more than 2 to 4% of all patients. Small amounts of blood, however, are frequently of no significance.

Mucus must not be confounded with saliva, which as a rule runs freely down the outside of the tube. The former is recognized by its stringy nature and comes of course only from the inside of the tube, it is also well seen when pouring the contents from one vessel into another.

Excepting the detection of blood, or food which has been eaten one or two days previous, an examination of the vomitus from a patient does not aid one much in the diagnosis of gastric disease.

Dr. Joslin has stated that during a three months' hospital service he has failed to encounter one case of chronic gastritis.

During a present ten weeks' service I also have not met one case of chronic gastritis.

This disease of the stomach, of which we hear so much, is not nearly as common as is generally supposed.

ARTICLE XXX.

THE DIETARY TREATMENT OF

CONSTIPATION.

BY HENRY F. HEWES, M.D.

OF BOSTON.

READ JUNE 9, 1903.

THE DIETARY TREATMENT OF

CONSTIPATION.

DURING my practice of medicine, in which through my hospital clinic and special branch of work I come in contact with large numbers of patients already under treatment at other hands, there is no fact which has impressed me more that the universality among the profession of the incorrect treatment of the condition of constipation.

To reinforce this statement let me take an extract from the records of my Out-Patient Clinic at the Massachusetts General Hospital. In this clinic, out of a total of twelve hundred cases seen during the months of July, August and September, 1902, six hundred and ninety, or fifty-one per cent., gave a history of habitual constipation. Of these cases of habitual constipation, six hundred and sixty, or ninety per cent., were using for this complaint a regular dosage of drugs which had been at some time prescribed for them and had used drugs from the time of their first medical consultation on the subject, having received no other directions for treatment excepting possibly that of a regular habit as to time of operation. Of the remaining ten per cent. of cases a few had received general directions. as to diet along with their drug prescriptions, and the remainder were using no treatment at all.

A review of the records of my private practice shows a very similar set of results. In this practice, practically all the cases of constipation seen were using drugs for relief. About half these cases, as against five per cent. in the hospital cases, had received directions as to diet and habits in connection with their treatment. But in all cases drug treatment was associated with the diet and regime from the start, and there were no cases in which a pure dietary treatment had been instituted at the start or in which a systematic transition from a mixed drug and diet treatment to a pure dietary regime had been planned.

The result in both hospital and private cases was that in a great majority we had no real improvement in the underlying condition as the result of treatment, but on the contrary a much more fixed habit, both physical and mental, and a need for constantly increasing or changing drug dosage for temporary relief superimposed. All these cases had been treating for constipation for a year or more, and in none had the necessity for drug dosage lessened.

Of course, there are physicians who prescribe diet and regime pure and simple for their cases of habitual constipation, and, of course, there are cases of constipation treated by drugs which if the dosage and habits of the individual are carefully managed are cured. And drugs may be useful for temporary conditions. But the general facts emphasized so clearly by these records quoted above, that the use of drug treatment with or without dietary or regime directions for habitual constipation is practically routine and universal in the profession, and that such treatment is in a large per cent. of the cases ineffective as regards cure, are undoubtedly true.

There is no necessity for me to dwell upon the fact with you that this condition of things is all wrong from the point of view of good medicine. The regular use of drugs to preserve the continuance of or to stimulate a physiological