The hypodermic injection of .1--1 gr. Pilocarpine will act with equal rapidity, and it can he administered when the patient refuses, or even when he is unable, to swallow the bulky, unpleasant solution. Cocaine, Kola Nut, Caffeine, and very strong Coffee, produce somewhat similar results, but much more slowly and less satisfactorily.
Acute gastritis following a debauch. and leading to serious vomiting, is best met by a large blister over the stomach, and by the administration of small quantities of ice by the mouth, and Morphia hypodermically, or by the following mixture: R . Bismuthi Garb. 5iij.
Acid. Hydrocyan. Dil. min. xlv. ituci Reccntis Liquor. llorphince Hyd.
Aqucc Chloroformi ad 3iv. Misce.
Fiat »iistura. Cafiiat cochleare »lire. onini Nora, p.p.a.
Lavage may be resorted to if there be no collapse or severe pain, the stomach being washed out with 4o oz. water in which 5-to mins. of Creosote have been dissolved. In the chronic vomiting, Creosote cap sules, gr. of Morphia in minute pill, or r min. doses of Fowler's Solution, or io grs. Bismuth and 5 grs. Heavy Magnesia, may he given. The writer has often seen vomiting stop after ro-r5 min. doses of Tincture of Capsicum, which had been given to allay. the craving. By far the best food at this stage is good acid buttermilk neutralised with kali water, and this combination may stop vomiting which has resisted all treatment; moreover, it is the best agent for the relief of the intense thirst. (The fluid known in Ireland as buttermilk differs widely from the compound known by the same name in most parts of England, where only the cream and not the entire bulk of the cow's milk is churned.) The chronic dyspepsia of drunkards is a troublesome affection, in which drugs are of little value. The great difficulty experienced by the physician is to select some form of liquid nourishment which can be taken copiously by the patient at short intervals, which will be easily digested and accept able to the vitiated palate. There is nothing better than the buttermilk just mentioned, which may be given in unlimited amount. It may be administered every 13 or 3o minutes, either alone or mixed in equal quantity with fresh milk or kali water. The formula mentioned upon p. 19 for preparing artificial koumiss will make a palatable and nutritious liquid. The writer has been informed by a medical man who had success fully overcome the alcohol habit in his own person, and has had consider able experience in treating others, that he found great assistance from the variety of the " flop Bitters " which contains no alcohol. Carefully
prepared beef tea and chicken soup, either of which can be thickened with barley water, and fortified with Liebig's Extract of Meat, or ordinary clear or thick soup of any kind that the patient may fancy, can be freely given. If there be great weakness or prostration, and the stomach to accept any nourishment, except in very small quantity, Bovril, Valentine's Meat Juice in drachm closes every half-hour, or Brand's Beef Jelly, with ice every hour, affords the best chance of tiding over the difficulty.
Associated with gastric symptoms is the intense craving for alcohol in some form. This should be stoutly withheld. The physician generally sees the patient after he has been indulging freely for a considerable period, and alarm has been excited by the depression produced by con tinuous vomiting or by the dread of delirium tremens. The serious diffi culty which at once confronts the attendant is the responsibility of cutting off the stimulant. There is a deeply rooted prejudice against this line of action, held both by the unfortunate victim and his friends, and, if such a step be taken, any mishap occurring is sure to be attributed to this point in the treatment.
In the vast majority of cases this is the correct course to pursue. The experience of gaol surgeons proves how constantly immediate im provement sets in, and how exceedingly rarely does any mischief follow the abrupt withdrawal of stinntlants, even in the brokendown patients committed to prison for some aci perpetrated during their prolonged debauch.
This prejudice has, to a large extent, arisen from the aversion to alcohol often noticed in patients just before symptoms of delirium tremens set in at the end of a drinking bout. The supervention of the delirium is attributed to the cessation of stimulation, whilst, in reality, it is but a symptom of the disease. The prejudice is also traceable to the memory of the horror and depression caused by the cutting off of the stimulant in former attacks, and the patient is generally loud in his protestations that death will follow the sudden withdrawal of his liquor.