While this disease is undoubtedly due in many instances to the persistent use of alcohol, yet bad cases are often observable in total abstainers. The abuse of alcohol is, therefore, not its only cause. Digestive and uterine derangements also act as provocatives. When once established, the trouble will be aggravated by exposure to cold and to excitement, while constipation and indigestion, especially when chronic, will increase its severity and persistency. In women, uterine disorders are an extremely common cause of it and should always be sought for and corrected. Alcoholic beverages should be forbidden in all cases.

No one diet can be prescribed. Food must be carefully adapted to the digestive disorder that may afflict the patient. Distention of stomach and bowels from overeating, by fermentation, and because of chronic constipation must especially be prevented. No restriction of diet is so important to insure relief as eating abstemiously and avoiding meats and rich food.

The disease is a chronic one, sure to tax the patience and ingenuity of the physician. Local treatment is quite as necessary as dietetic and hygienic measures.