hot wine and water in this stage. However, I found that the stage was very transitory, and that hot milk and water was quite as restorative; the patient soon went to sleep, and normal warmth returned.
Hepatic disease is not so frequent in the Punjab as it is found down country, nor by any means so severe. I can not recollect any deaths due to it directly during my stay, or any case of hepatic abscess. Minor congestions and enlargements were a frequent cause of sickness and invaliding. The treatment a few years earlier consisted in blistering, stimulants, and a mercurial course. Some time in 1863 a surgeon in Burmah, whose name I can not now recall, recommended ammonium chloride. This I tried, and thought it acted very favorably. About 1866 an immense change for the better was brought about by the introduction of podophyllin. It was called the vegetable mercury, having quite supplanted that metal, which indeed became on all hands, in all diseases, quite decried. At the time I now refer to (1870) I began to discontinue the use of podophyllin in hepatic disease, finding Epsom salts far more active and rapid in effects. I remember getting the idea from a translation in the Sydenham Society series of some German researches on the effect of certain saline springs, and made for myself an artificial mineral water. This, the equivalent of the present white mixture, eased the pain and reduced the size of the liver, a fact we are now familiar with, but which was then to me a real discovery. After a few days of this treatment the patients were very much the same as convalescents from chest disease. They needed time and rest and suitable food—in short, nursing—and had a chance of regaining health. Hepatic disease is, however, ineradicable. It soon recurs in the great heat of the climate and in men not very abstemious, and few once ailing with it serve long in hot climates.
Thus, in one after the other of these important diseases, experience was altogether against the employment of alcohol. It must be borne in mind that I began with no theory. I gave alcohol in pneumonia and hepatitis, while rigidly withholding it in fever and diarrhœa. I delayed the alcohol, however, in those diseases to a later stage, until the temperature was nearly normal, and at length discontinued it altogether, finding that it retarded the cure and prolonged convalescence. I lost some cases, of course, and, among others, one from delirium tremens—an old soldier, who had frequently suffered before—and it was at first a matter of great pain to me to think that, if I had followed the usual routine of treatment, the cases might have ended differently. My colleagues, I knew, would probably have held so. However, my confidence revived in watching their practice. I
