6o8 
American Nervousness . 
[September, 
without any unpleasant after effects. In the treatment 
of nervous cases, it is sometimes necessary to use all of 
these potent remedies in incredibly and absurdly small doses. 
Dilute nitro -muriatic acid , either alone or combined with 
the vegetable bitters, I use in different forms of nervous 
exhaustion, especially where the urine is over loaded, as it 
often is, with oxalates and urates. 
Of cod-liver oil , I may say that it probably does more for 
the nervous than it does for the consumptive. Oil and fats, 
like cream and butter, are brain food, and if used judiciously, 
as the stomach can bear them, aCt both as food and as 
medicine. The oil I use generally in the form of emulsion, 
and I use it with great freedom. 
Of phosphates , this can be said : that they belong to the 
list of over-praised and over-used remedies. All these stock 
remedies have a certain power which, in very many cases, 
they soon expend — they reach the limit of effeCt, beyond 
which they cannot be forced. 
Another new remedy, or comparatively new to this country, 
is koumiss — fermented milk. The power of this remedy to 
produce sleep is very great, and very satisfactory. It is a 
means of nourishing the body without disturbing or even 
using the stomach to any very great degree. Koumiss is 
really digested milk, and is absorbed and taken up into the 
system without any strain upon the digestive apparatus. I 
am persuaded that the use of koumiss in the future is to be 
very widely extended for all conditions where nutrition is 
difficult — not only in adults, but in children. The one dis- 
advantage of koumiss in some cases — that it constipates 
the bowels — is to be met by laxatives. 
Another very old remedy, but as good as it is old, where 
it is properly used, is counter-irritation, which I employ 
both in the form of actual cautery , and galvanic cautery, and 
very small blisters, so small and so arranged as to cause 
very little annoyance. Counter-irritation in the hands of 
those who really understand how to use it without abusing 
it, is one of the three or four major remedies of neuro- 
therapeutics. The acftual cautery, as it can be used, and is 
used by those who understand it, is not specially painful, 
even to the most delicate woman. The pain is in the idea 
of the thing — in the expectation, and not in the burning. 
I speak of this point particularly, because the cautery is an 
agent of such great therapeutical power. This mode of 
treatment, like the blisters already referred to, must be, and 
now can be, modified and adapted to the sensitive modern 
constitution. 
