affected; all the various arthritic or gouty forms when the place of least resistance is the surface of the joint.

From the reasons above stated, it is clear that the uric deposits lying in the tissues and determining the various morbid entities, can never be reabsorbed into the circulation except when the quantity of uric acid circulating shall be reduced in such a manner (by elimination or by oxidation spontaneously or artificially produced) as to permit the blood to hold it free within the limits of its natural saturation.

In this lies the explanation of the lack of success, not now refuted, regarding the various drugs, litholitic and anti-gout, whose efficacy lies in their solvent action on uric acid, elective action by piperazine, lisidine, uricodine (Weiss) especially on the uric deposits lying in the joints.

As physicotherapy proceeds by causing the elimination or final transformation in the organism of the excess of uric acid in circulation, does it do this in order that an absorption with the circulation of the uric salts deposited in the tissues may be possible? Wholly on the contrary, physicotherapy is employed to stimulate the activity of all the natural emunctories, the kidneys, the skin, the lungs and intestines, which in the uric diathesis are habitually very torpid and insufficient in their functions. It is especially the function of the kidneys, though often anatomically altered (gouty kidney) which with a scanty secretion of the solid components of the urine gives the greatest contribution to the supersaturation of uric acid in the blood. This renal function can in great measure be stimulated and favored by the liberal drinking of appropriate mineral waters, especially those of scanty mineralization (Fiugga), since it is now recognized that in the uric diathesis a water is as much more efficacious as it is less rich in solid materials of its own, that which renders it capable of holding force and drawing with it, through the renal filter, a greater proportion of the uric acid circulating in the blood. But however much it is possible to improve by hydrotherapy the function of the kidney, the latter will never be in a way to realize the sole but sufficient depurization of the blood. It is necessary, therefore, to have recourse to the aid of the other auxiliary functions, first of all, sweating, that great emunctory of reserve, whose functional capacity has limits far out, being rare in dangerous surprises. And it is thermotherapy which comes into play.

The action of heat upon the tegumentary surface of the body has for effect vigorous hyperemia of the surface tissues, and stimulating of the function of the sweat-making glands. The sweat, as is known, carries away with itself an abundance the anomalous elements free in the blood, the products of the accelerated change.

Here is not the place to compare the various means by which thermotherapy accomplishes such a result. The principal ones are: the bath of warm or artificially heated water, natural baths, artificial vapor baths, sun baths, Turkish baths, and Roman baths. All who are informed are so far agreed that among the various methods of thermotherapy, the one which produces the most perspiration, and with the greatest degree of tolerance, is the application of dry heat. The dryness of the surrounding air in which the sweating is induced favors rapid evaporation of the liquid which transudes from the pores, and thereby abstracts heat from the skin, permitting the toleration without discomfort of a temperature incredibly high. Of the various forms of general administration of dry hot air those are preferable which do not exclude the head from the surrounding hot air, the superheating of the respiratory tract having the advantage of rendering more active elimination by the lungs of those products of change whose destruction is not a superfluous intervention of this third. formidable ally.

The participation of the respiratory tract in the action of the superheat, as it occurs in the Roman bath, has not only the value of a greater diaphoretic efficacy, but the fundamental conditions of safety and harmlessness. In fact, in the application of heat from which the head is excluded, as occurs in the Kellogg bath of light, cerebral congestions are far from avoided, and the unbalance of temperature which is established on the cutaneous surface and the lung surface is such as to cause very serious inconvenience on the part of the heart and of the very delicate vessels of the visceral net.

We owe to the intestines the fourth ally among the emunctories of the blood. The activity of the intestinal mucous glands will be stimulated by mild and daily saline purgatives, preferably by mineral waters having chloride and solid sulphate. The effect will be twofold, a greater elimination of uric acid from the mucous coat, and diligent cleansing of the

intestines from the waste products of digestion, in the stagnation of which, according to recent research, is the prime material from which uric acid is generated. Discharged thus, by so many and various ways, the excess of uric acid free and circulating in the blood, the absorption and the return into circulation of the uric deposits lying in the tissues, becomes much easier, and in the condition under consideration in the nerve sheath there is immediately a dislodgment and decrease of pain.

Besides fundamental elements of cure physicotherapy offers practical aids suited to combat directly this or that symptom, such as, to diminish pain, concurrent with a moderate electrogalvanic application upon the nerve, the current of high frequency, and mild massage of the part may be employed. Massage is very useful in stimulating the nutrition of the muscular mass of a joint, removing the atrophy when present.

Physicotherapy will not complete the task if the physician wishes to establish a treatment truly rational for uremic neuralgia, and to prevent its return by eradicating the cause. The uric diathesis is habitually manifested in individuals in whom change of material is retarded, in persons in whom the regulative mechanisms of the internal acts of nutrition do not perform their functions with that activity and regularity which they should normally have. Until this function of organic metabolism is permanent, the elimination of an excess of uric acid represents only an effect, direct and momentary, from diuresis and from sweating. The action of these having ceased, the uric acid will again accumulate little by little in the blood, and will tend to resume its former condition of saturation, with a repetition of the same morbid manifestations.

Acceleration of organic change is obtained principally by means of methodical exercise of the muscles, including all of the muscular masses of the body, regulated to the working power of each of them, a task easy to accomplish, especially so with the Zander mechanical system and in addition an appropriate dietetic régime from which is excluded meats, coffee, and alcoholics.

Assuming, therefore, that it is possible to establish a rational programme for the radical cure of sciatic neuralgia of uricacid nature, the treatment should include the concurrent employment of at least four different physical agents, viz., hydrotherapy, thermotherapy, kinesitherapy, and electrotherapy, not to include among the physical agents dietetics, though it has the closest affinity with them.

(To be continued.)

ILLUSTRATIVE EFFECTS OF STATIC AND HIGHFREQUENCY SPARKS.*

BY W. A. DEEKS, M. A., M. D., NEW YORK. Instructor in Electro-Therapeutics in the New York Post-Graduate Medical School and Hospital.

The accompanying series of photographs were taken by Mr. E. G. Wilkinson and the writer at the office of Van Houten

Fig. 1.-Morton Wave-Positive Spark.

and Ten Broeck. In each instance one pole of the static machine or high-frequency apparatus was grounded as was also the inactive side of the photographic plate. The other electrode was approached to the active surface of the photographic

Presented at the Fifteenth Annual Meeting of the American Electro-Therapeutic Association, at New York, September 20, 1905.

plate which was covered with black paper. As soon as a spark passed the plate was removed and developed.

The following are the interesting points to observe. (1) The concentrated action of the static induced spark in comparison with the finely disseminated character of the high-frequency spark whether induced by Morton's solenoid-condenser, D'Arsonval, or Tesla high-frequency apparatus. (2) The very characteristic difference between the negative and positive

sparks which may throw some light on the reasons for the more painful character of the former. As will be seen the terminations of the negative sparks have a feathered or spattered out appearance, or as Mr. Wilkinson suggests, a pine-needle effect; whereas those of the positive sparks gradually disappear in fine ramifications.