The principal theory of the action of alcohol in all fevers is that it serves as a food; it is readily absorbed and carried in the blood to all parts of the body, and it is believed that its combustion saves in some degree the wear and tear of the tissues, as the alcohol burning in a spirit lamp furnishes energy in the form of heat, and itself becomes oxidised to waste products, but spares the carbon of the wick. The latter is not itself burned up or oxidised until the alcohol has been exhausted. Another theory of the use of alcohol is that it possesses a positive antipyretic action by which it controls the body temperature by restricting heat production. It is also believed that alcohol in fevers acts upon the nervous system, strengthening and supporting it, in this manner indirectly controlling the nerve currents which preside over the activity of nutrition, chemical change, and heat production. The subject is a very broad one, and is obscured by the lack of definite knowledge as to the exact nature of the chemical processes concerned in heat production, which are probably very complex. It is possible that in many instances alcohol may act simultaneously in all the ways suggested, having the combined effect of- a food, a nerve tonic, and an antipyretic.

This view is ably advocated by Dujardin-Beaumetz, who gives an exhaustive discussion on the subject in his work on alimentation in fevers (Du Regime Alimentaire dans les Maladies Febriles, p. 227).

Light white wines, diluted claret, and even beer are recommended in fevers by some writers on dietetics, especially in those countries in which good water is unobtainable, or in which for other reasons wine drinking is in much more common daily use than it is in America, where there is an abundant supply of pure water. In France and Germany light red wine is frequently allowed throughout the course of mild fevers, and from five to ten ounces are given daily. The fever diet in the Munich General Hospital includes 150 to 300 grammes of light red wine or white wine. Beer is also much used in Germany for fevers, and it contains some nourishment.

If alcohol is not required for its stimulating effect upon the circulatory or nervous systems it is better to withhold it, for in continued fevers emergencies may at any time arise in which it is imperatively demanded to strengthen the failing powers or aid in controlling the exhaustion of delirium. Its influence will always be more decided and its action can be much better controlled if spirits have not previously been given, and when it is needed for any such reason it is best to prescribe it in the form of brandy or whisky.

In general, it may be stated that alcohol is usually needed if the temperature remains for several days above 1030 F., and is always required if it remains as high as 1050 F. The typhoid condition supervening in the course of any fever always demands it - i. e., the condition characterised by great prostration, low muttering delirium, subsultus, rapid feeble pulse, dry tongue, etc.

In the convalescence following prolonged fever the daily use of liquors with meals, or in the form of toddy or punches between meals, two or three times a day, is often indicated. This is particularly the case among elderly people convalescing from pneumonia and other acute febrile diseases or who have been greatly weakened by some prolonged adynamic disease. In infancy also, and early childhood, the use of alcohol may be demanded in the course of acute fevers.

Persons who have been habitual though moderate drinkers for many years, or throughout their lives, when attacked with any severe acute or infectious disease possess less vitality and resistance than those whose tissues have not been constantly bathed in alcohol. To withhold the long-accustomed stimulation in these cases is often to precipitate serious exhaustion, and the problem of properly adapting the quantity of alcohol to the patients' actual needs becomes a very serious one to the physician, to which he should give careful and thorough study. Caution should be given against the continued use of alcohol by patients in whom there is danger of inducing the alcohol habit. It not infrequently occurs that those who have been addicted to excessive drinking, but who have been temporarily cured of the habit, and who have taken no liquor for possibly several years, acquire some acute disease in which there is need of active stimulation. In such cases, having in view the possible recovery of the patient, with a renewal of his alcoholic habit, this stimulant should be withheld as long as possible while efforts are made to sustain the enfeebled heart power by strychnine, digitalis, or diffusible cardiac stimulants, such as ether, ammonium carbonate, aromatic spirits of ammonia, camphor, etc.

From the above account it appears that the question of the use of alcohol in all febrile disorders should be considered from two chief standpoints, embracing, first, its value as a food, with its relation to other foods and to nutrition; second, its value as a stimulant and the extent to which it may be replaced or re-enforced by drugs. The continued use of strong alcohol always disorders digestion, and since the stomach is weakened in fevers, it is more susceptible to such influences, and this is an additional argument for not employing alcohol in a routine method, but for saving it for positive indications, such as asthenia. But in those cases in which the battle for life must be waged largely with stimulants as much as one ounce an hour (twenty-four ounces per diem) of brandy or whisky must sometimes be given, and it is a curious fact that in the presence of high fever patients can often tolerate such dosage without the indications of alcoholic poisoning which in health would promptly follow the use of a smaller quantity.