The position of alcohol as both a food and a stimulant has already been fully discussed in connection with its physiological and dietetic action (p. 231).

The effects of poisoning by alcohol differ according as they are acute or chronic, and according to the previous alcoholic habits of the patients. Habitual drinkers easily consume quantities of raw spirits which might prove fatal if drunk by one not inured to their use. Men have been known to drop dead a few moments after quickly drinking a pint or more of whisky on a wager. Although, according to Professor Atwater, two and a half ounces of alcohol may be daily oxidised by a person in health, the continued use of beverages containing this quantity is liable to produce alcoholism in any one.

When alcohol is used to excess as a stimulant its effects are manifested by the increased mental excitement of intoxication. There is a period of restlessness, insomnia, loss of memory, and irritability. The stage of insensibility and final stupor or coma develops later after long taking large quantities of alcohol. Patients suffering from alcoholic coma are always in danger of heart failure from paralysis of that organ, which forms no exception to the general rule that overstimulation of any muscle produces exhaustion and paresis. When in this condition, however, they are fortunately incapacitated from making any sudden or violent exertion, and in acute cases alcohol is eliminated with considerable rapidity from the various excretory organs of the body, especially the kidneys, in the form of waste matter, which it produces.

The continued use of strong spirits, as well as the occasional use of alcohol in excess, almost invariably results after some time in the establishment of chronic gastric catarrh, which is characterised by the formation of thick, ropy mucus, and thickening of the gastric mucous membrane, with atrophy of the gastric glands. There is always malfermentation with more or less acidity and heartburn and considerable nausea, especially in the morning, when the mucus or products of indigestion have accumulated overnight. There is also an increased production of connective tissue in the stomach wall. The effects of chronic alcoholism upon the alimentary canal are chiefly manifested in the stomach, although the intestine may share in the pathological changes. This is due to the fact that the alcohol reaches the stomach in a more concentrated form, and that being very diffusible it is absorbed in great part without entering the intestine.

In addition to the local gastric catarrh and inflammation which it may produce, alcohol gradually alters various viscera, causing cirrhosis of the liver, nephritis, chronic endarteritis, etc. Chronic alcoholism is one of the commonest causes of multiple neuritis, chronic pachymeningitis, and myelitis.

In chronic alcoholism the intense craving for alcohol in any form tends to weaken and overcome the will power and debase the moral nature of the individual, and those who are afflicted by this habit very often drink periodically - that is, the intervals between their excesses may be prolonged for one or several months, during which time they touch no alcohol in any form, and, indeed, in some cases they may have a positive loathing for it. The very sight of it nauseates them. The craving then returns and becomes so irresistible that if they cannot obtain liquor they have been known to drink raw alcohol from spirit lamps or in any shape in which they can obtain it. The craving consists partly of a special appetite for liquor in the stomach, and in part of the general irresistible desire of the system, which is somewhat akin in its effect to intense hunger, although the effect on the will power is more disastrous.

The evil results of excessive indulgence in alcohol are strikingly shown by its effect upon liquor dealers, the mortality among whom, from various diseases, as compared with that of other men, bears the ratio of 3 to 2. When a similar comparison is made in regard to the mortality of liquor dealers from special diseases, the result is still more striking; thus for liver diseases the ratio is 6 to I, for nervous diseases nearly 2 to 1, and for alcoholism 5.5 to 1.

The dietetic causes of inebriety form an interesting study. The craving for alcohol is undoubtedly fostered in many cases by monotony of diet, by ill-prepared food, and the resulting catarrhs of the alimentary canal and lack of nutrition. To meet the symptoms of anorexia, heartburn, and weakness from malnutrition "tonics " and "bitters" containing alcohol are often resorted to, or alcohol is taken more directly in the form of strong spirits. While this may temporarily relieve the craving for some form of stimulation, it often merely makes the digestive disturbance worse and increases the mental depression of "biliousness." In such manner the drink habit is easily established.