C.

RADIUM IN MALIGNANCY.

W. MANSELL MOULLIN, at the Roentjen Society, London, denied that radium had a cumulative action. A second exposure was more destructive than the first, not because the influence of the radium was cumulative, but because the resistance of the tissues had been lowered, and they had not had time to recover. Nor would he admit a selective action on the part of radium. As to the indications for radium therapy, he thought there was no inconsiderable degree of danger in treating any but small and superficial growths with the small quantities of radium at present at our disposal. Excepting rodent ulcer, radium should be. reserved for cases either inoperable or inaccessible to ordinary methods, and even in rodent ulcer he had known radium to fail completely. Leaving on one side all questions as to size and depth of tumors, the facts that seemed to weigh most in determining the clinical value of radium were slowness of growth and mildness of malignancy.

Mr. Mackenzie Davidson was even more emphatic in expressing his distrust. of radium in malignant disease. He had never seen a malignant growth of any considerable extent which had been cured by radium. The immediate effect was often remarkable, but there was recurrence. He agreed with Mr. Mansell Moullin in deprecating the desire on the part of the ignorant public to "try radium." By "trying radium" some patients had ended their existence a little sooner than they would otherwise have done. In ophthalmic surgery radium had the

greatest value. In every case of the hitherto incurable "spring catarrh" that he had treated he had found the most satisfactory result. Although most cases of rodent ulcer got well, he had known some in which radium had failed, and one at least in which it had "fanned the flame."

Dr. Horace Manders found that the use of adrenalin before an application of radium was a great advantage; the success of the treatment coincided to a great extent with its use, and he thought it worth while taking into account in connection with the possibly unfavorable effect of hyperemia in radium therapy.

Radium had a defender in Dr. N. S. Finzi, who stated that he had been working with more than 20 centigrams, although he did not consider even this amount to be large enough, and looked forward to working with grams instead of centigrams-as his stock of radium had increased, so had the success of his treatment. The second 50 of his 120 cases had yielded better results than the first, and the last 20 better still. These 120 cases were cases of inoperable malignant disease, and out of 90 in which treatment was finished, he had 10 in which the growth completely disappeared, but in 3 of these 10 there had been recurrence. In 1 of the remaining 7 the cure had lasted for more than two years.

ELECTROLYSIS AND IONIC MEDICATION.

Sinclair Tousey, in the American Journal of Dermatology, states that treatment by electrolysis is useful in re

moving superfluous hair, and it is important to use the negative electrode as the puncturing needle, because otherwise the skin may be indelibly marked by metallic ions carried into it by the current. This might happen with iron or steel needles, but probably not with either platinum or gold; still it is better to use the negative electrode because it has a liquifying effect which loosens the hair and the needle better than if the current is reversed. It surprises one at first to see how deeply the needle must be introduced in order to kill one of these hairs; it should catheterize the hair follicle, not penetrate the flesh, and the strength of current employed by the author is about four milliamperes applied for about ten or fifteen seconds. The needle is introduced, and then the current is turned on and regulated to the proper strength while the patient presses her hand upon a sponge electrode. After a sufficient application the patient raises her hand slowly from the sponge electrode and the current ceases to flow. Then another hair follicle not too near the other is catheterized, and again the patient starts the flow of current by pressing her hand upon the sponge electrode. One adjustment of the rheostat and strength of current usually suffices for an entire treatment, at which a dozen hairs may be removed one after another. A downy growth had better be left alone and the treatment used only in cases with strong, heavy hairs, especially if they are black. A certain percentage of the hairs which are removed return and have to be treated again; and other hairs which originally were not coarse become so in consequence of stimulation. The treatment is, therefore, apt to be tedious. Great care must be exercised to avoid making too much of a pustule with the galvanic needle, as that would produce a disagreeable scar or possible pitting like smallpox.

Galvano puncture is excellent for

small warts and moles and fleshy tumors of the skin, and also for angeiomata; but carbon dioxide snow is preferable in some cases of the latter disease, and the high frequency spark in some cases of the other troubles.

Ionic medication by electrolysis, usually cataphoresis, will probably be found of immense value in a very great variety of skin diseases, and the author predicts its wide utility in skin diseases of a germ origin. Stephan Leduc has done a great Ideal to further this treatment, and the present author has employed it with such brilliant success in a case of long standing furunculosis that details of the treatment of this case may be valuable. For two years and a half the patient, a man of forty-five years, had never been free from a number of boils simultaneously on the back of the neck; some developing, others at their height, and others healing. The condition had been general for six months with forty large boils requiring to be lanced in different parts of the body and limbs. The systemic disease subsided under a treatment which has afforded the author success in scores of cases of furunculosis. A laxative is given every day, such as cascara podophyllin and belladonna. A specific remedy is given such as R, O1. Phosphorati 3ss, Ol. Morrhuæ ad iii, M. Sig. 3ii, t. i. d.; or R, Syr. Hypophosph. Calc. Sod. Pot. (each gr. v) t. i. d. The former is too disagreeable for some people, but is wonderfully effective. High frequency currents were applied as a nerve tonic and rhythmic galvanic currents to relieve spasm of the cerebral arteries, which was really the cause of the patient being referred to me for treatment. A combination of these treatments made the patient robust, but still it seemed impossible to get rid of the recurrent boils, by this time not much more than bad pimples on the back of the neck. Germs were evidently deeply lodged in the sebaceous glands, and for a time the author debated between the use

of the X-ray to dislodge them and ionic. medication by cataphoresis to carry a germicide into the pores and destroy the germs in situ. The latter method was adopted with complete success. The negative sponge electrode was applied to the epigastrium and was moistened with a weak solution of sodium bicarbonate which the author finds greatly preferable to salt solution for moistening sponge electrodes. The positive electrode was a polished metal disk 17% inches in diameter, covered with three thicknesses of cotton wadding such as is sold by dressmakers' supply stores. This was thoroughly moistened by pressing it again and again against the bottom of a saucer full of 1/200 solution of zinc sulphate. The current was of a strength of from 5 to 8 milliamperes and was a constant one for five minutes. During this time the abdominal electrode was practically stationary, but the one at the nucha was rubbed over the affected region without breaking the contact. The skin of the back of the neck was decidedly red after each application and felt quite raw after one application with a stronger current of 10 to 15 milliamperes. Reversing the current with the original 5 to 8 milliamperes immediately produced a strong burning sensation from carrying acid ions into the skin; so it was important to see that the right polarity was used. Twelve cataphoretic treatments were given from January 28th to February 24th, 1911, and on June 1st, 1911, there had been recurrence.

ELECTRIFIED CHILDREN.

Interesting investigations into the effects of electricity upon the development. of school children have recently been made in Stockholm. The walls and ceilings of a schoolroom were lined with a coil of wires through which a high-frequency current was passed. The children in the room were thus in the position of an iron core in the center of a magnetizing coil. Fifty children were

kept in this room, while fifty others of the same average age, size and mental development were kept in an adjoining room without electrical treatment. It is stated that at the end of six months the children under electrical treatment showed an average growth of two inches, while those without electricity grew only 14 inches. The electrified children showed an increase in weight and other forms of development in proportion to their height. The electrified children also showed an average proficiency in their studies of 92 per cent, and 15 of them showed 100 per cent. The unelectrified children, on the other hand, were only 75 per cent proficient on the average and not one of them reached 100 per cent. It is added that the electrified children appeared to be much brighter, quicker and more active. They were prompter in attendance and much less subject to fatigue. The teachers also showed superior working capacity in the electrified room. While there was an odor of ozone in the room, it was held that the presence of ozone would not account for the results observed.

THERMO-THERAPY IN GYNECOLOGY. By S. Flateau, M. D., Nuremberg (From The Lancet).

Ages ago the therapeutic instinct recognized the healing properties of warmth and added them to its stock. But the employment of heat as a treatment, founded on scientific principles, dates from the time when August Bier collected, extended and enlarged the earlier works of physiologists and pathologists in his system, "Hyperamie als Heilmit

tel."

As a matter of course, the gynæcologists, too, were desirous of applying the advantages of hyperæmic treatment to their special branch, the accessibility of the female genitals favoring the introduction of heat. Finally, according to the researches of Goldscheider,1 the abdomen seemed especially adapted to the

stimulating properties of warmth on account of the numerous nerve endings susceptible to heat which it contains (Ruffini termini). We know, indeed, that warmth exercises an expanding effect on the vascular system and that the amount of blood in the skin operates on the neighboring deeper-lying vessels in the sense of causing a more rapid exchange, a larger "turnover." "2 As a matter of fact, the abundant subcutaneous cellular tissue by its low conductivity (which was demonstrated by Fuchs3) forms a great obstacle to the penetration of heat when we desire to apply it only through the skin. But, on the other hand, by reason of the extraordinarily decreased speed of the blood in the pelvic venous system, we may assume that the heat will not be too rapidly dispersed or lost, but that, on the contrary, it will accumulate. Moreover, the stimulating effect of heat therapy increases, to a certain degree, with the degree of temperature and the duration of the application. It is on this hypothesis that thermotherapy, in cases of pelvic diseases in women, must be built up.

But a long time passed before a useful and practical method, which was destined to receive widespread recognition in medical circles, made its appearance. Strictly speaking, the first applicable thermo-apparatus was that produced by Polano, while working side by side with Bier and Klapp in Greifswald. In this apparatus hot air, up to a temperature of 100° C., was caused to circulate round the abdomen of the patient, the abdominal regions being isolated in a wooden case. But in spite of the excessive heat registered by Polano's thermometer, the

On the other hand, the method is out of place in treating cases where there is fever, and in all diseases of the annexa in which pus is present or may be expected to form, and in tuberculosis of the genitals. As is well known, the gonococcus is hypersensitive to high tem

perature,11 and hence diathermal experiments in cases of infection with Neisser's diplococcus would probably be attended with success. Usually I apply the instrument to patients for three hours daily, although, of course, there is no reason why this duration should not be increased. The temperature of the pelvis. falls very slowly after the instrument is removed, so that the tissues only assume their normal temperature after one or two hours.

I demonstrated my apparatus before the Franconian Gynecological Society on October 24th, 1908, and spoke, too, of the extent to which it might be employed.12 This I wish to emphasize because the whole idea was evidently in the air during the development of our electrotherapeutic methods-I mean the idea of diathermia, the thermo-penetration of segments of the body (vide the works of von Zeynek, von Preyss and von Berndt, Klingmüller and Nagelschmidt). Thus, Sellheim described, eighteen months later,13 a process in which the temperature of the pelvic organs was raised to 40° and 41° C. by passing the so-called high-frequency currents (de Forrest current) between two electrodes. For the present, however, there are two argurients against the general employment of that method. First, we still know too little concerning the physical and biilogical effects of the high-frequency current on the living tissues. Secondly, Sellheim's apparatus is much too dear. Its price ranges from £35 to £45, and only one patient at a time can be treated. The purchase of a number of Sellheim's apparatus for a large gynæcological department with moderate means would be in most cases an impossibility.

Next, Feis, in Frankfort, in ignorance of my first publication, announced his kolpotherm.14 In this instrument a small electric lamp is enclosed in a metal case and introduced into the vagina. Compared to the fragile carbon wire and glass case in Feis's kolpotherm, my de

vice has the advantage of being absolutely unbreakable, and can be used for an unlimited length of time.

I do not report a large number of cases, but I wish to make more generally known a method which I devised three years ago, and since then have thoroughly tested in my clinic and in private practice. To recapitulate: (1) This vaginal heating instrument, the "Pelvitherm,"15 raises the temperature of the female pelvis up to about 40° C. for any length of time; (2) its use, in contrast to all other existing methods, requires no special superintendence, and therefore does not take up the time of the clinical staff; (3) it can be used anywhere where electric light is in use, including the patient's home; and (4) the instruments are so cheap and lasting that every hospital or private practitioner can procure a number of them.

X RAY TREATMENT OF SARCOMA: By J. Delpratt Harris, M. D., M. R. C. S., in The Lancet.

The following case may prove useful in marking out a new line in the use of X-rays therapeutically:

The patient, a boy, aged 4 years, was brought to the Royal Devon and Exeter Hospital for a small swelling over the ascending ramus of the jaw on the right side. As he had at the time a catarrhal condition of the auditory meatus on both sides, the swelling was thought to be glandular, and the ears were thoroughly treated until the discharge ceased. During the next month the swelling became much larger, the whole bone on that side appearing implicated and the enlargement being now noticeable both inside the mouth and externally. A fortnight later the swelling had increased. in size and a point of softening was noticed on the inside. At this time (June 25th, 1910) the case was admitted.

On admission the patient was drowsy and took very little notice. The tem

perature ranged between 98° and 100° F., rising on July 4th to 103.4° in the evening. On July 5th, under chloroform anææsthesia, an exploratory puncture in the mouth was made, and some soft material was removed for miscroscopical examination. Some slight gouging and examination with a probe was made in order to ascertain whether tubercular disease of the bone existed. No evidence of this was obtained. On July 11th the pathologist reported: "The growth proved to be small round-celled sarcoma."

After the operation the patient became more drowsy than before, the skin over the tumour becoming reddened and softened as though about to break down. The temperature ranged between 101° and 104°. Inside the mouth the condition was that the swelling was so situated that the teeth could not be made to touch, and mastication of food was prevented, the teeth chewing the tumour and causing a line of ulceration. Coley's fluid was now injected: July 15th, m was given; 16th, m 4; 17th, m %; 18th to 20th, m 2: 22nd, m 34; 23rd and 24th, m 1%; 25th, m 13%; July 26th to August 3rd, m 12. After the injections, which were given in the forenoon, the patient usually had an evening reactionary temperature of 101° to 102°, the temperature becoming normal in the morning. As a result of nearly three weeks injections, the swelling was noted as being "much smaller, the skin becoming normal in appearance, and the general condition much improved. The fluid was sometimes injected into the tumour, at other times into the arm."

On persevering with this treatment it was noted that reaction was still obtained

on August 20th, but on Sept. 9th, although m iv. were given as one dose, no reaction was obtainable. The case being now in a latent condition and no further benefit appearing, on Sept. 18th, 1910, what must be called a colossal dose of X rays was given, since the word massive