A proper regulation of the diet is indispensable to the obtaining of satisfactory results from the use of tonic medicines. Experience has established the fact, beyond controversy, that a mixture of vegetable and animal food is best suited for man. There can be as little doubt, on the score of experience, that animal food is more supporting to the system, and more stimulating than vegetable. Indeed, the effects of a relative increase of the former in the diet are not dissimilar to those produced by tonic medicines; proceeding at first from a direct excitant impression on the stomach, and subsequently from an augmented richness of the blood. A long-continued excess of animal food leads also, like an abuse of tonics, either to plethora with its dangers, or to a complication of diminished excitability with local inflammation. We may, therefore, rank the use of animal food, beyond the ordinary proportion, among tonic influences; and, when an indication exists for these medicines, there is generally a coincident indication for the kind of diet referred to.

As the main object of tonics is usually not merely to stimulate the functions, but to obviate debility by sustaining, through the process of nutrition, a due state of the organization, it is obvious that, in order to produce this effect, there must be nutrient material for them to operate with. It does not, however, necessarily follow, that the quantity or richness of the food taken should be increased; for the patient may have been in the habit of taking more than his digestive powers could manage; and the end desired is attained by a more thorough assimilation, and less waste of the nutriment, through the greater energy given to digestion by the medicine. In judging, therefore, as to the propriety of increasing the amount of food, the practitioner must take previous habits into consideration; and, if the diet should be found to have been in excess, in reference to the digestive and assimilative powers, there would be no propriety in augmenting it, at least until the balance should be restored.

The kind of food previously used must also be allowed to modify the prescription. If the diet had been exclusively vegetable, it is obvious that a relatively smaller quantity of animal food should be directed; if exclusively animal, it would be necessary, in order to obtain the same end, to employ it more freely.

Reference must also be had to the habits of the patient in relation to exercise. Food is consumed by bodily exertion, and the greater the latter is, the more will be required of the former. To produce a tonic effect, therefore, a greater elevation of the diet would be necessary in a person of active, than in one of sedentary habits.

The quality of the animal food employed is scarcely less important than its quantity. Some kinds are more stimulant, some more nutritious, and some more digestible than others. The most stimulating may produce an excitant effect greater than desired; but food can scarcely be too nutritious, or too easily digested for tonic purposes. A few words, therefore, on the more common articles of animal food, in reference to these points, may not be out of place here.

One of the lowest varieties of animal food in stimulant and nutritive properties, taking bulk into consideration, is milk;* but it is easy of of meat, are more stimulant and less nutritious than solid flesh, and, though they may be employed, should never be relied on. Meat extracts contain the soluble parts of meat, obtained first in a liquid form, and then evaporated to a solid consistence. They are in fact concentrated soups, and when used are brought into the liquid form by treating them with boiling water.* The essences arc too stimulating for a mere tonic course.† Whatever food is taken should be thoroughly masticated. Fresh vegetable food of easy digestion should not be excluded; for, though destitute of tonic properties, it imparts qualities to the blood which are indispensable, and without which there would be constant danger of producing a scorbutic character of that fluid. Potatoes, from their highly nutrient and antiscorbutic properties, are very useful in a tonic regimen.

Milk Cure

* Milk Cure. Milk has been recently raised, in Russia, almost to the dignity of a panacea. Dr. Philip Karell, "Physician to his Majesty the Emperor of Russia." in a communication to the Medical Society of St. Petersburg, after giving a history of the therapeutical uses of milk by his predecessors in various parts of Europe, some of whom had most extraordinary success, proceeds to offer his own mode of treatment, in the remedial efficiency of which he seems to have unbounded confidence. He generally commences the treatment by directing the exclusive use of milk for nourishment, permitting no other food. He prescribes for the patient, three or four times a day, at regular intervals, from two to six ounces of skimmed milk of the best quality. The whole of each dose should not be swallowed at once; but it should be taken slowly, and in small quantities, so as to be well mixed with the saliva. If the patient digest the milk well, which may be inferred if the stools, before liquid, become solid, the dose is to be gradually increased. For the first week the patient has great difficulty in resisting his craving; but this is removed in the second week, during which two quarts are given daily. If the cure take its regular course, the milk must now be drank four times a day; at eight a.m., at noon, at four p.m., and at eight p.m. If the patient wish other hours, he may be allowed to change; but the same interval must always be enjoined; and on no account should he be left to his own discretion either as to the time or quantity. When the bowels become constipated, as often happens, this may be obviated by injections of warm water, or by the use of castor oil or rhubarb. Should the cos-tiveness be obstinate, a little coffee may be given every morning with the milk, or towards four o'clock stewed preserves or a roasted apple. If, at the end of the second or third week, there is a craving for solid food, a little stale bread with salt, or a small salt herring, may be allowed; and a little stale bread at the dinner-hour. Once a day, the patient is permitted to take some soup made of milk and oatmeal. After five or six weeks, the milk may be given only thrice daily, and once a chop or steak. Dr. Karell has found raw meat to digest the most easily. Great confidence on the part of the patient, and a rigid adherence to the rules given, are necessary to assure success. The affections to which the milk-cure is applicable are dropsy with impoverished blood; disordered innervation in the forms of hysteria and hypochondriasis; obstinate dyspepsia; catarrhal, rheumatic, and gouty affections; nervous maladies dependent on defects in the fluids; chronic irritation of the pharynx and oesophagus, ulcers of the stomach, and similar affections of the bowels. The gastric cases formed the larger portion of those successfully treated. (Edin. Med. Journ., Aug. 1666, p. 97).

Now I can bear testimony to the great efficiency of an exclusive or almost exdigestion, and may be preferred in a tonic course when the digestion is feeble, and the previous habits of the patient have been those of abstinence. The same may be said, in less degree, of its derivative butter. Another derivative, cheese, while probably not more nutritious, is more difficult of digestion, and, in consequence of chemical changes, often much more stimulating. The latter, therefore, should not be given when the stomach is feeble. Next in the ascending scale of nutritive and excitant power, are oysters, eggs, and the lighter kinds of fish; and these are generally easy of digestion, when properly prepared. Raw oysters, particularly salt oysters, are themselves stomachic, often exciting the appetite, generally easy of digestion, and an excellent ingredient in a tonic regimen. The eggs should be soft boiled; or, if hard, should be grated very finely so as to overcome their cohesion, and render them more easily soluble in the gastric juice. Next come the different kinds of poultry with white flesh, and after these the ordinary meats, as mutton and beef. The dark-fleshed poultry, as ducks and geese, and all the varieties of pork, are most stimulant and most difficult of digestion, and, though highly nutritious also, should be used only when the digestive powers are strong, and exercise is taken abundantly. Wild animal food is preferable to the same varieties tame, as being more easily digested. On the same score, adult animal food is preferable to the very young, which is too stringy, and less nutritive, or to the very old, which is often very tough. Beef, mutton, and fowls are preferable to veal, lamb, and chickens. Very fat meats, though stimulant and nutritious, are not so easily digested, and often unsuitable. Salt meats are less nutritious than the fresh, and also less digestible, and, though often admissible, particularly in small quantities as condiments, should be excluded, as main articles of diet, when the digestion is feeble. The mode of cooking, too, has much influence over the quality of the food. Boiling renders meats less nutritious, and therefore less suitable for a tonic diet. Frying, and other modes of preparation, in which butter and fats are heated with the meat to the point of decomposition, are unsuitable, in consequence of the indigestible, as well as irritant character, often imparted to the food. Roasting, broiling, baking, and stewing are more appropriate modes of treatment Soups, which contain the extractive, gelatin, and other soluble parts clusive milk diet, particularly in morbid states of the blood, and in cases of obstinate vomiting, and chronic diarrhoea; having recommended and employed this remedy, under such circumstances, for more than thirty years. In reference to the blood, I have used the remedy on the grounds of the easy digestibility of milk, and its composition, as it contains all the constituents necessary for making wholesome blood; and, in reference to diseases of the stomach and bowels, of its perfect bland-nesB, in addition to the properties mentioned. But I am, nevertheless, indisposed to admit its claims to a position of special eminence as the milk-cure. (Note to the third edition).