The old claim that alcohol is a food makes it necessary to make some statement here regarding its use in the rick-room, notwithstanding the fact that it has recently been shown to have no food value. While the effect of alcohol upon the healthy individual is always deleterious when it has any noticeable effect, still, it is believed by many clinicians that it has a distinctly advantageous effect on certain febrile conditions. That it has an actual food value is, of course, out of the question, but it may decrease body waste in fever by decreasing metabolism. Its narcotic drug effect, sufficiently explained above, would easily make such an effect possible, and it is altogether likely that herein lies any advantageous effect that alcohol may have in these cases.

Whether the physician administers alcohol to his patient will depend largely upon the previous habits of the patient. If he has been used to moderate amounts of alcohol the physician may consider it wise to continue its administration. However, even in these cases the responsibility should always be assumed by the medical attendant, and never by the nurse or other attendants. In carrying out the physician's directions the dietitian will need a certain amount of information regarding various alcoholic beverages.

Alcoholic Beverages may be classified into two general classes, Distilled and Fermented.

Distilled alcoholic beverages comprise spirits and liquors. The spirits are represented especially by whisky and brandy, whisky being distilled from fermented grain, as wheat, corn, or rye, and containing from 50 to 58 per cent of alcohol, while brandy is distilled from fermented fruit and contains from 42 to 55 per cent of alcohol. Liquors are prepared from distilled spirits by adding various flavoring matters. Distilled spirits should never be given full strength but should be diluted with at least three volumes of water or other liquid. This proportion should be particularly observed if they are to be taken upon an empty stomach, as the full strength of spirits would have a strongly irritant action upon the mucous membrane of that organ.

Fermented alcoholic beverages include ales, porters, beers, and wines. Ales, porters, and beers contain from 3 to 10 per cent of alcohol, and wine 6 to 22 per cent. In a general way, it may be said that the less alcohol beer contains the better it is and the least disturbing to the body functions.

Wines are subdivided into four classes: spirituous, astringent, acid, and sparkling. Spirituous wine is that to which spirit has been added in the form of grain alcohol or brandy. These may be subdivided into two varieties, the spirituous dry wine, the examples of which would be Port and Sherry, and the spirituous sweet wine, containing 17 to 22 per cent alcohol and a larger amount of sugar than is found in the dry wine; examples of these would be Malaga and Tokay.

Astringent wines, usually red in color, contain only the alcohol incident to the fermentation of the sugar of the grape, and this does not exceed 15 per cent, more usually 10 to 12 per cent. Their astringency is due to the presence of tannin, which is extracted from the seed, skins, and stems of the grapes incident to the fermenting process. Examples of astringent red wines are Claret, Bordeaux, and Burgundy.

Acid wines contain about the same percentage of alcohol and are usually white in color, as they are prepared from white grapes. The acidity is due to the presence of acetic acid and tartaric acid made more evident to the taste through the depletion of the sugar in the fermenting process. Examples of white acid wine are Rhine and Moselle.

The sparkling wines are those in which carbon dioxid gas is held under pressure. Among these wines are the champagnes. The natural champagnes are those in which the carbon-dioxid gas collects as a result of the fermenting process. The carbon-dioxid gas is retained by bottling the wine while it is still in the process of active fermentation. The CO2, unable to escape, gradually collects until the pressure is high and until the fermentation process gradually ceases. On removal of the cork from a champagne bottle this carbon dioxid escapes rapidly at first, more slowly later, until an equilibrium has been restored between the CO2 of the wine and that of the atmosphere. The best natural champagnes require several years in the making. This has led to the preparation of artificial champagnes in which the carbon-dioxid gas is forced in at the time of the bottling. These champagnes may be very quickly prepared. While they differ somewhat in flavor, they are not essentially different in physiological action on the system. Champagnes have been classified as sweet and dry, the sweet champagne having a larger proportion of sugar, the dry champagne a larger proportion of alcohol.

Because of the presence of acid and also a certain amount of tannin in all of these wines, they all hinder digestion, not only the gastric digestion but also the intestinal digestion. Naturally the astringent and acid wines are more deleterious than the others. The sparkling wines are less deleterious than any of the other varieties in their influence upon digestion.

Aside from the interference with the digestive processes by the tannin and acid present in the wines, the principal action of these on the system is due to the presence of alcohol.

In its drug action alcohol, as stated above, under "Food Accessories,"decreases muscular power, decreases the force of the heart action, and acts as a narcotic on the central nervous system. Whenever the physician wishes to produce these effects he has in alcohol an efficient drug. In order to produce the narcotic effect with the least interference with digestion, it would be better to give either dilute alcohol or diluted spirits rather than to give the wines.