One end of a piece of flannel which is broad enough to cover the abdomen and long enough to go around the body and twice over the abdomen is wet in water of the desired temperature, and the bandage is applied and pinned in place. Or a towel may be wrung out of cold water, placed over the abdomen, covered with an impermeable tissue, and held in position by a flannel bandage encircling the body. The impermeable tissue prevents drying and lessens the chilling action of the cold. The compress may be worn day and night, and should be changed twice during the twenty-four hours.

In many of the diseases of the stomach the abdominal sympathetic is depressed and irritable. Neurasthenia gastrica is a disease which affects chiefly the nerves of the stomach. Many other diseases of the stomach, both organic and dynamic, can be favorably influenced by giving tone to the nerve supply, and hydrotherapy furnishes the most active remedy for the realization of this object. We refer to a special form of the needle-spray.

The intensity of the action of water on the nervous system is dependent on the temperature of the water, on the impressionability of the patient, on the mechanical excitation of the nerve endings, and on the location, extent, and duration of the application. The further the temperature of the water is above or below the indifferent point, the greater is the excitation. Consequently, a fine needle-spray momentarily applied under moderately high pressure, consisting alternately of hot and cold water, and extended over the area of distribution of all the nerves connected with the centers controlling the stomach, exerts a most powerful action on this organ. The needle-spray, applied in the manner which is here recommended, increases the activity of blood circulation in the spinal centers and in the mucous membrane of the stomach, and thus relieves their congestion and improves their nutrition, excites peristalsis and causes the stomach to contract firmly on its contents, and restores normal secretion and tones the abdominal sympathetic, as does no other single remedy.

The needle-spray should be used in the following manner, varying the temperature of the water, the hydrostatic pressure, and the duration of the bath so as to be appropriate to the individual case. The chest should be protected during the application, which should not extend above the level of the lower end of the sternum. The temperature of the water may be as high as 95° F. and as low as 60° F. The hot water is first used, and then, rapidly changing without gradua

tion, the cold water is employed. The application is made with the hand nozle, revolving the spray for ten to twenty seconds over the abdomen, and then for the same time over the front and then the back of the lower extremities. The hot and the cold spray require only one-half to one minute each for their application. The douching is followed by rapid drying, brisk rubbing, and immediate dressing. The stomach should be empty when the bath is taken.

The Uses of Electricity.-Electricity is one of the most useful of the physical remedies in diseases of the stomach.

Fig. 17.-A, Rosenheim's intragastric electrode: B, Wegele's spiral electrode covered with rubber tubing, to be used in the ordinary stomach-tube.

Each physician has his own favorite methods of employing it. Only those will be described which in our own hands have given the best results.

Electricity may be applied internally or externally. The internal use is advisable in one disease and one conditionmyasthenia-when the patient is accustomed to the use of the tube. Here the internal application would seem to be more powerful than the external; how much of the additional benefit is due to the more vivid impressions and suggestions it is very hard to estimate. The intragastric electrode of Rosenheim is

a very good instrument. Einhorn has invented a capsule electrode which is to be swallowed. The best intragastric electrode is the one recommended by Wegele. It consists of a stomach-tube through which runs a removable spiral conductor. The instrument can be kept clean and can be used to wash out the stomach, to introduce the water which serves as the intragastric electrode, and to remove the water after the sitting. The external method consists in the use of one or more forms of electricity in a particular manner-general faradization, central galvanization, and the local use of the two currents. Each method has its effects and its indications.

The effect of the galvanic and faradic currents on the secretions of the stomach may be considered well established by

experiments, first on the dog and then on man, and by the analysis of the gastric secretion thus excited and obtained by the aid of the stomach-tube. After the use of a moderately strong current for about ten minutes, 20 or 30 c.c. of gastric juice may be obtained, rich in all the elements of specific secretion. Secretion may be excited both by external galvanization and by internal faradization. The motor function may also be notably excited-the contractions being tonic or peristaltic according to the strength of the current and the mode of application. Some deny that electricity excites contractions of the stomach. Meltzer laid bare the stomach of an animal and applied the electrode directly to its

wall. Faradization produced tonic contraction only when the electrode was near the pylorus; over the fundus the result was negative. With one electrode over the stomach and with the other either over the spine or within the stomach, no contraction of the stomach could be excited; but these experiments were made on anesthetized animals during shock. In spite of the denials of some clinicians, there is no doubt that electricity does produce tonic contraction and peristalsis. of the human stomach. We have seen both galvanization and faradization cause gastric splashing to cease. When patients have thin abdominal walls, we have seen and felt the peristaltic contractions of the stomach produced by external galvanization, and these patients were not affected by peristaltic unrest (tormina ventriculi). A glass of water, the testbreakfast, and the test-dinner are evacuated earlier than normal by the electrified stomach. The effects of faradization and negative polar galvanization are greatest, both on secretion and on the movements of the stomach, after they have been employed for several successive days.

Electricity may also promote absorption, and is the one direct remedy which excites this function through its influence on the vasomotor nerves and the cells under the control and activity of which the process goes on.

But electricity is not only valuable on account of its action on the secretory, motor, and absorptive functions of the stomach. It can exert a favorable influence on the general sensations of the stomach, while it is very doubtful whether it has any direct action on the special sensations or the appetite.

This remedy also possesses an undoubted trophic action, which may be utilized in the treatment of the chronic anatomical diseases of the stomach.

Contraindications.-The contraindications to the employment of electricity in any form do not seem to have attracted much attention. The remedy may be harmful or useless.

I. It can only do harm in acute gastritis. It disturbs the organ when rest is imperatively demanded.

2. Electricity of high density does no perceptible good in severe degrees of myasthenia. It acts in the same manner as an excitant diet would under the circumstances.

3. The remedy should not be used during the active period of digestion. Theoretically, it would seem plausible that the functions of the stomach might be aided in the performance of digestive work; but practically the result of the combined action of the contents and of the remedy can not be con

trolled. Electricity may, however, be given in myasthenia near the end of the digestive period.

4. A recent gastric hemorrhage is a contraindication. Neither should it be employed in diseases of the stomach commonly associated with hemorrhage. Chronic indolent ulcer may, however, form an exception where hemorrhage is not favored by the light hyperemia which accompanies the gentle electrization of the vagosympathetic with a view to obtaining a trophic influence.

We do not believe in the nihilism which claims that electricity acts solely through suggestion, or not at all. This may be true when the remedy is used without selection, method, or purpose. The physiological action of electricity. and therapeutic experience should guide us in the choice and manipulation of the electrodes and in the determination of the form, strength, and density of the currents and of the duration and frequency of the sittings.

The best electrodes are the nickel-plated ones, with a halfinch thickness of sponge covered with linen. The electrodes. are moistened in warm water. The supply should be large enough to enable us to use the requisite current strength and density and to apply them in the proper manner-continuous, interrupted, stable, or mobile.

The density of the current is represented by a fraction, the numerator of which is the current strength in milliamperes and the denominator, the surface area of the active electrode in square centimeters. The "active electrode" is the one over the point of greatest excitation, or over the central nervous system. If both the electrodes be over indifferent points, the mean surface area of the electrodes is taken. A current density of should not be exceeded in the electric treatment of the diseases of the stomach, and when the active pole is over the spine or neck it should not be greater than. The selection of the poles in the employment of faradism is of no consequence; but galvanism possesses a decided polar difference, the negative pole being exciting and the positive pole sedative. To obtain the pure polar influence of the anode, only mild currents should be used, and care should be exercised in turning on and off the currents. Begin at zero and gradually and slowly increase to the desired strength; and at the end of the treatment the strength of the current must be decreased to zero in the same manner before the firmly-held electrodes are removed.

The duration of the sittings should be regulated according to the effect desired. Short applications are most generally