to swing in a metal frame and can be actuated by an electric motor, foot, or hand power. In the top of the box are placed red and orange windows for cutting out the actinic rays from the lamps, so that the plate is not fogged or otherwise affected. Above these is the glass tray for the developing solution. In carrying on the developing, the light may remain on, can be

shut off, or turned down at will. With this arrangement frequent observations can be made during the process of developing, without removing the plate, thus being able to determine the proper time to remove said plate from solution. It has therefore, numerous advantages, the principal ones of which

are:

(1) Observations can be made under the most favorable conditions.

(2) It provides an agitating device which is easy to manipulate.

(3) It can be used as an illuminating box.

This apparatus is manufactured, and patents controlled, by E. B. Meyrowitz of New York City.

BY WILLIAM BENHAM SNOW, M. D., NEW YORK.

From the earliest times of which we have any record diet, exercise, massage, heat, light, bathing, and later cupping, and other mechanical procedures were employed; but empirically then not as now in the light of a more perfect knowledge of histology, pathology, and their physiological effect upon the tissues of the body. The value of hydrotherapy or the action of light, heat, and electricity could not have been fully appreciated before the days of Harvey, nor the effects of these agents upon germs before Pasteur's time, before the recognition of the numerous microscopic organisms which infest the human body, or until the more recent knowledge of the action of the leucocytes which war against the infectious elements.

It is the better knowledge of the various functions of the human organism and the demonstration of the causes of disease, that have made possible the development of rational therapeutics. The past is history, and full of vagary and superstition, and though there were men in all ages who were earnest investigators, ignorance, like a pall, darkened the vision, shutting out the true relations of cause and effect in therapeutics until research revealed important truths. In most cases, administrations of which little was known were made for the relief of conditions the character of which much less. was known. Post hoc, propter hoc, has in proper terms expressed the doubtful efficacy of the things of which little was known.

From the earliest times to the present day experimental medicine has been the bane of both physician and patient, and in practice to-day, particularly in the use of drugs, views and methods are diverse. Less now than in the olden time, be

*Presidential address delivered at the Sixteenth Annual Meeting of the American Electro-Therapeutic Association at Philadelphia, September 18, 1906.

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cause the better knowledge of pathology and more accurate methods of diagnosis, have rendered more definite the lines of indication.

Advanced knowledge of diseased conditions has not only made possible the employment of definite mechanical or chemical measures for the relief of local and constitutional derangements; but has created a demand as well for more exact and rational methods.

Chemical agencies under favorable conditions may induce mechanical effects, capable at times of relieving physical conditions, but in numerous instances, coincidentally induce subsequent injurious effects. The recognition of this fact leads the observing, as years advance, to abandon many of the drugs which in his youthful career he had considered as standards of the pharmacopoeia. No truth is more pregnant in the minds of the members of the profession, than that the physician as he grows older employs less and less the doubtful, though unfortunately recognized, preparations of the pharmacopoeia, and seeks other means of combating disease. The resourceful man and conscientious student under these conditions, seeks rational measures and such he finds in physical therapeutics. Too often, however, the busy practitioner devotes little time to the investigation of the more definite therapeutic measures; and they are, therefore, often neglected.

The luring field of surgery with its bountiful remuneration and positive results-either relieving suffering by restoring, dismembering, or sacrificing the life of the individual in the attempt attracts where drug medications have been discouraging, and another extreme arises-to cure by surgery. Great is the triumph of modern surgery, but in the light of the great possibilities of other more safe and equally effective means in many cases, which do not dismember, or destroy, the use of the knife is certain to be curtailed in the future.

Physical agents in the hands of those trained in their employment, will fill the most important field in future therapeutics. In their employment, as much depends upon the skill of the operator to obtain the best results, as upon the skill of the surgeon who holds the knife-a fact too often disregarded.

The various so-called therapies should no longer be ranked as specialties. The study of the relative merits of them all calls on each to fill a definite field in the future, but they must

be employed in an effective manner, as indicated in the various conditions as they arise. The physician who has best command of them all, will best serve his patient.

Colombo and others have shown that there are few cases that do not require more than one modality or measure to combat the symptoms complex as they occur in most cases. Those who confine themselves to the use of drugs, surgery, electrotherapy, phototherapy, mechanotherapy, or any other means or method are certain to neglect to a degree the means of meeting effectively all of the indications as present in most cases. The call is for a broad-gauge, honest investigating spirit, with a willingness to adopt all that is good, and a determination to weed out the spurious and dangerous in therapeutics.

The indifference of the uninformed who either attempt to prejudice others or assume to make use alone of means with which they are familiar, now, in the light of their demonstrated. value, is to be deplored. We find the evidence of this in the autocratic position of surgeons who attempt to cure organic affections with the knife. So also is the disposition of some who adhere too exclusively to the employment of electricity, mechanical vibration, or massage, to the exclusion of the others, or of surgery, or often indicated drugs of the pharmacopoeia. The osteopath and others outside of the profession, who attempt to employ them, also bring discredit on physical

measures.

The number of the profession who have made honest, conscientious study of electricity, radiant energy, heat and cold, exercise, mechanical vibration, and other mechanical measures, and have a fair conception of their value in therapeutics is relatively small. Advanced knowledge of these means, however, in the hands of those who do understand them, has added virility to therapeutics, when such as Osler have learned to look upon that department of our science as little less than impotent.

In the treatment of disease there are cardinal indications which include: (1) prevention by removal of the causeprophylactic therapeutics which include regulation of habit and diet; (2) removal of infectious germs and their effectstoxemia and congestion; (3) removal of the effects of trauma, local stasis as it presents itself in the region of simple inflam

mation, associated with varying degrees of infiltration; (4) establishment of general activity when torpor or functional irregularities are present.

It will be readily observed that these indications are best conserved by measures which facilitate restoration without adding to the dangers of the conditions. The restoration of unimpaired functional activity is health. Regulated exercise, healthy environment, moral and physical, and a proper diet, are prerequisites. Given these, which are essential to health, and it but remains to remove causes of conditions which are found present to effect the cure. Failing in this, to cure is impossible.

It is a well-recognized fact that disease is generally associated with an inflammatory process either infected, or noninfected. Considering therapeutics from this point of view, the modalities or means indicated may be divided into those which relieve the stasis of simple localized inflammation and promote elimination of the products of inflammation from the tissues involved, and those from which it is necessary to first remove the infecting germs which are the exciting cause of the inflammatory process.

The therapeutics of the simple non-infected inflammatory conditions, when it is apparent that such lesions result from some irritant other than infection, as trauma or sequelæ of a protracted hyperemic conditions resulting in a chronic process, must depend upon the restoration to normal of a circumscribed region of local stasis. When we realize that the inertia thus present in the tissues is well established, and a chronic condition for which nature has provided no immediate means of relief, the indication is apparent-its removal.

Who would now presume by medicinal remedies to overcome local stasis? and yet drugs are commonly administered to accomplish this result. No other than a mechanical measure, one which is capable of relieving the stagnation, would be contemplated by the rational physician. To remove the indurated area, and re-establish circulation and activity in the tissues which are the seat of the trouble, are the indications to be met in every case of non-infected simple inflammation. The measures that can be relied upon to meet these indications will vary with the location of the patient (whether the best means are at hand), and location of the lesion or the tissue involved.