An unsteady, weak and easily compressed pulse, and a corresponding condition of the heart, with the typical symptoms of the " typhoid " state, are regarded as clear evidences of the necessity for alcohol. The writer has watched by the bedside the effects of alcohol under these circumstances, and he has satisfied himself that by its use life may some times be saved, which, without it, would be lost. The effect of the drug requires the closest watching, and herein lies the secret of success, because it may sometimes be found to do harm in the case where the indications for its use may appear clear, and it is the duty of the physician to give the case his anxious attention for the first S or i 2 hours after beginning the alcoholic treatment.
This has been forcibly put by Brunton: " The various rules which have been given for the administration of alcohol in fevers may he con densed into one. If the alcohol tends to bring the patient nearer to his normal condition, it is doing good: if it takes him farther away from his healthy condition, it is doing harm.
" The points which arc usually specially attended to arc the condition of the tongue, pulse, respiration, skin and nervous system. If it is found that the alcohol (I) renders the dry tongue moist, (2) slows and strengthens the pulse when it is too quick. or quickens it when it has become abnormally slow. (3) slows the hurried respiration, GO renders the skin cooler or moister when too hot and dry. and (5) lessens delirium and brings on sleep—then its action is beneficial. If it has an opposite effect it does harm. Useful indications the advantage of alcohol and the dose may be obtained by the practitioner remaining beside the patient counting the pulse and watching the tongue. respiration, skin and general condition of the patient for a quarter of an hour after the dose has been given. Particular care should be taken in the administra tion of alcohol to patients in the small hours of the It is about this time that attendants are most apt to become sleepy and therefore careless, and just at this time also the external temperature is lowest, the fire is apt to get low, and the vital powers of the patient are most likely to sink." The question of the dose and form in which the alcoholic stimulant is to be given is an important one. First. as regards the variety of alcohol, the writer believes that brandy or whiskey should always be preferred to wine, and the selection of brandy as against whiskey. or vice versa, should be made after considering which of these agents can be procured in the purest form. As a rule, in this country, a pure matured whiskey is more easily obtainable than a pure brandy, hence the writer always employs whiskey, and he is satisfied that the product of the patent-still should not be employed. The so-called " silent " spirit and the numerous blends into which it enters do not produce the cardiac stimulating effects of a matured malt whiskey made by the old pot still process. The ethers produced by the splitting up of the traces of fusel oil left in the latter process possess valuable stimulating properties, and, moreover, they appear to aid in the entire combustion of the spirit in the blood.
The whiskey can be given to the greatest advantage along with the milk, when the patient does not object to this plan. and in proportioning
the dose the symptoms and their severity and the ascertained effects of the agent must be taken into account along with the previous history of the patient. e to 3 oz. are often prescribed as the daily dose; this can be of no use in severe cases, and in mild types of the disease the patient will probably do better without such a dose. The only value that can come of such a small quantity is that already mentioned—i.e.. to aid in the digestion of the liquid nourishment, or to act as a food by being burned up in the organism like carbohydrates.
The practice of the writer is only to give alcohol when clearly and urgently needed. Hence the dose which he generally employs will appear larger than that usually recommended. Less than 5 oz. of old whiskey spread evenly over the 24 hours will be of little use to an adult in the condition indicating the exhibition of alcohol. In bad examples of the typhoid state, with a very fluttering pulse, dry tongue, and the mouth covered with sondes. the writer has given twice and sometimes three times this quantity with the most satisfactory results.
The views of Wood are similar to those already stated. Ile says the " guide to the amount given should he the effects produced; so long as it lowers the temperature and pulse-rate, moistens the dry tongue and skin, and quiets the nervous disturbance, it does good. If, however, t he tongue grows drier, the pulse puts on an angry, bounding character, and the patient becomes restless and uneasy, stimulation is being pushed too far. and the amount exhibited should be lessened. Whenever the odour of liquor appears upon the breath the patient is almost certainly taking too much." Very large doses of alcohol have a lowering effect upon the temperature, but it is out of the question to think of using it merely for this purpose in typhoid fever. Where the cold or tepid water bath is being used, a small amount ot alcohol is considered necessary, and there is no reason why lcohol, quinine, and the tepid bath may not be all indicated in the same case at the same time.
Often the nature of the complications present will determine the best form for the administration of alcohol. Thus, where stimulants are indicated and the patient is vomiting, champagne may be selected instead of either brandy or whiskey , and if diarrhoea is a marked feature the effects of a good old port wine may be tried, but these wines cannot be given mixed with the food or milk, hence the champagne should be diluted with an effervescing water and the port with plain water.
Elsewhere the wi iter Las summed up the question of the administration of alcoholic stimulants in fevers: "Most authorities would probably agree t-hii-t–.2.1cohol is not necessary at all in the majority of cases; that often unpromising cases pull through without it; that in severe cases it cannot he safely withheld from those habituated to it; that occasionally by the use of alcohol life may he saved which would otherwise be lost; and that it is rarely needed in the very large doses prescribed by some-8 to io oz. may he regarded as representing a liberal daily allowance of whiskey."