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XXXIII] When hyperæmia becomes chronic, when the patient is continually suffering with "liver," he should leave the tropics for a time. Nothing relieves these cases of chronic congestion so quickly or so effectively as a visit to Carlsbad or to Harrogate, and a thorough course of the waters there and of the dietetic restrictions imposed in the Carlsbad cure. This should be followed up by country life in England and the active pursuit of country sports; the usual precautions in the shape of warm clothing, avoidance of cold baths, chills, alcohol, and high living being scrupulously observed and a weekly saline purge taken.

A serviceable imitation of the natural Carlsbad water may be made by dissolving 53 gr. of the powdered salt in a pint of boiling water.* This may be divided into three equal portions, which are to be sipped as hot us possible, at intervals of twenty minutes, on an empty stomach, the first thing in the morning. While taking the solution, gentle exercise, as moving about the room, should be indulged in. Breakfast must not be taken till an hour after the last dose. If the bowels are not gently acted on, an increased quantity of the salts should be taken. During the course, which should be persevered in for three weeks, the diet must be carefully regulated; butter, fat, nuts, fruits, pastry, preserves, tinned foods, cheese, salads, wines, spirits, and beer are to be avoided. Too much meat must not be taken; a small meat meal once a day must suffice. The quantity of food, too, should be restricted, and clothing, exercise, and bathing be carefully attended to. Much excellent advice on the subject of the Carlsbad treatment will be found in Surgeon-Major Young's book, " The Carlsbad Treatment for Tropical Ailments."

During severe attacks of acute congestion, or of severe hepatitis attended with fever and much local distress, the patient must be kept in bed and placed on a very low diet of thin broths, barley-water or rice-water, or milk and water. He should be purged