the product of education, of innate character, of environment, of experience, of fate, of fortune, and of numerous other conditions and must be studied in its relationship to all of these modifying influences each of which has its clinical value. The fundamental elements of insanity are disorders of the emotions and the intellect, and the so-called disorders of the "will" are merely expressions of one or both of the former. In analytical work we note not only positive but negative results. We can frequently determine what disease the patient has by finding out what he has not, making one of the most refined and scientific diagnoses, that by exclusion. Another great field is in the cases classed as neurasthenic and psychasthenic. The remedy for these is in education, plus right environment and living. Good moral education is the surest prophylaxis of nervous exhaustion. These patients are imbued with autosuggestions and must be led away by the earnest efforts of the thoughtful, resourceful physician. Some physicians have so little knowledge of the mentality of nervous people that they do more harm than good. It is in proper self-education that the sick find a cure and well people a preservation against nervous diseases.

HYDROTHERAPY.

EDITED BY CURRAN POPE, M. D.

Hydrotherapy in Acute Leptomeningitis.

Dr. Geo. C. Merriman in an editorial in the Monthly Cyclopedia of Practical Medicine calls attention to the beneficial influence of the hot full bath upon this most unpromising affection. In addition to medication, dietetics, etc., he pursues systemically the plan laid down by Aufrecht. The editor has found it best to place the patient in a tub at a temperature of 95° F. and add water until the temperature reaches 104° or 105° F. The duration of the bath is 10 to 15 minutes, an ice cap being kept upon the head during its application. The bath-tub should be cushioned with blankets and the patient carefully moved to and fro by means of a sheet. The bath should never be administered in the early morning or late in the evening. Its rationale is to draw the blood from the brain. and meninges to the skin; to increase the activity of the latter and the secretions from the sweat glands; to eliminate large quantities of toxins by acting upon the kidneys and produce upon the sensory nerve tracts an anodyne and sedative effect. The editor concurs with Aufrecht and Vorochilsky that the entire course of the disease is rendered mild by these baths.

Lumbar puncture in two personal cases has seemed to help. Personal experience has shown that the hot full bath possesses another feature of no little consideration in the treatment of this disease, and that is the relief of some of the most distressing symptoms that cause great mental anguish to the members of the patient's family.

Dr. Merriman says: "It has been said that the treatment of all cases of meningitis is hopeless, and to save their lives is a crime. I am willing to admit that, in the tubercular form of the disease, our efforts have not been crowned with any very gratifying degree of success, though a limited number of cases have been reported in which the cure was effected and recovery apparently complete.'

So far the treatment of acute leptomeningitis has been, of necessity, purely symptomatic. There is no disease in which the personal equation of the patient bears so great a part as in this most insidious one.

Begin with an active calomel purgative, combining with it a good, honest dose of Dover's powder. Reduce the temperature with ice water sponges and by the application of ice bags direct to the cervical region, posteriorly. Then inject from 1500 to 5000 units of diphtheria antitoxic serum, varying the dose according to the age of the patient and the degree of the infection. After six hours repeat this dose, and continue to repeat every six hours until there be a remission of the symptoms, or the condition of the patient's heart contraindicates the further use of the serum. When the temperature goes above 103° F., or the other symptoms are alarming I give a hot bath, beginning at about 99° F., and increasing the temperature of the bath to from 104° F. to 106° F. The patient is then wrapped in woolen blankets, without drying, and ice bags applied to the neck, or to neck and spine. If the ice be not applied, the temperature will continue to rise, though the general condition of the patient will be improved. I would say that I have found, in collapse, that the administration of a hot bath without the application of ice has a decidedly beneficial effect. Ergot in full doses should be administered, until its full physiologic effect on the circulation is obtained, and the nervous system should be not only depressed, but absolutely held down, by the use of morphine, codeine, or hyoscine. These cases will take enormous dose of the narcotics; I have in several instances been obliged to give small children half a grain of coedine sulphate hypodermically, in order to get any satisfactory quieting effect. As there is no diseased condition in which the indications for the use or withdrawal of a given remedy so quickly and so radically change as in acute leptomeningitis, the utmost caution is needed in the administration of medicines. The temperature must be carefully watched, as

it is irregular, and sometimes drops rapidly under ice, and there is danger of driving it subnormal and bringing on collapse. The bowels must be kept open by the use of cathartics, and all effort must be made to maintain intestinal peristalsis. The bowel may be helped out by the use of high enemata.

In collapse give a hot bath, 103° F. to 107° F. and push active stimulation. Nourishment is maintained by soups, strong broths, milk, whisky, brandy and water. As the patient begins to recover, the dietary is increased and tonics are given, together with iodine in some form, and mercuric chloride.

MECHANICAL VIBRATION-THERAPY.

EDITED BY FREDERICK H. MORSE, M. D.

The Combined Use of Mechanical Vibration and Light in Therapeutics.

Dr. W. R. Rushin, Macon, Ga., sends to the Editor a description of the following method of employing light and mechanical vibration jointly in his treatment:

"My experience with the use of mechanical vibration with light and radiant heat from the high-power incandescent lamp, which I have been using separately for several years, has been followed by excellent results. For the past few months, however, I have combined the two and have achieved results that were far superior to the former method as used separately. In instances with cases of dysmenorrhea, sciatica, and inflammatory rheumatism, it formerly took from three to fifteen treatments to give relief and bring about resorption of the exudates around the joints. Now, one to five applications does the work, giving complete cessation from pain after the first treatment. As an adjunct to the medicinal treatment of diseased conditions, I find the method invaluable.

As to technique of employment, I first turn on the high-power incandescent lamp for three or four minutes and then begin the vibration, while allowing the light to shine directly in the points being treated with the vibrator. I find that patients can bear much higher degrees of heat from the concentrated light while the vibrator is vibrating, than when it is not operating. I also find that penetration is much deeper, thereby producing a more decided effect, through inhibition or stimulation as the case may demand, than with the use of the vibrator alone. Again there is a hyperemia induced by the light and heat from the lamp that is much to be desired in these cases, by reason of the leucocytosis produced thereby enhancing local metabolism to a marked degree."

The writer considers this method of treatment wherever it can be applied to be a most rational therapeutic measure, because the effects are both physiological and philosophical; certainly so in chronic and blood stasis conditions.

STATIC ELECTRICITY.

EDITED BY J. H. BURCH, M. D.

A Plea for Static Electricity. By Margaret M. Sharpe, L. R. C. P., Archives of the Roentgen Ray, January, 1907. The writer narrates a case which she saw while attending the clinic of Prof. Charcot of the Saltpetrière, where among his patients was a diabetic with a paralyzed arm, middle-aged, thin, and feeble. He was submitted to the static treatment, under Dr. Vigouroux, and after six weeks was again shown to the students. The sugar had diminished more than one-half, the arm had recovered almost entirely, and the whole change was for the better. From the results obtained by Dr. Vigouroux the writer was convinced of the extraordinary influence static electricity has upon human metabolism. She also refers to a work of John Wesley's in which he lauded it as a very near approach to the panacea of all ills. She attributes the disuse and neglect of the static machine to a difficulty in making it to function under every condition of weather. She had the good fortune to possess a machine of the Wimshurst type, which the late Mr. Wimshurst ordered made for her, and which she has used for the past fourteen years with the utmost satisfaction. The writer refers to the wide range of indication for static electricity and suggests that there are some conditions in which it exceeds in value any other known remedy. She refers particularly to its value in conditions of depressed vitality; cases, in which force has been given out beyond the recuperative power of the patient, from various causes. She has succeeded in numerous cases that have tried drugs, change of air, massage, water cure, and rest cure. The tonic effect of static electricity is a valuable adjunct, particularly where there are loss of appetite and loss of sleep. She recognizes the importance of correcting faulty metabolism and locally applied for the relief of pain and swelling, and reabsorption of exudation. Under its influence an increased range of movement can be obtained after years of rheumatoid arthritis. She calls attention also to the fact that many of these conditions are not so liable to recur after treatment by electricity as by other methods, and cites a case of lumbago which recurred every year for many years, but after treatment by static electricity

there was no recurrence for ten years. In the local treatment of joints, she employs the current produced by putting two Leyden jars and an Oudin resonator in circuit with the machine, by which she derives a shower of sparks which may be administered without distress to the patient, and have a speedy influence upon the swelling. These sparks may be used even upon the face without causing pain, and are of great service in skin diseases, malignant or otherwise. She contests the claim of Delheim and Lacquerreire who take to themselves the credit for having instituted this treatment for epithelioma, whereas she recorded a case at a meeting of the Roentgen Ray Society four years ago. The writer finds the combination of general static treatment with local treatment by indication valuable, especially in eczema and psoriasis. In the later disease she was not able to effect a permanent cure, until the two methods were combined.

The writer gives credit to the Americans for having found out the estimable value of static electricity in drug habit and alcoholism, acknowledging that static electricity is there (in America) "estimated at its full value, whereas in England, it is too often regarded as a sort of fetish or miracle worker, worthy only of the attention of quacks." The writer speaks farther of the value of the static spray in the treatment of all sorts of ulcers, including those which have resisted other forms of treatment for years, and refers to its value in arresting or preventing x-ray dermatitis.

She concludes by stating that there are many other modes of using the current from the static machine, including the induced current and the induction of the x-ray, and also that with the use of the resonator it will produce high-frequency currents. She states quite positively that the high-frequency and static currents do not resemble one another, and cannot produce the same effects, which is the opinion of all observers who are familiar with the static current.

ORGANOTHERAPY.

EDITED BY I. OGDEN WOODRUFF, M. D.

Some Facts about Digestive Ferments.

Torald Sollman (Jour. A. M. A., February 9, 1907) considers the fate of the digestive ferments in the alimentary canal, and raises the question as to whether there really be any therapeutic indication for the employment of them internally.

Pepsin, as the stomach is peculiarly the seat of its activity, may become active when artificially introduced.