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Equally as important is it that no procedure should be prescribed which will in any way frighten a patient, or cause that patient to lose confidence in a method which is new to the large majority of them, therefore, in the treatment of neurasthenia, I make it a practice to employ the milder measures at first, and gradually work up to the highest degree of hydrotherapeutic treatment. For example: the patient is only sent to the bath three times a week for the first week, and if their reactive capacity is fair, and they have grown accustomed to the procedures as ordered, they are sent daily.

A general prescription reads as follows:

Hot air box to point of perspiration.

Circular douche 100°-90°-2 minutes-15 lbs.

Fan and jet douche to entire body, 90° to 80°-10 lbs-1 minute.

Lower minimum temperature 2 degrees and increase pressure 2 lbs each treatment until a temperature of 60° and a pressure of 30 lbs is reached.

The above prescription is suitable for a female; male patients can be treated more actively, beginning with lower temperatures and higher pressures.

After the patient has become accustomed to the jet douche, the Scotch douche (alternating hot and cold) may be used with good results.

Usually a walk in the open air, to the point of fatigue, is ordered to follow the bath.

Melancholia.-The same treatment as outlined above. If it is impossible to place the patient in a hot box, owing to some mental phase, I would suggest as a substitute the circular douche at 102 or 104° for two minutes before reducing to 90°, as it is important that the body be well warmed before any cold is applied.

In the melancholic, the Scotch douche, used freely all over the body, markedly stimulates the circulation and imparts a sense of well-being, substituting the depression; and also considerably lessens the lethargy, inclining the patient to greater activity. As the treatment progresses, day by day, the periods of euphorbia lengthen, and the depression decreases until finally normal mental health is restored.

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Following the bath a vigorous towelling is indicated, more particularly in cases where reaction is not marked. This is usually required in the early stages of treatment in the majority of cases.

In case of any difficulty with the patient refusing the douches,

the nurse steps into the bath and manipulates the patient, at the same time reassuring him.

DEMENTIA PRAECOX.

(a) Hebephrenic Type.-Some good has been obtained in these cases by the use of stimulating baths of various kinds. The patient should go to the bath daily, and the treatment should be the same as in neurasthenia and melancholia, and gradually be increased in strength. Circular, rain, jet and Scotch douches are indicated with lowering of minimum temperature, and increase of pressure each day until the highest point of efficiency

is reached.

(b) Catatonic Type.-As above. Results not so encouraging.

MANIC DEPRESSIVE INSANITIES.

(a) Manic Type.-Control excitement by continuous bath, 100°-one-half to six hours, according to condition.

Hot or cold packs (cold preferred) continued until excitement subsides. If patient falls asleep, leave him in the pack until he wakens, in the meantime keep him well covered with additional blankets. On removing patient from the pack, a half bath, 80° or 85°, should be quickly given with active friction, to restore tone of dilated blood vessels, and then return patient to bed.

Pack repeated two or three times a day if necessary. (b) Depressive, the same as melancholia.

Exhaustion Psychoses, or Exhaustion Following Acute Disease.-Half bath, or drip sheet, or affusions night and morning— temperature 80° to 85°, duration 3 to 5 minutes, followed by a vigorous towelling, and patient returned to bed, and in serious cases the temperature may be reduced to 70° or even 60°. Baruch says, "Let not the fear of cold water deter anyone from resorting to cold affusions in these desperate cases. They are the hydriatic substitute for digitalis and alcohol." I can fully endorse this statement, as I have recently treated a serious case of exhaustion and collapse in this way, and I can assure you that the result has been most gratifying.

Alcoholism-Prescription (daily) :

Hot-air box, 140°-185°-10 minutes.

Circular rain douches-100°-60°-3 minutes-25 lbs.

Scotch douche-100°-60°-5 minutes-25 lbs.

Rain douche-60°-30 seconds.

Hot-air box may be omitted after first two weeks.

Morphinism-Cocainism.-For the unpleasant symptoms of pain and restlessness during and following the reduction of the drug, I know of nothing better than full tub bath, temperature 102, gradually increased to 110°, duration 15 minutes, at least; may use this twice daily.

In our year's experience with general hydrotherapy our most excellent results have been obtained in neurasthenics, melancholics, exhaustion psychoses, manic depressive insanity, and alcoholics. In the other psychoses only fair results have been obtained.

Incidentally it has been found that the use of the perineal douche, temperature 85°, pressure 25 lbs., 2 minutes, patient sitting or standing over it, has been useful in chronic constipation. This is only of recent date, but, so far, results are good. The jet douche-same pressure and temperature-applied to the abdomen is also useful in torpor of the bowel. Sitz bath in sexual neurasthenia warm gradually reduced to cold-five to ten min

utes.

Much of the success of hydrotherapy at the Homewood is due to my first assistant, Dr. E. C. Barnes, who has been untiring in his efforts to place the treatment on a practical basis. In this he has been materially aided by the intelligent co-operation of the nursing staff. By means of lectures and practical demonstrations the nurses have been instructed in the physiology and anatomy of the skin, and the various organs and functions of the body that are affected by hydriatic procedures, the effects of the various kinds of baths and the indications for their use, but above all, they have been taught to be exact in all procedures, and have now learned to fully appreciate the necessity of this by the gratifying results that have been obtained.

A SMALL meningocele may resemble a sebaceous cyst. The previous history is important in the diagnosis. A meningocele of this character is present "as long as the patient can remember" and remains about the same size; a cyst begins as a small nodule later on in life and increases in size.

PERSISTENT furunculosis and allied suppurating skin lesions appear to yield in a large percentage of cases to Wright's vaccine treatment. Stack vaccines are usually suitable to such cases. The internal administration of yeast, calcium sulphide, etc., affords only occasional help.-American Journal of Surgery.

¡OUR EXPERIENCE IN BRONCHO-PNEUMONIA.*

By C. S. McVICAR, M.B.,

Hospital for Sick Children, Toronto.

In the past seven years 75 cases of Broncho-Pneumonia have been admitted to the medical wards of the Hospital for Sick Children.

Number of cases of Primary Broncho-Pneumonia....
Number of cases of Secondary Broncho-Pneumonia..

Total

Deaths from Primary Broncho-Pneumonia
Deaths from Secondary Broncho-Pneumonia
Number of cases under 2 years

64

11

75

25-39%

8-73%

32-43%

Number of cases under 2 years

20-66%

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Character of Temperature:

Remittent in 56 or 75%

Continued in 19 or 25%

In 42 cases with recovery:

Decline was by Lysis 29, or 69%
Decline was by Crisis 13, or 31%

Cough was present in 75 cases, or 100%
Cyanosis was noted in 61, or 80%

It is perhaps impossible from Hospital records to get a correct idea of the relative severity of cases, but if we take the averages of the maximum temperatures, pulse rates, and respiration rates, in each series, we have, at least, an approximate conception of the disturbance caused.

* Read at meeting of Canadian Medical Association, Ottawa, June, 1908.

The following table may be used for purposes of comparison:

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From this table it seems reasonable to infer that increased respiration rate is the most serious feature in determining the prognosis-although the pulse rate is also higher in the fatal cases while the temperature is not significant.

In the whole series of 75, the temperature rose above 106 degrees in four cases-three with death, and one with recovery. A few facts in connection with treatment may be of interest. Eight cases with recovery were treated without stimulation or local application of any sort. Eighteen cases with recovery were treated without stimulation. Some idea of the severity of these cases may be gained from the following table:

Eight cases with recovery without

Average
Max. Temp.

Average
Max. Pulse.

Average Max.
Respiration.

142

53

103'

143

53

stimulation or local application.. 103 Eighteen cases with recovery without

stimulation ... The therapeutic measures used may be conveniently classified as follows:

1. MEANS Used for ReLIEF OF TOXIC SYMPTOMS. (a) Antipyretic drugs were used in five cases, of which two died and three recovered. In two cases no effect was noted. In one case the temperature fell with each dose and rose again in a few hours, indicating that while the manifestation of toxaemia was modified, the toxaemia itself persisted. In one case depres sion of the medullary centres as shown by increased cyanosis is noted.

(b) Hydrotherapy has proven of greatest value. The administration of as much fluid by the mouth as the child will take has always seemed valuable. The hot pack is the best external means of controlling nervous symptoms. It seldom fails to keep the temperature within bounds. Cold packs and cold sponging have proven, in so many instances, distressing to the child, that they are to be avoided as routine measures. When the hot pack

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