Almost nothing is known in regard to the excretion of alcohol by diseased kidneys. Experiments were begun at my instigation, but they are not yet completed, owing to the decided technical difficulties encountered in the quantitative estimation of alcohol; and I cannot yet report upon them. We know, however, that alcohol is one of the worst poisons for the kidneys when it is carried to them in the blood and circulates around and through their substance for any length of time. It is immaterial whether it is absorbed from concentrated spirituous liquors, such as whiskey, etc., or from mild alcoholic beverages, like beer, etc. Alcohol undoubtedly irritates the kidneys directly. We do not know the limits beyond which alcohol is injurious to them in health. That there is a zone within which no harm can result, we may assume with certainty; and we must not allow zealous temperance advocates to confuse us on this point, which has been proven by experience. For the kidneys, when they are diseased, the limits of the harmless zone are undoubtedly narrower than for healthy kidneys. As we do not know these limits nothing can be said against the prohibition of alcohol, at least in acute disease, on the part of cautious physicians, provided, of course, no definite indications make its use advisable or necessary. I belong to those heretics who, in spite of the noise made by the Anti-Alcoholic League, recognize alcohol to be a very important and often an indispensable medicine. Even in patients with acute or chronic nephritis, I sometimes find indications for its use. Among these indications I include attacks of cardiac weakness with small and thready pulse. Small, oft repeated doses of alcohol in concentrated form act remarkably well and so rapidly in such cases that all objections to its employment may be overlooked. Moreover, everyone who is not intentionally blind to these things must admit that in some nephritic patients the power of the stomach to retain food is decidedly improved by the administration of small quantities of wine or of diluted brandy. They stimulate the appetite and moderate the nausea, which in the case of acute and sub-chronic nephritis only too often makes nutrition difficult.

I cannot say that I have ever witnessed any harmful results from the careful use of alcohol in acute and sub-chronic nephritis. But I usually avoid it unless special indications are present. Perhaps we have all become too careful, under the influence of the propaganda against alcohol. We must remember that two of the food stuffs which give excellent results in the convalescent stage of acute nephritis and in the sub-chronic form of the disease, supply the patient with much alcohol; viz., kefyr and kumyss. They contain 2.2 per cent, of alcohol on an average. As in kumyss or kefyr cures the quantity taken reaches three or four liters a day, 66 to 88 g. of alcohol are ingested, or about the same amount as is contained in 100 to 130 cm. of cognac, in one liter of moderately heavy Rhine or Burgundy wine, or in one and a half to two liters of beer. Everyone seems to believe that such quantities of alcohol in the form of cognac, wine, or beer are harmful for nephritic patients, yet in the form of kefyr or kumys they are prescribed unhesitatingly; this is a paradox that awaits solution.

For alcohol in atrophic nephritis, see below.