domestic hygiene. Atony of the digestive apparatus may be relieved by the action of quassin or other bitter tonics. A better supply of blood can be directed to the digestive apparatus by the use of iron and similar remedies. The blood can be freed from fecai contamination by proper attention to elimination and the regular evacuation of the bowels.

In tuberculosis we have an acknowledged distinctly evil influence from alcohol with which to contend, and that is its tendency to favor the hyperplasia of connective tissue, with consequent atrophy of the cellular elements of the lung. This condition exists in all chronic pulmonary tuberculosis, and to a certain degree may be looked upon as a curative process. Nevertheless, there is a tendency to the formation of cicatricial tissue beyond the desirable limit, and this is favored by alcohol. Moreover, it has been the writer's constant experience that tuberculous patients, when placed upon any preparation containing alcohol, tend to rely upon it more and more as a nutriment, and to the extent to which they partake of alcohol they consume less and less real food. Hence the improvement which is claimed by them from alcohol is illusory, the effects here mentioned being most undesirable in every way. The increased cutaneous radiation leads to increased wasting in some cases; in others the normal healthy tissues tend to be replaced by useless and unhealthy fat.

Besides this, alcohol, as Metschnikoff has pointed out, exerts a deleterious influence upon the leucocytes, paralyzing these sturdy defenders of the human empire, and leaving the way clear for extension of invading colonies of tubercle bacilli and other microorganisms.

The proper scientific treatment for tuberculosis would require a book: I simply point here to the importance or reinforcing leucocytosis by the use of nuclein; combating the numerous varieties of micro-organisms in the tuberculous tissues by saturating the body with the sulphides of arsenic and of lime, moderating the wasting fever by

the use of the vasomoter regulators, purifying the blood and rendering it less suitable as a culture ground for the bacilli by preventing the absorption of fecal toxins; carefully regulating the digestive apparatus and securing every possible advantage that a well-selected diet, pushed to the limit of the patient's digestive capacity, will afford; the minute treatment of symptoms as they arise, and that attention to hygienic matters which means so much to every individual patient.

If a

Alcohol has been recommended as a remedy for persistent vomiting. Just why an irritant should be employed to sedate an already irritated stomach seems incomprehensible. The best remedy for such irritation is to keep the stomach absolutely empty until the irritation subsides. direct sedative is required, we have better remedies in cocaine, condurangin and bismuth, and in cases of severity small injections of morphine over the epigastrium. The action of these remedies is direct and unquestioned, and far more frequently and powerfully effective than alcohol in any shape could be.

A popular and most common application of alcohol is to take it in the form of a hot drink in order to prevent taking cold, when a person has been exposed to cold and wet. Here we have to deal with spasm of the cutaneous blood-vessels, when the blood is pushed into the interior of the body, where the circulation is engorged and there is danger of local inflammation resulting. A glass of hot water with camphor, or spice, frequently relieves this condition, and accomplishes the desired result quite as well as does alcohol. It may not be so pleasant to the patient's palate, but we are not dealing with the craving for stimulants but with medical matters.

Or, the circulatory equilibrium may be more effectually restored, which is the actual indication for treatment, by the administration of aconitine and digitalin in combination, especially if taken in hot water; with a hot mustard foot bath, or a general hot bath. Alcohol is unnecessary,

it is not the best remedy, and it possesses a danger of its own, since we occasionally hear of patients falling dead from heartfailure after a generous dose of alcohol taken under such conditions.

The physician who by practice has rendered himself proficient in the study of abnormal vasomotor conditions, and in the application of remedies which are directly instrumental in restoring the circulatory balance, finds that charm in the practice of medicine which comes from one's knowing what he is doing and why he is doing it, and from the security he feels that the remedies he employs will exert exactly the influence he desires. We relax vasomotor spasm by the action of aconitine, veratrine or gelseminine, either of which at the same time improves nutrition by letting in a freer supply of blood, and favors elimination by opening widely the doors by which excreta escape from the body. At the same time we relieve the vasomotor paresis, which permits of hyperemia or congestion, by the administration of digitalin or strychnine; the first of which sustains and strengthens the heart, the second strengthens and sustains the respiration, and by its influence. over the nerve centers increases the control of the central nervous system and energizes every function of the human body. Our study of disease has taught us the importance of keeping the alimentary canal in proper condition, and preventing the absorption of toxins from fecal matter; and of regulating the diet and other points of personal hygiene to the patient's needs and circumstances.

When one has accustomed himself to the study of the symptoms presenting in cases that come under his observation, and to fit thereto the remedial measures which are indicated in that particular case, from a study not of its dead anatomy but of its living physiology, he will inevitably find his application of alcohol constantly decreasing until they arrive at the vanishing point. This has been the writer's experience, although he commenced the study of medicine with a firm conviction that alcohol was one of the prime necessities in

medical practice; the conclusions herein. stated being forced upon him by his clinical experience, against his will, as it were; while he never allowed himself to be moved in the slightest degree by any other consideration than that of a determination to know and do what is best for his patients, in the way of promoting their restoration to health and prolonging their life.

sure.

Stockman concluded from his experiments that moderate doses of alcohol did not influence the pulse-rate or blood-presUnder large doses of the drug the blood-pressure falls. Since it is certain now that alcohol does not stimulate the brain but depresses it, it is now asserted that it is this sedative action of which the physician makes use. If this action is desirable, however, we have other means of producing it, much less objectionable than alcohol. Few physicians would think now of giving alcohol to a fever patient as a sedative, especially since when this poison adds its effect to those of the toxins already in the body, we may have a furious delirium as the result.

Another claim recently put forward is that alcohol is beneficial because it retards cell-action; but unfortunately the cell-action which it impairs is that upon which we mainly depend for the continued existence of our patient; that is, the action of those cells which are engaged in eliminating the toxins whose collection in the body is the principal source of peril.

Medical men cling with unexampled conservatism to their practice and opinions. McDonald, who writes recently in the British Medical Journal a defence of alcohol in medicine, says there still remain a few practicians with whom it is an article of faith to treat all cases of pneumonia with copious libations of brandy, but they are a decadent minority. But there are many who hold, as McDonald does, that alcohol judiciously employed forms an important part in the treatment of this disease. We may look upon this also as a relic of that earlier belief represented by those just mentioned.

For some time after discontinuing the use

of alcohol in other cases, the writer continued to employ it with those who had been accustomed to its use, in the treatment of grave diseases, believing that it would be unwise to call upon such persons to reform, while struggling with a malady which in itself might prove fatal.

Here, however, I come in touch with the results obtained in hospitals which discontinued absolutely and from the start the use of alcohol with patients suffering from delirium tremens. The fact that their results were better when alcohol was not used in any shape, showed that even here alcohol was unnecessary. I, therefore, discontinued the use of alcohol even in habitues with pneumonia, typhoid fever, etc., and up to the present I can say frankly that I have had no reason to regret the change.

I will sum the matter up by saying that personally I stand ready to use alcohol at any time when I believe it is to the best interest of my patients, but that I do not know a solitary use or a solitary case occurring in the widest range of medical practice in which alcohol is the best remedy that can be applied.

In discussing this question I have left out absolutely all consideration of the morai effects and perils accruing from the use of alcohol, and have endeavored to look at the question simply from the standpoint of a physician who is solicitous to know what is the best treatment to be given to his patient in each condition of disease the doctor is called upon to treat.

could be given, without adding to the danger of the condition, as alcohol would certainly do.

4. As a stimulant of digestion alcohol is not equal to quassin or other simple bitters, with such artificial digestants as the case may require.

5. To prevent a cold or chill when wet, alcohol is not equal to a hot drink containing camphor or spice, or to a hot mustard footbath.

6. As a remedy for pain nobody would think of using alcohol, excepting in the absence of morphine, hyoscine, ether, chloroform, atropine, camphor, cannabis, or any of the other direct analgesants.

7. In all forms of diarrhea and dysentery it is now understood that the best treatment is to remove the cause or irritation, and to soothe the irritated pneumogastric by the use of atropine, stopping microbic action in the alimentary canal by the use of intestinal antiseptics, and in case of dysentery soothing the irritation by single doses of emetine. There is no place for alcohol in this group of diseases in the hands of those who know how to use the active remedies of our profession.

8. As a hypnotic, alcohol may produce sleep by paralyzing the cerebral functions of the patient, a most undesirable and irrational method; or by momentarily equalizing the cerebral vascular pressure. In the latter case the same effect may be safely and quickly induced by administering a glass of hot water, or a few granules of aconitine, or of digitalin, according as the pulse tension needs to be lowered or elevated. Here again alcohol could only be used by those ignorant of the resources of modern medicine, and incapable of recognizing a pathologic condition and applying to it the remedy best calculated to restore normal, physiologic equilibrium. This applies to every use that could be devised for alcohol in the treatment of disease.

Ravenswood.

GOOD FOOD AS A PREVENTIVE OF

THE CRAVING FOR SPIRITS

AN DDRUGS.

BY GEO. M. NILES, M.D.,

Atlanta, Ga.

SIR JAMES CRIGHTON-BROWNE, in a recent address, said: "The health and welfare of individuals and of peoples must depend on right methods of living, and of all methds of living the most momentous are those relating to the up-keep of the body by alimentation."

If the various organs which transform the inanimate food and drink into heat, energy and thought are to be enabled to perform their functions with that nicely balanced adjustment and well ordered co-operation called health, they must be adequately furnished with materials suited to their proper working.

With just treatment the digestive organs perform their constructive housekeeping silently and without complaint. Under imposition they continue their duties, though in a rather dissatisfied way, manifested by vague feelings of discomfort and ill-being, generally attributed by their masters to some other cause.

Gross indiscretions of diet, bringing on speedy pains and penalties as they do, need not be considered here, but those undefined sensations resulting from disordered nutrition, where the system is constantly calling for something it knows not what, where a tiny voice of unrest is continually begging for some soothing balm,-those may well claim our attention.

It has become the fashion to admit that the Americans as a nation eat too much, and we acknowledge the soft impeachment with about the same smug satisfaction that we boast of our material progress or our expanding domain. It is true that large It is true that large numbers of our population do eat not only extravagantly, but excessively, but it is rare that one dies of surfeit. Death attributed to that cause is usually due to interference

by a distended stomach with the action of an already enfeebled heart, and I might add that the term acute indigestion has become a medical mantle of large proportions, covering a multitude of slipshod diagnoses.

Just now there is a campaign being waged against this alleged evil of overfeeding, and if the able advocates of this new theory are correct, our dietetic standards have been wrong from the foundation of the earth; and, as regards proteid, the most important element in any diet-the element that gives heat and energy, as well as forms tissue, we have been consuming double or treble the amount necessary, to our no small injury. This new school would teach us that perfect health and strength adequate for hard physical labor, may be maintained on practically half of the daily ration we were taught as the orthodox

standard.

Now, while many of the experimental demonstrations of this new school, led by such bright investigators as Professors Chittenden and Fischer, of Yale, and Dr. J. H. Kellogg and Mr. Horace Fletcher, have yielded surprising and almost spectacular results, it must not be forgotten that all of the successful races in the world's history have consumed meat and other proteid-containing foods far in excess of the Chittenden standard, and far in excess of what was actually needed for tissue repair.

Without desiring to break a lance with. any of those doughty champions of this new (dietetic) thought, I assert as my honest conviction that the American people do not, as a nation, eat too much. To barely gauge the amount eaten with the requirements of our physical economy would be like a salaried man who calculates his expenditures in exact accordance with his weekly or monthly income, making no allowances for probable contingencies.

What I do claim, however, is, that in many instances the food, though abundant in quantity, is either poorly prepared or lacking in balance. Poorly prepared food and meals containing too much of one element and too little of another lead to either

insufficient ingestion or insufficient utilization of that which is eaten.

Dr. A. L. Benedict, of Buffalo, says: "When tissue hunger is accompanied by disturbances that spoil the appetite, the craving for food that ought to exist is converted into a craving for some sort of stimulant that will afford transient strength, or, at least, a temporary sense of well-being. Alcohol fulfills this craving best of all."

When alcohol is not available, there are either the alcohol-containing nostrums, with which the market is flooded, or the various medicines and beverages, masking under seductive titles the presence of nervesedative or nerve-stimulating drugs.

The present day chef is a personage educated in dietetic principles, a student of both cookery and physiology. His "culinary symphonies" are physiologically and es thetically satisfying, and are balanced with discriminating skill.

Unfortunately very few are able to afford an educated chef, neither is it convenient for even a fair proportion of our girls and young women to attend schools where domestic economics are taught. The very class who need it most, those who marry farmers, artisans, laborers and clerks, are the ones who know the least about how to buy food understandingly and serve it properly.

When illy selected and poorly prepared food is habitually eaten one can readily see how much harder is the task of the digestive organs, and how easy it is to depend on some alcoholic stimulant or sedative drug to either impart a temporary sense of well being, or allay actual discomfort.

Given well selected, nicely prepared meals, so that the nutrition of the body is sufficient, while the organs concerned in the digestion and assimilation of this food are kept busy enough to prevent their playing freakish pranks on the nervous system, but are not unduly taxed, an important causative factor in the inebriety and drug addictions of this nation will be removed.

Before closing I wish to quote Dr. Benedict's epigrammatic definition of the term.

diet: "Diet does not mean milk, scraped raw beef, beef tea, junket, meat extracts, patent proteid at fancy prices, and dilute sweetened alcohol mixed up with animal and cereal extracts. It means lamb chops, steak, roast beef, tender boiled ham, chicken, scrambled eggs, omelet, even hardboiled eggs, toast, crackers, butter, jelly, certain soft fruits, ice cream, and candy in some cases, all properly selected and daintily prepared, so as to present the stimulating effect of taste and variety."

That this branch of the domestic arts is worthy of a place in our public schools is conceded by many thoughtful observers; and while our law makers are enacting legislation making it difficult for the public to obtain stimulants and narcotics, I submit that legislation, which will enable every school girl to acquire a working knowledge of dietetics and cookery, will greatly aid the battle now being waged for sobriety, healthy bodies, and normally-strong nerves. 409-10 Candler Building.

SOME PREVALENT FALSE NO-
TIONS ABOUT DIET.

BY DR. A. L. BENEDICT,
Buffalo, N. Y.

Author of "Practical Dietetics and Golden Rules
of Dietetics,"

1. THAT the average American eats too much. Many do, but many others leading solitary and monotonous lives and thus iacking the stimulus of appetite, as well as others on account of false ideas of economy or of the benefit of abstemiousness, eat too little.

2. That nourishment can be “condensed." Fat yields a little over twice the number of calories per gram that carbohydrate and proteid do. The maximum of fat that can be assimilated without great proportionate waste is 150 grams. In addition, enough proteid and carbohydrate must be given to make 419 grams, in order to yield 2500 calories, a fairly liberal allowance for an adult at moderate labor. No amount of