Cases of the second group also often require moral suasion, but in a somewhat different spirit, to induce the ingestion of sufficient nourishment. The services of an efficient diet nurse in preparing dishes that appeal both to the eye and the palate, are especially valuable. Even without manifestations of hysteria, persons recently bereaved or subjected to worry and fatigue, or leading a monotonous life, and eating alone or in small families, often lose appetite. A change of scene or even the advent of a guest or a change of methods of cooking, may suffice to restore nutrition.

Toxaemic conditions, however manifested, do not warrant the diagnosis of hysteria any more than disturbances of mentality due to atropine, alcohol and other drugs. In some cases, the socalled hysteria is amost purely intestinal, due to fermenting and putrefying food. In others there is hepatic sclerosis, chronic Wright's disease etc. Especially in women, pelvic reflexes or more or less obscure thyroid disturbances are common at the menopause. The appropriate diet is discussed under these and analogous headings.

Neurasthenia borders on hysteria of the second type. While there may be no indication for special dietetic precautions and while boulimia may be observed, there is usually loss of appetite and the patient requires rest and change of scene, and diet.

The S. Weir Mitchell rest and diet cure is indicated in severe cases. The patient is isolated from family and friends and put to bed in a quiet room under the care of a nurse. In addition to baths and massage, the diet is restricted. At first, milk alone is given every two hours, day and night, unless the nocturnal feeding interrupts the sleep too much, when two four-hour intervals are allowed. If the patient manifests an antipathy to milk, only a tablespoonful is given at a time at first, otherwise it is increased as rapidly as possible up to 300 c.c. at each feeding. (Note. The author, for reasons stated elsewhere, would never feed so frequently nor give so much as 3600 c.c. of milk in the 24 hours.)

If necessary, the milk may be flavored with coffee or cocoa, caramel etc., and lime water, Vichy, barley or rice water, may be added if pure milk causes eructations or epigastric oppression.

The milk diet causes drowsiness, favors rest and not only produces a minimum of toxins but by diuresis, favors elimination of those in the system, with the assistance of massage.

After five or six days, a chop or poached egg may be given in the middle of the day; the next day, bread and butter or bread and milk is added for supper; on the third day egg, meat or bread stuff is added for breakfast. The milk is correspondingly reduced until, within a week, the patient is taking 2 quarts of milk and a light solid diet daily.

It should be carefully considered in any case, whether the patient will be more benefited by a month or two of this vegetative existence or by rest and recreation in the open air - not at a fashionable resort - with an abundance of plain food. But the need of the absolute rest cure must be recognized in certain cases.

Heat stroke requires no feeding for a day or two and, owing to the exhaustion of nervous energy, neither hot nor cold drinks should be allowed. Hot or cold saline solution, according to the indication, may be given by the bowel.

Delirium Tremens, while ultimately due to alcoholism is not alcoholic intoxication but a toxaemia due to various metabolic substances whose nature is not well known and which are probably not the same in all cases. Probably certain cases are essentially uraemic, others cholaemic, others due to intestinal putrefaction and others due to more recondite intoxication. So far is delirium tremens from l>eing an alcoholic intoxication that it may be prevented, when imminent, by continuance of alcohol and its treatment is considered by most authorities to demand a moderate use.

The possibility of delirium tremens should be borne in mind in surgical accidents, typhoid fever, pneumonia and other diseases, occurring in chronic alcoholics, and too sudden interruption of the alcoholic habit should be avoided, although it should always be indulged in moderation.

Water, fruit juices, saline enemata etc., are usually indicated to aid purgation and diuresis and hot catnip and other teas may be employed as sudorifics.

The diet should be as liberal and as unirritating as possible and predigestion or artificial digestants should be employed if necessary. On the whole, the best diet is one of milk, eggs, eggnog, peptonized milk, expressed beef juice, junket, wine whey, brandy and egg etc., with moderate use of cereals. While care should be taken not to overload the system with products of protein and purin metabolism or intestinal putrefaction, meat and even tea and coffee are often indicated for their stimulating effect.