Moorhead has completed an extensive series of tests with bitt on five hospital patients with chronic cachexia and poor appeti using the method of weighing the food consumed, on the the< that if the bitters actually increase appetite this should be reveal in the food consumption. Tonic days were alternated with no-toi days, so as to exclude any progressive increase or decrease in t appetite from other causes. The results are as follows:

Patient A: given tincture of gentian. The patient was t< that the medicine would help his appetite and digestion, a said he felt that it did improve his appetite a great deal. Eviden the subjective faith and hope was greater than the objective result

Number of control or no-tonic meals.........45

Number of tonic meals.....................87

Average food consumption, no-tonic meals. . .. 10.3 oz. Average food consumption, tonic meals.......11.3 oz.

Average increase.................... 1 oz. per meal

Patient B: given elixir of iron, quinine, and stiychnine. Tl patient was not told what the medicine was given for, hence did not know that any attempts were made to improve his appeti

Number of control or no-tonic meals.........60

Number of tonic meals.....................48

Average food consumption, no-tonic meals. . .. 11.8 oz. Average food consumption, or tonic meals.....13.8 oz.

Average increase

2 oz. per meal

Patient C: given elixir of iron, quinine, and strychnine, without being told for what purpose. This patient was a chronic alcoholic and cachectic, with no other definite ailment.

Number of control or no-tonic meals........33

Number of tonic meals....................27

Average food consumption, no-tonic meals. . .. 9.95 oz. Average food consumption, tonic meals......10.84 oz.

Average increase................... o. 89 oz. per meal

Patient D: given elixir of iron, quinine, and strychnine. This patient had chronic myocarditis, and was anemic and cachectic.

Number of control or no tonic meals.........32

Number of tonic meals.....................37

Average food consumption, no tonic meals____11.7 oz.

Average food consumption, tonic meals.......13. 2 oz. '

Average increase.......................1.5 oz.

Patient E: given tincture of gentian. This patient had pernicious anemia, and was very emaciated. He was told that the medicine given him would improve his appetite, and he was very anxious to have his appetite improved.

Number of control or no tonic meals.........22

Number of tonic meals.....................21

Average food consumption, no tonic meals.... 19.4 oz. Average food consumption, tonic meals.......23.1 oz.

Average increase.................... 3.7 oz.

The number of different kinds of bitters advocated from time to time as useful in disease is a large one. They are of such varied chemical composition that the only thing they have in common is the bitter taste. Of course, in this discussion, we do not include such substances as quinine or strychnine, or the bitters with alcohol as the main constituent, as these substances have distinct physiologic actions not directly related to appetite, after absorption into the blood.

The bitter tonics are common "home remedies" and favorite "drug-counter prescriptions." They are given to convalescents who would continue to improve, tonic or no tonic, and the tonic, not the recuperative power of the patient, gets the credit, or t physician prescribes a more hygienic living and a tonic. The heal improves and both physician and patient think the tonic did it.

But even if the bitters have no direct action on gastric secretin and digestion, and no appreciable indirect action on the secretion gastric juice, may they not be valuable aids in expelling worry and implanting hope and good cheer in the mind of the patient ? May they not be an efficient handmaid to psychotherapy? There no question that the bitter tonics connect up with the popular belief that the potency of a medicine is directly related to i strong (or bad) taste. And the readiness with which these tonic are dispensed nourishes the popular superstition that there is, must be, a specific drug remedy for every ailment, a superstition that constitutes the chief aid of the medical quack and the pate medicine vender.

The stimulation of certain nerve-endings in the mouth and the normal gastric mucosa unquestionably contributes to the com-plex sensation of appetite, and these nerves are stimulated 1 condiments and flavors of food. Apart from this, the physiologcal way of augmenting hunger and appetite is moderation in the for intake or increasing the utilization of the food in the body by outdoor living, fresh air, cold baths, and physical work. If these measurr do not improve appetite and hunger, the chances are that the digestive tract is not in a condition to take care of the amount food demanded by stronger hunger and appetite sensations.