Alcohol in fit doses improves the nerve energy, and so increases temporarily the muscular power of the intestinal and abdominal walls.

When blood in ever so small a quantity is observed in the stools, the patient is to be kept in the recumbent position. He should not be allowed to make any effort, and on no consideration to sit on the close-pan, or raise himself, or be raised by others, to pass urine, etc. If the patient is unable to pass urine when in the recumbent position, the urine should be drawn off by catheter. All movement of the bowels should be restrained as far as possible and for as long as possible. It is a point of the greatest moment to keep the bowels empty, and therefore nourishment should be given in the most concentrated and absorbable form - e.g., essence of meat in tablespoonful doses frequently repeated. All nourishment which leaves solid residue - e.g., milk - should be avoided. Lumps of ice should be sucked, and all essence of meat, etc., be iced.

In a disease which runs a limited course like typhoid fever the greatest possible care should be taken to preserve the powers of the stomach, as the life of the patient may depend on his power to digest nourishment towards the end of the disease.

To avert death from failure of heart power, alcohol is the great remedy. Over defective cardiac action - due altogether to changes in the muscular tissue, when once established, or to the circulation of poisoned blood through its vessels - alcohol exerts comparatively little influence; but when the weakness and frequency of cardiac action are due to nerve influence in part or altogether, then alcohol exerts a singularly beneficial effect on the rapidity and feebleness of the heart's action.

I may sum up my experience in regard to the use of alcohol in the treatment of typhoid fever thus: Its influence is exerted primarily on the nervous system, and through it on the several organs and processes; for example, the heart and the general nutritive processes - changes on which the rise and fall of temperature depend. In judiciously selected cases it lowers temperature, increases the force and diminishes the frequency of the heart's beats; it calms and soothes the patient, diminishes the tremor, it quiets delirium, and induces sleep. It should never be given in the early stage of the disease, or with the hope of anticipating and so preventing the occurrence of prostration and debility, but should be prescribed only when the severity of special symptoms, or the general state of prostration indicates its use. Hence a large number of cases of typhoid fever end favourably without alcohol being prescribed from the beginning to the termination. It should not be prescribed when a sudden gush of blood has induced faintness, unless the faintness is so great as to threaten life immediately. Nor should it be given when, after the first few doses, the temperature rises, the heart's action becomes more frequent or more feeble, delirium increases, sleeplessness supervenes, or drowsiness deepens, so as to threaten to pass into coma. When the urine contains a considerable quantity of albumen, alcohol should not be prescribed unless absolutely necessary for the relief of some symptom immediately threatening life, and then it should be given with the greatest caution, and its effects on temperature, the circulation, and on the urinary and other secretions, both as to quantity and quality, be carefully and frequently noted. The quantity of alcohol prescribed should be as much only as may be necessary to effect the object for which it is prescribed. In the fourth week, to tide the patient over the concluding days of the disease, it may, as a rule, be given more freely than in the second or the beginning of the third week of the disease, but it is in exceptional cases only that more than twelve ounces of brandy in the twenty-four hours can be taken without inducing some of the worst symptoms of prostration. Nearly all the good effects of alcohol, when its use is indicated are obtained by four, six, or eight ounces of brandy in twenty-four hours. Taken in excess - even when in smaller quantities it would do the patient good - it dries the tongue, muddles the mind, or induces delirium or drowsiness approaching to coma, and diminishes the action of the secreting organs, on the healthy action of which the elimination of the materials destroyed by the action of the fever poison depends. For the last thirty years I have made it the rule of my practice in the treatment of typhoid fever to abstain from giving alcohol if, in the case before me, I doubted the wisdom of giving it; when in doubt I do not give alcohol in typhoid fever, and when there is a question in my mind of a larger or smaller dose I, as a rule, prescribe the smaller. The reverse of the rule I laid down for myself in the treatment of Typhus fever.

Alcohol, by the influence it exerts on the nervous system, is of the greatest value in the treatment of typhoid fever, but it should only be given for the purpose of attaining a definite object; its effects should be watched, and the dose so regulated as to attain the desired effect from as small a quantity as possible. As the treatment in reference to many symptoms is in the present state of our pathological knowledge tentative, it may have to be varied frequently both as regards continuance and dose of drugs, of stimulants and of cold. My experience has impressed on me the conviction that that man will be the most successful in treating typhoid fever who watches its progress, not only with the most skilled and intelligent, but also with the most constant care, and gives unceasing attention to little things, and who, when prescribing an active remedy, weighs with the greatest accuracy the good intended to be effected against the evil the prescription may inflict, and then - if the possible evil be death, and the probable good short of the saving of life - holds his hand."