evacuate the bladder with much pain and difficulty, the urine containing large quantities of blood and mucus. This condition of affairs, accompanied with the knowledge of the injury received at the time of the fall, made it plain that we had a case of Traumatic Hæmatura, complicated with acute inflaramation of the bladder, to deal with.

The patient was placed in the recumbent position in bed, and under the judicious use of alkaline drinks, benzoic acid, biborate of soda, infusion of buchu and uva ursa, he continued to grow worse until he became reduced to skin and bones, passing large quantities of bloody urine frequently when not under the influence of ergot. It is only necessary to state that the temperature ranged from 102 in the morning to 105 in the evening during the first four days to realize the danger he was in. It now became apparent that something must be done different from what we were doing or the worst might be expected. I then prescribed tritica, discontinuing all other remedies, except such dietetic and other auxiliaries as successful use in the profession warranted. Recovery began at once and progressed rapidly. On the sixth day after beginning tritica all traces of renal hemorrhage had disappeared, the urine became normal,strength and flesh accumulated rapidly; in short, the patient mended so fast that in three weeks he had gained in weight fifteen pounds and has been in robust health since.

I believe that a skilful use of tritica, benzoic acid, biborate of soda and an enforcement of dietetic rules, recumbent position, opiates only when strongly indicated, will make short work of any case of acute cystitis not complicated with lesions, rendering rapid recovery impossible. Mild attacks treated with tritica alone end favorably in two or three days.

Objections to Placing Hot Air Registers in Floors.-We have noticed on several occasions a most disgusting, if not dangerous, practice arising from placing hot air registers in floors. Reference is made to using the register for the purpose of a cuspidor. If attention is paid to this, one will be surprised to note the number of persons guilty of this act.

Recently in a hotel heated by natural gas, and having a large hot air register in the floor, we saw not less than half a dozen persons discharge their saliva into it. One of these was the proprietor of the hotel, an old man suffering from chronic bronchitis with a copious muco-purulent expectoration. One can scarcely imagine anything more horrible. And if we consider that consumptives may sometimes cast their expectoration into the register, the danger of the practice becomes apparent; for a more efficient method of scattering germs of tuberculosis through the air of an apartment could not be devised.

The floor is seldom or never the place for a hot air register. With the greatest possible care a considerable amount of dirt will collect in it, polluting the air more or less, that enters the room. In the absence of cuspidors, it always offers a tempting place for the chewers of tobacco to dispose of their spittle without betraying their filthy habit. Persons coming in from out of doors, with wet, dirty feet, will nearly always stand over the register to dry their shoes, affording another source of air pollution. Other objections present themselves, but those given should suffice to condemn placing hot air registers in floors, and especially in public places.-Monthly Sanitary Record (Ohio).

Burns.-The following is an excellent dressing for burns: R Campho-Phenique, one-half ounce; Lanolin; Ung. aquæ rosa, aa one-half ounce. SigApply two or three times a day.- Weekly Medical Review, March 12th, 1892.

Cephalalgia.-Extract from an article on Antipyretics, read at the meeting of the Union Medical Association of Northeastern Ohio, at Akron, O., by T. W. Johnson, M.D., Canton, Ohio. Taken from the Medical Record, June 6th, 1891. In the section referring to Antikamnia, he says: "Its action as an analgesic appears from the best evidence to be central, and I do not doubt that its antipyretic action is of a central character, thereby depressing heat production.

"I ordered 8 grain doses in a case of Cephalalgia, to be repeated at the end of three hours until four had been taken, with gratifying results. It causes no excitation and no depression of the vital forces, and is best administered in liquid form. It is without disagreeable taste."

The Disinfectant of the Future.-The New York Medical Journal says :—

In a recent coeversation, Professor Alfred L. Loomis remarked that chloride of zinc had maintained its long-established reputation as a disinfectant, as was shown in Mignel's classification. Sulphurous acid and chlorine were powerful germicides, beyond question, but their every-day use was impracticable, and the bichloride of mercury, although it might be the most potent of all the agents that were chiefly talked about, was hardly to be considered safe for domestic use. But the preparation known as "Platt's Chlorides" (a solution of the chlorides of zinc, lead, calcium and aluminium), which he had made use of freely for the past five years, both in his own house and among his patients, he considered by far the best for all the sanitary requirements of the household.

Contributions and Selections.

THE STATUS OF WATER IN MODERN
MEDICINE AN ADDRESS DELIVERED
BEFORE THE SOCIAL SCIENCE ASSOCI-
ATION AT SARATOGA SPRINGS, N. Y.
BY SIMON BARUCH, M.D., Attending PHYSICIAN TO
THE MANHATTAN GENERAL HOSPITAL, PHYSICIAN
AND SURGEON TO THE NEW YORK JUVENILE
ASYLUM AND CONSULTING PHYSICIAN TO THE
MONTEFIORE HOME FOR CHRONIC INVALIDS, NEW
YORK CITY.

(Continued from June number.) The lay mind is prone to reason that if lying between damp sheets in an illy kept hotel produces rheumatism; the wet pack resorted to in hydrotherapy must be equally injurious. But the difference is pronounced. In the one case air freely circulates between the sheets, producing evaporation and cooling of the skin, while in the other the body is snugly wrapped in the wet sheet which is almost hermetically tucked all around and covered by a blanket similarly applied. This produces a gentle vapor bath over the sheet enveloped skin, from which the patient is taken into a cold bath which produces a reaction and glow over the entire body. Thus the wet pack may become the most useful remedy for "colds."

ANATOMY AND PHYSIOLOGY OF THE SKIN. The anatomy and physiology of the skin is doubtless familiar to most of my hearers. You know that it is the largest anatomically continuous surface of the body, that it forms the outer envelope and consists of three layers, the epidermis, which is a more or less horny layer, waterproof, but admitting the passage of gases, and certain metallic substances, entirely devoid of vessels and nerves, a bad conductor of heat, in short, a kind of varnish for the second layer, the true skin which consists of elastic fibres, capable of contracting and expanding, nerves, blood vessels, sweat and sebaceous glands and hair roots.

A third layer is the cellular connecting link between the skin and subjacent structures. This con

tains the fat, affording smoothness and protection against sudden temperature changes.

The functions of the skin with which treatment by water is most concerned, is as an organ of sense. The vast network of sensory nerves distributed over the skin (not the minutest point of a needle can penetrate it without producing pain), endows it with the power to receive impressions of an irritating or soothing nature which are conveyed, as physiology teaches, by the different nerve fibres to the brain and spinal cord (the nerve center) and elicit from the latter a response by means of the different nerves, which is called "reflex.' A common illustration of this reflex you have all observed in the rapid closing of the eyelid, when a foreign body, like a cinder, strikes the eyeball, or in the deep inspiration following a sudden dash of cold water upon the face of a fainting person This reflex action upon the nerves of the skin, affects, as physiological experiment has demonstrated beyond a doubt, the three functions of the body, the circulation, respiration and heat production. The contraction of the blood vessels of the skin (which you know are so numerous that not the minutest point of a needle fails to draw blood from the skin) is the first response to any irritation of the skin be it by cold, heat or other agent. The result is a diminution of the quantity of blood in the large vascular area, and a corresponding increase, on hydraulic principles, of blood in the interior of the body by means of the receding stream. As a normal calibre of the blood vessels of the body is a sine qua non to a normal action of the heart, whose function it is to pump the blood through this hydraulic system, it is evident that this sudden change in the calibre of the vessels must at once affect the action of the heart. This is indeed a constant result; the heart being called upon to overcome this derangement, acts with more vigor. It may become inadequate to its duties if originally feeble. or crippled. Hence judicious management is import

ant.

If the irritation at the periphery is temporary, the result is likewise evanescent. But it is followed more or less rapidly, according to the constitutional vigor

of the recipient and the intensity or duration of the local shock by a relaxation. Plunge a hand, previously warmed by friction, into ice water and withdraw it immediately. What is the effect? The hand becomes pale from contraction of its blood vessels, but so soon as it is withdrawn, especially if friction be applied, these vessels dilate and it becomes ruddy. If the immersion in ice water is continued for a longer period, the contracile power of the vessels is overcome, paralysis of their coat ensues; they dilate, circulation becomes sluggish, the hand assumes a purplish hue. If the immersion is still continued, the circulation stops, frost bite occurs, with consequent gangrene or destruction of tissue. The length of time of immersion, the intensity of the cold, the area exposed, the vigor of the subject, are, therefore, elements upon which the result depends. A brief immersion into cold water stimulates the circulation by the reaction which ensues; a prolonged exposure to cold water depresses it because reaction is prevented.

REACTION THE KEY TO VALUE OF HYDROTHERAPY.

Reaction, therefore, is the key to the value and versatility of hydrotherapeutic procedures. The extent to which this reaction may be carried or prevented, explains the seeming contradictions of the results obtained by the water treatment and its remarkable adaptability to many and various diseased conditions. The effect upon the circulation is thus briefly outlined.

The effect of external application of cold upon the respiration has fallen under the observation of most persons. Who has not experienced the effect of the sudden shock of a cold douche, or a cold wave in sea bathing, upon the breathing? The respiratory act is checked but soon full inspirations follow, the breathing becomes deeper and slower; more oxygen is taken into the lungs and therefore into the blood. No medicinal agent is capable of such an effect!

The body heat is materially influenced by irritants. applied to the skin. The narrowing and dilating of the vast area of blood-vessels by cold, for instance, gives us control over the heat regulating processes, which are a certainly determined by changes in the circulation. When the superficial vessels are narrowed, excessive cooling is prevented. When they are dilated, evaporation is increased, perspiration is stimulated and cooling is enhanced. The effect of cold upon the respiration produces similar results. Anything that deepens the inspirations, enhances the cooling effect of the air upon the blood.

These effects are incident, however, only to the giving off of body heat. The production of heat is another vital element in the heat regulating problem. Physiology teaches that heat is chiefly evolved by the changes which are the result of the building up of

the tissues by food and drink, and their subsequent destruction in the vital processes. The blood is the great highway and medium by which nutritive material is transported from the digestive workshop, the upper intestine, into every nook and corner of the human frame. The blood also is the medium of carrying away the elements of destructive tissue change, the so-called impurities which result from the physiological processes as well as all unused material. Oxidation, is, as you know, the process of combustion from which heat results in animate as well as inanimate nature.

Whatever accelerates oxidation must of necessity influence the body temperature. The equable condi tion of the latter is due to an exact balancing and counter-balancing between heat production and heat elimination. There is no influence so potent in disturbing this balance as an irritant impression made upon that extensive nervous and vascular area, the skin. Common observation confirms this well ascertained physiological fact that the body heat is maintained at the normal standard mainly by means of the responsive action of the skin to the irritants which surround it, and that when the responsive action is inhibited cooling takes place more rapidly. Hence, sleeping or drunken persons freeze more rapidly.

These primitive physiological data which are familiar to most of my hearers are rehearsed because they furnish a clue to the powerful effect of water as a remedy.

As a carrier of temperature influences (irritants) water becomes a potent modifying agent of the functions of the human body.

INFLUENCE OF WATER ON THE CIRCULATION.

That the circulation of the blood in the interior of the body may be influenced by thermal agents, externally applied, has been demonstrated frequently. I need mention only the experiment of Dr. Schüller, who removed a portion of the skull from a rabbit, in order to expose the blood-vessels of the brain envelopes. A stream of cold water poured upon the belly or back immediately contracted the blood-vessels of the brain if brief, but dilated them if prolonged. A warm bath contracted these vessels.

It would lead into wearisome details to lay before you even a tithe of the vast material which has been gathered by positive experiment and from which it may be axiomatically deduced that by the various method of Hydrotherapy we may impress through the nervous system such changes upon the most important functions of the body, the circulation, respiration, secretion and tissue change which no other remedy is capable of producing.

No other remedy can produce such decided effects. upon the system.

A familiar example is the effect of a dash of cold water upon the face and chest of a fainting person. There is no medicinal agent which will deepen the inspiration, bring the flush of health to the pallid cheek and brightness to the glassy eye. It must suffice for our purpose on this occasion, to summarize the effects of cold water applied to the surface as refreshing effects. This effect is daily exemplified by our simple morning ablution of the face, neck and hands. That the exposure of a much larger and more sensitive surface results in a proportionately more decided refreshing effect, is testified by many robust persons who habitually resort to daily cold ablutions of the entire body.

There is no doubt that this practice is a most valuable prophylactic against illness and an invigorating measure of unsurpassed efficacy. The Indian gave his reason for not suffering from exposure that his body is all face. And he pronounced an indubitable truth. If the entire body were daily subjected to the same ablution and friction which the face receives, the nerves, ganglia and blood-vessels of the skin and immediately subjacent parts would obtain a discipline which would enhance its power of resistance to that potent disease producing factor-temperature changes.

Moreover my hearers need not be reminded that the daily removal of accumalated secretions would enhance the functions of the skin and thus aid the elimination of the products of tissue change. "We wash our clothes" says Prof. Pettenkofer, "every week, but our bodies are neglected."

Pliny tells us in the 1st Chap. 29th Book of Historia Naturalis, that for 600 years the Roman people required no physician, because they were diligent

bathers.

The prophylactic value of baths is again obtaining recognition. In Germany public baths are multiplying, in which the poor may obtain them readily. An evidence not only of the philanthropic spirit of the day, but of a realization of the immense prophylactic valve of bathing, is furnished by the fact that an association for the promotion of public baths has recently been formed in New York City under the auspices of Bishop Potter, Mr. Cornelius Vanderbilt, Mr. J. Brisbane Walker and others, which may, I trust, inure to the welfare of our laboring people, whose opportunities for bathing are extremely limited even in Summer, and almost entirely absent in Winter. It is to be hoped that no effort will be made to emulate the Romans in the construction of imposing structures, containing luxurious appurtenances. Simplicity should be the chief aim; ample means for cleansing the body, the sole and important object.

I offer you in this connection a plan kindly designed at my suggestion by Messrs. Brunner and Trion, Architects, of N. Y. City, for the construction of

public rain baths. (Description is here omitted.) In this building space and time, the most valuable elements, are economized without sacrifiicing utility.

If this essay shall be the means of arousing your interest in furthering this important movement for civilizing the people by soap and water, one of the Sureobjects of your Society will attain realization. ly such interest in the classes whose sad lot in life places them at a fearful disadvantage in the battle of life, and forms the germ of discontent which is now breeding untold misery for all classes, must tend to give impetus to the efforts of your Society in the direction of amelioration of the social condition.

If the cartoonist be correct in representing the Anarchist as a dirty, long-haired individual, may we succeed in transforming his destructive bent by encouraging personal cleanliness as the first step. As a financial investment the prevention of disease alone would amply compensate for the outlay.*

If the masses could be familiarized with the use of water as a daily practice, their antagonism to its application in disease would be removed. It is difficult. to portray the prejudice daily encountered-existing as it does, among physicians even, many of whom require to be educated in this direction.

The triumphs of the application of water for remedial purposes are so numerous, precisely ascertained and indubitable, that no unbiased mind can fail to be convinced of its value.

I will offer you but one illustration. Typhoid Fever is, as you are aware, one of the scourges of the present time, owing to its frequency and its great mortality. The N. Y. City Board of Health reports from 1876 to 1885, 7,7.2 cases with a mortality of 3,184, or 41.28 per cent. Dr. Dalafield computed the average mortality in the City Hospitals as 24.60 per

cent.

Statistics which are superior to any others ever presented on a medical subject, demonstrate that the mortality from Typhoid Fever may be reduced to less than 3 per cent. by the bath treatment properly applied. We have the records of one Hospital, that of the Garrison at Munich, presented by Dr. A. Vogl, Chief of Staff, in which men of the same age, almost uniform physical development and occupation, were treated during a period of forty-six years. These furnish exact data gathered under military discipline, of the type of the disease, the treatment and the mortality, which show that the methods in vogue in the profession at large were pursued here as in other hospitals and as taught in the works of authors of the respective periods. The mortality among these strong young men who were subjected to treatment early and thor

*NOTE-The reading of this paper has borne good fruit in the construction of several public baths on the above principle in New York City and elsewhere.

oughly ranged from 23 to 40 per cent. under this treatment. Since 1875, when the bath treatment was systematically begun, the mortality per cent. has averaged only 2.7 per cent.

Medical Statistics are prone to be fallacious, because they are usually gathered from multifarious sources, from differing climates and peoples, and but too often without precision.

In this instance we have a continuous uninterrupted record of 8,810 cases of typhoid fever, amid almost uniform environment and conditions, which furnishes a reduction of mortality from 40 per cent. to 2 per cent. Need I cite a more convincing proof of the superiority of the bath treatment over all other methods hitherto and at present in vogue? Think of the thousands who are annually sacrificed in this country to this destructive Moloch! Reflect that these thousands may be reduced to fifties, and you may readily compute the enormous saving of life and prevention of misery, resulting from this simple and beneficent treatment.

CONVINCING PROOF.

The omission of systematic bathing from typhoid fever treatment, should render the physician chargeable with neglect of the most valuable life-saving agent in this disease.

If the improvement of the physical, mental and moral condition of man be the object of Social Science, you may find in the encouragement and furtherance of the bath treatment of many acute diseases, by neutralizing prejudice and upholding those who have courage to brave the latter, a cause worthy of your best effort.

This instance of the incalculable value of water in the treatment of disease is of modern origin; I could cite thousands of cases from the best clinical teachers in Germany and France in confirmation. I have, however, brought forward this single evidence of what has been accomplished in one disease, because, the proof being incontrovertible, it may serve as an illustration of the value of water in the management of many other acute aud chronic maladies.

In Scarlet Fever and Pneumonia extremely favorable results have been obtained.

In Chronic disease the water treatment, under the name of Hydropathy, has long been used, or rather abused. Systematic, judicious application of baths and douches, in the hands of educated physicians, has proven superior to other methods, in the most varied nervous affections and dyspepsias which are now so prevalent. In chronic rheumatism and gout, in debility from functional causes, anæmia, scrofula, and many forms of insomnia, and even in Phthsis remarkable recoveries have been recorded.

by debility, loss of appetite, and nerve and muscular depreciation, the water treatment has brought success after failure of medicinal treatment.

It is the just claim of Modern Medicine that it is rescuing this treatment from the hands of the Empirics, who have so long thriven upon it, and who have, despite many good results by its ignorant execution, prejudiced intelligent people against it.

The fact that such eminent physicians and teachers as Charcot and Dujardin Beaumetz, in France; Leyden, Nothnagel, Erb, Ziemmssen, in Germany; Semmola and Cantani, in Italy, advise the water treatment, under medical guidance, in the diseases above referred to, testifies eloquently to the true status of water in modern medicine.

My own researches and practice also sustain me in my advocacy of Hydrotherapy.

But while I espouse it with an earnestness born of truth, I am not prepared to disregard the magnificent results attained by the best minds of the medical profession in the application of other remedies in disease. I cannot disregard the teachings of an experience of thirty years at the bedside, which has demonstrated their great value. Drugs which possess the power of reducing or increasing the rate of the pulse, of diminishing or enhancing its tension, of lowering at will the temperature of the body when elevated by disease, of lulling to rest the wearied brain, of completely abolishing consciousness of pain, of supplying deficient elements to the gastric juice-such drugs are entitled to the respectful attention of the conscientious physician. Of all men the physician should be broad and liberal; in the battle against disease and death he must eschew all exclusive or universal remedies, for there are none. The abuse of drugs is reprehensible, but their entire neglect is not less culpable. Water is the most potent of all remedies. This is probably the reason why a medical sect has been constructed upon it, which claims to cure all diseases by it alone.

The true physician utilizes it according to the indications of case, and does not despise other remedies that may lead him to the goal of successful treatment. Hydrotherapy, the scientific application of water in disease with or without other remedies, has triumphantly established its claim upon the medical profession.