symptoms. It is a misfortune to many persons to have a good stomach. A person with a sensitive stomach and weak digestion suffers so seriously from slight indiscretions that he soon learns what he can do and what he cannot do, while a person with a good stomach will receive no warning, and may go on in a course of reckless living until serious organic disease is developed.

This man presents all the symptoms of dyspepsia of the irritative catarrhal type. We have a proof of the condition of the membranes, in the habitually coated tongue, the unhealthy mucous from the pharynx, with the frequent clearing of the throat. The stomach when not occupied with digestion, secretes a glairy acid mucous, so that in the morning it contains a quantity of this irritating matter and there is nausea until it is vomited. This morning vomiting is extremely significant of serious catarrhal dyspepsia. Then, of course, we have the appitite impaired. The presence of food increases the distress and causes weight, fullness and discomfort in the epigastrium. The secretion of the liver is also affected. The urine is reddish in color, and throws down a brick dust sediment, and from time to time this man has had socalled bilious attacks or a lithemic condition in which there would be heaviness and dulness, often with severe headache and sorenest of the eye-balls. This man fortunately recognized that his troubles were due to his own indiscretions, and he has rectified his diet, and for the past few months he has slowly improved. Too often, however, when these feelings of weakness come on they suggest further stimulation, and the patient tries to drive the stomach by taking more stimulants, thus engendering more serious conditions and bringing on incurable disease.

In a case of this character the diet must, of course, be digestible and the quantity regulated by the actual capacity of the stomach. It is sometimes necessary to give an extremely restricted diet. This is, however, not often called for. If the stomach is very irritable, you may find, as in the previous case, that a milk diet in restricted quantity is required. It is often advantageous to give to such a patient, before any food is taken, a certain amount of very hot water, from two to eight ounces.

The object of this is to thin the thick mucous which is in the stomach, wash it from the surface and to excite peristalsis and cause it to be passed from the stomach, leaving that organ with only its proper secretion of gastric juice. Then food may be introduced. This may consist of finely minced meat which has been slightly broiled and to which a little pepsin has been added. This is highly nutritious, readily digested and quickly assimilated. A course of diet of this kind will often give brilliant results in this type of dyspepsia. This hot water treatment has of late been used in the treatment of all sorts of diseases. While it is very very valuable in certain classes of cases it is distinctly limited to these cases. In improperly selected cases, it is capable of doing great harm. In this case, a carefully regulated diet will, I think, be sufficient. His breakfast should consist of a glass of milk, which should be preferably hot and a little dilute, well cooked porridge, and perhaps a soft boiled egg. At dinner, I should suggest a cup of hot water, a piece of tender steak or the soft parts of eight or ten oysters with a roasted potato, and stale bread and butter. In the evening, I would give weak tea, a soft boiled egg and dry toast or stale bread.

In such a case as this, the drugs should be alterative and slightly astringent. If there were constipation, I should order in the morning a glass of hot water containing half a drachm or one drachm of sulphate of sodium. This will exert an excellent effect upon the mucous membrane. If the bowels were regular this should be omitted. If there were heaviness and nausea in the morning, a glass of hot water might be taken before breakfast. All irritating purgatives should be avoided, for they do harm to the weak mucous membrane of the stomach. The dilute mineral acids are proper remedies in these cases. These These may be given alone, or with pepsin. Strychnia or nux vomica may be associated. Small doses of nitrate of silver with opium or, where there is a tendency to constipation, with belladonna, are of service, particularly where there is a disposition to thickening of the membrane.

CATARRHAL JAUNDICE.

This woman illustrates another point in catarrhal dyspepsia.

She is 55 years of age and married. There is nothing noteworthy in the family history. She is a hard working woman, and her habits are good. For years she has suffered with dyspepsia. Last July, as a result of overwork, she became very sick and worn out. Her digestion broke down entirely, and she suffered from a severe catarrhal attack. Ever since then the digestion has been worse. About five weeks ago the orifice of the bile duct in the duodenum was closed by a swelling of the mucous membrane, and she suffered an attack of jaundice from obstruction due to the extension of the catarrhal process into the bile duct. Thus we often have catarrhal jaundice making its appearance in the course of a case of gastro-duodenal dyspepsia. In fact, one of the elements in the diagnosis of catarrhal jaundice is that it has come on where there have been symptoms of mild catarrhal inflammation of the stomach and duodenum.

The jaundice is much improved. This has been effected simply by care in the diet, and a little counter-irritation over the region of the gall ducts. Internally she has received very simply remedies, consisting for the most part of bi-carbonate of soda with gentian; seven and a half grains of bi-carbonate of soda with two drachms of the compound infusion of gentian were given an hour after meals. In catarrhal jaundice, nitrate of silver is almost a specific. A mild saline in hot water should be given in the morning, and if necessary in the evening, to remove the thick mucous, and it may at the same time render the biliary secretion more liquid. Nitrate of silver will then hasten in a remarkable way the subsidence of the swelling and the removal of the jaundice. I always use it in these cases unless the jaundice seems to be passing away of itself. I shall give this patient a pill containing one-twelfth of a grain of nitrate of silver with one grain of extract of quassia, three times a day after meals. We shall have her return in a couple of weeks that we may note the result.-Weekly Med. Review.

Selections.

NITROGLYCERIN, STRYCHNINE AND ERYTHROXYLON COCA IN THE TREATMENT OF ACUTE ALCOHOLISM.-In treating acute alcoholism, we often meet with a case in which, though no spirituous liquor has been taken during the previous ten or fifteen hours, the patient cannot stand erect without feeling a lightness in the head, an inclination to reel and fall. Perhaps this disposition to cerebral syncope is so marked that the patient cannot even lift his head from the pillow without bringing on an attack. In connection with this cerebral anæmia and consequent syncope on raising the head, there is very often a sinking sensation about the heart, a sensation of insecurity, of impending heart failure, and a morbid fear that death may occur at any moment. In this class of cases, we have the heart exhaustion of alcohol (secondary), the increased arterial tension of the cerebral blood-vessels (secondary), due to alcohol, and, the aggravated cerebral anæmia (arterial), arising from these causes-an exhausted heart and high tension. Here chloral would mean murder, bromide of potash would be but little less injurious, the other bromides inferior to even a stimulant dose of morphine, digitalis too slow, and even then not wholly indicated. The nitrites alone fill the complete indication. Nitroglycerin, drop doses of the one-percent. solution dropped on the tongue, is the remedy, and the relief obtained from it is speedy and certain. Supposing you were called, as we were this afternoon, to a patient presenting the above indications, the dose may be repeated every two or three hours until you call again late in the afternoon; on your second visit you will find that he has given up all fear of dying, and, as was our experience to-day, that he is enjoying a good sleep with2 S. P.

out, as we have seen, having been bromized or hypnotized for

that purpose.

Theoretically, we would prefer smaller doses, drop doses of a half or quarter-per-cent. solution, repeated oftener, because the rationale of the treatment lies in this, that we wish to combat the secondary effect of alcohol on the heart, arteries, and cerebral blood supply, by pitting against it the primary effect of nitroglycerin on the same. Remedies that increase heart power in in minimum doses, depress the heart in maximum doses, in doses sufficient to produce secondary effects; consequently, our doses of nitroglycerin should not be large enough to produce secondary symptoms.

We have already remarked that digitalis was not wholly indicated in the foregoing case; we will, however, put it stronger, and say that the case did not present a single indication for digitalis in ordinary doses. If now we compare the action of alcohol, nitroglycerin, and digitalis on the heart and arteries, we will readily see the reason why:

Alcohol in maximum doses, is a muscle poison, and, and like all remedies that affect muscular rather than nervous irritability, inhibits the heart in diastole.

Nitroglycerin and the nitrites belong to the same class, muscle poisons (heart), and in maximum doses, inhibit the heart in diastole.

Digitalis in maximum doses is a poison to the nervous rather than muscular system of the heart, and inhibits the heart in systole.

Alcohol in small doses (primary effect), increases the number of heart beats, lowers arterial tension, and induces cerebral congestion.

Nitroglycerin, in small doses (primary), does the same, but the effects are more marked, rapid, and perhaps, evanescent.

Digitalis in minimum doses, produces an effect (primary), the direct opposite to the foregoing; it slows the heart and increases arterial tension. The indications for ordinary doses of digitalis, then, are a rapid pulse with low tension of the heart and arteries, and are met with in the primary stage of acute alcoholism if at