I believe that there may occasionally be cases in which the physical benefits derived from their use outweigh the injury they inflict, but I think this use is very much less than is generally supposed, and if we can judge from the preponderance of evil effected by such use, these substances ought to be considered as the materialized curses of God rather than as beneficent gifts. The prevalent idea as to the beneficent nature of these substances I consider to be a delusion that can only be explained upon the hypothesis that there is a widespread lack of appreciation of the fact that, though they may have an immediate pleasant and agreeable effect upon the body, their injurious effects are cumulative, and are usually ultimate, and so distant as to be difficult of direct connection with their cause to ordinary observation. The more moderate the use of these substances, the more remotely is the effect removed from the cause and more difficult of detection. That the ordinary habitual, so-called moderate use of stimulants and narcotics, such as tea, coffee, tobacco, and alcohol, is, in the vast majority of cases, really an abuse, is a proposition that I think should be admitted by all who have given the subject an unbiased study. The idea that the user of tobacco and other injurious substances will be cognizant of the injury inflicted by habitual use in moderate or even excessive amounts is an undoubted fallacy. The daily, weekly, or monthly injurious effect may be entirely unobservable to even trained physicians, and yet the ultimate cumulative effect may be fatal. I can instance numerous cases of physicians directly fatally injured by the use of alcohol, who have never had the slightest cognizance of the fact; and I can also instance cases of grave disease from the use of tobacco where the patients never have believed that tobacco has been the cause of their troubles, even after a unanimous opinion to that effect has been expressed by a number of competent medical advisers. The habitual consumption of opium, in doses of any amount, is generally admitted by most people to be physically injurious outside of its strict medicinal application. Moderate indulgence in alcohol as a beverage is beginning to acquire a very widespread evil reputation. But how about tobacco? Tea and coffee we can confidently leave to the consideration of a somewhat remote posterity of a considerably advanced intelligence and elevated hygienic ideals.