Every patient is first taught the following positions of the hand by heart: (1st) Fingers extended and approximated (Fig. III); (2d) Fingers extended and separated (Fig. IV); (3d) Fingers flexed at right angles to the hand and approximated (Fig. V); (4th) Same, but fingers separated; (5th) Fingers flexed at nuckle (first phalanx forming straight line with hand), fingers approximated (Fig. VI); (6th) Same, fingers separated (Fig. VII); (7th) Fingers flexed upon the palm and approximated (Fig. VIII); (8th) Same, but fingers separated as much as possible.

(3) Fin

After the patient has learned these perfectly, and by number, the following exercises are given him to exercise at home: (1) The fingers are to be brought from 1st to 2d position, one after the other (muscles exercised are the interossei, volares et dorsales, and the external fibres of the extensors). (2) Fingers to be brought successively from 1st to 3d position (muscles exercised are the flexor digit. commun., sublim., and profund., principally the former). The lumbricales and interossei also assist in this movement. gers to be brought from 1st to 5th position (muscles exercised, flexors, principally the flexor profundus). (4) Fingers from 1st to 7th position (muscles exercised are the flexors equably and the four lumbricales). (5) Fingers from 2d to 3d position (muscles exercised are the same as No. 3, together with the interossei). (6) Fingers from 2d to 5th position. (7) From 2d to 7th position. (8) From 3d to 4th position. (9) From 3d to 5th position. (10) From 3d to 7th position. (11) From 4th to 6th position. (12) From 4th to 8th position. (13) From 5th to 7th position. (14) From 6th to 8th position.

Reversing these movements will of course exercise the antagonists; thus, in exercise 2, if instead of commencing with the 1st position, and bringing the fingers to the 3d, we reverse matters, and bring them from the 3d to the 1st, then, instead of bringing the strain upon the flexors, we do so upon the extensors. These exercises must be chosen with care, and given to the patient for execution at home, one at a time, care being taken that they are well understood and satisfactorily executed.

The opposed movements which are the most serviceable are the following, which of course can be executed with the aid of the operator: (1) Hand of patient in position 1, each finger is successively to be brought into position 3, while the operator endeavors by counterpressure to prevent it. (2) Fingers in position 3, operator endeavors to bring them in position 1 while the patient prevents it. (3) Fingers in position 1, to be brought to position 2 while operator opposes. (4) Fingers in position 2, to be brought to position 1 by operator while patient opposes. (5) Fingers in position 4, to be brought to 3 by the operator. Fingers in 3 to be brought to 4 by patient. (6) Fingers in position 6, to be brought to 5 by operator. Finger in 5, to be brought to 6 by patient, operator opposing.

To enable the patient to perform certain opposition movements at home, and at the same time to be sure that a cer

tain amount of equable opposition is being used, Dr. Jacoby has constructed the following apparatus. The movements which are to be executed are simply those of extension and flexion, and the opposition is furnished by rubber bands. The apparatus consists of a metallic bracelet, inside of which is padded. One end of it consists of a ratchet, which admits of increasing the size of the bracelet to fit any arm, and at the same time allows it to be tightly fastened. Upon one

FIG. IX.

side of the bracelet, the top or bottom, as the case may be, are fastened five brass pegs. Rubber bands are fastened to these by means of leather end-pieces. The other ends of the band terminate in leather finger-coverings, which are slipped over the fingers of the hand. The bracelet is always to be adjusted just above the [wrist] joint, and tight enough to keep it from slipping. If the extensor muscles are the ones to be exercised, the bracelet must be so placed as to allow the pegs to be at the bottom. Care must be taken that the apparatus be placed on the arm in pronation for flexion movements, and in supination for extension. The kid fingers are then slipped over the fingers of the hand, and the elastic bands must be chosen for each case, and frequently of different strength for the various fingers. If the flexors are to be exercised, the bracelet is applied with pegs pointing upward, and the bands then adjusted. The opposition is

FIG. X.

thus furnished, and the patient can execute the movements at home (Figs. IX and X). The thumb must always be exercised separately. For opposing abduction, the band is brought from the inside of the thumb over the palm around the ulnar border of the hand, and fastened with the pegs downward. The rubber band is then brought over the back of the hand around the ulnar border and fastened to the desired peg below.

The question whether patients afflicted with one of these

FIG. XI.

artisan's neuroses must give up their employment during the time of treatment, must be answered in the affirmative for all except writers, and these can, by means of an apparatus designed by v. Nussbaum, continue writing dur

ing the time of treatment. In fact, the more they write with

the latter can be avoided by employing the antagonists-the extensors and abductors-in all writing. The apparatus to effect this consists of a thin, oval, hard-rubber ring of about two centimetres in width (Figs. XI and XII). This ring is somewhat convex above, and is made to fit over the first four fingers (thumb, index, middle and ring). It is passed over these fingers, the small finger remaining outside. Upon the upper surface of the ring is a movable penholder, which

The

can be fastened in any position by means of a screw. ring must be chosen somewhat wider than the fingers to be surrounded by it. In order to keep the apparatus from sliding off the hand, the patient is obliged to keep his fingers forcibly abducted, the thumb pressing upon one side, and the ring-finger upon the other. Thus the abductors and extensors are the muscles used. For persons who are obliged to keep to their business during the course of treatment, the apparatus is invaluable; as after a very few hours of practice they can write plainly and legibly, and without any exertion; and, as already stated, far from having any deleterious effect upon the results of the treatment, it may be looked upon as an ingenious adjuvant.

Ingluvin.

Ingluvin is the essential principle of the gizzard, and bears the same relation to poultry that pepsin does to the higher animals. The honor of its discovery and utilization, in its crude state, remotely dates with the Chinese gastronomer, as well as to the Caucasian chemist, in its refined condition. From time immemorial the inhabitants of the Celestial Empire have used the gizzards of chickens and ducks in nearly all made dishes. Their writers have recommended the practice as a sovereign treatment of dyspepsia, weak stomach, and vomiting. A favorite prescription of Chinese physicians for chronic indigestion is to cut up the digested chicken giz zards in hot water until they are reduced to a pulp, and then add some spices. A tablespoonful or two of the resulting paste is taken at each meal until the patient has entirely recovered. From China the practice passed to other parts of Asia, and was adopted here and there among the Mediterraneau peoples. Strange to say, it was never learned by the great nations of Europe until the latter part of the present century. On the other hand, the organic chemists of Europe discovered, about 1850, a powerful nitrogenous radical in the gizzard. Experiments thereafter showed it to possess many of the qualities of pepsin. These experiments led to its isolation. Numberless experiments have proven it to be a very valuable addition to therapeutics. Where pepsin refuses to act, and where, in severe cases, it has been rejected by the stomach, ingluvin effected relief rapidly, and with the greatest ease.

In four recent cases of poisoning by root beer (Brooklyn, June, 1886), Dr. George Everson, Jr., a well known physician of that city, reports that after pepsin and all other sim