pecially in the severe cases. The Rockbridge and other alum waters, have some reputation as curative, but the effect is at least doubtful.

I believe that in some cases, carefully selected physical exercises, particularly of the abdominal muscles, are most useful. Undoubtedly such exercises rather increase peristalsis, but the circulation is improved and the action of the liver is also improved. More bile is secreted and discharged, and the whole process of digestion is helped. These exercises must be carefully selected by the physician, and cannot be well described here in detail, but those used must exercise strongly the abdominal muscles, increasing intra-abdominal pressure; in fact, fairly squeezing the bowel against the spinal column. An intelligent patient at once realizes what is wanted and helps in the selection of suitable movements.

This is, I believe, a most important therapeutic measure, and if carefully done, and persisted in, may be made very useful.

The avoidance or relief of nerve strain is most essential, for as already suggested, the nervous system affects largely the question of diarrhea and constipation.

The question of diet is most important and most difficult, and it is essentially individual. Theoretically, this or that is good, but the question always is, does it work, does it help the patient?

We must keep well in mind the pathological conditions present, the stage of the disease in which the patient is, whether he is in bed or at work, whether he is running down, or has sufficient digestion to keep his flesh and strength.

No two can be fed alike. If catarrh of the small intestine is present, we must remember that the bile, pancreatic and intestinal secretions are probably diminished in amount, and thinned by the mucous secretion. There is diarrhea, and frequently hyperacidity of the stomach.

If the disease is confined to the large intestine, both

stomach and small bowel may or may not be doing their work very well. There is usually an alternating diarrhea and constipation, for which, certainly, the same diet is not applicable.

If we are dealing with the atrophic form of the disease, and the process is extensive, it will be a very difficult matter to keep up the nutrition of the patient. In most cases, the excessive amount of intestinal gas, is a most uncomfortable symptom, and the diet must be made such as to help in preventing this.

Many patients, I believe, are under-fed, and many more are soon so sickened of their limited diet, that they eat too little. No sooner do you get your patient well established on a diet of rare beef and dry bread, than you find he is a uric acid subject and cannot stand such a strongly nitrogenous diet. If you turn to milk, you soon find his gas increased, and the stools filled with milk curds, which are surely increasing the diarrhea.

I have carefully studied a good many diet lists, and have never yet succeeded in fitting one to a patient. Unsatisfactory then as it may seem, I would like to leave the diet question in this way. Study carefully each patient, his strength, his weight, his blood condition, his stools, and work out the best diet possible for each case, without any reference to theories or what you may have done for another, always making the diet as liberal as possible. If the patient continues to run down in weight and strength, either he is under-fed or he is in a very serious condition.

If constipation is present, the diet question is much easier, for sufficiently laxative foods can easily be added to regulate the action of the bowels.

Many physicians have a diet list, from which they strike out the foods not considered desirable for the patient. This, perhaps, is a good plan, but such rulings are entirely arbitrary, and should always be subject to the experience of the patient. I have seen a good many

seriously reduced by too long a use of a limited diet, one that was scientifically correct, but practically insufficient.

The medical treatment of chronic enteritis is not very satisfactory. With the long list of so-called intestinal antiseptics, you are familiar. In my experience, the best one is Salicylate of Bismuth in five to ten grain doses, several times a day. Naphthaline may be useful. Subnitrate of Bismuth in twenty or thirty grain doses lessens diarrhea. Nitrate of Silver is sometimes helpful. What seems useful in one case, appears useless in the next.

If the catarrh involves the large bowel, irrigations may be used. A large catheter or rectal tube is passed high up in the bowel, and large quantities of water are used, first for cleansing purposes. When this is passed, a solution of tannic acid (one dram to the pint) may be used, to be retained as long as possible, or corresponding solutions of Zinc Sulphate, Boric Acid, or Salicylic Acid. If the disease has reached the point of ulceration, solutions of Nitrate of Silver are most effective, or two or three drams of Bismuth to the pint of water, used as an

enema.

In short, then, the best treatment is hygienic and dietetic, with the careful use of such drugs as may control the diarrhea or constipation, or improve the digestion.

Finally, may I recapitulate the points that seem to me most important?

First, the prevalence of the disease, and the serious effect on the general health.

Second, the important anatomical changes found in the bowel, and the incurability of them.

Third, the importance of attention to all acute attacks, in the hope of avoiding the chronic state-this especially in children.

Fourth, the treatment; hygienic, dietetic and medi

cinal, all based on a careful study of each individual case. The form and stage of the disease present the condition and digestive capacity of the rest of the organs of digestion.

Fifth, the marked effect of the nervous system, in increasing either the diarrhea or constipation. The depression of mind and weakness of body found at least in the severe and long continued cases.

Sixth, the presence of the disease as a complication of other diseases, and the important part it may then play, in the general health and nutrition of the patient.

A VALUABI.E NERVE TONIC OF RECENT ORIGIN;

OR,

THE GLYCERO-PHOSPHATES;

PARTICULARLY,

THE GLYCERO-PHOSPHATE OF SODIUM.

P. W. STREET, M.D.,

SUFFIELD.

In 1894 Dr. Albert Robin presented to the Academy of Medicine of Paris a report upon the results of his em ployment of the glycero-phosphates of Calcium, Potassium, and Sodium, which he had been using in his practice, at that time, for six years. Noted as an observer, his conclusion that these are valuable agents in the treatment of nervous debility from various causes, attracted wide attention. Soon afterward, both in France and America, other physicians of prominence began to util ize the information he at that time imparted, and later, with striking unanimity, they corroborated his results.

An investigation of the subject reveals an absolute lack of information at the usual sources; and the information as yet obtainable is found only in contributions to medical periodicals.

Known to exist, and regarded as likely to possess important therapeutic value, the glycero-phosphates were not put to therapeutic uses for many years because of the inability to produce them upon an industrial scale.

DERIVATION. They are products of the action of glycero-phosphoric acid upon various bases.

Glycero-phosphoric, or glycerino-phosphoric, or phos