electricity as utilized in medicin (also relegated to special experts).

Notwithstanding the large number and value of the methods I mention briefly or describe and advocate, they are not yet regarded by the older and more "conservativ" (or rather prejudiced) members of the profession with the confidence they deserve. There is such a vast amount of evidence growing in favor of their elemental efficiency that it will soon be impossible to disregard them.

The main reason for this is that these physicians had no systematic instruction therein during student days or formativ periods. Unfortunately, certain of the best of physicodynamic principles of healing have been exploited by shrewd, farseeing, but blatant and unreliable persons. Hence, natural repugnances are formed, their potential integrity is questioned and the profession refuses to inquire open-mindedly into what is undoubtedly a promising and valuable field of endeavor. It is even difficult to obtain a hearing before medical organizations.

Novel, unusual, especially the more simple principles and methods, however efficient they may prove to be, always have been, and always will be, assailed by those ignorant of their scientific foundations and the unimpeachable evidence afforded.

The one essential of the pioneer, as Huxley has said, the capability of judiciously exercising imagination (vision, the long perspectiv) is absent in them.

The purpose of my lectures is to give the students succinct practical hints whereby they can broaden and amplify their helpfulness to patients, and supplement whatever special or particularized forms of medication are indicated or being employed. Some of the measures described are not only efficient in themselves, but much more available, prompt, thoro and free from possible or doubtful by-effects than is medication. I maintain that medicins, oftentimes, are the only agents which can perform the work required; also, are more applicable for more applicable for many reasons; occasionally, are the only agencies which can turn the tide of morbid forces or save life.

None the less, many occasions arise when so-called "home remedies" amplified by experience, illuminated by science and elaborated to meet specific needs are the very ones on which it is important to rely.

Principles of mechanics, statics, hydrostatics, thermodynamics, and the like can

and will be utilized more than they are. They broaden out into the wide field of euthenics, the effects of improved conditions of environment, specialized into constructiv and reconstructiv hygiene.

In order that we may comprehend the workings of the human body sufficiently to guide it, in and out of health, we should learn to approach the problems from several separate, but correlated, points of view. The undergraduate student is supplied an admirable general concept, with elaborations of the natural history of disease; also training in how to meet the effects of disease by reputable laboratory and pharmacodynamic resources. The physicodynamic afford other additional means. We shall have a vastly better group of medical advisers when several preliminary years are devoted to a study of the normal structures and functions, also variations from the norm and the earlier phenomena of abnormality. Even now special research workers add most to advances who give the most time to studying normal problems of clinical histology and physiology. For example, recent testimony is to the effect that the marvelous revelations of the X-ray can only be rightly interpreted by men who are thoro masters of anatomy, physiology and pathology, as well as of special technicalities. The student of the future must devote a longer, more protracted and thoro course of study to the normal structures and actions before he can become a master

clinician.

In so brief a communication, it is only possible to indicate a few of the mechanical factors which must be reckoned with.

Let us here consider the human body first from the standpoint of a series of psychomotor and hydrostatic mechanisms, and dwell upon the simple, yet practical standpoint of the spinal reflexes.

The functions of the human body may be studied as a "temple for the soul" or spirit, animated by a vital flame, or dominating mind, whose mechanisms are largely controlled by the psyche.

The human body itself should be studied as a living entity, an animal (primate) and appraised from different angles of approach.

In my course at Temple University, the human body is described as a psychophysical vitalized mechanism dominated by a sentient mind, and students are shown, first, how the mind affects itself, acts or reacts in, thru and upon itself; and, next, how it affects the workings of the body in

and out of health. This we may call psychodynamics, a colossal subject, the nature and extent of which is by no means defined and is the battleground of vast controversies. None the less, we can utilize certain fairly well defined experiences and make use of them to advantage under the heading of psychotherapy. There is evidence to show that so delicate a mechanism as the human body, so responsiv to stimuli, psychic and physical, demands open-minded attention at all times and under all circumstances. New points of vision must constantly arise, but always there are simple guiding fundamentals and my chief object is to simplify the concept of the human body as a vitalized mechanism subject to and interpreted by the laws of physics. Hence, we can profitably study the body from the standpoint of physicodynamics, as well as biodynamics, both as to diagnosis and treatment. All modern advances in knowledge of the body processes involve a review of the physicodynamic phenomena.

The mind and the body are equally transformers and transmitters of energy. Physics is the study of matter and energy.

It includes a knowledge of mechanisms, how they work, how energy is transmitted and directed and controlled. Among the subjects deserving occasional review by the student of medicin, at whatever age or ' degree of proficiency, are: Laws of motion, statics, equilibrium, gravity, friction, properties of matter, of gases, of liquids (hydrostatics), of solids, malleability, ductility, elasticity, elastic limits, elongation, bending, torsion, etc.; laws of heat, expansion, changes of state, etc.; laws of vibration, of tonicity, etc.; with all or most of these it is essential to become familiar in order to begin to understand the human body at work.

I will end this paper with a few remarks on reflexes and the rôle they play in clinical phenomena.

Control of body function depends largely upon reflexes. They lie at the basis of all acts of life. We may divide them roughly into the major and minor reflexes. Among the minor are the automatisms; the acts of vegetativ life, analogous to habits, e. g., respiration, circulation, deglutition, walking, etc., become free from volitional control, instinctiv, adaptiv impulses. Some parts can act independently of the central nervous connections, e. g., the heart after nerves are

cut away, etc. The whole group of tubular mechanisms act thru reflexes which cause them to open and shut, hence, to propel the contained fluids and distribute them.

Many reflex acts are so perfectly coordinated that one is constrained to believe that in the spinal cord there exists a subsidiary brain. The most mystifying phenomena, however, often rest upon the least complex causes.

All diseases are manifested by a direct and indirect series of phenomena; the latter embrace the reflex symptoms. Some individuals have exaggerated reflexes. It is desirable, indeed essential, to familiarize one's self with the more dominant, broadly acting, and more readily controllable reflexes, such as the spinal (or vertebral), the vagus, the vasomotor (sympathetic), and the autonomic.

It becomes a study in clinical physiology of the action and reaction thru these reflexes.

The leading points can readily be learnt. from textbooks, others from clinical papers; then one can use with advantage any one of the now numerous excellent charts, and soon the seeming mysteries will clear up after repeated experiences and verifications.

For some years, the term "reflex disturbance" became a dumping ground for ignorance, and the subject was deservedly condemned by neurologists.

Unfortunately, the general practician thus came to pay less rather than more attention to the subject; hence ignorance was added to indifference. Now, attention is again being directed to this most promising field. It is quite possible to learn enuf, especially of diagnosis as well as treatment, thru regulating the reflexes and to encourage research and thus simplify many obscure phenomena.

All or nearly all of the often remarkable and excellent results of that group of irregular healers who pre-empt the backbone as their domain are achieved by primitiv, often unconscious, but efficient, stimulations of the spinal, the vasomotor and autonomic reflexes. This can be done by the deft hand alone in many instances. A few hints will suffice to guide, and close observation and experience can do more.

The moment one turns one's attention to the subject of reflexo-diagnosis, valuable facts will present themselves, enlarging our means of knowing how functional perturbations can be appraised and controlled. The first thing to do after acquiring a fair

foundation of knowledge of the underlying principles is to examin the surface of every patient by vision and also by touch, beginning with the back, combining this and verifying it by all the other means customarily employed, e. g., auscultation, percussion, etc. Many points will be thus revealed and new means afforded of appreciating the powers of our auxiliary clinical resources.

Among the objects to be determined are varying degrees and kinds of resistance, alterations in densities, relaxation and also local tendernesses, hypersensitivness of masses, points of pain in or near nerve centers and in their continuity, etc.

Again, thru the vasomotor subcenters in the cord circulation can be largely influenced. The paravertebral tissues (erector spinæ muscles innervated, as they are, by the posterior primary divisions of the spinal cord) are useful. Steady pressure on these areas dilate the peripheral vessels; alternating pressures induce vasoconstriction.

Tender spots usually indicate some peripheral disorder, which can be delimited in accord with innervation.

Here is the whole story in a nutshell of dominant control of the ebb and flow of arterial blood; hence, of local congestion, or anemia; hence, of nutrition and repair.

Take one crude illustration of the spinal reflexes. The vagus can be stimulated;, hence, vasoconstriction induced, also the reflex of contraction in the heart, larger blood-vessels, aorta, etc., by concussing the seventh cervical vertebra. To induce the opposite, dilation, concuss the tenth thoracic. The whole subject of the visceral reflexes of contraction and dilation has been reduced to simple factors by Abrams' original work.

To be able to contract at will the viscera is to open up vast avenues of betterment in losses of motor tone in hollow and tubular organs. Also expert pressures with the finger can induce desirable effects on nerves in continuity, awaking their action when dormant, relaxing spasm or stimulating to renewed action.

Thus it will be plain that the domain of auxiliary therapeutics, the play of mechanical forces on the organism, is a rich field for research, as well as of practical utility.

Yet another means of eliciting desired reflex responses is thru expert manipulation. By this, I do not mean the perfunctory rubbings and slappings as given by ignorant

routinists.

I use the term manipulation to broadly

include all treatments applied by the hand, that most marvelous and adaptable instrument of sensitiv appreciation, apperception and application. Hereby we can influence surface and deep structures in their mass and induce reactions thru both direct and indirect approach.

Direct: By squeezing and relaxation, separation of muscle fibers, skin and fascia by lifting subdermal structures, by traction and torsion of joints, etc.

Indirect: By surface stimulation, which tends to induce the visceral reflexes of contraction and dilation, tho not so emphatically as by concussion of vertebræ.

Mere routine massage is of limited usefulness.

Particularized and intelligently directed manipulation by a real expert is of enormous collateral utility. So few medical men take the trouble to learn this craftsmanship that it has never filled the rôle it deserves.

I strongly recommend that every clinician shall learn the rudiments, and from several experts. They can then oftentimes perform remarkable exploits of betterment in a few moments where nothing else can suffice. In another time and place I shall endeavor to prove my contentions.

Vaccination Legislation in New York.

EDITOR MEDICAL WORLD:-As showing the vicissitudes of compulsory vaccination legislation, a curious and interesting condition of affairs has arisen in New York State. The Commissioner of Health began, during the past year, to enforce a law requiring the vaccination of school children in the rural districts, and caused the vaccination of some 300,000 children. As a result of this campaign, which was apparently very unpopular with the people, a number of bad arms developt and some children were attackt by tetanus, but only those in the country districts; none in the cities.

A bill has been introduced into the New York Assembly, known as the "Tallett Bill," which was in large part instigated by a Mr. Loyster, who lost a son from poliomyelitis, which he attributed to vaccination. This bill makes no provision for vaccination of school children except when smallpox exists in any school district or city or in the vicinity thereof. The bill was supported by the Commissioner of Education and by Dr. Biggs, Commissioner of Health, who, however, wisht it to apply only to the rural districts, and not cities of the first and second class. The bill was

recovered that I was able to sing and teach. But I had learnt to protect my throat, wearing a flannel around my neck and keeping warm generally. In fact, I adopted and inculcated in others the motto, "If you would avoid taking cold keep warm."

I illustrate further by later experiences. After taking my degree in medicin and practising several years, I yielded to what I believed to be a higher call, and entered the Christian ministry. Besides on the Sabbath preaching morning and evening, sometimes attending an extra service in the afternoon at some out-station, I always held an evening service, at times driving out two or three miles for this. I occupied anywhere from two to six evenings a week conducting meetings several miles away, all thru the fall, winter and spring. In doing this I was careful to keep warm and dry. I instructed the people to keep the room warm till service was closed so people would not have to go out in the cold when chilled. To the best of my recollection I never took cold in going home from a meeting, tho I was naturally exercising vigorously during the service, and might sometimes be in somewhat of a perspiration. Of course, I would avoid that when possible, but I would rather be so than chilly; for I would put on wraps enuf to keep warm. I do not say I never had a cold during those years, for colds are often epidemic and contagious; but unless a cold was unusually severe, I kept going.

Late in the year 1889, I think it was, when influenza was prevailing in a very severe form, I suffered an attack, from the effects of which I have never fully recovered. After the acuteness of the attack had passed I tried to keep up my work. recovered my usual strength, but was peculiarly sensitiv to cold. I could not bear to touch cold things nor let cold air strike my face.

I

I had to warm all my clothes when I put them on; could not sit on a bare chair at the ordinary temperature of the room in which I lived. To do any of such things would make me sick. I would wrap up, throw a shawl over my head and face, and let some one drive me to the station so I could go to my preaching appointment; for I was laboring some fifteen miles from my home. I struggled along thru the winter, sometimes failing to meet my appointments, and then resigned my charge.

Some two and a half years after, having partially recovered from this morbid sen

sitivness, I accepted a call to a church in Connecticut. I had to use great precautions against cold and chill. So people noticed it, and many said I should not be able to stand the work. But I did. I visited the people and attended meetings as I had been in the habit of doing, and besides did considerable medical work. My health gradually improved and I continued my labors in that state something more than six years. In 1899 I returned to my home. where I am now, in Brentwood, N. H.. since which time, until within a few years. I have supplied pulpits, done some medical work, and when not thus engaged, work: on my farm. Tho realizing some failure from the lapse of years, I am still able to do light work on and about the farm; stil using great precautions against taking cold. and very rarely take cold. I suffer one or two mild attacks a year. I give these details to illustrate the course I take and recommend to others. I have practised on this plan in my family, and whether on account of it or in spite of it, my wife lived with me more than fifty-seven years and passed away at the age of 78; the 8 children born to us are all living, married and raising children, so that my grandchildren number 24. I myself am nearly 82, in comfortable health notwithstanding what I have told, and besides having suffered in my 18th to 20th years from chronic diarrhea and enteritis so that I was entirely disabled from activ work, and was expected by people in general to die, and which disease has lingered in my system all these years, has often broken out and thrown me down, and always, like a wild beast, been crouching in ambush ready to pounce upon me, compelling me to be constantly on my guard. E. B. PIKE, M.D.

Exeter, N. H., R. R. No. 1.

[It has been our experience that people with tender skins like yours will overcome their susceptibility to catching cold by hardening their skin by cold baths. We have known it to succeed repeatedly. Undoubtedly these same people may catch cold in spite of this if other conditions are not satisfactory. They may live in overheated houses or hug the fire too closely when indoors. An excess of external heat or a surplus amount of clothing will relax the skin and open the pores at any time. Then is when a person catches cold. But a matter that is probably still more important is to increase the internal resistance to cold. This is accomplisht by anything