CONCENTRATED RAYS OF THE SUN (SOLAR CAUTERY) AS A REMEDIAL AGENT.

By O. V. THAYER, M. D., San Francisco.

Since the publication of my paper on "Solar Cautery" in the July number of the PACIFIC MEDICAL JOURNAL, I have been deluged with letters from physicians far and near, asking in. formation and instructions as to the technique and details in the application of the concentrated rays of the sun.

I have thought best to produce in full one of the many letters received, which embodies most of the interrogatories:

"DEAR DOCTOR:-I have read an article from your pen on 'Solar Therapeutics,' and am anxious to know something about the details. The novelty of the agent, to say nothing of the brilliant results obtained by you, in cases that ordinarily ignore special therapy, excites a deep interest, and I am extremely anxious to learn from you how I may use it as a curative agent. Any information on the subject will be thankfully received. Indulging a hope that you will kindly enlighten me how to handle a given case by this, to me, novel plan,

To satisfy the desires of the many inquirers I will give the technique and details of the successful treatment of one or more cases with the solar cautery.

The first step is to obtain proper lenses of pure, transparent glass from four to five inches in diameter. My favorite is four and one-half inches with a convexity that will focus the rays two lines in diameter O. The eyes of the operator should be protected by dark goggles or glasses, as the concentrated light is injurious to the naked eye. It is impossible to watch the burning with unprotected eyes. To be successful, every step of the operation must be watched with assiduous care, that no injury be done by so potent an agent.

When much surface is to be treated, especially if the subject be a child or timid person, anesthesia is necessary, general or local. Never attempt an operation, unless you have a clear sky with perfect sunlight. (The rays will not act through a window pane.) If the disease be a morbid or malignant growth, destroy the morbid tissues fully. The after-treatment is the same as in general wounds. In the removals of discolorations of the skin

such as birthmarks, India-ink and powder marks, etc., also capillary aneurisms (angioma), destroy only the cuticle, to avoid unsightly scars.

In operating upon the surface of the skin I never continue the application longer than a few seconds at one time. Generally remove the lens as soon as the part turns a light gray color. The burnt surface should be dressed with zinc ungt., to protect it from the air. Nature does the rest.

CASE I. Birthmark (angioma.) Mr. P-, a bachelor, 38 years of age, consulted me as to the removal of a discoloration of the skin, covering the whole of one side of the face. The skin was of a vermillion color, and the surface of the same was studded with vascular elevations the size of half a small pea, which bled on the slightest injury. Operation.-At the first sitting I burned all of these elevations down even with the skin, then covered the surface with zinc ungt. The burnt surface healed readily. At the end of ten days he was ready for the second operation, when I proceeded to burn the whole discolored surface, after which I applied the same covering as before, which was continued until the skin resumed its natural function. Some three weeks after the last operation he presented himself at my office. The change was most wonderful for the better. I still advised another application of solar heat, which was done with the result of removing the discoloration almost entirely from the face. I advised one more operation, but he demurred. Said he was fully satisfied with the improvement already made, as he was no longer stared at by strangers."

CASE II. India-ink discoloration. Mr. S., from New Lon don, Conn., called at my office and desired the removal of an India-ink mark resembling a bracelet encircling the wrist, which was placed there many years since. It was some one-half inch wide composed of filigree work, very pretty, but an eye-sore to the bearer. I proceeded to operate, by concentrating the sun's rays over the India ink, tracing each line of the filigree work, until the skin was destroyed over the inkmarks. (Experience has taught me that a dark surface is more quickly burned than a light one, consequently it only requires a few seconds to destroy the skin over India-ink marks.) The wound was dressed with zinc ungt. as u sual in such cases. I now waited a few days until the burned skin began to ulcerate. I then removed it and with

it most of the India ink. What little remained was scraped off with a scalpel, after which the part readily healed.

There is no hemorrhage following the use of the solar cautery, not even in the destruction of vascular tumors.

Sections.

INTERNAL MEDICINE.

Under the Charge of FRED. W. D'EVELYN, M. B., C. M. (Edin.) etc. Professor of Pediatrics in the Post-Graduate Department (S. F. Polyclinic) of the University of California; Clinician Med. Dept. Univ. Cal.

Cerebral Hemorrhage.-Bower, of Chicago, read a suggestive paper upon this subject before the Pan-American Congress. The following points seem worthy of note:

Cerebral hemorrhage has its foundation in arterial degeneration. This arterial degeneration cannot be recognized by simply using the tactus-eruditus on the radial arteries, but by a careful examination of all the arteries accessible to the touch. If the examination is limited to the radial, it will often be overlooked, for the reason that the radial often escapes the degenerative process until long after it has made marked advancement in other vessels. The degeneration that results from syphilis can best be treated with the hypodermatic use of the bichloride of mercury, with the use by the mouth of iodide of potash. * * * The degeneration that belongs to alcoholism and interstitial nephritis is most amenable to the hypodermatic use of the chloride of gold and sodium. That due to gout and lithæmia requires a judicious dietary, careful attention to elimination, and the use of alkalies, salicylates and colchium. In all these cases diet is of prime importance-a starvation diet is objectionable; careful attention must be paid to elimination. The condition of the heart is important; if it is too feeble, general nutrition suffers; if too strong, hemorrhage is provoked. If arterial tension is persistently high, nitro-glycerine is a valuable remedy, and if the tension is low, digitalis and nux vomica may be of service. When a blood-vessel is ruptured, venesection may be necessary. The throbbing carotid, the tumultuous heart, the congested face, the full and strong pulse, are the external evidences that blood-letting is indicated, but in my experience the benefits to be derived, even under such indications, are very

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small and often negative. On the contrary, with a small and feeble pulse, with weak heart-sounds, I have seen much benefit from the use of stimulants. Intra-cranial blood-pressure is best lowered by bleeding the patient into the abdominal vessels, by brisk-acting cathartics, and of these croton oil is the most reliable and most easily administered. Heat to the lower extremities, ice to the head and tincture of aconite and bromide of potash internally are all efficient agents for the same purpose. ** When the danger from inflammatory disturbance has passed away, then we may still pursue our efforts at promoting absorption by the administration of iodides with mercury and the use of the constant galvanic current to the brain. * * * The galvanic current should be passed through the head and does modify the nutrition of the brain in its passage. The descending current, I believe, is the most useful one of the two, a large electrode (the positive) being applied over the forehead, and a large electrode (the negative) at the nape of the neck. The seance should be from fifteen to twenty minutes, and the current should be from four to five milliamperes in strength. After the current has been passed in this way the electricity should next be applied to the glands of the cervical sympathetic in the neck, reversing the direction, placing the positive pole in front over the cervical glands, the smaller electrode and the large electrode (the positive) at the nape of the neck. The paralyzed muscles should be gently stimulated with the faradic current. They should receive daily treatment by massage, and the internal treatment of the patient should be such as will provoke to the utmost the nutritive process. Then the patient must be taught to use every possible effort to bring the power and force of the will on the parts that are paralyzed, and to resort to frequent daily efforts at movement. If the case has aphasia, an effort should be made to teach the patient to work with the hand of the non-paralyzed side, and his knowledge of the relation of words and ideas to things should be daily cultivated by objectlessons, and the movements of the leg and of the arm that are defective or lost should be cultivated by daily assiduous efforts.

The Nervous Origin of Jaundice.-At a recent meeting of the Massachusetts State Medical Society, Dr. A. D. Rockwell read a paper on this subject. (Boston Med. and Surg. Jour.) He said it is a well-known fact that disturbance of the brain,