THE PERSONAL FACTOR IN DIET.

129 Oxygen which Dr. Macalister mentions is but another apomorphine will cure an inebriate, but it Lieutenant-Colonel instance of the same thing, for the effect of oxidation (i.e., very useful drug upon occasion. Douglas admits that bromide is sometimes useful. In this Ilcid formation) is to diminish the alkalinity of the blood heartily agree with him, When a patient has been drinkingaand so the solubility and excretion of uric acid. Conversely freely and his system is thoroughly saturated with alcohol < leficient oxidation increases the excretion of uric acid but it is very good practice to keep him in bed for two or three 1bhis, like all excretion under solvents, gets less the longer days under the influence of huge doses of bromide. Athe solvent is continued, i.e., as the stores in the glands and drinking bout can be cut short in this way. But the most tissues are reduced. If it were formation it should continue useful drug, the one which can be relied upon in the treat-at the same level in relation to urea-that is, to the general ment of inebriety, is atropine. This should be administered level of metabolism. Further, if the above-named diseases by hypodermic injection with strychnine twice a day. In were due to excessive formation of uric acid no change of -this way it is possible to treat inebriates successfully, both diet could relieve them. On p. 1808 he mentions the case of men and women, and that without the aid of any institution. a man whose recipe for a long and happy life was "live They will give up their alcohol while living in houses where on milk." It may be remembered that the late Professor others take it and they will safely pass public-houses tn Humphry found that the centenarians whose diet he investitheir way to and fro for the treatment. Gradually their gated had mostly been in the habit of contenting themselves power of self-control becomes established and they become with very small quantities of flesh and alcohol. The flesh permanent abstainers. I have cases now of more than two they left out was no doubt replaced by an increase of breadyears’ standing who have been treated in this way. If stufEs, milk, and cheese, so that there was no diminution of Douglas could spare a day to visit albumin or of carbohydrates. May we not conclude that Dr. Lieutenant-Colonel Nottingham I could bring case after case and prove to his Macalister’s case was not idiosyncrasy, but one instance of satisfaction that the drug treatment for inebriety is a a general rule ?‘! I am, Sir, yours faithfully, brilliant success. Lastly, may I say that my thesis is not that uric acid is the JOS. S. BOLTON. cause of all disease, but that it is the cause of some ; that Mansfield-road, Nottingham, Jan. 7th, 1908. it is the cause of some cases of headache, fits, depression, &c., when these are not due to obvious organic disease. Such troubles when due to uric acid are generally temporary or

not maintain that

is

a

THE PERSONAL FACTOR IN DIET. To the Editor

of

THE LANCET.

to thank Dr. C. J. Macalister for his very kindly mention of my writings in his address1I should also like to make a few remarks on what he speaks of as my

periodic and

a uric-acid-free diet. I am, Sir, yours faithfully, ALEXANDER Brook-street, W., Dec. 30th, 1907.

are

relieved by

HAIG.

SIR,-While I desire

"

mistake." I do not deny that there is such

but to

postulate

it is to take

thing as idiosyncrasy, refuge in the unknown. a

HYPERTROPHIC STENOSIS OF THE PYLORUS.

To the Editor of THE LANCET. this heading is often a mere result of the relation of uric SIR,-During the last year I have had two cases of this acid to its solvents in the blood stream. For those whose aaffection under my care and they make me doubt two stateblood is in a condition to dissolve considerable quantities of ments n I have recently read in medical journals. The first uric acid are at once depressed by its administration and aappeared in THE LANCET a few weeks ago and was to the exhibit slow capillary circulation, headache, lethargy, and effect that this affection is to be diagnosed from other infane t affections of the stomach by (amongst other signs) depression ; while those whose blood is not a good solvent tile are stimulated by it, showing quick capillary circulation and palpating the enlarged pylorus. The second statement well-being. This has, no doubt, often been taken for idio- sappeared in the Clinical Journal, " as regards the severe in which lavage fails, the only recourse is to try operac yncrasy, but that it is not so is proved by the fact that cases both effects may be seen in the same individual under ttive relief." Both my cases were typical of hypertrophic different conditions of season, climate, or general nutrition, sstenosis. Born healthy, a few weeks after birth the" pumpsometimes merely at different times of day. I have in- ing i " vomiting commenced, with rapid wasting, peristaltic B jected considerable quantities of urate into the blood waves passing from left to right across the epigastrium, the stream and yet found that the same blood drawn a sunken lower and distended upper abdomen, constipation, few minutes later contained less than usual. What hadaand when the bowels did act small hard motions, and with happened here ? The injected urate had been re-all these hunger directly after the vomiting. tained in the liver, spleen, &c. After trying almost every food advised for infants I (Sir A. Garrod), and it had there acted as a uric acid filter and cleared the blood of operated on the first case, hoping that I might be able to the quantity usually present, just as lime added to a hard (dilate the pylorus by invaginating with my finger. The much Here the (enlarged and elongated pylorus was completely covered by water precipitates all the lime it contains. - administration of uric acid acted as a stimulant and every-the large infantile liver and demonstrated conclusively how thing that clears the blood of uric acid does the same. Onimpossible it would be to palpate a pylorus in such a the other hand, if the blood is in a condition to dissolve position. It was as hard as cartilage and invagination was uric acid freely an identical administration will act as a out of the question, so that I performed pyloroplasty as depressant and the blood will be found to contain more than quickly as I could. The child unfortunately died about usual. The result of a given dose is always dependent onseven hours after the operation. The second child I did not the solvent powers of the blood ; it is not a matter of idio- expect to recover. He wasted to 3 pounds and the parents Hence the dyspeptic and longed for his death as he was " too awful to look at." On - syncrasy but of chemistry. debilitated with his blood highly alkaline is depressed by the several occasions he was thought to be dead. No pylorus same dose that acts as a tonic and stimulant to the strong could be felt. and well nourished. Yet the strong and well nourished has As a last resort all nourishment by the mouth was stopped
Further, I think that what Dr. Macalister includes under