duced by a rapid rotary motion. This is a useful remedy in rheumatism, neuralgia, local paralysis, etc. By the use of insulated needles a galvanic current may be conveyed to deeplyseated nerves. For purposes of counter-irritation a form of acupuncture is now used termed Baunscheidtismus. In this, an instrument is employed consisting of a heavy disk about half an inch in diameter, having inserted in it about twenty-five sharp needles, each about nine-sixteenths of an inch in length. To this disk is attached a strong wire spiral spring five and a half inches in length, and the other extremity of the spring is inserted in an elongated spindle-shaped handle, the spring and needles being contained in a cylinder, with the handle attached. In applying the instrument the open extremity of the cylinder is placed upon the skin; the handle is drawn up, and when this is suddenly loosed the needles are driven into the skin, the punctures being afterwards rubbed with diluted croton oil or other irritant.

7. PNEUMATIC ASPIRATION is the employment of an instrument termed an ASPIRATOR (invented by Dieulafoy) for the removal by suction of pathological fluids.

The aspirator consists of:

I. A glass bottle or reservoir, A, mounted with a two-way stop-cock, B, and having an opening at the bottom for the insertion of the tube, C.

2. An exhausting syringe, D, with elastic connecting-tube, H. 3. A tubular needle, E, to be attached to the reservoir by an india-rubber tube, F.

A syringe and stop-cock for injecting astringents or other fluids is supplied if desired. The stop-cock is, in such cases, fixed to the tube F at its junction with the stop-cock B. Thus the tube can be detached from the aspirator without any chance of air entering the morbid cavity.

Directions for Use.-Adjust the aspirator as figured in the diagram, with the stop-cock B turned vertically, that is, open to the bottle; close the stop-cock in the tube C, and form a vacuum by a few upward and downward movements of the piston of the exhausting syringe D.

Insert one of the needles beyond the two eyes, attach tube F to it, turn the stop-cock B towards the needle, namely, horizontally, and continue the insertion of the needle until fluid is seen to flow through the short glass tube G into the reservoir. To empty the latter, turn the stop-cock B vertically, detach the syringe tube, and open the stop-cock in tube C.

The presence of fluid having been established by the use of one of the fine needles, it is recommended for more quickly emptying the cavity to use one of the larger needles or trocars.

The introduction of the needle into the tissues requires some precautions. In place of endeavoring to penetrate by pressure, as with an ordinary trocar, it is preferable to combine pressure with rotation, by taking the needle in the forefinger and thumb and rolling it between them. Such a manœuvre is rendered necessary by the extreme fineness of the needle, which would be liable to bend or twist if driven in by direct pressure. Before using a needle it is well to be assured of its permeability.

Aspiration has been employed with safety and success in the removal of intrathoracic effusions (as in chronic pleurisy, empyema, and pericarditis), of the fluid of hydrocephalus, ascites, cysts and abscesses of the liver, of the urine in retention, and of poisonous liquids in the stomach. It is also applicable to the diagnosis and treatment of morbid fluids and to the arrest of internal hæmorrhage.

PART II.

IMPONDERABLE REMEDIES.

UNDER this head are included Light, Heat, Cold, and Electricity.

I. LIGHT (Lux) exercises an important influence in the organized world as a vivifying stimulus. It is useful as a therapeutic agent, in diseases dependent on imperfect nutrition and sanguification; and the exposure of the surface of the body to

IMPONDERABLE REMEDIES.

23

its action, as far as nudity is compatible with proper warmth promotes the regular development and strength of the organs. On the other hand, in many diseases the action of light is injurious, and darkness is resorted to as a sedative and tranquilizing agent.

2. HEAT (Calor), applied to the human system in moderate amount, acts, both locally and generally, as a stimulant; in intense degree it destroys vitality and organization. It is employed as a local excitant and revulsive, by means of hot bottles, hot bricks, the hot foot-bath, etc., and as an application to painful and inflamed parts in the form of elastic bags containing hot water, and of poultices and fomentations. As a general application heat is chiefly resorted to in the form of the water-bath and vapour-bath. The warm bath, at a temperature from 92° to 98° F., is used as a relaxant in dislocations, herniæ, spasm, infantile convulsions, croup, etc., and also for its action on the skin in rheumatic and chronic cutaneous affections. The hot bath has a temperature of from 98° to 112°, and is a powerful excitant in cases of exhaustion, asphyxia or suffocation, and is employed also in old paralytic and rheumatic cases. The hot air-bath, at a temperature of from 98° to 130°, is useful as an excitant, diaphoretic and revellent, and is employed in cases of internal congestion, to produce vicarious action from the skin, where the secretion from other organs, as the kidneys, is suspended, and in rheumatic, neuralgic, and cutaneous affections. The hot vapour-bath is adapted to the same class of cases as the hot air-bath, and exerts a more marked diaphoretic and relaxing influence.

The destructive agency of heat is resorted to for the purpose of vesication, as by the application to the skin of the metallic plate heated to 212° by immersion in boiling-water; and of cauterization, by the employment of red-hot iron, or of moxa. Hot iron (known as the actual cautery) is used chiefly as a styptic. The term moxa is applied to small masses of combustible matter (as cotton-wool), which are burnt slowly in contact with the skin, with a view to a revulsive effect in deepseated inflammations, nervous affections, etc.

3. COLD (Frigus).—The application of cold to living bodies produces a reduction of the temperature and volume of the parts, with contraction of the bloodvessels and other tissues, and suspension of the secretions and exhalations. The application of excessive or prolonged cold is followed by the torpor and death of the parts. When it is applied in moderation and for a short period, reaction generally takes place, with a return and even increase in temperature, volume, colour, and sensibility.

Cold is employed therapeutically, with a view to both its primary and secondary effects. The primary action of cold is used: 1. To lessen vascular and nervous excitement and preternatural heat, as by the use of cold lotions and spongings in fevers, the ice-cap in cerebral affection, the shower-bath in insanity, the bladder filled with ice to the spine in epilepsy, the ether spray to the spine in chorea, etc. 2. To constringe the tissues, promote the coagulation of the blood and lessen the volume of parts; hence the local application of ice or cold water to abate inflammation, check hæmorrhage, cure aneurism, and reduce strangulated hernia. 3. To produce local anæsthesia in surgical operations, by means of a freezing mixture topically applied.

The secondary effects of cold are obtained by the employment of a less intense degree of cold. They are resorted to: 1. To invigorate the system, as with the cold shower-bath and plunge-bath. 2. To rouse the system, as by cold affusions in coma, asphyxia, syncope, and the narcotism from opium, chloroform, hydrocyanic acid, alcohol, etc. 3. In spasmodic diseases, as laryngismus stridulus, chorea, etc. 4. To recall the vital properties to frost-bitten parts. 5. To effect local excitation, as by the application of the cold douche to rheumatic and paralyzed limbs.

The cold bath, or packing in a cold wet sheet, is employed with much advantage in sunstroke, and in fevers where the temperature of the body is very high, as scarlet fever, typhoid fever, acute rheumatism, and, generally, to reduce excessive hyperpyrexia.

The ice-bag is sometimes applied along the spine in convul