The masseur is requested to continue this treatment until otherwise directed, unless obvious change in the condition of the patient renders desirable an earlier consultation of the prescribing physician. The time of day may be indicated if desired.

The above is actually in use in this city, and its practical value demonstrated. The masseur or masseuse stands in the same relative position as the druggist to the physician, and simply carries out his directions as indicated by the prescription.

Vibrotherapy. A form of percussion massage, in which the hand, or instrument, is kept in contact with the surface, while a mild percussion force is applied many times in the minute, causes a vibration in the deeper tissues, which is capable of producing physiologic and therapeutic results. J. Mortimer Granville, of London, was among the first to place this method upon a scientific basis and to use instruments for the purpose. Acute and sharp pain, he compared to a high note in music, which is produced by very rapid vibrations; while a dull, heavy pain resembles a low note, which is caused by slow vibrations. He therefore applied a slow rate of mechanical vibration in order to interrupt the rapid vibrations of acute pain; and conversely, applied very rapid vibrations for the relief of dull pain. By thus introducing discord into the rhythm of morbid vibrations, he claimed that relief or cure of neuralgia can be effected. He devised an instrument which he called a “percuteur,” which was so constructed as to deliver a rapid succession of

blows of moderate force; both the strength and the rate of the percussion being subjected to regulation according to the case.

A number of instruments and elaborate apparatus have been devised for producing mechano-vibration. In some of these the power is obtained from compressed air; others work with a hydraulic motor; but the best forms

The Chattanooga Vibrator.

are run by the electric current, either alternating or continuous. A very satisfactory form of vibrator is shown in the accompanying illustration, which is made by the Vibrator Instrument Company, of Chattanooga, Tenn. Other forms in which the electric current is used, are the Waite apparatus, invented by Dr. Henry Waite, of the Waite & Bartlett Electric Manufacturing Company, of New York, and the Fraley vibrator, of Philadelphia. The special characteristic of the latter is that it has an attachment to, and is

applied by, the hand of the operator, so that the force of the application is subject to conscious control. Vibration can be used in connection with other forms of massage, or with the faradic or galvanic electricity, if desired.

Vibrotherapy is useful in a wide range of functional disorders. It not only stimulates the peripheral nerves, but also the vasomotor and trophic distribution. It acts upon the lymphatics and veins of the parts, so as to hasten absorption of effused products, or eliminate waste. It regulates the blood and nerve supply of glandular organs, like the liver, which it induces to increased physiologic activity. For hepatic disorders, the vibrations are directed to the right hypochondrium principally. In the treatment of insomnia, the vibrations are made from the sixth dorsal vertebra up the spine to the cervical region, for a short time; the patient then turns over upon his back, and vibrations are made to the intestine and abdominal organs, the latter with the view of attracting the blood from the head. For nervous headache, the vibrations should be directed along the spine, and be mild in character, so as to produce a quieting and soothing effect. By an adjustment of the apparatus, the stroke may be made stronger or weaker as desired, and at the rate of vibration preferred. This method is finding many applications at the present day, and is a valuable adjunct to other methods of treatment.

By the use of vibrotherapy, Granville claimed that pain could be relieved, the cerebro-spinal and sympathetic ganglia stimulated, torpid nervecentres aroused to action, the reflex irritability of subordinate centres subdued, and these placed under the control of the higher centres. The vibrations may be propagated along the trunks and into the branches of the principal nerves from their centres of origin; or these may be called into action, reflexly, by the afferent nerves connected with those centres. Among its special applications is deficient motility of the digestive organs; in constipation, for instance, it never fails to produce a movement of the bowels. When properly regulated, it has a sedative action upon sensory nerves.

At the Fourteenth International Medical Congress, held at Madrid in 1905, Dr. J. Rivière called attention to a comprehensive plan of treatment which he calls "Physicotherapy." This is a curative method based upon the plan for increasing normal vital stimulants, by means of electricity, heat, light, baths, massage, and, in fact, all agents and apparatus intended to quicken physiologic processes. The object of the treatment is to improve cellular activity; and especially to aid the trophic and excretory functions, to regulate blood-supply, and overcome congestion and stasis. This is accomplished by apparatus for electrotherapy, vibrotherapy, radiotherapy, phototherapy, hydrotherapy, pneumotherapy, and other well-known means of kinesitherapy. In many cases, remarkably successful results have been obtained in functional and nutritive disorders, especially those of a chronic character, by a course of treatment such as just indicated, in which treatment by drugs is either subordinated, or entirely omitted.

PNEUMOTHERAPY AND PNEUMATIC DIFFERENTIATION.

Pneumotherapy, atmiatria, or pneumatic medicine, considers the administration of gases and remedies in a gaseous condition in the treatment of disease. The effects of changes in density and of the use of remedies under circumstances increasing or decreasing atmospheric pressure have re

cently received so much attention that they will require separate discussion. The subject, therefore, will be divided into:

1. The administration of remedies in a gaseous form: Pneumotherapy. 2. The administration of such remedies under altered conditions of atmospheric pressure, or in more or less condensed or rarefied form: Pneumatic differentiation.

A strict construction of the term "pneumotherapy" (veμa, air or TVEνμOV, lung, and Oepareów, to heal) would restrict it to the consideration of respiratory disorders, but it may also be employed as applied to treatment by the use of air or gases. An ancient medical sect, known as pneumatici, or pneumatic physicians, founded by Athenæus, held that an immaterial principle or element existed, upon which depended conditions of health, the excess or diminution of which caused disease. Previous to the revelations of the microscope and the advent of modern pathology and chemistry, this was about as far as hypothesis could be expected to carry us toward the discovery of the true nature of many diseases, but there is no good reason for the existence of such a medical theory in the twentieth century.

In proceeding to consider the therapeutic employment of certain gaseous substances, it is proper, in the first place, to devote a few words to a gaseous compound known as atmospheric air, its composition, and the effects upon the human system of alterations in the proportion of its constituents and the results of its contamination. Air is a universal and indispensable gaseous food. It is not a chemical compound, but simply a mixture of oxygen (about one-fifth) and of nitrogen (about four-fifths) with variable, but usually small, quantities of argon, helium, carbonic acid, ammonia, watery vapor, dust, etc. We cannot dwell here upon the physiological facts in connection with the effects of increase or decrease of carbonic acid or the presence of certain contaminations, especially the various forms of microbes and disease-germs. We may, however, in passing, point out, in a very general way, the difference in the rate of growth and development of children who have a plentiful supply of fresh, pure air as compared with those who lead a sedentary life in house or school. The subject of the ventilation of sick-rooms and apartments where many persons are crowded together, as in schools, factories, and work-shops, has been fully investigated of late years, and the breathing of foul air is now regarded as one of the principal causes of ill health and degeneration.

Conversely, in many patients the first therapeutic step to take is to secure for them a greater quantity of pure air than they have been accustomed to having. In modern treatises upon the practice of medicine great stress is usually laid upon the importance of the ventilation of living-rooms, and also of exercises in the open air. Drs. Trudeau and Sternberg found that the mortality from consumption, in rabbits inoculated with tubercle bacilli, was very much greater among animals confined in crowded, ill-ventilated hutches than among others which were allowed to run out and live in the open fields. Heated air has been employed in therapeutics not only in the form of the Turkish bath, but also used simply by inhalation. The effects here being simply those of elevation of temperature, they will be considered under the head of heat. The effects of differences of atmospheric pressure will be discussed in the present section, under the title of "Pneumatic Differentiation." The effects of breathing rarefied air are closely connected with those attending residences in elevated localities, where atmos

pheric pressure is less than at ordinary levels. This deserves careful study, as upon it often depends the decision as to the proper sanatorium to send an invalid. It may be accepted as an axiom that patients suffering with advanced disease of the heart, lungs, or kidneys are injured by removal to a high altitude, as their systems do not readily become accustomed to the increased labor of breathing necessarily required by the rarefaction of the air. This, however, will be considered, more in detail, under the subject of "Climatology." Under this head, also, will be considered the effects of the presence in the air of moisture, and the differences between marine and mountain airs and places.

The presence of ozone in the air, and its consequences, will be hereafter referred to in discussing oxygen. When present, it is an important witness to the purity of the air and its freedom from organic contamination. Where great numbers of people live in crowded communities, ozone is never present. If the fact is borne in mind that the expired air from the lungs contains more or less excrementitious organic matter, it will be understood why crowd-poison, or rebreathed air, may be the cause of disease. Besides the increased quantity of carbonic-acid gas and the diminished proportion of oxygen, the expired air further varies from the standard of pure air, in that it has an excess of moisture, which contains odorous particles, and frequently bacilli and other forms of bacteria. Atmospheric air, however, except in special locations on the tops of mountains, may also contain many varieties of bacterial forms, and also organic material, in the form of dust, which may be of a very irritating character. The expectorations of tuberculous patients in the streets become dried, and tubercle bacilli have been shown by actual experiment to be present in street-dust, as well as in the confined air of the consumptive wards in a hospital. Manifestly, therefore, persons who, by heredity or acquired predisposition, are liable to suffer from phthisis, should live in a neighborhood where they can breathe pure air, as free as possible from all irritating matters, and especially pathogenic substances, and they should carefully avoid crowded vehicles or public halls. Consumptive nurses should never be allowed to contaminate the air that young children breathe by fondling and kissing them, infants being particularly liable to infection from this source. Operatives who work in overcrowded rooms, such as cigar. makers, cloak- and dress- makers, especially where there is much dust in the air, show the effect of privation of fresh air in their pallid faces and wasted frames, and they are also very subject to pulmonary affections from inhaled particles, which act as irritants. The first prescription for a cough, under such circumstances, would be fresh air, as pure as can be obtained. One of the principal beneficial effects of the movement-cure and massage is seen in the increased activity of the respiratory function which follows physical exercises; but increased respiration will not be of great benefit unless, at the same time, provision be made to supply a sufficient quantity of pure The report of the English Army Sanitary Commission, published in 1858, is conclusive in its proof that "the excessive mortality from consumption among soldiers, and in particular regiments, was due to overcrowding and insufficient ventilation. Previous to that inquiry the cubic space per soldier in the barracks of the Foot Guards only amounted to 331 cubic feet, and the phthisis mortality was as high as 13.8 per 1000. In the Horse Guards, on the other hand, with a space per man of 572 cubic feet, the mortality from phthisis did not exceed 7.3 per 1000. It was found that phthisis prevailed

air.