ed contentment and satisfaction with oneself. This may be a desirable psychological state but one is less able to perform duties and accept social and community responsibility.

According to all tests, both learning ability and memory are reduced and thoughts are less likely to be organized in a logical manner. Mental activity is clumsy, similar to the clumsiness of both hands and feet. There is no evidence that alcohol stimulates creative thinking.

The depression following the drinking of alcohol is not like sleep in that it is followed by refreshing recovery but by continued depression. Additional alcohol taken at this time does not permanently relieve the situation.

AS A THERAPEUTIC AGENT: There is no satisfactory evidence either for or against the use of alcohol in the treatment of acute infectious diseases.

Alcohol is of no value in the treatment of snake-bite. It does not neutralize the poison and therefore its use is contraindicated in this condition.

The therapeutic uses of alcohol are summed up by a prominent group of physicians in "Alcohol and Man":

"As a solvent of various medicaments alcohol performs a useful perhaps indispensable function, and the pharmacist requires it to compound many of our widely used therapeutic preparations. The therapeutic part played by alcohol in these preparations is very limited. As a therapeutic agent, alcoholic beverages have a place in rendering more comfortable and peaceful the disturbances of chronic disease and old age. Sometimes it is useful to increase appetite. Beyond this there are very few conditions needing alcohol and alcoholic beverages in their treatment. Much of the use of alcohol and alcoholic beverages of the past no longer exists for better therapeutic measures have replaced them. It seems a fact that in both private and hospital practice the utilization of alcohol and alcoholic beverages by the better trained physicians has decreased greatly and is continuing to de

crease.

RESISTANCE TO INFECTIOUS DISEASE: There is undoubtedly a higher death rate from pneumonia in alcoholics as compared with abstainers of the same age.

The British Medical Research Council states that alcohol "by devitalizing the tissues, lowers the defences of the body against microbial invasion; consequently, specific germs, such as those which cause pneumonia and tuberculosis, as well as the ordinary microbes of 7 septic inflammation and blood-poisoning, find a suitable soil."

AS AN APHRODISIAC: Alcohol is not an aphrodisiac. Indirectly, it may be regarded as a sexual stimulant because the inhibition of the higher centers of the brain removes social barriers and restraints. Large amounts will decidedly suppress the sexual urge.

ALCOHOLIC NEURITIS AND CIRRHOSIS OF THE LIVER: It is now generally agreed that the polyneuritis which may accompany alcoholism is not due directly to the effect of alcohol it

self.

8

Recent experiments by Blotner have shown that the activity of certain gastro-intestinal enzymes may be destroyed in vitro and in vivo by proper amounts of alcohol and these results suggest that so-called alcoholic neuritis is a deficiency disease caused in part at least by faulty digestion and assimilation of food resulting from the destruction of digestive enzymes by large quantities of alcohol taken over a long period of time.

9

Studies by Jolliffe and Colbert upon twenty-eight alcoholic addicts having uncomplicated neuritis led them to the conclusion that "alcohol per se is not the cause of polyneuritis in the addict", and that "vitamin B deficiency is a cause of polyneuritis in addicts."

Formerly it was thought that alcohol played a role in the causation of cirrhosis of the liver but there is no good evidence to support this view. In fact, all recent observations such as, for example, that of Bowles and Clark refute it.

10

These authors state: "From the analysis of 4000 consecutive autopsies performed at the Philadelphia General Hospital it is concluded that alcohol can not be regarded as a specific factor in the etiology of cirrhosis of the liver."

MISCELLANEOUS OPINIONS OF INDIVIDUAL OBSERVERS

EFFECT ON LONGEVITY:

All studies of the mortality among policyholders of life insurance companies in America indicate that abstainers have a decidedly longer expectancy of life than non-abstainers. Thus, Arthur Hunter, L. L.D., of the New York Life Insurance Canpuny, says: "Those who drink occasionally to the point of intoxication or have a few protracted sprees yearly are distinctly shorter lived than the average.

11

Data from a British insurance company also have proved to the satisfaction of the Medical Research Council that the death rate is lower and the expectation of life longer among total abstainers than among those who are not abstainers from alcohol, but the evidence that a consistently moderate use of alcoholic beverages shortens life is as yet inconclusive.

On the other hand, Professor Raymond Pearl of Johns Hopkins University, concluded from his studies of the family history records available to him in Baltimore, that moderate drinking of alcoholic beverages did not tend to shorten life. He found, in fact, somewhat lower rates of mortality and a greater expectancy of life in average moderate drinkers than among abstainers. However, numerous attacks upon Pearl's data and conclusions have been published by authors of equal dependability here and abroad.

The main point at issue appears to be the distinguishing of "moderate", "steady", and "heavy" drinkers of alcoholic beverages. If longevity of abstainers is compared with nonabstainers of all degrees, the weight of opinion supports the statement that abstainers have a greater expectancy of life. But when efforts are made to classify non-abstainers according to the degree of consumption, and to compare these classifications with abstainers, the evidence becomes inconclusive.

12

USE IN OLD AGE: Doctor Harlow Brooks says: "Either as a food, as a medicine or for its comfort-giving qualities, alcohol properly administered is one of the greatest blessings of old age. Properly used in this period of life it is probably more useful from all viewpoints and probably more beneficial than for any other purpose.

13

INHIBITORY INFLUENCE: Munsterberg says, in American Problems: "Psychologically the case stands thus: alcohol has indeed an inhibitory influence on mind and body. The feeling of excitement, the greater ease of motor impulse, the feeling of strength and joy, the forgetting of sorrow and pain--all are at bottom the result of inhibitions; impulses are let free because the checking centers are inhibited. But it is absurd to claim from the start that all this is bad and harmful, as if the word inhibition meant destruction and lasting damage...If a moderate use of alcohol can help in this most useful blockade, it is an ally and not an enemy."

14

ALCOHOL AND ACCIDENTS: Doctor Walter R. Miles, Professor of Experimental Psychology, Yale University, says that 25 to 40 percent of cases where drivers' licenses are suspended or revoked, it is on the charge of intoxication, and to alcohol is attributed 7 to 10 percent of all fatal highway traffic accidents. "In general", he says, "quite aside from the difficulties with voluntary muscular control, the slightly alcoholized person, driving on the highway resembles in his behavior tendencies, the absent-minded much introverted individual found by test to be accident-prone. A feeling of remoteness from the outside world and a sense of being cozily wrapped up in their own pleasant thoughts are not the ideal subjective states for drivers who mingle in the traffic with other drivers, most of whom expect quick perception and prompt responses on the part of persons whom they pass or meet.

15

DRINKING DILUTE ALCOHOL: Starling, in "The Action of Alcohol on Man" says: "The increased enjoyment of a meal from the use of beer or wine is therefore chiefly a question of the action of alcohol. If we consider the effects of moderate doses-a glass of beer or half a bottle of wine--they will not be immediately apparent any more than they were in the experiments (on digestion) recorded in the last chapter, on men in the respiration chamber. Indeed, objectively we might say that such small doses had no effect, and on superficial observation we may notice little, if any, difference in the demeanor or behavior of a man before and after a meal in which such small doses of alcohol have been taken. Subjectively, however, there is a considerable difference. He has obtained not only greater enjoyment of the meal, resulting in increase of appetite and consequent improvement in the process of digestion, but the greater enjoyment is due itself to the fact that this small dose has given him repose of spirit from the endless little worries of the day's work."

16

Health Officer of Los Angeles, company we keep and beer has intoxicating liquors. It is

Writing for a commercial journal, Doctor George Parish, has said: "Unfortunately in this world we are judged by the for years and decades been the constant associate of strong, not an intoxicating, poisonous liquid or drink, but in most instances it has real medicinal value both as a drink and as a food. Beer from the beginning of time has had a useful and often necessary place in the daily menu of man and had it not been for the abuse of it instead of the use, would not now be condemned. "

17

ALCOHOL AND CRIME: Herman Adler, Professor of Psychiatry, University of California, regards the evidence in support of the direct relationship of alcohol to crime as not very trustworthy. Psychiatrists now realize that "the hope of finding specific causes of any of the major behavior disorders such as crime and delinquency is likely to be futile one. Yet it seems clear that "any chemical reagent which disturbs the smooth functioning of the organism may produce situations from which a criminal act may result.

"

Social behavior is a very complicated reaction between the human being and his environment. It is hence evident that many factors enter into the causation of crime. Despite the widespread belief to the contrary, alcohol does not appear to play a major role in the causation of crime.

MODERATION RECOMMENDED: Some manufacturers of alcoholic drinks are recommending in their advertising the moderate use and the avoidance of the abuse of their products. For example, a well-known distillery says in a recent advertisement: "There is a common problem which you as consumers and we as distillers share. It is the right use of liquordrinking in moderation. Every intelligent person realizes that there are two kinds of drinking. One is moderation; the enjoyment of good liquor for its taste, its aroma, its

warmth, and the friendly feeling it engenders.

"The other is excess; with the unpleasantness, embarrassment and regret it generally brings."

"Between these two there is a sharp dividing line. The dividing line is the extra drink that is one too many... A thoughtless minority must not be allowed to endanger the liberty and enjoyment of countless thousands who consume whiskey as it should be consumed.... in moderation."

18

In answer to a number of questions regarding the effect of the repeal of the Eighteenth Amendment, the Survey Graphic has recently published an article, which in addition to the statistical data regarding criminology and intoxication, reproduces posters used by the New York State Liquor Authority's educational campaign on the use of alcohol. Slogans are: "The Back Seat Driver (Alcohol)-Don't Trust Your Life to Him", and "Intemperancehandicapper in life's race."

CONCLUSIONS OF BRITISH COMMITTEE: The principal conclusions of the Alcohol Investigation Committee, Medical Research Council were:

"(a) That the main action of alcohol apart from the effects of its continued excessive use is confined to the nervous system;

(b) That alcohol is narcotic rather than stimulant in action;

(c) That its nutritional value is strictly limited;

(d) That its habitual use as an aid to work is physiologically unsound; and

(e) That the ordinary use of alcohol should not only be moderate, but should also be limited to the consumption of beverages of adequate dilution, taken at sufficient intervals of time to prevent a persistent deleterious action on the tissues." 19 While the opinions and experimental evidence presented above cannot be said to give complete knowledge as to all the physiological effects of alcohol upon the human system, nevertheless, it is believed that they do sum up the important points about which the laity most frequently questions the public health worker.

1.

2.

REFERENCES

Alcohol and Man: The Effects of Alcohol on Man in Disease and Health. Ed. Haven Emerson, M.D. et al. New York, The Macmillan Company, 1932.

Alcohol: Its Action on the Human Organism, 2nd ed. enlarged and revised. Alcohol Investigation Committee, Medical Research Council. London: Printed under the authority of His Majesty's Stationery Office by Harrison & Sons, 1924.

8.

9.

Blotner, Harry, M.D. Boston. Effect of Alcohol on Digestion by Gastric Juice, Trypsin and Pancreatin. Jour. Amer. Med. Assn., 106:23, 1970-71 (June 6, 1936).

Jolliffe, Norman, M.D. and Colbert, C. N., M.D., New York. Etiology of Polyneuritis in Alcohol Addicts. Jour. Amer. Med. Assn., 107:9, 642-47 (August 29, 1936).

10. Bowles, Russell S., M.D., and Clark, Jefferson, H., M.D. Philadelphia. The Role of Alcohol in Cirrhosis of the Liver. Jour. Amer. Med. Assn., 107:15, 1200-03 (Oct. 10, 1936) 11. (1) p. 342

12. (1) p. 162

13. (1) p. 267-268

14. (1) p. 256-257

15. (1) p. 268

16. Parish, George M. M.D. Health Value of Beer. Health Digest, 3:8, 15-16 (August 1936). 17. (1) p. 324

18. Kay, H. H. Balance-Sheet of Repeal. Survey Graphic, 26:1, 20-24 (January 1937). 19. (2) p. xiii

METHODS OF HEALTH EDUCATION

JOHN W. KNUTSON, D.D.S.

Asst. Dental Surgeon, U.S.P. H.S.
Commissioned Officers' Class, 1937

The title of this paper implies that this discussion will be limited to the various orderly arranged and established systems of teaching health. Such a limitation would compel the writer to conclude with "finis" after the next sentence. There are none. However, we are now confronted with numerous attempts at formulating methods of health education. These are in the experimental stage. We have no data for a preliminary report. Consequently, we are compelled to digress from the title and discuss the scratchings in the field of health education--a field which definitely needs cultivation.

Health education has been defined as the "sum of all experiences which favorably influence habits, attitudes, and knowledge relating to individual, community and racial health." The term "health" not only refers to physical soundness but to social, moral, and mental well-being as well.

The aims of health education according to a joint committee of the National Education Association and the American Medical Association may be briefly summarized as: to instruct children to conserve and improve their health through habits and principles of living which will assure vigor, vitality, happiness and service in personal, family, and community life; and to influence parents and other adults, through their contact with the children, to health consciousness which will insure a better second generation, a still better third generation, and a healthier and fitter nation and race.

With this preliminary definition of terms and purposes we perfunctorily separate health education into two major divisions, adult, or popular health instruction and child or school health direction.

ADULT HEALTH EDUCATION

The modern concept of health education regards health behavior as more important than health knowledge. The aim is favorably to influence habits and attitudes through knowledge, an aim which can only be fully realized through child health education.