care, forth with produce an agony of dyspepsia, which so wore upon the already exhausted patient, that the loss could hardly be made good by a pint of acceptable and assimilated nourishment.

In this exigency, koumiss may avail,-a mild, carbonated, alcoholic liquor, which would have been considered previously but for its proper allusion in this place. The same patient who cannot take a tablespoonful of milk, has been brought, after brief experience, to receive a quart bottle of koumiss in the twenty-four hours, with satisfaction and comfort, and to thrive upon it. It may be said without hesitation that it has been known to solve the problem at its most critical point, and, seemingly, to save a life. Here, in its best operation, it is all that champagne or carbonated brandy is, and it is more. "Nothing succeeds like success," where koumiss is successful. Unfortunately, it is not always acceptable and it is not always available. However it might have proved with the stomach, with some patients the taste is offended from the first and they cannot learn to take it kindly. An offended palate is a hopeless obstacle with any food in persistent vomiting. Again, notwithstanding the claims of manufacturers, koumiss is a difficult material for the physician to obtain whose practice is located away from the cities, and a difficult material for any physician to direct in hot weather. At the best, it is liable to prove variable in quality and taste, especially in the summer months; and this is a great inconvenience, to say the least, in its present application. In short, it is an essential article of the

armamentarium, but, as respects the special case, is now indispensable, and, again, wholly without value.*

* Suggestions respecting the treatment of vomiting due to certain especial states may be found in the chapter on Ipecac.

A word concerning rectal feeding, to which allusion has been made once or twice, and which may prove a material, if not an essential, aid in support of the subject of continued stomachal incontinence. Dilute alcoholic liquors are doubtless absorbed from the rectum and lower bowel and appropriated ; in respect of food undigested and unaccompanied with a digestive ferment, we cannot be so sure. There is reason to believe that the more nutrient part of a milk punch or an egg-nog, given as enema, can perform no service at all; and the same applies to animal broths and teas, On the other hand, without quoting authorities and reports, there is both physiological and clinical evidence of the substantial value of digested fluids, such as peptonized milk, of the "beef peptonoids," etc., and these are always available.