26 PSYCHOLOGICAL EFFECTS OF ALCOHOL. 



At the beginning of the first experimental period, each subject was 

 requested to supply data for the following questions : 



Identification number, . Date, 



Nationality of father, Mother, 



When married? 



Number and ages of brothers and sisters, 

 Does father take any alcohol? ; kind, : amt., ; time, ; effects, 



mother " " 



brothers " " 



sisters " " 



Is there any habitual use of other drugs by any member of the family? 

 Any nervous or mental disease in the family history? 

 Any excessive use of alcohol in family history? 



Subject's age, ; height, ; weight, ; occupation, ; sport, 



Education, ; college or high school, ; place, ; scholarship, 



studies, ; worst, 



Verbal memory, ; quick, ; accurate, ; long, ; responsive, 



If abstainer, what are the reasons? moral, ; scientific, ; practical, ; 



family, ; social, ; accidental, 



If non-abstainer, kind, ; amt., ; time, ; effects, 



Largest amt. ever taken? kind, ; time, ; effects, 



Last use? amt., ; " ; ; 



Ever intoxicated? ; when, ; kind, ; how often? 



How much without noticeable effect? ; kind, ; time, 



First noticeable effects, 



excitement or the contrary, ; normal, 



talkative or the contrary, ; 



happy or the contrary, 



peculiar sensations, 



effect on flow of ideas, 



effect on affection, ; temper, 



effect on pain, mental, ; physical, 



effect on routine work, ; strength, ; accuracy, ; ease. 



effect on sense of propriety, ; on morals, 



effect on digestion, ; urine, 



Use of tea and coffee, 

 When last examined for life insurance, ; what company, 



In each case the subject was assured that his replies and the experi- 

 mental data would be published anonymously. Every precaution was 

 taken by the experimenter to secure accurate replies. A complete set 

 of these histories of our subjects is published in Appendix II. 



At the conclusion of the last experimental session each subject was 

 given the following form, which he was required to read, fill out, and 

 sign. No serious "exceptions" were noted under this form by any of 

 the subjects. 



The undersigned hereby makes affidavit on bis honor as a gentleman: 



(1) That all data given by me concerning last ingestion of food, and the use of alcohol, 

 were correct according to the best of my knowledge and belief, except as herein specified. 



(2) That there has been no conscious modification of effort or attention to modify the 

 results; and that there has been no intention to modify them, except as herein specified. 



(3) That there has been no discussion of the experiments and their probable results with 

 any person outside the psychological laboratory, except as herein specified. (Please be full 

 as to time and nature of the conversation, if there are exceptions.) 



(4) That there has been no habitual use of drugs during the experimental weeks, and no 

 occasional use of any drug that might modify the effects of the alcohol as far as I know, 

 except as herein specified. 



