As a cardiac stimulant alcohol is of use in syncope and in certain cases of acute fever, such as enteric and pneumonia. In the latter class of case it is chiefly of service in tiding the patient over a temporary danger; it should on no account be given as a matter of routine. The test of its value in such cases is its influence on the pulse, the temperature, and the general condition of the patient: if it slows the pulse, lowers the temperature, and calms delirium, we conclude that it is doing good; but unless there is distinct evidence that it is doing these things, it is best to withhold it, for it must never be forgotten that alcohol not only tends to poison the heart muscle but also to weaken the natural defences of the body against pathogenic bacteria.

When with hyperpyrexia there is considerable constriction of the superficial arterioles, as may happen, e.g. in enterica, a preliminary dose of alcohol, by dilating these vessels, may facilitate the reduction of the temperature by means of the cold bath.

Simple uncomplicated cases of pneumonia are best without any alcohol. The like is true of acute bronchitis, especially if the patient is middle-aged and obese; much more good results from judiciously restricting the food than from plying the patient with alcohol.

While alcohol may be of some service in acute disease, its chief therapeutic use is in chronic states of debility, such as are met with in the anaemic, in the overworked, and in those exhausted by chronic suppuration, or by such diseases as influenza and malaria. It is probable that in all such cases alcohol essentially benefits by stimulating appetite and digestion. It is true that in some it may be quite useless, nay, even harmful, causing headache, flushing, and other disagreeable symptoms, but in others, under the judicious administration of champagne, stout, or port wine, the patient at once begins to make headway.

The following is an illustration of the value of alcohol in promoting digestion in a case of debility from overwork. A busy professional man finds that after a good holiday he is able quite well to dispense with alcohol, but when the effects of his holiday have worn off he generally appears at the luncheon table pale, weary, and overwrought, with no relish for his food, which he swallows mechanically and without feeling any the better for it. If, however, he takes a glass of port early in the meal all this is altered; he enjoys his food, the blood comes back to his lips and cheeks, and the irritable mood is replaced by one of serene geniality, resulting in a flow of easy and agreeable conversation. In such a case alcohol not only acts as a sedative but also as a stimulant; it allays irritability and stimulates function. Exactly the same experience is repeated at dinner.

Though alcohol may undoubtedly be useful in cases like this, where the weakness of digestion is part of the general bodily weakness resulting from fatigue, much may be done to revive the flagg ing energies by other means, such as complete rest of mind and body for twenty minutes before the meal, the slow sipping of some hot stimulating soup or even simple hot water, the taking of a dose of quinine or other vegetable bitter, and finally by bathing the face and neck, or even the entire head, in hot water. The formality of dressing for dinner may go a long way to remove fatigue and to give a zest for the meal.

In fatal diseases which are not likely to run a long course, such as carcinoma and many cases of phthisis, alcohol may often be given with advantage. In so far as it is capable of soothing the incurable patient and giving him a passing sensation of well-being, it should be allowed without hesitation, even though in other respects it may be detrimental.

Alcohol in the form of whisky or gin is often given to relieve dysmenorrhoea, but other and more efficacious remedies are available, and it is not wise to prescribe it for this purpose. Nor should we sanction its use for the relief of "windy spasms," or for the "sinking" feeling at the pit of the stomach so frequently experienced by women, especially at the climacteric. Alcohol undoubtedly relieves these symptoms for the time being, but the practice of flying to it for relief not infrequently eventuates in hopeless inebriety. Most women are best without any alcohol whatever during the climacteric. And here it may be remarked that great caution should be observed in regard to alcohol by lonely childless women. Much alone all day, with perhaps little to occupy them, they form a class peculiarly liable to drift unconsciously into habits of intemperance.

Dosage

In prescribing alcohol, it is very necessary to give precise directions as to quantity and as to the length of time during which it is to be taken, otherwise we may find the patient taking a larger amount and for longer than we intended.