geously as follows: Instead of placing the patient in a cold bath, he is immersed in water at a temperature one or two degrees below that of the body. The temperature of the bath is reduced 1° every ten minutes until it reaches 86°, never lower. This keeps the patient in water at a temperature below that of the body for a considerable period without at any time. producing the phenomena of reaction, and hence avoiding the augmentation of heat-production, which is the chief objection to Brand's method. A method which we have found advantageous, and which is perhaps as effective as any of those mentioned, is the application of sheets wrung out of hot water and wrapped about the patient. Sponging with hot water, the application of fomentations to the spine, and in cases in which the surface is cold, employment of hot blanket packs, are also measures which we have found advantageous. The effect of applications of this sort is at first to reduce heat production as the result of the reflex action set up by the contact of warm or hot water with the surface of the body. The body is cooled by the greater amount of heat brought to the surface by the blood in the dilated blood vessels. By subsequent evaporation the surface is cooled, and thus heat elimination is further promoted. We thus have a decrease of heat production with a coincident increase of heat dissipation.

The second indication, which requires the elimination of the ptomaines and other toxic products of microbic action, is best met by the internal administration of water in large quantities, both by the mouth and the rectum.

Our usual prescription is half a glass of water every hour by the mouth, and large enemas administered in such a way as to bring the water in contact with the whole colon two to four times daily. By this means the alimentary canal is emptied of germbreeding material, and great quantities of microbes and their products are carried

off; at the same time the portal circulation is flooded, the action of the liver and kidneys is promoted, and the feverproducing toxines are both destroyed and eliminated.

The third indication is to be best met by means of an aseptic diet and the administration of aseptic or germicidal drugs. No one would think of administering beef or flesh food in any form to a patient in the early stages of typhoid, and yet many practitioners are so inconsistent as to administer beef tea and beef juice in large quantities, while at the same time they withhold beef, mutton, and other forms of flesh food. They forget that beef juice or beef tea contains all the objectionable elements of flesh food, with little or none of the really nutritious and comparatively wholesome elements. Flesh food is fever-breeding because it contains toxic substances, the product of tissue disintegration, excrementary materials on their way out of the system of the animal; and because it furnishes the most fertile kind of soil for the development of pathological microbes and their characteristic toxines and ptomaines. Eggs are thus declared objectionable on the same ground, and in our opinion, milk must also be regarded as not the most wholesome article of food for a typhoid fever patient. We say this while fully aware of the fact that its general use by physicians in typhoid fever will doubtless lead to a general dissent from the view expressed. Nevertheless, the readiness with which typhoid bacilli develop in milk, producing all its characteristic morphological features and its specific ptomaine, typho-toxine, very clearly suggests the propriety of substituting some nutritious and more appropriate article of diet for typhoid fever patients. The principal reason, perhaps, why milk is recommended in these cases, and is so generally used, is the ease with which it can be administered. But modern study of dietetics has shown very clearly that milk

is by no means the most easily digested food for adults, and the bacteriological fact to which we have just called attention seems sufficient to condemn its use. Kumys is better than milk, on account of its being more easy of digestion and because it has less tendency to form gas in the intestines. We have found lactated milk

still better.

In typhoid fever the system requires a considerable amount of carbo-hydrates to support the abnormal evolution of heat and consequent consumption of reserve tissue. It is true that milk contains this element in the form of fat, but we have also in the carbo-hydrates a source for a heat producing element which is easy of digestion and assimilation, and which does not furnish, as does the caseine of milk, a favorable soil for the development of the typhoid bacillus. Starch and sugar are found in abundance in the various grain preparations, which can be easily taken by the invalid in the form of gruel, puree, granola, zwieback, and a variety of other forms. Some juices are also a valuable means of presenting nourishment in these cases; but it is not the purpose of this article to enter into the details of the dietetics of typhoid fever, and we will dismiss this part of the subject with one further observation; namely, that sugar and starch, the chief elements in farinaceous food, constitute the most convenient source from which

the liver can obtain its supply of glycogen, which has been shown by the investigations of Bouchard and his pupils to be essential to the ptomaine-destroying function of the liver, a function which it is of the greatest importance to promote and support in typhoid fever as well as all other febrile infectious disorders.

Sir Wm. Jenner has called attention to the fact that excessive feeding is responsible for much of the intestinal trouble in typhoid fever patients, and insists that no more food should be given than can well be digested. Dr. Wallace Beatty, an eminent Irish physician, limits the food

to three pints of liquid food in twentyfour hours, and maintains that the limitation of the food to the actual ability of the system to digest and assimilate, is the best means of combating the diarrhoea which constitutes a prominent and troublesome feature in this disease.

Various antiseptic drugs have been recommended for use in this disease. Some of them certainly possess considerable value. An eminent French physician, some years ago, introduced chloroform, administered several times daily, or half an ounce of a one-per-cent aqua solution of chloroform, and with results which seem to commend this remedy to the confidence of the profession. We have used it in a number of cases, and believe it to be valuable. Salicilate of bismuth, naphthol, salol, salophen, and other remedies have been recommended by various observers, the recommendations being comparatively well established by favorable statistics. Dr. Wilks reported more than twenty years ago a succession of 171 cases of typhoid fever without a death. He relied chiefly upon sulphurous acid, which was administered in doses of twenty minims every twenty-four hours, continuing for a week or ten days, or until the patient complains of a sulphurous taste in the mouth and emits from his breath and body the odor of sulphur.

Dr. Yeo, an eminent English physician, recommends chlorine water, which he prepared by placing fifteen grains of powdered chlorate of potash in twelve ounces of water, adding a dram of hydrochloric acid. The bottle should be tightly corked at once. Chlorine (chloric acid) gas is quickly liberated, as indicated by the greenish yellow color assumed by the contents of the bottle. When the action has ceased, pour water into the bottle, two or three ounces at a time, quickly closing the bottle, and shaking and repeating till the bottle is full. be used in very small doses. hydro-naphthol, and carbolic acid have also been used.

This must Charcoal,

J. H. K.

THE THERAPEUTIC APPLICATION OF RAPID VIBRATORY MOVEMENTS.

SOME ten or twelve years ago, Charcot, Mortimer Granville, and other experimenters investigated at some length the effects of rapid vibrations, termed by Granville nerve percussion. Granville devised an electrical appliance for producing rapid vibrations, one of which. was obtained by the writer and used for some time with some degree of success. Recently the late Prof. Charcot renewed his investigations of this subject, his attention being called to the value of vibration as a therapeutic means, by the reports of patients suffering from paralysis. agitans, who said that they experienced great relief from riding in railroad trains or on wagons. These patients stated that during these journeys they were often completely relieved of all painful and unpleasant sensations, and that the relief continued for some time after the journey had ended.

This led Prof. Charcot to construct a chair for the purpose of producing vibrations similar to those produced by the jolting of a railway carriage, or of a wagon. Many patients have since been treated by him and his assistants with the vibrating chair, and with excellent results. The treatment must be administered daily and continued from eight to ten minutes. Good effects are generally most apparent on the day following the application. Gilles de la Tourette has extended the application of this mode of treatment by devising a vibrating helmet by which the vibratory movements are communicated to the skull and its contents. This apparatus, which the writer had the pleasure of testing recently, is said to be of great utility in cases of sleeplessness. The writer has employed vibration in the treatment of disease for more than fifteen years, and for ten years or more has had in use a vibrating chair, the effects obtained by which have often

been found to be very satisfactory. Dr. Morselli (Klinische Hydrotherapie) has made a variety of experiments with this therapeutic agent in different forms of psychosis, and offers the following summary of the results obtained :1. Vibrations may be appropriately applied in cases of psychosis with local symptoms, especially in cases of mental debility with neuralgia.

2. Simple or passive melancholia in the first stage, melancholia with intercostal neuralgia, and insanity with delusions, have sometimes shown a decided improvement upon the application of a vibrating tuning fork either to the forehead or to a painful point.

3. In some cases of hypochondriasis with occipital neuralgia, short periods of relief were obtained.

4. In cases of sleeplessness in persons mentally diseased, vibrations seem to be

without effect.

5. In cases of neurasthenia and hysteria, the method was very successful. 6. The effects of vibration were in most cases quite transient, seeming to depend upon suggestion.

7. Vibrations seem to have a marked sedative rather than an exciting effect upon the nervous system. J. H. K.

Chronic Iodism.- In a recent number of the Hospital Gazette, Mr. Jonathan Hutchinson, the famous English surgeon, differs from the opinion expressed by some army and navy physicians as to the effects of syphilis upon the muscles, asserting that the great depreciation in muscular energy frequently noticed in many syphilitic cases at least, is not due to the disease itself, but to the prolonged use of iodide of potash. This fact is an important one, to which the attention of the profession cannot be too

earnestly invited. earnestly invited. The depressing influence, not only of iodide of potash, but of all iodide salts, is well recognized by all authority; nevertheless, physicians

not infrequently prescribe this drug in large doses, and continue it for months and even years. That the patients should find themselves in a state of muscular and general enervation after swallowing from a half dram to two or three drams of iodide of potash every day for a prolonged period, should not be a matter of astonishment. The success which attends the treatment of this class of maladies at Hot Springs and other places where hot baths are freely used, is not due to the specific virtues of the water employed, but to the fact that the vigorous perspiration induced aids a more rapid elimination of the iodide of potash and other drugs employed, and thus prevents, in part at least, very serious injury from the long exposure of the tissues to the toxic influence of these agents.

The principle involved in this matter is a very important one, and one which has a broad application. There can be no doubt that thousands of people induce chronic and sometimes incurable diseases by the habitual swallowing of patent medicines containing powerful drugs of various sorts. But it is probably unfortunately true also that medical men are not infrequently responsible for the damage produced in the same way through neglecting the fact that drugs are two-edged swords, and capable of producing great injury as well as great good.

J. H. K.

Thyroid Grafting in Myxedema. A case was recently reported in the Edinburgh Medical Journal in which myxodema of a very advanced and pronounced type, was cured by the ingrafting of a portion of the thyroid gland. The writer has seen great improvement in these cases from the employment of electricity, massage, regulation of diet, baths, and other hygienic means. Improvement has also been reported from the use of the powdered thyroid gland administered by the stomach. J. H. K.

The Policeman's Club.- We are glad to note an editorial article which appeared some months since in the Alienist and Neurologist, entitled, "The Deadly Policeman's Club and the Brutal Clubber." Any person who has had any considerable experience in the city dispensary work will heartily agree with Dr. Hughes that science and humanity protest against the "brutalism" of the policeman's club, and that it is high time that "the club" should be abolished and the "clubber" suppressed. It is not an uncommon thing to find men who have been severely clubbed for no offense whatever on their part, except that of finding a bed on some door-step or falling asleep in some narrow passage for want of some better sleeping place. A blow and a gruff order to "Mové on" is the brutal sort of sympathy too frequently manifested by the guardians of the public peace in our large cities. The writer has often met men whose heads or shins had been so badly bruised in this manner as to require some weeks of treatment to secure complete recovery. It is certainly time that this brutality should cease.

J. H. K.

The Umschlag for Insomnia.-Late medical journals are publishing an article on the hypnotic effects of warm bandages, quoted from a French medical journal,

crediting Alldorfer with the invention of the moist abdominal bandage as a relief for insomnia. The bandage is applied by means of a linen cloth moistened in water and wrapped about the trunk, then covered with oiled silk or rubber cloth to prevent evaporation, and lastly with a flannel to prevent loss of heat. Alldorfer claims excellent results from the use of this remedy for relieving insomnia, his theory being that by the dilatation of the vessels of the trunk, a condition of anæmia is produced in the brain which favors sleep.

It seems not to be known to our medical contemporaries that this method of

treating insomnia originated not with Alldorfer, but with Priessnitz, the watercure empiric who created such a great sensation in the early part of the present century, attracting to his water-cure in Austrian Silesia chronic invalids from all parts of the world, and astonishing and puzzling the medical world with the rapidity and soundness of the cures which he effected. Winternitz, professor of hydrotherapy at the Polyclinic at Vienna, employed moist leg bandages from the knee down in addition to the trunk bandage.

Having employed measures of this sort for the relief of insomnia for more than twenty years, and with most excellent results, we feel prepared to commend this simple remedy as far superior to any medicinal hypnotic which has been extracted from coal-tar products or from any other source. The moist abdominal bandage is retained over night. On removal in the morning, the parts should be bathed in cool water, or equal parts of water and alcohol, and a dry bandage should take the place of the moist bandage to be worn during the day.

J. H. K.

Vegetarian Diet in Disease of the Thyroid Gland. L. Breisacher, of Leipsic, observed that meat extractives produced poisonous effects in dogs upon whom the operation of thyroidectomy had been performed. Ewald found that a removal of the thyroid in pigeons produced no effect whatever upon health. Rabbits were also unaffected by the removal of the thyroid gland. Ewald attributes the differences in thyroidectomy upon dogs and rabbits to the fact that dogs are carnivorous, while rabbits are vegetable are vegetable eaters. Dr. Thompson argues from this fact, in a recent article in the New York Medical Journal, that in cases of grave disease of the thyroid, a meat diet is to be as much restricted as is a farinaceous diet in diabetes, it being clear from the

Substitute for Senn's Discs. The

ingenious decalcified bone discs invented by Dr. Senn, gave a new impetus to intestinal surgery, and revolutionized the methods employed in this branch of surgery, besides giving rise to a number of new operations which had not previously been attempted. Numerous substitutes for the discs have been proposed, but none, so far as we know, which has offered any real advantages over the decalcified bones. One of the latest substitutes is that suggested by Baracz, which consists of sections made from the Swedish turnip. J. H. K.

A

REVIEWS.

new Illustrated Dictionary of Medicine, Biology, and Collateral Sciences.-P. Blackiston, Son & Co., Publishers, Philadelphia, Pa.

Dr. George M. Gould, already wellknown as the editor of two small Medical Dictionaries, has now about ready an unabridged, exhaustive work of the same class, upon which he and a corps of able assistants have been uninterruptedly engaged for several years.

A feature that will attract immediate attention is the large number of fine illustrations that have been included, many of which - as, for instance, the series of over fifty of the bacteria-have been drawn and engraved especially for the work. Every scientific-minded physician will also be glad to have defined several thousand commonly used terms in biology, chemistry, etc.

The chief point, however, upon which the editor relies for the success of his book, is the unique epitomization of old