Tobacco has been accused of causing many ills and has been thereby much maligned. We can not see that the use of tobacco in any form in moderation is harmful to most men. Undoubtedly the blood pressure is raised when mild tobacco poisoning occurs, and individual peculiarities of reaction to the weed are multitudinous. But to condemn offhand its use is the height of folly. There is no reason why the arteriosclerotic who has always used tobacco in moderation, should not continue to use it, whether he smoke cigarettes, cigars, or pipe. His supply should be decreased, but there is no sense in depriving a man of one of the solaces of life, unless, as is sometimes the case, abstinence is easier for the patient than moderation.
As for alcohol, opinions differ widely.[19] Some see in alcohol one of the most frequent causes of arteriosclerosis; others do not believe that the part played by alcohol is a serious one, only in conjunction with other poisonous substances is it dangerous. Probably unreasoning fanaticism has had much to do with the wholesale condemnation of alcoholic beverages. The general effect of alcohol is to lower the blood pressure by causing marked dilatation of all the vessels of the skin. True, the alcohol circulates in the blood, and is broken up in the liver, and this organ would seem to bear the brunt of the harm done. Alcoholic drinks in moderation, I do not believe have any deleterious effect on health. On the contrary, I believe that they may in some cases assist digestion and assimilation. Indiscriminate indulgence is to be condemned, as is overindulgence in exercise or eating. What may be moderate for A, might be excessive for B. Every man is then the arbiter of his own fortune and within his own limits can indulge moderately (a relative term after all) without fear of doing himself harm. In advanced arteriosclerosis it is necessary to decrease the supply of alcohol just as it is necessary to cut down the food supply. This must rest entirely on the judgment of the physician, who must not act arbitrarily, but must have his reasons for every one of his orders.
[19] Discussion of alcohol at present has value only as it relates to the past. The present is dry. The future is in the lap of the gods.