it seems scarcely necessary to still call them rodent ulcers. Probably the term will gradually cease to be employed." Rose and Carless state that it is generally admitted to be a cancerous tumour of an epithelial type; while Hamilton says there seems little doubt that it is of an epitheliomatous nature; Snow says it is a variety of epithelioma; Bryant calls it epithelial cancer; and Quain places it amongst the cancers. Erichsen considers that it stands midway between the innocent and the malignant tumours. Histologically, Payne says that it very closely resembles flat-celled epithelioma, and considers that the difference between these two diseases is probably one of origin, squamous epithelioma arising from that portion of the epidermis which is endowed with the power of forming superficial horny scales, while rodent ulcer originates in that portion which either has formed, or is capable of forming, the appendages of the skin. Hence it will be seen that, in calling it rodent cancer, one has plenty of authority for the title. Although the progress of a rodent cancer is usually extremely slow, its action in destroying every tissue that it attacks is as remorseless as that of the worst forms of cancer. If unchecked In by treatment it slowly, yet persistently, pursues its relentless course. No tissue can withstand its attack, and in some of the worst cases the nose, the cheeks, the eyes, and even portions of the brain have been eaten away by it. St. George's Hospital Museum there is a specimen of a case in which a patient lost every feature of his face except one eye, which was in the same cavity as his tongue. The malignancy of its local action is thus beyond question. Until very recent years the treatment of this intractable disease was limited to three methods, namely, excision, the application of the actual cautery, and the application of powerful caustics and escharotics. These were all exceedingly painful; excision was perhaps the least so, but the application of the actual cautery necessary to efficiently destroy the disease was very severe; and the intense pain produced by powerful caustics, such as fuming nitric acid, acid nitrate of mercury, chloride of zinc, Vienna paste, or strong sulphuric acid, was so great as to render this mode of treatment only a last resort. If one attempted to lessen the severity of the application by reducing its strength, it only seemed to render it useless without sensibly relieving the patient's sufferings. During the last few years, however, three new methods of treating this disease have been brought forward, which, besides possessing the very great advantage of being practically free from pain, have so far given results as good as, if not better, than the old modes of treatment. They are: 1. The destruction of the growth by comparatively large currents of electricity. 2. The application of the X rays. 3. The application of the Finsen light. I propose in this paper to deal more particularly with the first of these methods, namely, the destruction of the growth by electricity. This is effected under anæsthesia by an operation which was first described, so far as I know, by Dr. Inglis Parsons, of Mayfair, London, about eight years ago, and I cannot do better than give you a description of the operation as performed by him. It consists of a complete destruction of the whole of the invaded tissue by electricity. He employed a Bichromate battery of about 80 cells, having a potential of about 160 volts. The two wires from this are attached each to a holder containing a platinum or gold needle. These two needles are inserted in the healthy tissue on one side of the growth, and quite clear of it, so as to be fairly parallel to each other, but some little distance apart, say half-an-inch or so. It is, of course, necessary to have some form of switch in the circuit in order to promptly turn the current on or off. For convenience sake, I have placed this in one of the handles carrying the needles, since in that position the current is completely under the control of the operator, who can close or open the circuit instantly. Now, the amount of current which will pass across the tissue which intervenes between the needles depends on two things: the resistance of these tissues themselves, and the voltage of the battery employed. The wider apart the needles are, or in other words, the greater the width of tissue between them, the greater the resistance and the less current will pass with a fixed voltage. On the other hand, if the needles remain in a certain position, that is, in other words, the resistance is fixed, it becomes necessary to increase the voltage by employing more cells in the battery if we wish to increase the amount of the current. There are thus two ways of increasing the current, first by decreasing the resistance, that is by bringing the needles closer together, and second by increasing the voltage, that is by employing a larger number of cells. In one of these ways, or both, any desired current may be obtained. Dr. Parsons employed the form of battery known as Stohrer's, in which the number of cells in use may be increased by pushing the sledge along to the required point. Having placed the needles in position, a current of about 40 or 50 volts is switched on and the milliamperemeter read. Since contact is only kept up for one or two seconds, it is well to have a milliamperemeter of the "dead beat" variety, which will give a reading instantly. Less than 300 to 400 milliamperes is useless, and if the instrument shows less than this the voltage must be increased by using a greater number of cells, until the current necessary to destroy the tissue is obtained. This may also be effected by having a rheostat in the circuit and gradually taking it out. The current should only be kept on for one or two seconds, and then interrupted. It is then reversed, and again sent through in the opposite direction for one or two seconds. It is requisite to produce a certain effect, and the current must be increased until this is obtained. The effect required is made evident to the operator by a striking change in the appearance of the soft tissues between the needles. When the current has been made sufficiently large these instantly change colour. All circulation in them ceases, and they become of a yellowish white colour; they are, in fact, dead. When this change is clearly apparent, one needle is withdrawn and reinserted a similar distance on the opposite side of the other needle, so as to take up a fresh piece of tissue continuous with the first, and this is destroyed in the same manner. This process is continued until the growth is completely encircled. Its vitality is thus entirely destroyed, it is electrocuted in fact, and is converted into a piece of dead tissue, a slough, which rapidly separates, leaving a cavity covered with healthy granulations, which quickly fill it up and complete the healing, nothing remaining but a scar. The aftertreatment is of the simplest description, and merely consists in keeping the part clean and in assisting in the shedding of the slough. In the case I desire to bring under your notice, I used for the operation 50 accumulator cells, having a potential of 100 volts, and capable of giving a current far in excess of requirements. The maximum current I employed considerably exceeded 1,000 milliamperes, although Dr. Parsons says 300 to 400 is usually sufficient. He, however, states that he has used as much as 1,000. The effect of this enormous current was most striking. The death of the tissue took place almost instantly, but in addition to this its effect on the patient was most peculiar. Every muscle of the face twitched violently, and not only the muscles of the face, but every muscle in the body seemed to participate in a sudden spasmodic contraction, which shook the table almost as though it had been struck a blow. It has been said that there is in this way some danger of shock; but speaking from an electrical point of view, I should say that it is impossible to get sufficient current to be dangerous to traverse parts any distance from the needles. To be on the safe side, however, it would be as well to confine oneself to ether or ACE mixture as an anesthetic, since there is just a possibility of the sudden muscular spasm I have described affecting the heart. Since the death of the tissue is complete it follows that there is no hæmorrhage. This is distinctly shown in the fact that, supposing a drop or two of blood flows when the needles are first inserted, it instantly ceases on the passing of the current. Since the nerves are all also completely devitalised, there is no pain whatever after the operation. Now we all know that rodent cancer has been cured both by excision, by cautery, and by caustics, but the operation I have just described possesses great advantages over any of these methods. It is, for instance, quite free from the intense pain which invariably accompanies the use of the cautery or strong escharotics, as well as from the great risk of failure of these from inefficient application. Compared with excision, again, the freedom from hæmorrhage is of great importance. In so vascular a part as the face the free hæmorrhage which accompanies the first incision by the knife always tends to obscure the rest of the operation. It is very necessary to avoid cutting away more of the healthy tissue surrounding the growth than is absolutely necessary for its complete and thorough removal, on account of the resulting disfigurement of the patient's face. It must necessarily be difficult to do this when the face is flooded with blood; and although bleeding is now always completely and thoroughly controlled in all operations, we all know that it is frequently difficult to do this, especially in parts well supplied with blood vessels. Parsons mentions a case where the hæmorrhage was so severe as to interfere with the operation, and rendered it only partially successful, yet at a later stage, and when the growth was much larger, it was removed by this method without any hæmorrhage whatever. It has never been proved that any contamination of the healthy tissues surrounding a malignant growth can be brought about by a knife which has just passed through part of the invaded tissue, but on the other hand, it has never been proved that this cannot occur. In the operation I have just described this risk-if there is any such risk-does not exist. The insertion of sutures, too, which is the usual procedure after the operation of excision, is rendered unnecessary. It is a well-known fact that after the most carefully-conducted operations sutures sometimes give rise to trouble, and it has always appeared to me that the insertion of sutures after the removal of a malignant growth may result in sufficiently local irritation to be a direct factor in causing the disease to return. Whether this be so or not, sutures are not employed in this operation, and hence there can be no after-irritation from that cause. The resulting slough separates in a few days, from three to five or six, and the wound then rapidly heals up. The cicatrix which results is also said to be less than that which occurs after excision. In the case I am reporting it took longer than usual to heal, owing to the fact that I destroyed the growth so effectually that I destroyed a piece of the nasal bone as well, which took a week or two to separate and shed. The In describing this operation, Dr. Parsons attributed the result to electrolysis. Now, although electrolysis sufficient to end in the destruction of the part may take place when smaller currents are employed, this is not the case when these large currents are used. Only the very slightest evidence of electrolysis is seen, and the tissue is killed, not by electrolysis, but by electrocution. The action of electrolysis would be in the direction of a chemical decomposition at the needles. which might be of such a character as to set up rapid inflammatory destruction of the part, but this is not so with these larger currents. chemical decomposition at the needles is comparatively slight, and the change in the tissues is due to death and not to decomposition. The death of the tissue is practically instantaneous; its circulation is arrested and its sensation destroyed. This would not be the case were it due to electrolysis. I therefore maintain that this is as truly electrocution as if a current, sufficient to destroy life, were sent between the crown of the head and the foot, the only difference being that we limit the destruction of vitality, in the operation I have described, to the small piece of diseased tissue. In the case of the execution of a person by electrocution, one could hardly maintain that such a result was produced by electrolysis, and I think it has just as little to do with the rapid and practically instantaneous destruction of the tissue of a rodent cancer. The inflammatory destruction of the part, as a result of electrolysis pure and simple, would also be accompanied with much pain, which is not so in this case. With regard to the risk of recurrence, it is too early to speak with certainty, but there is no reason to suppose that it can be any greater after this method than after the older ones. On the contrary, there is every reason to suppose that it will be less; indeed, so far as Dr. Parsons' observations go, this appears to be the case. Should any recurrence take place, it can be promptly and easily cured by an early resort to the same treatment, which in the very early stage is a small matter. With regard to the other two new methods of treating this disease-namely, by the Xrays and by the Finsen light, I do not propose to refer to these in detail, but will reserve that, possibly for a future communication. There is no doubt whatever about the success of both these modes of treatment, and it is probable that later on it will be found that each is more suitable to some particular class of case. The case to which I wish to draw your attention was sent to me by my friend, Dr. H. W. Bryant, of Williamstown. He thought it might be treated by the X rays, but as soon as I saw it, I concluded that it was a typical case for treatment by electrocution. The operation was accordingly carried out last August, and the patient has remained well ever since. The following notes of the case were kindly sent to me by Dr. Bryant :— "Mrs. æt. 60, has had good health all her life. No family history of cancer. About three years ago a small warty growth appeared on the right side of her nose. This gradually became an ulcerating sore, which slowly eat into the surrounding tissues. This was operated on at Daylesford, and remained healed for about six months, and then broke out again." The photograph shows the condition of the patient when I saw her. The inrolled edge and the other symptoms were distinctly those of rodent cancer. Dr. Bryant sent a scraping of it to Dr. Mollison, who stated it was rodent cancer. The second photograph shows the patient after it had healed, and I venture to think that the resulting scar is less than would have followed the operation of excision. think a comparison of the size of the growth and the size of the resulting scar will establish this. The contraction of the scar has drawn up the ala of the nose on that side, and the inner canthus of the eye down, but not sufficiently to call disfigurement. I It This, then, is a brief description of this operation, which, so far as I know, is new here. is very simple, and can be easily carried out by anyone with some knowledge of electricity. At a meeting of the Pharmaceutical Association at Christchurch, N.Z., it was stated by a leading chemist that one firm had paid commissions to doctors amounting to 50 per cent. of the retail price. The result was that nine out of ten prescriptions written by some medical men would contain the name of the firm referred to. Druggists who paid commission frequently could not make up the loss by higher charges to the public owing to competition, and were, therefore, reduced to the position that they could not honestly dispense the prescriptions. A resolution was carried disapproving of secret commissions to doctors in any form whatever. BIFOCAL LENSES. By T. K. Hamilton, M.D. (Dub.), F.R.C.S.I., Adelaide. (Read before the Sixth Intercolonial Congress at Hobart.) THE public has evidently come to appreciate at last the comfort and convenience of Bifocal Lenses, as shown by the increasing number of individuals who have, of late, adopted this combined method of vision correction. Some few years ago it was quite an unusual thing to see a person wearing bifocals, and the few who did thus sacrifice appearance to convenience and utility made themselves somewhat conspicuous by so doing, for the older combinations of the two lenses produced anything but a pleasing effect. All this has now, however, to a great extent changed, as the newer varieties of bifocals are not only more presentable in form and shape, but the application of sounder optical principles has been brought to bear on their construction, and certain difficulties, which up till recently prevented them coming into more general use, have been overcome. The ophthalmic surgeon, with the aid of the scientific optician, has done much to secure this end; and utilitarian, and perhaps fashionable considerations as well, have done the rest. The oldest form of bifocals-that in which the two lenses were of equal size, and joined in a straight line running across the centre-has now been quite superseded, and one rarely sees such combinations worn at the present time. Probably the first change made was to cement one glass on top of the other, and I am indebted to Dr. Kent Hughes for following up a reference I gave him to bifocals, as made several years ago by the Société des Lunétiers in Paris, and for discovering that their method was merely the cementing one. The next improvement in the method of construction was in the direction of grinding the two lenses on the one piece of glass. The adoption of this method dates back some considerable time, as well as I can gather from any available information on the subject, and from what Mr. Köhler, of Flinders Street, my optician, tells me of methods in vogue for years past in Germany and Paris. As far as my own practice is concerned, I have been using this kind of combination now for upwards of 10 years, and the glasses ground on this plan for me in Adelaide have done infinite credit in their manufacture, surface, polish, etc., to Mr. Köhler's skill and workmanship. I thought, when I first used these glasses, that they answered all expectations, and fulfilled all the indications possible under the circumstances. This opinion I held up to about three years ago, but, at the same time, I had always a feeling in my mind that in them we had not quite gained all that was possible to attain to in the way of optical perfection, and this feeling was from time to time accentuated by noticing that a certain number of my patients found very considerable difficulty in getting accustomed to the use of these combinations, and a certain other, though proportionately a smaller number, never could or would get into the way of wearing them. This was to me extremely disappointing, as both my optician and I at one time thought that we had reached the height of perfection as far as mechanical technique, cosmetic effect, and utility all combined were concerned. Further experimentation, however, as time went on, led us to conclude that this what seemed to us mathematically perfect arrangement was really not so in its practical application; and herein lay the explanation of the difficulty, which I have just referred to, which patients manifested in becoming accustomed to their use. The The objections to this one-piece or "ground" bifocal are:-1st, the prismatic effect they produce, and 2nd, their limited range for distant vision. That this variety of bifocal always produces some prismatic effect is a fact beyond dispute, and this is due to the mechanical impossibility of centering both spherical surfaces upon the same piece of glass. specimen which I exhibit is a one-piece lens made by my optician some years ago; its prismatic effect is almost nil, but the dispersion rays are too great, so the glass is almost useless, and it is, moreover, very difficult to make. Dr. Kent Hughes, in his first contribution (Australian Medical Gazette, Sept. 26, 1897) claimed originality for his optician-Mr. Pugh, of Fitzroy-in devising this one-piece kind of bifocal, but, as I pointed out in my letter in the same journal of Nov. 20th, this method of using a periscopic lens and grinding into the posterior (concave) surface is by no means a new idea, as my optician has been grinding the same for many years past, and in them the prismatic effect is lessened, but not to any great extent. Dr. Kent Hughes states that every combination is possible except + sphericals with + cylinders. He comes to this conclusion, doubtless, on account of there being no concavity to work into, but this can be overcome by making a toric lens, thereby producing a meniscus. A "toric" lens is a surface engendered by a circle which turns about an axis situated on the plane of a circle. These lenses have never been manufactured extensively, their cost being considerable, and they are chiefly used when lenses of high power are |