It is entirely a mistake to suppose that enteric fever patients need alcohol necessarily as a routine. On the contrary, it is certain that much harm may be caused by its indiscriminate use. The too liberal employment of stimulants in this fever is associated in my mind with such conditions as restlessness of the patient, irritability of the bowels, and increased liability to haemorrhage, and other ulcerative accidents. The vast majority of patients are able to dispense entirely with alcoholic stimulants throughout the whole course of their fever. Of my own patients not more than one in ten is systematically dosed with alcohol. A slightly larger number get occasional doses should necessity arise.
As regards the indications for stimulation, patients who are alcoholic will probably require it. Elderly patients, again, persons over forty years of age, are much more likely to benefit by the use of alcohol than children or young adults. When the pulse becomes rapid, exceeding 120 in an adult, when the first sound of the heart is almost or quite inaudible at the base, and when the tongue is severe and very dry, the advisability of prescribing stimulants must be seriously considered. In cases, also, where there is marked pulmonary congestion alcohol is often of great advantage. Even in these circumstances, however, its systematic and regular use may not be necessary and often very small amounts once or twice repeated may have the effect desired. In every case the result of the dose of alcohol must be carefully noted, and if it does not favourably affect the rate and character of the pulse there is little use in persisting with it. If, again, the patient becomes restless and excited, it is probably doing him more harm than good. It is always well to remember Jenner's advice on this subject. If in any doubt about stimulating, don't !
Stimulants may be found useful in small quantities on certain special occasions. If the cold bath treatment is being systematically used a small dose is prescribed by most authorities immediately after the patient is removed from the bath. Again, after irrigation of the large intestine, a prolonged and somewhat exhausting operation, it may be occasionally advisable to give a small quantity of spirits. Under certain circumstances, again, a little whisky in the form of hot toddy may be found useful as a soporific if a cupful of hot beef-tea has failed, and if a hypnotic drug is not thought necessary.
As regards the choice of the stimulant employed, during the acute stage there is probably nothing more useful than sound Scotch whisky. This may be started in doses of even such small amounts as one drachm every four hours, and should rarely be increased beyond half an ounce at similar intervals. If there is much diarrhoea, or any tendency to sickness, brandy is more useful and is likely to be better tolerated. In convalescence many patients are much the better of a glass of port wine with their dinner and at night, and in private practice a good Burgundy may be employed at this time with great advantage.