cavity, or setting up tubal inflammation. Doleris1 prefers curetting to the application of caustics, which also received the sanction of Goodell. Aseptic curetting is commonly safe, and causes no such ill effects, even in complicated cases.

In a case of recurrent luxation of the shoulder, Dubreuilh overcame the tendency to dislocation by six hypodermic injections, performed every second or third day, of 0.12 c.cm. (or mij) of a 10-per-cent. solution of zinc chloride. The fluid was deposited in various portions of the anterior superior portion of the capsule below the acromion process.

Injections of zinc chloride have also been employed, with reported advantage, in order to promote union of fractured bones. About 1 c.cm. (or mxv) of a 1-per-cent. solution are injected into the neighborhood of the fracture. The same procedure has likewise been made use of in pulmonary tuberculosis. Dr. Jules Comby has resorted to this method in a number of cases, and states that the results were favorable and that the treatment merits further trial. The strength of the solutions which he used varied from 1 in 50 to 1 in 20, and 0.18 c.cm. (or miij) were introduced every third or fourth day. All the cases thus managed were in an early stage, and the disease was confined to the apices. The object of the treatment is to favor the formation of fibrous tissue and produce a cure in the same manner as occurs in the natural arrest of the disease. The same plan has been applied in cases of tuberculosis of joints and in lupus.

Zinc sulphate is a decided astringent, and in doses of 0.65 to 1.20 Gm. (or gr. x-xx) is a prompt emetic. It has been used for the latter purpose in narcotic poisoning, croup, and for promptly evacuating the stomach. It is a systemic emetic, and causes vomiting when injected into the blood. As an astringent, it has been administered in combination with opium or Dover's powder, in diarrhoea, and chronic dysentery. In small doses, it has been employed as an antispasmodic in asthma, chorea, epilepsy, angina pectoris, hysteria, etc. The stomach becomes remarkably tolerant of the sulphate, so that as much as 2.60 Gm. (or gr. xl) have been given, thrice daily, without exciting sickness of the stomach. Such massive doses, however, should not be long continued, as they eventually occasion superficial ulceration of the stomach. Zinc sulphate is also occasionally employed internally for the relief of bronchorrhoea.

In the treatment of chorea, zinc sulphate is used, beginning with 0.065 Gm. (or gr. j) doses three times daily and gradually increasing them until the limit of tolerance is reached. A case has been recorded by Dr. J. Sidney Hunt in which traumatic tetanus was successfully treated by a combination of opium and zinc sulphate. Zinc phenolsulphonate is an antiseptic and astringent. Dr. W. F. Waugh has used this salt for several years in cholera infantum and typhoid fever, and all cases in which the occurrence of fetid stools, with tympanites, etc., indicates the need of intestinal antisepsis. In typhoid fever he claims to have treated upward of seventy cases, with no death in any case where this salt was employed from the beginning. The dose is 0.03 to 0.065 Gm. (or gr. ss-j) for children, 0.16 to 0.32 Gm. (or gr. iiss-v) for adults, to be given every two hours until the stools are odorless, and thereafter in doses sufficient to keep the stools in this condition. The effects are a reduction of the fever, tympanites, diarrhoea, and delirium; the attack

1 Provincial Medical Journal, Dec. 1, 1890.

is shortened and rendered less dangerous. When the symptoms of cholera infantum assume the dysenteric form, the zinc is given in enemas, 0.65 Gm. in 60 c.cm. (or gr. x-fžij) of warm water. Zinc cyanide is used in Germany as a substitute for hydrocyanic acid; the dose is 0.015 Gm. (or gr. 1) gradually increased to 0.10 Gm. (or gr. iss) given in a mixture. It has also been employed in epilepsy, chorea, and in neuralgia, in painful affections of the stomach, and dysmenorrhoea. Professor Lashkevich recommends the cyanide in the treatment of palpitation, want of rhythm, and pain in the region of the heart.

In many nervous affections, the zinc valerate has special advantages over other salts in neuralgia, nervous headache, nervous cough, ovaralgia, chorea, epilepsy, etc.; if given in small doses, repeated at short intervals, it is beneficial. The night-sweating of phthisis is sometimes checked by zinc oxide, given in pill form (0.20 Gm., or gr. iij, at night); the oxide may also be given in the summer diarrhoea of infants or adults. In chorea the same salt is of much value alone, or combined as follows:

R Zinci oxidi

Ferri pyrophos.

M. et ft. pil. no. xx.

Sig. Two or three pills a day.

132 Gm. or gr. v. 260 Gm or gr. xì.

Zinc oxide is serviceable in gastralgia, and has sometimes proved useful in epilepsy. Bartholow believed that it is most successful when epilepsy is the result of peripheral irritation, having its origin in the stomach. The same writer esteemed the oxide as of prophylactic value in spasmodic asthma. Whooping-cough and chronic alcoholism have their symptoms relieved by the oxide, which has also been advantageously employed in chorea. The tremors and unsteadiness due to chronic alcoholism will sometimes yield to the influence of zinc oxide, and Guéneau de Mussy reported it as of value in subduing the tremor caused by mercurial and arsenical poisoning. Zinc lactate has been serviceably administered by von Graefe and others in rapidly developing cases of amblyopia, especially when of hysterical origin. Zinc cyanide has sometimes relieved the pains of articular rheumatism, but its use is apt to be followed by headache and it has been effectually superseded by more modern remedies.

ZINGIBER (U. S. P., B. P.).-Ginger.

Dose, 0.65 to 1 Gm. (or gr. x-xv).

Preparations.

Fluidextractum Zingiberis (U. S. P.).—Fluid Extract of Ginger. Dose, 0.06 to 1.20 c.cm. (or mi-xx).

Oleoresina Zingiberis (U. S. P.).—Oleoresin of Ginger.

(or mss-ij).

Dose, 0.03 to 0.12 c.cm.

Syrupus Zingiberis (U. S. P., B. P.).—Syrup of Ginger. Dose, 4 to 15 c.cm. (or f3i-iv). B. P., 2 to 4 c.cm. (or f3ss-j).

Tinctura Zingiberis (U. S. P., B. P.).-Tincture of Ginger (20 per cent.). Dose, 2 to 8 c.cm. (or mxxx-f3ij).

It also enters into aromatic powder and compound rhubarb powder (U. S. P., B. P.).

Pharmacology.-Ginger is the dried rhizome of Zingiber officinale (Zingiberacea), cultivated in tropical countries as a spice. Ginger from which the cortex has been scraped is also known as "white" or "peeled" ginger. It is less active than the whole ginger. Green ginger is put up in syrup or

candied, and used as a digestive condiment at the dinner-table as a corrective of flatulence. It comes from different sources, but the Jamaica ginger is preferred for culinary purposes, having the best flavor. An excellent ginger comes from Shimonoseki, Japan. Ginger contains traces of an alkaloid, but its activity depends principally on a volatile oil, consisting principally of Gingerol, and also a pungent resin. The tincture, spirits, or essence of ginger is a very popular remedy. Unfortunately, it is very frequently made with wood alcohol, which makes a cheaper article, but persons taking it too freely are likely to suffer with symptoms of amylic alcohol poisoning. A characteristic symptom is atrophy of the optic nerve and blindness. Death has been caused by the use of this adulterated product.

Physiological Action. It is an agreeable carminative and stimulant, increasing the secretions and promoting peristalsis. It increases slightly the amount of urine, and acts as an irritant to the bladder and urethra. Externally it is rubefacient.

Therapy. Ginger is added to purgative pills to prevent griping, and to salines in order to disguise their taste. It is useful in atonic dyspepsia, especially in elderly persons, and is of service in flatulence and diarrhoea. The syrup is commonly used as a vehicle for stomachic preparations and tonics. The addition of 4 to 7.5 c.cm. (or fɔ̃i-ij) of the tincture to a glassful of hot water (180 c.cm., or f3vj) makes "ginger-tea," which is useful in flatulent colic, in diarrhoea of relaxation, and in dysmenorrhoea due to cold. By the use of a hot foot-bath with free use of ginger-tea, diaphoresis may be excited and further progress of colds checked.

PART III.

NON-PHARMACAL REMEDIES AND EXPEDIENTS EMPLOYED IN MEDICINE NOT CLASSED WITH DRUGS.

THIS portion of the work will be devoted to the discussion of certain agents and expedients employed in clinical therapeutics which cannot be properly classed with drugs. Each will be considered under its own heading, with the following titles: "Electro-therapeutics"; "Kinesitherapy, Massage, and Rest-Cure"; "Pneumotherapy"; "Hydrotherapy and Balneology"; "Mineral Springs"; "Climatotherapy"; "Diet in Disease"; "Psychotherapy, Metallotherapy, and Suggestion or Hypnotism"; "Heat and Cold,” “Light and Darkness," "Music," etc., concluding with a brief review of various methods and expedients, chiefly mechanical and local in their effects. Although the latter find a limited place in practical medicine, they are, as a rule, surgical expedients, and are, therefore, in this place, less fully considered than they would be in a treatise specially devoted to that depart

ment.

ELECTRICITY IN MEDICINE-ELECTRO-THERAPEUTICS.

Present Standing and Importance of Electro-therapeutics.-The scientific application of electricity to the human body for the treatment of disease has recently been greatly stimulated by its remarkable commercial development. Electrical science being essentially of modern origin, new principles and new economical applications being announced almost daily, it becomes absolutely necessary for a discussion of the employment of electricity in medicine to be introduced by a few words upon the present state of our knowledge of this department of physical science. A very brief consideration of the laws of electricity, with explanation of its terms and its technique, therefore, will precede a review of its therapeutic applications. It is unfortunate and embarrassing, to the medical student particularly, to find confronting him, at the very threshold of this subject, a mass of literature which has come down from a period when purely empirical methods prevailed and the nature of this force and its effects, both physiological and therapeutical, were very imperfectly understood. Not infrequently, even at the present day, medical writers betray a want of knowledge of its fundamental principles. There is less excuse for this now than ever before, because the ingenuity of electricians and expert instrument-manufacturers has been attracted in this direction and has brought to our aid apparatus of precision, both for therapeutics and for diagnosis, with which it is the duty of every physician to acquaint himself. Even if he does not purpose to apply it to a great extent in his practice, he should do this much, at least, for his own protection, since he must at times rely upon some form of apparatus; and some of the elec

trical instruments which are offered for sale are of poor construction, entirely unfit for medical use. Moreover, many persons bring discredit upon medical electricity by claiming to be specialists who are mere tyros, if not open charlatans, ignorant of the first principles of medical or of physical science. It is a comparatively easy matter for the well-trained physician to recognize and expose such pretenders, especially should they venture to boast of their results in public or before medical societies.

The Foundation of Success in Electro-therapeutics.-The study of electro-therapeutics requires not only that we shall be versed in the laws and terms of electrical science, but also that we shall have good anatomical and physiological knowledge. It is, moreover, very evident that we must be familiar with pathology in its most comprehensive sense, in order to form a correct judgment, or prognosis, as regards the probable utility of electrical or any other treatment in a given condition, so that this valuable agent may not be brought into disrepute by being used in unsuitable cases. As it is necessary that such knowledge shall be acquired systematically, all reputable medical schools now strive to teach thoroughly the principles of electricity and the construction of medical electrical apparatus and batteries, this course of study being made practical and attractive by abundant didactic and clinical instruction in this important branch of therapeutics. Since the best results can be obtained in this direction only by a due recognition of the dignity of this branch in the curriculum, it is hoped that there soon will be established a chair of electro-therapeutics in every university and medical college in the country.

Definition of Electricity.-The phenomena of electrification are due to a condition of matter when it is acted upon by a peculiar force known as electromotive force. This "electromotive force" is a form of energy which is convertible into and is, therefore, said to be correlated with the other physical forces, in accordance with the well-known law of conservation of force demonstrated by Helmholtz. That is to say that, whereas light, heat, motion, chemical action (electrolysis), and magnetism may be obtained from electricity, so, by the law of the correlation of forces, light, heat, motion, chemical action, and magnetism may be transformed back again and be manifested as electricity. These forces are all manifestations of molecular motion due to radiant energy, acting under different conditions.

Principle Underlying Electrical Manifestations.-It is upon this principle that all forms of apparatus for economical and medical applications of electricity are constructed. Atmospheric electricity, which Benjamin Franklin proved to be identical with friction-electricity, certainly exerts an important influence upon health; and instances have been recorded where an electrical shock (lightning-stroke) has been followed by important physiological changes (i.e., relief from paralysis, etc.); but no attempt at systematic therapeutic application has, as yet, been made with electricity from this source directly. The usual sources are chemical action, heat, magnetism, and motion (friction and dynamo).

The Electric Current: its Physical Characters and Properties.-Although electricity is simply a condition of matter, or a "mode of motion,"a "peculiar vibration or tension of the molecules of a body said to be electrified,"-it is convenient to speak of it as if substantial, and, in fact, as matter in a fluid state. In some respects it appears to be analogous to water when the latter is acted upon by the force of gravity and atmospheric pressure;