"But the theory that alcohol directly combines with the oxygen of the blood by which it would be converted into carbonic acid and water with evolution of heat is completely refuted by the well-known fact that its presence in the blood diminishes both temperature and elimination of carbonic acid as already stated. Physiologists of the present day very generally agree that the capacity of the blood to receive oxygen from the lungs, and convey it to the systemic capillaries and various tissues, depends chiefly on its hemoglobin (red coloring matter), protein, or albuminous and saline elements.

"Both experimental and clinical facts in abundance show that alcohol at all ordinary temperatures displays a much stronger affinity for these elements of the blood and tissues, than it does for oxygen. And when present in the blood, it rapidly attracts both water and hemoglobin from the corpuscular and albuminoid elements of that fluid, and thereby diminishes its reception and distribution of oxygen. We are thus enabled to see clearly how the alcohol diminishes the oxygenation and decarbonization of the blood, and retards all tissue changes both of nutrition and waste without itself undergoing oxidation with evolution of heat. Consequently, instead of acting as a shield or conservator of the tissues by simply combining with the oxygen, the alcohol directly impairs the properties and functions of the most highly vitalized elements of the blood itself, and thereby not only retards tissue waste but also equally retards the highest grades of nutrition, and favors only sclerotic, fatty and molecular degenerations, as we see everywhere resulting from its continued use. Can an agent displaying such properties and effects be called a food, either direct or indirect, without a total disregard for the proper meaning of words?"

In another place he says:—

"This lessening of the elimination of tissue waste is simply an evidence of the accumulation of poisonous substances within the body, through the lessened activity of liver and kidneys and the impairment of the blood."

Dr. Ezra M. Hunt says in Alcohol as Food and as Medicine, page 37:—

"It sounds conservative of health to say of a substance that it delays the breaking down of tissue, but the physiologist does not allow a substance which occasions such delay, to possess, because of that, either dietetic or remedial value. To increase weight by prolonged constipation is not a physiological process."

Dalton says:—

"The importance of tissue change to the maintenance of life is readily shown by the injurious effects which follow upon its disturbance. If the discharge of the excrementitious substances be in any way impeded or suspended, these substances accumulate either in the blood or tissues, or both. In consequence of this retention and accumulation they become poisonous, and rapidly produce a derangement of the vital functions. Their influence is principally exerted upon the nervous system, through which they produce most frequent irritability, disturbance of the special senses, delirium, insensibility, coma, and finally, death."

The power to retard the passage of waste matter from the system is one of the gravest objections to the use of alcohol in sickness, as the germs of disease are thereby caused to remain longer in the body than they would, were no alcohol or drug of similar action, used. Thus recovery is delayed, if not effectually hindered.

The preponderance of scientific evidence is all against alcohol as possessing food qualities. It contains no elements capable of entering into the composition of any part of the body, hence cannot give strength; it is not a fuel-food as it does not supply heat to the body, but decreases temperature; and its classification as indirect food because it retards the passage of waste matter is shown to be utterly unscientific, as any agent which interferes with the natural processes of assimilation and disintegration is a dangerous agent, a poison rather than a food.

The question naturally arises:—

If these drinks are not liquid food, as we have been taught to believe, how is it, since they are made from food, as barley, corn, grapes, potatoes, etc?

These drinks are not food, although made from food, because in the process of manufacturing them the food principle is destroyed. The grain is malted to change starch into sugar—loss of food principle begins here—then the malted grain is soaked in water to extract the saccharine matter. When the sugar is all in the water the grain goes to feed cattle or hogs, and the sweetened water is fermented. The fermentation changes the sugar into alcohol.

Analyses of beer by eminent chemists show an average of 90 per cent. water, 4 per cent. alcohol, and 6 per cent. malt extract. The malt extract consists of gum, sugar, various acids, salts and hop extract. Starch and sugar are all of these capable of digestion, and the amount of them would be equal to 39 ounces to the barrel of beer. Liebig, the great German chemist, said:—

"If a man drinks daily 8 or 10 quarts of the best Bavarian beer, in a year he will have taken into his system the nutritive constituents contained in a 5 pound loaf of bread."

Eight quarts a day for a year would be 2,920 quarts, or a little more than 23 barrels. If sold to the consumer at the low rate of five cents a pint, it would cost him $292; a high price for as much nourishment as in a 5 pound loaf!

Analyses of wine by reliable chemists show that the consumer must pay $500 for the equivalent in nourishment of a 5 pound loaf of bread, wine being higher priced than beer. Wines average 80 per cent. water, about 15 per cent. alcohol, and 5 per cent. residue. This residue is composed of sugar, tartaric, acetic and carbonic acids, salts of potassium and sodium, tannic acid, and traces of an ethereal substance which gives the peculiar or distinguishing flavor. The only one of these ingredients possessing food value is sugar; this exists chiefly in what are called sweet wines. Yet how many thousands of people spend money they can ill afford for wines and beers to build up the failing strength of some loved one! A costly delusion, and too often a fatal one!

"Distilled liquors, if unadulterated, contain literally nothing but water and alcohol, except traces of juniper in gin, and the flavor of the fermented material from which they have been distilled."—Influence of Alcohol, by N. S. Davis, M. D.

It is the solemn duty of those to whom the people look for instruction in matters of health to undeceive the toiling masses as to the food-value of alcoholic liquids. Some of the medical profession are faithful in this regard, but too many others are themselves deceived, or care not for the destruction of the people.

IS ALCOHOL A STIMULANT?

A lady asked her family physician several years ago what he thought of the views of those medical writers who class alcohol as a narcotic, and not a stimulant. He answered with some heat, "Any one who says alcohol is not a stimulant is either a fool or a knave!" He could not have been aware that some of the most distinguished professors in American medical colleges teach that alcohol is not, properly speaking, a stimulant, but a narcotic.

The accepted definition of a stimulant in medical literature is some agent capable of exciting or increasing vital activity as a whole, or the natural activity of some one structure or organ.

Dr. N. S. Davis has said repeatedly that both clinical and experimental observations show that alcohol directly diminishes the functional activity of all nerve structures, pre-eminently those of respiration and circulation, thus decreasing the internal distribution of oxygen, which is nature's own special exciter of all vital action.

"Consequently it is antagonistic to all true stimulants or remedies capable of increasing vital activity. Instead, therefore, of meriting the name of stimulant, alcohol should be designated and used only as an anaesthetic and sedative, or depressor of vital activity."

The following is taken from an editorial article in the American Medical Temperance Quarterly for January, 1894:—

"Drs. Sidney Ringer and H. Sainsbury in a carefully executed series of experiments on the isolated heart of the frog, found that all the alcohol when mixed with the blood circulating through the heart, uniformly diminished the action of that organ in direct proportion to the quantity of alcohol used, until complete paralysis was induced. In closing their report in regard to the action of different alcohols, they say that 'by their direct action on the cardiac tissue these drugs are clearly paralyzant, and that this appears to be the case from the outset, no stage of increased force of contraction preceding.'

"Professor Martin, while in connection with the Johns Hopkins University, performed an equally careful series of experiments in regard to the action of ethylic, or ordinary alcohol, directly on the cardiac structures of the dog, and with the same results. He makes the following explicit statement of the results obtained by him. 'Blood containing one-fourth per cent. by volume, that is two and a half parts per 1000 of absolute alcohol, almost invariably diminishes, within a minute, the work done by the heart; blood containing one-half per cent. always diminishes it, and may even bring the amount pumped out by the left ventricle to so small a quantity that it is not sufficient to supply the coronary arteries.'

"In 1883, R. Dubois, by direct experimenting upon animals, found that the presence of alcohol in the blood much intensified the action of chloroform and thereby rendered a much less dose fatal.

"Prof. H. C. Wood of the University of Pennsylvania, in an address upon Anaesthesia to the Tenth International Medical Congress, of Berlin, in 1890, said: 'In my own experiments with alcohol, an eighty per cent. fluid was used largely diluted with water. The amount injected into the jugular vein varied in the different experiments from 5 to 20 c. c.; and in no case have I been able to detect any increase in the size of the pulse or in the arterial pressure produced by alcohol, when the heart was failing during advanced chloroform anaesthesia. On the other hand, on several occasions, the larger amounts of alcohol apparently greatly increased the rapidity of the fall of arterial pressure, and aided materially in extinguishing the pulse.

"Sir Henry Thompson says: 'That alcohol is an anaesthetic and paralyzant is a fact too well established to be questioned or contradicted.'

"Dr. J. J. Ridge, of London, has published elaborate tables, showing that even small doses of alcohol, averaging one tablespoonful of spirits—not quite half a wineglass of claret or champagne, and not quite a quarter of a pint of ale—impair vision, feeling, and sensibility to weight, without the subject's being conscious of any alteration. Dr. Scougal, of New York, has repeated and confirmed these experiments, and also demonstrated that the hearing was similarly affected.

"Drs. Nichol and Mossop, of Edinburgh, conducted a series of experiments on each other, examining the eye by means of the ophthalmoscope while the system was under the influence of various drugs. They found that the nerves controlling the delicate blood-vessels of the retina were paralyzed by a dose of about a tablespoonful of brandy.

"Dr. T. D. Crothers, of Hartford, Conn., has deduced some valuable facts from his experiments with the sphygmograph, upon the action of the heart. He has found by repeated experiments that while alcohol apparently increases the force and volume of the heart's action, the irregular tracings of the sphygmograph show that the real vital force is diminished, and hence its apparent stimulating power is deceptive."—Extract from the Annual Address before the Medical Temperance Association at San Francisco, Cal., June 8, 1894, by Dr. I. N. Quimby, of Jersey City, N. J.

Dr. J. H. Kellogg, of Battle Creek, Mich., has made extensive experiments as to the effects of alcohol. In summing up the results of these he says:—

"It would seem that no further evidence could be required that alcohol is a narcotic and an anaesthetic, rather than a stimulant, and that its use as a supporting and tonic remedy is a practice without foundation in either scientific theory or natural clinical experience."

Sir B. W. Richardson at a medical breakfast in London in 1895, stated that though alcohol produced an increase in the motion of the heart it was ultimately weaker in its action, so he resolved to give up using such an agent.

Dr. A. B. Palmer of the University of Michigan prepared a "Report" upon alcohol in 1885 for the Michigan State Medical Society in which he cited experiments showing that the opinion that alcohol stimulates the heart by an increase of real force, is an error. It creates a flutter, but decreases power.

"Increased frequency of pulsation is often the strongest evidence of diminished power—as the fluttering pulse of extreme weakness."

He classes alcohol with chloroform.

"If chloroform is a narcotic, alcohol is a narcotic. If chloroform is an anaesthetic, alcohol is an anaesthetic. If one is essentially a depressing agent, so is the other. Their strong resemblance no one can question. The chief difference is that the alcoholic narcosis is longer continued, and its secondary effects are more severe."

In closing his summary of the changes in scientific knowledge of this drug he says:—

"We said it was a direct heart exciter. We now know it is a direct heart depressor. We said, and nearly all the text-books still say, it is a direct cardiac stimulant. We know from most conclusive experiments it is a direct cardiac paralyzant."

The following is taken from one of the many excellent papers upon alcohol written by that Nestor among physicians, Dr. N. S. Davis:—

"Alcoholics are very generally prescribed in that weakness of the heart sometimes met with in low forms of fever and in the advanced stage of other acute diseases. It is claimed that these agents are capable of strengthening and sustaining the action of the heart under the circumstances just named, and also under the first depressing influence of severe shock.

"There is nothing in the ascertained physiological action of alcohol on the human system, as developed by a wide range of experimental investigation, to sustain this claim. I have used the sphygmograph and every other available means for testing experimentally the effects of alcohol upon the action of the heart and blood-vessels generally, but have failed in every instance to get proof of any increased force of cardiac action.

"The first and very transient effect is generally increased frequency of beat, followed immediately by dilatation of the peripheral vessels from impaired vasomotor sensibility, and the same unsteady or wavy sphygmographic tracing as is given in typhoid fever, and which is usually regarded as evidence of cardiac debility. Turning from the field of experimentation to the sick-room, my search for evidences of the power of alcohol to sustain the force of the heart, or in any way to strengthen the patient has been equally unsuccessful. I was educated and entered upon the practice of medicine at a time when alcoholic drinks were universally regarded as stimulating and beat-producing, and commenced their use without prejudice or preconceived notions. But the first ten years of direct clinical or practical observation satisfied me fully of the incorrectness of those views, and very nearly banished the use of these agents from my list of remedies. While it is true that during the last thirty years I have not prescribed for internal use the aggregate amount of one quart of any kind of fermented or distilled drinks, either in private or hospital practice, yet I have continued to have abundant opportunity for observing the effects of these agents as given by others with whom I have been in council; and simple truth compels me to say that I have never yet seen a case in which the use of alcoholic drinks either increased the force of the heart's action or strengthened the patient beyond the first thirty minutes after it was swallowed. * * * * *

"Nothing is easier than self-deception in this matter. A patient is suddenly taken with syncope, or nervous weakness, from which abundant experience has shown that a speedy recovery would take place by simple rest and fresh air. But in the alarm of patient and friends something must be done. A little wine or brandy is given, and, as it is not sufficient to positively prevent, the patient in due time revives just as would have been the case if neither wine nor brandy had been used."

In the Medical Pioneer of November, 1895, Prof. E. MacDowel Cosgrave, Professor of Biology, Royal College of Surgeons in Ireland, says:—

"The result of all recent investigation is to show that the use of alcohol when a stimulant effect is desired, is an error; and that, from first to last alcohol acts as a narcotic."

Dr. Edmunds, of London, said in an address given in Manchester:—

"By giving alcohol as a stimulant in exhausting diseases, I believe we always do as we should in giving a dose of opium and brandy and water to comfort a half suffocated patient; i. e., increase his danger. If that be so, we reduce alcohol not only from the position of food medicine, but we reduce it from the position of a goad; and we say that the supposititious stimulating or goading influence of alcohol is a mere delusion; that in fact alcohol always lessens the power of the patients, and always damages their chance of recovery, when it is a question of their getting through exhausting diseases."

Many more such quotations might be adduced. Enough are given to show that the popular use of alcohol, when a stimulant is required, is considered a grave error by those who have most thoroughly studied the effects of this drug.

ALCOHOL AS A TONIC.

Dr. J. J. Ridge, of London, says:—

"The action of alcohol in relaxing unstriped muscular fibre, which entitles it to be called an anti-spasmodic, robs it of all claim to give tone. The sense of exhilaration which follows small doses of alcohol has been mistaken for real strength and increase of vitality. It is well known that relaxation of the blood-vessels throughout the body is one of the first effects of alcohol. The arteries of the retina have been observed to dilate after very small doses of alcohol. The diminution of tone is well seen in the tracings of the pulse under the influence of alcohol. If one needs a tonic, therefore, alcohol is one of the things to be shunned altogether.

"But alcoholic beverages contain other things beside alcohol. Beer contains infusion of hops, or other bitter stomachics. Some wines contain tannin. These ingredients, by creating or stimulating the appetite, increase the strength and vital power in certain cases. But we have a large number of drugs which will do the same without the disadvantages arising from the presence of alcohol, and, if the flavor be objected to, many of them can be taken in the form of coated pills.

"The external use of cold, either by a dripping sheet, cold sponging, or a shower-bath, according to the power of reaction, is a valuable means of giving real tone.

"Wine is frequently prescribed for those young persons who are growing rapidly, and whose strength does not seem to keep pace with their growth. It is important to know that alcohol is not desirable in such circumstances. There is often found in such cases a defective appetite, perhaps even sub-acute gastric catarrh, which may be due to imperfect mastication through bad teeth, or aggravated by it. There are other causes, such as late hours, bad habits, improper food or irregular meals. In such cases those means must be resorted to which are so effectual in improving the condition and strengthening the heart of athletes. Regular and regulated meals, exercise in the fresh air, a good amount of rest and sleep—these will do more than anything else to invigorate the bodily health."

Dr. N. S. Davis says:—

"Although I was taught, like all others, to use alcohol as a tonic when patients were sick, to hasten their recovery and promote their strength, yet it did not take me very long to find out that here and there was one already a teetotaler who would not take wine long, nor any kind of alcoholic drink unless prescribed, just as castor-oil, dose by dose, but who, when he got beyond the necessity of having it as a medicine, took no more. What was the comparison? My patients who refused, or did not take alcohol, got strong quicker and had less tendency to relapse than those who continued its use. Here was the first step in progress, and consequently I came soon to cease the recommending it merely to hasten recovery of strength. As a tonic, I found it of no value."

Dr. James Miller, of Edinburgh, says in Alcohol, Its Place and Power, written many years ago:—

"It may be well here to correct an important error, yet very current, in regard to the medicinal use of alcohol. People regard it as a simple and common tonic; and are ready to accept its supposed help as such in every form of weakness and general disorder of health. But it is ordinarily, no true tonic."

Dr. Ernest Hart, editor of the British Medical Journal, stated some years ago at a meeting of the British Medical Temperance Association that "the medical profession were nearly all agreed that alcohol is neither a food nor a tonic."

Many drunkards have been made, especially among women, by the delusion that alcohol has tonic effect. As a sample of these sad cases the following is given, taken from a recent number of The National Advocate:—

"There is in the jail at Elizabeth, N. J., a woman who was arrested while participating in wild drunken orgies with a gang of tramps in the woods near the town. She appears nothing but a besotted hag, but was only a short time ago a dutiful wife of a respectable man, and the mother of three beautiful children. Her father, who is said to be living in a village in New York State, is a highly respected minister of the Methodist Episcopal Church. Her children are in an asylum, and her husband is a wanderer in the West. The cause of her ruin was beer, prescribed for her by the family physician as a tonic. At first she refused to take it, having always been a teetotaler, but persuaded to obey the physician, she soon acquired a taste for the drink that speedily developed into the overmastering appetite, which has brought her and hers to this sad condition."

ALCOHOL AS A SEDATIVE.

Dr. J. J. Ridge says in the Medical Pioneer, April, 1893:—

"Alcohol, chiefly in the form of spirits, is often given to procure sleep and to relieve pain, such as that of neuralgia, dyspepsia, colic and diarrhoea. It is as a sedative that alcohol is so insidious and seductive in cases of chronic disease, as, if frequently resorted to, the drink craving is almost certainly developed. Hence the importance in many cases of rather bearing the ills we have than of flying to others that we know not of. It is clear that other narcotics, such as opium, morphia, chorodyne, chloral, are open to the same objection, and the victims of these drugs are terribly numerous. * * * * * In many instances some form of dyspepsia is the cause of the sleeplessness, palpitation or other uneasy feeling for which a sedative is desired, and when this is cured the symptoms vanish."

A prominent minister in a large American city was afflicted with insomnia a few years ago, and, after trying various remedies, was advised by a physician to try whisky "night-caps." He became a hopeless drunkard. A young medical student in New York appealed to one of his professors for aid in overcoming aggravated insomnia. The professor advised whisky and morphine! The advice led to the ruin of the young man.

ALCOHOL AS AN ANTIPYRETIC.

"By the power of alcohol to retard the evolution of heat in retarding molecular changes in the tissues, the liquids containing it may be used as antipyretics when the temperature is too high, and to retard the processes of waste when these are too rapid. But the antipyretic influence of alcohol is so feeble in comparison with the proper application of water to the surface, or with the internal administration of sulphate of quinia, salicylic acid, digitalis, etc. that no one thinks of using it for antipyretic purposes."—Dr. N. S. Davis in Principles and Practice of Medicine.

PROFESSOR ATWATER'S CONCLUSIONS UPON ALCOHOL AS A FUEL-FOOD.

In 1899 a decided sensation was caused by the announcement that Prof. Atwater, of Middletown, Conn., had proved that alcohol is a fuel-food equal in value to carbohydrates and fats. The study later of Prof. Atwater's report of his investigations led to prolonged discussions among medical men interested in the alcohol question, and his theory that alcohol is a food because it is oxidized in the body was vigorously opposed by many scientists of high standing. Professor Abel, of Johns Hopkins University, Baltimore, an investigator of alcohol who worked with the Committee of Fifty, said on this point:—

"Oxidizability cannot be made the measure of usefulness in regard to this substance."

Professor Gruber, president of the Royal Institute of Hygiene, Munich, said:—

"Does alcohol truly deserve to be called a food substance? Obviously, only such substances can be called food material, or be employed for food, as, like albumen, fat, and sugar, exert non-poisonous influence in the amounts in which they reach the blood and must circulate in it in order to nourish * * * * Although alcohol contributes energy it diminishes working ability. We are not able to find that its energy is turned to account for nerve and muscle work. Very small amounts, whose food value is insignificant, show an injurious effect upon the nervous system."

Sir Victor Horsley, the well-known London surgeon, said:—

"We know that alcohol lowers the temperature of the body. It can only do that by diminishing the activity of the vital processes. It also diminishes very greatly the power of the muscles, and it diminishes the intellectual power of the nervous system. To call an agent that causes such diminution of activity throughout the whole body a food is ridiculous."

An editorial in the Journal of the American Medical Association said:

"The fallacy of the reasoning which would place alcohol among the foods is very apparent when we put it in the form of a syllogism: All foods are oxidized in the body; alcohol is oxidized in the body; therefore alcohol is food. As logically we might say: 'All birds are bilaterally symmetrical; the earthworm is bilaterally symmetrical; therefore the earthworm is a bird.' Oxidation within the body is simply one of several important properties of food, as bilateral symmetry is one of several important characteristics of a bird."

Schafer's Physiology says:—

"It cannot be doubted that any small production of energy resulting from the oxidation of alcohol is more than counterbalanced by its deleterious influences as a drug upon the tissue elements, and especially upon those of the nervous system."

The Bulletin of the A. M. T. A. for July, 1899, contained an article upon Prof. Atwater by Dr. J. H. Kellogg, from which the following is taken:—

"Starch, sugar and fats become foods or fuels only through their assimilation. Abundant physiological evidence attests that no substance can act as a food, or as a true source of energy, unless it has first entered into the composition of the body. It must be assimilated. The forces manifested by the body, the muscular forces, or nervous energy, are the result of the breaking down of organized structure into simpler forms. For example, in the case of nervous energy, material from which nerve energy is derived is stored up in the nerve cell, and can be seen with the microscope in the form of minute granules, which disappear as the cell energy is expended, leaving the cell blank and shriveled when in a state of extreme fatigue from overwork. The same is essentially true of the muscle cell. The source of muscular energy is glycogen, an organized substance which becomes a part of the muscle tissue in a well-nourished muscle in a state of rest.

"Experiments have clearly shown that fat, sugar and starch must all alike be converted into the form of glycogen and enter into the muscle structure before they can become a source of energy.

"Professor Atwater tells us that alcohol can not form tissue, hence the query is pertinent, How can it be a source of vital energy? The body does not burn food as a stove does fuel. Food can be called fuel only in a highly figurative sense. The oxidation of food in the body does not take place directly. Food is assimilated, becoming a part of the tissue. Oxygen is also assimilated, entering into the composition of the tissue along with the food elements under the action of special organic ferments brought into play by nervous impulses received from the central ganglia.

"The molecules of these residual tissues which form the storehouse of energy in the body are rearranged in simpler forms, thereby giving up a portion of the energy which holds them together in the state in which they exist in the tissues, and this energy thus set free appears as muscle force, mental activity, glandular work and various other forms of functional activity."



CHAPTER VII.

ALCOHOL IN PHARMACY.

In the Journal of the American Medical Association for November 13, 1897, Dr. T. D. Crothers, editor of the Journal of Inebriety, says in a paper upon "Concealed Alcohol in Drugs":—

"A very important question has been repeatedly raised, and answered differently by persons who claim to have some expert knowledge. The question is, can strong tinctures of common drugs be given in all cases with safety; tinctures of the various bitters which contain from 10 to 40 per cent. of alcohol, and are used very freely by neurotic and debilitated persons? It is asserted with the most positive convictions that such tinctures are more sought for the narcotic effect of the alcohol than for the drugs themselves.

"In my experience a large number of inebriates who are restored, relapse from the use of these tinctures given for their medicinal effects. * * * * *

"The question is asked, how much alcohol can be used as a solvent in drugs without adding a new force more potent than that which is brought out by the alcohol? Opinions of experts differ. One writer thinks 10 per cent. of alcohol in any drug will, if given any length of time, develop the physiologic effect of alcohol in addition to that of the drug. An English writer says that in some cases a 5 per cent. tincture is dangerous from the alcohol which it contains.

"There is some doubt expressed by many authorities as to the potency of a drug which is covered up in a strong tincture. It is clear that the value of a drug is not enhanced, and it is certain that a new force-producing, or exploding agency, has been added to the body.

"In experience, any drug which contains alcohol can not be given to persons who have previously used it without rousing up the old desire for drink, or at least producing a degree of irritation and excitement that clearly comes from this source. It is also the experience of persons who are very susceptible to alcohol, that any strong tincture is followed by headache and other symptoms that refer to disturbed nerve centres.

"In many studies I have been surprised at the increased action of drugs when given in other forms than the tincture. Gum and powdered opium, have far more pronounced narcotic action than the tincture. Yet the tincture is followed by a more rapid narcotism, but of shorter duration, and attended with more nerve disturbance at the onset.

"I am convinced that a more exact knowledge of the physiologic action of alcohol on the organism will show that its use in drugs as tinctures is dangerous and will be abandoned.

"There are many reasons for believing that its use in proprietary drugs will be punished in the future under what is called the poison act."

Dr. J. J. Ridge published in May, 1893, in the Medical Pioneer, the following statement of the pharmacy of the London Temperance Hospital:—

"When the Temperance Hospital was first opened, it became a question of practical importance, what should be done with regard to the alcohol so largely employed as a vehicle and drug excipient. Not that the principle of the treatment of disease without the ordinary administration of alcoholic beverages precludes the employment of alcoholic tinctures, but it was felt that in such a test case as this it was important to obviate the objection that while withholding alcohol as a beverage, it was given in the medicine. As a matter of fact, it is surprising, when one looks into it, how much alcohol is often given merely as a vehicle for other drugs, and without the special action of alcohol being required or desired. In prescriptions which are to be seen in many text-books, it is not uncommon to find from one to two or three, or even four drachms of rectified spirit in the form of tinctures or spirits. This is very undesirable. If alcohol is needed it should be given in proper measured dose. But if it is not indicated, then it is not well to administer it in this indirect manner.

"Experiments were therefore made, partly at the hospital and specially by Messrs. Southall Bros. & Barclay, of Birmingham, with the result that new non-alcoholic tinctures were made replacing the following alcoholic tinctures and wines:—

Tinct. Aloes. " Arnicae. " Aurantii. " Belladonnae. " Buchu. " Calumbae. " Camph. Co. " Capsici. " Cascarillae. " Catechu. " Chiratae. " Cinchonae Co. " " Flav. " Cinnamomae. " Colchici Sem. " Conii. " Digitalis. " Ferri Acet. " Ferri Perchlor. " Gentiani Co. " Hyosciami. " Kino. " Krameriae. " Limonis. " Lobeliae. " Nucis Vomicae. " Opii. " Quassiae. " Rhei. " Scillae. " Serpentariae. " Stramonii. " Valerianae. " " Ammon. Vin. Aloes. " Colchici Rad. " " Sim. " Ipecac. " Opii. " Rhei.

"These were made by extracting the principles of the drugs in the usual way except that instead of alcohol a mixture of glycerine and water was used in the proportion of one-fourth to one-third part of glycerine, and about five per cent. of acetic acid. These made very elegant preparations, and in the majority of cases appeared to have just the same, and just as great physiological action. Subsequently the ordinary tinctures were distilled, and the extracts thus obtained dissolved in the above menstruum, as far as was possible, in most cases the residuum being found to be inert.

"Gum resins and essential oils were found to be insoluble in this menstruum, and hence such drugs have been given in the form of pill, powder or mixture. Such tinctures are those of assafoetida, benzoin, cannabis indica, cantharides, castor, cubebs, lavender, myrrh, pyrethrum, sumbul, tolu and ginger. Out of 62 tinctures it was found that 46 made good preparations, and 16 did not.

"These were employed for several years. But for some time past, somewhat more reliable preparations have been made for us which contain all the constituents of the alcoholic tinctures without the alcohol. They are for the most part made by taking standardized tinctures, mixing with them sugar of milk, and distilling off the alcohol. The alcoholic extract remains behind in a finely divided condition mingled with sugar of milk. This is broken up, pulverized and compressed into tabloids of a definite dose, which can be taken either in that form or rubbed up and dissolved or suspended in gum water.

"The following have been made up in this form: aconite, belladonna, camph. co., cannabis indica, capsicum, cinchon. co., and cinchon. simpl., digitalis, gelseminum, hyosciamus, nux vomica, opium, strophanthus, ginger and Warburg. Other tinctures will be gradually added to this list.

"As external liniments those commonly used are the linimentum terebinthinae and the linimentum terebinthinae aceticum, which do not contain alcohol. A strong solution of iodine is made with iodide of potassium.

"The spiritus ammoniae aromaticus is made without the spirit, the aromatic oils being emulsionized by means of rubbing up with fine sand, but most of these subsequently rise to the surface. The spiritus etheris nitrosi is impossible without alcohol, but nitrite of amyl, and nitrites of potash or soda can be substituted. The spiritus chloroformi is replaced by aqua chloroformi, or as a sweetening agent by solution of saccharin. Thus a favorite expectorant mixture contains carbonate of ammonia five grains, acetum ipecac, ten minims, and solution of saccharin in each dose.

"As a special stimulant a subcutaneous injection of a drachm of pure ether has been given in a few cases; in others digitalis, or caffeine or ammonia in some form, such as the carbonate dissolved in a cup of hot coffee; or hot solution of Liebig's extract, or rectal injections of hot water."

It may be objected by some that glycerine belongs to the family of alcohols, hence hospitals using glycerine tinctures are not, strictly speaking, non-alcoholic. To this the answer is, that while glycerine certainly is classed in the family of alcohols, it is of a very different nature from ethyl alcohol, which is used for beverage purposes. Ethyl alcohol, the alcohol in all intoxicating beverages in common use, and the alcohol generally used in medicine, creates a fatal craving for itself, and is injurious to the body. Glycerine does not create any craving for itself, and has not been demonstrated to have injurious properties, and is not used for beverage purposes.

At the annual meeting of the New York State Medical Society, held in New York City, in October, 1898, a discussion was held upon the use of alcohol as medicine. Dr. E. R. Squibb, a leading pharmacist of Brooklyn, stated that during the last two or three years much had been accomplished in retiring alcohol as a menstruum for exhausting drugs. Of the other menstrua experimented with up to the present time, that which had given the best results was acetic acid, in various strengths. It had been discovered that a ten per cent. solution of acetic acid was almost universal in its exhausting powers. There were now in use in veterinary practice, and in some hospitals, extracts made with acetic acid. They were made according to the requirements of the pharmacopoeia, except that acetic acid was substituted for alcohol. Acetic acid, when used with alkaloids gives the physician some advantages in prescribing, owing to there being fewer incompatibles. In small doses, the percentage of acetic acid in the extract is so small as to be hardly appreciable, and when larger doses are required, the acetic acid can be neutralized by the addition of potash or soda.

Dr. Noble said, in article to London Times before referred to:—

"Modern science has shown that those drugs which are soluble in alcohol only, are, in all probability, more hurtful than useful."

The following from Dr. Jas. R. Nichols, editor Boston Journal of Chemistry, is too good to be omitted, although it should be familiar to temperance students:—

"The facetious Dr. Holmes has said, that if the contents of our drug-stores were taken out upon the ocean and thrown overboard, it would be better for the human race, but worse for the fishes. This statement may be a little sweeping; but it is true that all the showy bottles in drug-stores which contain alcoholic decoctions and tinctures might be submerged in the ocean, and invalids would suffer no detriment. Since the active alkaloidal and resinoidal principles of roots, barks and gums have been isolated and put in better and more convenient forms, there is no longer need of alcoholic tinctures and elixirs. Laudanum, which is a tincture of opium, might be banished from the shelves of every apothecary, as it is not needed. It is now known that the valuable narcotic and hypnotic principles of opium are contained in certain crystalline bodies, which can be isolated, and used in minute and convenient forms, and that they can be held in aqueous solutions. Alcohol is no longer needed to hold the active principles of opium, Peruvian bark or other indispensable drugs. As regards the vegetable tonics so called, the best among them is the columbo (Radix columbo) and this readily yields its bitter principle to water, as does quassia, gentian, senna, rhubarb and most other valuable substances. A careful survey of the contents of a well-appointed modern pharmacy leads to the conclusion that there is no one indispensable medicinal preparation which requires alcohol as a free constituent.

"The catalogue of modern remedies is almost endless, and many of them hold alcohol in some form; but every intelligent physician knows that 90 per cent. of these alleged remedies have little or no intrinsic value. The nostrums of the quack, the bitters, elixirs, cordials, extracts, etc. nearly all contain alcohol, and this is the ingredient which aids their sale. The whole unclean list might, with advantage to mankind, be thrown to the fishes.

"The chemist, more particularly the pharmaceutical chemist, may inquire how he is to conduct his processes without alcohol. It is from the pharmaceutical laboratory we derive some of the most important substances used in medicines and the arts. Among them may be named ether, chloroform and chloral hydrate, three of the most indispensable agents known to science, and the employment of alcohol is essential to their production. Alcohol is a laboratory product; it is a chemical agent which belongs to the laboratory; it is the handmaid of the chemist, and, so long as it exists, should be retained within the walls of the laboratory. In the manufacture of most of the important products in which alcohol is either directly or indirectly used, its production may be made simultaneous with the production of the agent desired. In the manufacture of ether and chloroform, the apparatus for alcohol may be made a part of the devices from which the ultimate agents, ether and chloroform, result. Fermentation and distillation may be conducted at one end, and the anaesthetics received at the other. It is true that in a chemical laboratory alcohol is an agent very convenient in a thousand ways. But, if it were banished utterly, what would result? There are other methods of fabricating the useful products named, and many others, without the use of alcohol, but the processes would be rather inconvenient and more costly. The banishment of alcohol would not deprive us of a single one of the indispensable agents which modern civilization demands, and neither would chemical science be retarded by its loss."

"It must be remembered that modern science has given us glycerine, naptha, bisulphide of carbon, pyroligneous products, carbolic acid and a hundred other agents which are capable of taking the place of alcohol in a very large number of appliances and processes."

The sale of liquor in drug-stores is beginning to be deplored by the more respectable pharmacists. At the annual meeting of the Massachusetts State Pharmacists' Association in 1895 the president said in his address:—

"One thing that every pharmacist, who has the best interests of his calling at heart, must bear in mind is that the liquor part of their business is being, and must be, slowly crowded out. Public sentiment has changed greatly in the last few years, and instead of all being classed alike, the line has been sharply drawn, and the stores that sell the least amount of liquor that they possibly can are gaining the confidence and esteem of the public, and consequently their business is growing from year to year, while the others are losing ground and dropping lower and lower."

The Evening Record of Boston contained the following in its issue of March 7, 1896:—

"The number of flagrant offences on the part of druggists in certain no-license towns—offences not only against the liquor laws, but also against the laws of decency and humanity—brought before the board of pharmacy, would appall the public if they were known. The Looker-On has seen the record of several of these druggists as transcribed from the police courts and they are very black records. One druggist after selling liquor over and over again to one customer, and several times getting him completely intoxicated, finally deposited him one night in a snowbank, in a state of frozen stupor, where he would have frozen to death had not the wife of the druggist's clerk threatened to complain to the police unless he was rescued.

"The story is told of one of the druggists of a neighboring no-license town. A man came in and asked for a pint of whisky. He was asked what he wanted it for. His reply was that he wanted it to soak some roots in. He got it, and as he went out he dryly remarked, 'I should have told you that it was the roots of me tongue that I want to soak.'"



CHAPTER VIII.

DISEASES, AND THEIR TREATMENT WITHOUT ALCOHOL.

The question, "What shall I take instead of wine, beer or brandy?" is frequently asked by those who have been trained to think some form of alcohol really necessary to the cure of disease, but, who, from principle would prefer other agents, if they knew of any equal in effect. This chapter deals somewhat with the answer to that question.

ALCOHOLIC CRAVING:—The craving for alcohol may be present for a time after a person has commenced to abstain from all beverages containing it. Or, it may occur periodically, as a sort of irresistible impulse. For the periodical craving Dr. Higginbotham, of England, recommends that a half drachm of ipecacuanha be taken so as to produce full vomiting. He says the desire for intoxicating drinks will be immediately removed. The craving is caused by vitiated secretions of the stomach; the vomiting removes these. Dr. Higginbotham says:—

"If a patient can be persuaded to follow the emetic plan for a few times when the periodical attacks come on, he will be effectually cured."

Some men in trying to abstain have found the use of fresh fruit, especially apples, very helpful. Nourishing and digestible food should be taken somewhat frequently. A cup of hot milk or hot coffee taken at the right moment has saved some.

ANAEMIA:—In this complaint there is a deficiency of the red corpuscles of the blood. It may be the result of some fever or exhausting illness; it may accompany dyspepsia, and is then due to imperfect digestion and assimilation of the food. The poverty of the blood produces shortness of breath, and often palpitation of the heart also, especially on a little exertion. There is generally more or less weariness, languor and debility, sometimes also giddiness, sickness, fainting and neuralgia.

"In the treatment of anaemia, port wine and other alcoholic liquors are worse than useless."—DR. J. J. RIDGE, London.

"The common prescription of wine or some form of spirits for states of general exhaustion and anaemia, is a serious mistake. It assumes that the temporary increase in the action of the heart is renewed vigor, and that some power is added to the failing energies. This theory rests solely on the statement of the patient that he feels better. In reality the exhaustion is intensified, though covered up."—Medical Pioneer.

"Deficiency of nutrition, of light and of pure air may be mentioned as common causes of anaemia. * * * * * It is evident that the first step in the treatment of this disease is to remove the cause. If the cause is dyspepsia, this must receive attention; if intestinal parasites, they must be dislodged; if prolonged nursing, nursing must be interdicted; if too little food, a larger quantity of nourishing, wholesome food must be employed. Such simple and easily digested foods as eggs, poached or boiled, boiled milk, kumyzoon, good buttermilk, puree of peas, beans or lentils, boiled rice, well-cooked gruels and other preparations of grains are suitable. Beef tea and extracts are worthless. * * * * *

"A careful course of physical training is essential to securing perfect recovery in cases of chronic anaemia due to indigestion, or any other serious disturbance of the nutritive processes."—DR. J. H. KELLOGG.

APPETITE, LOSS OF:—"There is often disinclination for food because it is not required. Many cannot eat much breakfast, because they have had a hearty supper. Or having had both a hearty breakfast and luncheon, they feel but little desire for a dinner of four or five courses. Generally the stomach is right and the habits wrong. What is to be done then, for such lack of appetite? Simply go without food until appetite comes.

"When ale or beer is taken regularly with meals the stomach learns to expect them, and the food is not relished without them. The appetizing power of beer and bitter ales is chiefly due to the hop or other bitter ingredients which they contain. When it seems necessary to assist the appetite temporarily, a small quantity of simple infusion of hops may be taken.

"Sometimes appetite fails because of exhaustion of body and mind. This may be nature's warning against overwork, and cannot be neglected with impunity. Life will inevitably be shortened if it is found necessary to rely upon the aid of alcohol in any form in order to do a day's work.

"Bouillon, or beef soup, at the beginning of a meal are incentives to appetite. Change of scene, and life in the open air are the very best aids to appetite, when aids are really required."

APOPLEXY:—"There is a popular idea that whenever a person is taken ill with giddiness, fainting or insensibility, brandy should be at once procured and poured down his throat. Nothing can be more dangerous in apoplexy. This disease is due to the bursting of some blood-vessel in the head, and the poured-out blood presses on the brain and leads to more or less insensibility. If fainting occurs, it may possibly save the patient's life, because then the blood-vessels contract, and the flow of blood ceases immediately; time is thus given for the ruptured blood-vessel to became sealed up by a clot, which will prevent further loss of blood. If brandy is given, there is, first, great risk of choking the patient; if that danger is escaped and the brandy is swallowed and absorbed, the vessels become relaxed and the heart recovers its force; hence the ruptured vessel, if not sufficiently sealed by clot, may be started again, and fatal hemorrhage result.

"The only treatment which unskilled hands can adopt is to lay the patient on his back on the floor or sofa with the head and shoulders somewhat raised; to loosen all the dress round the neck and body; to apply cold to the head and hot flannels or a hot bottle to the feet and hands, or to soak them in hot mustard and water, and to gently rub the arms and legs."—DR. J. J. RIDGE.

Dr. Alfred Smee, surgeon to the Bank of England, says:—

"Give nothing by the mouth. Apply a stream of cold water to the head. If the feet are cold apply warm cloths. If relief is not soon obtained, apply hot fomentations to the abdomen, keeping the head erect."

BED-SORES:—Some object to using alcohol even as an outward application. Dr. Ridge recommends that when a patient is confined to bed the parts pressed on be well washed every day with strong salt and water or alum water, and carefully dried. Glycerine of Tannin may then be applied. If any redness appears, especially if any dusky patch is formed, collodion may be applied with a brush, and all pressure should be taken off the part by a circular air-pillow or by a cushion; or small bran or sand-bags may be made and carefully arranged. If the skin is broken, zinc or resin ointment may be applied.

Some recommend finely powdered iodoform sprinkled over the surface of the sore.

BOILS AND CARBUNCLE:—"In many cases these troubles result from an overloaded condition of the system, which is the result of taking too much food, or some error in diet. The boils are an effort of nature to be rid of offending matter. In some cases they are due to the use of impure water, or the presence of sewer gas in the house. In others, overwork, or other debilitating causes, may have produced the state of the digestive organs which usually causes the boils. Carbuncle is, essentially, an extensive boil.

"Apply iodine early or a piece of belladonna plaster. The diet should be plain and unstimulating, condiments being avoided and plenty of fresh vegetables taken, if possible. Fresh-air, exercise and proper rest should be obtained, and late hours avoided.

"Medical advice is requisite in carbuncle. The popular notion that port wine is absolutely necessary is both erroneous and mischievous."—RIDGE.

CATARRH:—Among the causes are repeated colds; errors in diet, especially excess in the use of fats and sugar, and an inactive state of the liver.

Cut off from your bill of fare all salted foods, avoid fats and condiments; drink freely of pure water; live in the open-air and sunshine as much as possible, taking much out-door exercise. Take a cold sponge or towel bath every morning, beginning at the face and finishing by plunging the feet into a foot-tub. Follow with vigorous rubbing with a crash or Turkish towel. Those subject to sore throat should hold the head over a basin of cold water and lave the neck with the water for about two minutes. The writer was formerly subject to frequent sore throats, but has had none for over two years, as she believes, because of the adoption of this measure, together with the towel bath every morning, summer and winter.

Care should be taken to avoid exposure to draughts, or any other means which will produce liability to cold. Care in diet, good ventilation and the morning cold bath are essential if a radical cure is desired. Local measures, while giving relief, will not remove the predisposing causes. Dr. Kellogg recommends saline solutions in the form of the nasal douche, a teaspoonful of salt to a pint of soft water, adding twenty to thirty drops of carbolic acid, if there is offensive odor, as a relief measure.

Sleeping in a poorly ventilated room is said to be one cause of catarrh.

Hay Fever is a form of catarrh. The vapor bath is recommended as very helpful in this trouble. Nature Cure says that two vapor baths and a two or three days' fast will cure any case of hay fever. The use of pork and other clogging foods should be avoided by those afflicted with this trouble. The bowels should be kept in good condition. If constipated, the use of prunes, figs, grapes, apples and other such fruits will be very beneficial; walking, and massage of the bowels, being added if the fruits are not sufficient. No one able to walk should depend upon drugs to relieve a constipated condition.

COLDS:—"If the bowels are constipated, the skin over-burdened and clogged with bilious matter, and the lungs weak, it is as easy to take cold as to roll off a log. If, on the contrary, the lungs are well developed, and the respiratory power large, providing abundant oxygen to keep bright the internal fires, the colon clean, the skin daily washed, and the system hardened by the cold bath, taking cold is next to impossible.

"The first remedial agent for a cold should be a copious enema. Then open the pores of the skin by a hot bath; take a glass of hot lemonade and go to bed."—The New Hygiene.

CHILLS:—For chill, take a hot foot and hand bath, with mustard in the water, 1/4 pound to a gallon; then go to bed in a well ventilated room. Drink freely of hot lemonade or hot water. Catarrh, colds and hay fever may all be effectually relieved by hot baths. Relief may be gained also from inhaling the vapor from pine needles or hemlock leaves. Put them in a bowl, pour boiling water over them, hold the face down over the bowl, the head being covered, and inhale the vapor well up into the nostrils and head. A few drops of hemlock oil in the hot water will do as well.

COUGHS AND HOARSENESS:—Boil flaxseed in 1 pint water, strain, add two teaspoons honey, 1 ounce rock candy, and juice 3 lemons. Drink hot. Also; roast a lemon till hot, cut, and squeeze on 3 ounces powdered sugar.

COLIC:—This may arise from cold, or from error in diet. If the latter it is desirable to induce vomiting. For the pain, apply hot flannels or fomentations; drink hot water. In severe cases, sprinkle a little turpentine on flannel, wrung from hot water, and apply to abdomen. Colic resulting from the accumulation of fecal matter should be treated with hot enemas until relieved. A hot hip-bath is sometimes necessary to relief.

The colic of children and infants should never be treated with alcoholics. In infants it generally arises from excessive or improper feeding; care should be taken that the milk provided them is not sour.

In severe cases the babe should be immersed in warm water, keeping the head above water, of course. This is also the best remedy in convulsions. The hot bath, with a copious enema of warm water, has saved the lives of many babes.

For adults, hot water, with a pinch of red pepper added, will do all that brandy can do, and more.

CHOLERA:—Brandy has been considered by many a really necessary medicine in cholera. The following is a discussion upon Alcohol in Cholera which was held at the annual meeting of the British Medical Temperance Association, in May, 1893, and is taken from the Medical Pioneer of June, 1893:—

"Dr. Richardson opened a discussion on Cholera in relation to Alcohol. He said he would bring forward five points on the subject.

1. The negligence among the people at large produced by alcohol in the presence of a cholera epidemic. There was no doubt on the part of any who had seen an epidemic of cholera as to the mischief done by alcohol, apart from its action as a remedy. People rush to the public houses and take it to ward off the danger, or to relieve them when they begin to feel ill, and the result is very bad morally. He had seen this in different epidemics. Or people got in spirits to face the danger, and many became intoxicated and less able to resist.

2. Its misuse by those affected. It was often given to cheer them up and remove their fear and nervousness. In his opinion it invariably produced mischief.

3. He was unable to find any physiological reason for giving it. There was a constant drain of fluid, causing spasms and cramp, both of the muscles and blood-vessels, and difficult circulation through the lungs. Spasm may be relaxed by alcohol, but, on the other hand, alcohol is exceedingly greedy of water, and so increases the flux. But it also reduces animal temperature, which is a strong feature of cholera, so much so that he could almost diagnose cholera blindfold in the stage of collapse, by the icy coldness.

4. Its uselessness as a remedy during the acute stage. He had seen a great deal of cholera and never saw alcohol do any good whatever. There was a temporary glow which passed away in a few minutes, and then the evil it does in other ways was brought out. Water was far better, even if cold. The College of Physicians had given some instructions and ordered great care in the administration of alcohol; this was not far enough, but good as far as it went. The recoveries were best where the treatment was simplest, such as external warmth with plenty of diluents. He had given creasote largely.

5. Its injuriousness during the stage of reaction. The reactive fever following collapse caused a great number of deaths. In this stage alcohol was absolutely poisonous. He could recall many such cases in which he had given alcohol through ignorance, and always with disaster.

"Brigade-Surgeon Pringle said that when he went out to India he thought alcohol was something to stand by, but he had soon found out his mistake; he had himself suffered from it. He could confirm what Dr. Richardson had said as to the demoralization produced by alcohol to which men resort to keep up their spirits, and men seized under these circumstances were in the greatest danger. Nature effects a cure in many cases without assistance, and often with wonderful rapidity. People apparently dead and about to be buried, he had known to get up and recover. When alcohol is given during collapse there is often no absorption until reaction occurs, and then the quantity accumulated speedily produces intoxication. It was the same with opium: he had found pills unchanged in the stomach for hours. He recommended hot drinks; he had tried every kind of medicine and had little faith in it. The nursing was very important, and it was important that the nurses should abstain.

"Dr. Morton said it was easy to see that on physiological grounds alone, alcohol, with its strong affinity for water and its tendency to lower temperature, could not be a useful drug in the treatment of cholera collapse, and with its powers of paralyzing vascular inhibition and checking elimination of effete matter, could not be otherwise than harmful in the stage of reaction. As these conclusions were corroborated by practical experience he did not think members would hesitate to banish it from their equipment against cholera.

"Dr. Ridge said it should be remembered that Doyen had made experiments on guinea-pigs and had found they were proof against cholera, unless they had previously had a dose of alcohol. This explained why drunkards and hard drinkers were so much more liable to have cholera, and have it badly as all observers declared to be the case. Another reason might be that small quantities of alcohol, such as would be found circulating in the blood, favored the growth and multiplication of bacteria, certainly those of decomposition, and probably those of cholera. Hence, other things being equal, the abstainer had a great advantage.

"Dr. Norman Kerr said that he had observed both in America and Glasgow that not only notorious drunkards but free drinkers suffered; abstainers were less liable unless they took contaminated water, and the less liquid taken the less chance of taking cholera; beer-drinkers often took more than abstainers. The alcohol-drinker uses up more water from his blood and so has less to flush out the system. Alcohol, given to a patient, disguised his condition so that he might seem better though really worse. Hence it is better and safer not to give any. The doctors and nurses ought to be abstainers. A doctor after dinner was more likely to take a roseate view of a case, looking at it through an alcoholic pair of spectacles. Alcohol was not really a stimulant, but a depressant, and this is a very depressing disease; it was important to have our vital resisting power as vigorous as possible. Hot water both relaxes and stimulates, and the whole cry of the sufferer is for water. Many persons who died in cholera did not die of the disease, but of the drugs such as alcohol and opium. Acid drinks should be given, as the bacilli could not live in acid mixtures. Cholera might come, but he believed we were better prepared to meet it and to treat it.

"Surgeon-General Francis sent a communication which was read by the Honorable Secretary. He said: 'Having had many opportunities of treating cholera in various parts of India and amongst all classes, I have no hesitation in affirming that alcohol in any shape is one of the very worst remedies. Life is, so to speak, paralyzed, and we give a remedy which, apparently stimulating, is in reality, a paralyzer and therefore mischievous; the death-rate might be considerably reduced provided alcohol were rigidly excluded.'"

Dr. Norman Kerr in a valuable paper upon Cholera says:—

"The first thing is to get rid of the poison. How? By assisting it out; but alcohol keeps it in by blocking the doors, just as the doors were blocked in the terrible calamity at Sunderland not long ago. The alcohol makes the heart and circulation labor more. Alcohol not only retains the cholera poison, but retards the action of the heart. Brandy and opium used to be employed, but the records show that if the object had been to make cholera as fatal as possible, that object was achieved by the indiscriminate administration of brandy and opium. Better leave the victim alone, and his chances of recovery will be greater than if he have a thousand doctors, and as many nurses, administering to him brandy and opium. Alcohol is especially dangerous in the third stage, that of reactive fever, because it adds to the fever. Then, alcohol is not only unsafe in the three stages of genuine cholera, but especially unsafe in the premonitory diarrhoea stage, which gives nearly every one warning before they are attacked by genuine cholera. Brandy is taken simply because it puts away the pain. If there are only the pain and slight diarrhoea, speaking medically, it is all right, but if there is anything behind the pain, it is all wrong. After the alcohol, the mischief is going on, only the patient does not know it, and valuable time is lost. All the alcohol does is to deaden sensation. * * * * * Here I can thoroughly recommend ice and iced water. I have always treated cholera patients with these. Let them drink iced water to their hearts' content; they can never drink too much; and this opinion is fortified by that of Professor Maclean, of Netley. There is no need of a substitute for brandy in cholera, because in ordinary circumstances in that disease the action of a stimulant is bad. Flushing of the blood is required, and water will do it. Milk will not do it, because it is too thick—nothing but pure, cold water, all the better if iced."

In 1893 Dr. Ernest Hart, editor of the British Medical Journal, read an able paper upon Cholera before the American Medical Association. His argument was that the introduction of such a substance as alcohol, itself being a product of germ action, into a system already suffering from the toxic influence of a ptomaine, could not be otherwise than pernicious.

CHOLERA MORBUS:—Dr. Kellogg says: "The stomach should be washed by means of the stomach-tube when possible. A large hot enema should be given after each evacuation of the bowels. The addition of tannin, one drachm to a quart of water, is serviceable. When the vomited matter no longer shows signs of food, efforts should be made to stop the vomiting. Give the patient bits of ice the size of a bean to swallow every few minutes. At the same time apply hot fomentations over the stomach and bowels. If the patient suffer much from cramp, put him into a warm bath. The first food taken should be farinaceous. Oatmeal gruel, well boiled and strained, is useful."

CHOLERA INFANTUM:—"Iced water may be given in very small quantities every few minutes. Give the stomach entire rest for at least twenty-four hours. There will be no suffering for want of food as long as the stomach is in such a condition. Withhold milk until nature has had time to rid the alimentary canal of the poison-producing germs. White of egg dissolved in water is an excellent preparation in these cases. Egg enemata may also be advantageously used.

"Warm baths, the hot blanket pack when the surface is cold, and the hot enema are all useful. Keep the child wrapped warmly.

"Great care should be taken in returning to the milk diet. The milk should be thoroughly sterilized by boiling for half an hour, and should be mixed with some barley water so as to avoid the formation of large curds in the stomach. Cream, diluted with water, may be used instead of milk."

CONSUMPTION.

Dr. Koch, the celebrated German microscopist, pronounces consumption contagious, because during its progress a very minute bacterium is developed which may be transmitted from one person to another.

It is said that a person with healthy lungs might daily breathe millions of tubercle bacilli without any danger, and that the best preventive of this disease is to live much in the open air, or if this is impossible to spend ten or fifteen minutes a day in deep breathing exercises in the open air. "Fresh-air and disease-germs are antagonistic."

Alcohol, chiefly in the form of whisky, was for many years considered of great value in the treatment of consumption of the lungs. Indeed, it was looked upon not only as a curative, but also as a prophylactic, or preventive, of great service to those predisposed to this disease by reason of narrow chest and weak lungs.

Sir Benjamin Ward Richardson was the first medical scientist who showed plainly that alcohol, instead of being a preventive of consumption, is really the sole cause of one type of this disease, the type now classed under the head of "alcoholic phthisis." For this kind of phthisis there is no hope of cure.

French physicians some years ago came to the conclusion that alcohol was a prolific cause of tuberculosis and that the administration of alcoholic liquors in tubercular troubles was a great error, and in the International Anti-Tuberculosis Congress held in Paris in 1905, about 2000 medical scientists being present, they presented the following resolution, which was adopted: "In view of the close connection between alcoholism and tuberculosis, this Congress strongly emphasizes the importance of combining the fight against tuberculosis with the struggle against alcoholism."

Since that time a great crusade against tuberculosis has been carried on by means of exhibits and lectures, and in connection with these, almost invariably the people are warned against intemperance. For example, a pamphlet sent out by the Boston Association for the Relief and Control of Tuberculosis says: "Do not spend money for beer or other liquors, or for quack medicines or 'cures.' Self-indulgence and intemperance are very bad. Vice which weakens the strong kills the weak." The New York State Charities Aid Association, working with the State Board of Health, says in a pamphlet: "Patent medicines do not cure consumption. They are usually alcoholic drinks in disguise, and the use of alcoholic drinks is dangerous to the consumptive." At the great exhibit in Washington in September, 1908, in connection with the International Anti-Tuberculosis Congress different warnings against alcohol were upon the walls. Among these was a large poster of white cloth on which was printed the opinions on alcohol, in brief, of some of the best-known authorities on consumption. The opinions as given on that poster are given here, with others, in order to show the great change of sentiment regarding alcohol and consumption which has come about within a few years:—

"Alcohol has never cured and never will cure tuberculosis. It will either prevent or retard recovery. It is like a two-edged weapon; on one side it poisons the system, and on the other it ruins the stomach and thus prevents this organ from properly digesting the necessary food."—S. A. KNOPF, M. D., New York, Honorary Vice-President of the British Congress on Tuberculosis.

Dr. Knopf in his prize essay on "Tuberculosis and How to Combat It," says in several places: "Avoid all alcoholic beverages." He says also, "Alcohol should never be given to children even in the smallest quantities."

"It is a recognized fact in the medical profession that the habitual use of alcoholic drinks predisposes to tubercular infection. It is also recognized, I think, by most physicians that alcohol as a medicine is harmful to the tubercular invalid."—FRANK BILLINGS, M. D., Chicago, Ill., Former President American Medical Association.

"Alcoholic liquors are of damage to consumptives because they tend to impair nutrition, disturb the action of the stomach, and give a false strength to the invalid on which he is sure to presume. Besides, we know that in countries where drinking prevails most, the ravages of tuberculosis are most marked."—EDWARD L. TRUDEAU, M. D., Adirondacks Sanitarium for Consumptives, Saranac Lake, N. Y.

"In my judgment whisky should not be used by people who have consumption, and in my practice I prohibit its use absolutely. At the White Haven Sanitarium and Henry Phipps Institute we do not use alcohol in any form in the treatment of our patients."—LAWRENCE F. FLICK, M. D., Vice-President of the National Association for the Study and Prevention of Tuberculosis, Philadelphia, Pa.

"I do not feel that I can emphasize strongly enough the harm that can be done by the use of alcohol in tuberculosis, and the indiscriminate use of it certainly borders on the criminal. I do not believe that any legitimate reason can be given for the routine employment of alcohol in the treatment of tuberculosis. I furthermore know of no emergency in which it is indispensable. My experience with patients who have been accustomed to the use of alcohol, especially moderately, is very unsatisfactory. They seem to show an abnormally low resisting power to the tubercle bacillus. The fact has been established that alcoholism is a very potent factor in the causation of tuberculosis. I find it not only unnecessary in treatment but believe it to be contraindicated."—F. M. POTTENGER, M. D., Superintendent the Pottenger Sanitarium for Diseases of the Lungs and Throat, Monrovia, California.

"I have met with a small class of consumptive patients who could take alcoholic liquors freely for a length of time, without deranging either the stomach or the brain, and with a decided amelioration of the pulmonary symptoms, and an arrest of the emaciation. Some of these have actually increased in embonpoint, and for three to six months were highly elated with the hope that they were recovering. But truth compels me to say that I have never seen a case in which this apparent improvement under the influence of alcoholic drink was permanent. On the contrary, even in those cases in which the emaciation seems at first arrested, and the general symptoms ameliorated, the physical signs do not undergo a corresponding improvement; and after a few months the digestive function becomes impaired; the emaciation begins to increase rapidly; and in a short time the patient is fatally prostrated."—DR. NATHAN S. DAVIS, SR., of Chicago.

"The use of whisky in this disease positively interferes with digestion which must under all circumstances be kept as perfect as possible in order that the patient may assimilate the food which is so necessary to the upbuilding of the system and to gain strength to fight the onslaught of the disease.

"Its constant use would not only interfere with digestion but would have a tendency to create disease in other organs of the body so that we therefore consider the use of whisky in tuberculosis positively contraindicated.

"Wishing you success in your laudable campaign."—DR. M. COLLINS, Superintendent National Jewish Hospital for Consumptives, Denver, Colorado.

"It is difficult for many people to adapt themselves to a methodical plan of life long enough to establish a permanent cure in consumption. I have known many a young fellow with only a slight trouble in his lungs to die in the Adirondacks more from the effects of whisky than from the disease itself."—DR. HENRY P. LOOMIS, of New York City, in a Lecture on Consumption. (See page 232, of Handbook, on the Prevention of Tuberculosis.)

"The majority of our patients receive no medication whatsoever. The stomach is rarely in condition to bear excessive medication, and the promiscuous use of creosote and similar preparations is to be condemned. Milk and raw eggs are the best articles of diet in addition to a regular diet of simple food."—JAMES ALEXANDER MILLER, M. D., of the Vanderbilt Clinic, New York. (From Medical Record.)

"In my specialty, the treatment of pulmonary diseases, I rarely prescribe alcohol in any form, and in the sanitaria with which I have been connected it is the exception where alcohol in any form is prescribed. I have advised against its use where such has been the custom, believing that as a rule alcoholic liquors do more harm than good in the treatment of this disease."—PROF. VINCENT Y. BOWDITCH, M. D., Harvard Medical School, Boston.

"From personal experience in handling pulmonary tuberculosis, not only at the Nordrach Ranch Sanitorium, for the past five years, but in an active practice of thirteen years, I am more than convinced that whisky and liquor, in any form, are absolutely poisonous to the consumptive.

"Whenever we admit a patient to the Nordrach Ranch Sanitorium, we ascertain whether the individual is an alcoholic or not; and we invariably find that such an individual is lacking in vitality enough to combat the disease. They may look fat and strong, pulmonary tuberculosis usually makes quick work of them.

"It is also a noticeable fact, proven by various statistics, that a very large percentage of alcoholics become tubercular; and if we ever stamp out tuberculosis, we will also have to stamp out intemperance.

"Trying to cure consumption with whisky is like trying to put out a fire with kerosene. This is very easy to understand when we stop to consider the nature of this disease. In the first place, we have a very rapid heart's action, dating from the very earliest manifestations of the disease. The pulse is often in excess of 100, even in incipient cases, and if the stimulation of alcohol is added, we have what might be called a 'runaway heart'; and if there is one thing needed in the long combat against tuberculosis, it is a good heart."—JOHN E. WHITE, M. D., Medical Director Nordrach Ranch Sanitorium, Colorado Springs, Colorado.

"You ask me my opinion as to the use of whisky in the treatment of consumption. In reply permit me to say that I regard its use in this disease as most universally pernicious."—PROF. CHARLES G. STOCKTON, M. D., Buffalo Medical College, Buffalo, N. Y.

"It was formerly thought that alcohol was in some way antagonistic to tuberculous disease, but the observations of late years indicate clearly that the reverse is the case, and that chronic drinkers are more liable to both acute and pulmonary tuberculosis. It is probably altogether a question of altered tissue soil, the alcohol lowering the vitality and enabling the bacilli more readily to develop and grow."—DR. OSLER, formerly Professor of Medicine in Johns Hopkins University, Baltimore, Md., now of Oxford University, England.

"Upon investigation I found 38 per cent. of our male tubercular patients were excessive users of alcohol, 56 per cent. moderate users. From my study of the cases I am led to believe that in a vast majority of these cases drink has been a large factor in producing the disease, by exposure, lowering of vitality, etc. I believe that alcohol has no place in the treatment of tuberculosis. Many patients are deceived by the false strength it gives them."—O. C. WILLHITE, M. D., Superintendent of Cook County Hospital for Consumptives, Dunning, Ill.

"In tuberculosis there is a state of over-stimulation of the circulatory system due to the toxins. The use of alcoholics simply makes the condition worse. It reduces resistance and makes the person more susceptible to the disease."—H. J. BLANKMEYER, M. D., Sanatorium Gabriels, in the Adirondacks, N. Y.

"The practice of taking alcoholics of any sort, and in any quantity, over a considerable length of time, is certain to produce more or less injury to a tubercular patient, and their use by tubercular people cannot be too strongly condemned."—H. S. GOODALL, M. D., Lake Kushaqua, N. Y.

Most of these opinions were written for the author of this book in response to letters of inquiry. Are they not indicative of a day when the medical profession will lay aside alcoholic liquors in the treatment of all diseases? It is acknowledged that the past usage of giving whisky and cod-liver oil to consumptives was an error; some day, it may be not far distant, a larger acknowledgment may be made, and the medical use of alcoholic liquors will be entirely a thing of the past.

Rev. J. M. Buckley, D.D., editor of The Christian Advocate, was in early manhood considered an incurable consumptive. Being a man of great will power and indomitable perseverance, he resolved to try the open-air cure, together with the use of an inspirator. The result was perfect restoration to health, so that, as is well known, he can be easily heard by audiences of thousands at Chautauqua and other places where he is greatly in request for lectures. He has written a pamphlet giving a full history of his case. It can be obtained from Eaton & Mains, 150 Fifth Avenue, New York, for fifty cents, and should be read by all consumptives who have any "grit" in their composition.

Dr. Forrest, a hygienic physician, says:—

"What is to be done if the germs have already obtained lodgement in the lungs? Increase the general nutrition of the body in every way, and then the lungs can resist the inroads of the disease. The first thing necessary to improve the nutrition of the body is to stimulate the digestive and absorbent functions of the stomach and intestines. Naturally then, you must throw the so-called cough medicines out of the window. The drugs used to stop a cough are sedatives. Now, no sedative or nauseant is known that does not lock up the natural secretions and thus lessen the digestive powers. The cough is nature's method of expelling offending matter from the lungs and bronchial tubes. It is infinitely better to have this stuff thrown out of the lungs than retained there."

Keep the bowels clean is this physician's next recommendation.

Sweet cream is preferable to cod-liver oil as it is not so likely to derange the stomach. Easily digested food is necessary, as the organs of digestion are in weakened condition.

Again Dr. Forrest says:—

"The consumptive should live as much as possible in the open air.

"Dr. Trudeau inoculated twelve rabbits with tubercle or consumptive germs. Six of these he turned loose on an island where they ran wild. The other six were kept confined in hutches such as rabbits are usually kept in. Results—All the six rabbits in the open air recovered from the inoculation and remained well. Five of the confined rabbits died of tubercles in the lungs and different parts of the body. The sixth was still lingering, badly diseased, when the experiment was brought to a close. Fresh air and exercise enabled the first six to overcome the disease germs. Confinement gave full play to the disease in the others.

"Now, you house lovers, sleepers in close bedrooms, people afraid of cold air, you are the rabbits in the hutches. Beware, lest the verdict be in your case, 'Died of tubercles in the lungs.' If you are not able to leave your home, live with open windows, day and night, summer and winter.

"Exercise systematically, especially those exercises, accompanied by deep breathing, that open and strengthen the lungs—exercises without fatigue.

"If you are hoping that some wonderful, mysterious drug has been or will be discovered, a drug that will cure consumption without your help, you are hoping against hope. Improved nutrition is your salvation, and that must come through exercise, diet and fresh air."

Dr. J. H. Kellogg, in his Home Hand-Book of Hygiene and Medicine, recommends a salt sponge bath upon retiring, to arrest night sweats, or sponging with hot water. He adds:—

"It is important that patients should know that the sweats are greatly aggravated by opium in any form, and hence are increased by cough mixtures of any sort which contain this drug. Very simple remedies are often effective to relieve the most distressing cough, such as gargling of water in the throat, holding bits of ice in the mouth, taking occasional sips of strong lemonade, and similar remedies. As a general rule, patients run down and the disease progresses much more rapidly, after beginning the use of opium in any form. Sometimes it is best that the cough should be encouraged instead of being repressed. When the patient expectorates very freely, the cough is a necessary means of relieving the chest of matters which would seriously interfere with the functions of the lungs if retained, by filling up the bronchial tubes and air-cells. The kind of cough needing relief is an irritable, ineffective cough, unaccompanied by any considerable degree of expectoration. Loaf sugar, honey or a mixture of honey and lemon juice, and other simple, familiar remedies are often effective in relieving such a cough. * * * * *

"It is perhaps needless to add that the numerous quack remedies for consumption advertised in the newspapers are wholly without merit. There is no known drug which will cure this disease, or in any certain degree influence its progress. Numerous remedies have been recommended as curative, but not one has thus far stood the test of experience."

DISPLACEMENTS OF THE UTERUS:—These conditions are not among those for which alcoholic liquors are likely to be advised by a physician, but women frequently resort to Lydia Pinkham's Compound and other alcoholic preparations in the vain hope of finding the relief so positively promised in the nostrum advertisements. Women are sometimes seriously injured by using the nostrums specially advised for uterine weaknesses, for this reason: a drug which may be of service in an anaemic condition of the womb may do much damage in an inflamed or engorged condition, yet the nostrum vendors advise their preparations for all alike, without a word of warning as to possible dangers.

Ordinary displacements may be recovered from by cleanliness of the parts and by exercises which strengthen the muscles in the pelvic region. The writer has known a considerable number of women who have been restored to health by exercises after months, in some cases, and several years in others, of weakness and misery. One of these women was a close relative of a celebrated specialist in women's diseases. He said he could not do any more for her, and gave permission for her to try the exercises, which were given her by a well-equipped teacher of physical training.

There are three kinds of displacements: anteversion, retroversion, and prolapsus. The causes of these troubles are various; lack of proper care in child-bearing, miscarriages, heavy lifting, a hard fall, jumping out of a carriage, straining, too violent exercise in gymnasium work, and tight-lacing, also gradual weakening of the ligaments which sustain the uterus in position.

An abdominal supporter should be worn constantly during the day for a year or so, then left off gradually an hour or two at a time. It should be worn during the second year whenever any extra work is to be done.

There is a supporter sold by the Battle Creek Sanitarium which is highly recommended, but any physician can get one for a patient.

Perfect cleanliness is necessary. For this purpose a hot vaginal douche should be taken two or three times a day. This douche should be made astringent by adding to a pint of water a quarter ounce of alum or tannin. The hot astringent injections tone up the lower supports of the uterus, and cleanse the passage. The patient should remain in a recumbent position for some hours after the douche if possible. Considerable rest hastens a cure. Take the rest in the fresh air when weather permits. Persistent use of sitz baths will be found helpful.

For prolapsus the simplest form of internal supporter is a small roll of cotton. After the organ is carefully put into position this supporter should be pressed up against the mouth of the womb, the patient meanwhile lying upon her back. The ball of absorbent cotton should be large enough to be retained in position, and should be saturated with a weak solution of glycerine and alum or glycerine and tannin before being applied. A piece of white cord should be tied firmly around the centre of this tampon by which it may be removed. Remove before taking the douche.

Persons who feel unable to purchase an elastic or other abdominal supporter can make a substitute (not so good, but of considerable service) from unbleached muslin made in the shape of the letter T, and having the cloth double. It should go up to the waist and be made to fit over the hips, then should be fastened firmly in front with safety-pins, and the cross-piece be drawn up from the back and fastened securely in front.

The daily exercises are the most important part of the treatment. They must be begun gradually, and taken at greater length as strength is gained. Those for prolapsus will be given first:—

The patient should lie upon a rug, or on a firm long sofa or couch. The feet should be drawn up as close to the body as possible. Now lift the lower part of the body so that the hips and lower portion of the trunk will have no support but what comes from the feet and shoulders. Hold this position for a minute or two (longer when able without much fatigue). After a few minutes' rest repeat. This exercise may be continued from twenty to thirty minutes, according to patient's strength. The elevation of the hips in this exercise aids in the restoration of the organ to its natural position. This exercise should be continued daily, the number of times being increased as strength increases.

A second exercise which is very helpful in prolapsus is to support the body on the toes and elbows with the face downward, and the hips raised as high as possible. Another exercise may be taken with an assistant; the patient should lie face downward, supporting the body by the chest, and keeping the limbs rigid while the assistant lifts the feet as high as possible without hurting. These movements strengthen the abdominal muscles and draw fresh blood to the weakened parts, and cause quickened circulation in addition to restoring the displaced organ to natural position. They should be taken at night just before retiring after a hot douche. The bowels should be kept open by the free use of fruit. The patient should sleep with the hips elevated as much as can be endured without real discomfort and sit with the feet on a stool. When strength sufficient is acquired the exercises for anteversion will be found useful, and any other exercises which strengthen the abdominal muscles, such as bending backward and forward, and sideways. Kneading and percussing the abdomen by an osteopath or masseur strengthens, and also relieves constipation. Rest during the day should be taken with the feet higher than the head.

Prolapsus due to laceration in child-birth may require a surgical operation.

In case of antiflexions the first exercise given for prolapsus should be taken daily. (The advice for the prolapsus treatment and the exercises are taken from the writings of Dr. J. H. Kellogg, superintendent of the Battle Creek Sanitarium.).

ANTEVERSION:—Persons suffering from anteversion or retroversion should sleep without pillows under the head, and lie flat upon the back; they should sit with the feet as high as convenient and avoid high seats which hinder the feet from touching the floor. They should discard corsets and tight stocking supporters which push or hold down the organs which need to be replaced. Stocking supporters should be fastened over the hips and comfort waists can be bought in place of corsets.

It is well to have an attendant to prepare weak patients for first exercises in all uterine troubles by the use of towels wrung from hot water applied to the back and abdomen for a few minutes to relax the muscles, or a hot water bottle, or hot salt bag may be used. Then, with the patient lying with head low, the attendant should give the abdomen and small of the back a thorough rubbing or kneading for ten minutes or less according to strength of patient. Olive oil can be used on the hand in the rubbing.

FIRST EXERCISE FOR ANTEVERSION:—Lie on bed or rug; fold arms on chest; hold trunk of body still; stretch legs, and hold the position about half a minute, then relax at the knee and ankle. Then point the toes down and stretch upper leg muscles; relax; then stretch under leg muscles by stretching heel out. The patient will feel the exercise as far as the shoulders, and should be careful not to lift the body from the floor at first. When patient can hold stretching exercise for a minute then lift first the right, then the left leg, and take same exercise until the person can give a quick little kick for, say, twelve times, as the leg is straightened.

SECOND EXERCISE:—Lying on the back, stretch to full length; move the left leg out at the side, then up and back to position, forming a semi-circle, keeping muscles tense throughout. Then move right leg out at the side—left—stretch toes long—relax—stretch heel—, lift a little higher and bring back to place in a circle and rest. Same with left leg and then both together. Few people can do this easily at first, the weight of the legs is too much for the weak muscles at the back; but some one can hold the foot at first. When the patient can do this easily without bringing on any pain or ache, she may sit in a low chair and take arm lifting exercises.

Raise both arms out at the sides, then slowly raise them up close to the head and consciously lift all the organs of the body up, relax, and lower arms down front and repeat slowly, six or ten times at first, until for five minutes the patient can do this sitting. Then take it standing for ten minutes or more. Stand with feet wide apart. Dr. Anderson says, "A woman who will do this twenty times each day can never have anteversion, if she dresses properly, for it lifts the organs in place each time." It lifts the chest and abdomen up, and brings a feeling of exhilaration if done in the open air.

After the patient has taken exercises for five or six weeks she may lie flat on the back, fold arms and raise body up to sitting position without unfolding arms. Then turn on right side and do the same, then on left side and do the same. This is fine for back and abdomen muscles.

Anteversion needs the Rest Cure, and resting with the body in a position in which nature can right things is an important thing to remember. Rest always after exercise, either with a pillow under the knees or with the legs hanging over a low foot-board, or lying on a couch with the feet higher than the head. Exercise will relax the muscles and call for blood which will revitalize and stimulate the weakened conditions. A woman with this trouble should be careful about bending quickly over, or climbing stairs, until she gains strength.

RETROVERSION:—Place the patient with face downward on bed or mat and with a small pillow under the lower part of the abdomen. Relax the muscles by applying a hot towel, hot salt bag or hot water-bottle just below the small of the back, and lower part of the abdomen for ten or fifteen minutes. (Hot salt bags are most effective and are easy to handle.) Then rub the back briskly with a circular movement; if tender in front, do not rub the abdomen. The circulation will gradually carry away any inflammation as soon as the muscles reach a normal condition, though kneading of back and abdomen, using sweet oil on the hand, is helpful if the patient can bear it.

The patient must remember that these conditions have been months in coming and only painstaking work and time can restore the weakened organs. The manner of dress is very important; loose, comfortable clothing must be worn. Sleep with the face down as much as possible; nature will correct itself, if allowed, many times.

FIRST EXERCISE:—Fold arms under forehead and draw right knee up close to body and hold two minutes (unless painful) and slowly straighten, and stretch very slowly. Do the same with the left leg until the patient can repeat the exercise twelve times with each leg and hold five minutes instead of two, with the knee close to the body. It will probably take two weeks to gain strength for this. After that time raise the body up on hands, and move legs just as a baby does when creeping, except that the patient only follows the movement and does not move along.

SECOND EXERCISE:—Patient take sitting position on floor and clasp hands under knees, and bring knees up, so that chin and knees meet and hold. Then straighten legs, slide hands toward the heels as far as hands can reach, (stretch hands toward heels); make a continuous movement of this.

THIRD EXERCISE:—Sit on floor. Place the hands on floor at sides, legs straight out in front, lift the body from the floor with the arms, up and down. This is a fine exercise for raising up the misplaced organs.

FOURTH EXERCISE:—Place the patient flat on back and push the body up to sitting position with hands quite far back and palms down, recline again, up and down until arms and back are very tired. Then sit up, legs straight in front, raise the body from the floor, (an inch) and move backward, resting weight on hands, then move over on knees as at first exercise and creep, then sit up and move backward again. These will take a month to perfect. Begin by exercising five minutes and gradually work up to half an hour, rest between, always. The patient must have the right mental attitude, must think that she is trying to replace the uterus by lifting it to its natural position. The exercises must not be lazily done.

Sitting in a tub of hot water is most helpful where there is much tenderness, or inflammation. Witch-hazel in hot water douches or a weak solution of hot salt water is a wonderful tonic in some cases.

EXERCISE FOR REPLACING UTERUS TO BE TAKEN JUST BEFORE RETIRING:—Kneel on the bed; bend forward until the chest is touching the bed and the hips are elevated as high as possible. The inlet of the vagina should then be opened so as to admit air. As soon as the air enters the womb falls into position. Lie down at once and give nature a chance to regain strength while you sleep.

The tampon soaked in glycerine and alum, and the douches of hot water, in which a little alum is dissolved, are both of great service in controlling the flooding which so frequently accompanies change of life and miscarriages. (Exercises for anteversion and retroversion supplied by a successful teacher of such work.)