studied the effects and indications of cold baths; and, thanks to their works, Balneology became more extensively known and practiced.

Three great indications dominate the treatment of eruptive fevers: to moderate the fever, quiet the nervous disturbances, prevent or combat the secondary infections. To moderate the fever is to moderate all its component elements, the rise of temperature, acceleration of the pulse, dryness of the mucous membranes, disturbance of the excretory functions, etc. In Germany great importance is attached to hyperpyrexia, and this is what they seek to combat by means of cold water. High temperature is but one element in disease, and to-day it is no longer considered as the cause of the cerebral lesions and albuminuria, these manifestations depending more upon the infection; yet high temperature directly threatens life by the disintegration of tissues and death of the leucocytes. The antipyretics, quinine, anti-febrin, etc., give but insufficient results, and are not without drawbacks (toxic effects, cyanosis, nervous depression), besides their effects are inconstant. Therefore it is better to avoid their use and attempt to obviate the general disturbances which accompany high temperature. Hydrotherapy certainly provides more efficient means, easier of control than any other method of treatment, enabling the physician to combat the fever and the nervous disturbances.

Water can be administered in the following ways: warm baths, tepid baths, cold affusions, cold pack, cold bath.

1o. A warm bath is useful at the commencement of all eruptive fevers, particularly of scarlatina and variola (at the beginning of the eruption); it cleans the skin, decreases the painful sensations of heat and tension caused by the eruption, when the latter appears on a skin thickened and unclean. This is the only real indication of the warm bath; yet it is useful in young children, at the period of invasion of the disease, when convulsions are threatened. The temperature of the bath should be 86° to 95°F., and the duration ten to fifeeen minutes; the child at the end of the bath should be wrapped up in a warm sheet, put in bed and thoroughly rubbed dry.

2o. The tepid bath, 77° to 86°F., is not much indicated except as a means of preparing the patient for cold baths. Its action is sometimes sufficient to produce quiet and diuresis.

3°. The cold affusion is indicated when the temperature becomes high, 102° to 106°F., with a dry skin, and when at the same time adynamia, delirium, excitement give rise to fears of convulsions. Such a condition is particularly observable at the beginning of eruptive fevers, before the rash or during its development. The affusions are to be applied as follows the patient being carried naked in a bath-tub, three or four pails of cold water are thrown suc

cessively upon him. Trousseau recommends water of a temperature of 68° to 77°F. For children the first affusion should not be below 76°, for adults it may be as low as 75°, the temperature of each succeeding affusion being lowered. The duration must never exceed one minute, the patient is then wrapped up in a sheet and blanket, put to bed, but not wiped dry.

The affusion does not lower the temperature much, but it slows the pulse and relieves the cerebral symptoms, the delirium and excitement; it favors the cutaneous congestion and eruption, causes a tendency to sleep, sometimes even a true depression that can be overcome by alcohol. The effects are short; therefore it must be applied four or five times daily.

4° The cold pack is only applicable to children; for it requires that the patient be frequently moved and a frequent repetition. The patient is wrapped carefully in a sheet wrung out of water at 54° to 57° F. for ten minutes, after which he is placed on another sheet prepared in the same way. Three or four packs are used at each sitting, and after two hours' rest the whole procedure is repeated again. The process is certainly quieting and cooling, but it is tiresome and unpleasant to both patient and nurse.

5°. The cold washings are indicated in the same cases as the cold affusions. The process is simple; a sponge full of water at 64° to 77° F., is passed over the body repeatedly for two minutes. The skin becomes less hot and dry, the pulse falls from 180 to 150 in children, from 140 to 120 in adults; the cerebral symptoms lose some of their intensity, but the effects are of short duration, the operation having to be repeated every two or three hours. Steiner recommends us to add some vinegar to the water and to rub the skin until it becomes thoroughly red, after which the body is wrapped in a cold sheet, while the lower extremities are covered with a warm blanket. A blanket is then wrapped around the whole body.

The cold baths constitute the selective method in persistent pyrexia, with tendency to adynamia, when there is no cyanosis nor feebleness of the pulse. The pulmonary complications, congestion and bronchopneumonia, far from being contra-indications, are favorably influenced by the cold baths.

The duration of the bath should be short when the patient is a child. As a rule an adult requires an immersion of fifteen minutes. The abstraction of heat which at first takes place is followed by a reaction which sends up the temperature, and therefore the immersion must be sufficiently long. The bath should be repeated every three hours, until the temperature. has approached normal.

7°. We must refer to another form of Balneation, we mean baths made gradually colder, which are especially applicable to children. Whatever be the temperature of the bath, it is beneficial when the patient is a young child, to pour upon the back of his

neck small quantities of water, slightly colder than that of the bath.

Scarlatina. During the invasion and at the beginning of the eruption, hyperpyrexia, extreme excitement, violent deliriums, rapidity of the pulse and dyspnoea require the energetic use of cold water.

The cold sponging is only useful to decrease the sensation of heat of the skin and quiet a moderate nervous excitement. When the danger is great and hyperpyrexia extreme, one must have recourse to affusion; under its influence the patient comes out of his torpor, resists and cries, his breathing becomes easier, the cyanosis disappears. When just back to bed, he generally goes to sleep. The affusion has sometimes to be repeated six to eight times during the day.

The cold bath is indicated when the fever persists, without oscillations, around 104° F., and is accompanied with cardiac and respiratory trouble. The duration of the bath should not exceed five to seven minutes for children; it is better to renew it than to make it longer, for there is danger of increasing collapse and weakening the heart. When this is to be feared the bath must be limited to two or three minutes, and small doses of caffein injected hypodermically.

If, for certain reasons, the cold bath cannot be used, a gradually cooled bath should be substituted. Its action, however, is less efficient, and it may cause shivering.

Measles. In malignant measles with hyperpyrexia, delirium, cyanosis, hydrotherapy is the only active means. The cold bath is to be administered as explained above.

When adynamia is great, the cold affusion is serviceable. In convulsions, a tepid bath with cold affusion to the head is to be commended; at the same time small repeated doses of chloral are good, by mouth or in enemas.

Pulmonary congestion and broncho-pneumonia with high temperature are favorably affected by baths. A tepid bath gradually rendered colder and combined with cold water poured on the head is useful in the course of broncho-pneumonia when meningeal compli

cations are feared.

Variola. The use of cold baths is eminently useful to overcome the nervous accidents and moderate suppuration; tepid baths decrease the pain; warm baths cleanse the skin..

bath does not have a bad effect upon the eruption; far from it, for it favors the dilatation of cutaneous vessels, and also facilitates diuresis. It must be renewed whenever the temperature reaches 102° to 104°, never less often than at three hours' intervals. After fifteen minutes immersion the patient is wrapped in a sheet, put to bed, given some alcoholic, and dried rapidly.

During the suppurating and dessicating period the prolonged tepid bath (one-half hour) will moderate the swelling and quiet the pains. If baths cannot be used they may be replaced by general washings with a solution of sublimate of 1 to 1,000, repeated two, three or four times a day.

Medical Society Notes.

SEMI-ANNUAL MEETING OF THE MEDICAL AND CHIRURGICAL FACULTY

OF MARYLAND. November 17, 1891.

Dr. G. J. Preston read a paper on the "Rest Cure, and the Cases to which it is Applicable," in which he referred to Hodges' experiments as the material foundation for this plan of treatment. It has been shown conclusively that when a nerve cell has been kept at work for some time by electrical stimulation and its protoplasm used up, it. will regain its lost material if it is allowed to rest. We have come to apply the principle of rest to deranged function or disease of many organs. Thus, where the stomach fails to carry on properly the process of digestion, whether merely from functional derangement or because of actual structural disease, we feed by rectum and thus put the stomach at complete rest. The rest cure may be said to be made up of the following elements: isolation, rest, forced feeding, and artificial exercise, which latter is effected by massage and faradization. Isolation should in most cases, and always in the bad cases, be absolute. The patient should be removed to a hospital or boarding-house, and not allowed to see any member of his family or friends-no one but the doctor and nurse. One of the advantages of isolation is that the patient is taken away from the sights and sounds that in so many cases have become well-nigh intolerable. The room in which the patient is put should be of good size, airy and simply furnished; it should at first be moderately dark; though later on, and in some cases from the beginning, a sunshiny room is best. The temperature should be kept at the same point, and it is better to have the room too cold than too warm. In the worst cases absolute rest must be insisted upon, the patient being put in a comfortable bed and not allowed to make a single movement. In other cases rest should be only moderate;

perform certain duties, but dressing or undressing, or anything that is fatiguing should be done by the nurse. Forced feeding is one of the most important elements of the treatment, and one that requires great care in its application. Most of the cases that require this treatment are dyspeptic, have no appetite and loathe food. It is well to have the diet light for a few days, the bowels being well opened, and the patient allowed to have a little bread and butter and a glass of milk three times a day. In a certain class of cases, especially those mentioned by Playfair, in persons who are fat, it is a good plan to reduce the fat by moderate starvation, and then put it on again by feeding. After a few days of light diet, the amount of food is to be gradually increased and rendered more nutritious. A cup of strong coffee with a biscuit in the morning on waking, in an hour a substantial breakfast of steak, eggs, etc., in two hours a roll and a glass of milk, in two hours a stout lunch or dinner, with a glass of ale or beer, milk again in the afternoon, and tea or dinner at the close of the day; another glass of milk before bedtime and a glass during the night. In some cases it is necessary to give smaller quantities of food at shorter intervals. Alcohol is to be used sparingly; a glass of sherry and a biscuit once or twice a day-or, what is better, malt liquor at the midday and evening meal. If the patient has always been accustomed to a late dinner, and is not kept awake by eating a large meal at the close of the day, it may be taken then, otherwise at midday, and the evening meal may be a light one. Sometimes we may give anything that the fancy of the patient may dictate, and others it is necessary to use certain special preparations, as raw meat-soup, finely chopped raw or rare meat, partially digested food,

etc.

The author prefers to get the patient as soon as possible on ordinary diet; raw beef, eggs, oysters, sweet-bread, soups and milk in abundance.

The nurse selected should be firm, cheerful and not too talkative, and thoroughly understand massage and the use of the Faradic battery. Massage should be begun a day or two after the patient comes under treatment. General massage with passive movements of the joints should be practiced every day, beginning with a séance of fifteen minutes, and gradually increasing up to an hour or an hour and a half. This should be done in the morning, and so timed that the patient may have a sleep after it is all over. In the after

noon the muscles should all be made to contract with the Faradic current, without causing too much pain. As the patient begins to improve, which is often after a week, some very limited voluntary motion may be allowed, such as sitting up in bed for a few minutes. She should not be allowed to get up for several weeks, and then very gradually; at first only for a few minutes on the sofa, then longer; then a walk across the room, and so on until out-door exer

cise can be taken without fatigue. It is well to have the patient sponged every day with tepid water, and as improvement goes on use the cold spinal douche, or the alternate cold and warm douche every morning.

As regards the class of cases in which this treatment is indicated, the one in which the best results can be expected are cases of nervous exhaustion, or neurasthenia. There are patients, however, to whom the rest cure soon becomes intolerable and it has to be abandoned, and others who are willing to submit but derive no benefit from it. If besides the neurasthenia there is a marked element of neurasthenia or hypochondriasis, the case is much more difficult to treat, although the strong mental impression produced by isolation and strict discipline is often beneficial.

Dr. T. A. Ashby said that he had had a number of cases in his own practice, where the rest cure had proved of great value. He thought that the ovaries were removed too frequently in neurasthenic cases.

Dr. Black believed that forced feeding was of the greatest importance, and recommended especially peptonized enemata. He had observed in many cases that the patient, even with the most perfect rest, would not show improvement until forced feeding is resorted to.

AMERICAN PUBLIC HEALTH ASSOCIATION. October 20-23, 1891.

Dr. McDonald, of Kansas City, read a paper on "The Cause and Prevention of Infant Mortality," in which he presented statistics showing that infant mortality soon after birth is 20 per cent. One of the principal causes is exposure to a low temperature (a chilly room) soon after birth. Forcing sleep by soothing syrups to counteract the effects of this exposure is another evil, and another is the forcing of food, such as crackers, water, and whiskey into the stomach of the newly-born child. Improper feeding and dressing are prolific causes of infant mortality.

Mr. Allen Hagen, of Lawrence, Mass., in a paper on "Water Supply and Public Health," spoke principally upon the typhoid fever and cholera germs which infect impure water, and are taken into the system through food and drink. If water is free from sewage it can be depended upon as being comparatively pure, although many waters not polluted by sewage have been known to breed disease. Flowing streams will partially purify themselves; reservoirs and long channels, where water flows and becomes ærated, will not always purify it. Some method of filtration is therefore requisite, but most of the methods thus far proposed are more or less defective. Dr. Paul Pacquin read a paper on "Vaccine and Vaccination," in which he emphasized the necessity of obtaining perfectly pure vaccine matter. In speci

mens examined by him he had found pus organisms, the bacillus septicus and gangrene micrococcus. When inoculated on rabbits, guinea-pigs and fowls such vaccine matter produced abscesses, gangrenous lesions, septicemia and pyæmia.

Dr. Peter H. Bryce discussed the "Present Position of the Milk Supply Problem from the Public Health Standpoint." His conclusions were as follows: 1. It is especially desirable that a system of periodic veterinary inspection should be exercised in addition to the dairyman's inspection. 2. The nature and quality of food for cows should be carefully investigated. All decomposed foods, as well as those which are liable to undergo fermentation, should be wholly avoided. The best foods are well ripened grains and grasses. 3. The stables of the cows are a point of great importance, as is also the water supply. The stables are frequently nothing but dark, damp, and ill-ventilated pens. 4. The care of the milk at the time of taking and subsequently is of all points at once the most difficult and the most necessary to supplying a wholesome milk. The steritizing of all cans and bottles by steam or dry heat and the boiling of all strainers will be necessary. 5. The delivery of milk is of prime importance, and when it has reached the consumer it must be placed in a refrigerator or promptly consumed.

Prof. W. W. Daniels read the report of the committee on car sanitation, in which the general conclusion was reached that all the systems of heating cars are defective, because no particular attention is paid to ventilation.

In a paper on "Rabies" Dr. J. J. Kinyonn opposed the idea that the disease is confined to warm weather, as statistics show that the greater number of cases occur in December and May. He advocated the establishment and enforcement of strict quarantine regulations in order to eradicate the disease.

Literary Notes.

TREATISE ON GYNECOLOGY, MEDCAL AND SURGICAL. By S. Pozzi, M D., Professeur agrégé à la Faculté de Medicine, etc. Translated from the French, under the supervision of and with additions by Brooks H. Wells, M.D., lecturer on Gynecology, New York Polyclinic, etc. Vol. I., with 305 engravings and 6 full-page plates in color. Pp 591. New York: William Wood & Co., 1891.

This stately volume demonstrates on every page that it is written by a man who is practically conversant with his subject, from an historical and clinical standpoint.

The author takes a just pride in the "glorious past" of French gynecology, and offers ample historical evidence in support. He has succeeded admirably He has succeeded admirably

in his "endeavor to present an exact statement of the present condition of gynecology in all countries, without giving a cumbersome mass of detail." The opening chapter, "Antisepsis in Gynecology," attests the good sense of the author. "Absolute cleanliness of the hands is of great importance in surgery, but is preeminently a matter of necessity where there is to be manipulation of the vaginal and uterine cavity; for, in these situations, pathogenic germs find a culture medium essentially favorable to their development, and infection is rapidly initiated."

The author gives minute, yet not cumbersome details, on disinfecting the operator, instruments, operating room, patient, etc.

Anæsthesia, hæmostasis, sutures, and gynecological examinations are followed by pathology, symptom atology and treatment of all diseases peculiar to

women.

The illustrations and mechanical execution of the work leave nothing to be desired, the name of the house issuing the work being a guarantee therefor.

The plates, giving an easily comprehended plan of the Johns Hopkins operating room, and that of the Lourcin-Pascal in Paris, are beautiful. The colored plates on laceration of the cervix, submucous fibroids and Hegar's treatment of the pedicle after supera vaginal hysterectomy, are simply superb.

The chief value of the work lies in its adaptability to the general practitioner, who, removed from daily contact with the operating room, will find in the vast treasures of this book, help and inspiration in trying emergencies, and practical counsel in the more ordinary cases which present themselves.

We would be unjust to our readers and to the. author of the work did we not candidly acknowledge that "this treatise is undoubtedly the best work on gynecology which has appeared for many years." These words coming from the editor, who is so favorably known as a teacher and editor of the American Journal of Obstetrics and Diseases of Women, and the associate of Dr. Munde, to whom Americans owe so much in the literature of gynecology, are the best commentary we may make on Pozzi's great work.

The Nutrition of the Heart.-Prof. Zunz likens the working power of the heart to that of a machine which daily lifts 20,000 kilogrammes, one metre. Of course, increased muscular exertion augments the work done by the heart because it has to transmit a large quantity of nutriments and oxygen to the muscles. Hence, to attain this end without increasing the work of the heart, the blood should be concentrated as much as possible by an albuminous diet and restriction of the amount of fluids taken into the system.

THE

salads with oil and use oil in cooking. The Asiatics have been large oil consumers, as we are told that

66

A recent paper on American Climates and Their Physical Effects on Man," read before the American Climatological Association, and published in the Sanitarian for January, 1892, by Dr. Remondino, justly lays stress upon the great need of attention to this subject. The great neglect of the matter of adaptation of diet to climatic condition is a constant source of ill health and of evil climatic effects which otherwise would not exist. We here neglect to observe the silent teachings of nature, which point to the fact that our body needs a certain steady amount of fats. In the far north the Esquimaux is supplied with the seal and other animals that are rich in oil. In the temperate regions we have nuts and many seeds that are as oily. In the tropics nature has provided man with an endless variety of palms and other plants that furnish a generous supply of oil. In the far south a variety of fat sea fowl furnish rich, oily food, just as it is found on the Icelandic coast and in the extreme north of western Europe. On the shores of the Mediterranean the inhabitants, from a knowledge reached by the accumulated experience of ages, which has merged it into an unconscious taste through heredity, use large quantities of vegetable oils; they make

Tyrian artisans alone were furnished with one hundred and fifty thousand gallons of olive oil as part of their food supply. Palestine received the largest part of her royal revenues, in the palmy days of the Judean kings, from its duties on the export of the oil to other Mediterranean ports in Europe, Asia, and Africa. The use of these oils does not affect man like the fat of beef or of pork, nor it does require the same digestive efforts, neither does it furnish to the system those products which if uneliminated tend to develop uraemic diseases; for this reason they are peculiarly applicable as foods in our variable climates, where sudden changes to great warmth makes a too free and generous animal diet dangerous. Americans should cultivate a taste for olive oil and encourage its manufacture. The planting of olive groves wherever practicable, and the curing of the olive, should receive more encouragement and attention from the Department of Agriculture. The use and taste of the olive as a food should be taught, encouraged and cultivated. This seems a trivial thing; but were olive oil more generally and extensively used, many of the symptoms and conditions which go to form the long category of neurotic ailments that Beard has so graphically described under the general head of American nervousness would disappear. The ancient habit of bathing and anointing would greatly assist in producing a better condition in man subject to variable climates. Climates may be bad, but many of their evil results we can avert or modify, and to do this we must use our observation, study into past and act on intelligent premises."

Experience has demonstrated the increased tendency to gout, rheumatism, Bright's disease, and nervous affections in persons who habitually consume large quantities of meats. The extractive salts contained in meat are known to be inimical to the human economy; they are eliminated rapidly from it. Indeed they have been not inaptly regarded as almost analogous to certain constituents of the urine.

The accumulated experience of the profession has demonstrated the value of abstaining from the free use of red meats, especially in the diseases referred to. Fothergill, than whom we have no more practical guide to diet in gout, rheumatism, and Bright's disease, maladies so prevalent in Great Britain, that they have long claimed the most careful study of its practitioners, has given us a graphic warning which, unhappily, is too much neglected at the present day.

In prescribing a non-meat diet we are often met by the question, what is left for me to eat? Fats, fish and farinacea. These, carefully prepared, and adapted to the condition of the patient's digestion, as indicated by gastro-intestinal symptoms and careful