I have also used the extract of lettuce (English) in ten-grain doses, every two hours.

DIET AND STIMULANTS.

In the management of these cases diet is as important as medication. With the plan which I am now pursuing I rarely have nausea lasting longer than a few hours, a very important point, both as regards the comfort of the patient and the possibility of full nutrition. Diarrhœa, too, so common in Levenstein’s plan, rarely proves troublesome, is often entirely absent, and I am occasionally obliged to use laxative medicine. If there is any tendency to relaxation of the bowels I interdict the use of fruit, of which these patients are very fond, and give subnitrate of bismuth, in large doses.

Beefsteak, beef broth, chicken soup, mutton broth, wine jelly, eggs and plenty of milk are called for. With the milk a little lime water should be used. If the digestion is slow and labored, from ten to twenty grains of pepsine should be given after each meal. If there seems to be decided gastric catarrh nothing acts so well as pills composed of—

℞.Argent. nitrat.,gr. 1/6
Creasote,gr. ss.

One, one hour before meals.

If there are symptoms of collapse, although this is unusual, wine should be given freely, or whiskey hypodermically, three or four syringefuls at a time. Milk punch is an excellent stimulant and food, and egg-nog good, when well borne by the stomach, which is not always the case.

The best wine for these patients is sherry, and it should be better than that found in drug stores and bar rooms. Port is usually largely adulterated. Claret causes acidity. As a rapid stimulant the best champagne is excellent. There comes a little apparatus that can be screwed through the cork of the bottle, and by turning a faucet as much or as little can be drawn as is wanted. It saves wine and keeps it from staling.

Bottled beer is of service in some cases. The purest only should be used. It may be kept from staling in the same manner as the champagne.

Alcoholic stimulants should be continued only so long as is absolutely necessary, which is never more than ten days. This is very important, for it must be borne in mind that these patients are prone to go to excess with stimulants, as well as narcotics.