leaves a scar disfigured by telangiectases, which the Finsen scar avoids. Rodent ulcer is another disease in which x-rays have proved a most valuable remedy. It can not be said the x-rays are sure to cure every case of rodent ulcer, but it is well worth a trial in all cases, for the successful cases are, in my experience, quite 70 per cent. Recurrence is rare afterwards, and appears to be successfully met with further treatment. Sequeira's experience bears this out. Latterly he has in all cases of x-ray treatment been prescribing treatments only. once a week or fortnight, instead of three times weekly. I feel sure that, taking the cumulative action of the rays into account, this is a move in the right direction. Lupus erythematosus is unlikely to benefit with x-rays; in fact, their application is more likely to be fraught with evil than with good. It is perhaps among the rarer cases of skin disease that the most remarkable results have been obtained. Thus, mycosis fungoides, one is justified in saying, is curable by means of x-rays. Whether the cure is rarely a perinanent one is not yet certain, but in a case which was discharged cured nearly two years ago there has been no relapse; at least, I saw the patient after a year, when he was still quite well, and he was warned to return for further treatment at the slightest reappearance of the disease, and he has not come back. In Kaposi's disease the x-rays have proved similarly successful. Chronic ulcers, such as varicose and perforating, have been treated successfully, and x-rays may prove a valuable addition to our means of treating these inveterate cases. With regard to malignant disease, whether sarcoma or carcinoma, the only case in which I have seen the tumors actually atrophy was one of sarcomatosis cutis in an old man, in which the disease was far too extensive to hope for a successful result. Nevertheless, some of the tumors treated did disappear. I think that certainly the pain of carcinoma is relieved by x-rays, and I think also that some cases appear to be re tarded in their growth. Multiple warts can be cured, and some of the blood diseases associated with enlarged spleen may be treated with benefit. Before leaving the subject of x-rays I must just mention the cases of dermatitis which result from over-exposure. Clinically I think these may be described as embracing two varieties the acute and the chronic. The former may occur after one, two, or more over-exposures, and causes superficial ulceration, which heals somewhat slowly. The latter is far more insidious, and is met with as the cumulative action of the rays after many weeks or months. This is far more serious, and, when fully established, appears to be incurable, and tends to terminate in epithelioma. The acute variety is apt to cause permanent alopecia in cases of ringworm, while the chronic dermatitis must be carefully guarded against by all workers in x-rays. In the hands, where it is naturally most often met with, the earliest symptoms are undue redness and a shiny appearance around the nails, which themselves appear to grow more quickly than normally, and hence require more frequent cutting. IV. RADIUM EMANATIONS AND HIGH FREQUENCY ELEC TRICITY. As I have said before, treatment with radium has proved disappointing. The salts used in therapeutics have been the bromide, the nitrate, and a compound radium and barium salt. The marvelous physical properties of radium, discovered in 1903 just when the value of x-rays in therapeutics was becoming generally recognized, and aided by sensational articles in the lay papers, all conduced to first of all magnifying its value in disease, and per contra as is always the case when great expectations are disappointed, to its almost entire oblivion at the present time. To be frank, generally speaking, as a therapeutic agent radium is not worth its cost; but it has in a decidedly limited field a certain value. It was hoped, for instance, at one time that inhaling the emanations of radium might cure phthisis; this hope has not materialized. Radium is useful in cases of rodent ulcer, when the disease is not extensive, and when for some reason or other x-rays are not available. Lupus of the mucous membrane of the nose or other small cavity, inaccessible to Finsen light or x-rays, is another indication for its use. I think also that, owing to its safety, radium is perhaps the agent of radiation for ophthalmic surgery, in the few cases where it may be desirable. Owing to its expense, small quantities only are usually available, and therefore the treatments require to be prolonged, lasting 30 minutes or an hour. But the sittings can be quite safely left for the patient to carry out. The radium is, I think, best applied in a small sealed glass tube, in a holder made of some such material as copper wire, which can readily be made by anyone. High frequency electricity is another form of radiation which experience has on the whole proved to be disappointing. Personally, I strongly object to such terms as d'Arsonvalisation, effleuve, auto-condensation, etc.; they smack of quackery, and appear invented to dumfound the multitude and to white-sepulchre the whole proceeding. It is commonly said that high frequency electricity is practically the same as static electricity: Nothing from a physical standpoint could be further from the truth; the basis on which this statement rests is that the same class of patient receives equal benefit from both. And the class of patient is the neurotic-I need say nothing further. Provided that treatment by suggestion is not abused, and particularly in these days of nervous breakdowns, neurasthenia, and so forth, both high frequency and static electricity should prove very valuable additions to treatment. Static electricity also seems capable of being useful in other fields; but this paper is endeavoring to deal with radia tions and not electricity generally, so it would be out of place to discuss this further. With regard to high frequency, it was at one time claimed that it was capable of causing sufficient anæsthesia for minor surgical operations; however, an investigation of the literature of the subject shows that this claim is an empty one. Other diseases on which it has been tried are such widely different ones as diabetes, tuberculosis, keloid, alopecia areata, psoriasis, mucous colitis, and neurasthenia. It will be noticed that these diseases have only one thing in common, and that is that they are often singularly rebellious to other forms of treatment. I do not say that high frequency will eventually find no permanent place in therapeutics; but to be strictly honest, I must admit that in my hands this form of radiation has proved extremely disappointing, except in those cases where a functional neurosis was at the bottom of the trouble.-The Hospital, June 2, 9 and 16, 1906. PROGRESSIVE MEDICINE. A Quarterly Digest of Advances Discoveries and Improvements in the Medical and Surgical Sciences. Edited by H. A. Hare, M. D., assisted by H. R. M. Landis, M. D. Vol. IV, December, 1905. Diseases of the Digestive Tract and Allied Organs: Liver, Pancreas and Peritoneum. Anesthetics, Fractures, Dislocations, Amputations, Surgery of the Extremities and Orthopedics, Genitourinary Diseases, Diseases of the Kidneys, Practical Therapeutic Referendum. Paper, 367 pages. Price, $6 per annum. Philadelphia: Lea Brothers & Co., 1905. The excellency of this volume is in keeping with those previously issued. It is written by thoroughly qualified men who have the requisite clinical experience to enable them to take from the literature all there is of practical value and present it in a readily accessible and interesting manner. Dr. J. Dutton Steele writes on the Diseases of the Digestive Tract and Peritoneum; Dr. W. T. Belfield discusses Genitourinary Diseases; Dr. J. R. Bradford writes on the Diseases of the Kidneys. Dr. J. C. Bloodgood discusses Anesthetics, Fractures. Dislocations, Amputations, Surgery of the Extremities and Orthopedics. Under the title Practical Therapeutic Referendum, Dr. H. R. M. Landis writes on new remedies and agents used for medicinal purposes. VARICOSE VEINS OF THE LEG BY THE BY ROBERT T. MILLER, JR., M. D., Assistant Resident Surgeon Johns Hopkins Hospital. Many methods are employed in the treatment of varicose veins of the legs, no one of them being generally accepted or satisfactory. The aim of almost all operative procedures is to block the saphenous vein in order to do away with abnormal circulatory conditions existing in the leg as a result of valvular incompetency of the superficial venous system. The particular method employed is perhaps one of arbitrary choice since it is unusual to find any procedure recommended because its results, ultimate as well as immediate, are known to be good. Schede, in 1877, published the method which goes by his name, consisting of a more or less extensive division between ligatures of the superficial veins a short distance above an ulcer. In 1884 Madelung published the method with which his name has become associated; this consists of excision of the varicose saphenous vein and its branches, the extent of operation varying with cases. This procedure had been employed by others before Madelung's paper appeared. In 1891 Trendelenburg published a paper in which was embodied the first accurate statement of the hydrostatics of the condition, together with a description of his operation consisting of division between ligatures of the long saphenous vein. The point of division elected by him was in the lower third of the thigh, but the tendency has been to divide at a higher and higher point until today the attempt is made to block the venous stream just at the saphenous opening in the deep facia of the thigh. In general, the present operative therapy consists of the employment of some one of these classical methods or a combination of them; the choice of method, however, is often blind, being influenced by little else than the immediate future simply because late results are unknown. Attempt is made to present in this paper the results of treatment of varicose veins of the leg as practiced in the Sur |