As already indicated in the introduction to this section, alcohol is now very much less employed in the treatment of disease than it was some ten or twenty years ago. There is little doubt that this restriction in its use has not been attended with any disadvantageous results to such patients as would in former years have been freely "stimulated." On the contrary, there is reason to think that this alteration in the custom of the medical profession regarding the use of alcohol in disease has been a factor of some value in diminishing the number of those who ultimately fall a victim to its effects. We must, at the same time, recognise that alcohol is a very valuable therapeutic agent in the treatment of some diseased conditions. These call for detailed consideration.
In certain acute fevers, such as pneumonia, diphtheria, and the like, when the circulation is distinctly failing, as shown by a rapid, weak, and irregular pulse, the administration of alcohol in doses of i dram to I ounce every two or four hours, according to the age of the patient and the severity of the fever, is followed by a very material improvement in the general condition of the patient. It should be noted, however, that the proportion of cases of pneumonia which call for its administration is a really small one. In the general run of cases occurring in healthy subjects of non-alcoholic habits there is no necessity to have recourse to stimulants. In exceptional cases, however, and in those who have been previously addicted to its use, the free use of stimulants is necessary. Diphtheria is such a treacherous condition, and the risks of establishing a habit from its use are here so remote, that it is advisable to have recourse to the use of stimulants if there is the least dissatisfaction with the general state of the patient or the condition of his circulation. It may be given in doses of I to 4 drams or thereby every two or four hours, according to indications. In weak elderly subjects suffering from bronchitis with congestion of the lungs, and in elderly subjects with chronic heart disease, a little whisky, brandy, or dry champagne is often of very great value as a stimulant. It may have at the same time a sedative effect on the nervous system, as it often tends to promote sleep.
Alcohol is sometimes of considerable value in cases of failure of digestive power, as indicated by inability to take and enjoy food, and also in states of general weakness. Here it may be given in the form of a little whisky (1/2 ounce), twice or three times a day with meals, or as a glass of dry champagne or other sound wine, given with luncheon and dinner. Great care is, however, necessary in prescribing alcohol in these cases, more especially in the.case of female patients suffering from general nervous exhaustion, as these are so prone to become permanently addicted to its use. The use of all medicated wines, elixirs, and the like cannot be too strongly deprecated. A glass of beer or stout given with one or two meals daily for a time is occasionally of distinct value, acting as a bitter tonic, and at the same time supplying a relatively large amount of nutriment in a fluid form.
Patients afflicted with gout or rheumatism are, speaking generally, better without alcohol in any form. This, however, is often a counsel of perfection, and as such impracticable. Such patients should therefore be advised to abstain from malt liquors, and all wines rich in sugar, and also those with a high degree of acidity. Whisky is for them the safest drink, and after that a dry sherry or Madeira or sound claret, and these should not be taken every day.
In protracted convalescence from some acute diseases, a glass of beer, a little whisky in water, or a glass of wine taken with the chief meals, may improve the tone of the digestion and accelerate the rate of recovery. The advantages of these are perhaps best seen in some cases of influenza.