(2) Alcohol introduces a not insignificant amount of fuel into the body (see p. 87). One gram produces by its oxidation in the organ ism seven calories, and while the alcohol is being consumed it saves the consumption of some other non-nitrogenous especially fat. for example, heat to the value of 100 calories is to be de veloped, 100 ÷ 9.3 = 10.75 gm. fat is needed; the same effect is ob tained by the burning of 100 ÷ 7=14.3 gm. alcohol. In other words, when a man takes 14.3 gm. alcohol he can, without having to fear a deficit in fuel, leave out 10.75 gm. fat from his diet. Since we often have to give the diabetic very large quantities of fat, it is a matter of great importance that we possess in alcohol a means whereby a certain reduction in the allowance of fat can be effected. Of course we can avail ourselves of this means only to a limited extent, for with large quantities of alcohol a far more harmful factor enters into the equation, namely, the poisonous effect of alcohol upon the protoplasm of the cells (von Noorden and Miura '). This effect is, however, to be feared only in case of an excessive indulgence. In view of the dangers of larger quantities I would advise that the aver age limit of 60 grams of alcohol a day be not exceeded, except only in those cases in which through long-continued indulgence in alcohol the body has acquired a certain immunity against its toxic effects.
(3) In the third place alcohol recommends itself as a good nervine, the dose of which can be accurately graduated, and as a powerful heart tonic. Its effects upon the nervous system and heart must
indeed be carefully studied in each case, for it is well known that its action varies considerably in individual cases. In the hands of one who knows how to individualize alcohol is an invaluable nerviue and tonic remedy, but it is a two-edged sword in the hands of the mu tinist and generalizer. It is especially in those cases in which the body has long been accustomed to the use of alcohol that we are un able to dispense with it as a nervine and cardiac tonic. I have seen its withdrawal in such cases followed by very decided injurious effects, such as obstinate insomnia, great irritability, depression of spirits, anxiety, and a feeling of weakness. For this reason I cannot advise the withdrawal of alcohol even where a concomitant obesity and arteriosclerosis would in principle demand its prohibition. The older the individual is the less reason is there that alcohol should be forbidden. But it is very fit and necessary in cases of this kind that the use of all the stronger alcoholic beverages should be prohibited, and only the lightest wines be allowed.
More particular directions as to its employment will be found in the following sections. By way of explanation it may be stated that 100 grams of alcohol, for the most part without admixture of carbo hydrates, are contained in—