9.30 or 10.—A cup of peptonised milk and a slice of thin bread and butter.

Food During the Night.-In case of wakefulness there should be within reach, and arranged so as to be readily warmed, peptonised milk. The ordinary Etna or spirit lamp will be convenient for this purpose.

(b.) Slighter Cases.-In slighter cases we may have only the characteristic mawkish breath and the muscular tremors, or other commencing nervous symptoms, indicating the patient's danger and the necessity for reforming his mode of life; and in these milder degrees of the condition, if we succeed in inducing him to leave off every form of alcoholic stimulant, and to take plenty of plain, simple food, rapid restoration to health may be anticipated. We should diet such a patient in the following manner :

Breakfast.-A lightly-boiled egg, or a little bit of white fish or of bacon, or a light savoury omelette; toast, or bread and butter; a cup of weak tea or of coffee and milk.

Early Dinner, I o'clock.-A slice of roast mutton, or the wing of a chicken, or a plain cutlet, with a spoonful of mashed potato and some well-boiled green vegetable. A few spoonfuls of any plain milk or bread pudding, with occasionally some stewed fruit. Beverage-A glass of plain or aërated water, to be taken slowly towards the close of the meal.

Afternoon.--A cup of tea with milk may be allowed, with toast or rusk.

Supper, 7.30.-A light meal of fresh fish, or of bird, or of calf's head, or of tripe, with dry-boiled rice or bread. Beverage-Small glass of milk and soda-water.

ACUTE ALCOHOLISM (Delirium Tremens).

Anorexia is always a prominent symptom in cases of acute alcoholism, especially at the beginning of the attack. If the subject of acute alcoholism has been a chronic drinker, and

the pathological changes briefly enumerated under the head of Chronic Alcoholism have been established, his powers of digestion are so enfeebled that alimentation becomes a matter of extreme difficulty. The condition may, however, arise occasionally in more healthy subjects who have not been habitual drinkers, and whose constitutions, therefore, are not so far gone as in the case of those who are saturated with alcohol. In both classes the question of alimentation is of vital importance, but in the latter it will probably be managed far more easily and successfully than in the former. In the latter, moreover, there is no fear of evil results following upon the omission of alcohol in every form from the dietary. As soon as the patient can be induced to take a good supply of nourishing food, the depths of his depression have probably been reached, and there is every hope of his soon obtaining refreshing sleep. In beginning the treatment, small quantities of food must be given at intervals of two hours, or oftener, if the quantity taken at a time be very small and the patient extremely restless.

Dietary,-A cupful of good soup, mutton-broth, or chickentea, thickened, should alternate every two hours with a cupful of milk, plain or peptonised.

An egg beaten up in weak tea with milk may take the place of one or two of the supplies of plain milk, say in the morning and evening.

As natural sleep returns, and the patient's general condition improves, the stomach will become able to deal with larger supplies; therefore increase the amount by one-half, and add to each supply some farinaceous material. Increase also the interval to three hours, not awaking the patient to take food, but getting in the supplies between his sleeps. As convalescence becomes established the following diet will be well borne :

Early Breakfast in Bed.-A cup of tea or of milk with an egg beaten up in it, a slice of toast or butter; on alternate days a cup of cocoa with bread and butter.

In the Middle of the Forenoon.-A cup of good meat soup (Recipes 1-10, and 40), with toast, or a cup of warm milk and a biscuit.

Early Dinner, 1.30.-A small basin of plain purée of meat, with bread, or a panada of chicken with a little mashed potato, followed by a simple milk-pudding (Recipes 57-64). Beverage- A small glass of home-made lemonade or of milk and soda-water.

For Afternoon Tea.-A cup of cocoa or of tea, with plenty of milk, with a slice of bread and butter or a plain sponge-cake. Supper, 7.30.-Fish or sweetbread or tripe, or a few oysters with brown bread and butter. Beverage-A glass of milk and soda-water.

In the later stages of convalescence the same diet as directed for the slighter forms of chronic alcoholism will be found suitable (p. 120).

Exclusion of Alcohol from the Dietary,―The advisability of excluding every form of alcohol from the dietary of patients suffering from delirium tremens is by some called in question, but it may safely be asserted that in the great majority of uncomplicated cases no harm follows the practice of cutting off alcoholic stimulants altogether. Where, however, there is great feebleness of constitution, especially in old people, or where some complication such as pneumonia sets in, the case is altered, and it may then be absolutely necessary to give some form of alcohol to prevent the patient from sinking. Spirits should even then be avoided, and if the patient can take it, some form of malt liquor given with food. In cases, too, where prolonged sleeplessness has become a source of anxiety to the medical attendant, it may be found necessary to give stout or other malt liquor if sedatives by themselves have failed to produce sleep.

Nutrient Enemata.-In all cases where sufficient nourishment cannot be taken by the mouth, or where the patients fight against their food, nutrient enemata should be freely given.

CHAPTER XV.

NERVOUS DISORDERS.

GENERAL CONTENTS: Hysteria-Weir-Mitchell Treatment.

HYSTERIA,

THE question of diet is one that should bulk very largely in the treatment of all hysterical patients. The food question is a constantly-recurring difficulty, and one that in some form or other meets the physician at every turn. Careful inquiry will usually prove that a sufficiency of food is not being taken, or that the diet is sadly deficient in some important particulars. Some hysterical patients like to pose as interesting invalids, who can eat next to nothing; others have so many likes and dislikes-the dislikes greatly preponderating -that the least digestible, least nourishing, and altogether most unsuitable articles of diet are the only things taken. In both classes a state of semi-starvation is kept up. The nervous system, already disordered, and requiring to be well. nourished, is alternately excited and depressed by the unwholesome supplies of food and drink; morbid ideas increase, and a vicious circle is established by these factors acting and re-acting on each other. The result is indigestion more or less constantly present.

Gradual Increase of Food.-It is useless in such circumstances to attempt to remedy this condition of affairs by putting the patient suddenly on to a full diet. We must. begin by interdicting the improper foods. All stimulants

must, save in exceptional cases, be absolutely forbidden; also strong tea and coffee. A dietary consisting largely of meat, to the exclusion of farinaceous substances, green vegetables, and fruit, is often indulged in by such patients, although it is not well adapted to their actual wants. What they do require is food in such forms as will readily supply nourishment to their disordered nervous systems-not an unlimited supply of nitrogenous material, for that would further tax their already weakened digestive organs. Eggs, fish, fat meats, butter, cream, milk, puddings made with milk, fresh vegetables, and cooked fruit should enter largely into the dietary we prescribe.

Small Meals. Large quantities of food at a time are not well borne; hence four or five small meals will be the order of the day.

Breakfast.—A saucerful of porridge (well-boiled oatmeal, wheat-meal, or hominy) with cream, followed by a frizzle of fat bacon or an egg, and a slice of bread and butter, will form an excellent breakfast. In the middle of the forenoon a cup of milk with a biscuit.

Luncheon, at 1.30 or 2 o'clock.-A plain meal-two courses-fish or meat, and pudding; thus, a slice from the joint, a spoonful of mashed potato, and some well-boiled green vegetable. A milk-pudding or plain shape, with stewed fruit.

Beverage. Half a tumblerful of cold water. In the afternoon a cup of weak tea, with milk, or a cup of cocoa, and a slice of toast or of bread and butter.

Supper, at 7 or 7.30.-A light supper, consisting of egg or fresh white fish, chicken, sweetbread, or the like, with bread and butter, and half a glass of water. Before going to bed a teacupful of milk (with the chill taken off), and a biscuit or slice of bread and butter.

If the patient wakes early in the morning, she should have within reach some milk, easily warmed by means of an Etna or other form of spirit-lamp, and in any case some