that there are not a few cases of dyspepsia and lithæmia, of certain types of rheumatism and gastro-intestinal catarrh, in which the use of considerable quantities of hot water, combined with simple restricted diet and healthful regimen, constitutes the very best treatment. This is the foundation of the use of many of the most valuable mineral waters which are very dilute solutions of comparatively inert salts, and for many who resort to such spas for treatment there is no question that it would be better if the medicated water were to be substituted by a chemically inert water of equal temperature. I cannot of course discuss here the question of the limitations of this system. Carried to the extent recommended by its advocates, it is by no means an indifferent practice, but one capable of doing quite as much harm in unsuitable as it is of doing good in suitable cases. In its present form it does not possess even the merit of originality. Sangrado bled his patients furiously and then filled their depleted veins by copious draughts of warm water. In Pryor's life of Burke we read, “at a late period of life when excited by mental exercise or an attack of indigestion arising from close application he was accustomed to take large quantities of hot water as hot as could be drunk. "Warm water,' said he 'sickens, but hot water stimulates.""

While however the hot water method can be used with advantage in a limited number of selected cases, but is liable to be abused and to cause serious harm in many others, I have no doubt that the recent craze has done good by calling attention to the fact that our customary beverages, tea and coffee, are taken far too strong. I am almost tempted to say that, taking men and women together into consideration, as much harm is done to health by the excessive use of strong tea and coffee as by alcoholic excess. My case books show so many and such extreme degrees of insomnia, of vertigo, and of various forms of digestive trouble due to this cause, that I have felt that it must be unnecessary to quote any in illustration. But to many a hard

worker who feels himself on the brink of nervous strain, the abandonment of strong tea and coffee, and the habitual use with each meal of a cup of very hot water barely tinged with congo, the fa

nervous.

miliar English breakfast tea, with a small piece of sugar but without milk or cream, will serve an excellent purpose and enable him to enjoy a cup which cheers but neither inebriates nor makes I have glanced at these various extreme methods of diet and regimen, partly to show the self-evident fact that none of them is of general value or applicable to all patients, but also because they exhibit the enormous power of systematic dietetics and suggest the largest possibilities for the future. We are rapidly advancing towards the time when for each carefully diagnosed group of cases there will be a series of scientifically adapted diets, based upon familiar knowledge of the composition of food and critical analysis of the excretions of the patients, conjoined with close study of their variations in weight and in functional activity. It will then be found that very many cases of disease are curable by regimen alone, and that in all cases of disease our remedies can act with full effect only when they are applied to a system under the influence of such scientific regimen. More than this, it is not Utopian to hope that a wider diffusion of hygienic knowledge will then have prepared the intelligent classes for the appreciation and practice of preventive medicine, the reign of which will be the glory of the scientific physician and the golden age of the world.

If time allowed, I would gladly enter more fully into other illustrations of the relative deficiency of functions or of organs, but I must limit myself to a few desultory remarks. It must be a very familiar thing to most of you to meet with patients suffering with some pronounced functional disorder, which obstinately resists ordinary treatment, and yields only when we have recognized that the patient is living on a wholly wrong scale and that we are striving to force a defective part to work up to the standard of more vigorous ones. A good many years ago the late Samuel Jackson, Professor of Physiology in the University of Pennsylvania, and the most philosophic and suggestive of physicians, and then over 80 years old, in speaking to me of his past life and habits of work, said, "I got on very well up to a certain age, about 40 years, when I began to find everything tired me, and it seemed as if I could no longer get through with anything

and I was in despair at my apparent failure. Turning my thoughts in on myself, it was not long before I found the trouble. I was a five minute horse trying to travel in 3.20. I changed my pace, and have since rarely failed to cover a good day's journey." We see this want of correspondence in many ways. I have met with instructive instances of obstinate dyspnoea without discernable organic disease, and after many theories had been erected, and many modes of treatment based thereon tried without avail, it was recognized that disuse and weakness of the diaphragm or of some other part of the respiratory muscles lay at the root of the trouble and that pulmonary gymnastics, which enabled the patient to secure his full allowance of oxygen, the most essential of all articles of diet, soon brought up his respiratory powers to the level of his system's needs, and removed the distressing symptom. In the same direction, who is not familiar with such cases as this: Mrs. C., aged 65, of active habits, within the past few years had begun to suffer with dyspnoea, greatly increased by exertion and also increased almost to the extent of asthmatic distress by slight bronchitic spells to which she became increasingly liable. The heart's action grew frequent and weak, and in the absence of any other demonstrable organic disease, a diagnosis of fatty degeneration of the heart was naturally made. She came of a gouty family, and had the arcus senilis and some rigidity of radials. When I saw her in October, 1882, she was confined to her room, and for three months had been unable to go up stairs. Her nights were terrible and were spent sitting up and gasping for breath, and obtaining only partial relief from repeated doses of Hoffman's anodyne. The fact that she had been gradually but steadily gaining weight had not attracted attention. Her height was not over five feet, and at the age of 40 she had weighed 140 lbs., but her weight in October, 1882, was 165. She did not properly assimilate her food, as there were daily two or three movements of the bowels, often loose in character. She was placed on a rigid diet, calculated to reduce her weight. She took for breakfast a cup of weak cocoa, one egg and very little bread. For dinner, a small piece of lean meat and one green vegetable. For supper, a glass of buttermilk or lemonade, with a piece of dry bread. Nitrate of

silver and opium in small doses helped to keep the bowels in check, and later she used with advantage small doses of jaborandi in combination with digitalis or nux vomica. As her weight was reduced under this diet she gradually improved until in nine months she weighed 140 lbs., was able to walk a mile, to sleep quietly all night, and was indeed perfectly well, and had no occasion for any drugs.

I could match this interesting case with a large number of similar ones illustrative of pulmonary or cardiac deficiency in which grave and threatening symptoms, dyspnoea, asthma, obstinate bronchial cough, bronchorroa and bronchial hemorrhage, œdema and intermittent albuminuria, could be recognized as dependent upon some disproportion between the pulmonary or cardiac power, and the mass of the body, the amount of ingesta or the degree of muscular exertion maintained; and which were more or less speedily relieved by an appreciation of this and by an adjustment of the physiological balance..

I have alluded to transient albuminuria noticed in some of these cases of pulmonary or cardiac deficiency, but there is another class of cases which I fancy must be comparatively rare, in which albuminuria may appear apparently as the result of renal deficiency. One of the most interesting of these cases is now under my observation: C. H. C., age 24, was seen in consultation with Dr. W. W. Keen. For about two years he has had a weary painful feeling in the legs from the knees down, especially in the calves; this is increased by muscular exertion, and came on first after excessive exercise in Switzerland. As a boy he had scarlatina quite severely, but it was not followed by dropsy, nor in the interval has there been any reason to suspect any renal trouble. For more than a year albumen has been occasionally detected in his urine. It has never been found in his morning urine, nor if he remains in bed will it be detected at any time. On one occasion he was kept in bed for several weeks, and almost every passage of urine was examined without a trace of albumen being detected at any time. If, however, a small amount of exercise is used, a distinct trace of albumen will speedily appear and gradually disappear after resting. The specific gravity and

amount of urine have been normal throughout and tube casts have never been detected, though scores of critical examinations have been made. The daily amount of urea averaged 45 grammes. Incidentally I may add that massage did not produce albuminuria. Under prolonged tonic treatment with cod liver oil, carefully regulated diet and habits of life, there has been a gradual increase in the power of exercising without the appearance of albumen.

During the last two years I have had two other similar cases under observation. The explanation does not seem very apparent, but these cases seem to illustrate the condition of an organ which without being actually 'diseased, either had originally or has acquired such weakness, as will under the pressure of slightly increased functional activity, induce symptoms of disease. Much more frequent than these cases of transient albuminuria from renal deficiency, are the familiar ones to which I have already alluded in connection with lithæmia, where the urine is scanty and loaded with excess of urates or uric acid. In the production of this very common condition the kidneys frequently unite with the liver in forming the weak links in the assimilative chain.

Among equally unusual symptoms of this kind must be ranked. the intermittent glycosuria, which patients may present without ever becoming true diabetes, and which I have met with in patients who also presented in marked degree the more familiar symptoms of lithæmia.

In yet other cases of this type we meet with unusual nervous symptoms, such as were present in the case of M. S., aged 19. Never very robust, she had quite a severe fall when 12 years old. Menstruation was irregular from its first appearance, and for several years. She has been very nervous, presenting alternately spells of melancholy and of hysterical excitement, the latter occur ring of late several times a day. She was a stout, plethoric girl, with rosy cheeks, of moderate height, and weighing 154 pounds. Her appetite was somewhat variable, but her diet was liberal and unrestricted. She had undergone much treatment, uterine and internal. January 26th, 1884, she was placed upon a rigidly