Hot Clam-bouillon.

Small quantities of clam-bouillon may be conveniently and rapidly prepared by pouring about half an ounce of the preserved juice (Burnham's) into a cup and filling the latter to the brim with hot water. Some pepper may be added for the sake of flavor.

Oyster-soup.

Take a quart of milk and bring it to the boiling-point and skim it. As it boils add a tablespoonful of flour rubbed smooth with an equal quantity of butter, stirring it until the milk is thickened by the flour. Then add twenty-five or more oysters and bring to the boiling-point, and remove at once or the oysters will be tough. For seasoning, one or two allspice may be added, with pepper and salt.

Oysters Chafed.

Heat the chafing dish and place in it a lump of butter; when hot, turn in the oysters and let them simmer for a few moments; remove, and add condiments to taste. Rice-soup.

Take half a pint of chicken-stock and two tablespoonfuls of rice. Let them simmer together for two hours, then strain and add half a pint of boiling cream or milk, and salt to taste. Boil up at once and serve hot.

Flour-gruel.

Mix a teaspoonful of flour with milk enough to make a smooth paste, and stir into a quart of boiling milk. Boil for half an hour, being careful not to let it burn. Salt and strain.

Flour-soup.

In a skillet place a lump of butter, and, when melted, add, with a dredging-box, sufficient flour to cover it; when this is thoroughly browned by the heat add a cup of milk and water, and season with salt while boiling. Strain and serve hot. This and the preceding are useful in bowel disorders.

Flour-ball.

Moisten a pint of flour with a couple of ounces of cold water, and tie up in a ball, tightly, in a strong cloth. Slightly moisten the cloth and sprinkle it with flour, and boil for ten hours. Then take off the cloth and let the ball dry in a slow oven for ten hours more. It is then ready for use in making

Boiled-Flour Gruel.

Grate two tablespoonfuls of flour from the ball, mix it with cold water, to a smooth paste, and stir it into half a pint of boiling milk. Simmer about three minutes and sweeten. This is a good food for children while teething.1

Predigested Food.2-To the earnest advocacy of Dr. William Roberts, of Manchester, England, the profession is indebted for a clear conception of the great value of the partial digestion of food before administration. The process can be performed extemporaneously in any household, and is an inestimable boon in cases of profound debility of the digestive powers. The following directions are given by Dr. Roberts:

Peptonized Milk.

A pint of milk is diluted with a quarter of a pint of water and heated to a temperature of about 140° F. (or the diluted milk may be divided into two equal portions, one of which may be heated to the boiling-point and then added to the

This and many of the preceding formulæ are based upon those contained in the excellent "Text-book of Nursing," by Clara S. Weeks. New York: D. Appleton & Co., 1885. For further observation on food, see author's papers on "Food and Diet in Health and Disease, including a Review of Many Prepared and Condensed Foods," Medical Bulletin, Jan., June, and July, 1892.

cold portion); the mixture will then be of the required temperature. Two or three teaspoonfuls of liquor pancreaticus, together with ten or twenty grains of bicarbonate of sodium (about half a small teaspoonful) are then mixed therewith. The mixture is then poured into a covered jug and the jug is placed in a warm situation, under a cosey, in order to keep up the heat. At the end of an hour, or an hour and a half, the product is boiled for two or three minutes. It can then be used like ordinary milk. By skimming the milk beforehand and restoring the cream after the final boiling, the product is rendered more palatable and more milk-like in appearance.

Peptonized Gruel.

A well-boiled, thick, and strong gruel, prepared from any of the farinaceous articles generally used for that purpose (wheaten flour, oatmeal, arrowroot, sago, pearl barley, etc.), is poured into a covered jug and allowed to cool to a temperature of about 140° F. Liquor pancreaticus is then added in the proportion of a tablespoonful to the pint of gruel and the jug is kept warm under a cosey, as before. At the end of a couple of hours the product is boiled and, finally, strained. This preparation is not generally acceptable to invalids, but may be used in conjunction with pep tonized milk, as:

Peptonized Milk-gruel.

First, a good, thick gruel is prepared from any of the farinaceous articles just mentioned. The gruel, while still boiling hot, is added to an equal quantity of cold milk. The mixture will have a temperature of about 125° F. To each pint of this mixture two or three teaspoonfuls of liquor pancreaticus and twenty grains of bicarbonate of sodium are added. It is then kept warm in a covered jug under a cosey for a couple of hours, and then boiled for a few minutes and strained. The bitterness of the digested milk is almost completely covered in the peptonized milk gruel.

Peptonized Soups, Jellies, and Blanc-manges.

In order to vary the regimen and increase its palatability, Dr. J. Milner Fothergill describes' other peptonized dishes which may be prepared. A soup may be made by using peptonized gruel, which is quite thin and watery, instead of simple water, for the purpose of extracting shins of beef and other materials employed for the preparation of soup. Jellies can be made by simply adding the due quantity of gelatin or isinglass to hot peptonized gruel, and flavoring the mixture according to taste. Blanc-manges may be made by treating peptonized milk in the same way and then adding cream. In preparing all these dishes the operation of peptonizing the gruel or the milk must be completed, even to the final boiling, before adding the stiffening ingredient.

Peptonized Beef-tea.

Half a pound of finely-minced lean beef is mixed with a pint of water and twenty grains of bicarbonate of sodium. This is simmered for an hour and a half. When it is cooled down to about 140° F., a tablespoonful of the liquor pancreaticus is added. The mixture is then kept warm under a cosey for two hours and occasionally shaken. At the end of this time the liquid portions are decanted and boiled for five minutes. Beef-tea prepared in this way is rich in peptone, and its nutritive value in regard to nitrogenized materials is about equivalent to that of milk. When seasoned with salt it is scarcely distinguishable in taste from ordinary beef-tea. As a convenient method of peptonizing milk, Messrs. Fairchild Brothers & Foster, of New York, have now on sale "peptonizing tubes," each of which contains sufficient extractum pancreatis to peptonize one pint of milk.

Peptonized Oysters, Milk-toast, etc.

The late Dr. N. A. Randolph, in a case of asthma which was aggravated by indigestion, found that, by treating stewed oysters, milk-toast, and other articles of diet for the sick in this manner, the patient was able to get along without any paroxysms as long as he continued the use of peptonized food. The same expedient might be useful in low fevers, dysentery, etc.

1

"Indigestion, Biliousness, and Gout in its Protean Aspects." Part I. By J. Milner Fothergill, M.D.

Koumiss.

Koumiss, or milk-wine, originally made by the Tartars by fermenting mares' milk, is now prepared on a large scale in this country from pure cows' milk. It is deservedly esteemed as a combined stimulant and nutrient, very beneficial in wasting conditions, and, from the carbonic acid which it contains, efficacious in allaying irritability of the stomach. Koumiss may be made at home, according to the following directions of the late Prof. S. W. Gross: "Dissolve half an ounce of grape-sugar in four ounces of water. Dissolve twenty grains of yeast-cake in four ounces of milk. Pour both into a quart bottle and fill nearly to the top with milk. Cork tightly, fastening the cork with wire. Put into a cool place and shake two or three times daily for three days. Keep for use no longer than six days. A champagne-tap introduced through the cork is necessary. Koumiss contains about 16 per cent. of alcohol."

Rectal Alimentation and Nutritive Enemata.—It sometimes becomes necessary to abandon for a time the usual route for the administration of food, as in cases of gastric ulcer, persistent vomiting, and athrepsia in infancy. Under such circumstances we may resort to the rectum, and introduce nutritive substances by injection. It is considered advisable to add a certain amount of pepsin or pancreatin to the prepared food in order to facilitate the formation of peptones and the absorption of albuminoids. Milk-punch and beef-essence or infusion may be used, with advantage, or sterilized milk, to which pancreatin and soda are added just before introduction into the bowel. Dr. Spencer has suggested nutrient suppositories made of beef chopped up, finely mixed with fresh pancreas or with pan

creatic extract.

The quantity of fluid food used at each injection should not be more than 60 to 120 c.cm. (or f3ii-iv), depending upon the capacity and toleration of the patient. In infants, from 15 to 30 c.cm. (or f5ss-j) is the limit. Irritability of the rectum may be overcome by a preliminary irrigation with cold water, or the use of an opium suppository or laudanum injection. The nutritive enema may be repeated every four hours, and may constitute the sole reliance for nourishment during a period extending over several months.1

In Ewald's clinic every case of simple gastric ulcer is fed exclusively by the rectum for six days, with excellent results. The patients have been free from pain on the third day. The method has also proved of value in the differential diagnosis from neurotic cases with similar symptoms.

The introduction of normal salt solution into the rectum not only supplies water and salt to the blood, and increases intravascular tension, but also stimulates secretions, especially from the kidney. In fact, the use of salt-water enemata furnishes a valuable method of flushing out the kidneys. This is an important feature of the treatment after nephrotomy, nephrectomy, or nephropexy. In all cases in which ether is used as an anesthetic, and there is diminution of the urinary secretion, this should be resorted to. In Dr. H. A. Kelly's private hospital it has been the custom, in all cases in which the kidney has been operated upon, to give one pint or more of normal salt solution by the rectum, every six, eight, or twelve hours, for several days after the operation."

1 "Rectal Alimentation and Medication in Diseases of the Skin," by J. V. Shoemaker, "Transactions of the Ninth International Congress," vol. iv, p. 170. 2 American Practitioner and News, Oct. 1, 1904.

PSYCHOTHERAPY; HYPNOTISM AND SUGGESTION;

METALLOSCOPY AND METALLOTHERAPY.

Psychotherapeia (ʊxn and beрañeuw), "the treatment of diseases through the mind," plays a most important part in the ordinary every-day practice of medicine. The influence of the mind upon bodily functions is so great that every experienced, intelligent physician is glad to enlist so potent an auxiliary, to some extent at least, in his treatment of diseased conditions. The eminent Dr. Rush always made a point, wherever possible, of explaining the action of the medicine which he prescribed for a patient, who, being thus made acquainted with the expected results, himself unconsciously favored their occurrence by what is known as "expectant attention." The confidence that a doctor inspires is generally acknowledged to be a powerful aid to his therapeutics. His hearty greeting acts like a stimulating cordial upon the drooping spirits of his patient, who takes fresh courage from his cheerful presence. This power of influencing others so as to affect their mental state or physical condition has been known and practiced since the most remote period. In the early history of medicine, when the duties of physician and priest were combined in the same person, many superstitious rites and ceremonies were employed in the treatment of disease in order to impress the mind of the patient and favor his recovery. The practice of the royal touch for the king's evil, or scrofula, which continued in England up to the time of Queen Anne, is a later illustration, and the ancient custom of wearing amulets to ward off disease has not yet entirely disappeared from even the most civilized communities. The wearing of iron rings for rheumatism, amber beads to prevent croup, horse-chestnuts in the pocket to protect from gonorrhoea, or gold rings in the ears to cure epilepsy, and other superstitious observances are of the same character. On a larger scale, we observe the so-called faith-cure, or Christian science, which could only find supporters among persons absolutely ignorant of physiology and correspondingly credulous and superstitious. The only proper criticism upon the latter is that "it is not Christian, and decidedly not science."

In order properly. to approach this subject the student should read Tuke's admirable essay, entitled "Illustrations of the Influence of the Mind on the Body in Health and Disease, designed to Elucidate the Action of the Imagination," and also Pettigrew's "Superstitions in Medicine Connected with the History and Practice of Medicine and Surgery," and, especially, the little work of Sir John Forbes, on "Nature and Art in the Cure of Disease," each of which is classical and should be part of the necessary course of reading for every candidate for the medical degree.

In every system of medicine practiced among rational beings the action of the mind is not to be overlooked or ignored. Medicines that are repulsive to the senses of the patient, and that are taken under protest, are likely to excite disgust and nausea even if they are not immediately rejected by the stomach. Such remedies, whenever possible, should be substituted by other pharmaceutical preparations having the same physiological action, but more agreeable to the palate. The latter form will not only be taken more faithfully by the patient, but he will be more ready to acknowledge that they are

doing him good, whereas he is sure that the other will not benefit him and is anxious to discontinue it. It must be acknowledged, however, that unpalatable remedies sometimes afford a strong argument in favor of early

recovery.

Hypnotism (vos, sleep), or artificial trance, is a condition accompanied by loss of consciousness and power of voluntary motion, but with preserved intelligence and the ability to perform muscular movements under the verbal directions of another person. Suggestion is the name given to the process of instructing the patient in this way to do certain things. The patient apparently surrenders entirely his individual will and volition, and becomes an automaton under the direction of the operator. It has been said that the effects may remain even after the hypnotic sleep has passed off, and that patients will proceed at an appointed time to perform certain actions, suggested to them while in the hypnotic sleep, of which they retain no recollection when awake. It has been positively asserted that subjects have been hypnotized and instructed, while in this condition, to go on a certain date to a named place and there commit a crime such as stealing a watch or attempting to kill a person with a knife, and that they have afterward obeyed the suggestion, which assumed the form of an uncontrollable impulse. The relation of this to medical jurisprudence is very evident, and at present it is attracting considerable attention. There is a therapeutic application, however, which deserves some consideration. In some neurotic disorders, characterized by pain, spasm, paralysis, or paræsthesia, it has been demonstrated that, by hypnotism and suggestion, these symptoms can be made to disappear either temporarily or permanently. The phenomena of transference, by which a symptom (pain, paralysis, contracture) is removed from one part of the body to another, or even from one patient to another, is also of much interest to the pathologist and clinician. The effects of certain remedies, it was even claimed by Luys, may be produced simply by suggestion, without administering them, but this was shown to be a fallacy by Dujardin-Beaumetz. Closely related to this subject is metalloscopy and socalled metallotherapy, which will be considered somewhat in detail at the

conclusion of this section.

Dujardin-Beaumetz, in a lecture1 on "Suggestion in Therapeutics," admirably summarized our knowledge of the medical relations of hypnotism. He traces it to the desire for the marvelous and mystical, which has always exerted a dominating influence upon the mind of man. The fakirs of India have employed it under one form or another, from time immemorial. The fakir, in truth, is a charmer, that is, a practicer of suggestion, and he develops in the individuals surrounding him phenomena of hypnotism and somnambulism. This also appeared in Europe under various forms, as the thaumaturgists, the demoniacs, the rosicrucians, and performers of miracles and of sorcery, which occupy so large a place in the history of the middle ages. At a later period we observe these practices assuming a scientific tendency; for, although the suggestive processes are always the same in character, whether performed by Paracelsus or Charcot, there is in our own day a desire to discover for the phenomena a scientific explanation. Paracelsus in the sixteenth century assumed the existence in man of a special animating principle to which he gave the name of animal magnetism. This explanation was adopted by his successors, Van Helmont, Mesmer, and 1 Bulletin Générale de Thérapeutique.