aid we have, that is negative galvanic electricity. A large copper ball, wrapped with cotton, gauze covered, wet with saline solution, is placed in vagina, through a speculum directly against and usually under the mass-then connected with the negative side of the source of supply of current. A large dispersive abdominal electrode, well wet with saline solution, is placed in position and connected with the positive side of the apparatus. And about 15 to 20 milliamperes of current gradually turned on, for the first three treatments, during the first week, he rarely gives over 20 M. A. of current, until the second week, but then begin to increase until the patient can comfortably stand 50 to 60 A. M. of current, and keep at that dosage on successive treatment.

About one treatment out of every three he wets the vaginal electrode covering with saturated solution of Potassi Iodine for the Cataphoric effect of the iodine. Again if there seems to be an involvement of the uterine canal he gives intra-uterine copper electrolysis, using a copper electrode that fills up the uterine canal, and connected with the positive pole. The generation of oxychloride of copper acts as a very thorough antiseptic and speedily brings about a change in the inter-uterine condition, and aids tubal inflammation.

After the first treatment the patient experiences great relief from pain, which relief is constant and progressive until pain disappears. The mass in the pelvis becomes more free, more movable, and less sensitive and in cases of ordinary severity, and small mass practically disappears, but should the mass remain the patient is free of pain, and decidedly comfortable and able to undergo the usual household duties, and enjoy life without annoyance from old trouble.

As very many cases of sterility are due to the results left from an attack

of the catarrhal form, leaving the mucus membrane of tube swollen and tube more or less occluded by discharge; this treatment is particularly efficacious as it brings about absorption of this condition of inflammatory exudate, thereby favoring pregnancy and making a new woman out of what was frequently a wreck.

THORACIC FLUOROSCOPY.

Wm. Engelbach, in the Interstate Medical Journal, states there are many pathological processes in the mediastinal and subphrenic regions that defy clinical diagnosis. Very frequently the symptoms and signs based upon clinical and physical methods are so indefinite or so insufficient that an accurate recognition of the disease is impossible. It is in these conditions that the fluroscope proves a most valuable aid to the other methods of diagnosis, and in many instances a fluoroscopic examination is absolutely essential towards the correct recognition of the diseased process. In thoracic examination it cannot be expected that observations made in one position will possess a high degree of accuracy. Owing to the relative position of the thoracic organs, it is most important to view the chest from as many angles as possible. It frequently happens that the shadows projected from a certain aspect of the chest appear entirely normal, whereas a slight change. of position will manifest the presence of some abnormality which might have escaped detection. It is most important that the examiner acquaint himself with the variations of shadows in the different positions.

In the systematic examination of the thoracic region, the author places the subject in the following positions:-(1) Direct antero-posterior, with the screen placed against the anterior chest wall; (2) antero-posterior, with the screen in contact with the posterior wall; (3) ob

lique (antero- and postero-lateral) on right and left sides; and (4) anteroposterior or lateral recumbent. The antero-posterior position finds its greatest usefulness in lesions of the lungs, aortic arch, and diaphragm. Changes in the contour of the diaphragmatic shadows are of great value in differentiating pleural lesions from subphrenic abscess. In the oblique position there is normally a light area situated between the vetebræ and large vessels-the prevertebral space A. Small aneurysms of the aortic arch and a tumor in the superior mediastinum, both of which may be indiscernible in the antero-posterior position, obliterate the upper part of the light area and are thus recognized in the oblique position. In latent aneurysm of the descending aorta, which is covered in front by the cardiac shadow, there is frequently a loss of light in the lower part of this area. Chronic inflammatory conditions and empyema of the mediastinum usually darken the middle and lower portions of the pervertebral space.

H. F. CURRENT AND X-RAY IN INFLAMMATIONS.

Wm. Benham Snow, in the International Journal of Surgery, states that the high frequency current produces twofold effects upon germ life: (1) The direct action upon the germs exterior to the mucous membrane, destroying them by the actinic and other antiseptic effects of the current discharges from the vacuum tube as previously described; and (2) the induction of profound hyperemia.

Since the high frequency currents do not produce contraction of the tissues, they may be employed with sufficient energy to produce a great deal of superficial heat from the Oudin or indirect d'Arsonval currents; and when the direct d'Arsonval is employed with considerable amperage, considerable heat is

produced by the large amperage passing, with consequent induction of hyperemia, through the interpolar field. With these modalities it is also possible, as has been frequently demonstrated, to force into the tissues by ionization agents which have an antiseptic effect upon germs.

The value of high frequency applications with vacuum tubes has been demonstrated by many observers in the treatment of infectious vesiculitis, vaginitis, tubercular

adenitis, prostatitis, and numerous superficial streptococcic and staphylococcic infections, as well as in chronic urethral ulceration and infection.

The Roentgen ray, it fust be admitted, possesses the remarkable action of sterilizing most if not all forms of life, animal and vegetable, and preventing fecundation and germination-an action established by most students and investigators. It seems, therefore, to be assured that, when the X-ray is employed in the treatment of local infection with sufficient energy, it is possible to arrest the process.

The course to be determined as to what will be the best and most effective technic to adopt in the varied conditions is the most important question.

The writer has frequently called attention to the fact the Roentgen ray will be robbed of its terrors when it is generally accepted, as has been already demonstrated in the hands of many scientific observers, that radiant light and heat and high-frequency vacuum tube discharges are capable of arresting the inhibitory action of the Roentgen ray by an opposite stimulating action. With these premises, the indication for its employment in the treatment of infectious inflammation is obvious.

The first indication, if infection is to be destroyed, is the employment of the most profound process of inhibition, which undoubtedly is the Roentgen ray. Prolonged exposure to the Roentgen ray,

fifteen to twenty-five minutes, according to the volume of the radiation, or several shorter daily exposures in sub-acute processes, to arrest the propagating process of infection and, with the germs in this condition, to be followed after an interval of twelve to twenty-four hours by the energetic institutions of means which still further inhibit their activity and simultaneously induce active hyperemia, and at the same time establish a positive chemotaxis, as radiant light and heat and the high-frequency currents do, constitutes a rational procedure against the extension and further development of infection, while the phagocytes brought into the field in large numbers also destroy the germs.

A varying degree of success and promptness of relief from this procedure will depend upon the opsonic index of the individual. If phagocytic activity and energy are sufficient, the infection will be promptly destroyed, and in the event of a lowered resistance the best possible results will be derived by these methods either singly or conjointly. There are few streptococcic, gonorrheal, or tubercular processes which cannot be speedily arrested by the procedure described. Probably no greater advance can be made than that suggested and demonstrated by the writer and others in the treatment of gonorrheal vesiculitis, prostatitis, and epididymitis, than which no greater obstacle to the preservation of the human species prevails.

These methods of treating inflammation are like all other innovations in the sanctum of medical science open to criticism and to improvement in technic. With them, employed from the point of view stated, such a uniform measure of success is, however, obtained, that the writer earnestly commends them to the fellows of the Congress.

GASTRIC RADIOGRAPHY. Barclay, in Archives of the Roentgen Ray, quotes the following examples.

where a radioscopic examination revealed the cause of the trouble. (1) Stenosis of the pylorus had been found at the operation and a posterior gastrojejunostomy had failed to relieve the condition. The radioscopic examination showed that there was an hour-glass contraction which had not been noted at the time of the operation. (2) A patient had been operated upon for gastric ulcer; vomiting was persistent and yet on radioscopic examination it was found that the food was passing out perfectly, but that there existed adhesions near the cardiac orifice almost bisecting the stomach. A further operation completely relieved the patient. (3) A patient had been operated upon for gastric ulcer and persistently vomited; on X-ray examination it was found that the food was held up in the duodenum, and apparently, a vicious cycle was formed. (4) A patient presented exactly the same clinical picture as the third case, but it was found that there occurred no delay in the duodenum and that everything was working perfectly. On the strength of the X-ray report, the surgeon spoke very strongly to the patient, reduced her to tears, and from that day onward she ceased to vomit and she regained her health. (5) Failure in another case was due to a spasmodic hour-glass contraction for which no cause could be found at a second operation. In conclusion author states that, provided that a good view can be obtained, a definite opinion can be expressed as to the actual state of the stomach, as to whether it fulfills its functions, and a definite idea as to the presence or absence of pyloric obstruction and hour-glass stomach can be formed. Proof of carcinoma of the stomach is obtained in many cases, and the need of operative interference for obstruction is always indicated often before a clinical diagnosis can be arrived at. Gastric ulcer may be diagnosed in some situations by reason of bismuth

left in the ulcer or in pockets of cicatrices, but its site is more frequently indicated by spasmodic contractions which play a part in all lesions of the stomach, and complicate the diagnosis.

SALICYLIC IONIZATION IN RHEUMATISM.

Wullyamoz, of Lousanne, reports a patient who had suffered severely on three previous occasions from acute rheumatism, and had been treated by the routine drug method with salicylates. At each attack the treatment lasted from six weeks to three months. In his latest illness the salicylate treatment produced no amelioration to speak of, and at the end of a month the patient could scarcely move, and showed an icteric tint and signs of dyspnea. A cataphoretic course of treatment was then determined upon. The whole surface of the body was first washed so as to relieve the pores of any grease that might oppose a resistance to the ions and the electrical current, and on the following day the first sitting was given. Large electrodes of 1 meter in length and 20 centimeters in width were employed, and over the whole extent of the one which served as the cathode was spread, not a solution of salicylate of soda, but, for the sake of simplifying the procedure, the powdered form of that substance. This was rubbed over the surface with the hand in such a fashion as, with the humidity of the electrode, to form a paste. The cathode was then applied to the leg, the base of the electrode resting upon the swollen instep, and the upper part covering the hip region, while the anode was placed on the posterior side of the leg. The upper extremity was dealt with in the same manner. A sitting of one-half hour was given for each of the affected limbs in

turn. Two days afterward the swelling had left the knee and the right hand, but the left foot was somewhat painful. Another sitting was given, and after a further forty-eight hours the patient was able to walk without assistance and to obtain a good sleep, which had been denied him for fifteen days previously. The cure was absolutely complete ten days after the commencement of cataphoretic treatment, and after five sittings.

THERMO-PENETRATION.

Eitner, in Wiener Klin. Wochenschrift, states that if proper care is used, this procedure is devoid of danger.

Many of the apparatus now on the market are of improper construction and deficient in quality of current. If the sparking is not perfectly regular, the condenser becomes heated and useless. Eitner prefers the Poulson lamp. This is an arc lamp which burns in hydrogen gas. If the sparking is not perfectly regular, undampened oscillations occur which produce muscular contractions. In treating joints he uses a large indifferent electrode at some distance and a smaller electrode over the joint. The duration treatment is from 15 to 45 minutes.

Twenty-one cases of gonorrheal arthritis were treated, eight of these were acute cases, six were cured by thermopenetration of the involved joints, and genitals in a very few days, without other treatment. Two interrupted the treatment. All the acute cases were relieved quickly of pain. Very favorable results were shown in the chronic cases. Eleven cases of rheumatic arthritis were treated. Two cases of acute involvement of the wrist and hand were cured in a few days with thermo-penetration alone. Five cases received salicylic acid preparations.

in addition from the physicians referring them. One case of chronic polyarthritis of knee, elbow, hand and several finger joints was so much improved by two months, treatment, that motion was fully restored. In two very old cases the result was not good. Two cases of gout with painful tophi were permanently improved. One case of neuralgia of the ulnar nerve was cured. One case of sciatica and one case of neuralgia of the trigeminus were treated without any result. One case of chronic bronchitis was materially improved. All cases of acute gonorrhea have been treated during the last one-half years, with thermo-penetration only during the first few days with the results of rapid amelioration of the burning and pain. The writer warms the pendulous portion between two electrodes. After the sensitiveness of the mucous membrane has subsided medicamental treatment is added. The introduction of metallic electrodes in the urethra is condemned because it is possible to damage on account of imperfect distribution of current. He uses, however, a syringe of peculiar construction. With this he fills the urethra with a one per cent solution of nitrate of silver, the syringe is held by the patient and serves as an electrode. The other electrode is placed over the skin of the penis. The parts are warmed to about 40° to 42° C. for one-half hour. Prostatic involvement is seldom treated by the writer with thermo penetration. Care should be exercised to use only undamped oscillations because if muscular contractions occur when using this method, pus is readily carried to healthy parts.

REACTION OF DEGENERATION. Albert C. Geyser, in the Journal of

Therapeutics and Dietetics, asserts that there is in medicine, especially in diagno. sis, no other agent which is capable of furnishing so much valuable and unerring information as the faradic and galvanic currents, but unfortunately the use of these currents seems to be shroud in undeserved mystery. The electrotherapist is in possession of certain facts regarding the action of these currents in health and in disease; he is not in possession, however, of the complete scientific rationale of this action, therefore, in order to make his pseudo science appear scientific, he uses the cloak of mystery and indefinite explanations to cover his ignorance. It is hardly to be wondered at that the profession in general has taken so little interest in so valuable an agent.

To test for the reaction of degeneration we make use first of the faradic current. Apply one pole, it does not matter which, over the region of the spine from which the nerve originates which is about to be tested; place the other pole upon the same muscle, on the opposite side of the body from the one which appears palsied. Gradually increase the current and slowly move the electrode over the entire length of the sound muscle until a distinct contraction is seen and felt, then transfer this same strength of current to the diseased muscle. If the paralyzed muscle contracts the same as the sound muscle, you may be sure you are dealing with a paralysis of central origin; if, however, the muscle fails to contract, it is an equally sure indication. that the lesion exists somewhere in the peripheral tract.

Next, if we desire to determine the extent of the lesion, we use the galvanic current, any galvanic battery of 15-20