deserves investigation and especially its hypodermic use.

Hoping you will see your way clear in complying with my request, I am yours very truly.

Yours,

J. A. BURNETT, M. D. Marble City, Okla.

(We publish this communication from Dr. Burnett in the hope that some of our readers may be induced to write us their opinion and experience on the subject. Meanwhile, we shall take steps to obtain an article thereon, as Dr. Burnett suggests, from an authoritative source, as early as possible.—Ed.)

A NEW JOURNAL.

Editor MEDICAL BRIEF:

With your kind indulgence I want to bring an important message to your readers. I am going to alternate my bi-monthly journal, "Physiologic Therapeutics," with "another new journal," which will bear the attractive title, "Successful Medicine." I believe that many of your readers will welcome this new journal, as it is to be a journal of commercial medicine, devoted solely to that side of practice which directly concerns the dollars and cents, published with the main idea of making its readers better-paid practitioners than mere brick layers or other skilled laborers who gain their skill with comparatively little sacrifice and who earn more than the average physician.

The financial side of practice is mighty important. They talk about the "science of medicine" and the "art of medicine," but if I am not badly mistaken, the dollars-and-cents side of medicine has been too lightly considered. Not, mind you, that the scientific and altruistic side of the doctor's work is depreciated-far far from it. Medicine today-as always -is filled with honest, scientific workers, and with men ever ready to help "the under-dog" when opportunity affords; but think of $700 a year as the income of the average American physician. Remember, too, that medicine unfortunately. takes no note of the eight-hour law.

It

"Successful Medicine" will deal with the problems of the physician in his office, and especially with those which concern the business of getting results and the money for it. It will be published bimonthly, beginning in September. will be regular magazine size with a minimum of 48 pages, and the price will be only twenty-five cents a year. Since this journal will be devoted to such an important phase of medicine, surely every reader of the MEDICAL BRIEF must be interested. How many will subscribe probably in advance of publication? Cordially yours,

HENRY R. HARROWER, M. D.

In Neurosine is offered drugs of positive utility, which present in permanent and palatable form an elegant and efficient combination of well-known and long-tried remedies, concerning whose virtues in the diseases and conditions indicated there is absolute unanimity of expression among all observers and authors upon the subject. In Migraine Nysteria, Chorea, Neuralgia, Neurasthenia and Neurosis, Neurosine is prescribed with satisfaction both to patient and physician. For years Neurosine has been recognized as a most efficient remedy in the treatment of Epilepsy.

VAGINAL DOUCHE THERAPY.

Cash prizes to the amount of $1,000 will be awarded for the best articles upon the "Therapeutic Value of the Vaginal Douche" by the Marvel Company of New York.

The competition will be open only to physicians.

You have an excellent chance to win some money.

Why not try it? Read their advertisement on another page in this issue and get a part of the $1,000.

THE DIRECT ELECTRICAL CURRENT

IN SCIENTIFIC MEDICINE.* By B. T. GREEN, M. D., BROOKINGS,

I'

S. D.

F an explanation of the choice of my subject were necessary it would

be the desire to rescue a valuable therapeutic agent from the disappointments of empiricism and place it upon a dependable scientific basis.

To the end desired, this paper will consider the physical and chemical properties of the direct (galvanic) electrical current as to their effect upon living animal tissue, and will attempt to point out the current's proper and legitimate range of therapeutic usefulness. Its value as an actual cautery in the rapid destruction of pathological tissue and as a counter-irritant and heat-producing agent, and its diagnostic value in nerve degenerations and for the illumination of stomach, bladder, and other body-cavities and orifices, otherwise inaccessible to visual examination, are purposely omitted from the discussion. It considers only the therapeutics of the gentle, almost painless current produced by chemical decomposition in a battery of cells connected in series, with amperage, accurately measured by milliamperemeter and controlled by a rheostat that insures against jars, interruptions, or variations.

In the consideration of our subject it seems necessary to recall, briefly, a few principles of physics and chemistry connected with the production of the direct current, for, without these in

*Read at the 30th annual meeting of the South Dakota State Medical Association, Pierre, June 15 and 16, 1911.

mind, galvanism as a remedy is still empirical and unscientific.

In its most elementary conception a battery is an apparatus for the transformation of energy. Chemical disintegration within the cell disturbs the electrical equilibrium of the so-called ether, and the current is the result of its flowing together along suitable conductors outside of the cell to restore the equilibrium thus destroyed. The carbon terminal (positive pole or anode) is arbitrarily regarded as the higher level, hence the current as flowing toward the zinc terminal (negative pole or cathode). Under appropriate conditions these terminals, when immersed in a suitable medium (electrolyte) containing certain chemical substances in solution, bring about chemical decomposition by breaking up the molecule and setting free the elements or groups of elements (radicals) making up the molecule.

Within the electrolyte these separated elements, or groups, are designated as ions. Each ion carries its appropriate charge of negative or positive electricity, and moves toward the oppositely charged pole. Those moving from the positive are designated as electropositive and are called anions, while those moving from the negative are electronegative and are called cathions. Each ion, after delivering its charge of electricity at the pole, becomes a nascent element, or radical, ready to unite with the chemical affinities of the vicinity.

In the familiar example of the electrolysis of acidulated water, oxygen is liberated at the positive pole and hydro

gen at the negative. What is true of water is also true of all chemical substances fulfilling like conditions, however simple or complex the substance. In the halogen group, salts of the metals and the alkaloids, invariably the elements represented by hydrogen, are liberated at the negative pole, and the radicals represented by oxygen are liberated at the positive pole.

It necessarily follows that if the electrolyte carries in solution a number of these chemical compounds, the analytic processes will be simultaneous. As the ions become nascent elements, or radicals, at their respective poles, and unite with other elements, or radicals, of the vicinity, a group of new compounds is formed. Necessarily, the free radicals. have formed acids around the positive pole, and free metals and alkaline compounds surround the negative pole.

Now, if our electrodes, instead of being immersed in the electrolyte of the laboratory, are applied to an electrolyte of living animal tissue, i. e., the human body, with its content of water and salts of potassium and sodium, we have like results. Surrounding the negative pole are the alkaline hydroxids of sodium and potassium, while in the vicinity of the positive pole are the acids of the chlorides. It follows therefore that the physiological effect of the positive pole is that of an acid, while the physiological effect of the negative pole is that of an alkali.

The effect of an acid upon organized tissue is to harden the albuminoids, and contract fibrous structure, while an alkali softens the tissues and relaxes fiber. Therefore, with the acid positive pole relaxed tissues are contracted, softened tissues are hardened, congestion is reduced, capillary hemorrhage is relieved, and, since pain is accompanied by excessive alkalinity, the acid pole neutralizes the alkalinity and is a sedative to pain. On the other hand, at the negative pole we have the softening and re

laxing effect of the alkalies; cicatrices, hardened glandular tissue, strictures, and fibrous growths and deposits are softened and absorption hastened;

anemic areas are congested by capillary dilatation, hemorrhage is encouraged, and, by increasing alkalinity, pain is increased.

These diametrically opposite effects of the two poles indicate that, next to determining the adaptability of the direct current to any pathological condition, the choice of poles means everything; that this choice is based upon chemical activity; and that empiricism has no place whatsoever.

But the therapeutic value of the direct current does not stop with the acid and alkaline effects just described. It has been stated that certain chemical substances are decomposed at the poles, that the electropositive ions seek the negative pole, and the electronegative ions seek the positive pole. As a familiar illustration: If the electrolyte be a solution of potassium iodide, and the poles of a galvanic battery be immersed, the dark color of the free iodine is socn observed about the positive pole. It follows that, if a suitable electrode moistened with a solution of potassium iodide and attached to the negative pole, is applied to the moistened skin and the circuit completed, through a larger wet pad placed at an indifferent point, the current decomposes the potassium iodide into its elements, and the iodine ions, being electronegative, immediately seek the positive pole. In their journey through the tissues they are deposited as pure iodine, producing the characteristic iodine effect.

In like manner cocaine is released from its radical and deposited deeply, But coas with a hypodermic needle. caine; being electropositive, the solution is necessarily placed upon the positive electrode. The process is known as phoresis, cataphoresis, or anaphoresis, according to whether the element SO

used is electronegative or electropositive. The metals are electropositive, and if metallic electrodes are used on the positive pole, the salts of the metals are deposited in the tissues. In electrotherapeutics, copper and mercury are extensively used for their antiseptic effects.

The very wide range of application of phoresis is at once apparent, and it is readily seen that where polar effect and phoresis may be combined the therapeutic value may be doubly efficacious.

If the foregoing be true, the value of the direct current in the treatment of pathological conditions. rests entirely upon physical and chemical behavior under the universally accepted laws of science.

Suc

It remained only for such scientifically minded clinicians as Apostoli, Newman, Massey, Neiswanger, and others, to demonstrate the applicability of these principles to the treatment of many diseased conditions. The direct current is not a cure-all, but from the foregoing it is seen that it is an indicated remedy in many pathological conditions. cess in its application depends upon properly selecting and applying a suitable electrode, determining and employing a suitable quantity of current during a proper length of time, and, if required, repeating the treatment proper intervals. In short, success depends upon mastery of principle and mastery of technic.

at

H. F. CURRENTS IN HYPERTENSION.

The Monthly Cyclopedia and Medical Bulletin declares that the effect of highfrequency currents as employed for the treatment of high arterial tension is undoubtedly one of the greatest discoveries in modern therapeutics. Those who have not yet investigated these effects can little appreciate the remarkable results obtained from their employment. It is a fact that hypertension arising from autointoxication or other cause

leading on to arteriosclerosis and other consequences of persistent hypertension is effectively lowered and controlled, often in advanced cases of arteriosclerosis, by autocondensation, diet and exercise, the patient being thereby maintained in a condition removed from the danger of cerebral hemorrhage. In most cases the blood-pressure will fall from 1 to 20 mm. after each seance of twelve to fifteen minutes, and under daily or alternate day treatment will be gradually lowered so that it can easily be kept between 140 and 150 mm. of mercury, at which level there is no danger from apoplexy. When once reduced it may be controlled with less frequent administrations, and without any danger of unfavorable effects. This should be generally appreciated by the medical profession; for no other means will accomplish such results.

X-RAY TREATMENT OF SARCOMA. Aspinwall Judd, in the Medical Record, applying the principle that the effect of the ray is to stimulate cell growth, argues that the effect upon sarcoma will naturally be the production of an adult type of connective tissue, that is, one rich in fibres, packed closely together, with few cells. The stimulation effected by the ray changes over the embryonal type of connective tissue into the adult type, changing a sarcoma into a fibroma. It also, by the production of an obliterating endarteritis, deprives the growth of a certain amount of its nourishment. The contraction of the growth also tends to reduce its vascularity, the end product being a fibroma with an inclusion of nests of sarcoma cells within its mass. In determining whether we shall treat a sarcoma with the X-ray the operability of the tumor comes into question. In these cases the writer strongly recommends its elimination by means of surgical procedure in all possible cases. Where we have an inoperable sarcoma, however, we are justified in the use of the ray. We have been fortunate in being able to

cause a disappearance of about 40 per cent of these tumors.

Recurrence. It is, unfortunately, true, says the author, that nearly all these cases recur after a time. The nests of cells included in the mass take on renewed energy, and it is essential that a second series of treatments be instituted. These recurrences react, however, just as kindly, in many cases, as the initial tumor. I have personally rayed a number of second and third recurrences with satisfactory results, and in one case I was compelled to treat the tumor for the fifth time. This case is now of six years' standing, and at the present time shows no sign of further recurrence. It must be remembered of these cases that we never get a complete disappearance of our mass. A fibroma of an extent proportional to the original tumor always remains. Where we can do so, it is advisable, after raying these cases, to enucleate the remaining mass. It must also be borne in mind that the danger of metastases is always present while our patient is undergoing treatment. In melanotic sarcoma this is a very grave danger; in spindle-celled, round-celled, and fibrosarcoma, proportionately less; and in osteosarcoma, still less. Osteosarcoma is more resistant to the action of the ray than any other type with which we have had to deal.

Details of Treatment.-If we are dealing with a deep-seated tumor of any type we must select a tube with the greatest penetration possible, i. e. a high tube with a large number of penetrating X-rays, The patient should be protected except for the parts to be rayed. As it is essential, owing to the location of the growth, that a larger area should be exposed, our protection is necessarily less complete than in superficial conditions. The tube is best placed at a distance of nine to twelve inches in the beginning, the exposures starting with ten minutes application two or three times a week, with an increase in the length of ex

posures and decrease in the distance, if it is deemed necessary after the idiosyncrasy of the patient is determined. These cases react very slowly, the treatment often extending over months. In one case four months was required before any effect was shown, and ten months before the final cicatrization of the mass. We must not fail to keep in mind the fact that a severe burn, in treating these cases, will produce a rapid increase in our growth and a rapid dissemination of metastases. In our earlier treatment I lost a case of osteosarcoma of the tibia in its third recurrence by failure to observe proper precautions, a severe burn going on to a spectacular growth of the tumor with metastases, resulting in death.

ELECTRO THERAPEUTICS AND

RADIOLOGY.

The Lancet publishes a report of the proceedings of the section on these subjects of the British Medical Association, representing their progress in the past year and their present status, which we reproduce for the benefit of our readers. In opening a discussion on

The Therapeutic Uses of Radium, Mr. Deane Butcher said that the time had come when it was possible to make a sane and sober judgment as to the utility of radium, and the cases which were amenable to radio-action treatment. The cases specially suitable were small circumscribed lesions of the skin. He protested against the practice of excising a portion of a doubtful growth for diagnostic purposes, since this defeated the very object of radium treatment-viz., the destruction of the neoplasm without opening the lymph channels. In extensive or deep-seated cancer the most hopeful procedure was to introduce the radium into the interior of the growth by a surgical operation or to introduce the radium ion itself by Hasel's electrolytic method. Mr. Deane Butcher alluded to the theory of immunisation by radiovaccination as a possible explanation of the good effects.