are doubtless sometimes affected, and then the pain closely simulates neuralgia from malaria or other causes.

The treatment of chronic rheumatism, as it attacks elderly people, may be most effectually directed to the locality of the pain. Stimulating and sedative embrocations and fomentations are of much value. Many internal remedies are reported to be useful, and justly so; but they are not discriminated with sufficient accuracy, any more than the distinction between rheumatic and other pains. The general remarks I have ventured to make on pain as inimical to life, and its tendency to abridge its duration, are as much applicable to rheumatic as to any form of pain, from any cause or of any other nature.

LUMBAGO.

This disease consists of a condition of the muscles of the loins in which any motion is attended with acute pain. It occurs far more frequently in adults while in the full vigour of life than later. It is in many medical works

confounded with rheumatism, but it differs essentially and by very well marked symptoms.

The attack of lumbago is most frequently, especially a first attack, sudden ; an unusual movement, stooping to lift a weight, a fall, a blow, or the like, is followed at once by severe pain in the lumbar region, with inability to move, to walk, to turn in bed, to rise from a sitting posture, to stand in an upright position, without aggravating the suffering. It may go off as suddenly, or continue a few days, or even weeks. It is not attended with fever or disturbance of the natural functions; it does not even prevent sound and refreshing sleep; but, on waking, the patient is scarcely able to turn in his bed.

Narcotics are, therefore, not called for. To the ordinary treatment,-mustard and linseed poultices, or hot fomentations to the loins, with a mild aperient,-I can add one item of great

use:

Let the patient resolutely leave his bed, place himself back to an upright wall, and lift himself gradually erect, and then walk about. The process is a painful one, but possible, although the sufferer

is often difficult to persuade, yet when accomplished it is efficient.

LIMIT TO THE USE OF NARCOTICS.

I would repeat, in order to make the opinion more emphatic, that narcotics should be employed for the most part only as temporary expedients to afford relief from suffering; they are at best but palliatives, and they may obscure the real disease which is causing the pain. The relief they afford should never exclude close investigation and immediate resort to the measures and remedies appropriate to the special disorder discovered to be the source of the suffering.

THE STOMACH AND DIGESTION.

It has been remarked by writers on medicine, that elderly people are less frequently subject to indigestion than the young and middle-aged; and when this disorder is met with in the latter, it has a different character. This may probably be partly ascribed to greater care in the selection of food, more moderation in the quantity taken,

better arrangement of the time of meals, and the habit of taking more repose after eating than young persons allow, these circumstances being guided by experience.

The appetite is generally more regular, and the action of the stomach upon the food (the first step in digestion) more perfect. I am inclined to regard these facts as indications of a power in the system (vis medicatrix) to check the tendency to decay, existing in all its parts-the recuperative power, without which every disorder would run on its course to the destruction of life.

Elderly persons should not take one large meal in the day, as they are apt to do, but make at least three lighter repasts. Sleep after dinner may, to some extent, compensate for the error when committed.

Any degree of oppression after eating should be avoided rather by taking a smaller quantity, and the omission of the less nutritious articles of food, -fish, pastry, potatoes, or other vegetables, even bread, and making the meal of the more nutritive, rather than seeking relief from stimulants. If, guided by appetite, flesh meats, etc., only or

mainly are taken, and oppression or other symptoms of lack of power in the stomach occur, instead of soda or other alkalies, relief may be sought by a comparatively new remedy supplied by science, namely, pepsine. Alkalies should never be indulged in without good advice, and after the conditions of the system generally have received attention; nor should pepsine, without first diminishing the amount of food to a fair quantity of animal substances, flesh meats, poultry, game, etc. It should not be used to force through the stomach a large amount of incongruous matter, more than the system needs.

Every part, however, demands sustenance and reparation, and therefore loss of appetite cannot in aged persons be neglected with impunity. Its cause should be sought and remedies applied, as in all cases of disease, without delay.

THE LIVER AND LOWER BOWELS.

These organs perform two functions equally important to the maintenance of health.

Assimila

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