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. 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 and at the same time reassures 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. 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 in melancholia. Exhaustion Psychoses, or Exhaustion Following Acute Disease. Half bath, or drip sheet, or affusions night and morningtemperature 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° to 185°-10 minutes. Circular (Rain) douches, 100° to 60°-3 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 most excellent results have been obtained in neurasthenics, melancholics, exhaustion psychoses, mania depressive insanity and alcoholics. In the other psychoses only fair results have been obtained. Incidentally, it has been found that the use of the periueal 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 bowels. Sitz bath in sexual neurasthenia warm, gradually reduced to cold-5 to 10 minutes. 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. THE DANGERS OF HYPERALIMENTATION OF THE TUBERCULOUS. BY MARCEL LABEE. Physician to the Paris Hospitals. The great majority of physicians hold that the alpha and omega of the treatment of tuberculosis are: fresh air and hyperalimentation. The principal of fresh air is universally accepted, but that of hyperalimentation is beginning to be adversely criticised. Yet it still represents the prevailing doctrine, if I am to judge from the answers given at the clinical examinations by the physicians of to-morrow, and from the type of overfed and obese phthisical persons which appears to constitute the ideal of many therapeutists, and if I consider the routine treatment in most sanatoriums at home and abroad. The idea of hyperalimentation owes its inception to two very interesting observations. First, the good results obtained by Dr. Debove, who fed through the stomach tube anorexic, dyspeptic, tuberculous objects who could tolerate no food, and vomited everything they took. With two "meals" a day, consisting of milk, eggs and powdered meat, he managed to fatten subjects whose emaciation nothing had previously proved capable of arresting. It was but a step from this to the establishment of hyperalimentation by milk, eggs and powdered meat. Then came Professor Richet's experiments, who showed that feeding dogs on raw meat rendered them vastly more resistant to tuberculosis. It was thought allowable to argue from the dog to man, apparently oblivious of the fact that the dog is much more carnivorous than man, and that food capable of fortifying a carnivorous animal may kill a herbivorous animal, and prove very injurious to an omnivorous animal. Simple, straightforward formulæ always carry great weight with both physicians and patients; consequently the conception of hyperalimentation was readily received, the object for the phthisical being to get fat, cost what it may. In hospitals, sanatoria and in private practice all tuberculous patients were subjected to hyperalimentation, and many who had read about it put the plan in practice for themselves, so that it is among practitioners and educated people that the system makes most victims. Hyperalimentation has been a fertile source of sickness. But does it cure tuberculosis? Were that so, we might be prepared to condone many shortcomings in exchange for one great benefit. Unfortunately that is far from proven. We must be on our guard not to be misled by the fact that the tuberculous patient is putting on weight. As has been very aptly remarked by Darenberg, the tuberculous subject does not get well, because he puts on flesh, but recovers because he is able to put on flesh. The increase of weight is a sign of improvement, an element in the prognosis, not a factor in the cure. Even so, too much confidence must not be reposed therein. One meets with bacilli-ridden patients in whom the lesions continue to run their course, in spite of the fattening process, and cavities are met with even in the obese. The damage due to hyperalimentation in the subjects of bacillosis-a euphemism for tuberculosis-has been proclaimed by many authorities, and it deserves to be made known to practitioners generally. The most frequent evil is gastro-intestinal disturbance as in the following case: M. P., an engineer, 34 years of age, had an attack of hemoptysis in 1900, with laryngitis and pulmonary tuberculosis. He was advised to live in the south, and to undergo a course of hyperalimentation. He obeyed, and indeed improved on the prescription. In addition to the ordinary regimen, he ate every day of his life twelve eggs, from twenty to twenty-four ounces of raw meat, together with two sherry glassfuls of cod-liver oil. In a very short time this regimen became insupportable, so that he gave it up every fortnight for a few days' rest. Under this treatment he pulled himself together and rapidly put on flesh, so that ere long he weighed over eleven stone. In 1902 he had another attack of bronchitis, accompanied by marked weakness and loss of flesh. Again he tried hyperalimentation, and he recovered in four months. Since that time he has retained the habit of eating large quantities of meat. In the beginning of 1907 his stomach began to give him trouble. He complained of epigastric pain, commencing four hours after lunch and lasting until dinner time. The pain sometimes came on at night so sharply as to wake him up. He suffered from constipation, and voided much mucus and fragments of membrane with the motions. There was no vomiting. Later on he complained of a good deal of pain in the track of the ascending colon, with extreme tenderness to pressure. His |