Past exam of the medicine course of the University of Oxford / 1867 / Second examination / Therapeutics / 5

What are the doses of Alcohol which may be advantageously given in various forms of Fever? Describe the symptoms which regulate its administration.

No single dose of ethanol can be inferred from the word fever. In 1867, wine or spirits were used variably for supposed exhaustion; the quantities describe disputed historical practice, not a beneficial modern treatment. It is essential to distinguish ounces of wine or spirits from ounces of absolute ethanol. Equal beverage volumes do not contain equal ethanol quantities, and the historical sources do not provide a universal standardized strength.

The intended historical distinction was between an uncomplicated febrile illness in a person maintaining circulation and food intake, for which a stimulant might be omitted, and a low or “adynamic” state with increasing prostration. In typhus, prescribers who used ethanol as a stimulant looked for deterioration of the pulse, cold extremities, weakness, tremulousness, inability to take nourishment and failing responsiveness. In typhoid fever, the same general assessment had to be combined with attention to abdominal complications; a new collapse might signify gastrointestinal bleeding or intestinal perforation, rather than an abstract need for more wine. A fever with a hot skin and rapid but well-sustained pulse did not by itself establish a need for ethanol. Nor did delirium distinguish exhaustion from drug effects.

A useful dose answer must supply actual contemporary quantities while admitting their limits. The 1867 Dundee typhus report records marked variation: only 44.7% of 2476 cases in its stimulant table received them. Among treated cases, the reported averages of each individual's maximum daily quantity were 3.19 ounces of wine and 2.6 ounces of spirits. Its corresponding figures below age 25 were 3.5 and 1.09 ounces; above age 50, 2.1 and 5.7 ounces. These are beverage amounts in historical ounces, not amounts of pure ethanol, and not a recommendation to combine both in every case. The author expressly warns that “stimulation” could describe very different quantities and that averages can mislead.^[ref] The defensible period rule is small divided quantities, if used at all, reassessed by effect rather than a fixed allowance for every disease name. Those observational figures cannot establish an advantageous dose for typhoid fever, scarlet fever or another distinct illness.

A second report published in October 1867 stresses individual response: even half an ounce of port could produce flushing or sleep, while an occasional adult two-ounce whisky draught was described as a sedating intervention. These examples span very different physiological effects; they are not interchangeable routine doses. The author rejects a fixed schedule that continues unchanged despite a changing condition.^[ref]

The signs a historical prescriber hoped to see after a trial were a fuller, steadier pulse, warmer extremities, clearer awareness, more restful sleep and improved ability to take food. Increasing flushing, excitement, worsening vomiting, stupor or a deteriorating pulse argued against simply escalating it. These are a reconstruction of the period's claimed bedside test, not validated endpoints proving that ethanol treats the underlying infection.^[ref] Natural improvement, fluid intake and selection of the sickest people for treatment all complicate causal interpretation of the reports.

Modern correction: there is no therapeutic beverage-alcohol dose for fever or sepsis. Measure severity and identify the cause, maintain appropriate fluid and nutritional support, and treat relevant infection. In suspected sepsis, assessment of blood pressure, consciousness, pulmonary ventilation and perfusion guides escalation; current guidance specifies assessed intravenous fluid resuscitation and reassessment, not wine as a circulatory treatment.^[ref] If habitual heavy ethanol exposure introduces a risk of alcohol withdrawal, that is a separate diagnosis. Monitored benzodiazepine treatment and indicated thiamine address that risk; administering wine for the fever is not its modern management.^[ref]