For the relief of ocular pains and headache, Doctor Shaller suggests vibration of the muscles. and integument located over the second or third cervical vertebra at the point of tenderness, which may be found upon pressure. If the recti capitis and oblique muscles are tender, which may be ascertained by deep pressure between the occiput and axis, vibration may be applied over this region until the tenderness is lessened, say from five to ten minutes.

When there is deep-seated or visceral pain of inflammatory origin, he examines the spine at the exit of the spinal nerves of each side for tenderness and applies the vibrator at that point. In acute conditions he relies on codeine for the relief of pain, while, of course, endeavoring to learn. the cause and correcting it.

Regarding the pains of severe and possibly incurable chronic disease, such as cancer, for instance, Doctor Shaller says: "If there is no possible chance to remove the cause, I would treat such a patient as I would wish to be treated under similar circumstances. While pain does not kill very quickly, still I would prefer to be comfortable. I prefer in such cases a combination of morphine, hyoscine, cactoid, pilocarpine and caffeine (known as H-M-C Modified-Abbott). I would permit such a patient to try to obtain relief from any source in which he or she had faith. I would not take away hope, but make every endeavor to keep the mind on the idea of relief, with belief in its attainment." He goes on to say: "There is no doubt that the mind has much greater. influence than physicians are willing to ascribe to it, in affording relief and even in producing cures. The sooner we begin, as a body, to train the mind to control the body through effort of the will, the sooner will we benefit our patients. This is without regard to the kind of treatment we give."

Dr. A. Rose, New York, thinks that the continuous warm-water bath is the ideal remedy to relieve pain. The monotony of Napoleon's life at St. Helena was interrupted by pains he suffered from cancer of stomach and liver, and he found relief by remaining in warm water for hours and even for whole days. The water had to be carried to Longwood from a distant fountain. In his testament he wrote "if my captivity is extended to my remains, I wish to be buried at the foot of the fountain to which I owe so much relief."

"A few weeks ago," writes Doctor Rose, "I saw a colleague who had been suffering and was suffering from severe abdominal pains and these pains had existed for weeks day and night. I had not been attending him, only learned at my visit that some obscure duodenal trouble was the cause of his distress. I suggested the continuous bath

and learned to my satisfaction that my suggestion had been accepted and that a few hours in the bath had given complete and permanent relief.

"In order to demonstrate the action of the continuous bath as an anodyne, we can study its effect in burns; here it gives almost immediate, and even complete, relief from pain, and can be regarded as the most excellent means of treatment. Even if it offered no other advantages, it would be of great value on account of this soothing effect when the pairs are most excruciating. Another advantage of the warm-water treatment is that the water penetrates the burnt tissues, in consequence of which they remain moist and soft. Without the immersion the cuticle which has been destroyed in its whole depth would harden and form an impenetrable covering over the underlying parts. Immersed in water, tissues which have become gangrænous cannot dry up, but remain

moist. They detach themselves easily and are washed away after having become detached. Thus the wound is constantly kept clean. There is no accumulation of pus, there are no crusts of dessicated wound secretions, and most essential, no dressing is required. The patient has not to suffer the often painful process of change of dressing.

"The most essential advantages of the continuous bath are those which we understand from its physiological action on circulation and innervation. It eliminates the products of inflammation and infection.

"The warm bath, in surrounding the surface of the body with an equally tempered medium, does away with fluctuation of the loss of heat, and thus acts soothingly. The thermic irritation of the peripheric nerve-ends, while it lessens the sensation of pain, calls forth at the same time, by way of reflex action, especially in the muscles, an increased metabolism. The fatigue or exhaustion of muscles is caused by a supernormal accumulation of the products of their function. To oxidize and eliminate these products a certain amount of metabolism is required. The specific effect of the warm bath is to afford immediate facility for

This

oxidation. The changes of the physical and chemical conditions of the tissues, the augmentation of the organic function, the acceleration of the blood circulation, the dilatation of the bloodvessels all depend on the specific action of the continuous warm bath on innervation. When a part of the body is placed in warm water, the nerve-ends of the skin become irritated. irritation is transmitted to the vasomotor nerves, and is followed by dilatation of the blood-vessels and, consequently, by an acceleration of the circulation. This accelerated blood circulation facilitates the elimination of the products of inflammation and infection, and, with the removal of pyrogenous substances and toxins through the general circulation, the fever will be reduced, the pain relieved.

"When reading history or studying ethnography we feel horrified upon learning of barbarous cruelties, but nothing can surpass medical cruelty when cases of extensive burns are treated with all kinds of dressings instead of resorting to the most rational, the ideal method of placing the patients into a warm bath.

"Of the soothing effects of the continuous bath in cases of arthritis, especially rheumatic arthritis, I need not speak here in detail; they are too well known.

"Bauddocque, the great French obstetrician, who lived during Napoleon's time, made use of the continuous bath in cases of peritonitis.

"In ecnelusion I beg to refer to my book, 'Carbonic Acid in Medicine,' in which I have devoted a chapter to the continuous bath, describing also the arrangement for it in all details, and also to my elaborate paper. "The Continuous WarmWater Bath the Rational Remedy in Phymatia (Tuberculosis) and Infectious Diseases in General,' International Clinics, Vol. II, 23d Series."

Dr. T. G. Atkinson, of Chicago, Ill., considers that the anodyne action of heat in neuric pain is almost wholly due to its vasodilatory effect. Practically all neuric pain is either toxic or anemic; due to either a perverted or an insufficient blood supply. In either case, the flood of wholesome blood, with its nutrient and defensive elements, which the expanding and relaxing influence of heat brings to the part supplies the need of the suffering tissues and changes the nerve message from one of pain to one of comfort and well-being. In the case of muscular pain the same principle is exemplified, though in a slightly different way. Muscular pain is usually the direct result of spasticity, which is relaxed by the action of the heat, and at the same time whatever toxic and anemic factors are present are removed in the same way

as in neuric pain. Wherever the pain is due to tension, of course, heat is contra-indicated.

In cases where heat is unavailing, as where pain is due to inflammatory, congestive conditions, and where cold is equally undesirable because of its reactionary effect, we have an excellent agent in the shape of electricity. The positive electrode of a galvanic battery, passed continuously over the painful part, with the negative electrode on some indifferent point of the body, contracts the capillaries and lessens the congestion, at the same time driving the excessive alkalies of the tissues away from the affected part toward the negative pole, thus relieving both the inflammation and the pain.

Massage the doctor regards as a mechanical counterpart of heat as an analgesic agent. Indeed, he questions very seriously if it be not the transformation of the friction into heat in the tissues that produces the desired results. This, of course, refers to hand massage and other forms which massage the tissues en masse. With vibratory treatment, which is also a valuable physical agent for the control of pain, the case is perhaps a little different, especially with high frequency vibrations. No doubt the effect of these vibrations, in addition to the heat which they generate, is a little more genuinely physiologic-that is to say, they induce some degree of molecular vibration in the tissues themselves, playing, as it were, the part of a tonal potential, such as the spinal cord plays, and thus bring nourishment and defense to the affected parts. Vibratory treatment is especially indicated in the pain of chronic conditions, and is a most valuable analgesic agent in these cases, as well as an alterative one.

Dr. Atkinson does not look upon hydrotherapy as anything more than a convenient mode of conveying heat to or from the body, and that which he has said under the heading of heat as an anodyne he wishes to be applied to the hydrotherapeutic treatment of pain. Cold applications he does not believe have any place in the relief of pain, and very little place in the control of inflammation. The reaction from cold makes it necessary that, for antiphlogistic purposes, it be applied continuously, for long periods; and this is not desirable in the great majority of cases, because of its lowering effect upon the vitality of the part. It is, in short, not physiologic; and is to be reserved for those cases of exceedingly severe, sthenic inflammation in which we are obliged to transcend and antagonize physiology.

There is one use of water, however, says the doctor, which has nothing to do with its heatcarrying properties, which is a very valuable

recourse for the relief of muscular and neuric pain, and which he thinks is not utilized nearly as much as it might be. That is the specific gravity, or weight displacement of water. To place a patient in a bath is often a most effective way of relieving an irritated nerve or a spastic muscle of its spasm, and not only of giving temporary deliverance from pain, but of inducing a relaxed condition which continues after removal from the bath. This result is attained by reason of the weight displacement effect of the water. It is best, of course, to combine the heat element with the displacement, and have the water in the bath appreciably warm. In this way we accomplish a double effect of resting the limb and inducing a healthy flow of blood and nutriment to it at the same time.

Ocular pains and headaches are of such various origin and character that the doctor finds it difficult to summarize any scheme of treatment. In general, he thinks, the indication in these cases is for what may be called the therapeutic negative, that is to say, the removal or correction of all those factors which are concerned in the production of the pain or which help to aggravate it. Fortunately, not many eye diseases cause any great degree of pain. Glaucoma and iritis are the two great exceptions, the pain of the former being due to intraocular tension, that of the latter to contraction of an inflamed iris-a muscular pain, in fact. The therapeutic indication is clear in each case. In glaucoma, to reduce the tension of the eyeball, first by instilling eserine, which draws down the iris and allows more room for the fluid content of the eye, and, if this does not suffice, by an iridectomy or trephining operation. In iritis, to place the iris completely at rest by means of atropine, and by the application of heat to the eye, as already advocated in muscular pain. Glaucoma is one of the few painful conditions in which cold, continuously applied, is not only permissible but imperative.

There are but two types of headache, according to Dr. Atkinson, which are amenable to physical treatment. One is the indurative headache, due to knotting of the occipital muscles and deposits at their insertions; the other is the true neuro-vascular headache, known as migraine. (N. B. Every one-sided or clavus headache is not migraine, by a long chalk, although usually diagnosed as such.) The indurative headache yields nicely to massage of the occipital muscles around their insertions. Any physician can learn to knead these muscles effectively, if he will but acquaint himself (or remind himself) of the anatomy of their insertion-points. True migraine will almost

always give way to a systematic course of physical treatment looking toward relaxation and perspiration, beginning with a hot bath, followed by a general massage, and ending with the patient being given a hot lemonade and wrapped in a thick blanket. The common treatment of migraine, which is just the opposite of this-cold compresses, absolute quiet in a cool place, etc.-is utterly ineffective. Migraine is a neuro-vascular spasm, and must be treated like any other muscular spasm.

The writer does not believe there is any physical means of relieving the deep-seated pain of visceral inflammations. Hot applications do not really relieve these pains; they merely succeed, if they are hot enough, in diverting the patient's consciousness from the pain to the heat. Not but what this is advantageous once in a while. order to be efficacious, they must be continuously applied; the moment they are withdrawn the pain is felt again.

In

He feels that the same is true of the pains of severe chronic and incurable diseases. They are not amenable to physical measures. The only way to reach and influence them is by means of anodyne or narcotic drugs. He believes, however, that there should be a difference in our method of con

trolling pain in such cases. If there is a good chance of ultimate recovery, we should refrain, as far as possible, from the use of habit-making narcotics. In such cases it is not always necessary that the pain should be completely abated; if it can be so mitigated, or if the patient can be so sustained, as that it becomes tolerable and does not interfere with sleep, that is often sufficient, and for this purpose we may use the physical means already spoken of, and ameliorating remedies. Gelseminine, for instance, while it has no direct analgesic properties, will many times render neuro-muscular pain bearable by lessening the tone of the muscles and thus giving them physiologic rest. In incurable diseases, on the other hand, the doctor thinks there is no contraindication to the use of opiates and other true narcotics, and that it is the duty of the physician to employ them to the extent of making an incurable patient as comfortable as possible.

济济

Nervous Lady (in whose street there have been several burglaries)-"How often do you policemen come down this road? I'm constantly about, but I never see you."

Policeman "Ah, very likely I sees you when you don't see me, mum. It's a policeman's business to secrete 'isself!''

Oily Hair The editor of the Medical Summary is responsible for the following excellent suggestions: A tar or sulphur soap combined with raw eggs is said to be one of the best shampoos for oily hair. A valuable agent for cleansing the hair is a tablespoonful of lime water to each raw egg. The mixture should be beaten thoroughly and massaged into the scalp. The limewater exerts a beneficial effect upon the enlarged sebaceous glands. Once in three weeks is often enough to wash an oily scalp, and too much washing seems to stimulate the flow of oil. Sprinkling the hair with corn meal and brushing it off again with a soft brush is beneficial, as it absorbs grease and removes dirt. A shampoo of one-half orris root and one-half corn meal makes an excellent agent. The mistake that most persons make is in rubbing the shampoo into the hair when it becomes a great source of annoyance because of the trouble it takes to remove it. A soft brush should be used, as a stiff one promotes the flow of oil. A mixture of three drams of glycerin and four ounces of limewater should be kept on the dresser table and the scalp wet with it every night.

Mercury as a "Cure All"-B. L. Wright (Med. Rec.) thinks that mercury has a specific curative action in all the acute diseases directly produced by vegetable parasites. In order to prove curative, however, it is necessary that the initial injection must be extremely large, small and frequently repeated doses not being productive of rapid results.

In infectious diseases, mercury has a dual action; first it unites directly with the bacterial organism and destroys it; second it stimulates the animal body to the rapid production of specific antibodies.

In his clinical work, Dr. Wright has been employing mercuric succinimide, for the reason that larger doses of this salt may be injected than of any other salt of mercury; while, also its parasitotropic property is many times greater than its organotropic advantages.

The initial dose, as already stated, must be very large, the requisite dose for an adult male being about 9-5 of a grain in the early days of an acute infection. At the end of twenty-four to thirty-six hours, if there is no improvement, a second injection of from 5-5 to 6-5 of a grain is injected, providing symptoms of mercurialism have not followed the first dose. In other virulent and quickly fatal infections, such as cerebrospinal meningitis, the initial dose should be 2 full grains. In chronic infections the average adult dose is somewhat smaller-from 5-5 to 7-5 of a grain.

In females, the dose should be from 1-5 to 2-5 of a grain less than for males.

Succeeding injections should be given at from two to four-hour intervals, until ten or twelve injections have been administered; providing the symptoms have not disappeared in the meantime. After ten or twelve injections, the treatment should be interrupted for from two to five weeks, in order to permit of the elimination of the mercury and to prevent the organism from becoming immune to the action of this metal. During the treatment, the oral cavity and teeth must be kept clean, and the bowels must move freely every day. The only contraindication to its use is serious organic disease of the kidneys.

The solution employed is made in the proportion of 1-5 grain of mercuric succinimide to 4 minims of distilled water. This solution is to be injected deeply into the gluteal muscle.

Dr. Wright follows these preliminary remarks with reports of a large number of cases of different diseases treated in this manner with mercurie succinimide. Among these are thirty-five cases of tuberculosis, nine cases of lobar pneumonia, six cases of lobular pneumonia, five cases of typhoid fever, thirty-nine cases of infectious arthritis, eight cases of rheumatic fever, besides a smaller number of cases of erysipelas, cerebrospinal meningitis and others.

Of especial interest is his experience with lobar pneumonia. Of the nine cases treated, eight he declares were cured by one injection, the crisis

usually beginning within about seven hours after the injection, although in several it began within an hour. These injections were given, in the different patients, at different stages of the disease, varying from the first to the fifth day.

In all of his cases of lobular pneumonia, an immediate cure re was obtained, although in one the action was somewhat delayed as the result of an infection of the middle-ear.

In typhoid fever the results were not quite so striking, although really quite remarkable, the disease being cut short in most instances.

In one case of rheumatic fever, when injection was made at 10:30 o'clock in the morning, the crisis occurred at 4 a. m. the next day, at which time all pain virtually ceased.

We quote from an excellent abstract published in the American Journal of Clinical Medicine. VE VE VE

The Pumpkin Cure for Nephritis-Kakowski has recently declared that the pumpkin fulfills all the indications for an ideal "cure" in cases of nephritis. We quote from the Medical Record, which says that Kakowski finds that it fulfills the following requirements of the ideal diuretic food; it should contain considerable water and natural salts, but should be relatively free from sodium chloride; it should be well borne by the alimentary tract and should act as a mild laxative; it should have nutritive value and should be palatable; it should not irritate the kidneys and should not give rise to harmful metabolic products; and it should be easily obtainable, cheap and easily preserved.

The edible portion of the pumpkin is prepared by Kakowski in the form of a porridge, by being cut into small pieces, covered with water and boiled over a slow fire for two hours. It is administered to the patient with butter, milk or cream, or preferably mixed with a rice soup. The preparation most agreeable to the patient is one in which the pumpkin is boiled with milk or with

cream.

The pumpkin cure was employed in severe cases of chronic nephritis in which an edema had been rebellious to the entire range of medicinal diuretics. Long standing and massive edemas disappeared within a short time under this method of treatment. Diuresis occurred after the use only of enormous quantities of pumpkin, varying from three to six pounds per day, and in most cases directly proportional to the amount of this food that was eaten. The diuresis occurred only during the period of administration. The number of casts rapidly diminished, and the reaction of the urine became alkaline. There was no evidence of any irritating effect upon the kid

neys nor of any otherwise harmful influence upon the body.

Diet in Psoriasis-According to Miller (Ther. Gazette) Schamberg's studies of protein metabolism in eight psoriasis cases show that a low nitrogen diet has a most favorable influence upon psoriasis, thus confirming the observation of Buckley made some years ago, who said: "Excess of meat will often increase the eruption, and an absolute and perfect vegetarian diet will often be followed by absence of the eruption as long as it is persisted in." In the clinic as well as in private practice the combined use of baths, arsenic and chrysarobin can still be depended upon to clear up this most annoying condition. A non-protein diet is also urged.

Development

Pineal Gland for Defective Berkeley (Med. Rec.) has been using pineal gland in children who suffer from physical or mental defects, using material obtained from young bullocks. In one case a girl of nine and a half years, about normal in height and weight for her age, with a negative family history, born at term in a precipitant labor with no instruments, remained well until five years of age and then had convulsions. She was operated on four times for adenoids and diseased tonsils, and had a rickety chest, but her organs were otherwise negative, save that she was mentally retarded and had been so for a number of years. The child received pineal gland twice daily; and seven weeks later was reported to have made very marked improvement. A year before the treatment began she could not write a word without help. After treatment she could write simple sentences. In September before the treatment she could not spell. At the end of January, when the treatment had been continued a month, she could spell thirty-eight words out of forty and was able to sew. Cases of a similar character are also quoted.

Berkeley is free to admit that the manner in which the pineal gland does good in these cases is entirely unknown, but he goes so far as to express the hope that if this gland accelerates the sluggish action of the brain in a retarded child, may it not also serve to arrest or delay certain cases of premature breakdown of the mental powers in old age? From his clinical experience he thinks it will.

Gonococci in the Female-A mistake made by many physicians, in examining specimens suspected of containing gonococci, says Norris (Long Island Medical Journal), is to take them from