These properties make them of value in certain forms of dyspepsia and debility, especially when induced by disease, overexertion, worry, neuralgia and the like. Their nutritive value depends upon their content of saccharin and albuminous substances. Although the moderate use of alcoholic liquors may not be open to very serious objection, it has been demonstrated, nevertheless, that all types of work are better accomplished without the use of any of these beverages. An excess of malt liquors produces effects similar to those of other forms of alcohol. Their tendency to cause obesity is a matter of common knowledge, and the check put by them on the oxidation and elimination of the waste matters of the body naturally favors the development of gouty conditions and other disorders which follow the accumulation in the organism of uric acid and its congeners. It must be remembered also that malt liquors are bulky drinks, and indulgence in them introduces a large amount of fluid into the circulation. The effort to expel this surplus fluid puts an extra strain on the heart, which may be very injurious if that organ is already damaged.

CONSUMPTION OF MALT LIQUORS.-According to the report of the United States Census in 1900, the total consumption of such alcoholic beverages was in excess of 1,332,000,000 gallons. Three years later it had passed the 1,600,000,000 mark. In 1906 it rose to more than 1,800,000,000 gallons. In 1907 the total consumption had reached 2,130,000,000 gallons. Startling as these figures are, they are surpassed by the records of European countries. France leads the list with an annual consumption of 35 gallons per capita; Great Britain, in 1903, had a consumption of more than 30 gallons per capita, while in the United States. the amount is 20 gallons per capita.

Low Alcoholic Beverages. Low alcoholic beverages were formerly produced by making a second brew of the grains after sparging. The liquid so produced was fermented separately and yielded a beverage called "small beer" which contained some saccharin material and from 1.25 to 2 per cent alcohol. It was a refreshing beverage, containing just enough alcohol to keep it for a time and quite strong enough to satisfy the craving of many people without producing alcoholism. Such beer might properly be termed "weak lager beer." This variety of beer unfortunately is not now produced, as the "smalls" are added to the "sweet-wort" and the entire ale is fermented at once.

Genuine malt liquors can be produced of low alcoholic strength (2 per cent alcohol); these are practically non-intoxicating. Such beers are now universally made as a result of prohibition laws. These low alco

holic beers have a flavor like that of lager beer and are agreeable. They contain a fair amount of malt extract and are satisfactory.

The

Herb Beers. Herb beers are made from a decoction of herbs, nettles and other green or dried herbs, saccharin malt and cane sugar. liquor is fermented with yeast. Herb beers should not contain more than from 1 to 2 per cent of alcohol.

GINGER BEER.-Ginger beer or stone ginger is made after a variety of formulas. When made on a large scale, the water is boiled in a steam jacket pan; from this it is run into a mash tub with ginger. After the ginger has been infused for one or two hours in a settling vat, the liquid is run off and citric or tartaric acid, sugar or honey are added and the mixture allowed to ferment. The honey gives a peculiar softness to the beverage and hastens fermentation. Gum is sometimes added to give body, and it may be clarified by using isinglass. It is bottled on the fifth day, and becomes well aerated in about ten to fourteen days. It usually contains 0.75 to 1.05 per cent alcohol.

SPRUCE BEER-Spruce beer is a fermented liquor made from the leaves and small branches of the Norwegian spruce, fir, or from the essence of spruce. There are two kinds of spruce beer, brown and white. The former is made with molasses and the latter with white sugar. The liquid is fermented with yeast. The proportion of alcohol varies from 7 to 16 per cent. Spruce beer is an agreeable and wholesome beverage possessing tonic and antiscorbutic properties.

STIMULANTS (23)

Stimulant is a term which is used with various meanings when ap plied to medicinal agents. The definition of the Latin word stimulus is to goad, to whip up, to spur on. Alcoholic preparations, which are true narcotics, are often referred to as "stimulants," and the same expression is employed to designate any agent which excites, even briefly, the organic action of any part of the human system. All excessive stimulation reacts into depression, and most of the agents which stimulate the nerve centers first will depress and finally paralyze them. In many cases the action is one of progressive stimulation primarily and progressive paralysis afterwards, affecting the centers in the inverse order of their development, the highest or latest developed centers being affected first, the lowest or oldest ones last. Generally speaking, stimulants act directly upon either the nervous system or upon the circulatory organs. Alcohol affects the latter more than the former. It is questionable if alcohol may be regarded as a

nerve stimulant.

Brain activity coincident with the administration of alcohol is no doubt due to an increased flow of blood through the brain rather than any direct action upon the cerebral cells.

Alcohol. Alcohol is produced by the fermentation of sugar with yeast. according to the well-known equation:

C&H12O6=2CO2+2C2H ̧OH
(sugar) (carbonic (alcohol)
acid)

The principal constituent of all alcoholic beverages is ethyl alcohol (CHO), each molecule of which is composed of two atoms of carbon, six atoms of hydrogen and one atom of oxygen. The respective proportions of these ingredients by weight are: carbon 52.17 parts, hydrogen 13.04 parts and oxygen 34.79 parts per hundred. Absolute alcohol is somewhat difficult to procure, since it is hydroscopic and rapidly becomes diluted with water when exposed to a damp atmosphere. Ethyl alcohol, CHO, or ethyl hydroxid, CH¿OH, is a transparent, colorless, mobile fluid of pleasant ethereal odor, mixing with water in all proportions. It boils at 78° C. (172.4° F.) and burns with a white flame. The specific gravity is 0.795. It is only used for technical purposes. What is known as pure spirit of wine consists of 93 to 95 per cent of absolute alcohol and 5 to 7 per cent of water. The small proportion of water causes it to burn with a blue flame.

The glucose in fruits when fermented is converted directly into alcohol, whereas the starches in grains and potatoes, etc., are converted into dextrin and maltose. Then by the aid of diastatic ferments, before alcoholic fermentation can take place, they are converted into glucose and after a certain period of fermentation are distilled, producing alcoholic beverages. Glucose, the formula of which is CH12Oe, is transformed into alcohol by a process of fermentation, through which each of its complex molecules loses two atoms of carbon, four atoms of oxygen (constituting two molecules of carbon dioxid, CO2), the portion remaining constituting two molecules of alcohol 2CH ̧OH.

The special characters of different alcoholic beverages depend to a large extent upon the particular kind of sugar and yeast concerned in the fermentation. It is also interesting to know that the process of fermentation as carried on in the manufacture of alcoholic drinks is not such a simple process as the above equation might induce one to believe. In the process of fermentation and distillation, several by-products, the

chief of which are methyl alcohol, carbon oxid gas and glycerin, are produced as well as alcohol. The nature and amount of these profoundly influence the character of the resulting beverage. It remains true of all alcoholic drinks that the principal constituent by which they affect the nutrition of the body is due to ethyl alcohol. It is therefore of much, importance to study minutely the effects of alcohol on the body, for upon the results of such study our opinion as to the value or detriment of alcoholic drinks, both in health and disease, may be correctly estimated.

LOCAL EFFECTS OF ALCOHOL.-The local effects of alcohol are those of a chemical irritant. If its evaporation is prevented, as by covering with a watch glass or a piece of rubber, or if the alcohol is rubbed in, it absorbs water from the tissues and hardens them. It coagulates the albumin of the part, but the coagulum is soon redissolved by the fluids of the tissues. It then dilates the vessels of the derma, producing a sensation of warmth upon the skin. If some strong spirit, such as whisky or brandy, is taken into the mouth, a sensation of burning is produced, owing to the irritation of the nerve endings, and by and by the mucous membrane becomes somewhat corrugated and whitened by reason of the removal of water from its surface cells and the coagulation of their protoplasm.

Internally, in moderate doses, alcohol acts briefly as a cerebral, cardiac and general stimulant; in large doses as an anesthetic, intoxicant, deliriant and finally as a narcotic poison and paralyzant of the nerve centers.

EFFECTS OF ALCOHOL UPON THE HEART.-As a cardiac stimulant, alcohol should be given when heart failure is impending. The radial pulse is not always a good indication of the strength of the heart. An incompressible pulse, due to obstruction of contracted arteries, may give the impression of a full, strong pulse, whereas the heart may be very weak. Upon auscultation, however, it can be determined exactly when alcohol should be given. In many cases of fever, only one sound of the heart can be heard, the first sound being so weak as not to be audible. This is a condition where there is great danger of collapse, for the first sound coincides with the systole and in proportion to its feebleness there will be weakness in the systolic contraction. At first the sound may be muffled, and as the contractions become more feeble it can only be heard by a practised ear. On the other hand, the second sound is due to relaxation of the heart. If it relaxes quickly, the sound is more distinct than if gradual, and this clearness of the second sound indicates the beginning of heart failure. Disappearance of the first sound always calls for the administration of alcohol. In cardiac failure accompanying acute

disease, unlimited quantities of brandy are indicated, but stimulants must be reserved for the actual time of heart failure. Alcohol is of great value for its stimulating effect upon the spirits in conditions of profound nervous exhaustion where there is great depression. It also produces remarkably soothing effects in muscular weakness.

The stimulating action of alcohol upon the heart is similar to that produced by violent muscular exercise, that is, a greater frequency of contraction with an increased force of the heart beat. The pulse is rapid and very short; consequently the arterial system is dilated and respirations increase. This is the main action of alcohol. Just as prolonged violent muscular exercise results in exhaustion, so this rapid action of the heart, produced by constant doses of alcohol, finally leads to cardiac weakness. In diseased conditions, however, when the heart is beating rapidly, but feebly and ineffectually, the administration of alcohol often diminishes the frequency of the beats, while at the same time, improves its force and volume. As long as these effects are maintained in a case of acute illness, one is reasonably safe in assuming that alcohol is doing. good.

The heart seems to show the stimulating effect of alcohol even before the liquid is absorbed, due probably to the action on the gastric nerves which are so closely related to those controlling cardiac action. In certain cases this reflex action is so marked that the heart ceases to beat. This phenomenon is not infrequently observed in the sudden death of heavy drinkers. Among the numerous investigations concerning the effects of alcohol on the circulatory system, those of Parkes and Wallowicz are enlightening. They studied a patient who imbibed daily from one to seven and one-half ounces of rectified spirits with the effect of rise in pulse rate of ten beats to the minute as compared with that in the time when alcohol was withheld. However, in accordance with the observations of other investigators, this cardiac stimulation was succeeded by depression in which the beat was not only slower than normal, but also more feeble.

This after-effect of alcohol is most important, for it points to the fact that the temporary stimulation must be followed by depression of the heart's action. Alcohol, it would seem, does not afford nutriment for the heart, but is merely an agent by which this organ is enabled to make temporary use of its reserve strength. The physician should learn from this data that alcohol must not be given too early in acute diseases, otherwise before the crisis is past the patient will have arrived at the state in which further stimulation is impossible.