This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol1", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
In low febrile diseases the alcoholic liquors are a most valuable resource, and, indeed, often indispensable. At least, I have very frequently met with conditions in these fevers, in which I should have quite despaired of a cure without their aid. They are not so well adapted to the prostration or collapse which sometimes occurs in the cold stage, at the commencement of the fever, as to the debility coming on in its course. The continuance of their stimulant influence into the stage of reaction, and their special tendency to the head, might possibly, under the former circumstances, injuriously increase the fever and cerebral disturbance; and they should, therefore, be employed only when the arterial stimulants may prove inadequate to the end in view. But to the latter condition, the debility, namely, which so often supervenes in febrile diseases. and not unfrequently constitutes their greatest danger, they are adapted, beyond all other medicines, by the universality as well as energy of their stimulant property. Operating specially upon the brain, they rouse it from the torpor by which it is apt to be overwhelmed in the advanced stage of fevers of the typhoid character, and prove much more efficient in sustaining life than the arterial or nervous stimulants. They are indicated when the pulse is feeble, and the skin cool, and particularly when, with these evidences of debility, are associated the dark tongue. the sordes about the teeth, and the stupor or low delirium of the typhous state, indicating a depraved condition of the blood. Even when the skin is hot, if the other symptoms appear to call for their use, they should be tried. I believe they not only stimulate in these cases, but prove useful also by directly contributing, through their nutritive properties, to the improvement of the blood. Unless the prostration is sudden and alarming, the mildest form of these stimulants should be first employed, and recourse be had to the stronger only as the increasing debility may seem to require them. Thus, it is usually advisable to begin with wine-whey, then, if necessary, to advance to pure wine, and ultimately to ardent spirit. Should the skin become hotter and dryer, the pulse more frequent, and the patient more restless and delirious under the stimulant, it should be diminished or discontinued; but, should the contrary condition occur, should the skin become soft or moist, the pulse slower, fuller, and stronger, and the patient more comfortable and less disposed to delirium, it may be taken for granted that the remedy is operating favourably, and should be continued. It is in typhus, enteric or typhoid, and petechial fevers, that the alcoholic remedies generally prove most useful; but most other febrile affections sometimes assume the same low character, and require the same treatment. The alcoholic liquids may often be advantageously used in scarlatina, diphtheria, smallpox, and erysipelatous fever, and occasionally in bilious remittent and yellow fevers, when they present typhoid symptoms. Even the existence of inflammation, under these circumstances, does not positively contraindicate them Active alcoholic stimulation is often necessary in typhoid or typhous pneumonia.
In the advanced stage of inflammation, when copious suppuration has taken place, and the patient is sinking under it, the alcoholic stimulants are often called for, to aid in supporting the strength until the exhausting influences shall have ceased, or, when the case is hopeless, to render the patient more comfortable, and protract his life. Such a condition is presented in the suppurative stage of pneumonia, abscess of the lungs and kidneys, purulent phlebitis, lumbar and psoas abscess, suppuration of the large joints, extensive caries of the bones, and very large or numerous ulcers upon the surface. To this category may be added various constitutional affections attended with suppurative or ulcerative conditions, as erysipelas affecting the cellular tissue, confluent smallpox after the maturation of the pustules, all scrofulous affec-tions including phthisis, syphilis in the ulcerative stage, and several of the cutaneous affections, particularly rupia and ecthyma.
Precisely the same indication is offered by gangrene, whether resulting from inflammation, from purely depressing agencies, or from a vitiated state of the blood. The system requires support against the directly depressing influence of the gangrene, and of the processes requisite for the separation of the slough, and also to enable it to repair the injury done. It is unnecessary to enumerate all the affections in which this condition may occur. In severe internal inflammations, there is occasionally an abrupt cessation of the pain, with symptoms of great prostration, which have been supposed to indicate the occurrence of mortification, and often perhaps truly, even though certain evidence may not be exhibited by putrefaction after death. Strangulation of the bowels, whether concealed as in invagination, or obvious, as in hernia, very often ends in mortification. Other examples of this affection we have in gangrene of the lungs and of the mouth, that which attends malignant erysipelas, carbuncle, and the malignant pustule, and lastly that arising from severe burns, injuries of the blood-vessels, arteritis, the poison of ergot, etc.
In the above suppurative and gangrenous affections, and all others of a similar character, alcoholic stimulation is very frequently indicated, ami sometimes strongly so. But it must be remembered that they are usually attended with more or less remaining inflammatory or systemic excitement, which requires caution in the use of the stimulant; and, as a general rule, the fermented liquors will be preferable to the spirituous. Most frequently, in these conditions, there is also an indication for the use of opium and sulphate of quinia or other preparation of Peruvian bark.
There is a state of system, essentially one of debility, in which the blood is poisoned by noxious matter absorbed into it, and which does not come exactly into either of the preceding divisions. To this belongs the condition denominated 'purulent infection, metastatic abscess, and pyogenic fever. It is a condition in which, probably, disintegrated pus, or other sanious secretion from vitiated sores, is absorbed into the blood, and depraves its character. Analogous to it is the state of system arising from dissecting wounds. Alcoholic stimulation is often indicated in this condition.