in ar- guing that exactly the same results would follow from the in- troduction of alcohol into the living stomach. The action of a given percentage of alcohol on ^proteolysis alone would be essen- tially the same in the stomach as in a beaker, provided the alcohol was not absorbed into the blood and thus removed from contact with the digestive mixture, and provided it did not exert any influence on the character of the gastric juice secreted. DIGESTION AND SECRETION. 169 But it is easily conceivable that a percentage of alcohol which does not interfere with solution of the proteid foodstuffs may so modify the amount or character of the secretion that digestion might be greatly stimulated or greatly retarded. Further, as already stated, the presence of alcohol in the stomach may so affect absorption and peristalsis that the rate of digestion may be modified from these causes ; hence, the results above recorded are to be used only in drawing conclusions as to the effect of various percentages of alcohol on the purely chemical process of gastric digestion, i. e., on pepsin-proteolysis. In conclusion, it is to be noted that our results are more or less in accord with what has been previously published concern- ing the action of alcohol on gastric digestion. Thus, Bikfalvi i found in artificial digestive experiments that alcohol, even in small quantities, retards normal gastric digestion. Klikowicz ^ found that the jiresence of five per cent, of alcohol in the diges- tion of egg and serum-albumin led to somewhat variable results, although, as a rule, there was an indication of a slight stimula- tion of proteolytic action. In the presence of ten per cent, of alcohol there was always marked retardation, while fifteen, twenty, and thirty per cent, of alcohol checked digestion to a marked degree. Roberts found by artificial digestion-experiments that in the presence of less than ten per cent, of proof spirit there was no appreciable retardation. With ten per cent., retardation was only barely detectable. With twenty per cent., there was quite distinct, but still only a slight, retardation. Above this point, however, the inhibitory effect of alcohol increased rapidly.^ That the action of a digestive ferment may be both stimu- lated and retarded by the same substance, according to the quantity present, has been already demonstrated ; * hence there is no inconsistency in the above results with alcohol. The same action has likewise been observed with yeast-cells.^ 1 Jahreshericht fiir Thierchemie, xv. 273. ^ Virchovfs Archiv, cii. 376. ' Digestion and Diet, p. 132. * Chittenden, Studies in Physiological Chemistry, Yale Univer., vol. i. p. 76; also vol. iii. p. 60. Dubs, Virchow's Archiv, cxxxiv. 519-540. ' Schultz, P/liiger's Archiv, slii. 617. Biernacki, Jahreshericht fiir Thier- chemie, xvii. 477. 170 THE LIQUOR PROBLEM. Action of WTiiskey. Pure whiskey, as is well known, is simply " a diluted alcohol with a peculiar flavor or aroma, due to the raw material em- ployed in its manufacture, and developed during the fermenta- tion, distillatiou, and aging of the liquor." ^ Analysis of a large number of samples of whiskey made under the direction of the New York State Board of Health ^ has shown that adulteration is limited mainly to the addition of water and coloring matter, while such deleterious substances as fusel oils may be present in liquors which have not been pro- perly rectified. Thus, the percentage of alcohol was found to vary from 28.9 per cent, by volume to 60.3 per cent. By far the larger number of samples analyzed showed a content of al- cohol ranging from thirty five to forty per cent, by volume. Our work on the influence of whiskey on gastric digestion was commenced by studying the influence of a medium quality of rye whiskey (Mount Vernon pui-e rye whiskey, one dollar per quart), analysis of which gave the following results : — Specific gravity 0.937 at 17.5° C. Alcohol, by volume 50-51 per cent.' Solid residue at 110° C 0.3284 gram per 100 c. c. Ash 0.0040 " " " Reaction acid. Experiment 20. Conditions : Proteid = fluid egg-albumin (10 c. c). 10 c. c. albumin solution contain 0.8146 gram dry albumin. 0.03 gram pepsin; 0.2 per cent, hydrochloric acid. Period of digestion 4^ hours at 38°^0° C. Undigested Proteid Relative proteolytic WhisKey. albumin. digested. action. per cent. 0.0182 gram. 97.8 per cent. 100.0 3 « 0.0176 " 97.9 " 100.1 5 " 0.0288 " 96.6 " 98.7 8 " 0.0284 " 96.6 " 98.7 10 " 0.0384 " 95.3 " 97.4 ' -Second Annual Report of the New York State Board of Health, p. 642. 2 Loc. cit., pp. 647, 648. ' Varying somewhat in different samples. DIGESTION AND SECRETION. Experiment 21. Conditions : Proteid ^= fluid egg-albumin (10 c. c.). 10 c. c. albumin solution contain 0.8146 gram dry albumin. 0.012 gram pepsin ; 0.2 per cent, hydrochloric acid. Period of digestion 6 hours at 38°-40° C. Whiskey. per cent. 1 Undigested albumiu. 0.0270 gram. 0.0231 " Proteid digested. 90.7 per cent. 97.2 Relative proteolyti action. 100.0 100.5 3 0.0333 " 96,0 99.2 5 0.0393 « 95.2 98.4 8 0.0616 " 92.5 95.6 10 0.0774 " 90.5 93.5 Experiment 22. Conditions : Proteid = fluid egg-albumin (15 c. c). 15 c. c. albumin solution contain 1.0522 grams dry albumin. 0.0024 gram pepsin ; 0.2 per cent, hydrochloric acid. Period of digestion h\ hours at 38°^0" C. Whiskey. Undigested albumin. Proteid digested. Relative proteolytic action. per cent. 0.4007 gram. 62.0 per cent. 100.0 1 0.4263 " 59.5 95.9 3 0.4545 " 56.9 91.7 6 0.5372 " 49.0 79.0 Absolute alcohol. 3 per cent. 0.5146 " 51.1 82.4 Experiment 23. Conditions : Proteid ^ blood-flbrin (2 grams). 0.016 gram pepsin ; 0.2 per cent hydrochloric acid. Period of digestion 2| hours at 38°-40° C. Whiskey. Undigested fibrin. Proteid digested. Eelat ive proteolyti action. per cent. 0.3401 gram. 83.0 per cent. 100.0 1 0.3357 " 83.3 100.3 3 0.3401 " 83.0 100.0 6 0.3678 " 81.7 « 98.4 Experiment 24. Conditions the same as in the preceding experiment : Fluid Undigested Proteid Relative proteolytic added. fibrin. digested. action, per cent. 0.2013 gram. 90.0 per cent. 100.0 5 « absol. alcoh. 0.2601 " 87.0 " 96.6 5 " whiskey 0.2312 " 88.5 " 98.3 172 THE LIQUOR PROBLEM. In the following experiment six different samples of whiskey were employed, several of which were known to contain only forty per cent, of alcohol, and their action contrasted with half the percentage of absolute alcohol : — Experiment 25. Couditious : Proteid = blood-fibrin (2 grams). 0.009 gram pepsin ; 0.2 per cent, hydrochloric acid. Period of digestion 11^ hours at 38°^0° C. Whiskey. Uudigested fibrin. Proteid digested. Relative proteolytic action. per cent. 0.C701 gram. 66.5 per cent. 100.0 20 0.9659 " 51.8 77.8 20 0.9849 " 50.8 76.3 20 1.0378 " 48.2 72.4 20 1.0156 " 49.3 74.1 20 1.0390 " 48.1 72.3 20 1.0735 " 46.4 69.7 solute alcohol. 10 per cent. 1.0673 " 46.7 70.2 It is thus evident from these experiments that when digestive action is fairly vigorous, as in the presence of moderate amounts of pepsin (Experiments 20, 21, and 23), small percentages of whiskey have no retarding action whatever upon gastric di- gestion ; indeed, there is even a slight suggestion of increased digestive action in the presence of from one to three per cent, of whiskey, much the same as was observed in the exj)eriments with absolute alcohol. In the presence of twenty per cent, of whiskey digestive activity may be reduced one fourth. Fur- ther, the retardation which is produced by larger percentages of whiskey is approximately equal to the retarding action caused by half these percentages of absolute alcohol. In other words, the resiUts would seemingly point to the contained alcohol as the main cause of the inhibition produced by the whiskey. In Experiment 22 we again have evidence of the greater retarding effect of both whiskey and alcohol when the gastric juice is weak, owing to the presence of a small amount of pepsin. In order to determine more definitely the exact cause of the inhibitory action of whiskey on gastric digestion the following experiments were tried : — DIGESTION AND SECRETION. 173 Experiment 26. Conditions : Proteid= fluid egg-albutain (15 c. c.). 15 c. c. albumin solution contain 1.0522 grams dry albumin. 0.0024 gram pepsin ; 0.2 per cent, hydrochloric acid. Period of digestion 6f hours at 38°-40° C. Whiakey. per cent. 1 3 6 Whiskey residue.^ 1 per cent. 6 Undigested albumin. 0.5065 gram. 0.5268 « 0.5496 " 0.6069 " 0.5105 " 0.4719 " Proteid digested. 51.9 per cent. 50.0 47.8 42.4 51.5 55.2 Relative proteolytic action. 100.0 96.3 92.1 81.6 99.2 106.3 Experiment 27. Conditions the same as in Experiment 25, except that the 15 c. c. of albumin solution contained 1.2219 grams of dry al- bumin, and the period of digestion was 4^'^ hours : — Whiskey. Undigested albumin. Proteid digested. Relative proteolytic action. per cent. 0.5552 gram. 54.6 per cent. 100.0 1 0.6239 " 49.0 89.7 3 0.6573 " 46.2 84.6 6 0.6883 " 43.7 80.0 9 0.7457 « 39.0 « 71.4 Whiskey residue. 1 per cent. 0.5559 " 64.6 « 100.0 6 0.5705 " 63.4 « 97.8 Experiment 28. Conditions : Proteid = blood-fibrin (2 grams). 0.016 gram pepsin ; 0.2 per cent, hydrochloric acid. Period of digestion, 2 J hours at 38°-40° C. Fluid Undigested Proteid digested. 91.3 per cent. 89.3 90.8 " per cent. 0.1759 gram. 6 " absol. alcoh. 0.2145 " 5 " whiskey residue 0.1847 " Relative proteolytic action. 100.0 97.8 99.4 ' The whiskey residue was prepared by simply concentrating a definite volume of whiskey on the water-bath until the alcohol and volatile matter were driven off, then making the residue up to tlie original volume with water. Hence, one per cent, residue means the residue contained in one per cent, of whiskey. 174 THE LIQUOR PROBLEM. Experiment 29. Conditions the same as in the preceding experiment, except that the period of digestion was 1 1 hours : — Fluid Undigfested Proteid Relative proteolytic per cent. 0.2032 gram. 89.9 per cent. 100.0 5 " alcohol 0.2317 " 88.5 " 98.4 10 " whiskey 0.2181 " 89.1 « 99.1 10 " " distil.i 0.2499 " 87.6 " 97.4 10 " " residue 0.2002 " 90.0 " 100.1 Experiment 30. Conditions the same as in the preceding experiment, except that the period of digestion was two hours : — Fluid Undigested Proteid Relative proteolyti added. fibrin. digested. action. per cent. 0.1970 gram. 90.2 per cent. 100.0 5 " alcohol 0.2830 " 85.9 95.2 10 " whiskey 0.3056 « 84.8 94.0 10 " " distil. 0.2336 " 88.4 98.0 10 " " residue 0.2027 " 89.9 99.6 Experiment 31. Conditions the same as in the preceding experiment, except that the period of digestion was l^^^ hours : — Fluid added. Undigested fibrin. Proteid digested. Relative proteolyti action. per cent. 0.3867 gram. 80.7 per cent. 100.0 5 " absol. alcoh. 0.4352 " 78.3 97.0 10 " whiskey 0.4481 " 77.6 96.1 10 " " distil. 0.4274 " 78.7 97.5 10 " " residue dissolved in water } 0.4968 " 75.2 93.1 10 per cent, residue dis- solved in alcohol ^ I 0.3604 " 82.0 101.6 If the detailed results obtained in these many experiments are carefully scrutinized it will be seen that the small amount of solid matter contained in whiskey — the so-called whiskey ^ The " whiskey distillate " was prepared by distilling a definite volunie of whiskey nearly to dryness and making the distillate up to the original volume with water, the ten per cent, whiskey distillate, therefore, meaning the volatile matter contained in that specific volume of whiskey. - The whiskey residue obtained as already described, but dissolved in al- cohol of the strength originally present in the whiskey instead of in water. DIGESTION AND SECRETION. 175 residue — has in the majority of cases little or no retarding action on gastric digestion. That there should be some varia- tion is to be expected, owing to possible variations in the amount and character of this solid matter. Further, the residue ob- tained by evaporation of whiskey is not always completely solu- ble in water, and the action of this material may naturally be somewhat different wlien mixed with water than when dissolved in alcohol (see Experiment 31). Still the general conclusion seems to be wai-ranted that, as a rule, the solid matter of the whiskey is not responsible for the retarding action of this fluid upon the chemical process of gastric digestion. Such action as the whiskey possesses is to be attributed mainly to the alcohol or other volatile matter it contains. At the same time it is to be noted that with a fairly active gastric juice (Experiments 29, 30, and 31), the amount of retardation even with ten jier cent, of whiskey is not great, any more than it is in the presence of five per cent, of absolute alcohol. When, however, the gas- tric juice is very weak from scarcity of the active ferment, as in Experiments 26 and 27, then even small amounts of whiskey exercise a very marked retarding effect upon the digestive pro- cess. Further, these two experiments plainly show that the retardation in these cases is due essentially to the volatile matter of the whiskey, and not to the solid matter contained in it. We may thus conclude, with Roberts,^ that taking into account the quantity of whiskey commonly used dietetically with meals, the amount so consumed is not sufficient to appreci- ably retard the speed of gastric digestion. For, if the digesting mass in the stomach be estimated at two pounds, a wineglass (two ounces) of whiskey added thereto would only equal five per cent, of proof spirit (or 2.5 per cent, of absolute alcohol) an amount too small to hamper digestion to any appreciable extent. Even double such an amount, as Roberts says, would scarcely have any marked retarding effect upon pepsin-proteolysis. Hence, whiskey can be considered to impede the solvent action of the gastric juice only when taken immoderately and in in- toxicating quantities. So much has been said and written about the widespread adulteration and falsification of whiskeys that we deemed it wise before leaving the subject to make a search for samples of 1 Digestion and Diet, p. 133. 176 THE LIQUOR PROBLEM. this liquor which would show a wide variation from what might be called the normal standard. The results thus far reported were obtained with whiskeys containing fifty per cent, of alco- hol by volume. Pi'ofessor James Babcock, in his first and sec- ond annual report as assayer of liquors to the commonwealth of Massachusetts, gives the strength of 257 samples of ordinary whiskey analyzed by him as varying from thirty to fifty-nine per cent, of alcohol by volume. The few samples that we have purchased in New Haven and analyzed, however, have, with one or two exceptions, shown very little difference in their con- tent of alcohol, although we took particular pains to obtain them from representative places. The character of these places may be indicated by their names. Alcohol. Sample A, from high-class grocer 50 per cent. " B, " Canadian Club whiskey .... 42 " C, " saloon of better class 40 " D, " " of low order 44 " E, " " of low order 43 " F, " " known as the " dead-house " . 42 " G, " " known as " Sneezer's " . . 40 " H, " " quite respectable 40 " I, " " McGraw's 30 With the exception of the first and last of these few samples there is very little variation in the content of alcohol. Diges- tion experiments tried with some of these whiskeys gave the following results : — Experiment 32. Conditions : Proteid = blood-fibrin (2 grams). 0.015 gram pepsin ; 0.2 per cent, hydrochloric acid. Period of digestion 1^ hours at 38°^0° C. ^T^. , Uiifligested Proteid Relative proteolytic nnisKey. fibrin. digested. action. per cent. 0.6131 gram. 69.4 per cent. 100.0 Sample I, 10 " 0.6591 " 67.1 " 96.6 B, 10 " 0.6876 " 65.7 '■ 94.6 " G, 10 " 0.7469 " 62.7 " 90.3 Experiment 33. Conditions practically the same as in the preceding experi- ment : — DIGESTION AND SECRETION. 177 Fluid Undigested Proteid Relative proteolytic added. iibriu. digested. action. per cent. 0.5945 gram. 70.3 per cent. 100.0 Whiskey D, 10 « 0.7711 " 64.5 « 91.7 C, 10 « 0.7352 " 63.3 " 90.0 «' F, 10 " 0.7609 " 62.0 " 88.1 " E, 10 " 0.8086 « 59.6 « 84.7 «' H, 10 " 0.8659 " 56.8 " 80.7 Absol. alcoh. 5 " 0.8362 « 58.2 " 82.7 If we compare the action of these samples of whiskeys, we see (Experiment 32) that sample I, with the lowest content of alcohol, has the least inhibitory effect. On the other hand, in Experiment 33 there are greater differences in the retardation produced by these several varieties of whiskey than one would expect from the slight variations in the content of alcohol. This, however, we are inclined to attribute, in part at least, to the presence of variable amounts of tannin. In accordance with this idea, we found that among those samples with a like content of alcohol the presence of tannin was more conspicuous in the whiskeys with the greatest retarding action. Action of So-called Fusel Oils on Gastric Digestion. So much has been written concerning the contamination of whiskeys and other liquors with fusel oil that we deemed it wise to give some thought to this matter in connection with our study of the influence of whiskey, brandy, and other liquors on the chemical processes of gastric digestion. It is a well-known fact that when fermented saccharine liquors are submitted to distillation there are obtained, in addition to water and ordinary or ethyl alcohol, small quantities of other alcohols, which are commonly known as fusel oil. Each raw material used in the preparation of a distilled liquor is supposed to have its own particular form of fusel oil. Hence, there is the potato fusel oil, sugar-beet fusel oil, rye fusel oil, corn fusel oil, grape fusel oil, etc., which contain in various proportions propyl, butyl, amyl alcohol, etc. Of these alcohols, amyl alcohol is said to be the most poisonous, and it is generally understood to be present in largest quantity in the whiskeys made from the potato. However this may be, the various constituents of these fusel oils react upon each other during the process of aging, forming new and more volatile combinations which help give to the re- spective fluids their aroma and bouquet. Hence, in old whis- 178 THE LIQUOR PROBLEM. keys fusel oils should be entirely absent, and in all properly distilled and rectified spirits the amount of these substances should be at the most quite small. Indeed, so far as our own experience goes, we have never found more than traces of these so-called oils in the whiskeys or brandies that we have examined. But with a view to ascertaining the effect of such substances on gastric digestion, assuming them to be present in whiskeys and other like liquors, we have tried some experiments with the al- cohols of this class, in order to ascertain how their possible presence would influence the chemical processes of digestion. The results may be briefly detailed in the following experi- ments : ^ — Experiment 34. Conditions : Proteid = blood-fibrin (2 grams). 0.02 gram pepsin ; 0.2 per cent, hydrochloric acid. Period of digestion 2 hours at 38°^0° C. Amyl alcohol. Undigested fibrin. Proteid digested. Relative proteolytic action. per cent. 0.566o gram. 71.6 per cent. 100.0 0.10 0.5316 " 73.1 102.4 0.25 0.6176 " 69.1 96.4 0.50 0.6179 " 69.1 96.4 1.00 0.6887 " 65.5 91.4 2.00 " 0.8801 « 55.9 78.1 Experiment 35. Conditions the same as in the preceding experiments, except that the period of digestion was If hours : — iBobutyl alcohol. per cent. 0.05 Undigested fibrin. 0.7225 grjim. 0.6580 " Proteid digested. 63.8 per cent. 67.1 Relative proteolytic action. 100.0 105.0 0.10 0.7583 " 62.0 97.1 0.25 0.7993 " 60.0 93.9 0.50 0.8313 « 58.4 91.4 2.00 0.8451 " 57.7 " 90.4 ' These experiments were carried out in our laboratory by Richard F. Rand, Ph. B. DIGESTION AND SECRETION. 179 Experiment 36. Conditions the same as in the preceding experiment : — Propyl alcohol. per ceut. 0.05 Undigested fibrin. 0.6136 gram 0.5514 " Proteid digested. 69.3 per cent. 72.4 Relative proteolytic action. 100.0 104.4 0.10 0.5025 « 74.8 lOS.O 0.25 0.4944 " 75.2 108.5 0.50 0.5872 " 70.6 " 101.9 2.00 0.6192 « 69.0 99.5 Larger percentages of propyl alcoliol gave the following re- sults, the conditions being the same as in the preceding experi- ment, except that the period of digestion was 2^ hours : — Propyl alcohol. Undigested fibrin. Proteid digested. Relative proteolyti action. per ceut. 0.5323 gram. 73.3 per cent. 100.0 5 0.7804 " 60.9 82.1 10 1.6271 " 18.6 24.0 15 « 1.8829 « 5.8 9.0 20 1.9047 " 4.7 6.4 Experiment 37. Conditions the same as in the preceding experiments, save that the period of digestion was 2^ hours : — ■ Methyl alcohol. Undigested fibrin. Proteid digested. Relative proteolytic action. per cent. 0.4892 gram. 75.5 per cent. 100.0 0.5 0.4492 " 77.5 102.6 2.0 0.4325 " 78.3 103.7 3.0 0.5381 " 73.0 " 96.7 5.0 0.5333 " 73.3 97.0 When it is remembered that these alcohols, if present at all, are found in whiskeys and similar liquors only in small quan- tities — hardly more than traces — it is seen that their action on the chemical processes of gastric digestion cannot be very deleterious. Indeed, so far as our data .show, the presence of traces of these alcohols tends to increase rather than to decrease the rate of digestive action. While they may be very unde- sir.able impurities in alcoholic liquors, and may perhaps have many physiological properties detrimental to liealth, they cer- tainly do not materially interfere with the chemical processes of gastric digestion. Physiologically, it is of interest to note how all of these alcohols, as well as ethyl alcohol, have the property 180 THE LIQUOR PROBLEM. of increasing the rate of digestive action when present in small amount. Also noticeable is the relationship between the posi- tion of the alcohol in the series and the extent of its stimulating and retarding action. Thus, methyl alcohol, the lowest mem- ber of tlie series, increases the rate of proteolysis even when present to the extent of two per cent., while amyl alcohol pro- duces stimulation only when present in amounts less than 0.2 per cent. Brandy. According to Dr. Edward Smith of England, " brandy is, or should be, the choicest and most agreeable member of the class of ardent spirits. It should be prepared by distillation from wine," but, as is well known, a large amount of the brandy consumed at the present time is simply alcohol distilled as in the jjreparation of whiskey, and flavored with oil of cognac. From this it may be inferred that brandy will have much the same action as whiskey on gastric digestion. The brandy used in our first experiments was of good quality, known as Home's cold distilled brandy, selling at #1.25 per quart. Analysis showed the following composition : — Specific gravity 0.940 (at 19° C). Alcohol by volume 47-48 per cent. Solid residue at 110° C. . . . 0.0430 gram per 100 c. c. Ash 0.0054 " Reaction acid. Experiment 38. Conditions : Proteid = fluid egg-albumin (15 c. c). 15 c. c. albumin solution contain 1.3395 grams dry albumin. 0.006 gram pepsin ; 0.2 per cent, hydrochloric acid. Period of digestion 7 hours at 38°^0° C. Undigested Proteid Kelative proteolytic Brandy. albumin. digested. action. per cent. 0.39G2 gram. 70.5 per cent. 100.0 1 " 0.4379 " 67.4 " 95.6 3 " 0.5012 " 62.8 " 89.0 6 " 0.5218 « 61.1 « 66.6 Brandy residue. 1 per cent. 0.3992 " 70.2 " 99.4 6 " 0.3654 « 72.8 " 103.2 DIGESTION AND SECRETION. 181 Experiment 39. Conditions : Proteid = blood-fibrin (2 grams). 0.016 gram pepsin ; 0.2 per cent, hydrochloric acid. Period of digestion 2| hours at 38°-40° C. Brandy. Undigested fibrin. Proteid digested. Relative proteolyti action. per cent. 0.3101 gram. 83.0 per cent. 100.0 1 0.3306 " 83.5 100.6 3 0.3140 " 82.8 99.7 6 0.3133 " 82.9 99.8 Experiment 40. Conditions the same as in the preceding experiment, except that the period of digestion was 2^ hours : — Brandy. Undigested fibrin. Proteid digested. Kelativc proteolytic action. per cent. 0.2013 gram. 90.0 per cent. 100.0 5 0.2251 " 88.8 98.7 Experiment 41. Conditions the same as the above, except that the period of digestion was Ij^ hours : — Fluid Undigested Proteid ReUtive proteolytic added. fibrin. digested. action. per cent. 0.3247 gram. 83.8 per cent. 100.0 5 " absol. alcoh. 0.3554 " 82.3 " 98.2 10 " brandy 0.3752 " 81.3 " 97.0 10 " " distil. 0.3489 " 82.6 « 98.5 10 « " residue* 0.3024 " 84.9 « 101.3 Experiment 42. Conditions the same as the above, except that the period of digestion was 1^^ hours : — Fluid added. Undigested fibrin. Proteid digested. Relative proteolytio action. per cent. 0.3361 gram. 83.2 per cent. 100.0 5 " absol. alcoh. 0.4040 " 79.8 95.9 10 " brandy 0.4242 " 78.8 94.7 10 « " distil. 0.4286 " 78.6 " 94.4 10 " " residue in alcohol \ 0.4334 « 78.4 « 94.2 10 " " residue in water \ 0.3609 " 82.0 " 98.5 * Dissolved in water, being the residue from this percentage of brandy. Undigested fibrin. 0.7941 gram. 1.0007 " Proteid digested. C0.3 per cent. 50.0 Relative prote trypsin-proteolysis than upon pepsin-proteolysis. Further, this retardation is not due wholly to the contained alcohol, but is atti-ibutable in part to the solid matter present. This latter, however, in a distilled liquor should obviously be very small, and it is quite apparent that if due care is used in the distillation and rectification of such a liquor and no additions are made, the only solid matter should be such as is extracted from the cask in which the liquor is stored. The liquors in question, however, did contain some DIGESTION AND SECRETION. 223 extractive matter other than tannin, and to this material, as well as to the tannin and the alcohol, the retardation of trypsin- proteolysis is unquestionably due. Wines, with their high acidity and low alcoholic strength, exert a retarding action on tryptic digestion more nearly proportional to the acidity than to the amount of alcohol, or even to their content of solid matter. All three of these elements, however, undoubtedly combine to produce the results recorded. The malt liquors, on the other hand, owe their retarding influence mainly to the large per- centage of extractives of various sorts which they contain, the alcohol playing a minor part in the inhibition caused by the fluids of this class. C. SALIVARY DIGESTION. In considering the influence of alcoholic beverages on salivary digestion, it is to be remembered that the latter process has for its main object the digestion of the farinaceous foods. This property is shared in common with the pancreatic juice, the utilization of all farinaceous foods by the body being depend- ent almost wholly upon the so-called amylolytic power of these two secretions. Salivary digestion is a comparatively rapid process, the trans- formation of the insoluble starch into soluble dextrins and sugar taking place in a relatively short period, as contrasted with the proteolytic action of either the gastric or pancreatic juice. Amylaceous or farinaceous foods are exposed to the action of the saliva in the mouth for only a short interval, but the evi- dence at present available points to the probable continuation of salivary digestion in the stomach for from ten to thirty minutes before the amylolytic ferment is killed by the increasing acidity of the gastric juice. In view of this relatively short period of digestion, retardation of amylolytic action may become a serious matter, since even slight retardation may mean the loss of more or less nutriment to the body. The amylolytic ferment of the pancreatic juice, however, may be able to convert the un- changed starch in the small intestine, providing the influence of the retarding agent does not extend so far. But in any event, retardation or stoppage of salivary digestion must be a serious evil, and it is to be remembered that the amylolytic fer- ment of the pancreatic juice is closely akin to, if not identical 224 THE LIQUOR PROBLEM. with, the ferment of the saliva, and hence is susceptible to the same influences that affect the salivary ferment. Methods employed. In testing the influence of alcoholic liquors on the salivary digestion of starchy foods, the following method was most generally employed : Ten c. c. of a freshly prepared starch- paste (one per cent.) were introduced into a suitable flask, a given volume of the alcoholic fluid together with sufficient water to make the resultant mixture up to 90 c. c, added, and lastly, 10 c. 0. of neutralized and filtered saliva, which had been previously diluted to some definite volume. The com- pleted mixture was thus composed of 100 c. c. The time at which the saliva was added was carefully noted, and the mix- ture placed in a suitable water-bath kept at 38°-40° C. In order to measure the rate of digestion a drop of fluid was withdrawn at intervals, placed on a white porcelain surface, and tested with a drop of a dilute iodine solution. The color ob- tained with iodine under these conditions is dependent upon the extent of amylolytic action. Thus, the presence of soluble starch, the first product formed, is indicated by a blue color. As digestion proceeds, the blue color gives place to a reddish color with iodine, owing to the presence of erythrodextrin, while the final products of amylolytic action, maltose and achroodex- trins, give no color whatever with iodine. The time when this so-called "achromic" point is reached is carefully noted, and the number of minutes required for the appearance of the " achromic " point serves as a measure of the rate of amylolytic action. A method less frequently used in our experiments, but better adapted to measuring accurately small shades of difference, was as follows : One gram of arrowroot starch was made into a paste with 40 c. c. of water, 50 c. c. of water alone (in the con- trol) or with the required volume of alcoholic fluid to give the desired percentage were then added, and lastly, 10 c. c. of a diluted neutral saliva. The mixture, or series of mixtures, was then placed in a bath at 38°-40° C. for thirty minutes, after which the solution was heated to boiling to prevent further action of the enzyme. The resultant solution was then made up to 150 c. c., and the extent of amylolytic action ascertained DIGESTION AND SECRETION. 225 by determining in one sixth of the sohition the amount of maltose formed by the use of Allihn's > gravimetric method. From the amount of reduced copper thus obtained, the amount of maltose was calculated on the basis of Salomon's ^ statement that 100 parts of anhydrous maltose will form Hi parts of reduced copper when boiled with Fehling's solution after the Allihn method. It is, of course, understood that in both methods all of the mixtures belonging to a given series were treated with the same specimen of saliva. Absolute Alcohol (99.5 to 100 Per Cent.). Experiment 116. (Saliva 1 : 15.) ' Alcohol. Appearance of the achromic point. per cent 7 minutes. 0.5 " 7 " 1.0 " 7 " 2.0 " 7 " 5.0 « 7 « 10.0 " 7 « Experiment 117. (Saliva 1 : 20.) Alcohol. Appearance of the achromic point per cent 7 minutes. 1 " 7 " 10 " 7 " Experiment 118. (Saliva 1 : 30.) Alcohol. Appearance of the achromic point. per cent 27 minutes. 0.5 " 27 « 1.0 " 27 « 2.0 " 27 " 5.0 « 27 " 10.0 " 25 " From these results it is plainly manifest that absolute alcohol has very little influence upon the amylolytic or starch-digesting ' Zeitsch. f. Analyt. Chemie, xxii. 448. " Journal fur Praktische Chemie, xxviii. 109. ' Being the dilution of the saliva added to the digesting mixture ; i. e., one part of fresh saliva in fifteen parts of water. It is to be remembered, however, that in the digestive mixtures (100 c. c.) the dilution of the saliva is increased tenfold. 226 THE LIQUOR PROBLEM. power of neutral saliva. Only when the saliva, added to the digestive mixture, is diluted in the proportion of 1 to 30 does the presence of even ten per cent, of alcohol have any measur- able influence, and then only to retard the appearance of the achromic point two minutes. As this percentage of absolute alcohol is equal to at least twenty per cent, of proof spirit, it follows that pure alcohol free from admixture is practically without influence upon the digestion of farinaceous foods by the saliva. A more accurate testing of this question was attempted by the use of the second method above described, with the follow- ing results : — Experiment 119. (Saliva 1 : 4.) Alcohol. Keduced copper iui. Maltose formed. Relative amylolytic actiou. per cent. 0.0885 gram. 31.05 per cent.' 100.0 0.5 « 0.0918 " 32.21 " 103.7 1.0 " 0.0908 " 31.86 " 102.6 3.0 " 0.0911 " 31.96 " 102.9 5.0 " 0.0897 " 31.47 " 101.3 0.0 " 0.0862 " 30.25 " 97.4 Experiment 120. (Saliva 1:5.) Alcohol. Reduced copper mi. Maltose formed. Relative amylolytic action. per cent. 0.1436 gram. 75.5 per cent. 100.0 5 " 0.1439 " 75.7 " 100.2 10 " 0.1367 " 71.9 " 95.2 15 " 0.1309 " 68.0 " 90.0 Experiment 121. (Saliva 1 : 4.) Alcohol. Reduced copper Maltose formed. Relative amylolytic actiou. per cent. 0.122 gram. 64.2 per cent. 100.0 5 " 0.120 « 63.1 " 98.2 10 " 0.119 " 62.5 " 97.3 15 93.4 Experiment 122. (Saliva 1 : 2.) Alcohol. Reduced copper in J. Maltose formed. Relative amylolytic action. per cent. 0.132 gram. 69.4 per cent. 100.0 5 « 0.131 " 68.9 « 99.2 10 « 0.126 " 66.3 " 95.3 15 " 0.125 " 65.7 " 94.6 ' Calculated on the one gram of starch employed. DIGESTION AND SECRETION. 227 At first glance these results would seem to be somewhat opposed to those obtained in the first series of experiments, but such is not the case. The first method simply tells us the time when all the starch has been transformed into achroodextrin and maltose. The second method, however, tells us more than this, viz., the actual amount of maltose that has been formed, and, as a certain amount of achroodextrin can be transformed into maltose by the continued action of the salivary ferment, it follows that this latter method gives us a clearer knowledge of the influence of alcohol upon the secondary action of the amylo- lytic enzyme. Thus, we find that small amounts of absolute alcohol may actually cause an increased formation of maltose. On the other hand, the presence of ten or fifteen per cent, of absolute alcohol leads to a distinct retardation in the formation of sugar, although the inhibition is not very pronounced con- sidering the amount of alcohol j)resent. This retardation of the secondary action of the ferment is perhaps suggested by the slight delay in the appearance of the achromic point in Experiment 118, in the presence of ten per cent, of absolute alcohol. Whiskey (with 50 Per Cent, of Alcohol). Experiment 123. (Saliva 1 : 30.) Whiskey. Appearance of the achromic point. per cent 28 minutes. 0.5 " 22 hours. 1.0 " no action beyond erythrodextrin.i 2.0 " no action whatever.^ 5.0 " Experiment 124. (Saliva 1 : 25.) Whiskey. Appearance of the achromic point. per cent 6 minutes. 0.5 " 8 1.0 " 17 hours. 2.0 " no action beyond soluble starch. 5.0 " no action at all. AbBOlute alcohol. 2.5 per cent 6 minutes. > The final observation was always made at the end of twenty-four hours. 2 Ibid. 228 THE LIQUOR PROBLEM. Experiment 125. (Saliva 1 : 20.) Whiskey. Appearance of the achromlc point. per cent 7 minutes. 0.5 " 8 " 1.0 " 9 " 2.0 " no action beyond erythrodextrin. 5.0 " no action whatever. Absolute alcohol. 2.5 per cent 7 minutes. Experiment 126. (Saliva 1 : 15.) Whiskey. Appearance of the achromic point. per cent 5 minutes. 0.5 " 5 " 1.0 " 7 " 2.0 " 24 hours. 5.0 " no action whatever. Absolute alcohol. 2.5 " 5 minutes. Experiment 127. (Saliva 1 : 7.) Whiskey. Appearance of the achromic point. per cent 3 minutes. 2 « 5 " 5 " no action beyond erythrodextrin. 10 " no action whatever. Absolute alcohol. 5 per cent 3 minutes. Experiment 128. (Saliva 1 : 3.) Whiskey. Appearance of the achromic point. per cent 3 minutes. 5 " 4 " 10 " 24 hours. Absolute alcohol. 5 per cent 3 minutes. Experiment 129. (Saliva 1 : 4.) ^^. .„, Reduced copper Maltose Relative amylolytic ^'""''^5'- in J. formed. action. per cent. 0.109 gram. 57.3 per cent. 100.0 5 « 0.110 > " 57.8 " 100.8 10 " 0.080 " 42.0 " 73.3 15 " 0.010 " 5.2 " 9.0 From these results it is apparent that whiskey may have a very great retarding action upon salivary digestion, the retarda- ' Allowance being made for the reduction obtained from a corresponding amount of the whiskey alone. DIGESTION AND SECRETION. 229 tion being the more pronounced the greater the cliUition of the saliva. When, however, the saliva is diluted only three or four times, so that the proportion of saliva in the digestive mixture is as 1 : 30 or 1 : 40, then the presence of even five per cent, of whiskey is wholly without action. It is furthermore apparent that the alcohol of the whiskey plays no part in this inhibitory action. What now is the cause of the retardation? In this connection it is to be remembered that all the whiskeys examined by us have shown an acid reaction ; furthermore, the saliva used in our experiments was neutralized saliva. Taking into con- sideration the well-known sensitiveness of the salivary ferment toward acids, the question naturally presents itself whether this retardation of amyloly tic action caused by the whiskey is not due to the acidity of the fluid. This question we attempted to answer by the following experiments : — Experiment 130. (Saliva 1 : 15.) Fluid added. Appearance of the achromic point. per cent. 4 minutes. 2.0 " whiskey 24 hours. 2.0 " " neutralized 7 minutes. 1.0 " absolute alcohol 4 " Experiment 131. (Saliva 1 : 25.) Fluid added. per cent. 1 " whiskey 1 " " neutralized Appea: ranee of the achromic point. 9 minutes. 24 hours. 22 minutes. 5 « « no action. 5 10 2.5 " " neutralized " absolute alcohol partial action. 11 minutes. From these results it is apparent that the retarding action of the whiskey is in great part overcome by neutralization of the liquor, providing the saliva is not too greatly diluted- It is furthermore apparent that with unneutralized saliva — i. e., with the normally alkaline secretion — the retarding action of at least small quantities of whiskey would be far less than is indi- cated by the above results. Indeed, it may be safely said that with a fair volume of unneutralized and not too greatly diluted saliva the presence of even five per cent, of whiskey would be practically without action on the salivary digestion of farina- 230 THE LIQUOR PROBLEM. ceous foods, a conclusion which Roberts has likewise reached. Obviously, however, the degree of acidity of a given sample of whiskey, together with the natural alkalinity of the saliva, would be important factors in determining the precise character of the result. In this connection the question may properly be asked why we employed neutralized saliva in our experiments instead of the normally alkaline fluid ? To this we would answer that in no other way was it possible to obtain constant and comparable conditions, since the alkalinity of the secretion is ever variable, and, moreover, every variation in the dilution of the fluid would obviously cause a corresponding variation in the degree of alka- linity. Further, the best action of saliva is normally obtained when the fluid is neutral, and the natural tendency of the food- stuffs is toward neutralization of the secretion, both in the mouth and in the stomach. Again, since the fluids we were testing all have an acid reaction, it seemed more probable that we should obtain a trustworthy indication of the action of these fluids upon the amylolytic ferment by using a neutral solution of the enzyme. In conclusion, then, we may repeat that the retardation of amylolytic action caused by large amounts of whiskey is not closely connected with the amount of alcohol the liquor con- tains, but is more intimately associated with the presence of volatile, acid-reacting bodies, possibly also ethereal bodies, volatile oils, and perhaps also tannin. Hence, the greater the purity of the whiskey, the less will be its retarding action upon the digestion of the farinaceous food-stuffs. That the solid, non-volatile portions of the whiskey that we experimented with have no retarding action upon the amylolytic power of the saliva is shown by the following experiment made with the residue left on evaporation of the whiskey, — an experi- ment which also shows that the acid-reacting bodies present in the whiskey are volatilized by heat : — DIGESTION AND SECRETION. Experiment 132. (Saliva 1 : 4.) Whiskey residue.^ Reduced copper in J. Maltose formed. Relative amylolytto action. per cent. 0.091 gram.2 47.8 per cent. 100.0 6 " 0.115 " 60.4 126.3 10 « 0.113 " 69.4 124.2 15 " 0.103 « 54.1 113.1 So far as these results go, they indicate that the solid matter present in this sample of whiskey, when free from alcohol and the volatile acid-reacting bodies, has a marked stimulating ac- tion upon salivary digestion. Whether this result may be ex- pected from all whiskeys is, of course, uncertain. Influence of the So-called Fusel Oils upon the Amylolytic Action of Saliva. Since the preceding results obtained with whiskey indicate that the retarding action of this liquor upon salivary digestion is mainly associated with volatile matters other than ethyl alco- hol, we have tried a few experiments ■^ with the alcohols liable to be present in the so-called fusel oils with a view to ascertain- ing their influence upon the amylolytic action of the salivary ferment. As already stated, we have very little personal know- ledge concerning the presence of fusel oil in the distilled liquors of the whiskey type. Such tests as we have made in this di- rection have either given negative results or else have shown the presence of these oils in very small amounts only. Still, as they are generally considered as impurities common to low- grade liquors, it is desirable to know something concerning the action of the alcohols present in them. Amyl Alcohol. Experiment 133. (Saliva 1 : 4.) Amyl Reduced copper Maltose Relative amylolytic alcohol. in J. formed. action. per cent. 0.1208 gram. 42.3 per cent. 100.0 0.1209 " 42.4 100.2 "' 0.1215 " 42.6 100.7 0.1234 " 43.2 102.1 0.1190 " 41.7 98.5 0.1130 " 39.7 93.8 0.05 0.10 0.25 0.50 1.00 ^ The residue dissolved in water. The percentages refer to the residue obtained from those percentages of whiskey. - Deduction being made for the reducing power of the residue itself. 8 These experiments were carried out in our laboratory by Philip Dowell, B. A., Ph. B. 232 THE LIQUOR PROBLEM. Isobutyl Alcohol. Experiment 134. (Saliva 1 : 4.) Isobutyl alcohol. Reduced copper in J. Maltose formed. Relative amylolytic action. per cent. 0.1137 gram. 39.8 per cent. 100.0 0.05 " 0.1122 " 39.3 98.7 0.10 " 0.1139 " 39.9 100.2 0.25 « 0.1152 " 40.4 101.5 0.50 " 0.1119 " 39.2 98.4 1.00 " 0.1161 " 40.7 102.2 Propyl Alcohol. Experiment 135. (Saliva 1 : 4.) Propyl alcohol. Reduced copper ini. Maltose formed. Relative amylolytic action. per cent. — — 1 0.05 " 0.1238 gram. 43.4 per cent. 100.0 0.10 " 0.1197 " 42.0 96.7 0.25 « 0.1288 " 45.1 103.9 0.50 " 0.1343 " 47.0 108.2 1.00 0.1254 " Methyl Experiment 136. 44.0 Alcohol. (SaUva 1 : 4.) 101.3 Methyl alcohol. Reduced copper Maltose formed. Relative amylolytic action. per cent. 0.0988 gram. 34.6 per cent. 100.0 0.25 0.1005 " 35.2 101.7 0.50 0.1040 " 36.4 105.2 1.00 0.1130 " 39.6 114.4 2.00 0.1042 " 36.5 105.4 5.00 0.1067 " 37.4 108.0 These results make it clear that, if whiskey or other distilled liquor should be contaminated with the above alcohols, their presence in any ordinary amount would not be prejudicial to salivary digestion. In fact, with the exception of amyl alcohol, these bodies, even in the largest percentages employed, tend to increase the amylolytic action of the saliva considerably above that of the control mixture. Physiologically, 'this fact is of considerable interest, although it does not help explain the cause of the retardation in amylolji;ic action produced by whis- key, brandy, and the other liquors of this class. ' This result was lost through an accident, and consequently the action of the various percentages of alcohol must be compared with the action of the lowest percentage. DIGESTION AND SECRETION. 233 Brandy (with 48 Per Cent, of Alcohol). Experimeut 137. (Saliva 1 : 20.) Brandy. Appearance ot the achromic point. per cent 5 miuutes. 0.5 " 7 " 1.0 " 12 " 2.0 " 17 hours. K(\„ J 10 action beyond soluble starch ( and erythrodextrin. 10.0 " no action whatever. Absolute alcohol. 5.0 per cent 7 minutes. Experiment 138. (Saliva 1 : 4.) T, , Reduced copper Maltose Relative amylolytic ^'•""'y- in J. formed. action. per cent. 0.113 gram.^ 59.4 per cent. 100.0 5 " 0.117 " 61.5 " 103.5 10 " 0.087 " 45.7 " 76.9 15 " 0.051 " 26.8 " 45.1 As with whiskey, brandy is wholly without deleterious action on salivary digestion when the saliva is not too greatly diluted and the brandy not present in quantities larger than five per cent. With saliva greatly diluted, on the other hand, even one per cent, of brandy is sufficient to cause retardation of amylo- lytic action. The alcohol of the brandy is in nowise respon- sible for the inhibitory action. Experiment 139. (Saliva 1 : 20.) Fluid added. Appearance of the achromic point. per cent. 7 minutes. 1 " brandy 12 " 1 " " neutralized 7 " 5 " " no action beyond erythrodextrin. 5 " " " 16 hours. 2.6 " absolute alcohol 7 minutes. Experiment 140. (Saliva 1 : 5.) Fluid added. Appearance of the achromic point. per cent. 2 minutes. 5 " brandy 12 " 5 " " neutralized 2 " 10 « " " 2 " 5 " absolute alcohol 2 " ' With due allowance for such reducing action as the brandy itself pos- sesses. 234 THE LIQUOR PROBLEM. Evidently, such retarding action as the brandy possesses is mainly connected with the acidity of the fluid, since on neutrali- zation of the liquor its inhibitory action is greatly diminished or even entirely overcome. The following experiment shows that, as with whiskey, the non-volatile matter present in the liquor is not responsible for the retardation of amylolytic action, but has by itself a stimulating effect on amylolysis : — Experiment 141. (Saliva 1 : 4.) Brandy residue. Reduced copper in J. Maltose formed. Relative amylolytic action. per cent. 0.113 gram.i 59.4 per cent. 100.0 5 " 0.124 " 65.2 « 109.7 10 " 0.116 " 61.0 " 102.7 15 " 0.104 " 54.7 « 92.0 Rum (with 51 Per Cent, of Alcohol). Experiment 142. (Saliva 1 : 20.) Rum. Appearance of the achromic point. per cent 11 minutes. 0.5 " . 35 " 1.0 " . 1.7 hours. 2.0 . 24 " 5.0 " no action bevond sol"t'>l'^ sffl.rpli. 10.0 . no action whatever Absolute alcoho! 5.0 per cent. . 11 minutes. Experiment 143. (Saliva 1 : 4.) Rum. Reduced copper Maltose formed. Relative amylolytic action. per cent. 0.112 gram.'' 58.9 per cent. 100.0 5 " 0.057 « 30.0 " 50.8 10 " 0.014 " 7.3 " 12.3 15 " 0.005 " trace. It is to be noticed from these experiments that rum has a far greater retarding action on amylolysis than whiskey or brandy, even when the saliva is fairly concentrated. Further, the alco- hol contained in the above percentage of brandy is entirely without influence on amylolytic action. This marked retarding action of rum is due mainly to volatile acid-reacting substances, ' With deduction for the reducing action of the sugar present in the brandy. 2 Making allowance for the reducing action of the rum itself. DIGESTION AND SECRETION. 235 presumably of the same nature as those present in whiskey and brandy, but present in larger amount. All samples of rum that we have examined have shown a decided acid reaction, consider- ably greater than we have found in whiskey or brandy, and to this we attribute the greater retarding action of this liquor. The following experiments attest the proof of this statement : — Experiment 144. (Saliva 1 : 20.) Fluid added. per cent. 1 " rum 1 " " neutralized 5 " 5 « 2.5 " absolute alcohol Appearance of the achromic point. 7 minutes. 3 hours. 7 minutes. no action beyond erythrodextrin. 7 minutes. 7 " Experiment 145. Fluid added. per cent. 5 " rum 10 " 10 " " neutralized 5 " absolute alcohol (Saliva 1 : 10.) Appearance of the achromic point. 3 minutes. 16 hours. no action beyond erythrodextrin. 3 miuutes. 3 " Thus, simple neutralization of the acidity of the rum is all that is needed to overcome wholly the retarding action of this fluid on salivary digestion. Further, the following experiment made with the residue obtained by the evaporation of rum shows that this acidity is due to something volatilized by heat, since no trace of its action is to be found in the residue : — Experiment 146. (Saliva 1 : 4.) per cent. 5 " 10 " 15 « Reduced copper in J. 0.119 gram.i 0.119 " 0.119 " 0.116 " Maltose formed. 62.5 per cent. 62.5 62.5 60.7 " Relative amylolytic action. 100.0 100.0 100.0 97.1 We may summarize our results with these strong alcoholic beverages as follows : Whiskey and brandy used dietetically, say to the extent of five per cent, in a digesting mixture, have no retarding influence upon the salivary digestion of farinaceous foods, providing the saliva is not too greatly diluted. When 1 Allowance being made for the reducing action of the residue itself. 236 THE LIQUOR PROBLEM. present in larger quantities they exert a retarding action upon amylolysis which is out of all proj>ortion to the contained alco- hol. The inhibitory effect appears to be connected in part, and perhaps mainly, with acid-reacting substances more or less vola- tile or destructible in nature. Rum differs from the two pre- ceding liquors in that it has a more marked retarding action, — an action dependent chiefly upon the presence in larger quantity of these acid substances, and not connected with the amount of alcohol present. Action of Wines. Our study of the influence of wines on the salivary digestion of farinaceous foods shows that these fluids are extremely potent in checking the action of the salivary ferment. Further, this action is entirely unconnected with the alcohol present in the wines, but is dependent almost wholly upon their acid character. Indeed, it is safe to say that as a rule the retarding action of wines on amylolysis is practically proportional to the acidity of the fluid. On neutralization of these acid wines their retarding action on salivary digestion at once disappears, as the following experiments show : — Sherry (with 21 Per Cent, of Alcohol and 4.7 Per Cent, of Solid Matter). Experiment 147. (Saliva 1 : 10.) Sherry. Appearance of the achromic point. per cent. 2 minutes. 0.5 " 17 hours. 1.0 " no action beyond erythrodextrin. 2.0 " no action beyond soluble starch. 5.0 " no action whatever. Absolute alcohol. 1.0 per cent. 2 minutes. Experiment 148. (Saliva 1 : 5.) Fluid added. Appearance of the achromic point. per cent. 1 minute. sherry 16 hours. " neutralized 1 minute. no action beyond erythrodextrin. 1 minute. no action whatever. 1 minute. DIGESTION AND SECRETION. 237 Claret (with 10 Per Cent, of Alcohol and 3.3 Per Cent, of Solid Matter). Experiment 149. (Saliva 1 : 15.) Appearance of the achromic point. per cent. 7 minutes. 0.5 " no action beyond erythrodextr , 1.0 « no action whatever. 2.0 « C( « 5.0 " II II 10.0 " « £• o •o ^ ■^ ^ § CO 0" CO d 00 d d (M 13 05 85 OS 10 d d 00 d > .a « CO S d d d 06 o d d d 00 > t-: 05 10 10 d d d q CO S 'If ■^ 05 d d •<* d q > •a © 00 i d d 1 oo' 1 a tr- io CO iH ■* C<5 d d d d > s " o 8 d d 10 d 0) 00 § d d 10 d g 5 id ^ § d d CO d CO 1 iq 5 d d CD d CO !•= t- rf d CO CO d CO d 06 (M 1 « i ■* ^ 01 lO oi 03 d LO CO d CO d © 00 - 1- o l-O o c<5 d d d © d 01 1 = o oi 05 10 d 10 d © Is.. I'SS < 4: a a. 1"^ 1^ a S p. suo a 3 "a if 13 m- 258 THE LIQUOR PROBLEM. alcohol directly into the stomach failed to provoke any reflex salivary flow in half an hour. Turning now to the influence of alcoholic fluids upon the rate of flow and composition of the saliva in man, the accompanying experiments, by the method above indicated, may be cited (page 257). The first two (I and II) show the results obtained with successive portions of water ; in the following ones a con- trol experiment with water in each instance preceded the trial with the alcoholic fluid. The alcoholic content of the fluids employed was as follows : brandy, forty-seven per cent, by volume ; gin, fifty-one per cent. ; sherry, twenty-one per cent. From these figures it is seen that the results obtained with two successive portions of water scarcely differ from each other, the tendency, however, being towards decreased flow accom- panied by decrease in dissolved material in the saliva. Inter- preted in physiological terms, these results indicate that the second stimulation with water is, if anything, weaker than its predecessor. In decided contrast appear the results obtained with the alcoholic liquors. Here may be observed an increased flow of saliva, not pronoimced, but accompanied by an increase in both organic and inorganic constituents. The effect is pre- cisely analogous, both in composition and rate of flow, to that brought about by an increase in intensity of stimulation when the salivary glands are electrically excited through their nerves. ^ The following diagram represents in graphic form the results given in the preceding table, i. e., (1) the relative rate of flow induced by water and by the alcoholic fluid ; (2) the content of solid matter, together with the relative proportion of ash or in- organic matter and of organic matter as indicated by the loss on ignition. 1 Cf. Heidenhain, Archw fur die ges. Physiol., 1878, xvii. 7, and Her- mann's Handbuch der Physiologie, v. 52. DIGESTION AND SECRETION. II II ll II I. II. III. IV. V. VI. VII. a. b. a. b. a. b. a. b. a. b. a. b. a. b. Water. Water. Brandy. Brandy. Brandy. Brandy. Gin. Diagram illustrating the relative influence of alcoholic fluids on the rate of secretion and composition of human saliva. The lufluence of Alcoholic Liquors introduced directly into the Stomach. In our experiments on the reflex stimulation of salivary flow, the attempt to produce a persistent secretion clue to the pre- •sence of alcohol in the stomach was unsuccessful ; nor have we been able to obtain evidence of an unusual flow of saliva under such circumstances in dogs with gastric fistulae. It seemed desirable, however, to examine the possible direct influence of 260 THE LIQUOR PROBLEM. alcoholic fluids on the salivary glands and the resulting secre- tion, when other factors were excluded as far as possible. In these experiments dogs from ten to eighteen kilos were used. Chloroform-ether mixture was employed to produce anaesthesia and was administered through a tracheal tube in part of the experiments, the danger of respiratory difficulties resulting from salivary flow induced in the glands as a result of the ether stimulation being thus avoided. In the later stages of the experiments the alcohol introduced usually sufficed to main- tain the animal in perfect quiet. Frederictj ^ lias recommended the use of alcohol for producing narcosis in rabbits ; it has been found quite satisfactory for this purpose in the dog, the effects passing off with relative rapidity. A glass cannula, bent at the end, was tied in Wharton's duct (and occasionally a second cannula into the duct of the sub- lingual gland). The chordo-lingual nerve was ligatured and cut at some distance centrally to the point where the chorda tympani branches oft' to the glands. All secretion in the corre- sponding gland was thus stopped, except dui-ing stimulation of the chorda, which was accomplished through raising the periph- eral end of the cut nerve by the ligature and slipping hook electrodes under it. The interrupted current of a du Bois induction coil with a single element was used as the stimulus. Saliva was collected in small graduated cylinders. Alcohol was introduced into the stomach by making an incision through the linea alba, etc., and the fluid was injected directly into the organ thus exposed by means of a large needle-pointed syringe. By careful avoidance of the larger gastric vessels, bleeding was minimal. The general course of the experiments was as fol- lows : A distance between the primary and secondary coil of the inductorium was selected, such as a preliminary trial showed to give a medium rate of flow. This stimulus was, so far as possible, kept constant throughout the experiment. The chorda was repeatedly stimulated for periods of one minute, followed by pauses of two minutes, during which the nerve was kept covered. In this way sufficient quantities of saliva for analysis were collected. Before collecting a sample of saliva under any given conditions, the six or seven drops first discharged were thrown away, and thus the fluid stored up from previous stimu- ' Fredericq, Manipulations de physiologie, p. 19. DIGESTION AND SECRETION. 261 lation in the gland lumina, ducts, and cannula was avoided.^ After collecting two or three control samples, the fluid to be considered (usually warmed slightly) was injected into the stomach in the manner already described, and this was followed by a pause of five minutes. The pulse was observed at frequent intervals to detect any possible influence on the heart's action and consequent blood flow. The samples of saliva collected were analyzed in the manner already described. At the con- clusion of the experiment the animal was kiUed by bleeding, and the condition of the glands, as well as of the stomach and other organs, examined. The protocols of three typical experi- ments are given below : — 1, iii. 1897. Dog. Weight 14 kilos. Chloroform and ether administered through tracheal tube during part of the experiment. Distance of sec- ondary coil = 200 mm. Period of stimulation = 1 min., followed by a pause of 2 min. Time. Amount saliva Rate of secretion Water. Total solids. Organic matter. Salts. Chlorine. collected. per min. c. c. per cent. per cent. per cent. per cent. per cent. I^ 10.35 5.3 0.7 98.76 1.24 0.94 0.30 0.026 II 11.08 5.4 0.6 98.94 1.06 0.73 0.33 0.036 III 11.38 5.2 0.8 98.95 1.05 0.69 0.36 0.044 IV 11.56 4.0 0.8 98.90 1.10 0.048 12.20 80 c. c. 50 per c ent. alcohol injected into stomach. V 12.35 4.8 0.8 98.96 1 1.04 1 0.69 1 0.35 0.047 VI 12.55 4.8 0.8 99.01 1 0.99 1 0.59 | 0.40 0.076 1.15 100 c. c . 50 per cent, alcohol injected into stomach. VII 1.21 4.9 0.8 99.05 0.95 0.59 0.36 0.0.55 VIII 1.42 6.0 1.0 99.05 0.95 0.60 0.35 0.060 IX 2.02 5.5 0.9 99.14 0.86 0.52 0.34 0.048 X 2.24 5.2 0.8 99.17 1 0.83 0.47 0.36 0.042 2.53 100 e. ( . 50 per cent, alcohol injected into stomach. XI 2.58 4.5 0.6 99.07 0.93 0.63 0.30 0.034 XII 3.27 6.0 0.6 99.18 0.82 0.53 0.29 0.037 XIII 4.10 5.0 0.7 90.17 0.83 0.49 0.34 0.038 Dog killed. Stomach mucosa normal in appearance. Urinary bladder and gall bladder greatly distended. Stomach contents = 450 c. c, faintly acid in reaction and containing 24.6 grams of alcohol. No food present. ' Cf. Heidenlmin, Hermann's Handbuch der Pkysiologie, v. 53 ; Langley and Fletcher, Philosophical Transactions, 1889, clxxx. B. 112. ^ In this first period the distance of the secondary coil was 280 mm., but the stimulation was unsatisfactory. 262 THE LIQUOR PROBLEM. 22, iii. 1897. Bitch. Weight 10 kilos. Chloroform and ether adminis- tered during operation. Tracheotomy performed after operation. Dis- tance of secondary coil = 240 mm. Period of stimulation =: 1 min., fol- lowed by 2 min. pause. Time. Amount saliva collected. Rate of secretion per min. Water, per cent. Total solids. per cent. Organic matter. per cent. Salts. per cent. Cblorine. percent. I 11.30 4.6 1.1 98.68 1.32 0.03 0.29 0.032 11 11.42 4.7 0.9 98.70 1.30 0.96 0.34 0.074 111 11.67 4.0 0.7 98.84 1.16 0.73 0.43 0.146 IV 12.35 12.41 150 c. c 4.9 . burgundy injected into stomach. 0.8 98.72 1.28 0.91 0.37 0.092 V 12.59 5.5 0.6 98.78 1.22 0.87 0.35 0.096 VI 1.29 4.7 0.7 98.91 1.09 0.82 0.27 0.071 VII 2.00 2.06 200 c. e 4.7 . burgundy injected into stomach. 0.6 98.88 1 1.12 1 0.82 0.30 0.058 VIII 2.32 - - 98.98 1.02 0.69 0.33 0.099 Dog killed ; stomach contents = 190 c. c. ; claret color ; mucosa not inflamed. Contents contained 13.1 grams of alcohol. The burgundy useli contained 5.2 per cent of alcohol. 12, iv. 1897. Bitch. Weight 9 kilos. Chloroform and ether during operas tion. Distance of secondary coil = 190 mm. Stimulation, 1 min., fol- lowed by a pause of 2 min. Time. I 9.24 11 9.40 10.40 III 10.53 IV 11.21 11.50 V 11.56 VI 12.25 VII 12.51 1.18 VIII 1.23 IX 1.44 X 2.03 XI 2.25 Amount saliva collected. Water, per cent. 4.5 0.9 98.76 1.24 0.97 4.6 0.7 98.89 1.11 0.81 100 c. c. distilled water injected into stomach. 4.7 I 0.6 I 99.04 I 0.96 I 0.66 6.0 I 0.5 I 99.09 I 0.91 | 0.60 100 c. c. distilled water injected into stomach 4.5 I 0.5 I 99.30 I 0.70 I 0.54 4.5 0.6 99.33 0.67 0.36 4.6 I 0.7 I 99.39 | 0.61 | 0.36 100 c. c. 50 per cent, alcohol injected into stomach. 6.7 " " 4.8 4.7 4.7 0.7 99.35 0.65 0.36 0.8 99.38 0.62 0.32 0.7 99.47 0.53 0.29 0.6 99.47 0.53 0.22 Salts. Chlorine. per cent. per cent. 0.27 0.062 0.30 0.054 0.30 0.049 0.31 0.060 0.16 0.024 0.31 0.078 0.25 0.063 0.29 0.067 0.30 0.087 0.24 0.087 0.31 0.097 Dog killed. Stomach mucosa normal, of alcohol. Contents = 100 c. c. No odor DIGESTION AND SECRETION. 263 Experiments of the character indicated by these protocols were carried out with alcohol in varying doses, whiskey, brandy, and wine, and control experiments with water were also made. In attempting to interpret the analytical data thus obtained in experiments extending over several hours, it is necessary to bear in mind facts regarding salivary secretion which seem to be sufficiently established. Ludwig ' showed that the submaxillary saliva secreted during stimulation of the chorda tympani under- goes a change in composition varying with the duration of the flow, the content of organic solids decreasing in far greater degree than the dissolved salts. Heidenhain^ found that the percentage of salts in the saliva varies directly with the rate of secretion, quite independently of the state of the gland, the organic constituents, however, being influenced by the condition of the secreting organ as well as by the strength of stimulus and resulting rate of secretion. These observations, verified by Werther ^ and by Langley and Fletcher,'* have been extended by the latter investigators, who formulated the opinion that " the secretion of organic substances depends wholly, or almost wholly, upon the strength of the stimulus, whilst the secretion of water and of salts depends also upon the amount of blood flowing through the gland." ^ In view of the well-known fact that changes in the strength of the stimidus immediately bring about a change in both rate of secretion and composition of the saliva, we have attempted to maintain a constant stimulus throughout each series of observations by selecting some satis- factory distance of the secondary coil of the inductorium and by applying the electrodes as uniformly as possible. Owing to the gradual decline in the irritability of the exposed nerve, the impossibility of applying the electrodes constantly in one posi- tion, and other unavoidable difficulties, ideal results cannot be obtained. However, the difficulties were present in every exper- iment and the results are therefore more or less comparable. An examination of the data obtained in the manner above 1 Ludwig and Beeher, Zeitschr. f. rat. Med., 1851, N. F., i. 278. Cf. also Heidenbaiu, Hermann's Handhuch der Physiologie, v. 47-49. - Heidenhain, Archiv fiir die ges. Pki/sioL, 1878, xvii. pp. 4, 6. 3 Werther, Arclui: f. d. ffex. 'Ph;/.siol., 1886, xxxviii. p. 293. * Langley and Fletcher, loc. cit., 152. 5 Ibid., p. 132. 264 THE LIQUOR PROBLEM. indicated shows no constant appreciable influence of alcohol or alcoholic fluids upon the rate of secretion of submaxillary (or sublingual) saliva under the influence of a constant external stimulus. Even large doses of alcohol, sufficient to produce pro- longed narcosis, fail to check the salivary flow, a result in strik- ing contrast to the effects which morphine may bring about when used in moderately large doses. We have not infrequently observed, in other experiments, an entire absence of salivary flow, even with very strong stimuli, when morphine was unin- tentionally given in doses larger than were necessary to produce a mild narcosis. On the other hand, there is likewise an absence of any stimulating action on the glands, in our experi- ments ; at least the slight variations in the rate of flow after alcohol is administered are no greater than those brought about by water alone (cf. third protocol above). On the total solids likewise, the presence of alcohol seems to exercise no noticeable influence. There is a tendency toward decrease in amount as the experiments progress ; this decrease, however, is entirely confined to the organic constituents of the saliva, the salts remaining comparatively constant in amount, as can be seen in the protocols above. The decrease in organic substances is in no way to be attributed to alcohol, since it may be obtained with water alone (cf. protocol third), or in the course of any protracted salivai'y secretion. Nor is this deciease remarkable when it is remembered that a small gland weighing a few grams has furnished fifty to seventy-five grams of saliva in the course of thi-ee or four hours. The organic constituents of the cells must thus be exhausted somewhat more rapidly than the ana- bolic processes of the gland can replace them, while the salts are obtained with relative ease from the blood. Any effect upon the secretion of inorganic salts such as might result in accord- ance with Langley's law (cf. page 263) was not observed. A large number of determinations of the alkalinity of the saliva (towards lacmoid) likewise failed to show any constant rela- tions. It is interesting in this connection to note that the sub- maxillary saliva of the dog was always found alkaline to phe- nolphthalein, litmus, lacmoid, and methylorange. Mixed human saliva, like the bile of a number of animals, is almost always acid toward phenolphthalein.^ * Chittenden, "The Reactions of Some Animal Fluids," Science, n. s. v. 902. DIGESTION AND SECRETION. 265 B. GASTRIC SECRETION. It has already been pointed out that in an accurate and com- plete study of the influence of alcohol and alcoholic drinks upon gastric digestion, no single line of experimentation can lead to full and concise results covering the whole ground of inquiry. It was therefore deemed advisable, for experimental purposes, to study the subject under several distinct heads, as (1) the influence of alcohol and alcoholic drinks upon the process of secretion ; (2) upon the processes of absorption ; (3) upon the motor functions of the alimentary canal ; and (4) upon the purely chemical processes of gastric digestion. The last phase has already been considered at some length. The older announcements regarding the influence of alcohol are summarized in the statement that it is a strong stimulant of gastric secretion, and alcohol is recommended as a means of obtaining gastric juice from fistulfe in animals.^ Larger doses are regarded as detrimental to the stomach, giving rise to trans- udation of alkaline fluid, — a process evidentlj' pathological.^ Gluzinski ^ found in experiments on man with brandy and dilute alcohol that these liquors gave rise, after a brief preliminary period, to the formation of a very active secretion rich in hydrochloric acid. Likewise Wolff ' states that cognac in small doses increases the secretion of hydrocliloric acid, while in larger quantity it decreases the acidity of the gastric juice and retards peptone formation. The stomach fails to respond in a positive way, however, after the continued use of alcohol. While Klem- perer^ failed to note more than a very slight increase in secre- tion resulting from moderate doses of afcohol, Blumenau ^ ob- 1 Cf. Frerichs, Wagner's Handwdrterbuch der Physiologie, 1846, iii. (1), 788 ; Kiihne, Lehrhuch, pp. 28, 30 ; Heidenhain, Hermann's Handbuch der Physiologie, v. 115. * Cf. Heidenhain, loc. cit. ; Lauder Brunton, Disorders of Digestion, 1886, p. 144. " Gluzinski, Deutsches Arckiv. f. klin. Med., 1886, xxxLx. 405. See Jahresbericht fiir Thierchemie, 1886, xvi. 263. * Wolff, Zeilschr. f. klin. Med., 1889, xvi. 222 j Jahresbericht f. Thier- chemie, 1889, xix. 266. 6 Klemperer, Zeitschr. f. klin. Med., 1890, xvii. Supp., 324 ; Centralbl. f. med. Wissen. 1891, p. 751. ' Blumenau, Therapeutische Monatshefte, 1890, v. 504 ; Jahresbericht f. Thierchemie, 1891, xx. 212. 266 THE LIQUOR PROBLEM. served that twenty-five to fifty per cent, alcohol introduced into the healthy human stomach acts as a secretory stimulant, bring- ing about an increased flow of gastric juice with rise of acidity after a period of two to three hours. More recently Brandl * has found in experiments on fistulous dogs that alcohol — as contrasted with water introduced with foodstuffs into the stom- ach — brings about an unfailing, though not particularly large, increase in gastric secretion. With repeated and increasing doses of alcohol, Haan ^ has further observed an augmentation of acidity in the dog, followed by a diminution in the amount of secretion and a gradual decline in acidity after several doses. In our first series of experiments on gastric secretion, atten- tion was directed to the volume and acidity resulting from the introduction of alcoholic fluids into the stomach, independently of any stimulating action due to food simultaneously intro- duced. Dogs in fasting condition were employed in every instance, and morphine sulphate (introduced subcutaneously) followed by chloroform-ether was used preparatory to operative interference. The method consisted in ligating the duodenum just beyond the pylorus and then introducing a definite vol- ume of the fluid to be examined into the empty stomach in the manner already indicated in previous experiments. In sev- eral cases, dogs with gastric fistulie were employed. The abdomen was quickly sewed up after this operation, chloroform- ether stopped and the animal allowed entire freedom of move- ment. The liquid employed was ordinarily warmed gently to avoid the asserted stimulating action of cold fluids on the gas- tric mucosa.^ Ligations of the cesophagus and oesoiohageal fis- tulse were avoided, since a somewhat extended exjjcrience with gastric fistulse dogs, as well as the experiments about to be described, have convinced us, in agreement with Heidenhain's observations,* that under ordinary circumstances, i. e., in the absence of unusual stimuli (and with slightly narcotized ani- mals), the amount of saliva secreted is small at most and fails to induce any pronounced secretion in the stomach.^ Further, 1 Brandl, Zeitschr.f. Biologic, 1892, xxix. 304. 2 Haan, Camples rendus de la societe de hiologie, 1895, ii. 817. ' Cf. Kiibne, Lekrbuck der physiol. Chemie, 28. * Hermann's Handbuch, v. 112. * Compare also the experiment described on page 260. DIGESTION AND SECRETION. 267 we have found that an unusual flow of saliva is at once readily detected by the physical character of the stomach contents, e. g., frothing, etc. Furthermore, the conditions of our experi- ments were intended to approach those normally obtaining in the body as nearly as possible ; and finally, a sufficient num- ber of control experiments in which water was introduced into the stomach have left no doubt as to the validity of the method. At the end of from three to four hours — a period shown by our experiments to cover the digestion time of a test meal for the dog — the animal was bled to death, the CESophagus ligated at the lower end, the stomach removed from the body, wiped free from blood, and the contents discharged into a graduated vessel. In the fluid thus obtained, total acidity, free and combined HCl, and acid-reacting salts were determined by the method of Tijp- fer ; ^ alcohol was estimated, when present, in the distillate from a definite portion of the gastric contents, by the pycnometer method ; total solids were determined by drying a weighed quantity of fluid in a tared crucible at 100°-105° C. Protocols foUow : — Control Experiments ■with Water. I. 31 V. 1897. Dog, with gastric fistula, well healed Weight 21 kilos. Fluid removed completely through fistula. Introduced 200 c. c. distilled water at 10.50 A. M. Contents removed at 1.55 P. M. =3^ hrs. Volume of fluid recovered from stomach =: 160 c. c. = 80 per cent, of original volume. Analysis of the contents gave : Total acidity 0.203 per cent.'' Free HCl 0.192 Loosely combined HCl . . 0.002 Salts 0.009 Total solids 0.624 II. 28 vi. 1897. Dog, with gastric fistula, well healed. Weight 25 kilos. Fluid removed completely through fistula. Introduced 135 c. c. distilled water at 11 A. M. Coutents removed at 1.45 p. M. = 2| hrs. Volume of fluid recovered from stomach = 110 c. c. =: 81 per cent, of original volume. ' Topfer, Zeitschr. f. physiol. Chemie, 1894, xix. 104. ^ Expressed as HCl in all the experiments. 268 THE LIQUOR PROBLEM. Analysis of the contents gave : Total acidity 0.274 per cent. FreeHCl 0.241 Looa;ly combined HCl . . . 0.018 Salts 0.015 Total solids 0.77 III. 24 V. 1897. Dog. Weight 7.7 kilos. Introduced 125 c. c. distilled water at 10 A. M. Contents removed at 1.50 P. M. = 3| hours. Volume of fluid recovered from stomach = 114 c. e.^ 91 per cent, of original volume. Analysis of the contents gave : Total acidity 0.094 per cent. Free HCl 0.065 Loosely combined HCl . . 0.004 Salts 0.025 Total solids 0.47 IV. 29 V. 1897. Dog. Weight 14.5 liilos. Introduced 200 c. c. distilled water at 9.30 A. M. Contents removed at 1.15 P. M. ^ 3| hours. Volume of fluid recovered from stomach = 206 c. c. = 103 per cent, of original volume.^ Analysis of the contents gave : Total acidity 0.047 per cent. Free HCl 0.040 Loosely combined HCl . . 0.004 Salts 0.003 Total solids 0.50 V. 2 vi. 1897. Dog. Weight 10.5 kilos. Introduced 125 c. c. carbonated loater at 9 A. M. Contents removed at 12.45 P. M. = 3| hours. Volume of fluid recovered from stomach = 125 c. c. = 100 per cent, of original volume. Analysis of the contents gave : Total acidity 0.191 per cent. Free HCl 0.152 Loosely combined HCl . . . 0.014 Salts 0.025 Total solids 0.55 In this experiment the COj was completely absorbed. VI. 1 vii. 1897. Dog. Weight 10 kilos. Introduced 76 c. c. of 2 per cent, dextrose solution at 9.10 A. M. ' A small quantity of saliva doubtless found its way into the stomach, as the dog salivated somewhat at the beginning of the operation and the stomach contents had a frothy appearance. DIGESTION AND SECRETION. 269 Contents removed at 12.40 p. M. = 3^ hours. Volume of fluid recovered from stomach ^ 68 c. c. = 90 per cent, of original volume. Analysis of the contents gave : Total acidity 0.072 per cent. Free HCl 0.047 Loosely combined HCl . . . 0.007 Salts 0.018 Experiments with Strong Ethyl Alcohol. VII. 17 V. 1897. Dog. Weight 23 kilos. Introduced 200 c. c. of 37 per cent, alcohol at 10.45 A. M. Contents removed at 2.15 p. M. = 3^ hours. Volume of fluid recovered from stomach i= 407 c. c. =^ 203 per cent, of original volume. Analysis of the contents gave : Total acidity 0.164 per cent. Free HCl 0.112 Loosely combined HCl . . . 0.043 Salts 0.009 VIII. 31 V. 1897. Dog. Weight 21 kilos. Gastric fistula well healed. Contrast experiment with water and alcohol, a. The first part of this experiment has been described under I. page 267. 3. After discharge of previous stomach contents completely through fistula, 200 c. c. 37^ per cent, alcohol were introduced into the stomach through fistula at 1.55 P. M. Contents removed at 5 P. M. = 3^ hours. Volume of fluid recovered from stomach = 460 c. c. = 230 per cent, of original volume.' Analysis of the contents gave : Total acidity 0.220 per cent. Free HCl 0.164 Loosely combined HCl . . . 0.011 Salts 0.045 Total solids 0.987 Experiments with Weak (5 per cent.) Ethyl Alcohol. IX. 24 vi. 1897. Bitch. Weight 8 kilos. Introduced 100 c. c. .5 per cent, alcohol at 10.45 A. M. Contents removed at 2 p. M. := 3^ hours. Volume of fluid recovered from stomach z= 110 c. c. =; 110 per cent, of original volume. Analysis of the stomach contents gave : ' A post-mortem examination showed that the stomach contents could be completely discharged through the fistula by the method adopted. 270 THE LIQUOR PROBLEM. Total acidity 0.119 per cent. Free HCl 0.086 Loosely combined HCl . . . 0.011 Salts 0.022 Total solids 0.69 X. 8 vi. 1897. Bitch. Weight 7.3 kilos. Introduced 110 o. c. 4.8 per cent, alcohol at 9 A. M. Contents removed at 12.45 P. M. ^ 3| hours. Volume of fluid recovered from stomach = 135 c. c. =: 123 per cent, of original volume. Analysis of the stomach contents gave : Total acidity 0.202 per cent. Free HCl 0.148 Loosely combined HCl . . . 0.021 Salts 0.033 The results of the foregoing experiments, expressed in per- centages, are combined in the following table : — A. With water. Relative volume of fluid at end of experiment. Total acidity. Loosely combined HCl. Free HCl. Salts. Total GoUds. I II III IV V VI 80 81 91 103 100 90 0.203 0.274 0.094 0.047 0.191 0.072 0.002 0.018 0.004 0.004 0.014 0.007 0.192 0.241 0.065 0.040 0.152 0.047 0.009 0.015 0.025 0.003 0.025 0.018 0.62 0.77 0.47 0.50 0.55 Average. 90.8 0.147 0.008 0.123 0.016 0.58 B. With strong alcohol. Relative volume of tiu'd at end of experimeut. Total acidity. Loosely combined HCl. Free HCl. Salts. Total solids. VII VIII 203 230 0.164 0.220 0.043 0.011 0.112 0.164 0.009 0.045 0.99 Average. 216.5 0.192 0.027 0.138 0.026 0.99 c. With weak alcohol. Relative volume of fluid at end of experiment. Total acidity. Loosely combined HCl. Free HCl. Salts. Total solids. IX X 110 123 0.119 0.202 0.011 0.021 0.086 0.148 0.022 0.033 0.69 Average. 116.5 0.160 0.016 0.117 0.027 0.69 DIGESTION AND SECRETION. 271 A glance at the data presented leaves little doubt as to the pronounced stimulating action of pure ethyl alcohol upon gas- tric secretion, even with solutions of only five per cent, strength. The effect is not merely one characterized by the discharge of water into the stomach cavity, but gives evidence of a true secretory process. Thus, the volume of fluid found after intro- duction of water into the stomach is not increased, there being rather a tendency in the opposite direction. Edkins,^ v. Mer- ing,2 and others have shown that the absorption of water from the stomach is practically nil, while the absorption of alcohol goes on quite rapidly. In our own experiments the alcohol used had entirely disappeared from the stomach in the course of the experiments ; the question of absorption will, however, be referred to in another connection. With five per cent, alco- hol the increase in the volume of the gastric contents is notice- able, becoming very pronounced with the stronger percentages of alcohol. The increase in total solids gives confirmation of stimulated secretion, as does also the increase in acidity. It must be remembered, further, that the increase in acidity shown by the figures is a relative one ; expressed absolutely in grams, the total acid secreted is obviously increased in far greater degree than the percentage figures indicate. The specific action of alcohol is strikingly shown in Experiment VIII., in which the conditions permitted of comparative experiments with water and alcohol on the same animal, with the following results : — Comparison of the Two Experiments (VIII. a,/3). Fluid introduced into stomach. Fluid recov- ered from stomach after three hours. Rela- tive volume. Total, acidity. Free HCl. Loosely bined HCl. Salts. Total solids. 200 e. c. water 200 o.c. alcohol 1 (37^ per cent.) j' 160 c. c. 460 c. e. 80r/, 230^ 0.203 0.220 0.192 0.164 0.002 0.011 0.009 0.045 0.624 0.987 A comparison of the proteolytic activity of the two secretions by Griitzner's carmine-fibrin method showed a decidedly greater ' Edkins, Journal of Physiology, 1892, xiii. 445. * V. Mering, Verhandlungen des XII. Congresses f. innere Medicin, Wies- baden, 1893 ; Therapeutische Monatshefte, 1893, vii. 201. 272 THE LIQUOR PROBLEM. digestive power in the case of the " water " secretion. Much stress cannot be placed, however, on a single experiment. The gastric fluids obtained in the experiments with alcohol possessed strong proteolytic properties in every case examined. In view of this pronounced action of alcohol on gastric secre- tion it seemed desirable to ascertain something more definite regarding the way in which this process is provoked. The con- trol experiments with water gave evidence that the mere con- tact of the fluid with the stomach mucosa could not be the cause of gastric stimulation. It will be remembered that even vigorous mechanical stimulation or irritation ordinarily fails to yield more than a few grams of secretion,' — an observation in decided contrast to the phenomena of gastric flow during the presence of digestible materials in the stomach. The following experiments throw light on the question raised : — XI. 25 V. 1897. Dog. Weight 23 kilos. The intestine was ligatured just beyond the pylorus. Another ligature was applied below the point of entrance of the duct of Wirsung. 20 c. c. of 60 per cent, alcohol were injected into the lumen of the intestine between these ligatures, while 105 c. c. of 60 per cent, alcohol were intro- duced into the intestine beyond the second ligature. Then Introduced 200 c. c. water into stomach at 10.45 A. M. Contents removed at 2.30 P. M. = 3f hours. Volume of fluid recovered from stomach = 260 c. c. ^= 130 per cent, of original volume. Analysis of stomach contents gave : Total acidity 0.241 per cent. Free HCl 0.213 Loosely combined HCl . . . 0.002 Salts 0.026 XII. 28 V. 1897. Bitch. Weight 28 kilos. Intestine ligatured just beyond the pylorus. Another ligature was applied below the point of entrance of the duct of Wirsung. 125 c. e. of 60 per cent, alcohol were injected into the lumen of the intestine below the second ligature.' Then Introduced 200 c. c. water into stomach at 11 A. M. Contents removed at 2.45 P. M. ^ 3| hours. Volume of fluid recovered from stomach = 375 c. c. ^= 187.5 per cent, of original volume. ' Cf. Tiedemann and Gmelin, Die Verdauung nach Versiichen, 1831, p. 95 ; Schiff, Lefons sur la physiologie de la digestion, ii. 244. ^ The return of alcoholic fluid into the stomacb was thus absolutely pre- vented. DIGESTION AND SECRETION. Analysis of stomach conteuts gave : Total acidity 0.333 per cent. FreeHCl 0.306 Loosely coinbiued HCl . . . 0.004 Salts 0.023 Total solids 0.30 Summary of Results of Experiments. 273 No. Relative volume of fluid at end of experiment. Total acidity. Loosely combiued HCl. Free HCl. Salts. Total solids. XI xn 130.0 187.5 0.241 0.333 0.002 0.004 0.213 0.306 0.026 0.023 0.30 Average. 158.5 0.287 0.003 0.259 0.024 0.30 From these data it seems clear that a stimulation of the gastric glands may take jjlace, independently of any direct gastric irri- tation, in consequence of the influence of alcohol absorbed from the intestine. The volume of the fluid in the stomach increased relatively far more than when five per cent, alcohol was intro- duced directly into the stomach (cf. Experiments IX., X., pages 269, 270). The composition of the fluid (high acidity, free HCl, total solids) likewise gives evidence of active secretion, while the fluid was found to be strongly proteolytic. The ab- sorption of the alcohol was complete in these experiments ; and when it is remembered how quickly alcohol is distributed and disappears in the body, the actual amount reaching the gastric glands must have been relatively small, or at least must have acted during a brief period only. It seems probable, there- fore, that there occurs here an indirect stimulation quite com- parable to that resulting after absorption of peptone from the alimentary tract, and it is interesting to note by way of com- parison that Khigine,! in his experiments upon the isolated fundus of the dog, found that the acidity of the secretion after absorption of digestion products runs parallel to a certain degree with the increase in volume. Whether the absorbed alcohol acts directly upon elements of the gastric mucosa (Heiden- hain's " secondary secretion "), or becomes a stimulus to spe- > Khigine, Archives des sciences biologiques, St. Petersbourg, 1895, iii. 461. 274 THE LIQUOR PROBLEM cific secretory nerve fibres (Khigine), we are unable at present to decide.' In connection with this " secondary " secretion of gastric juice due to the presence of alcohol in the small intestine, it is to be noted that Macfadyen, Nencki, and Sieber^ found among the bacteria normally present in this portion of the alimentary canal species which give rise to a production of ethyl alcohol from carbohydrates ingested. Experiments -with Alcoholic Beverages. It might naturally be assumed that the action of the various alcoholic beverages on gastric secretion would be similar, quali- tatively, to that of their common constituent, ethyl alcohol. Previous investigation, however, has shown that the influence of these liquors on the purely chemical processes of digestion is not necessarily proportionate to their content of alcohol ; ^ hence it seemed desirable to study the effect of a number of typical liquors on secretion, by the method of the previous experi- ments. This we have done with the following results : — XIII. 21 vi. 1897. Dog. Weight 10.7 kilos. Introduced 50 c. c. sherry -\- 2.5 c. c. water (14 per cent, alco- hol) at 10.20 A. M. Contents removed at 2.15 P. M. = 3^^ hours. Volume of fluid recovered from stomach = 160 c. c. =: 213 per cent, original volume. Analysis of stomach contents gave : Total acidity 0.367 per cent. Free HCl 0.300 Loosely combined HCl . . 0.020 Salts 0.047 Total solids 1.72 XIV. 2 vi. 1897. Dog. Weight 18.5 kilos. Introduced 50 c. c. whiskey -\- 100 c. c. water (16 per cent, al- cohol) at 11.15 A. M. Contents removed at 3 p. M. = 3| hours. Volume of fluid recovered from stomach ^320 c. c.:=213 per cent, original volume. Analysis of stomach contents gave : 1 Cf. Howell, American Text-Book of Physiology, 1896, p. 182. '' Macfadyen, Nencki, and Sieber, Archiv f. experimentelle Pathologie und Pharmakologie, 1891, xxviii. 311. '" Chittenden and Mendel, loc. cit. DIGESTION AND SECRETION. 275 Total acidity 0.382 per cent. Free HCl 0.346 Loosely combined HCl . . 0.011 Salts 0.025 Total solids 0.42 XV. 3 vi. 1897. Bitch. Weight 8 kilos. Introduced 125 c. c. hochheimer (13.3 per cent, alcohol) at 10 A. M. Contents removed at 1.43 P. M. = 3} hours. Volume of fluid recovered from stomach = 140 c. c. = 112 per cent, original volume. Analysis of stomach contents gave : Total acidity 0.230 per cent. Free HCl 0.165 Loosely combined HCl . . 0.038 Salts 0.027 XVI. 28 vi. 1897. Dog. Weight 23 kilos. Gastric fistula well healed. Contrast experiment with water and wine. a. The first part of this experiment has been described under II., page 267. $. After complete discharge of previous stomach contents through the fistula, 135 c. c. w^hite wine were introduced into stomach through fistula at 1.45 p. m. Contents removed at 4.30 p. M. := 2| hours. Volume of fluid recovered from stomach ^ 170 c. c. = 126 per cent, original volume. Analysis of stomach contents gave : Total acidity 0.425 per cent. Free HCl 0.342 Loosely combined HCl . . 0.018 Salts 0.005 Total solids 1.79 XVII. 23 vi. 1897. Dog. Weight 12.3 kilos. Introduced 125 c. c. claret (5.15 per cent, alcohol) at 9.30 A. M. Contents removed at 1.30 p. M. = 4 hours. Volume of fluid recovered from stomach r= 225 c. c. = 180 per cent, original volume. Analysis of stomach contents gave : Total acidity 0.373 per cent. Free HCl 0.324 Loosely combined HCl . . 0.025 Salts 0.024 Total solids 1.90 276 THE LIQUOR PROBLEM. XVIIl. 18 vi. 1897. Bitch. Weight 10.2 kilos. Introduced 100 c. c. lager beer (4 to 5 per cent, alcohol) at 10.20 A. M. Contents removed at 2.15 P. M. = Z\l hours. Volume of fluid recovered from stomach = 110 c. c. =: 110 per cent, original volume. Analysis of stomach contents gave : Total acidity 0.357 per cent. FreeHCl 0.241 Loosely combined HCl . . 0.064 Salts 0.052 Total solids 9.26 XIX. 23 vi. 1897. Dog. Weight 10 kilos. Introduced 100 c. c. lager beer (4.5 per cent, alcohol) at 10.10 A. M. Contents removed at 2 p. M. = 3| hours. Volume of fluid recovered from stomach = 125 c. c. = 125 per cent. original volume. Analysis of stomach contents gave : — Total acidity 0.241 per cent. Free HCl 0.169 Loosely combined HCl . . 0.032 Salts 0.040 Total solids 5.51 XX. 14 vi. 1897. Dog. Weight 14 kilos. Introduced 150 c. c. porter (3.75 per cent, alcohol) at 9.45 A. M. Contents removed at 1.30 p. M. = 3| hours. Volume of fluid recovered from stomach = 195 c. c. =: 127 per cent, original volume. Analysis of stomach contents gave : Total acidity 0.371 per cent. Free HCl 0.320 Loosely combined HCl . . . 0.036 Salts 0.015 Total solids 2.19 XXI. 7 vi. 1897. Bitch. Weight 8.5 kilos. Introduced 125 c. c. lager beer (4.7 per cent, alcohol) at 10.15 A. M. Contents removed at 2.10 p. M. ^ 31^ hours. Volume of fluid recovered from stomach = 285 c. c. ::= 228 per cent. original volume. DIGESTIOX AND SECRETION. 277 Analysis of stomach coutents gave : Total acidity 0.378 per cent. Free HCl 0.308 Loosely combined HCl . . . 0.016 Salts 0.054 Total solids 2.88 XXII. 14 vi. 1897. Dog. Weight 8.2 kilos. Introduced 150 c. c. porter residue ' at 11.30 a.m. Contents removed at 3.15 P. m. = 3| hours. Volume of fluid recovered from stomach = 135 c. c. = 90 per cent, original volume. Analysis of stomach contents gave : Total acidity 0.352 per cent. Free HCl 0.280 Loosely combined HCl . . . 0.014 Salts 0.058 Total solids 2.29 XXin. 9vi. 1897. Dog. Weight 10 kilos. Introduced 130 c. c. lager beer residue - at 10.30 a. m. Contents removed at 2.30 P. M. =^ 4 hours. Volume of fluid recovered from stomach = 175 c. c. = 134 per cent, original volume. Analysis of stomach contents gave : Total acidity 0.346 per cent. Free HCl 0.270 Loosely combined HCl . . . 0.038 Salts 0.038 Total solids 6.80 For the sake of comparison these data are contrasted in the following table : — ' The residue left on evaporation of 150 c. c. porter, dissolved in 150 c. c. distilled water. - Residue from evaporation of 130 c. c. beer, dissolved in 130 c. c. water. THE LIQUOR PROBLEM. Relative vol. of fluid ateud of ex- Total acidity. Loosely combined HCl. Free HCl. Salts. Total solids. periment. XIV. Whiskey + H2O . 213 0.382 0.011 0.346 0.025 0.42 (16 ';^, alcohol) XIII. Sherry + H^O . 213 0.367 0.020 0.300 0.047 1.72 (13f/p alcohol) XV. White wiue . . . 112 0.230 0.038 0.165 0.027 _ (13% alcohol) XVI. White wine . . . 126 0.425 0.018 0.342 0.065 1.79 (13<% alcohol) XVII. Claret , . . . 180 0.373 0.025 0.324 0.024 1.90 (10^ alcohol) XVIII. Beer 110 0.357 0.064 0.241 0.052 9.26 (4.7 <5^ alcohol) XIX. Beer 125 0.241 0.032 0.169 0.040 5.51 (4c^ alcohol) XXI. Beer 228 0.378 0.016 0.308 0.054 2.88 (i.Tc-/^ alcohol) XXIII. Residue of beer . 134 0.346 0.038 0.270 0.038 6.80 (like XXI.) XX. Porter .... 127 0.371 0.036 0.320 0.015 2.19 (5.3% alcohol) XXII. Residue of porter 90 0.352 0.014 0.280 0.058 2.29 (like XX.) These results afford tangible evidence of tlie stimulating action of the liquors examined, as shown in the increased volume of gastric contents, accompanied by increase in acidity. That alcohol is an important factor in the production of these phenomena seems certain. Contrast, for example, Experiment XX. with XXII., which differs only in the absence of the alco- hol. But the wines and malted beverages contain a variety of other constituents, such as organic acids, which perhaps con- tribute to increase the stimulating effect and are doubtless partly responsible in a number of experiments for the high acidity observed. The contrast between the action of water and wine is strikingly shown in Experiments XVI. a and /?, carried out on the same animal. DIGESTION AND SECRETION. 279 Comparison of the Two Experiments (XVI. o, 0). Fluid introduced into Btomach. Fluid removed from stomach after 3 hours. Relative volume, per cent. Total acidity. Free HCl. Loosely combined HCl. Salts. Total Bolids. 135 c. c. water 135 c. c. white wine . . . 110 c. c. 170 c. c. 81 126 0.274 0.425 0.241 0.342 0.018 0.018 0.015 0.065 0.77 1.79 The marked increase in total solids in many of these experi- ments, however, is not to be attributed, as in the case of pure alcohol, entirely to the increased secretion ; it is rather in part accounted for by the unabsorbed constituents of the liquor employed. The following table, compiled from analyses at hand, shows that a large portion of the total solids in the gastric juices obtained may be derived from other sources than the secretion itself : — T.'VBLE SHOWING TOTAL SoLIDS OF GaSTRIC CONTENTS. Nature of fluid introduced Total solids introduced Total solids in gastric into stomach. into Btomach. experiment. II. Water grams. 0.84 grams. IX. Weak alcohol 0.69 " VIII. Strong alcohol . 4.50 " XIV. Whiskey . . . 0.15 " 1.34 " XVI. White wine 2.8 " 2.41 " XVII. Claret . . 3.9 " 4.28 " XIII. Sherry . . 2.35 « 2.78 " XVIII. Beer . . 7.0 " 10.00 " XXIII. Beer residue 9.1 " 11.56 " XX. Porter . . 6.6 " 4.16 " XXII. Porter residue . 6.6 " 3.10 " Character of the Gastric Juice obtained by Stimulation with Alcohol. The gastric juice obtained as a result of the stimulating influence of alcohol and alcoholic liquors resembles that ordi- narily procured from gastric fistulje in its physical characters ; it is a thin, colorless, or very faintly yellow fluid containing occasional flocks of mucus in suspension. There was no evi- dence of irritation or hyperaemia of the mucosa, and all traces of blood were absent. After the doses used the gastric lining was of a pale or faintly pink color when removed after bleeding 280 THE LIQUOR PROBLEM. the animal. When colored alcoholic liquors were employed the gastric contents retained the characteristic coloring matter, the latter not being absorbed, while the alcohol entirely disap- peared. In chemical composition the gasti'ic juice appeared somewhat more acid than that ordinarily secreted. It likewise contained a larger amount of solid matter, and in harmony with this fact the proportion of combined hydrochloric acid was increased, which in turn suggests the presence of a somewhat larger amount of proteid or other like matter. The fluids were repeatedly tested with boiled fibrin for proteolytic action, and this was always found vigorous. In the experiments in which alcohol was introduced directly into the intestines (Experi- ments XI., XII., page 272) the intestinal lining was not abnor- mal in appearance, the reaction being alkaline to litmus in the upper duodenum and neutral or faintly alkaline farther along the alimentary canal. This corresponds with the observations on the normal reaction of the intestinal contents of the dog, by Moore and Rockwood,i whose statements we have repeatedly verified. C. GASTRIC DIGESTION. Since chemical, mechanical, and physiological processes go on side by side during digestion, we have carried out a series of experiments to determine in what way and to what extent the factors already investigated combine or cooperate under the influence of alcohol and alcoholic liquors. Our method has in- cluded the examination of the stomach contents after test meals were given. The statements current in the literature on this subject are by no means concordant. In experiments on a woman having a gastric fistula Kretschy ^ observed that alcohol retarded digestion. Buchner ^ found that in the human stomach alcohol, wine, and beer all retarded di- gestion, though not so markedly as in artificial digestion. Bikfalvi,* in observations on dogs, obtained a retardation of di- gestion with even small quantities of alcohol. Beer and wine ^ Moore and Rockwood, Journal of Physiology, 1897, xxi. 373. ^ Kretschy, Deutsches Arch.f. klin. Med., xviii. 527 ; Jahresbericht f. Thierchemie, 1876, vi. 173. ^ Buchner, Deutsches Arch. f. klin. Med., xxix. 537 ; Jahresbericht f. Thierchemie, 1881, xi. 286. ■• Bikfalvi, Jahresbericht f. Thierchemie, 1885, xv. 273. DIGESTION AND SECRETION. 281 showed no favorable influence, the latter even retarding di- gestion when given in large quantities. Ogata ^ states that beer, wine, and brandy retard gastric digestion noticeably. Schelhaas^ observed that in the living stomach wine did not retard digestion so long as there was free HCl present ; patho- logical conditions (carcinoma ventriculi) formed the only ex- ceptions. In an extensive series of experiments Gluzinski^ distinguishes two phases occurring during digestion in the stomach in the presence of alcohol : (1) a retardation of pro- teid digestion, and (2) secretion of a very active, strongly acid gastric juice. Henczinski ■* found no bad effect on digestion following the use of beer. Blumenau ^ states that from twenty- five to fifty per cent, of alcohol introduced into the healthy stomach induces a decrease in digestive action during the first two or three hours. Wolffhardt,^ experimenting on a healthy man, concluded that from fifteen to twenty grams of absolute alcohol interfere with proteid digestion, while the effect of cognac varies with the period of digestion during which it is taken ; he found that wines tend to promote digestion. AYith reference to the motor functions of the stomach Lauder Brunton states that alcohol taken into this organ increases its movements as well as its secretory activity, and by mixing its contents more thoroughly with the gastric juice accelerates digestion.^ Likewise Klempei-er* states as a result of his ex- periments that the motor functions are decidedly increased as measured by the oil method, while Haan ® has more recently ad- 1 Ogilta, Jahreshericht f. Thierchemie, 1885, xv. 274 ; Arch. f. Hygiene, 1886, iii. 204. ' Schelhaas, DeutscJtcs Arch. f. klin. Med., xxxvi. 427 ; Jahreshericht f. Thierchemie, 1885, xv. 271. ' Gliiziuski, Deutsckes A rch. f. klin. Med., 1886, xxxix. 405 ; Jahreshericht f. Thierchemie, 1886, xvi. 263. * Henczinski, Dissertation, 1886. Quoted by Munk, Die Erncihrung, p. 327. " Blumenau, Therapeutische Monatshefte, 1890, v. 504 ; Jahreshericht f. Thierchemie, 1891, xxi. 212. ' Wol£Ehardt, Munchn. med. Wochenschr., 1890, xxxvii. 608 ; Centralbl. f. med. Wissen., 1891, p. 47. ' Brunton, Disorders of Digestion, 1886, p. 146. ' Kleinperer, Zeitschr. f. klin. Med., 1890, xvii. Supp., p. 324 ; Centralbl. f. med. Wissen., 1891, p. 751. ' Haan, Comptes rendus de la societe de biologic, 1895, ii. 816. 282 THE LIQUOR PROBLEM. vanced similar conclusions as the result of work by another method. Gluziuski,^ however, notes that alcohol diminishes the mechanical action of the stomach in moderate degree. In considering the selection of subjects for experiment in the direction indicated, preference has been given to dogs. The series of investigations on man above referred to are already extensive, and the difficulties of obtaining definite answers to specific questions by this method of experimentation are obvious. It is rarely possible or desirable to carry out a large number of determinations on any single individual, while it is likewise practically impossible to control the physiological condition of the individual, i. e., diet, etc., over prolonged periods. The animals used in this research were large dogs of twenty-one and twenty-five kilos ; gastric fistulse were made, and a German- silver cannula introduced into the fundus of the stomach. In place of a cork, metal stoppers were devised to screw into the inner cannula tube by means of a small metallic key. The arrangement is shown in the diagram. The wounds healed perfectly and the animals remained in good health dur- ing the entire period of investigation, covering several months. Irregularities of diet were avoided by feeding definite portions of prepared dog biscuit with water ; this food was eagerly eaten and sufficed to keep the dogs in physiological equilibrium. The determinations of the acidity of the stomach contents were carried out according to the method of Tijpfer.^ The gastric fluid was occasionally centrifngalized when food par- ticles prevented pipetting off the fluid portion. Where only small quantities of fluid were available the titrations with phenolphthalien and dimethylamidoazobenzol were combined in the same five c. c. of fluid, according to the recommendation of Einhorn.^ Comparative expei-iments show that this modifica- tion gives the same values as the original method. Thus in one experiment : — 1 Gluzinski, loc. cit. 2 Topfer, Zeilschr. f. physinl. Chemie, 1894, xi.t. 104. » Einhorn, New York Medical Journal, 1896, May 9, p. 603. DIGESTION AND SECRETION. 283 Topfer method . . . (separate titrations) Einhorn-Topfer method (combined titration) Total acidity with Phenotphthaiien. N 1.55 c. c. jTjNaOH = 0.112 per cent. HCl. 1.55 c. c. ^NaOH = 0.112 percent HCl. Free HCl with Dimethylamidoazobemol. \l.Q c. c. j^NaOH ^=0.072 percent. HCl. (l.O c. c. ^NaOH I =0.072 per cent. HCl. Our experience with Tbpfer's method (or Einhorn's modifi- cation) leads us to agree with P. Hiiri ^ that in the absence of free HCl, i. e., when no reaction is obtained with the dimeth- ylamidoazobenzol reagent, the quantitative determinations of HCl by this method cease to be accurate, and under such con- ditions it cannot be employed. The occurrence of such con- ditions, however, is not frequent in the dog ; we have observed the absence of free HCl (during digestion) in one animal under circumstances resembling those of acute gastric catarrh.^ The food — dog biscuit — was largely undigested many hours after the meal, the acidity was high (0.55 to 0.594 per cent, expressed as HCl), and the gastric contents possessed an odor strongly suggesting fatty acids. Lactic acid was found present (Uffelman's test). In view of the increased volume of fluid found in the stomach when alcohol is introduced into that organ after ligation of the pylorus, it was of interest to learn what results follow under normal conditions of the pylorus. For this purpose from twenty to twenty-five per cent, alcohol, slightly warmed, was introduced through the gastric cannula, and at the end of thirty minutes the gastric contents were discharged into a graduated vessel. Control experiments were made with dis- tilled water, both fluids always being introduced into the empty stomach. This condition of the organ is shown by the lack of spontaneous flow when the cannula is opened, as well as by ab- 1 Hiiri, p., Arch. f. Verdauungskrankh., ii. 182, 332 ; Centralhl. f. Physi- ologic, 1896, X. 731. " Cf. V. Jaksch, Klinische Diagnostik innerer Krankheiten, 4te Auflage, p. 200. 284 THE LIQUOR PROBLEM. sence of free HCl. Flocks of mucus, alkaline to litmus, are usually present. The data obtained show no marked agree- ment, the fluid as a rule rapidly disappearing from the stomach. In seventeen experiments with water the average relative vol- ume recovered from the stomach through the cannula at the end of the thirty minutes after introduction of quantities from 40 to 200 c. c. was about thirty per cent. Fourteen similar experiments with alcohol gave an average of forty-five per cent. It is natural to ascribe the relatively greater volumes found in the stomach after the use of alcohol to an increased secretion of gastric juice occurring along with the rapid expulsion of fluid through the pylorus, and not to a retardation of the motor func- tions ; for current statements assume increased motility of the stomach under the influence of alcohol,^ while the experiments already reported justify the explanation given. Much emphasis cannot, however, be placed upon the averages given above, since the individual results vary widely among themselves and no constant coi-responding variations in acidity were observed, as in the experiments with ligated pylorus. In the following series of experiments test meals were given and the influence of alcohol and a considerable number of alco- holic beverages contrasted with that of water. Attention was directed to (1) variations in acidity and (2) time of digestion. Fifty grams of finely chopped lean meat were fed to the dog in each experiment, the stomach having been previously examined and found empty. Meat was chosen for the test meal because experience in this laboratory has shown that its composition, when it is obtained as described, does not vary much from time to time ; and after a trial of mixed food, e. g., dog biscuit, it seemed more satisfactory to employ a simple diet in which proteid preponderated. Similar recommendation is made by v. Jaksch in considering test meals for the human subject.^ Alcoholic fluids or water were introduced slightly warmed ^ into the stomach through the fistula, since dogs usually refuse to take the former by way of the mouth. At definite intervals of one quarter to one half hour small quantities of gastric con- tents were permitted to flow out of the fistula. Total acidity 1 Cf. references, pp. 280, 281. ^ v. Jaksch, loc. cit., p. 192. 8 Cf. note 3, p. 266. DIGESTION AND SECRETION. 285 (expressed as HCl), free and loosely combined HCl were determined by the method already described. The process of digestion in the stomach lasted, under the conditions described, about tliree hours, the average duration varying somewhat with the animal.^ There was no very gradual diminution of undis- solved meat particles noticeable until toward the end of this period, when the stomach very soon became empty. This cor- responds with the observations of Kiihne on man and the dog in experiments with duodenal fistulas.^ This investigator found only a slight disappearance of contents from the stomach until near the end of the digestion period, when the great bulk of material, excepting larger pieces of food, was discharged at once through the pylorus. Richet arrived at similar conclu- sions in experiments on man.^ We have usually observed a complete emptying of the stomach within a period of thirty minutes ; the conclusion of this process is designated in the notes as the " end of gastric digestion." Protocols of experi- ments follow : — Analyses of Alcoholic Beverages used. Alcohol by Dry solids. Alcohol by Dry solids. Per cent. Per cent. Per cent. Per cent. Gin .... 51.0 0.29 Stout .... 6.2 5.4 Whiskey . . . 50.0 0.32 Claret . . . 5.2 3.2 Sherry . . . 21.75 4.7 Porter . . . 5.3 4.4 White wine . . 13.32 2.5 Beer .... 4r-5 7.0 DOG A.- Weight 25 kilos. 9.25 A. M. 50 grams meat (no water). Analy sis of contents. Total acidity. Loosely combined HCl. Free HCl 9.55 0.382 0.292 0.104 10.35 0.425 0.234 0.148 11.10 0.425 0.220 0.180 11.45 0.407 0.224 0.176 12.15 Stomach empty; end of gastric digestion. Time of digestion = 2 hours and 55 minutes. 1 In experiments on a man, with a similar meal, Jessen found the diges- tion time equaled two to three hours. Zeitschr. f. Biologic, 1883, xix. 149. 2 Kiihne, Lehrhuch der physiol. Chemie, 1868, p. 53. 5 Richet, quoted in Garagee, Physiological Chemistry, 1893, ii. 159. THE LIQUOR PROBLEM. III. 9.10 A. M. ; 50 grams meat ■ fs c. c Anal; 1. water. ^■His of contents. Total acidity. Looselj r combined HCL Free HCl. 9.30 0.241 0.144 0.093 10.00 0.295 0.1C9 0.108 10.20 0.367 0.216 0.115 10.40 0.439 0.288 0.144 11.30 Stomach empty; end of gastric digestlou. TimE ! of digestion = : 2 hours and 20 minutes, 9.30.1 L. M. 50 grams meat + : 100 c. 0. water. Analysis of couteutB. Total acidity. Loosely combiued HCl. Free HCl. 10.00 0.299 0.173 0.090 10.30 0.475 0.230 0.122 11.00 0.518 0.230 0.173 11.15 0.497 0.202 0.241 11.35 0.494 0.191 0.202 11.50 0.479 0.205 0.195 12.10 0.382 0.194 0.187 12.30 Stomach empty; end of gastric digestion. Time of digestion = 3 hours. IV. 2.10 P. M. 50 grams meat -j- 150 c. c. water. Analysis of conteuta. Total acidity. Loosely combiued HCl. Free HCl. 2.40 0.252 0.137 0.108 3.10 0.374 0.194 0.130 3.40 0.533 0.245 0.198 3.55 0.547 0.234 0.234 4.10 0.490 0.205 0.216 4.25 0.385 - 0.101 4.40 Stomach empty ; end of gastric digestion. Time of digestion = 2 hours and 30 minutes. V. 9.05 a.m. 50 grams meat -{- 150 c. c. carbonated V7ater. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 9.35 0.263 0.083 0.122 10.05 0.360 0.158 0.140 10.35 0.468 0.194 0.216 10.50 0.486 0.205 0.216 11.05 0.540 0.234 0.198 11.25 0.580 0.234 0.248 11.45 Stomach empty; end of gastric digestion. Time of digestion ^ 2 hours and 40 minutes. DIGESTION AND SECRETION. 287 VI. 1.00 p. M. 50 grams meat -{- 100 c. c. 10 per cent, alcohol. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 2.45 0.497 0.209 0.230 3.10 0.464 0.220 0.173 3.30 0.436 0.180 0.202 3.50 0.400 0.162 0.202 4.10 0.263 - 0.094 4.30 Stomach empty; end of gastric digestion. Time of digestion ::= 3 hours and 30 minutes. VII. 2.30 p.m. 50 grams meat -j- 50 c. c. 20 per cent, alcohol. Analysis of contents. Total acidity. 3.00 3.30 4.00 4.30 5.00 5.30 5.30 Stomach nearly empty ; end of gastric digestion. Time of digestion = 3 hours. VIII. 12.45 P. M. 50 grams meat -(- 50 c. c. 20 per cent, alcohol. Analysis of contents. Total acidity. Loosely combiued HCl. Free HCl. 0.313 0.118 0.090 0.374 0.187 0.176 0.439 0.194 0.151 0.515 0.205 0.184 0.407 0.144 0.248 0.264 - 0.155 Total acidity. Loosely combined HCl. Free HCl. 2.30 0.439 0.213 0.158 2.50 0.457 0.191 0.205 3.10 0.403 0.205 0.227 3.30 0.3G4 0.129 0.187 3.50 Stomach practically empty; end of gastric digestion. Time of digestion = 3 hours and 5 minutes. IX. 9.15 A. M. 50 grams meat -\- 50 c. c. 30 per cent, alcohol. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 9.40 0.191 0.130 0.058 10.05 0.335 0.155 0.151 10.30 0.421 0.176 0.180 10.50 0.468 0.184 0.201 11.10 0.4G0 0.165 0.220 11.30 0.410 0.148 0.220 11.50 0.468 0.195 0.244 12.10, 0.417 0.112 0.240 12.30 0.360 0.086 0.216 1.00 Stomach empty; end of gastric digestion. J THE LIQUOR PROBLEM. X. 9.00 A. M. 50 grams meat -j- 150 c. c. hochlieuner. Analyeis of contents. Total acidity. Loosely combiiied HCl. Pree HCl. 9.30 0.374 0.140 0.176 10.00 0.432 0.154 0.191 10.15 0.450 0.151 0.198 10.45 0.497 0.187 0.220 11.15 0.533 0.198 0.271 11.30 0.555 0.241 0.227 12.00 0.508 0.248 0.173 12.15 Stomach empty; end of gastric digestion. Time of digestion = 3 hours and 15 minutes. XI. 9.00 a.m. 60 grams meat -|- 50 c. c. whiskey 4-50 c. c. water. Analysis of contents. Total acidity. TjOoeely combined HCl. Free HCl. 9.30 0.252 0.101 0.119 10.00 0.392 0.176 0.176 10.30 0.403 0.151 0.191 11.00 Stomach empty; end of gastric digestion. Time of digestion ^= 2 hours. XII. 2.45 p. M. 50 grams meat + 50 c. 0. whiskey -f! Analysis of coutenta. >0 c. c. wa Total acidity. Loosely combined HCl. Free HCl. 3.15 0.230 0.076 0.119 3.45 0.320 0.097 0.220 4.15 0.468 0.198 0.212 4.30 0.508 0.198 0.198 4.45 0.490 0.184 0.212 5.15 0.569 0.205 0.252 5.45 Stomach empty; end of gastric digestion. Time of digestion = 3 hours. XIII. 1.00 p. M. 50 grams meat -j- 50 c. c. gin -|- 25 c. c. water. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 2.00 0.439 0.173 0.194 2.30 0.450 0.170 0.197 2.45 0.428 0.158 0.238 3.00 0.442 0.154 0.212 3.15 0.410 0.140 0.215 3.30 0.420 0.143 ,0.234 3.45 0.338 0.122 0.180 4.00 Stomach empty; end of gastric digestion. Time of digestion = 3 hours. DIGESTION AND SECRETION. 2i XIV. 9.00 a.m. 50 grams meat + 50 c. c. brandy + 25 c.c. water Analysis of contents. 9.50 Total acidity. 0.237 Loosely combined HCl. 0.159 Free HCl. 0.065 10.20 10.50 11.20 0.368 0.465 0.533 0.201 0.230 0.267 0.133 0.205 0.194 11.40 0.468 - 0.158 12.00 Stomach empty; end of gastric tligestion. Time of dicrestion = 2 hours and 40 minutes. XV. 2.50 p . M. 50 grams meat + 150 c. c. lager beer. Analysis of contents. Total acidity. Loosely combined HCl. Free HCL 3.20 0.259 0.112 0.115 3.50 0.410 0.205 0.148 4.20 0.518 0.245 0.184 4.35 0.572 0.248 0.230 4.50 0.569 0.252 0.208 6.05 0.547 0.220 0.238 5.20 0.508 0.162 0.211 5.35 0.475 0.162 0.238 5.50 0.413 0.115 0.241 6.05 Stomach 1 empty ; end of gastric digestion. XVI. 9.40 A. M. 50 grams meat -|- 150 c. c. stout. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 10.10 0.304 0.140 0.187 10.40 0.446 0.166 0.180 11.10 0.555 0.220 0.295 11.40 0.616 0.212 0.302 12.10 0.580 0.266 0.247 12.40 Stomach empty; end of gastric digestion. Time of digestion = 3 hours. XVII o. 9.15 A.M. 50 grams meat + 150 c. c. beer. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 9.45 0.248 0.151 0.082 10.15 0.367 0.201 0.123 10.45 0.457 0.238 0.137 11.20 0.526 0.266 0.209 11.40 0.511 0.213 0.223 12.15 0.465 0.216 0.176 12.30 Stomach empty, end of gastric digestion. Time of digestion ^ 3 hours and 15 minutes. 290 THE LIQUOR PROBLEM. XVlI/3. 3.00 r. M. 50 grams meat -j- 150 c. c. water. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 3.30 0.227 0.130 0.090 4.00 0.400 0.209 0.129 4.30 0.522 0.274 0.158 5.00 0.583 0.310 0.195 5.15 0.583 0.302 0.205 5.30 0.446 0.209 0.184 6.45 0.569 0.^98 0.127 6.00 Stomach empty ; end of gastric digestion. Time of digestion := 3 hours. XVIIIo. 8.30 a.m. 50 grams meat-)- 50 c. o. water. Analyeis of contents. Total acidity. Loosely combined HCl. Free HCl. 9.00 0.371 0.227 0.126 9.30 0.443 0.274 0.144 10.00 0.518 0.252 0.234 10.30 0.569 0.263 0.252 11.00 Stomach empty ; end of gastric digestion. Time of digestion ^2 hours and 30 minutes. XVIIIiB. 2.10 P. M. 50 grams meat -f 100 o. o. 30 per cent, alcohol Analysis of contents. 2.40 Total acidity. 0.234 Loosely combined HCl. 0.112 Free HCl. 0.101 3.10 3.40 0.352 0.490 0.165 0.209 0.137 0.162 4.10 4.40 0.550 0.550 0.263 0.245 0.191 0.201 5.10 Stomach empty ; end of gastric digestion. Time of digestion ^ 3 hours. XlXa. 9.00 A. M. 50 grams meat -\- 100 c. c. water. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 9.30 0.324 0.165 0.137 10.00 0.378 0.198 0.144 10.30 0.494 0.259 0.169 11.00 0.487 0.220 0.188 11.15 0.457 0.205 0.131 11.30 Stomach empty ; end of gastric digestion. Time of digestion ^ 2 hours and 30 minutes. DIGESTION AND SECRETION. 291 XIX/3. 2.30 p. M. 50 grams meat -|- 150 c. c. lager beer. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 3.00 0.260 0.119 0.137 3.30 0.378 0.201 0.137 4.00 0.465 0.191 0.188 4.30 0.533 0.223 0.248 4.45 0.562 0.233 0.306 5.10 0.465 0.223 0.176 5.30 Stomach empty ; end of gastric d igestion. Time of digestion := 3 hours. XXo. 9.15 A. M. 60 grams meat -|- 75 c. c. sherry -(- 25 c. c. water. Analysis of contents. 9.45 10.15 Total acidity. 0.295 0.331 Loosely combined HCl. 0.108 0.101 Free HCl. 0.155 0.173 10.45 0.367 0.133 0.187 11.15 0.418 0.158 0.212 11.30 11.45 0.436 0.490 0.169 0.191 0.216 0.248 12.00 Stomach empty ; end of gastric digestion. Time of digestion := 2 hours and 45 minutes. XX3. 2.30 p. M. 50 grams meat -\- 150 c. c. carbonated water. Analysis of contents. 3.00 3.30 Total acidity. 0.238 0.360 Loosely combined HCl. 0.043 0.130 Free HCl. 0.126 0.176 4.00 4.30 0.432 0.533 0.187 0.169 0.169 4.45 Stomach empty ; end of gastric digestion. Time of digestion = 2 hours aud 15 minutes. Dog B.— Weight 21 kilos. I. 1.45 p.m. 50 grams meat (no water). Analysis of contenta. Total acidity. Loosely combined HCl. Free HCl. 2.15 0.353 0.191 0.118 2.40 0.443 0.222 0.180 3.00 0.511 0.227 0.198 3.20 0.525 0.227 0.280 3.45 0.572 0.260 0.209 4.15 0.568 0.349 0.195 4.45 Stomach empty ; end of gastric digestion. Time of digestion = 3 hours. 292 THE LIQUOR PROBLEM II. 9.15 A. M. 50 grams meat -\- 50 c. c. ■water. Analysis of contents. 9.50 10.15 10.45 11.15 11.35 11.55 12.15 12.30 12.45 Total acidity. Loosely combined HCl. Free HCl. 0.302 0.220 0.082 0.432 0.223 0.144 0.472 0.201 0.252 0.472 0.144 0.288 0.484 0.155 0.270 0.453 0.144 0.306 0.407 0.100 0.241 0.400 0.133 0.234 0.306 - 0.216 End of gastric digestion. Time of digestion = 3 hours and 30 minutes. III. 9.15 A. M. 50 grams meat -|- 50 c. c. 20 p. c. alcohol -|- water. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 9.50 0.136 0.086 0.036 10.15 0.285 0.108 0.144 10.45 0.479 . 0.173 0.244 11.15 0.472 0.177 0.252 11.35 0.518 0.237 0.252 11.55 0.486 - 0.209 12.15 0.421 - 0.213 12.30 Stomach empty ; end of gastric digestion. Time of digestion = 3 hoiua and 15 minutes. IV. 8.50 A. M. 50 grams meat -|- 100 c. c. 30 per cent, alcohol. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 9.20 0.324 - 0.144 9.50 0.493 - 0.072 10.20 0.641 - 0.100 10.50 0.547 0.338 0.166 11.20 0.588 - 0.206 11.50 0.544 - 0.230 12.20 .... - present. 12.30 End of gastric digestion. Time of digestion = 3 hours and 40 minutes. DIGESTION AND SECRETION. 293 V. 2.45 p. M. 50 grams meat -\- 75 c. c. claret. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 3.15 0.396 0.155 0.216 3.45 0.450 0.238 0.158 4.15 0.576 - 0.209 4.45 End of gastric digestion. Time of digestion = 2 hours. Via. 9.15 A. M. 50 grams meat -(- 150 o. c. beer. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 9.45 0.273 0.144 0.104 10.15 0.367 0.187 0.155 10.45 0.464 0.223 0.194 11.15 0.616 0.345 0.256 11.45 0.501 0.238 0.170 12.15 0.508 - 0.151 12.30 0.533 - 0.187 12.45 0.468 - 0.158 1.00 End of gastric digestion. Time ol ' digestion ^ 3 hours and 45 minutes. VI^. 1.00 p. M. 50 grams meat + 150 c. c. water. Analysis of contents. Total acidity. Loosely combined HCl. Free HCl. 2.00 0.620 0.282 0.201 2.30 0.590 0.266 0.234 3.00 0.666 0.392 0.224 3.30 0.627 - 0.206 4.00 - - trace. 4.15 End of gastric digestion. Time of digestion = 3 hours and 15 minutes. In the accompanying table the " time of digestion " of the experiments preceding is given in hours. The experiments marked a and /8 are strictly comparable, as reference to the protocols will show that they were carried out in succession on the same day. 294 THE LIQUOR PROBLEM. Table of Time of Digestion (in Houks). Doo A. Doo B. ii- ^> a « Ji ID ® ■3* m »'° i "S-^ ^ No. 1 1 < « No. is < 111 h. m. I . m. h. m. h. m. 1 7m h. n. h. m. XVII a j 3 15 XVII ;8 \ I 2 55 I ; II i 3( ) .'. II 2 20 III 5 !!!! VII i IV 3 ^ w VI ! 30 V 2 VIII ! 05 VIa( 3 45 IX 5 45 vip\ . j'i. XVIII a S 2'36 XVIII )3 1 i'" XIV 2'46 XV 3' 15 XlXa ( 2'36 XLXjS ] 3 " XVI 3 IV 2' 30 X 3 15 in xin 3'" XX o i 2 45 XX /3 ) 2 'is V 2 40 XI 2 xn 3 Average 2 40 i 20 3 10 2 40 n 5 ~3~ 50 2 52 From these results it is apparent that the time of digestion in the stomach for the proteid test meal employed is not greatly varied under the influence of alcohol. The results obtained suggest, ijossibly, a tendency toward prolongation of the period during which the meat remains in the stomach when alcoholic fluids are present. This tendency is most noticeable in the case of Dog A, and particularly in those experiments which immediately succeed each other on the same day and are there- fore strictly comparable. These differences are too small, how- ever, to have any great significance, especially as in Dog B weak alcohol appears to have increased the rate of digestion, and in Dog A strong alcohol did not cause any lengthening of the average time of digestion. Retardation is perhaps more marked with the malted beverages and is apparently out of proportion to the alcohol present. With reference to the DIGESTION AND SECRETION. 295 changes in the acidity of the stomach contents, a large number of observations disclose no specific differences in the various digestions. The variations are common to all the experiments. They include a gradual rise in total acidity during approxi- mately the fii'st two hours of digestion, followed by a gradual decrease until the stomach becomes empty ; at this point free HCl is absent. The combined HCl increases with the progress of digestion, the products of proteolysis combining with rela- tively larger quantities of free acid.^ Since the secretion of acid is continually progressing in the stomach, the percentage of free HCl increases gradually in the course of the digestion, likewise decreasing rapidly toward the end of this process. In agreement with our previous statements relative to the rather sudden discbarge of the gastric contents into the intestine (p. 285), an abrupt decline in acidity toward the end of the diges- tion period was frequently observed. Evidence of an " after period " of secretion was not obtained.^ D. DISAPPEAHiNCE OF ALCOHOL FROM THE STOMACH. It has long been known that alcohol disappears rapidly from the alimentary canal, and even so early as 1847 Bouchardat and Sandras stated that the absorption takes place from the stomach especially.^ More recent and conclusive experiments, in which the pylorus has been artificially closed, have demon- strated with certainty that alcohol, in distinction from water, is readily absorbed from the stomach.* Furthermore, many sub- stances, like sugar, peptone, etc., are readily absorbed from the stomach in the presence of alcohol, while their absorption from the intestine is likewise accelerated by this substance.^ Thus, an ordinary dose of chloral hydrate introduced in watery solu- tion into a stomach with ligated pylorus fails to bring about ' Cf. Chittenden, Digestive Proteolysis, 1894, pp. 53 seq. ^ Cf. Gluzinski, Jahreshericht f. Thierchemie, 1886, xvi. p. 264. ' Bouchardat and Sandras, Annales de chimie et de physique, 1847, xxi. 3 s^rie, p. 466. * Cf. for example, Tappeiner, Zeitschr. f. Biologie, 1881, xvi. p. 497 ; Brandl, Ihid., 1892, xxix. p. 277 ; v. Mering, Jahreshericht f. Thierchemie, 1893, xxiii. p. 293. ^ Cf., for example, J. v. Scanzoni, Zextschr. f. Biologie, 1896, xxxiii. p. 462. 296 THE LIQUOR PROBLEM. narcosis ; ^ if, however, a quantity of alcohol too small of itself to produce any pharmacological action be jireseut, narcosis fol- lows, just as when the open pylorus permits the intestine to participate in the absorption. The complete disappearance of alcohol from the stomach has been observed by us in a large number of experiments in which the pylorus was ligated. The following results, tabulated from the experiments on secretion (pp. 2G9-276), demonstrate this statement : — Table showing Absorption of Axcohol fbom Stomach. No. Weight o£ dog. Kilos. Duration of experiment. Volume of fluid introduced. Content of alcohol. Per cent, by vol. Alcohol found at end of experiment. Grams. VII 2,3.0 h. m. 3 30 200 (alcohol) 37.5 4 vni 21.0 3 00 200 ( " ) 37.5 4-5 IX 8.0 3 50 100 ( " ) 5.0 X 7.3 3 45 110 ( " ) 4.8 XIII 10.7 3 55 75 (sherry) 21.0 XIV 18.5 3 45 1.50 (whiskey) 16.0 XV 8.0 3 45 125 (wine) 13.3 XVI 25.0 3 00 1,35 ( " ) 13.3 XVII 12.3 4 00 125 (claret) 5.15 XVIII 10.2 3 55 100 (beer) 4.5 XX 14.0 3 45 1,50 (porter) 3.75 XXI 8.5 3 55 125 (beer) 4.7 The rapid discharge of watery or alcoholic fluids from the stomach through the pylorus has already been referred to on p. 284. The results are in harmony with those obtained by V. Mering on dogs with duodenal fistulse.^ In his experiments, for example, 500 c. c. being administered to a large dog, 490 0. 0. were expelled through the pylorus in twenty minutes. The rapidity of expulsion was found to depend on the state of repletion of the small intestine, — an observation in accord with the retarded evacuation of the stomach seen when food is given along with fluids, v. Mering further observed that when water holding CO2 in solution enters the stomach the gas is readily absorbed ; ^ alcohol is likewise absorbed, as J. Miller ' Cf . also experiments with strychnine. Meltzer, Journ. of Exper. Medi- cine, 1896, i. p. 529. 2 V. Mering ; quoted in Gamgee, Physiological ChemUtry, 1893, ii. pp. 441 seq. 8 Cf. also Experiment V., p. 286. DIGESTION AND SECRETION. 297 has recently verified for the human stomach. ^ Ogata ^ found that of 6.5 to 8.8 grams of alcohol introduced into the stomach in wine or beer, 80 to 90 per cent, disappeared within half an hour. In the presence of soluble products in the stomach an excretion of water by that organ is said to result in j)roportion to the amount of substance absorbed, — an idea akin to the one suggested in explanation of the relatively larger quantities of fluid found in the unligated stomach soon after introduction of alcohol, as compared with water. The experiments which we have made verify the statements of the investigators mentioned, as the following data, selected from protocols, indicate : — Data showing disappearance of alcohol from unligated stomach. I. Dog, with gastric fistula. a. 3.45 p. M. Litroduced 50 c. c. 20 per cent, alcohol into stomach. 4.15 " Removed gastric contents = 40 c. c. No alcohol found. b. 3.15 " Introduced 40 c. c. 25 per cent, alcohol. 3.45 " Removed gastric contents = 20 c. c. No alcohol found. c. 2.40 " Introduced 125 c. c. 20 per cent, alcohol. 3.10 " Removed a portion of gastric contents. Free HCl = 0.072 per cent. Small amount of alcohol present. II. Dog of 18 kilos, employed in a salivary experiment. In the course of the latter the animal received at intervals 45 c. c. absolute alcohol diluted with water. Two hours after last portion was given the stom- ach contents (200 c. c.) were removed. They contained 1.1 grams alcohol. III. Dog of 18 kilos. Salivary experiment. At intervals were given 70 c. c. absolute alcohol diluted with water. One and one third hours after last portion (40 c. c.) was given the stomach contents (350 c. c.) contained 9.4 grams alcohol. IV. Dog of 14 kilos. Salivary experiment. 140 c. c. absolute alcohol diluted with water were given in three portions. Three fourths of an hour after the last portion (50 c. c.) the stomach contents (450 e. c.) contained 24.6 grams alcohol. V. Dog of 10 kilos. Salivary experiment. 120 e. c. whiskey, containing 50 per cent, of alcohol, were given in two portions. Four and one half hours after the last portion (60 c. c.) the stomach contents (170 c. c.) contained 2.7 grams alcohol. VI. Dog. Salivary experiment. 135 c. c. brandy, containing about 50 per cent, of alcohol, were given in two portions. Two hours after last portion (75 c. c.) the stomach contents (240 c. c.) contained 8.8 grams alcohol. ' Miller, J., Arch. f. Verdauungskranhh., i. p. 233. Jahresbericht f. Thierchemie, 1895, xxv. p. 293. * Ogilta, Jahresbericht /. Thierchemie, 1885, sv. p. 274. 298 THE LIQUOR PROBLEM. VII. Dog of 10 kilos. Salivary experiment. 350 c. o. wine, containing 5.15 per cent, of alcohol, were given in two portions. One and one half hours after last portiouf (200 c. c.) the stomach contents (190 c. c.) contained 5.5 grams alcohol. It is of interest to note that the large volumes of fluid (170 to 450 c. c.) found in the stomach in Experiments II. to VII. correspond with the data already presented with reference to the increased secretion of gastric juice due to alcohol and alcoholic beverages. E. SUMMAKT. Some of the more important conclusions to be drawn from tbese series of experiments may be advantageously summarized here. Upon the secretion of saliva the presence of strong alcohol or an alcoholic beverage in the mouth has a direct stimulating effect leading to a sudden increase in the flow of saliva. This acceleration of secretion, however, is of brief duration. The stimulating effect is manifested not only by an increase in the volume of the secretion, but also by an increase in both organic and inorganic constituents. The effect produced is in no sense peculiar to alcohol, but is common to many so-called stimulants, such as dilute acid (vinegar), ether vapor, etc. Indeed, the effect is precisely analogous to that induced by an increase in intensity of stimulation when the salivary glands are electri- cally excited through their nerves. As to the possibility of alcoholic fluids absorbed from the stomach giving rise to an indirect stimulation of salivary secre- tion or exercising any appreciable influence upon the composi- tion of the secretion, our results give a negative answer. Thus, alcoholic fluids introduced directly into the stomach (of dogs) by injection through the stomach wall, thus doing away with any local action in the mouth, produce no appreciable effect upon the rate of secretion, as induced by a constant external stimulus, of either submaxillary or sublingual saliva. Even doses of alcohol sufficient to produce prolonged narcosis when introduced in this way fail to check the flow of saliva. There is likewise no specific influence exerted on the composition of the secretion. Hence, so far as our results go, alcohol and al- coholic fluids are without any specific effect upon the secretion of saliva, except to produce a transitory stimulation of secre- tion while in the mouth cavity. DIGESTION AND SECRETION. 299 Upon gastric secretion alcohol and alcoholic fluids have a marked effect, increasing very greatly both the flow of gastric juice and also its content of acid and total solids. Further, this action is exerted not only by the presence of alcoholic fluids in the stomach, but also indirectly through the influence of alcohol absorbed from the intestine. Thus, ordinary ethyl alcohol introduced into the empty stomachs of dogs, with the duodenum ligated, shows a marked stimulating action upon gastric secretion — as compared with the action of water under like conditions — increasing not only the volume of gastric juice very greatly, but also its acidity, content of solid matter, etc. Moreover, alcohol absorbed from the intestine, the latter being entirely shut off from the stomach, may likewise cause stimulation of the gastric glands, with a marked increase in the rate of secretion, etc. Whiskey, brandy, sherry, claret, beer, and porter all agree in producing stimulation of gastric secre- tion. Further, as already stated, the gastric juice secreted under alcoholic stimulation is more acid, contains more solid matter and more combined hydrochloric acid than the ordinary secretion. It is likewise strongly proteolytic. If these results are considered in connection with our previ- ous observations upon the influence of alcohol and alcoholic drinks upon the purely chemical processes of gastric digestion, it is seen that side by side with the greater or lesser retarda- tion of digestive proteolysis caused by alcoholic beverages there occurs an increased flow of gastric juice rich in acid and of un- questionable digestive power. The two effects may thus nor- mally counterbalance each other, though it is evident that modifying conditions may readily retard or stimulate the pro- cesses in the stomach according to circumstances. Foremost among the latter is the rapid disappearance of alcohol from the alimentary canal. Since any influence exerted by alcohol or alcoholic beverages upon the solvent or digestive power of the gastric juice in the stomach must depend upon the presence of alcohol in the stom- ach contents, it follows that the tendency toward rapid removal of the alcohol from the alimentary tract by absorption must necessarily diminish correspondingly the extent of any retarda- tion of gastric digestion which the presence of alcohol in the stomach may occasion. Since, however, the stimulation of gas- / 300 THE LIQUOR PROBLEM. trie secretion induced by alcohol is brought about not only by the direct action of alcohol in the stomach, but also by the in- direct action of alcohol absorbed fi-om the intestine, it foUows that possible inhibition of the digestive action of the gastric juice would probably be of shorter duration than the stimula- tion of secretion, and that consequently in the body alcoholic fluids would hardly lead to any retardation of gastric digestion. This point has been very carefully and thoroughly tested by numerous experiments on healthy dogs with gastric fistulse, using proteid test meals, with the result that certainly in the stomach of dogs digestion is not retarded in any pronounced degree under the influence of alcohol or alcoholic fluids. Of hastened digestion the results obtained give little or no positive suggestion, and we must therefore conclude that the two diverse factors above referred to more or less counterbalance each other, so that gastric digestion in the broadest sense of the term is not markedly varied under the influence of alcohol or alcoholic fluids. This conclusion, it may be mentioned, stands in perfect harmony with the results of the investigations of Zuntz and Magnus-Levy regarding the influence of alcohol (beer) on the digestibility and utilization of food in the body. These inves- tigators found by a series of metabolic experiments on men with diets largely made up of milk and bread, and on individ- uals accustomed and unaccustomed to the use of alcoholic bev- erages, that the latter did not in any way diminish the utiliza^ tion of the food by the body.^ Especially worthy of note is the rapid disappearance of alco- hol from the stomach and alimentary tract when alcoholic fluids are taken. As our results show, the introduction of even 200 c. c. of thirty-seven per cent, alcohol into the stomach of a dog, with the duodenum ligated at the pylorus, may be followed by the nearly complete disappeai-ance of the alcohol in three to three and one half hours by absorption through the stomach walls into the blood. With the outlet from the stomach into the intestine open the rate of absorption of alcohol is greatly increased. We may well believe, as stated by Ogata, that 1 Zuntz and Magnus-Levy, Archil) f. d. ges. Physiol., 1891, xlix. p. 438 ; Magnus-Levy, Ibid., 1893, liii. p. 544. DIGESTION AND SECRETION. 301 when six to eight grams of alcohol are taken into the stomach in the form of wine or beer eighty to ninety per cent, of the alcohol will disappear from the alimentary tract inside of half an hour. Indeed, our own experiments on dogs with gastric fistulse lead to this conclusion. Thus, in one experiment 50 c. c. of twenty per cent, alcohol were introduced into the stomach, and on withdrawing the stomach contents half an hour later no alcohol whatever was found in the 40 c. c. of fluid obtained. In view of this rapid disappearance of alcohol from the alimentary tract it is plain that alcoholic fluids cannot have much, if any, direct influence upon the secretion of either pancreatic or intestinal juice. 3. The Influence of Alcoholic Flitids on the Composition AND Amlolttic Power of Human Saliva.^ In this series of experiments the attempt was made to ascer- tain how far alcoholic fluids, acting as stimuli to secretion, will modify the properties of mixed saliva. The special agents em- ployed were ether, alcohol, whiskey, and gin. The first two were taken into the mouth in the form of vapor, and the saliva allowed to trickle from the mouth without motion of the jaws, the fluid so obtained being compared with saliva resulting from the mechanical stimulation produced by chewing a piece of rub- ber. With whiskey and gin, the mouth was well rinsed with the fluid and the saliva collected by allowing it to flow from the comer of the mouth. The control experiments with water were made in the same way ; i. e., the mouth was rinsed with water and the saliva allowed to trickle forth. Finally, for the sake of comparison and to ascertain how far two samples of saliva obtained at such close intervals, under similar forms of stimulation, differ from each other, four control experiments were tried with water and rubber alone. Following are the results obtained : — 1 The experiments here reported were originally published by R. H. Chittenden and Alfred N. Richards in the American Journal of Physiology, i. 461, 1898. 302 THE LIQUOR PROBLEM. Date. Time. Stimulus. Volume saliva Alkalinity calculated as Na,C03. Per cent. Amyloly- tic power. Milli^ams maltose. Total solids. Per cent. Organic matter. Per cent. Inor- ganic salts. Per cent. Dec. 3 A.M. 11.05-11.30 11.30-11.50 Rubber Ether 40 30 0.168 0.204 582.6 624.6 0.03 0.76 0.31 0.54 0.32 0.22 " 9 9..50-10.10 10.10-10.30 Rubber Ether 30 25 - 562.8 498.6 0.54 0.54 0.30 0.29 0.24 0.31 " 13 F. M. 11.40-12.00 12.00-12.35 Rubber Alcohol 40 28 0.122 0.132 472.2 510.6 0.41 0.43 0.21 0.19 0.20 0.24 " 14 10.00-10.30 10.30-11.00 Water Whiskey 30 35 0.061 0.102 473.4 485.4 0.32 0.42 0.19 0.29 0.13 0.13 " 16 10.15-10.40 10.45-11.20 Water Gin 23 24 0.071 0.102 483.6 642.0 0.34 0.53 0.20 0.30 0.14 0.17 « 17 10.20-10.38 10.45-10.55 Ether Rubber 27 28 0.122 0.183 586.2 577.2 0.32 0.52 0.16 0.24 0.16 0.28 " 20 p. M. 11.15-11.48 12.15-12.45 Water Water 24 24 0.071 0.102 606.6 564.0 0.68 0.38 0.55 0.27 0.13 0.11 Jan. 11 3.03- 3.35 4.05- 4.40 Water Water 26 30 0.053 0.081 436.8 532.2 0.30 0.35 0.16 0.21 0.14 0.14 " 13 p. M. A. M. 1 1.215-11.40 12.10-12.26 Rubber Rubber 30 30 0.1.53 0.261 571.8 550.8 0.49 0.47 0.26 0.24 0.23 0.23 " 14 l6.38-10..58 11.30-11.45 Rubber Rubber 34 32 0.1.32 0.142 577.8 594.6 0.50 0.51 0.27 0.26 0.23 0.25 A glance through these results shows at once certain marked differences in the character of the saliva obtained under the different conditions specified. Thus, saliva which flows from the mouth after the latter has been rinsed once with water in- variably shows a lower degree of alkalinity and generally con- tains a smaller percentage of solid matter than the secretion obtained by the other methods. In amylolytic power, however, there is great variation, some samples showing a relatively strong amylolytic action, while others with essentially the same degree of alkalinity are much weaker in their starch-digesting power. Simple mastication of rubber has a marked influence in raising the content of alkaline salts in the saliva, as well as the total inorganic constituents, and there is a tendency toward increase in amylolytic power, although the latter is not con- stant. DIGESTION AND SECRETION. 303 As to the influence of alcohol, ether, gin, and whiskey, there is, we think, no question that these agents taken into the mouth change the character of the secretion, increasing its alkalinity, amylolytic power, and content of solid matter. This is cer- tainly true if the secretion so obtained is compared with the saliva flowing from the mouth without stimulation of any kind. Saliva, however, secreted under the stimulation produced by chewing rubber, is, as we have seen, comparatively concentrated, and the difference between the secretion resulting from that method and the fluid coming from ether, alcohol, and other like forms of excitation, without mechanical stimulation, is not so decisive in the above experiments as to make the matter quite clear, especially in view of the fact that two portions of saliva obtained one after the other, by the same method of stimula- tion, are liable to show marked differences in composition and reaction. Particularly noteworthy is the fact that of two por- tions of saliva collected one after the other by mechanical stimulation (chewing rubber) or by simply allowing the saliva to flow from the mouth after once rinsing the latter vfith water, the latter portion of saliva is, as a rule, more concentrated and possessed of higher amylolytic power than the portion first secreted. It is thus obvious that great care must be exercised in drawing deductions from the composition and amylolytic action of mixed saliva when the latter is so prone to vary under what seem to be essentially the same forms of stimulation. It is furthermore equally obvious that the possible causes to which the above variations may be attributed are many, since there are involved three distinct sets of glands in addition to the buccal glands of the mouth cavity. Hence, increase or de- crease in amylolj'tie power, as well as in the general concen- tration of the secretion, may involve simply an alteration in the relative activity of the individual glands and not be con- nected primarily with any specific stimulation of metabolic or secretory activity. However this may be, it is quite clear that the natural varia- tions in the character of the mixed saliva, indicated by the results of the last four experiments of the above series, render it necessary to use great caution in arranging the conditions under which the experiments are tried. We have therefore repeated the above experiments, choosing for the collection of 304 THE LIQUOR PROBLEM. the saliva a time of day when we have found the mixed saliva most'coustant in composition ; viz., between 9.30 and 10.30 A. m. To be sure, there are variations in the composition and starch- digesting power of successive portions of saliva collected by the same method at this period, but they are relatively small ; quite small, indeed, as compared with the variations liable to occur at other periods of the day. The truth of this statement is illustrated by the two following experiments, in which the saliva was collected without stimulation, simply allowing it to flow from the mouth. Date. Time. Volume saliva. Alkalinity Na.,003. Per cent. Araylolytic power. Milligrams maltose. Total eoUdB. Per cent. Organic constit- uents. Per cent. Feb. 3 " 3 A.M. 9.32-10.06 10.15-10.42 21.0 22.0 0.0816 0.0918 569.4 549.0 0.50 0.46 0.31 0.29 " 3 " 3 5.00- 5.20 5.27- 5.50 19.5 n.o 0.0918 0.1122 573.6 613.8 0.49 0.68 0.31 0.51 0.19 0.17 0.18 0.17 Thus, the two portions collected between 9.32 and 10.42 a.m. are essentially alike, while the two fractions secreted between 5.00 and 5.50 p. m., all without stimulation, are more dissimilar. Adopting the morning hour as the better time for collection, experiments were tried with alcohol, ether, chloroform, whiskey, and gin, comparing in each case the saliva obtained under their influence with the secretion coming without stimulation of any kind. The exact method pursued in the case of the con- trol, i. e., with water, was to rinse the mouth once with distilled water, after which the saliva was simply allowed to drop from the mouth into a beaker. With ether and chloroform the mouth was filled once with the vapor and the saliva then al- lowed to flow spontaneously into a receptacle without any motion of the jaws. With the alcohol, gin, and whiskey, 10 c. c. of the fluid were taken into the mouth, held a moment, and then ejected, after which the saliva was collected as in the other cases. Lastly, an experiment was tried (February 15) by chewing DIGESTION AND SECRETION. 305 rubber as a stimulant and comparing the saliva so obtained with a control secreted without stimulation. Following are the results obtained : — Date. Time. Stimulua. Vol. sali- Alkalinity NaoCOj. Per cent. Amylo- Ij-tic power. MiUigrams maltose. Total solids. Per cent. Organic constitu- ents. Per cent. Inor- ganic salts. Per cent. Feb. 7 A.M. 10.05-10.32 10.37-10.56 Water 40% Alcohol 18.0 18.0 0.0714 0.1122 480.6 514.2 0.42 0.43 0.22 0.26 0.20 0.17 " 8 9.37-10.05 10.11-10.32 Water Ether 18.0 18.0 0.0612 0.1122 566.4 .558.6 0.42 0.54 0.25 0.29 0.17 0.25 " 10 9.53-10.18 10.27-10.47 Water Chloroform 17.5 17.0 0.0816 0.0714 604.2 644.4 0.51 0.69 0.33 0.48 0.18 0.21 " 11 9.40-10.07 10.14-10.36 Water Whiskey 17.0 17.0 0.0714 0.1020 493.3 547.8 0.39 0.50 0.25 0.31 0.14 0.19 " 15 9.52-10.16 10.21-10.27 Water Rubber 16.5 17.0 0.0816 0.1530 541.2 577.2 0.38 0.58 0.21 0.26 0.17 0.32 " 18 9.33-10.03 10.10-10.34 Water Gin 17.0 19.0 0.0714 0.1020 584.4 610.2 0.49 0.57 0.38 0.39 0.16 0.18 " 23 9.26- 9.51 10.01-10.24 Water Water 17.0 17.5 0.0714 0.0714 429.6 423.0 0.30 0.31 0.18 0.18 0.12 0.13 From these results it would seem quite clear that the several agents employed, with the exception of chloroform, give rise to a marked increase in the content of alkaline-reacting salts in mixed saliva. Mechanical stimulation, as by chewing rubber, however, is even more effective than the chemical stimuli em- ployed, although it must not be overlooked that in the above experiments the action of alcohol, ether, whiskey, etc., is neces- sarily of short duration. Further, there is evidence in most of the results of an increase in amylolytic power, as well as in the content of solid matter under the influence of the stimuli. It is thus safe to assert that alcohol and alcoholic fluids not only stimulate the flow of saliva, but that they also tend to increase the concentration and amylolytic power of human mixed saliva, — results which are in close accord with the action of these fluids upon the secretion of the sub-maxillary saliva of the dog. DATA RELATING TO THE USE OF ALCOHOLIC DRINKS AMONG BRAIN WORKERS IN THE UNITED STATES. J. S. BILLINGS, M. D. DATA RELATING TO THE USE OF ALCOHOLIC DRINKS AMONG BRAIN WORKERS IN THE UNITED STATES. Early in 1895 a circular letter of inquiry was sent to about 1500 men in the United States engaged in mental work of a high class. The list included the leading members of the legal, medical, and clerical professions, distinguished scientific men and educators, prominent business men, and managers of great corporations. To this circular 892 replies were i-eceived, and the data from these rei^lies have been compiled in the following tables. An attempt was made to obtain returns fi-om physicians with regard to the habit of use of alcoholic drinks and its effects upon the health of families under their 'charge, but the results were of little value. The records of 230 persons were received, of whom 31 per cent, were affected with chronic disease. The proportion thus affected was for the total abstainers 11.6 per cent, and for the moderate drinkers 31.5 per cent. Nearly all of the returns came from a few physicians who are prominent advocates of total abstinence. There is no great difficulty in obtaining opinions of physi- cians as to the effect of the use of alcoholic liquors ; but when it comes to filling out forms for each one of their patients, there are very few who are willing to take the trouble to do this. Dr. Robert T. Edes, of Jamaica Plain, Mass., kindly placed at the disposal of the Committee a number of reports received from the Massachusetts State Board of Health, Lunacy, and Charity, in connection with an inquiry sent out to physicians of that State in 1879 with regard to hereditary effects of the use of alcohol. These reports have never been collated. Dr. Edes stated that the facts were too few and too vague to be of value, and nothing was done with them. The following tables indicate the minimum proportion of users of alcoholic drinks among successful brain workers in this 310 THE LIQUOR PROBLEM. country. The total abstainers and moderate drinkers probably reported in greater proportion than the regular drinkers. It will be seen that the percentage of total abstainers was lowest among the physicians (1.4 per cent.), and highest among the clergymen (54 per cent.), and that the percentage of regu- lar drinkers was greatest among the business men (26.5 per cent.). Of the total abstainers 10.3 per cent, reported themselves as affected with indigestion, acute rheumatism, or nervous disease of some kind. Of the occasional drinkers 6.8 per cent, report themselves as thus affected, and of the regular moderate drink- ers 9.2 per cent, report as being thus affected. The regular moderate drinkers used mainly claret and light wines ; the occasional drinkers used chiefly whiskey and beer. As regards the percentage of those reporting themselves as being in bad health, it should be remembered : — 1. That the opinions of persons as to their own health have little scientific value. 2. That those who know that they are affected with serious chronic disease were less likely to furnish reports than those who believed themselves to be sound. 3. That the questions were sent chiefly to men known to be actively engaged in their professions or business and not broken down by ill health. 4. That the physical and mental qualities which tend to make a man specially successful in professional or business life include a more than ordinary power of resistance to various agents which may injure health. ALCOHOLIC DRINKS AND BRAIN WORKERS. 311 1 1 •f s ■sS ^s .^^ r f^ f.SB s N g p « B « S S !S 3 i^ ■ S - ' , . , ^ - t^ n ^n CM 1 fr- Tj" 11^ fc s § o 00 «> , CO 00 -* O >.-; s ■«) lO < •^ " S s " a M iS H Is p c s o ■ , o , ^ ■n D M H r ^ f r f f "|i s !S| ?si ^1 ^s ^8 ^g ^g i 2 H ?^ t- 3 s CO <5 oi S 1^ ■o ? ■ ■ n ifi •2 a • K g • ts 1 O 1 ll li •3 § i „■ 1 1 1 ■^ Hi o b ALCOHOLIC DRINKS AND BRAIN WORKERS. 313 Table showing the Pebcentages op Totaij Abstainers, Occasional Drinkers, and REonLAR Moderate Drinkers of the Total repokt- ING FOR each Occupation. 1 Total Abatoinere. Occasional Drinkers. Regular Moderate Drinkers. Occupations. 5 1 1 1 f 1 i 1 Legal 204 15 7.3 146 71.6 43 21.1 Clergymen (not teachers) . 152 82 64. 66 43.4 4 2.6 Professors and Teachers . . 132 29 21.9 89 07.4 14 10.6 Physicians 145 2 1.4 121 83.4 22 15.1 Army and Nary 30 3 10. 24 SO. 3 10. Business Men 147 29 19.7 79 53.7 39 20.5 Others 82 ' 8.5 54 65.8 21 25.6 Aggregates 892 167 18.7 of total 579 64.9 of total cases. 146 16.3 of total Many of the persons furnishing the reports, from which the above tables were derived, added remarks, and a number of these are given herewith. They represent all shades of opinion, but in general agree that the use of alcoholic drinks as a stimu- lus to mental effort gives bad results, although they may be agreeable as restoratives in fatigue. Group I. Remarks of Lawyers and Judges. No. 1. I was accustomed in earlier life to see all wines used very freely. I was led to think it as necessary or usual as a clean shirt. At about forty-five I was a very hard worker, and quite used up at times. Sir Henry Thompson suggested to me to let all wine alone, absolutely. For one or two years I drank nothing — I now rarely do — but drink daily, for form's sake, a wineglass of Scotch whiskey and soda or seltzer water at dinner. I am an excellent judge of what is good in wine, and have perhaps an exceptional taste. I do not miss wine at aU. I am enormously better without it. I would not miss the use of 314 THE LIQUOR PROBLEM. Scotch whiskey. I thiuk from this I suffer no harm. It is not in any way necessary. No. 2. 1 believe I have never been under the influence of liquor, but I should not advise any one to follow my methods of life. Temperament and constitutional conditions enter so largely into the question that it has seemed to me that the con- sumer should be licensed to drink according to his capacity and not the dealer. In army and professional life I have seen moi-e evil result than good from the occasional or rational use of liquor. No. 3. Before reaching my fifty-fourth year I drank wine freely at dinner and was in the habit of taking one and some- times two drinks of whiskey just before going to bed. Since giving up whiskey, seven years ago, there has been a decided im- provement in my health, and every addition to the two glasses of claret affects me unfavorably. My best judgment is that the omission of the claret also affects me unfavorably. No. 4. I keep my physical and mental activity always on the strain. Find a half bottle of wine slightly stimulating for a very short time, but invigorating for a longer period. Am sat- isfied that wine is useful as a food for body and for mind, if the quantity is properly graduated. No. 5. For a person with a touch of alcoholism, either in- herited or acquired, nothing less than total abstinence is safe. Alcoholism strongly hereditary — almost never acquired by use of light, still wines only — usually by spirits or champagne. Moderate use of alcoholic liquors generally safe for persons having no hereditary tendency. After fifty, very beneficial. Men under thirty better without it. No. 6. From personal experience I should say that drink ruins more men than any other form of indulgence. The con- stant aim should be to resti-ict the use of alcoholic drinks as much as possible by legislation that is regulative rather than prohibitory. Social customs that are calculated to cultivate a taste for strong drink should be corrected. Light wines taken at meals are at times beneficial, but ardent spirits should not be drunk on such occasion or any other. No. 7. I believe (in the U. S.) total abstinence in youth, fol- lowed (upon attaining manhood) with reasonable indulgence in stimulants, is not harmful ; that those who are much in the open ALCOHOLIC DRINKS AND BRAIN WORKERS. 315 air are least apt to be injured by stimulants ; a reasonable amount of wine (if pure) of the type generally known as claret, I believe to be wholesome, and commend its use ; mental exer- tion should never follow any use of stimulant ; the work may be well and quickly done, but the waste is too great ; the at- mosphere of the United States is itself rather stimulating and promotive of nervous troubles and excitement, — a reason for slight use of stimulants. On the other hand, in certain parts of the country a condition of climate exists called " malarious " col- loquially, which is enervating and depressing ; where this condi- tion exists more spirits can be used safely (and perhaps advan- tageously) than in a strong, cool, and bracing climate. On the whole, I believe the use of honest beer and wine in moderation is wholesome ; the use of spirits is dangerous from its tendency, but a moderate amount is not harmful — what is a moderate amount is difficult to define. The great danger in the use of spirits is the tendency to gradually increase the amount as the system becomes accustomed to the stimulant. No. 8. In administering the federal law in the criminal courts for twelve years I have been amazed to find how many crimes can be traced directly or indirectly to drink. For this, spirits — whiskey — is chiefly responsible. Here and in England drunkenness is common and reiiulsive. I cannot recall ever having seen a drunken man or woman in France. I attribute this to the fact that in France the use of light wines is the rule and the use of spirits the exception. If the use of light wines were encouraged here by the abolition of high tariff duties, and otherwise, it is certain that the use of whiskey would decrease. No man, certainly no hearty man, requires whiskey. One who uses it habitually is unfitted for any mental work. He is utterly unfitted for any position of trust. He is a useless and, often, a dangerous member of society. Until some more radical improvement is possible, and I fear that day is far distant, I would have reformers work along the line of substituting light and comparatively harmless stimulants for the " fire-water " which is the principal root of the evil of intemperance. No. 9. Am convinced that a moderate amount of whiskey, or gin, claret, or good ale at or after dinner each day is helpful, aiding digestion, taking away all desire to drink water while 316 THE LIQUOR PROBLEM. eating, and apparently answering a natural desire for a limited amount of alcohol, which taken in this way does not seem to increase. Such a regular and moderate consumption I believe is conducive to the health of the majority of men working and living as such majority do. Especially do I believe this true in the case of those whose vocations necessitate habitual intel- lectual work. No. 10. I drink when occasion offers, but have no craving for alcohol. I think I have a slight tendency to inflammation of the stomach, and that habitual drinking of spirits, and jjer- haps wines, would be injurious, and for this reason think the habitual use would be distasteful. I smoke, and drink coffee to an extent that would kill most men, but without visible injury. I think smoking has a ten- dency to make a man lazy and contented with things as they are, and thus has its good and bad side. Coffee is to me a most agreeable stimulant, and never followed by depression ; tea would injure me more than rum. No. 11. I think a moderate use of light wines and beers is conducive to health, and helps one to keep up his strength in time of need, and by driving out heavy liquors would tend to promote temperance. The evils to health and society are, I believe, almost wholly caused by the use of distilled liquors. No. 12. I do not profess to be an expert or to have much knowledge on the problem under investigation, but my impres- sion is that the occasional use of spirits is not injurious to one's physical health. Of course habitual use or excess at any time is injurious, but for a man of sedentary habits, I think an occa- sional stimulant is an advantage. My impression is that if I did not have children I would have a wine, claret, for instance, on my table every day at dinner ; but as a matter of precaution in connection with their training I do not have. I have never myself been under the influence of liquor that I know of in my life, and think I am but a type of a very large number of men in my sphere of life. I am quite clear that such use as I have made of liquor has been beneficial. No. 13. From observation I conclude that a majority of men over forty-five years old, who can digest spirits, wine, or beer, are benefited by the moderate use of either of these articles. Of course there can be no universal rule as to what quantity ALCOHOLIC DRINKS AND BRAIN WORKERS. 317 will be beneficial. I am also willing to believe that the use of drink by those under forty-five is not, on the whole, detri- mental. No. 14. For a long time I, habitually, took a drink or two between breakfast and dinner, usually whiskey, and generally without eating. I became satisfied that this practice was inju- rious, producing dyspepsia, and impairing working capacity. The claret and water which I now drink at dinner seems to go to the right place, but I am satisfied that stronger liquor would do me no good. With the excejjtion of yellow fever, in 1867, and dengue in 1880, I have never been sick. No. 15. From my personal experience should say that, aside from the matter of sociability, it would have been better for me, enjoying good health, not to have drunk at all, and my advice to the young would be not to begin to use alcoholic drinks in any form. No. 16. I was never intoxicated in the slightest degree in my life. I can, and occasionally do, at a club dinner, drink more than most men, and know that I feel it less. Before I have any effects from drinking my stomach rebels and rejects its con- tents. This has happened to me three times. On each occasion I was very tired, and had eaten extravagantly as well as drunk a great deal. From my observation, I am sure of one thing. There are many men who are strangely affected by one drink. After one drink they seem to lose all control of themselves and proceed to get drunk. These are generally men of weak physical vitality. Drink ruins them physically and mentally. After drinking it is some time before they recover their normal condition, and that is bad. Such men should never drink at all. Among the men of good general physical condition with whom I associate, I should say that ninety per cent, were moderate drinkers, and that not ten per cent, of these are at all injured by it. No. 17. I think moderate drinking not injurious. I think as one grows older he desires wine less and needs it more. I have never drank enough to be able to describe the effects of drink. No. 18. I believe that a man of ordinary health is not bene- fited by the use of liquors when under forty-five years of age. I believe that the proper use of liquors as a general thing is the 318 THE LIQUOR PROBLEM. very best form of stimulant that has yet been discovered ; and that the abuse of such stimulant is the worst thing in the world ; and that no kind of prohibitory law can or will reach the evil. No. 19. I have chronic dyspepsia which has tormented me for years. I carry around a little hell. I have found the reg- ular consumption of whiskey in very moderate amounts of enor- mous value to me. It has tided me over a thousand seasons of pain and left no ill effects or weakness. Beer I cannot touch, nor was I ever able to drink it regularly. When I was younger I drank moderately various kinds of wine, but found I had to give up one after another, and have come to the conclusion that the safest and best drink is Scotch whiskey. I believe that if I were to give up its use my health would suffer materially. No. 20. I believe that the daily use of spirits, wine, or beer is neither necessary nor beneficial to any man in a good normal condition of health. I believe in their use only to a limited extent as a social function and for their medicinal effect. No. 21. I never knew any person in health who was not in- juriously affected to a greater or less extent by the daily use of spii'its, wine, or beer, except old persons, to whom it is in many cases of benefit when taken in moderation. My observation has been somewhat extensive, my personal experience limited, although I am not a teetotaler. The result of both is that the regular consumption of a moderate quantity of whiskey, wine, or beer is not conducive to the maintenance of the health and working power of any class of men, at least until the effect of old age begins to be felt ; that occasionally each is useful as a stimulant, but that all other use tends to diminish the health and working power of all classes of men. I do not think that the average man in good health, in this country, may consume daily any quantity of whiskey, wine, or beer without more or less risk of eventually injuring his health ; because the constant use of any stimulant soon brings the system into an abnormal condition, and no man in an abnormal condition can be properly said to be in good health. He is only in good health so long as his natural vitality and vigor suf- fice, without artificial reinforcement, for the demands which his daily life makes upon him, at least until his powers are affected by his age. ALCOHOLIC DRINKS AND BRAIN WORKERS. 319 No. 22. I cannot find that the consumption of a moderate quan- tity of whiskey, beer, or wine either helps or hurts the health. In case of physical exhaustion or mental languor I do not doubt that a moderate amount of spirits has a stimulating and benefi- cial effect. No. 23. Speaking generally, find abstinence better for phy- sical condition than daily drinking would be. Find occasional use of wine, beer, and spirits beneficial, e. g. contrast a dinner party without wines with one where wine is served. No. 24. My own disposition is against the regular daily use of drink. From my own limited experience I should say that after forty or forty-five years of age an occasional use of stimu- lant for a properly balanced man is promotive of health. I question whether the " working power " of a man is inci'eased one atom by drink, except as it may preserve general health. I deprecate its use " as a social function " as inducing most people to use it before their decreasing powers indicate its need. I think the loose American habit of " treating" resjDonsible for a great deal of useless drinking. No. 25. If spirits and wine could be always used in small and temperate quantities, there would be, probably, no evil re- sults ; but the use of either, and of beer, is dangerous for young people. I regard the social punch-bowl as the source of much intemperance. The moderate use of spirits and wine, especially the latter, after one has reached the age of forty or fifty, I re- gard as wholesome and harmless. No. 26. Do not believe that the use of spirits, etc., is neces- sary to the maintenance of health, or conduces thereto, except in rare cases. Believe that the quantity of spirits, etc., which a man in good health may consume daily without injury to health, depends upon climate and occupation, and much less upon age, except in the case of the very young and very old. Do not believe stimulants should be used duiing the "growing age." No. 27. I consider the moderate use of whiskey now bene- ficial to me ; but have always found the constant use of beer, ale, and especially porter, injurious to my digestive organs. I believe the excessive use of ardent spirits so injurious to the community that laws restrictive of liquor selling are advisable. No. 28. Think moderate use of beer, wine, or liquor, not 320 THE LIQUOR PROBLEM. injurious, depending on a man's physique, in some cases de- cidedly beneficial. No. 29. My mind never works as actively or as clearly, either in my profession or in any matter of practical every-day judg- ment, after partaking, however slightly, of any alcoholic drink. Having a natural tendency to stoutness, beer makes me heavy and sleepy, and I accordingly avoid it wholly, except occa- sionally in very cold weather when I am going to get plenty of exercise after it, as in walking or skating. I enjoy good wines occasionally at dinner in the evening, but I always feel the next day as if I had lost a little ground which I must make up, and I do so in twenty-four hours ; but I would not on any account drink wine every day or habitually. I don't believe in it at all, although I am confident that I possess full self-control against any excess ; but I should n't care to risk the gradual and imper- ceptible loss which I think must come with habitual use. No. 30. My opinion is that a nervous man who is a brain worker should be a total abstainer. I regard any man as in danger who drinks spirits for the sake of the exhilaration. No. 31. For twenty years nearly I have taken a little ordi- nary table claret at my dinner, and I think it has been of service to me. Could all drinking of that which may intoxicate be lim- ited to our dining, and as moderate as my use has been, I think health would be promoted and no evil effects result. No. 32. As a general rule, I do not believe that the regular consumption of a moderate quantity of whiskey, wine, or beer is conducive to the maintenance of health and working power in any class of men. To this general rule, however, I think there are individual exceptions. Group II. Remarks of Physicians. No. 1. The experience of over twenty-five years as a physi- cian has firmly convinced me that active men, who from habit, inclination, or force of circumstances take but a light morning and noon meal and a hearty dinner at night may take wine or spirit of moderate amount with their dinner without injurious effects, and, probably, with benefit in some cases. Except as above stated, I do not think the daily use of spirit fails to injure the average man. A glass of sherry (one ounce) or claret (two ounces) or beer (one pint) may be taken with dinner by most men without noticeable injury. ALCOHOLIC DRINKS AND BRAIN WORKERS. 321 No. 2. Twenty-five years of observation of " Life Risks " leads me to think that the habitual daily use of undiluted spirits (whiskey) impairs longevity. Total abstainers, who have for- merly indulged to excess, are poor risks. A very moderate, temperate use of light wines, or diluted spirits, especially after the age of fifty-five, is more conducive to longevity than is total abstinence, so far as I am able to judge. No. 3. I find equal jjarts of Rhine wine and seltzer water " agrees " with me better than either tea or coffee for luncheon, " a very light meal." Professionally I find many men, who cannot use spirits or beer without digestive disturbance, can use light white sour wines diluted with some alkaline mineral water with actual benefit. I prescribe them for such cases when there is no " moral hazard " of forming a habit. I believe no healthy man under fifty needs any form of alcohol habitually. Many healthy men vuider fifty can use it daily in moderation (say Anstie's limit) without damage to their tissues, but without physical or mental benefit. The unfavorable results of this form of indulgence may appear in their children. I have no question that many men under fifty are injured by the habitual use of alcohol (always in moderation). I have seen many cases of dyspepsia and lithsemia undoubtedly caused by its use, and in man}' constitutions it predisposes to cardio- vascular changes, premature atheroma and its consequences. I may add that I doubt if the habit of over-indulgence is likely to be acquired in the class of cases above mentioned, for the reason that the alcohol is usually taken with meals ; hence no immediate and acutely stimulating effect on the nervous system is produced. No. 4. I have commencing cardiac and aortic degeneration, which has been a very common cause of death among my rela- tives. I am better in body, mind, and disposition, when I use alcohol in moderation. Those who live with me are as much convinced of this fact as I am. I was several years ago led to the use of liquor above described by the advice of the well known total abstainer, Dr. B. W. Richardson, of London. Were it not for my recognized obligation, as a member of the Church Temper- ance Society, to use only the smallest quantity of alcohol that I 322 THE LIQUOR PROBLEM. need, I should take at least once daily, at meal-time, the equiva- lent of from one to two glasses of sherry. I have no question that my bodily health would be in every way improved, and I may yet decide to do this. Individuals who are strong and well in body and mind are better without any alcohol. The enfeebled of either sex, with- out distinction of years, are often greatly helped by using it in connection with food, under competent and conscientious medi- cal guidance. It is, however, impossible to say this truthfully, unless at the same moment one insists upon the constant risk to health and self-control which goes with any transgressing of these medical limits. Thus, I have often known in urgent disease, the so-called " heroic " employment of alcohol to be in- dispensable to the saving of life ; and yet in certain instances as soon as the illness disappeared even the smallest use of this agent did harm. Further, the duty which weighs upon all medical advisers to insist as rigidly upon the abandonment of alcohol when health is restored, as to enjoin a resort to it in time of need, well shows the extreme difficulty of replying to this inquiry in any way but conditionally. In like manner, in the case of young persons, with habits of life still unformed, the beneficial and necessary employment of stimulants involves extreme risks, which can never be disregarded. Alcoholic stimulants taken in place of food, or rather to avoid eating, are wholly to be condemned. Used with food they are beneficial just so far as they, like condiments, salt, pepper, spices, improve the digestion (in the full medical sense) of the individual. In every instance the smallest quantity that will produce that result is to be distinctly preferred. It is then impossible to fix a uniform safe standard, as the second ques- tion seems to demand. The same rules apply here as in every other permitted indul- gence of the body ; less rather than more ; constant effort at self-control ; if the body is to be profited : temperate use, not uncompromising refusal. No. 5. In Germany I drank a glass of beer every day at dinner, at home here I drank occasionally at a public dinner or with a guest at home a glass of wine, for say fifteen or twenty years. For perhaps five to ten years I took a drink of whiskey on going to ALCOHOLIC DRINKS AND BRAIN WORKERS. 323 bed that I might secure sleep at once. I think I began to feel effects from it in an excitable condition of the heart. I found also that I could not work so well, became easier fatigued, had less inclination to work. I found also that alcohol in any form stimulated the use of tobacco, which encouraged languor and dreamy indolent states. So I quit both absolutely three years ago, and have been better, brighter, and stronger ever since, with nearly double working capacity. No. 6. I believe fermented drinks are unnecessary in ordi- nary life ; they do not give real strength or endurance ; that many may use these moderately without any deleterious effect on shortening of life I fully believe ; but many on the other hand demonstrate the evil effects. They are a most expensive luxury, which people of moderate means should not indulge in. I believe that people who do hard but outdoor work can far better resist the bad effects on the health than those of seden- tary habits. No. 7. The less alcoholic drinks taken, the better. If a stimulant is needed, black coffee or tea are the best. The con- stitution of the drinker has perhaps more to do with the effects, near and remote, than the quantity taken. Example has more to do with the habit than a really great desire. Food of good quality and quantity, properly cooked and ap- petizing, is the best stimulant for work ; alcoholic drinks are but the lash to the horse. No. 8. I believe that my distaste for strong liquor is heredi- tary. All my ancestors are Catalonians and have been very sober, frugal, and industrious. I have known of no habitual drunkard in my immediate family either on the paternal or maternal side. I have never felt that wine or alcohol in any shape was necessary for my physical or intellectual welfare. I enjoy the fragrant bouquet of the French liqueurs (Benedictine, Chartreuse, etc.) and the sweet wines of southern Spain (Mal- aga, Alicante, etc.), but merely after a social gathering at table. On such occasions the contagion of example and the stimulus of conviviality adds greatly to the inherent qualities of the wine, and to the pleasure of its use. I am convinced from personal experience that the regular consumption of even a moderate quantity of whiskey, wine, or beer is not necessary to the maintenance of health and working 324 THE LIQUOR PROBLEM. power in any class of men ; and that even tlie moderate but habitual indulgence in the stronger liquors (whiskey, brandy, gin, and rum) is injurious to health. I consider that heredity and environment are most important determining factors in the problem ; and under the head of en- vironment I would especially refer to the notable neurasthenic tendencies that are being progressively manifested by the most civilized races under the strain and friction of the conditions of our present civilization. No. 9. When exhausted by over mental work stimulants seem to revive without doing me harm. I have never used them prior to mental work and do not know what effect on it they would have. I think four ounces of whiskey would be benefi- cial rather than harmful to a man able to control appetite. In old age I believe four to six ounces of whiskey daily decidedly beneficial. I oppose the use of stimulants before the age of thirty-five, and always forbid it to nervous people who are very susceptible. No. 10. I find it desirable to keep my organism absolutely free from alcohol, whenever I intend to do hard mental work. On the whole, I feel best, more vigorous, and am in better spir- its when I totally abstain. I also sleep better, but on the other hand, occasional attacks of sleeplessness are easily overcome by alcohol (beer). It looks as if I am drifting towards total abstinence. No. 11. I had a long siege of septicaemia with glandular in- fection and rheumatism. Used whiskey, three or four ounces daily, with few exceptions, for many weeks with apparent bene- fit ; certainly it added to my comfort. I have for ten years used occasionally, when very tired or exhausted by special labor, whiskey (or wine), in moderate quantity, with benefit. I rarely get much fatigued, and have worked very hard for many years. I think stimulants affect most favorably men of middle age who have been temperate in their youth. No. 12. My personal observation, experience, and convictions are that the custom of treating at the bar, and the existence of liquor saloons are responsible for three fourths of the excessive use of liquor. There is no difficulty in tracing the downward course of many men in this city of high education who first be- ALCOHOLIC DRINKS AND BRAIN WORKERS. 325 came victims of the drink habit through invitations to the bar and acquiescence in the system of treating. No. 13. There can be no questioning, I think, the fact that the daily habitual use of alcoholic drinks predisposes to chronic gastritis and diseases of the liver and kidneys. No. 14. My father, a lawyer in large practice and of inde- fatigable industry, was accustomed to take about two thirds of a bottle of port wine every day (he was an Englishman). He drank three or four glasses with dinner and the remainder be- fore going to bed. He retired from practice in his 76th year, and died in his 91st year of mere age. Moderation, not abstinence, and the best quality of wines, etc., had much to do with this happy condition. No. 15. Many men after fifty are benefited by the moder- ate use of alcoholic liquid, not exceeding two ounces of alcohol daily ; but no one is free from danger of excess, and, therefore, its continuous use is always dangerous. Have known many habitual consumers to excess daily, and especially at night (night-caps) who have lived to advanced age in apparent per- fect and vigorous health. They were habitual consumers who never exceeded a certain amount — but always took that amount. No. 16. From my experience during a very active life of twenty-six years of medical practice, I have reached the con- clusion that the regular consumption of a moderate or even small quantity of whiskey, wine, or beer is not conducive to the most perfect health or the highest working power in my pro- fession or in any walk in life. In the conditions of life in cities, I believe the most effective work is performed by total abstainers from alcohol, but that the greatest harm is done to men of sedentary pursuits, and to those who through the stim- ulus of alcohol consume a larger quantity of nitrogenous food than they would otherwise take. It is in these cases that lithae- mia is produced with its many attendant functional disturb- ances. Leaving out of consideration all the harm done by alcohol in excess, the injury done by moderate regular indul- gence is incalculable. Almost all the ill health in men beyond forty is associated with alcoholic indulgence and with impru- dent or excessive eating in association with it. Chronic inter- stitial nephritis, a disease very frequently met with, is almost in 326 THE LIQUOR PROBLEM. every instance the direct result of these antecedents. A man who leads an active outdoor life may consume with impunity a limited quantity (three or four glasses of claret as a maximum, or two ounces of whiskey), but he is all the worse for the habit so far as his working capacity is concerned. Beyond sixty years, and in a northern or cool climate, such indulgence is at- tended with much less chance of injury ; but in all ages and in all climates alcohol is in my opinion not conducive to, does not aid in producing, the most perfect health. A man is in perfect health in spite of, and not by the help of, alcoholic drinks. Group III. Remakks of Clergymen. No. 1. I have taken a light wine, claret or hock, continu- ously for months, and then desisted for as long, or a longer period, because my system seemed not to require it, — or even to resent it. I have taken beer in the evening before retiring, similarly for a period of some months, and then desisted as having no desire for it. It is quite the exception for me to take either beer or wine. I have found that a little good whiskey diluted with water, taken before retiring, conduces to sleep, when I am working hard, and seems to have no ill effect. The last I think better than wine or American beer, but I have no fixed habit in the matter, and without inconvenience abstain entirely, except that if I abstain entirely while woi-king hard and late at night I am not likely to sleep well. I have a sin- gularly healthy and sensitive constitution ; a slight increase of whiskey will give me headache ; but from two to four table- spoonfuls (the maximum quantity) can be taken with impu- nity and with the result of giving me sleep. No. 2. The result with me is increasing doubt of the value of habitual daily use of any stimulant, and increasing convic- tion of the value of occasional use. No. 3. From what I have seen I believe that men who use stimulants sparingly are in better health than those who are abstainers. No. 4. My belief, based solely on personal experience, is that temperate use of stimulants is a good thing. I find no grow- ing taste, nor increasing demand for liquor. Family always have used liquor temperately — no drunkards known in it for several generations. ALCOHOLIC DRINKS AND BRAIN WORKERS. 327 No. 5. From personal experience of thirty-five years in the pastorate, the drink habit, in any degree, from beginning to end, is a curse, and in some member of the household of the poor is responsible for a large share of poverty as it confronts church benevolence. No. 6. When my two sons were ten years old I was con- fronted with the question of what I should teach them on this question. I desired to teach them both by precept and exam- ple that judgment which I believed to be upon the whole the safest. Should I teach them " total abstinence ? " or " temper- ance ? " There is peril either way. I chose temperance as the lesser of the two dangers. I think the result has vindicated my decision. As a clergyman I have avoided the position of a " total ab- stainer," because I have found that men who are in danger from drink will listen to me when they know that I am a rea- sonable man, and will not so readily allow themselves to be remonstrated with by a total abstainer. No. 7. My experience goes to show that after overwork, or when digestion is disturbed by irregular hours, a moderate amount of sjiirit is a restorative and a sleep producer. I ex- perience only good results from this practice. No. 8. Never saw any good to bodily health, mental vigor, or moral development from the use of alcoholic liquors ; but on the contrary have seen a great deal of injury to body, mind, and moral nature by its use. No. 9. It is my candid conviction, from my experience, that no one to my knowledge has ever received any permanent gain to health, if even temporary relief from pain, by the use of alco- holic drinks. It has proved destructive to all whom I know as habitual drinkers. I feel that it is no great credit to me that I am a total abstainer since I have never had the least inclina- tion to drink, the smeU of rum or beer rather nauseating me. Group IV. Remarks of Scientific Men, Teachers, Business Men, ajstd Others. No. 1. My own experience would indicate that the moderate use of alcoholic beverages of various kinds may be occasionally beneficial, though I have always seriously doubted whether or not the temporary stimulus was not succeeded by a correspond- 328 THE LIQUOR PROBLEM. iiig reaction. I am of the opinion that much depends on the individual idiosyncracy, and on the conditions of life and the climate. I have never felt better than when indulging moder- ately in such beverages with the people who habitually so in- dulge, and during the time when I was leading an outdoor life. I am inclined to believe that indoor life and especially seden- tary habits and mental occupation make it necessary to be very frugal in the use of such alcoholic beverages ; and that the in- direct effect of the alcoholic habit, when it becomes a necessity, altogether offsets any temporary benefit that may otherwise accrue to the moderate drinker. No. 2. My conclusion from my observation is that whiskey is one of the best drugs in the pharmacopoeia and one of the most dangerous beverages ever discovered or used. Malt liquors are excellent tonics in convalescence. The habit of drinking them surely leads to excess. In my own experience the use of liquor has never done much good or harm, except in convalescence, when it has benefited me. It has not done my constitution any permanent injury. Its moral effects are injurious. It leads to indiscreet words and acts. With certain persons it not only unbalances the judgment, but produces a homicidal tendency and other criminal tendencies. Nearly all the crime in the South has its origin in whiskey. So much am I convinced of this that if the enforcement of pro- hibitory laws was possible I would strenuously advocate them. With us much good is effected by local option. Unless the negroes can be rescued from the abuse of whiskey, their lot will become intolerable. No. 3. My experience as a mining man has satisfied me that while good liquors are very valuable medicines and should al- ways be obtainable, their habitual use, even in strict modera- tion, by working men is a mistake. I have not found that alcohol increases working power, physical or mental. When I had to make sudden demands upon men for heavy, uninter- rupted work of long duration, such as can occur in breakdowns of machinery, fires, etc., I have given plenty of tea or coffee or soup during the work, but no alcohol until the job was finished. Thus given it is very beneficial, as it gets the system over the " dead centre " when, as the men express it, " they are too tired to eat." ALCOHOLIC DRINKS AND BRAIN WORKERS. 329 I am strongly in favor of a rigid but intelligent restriction of the liquor traffic. Where this has existed, either by law or circumstances, I have had little difficulty in practically abol- ishing drunkenness among my men, not only during working hours, but also during the nights of the week, although liquor could always be obtained. Even on Sundays and holidays the amount of drunkenness was rarely very serious. Never al- lowed liquor to be sold on my land, and in this, as in all other measures for repressing drinking, had always the full support of my men, who were a rough set of whites and negroes, some of them ex-convicts, some notorious ruffians when drunk. No. 4. My observation leads me to believe that any one is unfortunate who contracts a habit of regular drinking, even if it be moderate. I believe the constant use of beer to be injuri- ous to health ; but not so with a very moderate use of pure wines. I think the use of distilled liquors always dangerous, but in very moderate quantities not injurious to health. I do not believe in prohibitory laws, but in teaching and practicing temperance. No. 5. I never found that it helped me at all towards doing- work to drink at the time. I cannot speak or write as well after taking even a moderate amount of alcoholic liquors or wines. What I take I do for my general condition. My digestion has improved markedly since I exchanged claret (which had come to produce flatulency) for Scotch whiskey. After severe exposure I should always take stimulants to pre- vent cold or undue depression ; but not to do work upon. With food I thoroughly believe in a moderate amount of wines or other stimulant for all persons at least who are past the period of superabundant activity. As to taking things at night I have my doubts ; but I do it for myself because I like it, and because I am well and hearty under that system. No. 6. From my observation both in Europe (Belgium, France (Germany more especially), I have come to the conclu- sion that moderate drinking of light wines and beer is not con- ducive to intemperance. No. 7. Alcoholic stimulants, whatever their nature, must invariably, and in any quantity, affect the brain more or less favorably or unfavorably, according to the condition of the par- taker. Sometimes one glass of beer will affect me unpleasantly, 330 THE LIQUOR PROBLEM. at other times I may drink four to six and feel the better for it bodily and mentally. Sometimes wine stimulates my brain power to greater activity ; at other times it incapacitates me for mental work. I have known men who needed the stimulus to accomplish certain mental exertion. The momentary condition and disposition of bodily and mental functions modifies the effect. If I may briefly add my views from the ethical and legisla- tive point, I consider the moderate use of stimulants (i. e. light wines and beers) as legitimate enjoyments of life, just as music and art, coffee and cigars, candy and cake. Abstinence from fear of excess argues a defective moral power which should be educated, or else of bodily disease ; ab- stinence from lack of enjoyment shows defective development of capacities to enjoy. As to legislative action, I believe in restriction or rather reg- ulation of the liquor traffic on the same principle as powder magazines, etc., are regulated ; this alone is really practicable, education must do the rest ; prohibition only leads to other im- moralities. No. 8. I find that during the winter months, when I am occu- pied in office work, a moderate use of stimulants is pleasant, and I fancy useful in promoting digestion. On the other hand, when in the field (and I have spent an unusually large part of my life in hard camp life, mountain climbing, etc., often involving great physical hardship) I need no stimulants, and I believe, from comparing my own experience with that of others engaged in similar life at the time, I am stronger and better without the stimulant. I have proved by actual experience that in a long exposure without food, and other hardships, one occasionally goes through in western exploration, that I. could endure more in the long run than men who had spent their entire lives in that kind of work, but who thought stimulants necessary, and used them freely. I believe if man could live a perfect sim- ple country life he would be better without any stimulant of any kind ; but that city life and the nerve strain that accompa- nies it is better endured with the help of a moderate use of stimulant ; but I also believe that such stimulation exhausts the vital force so much the quicker. The quantitj' that can be taken without harm varies with individual temperament. ALCOHOLIC DRINKS AND BRAIN WORKERS. 331 No. 9. Never drink water other than the so-called mineral or soda waters. Always feel better for some stimulant. Never took much alcoholic stimulant till I was thirty years of age, and never drank to excess. Feel better in health for moderate use of alcohol, and think it aids digestion when taken at meal- time. No. 10. I would not be willing to have the habit of drinking any spirituous liquor, even at my dinner table, so as to feel the want of it. But I agree with Matthew Arnold, that, inasmuch as a glass or two of wine at table is agreeable to me, prompts cheerfulness, and adds a little to the enjoyment of life, I find no harm in it. Occasionally, perhaps once in a month or two, when not likely to go at once to sleep from having something on my mind, I take half a small wineglass of whiskey in twice as much water, with a biscuit, just before going to bed. This I find almost invariably gives me a good night's rest. But I am not sure that I feel quite as well. No. 11. I never drink before dinner, and I dine at seven. I think drinking at lunch, or at any time before dinner, is injuri- ous to most men. If I am going to work on my books in the evening, a glass of sherry is quite enough. Drinking spirits and water, after an evening spent in study, induces me to sleep, and my sleep is, and has always been, good. I think rye whiskey agrees perhaps better with me than any other spirit. Beer does not seem to agree with me in winter. No. 12. Before the age of forty-one I spent some years in explorations and surveys in the western United States, and had charge of men and assistants. The men of most endurance were either total abstainers or not habitual users of either fer- mented or distilled liquors ; and now twenty -five (to thirty-four) years after, all the known survivors are those who were then either total abstainers or only occasional users. No. 13. I shoidd have had no scruple against using wine, etc., had I believed it useful to me, though much opposed to its com- mon use as a beverage ; and finding no need for it, I have abstained for the public good. My observation of effect of drinking goes decidedly against its daily social use. As a college officer I learned to dread its injurious effects on students. It invariably hurt those who drank habitually. No. 14. My personal experience and observation have taught 332 THE LIQUOR PROBLEM. me that the consumjJtion of a moderate quantity of wine, whis- key, or beer is not conducive to the maintenance of health in any class of men. It is impossible to determine the amount of these which may be taken daily without risk. It is not uncom- mon to see a robust man show the effect of an ordinary glass of whiskey, while I know a gentleman not robust, who weighs but 124 pounds, who can comfortably dispose of a bottle of it. In this city (Washington) I feci the effect of a half an ounce of whiskey. In Boston, I can take two ounces without feeling it. So I can at sea. In Washington, a bottle of Bass's ale I feel the effect of. At sea, or in London, I can take four with com- fort. Climate and occupation are undoubtedly large factors. No. 15. All heavy drinkers who began life with me are under the sod. Moderate, but constant, drinkers are older, in effect, than I am ; they are suffering with some ailment. To this state- ment I would make two exceptions, and these men are remark- able for their fine constitutions ; I look at them daily with wonder because they drink so much. No. 16. For forty-five years it has been my work to control and direct men, often by hundreds, sometimes by thousands. More than nine tenths of all the difficulties encountered have arisen from the use of intoxicating drinks, alike in civil life and in army life. These difficulties began in managing men on a farm when I was a youth and still continued in directing scien- tific research. No. 17. The facts regarding excessive drinking are plain ; it is a menace to health, happiness, character, and life of the indi- vidual, and to the welfare of society. Moderate drinking has, within ray experience, led to excessive drinking in so many cases that I regard the latter a natural sequence, and those cases in which the habit is held in moderation to be exceptional, though not rare. In such cases, the force of example in generating impulses that are not restrained seems to me a sufficient reason for the abandonment of moderation in drinking in favor of total abstinence. No. 18. Believe that whiskey, wine, and beer help nobody when good water is to be had. It is a question of no damage, or how much damage is done. I have observed that men who bathe much, exercise much, and perspire much, drink heavily with the least apparent damage. The English gentleman, for ALCOHOLIC DRINKS AND BRAIN WORKERS. 333 example, is oftentimes the picture of health and energy even when he is a heavy drinker. The American habit of desultory drinking is harmful in high degree. The English habit of drinking in routine with eating, bathing, and exercise, is much less harmful. Men of sedentary habits should not drink at all. Believe total abstinence impracticable of attainment, but repres- sive measures under the law advisable. Respectable classes should be taught how to drink reasonably. No. 19. The general conclusion drawn from observation and experience is that during all of earlier and middle life, while a man is in the full vigor of health, any form of vinous or alco- holic stimulant is unnecessary, and hence to a greater or less degree injurious, except during periods of extraordinary physi- cal and mental exertion especially accompanied by deprivation of sleep. In such cases, sometimes extending as many as from twenty -four to thirty-six hours, some stimulants during the latter part of the terra of exertion have been found indispensable. Later in life when the digestion becomes less vigorous and the physical strength somewhat impaired, my experience leads me to believe that a small quantity of dry wine or good whiskey with dinner is desii-able, but that any form of stimulant, except in case of great fatigue or great exhaustion, is decidedly injuri- ous. Perhaps the most remarkable fact in my own experience is that almost the only time when rheumatic pains are wholly absent is when the blood is flowing vigorously under the influ- ence of a reasonable quantity of good whiskey, and I do not discover that there is any injurious after effect, provided the stimulant is taken with considerable food, or following it, dur- ing the process of digestion and not upon an empty stomach. No. 20. I believe that the moderate use of a light claret has helped me to avoid difficulties of digestion more than anything else I have tried. I should state that my diet has always been very light and simple by preference as well as prudence. I have come to believe that the universality of the dyspeptic and nervous troubles, so characteristic of the over-worked profes- sional man in America, is very largely due to the reluctance to use a light stimulant in later life, a custom which, whatever its moral bearings, is universal in other civilized countries. No. 21. Young men who drink are in danger of contracting habits which destroy their business, social, and religious useful- 334 THE LIQUOR PROBLEM. ness. I always discriminate against a regular drinker in ex- tending credit ; so do all banks, insurance companies, railroad companies, and corporations generally. The consumption of whiskey, wine, or beer is not necessary, and leads to crime. In- troduce the sale of liquor where it is not sold, and you will at once increase crime. Men who want to have clear heads, pure hearts, and prosper in the community want to avoid habitual drinking. No. 22. No argument whatever can convince me that liquor is required in the world, and to wipe it out entirely would do more for Christianity^ and to create a gigantic real estate sale of hospitals and prisons, than everything else combined. No. 23. It is within my personal experience that men en- gaged in clerical work give the best satisfaction who do not indulge in spirits of any kind. No. 24. After a life of extraordinary vicissitudes and ex- tremes, physical and mental, my repeatedly tested conclusion is this : — Wine and distilled spirits may be taken beneficially in limited quantities and for a limited time, viz. : after extraordinary ex- posure ; after extraordinary fatigue ; after debilitating illness ; during a period of prostration ; but the use must not be suffi- cient to disturb or excite the system and cannot be continued long without injurious effects and a dependence of the system upon the stimulant. And I deem the use more injurious and dangerous for brain workers than for any other class of persons. But there has come within my observation a fact which is worth more for the Committee of Fifty than a thousand indi- vidual experiences : — During the war I was a prisoner for thirteen months in Louisi- ana and Texas. Among the prisoners were many men, soldiers and sailors, but chiefly sailors who had been addicted to drink. For four or five months the conditions of life were fairly sanitary. On the one hand the prisoners were in roomy, well ventilated barracks ; they had to police and keep clean their quarters and grounds under their own officers, acting with the cooperation of the Confederate authorities ; they had sufficient food and suffi- cient means for cooking it properly ; they had saved their clothes when captured ; they were allowed to go out and cut their own wood ; they were marched across Texas from Hempstead to ALCOHOLIC DRINKS AND BRAIN WORKERS. 335 Shreveport, and from Shreveport back to Tyler. On the other hand there was the confinement and depression of imprisonment, the lack of regular work ; a climate they were not accustomed to, and some malarial influences. Notwithstanding the latter conditions these men improved physically and mentally in such a marked degree that other officers agreed with me, at the time, that enforced total abstinence was the very best con- dition that could be imposed upon them. And in confirmation of the above, I repeatedly observed that many of these men, after they had returned to their homes with all the advantages of civilized life, had run down and did not appear either physically or mentally to be as fair specimens of manhood as they did while inmates of a Confederate prison camp. But here I must specially guard what I have above stated, by saying that those observations must be confined to the period of four or five months of fairly sanitary conditions. I do not mean to say that the filth and squalor and starvation and na- kedness and wretchedness which attended a considerable part of their captivity showed any favorable result whatever. No. 25. From a large experience with drinking men in a line of work for their rescue, covering many years, I find that the drink habit is one that they have formed not through pre- disposition, but during the years of eighteen to twenty-four from so-called good-fellowship and treating ; then, having ac- quired a habit, and their system craving alcohol, it became the old story of an uncontrollable appetite. This applies to the millionaires, and the sons of the same — who have the means to gratify their wants, and do so till their systems refuse, when mania-a-potu and death follows, as well as to the gutter-snipe who burns for rum, and dies the death of a neglected drunkard. Rum levels them both and affects them in the same way — here and hereafter. The curse is in the abuse, but the man, as a rule who is abusing the use of it, does not consider that it ap- plies to himself, but to the other fellow, and will sympathize, and sometimes remonstrate with him in his being a slave to drink. No. 26. I do not believe the regular consumption of whiskey, wine, beer, etc., is conducive to health, etc., but I am satisfied it is always attended with danger arising from gradual physical dependence upon stimulant. 336 THE LIQUOR PROBLEM. No. 27. Believe myself benefited of late years by tbe occa- sional very moderate use of alcoholic stimulants taken either with dinner or before retiring when physically depressed. On the whole, approve of total abstinence up to forty or forty-five years of age ; after that believe that the moderate use of stimu- lants is often beneficial. No. 28. During the war I was captured and held a prisoner for six months in Libby, Macon, Charleston, and Columbia. Insufficient and improper food produced a serious disarrange- ment of the digestion and left me with a tendency to a catarrhal condition of the stomach, bowels, and bladder, which became chronic later through overwork and nervous strain, which have been continuous through life, resulting in occasional break- downs and long absences for recovery. Five years ago, on one of these occasions, while crossing in a N. G. Lloyd steamer, I was led to try a little Mosel wine. It comforted my stomach and assisted digestion and assimilation. Its continued use pro- duced such marked and favorable results that I have continued it to this day, and am absolutely sure that to it is due a com- plete recovery of my digestion, and the disappearance of ca- tarrh, except from grip or a cold, which yields as in other cases. Used only unth food none of the things I take tend in the slightest degree to create an appetite. If it becomes necessary to go without anything, I do not miss it unless I go so long that the tendency to a catarrh begins to assert itself ; then I have the beginnings of indigestion ; but there is not the slight- est cravings for a stimulant. Few men endure more constant strain than myself. Taken merely as a stimulant and on an empty stomach any form of alcohol has rather a narcotic, not a stimulating effect. It does not assist mental action, and after a little, perceptibly diminishes it, even in small quantity. No. 29. The use of whiskey in moderation has not seemed to be deleterious ; on some conditions of the mental and physical system it has been a decided benefit. No. 30. I believe that we should encourage light native wines or beer as a beverage for the classes. Should be glad to see American wine sold as cheaply and used as freely as in Continental countries and all heavy liquors banished if possi- ble. Heavy liquors cannot be healthy in our climate as a ALCOHOLIC DRINKS AND BRAIN WORKERS. 337 steady drink. Englishmen and Scotchmen who in this country keep up their habits of drinking brandy as freely as at home generally become drunkards. I have made this a matter of careful observation ; I lived in England for nine years. No. 31. My own observation, both in Europe and Amei'iea, leads me to the conclusion that the use of wine in moderate amount at table is entirely harmless, and frequently beneficial ; that the tippling habit at the saloon or bar or club is always dangerous, and frequently destructive. No. 32. My opinion is that the habitual or even occasional use of spirits is always injurious. That the very moderate use of v.'ine or beer may not be injurious if kept within moderate limits, but is always attended with more or less danger of lead- ing to excess ; that it is always dangerous for a woman to drink at all : that it is dangerous for a man to drink until his habits and character are fairly formed ; that it is dangerous to drink before and during work ; that the reformation of a confirmed drunkard, either a periodical or a constant drinker to excess, is very rare. No. 33. Light Moselle or Rhine wine at meals. Occasion- ally beer during the day when in Germany, seldom here. Oc- casionally milk punch of rum ; seldom take any stimulant pre- vious to work. Have lived as above nearly all my life. Do not drink whiskey, and take brandy only as medicine ; believe in moderate stimulants as recuperator after work ; never take them before. No. 34. My personal experience is that a moderate use of good wine or spirits is conducive to health, and that people who cannot be moderate ought not to use stimulants at all. No. 35. I doubt whether the use of spirituous or vinous liquors is conducive to health, and equally doubt that the mod- erate use of either is harmful. No. 36. I think a man after fifty years can use a little liquor to his benefit if he has character enough not to abuse the use. I believe if used it had better be taken with the regular meals. As to the daily quantity, that would vary in the same manner as that of food. Every man should judge for himself. My observation is never begin to drink too early in life and become slaves to a foolish habit. Young men do not need liquor, and our social functions in this direction are bad. 338 THE LIQUOR PROBLEM. No. 37. I drink as a matter of habit, and not that I con- sider it especially healthful ; neither have I found it especially harmful. From personal experience I would not advocate par- taking of any alcoholic drink. As a dear friend of mine, a Ger- man professor of medicine, once said to me when we were dis- cussing the same subject, " I have known thousands to die from the effects of drink, but never knew one to die from the want of it." No. 38. I have seen or experienced no ill effects from a moderate consumption of liquor, but believe the regular use in many cases to be injurious, and especially in stand-up drinks. I think the main evil comes from the habit of treating, and in not considering it proper or manly to accept a drink without returning it as soon as the first drink has been finished. No. 39. From experience I find that a small quantity of light wine with one meal a day materially increases my capa- city for mental work. When the use of one gill of claret daily has been discontinued for a week or so, I find myself less inclined to mental work and apparently suffer greater physical fatigue in accomplishing such work. My experiences under other conditions are set forth in the March, 1887, " Fo- rum," under the title of " The Use of Alcohol in High Lati- tudes." Except where the experiences of other parties are clearly set forth in said article, the experience and observation are my own. EELATIONS OF DRINK HABITS TO INSANITY. BT J. S. BILLINGS, M. D. RELATIONS OF DRINK HABITS TO INSANITY. At the suggestion of the Physiological Sub-Committee the American Medico-Psychological Association undertook to obtain some data with regard to the relations between drink habits and insanity, and for this purpose the following form of queries was prepared corresponding to that used by the Bureau of Statistics of Labor of Massachusetts, in its twenty-sixth annual report, published in 1896. 30,000 of these forms were sent out to 117 state hospitals and asylums for the insane, and as a result 5145 cases were reported, being the current admissions at a certain number of these hospitals for one year. An effort was also made to secure data from some of the large general hospitals with reference to the drinking habits of the patients as admitted, but it did not meet with much success. A report has been received from Bellevue Hospital of New York city, furnished by the courtesy of Dr. W. Gilman Thomp- son, giving the record of 506 cases in the wards of Dr. Thomp- son's service, and giving the drink habits of each case, and also a note on 550 cases from the Presbyterian Hospital. The data obtained for the insane have been compiled into tables, which are herewith presented. From these tables it appears that of the 5145 insane persons, 2008 or 39.08 per cent, were total abstainers. In the Massachusetts statistics for 1886 persons, 36.87 per cent, were reported as total abstainers, while of the patients at Bellevue only 14 per cent, were reported as total abstainers, and at the Presbyterian 25.28 per cent. Of the excessive drinkers among the insane there were 12.22 per cent., the Massachusetts statistics giving 16.94 per cent., Bellevue Hospital 21.54, and the Presbyterian 14.90 per cent. Of those cases reported from insane hospitals the insanity was considered to be due to the influence of liquor in 1289 cases, or 24.08 per cent. The corresponding figure in the Massachusetts statistics is 20.86 per cent. 342 THE LIQUOR PKOBLEM'. COMMITTEE OF FIFTY. RELATIONS OF LIQUOR PROBLEM TO INSANITY. 1. (Name of lustitutioD filling this Schedule.) (Average insane population.) 2 (Date of Admission.) 1R<) 3 (City.) 4 (State.) 6 (Chiistian Name.) 6 (Surname.) 7 (Sex.) M F 8 (Age.) 9 (Occupation.) Place of BiETH or 10 (Patient.) 11 (Father.) 12 (Mother.) 13 (Citizen or Alien.> CB N A 14 (Language Spoken.) E and 15 Do you regard the patient's Insanity as due to the i of Intoxicating Liquors ? 16 Do you believe that the Intemperate Habits of one or both parents led to the Insanity of the person considered ? 17 Do you believe that the Intemperate Habits of the Grand- parents of the person considered led to his (or her) Insanity 7 IS Do you believe that the Intemperate Habits of Others (not parents or grandparents) led to the Insanity of the person con- LIQUOR HABITS. KIND OF LIQUOR. 19 Person. 20 Father. 21 Mother. 22 Person. 23 Father. 24 Mother. ED SD HD PD OD ED 8 D HD P D OD B D 8 D H D P D D W L B M L D L W L B M L D L W L B M L D L T A T A T A N. B. Draw a line across the letters designating the answers not applicable to the case. The letters C B, N, and A, under inquiry 13, denote respectively " Citizen Bom," " Natural- ized," " Alien." Letters under inquiries 15-18 Y, N, and N A stand for "Yes," "No," "Not Ascertained ; " E D, S D, H D, P D, O D, T A, under 19-21, for "Excessive Drinker," "Social Drinker," "Habitual Drinker," " Periodic Drinker," " Occasional Drinker," " Total Abstainer ; " those under 22-24 denote "Wine," "Lager Beer," "Malt Liquors" (other than lager beer), " Distilled Liquors." RELATIONS OF DRINK HABITS TO INSANITY. 343 Upon these and other figures presented in these tables It may be noted that the difficulty in measuring the influence of the use of liquor on poverty and crime by means of statistics pointed out by Prof. Farnam in his paper on " Some Economic Aspects of the Liquor Problem," in the " Atlantic Monthly," May, 1899, exists also in the statistical study of the influence of liquor upon disease, physical or mental. As a rule the use of liquor, when it is a cause, is merely one of a number of co- operating cases, while, not infrequently, it is a result rather than a cause of the disease. The data obtained by the American Medico-Psychological Association as to causes of insanity due to liquor, are largely based on the individual opinion of the observers, and these opinions are given without the data upon which such opinions were based. We do not know what symptoms were observed or record of history obtained, which led a physician to conclude that the insanity was due to the use of liquor, or otherwise, but comparison with the Massachusetts statistics gives percentages so nearly the same that it indicates, upon the whole, that the opinions of the physicians in the two entirely distinct groups were based upon the consideration of the same sort of circum- stances. The information furnished at the time when an insane person is admitted to a hospital, with regard to the cause of disease, is apt to be unreliable. Those habits of the patient which have been the most unusual, attract the most attention, and are given the greatest weight, and in the case of persons whose use of alcoholic drinks has been to excess, such use will be ascribed as the cause, although there may be a number of other causes, both inherited and acquired. In those cases reported as periodical drinkers, it is very doubtful whether the drink habits were causative so much as they were symptomatic. It is evident from the study of the tables that, as a rule, periodical drinking has not been considered as a symptom of disease of the nervous system, though it is well known to be such in many cases. The large number of excessive drinkers among the Bellevue patients is due to the fact that the proportion of hard drink- ers in persons admitted to this hospital is comparatively very high, a large number suffering from alcoholism when they are admitted. 341 THE LQUOR PROBLEM. Among those reported from the insane hospitals, the drink- ing habits of lOGO, or 20.60 per cent., could not be ascertained ; the Massachusetts statistics giving 26.58 per cent., Bellevue Hospital statistics, 4.54 per cent., and the Presbyterian Hospital 9.27 per cent. It is fair to assume that if tlie drink habit had been sufficiently marked to enter as a causative factor this would have been ascei'tained, and therefore the patients may be safely included in the class of moderate drinkers or total ab- stainers ; at all events they can be excluded from the hard or excessive di'inkers. We have no data with regard to the proportion of total abstainers in the class of population from which patients in hospitals for the insane are derived, and therefore do not cer- tainly know whether the proj:)ortion of total abstainers is greater or less than among the normal, but the proportion given by these figures, 39.02 per cent., would seem to be at least as high as, if not higher than, the proportion among average adults. In the data for persons in professional and business life collected by the Committee only 18.07 per cent, were found to be total abstainers. It is certainly improbable that nearly one quarter of the cases of insanity in this country are due to the use of alcoholic drinks, as might be inferred from these figures, and while in a given case of an excessive drinker who becomes insane, the con- nection between cause and effect may be plausibly made out, it is necessary to take into careful consideration other inherited or acquired abnormities or weaknesses of the nervous system. In any case where there is a tendency to psychic or nervous in- stability and abnormal action, either inherited or acquired, the excessive use of alcohol may act as the exciting cause, like a torch to inflammable material, but the same result may be pro- duced with any excess creating a strain on the nervous system, and the alcohol would produce no effect upon a nervous system in normally good condition. Inherited tendency to insanity, due to the use of liquor by parents, is reported in 122 cases. In 26 of these cases the fatlier alone was intemperate, and the mother alone in six cases ; while six cases were ascribed to the intemperance of the grand- parents. It would require something more than the usual amount of RELATIONS OF DRINK HABITS TO INSANITY. 345 attention given to the antecedent history of patients admitted to insane hospitals to determine the sources of inherited intem- perance, even if the antecedents give a plain history of intem- perate life. These statistics must be received with caution as showing possibilities rather than as definite evidence. To prove that the insanity of one generation is due to alcoholic excess of a previous generation, and is not merely a coincidence, requires that other causes of degeneration shall be carefully studied, and duly allowed for. 28J^It. or 55.27 per cent, of those reported from insane hosj)itals were citizens born, the Massachusetts statistics giv- i?ig 54:58 jjer cent, of citizens born. Of those whose insanity was considered to be due to the use of liquor, 44.26 per cent, were citizens born ; in males alone this percentage was 59.10, in females 41.74. It is to be hoped that this preliminary study may be supple- mented later by an exhaustive study of selected or representa- tive cases, seeking not alone the relations of the drink habit and insanity, but concomitant causes, as well as the relation of insanity to the drink habit conversely. Thus, in periodical drinkers, it should be ascertained how far the outbreak is a manifestation of a disordered brain. Frequently, it is doubtless rather an effect than a cause. The clinical study of alcohol habitues, and their mental degradation, must be accompanied by pathological investigation before the real truth can be ascertained. Table I. Table showing 5144 cases of insanity, the number of each in certain groups of ages, with distinction of sex and of causation. Insanity due to Liquor. Under Not 20 20-30 30-40 40-50 50-60 60-70 70-80 80 "scer. Total. M . . 5 123 247 207 111 45 10 1 19 768 F ... - 14 35 20 21 10 3 - - 103 Total. 6 137 282 227 132 55 Insanity not due to Liquor. 13 1 19 871 M . . 108 483 547 337 233 164 104 35 37 2048 F. . . 74 320 360 277 215 142 88 25 15 1516 Total. 182 803 907 614 448 306 192 60 52 3564 346 THE LIQUOR PROBLEM. Insanity due to habits of Parents. M . . 6 26 10 9 4 1 1 _ _ 57 F ... 5 23 20 9 2 3 1-2 65 Total. 11 49 30 18 6 4 2-2 122 Insanity due to habits of Grandparents. M..-1 1 1 - - ___ 3 F...- - 2 - - - -__ 3 TotaL -1 3 1 - - ___6 Insanity due to habits of Others. M..-- 1 2 - - -__ 3 F...- 1 8 2 4 4 -_- 19 Total. -1 9 4 4 4 ---22 Insanity cause not ascertained. M . . 11 76 101 70 34 26 15 8 14 365 F ... 5 48 49 45 20 19 7 3 8 204 Total. 16 124 150 115 64 45 22 11 22 559 Grand total. 6144 Tot. M 130 709 907 626 382 236 130 44 70 3234 " F 84 406 474 353 262 178 99 28 26 1910 Grand total. 5144 Table II. Table showing 871 cases of insanity due to liquor used by patients, with distinction of sex and nationality. DL W W W W W W LB LB LB LB ML Ml W LB ML DL LB LB ML DL ML DL LB ML DL DL ML DL Citizen born, M. 116 14 13 1 5 2 8 12 7 71 45 2 21 117 1 - 19 454 " "F. 427----1241--17--6 43 Total ... 120 16 20 1 5 2 8 13 9 75 46 2 21 134 - - 24 497 Iriah ...M. M12-----2 20 714 13 1-5 110 F. 446-----1351112 1-442 Total ... 58 58-----323 12 25 25 2-9 152 German ..M. 18 12--2-4-61-2 11--148 i< F. -------2----- ----2 Total ... 18 12--2-6-61-2 11--150 25311---117515 1B--368 2 - 1 - 1 - Scotland, S Canada, ) Total ... 273211--128516 17--4 78 RELATIONS OF DRINK HABITS TO INSANITY. 347 AU other |M. 22 21-2-12-99--24--173 countries, tF. __-___-____2- 1-1- 4 Tottd ... 2221-2-12-992-25-11 77 Nationality IM. 6------1-2--- 4--2 15 unknown, )F. ------------- ---2 2 Total .... 6------1-2--- 4--4 17 Grand total .... 871 Table III. Table showing 871 cases of insanity due to liquor habits of patients, with distinction of sex and nationality. Male. ED SD HD PD OD NA TA 00 Total. Citizen born . . 62 21 114 33 16 8 - - 454 Irish .... 67 1 33 3 3 3 - - 110 German ..35 1 9 2 1--- 48 Eng., Scot., Can. 39 3 21 2 3 _ _ _ 68 All others ... 46 3 15 4 2 3 - - 73 Natl'y unknown 61 1313--15 Total male . 255 30 193 47 26 17 - - 768 Female. Citizen born . . 17 2 11 5 3 5 - - 43 Irish ....22 4 7 4 14-- 42 German ...1 - - - 1--- 2 Eng. Scot., Can. 4- 31-2--10 All others ...2 - 1 - ____ 4. Natl'y unknown -- ___2-- 2 Total female .46 6 22 10 6 13 - - 103 Grand total . 301 36 215 57 32 30 - - 871 Table IV. Table showing 871 cases of insanity due to liquor habits of patients, with distinction of sex and nationality. Citizen Scotch, All other Natl'y Male. bom. Irish. Oerman. Canadian. countries. unknown. Total. Age under 20 years 2 - 1 1 1 - 5 " 20 to 30 " 82 17 6 7 11 - 123 " 30 to 40 " 163 23 7 25 26 3 247 " 40 to 50 " 118 28 19 20 21 1 207 « 50 to 60 " CO 26 10 6 8 1 111 " 60 to 70 " 17 10 5 8 5 - 45 " 70 to 80 « 5 3 - _ 1 1 10 " 80to - " - 1 - _ - - 1 Age not ascertained 7 2 - 1 - 9 19 Total male . . 454 110 68 73 15 768 348 THE LIQUOR PROBLEM. Female. Age under 20 years " 20 to 30 " « 30 to 40 " " 40 to 50 " « 50 to 60 " " 60 to 70 " « 70 to 80 " « 80 to - " Age not ascertained Total female Grand total . . Irish. German. 6 12 10 2 Eng., Scot. Canadian. All other couutriea. Natl'y unknown. Total. 3 _ _ 14 3 2 - 35 4 1 1 20 - 1 1 21 - - - 10 - - - 3 103 497 152 60 78 77 17 871 Table V. Table showing 150 cases of insanity due to habits of parents and others Liquor habits of patients, with distinction of sex and nationality Male. Citizen born Irish . . . HD German ... Eng., Scot., Can All others . Natl'y unknown *. Total male . Female. Citizen born . Irish .... German . . . Eng., Scot., Can. All others . . Natl'y unknown Total female Grand total . 18 Total. 43 1 4 2 13 B 63 63 3 7 6 2 28 12 38 38 64 150 Table VI. Table showing 63 cases of (male) insanity due to drinking habits of parents, with distinction of nationality. 5D SD HD PD ( 19 2 6 2 Male. Citizen born . . Irish German . . . . Eng., Scot., Can. . All other countries Natl'y unknown . Total . . . . NA TA Total. 5 - 37 - - 1 - - 4 _ - 2 1 _ 13 57 RELATIONS OF DRINK HABITS TO INSANITY. 349 !D 8D HD PD OD NA TA Total. - - - 1 - 2 3 Male. Insanity due to > grandparents J Insanity due to other persons Grand total }■ Table VII. Table showing 87 cases of female insanity due to drinking habits of parents, with distinction of nationality. Female. ED SD HD PD OD NA TA Total. Citizen born . . . 13 4 23 2 2 6 _ 50 Irish - _ 1 1 _ 2 German 2 1 _ 1 _ 4 Eng., Scot., Can. . - 2 1 1 _ 4 All other countries . - 1 _ 1 _ 2 Natl'y unknown . . - - - 3 - 3 Total 15 4 27 4 3 12 - 65 Female. Insanity due to l grandparents J Ius.anity due to ) other persons ) - - - 1 2 10 2 7 3 19 Grand total . . . 15 4 27 4 5 23 9 87 Table VIII Table showing 63 cases of insanity of sex, age due to habits of and nationality parents, with distinction Male. Citizen born. Irish. German English, Scotch, Canadian. All other countries. Total. Af re under 20 years ' 20 to 30 " . 5 . 21 1 1 1 1 2 6 26 ' 30 to 40 " . 3 - 1 1 5 10 ' 40 to 50 « 7 - - - 2 9 ' 50 to 60 " 1 - 1 - 2 4 ' 60 to 70 " . - - - 1 1 ' 70 to 80 " . - 1 - - 1 ' 80 to - " - - - - - - Not ascertained - - - - - - Total .... . . 37 1 4 2 13 67 350 THE LIQUOR PROBLEM. Male. Insanity due to grandparents. Age 20 to 30 years . " 30 to 40 " . " 40 to 50 " . Citizen bom. Irish. . . 1 . . 1 . . 1 English, Scotcli, All other German. Canadian, countries. Total 3 Male. Insanity due to other persona. Age 30 to 40 years .... 1 - - - - " 40 to 50 " .... 2 Total 3 - - - - 3 Graad total 63 Table IX. Table showing 87 cases of insanity due to habits of parents, with distinction of sex, age, and nationality. Female. C tizen born. Age under 20 years 5 " 20 to 30 " 17 " 30 to 40 « 17 " 40 to 50 " 6 " 50 to 60 " 2 " 60 to 70 " 2 " 70 to 80 « - " 80 to - " - Not ascertained 1 Total .... 50 Irish. German. 1 1 1 1 1 English, Scotch, Canadian. All other countries. Natl'y unknown. Total. 5 -• 2 23 2 20 - - 9 _ _ 2 - - 3 _ - 1 65 Female. Insanity due to habits of grandparents. Age 30 to 40 years . 1 Not ascertained Total , Female. Insanity due to habits of others. Age 20 to 30 years " 30 to 40 « " 40 to 50 " " 50 to 60 " " 60 to 70 " Total , 12 1 2 1 3 1 8 2 4 4 19 RELATIONS OF DRINK HABITS TO INSANITY 351 Table X. Table showing insanity due to the drinking habits of each parent. Male. Female. Father. Mother. Total. Father. Mother. Total. ED TA 26 ED TA 8 SD TA 2 SD TA 2 HD TA 4 HD TA 15 OD TA 2 PD TA 2 SD NA 1 OD TA 3 HD NA 5 NA TA 1 PD NA 1 ED NA 7 NA NA 5 SD NA 1 TA ED 1 HD NA 6 ED HD 1 NA NA 10 ED OD 4 NA HD 1 HD PD 1 ED HD 1 HD OD 2 SD OD 1 PD PE 1 HD ED 2 OD ED 1 HD OD 3 PD HD 1 Total . 57 Total . . . 65 Due to grandparents . . . 3 Due to grandparents ... . 3 " " other persons . . 3 " ' ' other persons ... . 19 Total . 63 Total . . . 87 Gra>nd. tota.1, both sexes . 150 Table XI. Table showing 150 eases of insanity due to drinking habits of each parent, with distinction of sex. Father. Mother. Total. Father. Mother. Total. ED TA 26 ED TA 8 ED HD 1 ED NA 7 ED OD 4 ED HD 1 SD TA 2 SD TA 2 SD NA 1 SD NA 1 HD TA 4 SD OD 1 HD NA 5 HD TA 15 HD PD 1 HD NA 6 HD OD 2 HD ED 2 PD NA 1 HD OD 3 PD PD 1 PD TA 2 OD TA 2 PD NA 1 352 THE LIQUOR PROBLEM. Father. Mother. OD ED TA ED NA NA Total Female. Total. Father. Mother. Total. 1 PD HD 1 1 OD TA 3 5 NA TA 1 NA NA 10 NA HD 1 67 Tot Due i\ . 65 3 to grandparents 3 3 " " other persons . 19 Due to grandparents . " " other persons . Total, male 63 Total, female 87 Grand total, hoth sexes 150 Table XII. Table showing 3564 cases of insanity not due to liquor habit, with distinction of sex, age, and nationality. English, Scotch, All other Natl'y Male. Citizen born. Irish. German. Cauadia J. countries. mknowD . Total. Age under 20 ye vrs . 77 2 4 3 20 2 108 " 20 to 30 ' . 335 16 25 19 87 1 483 " 30 to 40 ' . 305 27 58 44 106 7 547 " 40 to 50 ' . 188 23 49 29 46 2 337 " 50 to 60 ' . 123 30 23 26 30 1 233 " 60 to 70 ' . 87 24 20 20 12 1 164 " 70 to 80 ' . 50 20 10 7 9 2 104 " 80 to - ' . 23 6 4 1 1 - 35 Not ascertained . . 20 2 7 - 2 6 37 Total . . . . 1214 150 200 149 313 22 2048 Female. Age under 20 ye irs . 51 4 2 7 9 1 74 " 20 to 30 ' . 214 27 20 23 32 4 320 " 30 to 40 " . 238 26 16 36 41 3 360 " 40 to 50 " . 106 16 31 42 21 1 277 " 50 to 60 " . 25 135 15 26 13 1 215 " 60 to 70 " . 77 23 18 16 7 1 142 " 70 to 80 " . 51 22 7 6 2 - 88 " 80 to - " . 18 6 - - - 1 25 Not ascertained . . 4 1 2 1 6 1 15 Total . . . . 844 260 111 157 131 13 1516 Grand total . . 2058 410 311 306 444 35 3564 RELATIONS OF DRINK HABITS TO INSANITY. 353 Table XIII. Table showing 3564 cases of insanity nol due to liquor habit, with distinction of sex and nationality. Male. ED SD HD PL) OD NA TA Total. Citizen born . 21 125 20 15 2i«j 123 614 1214 Irish .... 4 9 3 7 57 3 67 150 German . . . 3 26 3 2 78 10 78 200 Eng., Scot., Can. 3 15 - 3 39 16 73 149 All others . . 5 43 2 2 106 11 144 313 Natl'y unknown - 1 - '■^ 4 4 9 22 Total male . 38 219 28 31 580 107 985 2048 Female. Citizen born 2 24 3 3 83 219 610 944 Irish .... 1 5 3 1 39 55 56 160 German . . . - 17 2 - 24 18 50 111 Eng., Scot., Can. 1 5 - - 16 do 70 157 All others . . . - 10 - - 13 29 79 131 Natl'y unknown - 1 - - 2 8 ^ 13 Total female 4 62 8 4 177 394 867 1516 Grand total . 42 281 561 1852 3564 Table XIV. Table showing 559 cases, cause of insanity not ascertained, with distinction of sex and nationality. Hale. Citizen born. Irish. German Eitf]^li.sh, Sooti'li, Canadian All other countrie.s Natl'v inikno%Vn Total. Under 20 years . 6 - 1 - 3 1 11 20 to 30 " . 53 1 1 3 10 8 76 30 to 40 " . 61 2 11 t'l 17 4 101 40 to 50 " . 35 3 6 6 14 6 70 50 to 60 " . 22 3 4 1 2 2 34 60 to 70 " . 11 4 6 - 3 2 26 70 to 80 " . 3 4 4 2 1 1 15 80 to - " . 2 2 1 _ _ 3 8 Not ascertained . 3 - 1 2 '■i 6 14 Total male . . 196 19 35 20 52 33 355 Female. Under 20 years . 5 - - - _ - 5 20 to 30 " . 21 2 10 2 10 3 48 30 to 40 " . 21 7 3 1 13 4 49 40 to 50 " . 17 4 9 5 6 4 45 50 to GO " . 7 5 3 1 3 1 20 60 to 70 " . 10 1 3 1 4 - 19 THE LIQUOR PROBLEM. Male. 70 to 80 years . Citizen born. Irish. 2 Ge^an. Kii^'liish, Scoti-h, Cauadiati. All other i-ouiitrieB. 2 Xatl'y uukuovvii Total. 7 80 to - " . 2 1 - _ - - 3 Not ascertained . 1 1 - - 1 5 8 Total female . 57 23 28 10 39 17 201 Graiiil total . . '283 42 03 30 91 50 559 Table XV. Table sliowiiig 559 cases, cause of insanity not ascertained, with cli.stinctioii of sex, age, and nationality. Male. ED SD HD PD OD NA TA Total. Citizen born . 10 45 ■.\ 5 30 70 33 196 Irish .... - 1 1 - 7 10 _ 19 German . . 1 3 1 - 5 24 1 35 Eng., Scot., Can 2 - 3 - 1 10 4 20 All otliers . . - 1 1 - 3 43 4 52 Natl'y unknown - - - - - 33 - 33 Total male . 13 50 9 5 46 190 42 355 Female. Citizen born . 1 1 _ - 1 55 29 87 Irish .... 1 _ 2 1 1 13 5 23 German . . . - 1 1 - 1 18 7 28 Eng., Scot.. Can. - - - - - 7 3 10 All others . 1 - 1 - 1 33 3 39 Nat'ly unknown - - - - - 14 3 17 Total male . 3 2 4 1 4 140 50 204 Grand total IG 52 13 6 50 330 92 559 The following meniorandum upon the drink habits of patients at Belle vue Hospital. Xew York city, under the care of Dr. W. Oilman Thompson for one year, has been furnished by Dr. Thompson : — Total number treated in the wards of Dr. Tliompson's ser- vice for one year 506 Males 380 Females 126 Of these there were hard drinkers, males Females 101 Total 109 Per cent 21.54 RELATIONS OF DRINK HABITS TO INSANITY. 355 Moderate drinkers, males 231 Females ................. 72 Total 303 Per cent 59.88 Abstainers, males 35 Females 36 Total 71 Per cent 14.03 Not ascertained, males 13 Females 10 Total 23 Per cent 4.54 Drinkers of spirits, males 14 Malt liquors, males 78 Wines 5 Spirits and malt liquors together 178 Drinkers of spirits, females 3 Malt liquors 34 Wine 7 Spirits and malt li(]uors together 27 A considerable proportion admitted into tliis service are suffer- ins;' from alcoholism when admitted, and the jiroportion of hard drinkers is very high: a large proportion of them are foreigners and are mainly Irish and German. THE INFLUENCE OF ALCOHOL ON GROWTH AND DEVELOPMENT C. F. HODGE, Ph. D. PROFESSOR OF PHYSIOLOGY, CLARK UNIVERSITY THE INFLUENCE OF ALCOHOL ON GROWTH AND DEVELOPMENT The following experiments were undertaken for the purpose of studying the influence of alcohol upon the more general physiological processes, such as growth, vigor, and resistance to disease, health, activity and development of intelligence, nor- mality and viability of offspring. In all four series of investi- gations have been made : — 1. Upon the influence of minute percentages of alcohol on the growth of yeast. 2. The influence of moderate doses of alcohol upon the growth of kittens. 3. The influence of alcohol upon the growth, intelligence, activity, and offspring of dogs. 4. Influence of alcohol on the daily activity of rats. The work was begim in the fall of 1895, and reports of these experiments uj) to dates of publication have been printed in various journals. ^ It is proposed here to give a brief summary of these publications and of additional results up to the present date. The point of view from which tlie work was undertaken was that most of the apparent contradictions in the results of at- tempts at the solution of the alcohol problem are due to the great complexity of the human organism. Of all animals man is the most adaptable to all sorts of conditions of life. Some men fail with alcohol, others fail as completely without it, and ' " Experiments on the Physiology of Alcohol made under the Auspices of the Committee of Fifty," Appleton's Popular Science Monthly, March and April, 1897. " Influence of Alcohol on the Viability of Offspring of Dogs and on their Susceptibility and Resistance to Distemper," Journal of the Boston Sociel)/ of Medical Sciences, December, 1897. " Variations in Daily Activity produced by Alcohol, and by Changes in Barometric Pressure and Diet, with Description of Recording Methods," Colin C. Stewart, American Journal of Physiologij, vol. i. 1898. 360 THE LIQUOR PROBLEM. the same is true of success. This has made the definite inter- pretation of the human experiment impossible. The method of physiological science is to reduce the problem to simplest terms in every way possible. A unicellular organism is millions of times simpler than a human body ; still all fundamental func- tions and processes, such as nutrition, growth, reproduction, excretion, appear similar in both. Hence by studying tlie influ- ence of alcohol upon these functions in simpler organisms, evidence may be gained by which more clearly to interpret the human experiment. The lower animals, complex as they are, are much simpler in all their physiological adaptations than man, and yet approach him more closely in the details of physiologi- cal processes, and thus render closer comparison jjossible. Their conditions of life, moreover, may be made more nearly compar- able than it would ever be possible to find or procure with men. In man, even after death, microscopical investigation of the tis- sues to demonstrate the influence of alcohol upon them is so complicated by all manner of disease and by post-mortem changes that no wholly trustworthy evidence is obtainable. Animals, on the other hand, may be killed in known conditions of health, and their tissues may be immediately prepared for microscopical examination. In this way important results have been obtained by Berkley ,i Dehio,^ Stewart,^ and others, that have materially aided the interpretation of findings in human tissues. Four t5'pes of physiological influence that alcohol may exert on a vital function are represented to the eye in the left hand diagram of Fig. 1. It may have no effect, as represented by the line mai-ked " normal." It may stimulate activity, dotted line Y, or it may depress, or decrease activity, dotted line X, or, finally, small amounts may exert a proportionally greater influence than larger quantities, heavy line N. This last was found to be the influence of minute percentages of alcohol on 1 Henry J. Berkley, " Studies of the Lesions produced by the Action of Certain Poisons on the Cortical Nerve Cell," Alcohnl, Brain, 1895, p. 473. - Heinrich Dehio, " Experimentelle Untersnchungen iiber die Veran- derungen der Ganglienzellen bei der acuteu Alkoholvergiftung," Centralbl. fur Nervenheilkunde und Psychiatric, 1895, p. 113. ^ Colin C. Stewart, " Lifluence of Acute Alcohol Poisoning on Nerve Cells," Jourtial of Experimental Medicine, vol. i. No. 4, 1896. 0% NORMAL. /^OOO f. ALCOHOL. y Fig. 2. — G. C, curve of a o-eometrical progression increasiii*;' at the rate of yeast growth iu the luirinal cultures for the first twenty-four liours. The numbers at the right indi- cate the number of toruliz found in a cubic millimetre of the different cultures. INFLUENCE OF ALCOHOL ON GROWTH. 361 the growth of yeast. The line N in the diagram is, in fact, plotted from the results of the fifth series of experiments. The figures from which the curve is drawn are as follows : — Growth of yeast, .leries 5. Per cent. Count V. of alcohol. 48 hours. 0. (■/„ 1102 0.001 '/„ 999 0.01 1% 912 0.1 % 602 1- "/c ^16 The diagram at the right in the figure expresses the same result as a race, a competitive effort, in which the cultures containing no alcohol are seen to win, the others falling below proportionately to their alcohol content. Fig. 2 is a similar expression for tlie third series of ex])eriments. The method of uniformly seeding the cultures had not been perfected ; still the same general effect is apparent. And this is the unquestionable result in all the experiments, fifteen in number. The form of the curves derived from all these experiments is that ordinarily obtained for the physiological fatigue of a tissue, muscle, nerve, or gland. This is what we should expect, since an important factor in causation of fatigue is accumulation of waste pi'oducts, and alcohol is a waste product in the activity of the yeast plant. Alcohol is probably, also, a partial decom- position product in the metabolism of a number of animal tis- sues, such as brain, muscle, and liver, but with some or all of these it is further oxidized to carbon dioxide and water.^ While of considerable physiological interest, the fact that alcohol in such minute traces interferes with the growth processes of so simple an oi'ganism as yeast, this result cannot be directly applied to organisms capable of oxidizing alcohol. Kittens, as comparable as it was possible to find them, were secured, alcohol was given to one pair, keeping a number of others as controls. It was intended to breed from them, if pos- sible, and follow a similar line of experiments as those to be subsequently described for the dogs. The doses of chemically pure alcohol, diluted vs^ith water to twenty, and later to thirty ' Scliiifer, Text-hnnk of Phf/siohr/i/, vol. i. 1-S82, Edinburgh and London, 1898. Also Hopiie-Syler, Ilamlliuch der chemischen Analyse, Berlin, 189.3, p. 40. 362 THE LIQUOR PROBLEM. per cent., began with 1.3 grammes, and were increased to 3.6 per kilogramme of body weight. Since kittens refuse to drink milk with even the odor of alcohol about it, the doses had to be given with a stomach pump, and the same amount of water was given the normals. Ten days of this regimen, however, was followed by so com])lete a collapse that alcohol was discontin- ued, until approximately normal health should be restored. This did not prove possible, the male lingering along, with very little gain in weight, for about four months, and the female partially recovered, but was killed by a dog. The disease that developed, first in the alcoholic kittens, seemed to be an acute catarrh of respiratory and alimentary systems with conjuncti- vitis. Some weeks later all the normal kittens were affected in the same way, and either died or were killed in the last stages of the disease. Practically all the cats in the neighborhood were affected in the same way, and the experiment was aban- doned. Fig. 3 gives at a glance the relative growth of the kittens during the course of the experiment. It will be noted that those having been given the alcohol are much stunted as com- pared with all the others, but whether this is caused by the alcohol or the disease it is impossible to say. In beginning the experiment, it was remarkable how quickly and completely all the higher psychic characteristics of both the kittens dropped out. Playfulness, purring, cleanliness and care of coat, interest in mice, fear of dogs, while normally de- velo])ed before the experiment began, all disappeared so suddenly that it covdd Fio. 4. Alcohol-diseaspd kittens! and 3. June 4. 1 895: hardly be explained characteristic attitude. When the pliotograph was taken, otherwise than aS a 5 p. M., all the normal kittens were playing actively. direct influence of the alcohol upon the higher centres of the brain. Fig. 4 presents the characteristic appearance of the alcoholic kittens. They simj)ly ate and slept, and could scarcely have been less active 1 895 2 Ki MAY J3S JUNE JULY AUG. „4 i<>^ rT^ '63X 1 4 — ^^ S ^^^v Fig. .J. — Gkuwtu ok Kittens. ■-', 4, i;, s. II, N.iR 1, 3, Alcoholic. Fig. G. — Gkowth of the Dogs. Tipsy. Nig. Fig. 5. — November 27, 1895. TorsY. Tii-sv. Nig. Fig. 12. — October, 1890. INFLUENCE OF ALCOHOL ON GROWTH. 363 had the greater part of their cerebral hemispheres been removed by the knife. None of the other normal kittens showed any- thing like so sndden and comjjlete a collapse. In a series of experiments upon dogs which, it was intended, should be continued during the length of their n.itinal lives, neither jjaius nor expense was spared to obtain animals as com- parable as possible and of good stock. The four cocker span- iels presented in Fig. 5 were finally selected, and for all pur- poses of the experiment they have been in breed and strain all that could be desired. Although belonging to two not closely related kennels, the four happened to have been born on the same day, February 22, 1895. April 29 they weighed as follows : — Tipsy . . . 2102 grammes. Bum . . . 2179 grammes. Topsy . . . 2150 grammes. Nig . . . 1556 grammes. Topsy and Tipsy are sisters. Nig and Bum, brothers from their respective litters.^ After preliminary study, in order to discover minor differ- ences in disposition, health, or character of the dogs, it was decided to give the alcohol to the more vigorous pair. Tipsy and Bum. Accordingly its administration, in the form of tested, chemically pure alcohol, thoroughly mixed with their chief meal, was begun on May 24 following." The dogs were weighed, at first daily, later once a week, and their growth may be read from Fig. 6, together with that of a subsequent group to be described later. No "stunting" effect of alcohol as administered is to be found in this growth chart. Probably four puppies could not be found to grow more uni- formly under ordinary treatment. Measurements also showed that the bony frame in each of the dogs was about the same ' The only apology 1 have to offer for the names is that in long-continued experiments of tliis kind names must be chosen for daily use, and need to be, with dogs, phonetically distinct, to avoid confusion. I thought it also desirable for long series of notes and descriptions that the name suggest the treatment to which the animal was subjected. - .\leohol, ordered for the purpose from Kahlbaum, was used throughout the experiments, and each lot was especially tested. The plan of the experi- ments, with the sub-committee's approval, was to give as large doses as pos- sible short of producing noticeable intoxication. This dose was found for the dogs to be four cubic centimetres per kilogramme of body weight. For further details, refer to Appletou's Popular Science Monthly, April, 1897. 364 THE LIQUOR PROBLEM. in relation to the otliers as its weiglit. That is, there was no evidence of excessive develoj)ment of fat that might have kept lip the weight while the framework of the body remained under- sized. Since both " stunting" and accumulation of fat are often insisted upon as due to direct effects of alcohol, these are impor- tant facts in its general physiology. Before passing to topics of more general physiological inter- est, we may turn aside for a moment to consider briefly three series of collateral experiments. The first of these, begun in April, 189G, had for its object the testing of ordinary commercial liquors, an ordinary whiskey, wine, and beer. Three puppies of the same strain and from the same litter were secured, and the respective liquors were administered as indicated again by the names of the dogs.' Their growth chart, with Topsy's and Tipsy's superimposed for corresponding months, is given in Fig. 6. Frisky and Winnie are seen to grow normally, while Berry falls considerably below. Their health remained apparently good until June, when they all broke out with eczema. Berry having it worst, Winnie not quite so bad, and Frisky lightest of all. The growth of Frisky and Winnie, at least, indicates the absence of deleterious ingre- dients in the wine and whiskey, and it is certainly going beyond the evidence to attribute the eczema to anything except the water in the liquors. This was its first appearance in the ken- nel, and neither Tipsy nor Bum was affected. Kennel man- uals uniformly caution against making the food of puppies " slojtpy," chiefly on account of danger from eczema, and the percentages of water in the liquors (whiskey, Qlfi, wine, 82fo, beer, 95.Tfo) made this necessary, especially with the wine and beer, if amounts of alcohol at all comparable with the other experiments were given. Two more experiments were made to test whether Berry's deficient growth should be considered a beer effect. One of these consisted in selecting three of Topsy's male puppies as 1 Frisky's dose was 100 cc. of wliiskey, of SS^/^, ; Winnie's, 120 ee. of wine, Burgundy, of 18'^/^, ; and the largest amount that Berry could be induced to take was 125 cc. of beer, of 4.3 '';;{, , alcohol content. The fate of each of these dogs may conveniently be stated here as follows : Berry was run over on the street and killed in the fall of 1S'J6, Winnie died of distem- per the following summer, and Frisky is still alive. Minnehaha. Bekky II. Fig. S. — November, 1897. INFLUENCE OF ALCOHOL ON GROWTH. 365 comparable as possible, and giving to two of them as much beer as they would take, keeping the third one on normal diet. Their weights are shown in the following table : — Weight of puppies, third beer experiment. At birth, Oct. 20, 1897. Jan. 1, 1898, beer, 50 cc. twice daily to Jan. 8. Mar. 20, 1898, beer, 100 cc. twice daily from Jan. 8 to date.' Normal, 358 gms Berry III., 219 gms Berry IV., 218 gms 3660 gms. 3490 gms. 3540 gms. 6860 gms. 7050 gms. 7550 gms. ' Experiment discontinued. Plainly this experiment gives no support to the first. And nothing abnormal was remarked about the animals, except that they became much more timid than any of the other puj)pies in the kennel at the time. This is a point of importance to be re- served for discussion in its proper place, but it was noted that if a stranger came into the kennel, all the normal pups would rush forward to make friends, while these two would run away. The other experiment, begun in the fall of 1896, and con- tinued for over two years, was made with three of Topsy's female puppies. One was given normal diet, a second was given beer, and the third had an amount of water equal to the beer. The puppies were named for convenience, respectively, Teeto, Berry II., and Minnehaha. A few of their weight rela- tions may be read below : — Weight of puppies. second beer experiment. At birth, Oct. 27, 189G. Jan. 1, 1896, beer and water, 50 cc. each. Jan. 17, twice daUy, 75 cc. Jan. 24, 1S97, 100 cc. each twice daily to May, 1897. Oct. 10, 1897, 200 cc. once daily tliere- after to last d.Ue. Mar. 12, 1898. Teeto, 250 gms. . . . Berry II., 220 gms. . . Minnehaha, 260 gms. . 2660 3280 3100 3690 4650 4280 7000 9570 9300 8510 11,.390 9470 Relations of stature are equally instructive, and may be given for November 14, 189T, when the dogs had practically attained their growth : — 366 THE LIQUOR PROBLEM. Length in cm. Height in cm. Berry II 08 Xi Minnehaha 01 24 Teeto 51..5 24 Topsy 01 31 Nig- 01 -Zd These size relations are further shown in Fig. 8, whicli siioukl be compared with Fig. 7, before deciding upon any " stunting " effect of beer. It sliouhl be added that Teeto was the only well-formed dog in the group. Both Minnehaha and Berry II. presented the lanky, scrawny appearance characteristic of the dogs in the first experiment. Both Teeto and Minnehaha conceived nor- mally, while Berry proved completely sterile. The beer was given, as in the case of alcohol and the other liquors, uniformly with the meals, twice daily nj) to about six months of age and once daily thereafter. Although frequently offered, none of the animals ever took any of the liquors when unmixed with food, and no trace of an " alcohol habit " could be detected. The reverse, in fact, was uniforndy noted, and, when given the choice, all the dogs experimented with showed a decided preference for food that did not contain alcohol or any form of alcoholic liquor. Having gained a general introduction to all the dogs in the kennel, we may now take up the dift'erent phases of their gen- eral physiology. And first we may properly discuss the health, vigor, and freedom from disease of all the animals for the entire research. Kennel hygiene has been maintained practically perfect throughout. The dogs have had a large sunny yard of nearly a quarter of an acre, and whenever possible have been given complete freedom besides. They have had a new, dry, clean kennel, which has been thoroughly disinfected twice a year, the best of food, Spratt's biscuit, milk, eggs, wholesome meat, and plenty of gnawing bones : and clean fresh water, renewed twice and three times a day in warm weather. Regular and careful attention was given to both external and internal parasites, and no complications have arisen from these sources. All these conditions have conspired to render the experiments physiologi- cally ideal. As a consequence, with one exception, > the health ' In the spring of 1896 Bum developed unilateral goitre. This yielded *""' _ - _ ^ - . : JL -, .!_-„- 1 ICCi_ - I ieSS--Z "•^"■-jS " ^ s;"^^. ?\ V -^1^ -/^-- ^i. ^ : ^Sn, An- t^I ^cs^ Zi ^v Jl ^- S 44?^ / CilJ-, Z ^z '5-; 15 3u] L.j^E-'S ii'-^ L^-^^yAli-- iooZ-'/-'t • s:_/^ z '5tf- tit-'tt ^-^ i^v'l ^, ^-'--i. j^. " :'-• [^* -K Si'"-' ^■^"^s.LAC 5L^^£<.-vB Ov-^ ^ 1i,Z-^l. ••""■" "±1 >:. ' 1^-1 """ sz! ~ "'■■ ' "^^ ^^ ''".„^.r'^' ^oimyaE _ --- 3cj -i;;i-3cc iraut . iiw..vi/n^ — ^- -jkw 3D»SE ' X i ALCOHOLIC '^ "4="" '^ o- T It ; 1 BAROMirEt^ r" " :,, "x Fig. 0. — Daily Activity. ALCOHOL TO BUM 35 G. DAILY NO ALCOHOL GIVEN / ^-- // ~^^ \ ^ / :/ \ / ^ / / \ / \, / 1 1 1 \ ^ / 1 \ / \ / 1 :x " / --- --' \ ^. " \ V / // \ > ,/ ►' y ^, \ X" [ / / / **»* y ^■-- --' " ^ ^^ N • ^^' ■ / J7^ 18 19 ZQ Zt Z3. i3 ^4 A3 26 47 26 29 30 Nig RETEre\TEB ^^^^— ^ " Attempts ■ Bum Retrieves - — - - " Attempts - Fig. 10. — Curve op Efficiency (Competitive). In a difficult competitive test calling for endurance, sustained attention, etc., the alcoholic falls much lower relatively than in ordinary dailj activity, Bum attaining to only thirty-two per cent, of Nig's efficiency. INFLUENCE OF ALCOHOL ON GROWTH. 3G7 of the clogs remained perfect for nearly two years and a half. The spring and early summer of 1897 were extremely wet. Distemper became epidemic throughout the city, and assumed a malignant type. Sick dogs were not uncommon on the streets. Many dogs died, Mr. Browning's kennel, from which all the females in our experiments were obtained, losing fifteen outright. Of course, this sickness and loss occurred in kennels, and among individuals maintained under what are usually considered normal conditions. The history of the epidemic in our own kennel thus derives practically all its significance from the possession of adequate controls in the normal dogs. The dogs in the kennel at the time were : — Alcoholic. Normal. Bum, Nig, Tipsy, Topsy II., Frisky, Teeto, Winnie, Minneliaha. Beny II. The disease appeared first in Winnie, July 6, and she died the evening of the 8th. She had four days previouslj' given birth to four whelps, all of which had died before the close of their second day. Tipsy was second to come down, July 9th. The affected dogs were promptly isolated from the rest, but Frisky was added to their number July 12, and Bum the day following. I have since been assured that they all passed through a mild form of the disease, but none of the other dogs developed the more characteristic symptoms of distemper. They were all rather sluggish for a few days, and discharged somewhat from the eyes and nose ; but they were not observed to cough and retch, and they did not lose flesh or appetite. With the four alcoholic dogs it assumed its severest form. The symptoms usually described as diagnostic developed rap- idly, excessive weakness and prostration, great loss of flesh, and complete absence of appetite. Frisky, however, rallied promptly, and was out of danger within a week. With Tipsy and Bum promptly to the proper treatment, which consisted in painting with tincture of iodine, and giving small doses of dessicated tliyroid, and has not ap- peared since. 368 THE LIQUOR PROBLEM. the disease assumed a niucli more serious form. Both were affected exactly alike, were completely prostrated, and refused nourishment of every kind, so that for a week I was compelled to drench them with hot milk and eggs at frequent intervals. In both eases the corneas ulcerated badly, the idcers being held in check with great difficulty by frequent applications of eye washes. All four corneas became completely clouded, and both dogs were tempoi-arily blind. For over two weeks I hardly expected either of the dogs to live from day to day. Under ordinary care, I have little doubt that both would have died. I resorted, however, to every possible device for feeding and proper medication. Alcohol was omitted from their diet, and though frecpiently offered to them, they invariably refused food containing it. After their severe sickness both dogs gained flesh rapidly, and none of the nervous sequel.-e, so often worse than distemper itself, made their ajipearance. The eyes healed and cleared up, with the exception of one of Tipsy's, which remained perma- nently clouded and blind. In a word, the line was quite sharply drawn in the kennel between the normal and alcoholic dogs. All the alcoholic dogs, with excei^tion of Berry II., and she had had the least alcohol of all, had the disease with considerable or very great severity. All the normal dogs had it in the mildest form possible. This would seem to indicate, for distemper, at least, if not increased susceptibility to infection, a much diminished power of resist- ance on the part of the alcoholic dogs. The bearing of this result on various human diseases is too patent to require refer- ence. Distemper would probably prove an intei-esting disease with which to study, in greater detail and with more exactness than was possible under the circumstances, comparative suscep- tibility to infection and resistance to disease in alcoholic and normal animals. The normal daily activity of the animals, development of in- telligence, and ability to withstand fatigue in the performance of difficult muscular feats, are topics naturally associated with the health and vigor of the nervous and muscular systems. To test daily activity a form of pedometer was devised ^ which could 1 For these pedometers Waterbury watches were taken, the hair springs removed, the balance wheel weighted on one side, and guard pins inserted Tipsy. Nig. Fig. 13. — November, 1805. BpM. Tll'SV. NlG. Fig. --'O. — December 1, 1900. INFLUENCE OF ALCOHOL ON GROWTH. 369 be strapped in the dogs' collars and read at corresponding times. Soon after beginning to administer alcohol it was often noted that the normal dogs were playing actively while the others were quiet. A quantitative expression of this difference is given for the months indicated in 1896, in Fig. 9, and since a number of investigations have shown that muscular and mental ability in men and animals tend to vary with the barometer, its curve for the time is superimposed. ^ Bum is seen to develop only 71f> of Nig's, and Tipsy only 51 fj of Topsy's spontaneous activity. A like tendency to quiet was noted in the other dogs to which alcoholic liquors were given with exception of those having beer. They, to all apjiearance, remained as lively as ever.^ These results give, of course, no expression of the quality of activity, and to devise a test that would give the comparative ability of the dogs as to strength, endurance, and resistance to fatigue, they were all taught to retrieve a ball when thrown. When it was desired to make a test, the dogs were all taken to the university gymnasium, and a rubber ball was thrown across the room, a distance of one hundred feet, as fast as it could be retrieved. A record was kept of all the dogs that started for the ball, and of the one that brought it back. One hundred balls constituted a test, and to throw them consumed about fifty minutes. The first series consisted of 1400 balls, thrown on fourteen successive days, Januarj', 1896, and the two normal dogs re- trieved 922, the alcoholics, 478. This gives the alcoholics an ef- ficiency of 51.9^0 as compared with the normals. Bum's ability that wouUl permit the release of one tooth of the escapement every time the watch was shaken. A very delicate pedometer resulted that recorded every movement of the animal. Two of these were carefully adjusted so as to run alike, in whatever position placed or however shaken, and were then placed in stout leather pockets in the collars of the two dogs whose activity it was desired to test. They were then read daily at exactly the same time, six o'clock P. M. To insure any change in the watches affecting the results, they were interchanged from dog to dog every three days, so that each dog wore the same watch the same number of days. No such variation, how- ever, in the watches was observed to occur. 1 For the barometric record we are indebted to Mr. Martin Green, of Worcester. ^ Dr. Stewart obtained a similar result with rats, except that there was an initial increase of activity on beginning administration of alcohol. 370 THE LIQUOR PROBLEM. 60 ao 40 Re«t« ^ \ r Di V* r ( > \ . 1 ^ "- ^ ^ \ ^ s / V « .. ^ ,^ ,,- 14 %^- • / Al Mil ^y fj" ^ ■ — N / ^ 'Tg ? , s ' '. ^*' RT' '. ,• •■ '* '' ll tli IS! Flo. 11. Chart of Ball Tests. as compared with Nig's is only 32^o (see Fig. 10). Tipsy and Ball* Bum also gave evidence of very 100 — I — I — I much greater fatigue. A similar series of 1000 balls, November, 1896, in which Bum and Nig- only participated, shows about the same result, and expresses (Fig. 11) these relations as to fatigue more exactly. Nig's curve of achievement is also seen to run much closer to his curve of attempt than in Bum's case, in both charts, and this affords good evidence of his greater alertness, strength, and energy. These differences, especially on the psychic side, are well shown by all the photographs that have been taken. Comparison of the faces in Figs. 5, 12, 13, and 20 demonstrate this too clearly to require further com- ment. It should be noted, however, in Fig. 20, that Bum is completely blind, which give the eyes a somewhat more wide- awake expression, and the direct sunlight, in which the picture is taken is rather strong for the eyes of the other dogs. Administration of alcohol was discontinued November 1, 1898, in order to ascertain whether the effects of alcohol already noted were transient or permanent. This point in the reseai-ch has special reference to its influence on progeny, as will be described under that head, but it is also of interest in connection with the normal activity of the animals. This was at the beginning of Tipsy's last gestation period, and no marked change in her general behavior could be noted up to the time of her death the following December. Bum's activity improved slowly, so that by the end of a year it had attained practical equality with Nig's, a test with the watches at this time giving the relation of 95j?o to Nig's 100^. Ball tests, also, made in the spring and fall of 1899, showed him to be about Nig's equal both in alertness and endurance. During the winter of 1899-1900, without any apparent cause, atrophy of both retinte began to be noticeable, and by the spring Fii;. 14. — Bdm, NovKMBEit, IS'.C) Fig. 1.5. — Nig, November, ii<'X) INFLUENCE OF ALCOHOL ON GROWTH. 371 of 1900 Bum had become totally blind. This, of course, has made further tests of activity and strength either impossible or useless. For the past season he has also been the only dog in the kennel to suffer from eczema. This has involved large tracts of the skin, and has been difficult to heal or control. Both these afflictions have contributed to give to Bum the appearance of an old feeble dog, while Nig is still in tlie prime of health and vigor. On the side of general intelligence the alcoholic dogs have been in no wise inferior to their mates. They have been, if anything, more teachable and much more easily controlled in learning the few things necessary to their education. A striking result of the entire research, and one entirely unexpected on account of the small doses of alcohol given, has been the extreme timidity of the alcoholic dogs. Magnan ob- tained a similar result with his dog, more extreme, because he gave large amounts of alcohol. While able to hold their own with the other dogs in the kennel, the least thing out of the ordinary caused practically all the alcoholic dogs to exhibit fear, where the others evinced only curiosity or interest. Whistles and bells, in the distance, never ceased to throw them into a panic in which they howled and yelped while the normal dogs simply barked. This holds true of all the dogs that had alco- hol in any amount. During the first year of the experiment Bum had a number of paroxysms of causeless fear with some evidence of hallucinations. He would apjiarently start at some imaginary object, and go into a fit of howling. This point is well illustrated by photographs taken on the same day and under exactly similar conditions. (Figs. 14-17.) It would seem from all the evidence that we are dealing with one of the profound physiological causes of fear, having wide applications to its phenomena in man. Fear is commonly re- cognized as a characteristic feature in alcoholic insanity, and delirium tremens is the most terrible fear psychosis known. We should naturally look for its effects in the cells of the brain itself, and the researches of Dehio, Berkley, and Stewart all point to alterations in various staining reactions in these cells. W^ith the discontinuance of alcohol in the diet the more acute features of this reaction have subsided, leaving, however, the characteristic timidity as a habit of life that does not seem to wholly fade out. 372 THE LIQUOR PR0BLF:M. It remains to discuss the reproductive histories of our animals and the influence of alcoliol upon their progeny, and here we find the most definite results of the entire research. The first three sexual periods are indicated by interconnect- ing lines upon the growth chart, Fig. 6, and stars in the course of Topsy's and Tipsy's curves give the number of whelps. At the first period Topsy conceived normally, while Tipsy did not. This may be interpreted as an effect of alcohol in retarding develo])ment of the sexual organs, but it occurs rather too often in kennels to be insisted upon. Topsy's small frame made whelping extremely difficult, and she died as a result of this and lack of proper assistance in time.' At the next period, Tipsy is seen to conceive normally, giving birth to seven whelps. Two of these were hare-lipped, and two were born dead. There were four whelps apparently normal in every respect. In Tipsy's next litter, seven in num- ber, three were deformed, two were born dead, and the others proved non-viable.'^ The next litter, of six. had three deformed, two born dead, and all non-viable. Alcohol was discontinued at the beginning of the next gestation in order to ascertain whether the excess of deformity and especially the non-viabil- ity of the offspring were a direct nutritional influence of alcohol upon development of embryos in iitero or attributable to its more general effects upon the maternal organism as a whole.^ This litter consisted of three whelps, all perfectly formed, but all born dead, and, in spite of very prompt assistance and the best care possible. Tipsy died with them.* On the side of the normal pair there is nothing out of the ordinai-y to be remarked. There have been eight litters born ^ It is commonly recognized in kennel management that undersized bitches are likely to give trouble in this way. It was, moreover, my first experience of the kind, necessary assistance was delayed until it was too late. ^ Milk appeared normal in quality and abundance, but the whelps refused to suck. '' Bum had been used for service of bitches in other kennels with uni- formly normal results. * At autopsy the walls of the uterus were found to be extremely thin and much infiltrated with fat. Whether this latter condition is to be attributed to alcohol or to the post-partem fever must remain for pathologists to decide. It was not present in the similar case of Topsy 1. Fill. ll'i. — TirsY. XoVKMKKU, 1>- Fir,. 17. — TOPSV. XOVKMKKK, isa') INFLUENCE OF ALCOHOL ON GROWTH. 373 up to (late, and there is every prospect of as niauy uiore. While hare-lips have ajjpeared in three litters, there has been no other deformity, and all the other whelps have been not only viable, but exceptionally vigorous. For the sake of ready conijiarison this history of the two pairs is exjjressed visually in Fig. 18 and again numerically iu 0000€.^« OOOOC €€€)Ct/^« OOO €€«cet^ oooooooo • ••+ OOOOOOM. ooooo oooooo OOO OOOOOOi/ O c • Fig. 10. Coml).ir.ltive tabulation of the otfspring of .alcoholic .ind normal Jiairs of Jofrs, and of ten inebriate and normal families (after Demme). Fig. 19, together with a tabulation of strikingly similar results of Professor Demme, obtained from comparative observations upon alcoholic and non-alcoholic families. INFLUENCE OF ALCOHOL ON PROGENY — DOGS. Bum — Tipsy. Nig — Topsy. No. of whelps (7-7- -6-3) 23 (5-3-8-8-5-6-3-7) 45 Deformed (2-3- -3-0) 8 (1-0-0-2-0-0-0-1) 4 Born dead (2-2- -2-3) 9 (0_0-0-0-0-0-0-()) Viable (-1-0- -0-0) 4: = 17 .4 'I (4-3-8-5-5-6-3-6) 41 =90.2 1^ MEN — DEMME. 10 Alcoholic families. 10 Normal families. No. of children 57 61 Deformed 10 2 Idiotic 6 Epileptic, choreic 6 (2 Bkwrd) Noii-viable 25 3 Normal 10 I [1?) = 17<5, 'o 54 = 88.5^ 374 THE LIQUOR PROBLEM. Frisky was mated with Bum, aud has up to the present given birth to six litters. She had been given whiskey from April, 1896, to >fovember, 1897. Their history is as follows: — Number of whelps (4-6-4-5-3-5) 27 Deformed (0-l-0-'2-l-2) 6 Horn dead (0-0-1-0-0-0) 1 Viable (4^5 ? i-0-O-O-l) 10 z=: 37'^^, Alcohol was also discontinued in her case from November, 1898, but in the two subsequent litters none of the whelps were viable, and only one was viable in the third. In the whiskey, Frisky did not receive as much alcohol as Tipsy, and it was given her case about one year less, but, aside from this, her reproductive history forms a rather close pai-allel to Tijisy's. In the matter of non-viability these puppies seemed as inex- plicable as many similar cases in man. In weight they were equal to, or exceeded, many of Topsy's viable whelps. They simply would not put forth the least effort to make a live of it. I spent hours milking in tiieir mouths, but to no avail. Exam- ination of the brains of a number of these pups failed to show any traces of medulation ; whereas normal whelps killed at birth were found to possess medulated fibres in the sensori- motor areas. No other malformations could be detected, and this seems to be the only clue to their lack of vigor.'- Considered in relation to the general literature of the sub- ject, our experiments supply additional evidence to prove that alcohol in small amounts exerts an inhibiting or sedative influ- ence upon certain physiological processes. This is seen in its effect in slowing the growth of yeast, and, while bodily growth has not been interfered with under the conditions of most of our experiments, it is plainly indicated in lowering the normal activities of animals to which it has been administered. The evidence also supports the general conclusions of hygienists that in feats of strength and endurance alcohol should be avoided. Alcoholic dogs also showed diminished resistance to distemper as compared with noi-mal animala under the same kennel man- agement. On the psychic side kittens showed a sudden collapse, not ^ Two of these were killed at birth for examination of brains. ^ I am largely indebted for these results to Dr. Frederick Burk. INFLUENCE OF ALCOHOL ON GROWTH. 375 only of intelligence, but even of fundamental instincts. While this was soon complicated by disease, nothing- so complete was observed in control animals similarly affected. AVith dogs no impairment of general intelligence was manifested, except that timidity develoi)ed as a characteristic psychosis in all those to which alcohol was given. This confirms tiie results of other experiments on dogs, and also has wide application to the human problem, fear being characteristic of acute alcoholic poisoning and of alcoholic insanities. Possibly the most imjiortant of our results relates to the vigor and normality of offspring. We do not attach much importance to the greater percentage of deformity, since this is of somewhat common occurrence in kennels, and our cases are too few. In respect, however, to vigor and viability of offspring the differ- ence between normal and alcoholic pairs is more striking. This result, it is to be hoped, may stinuilate to much more extended reseai'ch in this imi)ortant field. While the exjieriments are admittedly too fe^v to serve as basis for more definite general conclusions, the possession of control animals adds considerably to their value. And the great amount of time and labor necessary to their prosecution must justify adding the foregoing results to the literature of the subject. THE INFLUENCE OF ACUTE ALCOHOLISM ON THE NORMAL VITAL RESISTANCE OF RABBITS TO INFECTION. By a. C. ABBOTT, M. D.. FIRST ASSISTANT, LAI50RAT0RY OF HYGIENE, UNIVERSITY OF PENNSYLVANIA. THE INFLUENCE OF ACUTE ALCOHOLISM ON THE NORMAL VITAL RESISTANCE OF RAB- BITS TO INFECTION.' In the distribution of the several siibtlivisions of the general question relating to the influence of alcohol upon the physical anil moral well-being of those who use it as a beverage, the Committee saw proper to assign to Dr. Abbott for experimental solution the question concerning the influence of alcoholism, acute and chronic, upon the normal vital resistance of animals to various forms of infection. At the beginning of the work a general scheme of procedure was drawn up that seemed to meet most of the requirements of the problem, but it was found possible to cover onlj' a limited portion of the ground included in this scheme within the time allotted to the investigation. The lines along which it was proposed to conduct these inves- tigations are as follows : — 1. Determine if the normal vital resistance of animals to in- fection by the connnon pathogenic bacteria is demonstrably influenced by either acute or chronic alcoholism, induced through the use of known amounts of jnue ethyl alcohol. 2. If any or no effect is observed, determine if the same holds good for animals under the influence of the commoner alcoholic beverages, as beer, wine, whiskey, cordials, etc. 3. Determine if through either acute or chronic alcoholism the germicidal properties of the serum of the blood of animals is materially altered. If so, determine, if possible, the nature of this alteration. ' Abstract of a paper wliich appeared in vol. i., 1S9G, of the Jaurnal of Experimental Medicine. Investijiations bearing upon paragraph 3 have been conducted independ- ently 1)\- Dr. Alibott and Dr. Bergey, of the University of Pennsylvania, and pnblislied under the title, "The Influence of Alcoholic Intoxication upon certain factors concerned in the Phenomenon of HiEmolysis," in the August 380 THE LIQUOR PKOIiLKM. The results presented in this paper refer only to the influence of acute alcoholism upon the resistance of rabbits to infection by the pyogenic cocci — i. e. the streptococcus pyogenes (erysi- pelatos) and the staphylococcus pyogenes aureus — and by the bacillus coli communis. They are in many ways sufficiently instructive to warrant their publication. The following abstract will serve to present in general the lines along which the .study was projected and the results ob- tained. The details are given in full in the original paper. A difficulty that arose at the outset was in procuring cultiu'es of pathogenic organisms of suitably diminished virulence with- out their being at the same time totally devoid of this property. As experience has taught us to expect certain deviations from the usual course of infection when normal animals are inocu- lated with attenuated cultures, such, for instance, as prolonga- tion of the period of incubation and modification of the i)atho- logical lesions, the jiroblem under consideration seemed to be in part most easy of solution through a comparison of results ob- and September number of the Un'wersitij of Pennsylvania Medical Bulletin for 1902. The points considered by tlie authors in this paper were : — 1. Does alcohol administered per os influence the complement content (Ehrlich's nomenclature) of the blood of r.abbits ? 2. Does alcohol similarly administered have an influence upon the specific blood reactions of rabbits already artificially immunized against an alien blood ? 3. Does alcohol similarly administered have any influence upon the pro- cess of artificial immunization bj' an alien blood ? The results of studies upon these three questions seem to warrant the following conclusions : — 1. The daily administration of alcohol per os to rabbits brings about a re- duction in their circulating blood of the hismolytio complement. 2. Slight alterations in the normal alkalinity of the blood serum have no demonstrable influence upon the (hsemolytic) complement of the blood of alcoholized rabbits. 3. The diminished reactivating power of the blood of alcoholized rabbits is not due to the presence of sniiill amounts of alcohol as such in the blood. 4. The administration of alcohol to rabbits induces not only a marked re- duction in the complement content of their blood, but may cause, at the same time, a reduction in the specific haemolytic receptor iu the blood of rabbits artificially immunized against an alien blood. 5., The diminished complement content of the blood of alcoholized rabbits renders the animal more susceptible to the toxic action by an alien blood. INFLUENCE OF ALCOHOLISM ON RABBITS. 381 tained by the use of such cultures on groups of alcoholized and non-alcoholized animals. Should such modifications occur in the normal animals as would be anticipated, and an infection not differing from that produced by fully virulent cultures occur in the alcoholized animals, the difference could reasonablj' be referred to a reduction of vital resistance brought about by the alcohol administered. To meet the requirements it would perhaps have been best to have employed cultures of organisms that were diminished in virulence to definite degrees of attenuation, such, for instance, as the bacillus anthracis attenuated to the degree of virulence represented by its primary and secondary vaccines. As such material was not available, however, cultures of another sort were used, namely, those that were of a low degree of virulence without this degree being definitely determined. Again, cultures of organisms were employed, the pathogenic powers of which are usually irregular and uncertain ; while in still other tests an effort was made to detect a difference be- tween alcoholized and non-alcoholized animals when inoculated with virulent material, but in very small doses, hoping in this way to demonstrate, by a difference in the period of incubation, a difference of resistance in the animals composing the two groups. The experiments were made with cultures of streptococcus pyogenes of a low degree of virulence, with noi-mal baccillus coli communis, and with virulent staphylococcus pyogenes au- reus, and, as the results to be reported show, with vei-y diverse consequences. Another difficult}' was encountered in regulating the dose of alcohol. The intention was to have the animals daily in a state of intoxication, but it is not easy to decide just when this stage is reached, as the only certain indication of it is inco-ordination of muscular movement. It frequently occurred that when alco- hol was given to this stage, the direct effect of the drug was such as gravely to imperil the life of the animal, and in a certain number of instances the animals did not rally from even so few as one or two such administrations. If the dose were diminished, then one could often not be sure that the rabbit was intoxicated. On the other hand, one encounters occasionally an individual 382 THE LIQUOR PROBLEM. on which alcoholism to intoxication has apparently no effect upon the general health, and may be prolonged over relatively long periods. One of the animals, for instance, received daily doses of alcohol ranging from 5 to 15 cubic centimetres for one hundred and fourteen days. Its weight at the beginning was 1330 grams and at the end 13.50 grams, while during the in- terval its weight had been as high as 1520 grams and as low as 1090 grams. It died under the administration of 15 grams daily with macroscopic lesions of only the gastric mucous membrane. It is not improbable that the studies upon the effects of smaller, non-intoxicating doses of alcohol will demonstrate the possibility of continuing the administration of the drug over practically an indefinite period, quite to the stage of chronic alcoholism, in a fair proportion of the animals treated in this way. The individual susceptibility of different animals to the phy- siological action of alcohol differed in such a way as to require at the beginning a special dose for each individual. It is im- possible to maintain throughout a constant relation between body weight and dose necessary to produce the desired effects. For instance, if 5 cubic centimetres of alcohol produce intoxi- cation in a rabbit of 1000 grams weight, it cannot be said that 10 cubic centimetres will necessarily have the like effect in the next rabbit of 2000 grams weight. The dose for the individ- ual can be determined only by experiment. It frequently occurred tliat. when the appropriate dose had been determined, its continuous administration over several or more days resulted in very rapid and marked loss in body weight, an indication of the greatest importance, meaning that if the alcohol be continued the animal is practically certain to die. Under these circumstances it becomes necessary either to dimin- ish the dose or cease the administration entirely for a time, until the lost weight is partially or completely recovered. During the interval of rest, as it may be called, the animal is, of course, not daily intoxicated, and while the records of these experi- ments refer to animals " daily under the influence of alcohol to the stage of intoxication," it will be boi-ne in mind that with many of these animals such periods of rest, vai-ying in dura- tion, were more or less frequently necessary. As it was imjjossible to induce the rabbits to take alcohol voluntarily, either with the food or otherwise, it became ueces- INFLUENCE OF ALCOHOLISM ON KABBITS. 383 saiy to aclmiuister it through a soft rubber catheter passed down the esojAagus into the stomach, and though this was done as gently as possible, the irritation resulting from the re})eated passage of the catheter, together with the dejiressing influence of the drug, was accompanied in a number of instances by in- tercurrent infections which, from their character and location, can reasonably be traced to insignificant wounds of the mucous surface of the esophagus made when the alcohol was admin- istered. In only two instances was deatli positively the result of inspi- ration of alcohol into the air passages at the time of ojieration. When such an accident occurs death is practically instantaneous. The most common macroscopic effect of the direct action of the alcohol was erosion and inflammation of the mucous mem- brane of the stomach, a condition that was unfortunatel}' present in quite a number of animals, and which complicated matters in such a way as to vitiate considerably the results of the ex- periments. When the necessary dose of alcohol was determined, it was always given mixed with an equal quantity of distilled water. The dose necessary to positively produce intoxication ranged from 5 cubic centimetres to 15 cubic centimetres of pure ethyl alcohol, though the usual dose in rabbits of from 1500 to 1800 grams weight was from 7.5 cubic centimetres to 10 cubic centimetres, doses which, if taken by a man of 150 pounds weight, would be roughly equivalent to from two thirds to five sixths of a pint of absolute alcohol Notwithstanding this apparently very large amount, animals have repeatedly been en- countered on which frou) 10 to 12, and even 15 cubic centi- metres had no visible influence, though the continuance of these doses in many instances was followed by death associated with grave lesions of the gastric mucous membrane. W^hile rabbits offer conditions in a way favorable to experi- ments of this character, they are so liable to intercurrent bac- terial and protozoal infections as to lead to many irregularities when large numbers of them are used. In the course of this work a number of experiments were seriously vitiated by reason of such complications. The general plan followed in these ex- periments was to employ groups of equal numbers of animals. All were inoculated in the same way, then to one group alcohol 384 THE LIQUOR PROBLEM. was given, while to the other no alcohol was administered. They were all then kejjt under the same conditions of food, etc. Each animal was weighed in the morning before it was fed. In one or two cases the number of " controls " was fewer than that of the alcohol group. Control animals receiving only alcohol were not introduced into each experiment, as the necessary data on this ])oint could always be had by reference to the records of preceding experiments in which the different effects of the drug on different animals was recoi'ded. Without going further into the particulars, it will suffice to briefly summarize the results of each experiment as follows : — EXPERIMENT I. Summary of the results of the intravenous inoculation of rabbits receiving daily doses of alcohol to the stage of intoxica- tion, with bouillon cultures of streptococcus pyogenes obtained from a phlegmonous inflammation in man : — Of eleven rabbits inoculated intravenously with varying amounts of streptococcus pyogenes, six received daily doses of alcohol for different lengths of time. The remaining five of this group received no alcohol. In addition, two rabbits re- ceived only daih' doses of alcohol. Of the six inoculated an- imals that received alcohol, all died after marked loss of weight, and all exhibited lesions referable to the inoculation. One re- vealed a condition of the liver probably the result of the action of the alcohol. Of the five inoculated animals to which no alcohol was given, one died, one was killed, and three recovered. The one that died presented no lesions referable to the inocu- lation. Cultures revealed the presence of streptococci in the liver mixed with another organism, while the other internal organs were sterile. The animal that was killed presented no lesions of im]ior- tance, and its blood and internal organs were found by culture test to be sterile. Each of the three remaining animals suffered from temporary erysipelas of the ear at the site of needle puncture. They re- covered from this, and at the end of 120 days were apparently in good condition, one having gained 330 grams, the other 110 grams, and the other 270 grams in weight. INFLUENCE OF ALCOHOLISM ON RABBITS. 385 Of the two aiiimals that were not inoculated, but whicli re- ceived alcohol dailj% one died after 114 days with a condition of the gastric mucous membrane referable to the alcohol, the other after 3-4 days with no macrosco2)ic lesions to account for death. EXPERIMENT II. Summary of the results of intravenous inoculation of rabbits, receiving intoxicating doses of alcohol daily, with suspensions of streptococcus pyogenes : — The eighteen animals employed in this experiment were di- vided into four groups, and treated as follows : — Four received intoxicating doses of ethyl alcohol for five days and were then inoculated intravenously with 0.5 cubic centi- metre of a suspension of streptococcus pyogenes. Five received intoxicating doses of methyl alcohol for five days and were then similarly inoculated. The alcohol was continued in both groups after inoculation until death. Five received, in addition to the inoculation, daily doses of distilled water, injected into the stomach in the same manner as was the alcohol in the other animals, for fifteen days. After this, alcohol was given to two of them, — to one for two days, to the other for six daj-s, — while the remaining thi-ee got nothing from the fifteenth day. Four were simply inoculated. One of this group received a single dose of alcohol. The nine latter animals served as controls. Results. — Of nine inoculated animals to which alcohol was given, seven died with suppurative lesions. Of nine inoculated animals that received no alcohol until after the fifteenth day, when alcohol was given to two, five died, three were killed, and one was observed for fifty-two days. In only three of the nine were suppurative lesions detected at autopsy. Of the seven alcohol animals that died, five presented lesions at autopsy that could be attributed to the action of alcohol. EXPERIMENT III. Summary of the results of intravenous inoculation of rabbits receiving alcohol daily to the stage of intoxication, with sus- I^ensions of bacillus coli communis from human feces : — 386 illE LIQUOR PROBLEM. Of five rabbits, each of which was inoculated with one cubic centimetre of a suspension in bouillon of bacillus coli communis, and all of which had been receiving alcohol to the stage of in- toxication daily for five days, four died in from cigliteen to twenty hours and one in eighteen days after inoculation. None presented lesions referable to the inoculation. One revealed a condition of tJie gastric mucous membrane that evi- dently resulted from the direct action of the alcohol. Bacillus coli communis was obtained in cultures from the internal organs of all. Five rabbits, each of which had been receiving alcohol in doses ranging from 2.5 to 15 cubic centimetres daily for thirty- one days, were inoculated intravenously with the same material in the same amount that was emploj'ed in the preceding group. One died within twenty-four hours after the inoculation. Four died in from forty-three to fifty-five days after the in- oculation. Three presented at autopsy lesions referable to the inocula- tion, namely, the condition of the liver, gall bladder, and bile described by Blachstein.^ Two presented no lesions attributable to the inoculation. Two showed a condition of the liver that may possibly have resulted from the prolonged action of the alcohol, while in the remaining three no results of the alcohol were evident. Two control animals that were inoculated in the same man- ner with the same material, but which received no alcohol, were alive on the seventy-ninth day after inoculation. By the sixtieth day one had gained 230 grams in weight, while the other, though apparently well, had lost 200 grams in weight. EXPERIMENT IV. Summary of the results of inoculation of alcoholized animals with suspensions of bacillus coli comnnmis : — Three animals received intravenous inoculation of 0.5 cubic centimetre of a suspension of bacillus coli. Immediately after- wai-d the administration of alcohol was begun. One died during the night, and one on the day following the inoculation. Bacil- ' Blachsteiii, " Iiitraveiitms Inoculation of Rabbits with the BaciUns Coli Communis and the Bacillus Typhi Abdominalis," Bulletin of the Johns Hop- kins Hospital, vol. ii. No. 14, July, 1891. INFLUENCE OF ALCOHOLISM ON RABBITS. 387 lus coli was found by cultures in the internal organs of both. The third died eight days after inoculation with no character- istic lesions and no colon bacilli in the internal organs. The mucous membrane of the stomach was eroded, and there was a fibrino-purulent pericarditis and pleuritis, evidently the result of an intercurrent infection, probably induced by the repeated passage of the catheter along the esophagus. Three other rabbits that had been getting alcohol for four days were inoculated in the same manner as the preceding. Two died on the ninth day and one on the eighteenth day following inoculation. In one, dead on the ninth day, were the characteristic lesions described by Blachstein. There was also present a condition of the stomach that was manifestly the result of the action of the alcohol. Of the remaining two, in one death ensued from an intercur- rent infection, while in the other death was the result of an intestinal intussusception. This latter animal presented erosion of the gastric mucous membrane that was evidently the result of the action of the alcohol. In both animals that died on the ninth day colon bacilli were present in cultures from the internal organs, while in the one dead on the eighteenth day the blood and internal organs were sterile. Three control animals were alive and apparently well on the forty-sixth day. One had gained 50 grams, the other 280 grams, while the third had lost 120 grams in weight. In short, of six alcoholized rabbits inoculated with colon bacilli, all died. One presented characteristic lesions at autopsy. Of three non-alcoholized, control animals, none died. EXPERIMENT V. Results of intravenous inoculation of rabbits receiving alco- hol, with cultures of staphylococcus pyogenes aureus : — In this experiment the first inoculation was without effect, and the animals were inoculated a second time after an interval of seven days. Four animals were employed, viz., two alcohol- ized and two controls. The alcoholized animals died in four- teen and two days, respectively, after the inoculation. Both presented lesions referable to the inoculation, and neither 388 THE LIQUOR PROBLEM. showed conditions due to the direct action of the alcohol. One control animal died in four days after the first inoculation, while the second died in six days after the second inoculation. To this latter animal alcohol was administered from the time of the second inoculation. Both presented lesions referable to the in- oculation, and the one that got alcohol jiresented also conditions due to the direct action of the alcohol. This expei'iment does not demonstrate any material differ- ence between the alcoholized and the non-alcoholized animals as regards their susceptibility to this form of infection. EXPERIMENT VI. Subcutaneous inoculation of alcoholized animals with cultures of staphylococcus pyogenes aureus : — There were four animals in this group, two alcoholized and two controls. In all except one, an alcoholized rabbit, the sub- cutaneous inoculation was without effect up to the seventh day. On the seventh day the three remaining animals were inoculated again, but this time intravenously. Results. — One alcoholized animal died in three days after the subcutaneous inoculation. Death was due to pseudo-tuber- culosis of the lungs. There was only a trifling area of suppura- tion at the seat of inoculation. The other alcoholized rabbit died four days after the intravenous inoculation and presented the usual condition of widespread miliary abscess formation. Both control animals died after the intravenous inoculation — the one in seven days, the other in twenty-four hours. The former presented lesions characteristic of the inoculation, while the latter presented no macroscopic lesions at all at autopsy. The former control animal had been given alcohol since the date of its second intravenous inoculation. At autojisy it pre- sented lesions referable to the direct action of the alcohol. EXPERIMENT VII. Intraperitoneal inoculation of alcoholized animals with cul- tures of staphylococcus pyogenes aureus : — Four animals were employed ; two received alcohol and two served as controls. The animals that exhibited no effects of the intraperitoneal inoculation at the end of a week were reinoculated with the same material, but this time the inoculation was intravenous. INFLUENCE OF ALCOHOLISM ON RABBITS. 389 One alcoholized animal died the day following the intraperi- toneal inoculation, the other two days after the intravenous inoculation. In neither were lesions detected that could account for death, or be positively referred to either the inoculation or the alcohol. Both control animals recovered from the intraperitoneal in- oculation, and at the end of a week were inoculated intrave- nously. One died two days after this latter inoculation and presented neither mycotic nor alcoholic lesions, death being due to rup- ture of the gravid uterus, while the other died nine days after intravenous inoculation with abscesses in myocardium and kidneys. EXPERIMENT VIII. Intravenous inoculation of alcoholized rabbits with bouillon cultures of staphylococcus pyogenes aureus: — Of the six inoculated animals to which alcohol was given, three died in less than twenty-four hours and three in forty- eight to seventy-two hours after inoculation. In three, lesions were present that could jjositively be referred to the inoculation, and in one the condition was doubtful. In two no such lesions could be found. In five of the six animals a condition of the mucous mem- brane of the stomach was found that was evidently the result of the direct action of the alcohol. Of the six inoculated animals that did not get alcohol, three died in less than twenty-four hours, two after five and twelve days, respectively, while the remaining animal was apparently well at the end of forty-three days. Three of these animals presented lesions that resulted from the inoculation, in one the lesion was doubtful, in one no lesions were detected, and the sixth is still alive. This experiment demonstrates a slight, though not very im- portant or striking, difference between the course of infection in the two groups. EXPERIMENT IX. Subcutaneous inoculation of alcoholized rabbits with cultures of staphylococcus pyogenes aureus : — 390 THE LIQUOR PROBLEM. Of the six inoculated animals to which alcohol was given, one died during the night following the inoculation ; the remaining five died in from five to fifteen days later. Two of these animals presented uo lesions referable to the inoculation, one presented an extensive local lesion, and three presented a lesion of the pleurae and pericardium of doubtful significance. This condition was identical in the three animals and consisted of a fibrino-purulent inflammation of practically all the serous surfaces within the thoracic cavity. Cultures from this lesion revealed the jjresence of a staphylococcus that grew feebly, producing but a very faint, barely perceptible, cream color, and in general gave the impression that it might be an attenuated or enfeebled culture of staijhylococcus aureus. It was not studied in detail. The animals in wliich this lesion was found died in five, fifteen, and fifteen days, respectively. The three control animals used in this experiment manifested no ill effects of the treatment. They were alive and well at the end of forty-six days after inoculation. In none of the six animals that received alcohol was there any macroscopic evidence of the action of the alcohol on the tissues. EXPERIMENT X. Intravenous inoculation of alcoholized rabbits with staphy- lococcus pyogenes aureus attenuated (?) by exposure to chloro- form : — Four animals were used in this experiment. Of the two inoculated animals to which alcohol was given, one died on the fifth, the other on the second day following the inoculation. One presented a lesion of the kidney positively referable to the inoculation, the other a condition of the perito- neum that probably, though not certainly, resulted from the treatment to which the animal had been subjected. Both of these animals presented extensive erosions of the gastric mucous membrane that was manifestly the result of the direct action of the alcohol. Neither of the two control animals evinced any ill effects from the inoculation ; both gained in weight, and at the end of twenty- eight days were eliminated from the experiment as not likely to manifest evidence of infection. INFLUENCE OF ALCOHOLISM ON RABBITS. 391 CONCLUSIONS. The deductions that may be drawn from the results of these experiments are as follows : — That the normal vital resistance of rabbits to infection by- streptococcus pyogenes (erysipelatos) is markedly diminished through the influence of alcohol when given daily to the stage of acute intoxication. That a similar, though by no means so conspicuous, diminution of resistance to infection and intoxi- cation by the bacillus coli communis also occurs in rabbits sub- jected to the same influences. And that, while in alcoholized rabbits inoculated in various ways with stajjhylococcus pyogenes aureus, individual instances of lowered resistance are observed, still it is impossible to say from these experiments that in general a marked difference is noticed between alcoholized and non-alcoholized animals as re- gards infection by this particular organism. It is interesting to note that the results of inoculation of alcoholized rabbits with the erysipelas coccus correspond in a way with clinical observations on human beings addicted to the excessive use of alcohol when infected by this organism. In the course of the work an effort was made to determine if, through the oxidation of alcohol in the tissues to acids of the corresponding chemical group, the increase of susceptibility could be referred to a diminution in the alkalinity of the blood as a result of the presence of such acids. The number of ex- periments made on this point was too small to justify dogmatic statements, but from what was gathered there is but little evi- dence in support of this view. Throughout these experiments, with few exceptions, it will be seen that the alcoholized animals not only showed the effects of the inoculations earlier than did the non-alcoholized rabbits, but in the case of the streptococcus inoculations the lesions produced (formation of miliary abscesses) were much more pro- nounced than are those that usually follow inoculation with this organism. With regard to the predisposing influence of the alcohol, one is constrained to believe that it is in most cases the result of structural alterations consequent upon its direct action on the tissues, though in a number of the animals no such alteration 392 THE LIQUOR PROBLEM. could be made out by macroscopic examination. It is likely, however, in the light of the work of Berkley and of Friedenwald, done under the direction of Professor Welch, in the Pathologi- cal Laboratory of the Johns Hopkins University, that a closer histological study of the tissues of these animals would have revealed in all of them structural changes of such a nature as to indicate disturbances of important vital functions of sufficient gravity fvdly to account for the loss of normal resistance. The conspicuous influence of the alcohol on the gastric mu- cous membrane in many of these animals, with the consequent disturbance of nutrition, is undoubtedly the explanation of the marked loss in body weight that was observed in many of the animals employed in these experiments. In this light the sus- ceptibility induced by alcohol to excess is somewhat analogous to that induced by starvation, where we see the resistance of animals to particular forms of infection very markedly dimin- ished.^ Memorandum of Unfinished Investigation hearing upon the Influ- ence of Chronic Alcoholism upon the Vital Resistance of Monkeys to Infection. This investigation was designed to supplement that i^ublished in vol. i. of the " Journal of Experimental Medicine," under the title, " The Influence of Acute Alcoholism upon the Vital Resistance of Rabbits to Infection." The work was begun May 29, 1896, and was discontinued October 3, 1898. During the interval between these dates twenty animals, monkeys, were used. Of this number only eight were living at the time the research was abandoned. Of the twelve monkeys that died, three were purposely killed and nine died of a condition the nature of which could not be determined, even though careful examinations by pathological, and in most instances bacteriological, methods also were made. In none of the animals that died spontaneously was there evidence of tuber- culosis or of disease of the digestive tract or kidneys. In this experiment whiskey, instead of pure alcohol, was administered. ' Since the publication of this paper the results have received confinna^ tion at the hands of Laitinen : Acta Societatis Scientiarum Fennicce, 1900, tome xxix. No. 7 ; also Zeit. fiir Hyg- u. hfeklionskrankleiten, 1900, Bd. xsxiv, S. 206, as stated in the paper b}- Dr. Welch, p. 000^ INFLUENCE OF ALCOHOLISM ON RABBITS. 393 Of the eight animals that survived the experiment, one, a small rhesus monkey, had been receiving whiskey in varying amounts, and more or less interruptedly, since May 29, 1896, while the remaining seven animals, the so-called " pig-tail " macaques, had been getting whiskey under similar circum- stances since June 17, 1896. It is impossible to state accurately the amount of whiskey taken daily by any of these animals, notwithstanding the fact that it was given to them in measured quantities. The reason for this is that in order to get them to take it at all it was necessary to devise a more or less attractive mixture. After' several trials a mixture of milk, whiskey, and sugar was found to be most acceptable to them, but even this was not always totally consumed ; some of it was at times refused, again some was spilled by the animals in their attempts to drink, while again there were days when they refused the mixture entirely. It can be stated, however, that after the preliminary stages of the experiment, when the whiskey was begun in very small amounts and gradually increased, it was possible for the small rhesus and the larger macaque monkeys to take 100 and 150 c. c. respectively at a dose without evincing any visible signs of acute alcoholism. Doses much in excess of this (150 and 200 c. c. respectively) were almost certain to cause acute intoxication. It was also impossible to keep the animals steadily on a fixed dose. At times they exhibited such disinclination to the whis- key that it was often necessary to diminish the dose very much and then gradually increase it again. There were also a num- ber of instances when it seemed advisable to discontinue the whiskey entirely for a time. It is plain from this that only approximations as to the amount of whiskey taken by the animals can be made. It is interesting to note that the animals which died did so very early in the experiment, so that we are not inclined to at- tribute their death to the relatively small amount of alcohol that they were receiving at the time. The health of those that sur- vived was uniformly good ; indeed, the appetite in all cases seemed to be increased. On May 27, 1898, after a period of almost two years on whis- key, it was decided to make an attempt to determine if the vital resistance of the monkeys that had been getting the whiskey 394 THE LIQUOR PROBLEM. differed in any particular from that of monkeys tLat liad not been, under similar conditions. To this end the entire growth from five well-develoj)ed cul- tures of bacillus tuberculosis was carefully mixed with 250 c. c. of fresh milk, the alcohol was discontinued, and to each animal 20 cubic centimetres of the milk thus infected was given. In all cases it was entii-ely consumed. The animals were then kept under careful observation until October 3, 1898, a period of practically four months. Two days after the ingestion of this mixture of milk and tubercle bacilli one of the original eight monkeys died. It had been suffering from a catarrhal condition and a cough for a week or ten days before the test was made. At autopsy nothing that could be referable to the infected milk was discovered. The remaining seven animals of the original lot, as well as three newly purchased that served as controls, did not at any time during the four months show the slightest signs of tuber- culosis or any other impairment of health. Two guinea pigs that had received subcutaneous inoculation with the same cultures of bacillus tuberculosis, in oi-der to test its virulence, died of tuberculosis, but only in a very mild and limited form, so that the failure to infect the monkeys may have been due to the use of cultures that were more or less attenu- ated, though this was not known at the time they were used. When it was ultimately decided to abandon the experiment, two of the monkeys that had been receiving whiskey for the longest time and in the largest doses were killed, and careful autopsies made. These revealed the following conditions : — (1) Large macaque monkey — On incision through the abdominal walls there appeared a conspicuous amount of yellow fat. There was an unusual deposit of yellow fat over the omentum and about the kidneys. The liver was normal in size, color, and consistence. The kidneys were imbedded in fat, were normal in color and size, smooth on the surface and on section j)resented no changes recognizable by the naked eye ; the capsules of both kidneys were in spots very slightly adherent to the underlying cortex. There was a marked deposit of fat upon the pericardium. The heart was normal. INFLUENCE OF ALCOHOLISM ON RABBITS. 395 Eight lung was slightly adherent to the thoracic wall by several small, old adhesions. There was no evidence of recent or remote tuberculosis. The lymphatics showed no evidence of disease. The stomach and intestines were normal. The spleen was normal. Microscopic examination of liver and kidneys did not reveal any increase of connective tissue. (2) Small rhesus monkey — There was slight excess of moisture in the peritoneal cavity. Subcutaneous and deeper lymphatics a little large, but not apparently diseased. Peritoneum, liver, kidneys, spleen, heart, and lungs natural in all respects, in so far as macroscopic examination was con- cerned. The animal was well nourished, but did not present the same deposit of fat as was observed in the preceding animal. Microscopic examination of liver and kidneys did not re- veal any increase of interstitial connective tissues. Reasons for abandoning the investigation : — (1) From the conditions found in the autopsies just cited, as well as those revealed at autopsies upon the other animals, both those receiving whiskey and those not receiving it, that died during the time of the investigation, there was no evi- dence that the nutrition of the monkeys was in any way im- paired, and the outlook for positive and useful results did not appear as immediately promising. (2) In view of the fact that not one of the group of animals to which large quantities of tubercle bacilli had been fed, even though these may have been attenuated to some extent, showed the least clinical evidence of tuberculosis or of other im- pairment of health, the outlook also appeared as unpromis- ing. (3) Since the animals could only be kept in good health under proper conditions of warmth and dryness, and as the labora- tory building was the only place in which these conditions were obtainable, it was soon discovered that the maintenance of so many monkeys in a room in the laboratory became an intolerable nuisance. 396 THE LIQUOR PROBLEM, (4) The expensive nature of the work, requiring comparatively large sums of money for the purchase and maintenance of animals and for whiskey, exhausted the appropriation that was available for these studies. Date Due ' ] f) QP915 — ^ * ' ^^ v.l Billings Physiological aspects of the