very

symptoms. Examination.-Patient poorly nourished. The heart and lungs are normal. The abdomen is very thin and lax, and on the left side cf the abdomen is felt a rounded mass arising from the pelvis midway to the umbilicus. It is smooth, tense and painful. Vaginal examination. The cervix points upward and to the left. The left fornix is filled with a rounded, tense swelling, continuous with the tumor felt through the abdomen. It is nodulated. In the right side can be made out a smooth, hard mass filling the fornix and pouch of Douglas. The tubes cannot be felt nor the fundus of the uterus. The urine was normal. The red blood corpuscles were 3,200,000; white corpuscles 6,800, and hemoglobin 65 per cent. In opening the abdomen the following condition was observed. The mass felt on the left side rose from behind the broad ligament, and was tightly fixed between the left pelvic wall, and the uterus, to which it was firmly adherent. The tumor was about the size of a cocoanut. The sigmoid flexure was firmly adherent over it for a length of about five inches. The usterus was retroverted and the tumor projected over it. In the right side was a round, smooth, cystic tumor about the size of a lemon adherent to the broad ligament and to the posterior wall of the pelvis. The adhesions were slight and easily separated. It was twisted once upon its pedicle to the right, contrary to Freund's law that right-sided growths twist to the left and vice versa. In removing the tumors and uterus, which was done with some difficulty, owing to many adhesions, the uterus was amputated at the vaginal junction to save time.

Examination of specimens.-The left and largest tumor was multilocular, having three compartments divided by thick friable walls. The capsule of the cyst was thick and friable. Inside the cyst was lined with a rough skin lining, similar to that described in the first case and contained the same oily, yellow fluid. The right-sided cyst was unilocular and the membrane was thinner and tougher. The inner lining was comparatively smooth and the liquid lighter, resembling thin pus. There was no odor. The cyst was filled with a large ball of hair, tightly matted and dark brown in color. No hair was found growing from the cyst-wall. Microscopical examination showed the wall to contain numerous hair follicles and sebaceous glands and to be lined with a typical skin lining.

In these two cases the pathologic findings were similar, and it is interesting to note that the first case had no symptoms until the beginning of puberty, while in the second case no symptoms were noted till the menopause.

SOME OF THE NEGLECTED REMEDIAL MEASURES ASIDE FROM DRUGS.*

E. E. SHERMAN, M. D. KEOSAUQUA, IA.

WHAT we shall say at this time is presented with no thought of bringing before you anything new, nor of calling attention to any measure not well known and recognized by the profession in general, but in the language of the great apostle to the Gentiles, "I write that I may stir up your pure minds by way of remembrance.

Science is sometimes defined as classified knowledge. We learn and retain by classifying. We fail to learn and often lose many valuable ideas because we fail to properly classify. So it is well for us to make some distinction in the use of remedial measures.

It is my opinion that there is a tendency among us to pin our faith too exclusively to the use of drugs, often neglecting or overlook. ing other measures just as important and possibly more beneficial. I am by no means a disbeliever in the efficacy of drugs. I heartily indorse the therapeutic principle, "The smallest amount of drug to accomplish the desired therapeutic effect," and I would insist upon the use of active medication with a clear and positive knowledge of the physiological effect of the drugs.

To my mind we are responsible in quite a measure, for much of the charlatanism and quackery that prevail at this present time. The profession has neglected to make use of some of the very measures that have made so much capital for some of the self-styled scientists, thus failing to utilize some very valuable measures that are the common property of the profession, and should be utilized and made profitable to us in our work.

Mechano-therapeutics, manipulation, Swedish movement, gymnastics and calisthenics; these are all legitimate therapeutic measures and are recognized as such.

Our medical college curriculums are direlict in not giving more time and attention to some of these measures. I believe more time should be spent in our college work upon regional anatomy, the student should be made thoroughly familar with the topography of the living body, the location of the more important organs and viscera in the live subject, so that the nature and extent of anatomical changes brought about by disease and appreciated. or injury may be more readily recognized In addition to the above, there should be given a thorough course in mechano-therapeutics.

*Read before the First District Medical Society of Iowa at Fairfield, January 26, 1906.

Massage. This remedial measure is defined as a scientific treatment by certain pass. ive systematic manipulatious upon the nude skin of the body. The relief of diseased conditions by this means is by no means new. The Swedes for centuries have practiced centuries have practiced massage together with passive movement, for the same purpose for which it is used today, viz., to prevent stagnation, and produce an even and harmonious movement of the fluids of the body, also to stimulate or inhibit nerve function. These measures should be combined with, and not divorced from, the study of medicine. Much of this work has gone over to the scientific colleges, and physical culture is an important part of our literary college work. I take it that there is no place in the realm of science, nor no profession wherein the need of a thorough knowledge of gymnastics and physical culture is greater than in our profession, and no one should be more competent to direct the kind, and amount of physical culture in which a person should indulge, than the phy

sician.

There are four movements employed in giving massage treatment, viz., stroking, friction, kneading and percussing. These together with flexion and extension, also rotation, constitute the major manipulations.

Each of these may be readily mastered, and utilized in many conditions where our knowledge of anatomical conditions or changes may suggest.

These various movements should be centripetal, or in the direction of the flow of normal fluids, and one movement should often follow another.

Stroking is performed with the palm of one or both hands, with the thumb or finger tips and is most used upon the extremities.

Friction is usually performed over one group of muscles with the thumb or finger tips, should be centripetal, and followed by stroking.

Kneading is best done with the finger tips of both hands or the wrist part of the palm. Its aim is to reach deep structures and to separate them from surrounding structures. elasticity of muscles may be determined by thus increasing the distance between their points of attachment.

The

Percussion is done with the finger tips also, or the ulnar border of the hand striking the flesh quickly. The therapeutic benefit of these procedures upon the tissues may be mentioned as follows: Stroking is most active upon the skin, and superficial vessels, in stimulating movement of fluids. Friction stimulates nerve tissue both motor and sensory. Kneading stimulates deep structures and stimulates or inhibits according as pressure

is constant or intermittent. Percussion stim. ulates both muscle and nerve tissue.

Persons of a sedentary habit are those upon whom this line of treatment is most beneficial, for the obvious reason that there is less activity in the circirculating fluids and a weakened musculature.

Some of the diseases in which the above mentioned are useful are as follows: General muscular debility, whether due to acute disease, or chronic, or in recovering from operative procedures. Insomnia, superficial neuralgias, muscular atrophy, rheumatism and chronic constipation, are all conditions in which massage is helpful. Chronic constipation is a condition that confronts us often and is a condition in which drug medication alone is so unsatisfactory that it deserves more than a passing notice. In those atonic conditions of the bowel where the fecal discharges are bullet-like and covered with slimy mucus, indicating a catarrhal condition of the bowel, local massage of the abdomen, using the finger tips and proceeding from the center to the circumference with gentle kneading, and the free use of olive oil, both per ovum and per rectum, will relieve more cases than any other treatment.

Massage is used with benefit in many chronic eye troubles, phlyctenular ulcers both of conjunctiva and cornea, with chronic inflammation are benefited by local massage.

Scoliosis is a condition in which we can offer but little to the patient aside from this treatment. The aim of treatment should be to invigorate and develop the weakened muscles upon the convex side, to elongate the spine, to raise the lower shoulder and to counteract rotation of the vertebra, all of which can be best accomplished by local and general massage treatment, especially in the early stages of the disease.

Aquipuncture.-This applies to the inserting of sharp pointed instruments into the tissues of the body for the purpose of relieving pain and relaxing muscular contraction. It is seldom made use of today, but is a useful measure in some cases of acute lumbago and sciatica. Deep injections into the mus

cles of the back of normal salt solution for the former and of chloroform or morphine in the latter, is very helpful.

Hydrotherapy.-The use of this remedial measure, either hot or cold, is well recognized by the profession, and is, to a considerable extent, understood by the laity; yet while the above is true, I fear there are physicians who use the dangerous and poisonous coal tar products, to reduce temperature and quiet nervous conditions, instead of harmless cold. It is so easy to write a prescrip

tion or to dispense a few powders or tablets, that I fear many times this agent is neglected to the detriment of the patient. Often is this painfully true in the diseases of infancy and childhood.

In

In the selection of heat or cold in a given case, many times the comfort and well being of the patient is our only guide. asthenic cases with little fever, but much nervousness and pain, heat is to be preferred; also in severe sprains, headache in women, heat locally is to be used. In most local inflammations, whether superficial or in deep structures, cold is best.

Its therapeutic effect is well known in that it checks inflammation, stops congestion, reduces pressure upon nerves and thus relieves pain.

As a general therapeutic measure the use of oold for its influence upon deep-seated inflammation, for the reduction of fever, for its beneficial effect upon the cerebral circulation, and its soothing and quieting effect upon the nervous system is not to be overlooked. The ice-bag has many advocates in acute lobar pneumonia, and many equally qualified to speak, condemn its use. In properly selected cases, those of robust constitution, with high temperature and in the early stage of the disease, I regard it as the very best local application.

Cardiac palpitation, endo and pericarditis, meningitis, acute mastoiditis, pruritus ani and vulva acute prostatitis are conditions in which cold is a useful remedial measure.

Much has been written upon the best manner of applying hydrotherapy in fevers. Some favor tubbing, others the cold pack and again others simply sponge. The temperature of the bath should vary with the condition of the patient. A patient may be nervous, restless and sleepless, yet have little fever. In such a condition the tepid or warm bath should be used, for its tonic and quieting effect upon the nervous system.

In the rural districts where the facilities for the use of this measure are very meager, I have found that systematic, regular sponging with ice cold water a very reliable substitute for the Brand bath.

Baruch, the great apostle of hydrotherapy, gives some very wholesome views in a few emphatic don'ts as found in Hare's excellent work on therapeutics, viz. :

"Don't bath with cold water to reduce temperature only.

Don't permit cyanosis or chattering of the teeth.

Don't stop bathing because patient complains of cold, but consult your thermometer and shorten bath.

Don't neglect friction in all cold applications.

Don't neglect this therapeutic measure because the ideal appliances are not at hand, but utilize what you have.

Don't forget that the principal thing to expect and work for in applying cold is the reaction that follows."

Before leaving this very important therapeutic measure there are three conditions in which cold in the form of an ice pack should be emphasized, viz., in acute articular rheumatism the ice pack is, in my opinion, the very best local measure to use; in recent irreducible inguinal hernias the ice-bag has hepled me in many cases.

In membranous croup, not diphtheritio, an ice-bag applied early and continually to the throat is the very best external application, and will do good in all kinds of croup.

Dry heat as a therapeutic measure has been quite extensively advertised to the profession of late and many different kinds of apparatus for the application of this measure are upon the market.

Renal and hepatic insufficiency are two conditions wherein dry heat is indicated, whether due in either case to acute or chronic congestion.

I am of the opinion that many cases of acute nephritis could be cured by the careful, systematic and persistent use of this agent.

Acute colds are best relieved by a dry or moist cabinet bath. I have utilized dry heat in the treatment of rectal and anal troubles with benefit. A simple contrivance consisting of a perforated stool the heighth of a dining chair, around which is placed an oil cloth or rubber, reaching from the seat to the floor; beneath which I place an asbestos alcohol lamp. Seating the patient upon the stool I raise the temperature beneath to 200 deg. F., thus submitting the parts to the above temperature for thirty minutes every day. Hemorrhoids, both external and internal, pruritus ani, fissures and ulcers have all been benefited and some complete cures resulted.

Counter-Irritation.-While this therapeutic measure has somewhat fallen into disuse, especially as pertaining to vesication, yet it has its proper place in the relief of diseased conditions, and its use is based upon sound physiological laws. There are four distinct purposes for which this measure may be used, viz. To effect local inflammation; to cause absorption of inflammatory products; for the relief of pain and for its effect upon the whole system. Its action is both direct and reflex, usually should be applied for the lat

ter effect. In pleurodynia, for example, counter-irritation should be placed not over the seat of pain, but near the spine over the point where the nerve at fault takes its exit.

In iritis the irritation should be back of

the ear upon the affected side. Among the inflammatory affections in which vesication may be mentioned pleurisy, pneumonia, synovitis, cerebritis, meningitis and mastoiditis. In the early stage of acute pleurisy, and in the second and third stages of lobar pneumonia a small cantharidal blister will relieve pain and subdue inflammation in the former, and will hasten resolution in the latter. In catarrhal pneumonia in infants and children the mustard poultices applied twice or thrice during each twenty-four hours is in my judgment, preferable to any of the mud preparations so-called.

Cupping. This is a useful measure in a limited number of cases. The leech is not to be obtained many times when local blood letting is indicated, so the use of wet cupping is our only alternative. It answers the place very well and is much less revolting to timid patients. I have found wet cupping beneficial in some of the stubborn eye troubles, especially trachoma when complicated with phyotenular ulceration of the cornea. ounce of blood taken from the temple, and repeated every third day has resulted in recovery in some very stubborn cases in my hands. In chronic muscular rheumatism, especially of the lumbar muscles in elderly people, wet cupping will be generally helpful as an adjunct to drug medication.

An

Inhalation.-In view of the prominent part played by pathogenic germs, as a causative factor in many diseases of the respiratory organs, the value of inhalation should be more thoroughly understood and more frequently made use of in the treatment of dis. eases of these organs. Steam impregnated with some volatile antiseptic has been extensively employed in disease of the air passages, especially in children.

The generation of steam in the sick-room is helpful in all bronchial and laryngeal troubles. Medicated oils vaporized are soothing and healing to the respiratory mucus membrane. Lime vapcr is not to be lost sight of in croup, and medicated vapor in pertussis is a very useful adjunct in the treament of this disease.

The open air treatment of pulmonary tuberculosis is in advance of all therapeutic measures for the cure of this disease today, and the profession should be thoroughly alive to the benefit of gymnastic exercises in the open air, especially as pertains to thor

acic gymnastics, and should direct such treatment in a systematic and intelligent manner. Lavage.-I am quite sure this is a much neglected therapeutic measure. Its diagnostic value is important also. Many cases of fermentative dyspepsia, chronic in form, with more or less dilatation of the stomach, and in which pepsins, pancreatins and bitter tonics are not curative, a few thorough stomach washings will give better results than any medication can possible do.

In chronic gastric catarrh resulting from obstruction at the pyloric orifice, especially when due to cholecystitis, lavage of the stomach every day with a warm alkaline antiseptic solution is curative. In most cases of chronic gastric indigestion, lavage once or twice a week is a great help to our success in treating these often troublesome cases.

THE RELATION OF MAN TO NATURE (A STUDY PROMPTED BY "TESTIMONIES OF THE SEPULCHRES").

ALBERT S. ASHMEAD, M. D.

NEW YORK.

ELEVENTH PAPER.*

Haeckel's "Wonders of Life" is full of chemistry of life. The Riddle (Weltraethsel) appeals to me much more strongly-for the reason that I care less for the chemistry than I do for the conclusions of scientists from chemistry. The Riddle of the Universe is divided into four great divisions; Anthropological, cosmological, psychological and theological

These are treated so directly and the book presents an attractiveness from thoroughly with no superfluous words that which it is difficult to escape-one cannot easily resolve to lay the book down until it is lished at Bonn, by Emil Strauss, 1903, is the read through. The last edition, that pubbest. There must be an English rendering, for it must be that it has been translated. My copy is a "popular" edition. As to the "Wonders of Life," in his chapter on Origin of Life, he expounds the older and later hypothesis of archigony or spontaneous gener

ation.

We still read sometimes that the "unscientific" belief in abiogenesis or archigouy, has been definitely refuted by Pasteur's experiments, and that the question of the origin of ilfe has thus become an insoluble enigma. According to Prof. Haeckel there is an astonishing superficiality and lack of discernment in such an assertion. It was the myth

*The first paper of this series appeared in the MEDICAL FORTNIGHTLY issue of April 25, 1905.

of saprobiosis (the birth of living from dead or putrid organic matter), and not the theory of archigouy, which was refuted by Pasteur, when he showed convincingly that new organisms never appear in infusions of organic substances when these are sufficiently boiled, and when the atmosphere which reaches them has been chemically purified. Those experiments did not even touch the important and pressing question which alone interests us: "How did the earliest organic inhabitants of our earth, the primitive organisms arise from inorganic compounds?" Prof. Haeckel holds, and has held for forty years, that we may confidently assume that in the period when archigony took place the time when organic life first appeared on the cooled surface of the earth, at the beginning of the Laurentian age-crystalization of rocks the conditions of existence were totally different from what they are now. He admits, however, that as yet we are very far from having a clear idea of what they were, or from being able to reproduce them artificially. We are just as far from having a thorough chemical acquaintance with the albuminous compounds to which plasm belongs. "We can only assume that the plasma-molecule is extremely large and made up of more than a thousand atoms, and that the arrangement and connection of the atoms in the molecule are very complicated and very unstable. Of the real features of the intricate structure, however, we have as yet no conception. As long as we are ignorant of this complex molecule structure of albumin, it is useless to attempt to produce it artifically." Is it not absurd, then asks Haeckel, because the miscarriage of the attempt to produce the plasm artificially under such disqualifying circumstances to cry out: "Spontaneous generation is impossible?".

He holds, in the first place, that the phenomena of life are merely functions of plasm, determined by the physical, chemical and morphological character of the living matter. He is equally convinced that the energy of the plasm (by energy here is meant the sum total of the forces which are connected with the living matter) is subject to the general laws of physics and chemistry. The obvious regularity of the vital processes and the organization they produce are, in Prof. Haeckel's eyes the outcome of natural evolution; their physiological factors (heredity and adapta. tion) are subject to the law of substance. All the various functions have been mechanically produced, orderly structures having been created by adaptation and transmitted to posterity by heredity. Nutrition, far from being a miracle, is pronounced a physic-chemical process, the metabolism of which has an

analogy in inorganic catalysis. Neither is reproduction, in our author's view, a miracle, but a mechanical consequence of transgressive or redundant growth, analogous to the elective multiplication of crystals. The movement of organisms, indeed, is, in every form, affirmed to be not essentially different from the movements of inorganic dynamos.

In one of his most interesting chapters the author reminds us that the wonder of life which in the widest sense of the word we call "nutrition" is the chief factor in the selfmaintenance of the organic individual. A large part of the several nutritive processes are already explicable by the known physical and chemical properties of inorganic bodies; another part of them we have not yet succeeded in thus explaining. Prof. Haeckel, nevertheless, avers that all "impartial physiologists agree that such an explanation is possible in principle, and that we have no need of introducing a special vital principle. All the trophic (nutritive) processes, without exception, are subject to the law of substance." It is certain that "nutrition" is always bound up with a chemical modification of the living matter, an organic metabolism (circulation of matter), and a corresponding circulation of force. In this chemical process, plasm, or "living substance," is used up, built up afresh, and once more disintegrated. metabolism which lies at the root of the chemistry of food is the essential feature in the manifold processes of nutrition.

The

Of all the chemical processes the most important, because the most indispensable, for the origin and upkeeping of organic life is the constant reconstruction of plasm. To this process our author applies the name of plasmodomism (plasma-upbuilding), or carbon-assimilation. The fact is recalled that botanists have been of late accustomed to call the process briefly assimilation, thus causing a good deal of misunderstanding The more common and older meaning of assimilation in animal physiology was in the widest sense, the intussusception and preparation of the food received. The carbon assimilation in plants, which our author calls plasmodomism, is only the first and original form of plasma production. It means that the plant is able, under the influence of sunlight to form carbohydrates, and from these new plasm, out of simple inorganic compounds (water, carbonic acid, nitric acid and ammonia), by synthesis and reduction. animal is unable to do this. It has to take its plasm in its food from other organisms; plant eaters take it directly and animal eaters indirectly. The title of plasmophagous is given to these animal "plasma eaters." In working up the foreign plasm it has eaten

The