Treatment.-A physician must be summoned at once. Meanwhile the patient must keep absolutely quiet in bed, and must not even talk. Small bits of ice may be swallowed and ten drops of laudanum1 given in a little ice water. It is advisable to apply ice over the stomach in an ice bag or sponge bag. No food must be given by the month for days. The bowels should be emptied by an injection of warm soapsuds once a day, and a glass of warm milk containing the whites of two eggs and a little salt should be injected twice a day slowly into the bowel (after removing the tip of the syringe a towel should be held tightly over the entrance of the bowel to prevent the escape of the liquid). For three or four days after the bleeding has ceased, a half cupful of warm milk or strained gruel made from barley, rice, or oatmeal may be taken every hour. During the second week a cupful of milk may be taken every two hours, and raw egg beaten in milk once daily; in the third week, gruels, egg, and toast every three hours.

Vomiting of blood is a symptom of various conditions. Acute or toxic gastritis may cause it. Coming on, in young women, with pain after eating, and of a bright-red color, it is usually a sign of ulcer of the stomach, which is a curable disorder in most cases, under a physician's treatment. Cancer of the stomach is a frequent cause. Blows, kicks, and injuries to the belly-wall over the stomach may cause vomiting of blood. Swallowing blood from a nose-bleed,

1 Caution. Dangerous.

especially if it occurs at night, or from any source of bleeding in the mouth or nose, as from extraction of tooth, may lead to the symptom, and requires no treatment. Occasionally it is seen in persons without any apparent cause and in whom it never recurs. Disease of the heart, liver, and spleen, scurvy, yellow fever, smallpox, measles, severe anæmias, influenza, dengue or breakbone fever, and purpura sometimes produce this symptom. In women it rarely appears in place of the normal menstruation. Patients very rarely die while vomiting blood or directly from it.

INTESTINAL INDIGESTION.-In this form of indigestion, the food after leaving the stomach, in two or three hours after the last meal, does not properly digest in the bowels, but begins to ferment and form gas which distends the intestines and causes distress by pressing on the nerves of neighboring parts. This condition varies from a slight amount of fullness and discomfort to intense pain in the pit of the stomach, or elsewhere in the belly, and is only relieved by belching up wind from the stomach or passing it from the bowels. Palpitation and pain about the heart are also common symptoms, from pressure of the distended stomach which interferes with the action of this organ. Poisons, produced by the fermented food in the intestines, are absorbed into the blood; these are called ptomaines, and irritate the nervous system so that headache, backache, and neuralgic pains result. The skin. is not clear and ruddy, but dull and muddy in color;

eruptions are not uncommon; the whites of the eyes and inner surface of the eyelids are apt to present a yellowish appearance, and the tongue is soft and flabby, has often a brownish coating, and is marked on the edges by imprints of the teeth. Constipation is rather the rule, although diarrhea with slime or mucus is not uncommon; these conditions often alternate. The poisons, generated by the decomposing food in the bowels, escape from the system in the urine, and in so doing irritate the urinary organs. Frequent and painful passage of urine often occurs. In their effect upon the nervous system these same poisons cause insomnia or sleepiness, depression of spirits, and the symptoms seen in nervous prostration (see p. 285).

It is believed by the medical profession that chronic intestinal indigestion, with constant absorption of poisons from the putrefactive contents of the bowels, leads to such irritation of the heart, kidneys, and other organs that chronic diseases are the inevitable result. Many "chronic invalids" or hypochondriacs are such by reason of this affection.

Intestinal indigestion is to be distinguished from stomach indigestion by the fact that although pain may occur in the region of the stomach, it does not come on till some time after eating, and there are no stomach symptoms, as nausea or vomiting. The general distention of the belly, and passage of gas from the bowels, and slight yellowness of the eyes are also characteristic of intestinal indigestion.

Treatment. This depends chiefly on limiting the amount and variety of food. Rest, fresh air, warm clothing, moderate exercise, freedom from care are the first requisites. For a few days, or during the first week of treatment, the diet may be restricted to warm milk containing a third part of barley gruel, limewater, a glass every two hours, and sometimes koumiss or buttermilk. When milk is not agreeable to the patient, broths, gruels, and eggs may be substituted; starches must be avoided. After this preliminary treatment, and when the symptoms have begun to subside, the following diet should be followed indefinitely, not using any vegetables at first: eggs, poached, scrambled, or soft boiled; rare beef, lamb, mutton, roasted or broiled, poultry, veal occasionally, but no corned beef, ham, or pork in any form, except crisp bacon; fish of all kinds, except salt fish, oysters, clams, but avoiding lobsters and crabs; white bread, rye or Graham bread a day old and toasted, with a liberal supply of butter should be freely taken; plenty of water, especially between meals, to the amount of six to eight glasses daily; weak, black coffee, without sugar or cream, once a day; green vegetables, as lettuce (without mayonnaise dressing), green peas, string beans, asparagus, only one at a meal. Avoid all the following: potatoes, onions, cabbage, baked beans, cauliflower, carrots, turnips, parsnips, beets, celery, corn, radishes, egg plant, oyster plant, tomatoes, all fruits, cereals, candies and sweets of all kinds, pies and pastries, nuts, rich gravies, and thick

soups. The simple puddings, ice cream, and cooked fruits, as baked apple, stewed peaches and pears, but no berries, may be allowed.

An occasional dose of calomel is useful, particularly when there is any yellowness of the eyes or tongue, three to five grains, followed by a Seidlitz powder in six or eight hours, once or twice a month. An ounce of castor oil (without a Seidlitz powder) may be substituted. The bowels must be kept regular every day by some cathartic, such as aromatic fluid extract of cascara sagrada, fifteen to sixty drops at night. The patient should eat rather sparingly, and be guided by the general advice given under Nervous Dyspepsia. All excesses should be avoided, and tobacco or alcohol used with the greatest moderation.

ACUTE DIARRHEA; ACUTE CATARRH OF THE BOWELS (Acute Catarrhal Enteritis)—Treatment. Children and persons with severe attacks should remain in bed. No solid food should be taken. A cathartic is advisable at the beginning of the attack: three grains of calomel, a tablespoonful of castor oil or a Seidlitz powder. If, however, the diarrhea has existed severely for several days before beginning treatment, the cathartic may be omitted. Milk gruel, made by boiling flour in milk, boiled rice, or milk toast constitutes the best diet for diarrhea. If nausea or vomiting are present a teaspoonful of cracked ice with a few drops of brandy may be swallowed at frequent intervals. Water is permissible in all cases, but in