systematic absorption of some substance which has a curative effect far beyond those cells which can be reached by X-radiance in sufficient strength to produce a destructive effect.

Physicians ought to know and ought to let their patients know that the X-ray has a curative effect in cancer and that permanent success is very much more likely if the treatment is begun at an early stage. Another very important thing is to let patients know that they need no longer conceal a growth because of a feeling that the only treatment lies in operation. If they are not able or willing to undergo an operation immediately on their discovery that there is something wrong, they may have X-ray treatment. Improved means of accurate measurement have made this safer and more effective than ever before. It is not even necessary to wait for the growth to show unmistakable evidence of malignancy. It is better for the patient to be cured of a growth without knowing positively whether it would ever have developed into a cancer than to wait for positive evidence with its certainty of systemic involvement.

GASTRO-INTESTINAL FLUOROSCOPY.

Skinner's technique of fluoroscopy, as described in the American Journal of the Medical Sciences, consists in the use of the Beclere type of apparatus in a totally dark room. The current to the tube is controlled by a floor switch in the primary circuit, which is opened or closed by the foot of the operator. The tube is regulated by a weighted string which operates an adjustment upon the regulating bulb of the tube and is at the right hand of the operator. With the water-cooled tube, regulation is seldom required. We employ a continuous current of water in the tube, after a fashion seen at the Albers-Schoenberg-Haenisch Institute at Hamburg. This consists of a 2-gallon bottle, with a small rubber tubing attached to an outlet in lower segment.

This bottle is placed about two feet above the tube. After circulating in the watercooling compartment of the tube, the water runs off through a second tube to a container upon the floor.

Into the frame of the lead-glass covered fluorescent screen is fitted with thumb screws a piece of plain glass, upon which may be charted the outlines of the bismuth-filled organs and the anatomical landmarks, with blue and red fat-pencils. These charting glasses are readily changed and their markings may be copied later upon thin paper for record. It is poor policy to chart upon the leadglass of the fluorescent screen, as one will not have time to copy and erase the sketches.

The patient is prepared for the examination by a fast of four to six hours; the removal of the clothing to the hips; metallic markers are placed upon the ensiform and umbilicus; the patient may either stand erect or sit upon a movable bicycle seat, between the movable tube box and the screen.

For the examination there are required bismuth capsules of varying sizes; paste of bismuth, sugar of milk, and water; bismuth in water, and bismuth porridge. We use a fairly thick porridge of cream of wheat, into which 40 to 60 grams of bismuth oxychloride or carbonate is thoroughly mixed. This is the established Riederische Mahlzeit, when flavored with raspberry syrup. We prepare this in a chafing dish at the office or in the kitchen at the hospital.

Findings.

I. PYLORIC STENOSIS. (1) Dilatation of the stomach, both longitudinally and transversely. (2) Antiperistaltic waves running from the pylorus to the greater curvature. (3) Interference with the emptying of the stomach, the exit of the food being delayed eighteen to fortyeight hours. Suspicious symptoms which should be noted are: More or less degree of distention of the stomach; weakened peristalsis; food delayed in exit twelve to

twenty-four hours; adhesions of the pyloric area, which produce a fixed pylorus; pyloric filling defects; absence of any peristalsis at the pylorus, the wave running only from the greater curvature to the prepyloric area. The pyloric stenosis, whether produced by infiltrations and cicatrices about an ulcer or carcinoma, would produce almost identical symptoms. The differentiation can be determined by the stomach analysis, case history, and subjective symptoms.

II. GASTRIC CARCINOMA. Gastric carcinoma presents the following fluoroscopic findings: (1) Irregular filling defects in the outline of the stomach wall. (2) Abnormal peristalsis, there being no waves at the site of the filling defect; or, if the carcinoma involves the pylorus, antiperistaltic waves are seen. (3) Hourglass contraction where there is involvement of the middle portion of the stomach. The bismuth meal or water may be seen trickling through the narrowed lumen. (4) Adhesions of the stomach to adjacent organs, due to perigastric inflammation. (5) The lumen of the stomach is usually much smaller than normal, excepting, when the carcinoma involves the pylorus, we may have a dilatation.

III. GASTRIC ULCER. (1) Filling defects, which are not as irregular in outline as in carcinoma, the filling defect being due more to an irritation of the muscular action than to irregular outlines of mass changes in the stomach wall. This interference with the peristalsis in ulcers of the lesser or greater curvature is interesting. Where the ulcer involves the pylorus we have the additional symptoms previously noted when there is interference with the exit of the food.

THE X-RAY CHIMERA. BY E. H. SKINNER, M. D., KANSAS CITY, Mo. (In The Medical Herald.) There are so many false ideas regarding the probabilities and possibilities of the X-ray in diagnosis and treatment that it may be well to discuss frankly some

erroneous ideas which propagate through ignorance or indifference. To say that the X-ray is dangerous is no more truth than to speak of the danger of the intelligent administration of calomel. Even the more youthful practicians of the present day may recall cases of salivation following the administration of calomel, but we have not noted that such circumstances have aroused much adverse criticism to its intelligent use. We have learned that calomel and other dangerous drugs may be administered with scientific accuracy and precaution.

Likewise, the ill-effects of the X-ray in the early years of its use have taught many lessons. We now know how to protect against ill-effects of the X-ray and we can estimate the treatment dose with a degree of accuracy that eliminates accident.

The honored martyrs who have passed away and those who, though living, carry the scars of scientific interest in the roentgen ray, have contributed the knowledge that will prevent further sacrifice and pain. These men suffered injury before it was realized that there were ill-effects and that it was possible to guard against their inception.

The present agitation should serve to eliminate a large number of tyros who use the X-ray without proper knowledge of the laws of its application and protection. No X-ray should be generated in a tube that is not properly protected with guards to both the patient and operator. No fluoroscopic examination, however brief, should be conducted unless the tube is surrounded with proper materials, opaque to the X-ray, and the fluorescent screen covered by lead glass. The bellows fluoroscope should be discarded, as such a type serves only to promote carelessness and inaccuracy. Fluoroscopic X-ray examinations have a large and growing field in diagnosis, especially of the gastro-intestinal tract. It is hoped that no reports or criticisms, due to inefficient protection or unquali

fied X-ray operators, will ever hinder the future application of the roentgen method.

The profession is familiar with many remedies which have been heralded far and wide by manufacturers before their true scientific value had been determined. The X-ray has suffered likewise by the commercial eagerness of manufacturers. The country has been literally flooded with good and bad X-ray apparatus. The purchasers have lacked knowledge of its application, accordingly patient and physician have both suffered. Commercialism has done more than corrupt legislatures; it has harmed the lives and health of the innocent and ignorant.

There have been no ill-effects to roentgenologist or patient, since the knowledge of protection and dosage was established, where the X-ray was carefully and intelligently applied.

THE POST-OPERATIVE USE OF RADIANT LIGHT AND HEAT. There is probably no measure more deserving of general recognition in the after management of surgical cases, says the Western Medical Review, than the employment of radiant light and heat. The degree of comfort produced by prolonged applications, made with a fifty candle-power incandescent lamp, having a parabolic reflector, or the larger lamps, over the site of the operation, is remarkable. This application may be either direcently to the surface, immediately following operation, or, as it is usually applied, over light gauze dressings. It should be used two or three times daily on the first and second days after the operation, and to a degree daily until the wound is healed. If this is done, it will be found that there will be very little demand for anodynes in minor operations and great comfort added, with more rapid healing of the line of incision in all cases, than if left, as has been done, to Nature's course. This acceleration of the process of re

pair is effected through the induction of hyperemia in the tissues. Another effect is to lessen the liability of the formation of scar tissue at the site of the wound. These effects warrant a more general recognition of the value of a measure so simple of application, and so safe in all cases.

X-RAY PHOTOGRAPHS IN COURT. The Journal of the A. M. A. cites the Supreme Court of California that in the personal injury case of Kimball vs. Northern Electric Company (113 Pac. R. 156) certain X-ray photographs of the plaintiff's knee were introduced in evidence after two of the medical witnesses had been examined with reference to them. It was contended that the proponents of the photographs failed to introduce proof of their correctness, or that either of the physicians was an expert in such matters. While, perhaps, the examination was not so minute on that subject as one might wish, it did sufficiently appear that the two witnesses and others were present at another physician's office when X-ray plates were made of the plaintiff's knee, and that the photographs introduced in evidence were printed from those plates. While it would have been better, no doubt, to have introduced evidence of the familiarity of the physicians with the process of X-ray photography and the methods. employed in preparing these particular exhibits, the court cannot see that the omission so to do amounted to error necessitating the reversal of the cause. The witnesses were qualified surgeons. It is well known that the X-ray is almost universally understood and used by surgeons of the present day in examining injuries. Doubtless the court required less preliminary proof from such witnesses than would have been exacted from laymen. The surgeons had testified without objection that they had examined the injuries themselves by the use of the X-ray apparatus, and this tes

timony in itself was an indication that they were familiar with the use of the Roentgen rays. When, therefore, they testified to the taking of certain X-ray pictures, or rather the making of plates, the court doubtless assumed that the ordinary methods of those familiar with such matters had been followed. While counsel for the defendant objected to the testimony of the surgeons on the ground of the failure of the plaintiff to show their expert qualifications, no request was made of the court that they should be preliminarily questioned on that subject. The surgeons put initials on the plates at the time they were made, and testified that those initials appeared on the prints introduced in evidence. But, even if an error were committed in the admission of testimony relating to the photographs, it was harmless, for it was evident that the condition shown by the photographs did not differ from the circumstances disclosed by the testimony of the physicians based on their own observations. A photograph is used like any other chart, for illustrative purposes; and where, as in this case, such illustrations do not mislead, no error is wrought.

THE ELECTRIC ENEMA.

A new technic for intestinal obstruction and postoperative bowel paralysis is offered by W. H. Dieffenbach, in the Journal A. M. A. It consists essentially in the employment of seminormal saline. enemas through a hollow electric electrode connected with the galvanic current, followed later if necessary by faradization with similar enemas. He describes the technic in detail using a twenty-four dry cell apparatus with the usual attachments for galvanic and faradic currents with a galvanic current of fifteen M. A. After three minutes of electrolysis, with the negative pole in the rectum and the positive over the ascending colon, the pole is reversed about every thirty seconds for five or ten

minutes which usually produces peristalsis and desire for evacuation. If this is not sufficient following the interrupted galvanic treatment the rheophores is made to the high tension faradic coil and the current manipulated through the secondary coil so as to produce gradually increasing and diminishing contraction effects. After the electric treatment and removal of the bed pan, the patient is placed in an inclined position of twenty-five to forty-five degrees to favor normal peristalsis. He considers this important and has kept it up for three days in several cases. Following the treatment, normal saline retention enemas, one quart at a temperature of from 105 to 110 F., are given every two hours until normal conditions intervene. The earlier this treatment is given the better. The conditions in which he finds it useful are as follows: (1) chronic constipation with impaction of feces; (2) atony of the bowel; (3) traumatic, localized and general peritonitis with intestinal stasis; (4) intestinal torpor after shock; (5) slight volvulus or kinks in the bowel after prolonged manipulation, and chilling of the bowel following laparotomies; (6) intestinal paralysis after prolonged meteorism; (7) intestinal paralysis following various forms of hernia. The conditions in which the treatment is of doubtful or negative value are the following: (1) intussusception; (2) stricture of the bowel; (3) adhesive bands about the intestines; (4) malignant growths involving the bowel; (5) tumors impinging on the lumen of the intestines. In these cases surgery must be invoked, and the electric treatment can be subsequently employed for its stimulation of peristalsis.

GALVANISM FOR RESIDUAL
PARALYSIS.

Tom A. Williams, in Clinical Medicine, reminds us that muscles supplied by a cut nerve will atrophy and will not

regenerate although they may be massaged till the end of life.

If, on the other hand, these severed nerves are galvanized from the beginning, atrophy will not occur, for the exercise of their contractile functions maintains the integrity of the muscleclements; and it is only galvanism which can excite contractility when the motor nerve and its endings have degenerated. If treated by galvanism from the beginning, a living muscle-cell will greet each regenerated nerve-fiber which pushes to its destination. If galvanism is not used, the envelopes of only dead musclespindles will be encountered. The time for these to regrow, must, then, be added to the duration of every case not treated by galvanism.

It is necessary to restate these simple physiological facts on account of the vogue of the pernicious statement that no treatment of poliomyelitis should be gin until four months have elapsed. This doctrine is another instance of unthinking orthodoxy. But if the elementary physiological considerations just presented make no appeal, one need only cite the high authority of Erb, Bergenie, Zimmern, and Zappert, the latter the distinguished Viennese pediatrician (added to that of Duchenne's final experience) who makes a practice of galvanizing the paralyzed; and the negative pole should active symptoms subside.

The galvanic current should be applied only to those muscles which are paralyzed muscles just as soon as the be placed over the muscle itself near its tendon of insertion, while the positive pole should be attached to a large electrode, applied over the abdomen or other indifferent point. It is useless to stimulate the motor-point except during the first two weeks, that is, before any nerve-endings have ceased to be stimulatable on account of degeneration.

Of course, contractures and other deformities should not be permitted; and even when paralysis is complete and ir

remediable they can be mainly prevented by the maintenance of proper posture. Orthopedic expedients are too often the resort of despair and the result of neglect in providing proper and early treatment, but when necessary the weak or atrophying muscles may be reinforced. with advantage by elastic suspenders.

S

INJURY BY ELECTRICITY.

IR THOMAS OLIVER, writing on this topic in the Lancet, warns that electricity cannot be trifled with. Experience and experiment alike point the way by which some of the dangers incidental to its use may be averted. The danger depends upon the amount of current passing through the body, the kind of contact, and the insulated position of the individual at the particular time. If he is wearing damp boots, standing on wet soil, and the skin is moist, all of these will aggravate the effects of an electrical shock. The danger is not one of high potentiality of current alone, but of it plus the conditions under which the current is received.

Voltage in electrical parlance means pressure or electro-motive force. It is difficult to say what voltage is fatal to man. In the United States where the current has been used for the electrocution of criminals not less than 1450 volts has been insisted upon, but in some instances death was not instantaneous. As regards illumination of factories, there is one case on record where a lad on taking hold of a lamp which had been burning badly was killed by a 200 volts alternating current. On the other hand, contact with currents carrying 2000 volts pressure has been made and no serious injury followed. Although opinions are divided as to the comparative dangers of "continuous" and "alternating" currents, it is generally believed that of the two the "alternating" current is the more dangerous. Between 1902 and 1908 there were three fatalities due to continuous currents of 250 volts and lower,