In order to avoid confusion the treatment of vomiting from these various causes should be carried out as far as possible on general lines. It would be rather puzzling to the reader if a separate treatment were given for vomiting in each of these cases. Moreover, such a course is quite unnecessary.

There are very few cases where the administration of an emetic is requisite; but this preliminary treatment may be necessary in cases of acute indigestion due to the consumption of indigestible foods. In these cases the vomiting will cease as soon as the cause is removed. In all other cases it is equally necessary to find out the cause and remove it; but it is not always easy to do so. In the meantime a good deal can be done to subdue the gastric or nervous irritation which is producing it. First and foremost there are the means of acting on and through the stomach. It is obviously useless to endeavour to force a large quantity of anything upon the stomach; indeed, that would be one of the surest means of keeping up the irritation. We must begin by giving only the very smallest quantity of nutriment at a time, and it must be of the blandest and least irritating character.

Milk may be tried, but not pure milk. The best mixture is probably equal parts of milk and lime-water. The milk should be boiled, but can afterwards be cooled, or even iced; and it should have just a little salt added to it. Lime-water is a sedative to the stomach, but it is chiefly of value by preventing the formation of large curds of milk. The curds from milk and lime-water are very much smaller and softer than those formed from milk alone. Lime-water also neutralizes the slight acidity which is ever present in milk. The amount given at a time should not exceed a tablespoonful of milk and lime-water; but this should be given very often. If the stomach settles down under its influence the amount given each time should be increased every hour by adding a tablespoonful to the dose, until the patient can take two or three ounces at once, making a total of two pints in twenty-four hours. As soon as the patient can take and keep down four ounces of milk at a time we can also give some Bovril, Lemco, or beef-tea to the extent of a half-pint in twenty-four hours. Such would be the beginning of treatment in an ordinary case of vomiting which did not threaten to give rise to much anxiety. But in a bad case milk and lime-water, even in teaspoonful doses, might not be retained. The substance should then be quickly changed. It is useless to persist in giving the patient a food which obviously disagrees. Barley-water and milk, in equal parts, can be tried. I have found that albumin-water will often be retained when everything else is rejected. This food consists of the white of one raw egg in a small cupful of lemon-water, and just enough sugar to make it palatable. It can be iced. It should not be given in too large a quantity at once. Begin by giving a teaspoonful every five minutes; if that is retained for half an hour you may increase the quantity to a tablespoonful every fifteen minutes. But do not try "to force the speed"; if you do the vomiting will recur and the process will have to be commenced again. You must "make haste slowly". When you feel pretty sure that a tablespoonful of albumin-water will be retained you can add some Valentine's meat juice or Bovril to it. I have a special liking for Valentine's meat juice, and always recommend it for these cases. The quantity of any of these meat extracts, however, would be one teaspoonful in a cupful of albumin-water.

If albumin-water given in teaspoonful doses is rejected the outlook is pretty bad. We should then not be satisfied by icing the fluids, but give the patient small lumps of ice to suck; and now and then pour a few drops of Valentine's juice over a small lump of ice just when it is being put into the patient's mouth. Why did I not give ice sooner? you ask. Because the amount of nourishment which is retained in twenty-four hours by these patients is a mere starvation diet, and it seems to me absurd to reduce the quantity more than is absolutely necessary. Ice the milk and lime-water or the albumin-water by all means; the colder it is the better; but be sure the patient gets a little nutriment, and thereby ward off a state of collapse. A teaspoonful or two of iced champagne, or, in its absence, brandy and soda, is valuable not only for warding off collapse, but by assisting to subdue gastric irritability. The carbonic acid gas in champagne, soda-water, potash-water, Perrier, and Apollinaris is a useful sedative and assists in overcoming the tendency to vomit in a large number of ordinary cases; but a large bulk of fluid would not be retained. If it is suspected that alcoholism is the cause of vomiting it would not be proper to give brandy or champagne to stop it, although "a hair of the dog that bit him" is sometimes a useful remedy.

In acute gastritis it is often necessary to stop mouth feeding for a day or-two, merely allowing a little ice with Valentine's meat juice. But when the stomach is settling down a bit we can give albumin-water, lime-water, and milk or peptonized milk alternately. In meningitis and other forms of cerebral vomiting the patient will be able to take a larger quantity of albumin-water at a time; indeed, they can often retain half a cupful of it when a smaller quantity of milk and lime-water would be rejected.

No matter what the cause of vomiting may be, the feeding must be begun on these lines. There are rarely cases where this method fails. There are for these two other modes of treatment - viz., washing out the stomach and rectal feeding. Washing out the stomach will do no good in cerebral or renal cases, but it may do much good in gastric and intestinal cases. Rectal feeding is useful in gastric, renal, cerebral, and other nervous cases; but it is of little use in intestinal cases. The "feeds" may consist of peptonized milk or peptonized milk with some glucose or extract of malt; raw egg and a teacupful of milk with a little salt, or beef - tea and glucose. Four "feeds" may be given in twenty-four hours at intervals of six hours. In long-continued vomiting thirst becomes distressing and may be relieved to some extent by the injection of a pint of warm water into the colon twice a day.

In addition to these modes of feeding, the patient must be kept absolutely still. Moving about will perpetuate the sickness; sitting up to vomit aggravates the condition; shaking the bed, turning from side to side will also make things worse. It is better to keep the patient on one side and use a small basin or napkin to receive the vomited materials.

As the stomach recovers, the diet must be gradually improved. When the stomach will retain a teacupful of milk and lime-water or barley-water, we can begin by giving some bland and unirritating substance such as Mellin's food, arrowroot and milk, Plasmon, Tilia, Sanatogen, junket, custard, and jelly. The quantity must be very small until the stomach will bear it comfortably. A teaspoonful of Brand's essence of beef or Mosquera's beef jelly will usually be retained when a cupful of milk and lime-water or peptonized milk is kept down. Mellin's food does not lay a tax upon the stomach, and Benger's food gives very little trouble to it. The advantages of Plasmon, Tilia, and other milk powders in sickness is that they do not form a curd; neither does junket form a curd in the stomach, it is already curdled and is soft and unirritating. When the stomach will bear these things an attempt can be made with a teaspoonful of soft-boiled egg and a mouthful or two of bread and butter. Then some light milk pudding may be given, and then we can go on to a teaspoonful or two of sole or plaice. The quantity of food must be slowly increased, and any attempt to give what the patient might consider "a proper meal" before the cause of vomiting had subsided would be almost sure to end in disaster.