** > . . . . ~ * . . . . . 4. t ** A% - APRIL, 1905 & 4- ! - THE ARCHIVES OF PHYSIOLOGICAL THERAPY Devoted to the Diagnostic and Therapeutic Uses of Electricity, Radiant Energy, Heat, Water, Mechanical Vibration, Dietary Regulation, Exercise, Psychic Suggestion, etc. PUBLISHED MONTHLY witH ILLUSTRATIONS EDITED BY CLARENCE EDWARD SKINNER, M.D., LL.D., NEW HAVEN, CoNN. - In conjunction with * CARL BECK, M.D., NEW YORK, N. Y. GORDON GRANGER BURDICK, M.D., CHICAGO, ILL. -- JAMES KING CROOK, A.M., M.D., NEw York, N. Y. ADOLF DECKER, M.D., CHICAGO, ILL. GUSTAVUS ELIOT, A.M., M.D., NEW HAVEN, CoNN. WOLFF FREUDENTHAL, M.D., NEw York, N. Y. ARTHUR WILLIS GOODSPEED, PH.D., PHILADELPHIA, PA. GEORGE COFFIN JOHNSTON, M.D., PITTSBURG, PA. JOHN HARVEY KELLOGG, M.D., BATTLE CREEK, MICH. FRANKLIN MARTIN, M.D., CHICAGO, ILL. - - WILLIAM JAMES MORTON, A.B., M.D., NEw York, N. Y. GEORGE MITCHELL PARKER, B.A., M.D., NEW YORK, N. Y. GEORGE EDWARD PFAHLER, M.D., PHILADELPHIA, PA. WENDELL CHRISTOPHER PHILLIPS, M.D., NEW YORK, N. Y. ROBERT REYBURN, A.M., M.D., WASHINGTON, D. C. ALPHONSO DAVID ROCKWELL, A.M., M.D., New York, N. Y. JOY WEBBER SEAVER, A.M., M.D., NEw HAVEN, CoNN. SINCLAIR TOUSEY, A.M., M.D., NEW YORK, N. Y. Foreign Correspondents DR. ERNEST ALBERT-WEIL, PARIS, FRANCE DR. HERMANN ALGYOGYI, VIENNA, AUSTRIA - DR. JEAN BERGONIE, BoRDEAUx, FRANCE DR. LUDWIG HALBERSTAEDTER, BRESLAU, GERMANY MR. J. HALL-EDWARDS, BIRMINGHAM, ENGLAND DR. LEOPOLD LAQUER, FRANKFORT-ON-MAIN, GERMANY DR. ALBERT NEISSER, BRESLAU, GERMANY DR. LOUIS TOROK, BUDAPEST, HUNGARY RICHARD G. BADGER, PUBLISHER THE GORHAM PRESS, BOSTON, U. S. A. - * By suBSCRIPTION $3.00 A YEAR LONDON TORONTO MONTREAL MELBOURNE PARIS BERLIN THE ARCHIVES OF PHYSIOLOGICAL THERAPY CONTENTS FOR APRIL, 1905 PAGE Static Electricity in Chronic Nephritis: A Recapitulation º • C. S. Neiswanger, M.D.. I 13 The Therapcutic Application of the Con- & tinuous Current º © Truman Abel Pease, M.D. I. I 5 A Case of Hyperidrosis Axillae Treated by X- Rays . e © e & G. H. Stover, M.D.. I 19 Editorial . tº º © - º cº . I 2 O Radium in Therapeutics — Special Roentgen Number. Current Physiological Therapy . º º e . I 23 Miscellaneous Abstracts . © e e - . I 37 Electro-Therapy, I37 – Radiodiagnosis, 148 – Radiotherapy, I50 — Aero-Therapy, I 59. SPECIAL PLATES WII. Pott's Fracture . e © Gordon G. Burdick, M.D. J’III. Fracture of Tibia and Fibula © Gordon G. Burdick, M.D. IX. Same as J/III. — lateral view º Gordon G. Burdick, M.D. X. Sarcoma of Tibia . o © Gordon G. Burdick, M.D. XI. Supposed Dislocation of Hip & G. C. Johnston, M.D. XII. Dislocation of Hip e - G. C. Johnston, M.D. XIII. Congenital Dislocation of Hip . G. C. Johnston, M.D. RICHARD G. BADGER, Publisher, 194 Boylston St., BOSTON X THE ARCHIVES OF PHYSIOLOGICAL THERAPY TERMS OF SUBSCRIPTION THE ARCHIVES OF PHYSIOLOGICAL THERAPY is published on the 25th of each month. 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All advertising matter in THE ARCHIVES is edited as carefully as the text. Our readers may rest assured that our advertisers are in every sense reliable and responsible concerns. COPYRIGHT The entire contents of THE ARCHIVES is covered by copyright, and permission to reprint any article or illustration must be obtained from the publisher before using elsewhere. Entered at the Boston Post-Office as second-class mail matter March 22, 1905. RICHARD G. BADGER, Publisher, 194 Boylston Street, BOSTON. Special Roentgen Ray Number The first Special number of THE ARCHIVEs will be issued next month (May). In honor of the tenth anniversary of the discovery of the X-Ray this will be a SPECIAL RoeNT- GEN ANNIVERSARY NUMBER. The most noteworthy feature will be 16 full page plates, selected from the most remarkable Skiagraphs ever made in this country. Those who are not already subscribers should forward their order at once, as the advance demand is already very heavy. Price 50 cents. THE ARCHIVES OF PHYSIOLOGICAL THERAPY xi T H E T E S T IMO NY of a lamp is the ſight which if produceſ Tatents applied for 2 CANDLE POWER 6 VOLTS ACHROMATIC LENS MAGNIFYING 8 TIMES ABSOLUTELY FREE OF SHADOWS PRICE $12.oo NET Diagnostic lamp transformers for Alternating and Direct Currents Electro Therapeutic Appliance Company Malden, Maſſ., U. S. A. GEORGE H. MOSEMAN, General Agt, 176 Federal St., Boston, U. S. A. xii THE ARCHIVES OF PHYSIOLOGICAL THERAPY AT LEAST I6 Plates will be included in the Special Roentgen Number The Archives of Physiological Therapy for May, 1905 An Indispensable work to every Physician who uses /acuum Tube Radiations NOTES ON X-LIGHT By WILLIAM ROLLINS 4oo pages of text, 152 plates. Price $7.5o net. Printed at the University Press. The book is a good example of the Art of Printing D. VAN NO STR AND COMPANY, 23 and 27 Murray St., NEW YORK, N. Y. 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" Our products are used by the United States govern- ment, leading Hospitals, Universities, eminent surgeons, and Therapeutists. "I Those interested in X-Ray and Electro-Therapeutics, apply at once for valuable information and illustrations of the latest perfected apparatus. " Protected by patents and fully guaranteed. SCHEIDEL’S IMPROVED PRODUCTION OF OUDIN RESONATORS IS THE BEST A/Z foreign orders 772 tes: Öe accompanzed by draft - W. S C H E I DE L & COMPANY Office and Factory : 171-173 E. Randolph St., Chicago, U. S. A. Cable Address: SCHEIDEL, CHICAGO. Long Distance Phone, Main 1766 A G O O D | D E A Divided Stationary Plates Take them out and clean them once in a while and you can always depend on your machine. All Static machines generate well when they are new — and clean. The We/som machine is made that way Wrząe for cata/ogue ro NELSON SCIENTIFIC INSTRUMENT COMPANY C H I C A G O, I L L I N O I S º - ? º, * - - v ſ ºr ſ | Pott's Fracture, sustained in a railroad wreck, skiagraphed four months after injury. Plaster cast treatment. The joint is useless and ascending neuritis present. Swelling was so great that diagnosis by ordinary means was out of the question. Upon the strength of this skiagraph patient secured damages for $3,800.00 without question. Exposure Io seconds. A mode 20 inches from plate. Water cooling tube. 3o inch coil. Hydrochinon developer. By Dr. Gordon G. Burdick, Chicago, Illinois. The Archives of Physiological Therapy Special Plate VII Fracture of Tibia and Fibula, taken one year after in- jury, and illustrating the fallacy of the plaster cast treatment for fractures. The fracture was treated by an eminent sur- geon who does not believe in the X-ray; claims that it is unreliable. Exposure 5 seconds. A node 20 inches from plate. 30 inch coil. Regulating Tube. Hydrochinon developer. By Dr. Gordon G. Burdick, Chicago, Illinois. The Archives of Physiological Therapy Special Plate VIII Same subject as Plate VIII. Lateral view. Exposure 5 seconds. A node 20 inches from plate. 30 inch coil. Regulating tube. Hydrochinon developer. By Dr. Gordon G. Burdick, Chicago, Illinois. The Archives of Physiological Therapy Special Plate IX Sarcoma of Tibia with Tubercular Myelitis. Diagnosis confirmed by operation, which was fol- lowed by multiple sarcomata in various parts of the body. Exposure 5 seconds. A node 20 inches from flate. 22 inch coil. Light tube. Hydrochinon developer. By Dr. Gordon G. Burdick, Chicago, Illinois. The Archives of Physiological Therapy Special Plate X Supposed Dislocation of the Hip. Boy of 6 years. Plate shows arrested development of femur, ilium, ischium, and pubis. Queen coil. Water cooled tube. Wehnelt interrupter. Pyro developer. Cramer X-ray plate. I5 seconds exposure. G. C. Johnston, Pittsburg, Pennsylvania. By Dr. G. C. Johnston, Pittsburg, Pennsylvania. The Archives of Physiological Therapy Special Plate XI Dislocation of the Hip. Reduced by Lorenz method. Plate taken through plaster cast. Fifteen inch Queen coil. Wehnelt interrupter. Bario-vacuum water- cooled tube. Exposure 30 seconds. Pyro developer. By Dr. G. C. Johnston, Pittsburg, Pennsylvania. The Archives of Physiological Therapy Special Plate XII Congenital Dislocation of the Hip. Age 4 years. Female. Radiograph shows vulva and urethra. Exposure 15 seconds. I5 inch Queen coil. Wehnelt interrupter. Gundelach tube. Pyro developer. Cramer X-ray plate. By Dr. G. C. Johnston, Pittsburg, Pennsylvania. The Archives of Physiological Therapy Special Plate XIII THE ARCHIVES OF PHYSIOLOGICAL THERAPY Devoted to the Diagnostic and Therapeutic Uses of Electricity, Radiant Energy, Heat, Water, Mechanical Wibration, Dietary Regulation, Exercise, Psychic Suggestion, etc. VolumE ONE APRIL 1905 NUMBER THREE STATIC ELECTRICITY IN CHRONIC NEPHRITIS; A RECAPITULATION & By c. s. NEIswangeR, M.D., of CHICAGO, ILLINOIs \ Professor of Electro-therapeutics, Chicago Post Graduate Medical School and Illinois Medical College; President and Professor of General Electro- therapeutics Illinois School of Electro-therapeutics. RIGINAL investigation, es- pecially upon medical sub- jects, and where the results are almost phenomenal, is almost necessarily fatal to the finances and reputation of the investigator unless he be spared long enough to gain the company of suf- ficient support to strengthen his position. The above subject, although not orig- inally selected for this meeting, has been again chosen, partly at the request of friends, and we feel the more encour- aged to do so because other physicians —notably Reed of Philadelphia and Hurd of Minneapolis—have in recent articles upon the subject reiterated the writer's views. - How prone is the physician to criticise adversely the things that are new, and how inexplicable is human nature in general in this respect. The writer was forcibly reminded of this seemingly in- nate characteristic of all mankind when, eight years ago, he had the temerity to attack the old, accepted pathology of a recognized incurable lesion-chronic Bright's disease. And how nearly fatal it proved to his medical aspirations until, by persistent and extended clinical work, the dark clouds of adverse criticism are being replaced by the sunshine of honest investigation. Many letters are con- stantly being received stating the expe- rience of other physicians in this direc- tion and going further to prove the views of the writer. It is not deemed advisable at this time to consider either the etiology, pathol- ogy or diagnosis of the disease under All Rights Reserved. * Read before the Electro-Therapeutical Section of the International Electrical Con- gress held at St. Louis, Mo., September 12-17, I904. Copyright, 1905, by Richard G. Badger. 8 (II3) II.4. STATIC ELECTRICITY IN CHRONIC NEPHRITIS discussion, and only such pertinent points in the treatment will be given as will en- able the physician to apply it intelli- gently. These are omitted, first, be- cause the old are well known to every physician present, and the newer views of the writer have been almost con- stantly before the medical profession since their inception eight years ago; second, because they are not considered essential for the purpose of this paper, which is only a recapitulation. A few points, although contained in former literature upon this subject, may be mentioned here merely as reminders: That chronic nephritis is more essen- tially a disease of central nervous impair- ment. That one of the strongest proofs of this is the kind of persons afflicted. That the natural paths along which impressions are conveyed to the kidneys are through the splanchnics and spinal cord; and, when these tracts are im- paired, the function of the kidney is cor- respondingly affected. - That the results of decapsulation show it not to have a place in the suc- cessful treatment of this disease, and that other operative procedures have been equally barren of results. That the reduction of albumen ob- tained by strict diet has no clinical sig- nificance. That the remedy indicated is one that will hasten the oxidation of waste prod- UCtS. That static electricity is the logical remedy, because, by the evolution of ox- ygen, always accompanying this modal- ity, not only hastens the elimination of waste matter, but gives a better tone to the nerve centers affected by its vibra- tory action. - * That static electricity is a powerful equalizer of the nervous forces, as is evi- denced by its effect on the temperature, respiration and pulse. That in all cases of chronic nephritis treated by the writer, where there was mitral regurgitation or the hypertrophy which precedes it, the results have been almost entirely negative. It was the intention to present at this meeting the reports of twenty consecu- tive cases, in which the diagnosis was made by experts, but on account of the length and similarity of these reports it is only deemed advisable to present a summary of the twenty cases, as follows: Permanently relieved . . I2 or 60% Partially relieved 2 or IO% Failures 6 or 30% The two cases that were partially re- lieved were still taking treatment and showing some improvement, but were finally lost sight of. { Although the results in 30 per cent. were finally negative, two of the cases were so materially benefited after one month treatment that they were provis- ionally discharged. Both returned af- ter the lapse of one year as bad as when first seen, and were not benefited by sub- sequent treatment. In all the unfavorable cases the heart's action was characteristic of the advanced stage of the disease. Two had passed the age of 70, one was only I 5. - Longest time between the discovery of the disease and presentation for treatment in all the cases was six years. Of the twenty cases seventeen were males, three females. Five were physicians; four board of trade operators; three preachers; two housewives; one domestic; two traveling salesmen; one clerk in city hall; one jew- eler; one laborer. The treatment used has been the nega- tive head breeze for I 5 minutes, fol- lowed by positive insulation for the same length of time. The Morton wave current is alternately substituted for the head breeze. Treatments are given daily. After a few sittings the urea commences to increase, carbon dioxide is eliminated and albumin and casts de- crease. The patient has a feeling of • e o e s THERAPEUTIC APPLICATION OF CONTINUOUS CURRENT I I5 well-being, sleeps well and is free from pain. - If the results as stated in this paper serve to stimulate more extended re- search in this direction, the writer will feel amply repaid, and also be pleased to give more extended details—to any of the could be brought out in this paper. profession — than THE THERAPEUTIC APPLICATION OF THE CONTINUOUS CURRENT* BY TRUMAN ABEL PEASE, M.D., OF NORWOOD, N. Y. N age can hardly be called an Electrical Age if in it elec- tricity is limited to the mov- ing of wheels and sound and light. When men manipu- late all matter not by crude mechanical means but by the direct ap- plication of electricity — then we shall be able to say, This is an Electrical Agel The electrical Age is even at our doors, and as physicians we may lead the way in the varied application of this divine power as old as the ages and as little un- derstood by the many. To become efficient in this department one should be enthusiastic in the develop- ment and application of the various cur- rents used in Electro-Therapeutics, viz: The Continuous, The Faradic, The Sin- usoidal and the almost innumerable Static Modalities. - To make any vapor do our work we surround it by a stronger case. To uti- lize the power of a stream of running water we direct its course by a dam of greater strength. Likewise the work accomplished by any of the various cur- rents of electricity is ever the result of a rapidly moving stream of material * Read at the Fourteenth Annual Conven- tion of the American Electro-Therapeutic As- sociation at St. Louis, Mo., September 13-16, . I904, and published in this journal by special permission of the author and the Executive Council of the Association. atoms controlled and directed by a greater resistance. Every separate atom found in any elementary body is composed of a definite and constant vol- ume of negative electrons working in a corresponding mass of positive electri- city. The nature of the elementary body, i. e., the valency or number of that element, depends upon the number of ions in the atoms. The manner of the work done by electrical currents de- pends in a large degree upon the compo- sition of the electrode or electrolytes as well as upon the rate of vibrations. Of all agents used in the treatment of diseased conditions, none fills a wider field of usefulness than The Continuous Current. In surgery it may be used for the removal of the smallest blemish that mars the beauty of any fair face, while the largest neoplasm often yields to its persistent application. - Of the action of the Continuous Cur- rent applied for the disintegration of ab- normal and effete matter and its removal from the body by sentient matter through selected inherent power of its own, the following case will serve to illustrate: - Some twenty years ago the writer was called to treat a painful exostosis of the tibia. The tumor was about as large as a butternut and as firm and dense as any other part of the bone. It was very painful. After the application of many 116 THERAPEUTIC APPLICATION OF CONTINUOUS CURRENT remedies and the application of iodine by phoresis the pain and irritability were much relieved, while the size and den- sity of the tumor remained the same. At the end of four years after a success- ful treatment of a gangrenous abscess in- volving the middle lobe of the right lung with the hydrogen dioxide it occurred to the writer to try the same agent by cataphoresis upon the exostosis of the tibia of four years standing. After contriving a cup electrode of a cambric needle, some sealing wax and a piece of glass tubing he filled the cup with hy- drogen dioxide and placed it upon the tumor in such a way that the point of the needle came in contact with the skin. Connecting this electrode with the nega- tive pole of the battery and applying to the opposite side of the limb a large electrode made of a piece of wire gauze with a binding-post soldered to its cen- ter covered with moist absorbent cotton, to which he attached the positive pole of the battery. A continuous current of IO milliamperes from a Macintosh bat- tery of I2 cells was slowly turned on. At once a mass of white matter began to pile up about the point of the needle after the current ran for I 5 minutes, when the mass was as large as a large pea. days the growth disappeared entirely, leaving the bone in a normal condition. Much of the pain and suffering and especially a very large share of the pro- tracted nervous conditions that prostrate the patient and wear upon the attendant are either directly or indirectly the re- sult of stenosis. This may be avoided or remedied, if one relies upon electri- city for clearing the channels, whether large or so small as not to be discovered until the organs that depend upon a clear and free right of way through them to be healthy become congested, infiltrated and engorged by effete and useless mat- ter. In the treatment by phoresis an inti- mate knowledge of anatomy and physi- After I 2 treatments on alternate sented to the treatment. ology is most essential—having not only a knowledge of the various organs involved, but being also a percipient of the pathological conditions that appear. Case I. —Was called to see Miss I. B., aged 19, on the first of August, 1891. I found her in bed, where she had been for seven months as helpless as a new-born infant. She was ex- tremely emaciated and anaemic—weigh- ing 75 pounds, pulse I 20, temperature varying from 99 to IO2. She had not sufficient strength to raise her head from the pillow. When placed in an upright position in a chair her head would fall whichever way it was moved one inch from the center of gravity. There were four adenoid growths on one side of the neck and five on the other, varying in size from that of a hazlenut to an English walnut. Her bowels were very irregular—moving once in two to six days. On one occasion her mother told me there were thirteen days between stools. For weeks she had had convul- sions after every stool. After making a careful physical examination I pro- nounced the case one of hysterical neu- rasthenia, resulting from obstinate con- stipation and intestinal engorgement. I proposed treatment by saline phoresis. Her friends said that the case had been diagnosed as one of organic brain and cord lesion — a case in which it would be very dangerous to use electricity. But upon my assurance that there was no evidence of organic disease they con- I began treat- ment by intestinal saline phoresis. Plac- ing a large positive electrode covered with moistened absorbent cotton upon the abdomen I carefully introduced a perforated rubber tube containing a spiral metallic electrode into the colon. To the tube was attached an ordinary fountain syringe containing a normal sa- line solution. The valve was opened and a current of five or ten milliamperes was turned on and allowed to remain 20 minutes, or until two quarts of the TRUMAN ABEL PEASE I 17 solution had slowly percolated into the bowel. When the current was slowly turned off a secondary faradic current was applied for a few minutes. After 20 minutes there was a small evacuation of hardened feces covered with bloody mucus. The stool was followed by the usual convulsion, which lasted 20 min- utes. I continued the treatment on al- ternate days for one week. After the third treatment there were no more con- vulsions. The treatment was continued twice a week for the following two weeks, after which I gave her only one treatment per week for five months. She was then discharged entirely cured and weighing 140 pounds, her neck as smooth as at any time in her life. She has remained in perfect health since. Case II. — One of neuritis, involving the median, ulnar, and musculo-spiral nerves of the right shoulder and arm, resulting from cervical stenosis — cured by saline and mercuric phoresis. Mrs. F. B., aged 42 years, came to my office the 6th day of May, 1902, suf- fering intensely from a severe attack of neuritis that involved all the nerves of the right side of the neck, right arm, fore-arm and hand. The nerves and adjacent tissue were swollen, hyper- amic and hyperesthetic, so painful that they could be handled only with the greatest care. When they were touched she would cry out like a child when in the severest pain. The hand and arm were carefully held in a horizontal posi- tion, the fingers being flexed at right an- gles. Some of the muscles of the hand, especially the adductors of the thumb, were atrophied. The case had been under treatment for six weeks without any permanent relief when I began treat- ment with static electricity, using sparks, breezes with wave and high frequency currents. There was marked relief from pain and nervous suffering that was only temporary, the pain and insomnia returning on the second day after the treatment. On examination Oſle. of the cervix uteri I found that a very Small sound could not be passed. After the application of a solution of cocaine and adrenaline by cataphoresis I suc- ceeded in passing a small copper elec- trode, turned on the current, using 5 to IO milliamperes for five minutes. My patient then exclaimed, “Why, Doctor, my arm aches much worse !” I replied, “That confirms my diagnosis.” Ten minutes after the positive current had been turned on to the electrode in the cervix she exclaimed, “There is no pain at all in either shoulder or arm l’’ I re- plied, “That confirms my treatment.” At the end of five weeks she returned home and was able to use the arm and to sleep well every night. She has re- mained in perfect health, with no return of the neuritis. . Case III. — Mr. H. B. H., a granger, aged—mark the age — 83 years. He suffered intensely from prostatitis and stricture of the urethra at two points where I found ulceration. The urethra was so sensitive and sore as to make the evacuation of the bladder with a small catheter that he used himself so painful and difficult that, to use his own language, he had given up the case as a hopeless He came that I “might care for him to the end, which could not be more than two or three weeks at the most.” After the cataphoric application of a solution of adrenaline and cocaine upon a small cotton-covered sound I used a number 9 catheter with so little diffi- culty and pain that he said, “I would not have believed it possible had I not personally experienced it.” Upon my assurance that he would be able to re- turn to his home a well man in three or four weeks he replied, “You cannot do that, Doctor, in spite of your confidence in your new methods.” I began treat- ment of this case on the 30th day of June, 1902, using a normal saline solution at first by phoresis, after which I used a solution of resorcin, followed by a solu- tion of protargal applied to the bladder 118 THERAPEUTIC APPLICATION OF CONTINUOUS CURRENT and urethra by phoresis, always using a rheostat and milliampere meter in the circuit and never allowing the meter to show more than 10 milliamperes. He returned home on the 29th day of July, I902, in excellent health. He is well and at the present time he is able to at- tend to all the duties devolving upon one in his walk of life. Case IV. — Mrs. C., aged 29 years. Mother of two children. Came to me from a sanitarium, where she had been under preparatory treatment for three weeks for the removal of a tumor and where she had a severe hemorrhage of the bowels, lasting 36 hours, which com- pletely prostrated her. Upon examina- tion, I found the uterus, both the ovaries and the rectum in a mass of plastic tissue, so irritable and sore as to make a thor- ough examination very difficult. The use of a small flexible sound in either passage was followed by free hemor- rhage, which was controlled by the cata- phoric action of adrenalin. I then be- gan treatment by saline phoresis, fol- lowed by mercuric cataphoresis, never using more than IO milliamperes. After four treatments, in which I applied co- caine, adrenalin, and saline phoresis there was no further trouble on account of hemorrhage. The mass began to disintegrate and the pelvic organs were restored to their normal condition and proportions. The patient has so far re- covered as to return to her household duties. She is still my patient. Case V. — Mrs. E. W., aged 36. Mother of two children. I found her in bed with symptoms characteristic of enteric fever. Pulse I Io, temperature IO4° F. The abdomen, tense and sore and very sensitive to the slightest pres- sure. She had irregular paroxysms of pain, and there had been extreme tender- ness in the left iliac fossa. On making a vaginal examination I found all the pelvic organs prolapsed and adherent to the pelvic walls, forming a large mass having a doughy feeling. The uterus was retroflexed and immovable. There was a constant discharge of dark, bloody matter and a very offensive odor. A straight sound would not pass into the body of the uterus, but upon bending it at a right angle the point passed very easily in a posterior direction about three inches and a half, showing that portion of the tumor to be made up of the enlarged body of the uterus, while the opposite half of the tumor seemed to contain the left ovary and tube, being so firmly fixed to the walls of the pelvis as to make the whole mass immovable and to prevent the use of the speculum. The os was so low down as to be seen without the use of any instrument. After reducing the fever and rendering the local condition as nearly aseptic as possible, I began the cataphoric use of iodine, thapsia and aconite. After four treatments, which were given on alter- nate days, the fever and hemorrhage were entirely controlled. Then I be- gan treatment by mercuric phoresis, which restored the uterus and append- ages to their normal condition. She was under treatment at her home for one month, when I was able to place all the organs in a nearly normal position, supported by tampons saturated with itcholden, when she was able to resume her household duties and come to the office for treatment two or three times a week for three months. What can be more satisfactory to the earnest physician than the gratitude of the patient whom he has healed by a method which patients appreciate — a method painless, and free from the hor- ror of the knife and the mutilation? A CASE OF HYPERIDROSIs AXILLAE TREATED BY X-RAYS* BY G. H. STOVER, M.D., OF DENVER, COLORADO HE anatomical changes found in hyperidrosis are not strik- ing; often . no structural change at all can be found in the skin, showing that in many of these cases it is purely a functional disease. In Schmidt's report of a case of der- matitis atrophicans, due to prolonged exposure to the X-ray, the statement is made that the sweat glands were not affected; Pusey says that histological ex- amination shows atrophy of the Sweat glands as a result of X-ray exposure. The patient, No. 108, of whom I speak, a young married woman, is one of the most extraordinary examples of axillary hyperidrosis on record, I think. A dermatologist in New York who saw her some years ago stated that an Eng- lish patient whose disease was no worse than hers, had discharged two quarts of axillary perspiration per day, by meas- urement. I can well believe this, for in the dry atmosphere of Colorado my pa- tient required many changes of clothing every day; all the layers of clothing be- neath her arms clear to the waist and for a space of six to eight inches wide would be dripping and the sleeves from shoulder to elbow saturated in a short time after dressing; even while sitting quietly in the evening at the theatre or elsewhere this was the case. This had gone on for years in spite of many forms of treatment, including in- * Read at the Fourteenth Annual Meeting of the American Electro-Therapeutic Asso- ciation at St. Louis, Mo., September 13-16, I904, and published in this journal by special permission of the author and the Executive Council of the Association. - ternal medication, external applications, and even a large number of painful drug- injections into the skin of the axillae. Her life was rendered miserable by the affliction and she was becoming neuras- thenic in her despair following years of fruitless experiment. She was very willing to give the X- ray a trial; though I stated to her that I knew of no similar cases having been treated by this agent and could promise her nothing, yet I believed there was good reason for making the attempt. I used a Rhumkorff coil giving a six- inch spark, operated by an accumulator of ten volts, core drawing five amperes, hammer interrupter, a low tube at a dis- tance of four inches from the skin, ex- posing each axilla on alternate days for a period of ten minutes; I always wiped the axilla dry before beginning the ex- posure. After the tenth exposure the skin began to show some pigmentation; after the twenty-fourth exposure there was a slight erythema which never amounted to more than a mere blush; at the thirty-first exposure my notes state that the perspiration is distinctly less; at the thirty-eighth exposure the im- provement was very great; at the forty- fifth exposure, the hair, which had come out somewhat already, was falling rap- idly; at no time during the treatment did the hair become gray or white as has been mentioned by some; after the forty- eighth exposure she went to Cuba on a pleasure trip; at that time she was per- spiring very little indeed. While in Cuba, she, in company with others of the party, danced the two-step at the request of the orchestra leader, who had never seen it; this was fol- (119) I2O EDITORIAL lowed by other dances; the temperature of the ball-room was 94 degrees F., yet she perspired almost none. Four months after this she consulted me, as I had told her that further ex- posures would undoubtedly be needed; the axillary hair had returned and she was perspiring but little more, if any, than the average woman. I made twelve exposures on succeed- ing days, the first two being of fifteen minutes duration, the technique in the others being as in the former series of treatments; after the eighth exposure the pigmentation appeared and the hair fell again; there was some erythema at the end of the series, and perspiration had stopped entirely. - EDITORIAL RADIUM IN THERAPEUTICS HE discovery of this wonder- ful element has had such a profound influence upon physical thought that, for a time, it threatened to wreck the whole structure of physi- cal law which it had required years of labor to erect. The story of its discov- ery has oft been related, but constitutes such a triumph for analytical scientific methods that we turn to it with vivid in- terest every time it is presented. The mention of radium at once brings to mind the name of Madam Curie, whose brilliant, monumental investiga- tions resulted in placing the substance at the command of physicists. The fact that Becquerel's work led to her concep- tion of the fact that such a body might exist and started her upon the quest for it, does not detract in the least from the credit due her, and as long as physical laws are taught the name of this able woman will be honored as that of one whose work was epoch-making; marking and creating a point whereat was inau- gurated the destruction of time-worn fal- lacies and a further dissemination of the light of scientific truth. She had long been impressed by the fact that pitch-blende, composed mainly of thorium and uranium, gave off rays similar to those described by Becquerel, and after having separated the uranium from the mass she found that the re- mainder was very much more radio-ac- tive than the uranium which she had sepa- rated therefrom. Her husband, Pro- fessor Curie, became interested about this time, and together they analysed this remaining mass by tedious methods, each time selecting that portion which was more radio-active than the preced- ing, until finally they obtained an in- tensely radio-active body, in the form of a chloride, to which they gave the name Radium. The pure element has not yet been isolated, but the atomic mass was deter- mined by Madam Curie as 225, showing it to be one of the heaviest elements known, and locating it in the group with calcium, thorium, and barium in compli- ance with the periodic law. About one-tenth of a grain of radium is obtained from about two tons of pitch- blende after much repeated precipitation, filtering, and crystallization, making the cost of even a very small quantity almost EDITORIAL I2 I prohibitive. The radium of commerce, at present, is in the form of a bromide and occurs in small white crystals, very soluble in water, resembling the barium salts very closely in its chemical proper- ties, giving a characteristic spectrum, and imparting a crimson color to the Bunsen flame. It gives off heat continu- ously, fifteen grains being capable of raising the temperature of the air in its immediate neighborhood about three degrees centigrade. Radium gives off three kinds of rays called the alpha, beta, and gamma rays. The “a” rays are very fine particles of matter, travel at about one-third the ve- locity of light, carry positive charges of electricity, exhibit very little penetrative power, and are deflected toward the negative pole of the magnet. The “A” rays are the true “corpus- cles,” invariably carry a negative charge, are repelled by the negative pole of the magnet and attracted by the positive. They travel with varying speeds prob- ably somewhat less than the velocity of light, will penetrate human tissue to a depth of about one-half inch, and are considered by many to be similar to the cathode rays. They give rise to X-rays when arrested or deflected by a solid body. These are the valuable rays thera- peutically, and it is by reason of their action that destruction of tissue takes place. - The “y” rays are not particles of matter at all, but electro-magnetic pulses in the surrounding medium (ether). They resemble the rays from a hard Crooke's tube and are very penetrating, being capable of passing through about two inches of iron. Bone offers practi. cally no resistance to these rays, they do \ not discharge an electroscope, are not deflected by magnetic lines of force, and are of value therapeutically for their stimulating effect upon the cells of the human body. - It is worthy of note that physicians were about the first patrons of the Curies, paying the price demanded without de- mur, in the hope that the active element would be found useful in the treatment of disease. The early records of observers were so optimistic that the profession, with its proverbial conservatism, was rather in- clined to doubt their reliability, and as more operators came into the field, the reports became even more conflicting, until determining what to believe and what not to believe became a most diffi- cult problem. Analysis shows that the cause of many of these discrepancies was to be found in the fact that the first radium was purchased by X-ray operat- ors, who had had several years experi- ence with radio-therapy, and had gained Some knowledge of the appropriate methods of handling the particular class of cases in which radium would be likely to prove useful; these men had also learned the necessity of judiciously se- lecting cases that promised amenability to radio-therapeutic procedures. They were followed later by men who de- pended solely upon literature for their technic, who, not having the requisite knowledge or facilities for testing their radium were obliged to depend upon the honesty of the salesmen, and were some- times victimized by having had sulphide of calcium palmed off upon them as radium; it is not strange, therefore, that bad or indifferent results followed their efforts. I22 EDITORIAL Some good results have been secured, and it seems to be the unanimous opinion of X-ray workers who have used radium that its effects are identical with those of the X-ray, only incommensurably weak- er, but that this may be compensated for in some degree by the possibility of plac- ing radium in close contact with the dis- ease. Considerable advantages exhibited by radium are, that it can be conveni- ently used in the body cavities, that the rays can be made to travel in any desired direction, and that the radiance is uni- form in strength. It would seem that it might be useful when applied in com- bination with other radio-therapeutic Iſle a SUITCS. - • As to the physiological action of the radiance from radium, it is known that it exercises a pronounced inhibitive ac- tion upon pathogenic bacteria, that it will inhibit or destroy the germinating power of seeds, and that it exhibits a destructive action upon the nerve cells of the small mammalia, which a suffi- ciently long exposure will carry to the point of necrosis and death. Radium has been used extensively in lupus, keloid, epithelioma, carcinomata, sarcoma, chancroid, laryngeal tubercu- losis, and cyclitis, and somewhat in acne, eczema, psoriasis, and pulmonary tu- berculosis by causing the patient to in- hale the gases from aqueous solutions of radium or thorium emanations. It is unfortunate that radium can be obtained only in such small quantities, and reports of results must, necessarily, be incomplete until larger quantities are available. Until its idiosyncrasies are known and tabulated and a method of technic de- veloped its use should be restricted to those who have sufficient material, proper special facilities for its applica- tion, and requisite experience in radio- therapeutic work to endow them with good judgment in selecting their cases. Our present knowledge of it may be summed up in the statement that it is a valuable scientific toy, having feeble but pronounced therapeutic value, which has, up to now, done practically nothing that could not have been better done by the X-ray. The next (May) issue of THE ARCHIVES OF PHYSIOLOGICAL THERAPY will be a SPECIAL ROENTGEN NUMBER, in honor of the discoverer of the X-ray and the Congress, called by his name, which will be held in Berlin, Germany, from April 30 to May 3, 1905. CURRENT PHYSIOLOGICAL THERAPY JOURNAL OF ADVANCED THERA- PEUTICS New York, N. Y., March, 1905. I. Diabetes Mellitus — Francis B. Bishop. Y-Ray Diagnosis of Calculi — Russell H. Boggs. 3. Report of the Committee on Current Classification and Nomenclature of the American Electro-Therapeutic Asso- ciation. Further Experiments with Electrostatic Machines—Samuel Shel- don. (To be continued.) 4. Thoughts on the Subject of Appendicitis — E. Kirkpatrick. 5. Address Given at the Opening of the American Oncologic Hospital — G. Betton Massey. - I. Bishop does not believe that any remedial measure now at our command will cure those cases of diabetes which are dependent upon organic lesions in or near the medulla, lesions of the spinal cord, or structural lesions of the liver and pancreas. He considers, however, that a good many cases are due to a dis- turbance of metabolism from physical or mental shock, long continued mental de- pression and worry, etc., and that in these cases the continuous and magnetic- induced electrical currents constitute very efficient methods of management. Dietary regulation should accompany the electricity. His method of application is as fol- lows: A large surface electrode, 7 by 9 inches, is placed at the back of the head and neck; the patient reclining upon his back, with a pillow under the back of his neck; another electrode equally as large is placed over the liver and stom- ach, so that the upper portion of the spinal cord, the liver, pancreas, and solar plexus will be included within the field of electrical influence. The electrode at the back of the neck is made positive, that over the liver and stomach nega- tive, and a current of 20 ma. is passed for Io minutes. The current is then in- terrupted at the rate of 200 times per minute and passed for 5 minutes more. The patient is then turned upon his face and lies upon a large surface elec- trode (7 by 9 in.) which is so located as to cover the region of the liver, pan- creas, and solar plexus, and this elec- trode is connected with the positive pole of an induction coil. The negative pole is connected with an interrupting handle electrode with a surface about the size of a silver dime; the current is turned on in sufficient strength to produce good contractions, and this small negative electrode pressed down between the ver- tebral spines from the occiput to the last lumbar vertebra, the current being interrupted three of four times in each position. - - These applications are made about three times a week. º The case of a man 60 years of age, who had been under treatment by ordi- nary methods for five months without much improvement, is reported. When he came under Dr. Bishop's care he was passing 1,800 c.c. of urine which con- tained one per cent. of sugar and a trace of albumen. The above-outlined treat- ment was carried out and after five seances urinalysis showed 1,600 c.c., 78 per cent. of sugar, and a trace of albu- men. After one month's treatment urin- alysis showed 1,600 c.c., no sugar and no albumen. Two weeks later the pa- tient discontinued diabetic diet and grad- ually returned to starchy food. Since then he has, by his own desire, been treated twice a week, but no signs of sugar or albumen have been detected. Two other cases are mentioned which are doing well, but which have been under treatment for too short a time to render reports valuable at present. Bishop has not seen any very decided (I23) I 24 CURRENT PHYSIOLOGICAL THERAPY f; benefit in diabetes from the use of the high-frequency currents. The sugar will sometimes diminish under their applica- tion and the patient improve generally, but he has never seen a single case cured by them. 2. See THE ARCHIVES for March, I9 O5. 4. Kirkpatrick recommends treat- ing appendicitis by keeping the patient quiet in the recumbent position and re- fraining from the administration of mor- phine, cathartics, or foods of any kind; he washes out both the colon and the stomach, relieves pain by the use of heat, hops, and turpentine externally, and de- pends upon four ounces of normal salt solution per rectum every four hours for nourishment. For the prevention of suppuration he saturates a piece of blot- ting paper four inches square (with water P) and places it on the abdomen over the seat of the pain or over the ap- pendix. Over this is placed a copper plate of the same size, which is connected with the positive pole of a galvanic bat- tery. A sponge covered electrode is con- nected with the negative pole, located upon the back opposite the positive pole, and five ma. of current passed for fif- teen minutes. This is repeated twice a day, using the hamatocrit for six hours to keep track of the proportion of red and white blood cells. Operation is rec- ommended if suppuration supervenes. He appears to believe that the action of the current carries the oxychloride of copper into the seat of the inflammation and destroys the pathogenic germs, and suggests that this method might be a good management for all diseases where there is formation of pus, as otitis, ab- scess of the lungs and liver, hip joint dis- ease, carbuncles, boils, felons, etc. 5. Massey calls attention to the fact that the American Oncologic Hospital is the first institution in America to be devoted exclusively to the study and treatment of cancer and other tumors. The institution is to be devoted to spreading a knowledge of cancer among the people whereby proper treatment will be earlier sought, to investigation of the causes of cancerous degeneration, and to investigation and development of the best means for managing cancer which is already established. ARCHIVES OF THE ROENTGEN RAY London, England, March, 1905. I. Roentgen Rays and Sterility — F. Tilden Brown and Alfred T. Osgood. 2. Exophthalmic Goitre Reduced by Radium — Robert Abbe. 3. Notes of a Case of Peripheral Neuritis treated by High-frequency Currents— W. F. Somerville. 4. The Importance of Development of the Chest in the Young — E. M. Corner. 5. The Alcohol Question — Thos. Dutton. I. Brown and Osgood call attention to the condition of azoospermia which they have found by examination to be an almost constant condition among pro- fessional X-ray workers. They have not gathered sufficient data to be able to state how much exposure or how long a time is necessary to produce this result, nor whether the result is of sudden on- set or a gradual decline of testicular ac- tivity. The question of prognosis is un- answered. One case persisted for two years after patient had discontinued X-ray work. They presume that those men who have worked behind lead screens or have em- ployed the various tube shields will have escaped this condition. Other cases show that all those examined, whether medical men or manufacturers, demon- strators of apparatus, etc., who have been constantly in the X-ray field for the past two years are the subjects of to- tal azoospermia. In 40 per cent. of the total cases, the interesting fact was de- veloped that no children had been born to the wives of these men since they had taken up X-ray work. The number of CURRENT PHYSIOLOGICAL THERAPY I 25 men examined so far is 16, while reports substantiating the facts have been re- ceived from others. None of the cases have been conscious of any tendency toward impotence. 2. Abbe considers the surgical treat- ment of goitre so dangerous from the thyroidism following the most carefully conducted removal that he hesitates to urge it upon patients. This thyroid poi- soning is sudden and often fatal. Medi- cine affords no remedy, but he presents a case to which radium has been applied. The X-ray has been used in some cases, but with little effect. In July, I 904, the patient, a girl of 2 I, who had enjoyed excellent health un- til the present trouble, consulted him re- garding operation. Her throat was swollen in the center and on both sides, and palpitation, extreme nervousness, se- vere headaches, a sense of suffocation, protrusion of the eye-balls, and a pulse of I40, were present. The patient was able to walk but slowly; the circumfer- ence of the neck was 16% inches. Under cocaine anaesthesia, a small in- cision was made in the neck and the dis- section was followed to the isthmus of the thyroid. The middle lobe was 1% inches thick. A small incision was made in this lobe and a sterilized glass tube V6 inch in diameter containing IO centi- grams of Curie radium (three hundred thousand radioactivity) was buried at right angles to the skin, one inch deep, and left for 24 hours. It was then re- moved and the wound closed with strap- ping. The patient returned home. There was very little change for a month, the glands seeming more swollen. This was followed by a rapid diminution and all unpleasant symptoms disap- peared except huskiness of the voice. Four months later the pulse was IO 5. Patient looking well, able to run up stairs, play tennis, and walk. No head- ache, no exophthalmos, no smothered feeling on reclining. Neck measures I 5 inches, thyroid reduced to 1/6 of its for- mer bulk. No other treatment, except a small quantity of Carlsbad salts in the morning. - He explains the favorable action of the radium as due either to a retrograde change effected in all tissues of the gland or by irradiation of the sympathetic gan- glia. He theorizes that the Beta rays of radium may not be harmful to living tis- sue and may apply to the nervous system that which is lacking, or to the cells of hyperplastic tissue, the inhibitory power to control over-growth. - 3. Somerville reports a case of ataxia, muscular weakness, and anaes- thesia treated by means of the high-fre- quency current. Patient a male, aged 21. Suffered from peripheral neuritis. Began first as numbness and weakness of the right leg which caused him to resign his employment as a postman. Having obtained inside employment, he im- proved during the summer, but in June, 1904, after a severe drenching, his left leg became affected and the disease shortly attacked the right. He was soon confined to bed and suffered loss of power and sensation in the upper ex- tremities. He had no headache, girdle pains, or anaesthesia of the soles of the feet, nor could a specific history be ob- tained. The patient did not use alco- hol. His gait was staggery, able to ascend and descend the stairs only with difficulty. He was scarcely able to stand with eyes shut and feet together. The reflexes were satisfactory. Sensation in the hands was impaired and his writing ataxic. * - He received 48 applications of high- frequency currents. Auto-condensation was employed and the limbs electrically massaged. The ataxia had improved. He was able to ascend and descend the stairs without trouble and suffered but little fatigue. Sensation in the hands be- came practically normal. The hand- writing improved markedly following treatment. He was able to stand per- fectly straight with feet together and I 26 CURRENT PHYSIOLOGICAL THERAPY eyes shut. The knee reflexes were nor- mal. 4. Corner considers the chest to be the most important structure in the phys- ical development of an individual. He believes too little attention is paid to the development of our bodies and that from birth care should be taken in order to enable us to preserve a healthy body. When a person who is out of condition takes exercise the heart beats rapidly. As the heart is adapted for work during rest or quiet, it must be aided during muscular exertion. This is effected by the movements of the chest. The ex- pansion of the chest in inspiration is deeper during exercise. Not only is air inspired into the lungs, but the blood is thus aspirated from the great veins of the neck, arms, and abdomen, into the right side of the heart. The inspiration dilates the capillaries of the lungs and allows the right ventricle to relieve itself into them, and the respirations are also quickened, hence the blood loaded with the products of muscular work becomes aerated and purified when the respira- tion during exercise is adequate. The best index of a man's capacity for mus- cular work is the measurement of inspir- ation; it is not the external measurement of the chest, but the capability of that chest to expand and contract that is im- portant. Thus a slight girl may be more capable of a half-mile run than a profes- sional strong man, whose inspiration is out of proportion to his muscular devel- opment. He calls attention to the chest, chiefly in the young and feeble, which is nor- mally fixed in the position of expiration with the dorsal spine flexed, sternum vertical, ribs depressed, shoulders round, and hollow about the clavicles, scapula: prominent and abdomen often project- ing. Such a case suffers distress during muscular exercise. Much can be done for such a condition during the period of growth. Respiratory exercises are the remedy. Not a large chest, but a mobile chest, is to be attained. Good chest action should be cultivated. No. one portion of the body should be devel- oped in excess of or at the expense of others. The slouchy attitude with spine: flexed, head forward, and shoulders. stooping must be corrected. The main- tenance of a good position is an exercise in itself. * A good exercise is to stand erect with. hands on hips, inspire and expire slowly, bend the body back during inspiration, and forward during expiration, allow- ing a pause of IO seconds between these acts. Second, stand erect, slowly raise extended arms from the sides in a lateral direction, inspire during this, pause IO: seconds, then expire, and lower the arms. slowly. & • Children should be taught nasal res-- piration. A very large number of ade- noid cases can be completely cured by these means without an operation. If the tonsils be large it is wise not to defer operation. Adenoids are frequently as- sociated with the flat type of chest de- scribed. Respiratory exercise should form a basis of all physical culture, particularly so in children. They are especially use- ful in some cases of curvature of the spine. The effect of respiratory exer- cise on the abdominal muscles is marked. It strengthens these muscles, keeps them. healthy, and tends to minimize the risk of hernia. - - 5. Dutton deplores intemperate, ex- travagant statements indulged in by writers upon this topic and declares the matter must be investigated by medical men who can discuss the question with- out professional prejudice, or faddish preconception. The statement of lay writers that alcohol produces a decline in the economic value of the organism by actual change in cell-constitution is quite untrue, if the alcohol is pure and consumed in moderate quantities. He asserts that fully 80 per cent. of the pro- fession at large partake of alcohol and CURRENT PHYSIOLOGICAL THERAPY 127 If alcohol in small quantities produces the effect de- order it for their patients. scribed the profession who are certainly not ignorant of its effects would not pre- scribe it. In contradiction of this he quotes the opinion of the American com- mission that alcohol taken in moderate quantities is purely food, while an ex- cess of alcohol acts as does an excess of anything else. The danger lies not in the use, but the abuse of the article. It is irrational to claim that because it is abused it must be abandoned. The appeal of the temperance plat- form to the chemical laboratory for ar- gument to uphold their contention is fallacious and untrue. Bio-chemistry is very different from laboratory chemis- try, and it is foolish to attempt to solve the intricate problems of bio-physiologi- cal actions by laboratory experiment. Clinical results are a much surer guide. He advises medical men to test the value of alcohol by personal experimen- tation on themselves. He once for three months drank daily a regular amount of wine and spirits. This was followed in two months by gouty pains, loss of ap- petite, and disinclination for work. He then omitted alcohol for three months, became depressed, appetite and sleep failed; he was less inclined for work. The next three months he drank wine, beer, and spirits whenever so inclined. His appetite improved, he slept better, was ready for work, and the bowels acted regularly. He has since followed this plan, which he believes the best. Experience has taught him that beer is the best drink for those under 40 years of age, wine after 40, and spirits should only be taken when required or ordered. He has great faith in pure beer as the beverage for growing girls and boys. He has not found that chil- dren who are allowed beer take it to ex- cess when they attain adult life. On the contrary most drunkards in his expe- rience have been brought up on total abstinence. He ridicules the idea that submitted to that action. crime is produced through alcohol. He believes that crime follows the ingestion of those drinks doctored with silent spirits, which are sold instead of the genuine article. Excess of pure drink does not cause vicious or quarrelsome ac- tions. The spirits from potatoes, maize, etc., are responsible for the frenzy fol- lowing indulgence in alcohol. He be-, lieves that wine, more especially red wine, has a germicidal action upon pa- thogenic micro-organisms. He would like to see a pure drink bill passed, for he believes that the physical degener- acy following alcohol is due to the adul- terants used and not to pure beer, wines, and liquors. - BULLETIN OFFICIEL, DE LA SOCI- ETE FRANCAISE D’ ELECTRO- THERAPIE ET DE RADIOLOGIE Paris, France, January, 1905. I. The Action of the Galvanic Current upon Microbes, with Special Reference to the Nature of the Electrodes Em- ployed — Drs. Laquerriere and Apos- toli. 2. Chronic Constipation cured by Galvano- Faradization — Dr. Paul-Ch. Petit. I. This is the record of a series of experiments made by Apostoli and La- querriere in 1892 and 1893. They lead to the conclusion that the action of the galvanic current upon cultures of mi- crobes is in direct proportion to the in- tensity of the current (in milliamperes) and in inverse ratio to the mass of liquid A current of sufficient intensity kills the microbes. A current of feeble intensity, in proportion to the mass of liquid, attenuates the cul- ture, and sometimes a weak current may exercise a reviving action upon the mi- crobes. The microbicide effect in tubes separated by an inter-polar circuit, is exercised at the positive pole, and this action is in consequence of electrolysis which takes place there. There is no I 28 CURRENT PHYSIOLOGICAL THERAPY action upon the microbes at the negative pole and in the inter-polar circuit. As an instance may be detailed the technique of their first series of experi- ments. Three test tubes of equal di- mensions are connected by an absorbent strand of cotton. One cubic centimeter of a culture of anthrax is placed in each test tube. Two platinum electrodes with their extremities twisted into a spiral, were dipped into the middle of each of the test-tubes at the extremity of the circuit. Ten milliamperes were al- lowed to pass for ten minutes. Inocula- tions were made from the middle of the liquid at the positive pole, and no harm- ful action resulted, the guinea-pigs con- tinuing well. Similar inoculations from the center of the negative pole were made in two guinea-pigs, both of them dying in 48 hours with symptoms and lesions of anthrax. - Experiments were made with the ba- cillus of blue pus and comparative ex- periments in which the electrodes were platinum, copper, brass, silver, iron, aluminum, and carbon. The microbi- cide action of electrodes of platinum, copper, brass, and silver is about the same, while that of iron, zinc, and aluminum is very much less. Carbon has scarcely any. In the discussion, Oudin says that the conception of polar and inter-polar actions is entirely false. The ions are distributed in the whole circuit, and the chemical and bactericide effect take place at all points. Laquer- riere responds that the discoloration of a solution of iodide of potash in the neigh- borhood of one pole is visible proof of a difference in the chemical property of the liquid at that point. 2. The case of chronic constipation treated by galvano-faradization, was that of a man 33 years old, who had been treated since 1892 for dyspepsia and gastritis. The moment he sat down at the table the blood mounted to his head while his feet became like ice. He had colic which continued until after an abundant evacuation. He was not able to eat with a good appetite. As to the movements of the bowels, they did not occur except after glycerine injections. The stools were hard and formed of a conglomeration of very dark balls. He had been treated in 1904 by fifteen ap- plications of static sparks in the region of the colon without any appreciable re- sults. The abdomen was soft although somewhat thin, and no hardened matter could be felt in the intestine by palpa- tion. A large electrode was applied over the region of the loins, another of the same dimension over the abdomen. A galvanic current of 60 milliamperes was combined with a feeble faradic cur- rent which the patient perceived as mus- cular vibration of the abdominal wall. The following day there were two nat- ural somewhat soft movements. Appli- cations were made every two or three days from the 8th of October to the 26th of November, and these twenty seances sufficed to cure a constipation of several years standing. The patients never feel any colic dur- ing the seance, there are no evacuations for a good many hours afterward, usually not until the next day and some- times not until the second day. It seems as if the first result has been to lead to movements, and that the second part of the treatment has been to regulate them so that there has been one every day. The Faradic coil used was one with coarse wire. In discussing the paper, Laquerriere called attention to the fact that most cases of constipation are spasmodic and the value of galvano-faradization was very great. - BULLETIN OFFICIEL, DE LA SOCI- ETE FRANCAISE D’ ELECTRO- THERAPIE ET DE RADIOLOGIE Paris, France, February, Igos. I. Recurrent Epithelioma of the Lower Lip treated by the X-ray — Dr. Vidon. CURRENT PHYSIOLOGICAL THERAPY 129 2. Obstinate Cough relieved in Consequence of Applications of the X-ray — Drs. Dubois, Chavry, and Kocher. 3. Three Cases of Metrorrhagia, treated by High-Frequency Currents — Dr. Fauchon. - I. Man of 62 years of age who had been cured of an epithelioma of the lip in 1902 by the application of caustics. The original cause had been a very painful burn from a cigar. At present the cicatrix of the original trouble is at a little distance from the right labial commissure. There were little nodules which seemed like epithelial pearls, but which had not shown any increase since May, 1903. The recurrence dates from the middle of July, 1904. It appeared at the middle of the lower lip, entirely outside of the cicatrix of the former trouble. Treatment was begun in October, at which time the lesion was about I I mil- limeters in diameter, and was covered with a brown crust. There were no en- larged glands. From the 14th of Oc- tober to the 14th of January thirteen ap- plications of the X-ray were made at intervals of about a week. Treatment was with a small osmo-regulator tube, the anti-cathode being red hot most of the time. The patient's lip was at a dis- tance of 5 centimeters from the wall of the tube, a sheet of lead being used to protect the parts that were not being treated. The irradiation was at the rate of 9%. Holzknecht a minute, and the quality of the ray was No. 6 Benoist. At the first six seances three Holzknecht units were applied each time. The re- sult was an increase in the flexibility of the lip and also in the amount of secre- tion which became more fluid. At each of the following six seances 4 Holz- knecht units were applied. The secre- tion then became less, the crust took on a horny aspect, the patient cutting it off several times with the scissors. This crust fell off entirely after the twelfth seance, and was replaced by a gray 9 parchment-like membrane much larger than the original epithelioma. On re- moving this the lip was found entirely cicatrized except a point about as large as the head of a pin. On the 14th of February, 1905, there remains in the place occupied by the epithelioma no trace of any lesion whatever. The total time of exposure amounted to 46 Holz- knecht units. The only sign of reac- tion observed was a slight oedema of the lower lip, which appeared two or three times following the stronger appli- cations. * 2. One of the cases in which an ob- stinate cough was relieved by X-ray ap- plications was that of a patient with a primary inoperable cancer of the larynx; another, being a patient with sub-clavic- ular bilateral metastases following an operation for cancer of the breast. Both patients had been treated with heavy doses of the X-ray of 4 Holz- knecht units. The cough diminished in a very remarkable way after each seance. He thinks that the benefit was partly due to the direct action of the X- ray on the pneumogastric nerves, and partly following the progressive benefit upon the neoplasms. In one of these cases a fluoroscopic examination showed unequivocal signs of a peri-bronchial glandular involvement, which was im- portant because of a tendency to attrib- ute such involvement to the X-ray. It was present in this case before the X- ray was used. 3. Fauchon says that high-frequency currents act in cases of metrorrhagia with as great if not greater rapidity than the galvanic current. They have the advan- tage of requiring only fifteen-minute seances, while 25 to 40 minutes are re- quired for the galvanic. Furthermore, no large abdominal electrode is neces- sary. An ordinary intra-uterine copper electrode was used, the vaginal portion being covered with a rubber tube. One case was that of a lady aged 20 years, with a small fibroma in the ante- I3O CURRENT PHYSIOLOGICAL THERAPY rior wall of the uterus. A d’Arsonval apparatus was used in connection with a six-plate Gaiffe's static machine. The current was as powerful as possible. The duration of the application was ten minutes and there was no pain during the application. Two or three treat- ments were given, the metrorrhagia was entirely stopped. Another patient of 45 years of age with a fibro-cystic tumor of the uterus which had been treated in 1903 by gal- vano puncture of the tumor. In April, I904, she was suffering from an abun- dant metrorrhagia. She was very anae- mic. No trace of the previous tumor re- mained, but the uterus and cervix were large and congested. The first application was of 15 min- utes duration, and the hemorrhage stopped almost completely the following day. The patient was seen again three months later and after this single appli- cation there had been no return of the trouble. The periods were regular and not excessive. Another patient 50 years old, the pe- riods returned every I 5 days—in fact she was always flowing. A single appli- cation of high-frequency currents for ten minutes was made. The loss of blood continued for several days after- ward, then ceased completely and has not returned. The current in this case was supplied by a 35 centimeter coil, with a vibrating interrupter, and 6 am- peres of primary current. In the discussion Dr. Desnoyers said that in treating cases of sciatica it was necessary to employ as much as 600 milliamperes for IO minutes, and that the high-frequency currents and the coil are so much stronger than those of the static machine that the time required was only about one-third as long. ARCHIVES D’ELECTRICITE MEDI- CALE Bordeaux, France, February IO, Igos. I. Electric Treatment for various CEsopha- geal Strictures — Dr. C. Roques. 2. Two Cases of Grave Neurasthenia Treated and Cured by Static Elec- tricity — Dr. E. Bonnefoy. 3. What I have Seen in Germany in Medi- cal Electricity — Dr. Virgilio Ma- chado. & 4. Experiments on the Relation of the Cur- rent in the Crookes' Tubes by Dr. Villard's Method — G. Gaiffe. I. One patient was 45 years of age, a seamstress. At the age of 20 years she had begun to have a sensation of a lump in her throat, strangling dysp- noea, and vomiting. The commence- ment of this was coincident with a pe- riod of overwork, especially with the sewing machine. About three years be- fore she had been very unhappy about different matters, and in the month of May, 1902, a very painful dysphagia was added to the other troubles, so that it was absolutely impossible for her to swallow, and she vomited immediately any food which she tried to take. No food except small quantities of milk had been retained, and finally the vomiting occurred even without taking food. She came under treatment on the 28th of January, 1903, and on trying to pass an oesophageal tube it was found that No. 6 passed readily enough, and then larger sizes. Electric bougies were passed by means of the galvanic current up to No. 2 I. One could perceive, how- ever, that there was a spasm of the Oesophagus, which appeared particularly in the region of the cardiac orifice of the stomach. After this treatment she swal- lowed bouillon, some soft bread and soup. Milk was rejected but the bread was retained. At a second seance the galvanic bougies were passed up to No. 36. From this time, with occasional treatment, there was rapid and progres- sive improvement, all treatment being CURRENT PHYSIOLOGICAL THERAPY I3 I stopped at one month from the day of commencement. Six months later the patient was seen, and was well nour- ished, but still had a little difficulty in swallowing, and sometimes vomited. Six months after that there were six more treatments, about one every two days, the Faradic current being used for a couple of minutes, and also a static current—both being given. This checked the vomiting and dysphagia entirely, and three months later she was entirely free from the former troubles. Another case was that of a woman 55 years of age, who had had gastritis two years before, cured in a couple of months. Recently she had taken a mouthful of a solution of potash, thinking it to be wine. She was sure that she had not swallowed any of it, but from that time she was not able to swallow any large morsel of food, and any swallowing was painful and difficult. The dysphagia was progressively worse, and finally vomiting appeared. The food was im- mediately rejected, and the vomiting a few hours later was followed by abun- dant glairy mucus. She became thin and weak. Simple catheterization was attempted but without success. An examination by means of an oesoph- agoscope was made, which showed an Oesophageal stricture about 22 centime- ters from the dental arch, presenting a small orifice a little behind and to the left of the mass of cicatricial tissue, which admitted a small pledget of cot- ton about 3 millimeters in diameter. Treatment was by electrolysis and from the moment it was begun there was dilatation of the stricture and relief of the patient. This took place so rapidly and so steadily that the case is very in- teresting. The dilatation was practiced by means of bougies having a bulbous extremity, and a current of IO milliam- peres for several seconds for each bou- gie, the numbers used during the first seance being I 9, 20, 2 I, 23, 25. Treat- ment was given every other day, and at the end of the first week a No. 33 bou- gie could be passed and the patient was able to eat like any one else. On this particular day there had been a spasm of short duration which had prevented her from swallowing even a little coffee, but a moment later she was able to eat a good meal. After three weeks of treatment an- other oesophageal examination was made which showed that the stricture was very much wider and more dilatable, and that the mucous membrane had become nat- ural instead of appearing like cicatricial tissue as before. Treatment was stopped at this time, and the patient was seen two months later, still being very well; but about three weeks previously the dyspha- gia had suddenly reappeared and since then solids and liquids were swallowed with great difficulty and rejected either immediately or perhaps IO minutes later: This seemed to be due entirely to a spasmodic condition, and the same treatment was begun again, with the ad- dition of a weak faradic current for about Io seconds. Three days later the patient was considered entirely cured. In cases of stricture of the oesophagus there are sometimes two elements — one an organic stricture and the other a spas- modic condition. The organic trouble requires the galvanic current which ac- tually produces a physical effect upon the tissues, whereas the faradic current sim- ply relaxes the spasms, and is suitable as a local application, even when the spasm of the oesophagus occurs from other sources of irritation. 2. Bonnefoy thinks that static elec- tricity is really the thing for neurasthe- nia and that its action is of a triple na- ture: (1) upon the circulation, by in- creasing the rapidity of the heart action, raising the arterial tension, and giving an impulse to the capillary circulation; (2) upon the action of the respiratory capacity of the blood, by increasing the quantity of oxygen which the red cor-. puscles carry; (3) an action upon diges- I32 CURRENT PHYSIOLOGICAL THERAPY tion and assimilation, increasing the ap- petite and accelerating the digestive functions, and in this way producing a rapid increase of weight. The treatment ought to be of moderate strength and duration at first, because otherwise the increased arterial tension may act to in- crease the insomnia if the patient is not accustomed to it. One case was a man 40 years of age suffering with insomnia and very great muscular debility, intense headaches, a suicidal tendency, and entirely unable to attend to his business. He also had haemorrhoids. The first seance was of IO minutes duration, in the middle of December, 1902, and the arterial ten- sion was immediately increased more than 2 centimeters, with the result that the patient was not able to close his eyes all night. A six-plate static machine was used. At the next treatment only half the strength of the static machine was used, and the patient was able to sleep 6 hours during the night, in three different periods. By the 20th of January the full strength of the static machine was used and he slept every night for five or six consecutive hours. His appetite and digestion became good, the headaches disappeared, and he was able to work a little without causing the cerebral fa- tigue which the least intellectual effort had previously caused. This patient presented all the symptoms described by Charcot as characteristic of Beard's dis- ease — intense “en casque'' headaches, insomnia, the characteristic cerebral condition, muscular weakness, and gas- tro-intestinal dyspepsia. Another patient was a lady 30 years of age, with a very nervous tempera- ment who had suffered from regular hys- terical crises with loss of consciousness, following scarlet fever four years before. These had become so severe that she was able to take scarcely any food and was confined to bed. Her arterial tension at the wrist was 8 centimeters at the begin- ning of the treatment. At the end of a gia and certain dematoses. week her condition was improved as if by enchantment. She passed comfort- able nights and her sleep was quiet and without nightmare. Her appetite re- turned, arterial tension rose to II centi- meters. At this time a few static sparks were added over the dorso-lumbar re- gion and lower limbs. At the end of two months' treatment she was able to walk six or eight miles in the open air, and her arterial tension was I 5 centime- ters. Several months later she was still feeling very well and the arterial tension was I 5 centimeters, no treatment having been given in the meanwhile. • 3. Hydro-electric applications are very generally used in Germany. The patients dip all four limbs into little baths to which a galvanic or faradic cur- rent is applied, or the two combined. Electro-cataphoresis is used for the in- troduction of various drugs into the or- ganism. High-frequency currents are much used for treatment of diseases of the skin and of tuberculosis. Conrad's electro-magnetic system is very largely used, especially in the treatment of neu- ralgia, neurasthenia, and insomnia. Electric light treatment is used more than in any other country of Europe. Finsen light is used. In Munich they have a smaller lamp which works with 4O amperes and is very much less ex- pensive, and produces as good results as the Finsen apparatus. Red light baths are used as a stimulant in the treat- ment of anaemia and neurasthenia, and blue light baths as a sedative in neural- All sorts of electric motors are used to produce vi- bration, etc. The two interrupters which are most employed are the mercury jet interrupter and the Wehnelt. Simon's electrolytic interrupter is not so generally employed, and Heinze's interrupter does not seem to be used at all. Very common use is made of the ventril tubes to suppress the inverse current in X-ray tubes actuated by a coil. No use is made at all of the CURRENT PHYSIOLOGICAL THERAPY I.33 static machine for the production of the X-ray, and almost all the tubes are of the bi-anode focus type. Those most commonly used being made by Müller of Hamburg. Other very fine tubes are made by the Polyphos Company, for- merly the Volt-Ohm of Munich, and the Sanitas Mfg. Company, also Gundelach of Gehlberg. - Among diseases treated by the X-ray are lupus, epithelioma, rodent ulcer, fa- vus, sycosis, trycophytia, hypertricosis, warts, eczema, acne, sarcomata, glan- dular enlargements. They are just be- ginning to use shields of lead to protect the operator and the patient. They use Walter's chromo-radiometer, the Benoit radio-chromometer, and the Holzknecht chromo-radiometer to measure the qual- ity and quantity of the ray used. Among the important data which are considered in determining the rays from the Crookes' tubes they take into account the following — the coil used, the volt- age, and amperage in the primary, the number of interruptions per minute, the quality of the tube, the spark length, and the distance of the anti-cathode from the region to be treated, the penetration, as indicated by the chromo-radiometer of Walter or Benoist, the action upon the Holzknecht— or, if one has not the Holzknecht — the time of the exposure and the interval separating the seances. They do not appear to have begun to use the milliamperemeter placed in series to measure the secondary current passing through the X-ray tube. 4. Gaiffe calls attention again to the use of two ventril tubes connected on a short circuit allowing the inverse current to pass through them, and shows a very pretty experiment with an electro-magnet and a Geisler tube. In the one case without the two ventril tubes the light in the Geisler tube is separated into two halves — one projecting toward the north pole of the magnet and the other toward the south pole; in the other case, using the two ventril tubes, the light deviates toward only one pole of the magnet, showing that one set of vibra- tions has been suppressed by short-cir- cuiting through the ventril tubes. D’ELECTRICITE MEDI- CALE Bordeaux, France, February 25, 1905. ARCHIVES I. Concerning the Indications furnished by Benoist's Radiochromometer — Dr. J. Belot. 2. The Use of Compression in Radiography and a new Compression Diaphragm — Dr. J. Bergonie. 3. The Practice of Radiography and Radio- therapy in Germany — Dr. Jaime R. Costa. - - I. Benoist's radiochromometer con- sists of a thin disk of silver surrounded by sections of aluminum varying in thickness from one to ten millimeters. This can be used either with the fluoro- scope or in a radiograph for determin- ing the quality of the X-ray. The silver appears of the same shade as that one of the aluminum segments which pre- sents an equal resistance to the X-ray. The thickness of the aluminum segment in millimeters designates the degree of penetration of the X-ray emitted by the tube at the time the test is made. An important advantage of this instrument over Walter's radiometer is in the fact that Benoist's instrument gives readings which are independent of the intensity of the radiation and depend only on the quality of the ray. Another fact is that this instrument measures the average de- gree of penetration, not the maximum penetration, at the time the test is made. We have no means of determining the different qualities emitted by an X-ray tube at any one time. The X-ray is not refracted or reflected, so no spectrum analysis of it can be made. It is prob- able, however, that if the radiochro- mometer indicates No. 7, there are some rays No. 8 and some No. 6, but practi- cally no Nos. I or 2. I34. {} CURRENT PHYSIOLOGICAL THERAPY 2. Begonie believes in the necessity for excluding secondary rays by a cylin- der and diaphragms and hence does not consider compression alone, as by Cald- well's inflated rubber bag, sufficient. At the same time he considers Albers- Schoenberg's compression cylinder need- lessly complicated and expensive. His own consists of two uprights with a cross piece which may be secured at any height by thumb screws. At the lower extrem- ity of the cylinder there is a large hol- low cushion which enables one to make more effective pressure and without the discomfort produced by the hard lower edge of a metal cylinder. 3. Costa gives a résumé of the appa- ratus and technique of the various well- known radiologists in Austria and Ger- many. Holzknecht, Albers-Schoenberg, Rieder, Grunmack, and Perthes are among those whose work is minutely re- viewed. Albers-Schoenberg's success in radiography depends upon (I), fixation of the part radiographed; (2), elec- trolytic interrupter and variable self-in- duction in the primary coil, and an aver- age primary current of fifteen amperes; (3), the use of soft tubes giving rich de- tail. He uses large Müller tubes of the water-cooling type. Rieder takes ex- cellent pictures of the chest in five or ten seconds, using a powerful Volt-Ohm ap- paratus, celluloid films and two intensi- fying screens. JOURNAL DE PHYSIOTHERAPIE Paris, France, February 15, 1905. I. A Variety of Algia; its Pathogeny and its Treatment by Priessnitz Com- presses — Dr. Prosper Merklen. 2. The Importance of Abdominal Massage and its Role in Therapeutics — Dr. Salignat. 3. The Chemical Composition of the Radio- active Gases from various Thermal Springs — M. Ch. Moureu. Chair and Couch for Electro-Therapy — Dr. E. Albert-Weil. I. Certain cases of gastralgia and the like are part of a neuropathic condi- tion caused by auto-intoxication and en- nui. Priessnitz compresses are cold, wet applications covered with oiled silk and left on the abdomen all night. The bod- ily heat soon changes the application to a warm one. The local effect is to stim- ulate both circulation and nerve force and the general effect is most beneficial. 2. Abdominal massage acts partly in a direct mechanical and partly in a reflex manner. Directly it stimulates the blood current, causes the absorption of Oedema, and the emptying of the large intra-abdominal cavities and the excre- tory ducts of the different glands. By a reflex action one can produce either vaso- dilation or vaso-constriction and in this way regulate the arterial tension. Me- tabolism is greatly stimulated and a re- markable tonic effect is produced. It may be applied in such a way as to pro- duce an important sedative effect upon the general nervous system. The hands are the best instruments, but where pow- erful vibratory massage is required one of the mechanical vibrators must be used. General massage of the abdomen is indicated as a tonic in convalescence from acute diseases and in anaemia and chlorosis. It is important for an effect upon arterial tension and to modify gen- eral nutrition in arthritism, obesity, dia- betes, gout, chronic rheumatism. In certain diseases of the heart, in arterio- sclerosis, and in blood stasis and active congestion of the respiratory organs its effect upon arterial tension is of value. Local massage is indicated in a va- riety of chronic affections of the stom- ach, intestines, liver, pancreas, spleen, kidney, bladder, prostate, uterus, and adnexa. Contraindications are acute or sub- acute diseases, cancer, local tuberculosis, acute hamorrhages, acute or subacute lo- cal infection, pregnancy. 3. Helium is the radioactive element especially found in these thermal waters. CURRENT PHYSIOLOGICAL THERAPY I 35 It is a derivative of radium, which is it- self present in minute quantities in the gas from these springs. 4. This wooden arm chair has a back which may be converted into a table. The construction is simplicity itself, but it is suitable for the sitting or lying posi- tion for all sorts of radio- and electro- therapeutic applications. In the sitting position there is a head-rest which may be iºd back for applications under the Cſ1111. FORTSCHRITTE AUF DEM GEBIETE DER ROENTGENSTRAHLEN Berlin, Germany, Vol. viii, No. 3. I. Contribution to the Topography of the Gastro-Intestinal Canal in the Living Man, together with Investigations concerning the Duration of the Pro- cess of Digestion — Prof. H. Rieder. 2. The Trochoscope, a Universally Adjust- able Table for Radiography — Dr. G. Holtzknecht and Dr. I. Robinsohn. 3. For the Simplification of Screen-Tech- nique. The Angular Screens — Dr. I. Robinsohn. 4. The Deep Distribution of X-ray Effect — G. Holzknecht, Vienna. 5. Application of the X-rays for the Diag- nosis of Bladder Deformities — Dr. P. Wulff, Hamburg. 6. The Alternating Current and its Applica- bility in Roentgen-Work — Dr. B. Walter. Contribution to the Radiotherapy of Blood Diseases — Dr. Paul Krause, Breslau. I. In these investigations Rieder makes use of bismuth mixed with the food, using about an ounce mixed with about a pint of liquid, either milk or broths. He finds no danger or incon- venience resulting from the use of this large quantity of bismuth except obsti- pation. He calls attention to the dan- gers and inaccuracy of the older methods of examination by means of the sound and gas. The patient is examined either in the standing or the sitting posture. The an- ode of the tube is placed on a level with the umbilicus and at a distance of 60 cm. from the plate. The location of the um- bilicus is marked by fastening to it a coin. The exposures are made in a few seconds while the patient holds his breath. Fresh developer is used for each negative. The position of the stomach is influ- enced by the amount of contents, by its peristaltic movements, and by certain in- dividualities and habits. In general the normal position is vertical and this is es- pecially true in women. The article is accompanied with a number of beautiful plates which show the position, shape, and size of the stom- ach both in health and disease. The au- thor has also made studies to determine the time required for food to pass from the stomach and through the bowel. The time occupied by the food in pass- ing through the stomach is not influenced by the presence of the bismuth. The passage of the food through the bowel is considerably retarded by the presence of the bismuth. Normally from 3 to 6 hours are required to pass the stomach, and from 48 to 60 hours to pass the bowel. No difference is noted in the time required for either proteids or carbo-hydrates to leave the stomach, but fats are slower. Water is found to leave the stomach in from 2 to 34 hour, while beer leaves more slowly. The size and position of the colon can be studied either by the ingestion of food containing bismuth or by the administra- tion of enemata containing bismuth, and the author has found that the position is the same when studied by either method. The article is also accompanied by a detailed report of the cases studied. 2. This apparatus enables the exam- iner to study the patient in the recum- bent position, and to reduce fractures and search for foreign bodies under the immediate direction of the fluorescent screen. The table contains a rotating \ I36 CURRENT PHYSIOLOGICAL THERAPY disk underneath, which carries the tube, and this is in turn mounted upon a car- riage which is worked with pulleys which enable the operator to bring the tube into the proper position for study of the part under examination, without moving the patient. The compression screen is also an attachment. - 3. The author simplifies the tech- nique of using screens for the elimination of rays from the parts not actually under examination, by using two sheets of lead, the inner borders of which are cut into a right angle. These two sheets are then approximated until the proper size opening is left for the part under exami- nation. The author believes that the photographs are improved by this method. 4. Holzknecht is of the opinion that the X-ray effect depends upon the de- gree of absorbability of the tissue through which it passes, and also that the effect will vary with the quality of ray used. Each layer absorbs a definite quantity, and the next layer will absorb another definite proportion, but there is always a certain small proportion which passes on to the next. . Wulff demonstrated a deformity of the bladder by injecting a solution of bismuth as follows: Bi, subnit 5.0, Amyl. 2.0, Aq. ad. 5 O.O. The skiagraph then showed the size and position of the bladder. He speaks of the method of Keller in which the bladder is distended with gas, but Wulff believes his method to be more practical and more precise. 6. Walter here gives the second, or practical part of his paper upon the use of the alternating current in Roentgen work. The application of these currents is made by means of a motor interrupter, an electrolytic interrupter, a synchronous motor placed in circuit with the tube, or by means of a special tube containing two cathodes so arranged that they focus upon the same point upon the antica- thode. The two wires from the second- ary coil are then attached to the ca- thodes. With each alternation of the current one cathode becomes anode and the other the true cathode. A constant stream of rays are obtained in this way. The objection to this method is the ex- pense and difficulty of making the tubes, and the fact that the tube must always be kept at low vacuum. * 7. Krause gives a very complete re- view of the work done so far in the treatment of blood disease with the X- rays. Most of it has been done in leu- kemia. He has collected forty cases of this disease that have been treated by the X-ray. The improvement is easily divided into two headings, subjective and objective. In myelogenous leukemia the subjective symptoms seem to be com- pletely relieved, while in the lymphatic variety the symptoms as a whole are ap- parently not relieved and indeed seem to be made worse. The objective symptoms are improved as respects the condition of the blood, the size of the splenic tumor, and the in- crease in weight of the patient. The im- provement in these respects in some cases was remarkable. The author has collected also IO cases of pseudo-leukemia. In general there was improvement, but in many cases this improvement was not permanent. He also has collected other cases of blood diseases that were treated, splenic anae- mia, Banti's disease, malignant lym- phomata, pernicious anaemia. On account of the increase in haema- globin and in the number of red corpus- cles dependent upon its use, the author applied the X-ray in two cases of per- nicious anaemia and in one case noticed improvement. He believes that more observations should be made in this line. MISCELLANEOUS ABSTRACTS I 37 ELECTROTHERAPY SOME OBSERVATIONS ON THE EFFECT OF ALTERNATING CUR- RENTS OF MODERATE FRE- QUENCY ON DOGS G. W. Crile and J. J. R. Macleod, American Journal Medical Sciences, March, 1905. The experiments were carried out by means of the alternating currents used for illuminating purposes, varying in tension from 4OO to 2,700 volts; fre- quency 60 periods per second. The electrodes were made of copper or zinc, shaped either as thick rods which could be placed in the rectum or mouth, or Spoon-shaped for application to the sur- faces of the body; these were usually wrapped about with a sponge soaked in Saline solution to increase conductivity. Dogs rendered anaesthetic by morphine and A. C. E. mixture were used. It was found that the lethal current strength varied within limits of consid- erable latitude, that the lethal tendency was governed largely by the location of the electrodes, and that when the current was passed directly through the heart fibrillary contraction of the ventricles, the auricles continuing to beat normally, was induced which resulted in perma- nently lowering the blood pressure. Whenever the current was applied so as to traverse the heart and produce fibril- lary contraction respiration was also permanently inhibited. If the current was not applied so as to traverse the heart substance, a temporary cardiac and respiratory inhibition (through stimu- lation of the vagus nerve probably) was induced, but these functions re-estab- lished themselves when the current was broken. With the electrodes in the mouth and rectum the current would necessarily pass through the heart and the results were always lethal when they were so located; when so located that the heart was not directly traversed, as on the two anterior limbs for instance, the animals were not killed. They conclude that death under elec- trification is due to a direct effect of the current upon the heart muscle causing fibrillary contraction, and that if the cur- rent traverses the body so as to avoid the heart, temporary vagal inhibition of the heart and respiratory centers may oc- cur but not death; these functions will be re-established when the current is broken. As a possible prophylactic measure for persons exposed to the action of strong currents it is suggested that they wear a corset made of some conducting material, as copper. To be of value this corset would have to be closely applied to the skin about the shoulders and base of the neck above, and to the lower por- tion of the trunk below; in the cardiac region it should be separated from the skin by a layer of some non-conducting material, as India rubber. Contact with the bare skin at the upper and lower ex- tremities of the corset is necessary in order that the current passing along the body might have every facility for choos- ing the route of less resistance through the corset, rather than through the body tissues underneath it. By this means the heart might be protected from the cur- rent and lethal results avoided. Wear- ing such a corset over a woolen garment, whereby contact with both ends of the corset and the skin would be prevented, would therefore destroy the effective- ness of the protection; the woolen acting as an insulator. THE PRINQIPLES OF ELECTRO- THERAPEUTICS A. D. Rockwell, The Medical Brief, Febru- ary, IQO5. * “Electro-Therapeutics,” the author claims, “cannot be considered a specialty I38 MISCELLANEOUS ABSTRACTS in the sense for example that neurology or ophthalmology are specialties.” It is simply the application of a single rem- edy, although one having an enormously wide range, double-edged, many sided. Because of the power of electricity to modify the nameless and numberless phenomena that energize living tissue, and its influence over nutrition, it be- longs to every specialist as well as to every general practitioner. Unfortunately, however, for its gen- eral, successful utilization a far more in- timate acquaintance with its physics and physiology, and with the laws which govern the action of its various mani- festations on living tissue, is demanded of the average practitioner than he can claim to possess. How many physicians who undertake to utilize electricity un- derstand Ohm's law? But yet this law is the foundation upon which is built the whole superstructure. According to Rockwell the two prin- ciples upon which we must mainly rely in the use of electricity for diseased con- ditions are: Ist. Its influence over vaso-motor activity, and 2d, its action on the nerve units of the body. Pain must be due, as a rule, if not in- variably, to pressure upon nerve cells. If structural changes or organic condi- tions cause the pain, it is well understood that it is either incurable, or will yield only to operative procedure. If it be due to blood pressure, as is evidently the case in the majority of instances, the re- lief of pain is coincident with the relief of pressure. Electricity is quite capable of exciting the activity of the circulation through congested areas. It induces a sort of circulatory drainage, acting very much on the principle of heat, the differ- ence being that its effects are more far- reaching, as evidenced for example, by the influence, of massive doses of elec- tricity over the pain of deep-seated ma- lignant growths. The second underlying principle, viz., the action of electricity on the nerve units, or neuron bodies, while more con- jectural as to its nature than the vaso- motor effects, seems yet to be a neces- sary theory to account for the very re- markable effects so often obtained through the use of this agent in the va- rious neuroses, in such conditions as neu- rasthenia, hysteria, and hysterical paral- ysis, and those cases of mental disturb- ance that have not yet crossed the border line separating them from actual insan- ity. The neuron concept has not yet de- veloped into an established fact. In- deed much doubt has been thrown by later histological studies, by the work of Apath and Nissl especially, on this the- ory of the transmission of nerve im- pulses, but whether these nerve impulses are transmitted from the center towards the periphery through a permanently continuous chain of nerve tissue, or through individual nerve entities that are in contact by contiguity, the fact remains that the nerve wave is frequently inter- rupted in its course. Sometimes this interruption is perma- nent, sometimes only temporary. If per- manent, the causes are organic or struc- tural, and we get some form of incurable paralysis or insanity. If temporary, we have to deal with what in our ignorance we term a “functional ’’ causation, and the paralysis or amnesia, or mental dis- turbance either recovers spontaneously, or is amenable to treatment. If we accept the theory of amoebic movements (by which is meant the power of the neuron under pressure to expand and contract by means of the protoplasmic prolongations) by which the connections between neuron and neu- ron are alternately made and broken, we not only have a convenient, rational the- ory in explanation of the functional neu- roses, but an explanation as well of the curative effects of purely neuro-motor excitations and of physical methods of treatment. There is no form of electricity but ELECTROTHERAPY I 39 what has a certain influence in this direc- tion, yet for the purpose of increasing general nutritional activity, exciting met- abolic changes, and developing the po- tential energy of the cell life, it seems to be the general consensus of opinion that we have in these currents of high fre- quency and high potential, an energizing principle superior to the other electric modalities. On the neuron the influence of all high frequency currents, and of what is termed vibratory therapeutics, must be in the main mechanical or elec- tro-tonic. Changes are produced in the excitability of the neuron. New con- nections develop from out the protoplas- mic prolongations, opening up new paths of conduction for the transmission of the nerve-waves, the obstruction of which gives rise to so many symptoms of dis- ease. The powerful influence of strong emotional excitation in dissipating cer- tain functional nervous symptoms has long been recognized. It is believed that these purely emo- tional neuro-motor excitations accom- plish these results by overcoming the non-conductibility of the resistant neu- ron. In the same way it seems rational to believe that when a patient is placed within the field of influence of currents of high frequency, or is subject to such influences as central galvanization, gen- eral faradization, the static wave cur- rent, or high-frequency currents, the re- Sultant effects over sensory, motor, and mental symptoms are due to the power of these electric impulses to so stimulate the cell energy as to open up new paths for the transmission of the nervous cur- Tent. ENELECTROLYSIS : AN IMPROVED METHOD OF OPERATING ON SUPERFLUOUS HAIRS Balmanno Squire, London Lancet, February 25, IQO5. . The electrolytic destruction of hair as hitherto practiced has involved passing a sharp needle into the follicle, alongside of the hair, until the root or papilla has been reached (the hair being taken as a guide to the direction which the needle should follow), and the current then passed for a period of time presumably long enough to destroy the papilla, when gentle traction upon the hair with a pair of tweezers will easily remove it if the current has done its work. Prominent among the objections to this method are the following: First, the direction (slant) of the hair outside of the skin is not a trustworthy indication of its direction in the sub- stance of the integument (hairs fre- quently curl abruptly as soon as they emerge), hence finding the root of the hair with the needle point sometimes in- volves several applications of the cur- rent to different locations before the pa- pilla is finally located; as a consequence several foci of electrolytic destruction are formed which sometimes results in disfigurement that is worse than the pres- ence of the hair. Second, the necessity of passing the needle down alongside of the hair ren- ders it necessary to destroy a large area of tissue, in order that the destructive influences may be radiated to a suffi- cient distance to include all of the pa- pilla. Squire proposes to pull out the hair first and then pass the blunt (eye) end of the needle into the follicle where it occupies the space previously occupied by the hair itself, and enables the oper- ator always to apply the current exactly at the spot which it is desired to treat, without destroying unnecessarily large areas of surrounding tissue. This method is much quicker than the old method because only a very short elec- trolytic action is required to destroy the papilla when the needle is in actual con- tact with it, disfiguring was reduced to a minimum, the pain produced is prac- tically nil, and as the needle is merely entering a passage already existent it is I4O MISCELLANEOUS ABSTRACTS thereby guided in the proper direction for reaching the papilla, obviating the necessity of the operator's guessing at the direction and being deceived. Using the blunt end of the needle causes it to pass in easily, whereas if the sharp point was used it would be likely to stick into the sides of the canal, carrying the de- structive action into neighboring tissues. A little caution is necessary as regards locating the orifice after the hair has been removed. To make this certain it is recommended that the operator keep his gaze fixed constantly upon the orifice, after the hair has been pulled out, until the needle has been inserted; after this has been accomplished a little pressure in different directions will cause it to slip easily into the follicle. Location of the orifice can also sometimes be facilitated by observing its bearings with relation to neighboring hairs, before removal of its contents. Squire suggests the name of “Enelec- trolysis” for this procedure. CLINICAL RESULTS OF HIGH-FRE- QUENCY CURRENTS A. W. Crane, Fort Wayne Medical Journal- Magazine, March, IQoş. Although the public has always had a considerable amount of vague faith in the curative power of electricity yet it was not until the discovery of the diag- nostic and therapeutic powers of the X- ray that the members of the medical pro- fession were inclined to give it any great degree of credence. Crane makes the statement that the method of so trans- forming the discharge from a large coil, which is too powerful to be applied to the human body, so that it could be utilized, was discovered in America sev- eral years before the X-ray was known, but that the therapeutic possibilities in- volved lay dormant until d’Arsonval and Oudin developed them. Crane manufactured his own reso- nator as follows: “A bobbin of wood, thirty inches long and having a diameter of ten inches. Two sizes of copper wire are used, the larger size being known as No. 8, the smaller size as No. 16. The larger size wire (No. 8) is wound around the bob- bin 24 times, with four turns to one inch of the length of the bobbin. The smaller size wire (No. 16) is wound around the bobbin 192 times, with eight turns to the inch. The windings of the larger wire are separated from one an- other by windings of cord one-eighth of an inch in diameter. The smaller wire is wound on ribbed rubber matting such as is commonly used on stairs and in hallways, the wire being wound in the grooves of the matting which are just right for the purpose. The condensers are made by pasting tin foil on window glass. There should be from IOO to 200 square inches on each surface, with margins of two inches. “The full size resonator — thirty inches long and ten inches in diameter— when completed gave me a very abun- dant effluvia of soft sparks eight or nine inches long, which felt on the hand like the touch of a feather duster. If the hand were close enough, however, a vivid, crashing spark of six or seven inches would jump from the machine. But if a piece of metal be held between the fingers to receive the impact of the spark, nothing can be felt. The dis- charge is given off from a single ter- minal. There are no positive or nega- tive poles in the same sense as with the galvanic, faradic, and static machines. And if this single terminal be seized, the entire discharge of our resonator can be taken without the slightest sensation or muscular contraction of any sort.” He believes the current derived there- from is not an oscillating one, but uni- directional, and bases his belief appar- ently, upon observation of the method in which the X-ray tube lights up when it ELECTROTHERAPY I4 I is hung from a single pole of the reso- nator by its cathode terminal. The fol- lowing cases which were treated with the above-described apparatus are reported: “Case I. —One of my first cases was that of a business man whose office is in the same block as my own. He had arisen from bed that morning with a very stiff back, but managed to get down town. During the morning, however, the trouble increased very rapidly so that he could not assume any position that was not acutely painful. When he was helped into my office the diagnosis of acute lumbago was clear. I applied the high-frequency current through the me- dium of a vacuum tube for fifteen min- utes to the bare skin of the back. At the conclusion of the treatment the pa- tient asserted emphatically that he was entirely well. He had no pain what- ever. He could take any position he wished. He refused to go home, and took no medicine. He returned at once to work, and there was no recurrence after that single treatment. I have veri- fied these results with many acute lum- bagos since, except that often the symp- toms return after thirty-six hours, and the patient will come in for several more treatmentS. “Case 2. — A somewhat similar case was that of a young man who came in with his head drawn stiffly to one side by an acute torticollis. The effect of the treatment was immediate and the patient left the office wholly relieved. There was no recurrence and no second application. “Case 3. — Another case was that of a chronic rheumatism of the knee which had caused the patient to limp for a year, and had entailed much suffering. It will illustrate the extraordinary anaesthetic powers of the current. The first treat- ment of fifteen minutes wholly relieved the pain, and the patient walked off with- out a limp. But after about thirty-six hours all symptoms returned. Applica- tions were repeated every other day un- til finally after fifteen treatments the knee remained well. “Case 4. — Gout is a fine subject for high-frequency treatment. Pain is at once relieved, and the swelling and red- ness disappear after a few treatments. “Case 5. — The high-frequency cur- rent is of marked service in many rectal disorders. In one case, a chronic fissure in ano with ulceration healed with sur- prising rapidity. Pruritis ani is largely controllable by this means. Hemor- rhoids which can be replaced seem to be curable. “Case 6. — The most remarkable case I have to report is that of a woman of 66 who for four days previous to her visit at the office had been in constant pain in the rectum and throughout the pelvis. For months preceding she had had more or less pain daily, especially on defecation. Her passages were like thin ribbons. Her pain now never left her day nor night. On digital examina- tion the rectum at the height of the sec- ond sphincter was filled with a nodular growth by which the lumen was almost obliterated. The tip of the finger could barely distinguish the opening Exami- nation through a Martin's rectal specu- lum showed the rectum blocked and the lumen reduced to a small slit. There was no ulceration and no discharge. The age of the patient, her anaemia, and her history of several months of grad- ually increasing trouble caused me to make at once, in my own mind, a diag- nosis of cancer of the rectum. I said nothing to her, intending to communi- cate with her daughter. She begged for some relief and sleep, and morphine seemed inevitable. But first, I thought, I will put the anaesthetic power of the high-frequency to a supreme test. So with her permission I passed a cylindri- cal vacuum tube as far into the rectum as possible against the growth. She re- ceived the full discharge for 20 minutes. She then sat up and told me in sober earnestness that all her pain was gone, I42 MISCELLANEOUS ABSTRACTS and that all the distress and weight in the lower part of the abdomen had com- pletely vanished. Excepting a restricted diet and oil enemas, she had no other form of treatment. The next day there was a slight return of symptoms and she received another treatment. In the meantime I told her daughter my opin- ion of the case and advised a consultation with another surgeon, and the submis- sion to an operative procedure if founds advisable. Her son in Chicago con- sulted Dr. Bevan, and came on to Kala- mazoo with the intention of taking her to Chicago for treatment. The patient, however, refused to go to Chicago, and insisted on a continuation of the treat- ments. I advised against delay, but pending her decision continued treat- ments every other day. The patient be- gan to make a decided gain in general health, and the pains never returned. Defecation became easier and finally normal, and by the time she had taken thirty treatments, no obstruction in the rectum and no growth could be detected. She then consulted Dr. Bevan, who pro- nounced her free from rectal troubles. I stated to the family that I had been in error in my diagnosis of cancer. But, whatever it was, the result of the high- frequency application transcended any- thing in my experience. “Case 7. — In a case of cystitis in a lady of 50, the patient had suffered the usual tortures of that malady for about four months when her case came under my care. Her nights were especially miserable from incessant and painful urination. The alkaline urine contained 5 O per cent. of pus, a trace of albumin, but no casts that we could find. Under urotopin a decided improvement was made, but complete relief was a long way off. Hemorrhoids and rectal pains on defecation were also present, and I had her come to my office for high-fre- quency rectal treatments. After a couple of applications she informed me that her bladder trouble was helped by the rectal treatments. In order to ascer- tain whether or not the vesical improve- ment was due directly to the current or indirectly to the improved rectal condi- tions, I passed a slender vacuum tube into the bladder itself and run the reso- nator I 5 minutes. The next day I re- ceived a telephone message from one of the most grateful patients I ever had. “For the first time in months,” she said, “I slept nearly all night and could urinate without pain.” The trouble be- gan to return within thirty-six hours, but about twenty more treatments were given which, with the urotropin, brought the case to a favorable termination. “Case 8. — A case that I had oper- ated upon for dysmenorrhea by dilata- tion and curettage returned after four months of relief and announced that her old pains had returned to some extent. In spite of verbal encouragement and liquor sedans the trouble rapidly grew worse with each monthly period. The pains would begin shortly before the flow started and continue for three days. She refused to have the operation re- peated. One evening the mother tele- phoned me that her daughter had begun her monthly suffering and asked me to come up and give her something to re- lieve pain. I asked her to bring her daughter down in a closed carriage and I would see if a new form of treatment would be of any avail. A vacuum tube was inserted so as to lie against the uterus and I 5 minutes of the full cur- rent given. After IO minutes the pa- tient declared that her pain had van- ished. After the treatment she felt per- fectly well, the weight and dragging in the pelvic viscera having disappeared. . The pains did not return during that pe- riod. With great expectations of a per- manent cure I gave her repeated treat- ments preceding the next period. But the pains began just as before. A sin- gle treatment, however, after the onset of the pains, gave complete relief. Fur- ther observation fully convinced me that ELECTROTHERAPY I43 the pains could not be prevented by any treatment given before the onset of the periodic pains. I have had no opportu- nity of verifying these results in any other case. ' “Case 9. —One case of painful scar on the hand of a fireman is interesting. The pain radiated up the arm and for over a year had been intermittently of great annoyance. I told the patient that an excision of the scar would probably be necessary because of included nerve ends. . But first, I said, let me experi- ment with electricity on that thing. The first treatment of course relieved the pain. I had my assistant give daily treatments to the scar, which became very red. Under a lens, fine blood capil- laries could be seen ramifying the old scar tissue. After a week's treatment we stopped to permit the inflammation to subside. In a week redness disap- peared and the scar, which had been so prominent, was largely absorbed. This was doubtless due in large part to me- chanical irritation of the spark and the extraordinary increase of blood supply. The case has remained free of all symp- toms.” . . - Crane also removes warts, moles, and corns with the high-frequency spark, one application being usually sufficient for small areas. In the cure of excres- cences following X-ray burns on the hands of the operators it is very efficient and may possibly be of service in in- creasing the vitality of the tissue in X- ray burns. - SOME RESULTS witH THE HIGH- FREQUENCY CURRENT . Clarence E. Coon, American Medicine, March - 25, IQO5. Coon's high-frequency apparatus con- sists of a twelve-plate static machine which excites Leyden jars having 70 square inches of foil on both outer and inner surfaces during dry weather, and 130 square inches during moist weather. To the outer coatings of the jars is at- tached a “solenoid of ten turns of num- ber seven magnet wire, one meter in circumference, and continuous with this solenoid are 42 turns of number twelve magnet wire, and to the upper extremity of this resonator the electrodes were at- tached.” He runs the machine at 350. revolutions per minute and uses the ordi- nary high-frequency glass vacuum elec- trodes. Results of treatment in five cases of neuritis are reported. The first occurred in a woman, af- fected the left upper extremity and was accompanied by anaesthesia of the index finger. For several weeks she had been unable to sleep without an opiate and the usual remedies had given no relief. The first two or three high-frequency applications seemed to intensify the pain. Following the fourth there was. rapid improvement and in about three weeks the cure was complete. There had been no recurrence ten months after the final treatment. The second occurred in a woman aged 64 who had had a pain in the right arm and shoulder for I 5 years and for several months previously also in the left arm and shoulder. In front of the internal condyle of each arm were tu- mors about the size of a hen's egg. These tumors were sensitive to pressure which also caused pain to radiate down the forearm. Near the middle of the anterior surface of the forearm were Smaller tumors. The ordinary meas- ures had never produced relief in this, case, which was diagnosticated as chronic neuritis with neuromas. She was given five treatments with greater freedom from pain than she had experienced in years as a result and the tumors de- creased markedly in size. She then an- nounced her attention of continuing elec- trical treatment in another city and the final result is not given. I44 MISCELLANEOUS ABSTRACTS The third occured in a woman aged 33 who had had a sensation in the lower cer- vical and upper dorsal region, as though the area had been bruised, for years. Occasionally the arm and forearms would feel numb. An area of tenderness upon pressure was present over the spine and surrounding this area for a distance of about two inches on either side was a slight erythema. Various treatments had been applied without beneficial re- sult. She was much relieved after the second high-frequency application and complete cure followed 12 treatments extending over an interval of eight weeks. The fourth case occurred in a woman aged 25 who for six weeks had suffered with severe pain in various parts of the body. Twenty-four hours after the pain appeared an eruption would come on her skin, showing some signs of vesicula- tion over the areas affected, which were principally the buttocks, thighs, thorax, and upper extremities. She had not been free from pain at any time for six weeks. Diagnosis of atypic herpes zos- ter. The first treatment relieved the pain for several hours. Nine treatments extending over a period of about three weeks completely removed the trouble. Case five was a man aged 65 who, for 20 years, had been troubled with itching at different times unaccompanied by any visible lesion except scratch marks. The only way he could sleep was to Saturate his night-clothing with a sedative solu- tion and he had done this about once an hour every night for several weeks. He was treated daily for three months and then was able to sleep most of the night without the lotions. He was relieved of his itching. Although treated for three months this case was not entirely cured. Two cases of chronic constipation which had existed for several years were very greatly improved. tubercular adenitis on both sides of the neck, the larger of the tumors being an inch in diameter and a number of other One case of smaller ones being evident along the pos- terior margin of the sterno-mastoid mus- cle, showed gratifying results. The blood examination.showed ha-moglobin 61 per cent., white corpuscles I 3,000. The patient was treated at intervals for six months, by which time all the tumors had disappeared except one which was so small as to be scarcely discernible. Another case of tubercular adenitis occurring in a young girl and recurring four years after a radical operation for the removal of cervical glands, is also reported. These glands would fre- quently enlarge, suppurate, and after opening would be very slow to heal; as a consequence sinuses were almost con- stantly present somewhere in the neck. When she came under Dr. Coon's care there was a sinus about an inch in depth on the right side of the neck; this was entirely healed by four treatments. She was treated irregularly for about seven months, at which time she had entirely recovered and had remained so for five months at the time the report was pub- lished. A case of chronic rheumatism is also reported which was practically entirely cured by these applications. Dr. Coon considers the current very valuable for healing sluggish ulcers, and has had some gratifying results with it in an incipient tuberculosis; one patient increased 12 pounds in weight in three weeks, the cough lessened and the pa- tient became so much improved that she believed she had recovered and discon- tinued treatment. In chronic constipation the high-fre- quency current is believed to constitute a measure of considerable prominence. It is to be regretted that the technique employed by Dr. Coon was not de- scribed. ELECTROTHERAPY I45 CHRONIC RHEUMATISM, GOUT, AND OTHER URIC ACID DIA- THESES TREATED BY THE X-RAY, HIGH FREQUENCY CURRENTS, AND WIBRATORY MASSAGE Sinclair Tousey, Medical Record, March 4, I905. The X-ray is applied only locally and only in the few cases in which a single joint or nerve proves resistant to the other measures; it does not form a part of Tousey’s “Uric Acid Technique,” but is a most valuable adjunct in some cases. An eight or twelve inch coil is used with a liquid interrupter. Four amperes of primary current, a Müller heavy ancode tube of three inch spark resistance and a penetration of three or four layers of the tin foil of the author's radiometer; the tin foil weighs an ounce to one hundred square inches. The dis- tance from the anti-cathode to the near- est cutaneous surface is nine inches and the exposure three to five minutes twice a week. A Friedlander shield is used to protect the operator and all parts of the patient except an area five inches in di- ameter where the treatment is required. The effect is anodyne and resolvent. No reaction is excited in the skin. The “Uric Acid Technique” consists in the application of vibratory massage up and down the spine and over the ab- domen for about ten minutes, twice a week, and the application of high fre- quency currents for about fifteen min- utes on the same days and over the same regions, but in addition locally over the affected joints or nerves. - The vibrator used was made by Wap- pler; it has a 1/16 horse power motor, a flexible shaft and a ball extremity in which an excentric weight revolves. The ball is applied laterally so as to get a tapping effect with short rapid strokes and the effect is regulated according to the case. - - The high-frequency currents were ap- plied by means of a d’Arsonval trans- former (X-ray coil, liquid interrupter, IO two very large Leyden jars, solenoid, metallic electrode held by the patient, and glass vacuum electrode held by the author's completely insulated handle). Using a twelve inch X-ray coil the pri- mary current is from five to eight am- peres and the spark gap of the trans- former from a third to half an inch. The effect is the application to the pa- tient of a heavy current producing a great deal of warmth but no sparking. The new handle referred to is of hard rubber which extends an inch beyond the metallic socket into which the shaft of the vacuum electrode screws, so that the glass tube itself is the only uninsu- lated portion of the apparatus that comes anywhere near the operator or patient. It enables the application to be made in the most inconvenient loca- tions without the risk of giving the pa- tient a shock from the metallic part. Where metallic contact is made with the glass tube there is a wire passing through the wall of the latter and prac- tically sealed. This allows the high ten- sion current to enter the vacuum of the tube without the undue heating of the glass which would otherwise result from the use of a small surface of contact and powerful currents. The effect of high-frequency currents applied in this way is complex; ten thou- sand waves of ultra-violet light pass into the body each minute, a certain amount of ozone is generated upon the surface and carried in by the current, and an in- terrupted current of about a hundred milliamperes passes through the body. The greatest effects are local about the vacuum electrode, but there are marked constitutional effects in different dia- theses. The Oudin resonator and uni- polar application seems more especially suited to cases in which a brush dis- charge is indicated. It was not used in any of the cases alluded to in this paper. The vibratory massage produces an increase in the superficial circulation and an excitation of nerve function, or if the 146 MISCELLANEOUS ABSTRACTs pressure is deep and prolonged an inhi- bition of nerve function. It stimulates the circulation and functional activity of every viscus over which it is applied; and improving the action of the stomach, liver, intestines, and kidneys it is easy to understand the benefit produced by its application over the abdomen. Ap- plied along the spine its action is reflex, but has proven in many cases easily demonstrable. If the contact is made perfect, as by the use of a dusting powder, the high- frequency currents produce no sparking, merely a sensation of warmth. No sen- sation at all like that from faradic elec- tricity or the static spark, and with the usual bipolar application no muscular contraction. There is a slight increase in the cutaneous circulation and a sense of exhilaration which used to cause one patient to feel like walking all the way home to Seabright, N. J. The observa- tions of d’Arsonval, Berlioz and others are quoted as showing an increase in the amount of urine and in the amount of urea, uric acid and other solid ingredi- ents contained therein, also an increase in the amount of oxhaemoglobin in the blood, but Freund is quoted as saying that these observations have not been generally confirmed. - - In the cases reported the beneficial effect was reflected in the urine as well as in the other symptoms. There was no noticeable effect upon the tempera- ture during the treatment. The effect of the high-frequency currents is appar- ently due partly to a counter-irritant ac- tion increasing surface circulation, and partly to a reflex action through the nerve supply of the different organs of assimilation and elimination. Case I. — Man aged 54 with a fam- ily history in which occurred rheuma- tism (fatal in his father's case at thirty- nine), “ossification of the heart,” paral- ysis of the throat, and apoplexy on the paternal side, all of them being large in about two months. ness. men. On his mother's side they were all delicate and died at an early age with- out special diatheses. He himself is 54, has had no sickness since childhood ex- cept inflammatory rheumatism, which kept him in bed for a month, maximum temperature IO3.8° F. Present trouble dates from an attack of lumbago two years ago. Not sick in bed, but any movement was very painful in the morn- ing, with gradual improvement through each day. The symptoms disappeared Status praesens, six feet four inches in height, and weighs one hundred and seventy-eight pounds, some flat-foot and consequently extraordinary breadth to the ball of the foot. Right great toe joint is swollen and stiff and there is a gouty pain in it, especially on awakening. The middle toe of the right foot has a sensation as of slipping out of joint. The right hand has a rheumatic pain. These symptoms have remained so aggravated in spite of medical treatment as to threaten to incapacitate him for busi- Shortly after beginning treatment he had a fall, producing a severe ecchy- mosis of the left thigh, followed by stiff- ness of the knees and an added rheu- matic pain in the left hand. Treatment consisted in the high-fre- quency currents and vibratory massage twice a week, according to the author's Uric Acid Technique, and the adminis- tration of ten grains of salophen three times a day, the avoidance of tea, coffee, and tobacco, and the application of flat- foot braces. At the end of a month the gouty pain in the right great toe had almost disappeared, the stiffness and crick in the knee had been reduced two- thirds, the sensation as of the middle toe slipping out of joint had almost gone. Only a trace remained of the rheumatic sensation in the right hand, and the rheumatic pain in the left hand, brought on by the fall, had been reduced three-fourths. After another two weeks' ELECTROTHERAPY I47 treatment the patient reported himself so well in every way that it seemed proper to discontinue treatment. This case is typical of a large number. The effect of the first treatment is to bring them up from their lowest to their best condition and this takes place be- fore they have had the prescription for salophen filled. During the next two or three weeks this improvement is main- tained, but no further improvement takes place; then quite suddenly a progressive advance begins and in a few weeks the case is cured. Case 2. — A woman of 54, weighing two hundred and eighty-seven pounds, and a family history of rheumatic gout making them chair invalids for years. Personally she has always been careful about diet, but has gradually become more and more affected by a rheumatic or gouty condition which, in spite of medical treatment, has finally almost crippled her. For some time past she has not been able to walk more than two or three blocks, and on coming to a curb- stone would hesitate for some time be- fore attempting to step up those two or three inches. The knees were badly swollen, the joints of both feet were stiff and swollen, as was also the middle fin- ger of the right hand. The day follow- ing the first treatment she was walking any number of blocks, going up and down stairs, and “feeling like a bird.” This was before she had begun taking salophen, ten grains three times a day, which is the only suggestion I commonly make concerning medication in these Ca,SCS. - - The original brilliant improvement remained but was not surpassed until after two or three weeks of treatment twice a week. Then she started in to make a steady advance. The locations exhibiting the slowest progress were one knee, which she had strained some time previously, and the middle finger of the right hand. To these several applica- tions of the X-ray were made. The pa- tient was under treatment from Novem- ber 10, 1903, to March 20, 1904. At the latter date she seemed perfectly well, although there still remained a little en- largement of the joint of the middle finger. Now, many months after the cessation of treatment, she reports con- tinual increase in health and strength and thinks that the greatest benefit has come since the course of treatment was finished. This answers the question of- ten asked as to whether the benefit is not merely temporary and whether the treatment does not have to be continued indefinitely. Q. HIGH FREQUENCY, HIGH POTEN- TIAL CURRENTS, AND X-RADIA- TION IN THE TREATMENT OF EPILEPSY Samuel G. Tracy, N. Y. Med. Journal and Phila. Med. Journal, March 4, 1905. Tracy states that there are I2,500 epileptics in New York State, 2,500 of whom are public charges. Under the usual methods of treatment little hope is offered these unfortunates and the cures hitherto have not amounted to more than 8 per cent. He claims his method of treatment has given him better results than the older methods. He calls attention to the value of the bromides, and in certain cases considers its use indispensable, but believes that when used in conjunction with electricity and the X-ray less of the bromide is necessary and in some cases it can be dispensed with entirely. If the disease is due to alcoholism or fright, a cure may be effected by remov- ing the cause. During the convulsion he places the patient on his back and re- strains him moderately, so as to prevent him from injuring himself; the clothing is loosened about the neck and waist and the patient given plenty of fresh air. During the sleeping stage, follow- ing the convulsion, he places the patient in a comfortable position and does not I48. MISCELLANEOUS ABSTRACTS disturb him. When he awakes concen- trated nourishment is administered. Any exciting or reflex cause, such as worms, autointoxication, adherent pre- puce, foreign bodies in the ear or nose, naso-pharyngeal polypi, defects of vi- sion, eye strain, injuries to the scalp or skull must be attended to and the re- moval of such conditions frequently al- leviates or cures the disease. The galvanic and faradaic currents have been used with little success. He quotes Riggs as saying that epilepsy may be considered a paroxysmal dis- charging disease of the highest nerve center level, as described by Jackson. He considers that the proper applica- tion of the high-frequency currents have a remarkable nutritional effect on the brain, thus restoring the nerve centers to their normal function. The effects on the nervous system are marked. Freund states that melancholia and hy- pochondriasis are benefitted by this treatment as are hysteria and neurasthe- 111al. Tracy has found that decidedly bene- ficial effects are obtained in epilepsy by high-frequency currents combined with X-radiation. In some cases these are employed alone, in others I 5 to 60 grains a day of the bromide of sodium are administered as a side treatment. Both grand and petit mal are treated in much the same manner. Chronic cases do better when the treatment is combined with small doses of bromides. In females double the bromide just be- fore and during the menstrual period. Each patient is treated every other day. First, five to ten minutes X-ray treat- ment from a high tube placed 6 to Io inches above the head. Following this high-frequency currents are applied over the brain for IO minutes, and for 5 minutes over the spine. When this method is employed in conjunction with small doses of bromide, at least 25 per cent. of the petit mal cases may be tentatively cured, 20 per cent. of Jack- sonian epilepsy, and I2 per cent. of grand mal. All cases treated were im- proved more or less, both as regarded the frequency and severity of the seiz- ures, and in addition, the general men- tal and physical condition were much improved. Sufficient time has not elapsed to show how permanent these results will be. Nevertheless Tracy believes that he is on the right path. He reports several cases showing great improvement under this line of treatment. He believes that the high-frequency currents possess the power of liberating a larger quantity of the bromide as the solution of the salt circulates in the brain, thus smaller doses of the drug have more pro- nounced effects. He concludes that in the treatment of epilepsy all reflex disturbances must first be eliminated. In the high-frequency current we have an agent which acts as a nerve sedative, controls local con- gestion, and promotes the normal func- tional activity of the nerve centers, and in addition where the bromides are ad- ministered this electric modality sets free larger amounts of bromine in those areas of the brain where the lesion of epilepsy is likely to be located. RADIO-DIAGNOSIS THE X-RAY IN KIDNEY DISEASE Louis Gregory Cole, Medical News, March II, IQO5. Within the last year or so improve- ments in apparatus and technique have rendered it possible to make reliable neg- ative and positive diagnoses of renal and ureteral calculi, in subjects of moderate size. This is rendered possible by using what Cole designates as “the ray of se- lective absorption.” It is possible to show some renal calculi without this ray, RADIODIAGNOSIS I49 but such plates are worthless in making a negative diagnosis. Another factor which is apt to produce errors of inter- pretation of the plate is “fogging the plate by rays that go around the patient instead of through him.” Cole makes a skiagraph of patients weighing 130 pounds or less by expos- ing for from 5 to 20 seconds. As the efficiency of the apparatus in- creases, the difficulty of interpreting the plate also increases. We have the shad- ows of bone, muscle, calculi, feces, undi- gested food in the intestines, calcareous nodules or arteries and tuberculous de- ‘posits in the kidney to differentiate. Carcinoma of the lower end of the Oesophagus is also said to be observable. Any or all of these conditions might be mistaken for renal or ureteral calculi. Near the lower end of the ureter there are frequently found shadows which closely resemble ureteral calculi as re- gards both size and shape. Just what they are has not yet been determined, but the source of error due to their pres- ence should be borne in mind. The size and shape of the calculi should be de- monstrable in order that the diagnosis . may be complete. Cole locates the tube vertically over the umbilicus and eight- een inches distant from the plate. In order that a negative diagnosis may be relied upon “the spine and transverse process of the lumbar vertebra must show distinctly clear-cut edges all the way to the tip. The last rib and psoas muscle must also show. The kidney and wall of the intestines may show, but are not really necessary for even a negative diagnosis.” - In 179 cases he has failed once to show a renal calculus when it was pres- ent; this failure was due to the plate not extending high enough to cover the kid- ney region, and twice he has made a di- agnosis of a possible renal calculus where it did not exist. One of these was in a case of a man weighing 217 pounds and the mass was found to be feces; the other, a woman weighing over 200 pounds, and the shadow was cov- ered by gallstones and carcinomata of the head of the pancreas. In neither of these cases was he able to detect the size or shape of the supposed calculus. A WARNING AND A PROTECTOR FOR X-RAY WORKERS' Arthur Holding, Medical Record, March 25, I905. Holding reviews the injuries and dan- gers to which X-ray workers have been found to be liable, the latest being sex- ual sterility, and wonders if the next decade will show us as many unexpected dangers as has the last. He states that the liver, spleen, heart, kidneys, intes- tines, brain, blood, and lymphatic sys- tem may prove susceptible to the delete- rious action of the X-ray and suggests the advisability of all X-ray workers being thoroughly protected. The ordi- nary screen and protectors are either cumbersome, inconvenient or inefficient, and he suggests the use of “a lead par- tition between the operator and the X- ray tube. Such a protector can be ar- ranged by having the switchboard mounted on the side of the X-ray room farthest removed from the X-ray appa- ratus, and placing a strong oak framed screen, covered with two layers of sheet lead, each 1/16 of an inch thick, be- tween the operator and the X-ray tube. This screen should be about six feet high and three feet wide. A mirror can be arranged on pivot supports at one end of the screen, so that the operator can see the reflection of the fluorescing tube, and need not look directly at it. “Such a device gives more protection than most X-ray workers have been using in the past. It is too early to say whether it will secure absolute safety for the radiographer.” () RADIOTHERAPY DANGERS FROM THE X-RAY AT- MOSPHERE TO THE OPERATOR. THEIR PREVENTION H. W. Van Allen, Boston Med. and Surg. Jour., March 9, 1905. Seven patients who had been subjected to repeated radiations several months previously were examined to ascertain whether or not any effect had been pro- duced upon their sexual capacity. All had been rayed in the genital region so that the testicles were exposed to influ- ence, more or less dermatitis had been produced, and all were sexually normal when examined as far as they knew. None of them had been rayed for malig- nant disease and all were in good health when examined. The results were as follows: Case I. — Had had twelve treat- ments four months previously; sperma- tozoa were found to be present and nor- mal. Case 2. — Twelve treatments one year previously; spermatozoa normal. -Case 3. — Thirty-five treatments five months previously; spermatozoa absent; had had children and no other cause of sterility was discoverable. Age 38 years. Case 4. — Ten treatments one year previously; spermatozoa normal. Case 5. — Fifteen treatments four months previously; spermatozoa absent. Age 56. Case 6. — An X-ray tube maker who had not been exposed to the rays for six months; spermatozoa absent. Age 42. Case 7. — Forty-five treatments four- teen months previously; spermatozoa absent; had had children. Age 40. In cases I, 2, and 4 very decided der- matitis had been provoked, while in cases 3 and 7 scarcely any reaction was present, demonstrating that dermatitis had nothing to do with the absence of spermatozoa in these cases; their ab- sence occurred in the cases which had had mild exposures for long periods. Thus the sort of X-ray influence which produces this abnormality is the very one to which the operator is ex- posed and nearly all X-ray workers of experience show its effects, to a greater or less extent, in the form of dryness and yellowness of the skin, modification of structure in the nails and hair, intesti- nal indigestion, drowsiness, mental irri- tability, lack of mental concentrative power, etc. Radiographs are said to demonstrate a prematurely sclerotic condition of arteries in the thinner parts of the body in some cases. It may be that serious structural changes in the internal viscera will ultimately obtain. These are all signs of premature senil- ity and Van Allen believes them to be due to inhibition of cell production “through degeneration of the arterioles. It is in this way that epithelioma yields to its influence. The abundant blood sup- ply needed for its growth is cut off and recovery takes place. In the same way many of the symptoms complained of by the operators are explained.” To protect the X-ray worker it is suggested that all of the X-ray appara- tus except the tube, be located in one room, the tube being in a contiguous apartment with the patient. The wall between these rooms should be covered with lead at least 1/32 inch thick. The wires to excite the tube could be carried through the wall and a hole should also be so located in the wall that the tube could be watched while in action by the operator on the other side of the lead covered wall; this peep-hole should be covered by glass such as is used for cut- glass ware, which contains sometimes as high as 20 per cent. of lead. Another arrangement by which the tube could be (I 50) RADIOTHERAPY I5 I watched would be by arranging mirrors at proper angles over the aperture in the wall. This arrangement would, of course, not permit of fluoroscopic examination, but the proportion of cases in which fluo- roscopy is necessary or advantageous is so small that this is not a factor to be con- sidered, in this connection, as a serious objection. REMARKS ON THE RESULT OF X- RAY TREATMENT IN SEVERAL CASES OF CARCINOMA OF THE |UTERUS Sinclair Tousey, New York Medical Journal, March II, I905. The first case was that of a large, handsome woman of 50 years who had suffered from an enormous fibroid tu- mor of the uterus which had finally un- dergone carcinomatous degeneration of the cervix. There was a profuse san- guineous discharge, a very offensive odor, and great loss of strength. In February, 1903, she had taken ether for the purpose of having the tumor re- moved, but it was found that the entire pelvis was one carcinomatous mass and that anything like an attempt at extir- pation would be immediately fatal. A small portion of the cervix was removed and examination showed it to be carci- noma. She was brought to Dr. Tou- sey's office for X-ray treatment. The abdomen was found to be distended by the tumor, giving almost the appearance of the completion of gestation. There were very painful and somewhat tender areas corresponding to the positions of the broad ligaments. The vaginal por- tion of the uterus was cartilaginous to the touch, as were also the anterior vagi- nal wall, the urethra, and the entire for- nix. There was a profuse bloody dis- charge with offensive odor. The treatment consisted in allowing the X-ray to shine through the uncov- ered abdominal wall, and through a º Nott's speculum which has a duck-bill blade posteriorly and two divergent blades anteriorly; and in the application of high-frequency currents over the two painful areas. The current was from the I IO volt direct current. The Cald- well liquid interrupter was used, giving about IO,OOO interruptions a minute. An 8 inch coil was used, and the tube was a 40 cm. Gundelach tube, the strength of the primary current being about 4.5 amperes. The vacuum in the tube was adjusted so as to correspond with a resistance of about 2% inches, and a penetration of two or three layers in the author's radiometer, each layer consisting of tin foil weighing one ounce per IOO square inches. The distance was 9 inches from the anti-cathode of the tube to the nearest surface of the pa- tient, and the time of exposure was about 5 minutes over the abdomen and 5 minutes through the vagina. The high-frequency currents as used in this particular case were taken di- rectly from one pole of the X-ray coil by means of an insulated cord passing to an insulated handle by which the oper- ator held a glass vacuum electrode. When in operation this tube is filled with IO,OOO rays a minute of ultra violet and violet light passing into the patient's tis- sues and disappearing. A certain amount of ozone is produced and some of this is carried in by the current, while some remains upon the surface. The result of the treatment was the very prompt disappearance of pain, and of the discharge and odor. . There was at first a little general disturbance possi- bly due to the elimination of morbid products. In the course of four months the fibroid had diminished one-half in size, the discharge, odor, pain, and weakness were things of the past. There was scarcely any change in the cervix and vagina. She was then re- ferred back to her family physician, and continued well and happy for a whole year. At the end of that time she devel- I52 MISCELLANEOUS ABSTRACTS oped some gastric symptoms and sank very rapidly. Reviewing the case, the Doctor was confident that the woman's life was pro- longed for a year by the X-ray, and during almost all that time she was per- fectly comfortable. Another case was a woman 50 years old, from whom a tremendous fungat- ing mass had been amputated from the cervix and the treatment consisted in al- lowing the X-ray to shine through the abdominal wall and also applying it di- rectly to the vaginal fornix by means of a treatment tube. In this instrument there is a prolongation directly opposite the anode through which the X-ray passes and which may be introduced through the vagina or other cavity. The entire X-ray tube is constructed of lead glass opaque to the X-ray except at the extremity of the intra-vaginal prolonga- tion. The application over the abdo- ment was with a 40 cm. tube of medium vacuum and a current of about 4 am- peres. It lasted about 5 minutes at a distance of 9 inches from the anti-ca- thode. The application in the vagina was with a current of about 3 amperes and lasted about 3 minutes. High-fre- quency currents were also applied over the abdomen and up and down the spine aS a ton1C. The treatment was begun October I, I903, and was given on an average once a week until December 3, 1903. The effects were diminution of pain and very marked decrease in the amount of the discharge, but the patient's strength steadily failed, and treatment had to be suspended. She died about two or three months later. Another case was a woman about 35 years old, in whom the discharge and size of the tumor had been kept down and the patient's general appearance im- proved. A condition almost like that of health has been continued almost for a year. Treatment has been through the abdominal wall and through a vagi- nal speculum. Mild applications have been made twice a week. Several other cases are given in detail in which all the symptoms have im- proved very much; but the treatment does not appear to have actually cured any of them. He very strongly recommends the adoption of the treatment at any stage before a recurrent cancer has too far sapped the patient's vitality. THE PRESENT STATUS OF THE ROENTGEN RAY George Coffin Johnston, St. Louis Medical Review, March 18, 1905. The late advances in the diagnostic use of the X-ray have been principally along the line of more efficient work, the production of better radiographs with shorter exposures and improvements in instrumentation. That it has become an agent of unspeakable value in the diagnosis of obscure conditions is proven by the number of cases of severe hip joint disease in which the radiograph demonstrates pathology of the sacro- iliac synchondrosis, “rheumatic ankles’ which prove to be osteosarcoma, “teno- synovitis” which prove to be tubercu- lous osteitis, etc. The development of radiographic technique in renal calculi has reached a point where a negative finding is en- titled to respect, provided the operator is skilled. In a series of 42 cases exam- ined for renal calculi by Johnston no error has been made as far as is at present known. In 16 of these cases calculi were diagnosticated radiographi- cally and removed surgically. In six of them operation was refused, hence the radiographic finding has not been con- firmed. In one case of small stone in the ureter the stone was passed on the night following the examination. In one case wherein was present a quantity of cal- RADIOTHERAPY I 53 careous material in the bladder of a very obese subject the radiograph failed to show it. The calcareous material was removed later by crushing and washing out. The personal factor in the equa- tion of radiographic reliability is con- sidered to have a value of IOO per cent. Whereas gallstones have been found and a positive diagnosis is reliable, a negative diagnosis cannot at present be considered conclusive. Johnston has invented a fluoroscope consisting of a box which holds the tube in a fixed position. This box is X-ray proof and so constructed as to permit of the passage through a special window of a pyramid of rays which, at a distance of ten inches from the tube, is just 8x10 inches at the base. “At this point, then, the screen of the fluoroscope is intro- duced, and the X-ray field is just large enough to illuminate fully the screen, in- stead of half as in the old method. The fluoroscope is of a new construction, radi. cally different from the old instrument, which consists of a “reflecting mirror set at an angle of 45 degrees to the fluores- cent screen and reflecting the image on the screen to the eyes of the examiner, who is stationed at the side of the tube, totally removed from the field of X-ray influence.” By the use of this device the operator does not need to fear the pro- duction of burns. Johnston considers that the treatment of acne, sycosis, eczema, and lupus is complete only when this agent is used, and that superior results are obtained in these conditions to those secured by any other agent. The great trouble is that few men can afford a proper grade of apparatus, and fewer will give the time and trouble necessary to learn how to use it properly. In malignant growths it is very effi- cient in preventing recurrence, and the treatment should be applied as soon as the state of convalescence is established; it is also recommended that a “few hard radiations '' be administered over the site of operation and a considerable distance beyond it, before removal. Johnston has seen excellent results follow opera- tions when this has been done, upon cases which were so hopeless that extir- pation would not have been undertaken by a surgeon but for the promise held out by the X-ray. In sarcoma many good results in cases which would other- wise have been hopelessly doomed to early death have been obtained. As regards treatment of tuberculosis Johnston says: & “The treatment of the various forms of tuberculous skin, bone, and joint dis- ease is very satisfactory and certain and here the X-ray has undoubtedly done wonderful work. In the treatment of pulmonary tuberculosis the results are fair, but not better than under many other older methods.” He concludes as follows: “Ist. The X-ray is today a more useful adjunct to medicine and surgery than at any time since its discovery. “2d. Its employment today requires a higher degree of skill than of old. “3d. As a remedial agent its use is becoming more circumscribed as to the number of conditions treated, but these are better treated. “4th. Its place is that of skilled as- sistant to the surgeon. “5th. Its general value, post opera- tionem, to prevent recurrence of malig- nancy, is admitted but its limitations here are yet undefined. “6th. Radiotherapy is the practice of both medicine and surgery, and must be confined strictly to the profession. “7th. The present friendly attitude of the surgeon promises well for the ad- vancement of scientific X-ray work, and better results in the surgery of malig- nancy.” I54 MISCELLANEOUS ABSTRACTS THE VALUE OF RADIOTHERAPY IN GLANDULAR AND CUTANEOUS DISEASES Russel H. Boggs, St. Louis Medical Review, March 18, 1905. Sufficient work has now been done to determine pretty thoroughly the value of the Roentgen rays as therapeutic agents in certain diseases, and those who have made a careful study of X-ray therapy realize and appreciate their value in these diseases. In some cases cures result, in others only benefit, but positive results are more convincing than negative and failures can frequently be accounted for by lack of experience and skill on the part of the operator or the nopelessly advanced condition of the disease when the patient came under treatment. While many skin lesions can be cured |by this method, it is unwise to apply it to the trivial affections which can be cured by other methods much less ex- pensively. The differences of opinion existing among dermatologists as to the value of Roentgen therapy are probably due to differences in technique employed |by the different operators. “The Roent- gen rays must be prescribed and given in a therapeutic dose for each disease, in order to produce results. The dosage depends upon the quality and quantity absorbed, and one of these factors is equally important with the other in giving a therapeutic dose; to do the most successful work, they must be 'varied to suit each individual case. “It is a well known fact that tissues are not always affected to the same ex- tent by the same dose, any more than the same dose of a drug will always pro- duce the same physiological action. But by studying the patient and the disease, just as before prescribing drugs, almost as uniform results in producing reac- tions can be obtained.” Boggs does not believe that idiosyn- crasy is frequently a cause of excessive dermatitis, but a diseased area will react more readily than normal tissue simply because the vitality of the cells is lower. If it requires Ioo units of X-radiation to cause reaction in a certain diseased area it may be safely assumed that it will require 200 units to produce the same degree of reaction in healthy areas. If the dose is very small stimulation takes place, whereby nutrition is in- creased, but if the dosage is larger atrophy and degeneration will follow as a result of excessive stimulation. Acne constitutes a disease of con- siderable prominence in connection with X-ray therapy because it is so often ex- tremely resistant to the older methods. The rays give uniformly better results than curettage or incision, which alone is amply sufficient to justify the treat- ment of all cases of the pustular type by the X-ray; it is not, however, always necessary or desirable to treat acne of the milder form by this method. He considers that the X-ray cures acne by inducing a leucocytosis. Seventy-five per cent. of all cases of acne can be cured without producing dermatitis, but in the other twenty-five it will be necessary to provoke reaction to the degree of peel- ing produced by severe sunburn. Boggs believes that cases cured without the production of a reaction are much more apt to recur than those in which the ap- plication has been severe enough to be followed by peeling of the skin. In lupus no other agents can be com- pared to the X-ray and Finsen light as regards efficiency. In Europe the Fin- sen light is the favorite, while in this country the X-ray is most used. ' The method of using it in the different coun- tries is probably responsible for the dif- ferent preferences. The X-ray pro- duces quicker results than the Finsen light, and Boggs usually begins the treat- ment of these cases with the X-ray, con- tinuing the same until a slight derma- titis is produced, and then substitutes the Finsen light. He thinks that time is RADIOTHERAPY I55 thus saved and that the results obtained are better. Cases of lupus vulgaris that cannot be so cured are either not treated for a sufficient length of time or the disease is very extensive, involving deeper tissues and the patient not in a healthy physical condition. He advo- cates continuing treatment for some time after all visible signs of the disease have disappeared, giving enough treatment to produce a slight redness again. When this plan has been followed out in his practice he has seen no recurrence. A few cases have been reported of Hodgkins's disease as cured, and the hopelessness of this condition under or- dinary treatment renders it justifiable to give these patients the benefit of what good the X-ray will do. A remarkable improvement of the general condition almost always follows after only a few radiations. A few cases of goitre have responded readily to the X-ray when all other forms of treatment had failed. In some of his cases the growth has been reduced only one-half, but the symptoms of the disease have disappeared, and he considers this sufficient evidence to justify subjecting these patients to this treatment. As illustrating the comparative cura- tive effects of surgery and the X-ray in cancer he quotes from Dr. Hulst, who compared these effects to the results ob- tained by shoveling snow from a side- walk. No matter how thoroughly the shovel had been used still there remained in the cracks a small amount of Snow. This snow can be removed by means of salt. The surgical operation may be likened to the shoveling of the snow and radiotherapy to the sprinkling of the salt. He concludes as follows: “I. It is necessary to distinguish between the diseases which should, and those which should not, be treated by the X-ray. “2. While the continual cry of tech- nic may become tiresome to some who think the subject can be mastered in a few days or a couple of months, the method of application of the rays and the judgment of the operator account largely for successful or unsuccessful work. “3. It is just as essential to admin- ister a therapeutic dose, when applying the Roentgen rays, as it is when pre- scribing powerful drugs. “4. Idiosyncrasy is not a frequent cause of excessive dermatitis. { { A dosage that causes stimula- tion of healthy tissues will usually pro- duce a slight reaction in diseased tissue. “6. At all times it should be remem- bered that it is not so much the X-ray that cures, as the judgment with which the rays are employed. “7. The X-ray is one of the best therapeutic agents known for the treat- ment of acne and many other skin dis- eases, but it is unnecessary in many instances to treat the trivial and less obstinate cases by this method. “8. The X-ray, supplemented by the Finsen light, is the most efficient thera- peutic agent for the treatment of lupus. “9. The X-ray is the most efficient agent for the treatment of certain tuber- culous glands, Hodgkin's disease, and selected cases of goitre. “Io. Unless the operator has had a wide experience in the treatment of carcinoma, he should always consult a surgeon in each case, as it is certainly by the combination of surgery and X- ray that the best results can be obtained.” RADIOTHERAPY AND SURGERY, WITH A PLEA FOR PREOPERA- TIVE RADIATIONS William J. Morton, Medical Record, March 25, IQO5. Attention is called to the fact that if X-rays are applied mildly stimulation results: if excessively, degeneration and necrosis. Previously it was recom- mended to apply X-rays to epithelioma I 56 MISCELLANEOUS ABSTRACTS so extensively as to produce a “caustic effect” or a severe dermatitis; today only a mild dermatitis for the first series of sittings is allowable. Radiation used to be carried over a period of several months, but now a maximum effect is secured in from 4 to 6 weeks, and then an interval of half that period allowed to intervene before treatment is resumed. If treatment of a “facial epithelioma is continued after it has fairly cicatrized the whole area is very apt to break down and produce a condition worse than the first; hence the rays should be stopped when the case appears to be cured. Morton prefers to use a hard tube, not less than 5-inch spark resistance, three or four amperes in the primary circuit at 60 volts, anode nine inches from the lesion, and an exposure of I 8 minutes three or four times weekly. By follow- ing this plan he believes a serious burn is impossible. - Two cases of rodent ulcer which re- covered under X-radiation are reported. The first was a woman aged 57, in whom the process had begun ten years pre- viously. During this time she had been subjected to all sorts of treatment, the last having been an extensive operative ablation. The ulcerative process had been and was rapidly progressing; it showed hard infiltration in places. Pa- tient was put upon fluorescin, six drops of an aqueous solution, three times a day, and X-ray treatments. The pain diminished at once and in two months process had entirely disappeared. The second was a woman aged 52, who exhibited an ulcerated tumor over the left temple IVA inches in diameter and raised up above the level of the healthy skin about 1/3 of an inch. Mi- croscopical examination demonstrated it to be a rodent ulcer (superficial epithe- lioma). About ten weeks of treatment produced complete disappearance. Case three was a malignant tumor I V4 inches in diameter lifted about a quarter of an inch above the surrounding skin, occurring on the left cheek under the eye of a man 60 years old. He was ra- diated at intervals for a period of five months with entire cure as a result, Mi- croscopical examination showed the “cancer nests' characteristic of epithe- lioma. When seen early Morton believes that epithelioma involving the lymphatic glands and deeper structures of the face, neck, tongue, and throat, can be cured, and cites, as demonstrating this fact, the case of a physician 55 years old who consulted him for an ulcer upon the tongue. This patient had been advised by two or three surgeons of high repute to submit to surgical ablation, but at Dr. Morton’s request the patient refrained and allowed continuance of the X-ray and radium applications. Complete cure resulted in two months. Some cases of extensive sarcoma which have been cured by X-rays have been reported, but more failures. It is believed that there is ground for hope in this direction. If primary carcinoma of the breast is seen early a cure may be effected by X- ray therapy, even though the lymphatics are indurated and swollen glands exist in the axilla. Other types of mammary cancer on the other hand will proceed to the formation of metastases in spite of any amount of radiation. Other tu- mors in this situation, again, will be di- minished to a great extent, but a hard, clearly defined mass will persist in spite of radiation, and this should be removed surgically. Morton believes that the best treat- ment of cancer is to combine ablative surgery, X-rays, and radium radiation, and his invariable practice is to apply X-ray and radium radiations thoroughly about eight weeks before operation and apply after operation for about the same period. Action is carried just short of producing a mild dermatitis. He bases his belief upon the fact that outlying areas of cancer infection are rendered RADIOTHERAPY I 57 healthy, and that pre-operative raying does strongly localize the trouble, upon the following: “I. By the facts of the observed effect in many cases of recurrent cancer of the skin where this actual fact may be visibly studied and may be verified by palpation. Nothing is more common in the history of radiation than to see large areas of skin-infected carcinoma clear up, leaving a healthy skin. “2. By the early cure of recurrent cancer in cicatrices. “3. By observation of the behavior of cancer of the mucous membrane, where under radiation a distinct line of demarcation unfolds itself between the affected and the sound mucous mem- brane, and by that sign affords a new in- dication to the surgeon of where to in- cise. “4. By palpation of indurated lym- phatic vessels in breast cancer. Take a concrete instance of this alone. What surgeon would prefer to cut through in- filtrated lymphatics, when he could later on cut through flexible and disinfected lymphatics?” Confirmatory of his belief that ma- lignant processes are localized and sepa- rated, by a line of demarcation, from healthy tissues, he reports a case of epithelioma of the posterior region of the tongue and involving the velum pa- lati. Five days after radiations were commenced, after three treatments, he observed that a serpentine line of demar- cation had appeared on the mucous mem- brane of the hard palate separating the healthy tissues from the diseased ones. The red, dusky inflammatory tissue ended sharply at this line and from it onward the mucous membrane had now assumed a light colored pink and healthy tone. Such demarcation is very helpful to the surgeon in determining how much tissue to remove. Morton believes that pre-operative X-radiation of cancer should precede every operation with as much reason and force as pre-operative aseptic or antiseptic cleansing of the skin to be incised, and that an early X-ray treatment is the most important thing for the patient as well as early operation. A case that would be curable by opera- tion, also is as likely to be curable by ra- diation. With those that were curable by radiation the operation would not of course be necessary, and if the X-ray failed in a reasonable time then the pa- tient would be in better condition than before to submit to operation. He con- cludes as follows: “I. Radiation treatment exerts a retarding effect upon the growth of some Ca.11CCTS. “2. It cures some cases — the ratio to operative measures is not here dis- cussed. “3. Pre-operative radiation will in- crease the ratio of cures by operation. “4. Pre-operative radiation trans- forms some inoperable cases into oper- able cases. “5. Pre-operative radiation is rec- ommended as a precautionary measure, probably quite as important as pre-op- erative antiseptic preparation for surgi- cal operation.” X-RAY TREATMENT OF CUTA- NEOUS EPITHELIOMA C. M. Williams, American Journal of the Medical Sciences, March, IQoS. This report is stated by the author to be intended, especially, as a contribution to knowledge concerning the liability of a recurrence of cutaneous epitheliomata which have disapepared under Roentgen radiation; 18 cases are fully described, as regards both their behavior under radiation and their condition afterward up to the date of publication. Of the total 18 cases, one died of some intercurrent disease; four were so irregu- lar in their attendance or under treat- ment so short a time that conclusive I 58 MISCELLANEOUS ABSTRACTs judgment as to what the ray was capable of was not possible; one showed no im- provement after having been treated a month; in one case the condition was improved, but the lesion did not entirely disapepar; and in another the lesion dis- appeared, but recurred seven months later. Ten cases were apparently en- tirely cured, and none of them had ex- hibited any indication of recurrence after periods of four to eighteen months. The case that showed no improvement was a rapidly-growing epithelioma of the lower lip, a type which is believed to respond reluctantly to Roentgen radia- tion as a rule. That lip cancers do re- cover under radiation, however, is proven by the fact that one of the cured cases of this series was such a lesion. The case in which the lesion improved but did not entirely disappear exhibited a characteristic also present in other cases which were difficult to influence fa- vorably, viz., there was present a mass of almost stony hardness, deep in the skin and subcutaneous tissue, covered wholly or in part by apparently normal epithelium, and exhibiting little tendency toward ulceration; if an ulcer is present it heals readily, but the hard mass under- neath is affected but little or not at all. Williams believes that such cases require very vigorous treatment, and that some of them will not yield even then unless an ulcer is produced. Concerning technique Williams states as follows: w . “I. The distance between the tube and the lesion should be made as short as is consistent with the avoidance of sparking from the apparatus to the pa- tient. In treating a large area, like an extensive psoriasis, this rule does not hold. With a small lesion, as is usually the case in epithelioma, it reduces the time of exposure very materially; for since the quantity of rays received on a given surface varies inversely as the square of the distance between that sur- face and the anode, it follows that an exposure of four minutes at four inches is equivalent to one of twenty-five min- utes at ten inches. - .. “2. The screen used to protect the normal parts need not be entirely opaque to the X-rays. I have used ordinary rub- ber sheeting, folded into three layers, and have repeatedly carried the treat- ment to the production of a moist der- matitis of the exposed area, while the parts covered by the shield remained en- tirely unaffected. This seemed to show that the rays which affect the skin have very little power of penetration. The advantages of this material are the ease of manipulation and the avoidance of the disagreeable tingling so often noticed when lead is used.” - METHODS AND APPARATUS FOR THE MEASUREMENT OF RADIO- ACTIVITY C. Cheneveau, Le Radium, December, 1904. The subject is discussed under seven sections, setting forth in detail most of the methods that have been successfully employed in the quantitative determina- tion of radioactivity. . I. The photographic method is spoken of as rather uncertain except for qualitative test from a mineralogical point of view. The most sensitive effect of radioactive substances is the power they have of rendering conducting the air in their vicinity. Most of the active meters yet devised depend on this prin- ciple. - - - II. The construction of the well- known Curie electroscope is given in de- tail, the principle of which is the erection and rate of collapse of a single, thin, metal leaf. The charged instrument is discharged slowly or rapidly, according to the quantity and power of the sample under test. . \ III. The “electrometric method '' is the name applied to that method depend- ing on the well-known behavior of quartz AERO-THERAPY I 59 under stress. The electrification devel- oped by the quartz is proportionate to the applied stress in the form of known weights, and hence if this is opposed to the action produced by the active sub- stance, and a balance brought about by suitably adjusting the weights, the latter readily furnishes a measure of the ac- tivity of the specimen. IV. In this section more sensitive electrometers are described, suitable for the detection and measurement of even traces of activity. The Kelvin quadrant electrometer, as modified by the Curies and by Dolezolek, is described and recommended for this work. The needle is very light and suspended, in the Curie type, by a fine platinum filament serving for a conductor as well as for furnishing the required feeble torque to balance the electric force movement. The dimen- sions of a convenient and efficient instru- ment are given with great detail. In the Dolezolek type the suspension is a quartz filament sometimes silvered. V. In this section a more complicated instrument, depending on the “piezo’’ quartz principle, is described in detail. The arrangement is due to the Curies, and furnishes far more exact quantitative results than the simple device spoken of in section III. A simple formula, L F O. 6 + F Q. O.O 3E 2 gives the constant charge developed by the quartz under the stress, F, L, and E being constants of the instrument. VI. VII. Here are described more in detail certain important parts of the electrometers, e.g., the condensing plates for receiving the active material, a con- venient form of small storage cells for charging to constant known potential the instruments when in use, etc. AERO-THERAPY. LIQUID AIR AND ITS POSSIBILI- TIES Samuel G. Tracy, The Medical Brief, Feb- ruary, IQO5. The liquefaction of gases has occu- pied the attention of scientists for over a century. The first gas liquefied was chlorine. This was accomplished under pressure, in 1806, by Northman. Since then various physicists have accom- plished the feat with various gases, but the liquefaction of air was not accom- plished until 1883, by Wroblewski. It was not furnished for practical purposes, however, until 1892, by Professor James Dewar. Its price today is $10.OO per gallon, as made by the Tripler system in New York city. The process of its manufacture is as follows: “The natural air is compressed to the extent of 2,000 to 2,400 pounds to the square inch. This is allowed to escape and pass through certain small openings, each protected by its own valve, into tubes which coil upon themselves, over and over again, thus. cooling off the air more and more as it enters the liquid. The cooled compressed air is now allowed to escape into a vacuum, and a sudden and extreme ex- pansion results. By this method the two. necessary conditions are obtained to pro- duce liquid air, namely, critical tempera- ture" (or the temperature at which a gas liquefies, 220°F. below zero in the case of air when the critical pressure is also applied) “and critical pressure" (tension at which a gas liquefies). “The liquid air may now be drawn from the liquefier just as water is from a faucet, and its appearance is like that drawn from the hot water faucet, boiling and steaming.” Even when it became possible to make liquid air at a comparatively inexpensive rate, its usefulness would have been lim- ited, and, in fact, of no avail in medicine I6O MISCELLANEOUS ABSTRACTS and surgery except for the invention of a bulb by Dewar. This bulb is known as Dewar's bulb, and is used to hold this extraordinary product. It is a glass vessel, with two walls. The space be- tween is exhausted to high vacuum. When liquid air is contained in one of these bulbs it evaporates at one-fifth the rate it does in an ordinary glass recep- tacle. Later Dewar found that when the inner and outer wall were coated with a bright deposit of silver the evapora- tion was only one-sixth that from an ordinary vessel. Even with these Dewar bulbs, the proposition to sell the product to physicians does not seem attractive to the manufacturer, because of evapora- tion and because the bulbs are easily broken and cost from $3.75 to $12.00 apiece. Physiological effect. “When liquid air is applied to the skin and tissues of the body, the parts are immediately frozen. The solidity of the tissues de- pends on the amounut of liquid air used and the length of exposure. The result of this application is, first, anaemia of the part, followed by reddish reaction or slight inflammation. Then, if the freez- ing has been severe, there occurs a bulla, involving a smaller or larger area, de- pending upon the length of application.” Liquid air “is not only a local anaes- thetic, but much or little anaesthesia can be produced with it in a few seconds' time. The anaesthesia lasts longer and is followed by less sloughing than any other freezing mixture. There is slight pain attending its application as an anaes- thetic. After the degree of anaesthesia has been obtained, a minute or more should elapse, as the tissue may be too hard for satisfactory operative proce- dure.” *. Liquid air is applied with a swab, a flat wooden applicator about eight or ten inches long, on the end of which is wound some absorbent cotton. This applicator is dipped into the liquid, then shaken to remove the excess of this extremely cold fluid, and applied with firm pressure to the area to be treated. The application should last from twenty to sixty seconds, depending on the tissues to be affected. In many cases it is well not to treat more than a square inch of surface at one ap- plication. These treatments may be re- peated from twice a week to once in two weeks, the frequency of the application depending upon the amount of reaction induced. The histories of several cases of epi- thelioma and naevus which were treated with success by liquid air are related. In lupus erythematosis, where the lesion is not too large, liquid air has proved more satisfactory than any other reme- dial agent. As a résumé of the uses of liquid air, he says that: “First — It acts as a local anaesthetic. “Second — It reduces inflammation when cold is indicated. “Third—Stronger, more frequent applications produce stimulation and in- flammation of the parts, producing a slough, by causing an obliterating endar- teritis, and the destruction of nerve sup- ply. . “Fourth — Liquid air has a selective action for diseased tissue on account of its low vitality. “From the physical and physiological action of this new and remarkable thera- peutic agent, it certainly appears to be worth while to make use of it, in such conditions as lupus erythematosus, super- ficial epithelioma, some cases of scir- rhus cancer of the breast, indolent ulcers, abscesses, and particularly in the various forms of navi.” The most spectacular results have been attained in cases of cavernous or inpigmented naevi. Yºº. º * * * * * = } sºil {*: 2kºl *- §I. et #TTÜ * Printed at The Gorham Press, Boston, U.S.A. ſº sº * º: º P. J. Fºx, ſ ** § * .# A , ºr tº £ . Aſ .. # /4 §ptrial 3&otntgen Øuntuttgarp flumber ºA 47 / s MAY. 1905 & 72.57 MAY, THE ARCHIVES OF PHYSIOLOGICAL THERAPY Devoted to the Diagnostic and Therapeutic Uses of Electricity, Radiant Energy, Heat, Water, Mechanical Vibration, Dietary Regulation, Exercise, Psychic Suggestion, etc. PUBLISHED MONTHLY WITH ILLUSTRATIONS EDITED BY CLARENCE EDWARD SKINNER, M.D., LL.D., NEw HAVEN, CoNN. In conjunction with CARL BECK, M.D., New York, N. Y. GORDON GRANGER BURDICK, M.D., CHICAGO, ILL. JAMES KING CROOK, A.M., M.D., NEw York, N. Y. ADOLF DECKER, M.D., CHICAGO, ILL. GUSTAVUS ELIOT, A.M., M.D., NEW HAVEN, CONN. WOLFF FREUDENTHAL, M.D., NEw York, N. Y. ARTHUR WILLIS GOODSPEED, PH.D., PHILADELPHIA, PA. GEORGE COFFIN JOHNSTON, M.D., PITTSBURG, PA. JOHN HARVEY KELLOGG, M.D., BATTLE CREEK, MICH. FRANKLIN MARTIN, M.D., CHICAGO, ILL. GEORGE MITCHELL PARKER, B.A., M.D., NEW YORK, N. Y. GEORGE EDWARD PFAHLER, M.D., PHILADELPHIA, PA. WENDELL CHRISTOPHER PHILLIPS, M.D., NEw York, N. Y. ROBERT REYBURN, A.M., M.D., WASHINGTON, D. C.- ALPHONSO DAVID ROCKWELL, A.M., M.D., New YoRK, N. Y. JAY WEBBER SEAVER, A.M., M.D., NEw HAVEN, CoNN. SINCLAIR TOUSEY, A.M., M.D., New York, N. Y. Foreign Correspondents DR. ERNEST ALBERT-WEIL, PARIS, FRANCE DR. HERMANN ALGYOGYI, VIENNA, AUSTRIA DR. JEAN BERGONIE, BoRDEAUx, FRANCE DR. LUDWIG HALBERSTAEDTER, BRESLAU, GERMANY MR. JOHN HALL-EDWARDS, BIRMINGHAM, ENGLAND DR. LEOPOLD LAQUER, FRANKFORT-on-MAIN, GERMANY DR. ALBERT NEISSER, BRESLAU, GERMANY Dr. LOUIS TôRÖK, BUDAPEST, HUNGARY *ºr- RICHARD G. BADGER, PUBLISHER THE GORHAM PRESS, BOSTON, U. S. A. BY SUBSCRIPTION $3.00 A YEAR 2 LONDON TORONTO MONTREAL MELBOURNE PARIS BERLIN THE ARCHIVES OF PHYSIOLOGICAL THERAPY CONTENTS FOR MAY, 1905 PAGE The Effect of the X-Ray Upon Pregnancy . Sinclair Tousey, M.D. 16 I Illustrated with 2 Plates The Palue of the X-Ray in the Treat- ment of Tuberculosis . º Henry K. Pancoast, M.D. 164 Illustrated with 4 Plates & 6 Diagrams The Interpretation of Radiographs of the Chest . * e P. M. Hickey, M.D. 169 Illustrated with 3 Plates Notes on X-Light & e . J/illiam Rollins, M.D. 172 Illustrated with 2 Diagrams A Portable Illumination Box g . G. E. Pfahler, M.D. 176 Illustrated with Plate Editorial . e . I 77 Wilhelm Konrad Roentgen — American Roentgen Ray Society — X-Rays and Sterility — Additional Departments. Current Physiological Therapy o tº e . I 8 O Miscellaneous Abstracts º & & . I 90 Electrotherapy, IOO – Radiodiagnosis, IQ I – Radiotherapy, IQ2 — Hydrotherapy, 200 — Dietotherapy, 20I — Mechanotherapy, 202 — Psychotherapy, 203. Book Reviews º º º º sº sº . 2 O 5 SPECIAL PLATES JWilhelm Konrad Roentgen ºs ºr . . . . . . ACIP. Sarcoma of Humerus . . Gordon G. Burdick, M.D. XV. Pulmonary Congestion . & George E. Pfahler, M.D. XVI. Hydro-Pneumo-Thorax an Tuberculosis . º º George E. Pfahler, M.D. Ä/II. Stone in Kidney e e . W. C. Fuchs, M.D. XVIII. Stone in Extra-Pelvic Ureter . . W. C. Fuchs, M.D. XIX. Stone in Intra-Pelvic Ureter º . W. C. Fuchs, M.D. XX. Stone in Bladder e ſe . W. C. Fuchs, M.D. A XI. Tumor in Trachea e e M. K. Kassabian, M.D. XXII. Coxa Vara of Left Femur ſº M. K. Kassabian, M.D. XXIII. Compound Fracture of Humerus . Prof. Park & Dr. Plummer XXIV. Compound Fracture of Radius and Ulna g Q . Prof. Park & Dr. Plummer A X/Z. Broken Back . º e Gordon G. Burdick, M.D. RICHARD G. BADGER, Publisher, 194 Boylston, St., BOSTON TERNMS OF SUBSCRIPTION THE ARCHIVES OF PHYSIOLOGICAL THERAPY is published on the 25th of each month. Subscribers failing to receive their copies by the 5th of the succeeding month should immediately notify the publisher, otherwise missing numbers can not be replaced. Annual subscription $3.00. Foreign postage 60 cents. Single copies 25 cents. THE ARCHIVES is published for subscribers only, and back numbers are not carried in stock. All subscriptions must begin with the current issue. The standard size of THE ARCHIVES on which the subscription price is based consists of 48 pages of text and 4 pages of plates. SPECIAL NUMBERS At least two Sãecza/ ?? umóers will be issued each year. These numbers will contain an in- creased amount of text or illustrations or both. The price of such numbers will be 50 cents, but they will be furnished regular subscribers without extra charge. ADVERTISING RATES on application. Only strzcá/y ef/.2ca/ advertz sements wz/Z če 2nserted. Advertisements must be received by the first day of the month of issue. All advertising matter in THE ARCHIVES is edited as carefully as the text. Our readers may rest assured that our advertisers are in every sense reliable and responsible concerns. COPYRIGHT The entire contents of THE ARCHIVES is covered by copyright, and permission to reprint any article or illustration must be obtained from the publisher before using elsewhere. Entered at the Boston Post-Office as second-class mail matter March 22, 1905. Copyright, 1905, by Richard G. Badger. All Rights Reserved. Printed at The Gorham Press, Aoston, U. S. A. *pectal pumber In Honor of the Tenth Anni- versary of the Discovery of the Roentgen Ray WILHELM KONRAD ROENTGEN The Archives of Physiological Therapy May, 1905 This arm was treated by some of the most eminent men in the world for rheumatism. The X-ray showed sarcoma of the bone to be the trouble, after all other diagnostic methods had failed. By Dr. Gordon G. Burdick, Chicago, Illinois. Special Plate XIV The Archives of Physiological Therapy – May, 1905 This skiagraph was taken post-mortem in 1902, the patient in the supine position. A portable 7-inch coil was used, exciting a medium vacuum tube at a distance of 18 inches from the plate; exposure 2% minutes. Skiagraph shows the following: 1. The left side of the diaphragm 4 inches higher than the right. 2. The heart displaced to the right. 3. The outline of the stomach, below the diaphragm, containing a bolus of food. 4. The descending colon, showing the transverse folds. 5. The coils of the small intestines, showing a line of feces extending downward in one of them. 6. Shadows of congestion of the lungs. 7. The vertebrae, ribs, clavicle, and scapula. 8. The skin, subcutaneous tissue, the deltoid, biceps, brachialis, and triceps muscles. 9. The humerus, showing the medullary cavity and striations upon the bone. By Dr. G. E. Pfahler, Philadelphia, Pennsylvania. Special Plate XV The Archives of Physiological Therapy – May, 1905 Hydro-Pneumo-Thorax and tuberculosis. Skiagraph of patient taken with 15-inch coil, medium vacuum tube at 15 inches distance from plate. Exposure 2% minutes. Points of interest are as follows: Light area on the left side indicating the pneumo-thorax. Shadow of fluid at the bottom, about two inches above the diaphragm. Compression of the left lung, with cavities (C. C. C.) at the apex. Shadow of heart and aorta seen in the left chest. Tubercular deposits in the right lung with cavity at the apex. By Dr. G. E. Pfahler, Philadelphia, Pennsylvania. i Special Plate XVI The Archives of Physiological Therapy – May, 1905 Stone in Kidney (outline of kidney plainly visible). Skiagraphed with a Skala Walter tube, No. 6; anode 18 inches from plate; 16-inch coil with mechanical interrupter (Fuchs' system); 6 minutes ex- posure; and table lead diaphragm (Fuchs). By Dr. W. C. Fuchs, Chicago, Illinois. Special Plate XVII The Archives of Physiological Therapy – May, 1905 Stone in the extra-pelvic portion of the ureter. The same technique as employed with the preceding plate. By Dr. W. C. Fuchs, Chicago, Illinois. Special Plate XVIII The Archives of Physiological Therapy May, 1905 Stone in the intra-pelvic portion of the ureter. The same technique as employed with the preceding plates. By Dr. W. C. Fuchs, Chicago, Illinois. Special Plate XIX The Archives of Physiological Therapy – May, 1905 Stone in Bladder. The same technique as employed with the preceding plates. By Dr. W. C. Fuchs, Chicago, Illinois. Special Plate XX The Archives of Physiological Therapy – May, 1905 Ayº Bø/WE. AA/L/TT/5 CR/C0// CAP 7. ~554C& AE2/AAſ Vºca/ cººds - - Cºzyaz ZAZ Zºº 77////0A2 - - 22:22.72523/e/ZZ” 52%.2425. 7A2ACAEA Tumor in the Trachea. Skiagraphed with patient sitting on a chair, a five by seven plate laid against the trachea, head extended and bent a little toward one shoulder in order that the rays might traverse the plates between the vocal chords. Fifteen-inch coil, electrolytic interrupter, tube of highest degree of vacuum located ten inches from plate, exposure one second. Metol-Hydrochinon developer. It is usually taught that hard tubes are suitable only when penetration of dense structures is desired, and soft tubes for soft tissue differentiation. Kassabian finds that hard tubes are well adapted for soft tissue skiagraphy if the exposure be very short and the plate carefully developed. By Dr. M. K. Kassabian, Philadelphia, Pennsylvania. Special Plate XXI The Archives of Physiological Therapy – May, 1905 Coxa Vara of Left Femur, in a boy six years of age who was also suffering from tubercular disease of knee joint; skiagraphed four months after orthopedic apparatus had been applied. Skiagraph shows the angle of the neck of the femur to be more obtuse on the left side. Left iliac bone is larger, left pubic bone smaller than on the normal side. Lumbar and sacral vertebrae are twisted. Muscles of hip and thigh very distinct, testicles and cord visible. There is a cast on the left knee, plainly indicated in the picture. Skiagraphed in dorsal decubitus, tube in the median line, anode 18 inches from the plate, exposure 4 minute. Both feet were bound together so that they formed a right angle with the axes of the legs. By Dr. M. K. Kassabian, Philadelphia, Pennsylvania. Special Plate XXII The Archives of Physiological Therapy – May, 1905 Compound fracture of humerus caused by having the arm wound up by the belt- ing of a shafting. The attempt to secure union was unsuccessful with two operations but successful after the third. Skiagraphed with Mueller plain tube, five-inch spark gap; 40 seconds exposure; Forbes photographic plate without intensifying screen. Skiagraphed in the Surgical Clinic of Prof. Roswell Park, Buffalo, N. Y., by Dr. Ward Plummer. Special Plate XXIII The Archives of Physiological Therapy – May, 1905 Compound fracture of radius and ulna; from same patient as Plate XXIII; injury sustained in the same accident at the same time. The lower end of the radius has united to the ulna, and the lower end of the ulna to the lower separated fragment of the radius; a very unusual condition. Skiagraphed in the surgical Clinic of Prof. Roswell Park, Buffalo, N. Y., by Dr. Ward Plummer. Same technique employed as with Plate XXIII. Special Plate XXIV The Archives of Physiological Therapy – May, 1905 Broken back skiagraphed eight months after injury; successfully reduced by Pro- fessor Edds. Exposure 40 seconds; anode 20 inches from plate; 30-inch coil; water-cooling tube; Hydrochinon developer. By Dr. Gordon G. Burdick, Chicago, Illinois. Special Plate XXV The Archives of Physiological Therapy – May, 1905 Figure I Pregnant Cat, Skiagraphed October 6, 1904 Figure II Pregnant Cat, Skiagraphed November 18, 1904 Illustrating. The Effect of the X-Ray. Upon Pregnancy — Tousey The Archives of Physiological Therapy – May, 1905 THE ARCHIVES OF PHYSIOLOGICAL THERAPY Devoted to the Diagnostic and Therapeutic Uses of Electricity, Radiant Energy, Heat, Water, Mechanical Vibration, Dietary Regulation, Exercise, Psychic Suggestion, etc. VOLUME ONE MAY 1905 NUMBER FOUR THE EFFECT OF THE X-RAY UPON PREGNANCY “ BY SINCLAIR TOUSEY, A.M., M.D., OF NEW YORK CITY Surgeon to St. Bartholomew’s Clinic. HE purpose of this paper is to consider what effect, if any, the X-ray has in pre- venting conception or in pro- ducing abortion or still- birth. In this connection there are to be borne in mind the valuable observations of Dr. F. Tilden Brown and Dr. Alfred T. Osgood (Archives of the Roentgen Ray, March, 1905) to the effect that all of the X-ray workers, I6 in number, whom they have examined have shown either complete azoöspermia or a de- gree of oligospermia or necrospermia, which depended upon the length of time during which they have been radiolo- gists. He does not know whether this comes on gradually or “as a sudden cli- max after some particularly long and in- tense action of the rays.” To what Drs. * Read before the Section on Gynecology and Obstetrics of the New York Academy of Medicine, New York, April 27, 1905. Brown and Osgood say I may add that this condition develops in X-ray workers who have never experienced the slightest dermatitis or other visible effect from the X-ray. Albers-Schoenberg's experiments on guinea-pigs and rabbits (Munich, Med. Wochenschrift No. 43, 1903) show that an exposure at a distance of five or ten inches for ten minutes a day for 35 days, produces azoöspermia without any visible injury to the animal. Bergonie and Tribondeau (Archives D’Electricite Medicale, February 25, 1995), report that in experiments on white rats, complete azoöspermia with very marked atrophy of the testes and profound histological changes are pro- duced by repeated exposures without any external irritation. Their applica- tions were made with a tube of medium hardness, rays No. 6 Benoist, Io am- peres of primary current, and a distance of I 5 centimeters between the anticath- ode and the testes, which was the only Copyright, 1905, by Richard G. Badger. All Rights Reserved. II - (161) I62 THE EFFECT OF THE X-RAY UPON PREGNANCY portion of the animal exposed. An ap- plication of IO minutes represented 4 Holzknecht units. The exposures were about what would have been used in a case of cancer of the testes. ent rats were exposed to 5 applications of 2 H. every 8 days; 9 applications of I H. every 2 days; I I applications of 2 H. every 2 days; IO applications of 4 H. every 2 days; and 5 applications of 4 H. every 8 days. Phillip (Fortschritte auf dem Gebiete der Roentgenstrahlen, December 9, I904), reports two cases in which he X- rayed the testes for the express purpose of producing sterility. One of the pa- tients was a man with consumption. The tube was at a distance of Io or 15 centimeters and was of a low or medium vacuum. The exposures were IO or I 5 minutes every day for a month, making 365 minutes total exposure. The only external effect was a slight dermatitis of the scrotum, which healed in two weeks and left no scar. The semen was exam- ined every eight days and showed abso- lutely no deviation from the normal dur- ing the entire 30 days of X-ray treat- ment. The patient then submitted to a ligation of both spermatic ducts. Six months later an aspirating needle plunged into the epididymis brought out testicular secretion containing no trace of spermatozoa. Phillip's other patient was a man with pruritus ani, whose wife had long suf- fered from an affection of the throat and did not wish to have any more children. The technique was the same as in the first case; 19.5 minutes total exposure being given in IO minute applications in the course of three weeks. Seven months later the semen was examined for the first time and complete azoöspermia was found. This effect was not accompanied by impotence. The present author has for several years past been in the habit of envelop- ing the X-ray tube, in an impervious shield (Friedlander's) which permits The differ- the rays to emerge in only one direction. The operator and the patient are thus protected from this or any other unde- sired effect. - We come now to the effect of the X- ray upon the reproductive function of the female. Halberstädter February 25, (Semaine - Medicale, 1905), experimenting with rabbits exposed one-half of the ab- domen to the X-ray for 3O minutes at each session. After ten daily treatments the Gräafian follicles were found very much diminished in number and of a de- generative appearance and after fifteen days of treatment the Gräafian follicles had entirely disappeared. But he thinks additional observations are required to determine whether the effect is a perma- nent one. Histologically, the ovary con- tained a great many round, sharply de- fined vacuoles without any endothelial lining and a homogeneous mass which be- came diffusely colored by eosine. There was no change in the corpora lutea. The primordial ovules were few in num- ber and presented a degenerative appear- ance. He alludes to the observations of Tribondeau, Bergonie, and Recamier, who found that in rabbits exposed for from 16 to 140 minutes the weight of the ovary diminished by from 32 to 85 per cent. In all these cases the changes in the ovary took place without any change in the superficial tissues, skin, or hair. Laquerriere and Labelle report (Bul- letin Officiel de la Societe Francaise d'Electrotherapie, September, 1904), the case of a woman with an inoperable carcinoma of the neck of the uterus and the adjacent vaginal wall, invading Douglas's cul de sac and immobilizing the lower segment of the uterus. At the time that X-ray treatment was begun there was an enlargement of the body of the uterus which was supposed to be fi- broid, but which turned out to have been due to pregnancy of two months ad- Van Cement. - SINCLAIR TOUSEY I63 The treatment consisted at first in ex- ternal applications of the X-ray over the abdomen, pubes, perineum, and loins. This was begun December I Ith and continued to March 30th, the number of treatments given during this time being 39. The tube was placed at a distance of from 8 to I 5 centimeters from the skin, spark-equivalent from 6 to IO cen- timeters, anticathode reddening freely in from I 5 to 20 seconds, duration of exposure from 2 to 8 minutes. From March 30th to June, I I applications of the X-ray were made through a vaginal speculum as well as externally. The local and general conditions were so much improved that when her child was born, July Ist, the midwife who at- tended her did not notice that there had ever been any disease. The child was strong and well, but late in the autumn the mother's condition became worse again and an unfavorable termination was expected. The X-ray applications had been sufficiently vigorous at one time in February to cause an ulceration of the abdominal' wall which took a whole month to heal. affect the vitality of the foetus, which was then at its fourth month. The observation of my own which I But this did not wish to record was made in order to de- termine what effect, if any, would be produced by the short exposures which suffice for X-ray pictures. The subject radiographed was the cat belonging to our household. She is young and strong and has been the mother of several healthy families. The pictures were taken from the time that she appeared to be matrimonially inclined and this was five or six weeks before she showed any external evidence of pregnancy; they were taken at intervals up to the time when confinement was momentarily ex- pected. - - During the last ten days of gestation no radiograph was made. The cat was never in the X-ray room except during the taking of these pictures. Each pic- ture was taken with the cat lying upon her left side on the photographic plate, held there by my own hands which rested upon the cat and were equally exposed to the rays. A twelve-inch Wappler induc- tion coil was used; and usually a heavy anticathode Müller tube, No. 13; but for the picture of October 21st, a 40 centimeter Friedlander water-cooled tube was used. The exposures were de- signed to be of the same intensity and duration as for radiographing human TABLE OF EXPOSURES. Distance - from - I904 Time of Anticathode Spark Fººter Primary | Secondary | Primary I . exposure. to nearest equivalent. (#. Ctirrent. Current. winding. |Interrupter. surface of (Tousey's). animal. - Thicknesses Milliam- Self- Seconds. Inches. Inches. of tin foil. Amperes. peres. finduction. Oct. 6..... IO I5 3 5 IO 3 Large Wehnelt Oct. I2. I 5 I4. 2 5 II 2 Small Caldwell Oct. I6. . . . . 5O I4 3% 3 8 3 Large 4 & Oct. 2I. . . . . 3I II 8 4. I2 3 Large ( & Nov. 18. . . . . 45 I2 2 3 9 3 Large { { Nov. 29. . . . . 25 II 2% 4. IO 3 Large & Ł Nov. 29. . . . . 4O II 2% 4. IQ 3 Large *{ { Dec. I'7. . . . . 6O I4 2% 7 9 3 Large Wehnelt Total. . . . . 276 e e g º e º º a • o e s a • * * seconds, or 4% minutes. I64 THE VALUE OF THE X-RAY IN TUBERCULOSIS tissues of the same thickness, but owing to the cat's restlessness it was necessary to cut short some of the exposures. The same restlessness is partly responsible for any imperfections in the pictures. Measured by Holzknecht's chromora- diometer the total exposure of the near- est part of the cat's body would have amounted to only 9% H., or 4% minutes for the whole series. One H., it will be remembered, is one-third of the amount required at a single exposure to produce a visible reaction upon the human face. The result, of course, was absolutely nil as far as the outward and visible appear- ance of the cat and as far as my own hands were concerned. The pictures were made on October 6th, 12th, 16th, and 21st, November 18th and 29th (at which date the cat first showed unmis- takable external evidence of pregnancy), and December 17, 1904. Thirteen days after the last radiograph (that is, on December 30th, 1904), three large per- fectly developed kittens were born dead. The cat was not again exposed to the X-ray, and on March 12, 1905, two and one-half months after the still-birth, four large healthy kittens were born alive. and so is the mother cat. - It is unusual for kittens to be still- born and it had never happened before with this cat. I believe it to have been due to the action of the X-ray. They are still well and strong § The conclusions to be drawn are as follows: First. Precautions should always be taken to prevent unnecessary exposure of the ovaries or testes. - Second. Where X-ray exposure of the reproductive organs is required, as in the treatment of cancer, even the known existence of pregnancy may be disregarded, as even the full dosage re- quired for a therapeutic effect does not necessarily interfere with the progress of gèstation or the viability of the child. Third. Even the small dosage re- quired for radiography may sometimes destroy the life of the foetus, but there is no reason to believe that such expos- ures, even if required on several different occasions, will produce even temporary sterility. - THE VALUE OF THE X-RAY IN THE TREATMENT OF TUBERCULOSIS BY HENRY K. PANCOAST, M.D., OF PHILADELPHIA, PENNSYLVANIA Lecturer on Skiagraphy and Assistant Instructor in Surgery, University of Pennsyl- vania, and Skiagrapher to the University Hospital. HE treatment of tuberculosis has received so much careful study, and is founded upon such well worked out and common sense rules, that any statement claiming more for the X-ray in the deep-seated tubercular manifestations than that it is a useful addition to the therapeutic armamen- tarium and the diagnostic methods of the physician and surgeon, would tend to bring discredit upon those who spe- cialize in X-ray work. That it has val- uable therapeutic properties in combat- ting these lesions there can be no doubt. No deep-seated tubercular process can be aided by X-ray applications unless they are used in conjunction with the ac- HENRY K. PANCOAST I65 knowledged rigorous rules of medicine, surgery, and hygiene. The object of this article is to report briefly the work that is being done in the X-ray laboratory of the Hospital of the University of Pennsylvania in this direc- tion, with special emphasis in regard to lesions of the respiratory system. It is as important, for reliable statistics, at least, to enumerate the failures as well as the successful results, and, moreover, in a field where successes are the excep- tion and are far outnumbered by failures, each single cure should act as a stimulus to our best efforts toward a proper un- derstanding of the use and application of this new therapeutic agent, especially when the older ones have not proven sufficiently satisfactory. The value of the X-ray applications for tuberculosis of the superficial lym- phatic glands requires but little com- ment, as this method is now recognized as a part of the medical and surgical treatment. It should not be expected to replace surgical procedures in any case where operation has heretofore been in- dicated. Its place lies in the treatment of the pre-operative stage of the condi- tion, and as a post-operative measure to follow up the surgeon's work. RESPIRATORY SYSTEM Consideration will here be given to tubercular laryngitis, and secondarily to the pulmonary manifestation which is practically always present as the primary lesion. The following cases are cited: Case I. — J. K., white, male, 37 years, nativity and residence Philadelphia, oc- cupation driver and motorman. Re- ferred by Dr. W. B. G. Harland. Di- agnosis, tubercular laryngitis and con- solidation of the right apex with soften- ing. No tubercular family history, ex- cept possibly in the father. Personal his- tory negative except an attack of pleu- risy in 1895, from which he fully recov- ered. In March, 1903, he began to lose weight (138 to 121 pounds), and the diagnosis of phthisis was made in April, when his throat became sore, with occasional attacks of aphonia. In June, his weight was 122 pounds, had cough, tubercle bacilli in the sputum, hoarse- ness, dryness of the throat, occasional aphonia, flushing, night sweats, and a consolidation with softening at the right apex. Laryngoscopic examination showed an ulcer on the left side of the epiglottis, and a slight hyperemia of the cords. When seen in September, he had gained IO pounds, and the cough and night sweats had disappeared, but in October he contracted a severe cold, and became much worse. The laryngoscope then showed a perichondritis of the up- per left part of the epiglottis, and some swelling of the commissure. During • ** see e º e * & • * - ... • * > ... • **T ""--. * * * * * * * ** – Tº - • **-....” ***** e te ** .* * e **... ... • ** ** - - - - - - - - - *** FIGURE I November, at the beginning of the “ra- dium craze,” I 2 exposures of from IO to 45 minutes each were made with a specimen of 18,000 activity radium bro- mide, with, of course, no result. When the patient was referred to me February 8, 1904, for X-ray treatment, the ulcer- ation was still present on the epiglottis, and the swelling of the commissure had become a well-defined tuberculoma. (Fig. I.) Five minute exposures were made to the neck, each side alternately, and to the upper portion of the thorax. At the end of three weeks, the inflamed area of the epiglottis had decreased, but the tub- erculoma was larger and the throat felt I66 THE VALUE OF THE X-RAY IN TUBERCULOSIS & # 2 º Xº, { i " ; 2. FIGURE 2 worse. (Fig. 2.) Treatment was stopped for one week and then resumed, and after eight more weeks of treatment, Dr. Harland reported that the ulcera- tion had almost healed, the tuberculoma was pale and shrunken, and all signs of inflammation had disappeared. (Fig. 3.) The lung condition was then about the same as at the first examination, and his weight varied from 126 to I32 pounds. w g * • ****** - sa * * g • ** a -- ~ * * * * • * ~ * * * * * * * * * * * ... -->" s ... • *"T "T"---- • * * * * * ** , --->. * **---, º “”----, ...” ** ---e." * * * * . . . e. a 40 & Nº. *- : * * * **T*-* -- , , , , ~... s --~~~~~ ****, * $ & **--- - ----" " ** = - - - - - * * * * FIGURE 3 Exposures were continued less often until September, 69 having been made during a period of 32 weeks. The av- erage length of each was from 5 to 8 minutes. A medium vacuum tube was used, having a resistance of about 3 inches of spark gap, and the anode was placed I2 inches from the patient. There was always a decided skin reac- tion present. - The patient was examined in January, I905, by Dr. W. B. Stanton, and he re- ported that the old lesion at the apex could scarcely be located. Dr. Harland reports the larynx cured, and states that the patient works regularly, seems to be in perfect health, and weighs 135 pounds—a gain of 13 pounds. Case 2. — W. D. A., white, male, 36 years, born Washington, D. C., resi- dence Philadelphia, single, occupation broker. Referred by Dr. Allburger for X-ray or Finsen light treatment of an advanced tubercular laryngitis compli- cating a pulmonary lesion of each apex, with a small cavity in the right apex. No tubercular family history, His throat had become worse during a pe- riod of “open air” treatment in connec- tion with a sanatorium, and the severe cold of the zero weather had placed his larynx in a condition such that every ef- fort at Swallowing was agonizing. Evi- dently life would be short unless the pa- tient could be relieved sufficiently to take nourishment. - In January, 1905, Dr. Fetterolf ex- amined his throat and treated him. Both arytenoids were then reported to be badly infiltrated and swollen, and the left cord more or less fixed in semi-ab- duction. (Fig. 4.) Treatment was be- FIGURE 4 gun February 19th. Largely as an ex- perimental measure, daily ten minute ex- posures by a Finsen-Reyn lamp were made to each side of the neck alter- nately, over the larynx, during the whole course of treatment. If of no greater value, these applications certainly tended to control a skin reaction due to the X- rays. At this time the patient's weight was IOI pounds. Figure 7 Tubercular arthritis of right knee, child three years old. Lateral view, plate under outer side of limb. The picture shows an epiphysitis of the lower femoral epiphysis, enlargement of the condyles, with rarefaction, excessive or premature ossification of the patella, with rarefaction and distention of the joint capsule under the ligamentum patellae. Macalaster and Wiggin's tube, 24-inch coil, electrolytic interrupter, cur- rent 4 milliamperes in secondary, tube resistance 3-inch spark, exposure 15 seconds, Cramer X-ray plate 12 inches from anode, metol developer. Illustrating The X-Ray in Tuberculosis– Pancoast The Archives of Physiological Therapy – May, 1905 Figure 8 Normal left knee of the same patient, taken under the same conditions. Illustrating The X-Ray in Tuberculosis—Pancoast The Archives of Physiological Therapy – May, 1905 HENRY K. PAN COAST 167 After one week of daily Roentgen ex- posures to each side of the neck alter- nately and to the upper part of the tho- rax he had gained four pounds, felt bet- ter and stronger, his throat was not nearly so sore, and swallowing was much easier, and he was able to sleep well at night. . After ten days, his throat became worse, and the X-ray was discontinued for a short time, but soon resumed on alternate days, with five-minute expos- ures instead of ten. After two weeks, two tuberculomata were seen on the right cord (Fig. 5) nearly ready to ulcerate, FIGURE 5 and dysphagia was intense. Relief fol- lowed in a few days, however, and swal- lowing without much discomfort contin- ued until he left the hospital, April 20th. The tuberculomata had then disap- peared, the cords were less swollen, and the left one was more movable. (Fig. 6.) His lung condition had certainly not progressed, the cough was better, and the only really unfavorable sign was a continued gradual loss of weight after the first gain. • * * * * * * * * º • *** - s” * * * * * * * * ~~~~~.... • FIGURE 6 Case 3. — E. N., white, female, 34 years, married. Referred by Dr. Stout. Diagnosis, tubercular laryngitis with pulmonary lesion of the right apex. She had lost I 5 pounds in three months, could swallow liquids only, and spoke in a whisper. Laryngeal examination showed swelling and hyperemia of both cords. X-ray treatment was begun Feb- ruary 13, 1905, by Dr. Stout and my- self, and at the present date, after 3 I applications during a period of II weeks to the neck and thorax (through the clothing) she can swallow anything without discomfort, has but an occa- sional dryness of the throat, coughs less, has gained 9 pounds, and looks and feels much better and stronger. The ex- posures were of IO minutes each from a hard tube of 3 to 5 inches spark resist- ance, with the anode I2 inches from the body. The current in the secondary was 2 to 3 milliamperes. Improvement was first noted after the fifth treatment and progressed until the fifteenth, when an over-reaction required a reduction in do- sage. After this the improvement con- tinued. Case 4. — A. G., white, female, 22 years, single, dressmaker. Referred by nose and throat dispensary. Diagnosis, tubercular laryngitis with left sided pul- monary lesion. Tubercular family his- tory. The laryngoscope revealed a tu- berculoma of the interarytenoid space. She has had IO applications in three weeks. The usual improvement noted after the first few treatments was fol- lowed by a reaction and the appearance of a small 'ulcer near the tuberculoma. A decrease in dosage has been followed by marked improvement and the ulcer is healing and the swelling subsiding. The following conclusions are drawn from these cases: I. Tubercular laryngitis responds most favorably to X-ray treatments, and may often be cured. Recurrence is guar- anteed only by a subsidence of the activ- ity of the primary pulmonary lesion, I68 THE VALUE OF THE X-RAY IN TUBERCULOSIS t 2. Great care is necessary in deter- mining the appropriate dosage in each case, as too vigorous treatment will pro- duce a reaction that may be unfavorable. . The pulmonary lesions may be benefited often, provided a mixed infec- tion has not taken place, but even greater precaution should be observed. 4. Finsen light applications are probably valueless except as prophylac- tic measures against X-ray dermatitis. At any rate, only the most powerful lamps need be tried. Here and elsewhere I have very little confidence in the value of radium or ra- dio-active substances as therapeutic agents. I do not see sufficient grounds for believing that radium will do any- thing that the X-ray will not do, and it will certainly accomplish very little in comparison with the gratifying results brought about by the X-ray. TUE ERCULAR PERITONITIS We have treated two cases of tubercu- losis of the peritoneum following ex- ploratory laparotomies. The first case was referred to me by Dr. Shober for X-ray treatment during his absence from the city. He had successfully dealt with two or three recurrences, and sent the patient to me at the beginning of an- other. Thirteen exposures during a pe- riod of II weeks made an apparent cure, and Dr. Shober reports that she has had no further trouble since I last saw her, over six months ago. The second case is now under treatment, and though im- proving, there is nothing worthy of men- tion as yet. - We must realize that it is presump- tuous to claim much credit for the X-ray in treating a case of this kind after an exploratory laparotomy, as the fre- quency of cures brought about in some manner by opening the peritoneal cavity is so well recognized. JOINTS The value of X-ray applications in joint lesions must at present be held sub judice. They can certainly not do good unless, in conjunction, the usual and rec- ognized surgical methods of treatment are rigorously carried out. Several cases have been or are still under our care, but the results have so far not been note- worthy. The accompanying skiagraphs (Figs. 7 and 8) represent the diseased right knee and normal left knee of a child now under treatment. While in the hospital under close observation, there was some improvement, clinically, but the share of credit due to the X-rays cannot be determined. The knee be- came worse when the patient was taken home and allowed to walk and was sur- rounded by improper hygienic condi- tions, but improvement is now again manifest. A recent skiagraph shows no decided change. Similar remarks are applicable in con- nection with our experiments in treating spinal tuberculosis. It would seem that the most practical expectations in such cases would be the possible absorption of an exudate in a pachymeningitis when such a condition is present. STUPERFICIAL LESIONS Space forbids a discussion of these manifestations, and literature abounds with them already. The doubt still re- mains as to the relative values of the X- ray and the Finsen light. In my mind, one is of no more value than the other, as each has its own special indications. Proper judgment is the guide. In most instances I have found that a combina- tion of the two methods gives the best results. . The accompanying photographs (Figs. 9 and IO) represent an ob- stinate case of lupus of the face and nose that has been treated since February I 5, I903, and up to the present time has re- ceived 223 X-ray exposures and I 5 Fin- sen light applications. Unfortunately we have no photograph of his condition Illustrating The X-Ray in Tuberculosis — Pancoast 9. y The Archives of Physiological Therapy – May, 1905 Figure I Normal chest of healthy young man. Bronchial glands on each side conspic- uous. Note the rounded distinct outline of the heart. - Illustrating The Interpretation of Radiographs of the Chest – Hickey The Archives of Physiological Therapy – May, 1905 INTERPRETATION OF RADIOGRAPHS OF THE CHEST when he first came under our care, but the nose was covered with ulcers, there were nodules and ulcers covering both sides of the face in front, and a marked degree of ectropion of the lids on both sides. The X-ray was successful in removing almost all of the lesions and in causing absorption of exudate, but wherever there has been a marked skin reaction produced, such as we have had to pro- duce in this obstinate case, the pigment layer has been destroyed, and this seems to be a permanent loss so far. This has been our experience without exception, when applying the X-ray to the negro. The patient has been very careless about 169 his attendance during the past few months, and new lesions are continually making their appearance. On account of the undesirable X-ray skin effects in this case, we have lately used the Finsen-Reyn lamp, and when attendance is regular, the results are preferable to those derived from the X- ray. Freezing with ethyl chloride spray has also been of great assistance in deal- ing with the larger lesions. Fig. 9 rep- resents the appearance nearly two years ago, and soon afterwards the patient was much better. Fig. IO is made from a recent photograph, shows that there has been a partial recurrence, and that there has been no return of skin pigment. THE INTERPRETATION OF RADIOGRAPHS OF THE CHEST% BY P. M. HICKEY, M.D., OF DETROIT, MICHIGAN N bringing the above topic to the attention of this Society, it is the purpose of the writer to present the subject so as to give rise to discussion rather than to formu- late certain set rules. While the technique of rapid radio- graphy of the chest has made great prog- ress, particularly during the last three or four years, it is advisable for us, now that we are able to produce pictures of the chest of considerable clearness, to consider well the value of these repre- sentations in the art of diagnosis. Ra- diography has taken a prominent place in internal medicine and it is the belief of those who have paid attention to this particular branch that its usefulness will be increased constantly. In the technique of the production of chest negatives, the aim is to make the exposure as rapidly as possible and at the same time to secure the greatest * Read at the Fifth Annual Meeting of the American Roentgen Ray Society at St. Louis, Mo., Sept. 9-13, 1904. technique. amount of contrast. The realization of these two points is accomplished by many radiographers with some variations in The essentials of this tech- nique can, perhaps, be briefly summa- rized. First, a mastery of the tube, so that the vacuum is suitable for the indi- vidual case; second, the employment of a secondary current which will best suit the vacuum selected; and, third, the de- velopment of the plate by reducers which will secure the greatest detail and the maximum contrast. - In the interpretation of chest nega- tives, it is important to know the position of the target of the tube with reference to the area exposed. If the exposure is made with the plate against the anterior surface of the chest, the position of the target will perhaps best correspond to a perpendicular erected from the center of a circle, which would embrace the thoracic area. If the exposure is made, as it now generally is, sufficiently short so that the breath is held and respiratory movement minimized, the detail will, of course, be greatly increased. 170 INTERPRETATION OF RADIOGRAPHS OF THE CHEST In the interpretation of chest nega- tives it is, of course, best to use a suitable means of illumination of the negative, secured usually by a proper illuminating box. If extraneous light is excluded and the observer is seated at some little dis- tance, say eight or ten feet from the nega- tive, the general effect will be much bet- ter, and the appearance will also more nearly approach that of the stereoscopic image. In an exposure made with the front of the chest wall next to the plate, with the target behind the patient, and the arms elevated so as to remove the shadows of the scapula from the pul- monary area, the crossing effect of the shadows of the anterior and posterior portions of the ribs tend to heighten the stereoscopic deception. - In considering the different objects presented, we note first the line of the diaphragm. This is usually higher on the right side than on the left in the normal chest. amounts to from one-half to two inches. In cases of effusion or great thickening of the pleura, the diaphragm line will be lost on the affected side. In emphysema there will often be seen a somewhat tri- angular appearance, differing from the usual dome with its symmetrical curves. In the skiagraph of the cadaver, where pulmonary tuberculosis was the cause of death and the abdominal contents have fallen away from the diaphragm, the shadow of the diaphragm can be seen distinct from that of the liver. - The next point which will engage our attention is the distance of the ribs one from the other. In the time exposures which were formerly made the shadows of the ribs appeared much narrower, be- cause the central part only of the moving rib affected the plate during the expos- ure. In cases of restricted respiratory movement on one side we will find the ribs closer together. This is well illus- trated by a plate showing a tuberculosis of one side, in which there is a marked difference in the position of the ribs of This difference often the right and left side. In noting the cardiac shadow, we find if the target is placed somewhat low, say on a line with the apex of the heart, that we will get a clearer differentiation of the cardiac shadow from the line of the diaphragm; the size and the position of the cardiac shadow are somewhat de- pendent on the position of the target. It is evident that if the target is placed op- posite the center of the chest, the conse- quent distortion will render the apex of the heart more prominent, and vice- VCI'S2. - - In studying the shadows cast by the aorta upon a fluoroscopic screen, we often meet with cases where it is difficult to accurately differentiate between what might be termed a physiologic condition where the aorta appears large and cases of beginning aneurism. Of course in well defined or advanced cases of aneur- ism this difficulty of differentiation does not exist. Owing to the constant pulsa- tion of the aorta during exposure, even when the time is limited to one or two seconds, we find difficulty in stating the size of the aorta accurately. In the negative of a normal chest we find numerous fine white lines ramifying from the sides of the sternum at about the level of the third rib. The interpre- tation of these lines, which seem more prominent on the right than on the left side, has been very interesting to the writer. For a time it was thought that they represented beginning areas of con- solidation; they have been interpreted as the shadows of the walls of the rami- fying bronchi. An English writer has considered them to be the lines of the interlobular pleura. For the sake of es- tablishing the meaning of these tracings, a number of experiments were made. A cadaver was chosen, which was injected with the ordinary lead solution of the anatomical laboratory, as fully as possi- ble, the solution being injected at differ- ent intervals, so as to distend thoroughly the vessels. The cadaver was allowed Figure II Advanced tuberculosis limited to upper right. The compensatory increase in the distance between the ribs is well shown. Illustrating The Interpretation of Radiographs of the Chest – Hickey The Archives of Physiological Therapy – May, 1905 Skiagraph of cadaver. Trachea and bronchi filled with fine shot; blood vessels injected with bismuth and glycerine solu- tion. Figure III Note relations between bronchi and blood vessels, the latter being recognizable as wavy lines. P. M. HICKEY 171 to dry out, so that the tissues did not contain much fluid. An exposure was then made with the plate next to the dorsal side of the thorax, under condi- tions such as would accentuate the con- trast of the injected vessels. On com- paring this plate with the normal chest of the young adult, it will be seen that there is a marked similarity between the vague tracings of the living subject and the representations of the pulmonary ves- sels of the cadaver. In order to demonstrate the relations of the vascular and respiratory vessels, lungs were secured from an autopsy on a man who died from an accident; the trachea and bronchi were removed and filled with very fine shot, which were forced into the various ramifications as far as possible. An exposure was then made; the course of the bronchi can be seen from the plate. The blood vessels from the same pair of lungs were then injected with a bismuth and glycerine solution, the shot being still in situ, and a skiagraph made, which displays the relation of the injected blood vessels to the bronchi filled with shot—the bron- chi, of course, being easily recognized by the wavy lines. A study of these two plates shows the vessels more prominent than the bronchi. - In order to further elucidate this sub- ject, a medium-sized dog was secured, which was killed by chloroform, and the chest radiographed immediately after respiration had ceased. This secured a natural injection of the blood vessels. In studying this plate we find the line of the trachea and the ramifications of the bronchi showing as darkened streaks be- tween the grayish shadows cast by the cartilaginous walls. In order to further investigate the difference between the shadows cast by the blood vessels while filled with blood and the bronchi, the aorta, the trachea, and one lobe of the lung were removed. These were placed side by side on a plate and radiographed. The aorta filled with blood showed much greater obstruction to the Ray than did the walls of the bronchi. In a skiagraph of the normal human neck in a lateral position the air passages naturally ap- pear as darkened streaks in contrast with the adjacent soft parts. From these experiments it would seem to the writer that the tracings which we often see in the midst of the pulmonary tissue usually represent the ramifications of the pulmonary vessels. If we are able to shorten our exposures so that the im- pression can be made on the photo- graphic plate so rapidly that the move- ment of the pulmonary vessels during cardiac action is minimized—in other words, if we make our exposure so fast that we get rid of the pulsation — we believe that much more detail would be secured. It is important in studying chest nega- tives to have a standard of translucency. Generally the triangular space at the lower and outer border on each side is not obscured, except in cases of effusion. This region rarely shows tubercular de- posits. For this reason we may adopt this triangular space as a unit or stan- dard; in so doing we can secure a means of comparison of other parts of the chest. Such a standard, although not invariably correct, is indeed helpful. Where we have a thickening of the pleura, such as results after a healed pleuritis, or an ob- struction to the ray caused by the pres- ence of fluid, we must adopt another standard. The diagnosis of fluid in the chest is usually made with great ease, the lesion being most often unilateral, so that we have a fair means of comparison of one side with its fellow. In collapse of the lung following resection or per- foration, the extent of the space between the pulmonary and parietal pleurae can be easily measured. Tubercles in the lungs show them- selves in the radiograph as small white dots of varying size and shape, but which are usually sufficiently characteristic to be at once recognized by any one who I 72 NOTES ON X-LIGHT a 11CC. has had experience with their appear- They may at first sight be con- founded with the tracings left by the blood vessels, but a little care and dis- crimination will easily suffice to differen- tiate without any probability of doubt. Tubercular pneumonia will, of course, cause a diffuse obstruction to the ray with consequent easy recognition of the area affected, though not of the nature of the infection. Cavities if filled with air will be easily differentiated. Care should be taken not to consider as excavations the rounded dark areas in the apices formed by the normal pulmonary shadow within the natural curves of the first set of ribs. The latter are regular and symmetrical, and thereby not to be confounded with vomica. Tubercular glands, especially if they have been the seat of a calcareous change, show very plainly. Experi- mental work, however, should be done with the lungs which have been the seat of tuberculosis, in order to study the variations in the records left by isolated tubercles in the pulmonary tissue and by tubercular glands along the course of the bronchi. Tubercular glands in the neck which have been the seat of chronic change, producing deposits of lime, can, of course, be very easily detected. This point has been well brought out by Carl Beck in his recent work. In studying chest negatives it is impor- tant to remember that the mammary glands in females cause a decided shadow. This fact, unless recognized, might easily lead to incorrect conclusions about the translucency of the pulmonary tissues. The pectoral muscles, while usu- ally visible, do not often cause confusion. In closing this short essay the writer would like to make prominent the fol- lowing points: - - First, that the marked improvement in radiographic technique has resulted in adding a diagnostic measure of great value to our armamentarium of already tried methods of thoracic exploration. . . . Second, to realize to the fullest extent the benefit which can be obtained from this new diagnostic aid, the observer should be experienced in the reading of these negatives. Third, the shadows which emanate from the roots of the lungs in the normal chest are distinctly those of the larger pulmonary blood vessels. Fourth, that the triangular space found at the lower and outer border of the chest usually furnishes us a standard of trans- lucency. - Fifth, that this means of thoracic ex- ploration, while already developed enough so as to be of considerable diag- nostic value, is destined through future study and experiment to yield conclusions which will be still more valuable. NOTES ON X-LIGHT BY WILLIAM ROLLINS, M.D., OF BOSTON, MASSACHUSETTS THE TREATMENT OF INTERNAL DISEASES BY X-LIGHT HE chief use of X-light in therapeutics is in treating dis- eases below the surface. For surface conditions derma rays are more suitable, because they do not so profoundly af- fect the vital processes and require less expensive apparatus. In a number of papers published some years ago X-light was proved capable of producing blind- ness, paralysis, death of the foetus or of the animal, without burning the skin, provided certain precautions were taken. To show these results were not the effect willLAM ROLLINS I73 of any other agent, the animals were en- closed in a Faraday chamber, hung within another Faraday chamber. The experi- ments were the first which by excluding the participation of all other causes clearly showed what a dangerous agent X-light was and that the only symptom previously supposed to be produced by it—burning of the skin—was one of the minor effects. These experiments were undertaken to see if X-light could act be- low the surface, and if so whether the effects could be obtained without risk to the superficial tissues, for I had a friend who had been operated on for cancer in such a position that a second operation would not have been possible. As a re- sult of the experiments X-light was rec- ommended for treating internal diseases and certain principles which must always be used were stated. They were some- what as follows: The source of radiation must be in a box from which no radiation can escape except the smallest beam that will cover the area to be treated. The source of radiation should be placed at a long distance from the pa- tient, that the intensity of the radiation on the skin may not be measurably greater than at the deeper lying diseased tissues. - * The vacuum tube should be arranged to give a radiation not easily absorbed by the skin to avoid ionic destruction of the superficial tissues before therapeutic ef- fects are produced on the deeper tissues. Selective filters must be used to strain out those accompanying radiations which are easily absorbed by the skin. A patient must be enveloped in a non- radiable covering, exposing only the ne- cessary area. Instead of burdening this note with de- tails the following passage is quoted from an essay by Carl Hilty: ‘The read- ing of original sources gives one the ad- vantage of being sure of his material and of having his own judgment about it. There is this further advantage, that the original sources are in most cases not only much briefer, but much more interesting and much easier to remember than books that have been written about them. One of the great mistakes of modern scholar- ship as distinguished from that of the classic world is — as Winkelman has pointed out—that our learning in so many cases consists in knowing what other people have known.” . March 31, 1905. DESCRIPTION OF THE FIGURES In Fig. I is shown a non-radiable tube box with a non-radiable cone lined with fluorescent material—to limit the beam of X-light; the end of the cone being cov- ered with a selective filter to strain out not only those primary radiations easily absorbed by the superficial tissues, but also those secondary ones resulting from the impact of the primary rays. The top of the box has a non-radiable win- dow of lead glass (SS). By looking in the mirror (M), which can be attached either to the top or bottom of the tube- box, the tube can be seen. The position of the tube vertically is controlled by the handle (H) operating the rack (R), and in a horizontal plane by the handle (HH). For an explanation of the other parts of the tube-stand refer to Note 156, Electrical Review, June 6, I903. Longer cones than that shown in Fig. I are too heavy for attachment to the regular diagnostic tube box, therefore in Fig. II is shown a tube box and stand especially for therapeutic work. This arrangement is much simpler and cheaper to construct than the necessarily complicated tube stand required for use in diagnosis. The box holding the tube is also the limiting case for the beam of X-light. The tube is contained in one end of the case, shown at T, and is separated from the limiting part of the case by a dia- 174 NOTES ON X-LIGHT phragm plate only large enough to allow a small beam of X-light to escape. The case is lined throughout with a non-ra- diable coating, and is provided with win- dows in the top and bottom glazed with non-radiable lead glass, which prevents the escape of X-light and allows the tube to be seen either directly or by reflection in the mirrors M. * The tube case is supported on an ad- justable stand. The end opposite the tube is closed by a selective filter (SF) which strains out the radiations in the direct and reflected beams that are not wanted. Over the end of the selective filter is a diaphragm plate which limits the size of the escaping beam after it has been filtered. When these long lim- iting attachments are not used and the size of the beam of light is determined only by a diaphragm attached to the tube box, the selective filter should be in contact with the patient, covering the opening in the non-radiable cloth in which he is enveloped. ESCULINIZING X-LIGHT APPARATUS Dr. William James Morton has stated that “test tubes in which fluorescent solutions of esculin were allowed to stand during one or two weeks were found themselves to have become in- VAR tensely fluorescent after being emptied and carefully washed and dried.” “Such a test tube casts a shadow on a screen or gives a photographic print as dark as ordinarily would be caused by HH H FIGURE I WILLIAM ROLLINS I75 -ºr 2 tº ETERS - - D TO P VIEW *A 7 ammºms - smºs- s _ — — - T T SF Tº " - – - : * |TE T T T - - – – — — — =lſ, F---R [D] p. h ,” / z NON-RADIABLE TUBE - HOLDER VVITH sELECTIVE FILTERs, DIAPHRAGMs. - AND} ---T ADJUSTABLE SUPPORT B. Mº- → * – t - FIGURE II a piece of lead one-quarter of an inch in thickness.” • The following are some of the prac- tical applications of this discovery: In former Notes it was shown that X- light profoundly affected the vital pro- cesses, and therefore an X-light tube should always be used in a non-radiable case from which no X-light can escape except the smallest beam that will cover the area to be examined, treated, or photographed. Such tube cases were illustrated in Note 36, Electrical Re- view, August 17, 1898, and in Notes 47, 94, II2, I I6B, II6C, 139, 140, I43; I49, I 55, I 56, 162, 168, 169, I79D, I86, 199. The simplest way found to make the tube case non-radiable 176 A PORTABLE ILLUMINATION BOX was to coat it with a lead paint and to cover this with a fluorescent varnish. To allow the X-light tube to be seen, windows of lead glass were provided. These windows are heavy. As it is de- sirable to save weight the windows could be made thinner, non-radiability being obtained by soaking the glass in esculin solution. In 1897 attempts were made to pre- vent X-light from escaping from the X-light tube, except in the required beam, by making most of the tube of lead glass. This was not practical. The result sought—non-radiability—should be obtained by soaking the tube in an esculin solution after first coating a small area opposite the target with asphaltum varnish. When the tube is taken out of the esculin solution and the varnish re- moved we should have a non-radiable tube with a small radiable window for the escape of the required beam of X- light. In Note B, International Dental Jour- nal, July, I896, a non-radiable crypto- scope—fluoroscope — was shown, in which the observer's eye was protected from the X-light by an eyepiece of lead glass. In Note I45, Electrical Review, March 14, 1903, other forms of non- radiable cryptoscopes were illustrated. With the powerful apparatus now to be obtained such cryptoscopes require to be very heavy. Weight should be saved by treating the glass eyepiece with escu- lin solution and by making the walls of wood and coating them with a paint made of Morton's esculate of silica. A simple form would be an esculated water glass. - In Notes 45A, Electrical Review, February 8, 1898, and Notes 94, II6C, I79I, it was shown that a patient should be protected with a non-radiable cover- ing having an opening only large enough to allow X-light to reach the desired area. Such coverings, when made non- radiable by paints of dense metals, are heavy. They could be made lighter by using a paint made of Morton's esculate of silica. There are many other uses which can be made of Morton's discovery; a few only are mentioned to call attention to the matter. - A PORTABLE ILLUMINATION BOX BY G. E. PFAHLER, M.D., OF PHILADELPHIA, PENNSYLVANIA Director of the X-Ray Laboratory, Assistant Physician to the Medico-Chirurgical Hos- pital, Lecturer upon Medical Terminology and Symptomatology, and Demon- strator of Physical Diagnosis in the Medico-Chirurgical College. HE need of an illumination box for the purpose of dem- onstrating and studying X- ray negatives has long been felt. By this means whole classes or societies are en- abled to follow the demonstrator as he points out the various normal and patho- logical structures. Words need not be wasted in producing arguments to show the advantages of such an apparatus. A number of apparatuses for this purpose have been devised. * The apparatus which I shall describe has served us well in the Medico-Chirur- gical Hospital during the past two years, has been shown to the Philadelphia County Medical Society, and I believe has certain advantages over the others. The illustrations, I believe, are suffi- Dr. G. E. Pfahler's illuminating box for the study of X-Ray negatives. Left hand figure shows external appearance, right hand figure shows interior. The Archives of Physiological Therapy–May, 1905 EDITORIAL 177 ciently explanatory, but I will give a brief description. The base or stand consists of a heavy folding music stand. The box itself consists of a frame, the inside measurements of which are I4 x 17 x IO inches. This frame is supported by two bands of iron which cross and curve up- ward on each side, to be fastened to the top of the frame. At the point of intersection of the cross bands of iron, the box is fastened by a thumb screw to the top of a rod which has been flattened and curved at an angle of 45 degrees. This rod fits into the music stand. The lighting arrangement itself con- sists of a bank of thirty 8-c. p. frosted lamps. This gives a beautiful uniform light. I at first used four 32-c. p. lamps, but found that they gave an uneven light which was objectionable. The present arrangement is more expensive, but well worth the difference in cost. The top of this box is covered with ground glass and this in turn with a card- board mat, cut to fit the various sizes of plate smaller than 14 x 17. The whole box is now covered with black felt, which confines the light. A row of holes are punched around the top and bottom for the purpose of ventila- t1On. ** At first I used a rheostat to control the current, but lately have discarded it, be- lieving that it is not necessary. The box gives a beautiful uniform light, and when the stand is folded the whole apparatus can be carried in one hand. EDITORIAL WILHELM KONRAD ROENTGEN ILHELM KONRAD ROENTGEN, physicist, in whose honor a Congress of Radiological Science was held at Berlin, Germany, from April 30 to May 3, 1905, and this issue of THE ARCHIVES OF PHYSIOLOGICAL THERAPY is made a special Roentgen number, was born at Lennep, Germany, March 27, 1845. He finished his education under Kundt in Zurich, graduating from there in 1869. I872 he went to Strasburg, and settled there permanently in 1874. He went to Würzburg in 1870 as the assistant of Kundt. In After a short stay as professor at the academy at Hohenheim, he became Extraor- dinary Professor in Strasburg in 1876, and Ordinary Professor of physics in Giessen in 1879. In 1888 he took up a similar position in Würzburg. His experimental works, published in the “Annalen der Physik und Chemie,” treat of the accurate calculation of the relationship of the specific heats for air; the changing of volume and the double-breaking of di-electric bodies through the action of electric currents; the electro-dynamic action of such bodies during their passage through a homogeneous electric field; and the compressibility of liquids and the effect of pressure upon various of their physical properties. I 2 178 EDITORIAL The name of Roentgen did not become widely known, however, until the beginning of 1896, when his discovery of the X-rays (as he called them, but which have since been named the Roentgen rays) placed him at once among the best known scientists of the world. Little need be said to the readers of this journal about the inestimable assistance which his discovery has given in the solution of problems in the field of diagnosis, or the immense power into which it has developed in the field of therapeutics. It was not only a great discovery as regards pure science, but it carried with it the unusual property (as far as purely scientific advances.are usually concerned) of being immediately, directly, and in- herently, a boon of unspeakable value from a humanitarian standpoint. It ranks, in the way of practical importance, on a level with the discoveries of anaesthesia and antisepsis, and has shed upon the name of Roentgen a luster as unique as it is brilliant and enduring. Professor Roentgen is a large man (six feet tall and well-propor- tioned), has abundant brown hair and a large, full beard. He speaks slowly and quietly in a deep, bass voice, and his conversation is permeated by a fascinating, dry humor. He is very modest in his ways, and refers to his “can be used well sometimes.” Unlike the discovery as something that majority of those who have discovered and promulgated new and great truths of importance in the medical world, he has lived to see the acceptation and appreciation of his work, and we wish him long life and good health, in which to enjoy the well-merited honors which should accrue to one who has rendered a service of incalculable value to humanity at large, and which marks the beginning of a new epoch in our conceptions of physical forces and laws. \. AMERICAN ROENTGEN RAY SOCIETY The next (sixth) annual meeting of the American Roentgen Ray Society will be held at the Johns Hopkins University, Baltimore, Md., September 28, 29, and 30, 1905. - Arrangements have been made for an excellent program, and a large attendance is expected. The papers of the meeting for the first day will deal with the X-ray in diagnosis, and those of the second and third days EDITORIAL I79 with its therapeutical uses. There will also be an evening exhibit of lantern slides which promises to be extremely interesting. The Belvedere Hotel has been selected as headquarters. x-RAYS AND STERILITY The discovery that sexual sterility not infrequently follows prolonged or frequently repeated exposures to X-rays is a subject of vast moment, and merits the immediate and earnest consideration of workers in this line. We shall not write an editorial upon the subject, because all that is known about it will be found in the abstracts of articles dealing with this matter, on pages 124, 149 and 199 of the April and May issues of THE ARCHIVES, to which is called the attention of those desiring to know more of the obser- vations available to date. ADDITIONAL DEPARTMENTS It is intended that THE ARCHIVEs shall cover the whole field of physio- logical therapy in fact as well as in name, and the initial, formal in- troduction of departments. of Hydrotherapy, Mechanotherapy including physical exercise, Psychotherapy, Dietotherapy, and Climatotherapy, will take place in this and the next (June) issues. These departments will be under the charge, respectively, of Drs. John Harvey Kellogg of Battle Creek, Mich.; Jay Webber Seaver of New Haven, Conn.; George Mitchell Parker of New York, N. Y.; Gustavus Eliot of New Haven, Conn.; and James King Crook of New York, N. Y. CURRENT PHYSIOLOGICAL THERAPY JOURNAL OF ADVANCED THERA- PEUTICS New York, N. Y., April, 1905. I. One Year's Work, with Selective Elec- tric Harmonic Vibration — Morris W. Brinkmann. 2. The . Therapeutical Application of the * Continuous Current — T. A. Pease. 3. Further Research in Tuberculosis — J. * D. Gibson. 4. Some Experience in the Use of High Po- tential Currents — C. A. Northrop. A Case of Hyperidrosis Axillae treated by the X-Ray — G. H. Stover. I. Because of the fact that various cells in the body, notably those consti- tuting the organ of hearing, respond dif- ferently to the different vibration wave lengths as represented by different mu- sical pitches, Brinkmann has conceived the possibility that cells constituting other tissues of the body may also share this tendency, whereby different thera- peutical results could be attained by regulating the pitch or wave length of the vibration. He has had constructed a faradic coil with three separate interrupters, so ar- ranged that a current, interrupted at the same time by different frequencies, may be administered. He reports that thera- peutical results attained with this appara- tus are very much better than those at- tained with the ordinary coil, which gives a current with but a single frequency of interruption at a time, and promises to exhibit a finished and perfected ap- paratus, and describe clinical results at greater length, in the near future. 2. See THE ARCHIVES for April, I905. 3. Gibson considers that the great therapeutical elements in the treatment of consumption are the forcing of nutri- tion to the highest possible point, a 5 plentiful supply of sunshine, of air rich in ozone, and the locating of the patient in a dry altitude. If the patient's heart action is good he should be sent to the Rocky Mountains, which he considers the place par excellence for such a person to rest up and get well in. Anything that increases metabolism and the assimilation of food, such as electricity, etc., are most useful. He considers the X-ray to be a most valu- able adjunct; recommends that it be ap- plied from a high tube and with a large amperage in the exciting coil, and that this application should always be stopped short of its destructive or enfeebling in- fluence upon cell life. Its good effect is due to its power of increasing the blood supply of the part rayed, and it probably destroys bacteria secondarily by the in- crease of cell vitality dependent there- upon. He also recommends the use of artificial fluorescence in conjunction with the X-ray. Care should be exercised in cases advanced to the stage of cavitation, as febrile temperature and sepsis may be accentuated by too much raying. 4. A report of ten cases, commonly met with in general practice, and involv- ing sciatica, local inflammatory processes, neuritis, and traumatic,conditions, which Northrop has cured by the use of various static modalities. There is nothing new in the reports. 5. See THE ARCHIVES for April, I905. ARCHIVES OF THE ROENTGEN RAY London, England, April, 1905. I. On Osseous Formation in Muscles due to Injury (Traumatic Myositis Ossi- ficans — Robert Jones and David Mor- gan. 2. The Treatment of Epilepsy by X-Rays — Horace Manders. 3. A New and Possibly Improved Method of using Radium — Hugo Lieber. (18o) - CURRENT PHYSIOLOGICAL THERAPY I8 I 4. A Case of Severe Hysteria successfully treated by High-Frequency Currents — W. F. Somerville. - 5. Reflections on the Position of Oscillatory Currents in Therapeutics, and the Present State of our Knowledge Con- cerning Them — T. J. Bokenham. 6. Note on Sanatoria for Insane Patients, James Murry Royal Asylum, Perth - — A. R. Urquhart. 7. The Thyroid Gland: the Influence of Diet on its Structure and Function — Chalmers Watson. I. Jones and Morgan report I7 cases of bony formation in the muscles about the joints, chiefly the elbow, fol- lowing injury to the soft structures or dislocation. Over 250 such cases are on record. The type described differs from the successive ossification of mus- cles known as Myositis Ossificans pro- gressiva, and that local ossification known as rider's joint, etc. The pathology is not satisfactorily understood, neither is the origin of the bony mass. It is not, however, due to the transformation of the effused blood into bone. The periosteal theory ex- plains a large number of these cases. Thus, in injury, a flap of periosteum may be torn entirely free, and be de- posited in a muscle area; there, under the stimulus of the injury, it goes on to proliferation and ossification. More- over, the wounded periosteum remaining on the bone also reacts and forms new bone. In this way a complete bony wall may be formed around the effused blood, and a cyst formation occur at the site of injury. This explains the frequent at- tachment of these bony tumors to the bone. - Again Boppe has advanced the theory, which was confirmed experimentally by Berthier, that if a muscle in action re- ceives a blow some fibres may be torn off from the bone, carrying with them small portions of periosteum, which be- come true bone grafts. Again a direct injury to undetached periosteum may be followed by a pro- liferation of bone into the muscle sur- rounding. The greatest number of these cases have their origin from the peri- osteum of the diaphysis of the bone, and in many such cases fine pedicles have been traced from the secondary bony de- posits to the periosteum. - The article is to be continued and is illustrated by eight excellent radiograms, illustrating osseous formations in and about the elbow joint following injury. 2. Manders claims one person in every thousand throughout Europe is a sufferer from epilepsy, and he laments the inefficiency of medicinal treatment in the condition of petit mal, which is far more grave in its effects than the more amenable grand mal. Epilepsy has no definite pathology nor morbid anatomy. In an epileptic the cells of the gray substance of the brain or the upper portion of the spinal cord have not al- tered histologically in either way, either macro- or microscopically, and yet their reflex excitability is so exaggerated that the slightest irritation is sufficient in such individuals to set up a perfect storm of reflex excitability and action, which manifests itself as an epileptic attack. The cell change, then, is functional or dynamical. Branth in America three years ago suggested the use of the X-ray in epi- lepsy, upon the theory that epilepsy de- pends upon the instability of the cellular brain elements or an abnormal meta- bolism. Since it is accepted by many au- thorities that the X-rays stimulate pro- toplasm into greater activity, they were on this theory applied in epilepsy. Branth's technic consists of a tri- weekly exposure of I 5 minutes at I 5 inches, slowly increased to IO minutes at Io inches, a different part of the skull being exposed at each treatment. A tube backing a spark gap of from 5 to 8 inches is employed. The hair, of I82 CURRENT PHYSIOLOGICAL THERAPY course, suffers to a certain degree. The bromide which the patient has been taking should be withdrawn slowly. As a rule the patients gain weight rapidly. The seizures become lighter, occur at longer intervals, are of shorter dura- tion, and followed by less prostration. Patients who have habitually suffered from six to eight attacks daily, after a few weeks' treatment may have but one attack in two or three weeks. Those patients in whom degenerative processes in the brain have set in are not amenable to this treatment. He reports at great length a case of mixed grand and petit mal, originating in childhood, develop- ing fully in adult life, in a man aged 31, in which very decided benefit seems to have followed some I 5 months' treat- ment. 3. Lieber describes a method of em- ploying radium therapeutically. He claims that radium gives off about 95 per cent. alpha rays and about 5 per cent. combined beta and gamma rays. The alpha rays, as well as the emana- tions, are of no avail therapeutically if the radium is kept in a container. In order to get the maximum benefit from a given quantity of radium, it must be in such form that the walls of the con- tainer will not intercept either the alpha rays or the emanations, and the radium must be spread very thinly. - - He claims that most of the disap- pointing results in the therapeutic use of radium have been directly due to the fact that the container intercepted a large proportion of the rays. By con- tinued experiment he has succeeded in producing thin coatings of radium upon various rods of celluloid and instru- mentS. hol or amyl acetate, and into this solu- tion the instrument or rod is introduced, is then withdrawn, and the solution evaporates, leaving the material coated with an exceedingly thin film of radium, which is then bound by dipping the in- The radium is dissolved in alco- strument for a moment into collodion. This coating becomes so tough as to ab- solutely protect the radium, yet it is so thin as to permit alpha rays to emerge freely as well as the emanations. More- over, the emanation of radium readily follows an air current; thus a hollow tube may be coated internally with the radium solution, and the emanations from the interior of the tube can be in- haled by the patient, or air can be forced through the tube by means of a com- pression bulb and applied to any of the cavities of the body. Rods, applicators, disques, drainage tubes, etc., may be pre- pared with a thin film of radium in this manner and employed on the surface or within the body. The radium is amply protected by means of the collodion coats, and the effect of objects so coated upon the tissues with which they come in contact is open to investigation by phy- sicians. - 4. Somerville's case was a female aged 35, complaining of mucous dis- charge from the bowel, external hamor- rhoids, and a sense of distension of the abdomen. She exhibited an obstinate ul- ceration of the leg, and at the age of 20 showed symptoms of gastric ulcers with haematemesis, and the passage of blood per rectum, and these symptoms, with loss of flesh and weakness, continued for Io years, with occasional attacks of severe abdominal pain, attended with collapse so severe as to suggest perforation of the stomach. On one occasion the abdo- men was opened for the purpose of re- pairing such perforation, but the stomach was found perfectly normal, without any adhesions. The gall-bladder, however, contained 27 calculi, and these were removed, but no permanent relief fol- lowed. Daily attacks of stomach pain, distension of the abdomen, general rigidity and unconsciousness followed for a year. Some improvement resulted from a sanitarium treatment by massage, baths, etc., but relapse was prompt. CURRENT PHYSIOLOGICAL THERAPY I83 One year following, Somerville began treatment with high-frequency currents, using auto-condensation, one terminal applied to a large abdominal electrode, the other to the couch. On many occa- sions this treatment gave immediate re- lief, gradually the severity of the attacks diminished, and they finally ceased. For the treatment of the mucous colitis one electrode was applied to the tongue and the other was introduced into the rectum. Following this the hamor- rhoids shrank and the mucous discharge disappeared. The patient received 5 I treatments, recovered completely, and has remained so. 5. Bokenham calls attention to the value of the work of Dr. Wright in classifying correctly the forms of oscil- latory currents employed in therapeutics. The term high-frequency currents is inexact and should be discarded. The present attitude of the profession toward the employment of oscillatory currents in therapeutics varies from skepticism to total disbelief, and the results obtained are attributed to suggestion. Dr. Bonnefoy that most of the high- frequency apparatus should be classed as mere toys, few of them possessing therapeutic value. Too much has been written about results, and too little specific information concerning the exact current condition and technic employed. Bokenham claims that our present knowledge does not permit us to de- scribe this with scientific accuracy. He claims that the wide difference in the various styles of apparatus precludes the possibility of comparing the char- acter of currents employed. Unless the self induction of the coil and the char- acter of the secondary discharge is known, our knowledge is imperfect. We should have under control and be capa- ble of determining: A, Current quan- tity; B, Tension; C, Wave-length; D, Wave-form; E, Frequency of oscilla- tion; F, Rapidity, duration, and char- acter of the interruption between succes- He quotes sive wave-trains. This knowledge will prove a satisfactory solution of the prob- lem. Doubt and confusion will disap- pear and much worthless apparatus will be discarded. He pleads for the meas- urement and recording of all factors connected with the work, but claims such measurements are deceptive; that the milliampere meter reading is of value for a given installation, but affords no means of comparing different installa- tions or as a guide to dosage for another worker; equally deceptive is the length or volume of effleuve. Such measure- ments have only a relative, not an abso- lute value. - 6. Urquhart claims the difficulty attendant upon the early diagnosis of phthisis is increased in asylum practice by the mental complication. Patients received free from tubercle have de- veloped phthisis in the asylum. During seventeen years but ten cases of phthisis were under treatment in Murry's Asy- lum, all except one being diagnosed on admission. At this time a bad case was admitted from another asylum who was dirty in his habits and refused to adopt proper sanitary precautions. Following his advent six males developed phthisis, and a special sanitoria was added to the institution for the treatment of such pa- tients with satisfactory results. . In spite of the particularly fatal com- bination of phthisis and insanity, the results under open air treatment have been encouraging. During the last 25 years 32 cases of phthisis in the insane have been treated; I4 died, I 2 recovered physically, 2 improved bodily, 8 recov- ered mentally, one improved. Of 6 remaining, 5 have made physical recov- eries, one remains under treatment. During the past 25 years the death rate from phthisis in this institution has been 6 5/Io per cent., and with the new sani- toria still more satisfactory results are expected. 7. Watson has made a preliminary investigation which has shown that dif- 184 CURRENT PHYSIOLOGICAL THERAPY ferent diets are associated with histo- logical changes and alterations in the functional activity of the thyroid gland. A number of fowls were fed on a strictly raw lean meat and water diet, under which they died in from three to sixteen months. In each the thyroids were greatly enlarged, showing microscopi- cally the characteristic appearance of simple parenchymatous goitre. In two cases the parathyroid glands were enor- mously enlarged, showing microscopi- cally the normal structure of the glands. In rats a diet of raw minced ox-meat and water, as much as they would con- sume, was given. The results were sum- marized as follows: Distinct histological changes in the glands. The parathy- roids were generally unaffected. The appearance points to the condition of hypothyroidism with a probable modi- fication in the character of the secretion. He believes that the dietetic habits of the country have changed markedly. The blue book shows evidence of an in- creased consumption of meat, which has probably been accompanied by indica- tions of deranged function of the thy- roid gland. Evidence is afforded in favor of this view in the value of thyroid medication in skin diseases, obesity, etc., which have no known relationship to the thyroid. He believes that in many subjects an alteration in the character of the thyroid secretion has followed this excessive meat dietary, and when a sim- ple deficiency is present it can be reme- died by administration of thyroid glands. ARCHIVES DELECTRICITE MEDI- CALE Bordeaux, France, March 10, 1905. I. Case of Rebellious Psoriasis cured by Roentgen Therapie — Dr. H. Mar- Ques. - 2. Tubes for Medical Radiology — Dr. J. Belot. . 3. X-Ray and Wireless Telegraphy Auto- mobile Ambulance — G. Gaiffe. 4. The Practice of Radiography and Radio- therapy in Germany — Prof. Jaime R. Costa. I. The case reported is of a man 25 years of age who had suffered from pso- riasis of a pronounced type of the hands, elbows, back, chest, and knees for four years despite treatment by oil of cade and other medicaments. The X-ray was ap- plied at first to the hands. The author did not have Holzknecht's chromora- diometer at that time, but gives the fol- lowing details: I.2-inch coil; I IO volts; Contramoulin interrupter; soft tube; rays No. 5 or 6; anticathode at a dis- tance of six and a half inches; exposure 5 minutes on the dorsum and 5 minutes on the palms of the hands. Treatments were given every two or three days. After two weeks the sound skin was de- cidedly erythematous, but the scales were falling off and the intolerable itch- ing had entirely disappeared. This was all the treatment required for the hands. Other affected regions were subjected to similar treatment and with the same success. Five months after the end of the course of treatment, which had taken only a month and a half in all, there had been no recurrence. The static breeze and high tension effluvia had been tried in this case without any effect. 2. A description by Belot of the dif- ferent stages of development of the X- ray tube. 3. Gaiffe's automobile ambulance is run by a gasolene motor which can be used to operate a dynamo and one of his new transformers. The latter produces, without an interrupter, a current suit- able for exciting an X-ray tube. All the necessary appliances for X-ray work and wireless telegraphy are included. This would be especially useful in country dis- tricts and in military surgery. 4. Prof. Costa continues his series of articles by describing the work done in Vienna, especially by Holzknecht, Kienbock, and Freund. CURRENT PHYSIOLOGICAL THERAPY 185 ARCHIVES D’ELECTRICITE MEDI- CALE Bordeaux, F rance, March 25, 1905. I. Radiography in the Diagnosis, Prognosis, and Treatment of Congenital Dislo- cations of the Hip — Dr. H. Judet. 2. Therapeutic Use of Salts of Radium — Dr. A. Beclere. 3. Comparative Study of the Action of the Autoconduction Cage and the Con- denser , Couch in the Treatment of High Arterial Tension by High Fre- quency Currents—Messrs. A. Moutier and A. Challamel. 4. The Practice of Radiography and Radio- therapy in England — Prof. Jaime R. Costa. I. This is illustrated by several dia- grammative sketches from radiographs of the hip in cases of congenital disloca- tion both before and after reduction. His technique is to take a picture of the entire pelvis, with the tube over the linea alba at the level of the anterior inferior spines of the ilia, and with the feet sym- metrically placed. This is followed by three radiographs of the affected hip, tube over a point I cm. external to the femoral artery and I cm. above the crural fold; in one the foot is in a sagit- tal plane, in another the foot is inverted resting on its inner margin, and in the third, everted. After reduction by Lo- renz's method he finds it practicable to take a radiograph through the plaster of Paris by using a hard tube, resistance 15 to I 8 cm. and an exposure of six or seven minutes, long and weak development carried to the greatest possible extent and disregarding all portions of the image except just the hip joint. The anatomical changes are very slight at birth, but become much greater after several years. He thinks the radio- graphs prove Lorenz's method to be a COrrect One. 2. The radium salts used in medi- cine are the chloride and bromide of ra- dium, and the radio-active chloride and bromide of barium which is more or less rich in radium. Salts of radium con- stantly emit rays like those from an X- ray tube. They also have the property of causing neighboring substances to be- come temporarily radio-active. The ra- diation is in straight lines not subject to refraction, reflection, or polarization and is arrested by a thick screen of lead. The induction of radio-activity is trans- mitted by the air and will travel through a narrow and sinuous tube; it must be due to a gaseous emanation. The emanation of radium is not used therapeutically. Messrs. Bouchard and Balthazard and Mme. Curie have found that a certain amount of the exhalation mixed with air breathed by small mam- mals killed them very quickly. The ordi- nary containers for applying radium are transparent to the radiation, but retain. the emanation. He reviews the proper- ties of the alpha, beta, and gamma rays and the means of measuring radio-activ- ity. From a therapeutic point of view the degree of activity is of much greater importance than the quantity of the salt, but the latter must also be taken into ac- COUnt. Holzknecht's chromoradiometer is the most reliable measure of the thera- peutic activity of salts of radium of dif- ferent radio-activities and amounts, and in different containers. But this does not mean at all that an application of radium which will produce 5 H. has the same effect on the tissues as that of an X-ray tube producing 5 H. In his own application I 5 centigrammes of 5 OO,OOO activity are spread out in a layer six or seventh-tenths of a millimeter thick and II millimeters square, and covered by a sheet of aluminum one-tenth of a milli- meter thick. Measured by Benoist's ra- diochromometer the penetration of rays from radium is less than half of a de- gree; much less than the softest X-ray tube. - He reports a case in which he applied 45 centigrammes of pure radium bro- I86 CURRENT PHYSIOLOGICAL THERAPY mide in a glass bulb, for cutaneous no- dules following removal of cancer of the breast. In one case the application lasted five and in the other ten minutes. In both cases there was a vigorous reac- tion, the longer application resulting in superficial necrosis which healed with a scar; but in neither case was any marked change produced in the cutaneous no- dules. X-ray treatment would have caused the complete disappearance of the nodules without any effect on the surface of the skin. - After applying radium rays there is a pre-reaction the same day or the follow- ing day (redness, smarting, and itch- ing); and then often after several weeks the true reaction appears. Therapeutic uses are in three classes of cases. I. The Algias. 2. Arthropathies. 3. Malignant disease of the skin or mu- cous membranes (in those cases where the lesion is of slight extent and depth and whose anatomical site makes the ap- plication of the Roentgen ray difficult). The tabulated experiments of Moutier and Challamel show that in cases of high arterial tension the sole- noid (autoconduction cage) is decidedly more effective in lessening the arterial tension than is the autocondensation couch. As an example, in one case the arterial tension was 23 mm. of mercury; after treatment with the cage it was 17 mm. of mercury; after treatment with the couch it was 20% mm.; after a second treatment with the cage it was 16% mm. 4. The dominant personality in elec- trotherapeutic circles in London is Dr. Lewis Jones. He is assisted at St. Bar- tholomew's Hospital by Dr. Hugo Wal- sham, who has so well described the ra- diography and radioscopy of the thorax, Small coils of eight or ten-inch spark length are used generally with a Mac- kenzie Davidson mercury interrupter. The static machine is but little used for X-ray work. A milliamperemeter meas- uring the current passing through the X-ray tube is the usual instrument for determining the quantity of X-radiation, Holzknecht's chromoradiometer not being used to any extent. JOURNAL DE PHYSIOTHERAPIE Paris, France, March 25, 1905. I. Roentgen Therapy in Ulcerative Cancer - of the Breast — Dr. Haret. 2. Electrotherapy in Neurasthenia — Dr. E. Albert-Weil. 3. The Treatment of Dermatoses by Radium — Dr. M. Danlos. I. Haret reports the case of a woman 64 years old, with a carcinoma of the breast which had existed, un- treated, for four years. The nipple was still intact, but above it was an ulcerated mass the size of a Tangerine orange. There were no glandular involvements in the axilla, but cough and cachexia led to the suspicion of intra-thoracic metas- tases, and these were found on making a fluoroscopic examination of the chest. The prognosis, as far as concerned the local lesion, was good, but the X-ray was not expected to arrest the internal metastases. Treatment was by the ad- ministration of 4 Holzknecht's units once a week. After three weeks the sur- face ceased to bleed; then the pain disap- peared; little by little the surface of the ulcer became cleaner and its borders less thick; cicatrization began at the ninth treatment. A complete local cure was obtained in sixteen treatments — 64 H. —but the patient's general condition continued to become gradually weaker. Photographs are given of the condition before and after treatment. He con- siders this a case in which the patient would have been saved if X-ray treat- ment had been begun before internal in- volvement took place. - 2. The first few electrical treat- ments in a case of neurasthenia should be quite mild. Albert-Weil recalls a CURRENT PHYSIOLOGICAL THERAPY 187 case in which the first treatment, by a static bath and a series of sparks along the spine, kept the patient awake all night. The most generally useful ap- plication is the effluvia of high frequency from the bipolar resonator. A metallic electrode from the upper pole of one of the resonators is applied to the nape of the neck while the effluvia from the other electrode (connected with the up- per pole of the other resonator) is ap- plied over the abdomen. The maxi- mum effluviation is used and the appli- cation lasts fifteen minutes. Then the electrodes are changed and the effluvia applied up and down the spine for ten minutes. These treatments are repeated daily for twenty days. The static bath is the best thing when insomnia is a prominent symptom. Generally two or three series of twenty treatments each are required to effect a cure. In some cases a galvanic bath, with the hands in two basins connected with the positive pole and the feet in two basins connected with the negative pole, effects a com-. plete cure. For cerebral neurasthenia (“banded ” feeling about head and inability to work) cerebral galvanization, large pos- itive electrode on the nucha and a nega- tive electrode, 5 cm. by IO cm., on the forehead, the current very gradually and steadily turned up to 20 milliam- peres, duration fifteen minutes. For oc- cipital headache, static bath for ten min- utes, preceded by high tension effluvia for twenty minutes applied locally. Ar- terial hypotension relieved by bipolar effluvia of high tension current for fif- teen minute applications. When the blood pressure is very low indeed an elec- trode from the lower pole of one reso- nator is placed on the epigastrium and a series of spark discharges along the spine from a ball electrode from the up- per pole of the other resonator. For cardiac troubles (palpitation, irregular- ity, and angina) static bath with a breeze over the heart. For dyspeptic troubles especially of the nature of gastric as- thenia, generally the regular high fre- quency effluvia over the stomach with the plate electrode over the spine, suf- fices; if not then Beard and Rockwell's galvanization of the sympathetic ner- vous system is to be applied. A nega- tive electrode of IOO X I 50 cm. is placed on the epigastrium, the positive sponge electrode placed over exciting points of the pneumogastric and sympa. thetic nerves on each side for five min- utes, and then for the same length of time at each side of the cervical verte- brae, 8 to IO milliamperes. Constipation in these cases is nearly always spasmodic; treatment heavy gal- vanic or galvano-faradic currents. Dif- ficulty of micturition in the male sex, galvanism, positive electrode on peri- neum, large negative electrode over ab- domen or over the last dorsal vertebrae, the heaviest current that can be borne for ten minutes. Impotence, high fre- quency bipolar effluvia with a series of sparks over the erector center; or gal- vanism, large positive electrode over genitary centers of the spine labile appli- cation over the perineum, scrotum, sper- matic cord, and the root of the penis, Io or 20 milliamperes for I 5 minutes every day. In women, pelvic neuralgia; vaginal faradization, the other electrode on the abdomen, fine wire coil and very rapid interruptions. Or especially the static induced current, one pole in the vagina (connected with Albert-Weil rheostat) the other on the abdomen, and the unoccupied hand of the opera- tor massaging the abdomen. Myasthe- nia: rhythmic galvanism, positive elec- trode in the dorsal region, small nega- tive electrode exciting the different mo- tor points of the muscles of the limbs and trunk; 20 milliamperes, interrup- tions made by a metronome, duration of each seance IO to I 5 minutes. 3. Danlos says that the thinnest sheet of aluminum (two-tenths of a mil- limeter in his disk) absorbs 80 per cent. I 88 CURRENT PHYSIOLOGICAL THERAPY of the radiation from salts of radium of 3OO,OOO radio-activity; and that an im- provement consists in having the radium spread on the surface of the metallic disk and varnished over with a prepara- tion which is impervious to moisture, but transmits practically all the rays. Application with the original glass bulbs containing radium of 20,000 activity ap- plied for from six to thirty-six hours, produced a temporary redness at once, followed in from 5 to 20 days later by a macerated pale transparency of the epi- dermis with a redness of the deeper lay- ers of the skin, then slight blistering and superficial necrosis with slowly heal- ing ulceration which is usually painless. The metallic double-walled disks, which he has been using the last couple, of years, produced redness in from five to ten minutes, and with this radio-activity of 20,000 the exposure is about one to three hours. The application is re- peated in three weeks; for lupus the same point will require two or three ap- plications, while a single application suf- fices to cure a small superficial epithe- lioma (with epithelial pearls). The ap- plication invariably causes a persistent cutaneous erythema. Tubercular lupus affecting small areas is readily cured by radium and the resulting cicatrix is es- pecially immune against With lupus erythematosus the case is quite different, the benefit being very transitory indeed. For epithelioma with pearls, of small extent and superficial, radium is highly successful, a metal disk with 300,000 ac- tivity applied for from half an hour to an hour. A cure is effected quickly and painlessly and there is practically no scar. For little vascular navi applica- tions of an hour repeated if necessary every three weeks results in little smooth white cicatrices. He thinks the X-ray would be much better for more extensive lesions. Radium has a beneficial effect upon patches of psoriasis, but this is en- tirely transitory. It has no effect in hy- recurrence. pertrichosis, an application which is not strong enough to cause ulceration and scarring having no effect on the hair fol- licles. Leucoplasia of the tongue with painful fissures was somewhat benefited by the application of 300,000 radio-ac- tivity for half an hour or an hour, the effect being a slowly-healing and painful ulceration the size of the disk, but after healing the patient felt better although there was no great improvement in the local appearance. As to epithelioma of the tongue he regards the X-ray as bet- ter if the lesion is accessible, using tongue forceps if necessary. The use of a ra- dio-active fluid, ingested or injected, is still speculative, perhaps trials on ani- mals may produce more valuable results. LE RADIUM Paris, France, February, IQO5. 1. On the Therapeutic Use of Radium Salts * - — A. Beclere. 2. Radium Bearing Veins of Issy-l'Eveque — Jaques Danne. 3. Study of Phosphorescence — L. Matout. I. While the discovery of radium by the Curies was a conquest of French science, according to the author, com- paratively few publications on the use of that material for therapeutic purposes have yet appeared in France. He distinguishes carefully between the emanation from radium, and the va- rious kinds of rays emitted, stating that it is with the latter that the present ar- ticle deals, since usually the radium salt is so enclosed as to prevent the escape of the emanation. 22 - The various well-known methods of detecting and estimating the rays are re- ferred to, and the electrical method, pre- ferred by physicists, is given promi- nence. The author lays special stress upon the importance of always know- ing and stating the quantity of salt em- ployed on any case, as well as its activity referred to that of metallic uranium, the CURRENT PHYSIOLOGICAL THERAPY 189 total effect being proportional to the product of these two quantities, when other conditions are maintained con- stant. Knowledge of the permeability of the containing vessel is also very im- portant. Also attention is called to the ques- tion as to the proper method to employ in the comparison of the activity of Sam- ples to be used in therapeutics. Will any of the known methods result in a knowledge of the real therapeutic effec- tiveness of various samples? Surely not since the methods are not quantitatively comparable among themselves. As with Roentgen rays, the tissues are affected in proportion to the absorption pro- duced, and for this reason the doctor might better use a method of compari- son based on the absorption of the rays by some substance similar to the skin. The chromoradiometer of Holzknecht of Vienna is suggested for this purpose. The author describes some experi- ments with this instrument made in Curie's laboratory, the results of which justify him in suggesting its use by others. There are many corrections, however, to be applied to get strictly comparable results, especially if the Roentgen rays are also considered. Some special devices for using radium for therapeutic effects are described in detail. 2. This article gives the result of the attempt of the author to discover new sources of the rare element radium. The chief sources thus far have been from uraninite and from carnotite, both minerals containing uranium. minerals, however, are comparatively rare and in an effort to discover radium elsewhere the author has found that cer- tain lead-bearing deposits near Issy- 1'Eveque in France contain radium to a marked degree. the radium in this soil is shown to be pyromorphite or a phosphate of lead found in small crystalline masses. It is to be noted, however, that these in the presence of uranium. Both The chief source of radio-active lead minerals do not contain any uranium, though up to the present time no radium has been found except In fact it seems to have been shown by Boltwood and others that in uranium minerals the radium present is always proportional to the quantity of uranium in the sample, indicating of course that the radium has been generated from the uranium. The fact that the pyromorphite from Issy-l'Eveque contains no uranium, would of itself be evidence against this theory. The author, however, attempts to account for the fact in a way quite consistent with the theory, that in all cases radium is produced by uranium. He suggests that the radium found has been deposited in the pyromorphite in rather recent times by radio-active water. Much conclusive evidence is given to substantiate this view. The soil is very moist and permeable and from all the water sources in this vicinity the author reports radio-active products due to ra- dium emanation. From some locations, so located as to avoid the action of the water in question, samples of the mineral show no evidences of radium. Neither do samples of the same mineral when taken from other more remote places. The geologic formation of the region where these radio-active samples of py- romorphite were found also favors the explanation given for the presence of radium. 3. In this somewhat long and com- prehensive article the author gives a brief history of the development of our knowledge on this subject during the last 500 years. The phenomenon has long been observed in the case of dia- monds. The recent discoveries of the several new radiations which have been shown to excite phosphorescence in many substances have given a new interest to the matter, and the article will be found very useful to those wishing to look up any phases of the subject from original SOUITCCS. - I90 MISCELLANEOUS ABSTRACTS : v. The material is conveniently arranged under several heads, as follows: I. Spontaneous phosphorescence, in- cluding phosphorescent light emitted by animals and plants. - II. Phosphorescence brought about by mechanical action, i. e., by rubbing, by shock, or by fracture. III. Phosphorescence by light, or the effect resulting when certain sub- stances are taken into the dark after having been bathed in a strong light. To the varying intensity of this phos- phorescence the logarithmic law of de- crease approximately applies. . The various varieties of this interest- ing subject are discussed at considerable length and detail. ELECTROTHERAPY THE REMOVAL OF IRON AND STEEL. FROM OTHER PARTS OF THE BODY THAN THE EYE, BY THE USE OF THE GIANT MAG- NET, WITH REPORT OF TWO CASES Frank C. Todd, Northwestern Lancet, March - I5, IQO5. Magnets, both small and giant, have been frequently used for the removal of fragments from the eye, but Todd rec- ommends that the giant magnet also be used for the removal of fragments in other parts of the body, and for diagnos- ing such conditions. He uses for this purpose a heavy magnet swung from the arm of a movable stand. This magnet is so powerful that it will lift 400 pounds when connected with the 500-volt cur- rent. The power is perfectly regulated by a rheostat which is worked by the foot of the operator. He reports the follow- 1110 ; “Case I. — This case was referred by Dr. Spring, who had taken an X-ray picture, which he has shown tonight, showing the location of the foreign body, and he had endeavored, with the use of instruments, to find it. The foreign body was embedded in the muscular tis- sues of the forearm, and was a flat piece less than one-quarter of an inch in diam- eter at its largest part. Dr. Spring was unable to find it with the knife or other instrument. The application of the mag- net to the wound at once caused pain (due to the movement of the foreign body toward the magnet, thus proving the fact that a piece of iron or steel was buried in the tissues), and whenever the current was turned on this pain was pro- nounced. An application of cocaine was made completely anaesthetizing the parts, and the foreign body evidently worked its way out toward the magnet, and when the arm was drawn slowly away from the point of the magnet the tissues re- mained in contact with the magnet, being held there by the piece of steel which was attracted toward the point of the mag- net. By the use of a knife the soft tis- sues separating the magnet point from the foreign body were severed, and the steel readily made its way through this path, and was found upon the magnet oint. • “Case II. — This case was also re- ferred by Dr. Spring, and was another patient with a foreign body embedded in the tissues of the wrist. Dr. Spring has seen the piece of metal with the flu- oroscope, but it was still smaller than the piece removed in the other case, being sharply pointed like a needle, one-quar- ter of an inch long and about one-six- teenth of an inch in its largest diameter. It was removed in the same manner, but it was found best to direct the magnet so that the lines of force would bring it. out point first in order to secure it with- out much cutting. This foreign body was so small that it would have been im- possible to remove it without consider- able dissection and much searching.” RADIODIAGNOSIS A METHOD OF MEASURING THE X-RAYS Milton Franklin, New York Med. Jour. and Philadelphia Med. Jour., April 22, 1905. Franklin discusses the shortcomings in the present methods of measuring X- radiance, and recommends that the power of the X-ray to ionize the air be utilized, through an electroscope, as a means of accurate measurement. He has devised such an electroscope with a proper case, so constructed and arranged that no ultra-violet rays or other sources of error can enter. The instrument is portable, and provided with a window which can be opened so that the X-ray can be allowed to enter the electroscope when desired. The measurement is ob- tained by noting the rapidity with which the gold leaf falls, which denotes the degree of intensity with which the air is ionized by the X-ray, thereby giving a measure of the intensity of the ray under observation. The method of using Franklin's special electroscope is as fol- lows: “I. The electroscope is charged by having brought into contact with the knob a rod of vulcanite which has been electrified by friction. The knob is brought into communication with the filament, while the vulcanite is in con- tact, and released as soon as the filament has assumed a horizontal position. “2. The electroscope is brought to the same distance from the tube as the patient or plate (in any position), and, while the tube is running, the shutter is opened and the time in seconds, occu- pied by the filament in transit, is noted. The number of seconds is the exact co- efficient of energy of the rays, and when compared with any other reading made under any circumstances whatever, with a similar instrument, the ratio of ener of the two radiations will equal that of the two times.” BINOCULAR RADIOGRAPHY Charles D. Harrington, Northwestern Lancet, April 1, 1905. The stereoscopic radiograph was first suggested in this country in 1896. It gives you the X-ray picture; there is no distortion, and the full detail is seen at a glance. The author describes an in- strument designed by Dr. W. S. Fuller- ton of St. Paul, which consists of an ad- justable table, having attached to it a compression diaphragm. The essential points are the arrangements to move the tube definitely two and a half inches, and to remove the plate and replace it with another without moving the patient. The author then describes the Weigel stereoscope, which has been previously described by Dr. Weigel in the New York Medical Journal of November 16, I90I. The advantage of stereoscopic radiography is that it gives perspective, or the third dimension of space, in addi- tion to length and breadth, which last only are attainable with the ordinary skiagraph. AN IMPROVED X-RAY FOR THE STUDY OF BONE INJURIES AND FOREIGN BODIES G. H. Stover, Jour. A. M. A., March 25, I905. e In the ordinary skiagram information is furnished of but two dimensions of the object under investigation, viz., length and breadth, but no information is fur- nished as regards the third dimension, depth or perspective. By the use of the stereoscopic principle this third dimen- sion is supplied, and facilitates greatly the study of the actual relative positions of the different parts of the body under examination. The instrument recom- mended by Stover for the production of (191) I92 MISCELLANEOUS ABSTRACTS stereoscopic skiagraphs is as follows: “A plate-holder so arranged that a plate in its light-proof envelope can be in- serted, withdrawn and another inserted without disturbing the patient, who is placed on it, is quite necessary. - “If there are no good natural land- marks near the part to be examined, a metallic marker may be placed on the skin, its location being indicated by in- delible ink or nitrate of silver; in look- ing for a needle do not use a piece of straight wire as a marker, and if a bullet is sought, do not use a metallic disk, for very obvious reasons. “The tube is hung from a graduated support; a point on this support is found that is in a line perpendicular to the plate and passing through the center of the object to be examined. The tube is now placed so that the anode is a cer- tain distance, varying according to the thickness of the part, to one side of the base point already selected on the tube support; an exposure is made, the plate withdrawn from the plate-holder, and another plate inserted. The tube is then moved so that the anode is on the other side of the base point of the support, a distance equal to its former distance from it on the opposite side and another exposure is then made. “For examination, the finished plates are placed in a suitable light, side by side—there is a right and left in this arrangement—and they are then exam- ined by means of a special stereoscope. I use plane prisms of 12 degrees, with bases out; an ordinary parlor stereoscope will not do at all. - “In looking at the skiagrams, the at- tention is concentrated on the center of the picture, and the observer is rewarded by a view of the parts that gives their true perspective. There are other means of examining these negatives, but I think this is the simplest.” By reduc- ing the radio-stereograms in size they may be viewed through an ordinary par- lor stereoscope, but they all suffer some loss of detail in the process of reduction. If one is able to diverge the eyeballs these radio-stereograms can be exam- ined without the aid of a stereoscope, but not every one is able to accomplish this feat. The way to attain diverg- ence is to attempt to look through a point midway between the negatives or prints, at the same time focusing the eyes for a distance far away. • Stover believes that the time is close at hand when failure to apply skia- graphy as an aid in the diagnosis and treatment of fractures and dislocations will be considered evidence of neglect and incompetent treatment. RADIOTHERAPY CARCINOMA OF EYELID CURED WITH LIGHT TREATMENT Dr. Greef, Berliner Klinische Wochenschrift, 27, II, IQO5. The patient, who was 67 years old, noticed 15 weeks before, on the inner angle of the upper lid, a small pustule which very rapidly increased in size. Greef found a big, ulcerating “can- croid’’ reaching from the right eye across the nose to the lids of the left eye. The lids of the right eye were almost totally destroyed, the cornea cloudy, the bulbus blind. A microscopical examina- tion corroborated the diagnosis of car- cinoma (not the variety known as ulcus rodens). The bulbus was enucleated, and five days later the whole ulcerating area exposed to the Roentgen rays. Duration of each sitting, ten minutes. After eight applications the whole area was transformed into white, hard, cica- tricial tissue, and the carcinoma cured. A plastic operation followed with a gratifying result. RADIOTHERAPY I93 TUBERCULAR TESTICLE AND THE X-RAY. W. D. De Garmo, Medical Record, April 15, I905. - Report of a case of tuberculosis of testicle cured by means of the X-ray. This man was 56 years old, large and robust, and always had enjoyed the best of health. Admitted gonorrhoea 25 years before. denly began to swell and gave him in- creasing pain. He took the European trip to try the baths for it, but received no relief. He began to lose weight rapidly, and a diagnosis of tuberculosis of the testicle was made. Operation was advised and consented to after two months. Pathologists reported a “typi- cal tuberculosis.” . The patient made a prompt recovery, but immediately after- ward showed evidence of disease in the left testicle, and after trying an outdoor life for two months, presented himself with a testicle as large as the other had been. An operation was suggested and refused, and he was referred to Dr. F. D. Carpenter for X-ray treatment. One hundred and twenty-six treat- ments of ten minutes each with a medium tube at ten inches distance was given. Pain left at the first application; swelling and tenderness gradually subsided until at the end of the last treatment the testi- cle was apparently normal in size. The statement that no other cases are on record is an error, as 2 I cases of tuberculosis of the testicles were reported in American Medicine for January 14, 1905, by Dr. James Bullitt of Louisville, who reported 33 per cent. cured, 48 per cent. improved, with I 9 per cent. as failures. - . The author claims epididymectomy had cured many cases, but claims it should be used with caution, owing to the mental effect upon the patient. He calls attention to the alleged dan- ger of sterility of the individual from radio-active therapeutics, but justly I3 - One of his testicles sud- claims that the danger is very remote where this disease exists, as the damage has already been done. The very full report that is made of this case by the doctor is very welcome to X-ray operators, as there have been so many cases reported where the reports were open to serious question as regards both diagnosis and details of treatment. LEUKEMIA. THE ULTIMATE FAIL- URE OF THE ROENTGEN RAYS AS A THERAPEUTIC AGENT Everett J. Brown and Cecil M. Jack, Jour. - - A. M. A., March 25, 1905. In the present state of knowledge re- garding this disease, more especially as regards the place of the X-ray in its therapy, this article is most timely and of the greatest value. It completes the history of a case which was reported by the authors in the Journal of the Ameri- can Medical Association for March 25, 1904, as symptomatically cured. The patient was a cigarmaker, unmarried, 30 years of age, who first came under the observation of the authors July 1, 1903. Family history was negative, except that one sister had tuberculosis. He did not use alcohol, but smoked moderately. There was no history of malaria or syphilis. ' When the patient first came under observation he complained of physical weakness, pain in the back, and a feeling of weight and distress in the left side. Two years previously he had had a fall, alighting on the lower ribs of the left side, which compelled him to stop work for two days. He had had a slight cough for some time previously, and for six months had been troubled with pal- pitation, dyspnoea, and slight headaches. His feet had commenced to swell some. He was moderately well nourished but looked somewhat cachectic. Weighed I69 pounds. Was slightly anaemic. Lymphatic glands were not enlarged, I94. MISCELLANEOUS ABSTRACTS except in the inguinal regions; was troubled some with palpitation. Heart and lungs normal, liver dullness extend- ing to the edge of the ribs, and the edge of this organ was easily palpable. Splenic dullness begins on the seventh rib in the midaxillary line, and extends one finger's breadth beyond the median line. On palpation this organ was hard and smooth, but no notch could be felt. Pulse 90, temperature 99°F. Urine gives a slight precipitate of albumin and a few casts were found. Red blood cells number 2,600,000, white cells 800,000, haemoglobin 65 per cent. Slight poikilocytosis was present, and many nucleated red cells. Differ- ential count of the leucocytes gives: Poly- morphonuclears, 40 per cent. ; myelo- cytes, 40 per cent. ; eosinophiles, 8 per cent.: large mononuclear with basophile granules, 8 per cent. ; degenerates, 4 per Cent. - e Diagnosis, splenomyelogenous leu- kemia. He was given arsenic and iron internally and X-ray treatment to the splenic region twice a week; technique of the radiations not given. Two months later patient had im- proved to such an extent that he returned to his work. He had a good appetite, had gained in weight, spleen had de- creased in size, and a notch was felt for the first time. Edema of ankles less. Leucocytes decreased to 58,000, with an increase in the corpuscles to over 3,000,- OOO. - º - Iron and arsenic were then discon- tinued, and the X-ray exposures were given daily, to splenic region, the ends of the long bones, and to the sternum. Four months after beginning the treat- ment the leucocytes numbered 129,000, red cells 4, 124,000, haemoglobin 85 per cent; there was very little variation in size and shape of the red blood corpus- cles and no nucleated forms were found. Myelocytes, 25 per cent.; polymorphonu- clears, 60 per cent.; eosinophiles, 5 per cent. ; small lymphocytes, I per cent.; are relaxed, but there is no ascites. were myelocytes. degenerates, 3 per cent. ... " In February, 1904, or seven months after treatment had been begun, “the albumin had all disappeared from the urine, and the patient weighed 182 pounds, which is more than he had ever weighed before. The spleen could only be felt on deep palpation. Treatments were reduced to every other day, and the patient was advised to take long walks on the intervening days.” On May 1, 1904, the appearance of the patient was “that of robust health. His complexion is florid, quite a contrast to the cachectic appearance of ten months ago. He is working daily and rides his bicycle back and forth from work. The liver is of normal size, and the spleen is not palpable even on deepest inspiration. The ankles show no edema. His weight is 184 pounds. The abdominal parietes The previous inguinal adenitis has entirely disappeared.” - - On July I, the patient's good health had continued and the leucocytosis had reduced to II, OOO, 7 per cent. of which In September, 1904, or fourteen months after treatment was begun, pa- tient began to complain of weakness and pain in the back and the leucocytosis ran up to over 50,000; a few hyaline casts were found in the urine. From that time on the spleen became larger, a marked diazo-reaction was present in the urine, widal test was negative, and delirium developed. Within a week the leucocytes dropped to normal, and a se- vere diarrhea developed. Bowel move- ments contained some blood and much pus. Diazo-reaction still present and the urine contained albumin, numerous hyaline casts, and a moderate amount of calcium oxalate crystals. The low typhoid state continued for two weeks, the condition being a semi-delirium with great emaciation, no apparent suffering, no edema. Death occurred November I 5, sixteen months after beginning treat- RADIOTHERAPY I95 ment. + The findings at the autopsy, which was performed seventeen hours after death, are so interesting, instructive, and significant that we transcribe them ver- batim as follows: ATUTOPSY “The subject is a man of average size. Skin pale and sallow; muscles small and emaciated; panniculus almost absent. Both pleura free and no fluid in pleural cavities. The heart is of nor- mal weight, its endocardium slightly thickened; muscle is firm and of a brown- ish-red color. The auricles contain an- te-mortem clots and the ventricles fluid blood. The valves are normal. The lungs show marked anthracosis and yield slight exudate on pressure. There are no airless areas, but a slight hypostasis over lower lobes. The bronchi are empty and the mucosa pale. The spleen weighs I, I 33 gms. and measures I 5 x 9 x 6 cm. There is one notch. The cap- sule is greatly thickened and cuts with resistance. The cut surface is firm and dark bluish-red in color. The stroma is greatly increased, but the malpighian corpuscles are not visible. “The liver is enlarged but firm. The left lobe is atrophic. The veins of the capsule are congested, the capsule being thickened. On section the organ is fairly rich in blood. The cut surface is granu- lar, brownish-red in color, and the out- line of the lobules is distinct. “The fibrous capsule of the kidneys strips off easily. The surface is slightly pale. On section the labyrinth and the medullary rays are distinctly outlined. Connective tissue is increased. “The stomach is in normal position. Walls are pale. The small intestine shows no ulcers. The mucosa is pale. No enlarged glands in the mesentery. The rectal walls are much thickened and the mucosa is pale. The retroperitoneal glands are not enlarged. - “Pathologic Report. —The follow- lial. ing pathologic report was kindly made for us by Dr. A. S. Warthin of Ann Arbor, who is now doing much experi- mental work in this line: “Lung: There is moderate chronic passive congestion; there is some atrophy, and the smaller bronchi are somewhat dilated. The number of leu- cocytes in the blood vessels is not per- ceptibly increased. Lung does not show the characteristics of lung from case of leukemia. - - “Spleen : Marked fibrosis. There is a fibroid hyperplasia of the reticulum of the pulp closely resembling that of splenic anemia. There is marked chronic passive congestion, the venous side being greatly dilated and filled with blood. Follicles are not preserved. The cells of the pulp are chiefly of a fi- brous-connective-tissue type or endothe- Lymphocytes are relatively very few. Cells of the type of large lympho- cytes are more numerous. There are numerous large atypical cells of the en- dothelial type. There are few eosino- philes, and no myeloid changes. Leuco- cytes are relatively few in the blood ves- sels. The general picture resembles that of a spleen of splenic anemia and not that of a leukemic case. “Liver: There is atrophy, chronic passive congestion, and some parenchy- matous degeneration. Connective tissue is relatively and in some areas absolutely increased. There is no leukemic infiltra- tion. Glisson's capsule is somewhat more cellular than normal, but the cells are chiefly of a connective-tissue type. Leucocytes are not increased in vessels. “Pancreas: Post-mortem change. There is some atrophy, with slight fatty infiltration. There is no leucocyte infil- tration. Leucocytes are not increased in vessels. - “Small Intestine: There is slight atrophy and there are a few lymphoid elements. There is no evidence of leu- kemia. “Large Intestine: Small chronic ul- I96 MISCELLANEOUS ABSTRACTS cers are present. There is no evidence of leukemia. “Kidney: Sections of the kidney show remarkable lesions in the form of extensive deposits of lime salts, involv- ing chiefly the convoluted tubules. For the greater part these tubules are re- laced by masses of lime salts, either com- pletely filling up the tubule and replac- ing the epithelium or confined to the epithelium alone, either partly or wholly surrounding the lumen of the tubule. Some glomeruli show small deposits, and casts of lime salts are found also in the straight tubules. The deposit is, however, for the chief part, in the con- voluted tubules. Such convoluted tu- bules as are in part free from lime salts show more or less parenchymatous de- generation. Localized areas of acute interstitial inflammation are also pres- ent and hyaline casts are found in some straight tubules. There is no leukemic infiltration and no increase of leucocytes in the blood vessels. The general pic- ture closely resembles the parenchyma- tous changes with deposit of lime salts seen after poisoning with mercuric chlorid. . “Lymph Glands: The small lymph glands show a lymphoid hyperplasia re- sembling that of lymphatic leukemia or of some of the cases reported as lymphosarcoma (aleukemic leucoblas- toma?). The distinction between cor- tical and medullary portions is lost, the sinuses are filled with or obliterated by lymphoid cells, and the gland presents an almost uniform lymphoid structure. No germinal centers are found. The capsule in many places is infiltrated, and such infiltration extends also beyond the capsule into the surrounding fat tissue. There are no myeloid changes. Numer- ous large lymphocytes are present throughout the gland. There are a few eosinophiles. Leucocytes in surround- ing vessels are not increased. “Summary. — The only pathologic finding suggestive of leukemic disease is ~ the condition of the lymph glands. This resembles the gland picture seen in some cases of lymphosarcoma (aleukemic leu- coblastoma?) or that of a lymphatic leukemia minus the increase of mono- nuclear elements in the blood. The spleen picture is of the same type as that of the splenic fibrosis of splenic anemia. Counts made of the leucocytes in the ves- sels of all the sections show an unusually high percentage of mononuclears. Be- cause of the fixation, these cells could not be satisfactorily studied. There is, how- ever, nowhere any increase of leucocytes in the vessels suggesting the existence of a leukemia. - “The calcification existing in the kid- ney is remarkable for its extent. It would suggest the occurrence of an in- toxication causing degeneration or necro- sis of the epithelium of the convoluted tubules followed by deposit of lime salts, such as occurs in poisoning with mercuric chlorid, chromates, etc. - “Remarks. – The post-mortem find- ings in this case are very interesting in connection with the experimental work that has been done by H. Heinecke, and also the work now being done by War- thin which he will soon publish. Hein- ecke found that a brief exposure of mice, rabbits, and dogs to the rays induces a distinct destructive process in the lymph follicles. With an exposure too brief to induce changes in the skin, he could cause a distinct destruction of the nuclei of the leucocytes in the follicles of the spleen, leading to their almost complete disap- pearance. Analogous processes took place in other lymphoid elements. His remarks on the changes in the bone mar- row are not clear except that some de- struction of lymphoid elements took place. These experiments might suggest a physiologic basis for the use of the X- ray in leukemia, so far as 'the excess of white cells in the circulating blood and the presence of abnormal cell elements are concerned, and they compare most favorably with the results in our case. RADIOTHERAPY 197 Undoubtedly the X-ray has a selective action, apparently affecting tissue under- going pathologic hyperactivity and caus- ing degeneration and necrosis of such tissue; however, the damage done is ap- parently greater than the good. “Dr. Warthin, in summing up the pathologic findings, says: ‘If any con- clusion is warranted from the study of the specimens, it would seem to be that the X-ray treatment has resolved the leukemic condition into an aleukemic state, but that the essential disease pro- cess, as evidenced by the condition of the lymph glands, is still active. The leu- cocytes have been removed from the gen- eral circulation and from the areas of infiltration, the spleen presenting the characteristics of a chronic fibrosis. The part played by the latter would appear to be secondary. The remarkable con- dition of the kidneys offers room for Some speculation as to the source of a toxin. Such might result from the de- struction of enormous numbers of leu- cocytes.’” - The authors regret that no specimen of bone-marrow was obtained because, as it is generally believed that this dis- ease is located primarily in the bone- marrow, no real conclusion can be ar- rived at until this part of the subject has been thoroughly studied. . - THE TREATMENT OF LEUKEMIA WITH ROENTGEN RAYS Erich Meyer, Berliner Klinische Wochen- schrift, 13, II, 1905. The author reports two cases of leu- kemia treated with X-rays. Case I was radiated from May to December. In May the temperature was over Ioo, the spleen extended to the right side, the liver below the navel. The leucocytes in May numbered 152,000, in December only 2,300-2,600. Case II was a young girl with a large tumor of liver and spleen. The leuco- cytes before radiation were 42O,OOO; when patient left the hospital, I4O,OOO. The size of liver and spleen had only slightly decreased, but patient felt so well that she soon after accepted a posi- tion. In this case the radiations had to be stopped several times because she complained of pains in the spleen. In the discussion Von Raake reported a case of a 13-year-old girl, which so quickly improved that on November 8th, the day of the first irradiation, the leu- cocytes numbered 350,000; On Decem- ber IOth, only 32,000. FURTHER REMARKS ON THE TREATMENT OF TRACHOMA WITH RADIUM Hermann Cohn, Berliner Klinische Wochen- schrift, 20, II, I905. Cohn gives the advice in trachoma to be careful with radium and employ only a small quantity, about one milligram for from one to two minutes. He has had good results in seven cases without any detriment to the eye or the eyesight. FLUORES C E N C E ARTIFICIALLY PRODUCED IN THE HUMAN OR- GANISM BY THE X-RAY, BY RA- DIUM, AND BY ELECTRIC DIS- CHARGES, AS A THERAPEUTIC METHOD William James Morton, Journal of the A. M. A., April 1, 1905. The method described by Morton in- volves the administration to the patient of solutions of substances which fluoresce (or phosphoresce) when subjected to the influence of the X-ray, radium radia- tions, and radiant electric discharges. By internal administration of such solu- tions the patient's whole system is satu- - 198 MISCELLANEOUS ABSTRACTS rated thereby, and when any light capa- ble of exciting fluorescence is applied the tissues so saturated will be flooded with the fluorescent light as deeply as the ex- citing radiations can penetrate. He does not mean to imply that the fluorescence is light of the same wave length as that from the exciting source; it is, on the contrary, of a wave length considerably lower than the exciting source, but still akin to it in its property of being suscep- tible of refraction and dispersion, as are the violet and ultra-violet rays. These secondary radiations in their turn set up fluorescence. Morton has used the method princi- pally in deeply-located malignant pro- cesses, tuberculosis, etc., for which reason he has found it necessary to use the X- ray instead of the arc light as an exciting agent, because the latter would not pene- trate deeply enough to be able to excite the fluorescent phenomenon in the deeper tissues. The electric arc light, therefore, would only be valuable in this method with lesions so superficial that the rela- tively feeble penetrating power of this light could be made to go clear through them. - Some of the tissues of the body are more or less fluorescent naturally, and in some diseases this natural fluorescence has been found to be diminished. It is therefore reasoned that some medicines, which are of a fluorescible nature, may exert their beneficial influence by restor- ing to the tissues of the body their nor- mal fluorescibility. As an instance may be mentioned the use of quinine in ma- laria. Quinine is fluorescible, and in malaria the fluorescence of the blood is markedly diminished; by the adminis- tration of this drug, therefore, the im- paired fluorescence would be restored, and the action of the daylight would be to excite the fluorescence, which might have a lethal effect upon the plasmodia. The fact is well established that quinine solutions, when subjected to light, exert a deadly influence on some micro-organ- isms. Ullman, for instance, found that paramecia, when immersed in solutions of quinine, one to twenty thousand, are killed in eight minutes if exposed to the light, but only after five hours when so immersed and left in the dark. A very convincing demonstration that the tissues saturated with fluorescent solutions become fluorescent under the influence of the X-ray is shown by skia- graphing the hand of a person to whom they have not been administered, and to one who has, under the same conditions. The skiagraph of the hand of the person who has absorbed the fluorescent solu- tions shows a greatly superior detail and clearness, more especially of the Osseous StructureS. . . In connection with this treatment Morton also administers to patients under treatment a tablespoonful of water, which has been rendered radio- active by exposure to the emanation from radium twice daily. - For the production of this phenome- non Morton employs quinine bi-sulphate in doses of from 5 to 15 grains daily; fluorescin solution, I to 30, from 6 to 20 drops three times daily an hour after meals; or from 5 to I 5 grains of escu- line daily. He has treated a good many cases by this method, and considers that it is a very valuable adjunct in the treat- ment of disease by the application of light. The article is summarized and concluded as follows: “I. The excitation of fluorescence within tissue is a species of phototherapy and dependable on the same basis for curative effects. the term sensitization is not accurate, for it is not known what the term means. There is no proof that fluorescent substances make the cells or other micro-organisms vulnerable to the exciting radiation. - “2. What the fluorescent light lacks in intensity is compensated for by pro- pinquity to tissue. “3. The methods of Tappeiner, 1900, followed by Dreyer, I 903, con- RADIOTHERAPY I99 sist primarily of superficial applications, or of parenchymatous injections sub- mitted to the action of sunlight or to the action of the electric arc light. “4. The method here outlined con- sists of a medicinal saturation of the en- tire blood system with a fluorescent so- lution and submission of parts or of the whole of the patient to the Roentgen and Becquerel radiations and to electric discharges. - “5. The method naturally includes filling cavities with fluorescent solutions, as well as using these solutions medi- cinally. “6. This method is not of the same category as sensibilitization by Dreyer's method, for the process and the results are different. “7. The curative effects obtained by this method are probably due to the flu- orescent light. “8. This method permits of an im- provement in skiagraphic effects and of fluoroscopic examinations. - “9. Following the suggestions of the use of fluorescent solutions in diag- nosis and treatment, the method has proved of value in determining the posi- tion and size of the stomach and other cavities of the body. - “Io. The thoracic cavity presents on the fluoroscope a degree of illumina- tion greater than that produced by the X-radiation alone. ...” - “I I. The method is useful in tuber- culosis of the lungs, and in other cases of tubercular deposit, as well as in can- CeI’. - X-RAYS AND STERILITY F. Tilden Brown, M.D., and Alfred T. Os- good, M.D., American Journal of Surgery, April, 1905. Before the January, 1905, meeting of the Section on Genito-Urinary Dis- eases of the New York Academy of Medicine, the statement was made by the authors that men, through their pres- ence in the X-ray atmosphere incidental to the practice of radiography, X-ray therapy, or the testing of X-ray tubes, may, after a period of time, be rendered sterile. This statement was based upon a discovery that ten X-ray workers who had consulted them were the subjects of azoöspermia, although none of them had suffered from any venereal disease or traumatism involving the genital tract, none of them presented physical signs of abnormality of these organs and none was conscious of, or gave a history of functional derangement. Since that time the number of cases has increased, and the authors now have records of 18 cases in whom total azoöspermia, or oligo-necrospermia, has been demon- strated. All of those examined who have done extensive X-ray work for sev- eral years (more than three) show no spermatozoa in the seminal fluid, while a few of the men who have been en- gaged in the work for a shorter time and have exercised care in avoiding di- rect exposure to the active tube show varying states of oligo-necrospermia. This sterility has been produced with- out the slightest subjective or objective sign denoting its insidious development. In no case has even a transient erythema of the scrotum been noted, and in no case has there been evidence of deterio- ration of sexual activity. The writers quote from the experience of Albers- Schoenberg, Frieben, Phillip, Bergonie, Laponski, and others in support of their contention. As to the vital question of prognosis, the writers hold that it is still in abey- ance and must remain so until evidence can be collected as to the recuperative power of these organs and after months or years. - It is reasonable to suppose that some of the spermatogenic cells have escaped this blighting influence in many cases 2OO MISCELLANEOUS. ABSTRACTS where precautionary measures have been adopted or in those whose expos- ures have not been protracted or fre- quently repeated. The operator of Roentgen ray tubes should protect him- self by working behind a screen imper- meable to X-rays. He should expose himself only when absolutely necessary for examination of his tube, and then only for the shortest possible time. Such screening may be accomplished by many of the tube shields of the mar- ket. Some of these shields, however, are of little real value and give a false sense of security. The responsibility of guarding against the injury of assist- ants, patients, spectators, and others who may be exposed, rests upon the men whose business it is to understand as fully as possible the injurious as well as the beneficial effects of the force which we have all marvelled at, during the ten years since Roentgen's discovery put into the hands of the medical profession this great aid to our diagnosis, and gave impetus to the development of a valua- ble addition to our therapeutic measures. We want to give this warning to those who are employing or will make use of Roentgen rays: repeated, prolonged ex- posures of the testes does produce steril- ity in the human being. Adequate pro- tection of all parts of the body not di- rectly exposed for examination or treat- ment should invariably be provided. X-RAY BURNS L. R. McCready, Virginia Medical Semi- Monthly, April 7, 1905. Medical literature contains very little of real value regarding the treatment of X-ray burns, but McCready gets good results by exposing the affected part to the action of the Minim light until the “heat rays become painful. Then he covers the surface with a bland, unirri- tating, alkaline solution over which he places gauze and a close-fitting rubber bandage or adhesive straps. This dressing is removed once in 24 hours and reapplied. He prefers glycothymo- line or some such alkaline solution for this purpose. It is important that some dressing be used which will remain wet for a long time. HYDROTHERAPY OCEAN BATHING 4. Philip Marvel, Jour. A. M. A., April 18, 1905. While the stimulation, due to a bath of from I 5 to 30 minutes in the cool waters of the ocean, is beneficial to those whose vital powers are sufficient to en- able them to respond actively, prolonged baths in the ocean and lying around upon the sand in wet bathing-suits is to be deprecated as tending to produce dangerous debility and lowering of physiological resistance. Marvel con- siders that the poorly-regulated, hap- hazard sea bathing indulged in along the Atlantic coast is responsible for a vast deal of harm, and that physicians should raise their voices in protest against such disregard of the laws of health. There are four elements which are physiologically active in sea bathing. First, the percussive element due to the impact of the swells or surfs; sec- ond, the stimulation of nerve endings due to the difference in temperature be- tween the water and the skin; third, the chemical irritation of the salt; and fourth, mechanical influence of the forced physical activity. In this way a DIETOTHERAPY 2O I tremendous impetus is given to the fluids of the body and to the various reflex ac- tivities involved in metabolic processes. Sea bathing is contraindicated with patients suffering from arteriosclerosis, organic heart disease, rheumatism, chol- ilithiasis, intestinal febrile disease, or any condition whatsoever in which the W. normal physiological resistance has been sufficiently reduced to render necessary protection of the patient's vital forces. Miscarriage may be caused by bathing when the sea is rough and occasionally otitis media may be so provoked. It is also prejudicial to health during the menstrual period. DIETOTHERAPY THE DIETETIC USE OF PREDI- GESTED LEGUME FLOUR, PAR- TICULARLY IN ATROPHIC IN- FANTS: WITH A STUDY OF ABSORPTION AND METABOLISM David L. Edsall and Caspar W. Miller, American Journal of the Medical Sciences, April, 1905. This paper, “read by invitation be- fore the Buffalo Academy of Medicine, December 13, 1904,” embraces the re- sults of investigations, made under the auspices of “The William Pepper Lab- Oratory of Clinical Medicine, Phoebe A. Hearst Foundation,” concerning the value of predigested bean flour as a food for sick children. They were under- taken to determine (1) the feasibility of feeding vegetable proteids in the place of milk proteids to infants who have difficulty in digesting the latter; (2) whether the vegetable proteid has any different effect upon metabolism from that of milk proteid. It was impossible to find in the market any satisfactory bean or pea flour. Therefore the investigators got white kidney beans, dried them, ground them in an ordinary spice mill, removing the shell, and using only the dry fine flour secured by bolting. Subsequently they had a larger quantity ground elsewhere. The flour must be very fine in order to facilitate predigestion, and also to soften and disintegrate the tough mass of cellu- lose in which the proteid is enclosed, in vegetables when cooked in the ordinary Iſla 11116.1". A ten per cent. solution is then made by gradually adding water, and making at first a smooth paste, and later a mix- ture which can be easily stirred. It is then heated in a double boiler, at a good heat, for fifteen or twenty minutes, in the mean time being frequently stirred. It has then become a rather thick, paste. It is next cooled to between 60° and 70° C., and the ferment added and allowed to act for ten minutes, while the stirring is continued. The mass then becomes perfectly fluid, and resembles a rather thin soup. In order to stop the action of the ferment, the fluid is brought to the boiling point. After being cooled it is ready for use. * The ferment used was generally cereo, but sometimes maltine. Probably any good diastatic ferment would do as well. The resulting fluid contains little, if any, iodine-reacting starch, and the proteid is largely in solution, and therefore from a physical standpoint in a condition very suitable for absorption. In using this preparation it was cus- tomary to substitute it for a portion of the milk, as it had been given, appro- priately modified according to the age and digestive power of the infant; but yet maintaining unchanged the food value of what he received. In some cases 25 per cent. of the modified milk 2O2 MISCELLANEOUS ABSTRACTS was replaced by the IO per cent. Solution of predigested bean flour, in amount 25 per cent. more than the amount dis- placed. That is, if the child was receiv- ing 48 ounces of modified milk per day, I 2 ounces of this was replaced by I 5 ounces of the IO per cent. solution of bean flour. Usually the food as given contained from two and one-half to three per cent. of bean flour. Three per cent. of bean flour indicates sixty-five one-hundredths of one per cent. of pro- teid. Careful observations on two infants, extending over several days, showed that the nitrogen absorption did not differ very materially when a portion of the modified milk was replaced by the bean- flour preparation in the way just indi- cated, and that the bean proteid was ab- sorbed fully as well as the milk proteid. Further investigations, made upon one child and one adult, seemed to show that the influence of bean proteid upon metabolism was quite as satisfactory as that of other proteids, and to confirm the observation, made by others, that it is possible to maintain a nitrogen equilib- rium, and sometimes to produce a nitro- gen retention, on a vegetable diet. The clinical results obtained in 28 cases were decidedly encouraging. Most of the children showed marked improve- ment, both as regards the activity of the function of digestion, and also as re- gards the general nutrition, as indicated by an increase in weight. This bean flour, in which the starch has been predigested by a diastatic fer- ment, furnishes the means of giving an extremely concentrated food in fluid form and partially digested. A 25 per cent. solution, although fluid, is practi- cally equivalent to beef steak in nutri- tive value. Infants take the bean flour solution with milk, in the way described, very readily after one or two feedings; but to older children and to adults, espe- cially when given without milk, it quickly becomes exceedingly distasteful. This objection can, however, probably be generally overcome by the exercise of some ingenuity in flavoring the solu- tion, as was done in the case of one adult by adding cinnamon as a flavor. MECHANOTHERAPY TECHNIQUE AND EFFECTS OF MASSAGE Volume VII, Chapter I, Cohen’s “System of Physiological Therapeutics.” This article is a notable addition to the knowledge of mechanotherapy. It deals with a method of passive exercise which is little understood or used in this country by physicians in general, yet which forms an important part of the armamentarium of some of the fa- mous practitioners of the day. It is just as necessary to understand the proper in- dications for massage, and to have it skillfully applied, as it is to possess a thorough knowledge of drugs and a competent pharmacist to dispense them. Massage is defined as a form of pas- sive exercise by systematic manipulation of the body for definite therapeutic ends. If properly used it may affect in various ways the nervous, circulatory, digestive, and muscular systems. The movements accomplish much the same results as ac- tive exercises, but the latter are not al- ways possible however much they may be needed. The patient may be confined by injury, or he may have organic defect of the heart that requires the relief of peripheral resistance to the blood flow if the circulation is to be maintained in efficient form, or the nervous system may be so deranged that a series of reflexes PSYCHOTHERAPY 2O3 must be set in motion that will control and normalize its action before any fair approximation to health can result. The method of passive use and manipulation is also of high utility in maintaining the quality of a muscle that has been tem- porarily deprived of its natural nerve stimulation, as in Bell's paralysis of the facial nerve where serious deformity is likely to result if the circulation and muscular tone be not sustained by this (Il Ca.11S. A strong blow is struck at the absurd claims of quacks who claim certain “elec- tric.” power or “magnetism " that pro- duces wonderful effects on the patient at the expense of the masseur. The most efficient masseur is the person who has been so trained that he works to the best advantage and uses no more strength than is needed, and who has such a sur- plus of power that he is not exhausted by any amount of work that any fairly able-bodied man should do without com- plaining. ,' The personal requirements of an op- erator are physical strength trained to do the will of a trained mind, a hand that is soft and delicate in its touch and yet that is capable of vigorous action, a skin that is clean and warm, and a man- ner that is quiet and courteous. The value of massage is entirely de- pendent upon the manner of its execu- tion and is therefore to be definitely pre- scribed by the physician, as to the char- acter of the movements applied, their duration, and force. The neglect of this precaution is like turning over the do- sage of drugs to a nurse. The movements are classified under the four heads used by the French mas- seur: Effleurage, Petrissage, Friction, Tapotement. Some twenty excellent illustrations are inserted in the text that show the appli- cation of various forms of movement to different parts of the patient. The re- mainder of the chapter is devoted to the indications for and the contraindications to massage and this, to the average phy- sician, is the most valuable part. In the first category is placed the strengthening of muscles, skin stimulation, promotion of digestion, increase of intestinal ac- tion, improvement of circulation, arous- ing sluggish metabolic processes, etc., and in the latter category are placed fevers, breaks in the skin, pus forma- tions, malignant tumors, cysts, menstru- ation, etc. * Mechanical massage receives only a brief notice, as it is clearly not in the province of the writer to discuss every method of applying movements to the body, but the most expert and adaptable form is taken as a type for all the elab- orations that have been made to avoid work and to secure a new method. PSYCHOTHERAPY SOME POINTS IN THE PRACTICE OF HYPNOSIS Dr. Tuckey, St. Louis Medical Review, April 8, 1905. In the St. Louis Medical Review for April 8th, Dr. Tuckey develops the value of hypnotism and suggestion as a moral and educative agent in morbid childhood. It is to be noted that his claims have not the extravagance pecu- liar to some who work in this field. He views this morbid exhibition as due to certain fundamental psychological de- fects, usually the result of defective heredity. His suggestion is directed towards de- veloping a normal control, a wider asso- ciation of those factors which govern, rather than the mere erasal of the ten- dency by bare, direct suggestion. He 2O4 MISCELLANEOUS ABSTRACTS details four cases of kleptomania cured by him. In his statements as to dipsomania and chronic alcoholism he is likewise calm. He cures only 40 per cent., but in this no difference is made between dipso- mania and alcoholism in the tables. Neurasthenia he views as readily im- provable by hypnosis. This point, about which there is considerable difference, is, unfortunately, not developed. Here deep hypnosis is advised wherever pos- sible, after the manner of Wetterstrand, who keeps his cases of this type in a quiet sleep for weeks. The extreme brevity of the paper has not added to its value. DEVICE FOR REINFORCING HYP- NOSIS Dr. Dubois, Revue de L’Hypnotisme, Paris, April, 1905. In the Revue de L’Hypnotisme for April, Dr. Dubois notes the use of a species of vibrator attached to the head. The purpose is to produce that state of distraction most favorable to hypnosis. Its action is described as resting upon a vibration of the cerebrum. However potential cerebral sensation may be, the vibrator must have a considerable effect by limiting the attention, hence the con- sciousness, by its persistent, rapid, and monotonous touch sensation. Rein- forcing results for successful hypnosis are definitely claimed. HYPNOTIC SUGGESTION IN THE CURE OF THE DRINK HABIT Dr. Berillon, Rev. de L’Hypnotisme, Paris, April, 1905. In the same journal Dr. Berillon, anent hypnotism and suggestion in the drinker, remarks the necessity for pro- longed mental training, mental gymnas- tics, as it were, this being quite inde- pendent of suggestion. Here is a rational note of advice. Suggestion can- not reform absolutely de novo. There must be the accessory development of those qualities, by rigid training, which make for a higher and firmer personal synthesis. He further advocates the social support among themselves of those who are striving for a similar end of abstinence. MENTAL, ONANISM AND ITS TREATMENT Dr. Berillon, Rev. de L’Hypnotisme, Paris, April, 1905. Mental onanism, a self-explanatory term, Berillon considers as a most vicious fatigue factor in psychasthenia and neu- rasthenia. It is difficult to educe from the patient, but if acknowledged lends itself readily to relief by hypnosis. As a symptom it is often concealed and most tenacious, because of its intimate relation to an underlying psychopathic state. A STUDY IN PRECOCITY AND PRE- MATURITY C. L. Terman, A merican Journal of Psychia- try, April 5, 1905. The fundamentals of this paper exist in the definition of the conditions pro- ducing precocity and prematuration. The former he conceives as racial and individual, or, in other words, as a nor- mal variation liable to occur in the his- tory of the race or the individual. The latter, prematuration, is the artificial production of precocity, man's hand usurping the place of nature's. The conditions viewed as productive of prematurity are recited the more clearly by reason of the illustration of real precocity drawn from history under the several heads of Religion and Pre- BOOK REVIEWS 2O5 cocity, Nervousness and Instability and Precocity, etc. This is, of course, a review of familiar material, but in his latter sections, upon the conditions producing that precocity defined as prematurity, there is much that is both new and valuable. The medical man will find that many un- uttered thoughts of his own are here crystallized; thoughts that have arisen from observing the victims of our over- schooling, over-training, over-culture. It shows the point of departure of cer- tain psychoses in the unstable period of adolescence. Especially does it review the meaning of and the conditions favor- able for sexual precocity. The effect of climatic environment, the relation to seasons, the imitative factors seen in family and school, the specific excitation, the result of over-feeding and over-cul- ture, are determinants developed by the author. The article is fertile in its suggestive- ness rather than in its supply of specific detail. |BOOK REVIEWS STUDIES OLOGY. By Jacques Loeb. In two vol- umes, pp. I-782. University of Chicago Press, 1905. $7.50 net. Published under the above title and bound in a very attractive form is a col- lection of the numerous articles con- tributed by Professor Loeb to the do- main of general physiology. Although there is contained in the papers a wide diversity of topics, from “Instinct and Will in Animals'' to “The Limits of Divisibility of Matter,” yet a single idea runs through the entire list, and that idea is “to get the life-phe- nomena under our control.” Particu- larly interesting and instructive reading are the papers dealing with the direction of motion of different animals, and the experiments on heteromorphosis. Wide interest has been manifested in the results obtained by Loeb in his at- tempts to produce larvae artificially from the unfertilized eggs of various animals. These papers, together with those on the physiological effects of ions shows the originality and breadth of view of the investigator. While one may not per- haps agree with all the conclusions drawn from the experimental data, yet one is forced to admit that the investigations IN GENERAL PHYSI- of Loeb have been an impetus to the study of this class of life phenomena which has been productive of an immense collection of valuable data. The rendering into English of the original scattered papers will make the work accessible to all, and this fact alone would be excuse enough for the repub- lishing of the articles were any apology necessary. BEARD’S TREATISE ON NERVOUS EXHAUSTION (NEURASTHENIA). Edited and enlarged by A. D. Rockwell, A.M., M.D., Neurologist and Electro- therapeutist to the Flushing Hospital; Formerly Professor of Electrotherapeutics in the New York Post-Graduate School; Ex-Electrotherapeutist to the Woman's Hospital in the State of New York, etc. Treat & Co., New York, N. Y. Many works and innumerable articles upon neurasthenia have been written since the first appearance of this treatise — in every sense a classic—but all that has been written fails to modify in essen- tials, or improve upon the picture of the disease so ably delineated by the acute and original mind that first formu- lated its symptoms. With his keen 2O6 BOOK REVIEWS powers of analysis, Dr. Beard was active in formulating the thousand and one symptoms constantly detailed by the vic- tims of what were then vaguely classed as general debility, hypochondriasis, or hysteria, and gave to them, as it were, a “local habitation and a name.” To him, more than to any other, is due the credit of having first described, under the caption “Neurasthenia,” a congeries of symptoms, which has greatly simplified the treatment of such cases, and ought to do much towards the relief of a large class of suffering humanity. For all the various editions following the first, Dr. Rockwell, his former asso- ciate, has been responsible. The addi- tions to the present edition consist mainly of a chapter on the neuron theory in its relation to treatment, based on the hy- pothesis that if the theory be true it will necessitate a radical revision of the phy- siology of nervous activity, and if it is not true, that it still remains a good working hypothesis. The work of Apathy, Nissl, and others has thrown grave doubts upon the correctness of this theory; neverthe- less it is interesting and instructive to see the clinical and theoretical aspects of the subject correlated in the discussion of the relation of electricity to this morbid con- dition. The fact that in the considera- tion of the treatment of this affection, electricity as well as drugs is given a prominent place, will render the work especially interesting to those devoted to electro-therapeutics. DICTIONARY OF NEW MEDICAL TERMS. By George M. Gould, A.M., M.D. P. Blakiston’s Son & Co., IOI 2 Walnut St., Philadelphia, Pa. A considerable cause of much of the acrimonious controversy characterizing discussions upon many medical subjects is failure of the participants to compre- hend just what each means. While it is a fact that,many medical scientists can express themselves accurately, vividly, and beautifully, it is also true that the great majority have not a command of language sufficient to admit of such dic- tion, and the interchange of thought which constitutes the acquisition and dis- semination of knowledge is often ham- pered thereby. The enormous multiplication of medi- cal terms during the last ten years (this work contains 38,000 words), has in- tensified these difficulties, and Dr. Gould has conferred a priceless service upon the profession by reducing the philologi- cal chaos to order. That the task has been accomplished in the masterly man- ner which one would expect from this author is evident upon even a cursory examination. A very helpful feature, especially to those of us whose gradua- tions are some years behind us, is the section upon the abbreviations, prefixes, and suffixes used in medicine and chem- istry. The sections which treat of the “Stains '' used in bacteriological and pathological examinations, and the “Tests '' for detection of various chemi- cal substances are particularly complete, lucid, and satisfactory. This work will be of the greatest value to anyone who desires thoroughly to comprehend and appreciate current medical literature, and we heartily endorse it. RADIOTHERAPY AND PHOTOTHE- RAPY. Including Radium and High-Fre- quency Currents, Their Medical and Sur- gical Applications in Diagnosis and Treat- ment. By Charles Warrene Allen, M.D., Professor of Dermatology in the New York Post-Graduate Medical School; Consult- ing Dermatologist to the Randall's Island Hospitals; Consulting Genito-Urinary Sur- geon to the City Hospital; Member of the American Medical Association, the Ameri- can Dermatological Association, the New York Dermatological Society, etc. With the Coöperation of Milton Franklin, M.D., Lecturer on Electro-Radiotherapy, New BOOK REVIEWS 2O7 York Polyclinic Medical School, and Sam- uel Stern, M.D., Radiotherapist to Dr. Lustgarten's Clinic at the Mount Sinai Hospital; Clinical Assistant to the Skin Department of the New York Post-Gradu- ate Medical School. Dr. Allen's book is unique in one im- portant respect, viz., that it deals in a very exhaustive manner with the current literature upon these subjects, especially that dealing with the X-ray. Too much of a tendency has been present in most of the other books upon the X-ray, to confine the matter to an expression of the author's own individual experiences and opinions; Dr. Allen has stated the experiences and opinions of others whereby he has presented to his reader a much broader view of the field and en- abled him to form judgments of his own. This is particularly desirable when a sub- ject as youthful as X-ray therapy is being presented. Another important feature in Dr. Allen's work is that he has en- deavored to establish the reliability of the reports of other observers by per- sonal investigation before committing the statement to print. --- Radiography has been treated but slightly because of the fact that several books are already available upon this subject, and the object of the present one has been principally the presentation of the therapeutical side. In the derma- tological sphere, furthermore, the ther- apeutical measures discussed have not been confined exclusively to the X-ray and Dr. Allen's extensive experience, both as dermatologist and radiothera- peutist, causes these sections to be par- ticularly valuable. Neither the X-ray nor any other one agent will accomplish what it will when combined with others; a point which many enthusiastic X-ray men seem to have overlooked. The chapters upon “Measures of Dosage,” and the “Medico-Legal As- pects of the X-ray ” will be found of much value as describing the legal as- pects of injuries inflicted upon patients, a matter which bids fair to be of consid- erable importance in the future. Actinotherapy or phototherapy is ac- corded about 125 pages in which the sub- ject is treated very thoroughly but suc- cinctly. The various radio-active sub- stances which have been discovered and used are also treated succinctly and their various possibilities as ascertained up to the present time are laid down. High-frequency currents constitute Section 7 and are only accorded about 48 pages, but the matter has been han- dled in such a way as to cover the field most acceptably. We believe Dr. Allen's book to be one of the best expositions of these subjects which has yet been published. PRACTICAL APPLICATION OF ROENTGEN RAYS IN THERA- PEUTICS AND DIAGNOSIS. By William Allen Pusey, A.M., M.D., Pro- fessor of Dermatology in the University of Illinois, and Eugene W. Caldwell, B.S., Director of the Edward N. Gibbs Me- morial X-Ray Laboratory of the University and Bellevue Hospital Medical College, New York. Second edition, thoroughly revised and enlarged. Handsome octavo volume of 690 pages, with 195 illustra- tions, including four colored plates. Phila- delphia, New York, London: W. B. Saun- ders & Co., 1904. Cloth, $5.OO net; sheep or half morocco, $6.OO net. While divided by its authors into two separate parts, this work is in reality two separate works, part one, by Dr. Caldwell, being entirely devoted to the consideration of apparatus and manipu- lation, while partſ two, by Dr. Pusey, deals exclusively with the clinical side of the subject. The chapters on apparatus leave al- most nothing to be desired. They are very complete and the descriptions are unusually clear. The subject of coil vs. 2O8 BOOK REVIEWS static machine is considered in a per- fectly fair way, and the usual personal prejudice is not apparent. As compared with the other chapters that on radiography is disappointing, and one leaves it with the wish that Dr. Caldwell had said a little more. It is weak if one measures it by the following chapters on localization and plate devel- opment, which latter are most excellent. In part two the action of the X-ray is considered, and cumulative action proven by statistical evidence. So also is the question of idiosyncrasy. In de- tail are given the reasons for thinking its action upon tumors similar to the ac- tion of light upon the sensitized plate, i. e., chemical. Bactericidal action is discussed in full, and the production and treatment of X-ray “burns'' are well considered. Coils vs. static machine is again discussed, and the technique of some of the more prominent workers in the X-ray field is given very clearly. The remainder of the book (nearly one-half) is devoted to the different conditions to which the X-ray is applica- ble. Each in turn is taken up, references made to similar cases reported by other workers, and a very complete bibli- ography is appended. The author's own cases are presented, with histories and excellent photographs. These histories are the only redundant part of the work, and might well be omitted in view of the profuse presentation of such in the medi- cal journals. mulated reports are then summed up and a prognosis presented based upon them. The volume is well printed and the illustrations are fair. It is a book which deserves a large sale among that large body of physicians who are not doing X-ray work, but wish to know what they may expect from it in some particular case, before they take that case to an X-ray consultant. To these the book is a valuable one, for it tells what has been The results of these accu- done, what is being done, and what may be expected in all the different condi- tions which have come under X-ray treat- ment. MEXICAN VISTAS. By Harriott Wight Sherratt. Rand, McNally & Co., Chicago and New York. By no means the least of the elements which combine to produce good results in climato-therapy is the impression upon the psychic processes due to change of scene, habits, etc. If the patient knows beforehand that these changes will be of an agreeable character, and some- thing as to their actual nature, he will not only be less apt to procrastinate a necessary departure from his home, but will assume a frame of mind which will be conducive to the greater effectiveness of the step. e The climatic conditions prevailing in various parts of Mexico, have not been exploited from a therapeutical point of view as much as those of some other parts of the continent. Physicians who have practiced there for several years, however, tell us that they are unsur- passed, and perhaps unequaled in many respects, by those attainable anywhere else in the world, and that cases, of tu- berculosis at least, do much better there than in any other resorts. In many re- spects the conditions in Mexico are cer- tainly much more agreeable for the pa- tient than at most other places recom- mended, and Mrs. Sherratt's little book presents an attractive picture to one who is tired of the cold, hurry, and bustle of our rigorous northern states. Her de- scriptions carry with them a force im- parted by personal contact with the peo- ple and conditions of our sister republic and the illustrations are numerous and well selected. The volume will be of much value to those intending to travel in Mexico. THE ARCHIVES OF PHYSIOLOGICAL THERAPY xvii T H E T E S T L MO NY of a lamp is the ſight which if produceſ ‘Patents applied for 2 CANDLE POWER 6 VOLTS ACHROMATIC LENS MAGNIFYING 8 TIMES ABSOLUTELY FREE OF SHADOWS PRICE $7.oo NET Diagnostic lamp transformers for Alternating and Direct Currents Electro Therapeutic Appliance Company Malden, Maſſ., U. S. A. YOUR DEALER CARRIES THEM xviii THE ARCHIVES OF PHYSIOLOGICAL THERAPY THERAPEUTICS OF DRY HOT AIR By CLARENCE EDWARD SKINNER, M.D., LL.D. Second edition. The only authoritative and exhaustive work extant On one of the most useful and important of the physiological remedial agents. A practical treatise for the general practitioner who has had no experience as well as the specialist. Enlarged as regards both illustra- tions and text. Price, cloth, postpaid, $2.oo. “Dr. Skinner's book may be recommended to those who are interested in the sub- ject as a temperate exposition of the results which have followed his own extensive experience of its practical application.”—Brz/?sh Medical Journal. “. . . The book is full of valuable points. . . . To any one interested in this sub- ject we heartily recommend this volume. . . .”—AVezw York Medica/ /ozarzza/. “. . . This book will prove a valuable contribution to the practical library.”— Medical Reviezv of Revzews. A. L. CHATTERTON & CO., 259 William St., NEW YORK. An Indispensable work to every Physician who uses /acuum Tube Radiations NOTES ON X-LIGHT By WILLIAM ROLLINS 4oo pages of text, I 52 plates. Price $7.5o net. Printed at the University Press. The book is a good example of the Art of Printing D. V A N NO STRAND COMPANY, 23 and 27 Murray St., NEW YORK, N. Y. The HARVARD Direct Acting Vibrator A NEW APPARATUS EMBODYING THE FOLLOWING FEATURES ESSENTIAL TO A PERFECT WIBRATOR No Flexible Shaft Perfect Control New Gyratory Stroke Minimum of Friction Eli Percussion Stroke Compact and Portable * Angular Stroke Durable & Convenient Send for descriptive circulars of The Harvard Vibrator The Ovington High Frequency Apparatus Superlative X-Ray Tubes. J. EMORY CLAPP 1oo Boylston St. BOSTON, MASS. THE ARCHIVES OF PHYSIOLOGICAL THERAPY xix DR. F. F. 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SEND FOR CATALOGUE /*OS 7"OM OFA’ſ CE. /Jr. Mayóury, 8 Cumber/and S/. Mfg. /y Camp/e// Bros. Electrical Apparatus, LYNN, MASS. The Weſterm X-Ray Col/, A'eso/a/ors and //errº/ſers Were awarded the HIGHEST GOLD MEDAL at the St. Louis Exposition for superiority. The most eminent specialists endorse the “Western” Coils as being the best on the market. We GUARANTEE every apparatus made by us against break- down or burning out. Why not get the best ? Write for our special $150.00 outfit. Send for our catalogue. We manufacture the best OUDIN RESONATOR on the market. Correspondence solicited. Send 50c. for book on High Frequency Therapy. THE WESTERN X-RAY and COIL CO. 18–30 West Randolph St., CHICAGO, ILL. THE ARCHIVES OF PHYSIOLOGICAL THERAPY xxiii THE ARCHIVES OF Physiological Therapy - CONTAINs More text, More plates More abstractive matter More valuable articles than - any other publication of the kind in the world Isn't it about time ro/V subscribed ” (TEAR ON DOTTED LINES) S U B S C R. I. PT I O N B L A N K RICHARD G. BADGER, Publisher, 194 Boylston St., BOSTON Anclosed find &oo /or which send me 7//E ARC///VES O/7 P//YS/O/OG/CA / ZY// /&A PY for one year beginning with &/he current issue. (A // back numbers are out of print.) xxiv. THE ARCHIVES OF PHYSIOLOGICAL THERAPY THE - Attention of Advertisers is Called to Five Points 1. The publisher of THE ARCHIVES has no con- nection with any firm manufacturing OT dealing in apparatus or medical supplies of any kind. 2. All advertisements are printed on the finest coated paper. 3. Advertisements may be changed as often as desired. 4. All advertisements are set under the personal direction of the advertising manager to secure the best possible display. As many proofs as desired will be submitted for approval. 5. Only advertisements of a strictly ethical na- ture will be inserted. - - Address Advertising Department The Archives of Physiological Therapy RICHARD G. BADGER, Publisher, BOSTON A. º. º * Sº v =" ºil it º Ş. s: §:=Es:S lºſésºčās 5-3 geº Sºº Nº 6 §%ARTI et VGRITATI } J Printed at The Gorham Press, Boston, U. S. A. Devoted to the Diagnostic and Therapeutic Uses of Electricity, Radiant Energy Heat, Mater, Mechanical Wibration, Dietary Regulation • , Exercise, Psychic Suggestion, etc. Edited by CLARENCE EDWARD SKINNER, M.D., LL.D., New HAVEN, CoNN. In conjunction with CARL BECK, M. D., NEW YORK, N. Y. GORDON GRANGER BURDICK, M. D., CHICAGO, ILL. JAMES KING CROOK, A. M., M. D., New York, N. Y. ADOLPH DECKER, M.D., CHICAGO, ILL. GUSTAVUS ELIOT, A. M., M. D., NEW HAVEN, CONN. WOLF FREUDENTHAL, M.D., New York, N. Y. FAXTON EUGENE GARDNER, A.B., B.S., M.D., New York, N. Y. ARTHUR WILLIS GOODSPEED, PH.D., PHILADELPHIA, PA. GEORGE COFFIN JOHNSTON, M.D., PITTSBURG, PA. FRANKLIN MARTIN, M.D., CHICAGO, ILL. WILLIAM BRADBURY NOYES, M.D., New York, N. Y. GEORGE EDWARD PFAHLER, M.D., PHILADELPHIA, PA. WENDELL CHRISTOPHER PHILLIPS, M.D., New York, N. Y. ROBERT REYBURN, A.M., M.D., WASHINGTON, D. C. ALPHONSO DAVID ROCKWELL, A.M., M.D., New York, N. Y. JAY WEBBER SEAVER, A.M., M.D., New HAVEN, CoNN. SINCLAIR TOUSEY, A.M., M.D., New York, N. Y. . . . Foreign Correspondents DR. ERNEST ALBERT-WEIL, PARIs, FRANCE DR. HERMANN ALGYOGYI, VIENNA, AUSTRIA DR. JEAN BERGONIE, BordeAUx, FRANCE DR. CARLO COLOMBO, ROME, ITALY - DR. LUDWIG HALBERSTAEDTER, BRESLAU, GERMANY MR. JOHN HALL-EDWARDS, BIRMINGHAM, ENGLAND DR. LEOPOLD LAQUER, FRANKFORT-ON-MAIN, GERMANY - DR. ALBERT NEISSER, BRESLAU, GERMANY DR. LOUIS TOROK, BUDAPEST, HUNGARY T-i-m-m-m-Hº icopyright, 1906, by Richard G. Badger. Entered at the Post office at Boston, Mass, as second class mail matter, March 22, 1905) THE ARCHIVES OF PHYSIOLOGICAL THERAPY r- the Xcoil A powerful, efficient coil adapted to X-ray and high frequency work. Guaranteed to work satisfactorily on direct, alternating or battery current. A special interrupter differing in design and construction from any and all others admits of continuous work, with steady light for diagnostic work. Large Catalog Free on application. Special list on X-ray tubes. Our Therapeutic Lamp of 500 cºp gives 20% more light than any other. We are not in the trust and save the doctor 30%. We sell direct. W. M. M. E. Y. E R & CO . 56 Fifth Avenue, Chicago, Illinois Nearly all the experts are using the “M & W’’ X-Ray tube for their shortest expos- ures. May we not induce you to try some of them? M A CAL AST E R & WIG G IN BOSTON, MASSACHUSETTS No. 210 SU D B U R Y B UILD IN G Makers of X-Ray Tubes, Vacuum Electrodes, X-Ray Accessories. Glass Blowing of All Kinds. THE ARCHIVES OF PHYSIOLOGICAL THERAPY 243 THE QUALITY COIL EXCELS FOR ALL High Frequency Effects If Supplies SINGLE TERMINAL EFFECTS for vacuum electrodes or monopolar spray. DOUBLE TERMINAL EFFECTS for Bipolar Vacuum Electrode or Spray, X-Rays, etc. EXTRA HIGH FREQUENCY for special work. AUTO-CONDENSATION CURRENTS for use with Couch or our New Auto-Condensation Pad. D'ARSONVAL CURRENTS OF EITHER HIGH OR LOW FREQUENCY supplying rhythmic muscular contractions, or high amperage with great heating effect. ULTRA VIOLET RADIATIONS POWERFUL X-RAYS You will not have cause for regret if you investigate our apparatus before buying. CLAPP & EAST HAM COMPANY 120-A Boylston Street, Boston 244. THE ARCHIVES OF PHYSIOLOGICAL THERAPY W. S C H E I D E L & C O. WERE AWARDED The First Gold Meda/, Louisiana Purchase Exposition, St. Louis, Mo., 1904. - ** Our X-Ray Coils are indorsed _aº— by the most notable operators in the United States Govern- ment service; also by thousands of physicians and institutions throughout the United States, Canada and Mexico. We supply X-Ray apparatus to operate with equal satisfaction on alternating or direct current. They are sold under an absolute guarantee. Office and Factory, 171 - 173 East Randolph Street, Chicago, Illinois. Cable address, “Scheidel,” Chicago. Long Distance Telephone, Main 1766. - Beware of fraudulent award announcements, imitations, patent infringements and worth/ess guarantees. The Finishing Touches that go toward perfection—the elaboration of the most minute detail— contrive to make The McIntºsh Therapeutic Wall Cabinet, No. 9 an apparatus of superior merit. Its Points of Especial Advantage are a High Tension Faradic Coil, the McIntosh Monomo- tive Rheotome, a Special Cautery Circuit, a Current Combiner Switch, and our New Energy Changing Switch, as well as the ap- proved McLagan Wire Rheostat and the ac- curate McIntosh Shunt Milliamperemeter, as furnished with our more simple plates. The Modalities Available include a wide range of Galvanic, Interrupted Galvanic, Ga1- vano-Faradic, High Tension Faradic, Cautery, Sinusoidal, and Diagnostic Lamp Currents. The Source of Energy may be a lighting current of any voltage, direct or alternating, or a battery of liquid or dry cells. Priced AT A Popul AR FIGURE Our new Illustrated Catalogue, Series A, 27th edition, shows a full line of Wall Cabi- nets, Portable Batteries, Electrodes, Cautery Appliances. Sinusoidal Apparatus, Static Machines, X-Ray and High Frequency Equip- ments. Mailed upon request. Our goods represent the highest standard of excellence in artistic design, correct workmanship and therapeutic adaptability, and will satisfy the most critical eye. McIntosh Battery and Optical Company 39 W. Randolph Street, - chicago, ILL. CONTENTS FOR DECEMBER, 1906 The Archives of Physiological Therapy PAGE PAGE o SPECIAL PLATES RADIODIAGNOSIS LXIX—Osteosarcoma of Fibula — Dr. Radioscopic Procedure for Extraction Albert Soiland - . 248 of Needles . º © e . 274 ORIGINAL ARTICLES RIADIOTHERAPY Radiographic Measurement of the Di- The Effect of the Roentgen Rays upon a, . Of the Female Pelvis and jºi. Roentgen Dermatitis and 275 New Technique in Radiographing S 1 nerapy `-- . . . . . . . . Vesical Calculi — George E. Pfahler, The Unit I — A New Unit of Quantity M.D. º 249 of X-rays . 276 - . . e - º Direct Measurement of the Quality of A New Direct-Reading X-ray Meter— the Radiation from a Tube or Bon- George C. Johnston, M.D. - . 253 1nette . & - º . 276 Note Relative to the Estimation of e DIETOTHERAPY Roentgen Dosage — Henry G. Pif- 3 + 7-a- - - - - - - e -> e 1n the Wrong an ight USe O 1||< 11] fard, M.D * On the Wrong and Right Use of Milk i The Tube in Roentgen Therapy – Certain Diseases of the Skin . . 277 Ennion G. Williams, M.D. . . 260 Notes on Purin-Free Diets . c . 279 Further Experimental Research Con- The Dietetics of Obesity - & . 281 cerning the Direct, Indirect, and - Secondary Rays — Lewis Gregory HYDROTHERAPY Cole, M.D. . - º • . 263 Hepatic Douches e - º . 284 The Teaching of Roentgenology in Medi- The Nauheim Bath in Gynecology . 285 11 — V - jl ºilege-Vernor J. Willº, , MECHANOTHERAPY The Therapeutic Value of Artificial ELECTROTHERAPY Localized Hyperemia in the Treat- Results of Auto-conduction by Spiral ment of Ambulatory or Dispen- Resonators in Arterial Hyperten- sary Cases . . . - º . 289 Sion . º - * - 273 The Value of the Bier Treatment . . 291 Radia1 º Caused #. a Fracture |PSYCHOLOGY Of the Humerus. ectrica1 Ex- - & amination of the Denuded Nerve. The Induction of Hypnosis . - 292 Recovery in Spite of an Unfavor- CLIMATOTHERAPY able Prognostication e • 274 The Open-Air Treatment of Pneumonia 294 Attempting a Physical Explanation of a A Practical View of Tent Life in the Biological Process e - . 269 Southwest . - - . 295 An index to Wolume IV, july-December, is included in this issue. - $4.00 a year, 35 cents a copy. Foreign subscriptions 19 shillings postpaid. Subscribers failing to receive their copies by the 15th of the month should immediately notify the publishers. As the majority of subscribers desire unbroken volumes, THE ARCHIVEs of PHYSIoLogical THERAPY will be sent until ordered discontinued. This notice may be given at any time. RICHARD G. BADGER, Publisher, 194 Boylston Street, BOSTON An Indispensable //ork to every Physician who uses Vacuum Tube Radiations NOTES ON X-LIGHT By WILLIAM ROLLINS, M. D. 400 pages of text, 152 plates. Price $7.50 net. Printed at the University Press. This book is a good example of the Art of Printing * D. VANNOSTRAND COMPANY, 23 and 27 Murray Street, NEW YORK, N. Y. 245 246 THE ARCHIVES OF PHYSIOLOGICAL THERAPY A FREE SAMPLE OF Lumiere X-Ray Plates for those who ask. You are not getting the heſt resultſ without them LUMIERE. N. A. CO., Limited BURLINGTON, VT.’ LYONS, FRANCE N. Y. OFFICE: I I West 27th Street For INSONNIA ©ITOIOla, (Die thy lb arbit uric Acid or Diethylmalo nyl u rea) Average dose 7% grains. I Send for Literature to Send for Literature to Merck & Co m p a ny Continental Color and Chemical Co. NEW YORK. NEW YORK- THE ARCHIVES OF PHYSIOLOGICAL THERAPY 247 LEUCODESCENT Style “F Special.” 500 Candle Power. Leucodescent The Therapeutic Lamp that has made phototherapy a popular, practical and valuable assistant to the physician. The one Therapeutic Lamp constructed on scientifically exact lines. Correct dimen- sions are important because of the in- crease in power it gives the rays to penetrate. The one Therapeutic Lamp utilizing sufficient amperage to insure a compre- hensive and certain clinical value. | The amperage is import- ant, because more of it means increased quantity and quality of the rays you need. MIDGET, JR. Our new booklet will tell (Not Leucodescent Type.) you in a few words 32 c. p. 5-inch parabolic re- flector, uses about 3% amp. “What the Leucodescent of current. . . . . . . . . . . . . . $ 6.67 - > * - 1S - Three extra globes, red, vio- » MIDGET l -- - - let and yellow at $1.25. . . 3.75 -- What 1t will do ;" (Not Leucodescent Type.) Sold º at º: -> 50 i. p. 10-inch parabolic prices or idget outfit - « reflector, uses about complete. . . . . . . . . . . . . . . 19.98 The Tea SOInS why. amp. º current º .*s, 4.90 Volume No. 1 of the Leucodescent Bulletin, containing clinical reports, with an index to contents, has just been published. You will find them both of value to you. Send for them to–day. SPEAR – MARSHALL COMPANY 1233 Republic Building State and Adams Streets CHICAGO 248 THE ARCHIVES OF PHYSIOLOGICAL THERAPY SPECIAL PLATE LXIX OSTEOSARCOMA OF FIBULA Patient was a child ten years of age, and the lesion had been diagnos- ticated, before the roentgenograph was taken, as tuberculosis, fracture, osteomyelitis, and syphilis. The Roentgen diagnosis was confirmed by subsequent operation. Note nutritional loss in structure as compared with normal condition of the opposite leg. Made with a Griffith-Soiland coil with Wehnelt interrupter, Friedlander tube with anode eighteen inches from the plate, thirty seconds exposure, ten amperes in primary circuit. By Dr. Albert Soiland, of Los Angeles, California. THE ARCHIVES OF PHYSIOLOGICAL THERAPY Devoted to the Diagnostic and Therapeutic Uses of Electricity, Radiant Energy, Heat, Mater, Mechanical Vibration, Dietary Regulation, Exercise, Psychic Suggestion, etc. VOLUME IV DECEMBER, 1906 NUMBER VI RADIOGRAPHIC MEASUREMENT OF THE DIAMETERS OF THE FEMALE PELVIS AND NEW TECHNIQUE IN RADIO- GRAPHING VESICAL CALCULI* BY GEORGE E. PFAHLER, M. D., OF PHILADELPHIA, PENNSYLVANIA ROBABLY the most critical Pº in the life of a woman is that of the birth of her first child. Two lives are at stake at this time. Much of the uncertainty could be eliminated if the attending physician could determine accurately the diameters of the pelvis of the mother, and if with this he could know the exact size of the child’s head, the case could be dealt with in the most skillful manner. If the diameters were found to be contracted, premature labor could be induced, or all provisions could be made to assist in the labor before the woman became exhausted; or a Caes- arean section could be performed, and in this way the lives of both the mother and the child could be saved. Obstetricians have done much toward accomplishing this result by taking external measurements of the pelvis, and by measuring approxi- mately the internal diameters. Accu- racy has, however, not been obtained though very much desired. It is this long-felt want that prompted one of our obstetricians, Dr. W. Frank Haehnlen, to suggest to me the use of the Roentgen rays for this purpose. Scattered attempts have been made to measure the diameters of the female pelvis by means of the Roentgen rays, but in general the methods used have not been found practical. Even the method that I shall describe, though it seems very simple, may not be found practical. On account of the mass of tissue to be penetrated in a pregnant woman, it will be found difficult by any method, and it is likely that only those who have perfected their technique and are able to make short exposures will feel justified in attempting this work. Stereoscopic radiographs might be made, but this will necessitate two exposures, and in the light of recent experiments (which I believe to be *Read at the Seventh Annual Meeting of the American Roentgen Ray Society, at Niagara 249 Falls, N. Y., August 29–31, 1906. 250 RADIOGRAPHIC MEASUREMENT exaggerated in importance), it is im- portant to make a single exposure and that as short as possible. It was as a result of the suggestion of Professor Haehnlen that I have developed the following technique and apparatus for the purpose of measur- ing the diameters of the female pelvis. This, as well as any other technique which has for its end result accuracy, must have accuracy as far as possible in every little detail. Unless each measurement is taken accurately, the end result will be inaccurate and will be of more annoyance to the physician than assistance. The principles upon which this technique is based are as follows: 1. The plate must be placed parallel with the brim of the true pelvis. 2. The distance of this pelvic brim must be measured as accurately as possible and recorded. 3. The anode of the tube must be placed in the axis of the plane of the brim of the pelvis. 4. The exact distance of the anode from the plate must be accurately measured and recorded. If these four principles are accu- rately followed the diameters of the pelvis will be accurately determined. Any error in the observance of these four principles will necessarily give an error in the end result. Therefore our whole attention must be occupied in providing means to observe these four principles. I. For the purpose of placing the plate parallel with the brim of the pelvis I have constructed a bracket (Fig. 1), which consists of a base- board IO x 24 inches. At a distance of 9 inches from one end is placed a second board Iox II inches, at an angle of thirty degrees. This is sup- ported by a triangular piece of wood. This bracket is placed upon any radio- graphic table. The patient is placed upon this base-board with the buttocks and coccyx resting upon the bracket. FIGURE I This bracket will then correspond to the plane of the brim of the average normal pelvis. By means of a mat- tress, the body is raised about three inches, so as to bring the entire shadow of the brim of the pelvis upon the plate. Patients prefer to lie upon a mattress, and since it in no way interferes with the accuracy it is an advantage rather than an objection. The plate is then placed upon this bracket beneath the pelvis. The thighs are flexed upon the abdomen and ro- tated outward. They may be sup- ported by means of a bandage extend- ing from the hook at the end of the base-board. 2. We must now determine the dis- tance of the brim from the plate or from the anodes of the tube. By palpation the crest of the pubis can be felt, and the thickness of the fat esti- mated as accurately as possible, and subtracted from the total distance of the pubis from the plate or added to the distance of the anodes from the skin. The estimation of the thickness of the fat will give practically the only GEORGE E. PFAHLER 25 I chance for error in the end result. A man should, however, be able to esti- mate the amount of fat to within an eighth of an inch. 3. The third step is to place the anode of the tube in the axis of the brim of the pelvis. To facilitate this I have placed a rod at right angles to the board holding the plate, and at- tached it to the middle of the top edge (Fig. 1). The median line of the body should pass through this rod. This rod is now parallel to the axis of the brim of the pelvis. We now measure the distance from this rod to the inside of the pelvic brim, which can be felt at the symphysis pubis. To this distance is added two inches (half of the normal antero-posterior diameter). A second movable rod (Fig. 1), attached at right angles to the first rod, will facili- tate the making of these measure- ments (I am indebted to one of my students, Dr. Gaylord, who is a skilful mechanic, for the construction of these rods). The anode is easily placed in a line with the point obtained by these measurements, and this is done in less time than it takes to describe it. 4. The fourth step is to measure the distance of the anode from the plate. This, of course, is very simple. The anode can be placed at any distance. The greater the distance the greater will be the accuracy, but the difficulty of getting a good radiograph will also be greater. I have found twenty inches most convenient. Having recorded these factors and obtained a good radiograph, the deter- mination of the diameters of the pelvis is a mere matter of calculation. The diameters as measured in the radiograph represent the degree of divergence of the rays at the distance of the plate from the anode (twenty inches). The question then is, “What is the degree of divergence of the rays at the distance of the pelvic brim from the anode?” We obtain the distance of the anode from the symphysis by direct measurement, or subtract the distance of the symphysis from the total distance of the anode from the plate. - Reducing this to a formula, let “A.” represent the total distance of the anode from the plate; “B” the diame- ter as measured in the radiograph; “C” the distance of the symphysis from the anode; and “X” the diameter of the true pelvis. Then the formula would stand: A: B:: C: X (Fig. 2). \ . —--> FIGURE II RADIOGRAPHIC MEASUREMENT FIGURE III Take as a concrete example Figure 3, which is a radiograph of a normal skeleton pelvis. The distance of the anode from the plate was twenty inches; the antero-posterior diameter as measured in the radiograph is five and one-eighth inches; the distance of the anode from the symphysis was sixteen and three-quarters inches; therefore the antero-posterior diame- ter of the true pelvis must be 4.29 inches, and this is the correct measure- ment of the pelvis used. # Take as a second concrete example Figure 4, which is the radiograph of a normal pelvis in a living woman (non- pregnant). We have a right to assume that a woman who has given birth to a normal child, normally, has a normal pelvis, the woman being normal in all outward appearances. The distance of the anode from the plate in this instance was twenty inches; the antero-posterior diameter as measured in the radiograph is five and one-half inches; the distance of the anode from the symphysis pubis was fourteen and one-half inches; therefore the antero-posterior diameter of the true pelvis at the brim is 3.9875 inches. Four inches is given as the normal antero-posterior diameter, therefore this must be considered normal. This may seem like a complicated method, but it is not and the only real difficulties will be in obtaining a good radiograph in a pregnant woman, and in determining accurately the distance of the symphysis pubis from the anode of the tube. We should be careful to place the brim of the pelvis parallel to the plate. This can be done by determining that the anterior superior spines are the same distance from the plate. If the patient is allowed to twist her body, the pelvic shadow will, of course, be distorted. FIGURE IV GEORGE COFFIN JOHNSTON 253 This method has the advantages of simplicity and accuracy, with only one exposure. * I began this work only a short time before going away on my vacation. This, with the fact that our maternity wards are practically closed during the summer months, has prevented me from making practical application of the method in pregnant women, and in this way working out some of the practical problems that I feel will present themselves. New Technique in Radiographing - Wesical Calculi One of the disadvantages of the present method of radiograph- ing vesical ca 1 cu li is that the shadow must be projected a con- siderable distance before reaching the plate. This decreases the intensity of the shadow and at times makes it almost or quite impossible to recog- nize. Another disadvantage is the possibility of having the shadow of the vesical calculi obscured by the shadow of the pubic arch as it is projected forward. . By making use of the “pelvic bracket ’’ and the technique described for measuring the diameters of the pelvis (omitting the measurements), we bring the plate nearer to the calcu- lus, and thus increase the intensity of the shadow and the certainty of the diagnosis. - - It has not been my privilege to examine a case of vesical calculus since I have adopted this technique. I therefore have no illustration to offer to you. It surely offers some advan- tages, however, and I see no disad- vantages. I offer whatever apology is due the society for presenting these subjects incompleted, but lack of time and opportunity to date have prevented my completing these investigations. I pre- sent these subjects at this time before this body of expert radiologists be- cause they are purely technical sub- jects, and for the purpose of receiving criticisms and suggestions that will assist me in further investigations, and with the hope that they may be made use of by others. A NEW DIRECT-READING X-RAY METER+ |BY GEORGE COFFIN JOHNSTON, M. D., OF PITTSBURG, PENNSYLVANIA Secretary of the American Roentgen Ray Society; Radiographer to St. Johns Hospital, Allegheny, Pa.; Children’s Hospital, Pittsburg, Pa.; Professor of Radiotherapy at the Western Pennsylvania Medical College, etc. VER since Roentgen discovered the existence of the invisible form of wave length, since known by his name, efforts have been made to devise a means whereby a measurement could be obtained of the quality and quantity of rays emitted from the excited Crookes tube. With these attempts at measurement, this Society is familiar, but I shall enumerate briefly the virtues and defects of each. *Read at the Seventh Annual Meeting of the American Roentgen Ray Society, at Niagara - Falls, N. Y., August 30th, 1906. 254. A NEW DIRECT READING X-RAY METER Holzknecht’s Chromorad iometer This consists of a quantity of potash salts mixed with copal varnish in- closed in a celluloid capsule. As fur- nished to the operator this capsule is about the color of the varnish, a dirty yellow, but under the influence of the rays, it changes in color, finally becom- ing green. There is furnished with the capsules a scale of shades of green, divided into eleven spaces. The re- agent having been exposed to the ray, is moved along the scale until a point is found where its tint matches a tint upon the scale. Thus, if tint 4 of the scale matches the tint of the capsule, the surface upon which the capsule was placed during the exposure is said to have received four units, H. Holzknecht claims that by the use of this reagent an exact dose may be given and that precisely the degree of reaction prescribed and pre-determined will follow. It seems, however, that this method is not free from error, and I possess a dim recollection of one case wherein the result was so disastrous as to eventuate in the assessment of puni- tive damages at the hands of an un- appreciative court. These capsules, having once been used, regain their color upon exposure to light, but must never be used again. This method takes no account of idiosyncrasy, in fact, it ignores it, whereas every operator of experience knows that frequently an individual is met with, possessing such peculiar susceptibility to the undesirable effects of the ray as to render him an object of concern to the peace of mind of the roentgenologist. The unit H. is defined as that quan- tity of X-rays exactly capable of pro- ducing a certain reaction upon living tissues. Such a unit is inexact and unscientific and should be replaced by one founded upon definite chemical action as evidenced by the amount of a known salt (in solution or otherwise) decomposed by exposure to the ray, all other decomposing factors being carefully eliminated, or better by a C. G. S. unit founded upon the equiva- lent heat value of the ray when so transformed. - . Freund's method consists in esti- mating the amount of free iodine lib- erated by the ray when a solution of iodoform in chloroform is exposed to the ray. This re-agent, being sensitive to light, must be employed in non- actinic containers and the amount of iodoform liberated determined by means of quantitative analysis. This is a very exact method of telling what you have done, after you have done it. Sabouraud makes use of the platino- cyanide of barium, made into little wafers pasted on paper. The cyan- ide, upon exposure to the ray, changes from apple green through red, brown and maroon. With these pastilles is furnished one which has been exposed to a certain quantity of radiation cor- responding to the maximum dose of X-ray which it is safe to apply to a healthy skin of a normal patient, and which is just enough to produce a temporary epilation, but not enough to give rise to a dermatitis. This de- vice is particularly intended for use in the treatment of sycosis and other dis- eases where a quick, painless epilation is desired. The pastille must be placed not on the patient’s skin, but at a distance of eight centimeters from the anti-cathode. In some tubes, how- ever, this would necessitate placing the pastille on the surface of the tube, or even inside the tube, and with some tubes, the pastille is so close that it is GEORGE COFFIN JOHNSTON 255 acted upon by radiant heat from the tube, which will promptly produce the same change of color as the X-ray. These pastilles must never be used for the second exposure, although they do regain their color when placed in the light and where they may absorb In O1Sture. Kohler attempted to measure X-rays by means of a thermometer in the wall of the tube. This method does not need discussion in order to condemn it, as no one has ever proved any rela- tion between the heat and the X-rays emitted from any given tube. Kienbock places on the surface under treatment a piece of photog- rapher’s paper inclosed in a non- actinic envelope. After the patient has been treated, or at any time during the treatment, the jacket is removed, the slip of paper is developed and com- pared with the color scale. This method is accurate if the same sensito- meter test paper is always used, if it be developed immediately following the exposure in the same developer, at the same temperature, for the same length of time, washed and hypoed for the same length of time, and always ex- amined either dry or wet. But it in- troduces a personal equation in that the developed slip must be compared with a graduated scale of tints, thereby permitting of the possibility of great error. Guilleminot compares the illumina- tion of a fluorescent screen under the action of a sample of radium of known strength with that of a screen exposed to the influence of an X-ray tube, and measures the square of the distance of the screen from the tube necessary to produce equal illumination. Any one who has tried to compare the fluores- cence of two screens under different illumination or who has ever made any photometric readings will appreciate the possibility for gross error in this proceeding. Bordier uses platino-cyanide of bari- um made into a pastille, the back of which is adhesive and is to be attached to the skin over the part under treat- ment. There is supplied with these pastilles a color scale having four tints; number one a dull yellowish green. This is exactly the shade that the pas- tille will take when it has been exposed to the maximum dose of X-rays com- patible with the complete integrity of. the normal skin. With this dose, the hair falls out twenty days after the exposure, but grows again in another twenty days, and no reaction is present unless a very low tube is used. Other shades correspond to increasing doses of the ray. The milliamperemeter when placed in series with the X-ray tube is of great value when in the hands of an expert employing it with a tube with the working of which experience has made him thoroughly familiar. But it is necessarily an exact measurement of the current flowing in the tube cir- cuit and nothing more. And where one or a series of valve tubes is em- ployed in the circuit, it is not even a measurement of the internal resistance of the tube. I have one tube which gives a beautiful fluorescence and backs up a spark-gap of two inches. Yet when taking a current of two and one-half milliamperes, it gives off no X-rays whatever; at least none that can be detected by means of a fluoro- scope. With a normal tube, however, and a coil that is free from inverse discharge, it is a very valuable instru- 256 A NEW DIRECT READING x-RAY METER ment especially when making quick exposures with heavy currents in radiography. The meter which I have devised resembles these described in no re- spect. In my device a direct reading is given by a pointer moving over a graduated scale, the movement of the pointer being in direct relation with the quantity of one quality of radia- tion, and that the most important emitted from the tube. What I meas- ure is the quantity of rays which have the power of rendering fluorescent cer- tain salts, such as barium platino- cyanide, tungstate of calcium and others. These rays are the so-called X-rays, and while there are undoubt- edly many other forms of radiation emitted from an X-ray tube when in action, yet it is sufficient for the pur- pose that we be able to measure accu- rately, continuously and safely, the X-rays alone. This is accomplished by means of the following device: It is well known that when the X-ray strikes upon particles of certain salts, tungstate of calcium for example, these salts, if observed in darkness, may be seen to become brilliantly luminous or fluorescent, and this flu- orescence bears a constant ratio to the intensity of the rays and to the distance from the point of emission of the ra as they, in common with all forms of wave length emitted from a point, fall off as the square of the distance. Now it has been customary among X-ray workers since the discovery, to judge of the amount and the quality of the X-ray emitted from any tube when in action, by observing this power of the ray to induce fluorescence by means of a screen coated with crystals of tungstate of calcium or other salt and made a part of a light- tight box, having an aperture for the eyes of the observer, such contrivance bearing the name of a fluoroscope Estimations of the power of pene- tration of the ray were made by hold- ing behind the screen in the path of the rays, various objects (usually the hand of the observer), and this prac- tice was responsible for serious injur- ies, loss of fingers, hands and lives, since the repeated exposure of the operator's person to the ray resulted, Sooner or later, in peculiar ulcerations, miscalled X-ray burns, but in spite of this danger this method is persistently followed at present because experience has shown that it is the best way of actually determining the quality and quantity of invisible radiations emitted from the tube. In place of the ob- server's hand, various other objects possessing a variation in the degree of opacity to X-ray have been substituted and are used for such observation, but the readings are inaccurate; they re- quire, since they are made in the dark, that the observer's eye should be ac- customed to the darkness, hence their accuracy depends upon the condition of the observer's eyes at the time the reading is made, and no two observers will read the same degree of penetra- tion. In my invention the fluorescence induced or produced upon a tungstate of calcium or other screen is employed as indicating the quantity of the X-rays emitted. The fluorescent screen is placed in a light-tight box or container. Facing the fluorescent screen is placed a selenium cell, which cell, as is well known, has the property of changing its ohmic resistance to the passage of electrical currents with relation to the presence or absence of light waves. Such a cell when kept in total darkness GEORGE COFFIN JOHNSTON 257 protected from light of all kinds, may have a resistance of several hundred ohms, yet upon permitting light, nat- ural or artificial, to strike upon the cell, its ohmic resistance falls almost instantly to a great degree and the variation in ohmic resistance thus pro- duced bears a direct relation to the intensity of the light. If, therefore, there be placed in series with such a cell as described, a galvanometer or ammeter of sufficient - delicacy, a source of electrical current such as an ordinary so-called dry bat- tery, a variable rheostat providing a means of introducing more or less ohmic resistance into the circuit, and the rheostat, the measuring instru- - ment, and the selenium cell be bal- anced, a point will be found at which the ohmic resistance of the rheostat, the connecting wires, the selenium cell and the measuring instrument will exactly balance the electro-motive force of the battery cell and, no current passing, the measuring instrument (galvanometer or milliamperemeter) will stand at zero. - If now, however, the container hav- ing within it the screen and the seleni- um cell be placed in the path of the X-ray proceeding from an excited X-ray tube, the screen will become Lºgº tº cº-º-º: ſex Gºv. … Sºre- - º --- ſº tº - º n- Jºhnston JC Rey mee- bººk of º ºvnºsta-tº- lº sº wºrk - Lvotes ºnce 13c. luminous in proportion to its distance from the source of the rays and the quantity of rays striking it, the con- tainer will be illuminated, the selenium cell under the influence of this light will change its ohmic resistance, in proportion to the light, a current will flow proportionate to the change in ohmic resistance of the selenium cell, and the current flow will be measured and indicated on the dial of the gal- vanometer or other instrument em- ployed for the purpose of making this electrical measurement, and the read- ing of this instrument will increase or diminish directly as the variation in intensity of the fluorescence upon the screen, which fluorescence is depend- ent upon the activity of the X-ray tube in emitting those rays which have the power of inducing such fluorescence upon the screen so constructed. It is evident, therefore, that such an instru- ment will give a direct reading without calculation and a continuous reading of the rays emitted. It is necessary, however, that the current employed should be the same for each reading, and I have provided therefore a means whereby the voltage of the battery cell may be taken at any time in order to guard against error from this source. 258 ROENTGEN DOSAGE THE ESTIMATION OF I spent the greater part of three years in endeavoring to devise a meter which any one could read, which re- quired no calculations, not as much as it does to tell time by a clock. One, moreover, which would enable opera- tors in different localities, using utterly different apparatus, to estimate the actual output of every outfit in X-rays, and thus to be able to compare results and methods. Such a meter I believe I have at last devised. It is far from perfect and, like everything else, is open to improvement, but it is the first thing that I have ever been aware of that actually indicated the output of a Crookes tube in X-rays. I believe the fundamental ideas underlying it are not only new and novel, but accu- rate, and I hope to be able to place in the hands of the scientific X-ray worker within a short time, a carefully standardized meter, which will be recognized as standard and which will give at all times a true and accurate reading of the value of a tube as a transformer with relation to the quan- tity of electrical energy, transformed into X-rays. This meter has nothing to do with the current flowing in the tube circuit. It concerns itself not at all with the make of tube, coil or interrupter. It is not affected in its readings by anything or influence, ex- cept the quality and quantity of the X-rays which strike upon the fluor- escent screen. It will necessarily be expensive since the selenium cells themselves cost $30.00 each. But the apparatus must be manufactured with accuracy as the first requirement, and cost of production should not be allowed to interfere with proper COn St TU Ct 10 n. NoTE RELATIVE TO THE ESTIMATION OF ROENTGEN DoSAGE * BY HENRY G. PIFFARD, M.D., OF NEW YORK CITY USE the term estimation in pref- erence to measurement as there does not exist at the present time, so far as known to me, any method by means of which the quan- tity of X-rays delivered and their biological effects can be directly meas- ured. Numerous methods, however, are at command whereby certain physical and chemical phenomena may be measured and their effects on the tis- sues estimated with more or less accuracy. The most thorough dis- cussion of the various methods already proposed, that I know of, will be found in articles by Bordier (of Lyons); H. Lewis Jones (London); Kienbock (Vienna); Hall-Edwards (Birmingham) and Reus (Chemoga), contained in the June issue of the Archives of the Roentgen Ray. Holzknecht’s method is the one that certainly has been exploited the most, but it is now very generally dis- credited. Sabouraud and Noire used little pastilles of platino-cyanide of barium which under the influence of the rays change from green to yellow and finally to orange; and from all accounts this device gives perfect sat- isfaction in the city of its birth. One * Read at the Seventh Annual Meeting of the American Roentgen Ray Society, at Niagara Falls, N. Y., September, 1906. HENRY G. PIFFARD 259 objection to it, however, is the fact that to use it effectively necessitates a small tube whose diameter does not exceed four inches. Bordier also em- ploys the platino-cyanide as an indi- cator, but has greatly improved on the Sabouraud device, in so much as, with his pastilles, a tube of any size may be used, and he has a comparative color scale of five tints, ranging from a faint trace of yellow to deep orange. The change in the color of the platino-cyanide is due to dehydration of the salt under the influence of the rays, and without doubt works well when the atmospheric humidity is low. A warning, however, comes from Lon- don, as the damp atmosphere of that city so hinders the color change that a dangerous over-exposure is liable to occur if the test color is relied on. My personal experience last summer tends to confirm these findings. This summer the Bordier pastilles reached me about the middle of July and I immediately made a test with an exposure that certainly would have resulted in a severe burn of the third degree, and yet the color change would simply indicate a mild erythe- ma. A similar test was made with radium and with same result. I then heated one of the pastilles so as, in a measure, to dehydrate it, and the color change was very decided. I feel jus- tified, therefore, in concluding that the platino-cyanide indicators cannot be safely used in New York City dur- ing the summer season when for eight or ten weeks the relative humidity rarely falls below 80 degrees, and often runs up to 90 degrees or more. There is still another objection to the platino-cyanide, as the color change must be examined by daylight, not by artificial light. It occurred to me a few months since to measure the intensity of the electro-static field surrounding a Crookes tube during an exposure, thinking that it might possibly be a convenient means of estimating the energy that was being given off. To do this, I took a brass ball about one and one-quarter inches in diame- ter and supported it about four inches from the wall of the tube, and just within the circle of rays issuing from the anterior hemisphere. The ball was then connected by a conducting cord about eight feet long to the charging device of an electroscope. As soon as the current passed through the tube, the aluminum needle or foil indicated the charge, and the angle was easily read off on the scale. For this purpose, I found both Braun's electroscope, which is gradu- ated in volts, or the writer's, which is graduated in degrees of an arc, very convenient, and I found that the angle varied directly with the current passing through the tube. It further showed whether the tube was running steadily or not, and also indicated any notable change in the vacuum. I have not as yet been able to give the matter a thorough therapeutic test, in so much as I am not a fre- quent user of X-rays, and I present the matter now as a preliminary note, in order that those who use the rays more frequently may ascertain its practical value in this connection. P. S. Since the foregoing was written, I have received the August number of The Archives of Physio- logical Therapy, and in it find an article by Columbo which fully bears out my own conclusions as to the unreliability of the platino-cyanide methods, and I also find, somewhat 260 THE TUBE IN ROENTGEN THERAPY to my surprise, that others have ex- perimented with measurement of the intensity of the electro-static field. The details of this will be found in a note by Dr. E. Albert-Weil in the journal de Physiotherapie for Febru- ary 15, 1905. The procedure is that of M. Francois, and involves the use of an electrometer and a battery of seventy Clark cells. - THE TUBE IN ROENTGEN THERAPYºk BY ENNION G. williams, M. D., OF RICHMOND, VIRGINIA T is not my purpose in this paper to give a complete discussion of the tube, but simply to discuss briefly those points that have appeared to me to be of the most practical value in therapeutic work. The factors to be considered in a treatment are the duration and fre- quency of the exposure, the distance of the anti-cathode from the surface exposed, the current supplied to the tube, and last, but by no means the least, the character and conditions of the tube itself. It is within the tube that the meas- urable electrical energy is transformed into the radiant energy of the Roentgen rays, which is incapable of accurate measurement. The energy or the in- fluence given off from a tube is made up of rays of different physical and physiological properties; and these particular properties are dependent upon the construction of the tube and upon the condition of the variable factors of the tube at the time the current of electricity is supplied to it. For a thorough understanding of the tube it is well to review the construc- tion and the various features about a tube together with their purposes and significances. The length of a tube is of im- portance because the farther the ex- ternal terminals of a tube are apart, the less likely is the current to arc across from one to the other, thereby involving loss of electricity which would otherwise pass through the tube to be transformed into X-rays. This invisible loss of electricity in short tubes may be considerable and render the reading of the milliammeter erro- neous so far as it is supposed to measure the electricity transformed. The long tubes, therefore, possess distinct advantage. - The size of a tube has a decided influence in determining the ease or quickness with which the degree of vacuum changes. The larger the in- ternal capacity of a tube the less in- fluence has a certain amount of absorp- tion or giving off of gas upon the total amount present, or in other words, the degree of vacuum. The thickness of the glass opposite the anti-cathode is a very material factor. Glass is very impervious to the rays and a slight increase in thick- ness seriously affects the therapeutic * Read at the Seventh Annual Meeting of Falls, N. Y., August 29, 1906. the American Roentgen Ray Society, at Niagara ENNION G. WILLIAMS 261 efficiency of a tube. When we see a few layers of gauze filter out physio- logical rays we can realize how much influence even a thin layer of glass can have. The lack of efficiency of some tubes, under apparently the same conditions otherwise, may doubt- less be explained by the thickness or quality of the glass opposite the anti- cathode. The size of the cathode appears to be immaterial. It has been found that aluminum is the best metal with which to construct the cathode because it gives off particles under the electri- cal discharge less readily than other metals. The cathode rays are projected in lines perpendicular to the surface of the cathode. The surface of the cathode is made concave and the rays from it would consequently tend to come to a focus at its centre of curva- ture, but the particles composing the rays being similarly charged electri- cally are mutually repellent and so do not come to a focus until about twice the distance of the centre of curvature from the cathode. At this distance is placed the anti-cathode to receive the impact of the cathode rays. By the impact of the material particles com- posing the cathode stream upon an impenetrable substance is set into activity a series of ether waves known as the X-rays. The anti-cathode is made of platinum because of its density, impenetrability and its high fusing point. The heavier the anti- cathode the heavier the discharge of cathode stream it can stand without the temperature of the metal being raised too high. Since in therapeutic work heavy discharges of the cathode stream are seldom if ever required, it is not necessary to have a very heavy anti-cathode. The anti-cathodeshould, however, be sufficiently thick to pre- vent any cathode rays from being lost by penetrating the platinum. The whole efficiency of the cathode stream should be converted into X-rays and given off from the front surface of the anti-cathode. The cathode and the anti-cathode should be so placed that the line of the cathode stream should be so far from the walls of the tube that it is not inter- fered with by the strange static influ- ence due to the wall or by return of the positive particles. This is a possible error that tube makers are not likely to make. - . In some tubes the anti-cathode serves as the anode and in others the two are separate. The advantage of these being separate is that in case of reverse discharge there is less disin- tegration and shooting off of minute particles of platinum which deposit on the walls and which tend to absorb the gas and so to increase the degree of vacuum. It is, however, better to have the anti-cathode attached to the anode, for it is found that there is in such case greater efficiency to the rays. - - The kind of gas within the tube is apparently of no consequence since the atoms or molecules that compose the cathode stream are not those com- posing the gas, but sub-atoms or elec- trons which are apparently the ulti- mate subdivisions of matter. The degree of vacuum or the rela- tive quantity of gas in the tube is the factor of the greatest moment concern- ing the tube, for it is that which de- termines the resistance within the tube and this in turn to a great extent de- termines the penetrative quality of the rays and at the same time the quantity 262 THE TUBE IN ROENTGEN THERAPY of electrical energy allowed to pass to be transformed into radiant energy. In therapeutic work a most impor- tant consideration is to estimate the dosage. This can be approximately estimated only when the character of the tube is constant. To maintain a constant vacuum within a tube it is most desirable that a tube used in this class of work should not be subjected to the conditions which are so liable to bring about a change of vacuum, such as the heavy discharges commonly used in radiographic work. The heavy discharges raise very greatly the tem- perature of the metal of the anti- cathode and also of the glass of the tube. This alters the absorption and elimination of the gas contained in metal and glass. The heavy dis- charges also increase the shooting off of the particles which deposit on the surface of the glass and absorb the gas, thus permanently raising the V2CUIUIII] . - The regulating devices are, of course, exceedingly useful in maintain- ing the proper vacuum. They cannot and should not alone be depended upon in the effort to maintain a con- stant vacuum. This should be done rather by avoiding heavy currents in therapeutic work. My own best ther- apeutic results have been obtained by using a current of from one-half to one and a half milliamperes and the resistance in the tube estimated by an equivalent spark gap of from two and a half to six inches. With such a current a tube will maintain a fairly constant vacuum for a comparatively long time and need very little regulat- ing. Should an exposure of more than ten minutes be needed it is well to let the tube have an interval of a few minutes' rest. It is best to have tubes of different degrees of vacuum than to attempt to regulate the same tube to suit different C2S62.S. As to the physiological actions and the therapeutic uses of tubes of differ- ent degrees of penetration, I am in thorough accord with Dr. R. H. Boggs in his article on “The Adjustment of X-radiations for Various Physiological Effects,” published in the St. Louis Medical Review, November II, 1905, in which he describes the five degrees of penetration with their therapeutic indications. In conclusion: for therapeutic work it is exceedingly desirable to measure the dosage; to do this we must have as constant as possible the factors that are not measurable and to have varia- ble only the factors that are measura- ble. The duration, distance and elec- trical energy supplied to the tube are measurable, and the conditions of the tube are largely not capable of exact measurement, and therefore they should as far as possible be made COnStant. One requisite of a tube for thera- peutic work is that the total amount of electrical energy supplied to the tube should be transformed into radi- ant energy with as little loss as possi- ble. This is accomplished by the following means: first, that the exter- nal terminals of the tube should be so far apart that there is a minimum pass- age of electricity around the tube instead of into it; second, the glass of the tube opposite the anti-cathode should be exceedingly thin, for even the thinnest glass filters out a material amount of therapeutic efficiency; third the anti-cathode should be made of such material and thickness as to pre- vent any penetration of the cathode or LEWIS GREGORY COLE 263 X-rays thereby involving a loss of effective rays. This is an almost inconsiderable factor. The other requisite of a good thera- peutic tube is that it should be capable of maintaining a constant vacuum. This is accomplished, first, by having the tube of such size that the absorp- tion or elimination of the gas by or from the metal or glass will not greatly alter the relative amount in the tube or the degree of vacuum; second, the electrical discharge sent through the tube should never be so strong that the temperature of the anti-cathode or the glass walls is raised so high as to alter their absorption or elimination of gas. The tubes used for therapeutic pur- poses should not be subjected to the heavy discharges common in radiog- raphy. The same tubes should not be used for both kinds of work. It is better to have different tubes for the various classes of therapeutic work than to attempt to adjust the same tube to suit every case. -E FURTHER EXPERIMENTAL RESEARCH CONCERNING THE DIRECT, INDIRECT, AND SECONDARY RAYS + BY LEWIS GREGORY COLE, M. D., OF NEW YORK CITY Archives of the Roentgen Ray, I. the May, 1905, issue of the was published an article on “Experimental research concern- ing direct, indirect and secondary skiagraphic rays.” An understand- ing of that paper is essential and, as the paper was never read before a Society and was published in an Eng- lish paper, I feel that I must incor- porate some of it in this paper. It was in my early practice with the low vacuum method that I secured on several occasions results of so startling a nature that it led me to investigate more closely the conditions which pro- duced them. In the course of this investigation I obtained unmistakable evidence that better work could be accomplished with an old than with a new tube, and that an old, either high or low vacuum tube would, under other favorable conditions to be dealt with later on, give off a certain ray or class of rays, unobtainable from a new tube under any conditions, and in which were combined the best char- acteristics of both the high and low vacuum methods, giving perfectly clear outline and marked detail in all parts with short exposure. This I called the “Ray of Selective Absorp- tion.” The Roentgen ray, considered in the form in which it leaves the tube, has, in its application to skiagraphy, generally been regarded as homogene- ous in its character. To so regard it is, I believe, a serious misconception of its true nature, which is in a degree responsible for not only many of the unsatisfactory results obtained, but for * Read at the Seventh Annual Meeting of the American Roentgen Ray Society, at Niagara Falls, N. Y., August 29–31, 1906. 264 - DIRECT, INDIRECT AND SECONDARY RAYS the inability on the part of the ski- agrapher to account for many of those oft-recurring phenomena which are so mystifying. - In the article written in May, 1905, I said, “I shall assume, whether rightly or wrongly, that the rays in their primary form have their incep- tion at the focal point of the anode, where they may or may not be practi- cally identical in their nature, and from whence they radiate in direct lines to the walls of the tube through- out its anterior hemisphere.” Roentgen recognized the fact that the X-rays, as a whole, were capable of setting up secondary rays in substances with which they come in contact out- side of the walls of the tube, a char- acteristic which has been more fully investigated by Professor J. J. Thomas to the extent of having determined that the degree of this action is in direct proportion to the density of the object in which it takes place. But, as far as I have been able to discover, no effort has been made to demonstrate the occurrence of this, or a similar process, in the walls of the tube itself, although I am aware that Roentgen's original conception of the X-rays was that they were of a second- ary nature and produced by the cathode streams in contact with the glass not having a metallic target to be focussed on. I am convinced that there are two forms of rays emanating from the tube, their chief distinguish- ing features being, so far as they affect skiagraphy, as follows: I. The source of origin. (a) The direct ray from the focal point of the anode. (b) The indirect ray from the wall of the anterior hemisphere of the tube. 2. The direction of the line of flight. This is in the case of the direct rays being a continuation of their original line of projection from the focal point of the anode, and in the case of the indirect rays being at various angles therefrom. - My belief in this led me to the study of the life history of a number of tubes. In the new tube we have per- fectly clear glass of ordinary brittle- ness and smooth inner surface. Upon its first excitement the anterior hemi- sphere lights up with a bright, yellow- ish-green fluorescence; this color grad- ually changes, as the seasoning process advances, into a purplish-yellow of less brilliancy. This light, Dr. Stover, of Denver, Colorado, calls the “sun- flower ‘’ light, because of its rich, mellow color. Eventually, in a very old tube there is scarcely any fluores- cence whatever, and Roentgen spoke of this as a dead tube. -. After a new tube has been used a few times, the glass begins to assume a purple color in its anterior hemi- sphere; this increases with the use of the tube and there obtains a smoky appearance of the glass of the pos- terior hemisphere. This purple color of the anterior hemisphere has been regarded by some as a result of a platinum deposit of the inner surface of the tube. I do not believe this to be the case and further on shall give my reasons for this disbelief. In the new tube a heavy discharge of current will heat the anode red-hot, while the same discharge in an old tube will have no effect. In a fluoro- scopic examination with a new tube, it is necessary to place the object near the screen in order to get a clear outline of the bones, but as the tube becomes seasoned this distance may be increased, until in an old tube the LEWIS GREGORY COLE 265 object may be held at some distance and the bones will still appear black with clear, well-defined edges, and the medullary cavity showing. In the new tube there is not a brilliant fluorescence of the exposed parts of the screen, but a diffusion of light over its entire surface and a corresponding lack of contrast be- tween the various degrees of density of the interposed object. The crisis of the tube. After a tube has been in daily use for three or four months to the extent of six or eight skiagraphs and possibly a treatment or two each day, it will be found on some particular day that the vacuum is very high; it refuses gradually to respond to the usual methods employed, but after repeated application in lowering it, it seems to drop suddenly from a high to a low vacuum and there will be purple rays between the cathode and anode. It recovers, however, from being low- ered, and, if treated moderately for a few days, will pass through this stage and be a most useful tube for six or eight months, or even a year or two. During the crisis the tube acts most peculiarly. If the face of the anode is turned to the side in one direction, preferably north, or parallel to the magnetic current, you will get a very effective ray from the tube with a 2 or 3-inch spark; then if turned towards the earth, it will back up a 12-inch spark without giving off any rays; by simply returning the tube to its former position it will again give an effective ray on a 2-inch spark. This I have demonstrated to the hospital staff. It occurs only on one or two days in the life history of each tube, and usually after the tube has been used for three or four months. This fact I have noticed in every tube improves steadily. which has been used for that length of time. This is what I consider the crisis of the tube. An explanation of these phenomena I cannot give, but that they occur I am absolutely cer- tain, and that the tube is more effective after passing through this stage I am equally sure. Carrying the tube up to and through this critical period may be termed “seasoning ” it. The vacuum may be raised in a low tube by making and breaking the cur- rent repeatedly, preferably by approxi- mating and withdrawing the second- ary terminals. This I know will raise the vacuum of the tube, but its modus operandi I cannot explain. If, each time a new tube is used, it be allowed to rest for a day or so, it will bear a greater amount of current without the vacuum being impaired, and eventu- ally, instead of the vacuum dropping, it rises, and the character of the ray Up to this time the power of penetration of the soft parts, and the amount of spark it backs up, seem to be in proportion to the height of the vacuum of the tube. Changes in the gas in the tube. Dur- ing and presumably as a part of this seasoning process, the gas remaining in the tube seems to undergo some change productive of a higher vacuum. When a tube which has undergone this process is re-exhausted, it will act as a new tube as regards the falling of the vacuum during the period of ex- citement. If, however, the tube is not re-exhausted, this change continues to increase with the use of the tube until a 12-inch spark, or even a greater, is necessary to effect an excitement, which even then will continue only a few seconds, unless the vacuum be repeatedly lowered by heating the palladium point; but even with 266 DIRECT, INDIRECT AND SECONDARY RAYS this high vacuum, as before stated, the bones during the interval of excite- ment of the tube appear very black in the fluoroscopic examination with an accompanying great penetration of the soft parts, a combination to which I then applied the term: “The ray of Selective Absorption.” The difficulty encountered in excit- ing a tube which has reached this con- dition, owing to the discharge of the current around the surface of the tube, is generally attributed to the presence of the above mentioned platinum de- posit on the inner surface of the tube, acting as a conductor of the current between the poles. While this deposit may exist, I doubt if it so affects the discharge, for the reason that the tube, if re-exhausted, without undergoing any known process calculated to re- move such deposit may be excited by a moderate energy, the vacuum drop- ping as in a new tube and without the immediate recurrence of the phe- In O Iſle [] OI). A seasoned tube produces a brilliant fluorescence of the screen on its ex- posed parts, this being much dimin- ished where the soft parts interpose and an almost entire absence of light wherethe bones interpose, with marked detail throughout the entire skiagraph. If the new tube backs up six or seven inches of spark, the bones are nearly obliterated and the edges are blurred and indistinct, while an old tube may back up a 12-inch spark without increasing the penetration of the bones enough to perceptibly dim their shadow, and in an old tube even the small bones of the hand will ap- pear distinctly black, regardless of the length of spark which it backs up, and the soft parts will each absorb a cer- tain amount of light. In the meantime, the glass of the tube has become brittle and rough on its inner surface in the anterior hemi- sphere upon which the radiations from the anode have acted directly, while the glass of the posterior hemisphere is not perceptibly changed from its orig- inal texture. As to the cause of the discoloration of the glass of the tube, I am of the opinion that if this is due to the pres- ence of any metallic substance in any form, it is of aluminum rather than of platinum, for the reason that in the anterior hemisphere, the parts of the tube immediately adjacent to the aluminum parts are more highly col- ored than others, while the portion of the lower half of that hemisphere, which is shielded from the direct rays from the platinum secondary cathode by the intercepting anode, has less discoloration. The different color of the two hemispheres, the purple of the anterior and the brown of the posterior, might be attributed to the different manner in which the metallic particles are disposed upon or through- out the glass. The glass of the pos- terior hemisphere being unexposed to the direct discharge from the anode, undergoes less molecular disturbance, and the metallic particles are simply deposited on the inner surface of the tube, while the direct discharge from the anode upon the walls of the an- terior hemispheres sets up an intense molecular action in the glass, which permits of the metallic particles being carried into and even through the glass. That some of them are carried through the glass is indicated by the fact that this same purple discolora- tion takes place in pieces of glass which have been exposed for some time to the direct action of the rays LEWIS GREGORY COLE 267 outside of the walls of the tube. That the molecular action above referred to results in a molecular re- arrangement in the glass of the an- terior hemisphere is a further propo- sition which, while beyond absolute proof by any means at my command, is so strongly suggested as to at least be worthy of most careful considera- tion. This re-arrangement, it seems to me, is somewhat similar to that occur- ring in steel which has been magne- tized. Whether this consists simply of an alignment of the axes of the molecules in parallel with the normal direction of the discharge from the anode, this taking place slowly and progressively with the use of the tube, or whether it consists of some more complex action, that tends to a con- tinuance of the original lines of force of that discharge, is a problem, the solution of which is outside of my domain. - The lower the fusible point of the glass, the more susceptible it is to the action which results in the discolora- tion. The fluorescence in the tube com- posed of glass of a high melting point is of a brighter and more greenish hue than that occurring in glass of a low melting point, while glass of an ex- ceedingly low melting point fluoresces blue. The variety of results thus obtained is apparently due either to differences in the chemical com- position or the molecular construction of the different glasses composing the respective tubes, or both. The glass of the anterior hemi- sphere of the tube, exposed as it is to the action of the direct discharge from the anode, becomes, as already stated, more brittle than the glass of the pos- terior hemisphere. In the case of a seasoned tube becoming punctured in its anterior hemisphere, that part of the glass immediately surrounding the puncture, after being subject to a degree of heat necessary to the process of repair, is apparently restored to the condition of the glass in a new tube and resumes all the characteristics thereof; the color disappears, it fluor- esces a bright greenish-yellow, and probably is less brittle. All these facts, it seems to me, tend to verify the theory that some change takes place in the molecular formation of the glass which, as it progresses, permits the free passage of a con- tinually increasing volume of the direct rays or the capacity of the glass to generate indirect rays. When this change becomes practically completed as in a seasoned tube, we are able, all other conditions being equal, to secure a very large proportion of direct rays. Hitherto a skiagraph lacking in contrast, but with marked density in all parts, has been considered as due to a high degree of penetration. Con- sidering, however, the nature of these indirect rays, and the fact of their ability to set up secondary rays in all objects with which they come in con- tact in the surrounding atmosphere, and especially in the soft parts of the tissue which they encounter, it can be readily understood that they thus reach the plate from all directions, projecting themselves at various angles beneath the subject, behind the bones or other substances, causing thereby an entire lack of definition of all parts and an obliteration of detail in the soft parts. We are thus forced into a recognition of their baneful effects, and of the fact that to them, rather than to the degree of penetration, is due the imperfections above noted. 268 DIRECT, INDIRECT AND SECONDARY RAYS On the other hand, the direct rays, reaching the plate as they do in estab- lished lines from a fixed or ascertain- able point, and being absorbed by the tissues interposed, presumably in pro- portion to the amount of solids con- tained therein, give a clear outline and perfect detail, even of the softer tis- sues, and with a preponderance of these rays we are able to show not only the bones and muscles, but the kidney and spleen, the walls of the intestines, and the arteries, and in cases which I have recently made, even the blood within the veins, showing the anastomoses around the knee and elbow. The indirect rays are caused by the deflected cathode stream that has not been converted into X-rays at the focal point of the anti-cathode, but is carried along with the direct rays until they strike the wall of the tube and are there converted into what I termed indirect rays. First. As originally illustrated by Roentgen, the cathode stream caused a brilliant yellow fluorescence of the glass when focussed directly on it. Second. Prof. J. J. Thomson de- scribes an experiment in which he shows that all of the cathode stream is not converted into X-Rays at the focal point, but that some of it is deflected. : Third. The cathode stream causes great heat when focussed on glass. That part of the tube behind the target is not heated to the same degree and does not fluoresce like that part ex- posed to direct X-Rays and the deflected cathode stream. kiPourth. The similarity of the point in the posterior hemisphere near the shaft of the anode where a few of the cathode rays strike the wall of the tube and the fluorescence of the anterior hemisphere were the things that led me to this line of investigation. The X-ray, either direct or indirect, does not generate any amount of heat in passing through the glass. There- fore the heat of the glass tube is not caused by the X-rays generated at the focal point of the anode, and is not caused by the heat radiated from the anode, because the posterior hemi- sphere is colder than the anterior. Fifth. In a tube so constructed that a piece of tin, aluminum or glass shields some part of the anterior hem- isphere from the focal point of the anode, that part of the glass so shielded does not become hot, does not fluo- resce, and does not give off indirect rays. Heat is generated only when the cathode stream is converted into X-rays. In a low vacuum tube more of the cathode stream is converted into X- rays at the focal point of the anode than in a high vacuum tube, and in a very high tube the cathode stream deflected from the anode is not con- verted into X-rays at the wall of the tube, but is again reflected to some other part of the tube. Glass exposed to the direct X-ray, and the cathode stream direct, or the deflected, undergoes the molecular activity and change described in an earlier paper published in the Ar- chives of the Roentgen Ray, May, 1905, and does not generate the amount of indirect rays that new glass does. The thinner the glass the fewer indirect rays are generated. 3 A coil and interrupter so constructed as to generate a current of very high voltage with low amperage will cause LEWIS GREGORY COLE 269 more of the cathode stream to be deflected than one with a lower voltage and higher amperage. The tuning of the apparatus is, I believe, the regula- tion of it, so that the greatest amount of the cathode stream is driven against the anode at about the same velocity. A tube so constructed as to cut off all deflected cathode stream is the first thing we think of, but the ideal is a coil, interrupter and tube so con- structed that the entire cathode stream will be converted into X-rays at the focal point of the anode. Resume The direct rays are generated at the focal point of the anode by the impact of the cathode stream, from which point they pass in all directions in front of the anode and are absorbed by the tissues interposed presumably in proportion to the amount of physio- logical Solids they contain, giving clear-cut, well-defined shadows even of the very soft tissues. Some secondary rays are generated by the direct rays. The indirect rays are generated at the wall of the tube by the deflected cathode stream which has not been converted into X-rays at the focal point of the anode, but are carried along with the direct X-rays to the wall of the entire anterior hemisphere, where they are converted into indirect rays. These indirect rays pass in all directions from the wall of the tube, behind the target as well as in front, and owing to the large area of the source of origin and the secondary rays they generate in the soft parts. They cause a blurring of the outlines of the bones and soft parts. The secondary rays are caused as much or more by the indirect rays than they are by the direct rays. A tube so constructed that none of the deflected cathode stream can strike the walls of the tube will not fluoresce and will not generate in- direct rays. But the ideal is to have a tube, interrupter and coil so con- structed that the entire cathode stream will be converted into º: at the focal point whereby the X-rays will be purely direct rays. ºf Attempting a Physical Explanation of a Biological Process. (Von R. Sleeswijk, Zeitschrift fur Electrothera- pie, August, 1906.) The author calls attention to the well-known fact that in the process of cell division, two poles develop. One of these is the positive element and the other is the negative element, just as we have positive and negative electrical ele- ments, and that if an element or an energy is separated it must find a new energy with which to unite. This appears to be the general process of life. - S. T. THE TEACHING OF ROENTGENOLOGY IN MEDICAL COLLEGES + BY VERNON J. WILLEY, A.M., OF ANN ARBOR, MICHIGAN Instructor in Electro-therapeutics and Director of the Roentgen Laboratory at the University of Michigan HE value of the Roentgen rays as a diagnostic and thera- peutic agent needs neither defense or demonstration be- fore this Society. Every roentgenolo- gist has seen sufficient evidence to con- vince him of the utility of Roentgen diagnosis and Roentgen therapy. It is undoubtedly true, however, that the mistakes, failures and injuries incident to the experimental stage of the work as well as the lack of knowledge of the effect of the rays at that time, have done much to discredit roentgenology among many members of the medical profession. The increased knowledge of the action of the rays, physical, chemical, physiological and pathological, has been of such a nature in recent years that we can now say truthfully that almost in direct proportion as is the knowledge of the subject exact and the technique correct, may the utility of Roentgen rays be demonstrated. Yet, as a science, roentgenology is still in its infancy. We have still a great deal to learn. Careful study, comprehensive research, intelligent in- terpretation and more exact methods of work, will bring broader application and increased utility. At present we have reason to hope that our knowl- edge of the effects of the rays upon the living animal cell is sufficiently exten- sive, so that most of the dangers may be altogether avoided. 35-º- ºr § ** Since roentgenology has come to have a recognized place in diagnosis and therapeutics, and since satisfac- tory results are obtained only through intelligent use and correct technique it is of importance that the physician should be well informed on the scope and limitations of the subject. Espe- cially is this true since the physician of the future, no matter how he may wish to avoid it, will find himself under the necessity of using the rays either for diagnosis or treatment, not once, but many times during the course of his professional career. Whether or not he chooses to do his own Roentgen work, or to refer it to a roentgenologist, a knowledge of the application of roentgenology to clinical work will be a necessity. The medi- cal college of the present day must, therefore, give some attention to teach- ing the use of the Roentgen rays. I believe it is important in this connec- tion to confine the instruction to the principles of the subject, as far as we know them, and to avoid the exploita- tion of pet theories. It will not be possible to make Roentgen experts, nor will it be possible to enable each student to become proficient in tech- nique. The skill he must acquire for himself, but let there be a knowledge of principles preceding it. What the medical student should know is what can be done by the use of the Roentgen rays in therapeutics * Read at the Seventh Annual Meeting of the: American Roentgen Ray Society, at Meeting * Niagara Falls, N. Y., September 270 VERNON J. WILLEY 27I and diagnosis. He should also be given sufficient instruction to enable him to select such apparatus as will meet the needs of the roentgenologist, and to know that he must devote him- self to a thorough understanding of the apparatus and the conditions under which he labors, in order that he may develop a correct technique. In order that he may have a clear idea of the principles of roentgenology, the student must possess a general knowl- edge of radiophysics and of the physi- cal principles of the apparatus em- ployed. Demonstrations of appara- tus, under the different conditions which must be met, and of the methods of controlling and regulating the ap- paratus should be given in connection with a discussion of the physics of the subject. Given medical students of the pres- ent day where entrance requirements include a general knowledge of physics this instruction is comparatively easily and rapidly imparted. Of much greater importance, how- ever, is instruction in the practical uses of the rays. In diagnosis, the student should be taught how to make a fluoroscopic examination under con- ditions necessary for his own safety and the safety of the patient. The importance of shielding, of diaphragm- ing, and of making the examination within a proper time limit should be emphasized. He sh 1so be taught how to interpret, ', a general way, what he sees upon the screen, that it is not a picture but a record of the densities traversed by the rays, in passing through the structure under observation. He should be taught the purpose and the value of a fluoro- scopic examination, and the limited usefulness, the liability to error and the absolute insufficiency of relying upon it alone as a diagnostic instrument, especially where detailed information, such as can be given only by the radiograph, is necessary. - The advantage of the fluoroscope in studying motion, and in giving a gen- eral idea of relationships, cannot be denied. Yet one should have a clear idea of the limited use and extended danger in a too free use of the fluoro- scope. In radiography the student should be taught to recognize a radiograph which is reliable for diagnostic pur- poses, and the necessity for more than one radiograph of the pathological condition. Radiographs made at dif- ferent angles or stereoscopically, both of the pathological condition and of the corresponding normal anatomy of the patient, wherever possible, should be presented for interpretation. It is especially desirable that the stu- dent should understand the value of correct interpretation, not only for the purpose of treating the condition more skillfully but so that he shall real- ize the importance of this in medico- legal cases where radiographs are sub- mitted as evidence. He should also understand the conditions under which distortion is produced and never allow a radiograph showing an apparent de- formity to prejudice his mind against a case where good functional results were obtained. - The careful study of a series of radiographs, of both normal and pathological conditions, with especial reference to interpretation, is of the greatest value in a course in roentgen- ology, because it combines both prac- tical and educational value in a high 272 ROENTGENOLOGY IN COLLEGES degree. The real value of Roentgen diagnosis can be better demonstrated in this than in any other way. If a majority of the plates studied are those of patients seen in the clinics, so that the diagnosis and methods of treatment are fresh in the mind of the student, so much the better. If some of the radiographs are made in the presence of the section in roentgen- ology, the detailed methods of radio- graphic procedure demonstrated, these radiographs studied, and the treatment and recovery of the patient be kept under observation, it will be of still greater value. The careful and ex- tended study of a limited number of well selected cases will prove of greater value than a superficial study of a great many. In Roentgen therapy the student should be instructed in the effects of the rays upon the various tissues, so far as is known, and to what extent pathological conditions yield to irradi- ation. The application and limita- tions of the Roentgen rays in thera- peutics should be carefully presented. Demonstrations of the method of treating different conditions should be given, and the reasons for the tech- nique presented. Methods of meas- urement, both of current strength used to excite the tube and of the penetra- tion of the rays as measured by the Benoist and Walter instruments, should be demonstrated. The quan- titative measurements of the rays, inaccurate and unsatisfactory though they may be, should be presented, and the necessity for more accurate meth- ods of dosage than a time unit should be brought to the student’s attention. Patients receiving treatment should be under observation by the members of the class for as long a period of . time as circumstances will permit. In demonstrating the methods of treatment in a Roentgen ray clinic it is also of fundamental importance that the diagnosis should be accurately determined, and a microscopic ex- amination made in every case possible. The time which may be given to the subject will necessarily vary with the conditions which confront the roent- genologist. A very satisfactory way of presenting the subject is to have the senior class divided into small sec- tions, and the work given by lectures and demonstrations for one hour or two hours per week, for either a semester or half a semester. From twelve to twenty hours would be re- quired to present the essentials of the subject, without giving it any more attention than its importance de- mands. Through correspondence with the Deans of most of the American Medi- cal Colleges, I find that at present some attention is given to teaching this subject in nearly every one. The hospitals of even the smaller colleges are, as a rule, equipped with Roentgen apparatus for both diagnosis and therapy. In many of the colleges the instruction is comprehensive, system- atic and connectedly presented. I believe it is unfortunate to have the instruction presented intermittently by different clinical men, at only such time a fancy presents itself. It is, of couis important that the teach- ing be correlated with the clinical in- struction as far as possible, but it is a saving of time and is of greater value to the student, if the instruction be presented by a competent roentgen- ologist. The success of the instruction de- pends to no little extent upon both the ELECTROTHERAPY 273 mental equipment of the instructor and the equipment of his laboratory. He should be practical, and be pos- sessed of both a knowledge of the fundamental physics and the medical sciences. He should be familiar with the literature of the subject. He should keep in touch with the work of the different clinics, and with the work of other roentgenologists. A careful record should be kept in the labora- tory of all work done, the results ob- tained, the microscopic examinations made, and all physical measurements obtainable. It is only by careful, sys- tematic work and record keeping that we may hope to place roentgenology on a strictly scientific basis. But it is not the medical student alone who needs instruction in the ap- plications of the Roentgen rays. There are many physicians whose doubts might be removed and who would make use of the rays, were they con- vinced that such use would lead to better results in their practice. But they are not to be convinced by flatter- ing reports in medical journals alone. It is the duty and it should be the pleasure of every roentgenologist to present to his medical society such cases and such demonstrations as will lead to a just and true appreciation of the work of this agency. Though he be an enthusiast, the roentgenologist should scrupulously avoid making hasty conclusions, ex- travagant claims or of making positive diagnoses from his plates except when absolutely justified in doing so. It is better to err on the side of conserva– tism than to shake the faith of his colleagues by premature conclusions. There should be a united effort on the part of roentgenologists to give to the medical profession an accurate knowl- edge of the use of the Roentgen rays and to keep the work within the bound- aries of its legitimate field. ELECTROTHERAPY Results of Auto - conduction by Spiral Resonators in Arterial Hyper- tension. Two resonators are placed parallel to each other in such a way that their turns are in the same direc- tion in each and with the discharge of the condensers not circulating in a single external turn, but in 13 or I4 external turns. With this arrange- ment no effluvia are produced, but there is an enormous oscillating field around each spiral and the space be- tween the two spirals is the seat of the maximum effects of induction which can be obtained. Thus, a single turn of rubber wire placed in this field suf- fices to light up the several I2 to 20– volt lamps in series. He uses this field for auto-conduction in the same way as the auto-conduction gauge and with similar results. Two spirals are placed parallel and at a distance of about 60 centimeters. They are both wound in the same direction. The wire from one external armature of the Leyden jars passes to the external ex- tremity of the first spiral, and from the 15th turn of this spiral the wire passes to the external extremity of the second spiral, and from the 15th turn of the 274. CURRENT PHYSIOLOGICAL THERAPY second spiral it passes to the external armature of the other Leyden jar. The patient is placed between the two spirals in such a manner that the axis of his body follows the curvature of the external turns of the two spirals, sitting in a chair, for instance, with the knees bent up by means of a stool placed under the feet. Fifteen pa- tients have been treated by auto- conduction in this way and showed a notable diminution of the arterial pres- sure at the end of the treatment. Fifteen or twenty treatments of twenty or thirty minutes each are generally enough. In cases where the patient has suffered from general symptoms — vertigo, fatigue, dyspnoea, loss of appetite, sensation of cold and varia- ble symptoms — the patient has al- most always felt decidedly better after the sixth or seventh treatment. Radial Paralysis Caused by a Frac- ture of the Humerus. Electrical Ex- amination of the Denuded Nerve. Recovery in Spite of an Unfavorable Prognostication. (Dr. M. Chanoz, Archives d'Electricite Medicale, Sep- tember 10, 1906.) The case was that of an old man with a fracture of the humerus, with some little displace- ment of the fragments and immediate paralysis of the entire distribution of the radial nerve. At an operation per- formed five weeks after the injury the nerve was freed from the callus and an electrical examination of it was made. Bi-polar stimulation of the exposed nerve, either above or below the Zone liberated from the callus, produces no muscular contraction in the region controlled by the radial nerve. The prospect of recovery from the paralysis accordingly, seemed very slight. Be- fore the incision was made an electrical examination by means of electrodes applied to the surface of the arm showed that faradic excitability was completely abolished in the radial territory of the forearm. The triceps was a little less excitable than on the sound side. Galvanic excitability of the active electrode placed on the point of election of the muscles pro- duced slow contractions. The con- traction compared with the same in- tensity for either pole. Faradic stim- ulation applied to Erb's point over the parachial plexus required a stronger application to produce contraction of the triceps than on the sound side. Without any special treatment this patient gradually recovered the use of the paralyzed muscles. S. T. RADIODIAGNOSIS Radioscopic Procedure for Extrac- tion of Needles. (F. Wullyamoz, Ar- chives d'Electricite Medicale, Septem- ber 10, 1906.) Guided by the fluoro- scope, he draws a pencil line parallel with the direction of the needle and the same length as the needle. Then, by electric light or gas light, he makes a short incision through the skin at right angles to the direction of the needle. Then, using the fluoroscope again, he pushes in a pair of forceps through this short incision, grasping the needle at its middle point, and then by daylight or artificial light he makes a short incision over one end of the needle, and then using the fluoroscope again and twisting the forceps some- THE ARCHIVES OF PHYSIO LOGICAL THERAPY Devoted to the Diagnostic and Therapeutic Uses of Electricity, Radiant Energy, Heat, Water, Mechanical Vibration, Dietary Regulation, Exercise, Psychic Suggestion, etc. VOLUME FOUR INDEX JULY-DECEMBER 1906 Page Page A Air Dilatations in the Treatment Abbott, U. C. . . . . . . & © º e º ºs º e 89, 90 of Chronic Constipation . . . 238 Absorption of X-Rays, Method of Air in Some Common Patholog- Studying . . . . . . . . . . . . . . . . 25 ical Conditions, Dry Hot . . . 9 A Case of Double Tuberculous Orchitis Cured by High Fre- quency Effluvia . . . . . . . . . I9, 8 I A Case of Epithelioma of the Tongue with Secondary Growths in the Glands of the Neck and the Liver Treated by X-Rays, with Histological Changes in the Primary and Secondary Growths . . . . . . . . A Case of Exophthalmic Goitre Treated by Electricity and I34. Serum Therapy . . . . . . . . . . 2O4. A Case of Frozen Feet Treated by Thermaerotherapy. . . . . . I24. A Case of Unusual Dislocation (Symphysis of the Pubis) without Exterior Signs and Detected by Radiography . . IOI Action of Hydro-Electrical Baths in Various Cardiovascular Affections . . . . . . . . . . . . . . . I28 Action of X-Rays on the Sick Organism . . . . . . . . . . . . . . . 23O Adams, Edward . . . . . . . . . . . . . . 29 I Agostino . . . . . . . ... e. e. e º e s e º a s = & e 90 Aiken, Cottage Sanitarium. . . . . . 78 Air in Tetanus and Yellow Fever, Cold . . . . . . . . . . . . . . . . . . . . I56 Air Treatment of Acute Respira- tory Diseases, Fresh . . . . . . . I54 Albers-Schonberg, Dr. . . . . . . . . . I33 Albert-Weil, Dr. . . . . . . 9I, 128, 260 Allaire, Dr. . . . . . . . . . . . . . . . I96, 129 Allen . . . . . . . . . . . . . . . . . . . . . . . 2O6 Allison, Dr. C. C. . . . . . . . . . . . . . I56 Alopecia Cured by Static Elec- tricity, A Case of . . . . . . . . . . I90 High Frequency in . . . . . . . . . . I90 Premature Idiopathica Treated by X-Ray . . . . . . . . . . . . . . . . 25 Alternating Currents in Cerebral Anaemia . . . . . . . . . . . . . . . . 99 High Voltage, Pernicious Effects of . . . . . . . . . . . . . . . . . I88 A Medical Rheostat . . . . . . . . . . . I29 America and Mississippi Valley Medical Association . . . . . . . I2 I American Climatological Asso- ciation . . . . . . . . . . . . . . . . 16, 32 Journal of Surgery . . . . . . . 90, 208 Medical Editors’ Association . 89 American Medicine . . . . 188, 236, 27 Roentgen Ray Society. . . . . . . . 18 (i) THE ARCHIVES OF PHYSIOLOGICAL THERAPY A Modification of the Stereop- ticon Method of Locating Foreign Bodies. . . . . ... . . . . I.33 Anders, J. M. . . . . . . . . . . . . .25, 154 Anesthesia, Electrical Orientation . 1I] . . . . . . . . . . . . . . . . . . . . . . . . 189 - A New Apparatus for Ortho- photography in the Horizon- tal Position . . . . . . . . . . . . . . I34 Chromoradiometer . . . . . . . . . . I48 Diaphragm Protecting Case. . . Direct-Reading X-Ray Meter, by Johnston, George Coffin . 253 Method of Orthophotography 133 Unit for the Measurement of the Intensity of the Ra- diations of a Crookes Tube Ioff Annales d’Electrobiologie et de Radiologie - 89, 91, 92, 93, 94, 98, IOI, IO4, 223, 224, 225, I29, 13 I, I92, I93, . . . . . . . I94, 196, 197, 199 Annales de Physicotherapie . . . . 182 Anthrax, Morton Wave Current and Electrolysis in . . . . . . . . 94. An Unusual Case of Dementia Praecox, Associated with Epilepsy and a Most Exten- sive Bromide Eruption . . . . . I2 I Apostoli . . . . . . . . . . . . . . . e s - e º e 96 A Practical View of Tent Life in the Southwest . . . . . . . . . . . . 295 Archives d’Electricity Medicale I93, 194, 198, 201, 202, 98, IO3, IO4. Io9, 223, 224, 230, 231, 274, 276, 138, 139, 233, 19, 20, 23, 24, 25, 26, 148, 156, 129, 132 Archives of the Roentgen Ray I42, 194, I46, 268, 22, 98, IOO, - IO2, 225, I47 Arterial Hypertension, High Frequency in . . . . . . . . . . . . . I92 Tension, High Frequency in . . 224 Tension, High Frequency Currents in . . . . . . . . . . I93, IQ4. Arthritis Deformans and X-Rays 25 X-Rays in Tubercular. . . . . . . . 25 Ash, Edwin . . . . . . . . . . . . . . . . . . Attempting a Physical Explana- tion of a Biological Process. . 269 Aubertin . . . . . . . . . . . . . • * * * * * * * 198 Audhuy, Dr. . . . . . . . . . . . . . . . . . I56 A Very Simple Indicator for Locating Foreign Bodies Radioscopically . . . . . . . . . . 23 B Bacelli, Hon. Prof. Guido . . . . . . 90 Bacteria, Action of High Poten- tial Electricity on . . . . . . . . . 96 Balthazard, M. V. . . . . . . . . . . . . I48 Bandler, Samuel Wyllis . . . . . . . . 285 Banting, Dr. . . . . . . . . . . . . . . . . . 282 Barjon . . . . . . . . . . . . . . . . . . I38, 198 Barr, Sir James . . . . . . . . . . . . . . * Baso-Cellular Perukerato de Epithelioma Cured by X- Rays . . . . . . . . . . . . . . . . . . . . IO3 Beaujard, Dr. . . . . . . . . . . . . . . . . 198 Beaumont, Dr. . . . . . . . . . . . . . . . 236 Beck, Dr. Carl . . . . . .220, 221, 222 Beclere . . . . . . . . . . . . . . . . . . I38, 38 Bekhtcreff . . . . . . . . . . . . . . . . . . . 206 Bellevue Hospital, N. Y. . . . . . . . 209 Training School for Nurses . . . 208 Belot, J. . . . . . . . . 198, 201, 202, 276 Bennett, T. J. . . . . . . . . . . . . . . . . I5 I Benoist, L. . . . . . . . .25, 26, 94, 139 Bergonie . . . . . . . . . . . . . . . . . 39, 156 Berlemont Automatic Regulating Crookes Tube . . . . . . . . . .... I98 Berliner Klin. Wochenschrift. .23, 24 Berlioz. . . . . . . . . . . . . . . . . . . . ... 96 Bernard, Claude . . . . . . . . . . . . . . 2O6 Berne, Dr. . . . . . . . . . . . . . . . . . . . 30 Bertolotti . . . . . . . . . . . . . . . . . . . . 90 Bettremieux, Dr. . . . . . . . . . . . . . 2O2 Bienfait, M. . . . . . . . . . . . . . . . . . 92 Bier, Edwin . . . . . . . . . . • . . . . . . . 289 Billinkin, Dr. . . . . . . . . . . . . . . . . I28 Bishop, Francis B. . . . . . . . . . . I9, 92 (ii) r- THE ARCHIVES OF PHYSIOLOGICAL THERAPY Bladder, X-Ray Studies of Clos- ure of . . . . . . . . . . . . . . . . . . . IOO Blondel, Paul . . . . . . . . . . . . . . . . I9 Blood and Haematopoietic Or- gans, Influence of X-Rays on - 137, 138, 198 Pressure, High Frequency Currents and . . . . . . . . . I93, IQ4. Boedelser . . . . . . . . . . . . . . . . . . . . I94. Boggs, Dr. R. H. . . . . . . . . . . . . . 262 Bone Marrow, Effect of X-Rays on in Leukemia . . . . . . . . . . . I37 Bonnefont, Dr. E. . . . . . . . . . . . . 98 Bordet, Dr. . . . . . . . . . . . . . . . . . . 25 Bordier IO4, 139, 148, 231, 255, 258, 276 Brandt, Dr. . . . . . . . . . . . . . . . . . . 28 Breisacher L., Detroit, Mich. . . . 237 Brewster, Margaret P. . . . . . . . . . 2O3 Brickner, Walter M. . . . . . . . 89, 208 Bridge, Dr. . . . . . . . . . . . . . . . . . . . 171 British Medicai journal, 21, 185, 186, 199, 204, Io9, 137, 277 Brosius, William L. . . . . . . . . . . . . 181 Bruhns, C. . . . . . . . . . . . . . . . . . . . 24 Buchanan, R. J. M. . . . . . . . . . . . I37 Bulkley, L. Duncan . . . . . . . . . . . . 277 Bulletin Officiel de la Societe Francaise de Electrotherapie et de Radiologie, 20, 23, 25, I28, 129, 93, 193, 196, 202, 204 Burais, Dr. . . . . . . . . . . . . . . . . . . 93 Burdach . . . . . . . . . . . . . . . . . . . . 227 C Cabot . . . . . . . . . . . . . . . . . . . . . . . 238 Calculi, X-Ray Diagnosis in Detection of Renal . . . . . 99, IQ7 Shadows of Cystic and Xanthic Oxide . . . . . . . . . . . . . . . . . . . I32 Shadows Mistakable for Uret- eral . . . . . . . . . . . . . . . . . . . . . 22 Calculus, X-Rays in Diagnosis of Renal . . . . . . . . . . . . . . . . 196, 22 Renal . . . . . . . . . . . . . . . . . . . . . 228 California Medical Journal . . . . . 233 Cancer, Radium in . . . . . . . . . . . . 27 See also Carcinoma and Epithelioma. X-Rays in Uterine . . . . . . . . . . 24 Carcinoma of Lungs, X-Ray Diagnosis of . . . . . . . . . . . . . I32 X-Rays in . . . . . . . . . . . . . . . . . 2 I5 Cardio-Vascular Affections, Hydro-Electric Baths in . . . 128 Carpi, Dr. . . . . . . . . . . . . . . . . . . . 90 Case of Epileptiform Facial Neuralgia Treated Success- sively by Section of the In- fraorbital Branch of the Trigeminus, Ablation of the Gasserian Ganglion, Resec- tion of the Upper Cervical Ganglion of the Sympathicus and Radio-Therapy . . . . . . . 138 Central Institute for Physical Therapeutics . . . . . . . . . . . . . 83 Cerne, Dr. . . . . . . . . . . . . . . . . . . . IO4 Cessaro, Dr. . . . . . . . . . . . . . . . . . 90 Chandler, Prof. . . . . . . . . . . . . . . . 8O Chanoz, Dr. M. - 274, 193, 194, 196, 225, 233 Children's Hospital, Pittsburg, Pa. . . . . . . . . . . . . . . . . . . . . . 253 Chittenden, Dr. . . . . . . . . . . . . . . 28o Chromoradiometer, A New . I48 IO4. City and County Hospitals, Den- ver, Col. . . . . . . . . . . . . . . . . . 2 I5 Clean Milk . . . . . . . . . . . . . . . . . . I IO Climatological Association, Amer- ican . . . . . . . . . . . . . . . . . . . . 32 Climatology and Health Resorts of South Carolina . . . . . . . . . 71 Clinical Studies on the Polar Effects of Faradic Currents and of Condenser Discharges 129 Codivilla . . . . . . . . . . . . . . . . . . . . 90 Coe, Dr. . . . . . . . . . . . . . . . . . . . . . 90 Coe, Henry Waldo . . . . . . . . . . . . 89 Cohn, Max . . . . . . . . . . . . . . . . . . 23 Coils, Small and Large Induction 23 (iii) THE ARCHIVES OF PHYSIOLOGICAL THERAPY Cold Air in the Treatment of Tetanus, and Yellow Fever . 156 Cole, Dr. Lewis Gregory . . . . 40, 263 Coleschi, M. . . . . . . . . . . . . . . . . . . . Colombo, Carlo ... 83, 90, 199, 259 Concerning Shadows in the Roent- gen Negative which May be Mistaken for Ureteral Stones 22 Sources of Error by the Ortho- diagraph . . . . . . . . . . . . . . . . I33 The Dosage of the Roentgen Rays . . . . . . . . . . . . . . . . . . . . 23 I The Variations in the Results of Orthodiagraphy and Per- cussion of the Heart . . . . . . . I33 Condenser for High Frequency Currents, Monolith . . . . . . . 94. Congestion (Chronic) Treated by Electricity . . . . . . . . . . . . . . . 98 Constipation, Air Dilatations in Treatment of Chronic . . . . . 238 Electrical Applications in . . . . 93 Contacts, Experimental Re- searches upon Liquid . . I96, 225 Continuous Current, See also Galvanism. Zoster Occurring after High Frequency Cured by . . . . . . 93 Contremoulins, Dr. . . ISI, 139, I97 Contribution to the Early Diagno- sis of Tuberculosis. . . . . . . . . 98 Contusions, Recent Sprains and . 29 Convulsions (General) in Early Infancy Induced by the Taking of Food, and Their Bearing upon Pyloric Ob- struction in the Infant Corning, J. Leonard Costa, Prof. . . . . . . . . • * * * * * * * - - IO3 Costex, Prof. . . . . . . . . . . . . . . . . . 38 Courtrade, Dr. . . . . . . . . . . . . . . . . I39 Crane, W. W. . . . . . . . . . . . . . . . . . 158 Croftan, Alfred C. . . . . . . . . . . . . 28 I Crook, James K. . . . . . . . . . . . . . 71 Crothers, T. D. . . . . . . . . . . . . . . . 89 Cryesthesia, High Frequency in . 192 90 Cumston, Charles Green . . . . . . Curtin, Dr. . . . . . . . . . . . . . . . . . . Cutter, Dr. Elbridge G. . . . . . . . . D Dachteeler, Dr. J. N. . . . . . . . e s ∈ Daland, J. . . . . . . . . . . . . . . . . . . . Dangers and Contradictions of 90 32 2O9 I8 25 Radiotherapy in the Treat- ment of Epitheliomas of the Face Of Local Radiography (Com- pression Diaphragm) in the Detection of Calculi of the Urinary Tract - D’Arsonval . . . . . . . . . . . 37, 95, D’Arsonvalization, Duration of * * : * ~ * 4 ºr e g º e º e - - - - d. 3 & 6 g º ºs e º e º e º 6 & IOI I97 I94 Lowered Arterial Pressure • , Following See also High Frequency. Davis, Dr. N. S. . . . . . . . . . . . . . . . Debet DeBonnoit . . . . . . . . . . . . . . . . . . Delherme, Dr. . . . . . . . . . . . . 37, Dementia Praecox, Hydrotherapy * * * * * * * * * e º te e º e * * * * * * * * * * * * * * * * * * * * * * * 1I] . . . . . . . . . . . . . . . . . . . . . . DeNobele, Dr. . . . . . . . . . . . . . . . Denver and Gross Medical College, Denver, Col. . . . . . . Dermatitis, Roentgen Treatment and Roentgen . . . . . . . . . . . . Desnos . . . . . . . • - - - - - - - - - - - - - - Determination of Roentgen Ray Volume . . . . . . . . . . . . . . . . . Diabetes, High Frequency Cur- rents in . . . . . - e. e º s e º 'º - e. I94, Diaphragm Protecting Case, A New . . . . . . . . . . . . . . . . . . . . Diet During Second Year, Suit- able Dietetic Management of Infants in Hot Weather . . . . . . . . . . . Dietetics of Obesity, The . . . . . . . Dietetic Treatment of the Vomit- ing of Pregnancy (iv) 98 2O9 138 96 I4. I2 I 25 2 I5 IO2 I9 I28 224, 134 2O3 • * * * * * * e s tº s e º e º 'º - e º s 234. 28 I THE ARCHIVES OF PHYSIOLOGICAL THERAPY Diet in Tuberculosis . . . . . . . . . . Digestion, Influence of Rest, Exercise, and Sleep on Gastric Direct Current, Universal Con- troller for Measurement of the Quality of the Radiation from a Tube or Bonnette . . . . . . . . . . . . . . . . Doremus, Prof. R. Ogden Dosage of Roentgen Rays Dose of Roentgen Rays . . . . . . . . Doumer, Prof. I93, Dry Hot Air in the Management of Some Common Patholog- ical Conditions. . . . . . . . . . . . Dubois, Dr. S. . . . . . . . . . . . . . . . . Diuresis Resulting from High Frequency Treatment in the Autoconduction Cage . . . . . Dunogier, Dr. S. . . . . . . . . . . . . . . Durand, Dr. E. J. . . . . . . . . . . . . . Duration of the Lowering of Arterial Pressure after the Treatment of Permanent Hypertension by d’Arson- valization . . . . . . . . . . . . . . . . Dyspepsia, Treatment of Nervous e ºn e tº e s e º ºr e º 'º e º 'º e º e & s e e º & tº e s tº gº E Ear, Galvanism in Chronic Non- Suppurative Affections of the Middle . . . . . . . . . . . . . . . . . . Early Diagnosis of Chronic Pul- monary Tuberculosis by the Orthodiagraph, On the Eastmond, Charles Edwards, John Hall . . . . . . . . . . . Effect of General Application of High Frequency Currents upon Capillary Circulation . Effect of the Roentgen Rays upon the Skin: Roentgen Derma- titis and its Therapy, The . . . Ehrenretter is & e º 'º' 276 23 I48 I94 2O I93 I32 IO6 98 92 9I I3 I 23O 225 I93 275 2O6 (v) Einhorn, Dr. Max . . . . . . . . . . . . 209 Electrical Orientation in Spinal Anesthesia . . . . . . . . . . . . . . . 189 Resistance of the Blood and the Urine as a Test of the Func- tional Efficiency of the Kidney . . . . . . . . . . . . . . 186, 225 Treatment of Anal Fistula . . . . 128 Electricity in Furuncles and Anthrax . . . . . . . . . . . . . . . . . 94. Electrolysis in Urethral Stricture. I9 Electrotherapie Clinique . . . . . . . 37 Elliot, E. E. . . . . . . . . . . . . . . . . . . 295 Emaciation, Treatment of . . . . . . 237 Emanations from Radioactive Bodies, Physiological and Therapeutic Actions of . . . . I48 Emmet . . . . . . . . . . . . . . . . . . . . . . 28 Epileptiform Facial Neuralgia, A Case of . . . . . . . . . . . . . . . . 138 Epithelioma Cured by X-Rays . . Io9 Late Results of Roentgeniza- tion in . . . . . . . . . . . . . . . . . . I8I Of Face, Dangers and Contra- dictions of Radiotherapy in Treatment of . . . . . . . . . . . . . IOI Of Tongue, X-Rays in . . . . . . . I34. See also Cancer and Carcinoma. X-Rays in Cutaneous . . . . . . . . 2O I Epstein . . . . . . . . . . . . . . . . . . . . . 282 Erroneousness of the Radiometric Indications Furnished by Platino-Cyanide of Barium . 83 Esdra . . . . . . . . . . . . . . . . . . . . . . . 90 Evans, Britton D. . . . . . . . . . . . . . 90 Examination and Interpretation of Radiographs, On the . . . . 225 Existence of Rays of Very Slight Penetration . . . . . . . . . . . . . . 233 Exostosis, Skiagraphic Studies of 220 Experimental Researches on Liquid Contacts I96, 225 Eye, Protection of from X-Rays . 202 Steel Splinters Removed by Magnet from . . . . . . . . . . . . . I3O THE ARCHIVES OF PHYSIOLOGICAL THERAPY Gavazzinni Furuncles and Anthrax, Their Treatment by Morton's Wave Current and Electrolysis. . . . See also Continuous Current. Gaylord, Dr. . . . . . . . . . . . . . . . . . Geddings, Dr. . . . . . . . . . . . . . . . e Genital Activity, X-Rays and . . . Gibson, Dr. . . . . . . . . . . . . . . . . . . ** - F Facial Paralysis . . . . . . . . . . . . . . .92 Faradic Currents, Clinical Studies on Polar Effects of . . . . . . . . I29 Measurement of . . . . . . . . . . . . 225 Fassett, Charles Wood . . . . . . . . . 89 Fenwick, Dr. E. Murray . . . . . . . 208 Fernie, W. T. . . . . . . . . . . . . . . . . III Fibroids of Uterus, Electricity in - Treatment of . . . . . . . . . . . . . 185 Finger . . . . . . . . . . . . . . . . . . . . . . IOO First Italian Congress of Phys- iological Therapy . . . . . . . . . 90 Fistula, Electrical Treatment of Anal . . . . . . . . . . . . . . . . . . . . 128 In Ano Cured by High Fre- quency Currents, A Case of . 224 Food, Heart Failure as Result of Deficient . . . . . . . . . . . . . . . . Fortschritte auf dem Gebiete der Roentgenstrahlen, 132, 133, º I34, I48, 227, 229, 231, 22 Foster, Dr. Frank P. 33 . . . . . . . .89, 90 Fothergill, Dr. J. M. . . . . . . . . . . 2O9 Foulerton, A. G. R. . . . . . . . . . . . 96 Fractures, Influence of X-Rays upon Treatment of . . . . . . . . 2. I Fraenkel, Eugene . . . . . . . . . . . . . 229 Franco . . . . . . . . . . . . . . . . . . . . . . 90 Francois, M. . . . . . . . . . . . . . . . . . 260 Franklinization, Dosage of . . . . . . 94 Freeman, Dr. Leonard . . . . . . . . 2 IQ Fresh Air Treatment of Acute Respiratory Diseases with Special Reference to Pneu- IIloilla . . . . . . . . . . . . . . . . . . . I54. Freudenthal, Dr. Wolf . . . . . . . . . 7 Freund, Leopold. IO2, 140, 195, 254 Friedenwald, Julius . . . . . . . . . ... 236 Frozen Feet, Dry Hot Air in Treatment of . . . . . . . • * * * * * I24. Fubringer . . . . . . . . .* * ... • * * * * * * * * - Further Experimental Research Concerning the Direct, In- direct, and Secondary Rays . 263 Haig, Alexander Hall-Edwards, John Giglio, Dr. . . . . . . . . . . . . . . . . . . . Gillett, Dr. . . . . . • - - - - - - - - - - - . Goitre Treated by Electricity and Serum Therapy, A Case of Exophthalmic Goll, Frederick . Gonorrhea and its Complications by High Frequency Currents, Treatment of Grafe Lucas Grand River Medical Society Gramegno, Dr. . . . . . . . . . . . . . . . Gray, Henry Green and Bauer Green, Charles Leedham Grodel, Dr. . . . . . . . . . . . . . . . , º a tº Guillaume Guilleminot, H. . . . . . . 2O, I29, Guinard - Glycosuria, High Frequency in . . © & © & g º º º ºs e º 'º º e e º 'º e º e º is º e º e º e º º tº º º tº tº dº ſº e º 'º tº E tº e º e g tº e tº • * e º e e * * * * g tº e e s tº e e s m is e e º s H Haehnlen, Dr. W. Frank . . . 249, Haenish, Dr. Fedor Hahnemann Training School for Nurses e e e < a. s. e. e s is a e º e s e s e e e º 'º e s e º a tº º & s e e ſº e º º ºs Haret, Dr. G. . . . . . . . . . . . . . . . . Harrison Hartzell, M. B. . . . . . . . . . - - - - - - s & s e º e º – e. e. e º 'º & © tº 4 & # 8 º' (vi) 94. 9I 90 25 I 8O IO4. 187 90 I33 2O4. 206 I92 36 I8I 90 2O6 184 IOO I6 I 95 255 138 223 25O I34. THE ARCHIVES OF PHYSIOLOGICAL THERAPY Haultain, F. W. W. . . . . . . . . . . . . 185 Hayden, Dr. A. H. . . . . . . . . . . ... 81 Heart Disease, Nauheim Baths in 158 Failure as the Result of De- ficient Food . . . . . . . . . . . . . . 33 Heineike . . . . . . . . . . ... • * * * * * * * * * 198 Hemorrhoids Cured by High . Frequency, Thirty Cases . . . .192 Hepatic Douches . . . . . . . . . . . . . 284 Herdman, William J. . . . . . . . . . . 176 Herpes Zoster, High Frequency in . . . . . . . . . . . . . . . . . . . . . . 224 Hichman, Louis J. . . . . . . . . . . . . 238 Hickey, Preston M. . . . . . . . I74, I75 High Frequency Currents and Arterial Tension . . . . . . I93, IQ4. Blood Pressure . . . . . . . . . . . . . I93 Diuresis . . . . . . . . . . . . . . . . . . . I93 Effluvia in Tuberculous Orchi- tis . . . . . . . . . . . . . . . . . . . . . . 98 In Gonorrhea. . . . . .* * * * * * * * * * I92 In High Arterial Tension . . . . . 224. In Pulmonary Tuberculosis 2O In the Treatment of Cryesthesia Due to Arterial Hyperten- Sion . . . . . . . . . . . . . . . . . . . . . I92 In the Treatment of Small Benign Neoplasms and Hypertrophies of the Skin . . 125 Monolith Condenser for . . . . . 94 On Surface Temperature, Influence of . . . . . . . . . . . . . . 97 Their Action on Blood Pressure. Applications to the Treatment of Arterial Hypertension and Accessorily to the Treatment of Diabetes - Upon Capillary Circulation, Action of . . . . . . . . . . . . . . . . . What they are . . . . . . . . . . . . . . 95 In Anal Fistula . . . . . . . . . . . . . 224. In Diabetes . . . . . . . . . . . . . . . . 224. In Glycosuria. . . . . . . . . . . . . . . 223 In Hemorrhoids. . . . . . . . . . . . . I92 In Herpes Zoster . . . . . . . . . . . . 224. In Keloid . . . . . . . . . . . . . . . . . . Hippocrates Oscillating and High Period- icity Pulsating Currents in Medicine. . . . . . . . . . . . . . . . . . See also d’Arsonvalization. . Spark in the Treatment of Pre- mature Alopecia Zoster Occurring after . . . . . . . * , s = * * • * c & e º 'º e º e • * * * * * * * * * * * = ... • * * * Hirschfeldt • * * * * * * * * * * * * * * * * o Holland, G. Thurston. . . . . . . . . . Holt, Dr. L. Emmett. . . . . . . . . . . Holzknecht Hopitaux de Paris - : * ~ * - Hot Air in Some Common Patho- logical Conditions, Dry . . . . . How Cerebral Anemia Modifies Epileptiform Crises duced by Alternating Cur- rents Hughes, C. H. . . . . . . . . . . . . . . . . . Hydrarthrosis, Treatment of . . . . Hydro-Electrical Baths in Some Cardio-Vascular Affections . Hydro-Electric Baths in Cardio- Vascular Affections . . . Hydrotherapy in Dementia Precox . . . . . . . . ‘. . . . . . . . . . . . Hyperaemia, Treatment of Otitis by Artificial . . . . . . . . . . . . . . e & © tº e º ſº tº € $ tº e Imbert, A. . . . . . . . . . e e º e º 'º º . . . Indications for and Technic of Electrical Applications in Constipation Indicator for Locating Foreign Bodies Radioscopically. . . . . Induction of Hypnosis, The . . . . Ineryio Influence of Rest, Exercise and Sleep on Gastric Digestion . . . . . . 37, 139, 254, Pro- 99 I29 9I I28 I2, I Ioé IOI . 236 X-Rays on the Blood and Hem- atopoietic Organs. Treat- ment of Leukemia THE ARCHIVES OF PHYSIOLOGICAL THERAPY International Medical Congress 182 Interpretation of Radiographs . . 225 Investigations Concerning the Muller-Barlow Disease . . . . . 229 J Jacob, F. H. . . . . . . . . . . . . . . . . . 22 Jirotka, Bohumil . . . . . . . . . . . . . . I48 Johns Hopkins’ Hospital Bul- letin. . . . . . . . . . . . . . . . . . . . . . . 30 Johnston, Dr. George C. 18, 231, 253 Jones, H. Lewis . . . . . . . . . . I47, 258 Journal de Physiotherapie 91, IO I, IO4, 148, 192, 201, 30, 260, 284, 128, 138 Of Advanced Therapeutics I9, 92, 232 Of American Medical Associa- tion . . . . . . . . I to, 281, 237, 294 Of Cutaneous Diseases I35 Of the Kansas Medical Society 29 Of the Medical Society of New Jersey . . . . . . . . . . . . . . . . . . Of the Military Surgeons of the United States 2O3 tº gº tº e º a gº e º $ tº º QO Of the Minnesota State Med- ical Association a n d the Northwestern Lancet . . . . . . I3O K Kean, Major Jefferson Randolph 90 Keith . . . . . . . . . . . . . . . . . . . . . . . 185 Keloid, High Frequency in . . . . . . Kemper, G. W. H. . . . . . . . . . . . . 206 Kentucky School of Medicine . . . 12 I Kienboch . . . . . . . I41, 146, 255, 258 Kienboch’s Quantimeter . . . . . . . 2O2 King, Herbert Maxon . . . . . . . . . I52 Kinnicutt, Francis P. . . . . . . . . . . 158 Klemm . . . . . . . . . . . . . . . . . . . . . I95 Knox, Robert. . . . . . . . . . . . . . . . . I34 Kocher L. . . . . . . . . . . . . . . . . . . . . 23 Kohler . . . . . . . . . . . . . . 37, I4 I, 255 Kolipinski, Louis . . . . . . . . . . . . . IO7 Kopetzky, S. J. . . . . . . . . . . . . . . . IO6 Koplik, Dr. Henry . . . . . . . . . . . . 209 Kouindjy, Dr. . . . . . . . . . . . . . . . . 30 L La Clinique, Apostoli . . . . . . . . . . 37 Lahman Institute . . . . . . . . . . . . . 35 Lakewood, N. . J. Temperature and Sunshine in . . . . . . . . . . I6 Laquerriere, Dr. . . . . . . 37, I29, 224 Late Results of Roentgenization in Epithelioma . . . . . . . . . . . I8 Leduc, Stephen . . . . . . . . . . . . 24, IO3 Legendre, Dr. . . . . . . . . . . . . ... • * * Leidy, Joseph . . . . . . . . . . . . . . . . 2O6 Leredde, Dr. . . . . . . . . . . . . . . . . . IOI Leukemia, X-Ray Treatment of - 137, 138, 198 Leukoplakia Treated by Radium 7 Litchfield County Medical Society 9 Location of Foreign Bodies, Radioscopical London Hospital . . . . . . . . . . . . . 2O I Lancet . . . .99, 132, 134, 225, 228 Louisville Medical and Surgical Society . . . . . . . . . . . . . . . . . . I2. I Neurological Society . . . . . . . . I2. I Luther . . . . . . . . . . . . . . . . . . . . . . 2O6 Lymphosarcoma, X-Rays in . . . . 23 M MacDonald, Carlos . . . . . . . . . . . 90 Joseph . . . . . . . . . . . . . . . . . . . . 90 MacFarlane, Catharine . . . . . . . . 27 Magnet, Steel Splinters Removed from Eye by . . . . . . . . . . . . . I3O Magnifying Radiochromometer . 26 Malherle, Dr. . . . . . . . . . . . . . . . . . QI Maloine, A. . . . . . . . . . . . . . . . . . . 37 Malpiglii, Marcello . . . . . . . . . . . 2O6 Marcy, Henry O. . . . . . . . . . . . . . . 90 Marque, Dr. Raoul . . . . . . . . . . . 2O4. Mass. General Hospital . . . . . . . . 209 Massage in Neuritis and Poly- neuritis . . . . . . . . . . . . . . . . . 3O (viii) THE ARCHIVES OF PHYSIOLOGICAL THERAPY . Parametritis, Perimetritis, Salpingitis and Oophoritis . . 27 Mauchart . . . . . . . . . . . . . . . . . . . 2O6 McBurney, Charles. . . . . . . . . . . . 2O6 McCrann, Dr. W. J. . . . . . . . . . . I56 McGahan, Dr. C. F. . . . . . . . . . . 78 McGuire, James C. . . . . . . . . . . . . 229 Meals Medicinal . . . . . . . . . . . . . . III Measurement, Milliampere- meter in X-Ray . . . . . . . . . . . I47 Of Faradic Currents . . . . . . . . 225 Of X-Ray Volume, 26, 103, 139, I42, I44, 146, 202, 231 Measuring the Resistance of the Body without Special Appar- atus . . . . . . . . . . . . . . . . . . . . 2O Mediastinal Tumors, X-Rays in Diagram of . . . . . . . . . . . . . . . 227 Medical College of the State of South Carolina . . . . . . . . . . . 74 Electrology and Radiology . . . 97 Of Indiana, Indianapolis . . . . . 2O6 Record I52, I54, 158, 229, 238, 33, 289 World . . . . . . . . . . . . . . . . . . . . 90 Mellican, Kenneth W. . . . . . . . . . 89 Method and Apparatus for Prac- tically Studying Absorption in Radiotherapy . . . . . . . . . . 25 Dosage Apparatus in Frank- linization . . . . . . . . . . . . . . . . 94. Milk, Clean . . . . . . . . . . . . . . . . . . I IO Millener, Frederick H. . . . . . . . . . I88 Miller-Barlow Disease . . . . . . . . . 229 Minor . . . . . . . . . . . . . . . . . . . . . . 3O Mirror, Radiochromometric . . . . 23.I Mitchell, Weir . . . . . . . . . . . . . . . 2O4. Mobilization of the Lower Ex- tremities in the Treatment of Phlebitis . . . . . . . . . . . . . . . . 3O Monolyth Condenser for High Tension Currents . . . . . . . . . 94. Morris, Dr. . . . . . . . . . . . . . . . . . . I2. I Henry . . . . . . . . . . . . . . . . . . . . I32 Moschcowitz, Dr. . . . . . . . . . . . . . 208 Moutier . . . . . . . . . . . . . . . . . . . . . I94 Mount Sinai Hospital Dispensary 208 Training School for Nurses . . . 208 Movable Music-Stand Shaped Switch Board for Electro- therapy . . . . . . . . . . . . . . . . . I29 Moyer, Harold N. . . . . . . . . . . . . 89 Murray, William R. . . . . . . . . . . . I3O Museum of the Royal College of Surgeons . . . . . . . . . . . . . . . . I32. N National Italian Association of Physiological Therapy . . . . . 90 Nauheim Bath in Gynecology, The . . . . . . . . . . . . . . . . . . . . 285 Heart Disease . . . . . . . . . . . . . . I58 Necessity of a Uniform Technique in Radiography, On the . . . . I31 Necrosis of the Rib . . . . . . . . . . . . I74. Negro, Dr. . . . . . . . . . . . . . . . . . . . 90 Nervous Dyspepsia and Nervous Dyspeptic Troubles, Treat- ment of . . . . . . . . . . . . . . . . . 92 System, Action of X-Rays upon Central . . . . . . . . . . . . . . . . . I99 Neuralgia, A Case of Epileptiform Facial . . . . . . . . . . . . . . . . . . . 138 Of the Trigeminal Nerve Suc- cessfully Treated by Radio- therapy . . . . . . . . . . . . . . . . . IO2. Neurasthenia, Treatment of . . . . 204 Neuritis, Massage in . . . . . . . . . . 3O Peripheral . . . . . . . . . . . . . . . . . I9 New England Medical Gazette . . 131 New Medical Rheostat, A . . . . . . 196 Unit of Quantity of X-Rays, The Unit I . . . . . . . . . . . . . . . 23 I New York Medical Journal 95, 90, IO7, Io9, 291, 295, 189, - I95, 230, 27 Noire . . . . . . . . . . . . . . . . . . . . . . . 258 Northrup, W. P. . . . . . . . . . . . . . . 2.94. Note Relative to the Estimation of Roentgen Dosage . . . . . . . 258 Notes on Purin-Free Diets. . . . . . 279 (ix) THE ARCHIVES OF PHYSIOLOGICAL THERAPY The Use of Milliamperemeter in X-Ray Measurement . . . . 147 Nicenzo . . . . . . . . . . . . . . . . . . . . . 90 Nigano . . . . . . . . . . . . . . . . . . . . . . 90 Nordrach Ranch Sanatorium ... 169 Norstrom, Gustave . . . . . . . . . . . 27 North Missouri Medical Associa- tion . . . . . . . . . . . . . . . . . . . . . I8I O Oertel . . . . . . . . . . . . . . . . . . . . . . 282 O’Farrill, Gustavo . . . . . . . . . . . . 98 Ohio Valley Medical Association 121 On the Wrong and Right Use of Milk in Certain Diseases of the Skin . . . . . . . . . . . . . . . . . 277 Open-Air Treatment of Pneu- monia, The . . . . . . . . . . . . . . 2.94 Orthodiagraph, Sources of Error b I33 Orthodiagraphy and Percussion, Variations in Findings of . . . 133 A New Apparatus for . . . . . . . . I34 In Early Diagnosis of Pul- monary Tuberculosis . . . . . . I3 I Orthophotography, A New . Method of . . . . . . . . . . . . . . . Osler, Dr. . . . . . . . . . . . . . . . . 3O, I 73 Osteitis, X-Rays in Tubercular 25 Otitis by Artificial Hyperaemia, Treatment of . . . . . . . . . . . . . Ioô Otten, Dr. M. . . . . . . . . . . . . . . . . I32 Otis, Dr. . . . . . . . . . . . . . . . . . . . . 78 Oudin, Dr. . . . . . . . . . . . . . . . 2O2, 38 P Paget’s Disease Treated by X- Rays . . . . . . . . . . . . . . . . . . . . I35 Pan-American Medical Congress 32 Paralysis, Facial . . . . . . . . . . . . . . 92 Pattee, Alida Frances . . . . . . . . . . 208 Penetration, Rays of Very Slight 233 Percarolo, Dr. . . . . . . . . . . . . . . . . QO Percussion and Orthodiagraphy, Variations in Findings of . . . I 33 Peripheral Neuritis . . . . . . . . . . . I9 Pernicious Effects of Alternating Currents of High Voltage ... 188 Peters, Dr. . . . . . . . . . . . . . . . . . . . I34 Petit, Dr. P. Ch. . . . . . . . . . . . . . . 93 Pfahler, G. . . . . . . . . . . . . . . . 25, 249 Pfeffer, Dr. . . . . . . . . . . . . . . . . . . . I95 Phlebitis, Mobilization in Treat- ment of . . . . . . . . . . . . . . . . . 3O Phototherapy in General Practice 232 Physicotherapy and Physio- therapy . . . . . . . . . . . . . . . . . Physiological and Therapeutical Study of the Radiations E m i t t e d by Radioactive Bodies and of Their Emana- tions . . . . . . . . . . . . . . . . . . . . I48 Physiology Dep. University Chicago . . . . . . . . . . . . . . . . . 225 Physiotherapy and Physicother- a PY . . . . . . . . . . . . . . . . . . . . . I82 Piffard, Henry G. . . . . . . . . . . 95, 258 Pilcher, James Evelyn . . . . . . . 89, 90 Pisels, Godfrey R. . . . . . . . . . . . . 234. Pitcher, Herbert . . . . . . . . . . . . . . 232 Platino-Cyanide of Barium, Erro- neousness of Radiometric Indications Furnished by .. 83 Polar Effects of Faradic Currents 129 Polyneuritis, Massage in . . . . . . . 3O Pope, Curran . . . . . . . . . . . . . . . . I2 I Sanatorium . . . . . . . . . . . . . . . . I2 I Pottenger, Dr. F. N. . . . . . . . . . . . 33 Potts, W. A. . . . . . . . . . . . . . . . . . 279 Practical Dietetics with Reference to Diet in Disease . . . . . . . . . 208 Pratt, Dr. J. F. . . . . . . . . . . . . . . . I3O Dr. Joseph H. . . . . . . . . . . . . . . 3O Pregnancy, Dietetic Treatment of Vomiting of . . . . . . . . . . . . IO7 Presbyterian Hospital . . . . . . . . . 2O9 Presentation of Several Patients Treated by Radiotherapy . . Prioleau, Dr. . . . . . . . . . . . . . . . . . 8O (x) THE ARCHIVES OF PHYSIOLOGICAL THERAPY Protection of the Eye During X- Ray Treatments . . . . . . . . . . 2O2. Pseudoleukemia, X-Rays in . . . . IQ8 Pulse and Temperature in Diag- nosis and Treatment of Pul- monary Tuberculosis . . . . . . 169 Punton, Dr. John . . . . . . . . . . . . . 89 Pyloric Obstruction in Infant . . . Io9 Q Quadrone . . . . . . . . . . . . . . . . . . . 90 Quantimeter, Kienbock’s . . . . . . 2O2 Quantimetric Method, On the . . I46 R Radial Paralysis Caused by a Fracture of the Humerus, Electrical Examination of the Denuded Nerve, Recovery in Spite of Unfavorable Prog- In OStJ Catlon . . . . . . . . . . . . . . . 274. Radioactive Bodies, Physiolog- ical and Therapeutic Actions of Emanations from . . . . . . . I48 Radiochromometer, Magnifying 26 Radiochromometric Mirror . . . . 231 Radiographic Measurement of the Diameters of the Female Pelvis, and New Technique in Radiographing Vesic al Calculi . . . . . . . . . . . . . . . . . . Radiographs, Interpretation of . . Radiography, Uniform Technique 225 1I] . . . . . . . . . . . . . . . . . - e. e. e s is I3 I Radiometer, A New Chromo- . . . I48 Radiometric Methods . . . . . . . . . I39 Radioscopic Procedure for Ex- traction of Needles . . . . . . . . 274 Radiotherapy in Cutaneous Epithelioma . . . . . . . . . . . . . 2O I Experimental Tripanosomiases 25 Uterine Cancer . . . . . . . . . . . . . 24. Notes On . . . . . . . . . . . . . . . . . . IO4. Presentation of Several Patients Treated by . . . . . . . . . . . . . . 2O I See also X-Ray Therapy. Radium Employed in the Cavity of the Uterus . . . . . . . . . . . . . 2O2 In Leukoplakia . . . . . . . . . . . . . 7 Treatment of Cancer . . . . . . . . 27 Rando . . . . . . . . . . . . . . . . . . . . . . QO Rankin, Guthrie . . . . . . . . . . . . . . 2O4. John T. . . . . . . . . . . . . . . . . . . . I25 Raymond and Duchesne, Drs. . . . 284 Rectal Feeding . . . . . . . . . . . . . . . I5 I Rectum Cured by X-Rays, Tumor of . . . . . . . . . . . . . . . . . . . . . . IO3 Redard P. and Barret S. . . . . . . . 223 Reichman, Dr. Max . . . . . . . . . . . 22. Reid, Dr. . . . . . . . . . . . . . . . . . . . . 36 Rens, Chemoza . . . . . . . . . . . . . . . 258 Gustave . . . . . . . . . . . . . . . . . . . I42 Reports of Two Cases of Varicose Veins Successfully Treated with the X-Ray . . . . . . . . . . . 229 Resistance of Blood and Urine in Diagnosis of Renal Disease , 225 Renal Diagnosis, Electrical . . . 186 Body, Measuring without Special Apparatus . . . . . . . . 2O Respiratory Diseases, Fresh Air Treatment of . . . . . . . . . . .‘. . I54. Resphigi . . . . . . . . . . . . . . . . . . . . QO Results in Treatment of Diabetes at the Apostoli-Laquerriere Clinic by High Frequency Currents . . . . . . . . . . . . . . . . 224. Of Auto-Conduction by Spiral Resonators in Arterial Hypertension . . . . . . . . . . . . 273 Rheostat, A Medical . . . . . . . . . . I24. New Medical . . . . . . . . . . . . . . 196 Rhythm, As a Factor in the Domain of Therapeutics . . . I78 Riddele, James R. . . . . . . . . . . . . 196 Ringworm, Varieties and Treat- ment of . . . . . . . . . . . . . . . . . I99 Riolan . . . . . . . . . . . . . . . . . . . . . . 2O6 Riviere, Dr. J. H. . . . . . . . . . . . . . 182 Robinson, William J. . . . . . . . . . . 89 (xi) THE ARCHIVES OF PHYSIOLOGICAL THERAPY Roby J. . . . . . . . . . . . . . . . . . . . . . . I IO Rochefort, M. O. . . . . . . . . . . . 94, IOI Roentgen Congress at Berlin, Germany . . . . . . . . . . . . . 36, 146 Diagnosis of Primary Carci- noma of the Lung . . . . . . . . . I32 Roentgenization in Epithelioma, Late Results of . . . . . . . . . . . I8I Roentgenograms, Plastic . . . . . . . 229 Roentgenometric Standards. . . . . I42 Roentgen Ray Dosage . . . . . . . . . I48 Rays and Affections of Hem- atopoietic Organs (Leuk- emias and Pseudoleukemias) 198 Rays and Supernumerary - Teeth • * * * * * * * * * * * * * * * * * e I32 Rays, Dosage of . . . . . . . . . . . . . 23 I Rays in Tubercular Arthritis and Osteitis . . . . . . . . . . . . . . 25 Rays, See also X-Rays. Society, American . . . . . . . . I8 Treatment of Carcinoma . . . 215 - Volume, Determination of . , 128 Treatment and Roentgen Dermatitis is $ tº tº & ſº tº e º 'º º tº tº º º IO2 Rays upon the Central Nervous System, Action of . . . . . . . . . I99 Tubes . . . . . . . . . . . . . . . . . . . . 39 Ronneaux, G. . . . . . . . . . . . . . . . . 224. Roques, Dr. C. . . . . . . . . . . . . . . . 23 I Roth, Dr. . . . . . . . . . . . . . . . . . . . 225 Roux, Dr. . . . . . . . . . . . . . . . . . . . I95 Royal Army Medical Department Infirmary . . . . . . . . . . . . . . . . I37 University, Rome . . . . . . . . . . . 83 Rupture of the Urethra: Stricture Treatment by Circular Elec- trolysis, Cure Persisting after Two Years . . . . . . . . . . . . . . I9 S Sabouraud . . . . . . . I40, 89, 254, 258 Salomonson, Prof. . . . . . . . . . 23, 225 Salse Girera . . . . . . . . . . . . . . . . . 94. Scarpa . . . . . . . . . . . . . . . . . . . . . . 90 Schoenberg, Dr. Albers Schauffler, Robert McEwen. . . . . William Gray. . . . . . . . . . . . . . . Schmidt, H. E. . . . . . . . . . . . . . . . . Schule . . . . . . . . . . . . . . . . . . . . . . Scott, Dr. J. N. . . . . . . . . . . . . . . . Senn . . . . . . . . . . . . . . . . . . . . . . . . Sequeira, James * * * * * * * * * * * * * * Seventh Annual Meeting of the American Roentgen Ray Society . . . . . . . . . . . . . . . . . . Roentgen Ray Society - 249, 260, 263, Shattuck, Dr. F. C. George B. . . . . . . . . . . . . . . . . . Shenton, Edward W. H. . . . . . . . Short Summary of the Develop- ment of the Treatment of Uterine Fibromyomata with- in the Last Twenty-Five Years . . . . . . . . . . . . . . . • * * * Sigalin tº e g s = e º ºs e º is s sº e º 'º e º e º s e e º 'º & tº e º 'º º e # Significance of Pulse and Tem- perature in the Diagnosis and Treatment of Pulmonary Tuberculosis . . . . . . . . . . . . . Skiagraphic Studies of Exostosis (Five Special Plates) . . . . . . Skiff, Dr. Francis S. . . . . . . . . . . . Skin Diseases, X-Rays in . . . . . . . High Frequency Currents in Hypertrophies of . . . . . . . . . Skinner, Clarence E. . . . . . . . . . . Sleeswijk, Von R. . . . . . . . . . . . . . Small and Large Induction Coils. Smith, Andrew C. . . . . . . . . . . . . . Eustace . . . . . . . . . . . . . . . . . . . Prof. Andrew H. . . . . . . . . . . . . Society of Lying-In Hospital . . . . Some Remarks on Roentgeno- metric Standards Somerville, W. F. . . . . . . . . . . . . . Some Suggestions for Perfecting a Method of X-Ray Measure- Inent s & sº e º sº e º ſº $ s e e º e º e s tº * I8 270 2O9 90 228 185 90 22O I24. 24. I25 269 23 90 IO9 I2. 209 I42 97 THE ARCHIVES OF PHYSIOLOGICAL THERAPY Unheeded Principles Involved in Dietetic Management of Infants During Hot Weather South Carolina, Climatology and Health Resorts of . . . . . . . . . Spintermeter with a Ventril Tube Box . . . . . . . . . . . . . . . . . . . . Splenic Enlargement, X-Rays in Sprains and Contusions, Recent . Starr, Dr. L. . . . . . . . . . . . . . . . . . . State Board of Health of Massa- chusetts . . . . . . . . . . . . . . . . . Static Electricity in Alopecia . . . Steel Splinters Removed from Eye by Magnet Stembo, L. . . . . . . . . . . . . . . . . . . Stereopticon Method of Locating Foreign Bodies, A Modifica- tion of Stewart, Prof. G. N. . . . . . . . . . . . St. John’s Hospital, Allegheny, Pa. . . . . . . . . . . . . . . . . . . . . . St. Joseph's Hospital * * * * * * * * * s a s a a e e s e St. Louis Medical Review isó. Stoney, Florence A. . . . . . . . . . . . Stover, George Henry . . . . . 2 I5, Stricture, Electrolysis in Urethral Sudnik, Dr. Richard I29, Suitable Diet During Second Year Supernumerary Teeth and Roent- gen Rays. . . . . . . . . . . . . . . . . - Surgical Suggestions, Practical Brevities in Surgical Diagno- sis and Treatment Switch-Board, Movable Music- Stand Shaped. . . . . . . . . . . . . Symphysis of Pubis, Dislocation of Discovered by Radi- ography . . . . . . . . . . . . . . . . . * * * * * * • * * * * * * * * * * * * * s e º e º e • * * * g & e e Taylor, Dr. Charles F. . . . . . . . . . Dr. J. J. . . . . . . . . . . . . . . . . . . . Teaching of Roentgenology in Medical College, The 234. 7I IOI 23O 29 . 2O9. 8O . IQO I3O I92 I33 225 253 2 I5 262 98 264 I9 I92 2O3 I32 2O8 I29 IOI Technique in Radiography, A Uniform Teeth, Roentgen Rays in Super- numerary * * * * * * * * * * * * * * * * Temperature and Sunshine in Lakewood, New Jersey, IQOO-I905 In Diagnosis and Treatment of Pulmonary Tuberculosis, Pulse and Tesla, Dr. . . . . . . . . . . . . . . . . . . . . Tetanus, Cold Air in Texas Medical News The Action on Bacteria of Elec- trical Discharges of High Potential and Rapid Fre- quency The D’Arsonval and Other High Frequency Currents, What They Are and What They Will Do. . . . . . . . . . . . . . . . . . The Effect of X-Rays upon the Leucocytes in the Blood and Bone Marrow in Leukemia . Examination for Renal Cal- culus by Means of the X-Ray First Italian Congress of Physiological Therapy “Home Sanatorium,” ment of Consumption Indications for Roentgen Ray Treatment in Skin Diseases Influence of High Frequency Currents on the Surf a ce Temperature of the Human Body Journal of the American Med- ical Association Lancet, London. . . . . 96, 279, Mechanism of the Closure of the Bladder, as shown by Radiography Post-Graduate Production of Plastic Roent- genograms . . . . . . . * * * * * * * * * * * * g e e • e º e º O e s e - * * * * * * ~ * * * * * * * * * * * Treat- * * * * * • e - e. e. e. e. e. e. e. e. e. e s e º e = * I32 I6 169 I95 I56 I5 I 95 I37 22 90 3O 24. 97 25 292 IOO 285 . . 229 THE ARCHIVES OF PHYSIOLOGICAL THERAPY Therapeutic Value of Artificial Localized Hyperemia in the Treatment of Ambulatory or Dispensary Cases . . . . . . . . . Treatment of Acute O tit is Media Purulenta and Mas- toiditis, by Means of Arti- 284 ficially Induced Hyperemia . 106 Treatment of Emaciation . . . . 237 Treatment of Neurasthenia . . . 204 Value of the Roentgen Rays for the Treatment of Lym- hosarcoma . . . . . . . . . . . . . . 23 2O6 2O7 s & & © "g & © tº º Thielle, Dr. H. . . . . . . . . . . . . . . . . Thirty Cases of Hemorrhoids Cured by High Frequency. . 192 Thomas, J. Lynn . . . . . . . . . . . . . 2. I Professor J. J. . . . . . . . . . . 264, 268 Thompson, Dr. W. G. . . . . . . . . . 209 Tongue, X-Rays in Epithelioma of . . . . . . . . . . . . . . . . . . . . . . Traitement de la Tuberculose par les Curants de Haute Frequence et de Haute Ten- sion, Base sur Letude du I34. Chimisme Respiratoire . . . . 207 Transactions of the American Climatological Association, I905 . . . . . . . . . . . . . . . . . . . . 32 Treatment of Chronic Diseases of the Heart by the Nauheim Methods, Its Indications and Contra-Indications . . . . . . . . Non-Suppurative Affections of the Middle Ear by Tubo- Tympanic Galvanization 9 I Hydrarthrosis, On the . . . . . . . I29 Keloid by High Frequency Effluviation . . . . . . . . . . . . . . 223 Pulmonary Tuberculosis by Currents of High Frequency and High Tension . . . . . . . . 2O Recent Sprains and Contusions 29 Tripanosomiases, Radiotherapy in Experimental . . . . . . . . . . . 25 Tripet . . . . . . . . . . . . . . . . . . . . . . 95 Trudean, Dr. . . . . . . . . . . . . . . . . 78 Tube, Berlemont Automatic Regulating Crookes . . . . . . . In Roentgen Therapy, The . . . 260 Tuberculosis, Diet in . . . . . . . . . . Early Diagnosis of Pulmonary. 98 High Frequency Currents in Pulmonary . . . . . . . . . . . . . . 2O, “Home Sanatorium” Treat- ment of Pulmonary . . . . . . . 3O. Of Testicle Cured by High Frequency Effluve . . . . . . . . 98. Of the Head of the Left Femur with Mislocation . . . . . . . . . . I75 Orthodiagraphy in Early Diagnosis of Pulmonary . . . 131 Significance of Pulse and Tem- perature in Diagnosis and Treatment of Pulmonary . . . I69 X-Rays in Joint and Bone . . . . 25 Tubes, Roentgen . . . . . . . . . . . . . 39 Tuchler, E. S. . . . . . . . . . . . . . . . . 233 Tumor of the Rectum Cured by Radiotherapy Turner, Dawson . . . . . . . . . . 186, Two Cases of Glycosuria Sub- mitted to High Frequency Currents without Change in the Glycosuria or in the Nitrogenous Matters or the Chlorides - Herpes Zoster Cured by High Frequency Effluviation . . Paget’s Disease Treated by X-Rays, with the Report of the Microscopic Findings in One of Them after Prolonged Treatment . . . Splinters of Steel Removed from the Interior of the Eye, with the Magnet . . . . I3C IO3 225 223 224 I35 (xiv) THE ARCHIVES OF PHYSIOLOGICAL THERAPY U Ultra-Violet Ray in Posterior Urethritis Unit I . . . . . . . . . . . . . . . . . . . . . . . A New Unit of Quantity of X- Rays, The . . . . . . . . . . . . . . . Universal Method for Using Direct Electric Currents . . . Upon the Diagnosis of Medias- tinal Tumors with Reports of Cases and Roentgen Demonstration - Ureteral Calculi, X-Ray Shadows Mistakable for . . . . . . . . . . . Urethritis, Ultra-Violet Rays in Posterior . . . . . . . . . . . . . . . . Urinary Calculus and its Detec- tion with the X-Rays Uterus, Radium in Cavity of . . . . © 8 º’ e s = e e s = e e s a e e * * * * g e V Valenza, Dr. . . . . . . . . . . . . . . . . . Value of the Bier Treatment, The Vannier, Leon Vaquez, Dr. Varicose Veins, X-Rays in Varieties of Ringworm and Their Treatment Vassilides, D. Vickery, Dr. H. S. Villemin, Dr. . . . . . . . . . . . . . . . . . Vincent, Dr. . . . . . . . . . . . . . . . . . Volume, Determination of Roent- gen Ra Vomiting of Pregnancy, Dietetic Treatment of Von Leyden, Dr. * * * * * * * * * e e º ºs e ge * * * * * * * * * * * * e s e a e & e º ºs º is tº e º e g tº s º ºs e º 'º e s e e º is W Wallian, Samuel S. . . . . . . . . . . . . Walter, Prof. . . . . . . . . . . . . . . . . . Weik, Dr. . . . . . . . . . . . . . . . . . . . Western Pennsylvania Medical College 233 23 I 276 227 22. 233 228 2O2 I95 29I I3 I 23O 229 I99 25 209 IO4. I56 I28 178 37 275 What Influence Has the Use of X- Rays Had upon the Treat- ment of Fractures and Dis- locations . . . . . . . . . . . . . . . . White, John E. . . . . . . . . . . . . . . . Widal and Challamel, Drs. . . . . . Wilder, Prof. Burt G. . . . . . . 206, Willey, Vernon J. . . . . . . . . . . . . . Williams, Ennion G. . . . . . . . . . . Wilson, Dr. Robert Jr. . . . . . . 74, Thos. M. . . . . . . . . . . . . . . . . . . Wyman, Surgeon-General Walter X-Ray Dangers Diagnosis of Kidney Stones . . . Jn the Diagnosis of Urinary Calculus, The Measurement, Milliampere- Iſleteſ 11] X-Rays and Genital Activity . . . . Dangers a n d Contraindica- tions of in Treatment of Epithelioma of Face Effect of on Leucocytes in Blood and Bone Marrow in Leukemia Epithelioma Cured by Shadows of Cystic and Xanthic & Oxide Calculi . . . . . . . . . . . . . In Alopecia In Arthritis Deformans. . . . . . . In Diagnosis of Mediastinal Tumors In Diagnosis of Pulmonary Tuberculosis In Early Diagnosis of Pul- monary Tuberculosis In Epithelioma In Epithelioma of Tongue . . . . Influence of on Blood and Haematopoietic Organs 137, 138, Influence of on Treatment of Fractures a tº e s e e s e e º e e * * * * e s a º gº w w e s tº is a s * * g e º ſº tº e e º º tº e º te tº 2. I I69 223 218 270 26o I95 225 90 I97 99 I47 IO4. IO I I37 IO3 I32. 25 25 227 I3 I 2O I I34- THE ARCHIVES OF PHYSIOLOGICAL THERAPY In Lymphosarcoma . . . . . . . . . 23 In Paget’s Disease . . . . . . . . . . I35 In Renal Calculus . . . . . . . . . . 22. In Ringworm . . . . . . . . . . . . . . I99 In Skin Diseases . . . . . . . . . . . . 24. In Splenic Enlargements . . . . . 23O In Study of Closure of Bladder IOO In Tumor of Rectum . . . . . . . . IO3 In Trigeminal Neuralgia . . . . . IO2. In Ureteral Calculi . . . . . . . . . . 2.2. In Urinary Calculus . . . . . . . . . 228 In Varicose Veins . . . . . . . . . . . 229 Measurement of 26, IO6, 139, 142, I44, 146, 202, 231 Method of Studying Absorption of * 25 On Sick Organism, Action of . 230 Protection from . . . . . . . . I34, 202 See also Roentgen Rays. X-Ray Therapy, See also Radio- therapy. & Work in the Colonies . . . . . . . . Y Yellow Fever, Cold Air in . . . . . . . Z Zeissl . . . . . . . . . . . . . . . . . . . . . . . Zeitschrift fur Electrotherapie 269, Zimmern . . . . . . . . . . . . . . . . . . . . Zontana . . . . . . . . . . . . . . . . . . . . . Zoster Occurring after an Ex- posure to High Frequency and Cured by Continuous Currents e = * * * * * * * * * * * * * * * * * * * * Zuntz * * * * * * * * * * e e º s e e º e º e º 'º º 275 (xvi) RADIOTHERAPY 275 what he presses this end of the needle into the wound so as so grasp it quite easily with another pair of forceps, then lets go with the first pair of forceps and proceeds to extract the needle by pulling in the direction of its long axis by means of the forceps which have hold of its end. S. T. RADIOTHERAPY The Effect of the Roentgen Rays upon the Skin; Roentgen Derma- titis and Its Therapy. (Dr. Weik, Zeitschrift fur Electrotherapie, August, 1906.) The effect of the Roentgen rays depends upon the amount ab- sorbed. The reaction to the rays occurs after a latent period, and the duration of this period is in inverse proportion to the intensity of the rays. A sufficient quantity of rays to produce the first degree of reaction (erythema) will show its effect in from two to three weeks. A quantity sufficient to produce the second degree shows its effect in from one to two weeks, and a quantity sufficient to produce the third degree (mortification, ulcer with the formation of scar tissue) gives evidence in a few days. When the treatment is given in divided doses the duration of the latent period is difficult to estimate and therefore an interruption in the treat- ment should be allowed sufficient for the effect to become manifest. The above remarks refer particu- larly to the acute dermatitis. We have also a chronic dermatitis which usually affects those who work in the field of the rays almost continually and receive repeated small doses. A third variety, first no.iced by Holzknecht, is the erythema which develops a few hours after the exposure and is con- sidered by him to be due to other than the Roentgen rays; it occurs especially with tubes that give a blue color. This reaction disappears in a few days. Then there are people with idiosyn- crasies to deal with. The histological appearances of the skin, after treatment with divided doses sufficient to produce loss of hair and atrophic appearances of the skin, is as follows: in the corium is found infiltration about the vessels with round cells and Occasional polynuclear cells, and also in the rete is found some infiltration. The small vessels seem to be dilated. We must conclude that the cell elements of the skin are primarily af- fected and that the musculature, con- nective tissue and elastic tissue are not at all affected, or only secondarily. The chronic Roentgen dermatitis of the roentgenologist and the manufac- turer develops very slowly and is most persistent. It is increased by disin- fecting agents and developers. The symptoms of the dermatitis of the radiologist are described similarly by all authors and consist of at first a diffuse redness and swelling of the skin, reminding one of the appear- ances of a frost-bite. This is due to a deep-seated hyperae- mia. These blood changes vary from better to worse, but finally become stationary, and are aggravated in pro- portion to the amount of exposure. The next change is the formation of hyperkeratoses. These occur (I) in diffuse form, as an abnormal accumu- lation of the epidermis; (2) in circum- scribed form, as warts or swellings; 276 |CURRENT PHYSIOLOGICAL THERAPY (3) in further effects as the formation of ragades. . - Further symptoms are the dilatation of the vessels, the falling of the hair and the crippling of the nails, followed by atrophy of the skin and loss of function of the sweat and oil glands. Histologically in such cases is found in general a thickening of the layers of the cells of the epithelium. The spindle cells have increased in volume, and show an interstitialoedema. Leu- cocytosis is absent and the interstitial substance consists of serum. At the bottom of the ragades are often found carcinomatous cells, and on this ac- count they are difficult to heal. Cases are known too in which skin cancers became engrafted upon this chronic Roentgen ulceration. The best therapy here, as elsewhere, is prophylaxis. The most difficult of all forms of Roentgen dermatitis is that of the roentgenologist. Here we are re- minded that just as developers in- crease the inflammation, so all reduc- ing agents will do harm. To this class belong ichthyol, sulphur, resorcin, etc. and these must be avoided in the treat- Iſlent. Toward the removal of the hyper- keratoses we must direct our attention as follows: (1) The hands should be bathed in hot water so that the epider- mis becomes saturated with water. (2) Pack in impermeable material, such as guttapercha, rubber, Billroth- Battist, or cover with zinc oxide plaster. (3) Good effects are also obtained by bathing or applying wet dressings of carbonate of soda or potash, or soap baths. (4) The ap- plication of fats to increase the elas- ticity of the horny layer and, to a certain extent, replace the lost fats due to the destruction of the secreting glands. The hyperkeratotic points may be touched with hydrogen peroxide. Better apply the baths and the dry methods during the day and the salves at night. -- G. E. P. The Unit I — A New Unit of Quan- tity of X-Rays. (H. Bordier and j. Galimard, Archives d'Electricite Medi- cale, September 10, 1906.) The re- agent which they use is Freund's solu- tion of iodoform in chloroform and the strength is 2 per cent. The quantity of iodine liberated affords a measure of the amount of X-ray applied. One unit I is the quantity of X-rays which, acting upon a 2 per cent solution of iodoform in chloroform with a volume incidence upon a surface of one square centimeter and a thickness of one centimetre, is capable of setting free one-tenth milligramme of iodine. Comparing these units with Bordier's chromoradiometer and with Holz- knecht’s system of units the following equivalents are found: Bordier’s Tints Drlits I Units H I 3.5 5. II 5.5 7. III IO. I4. IV I5.5 22. Direct Measurement of the Quality of the Radiation from a Tube or Bon- . nette. (Dr. Belot, Archives d’Elec- tricite Medicale, August IO, Igoó.) The present sources of error are avoid- ed by allowing the X-ray to shine through only one section of the Ben- oist radiochromometer at a time. This enables one to make a more exact comparison between the shadow cast by the silver and by the different thicknesses of aluminum. S. T. DIETOTHERAPY On the Wrong and Right Use of Milk in Certain Diseases of the Skin. (L. Duncan Bulkley, New York, The British Medical journal, October 6, 1906.) Milk is Nature's specially pre- pared food, containing all the elements necessary to nutrition, marvellously combined, upon which animals of many species depend during early life. Milk is also more or less used by man in adult life, both in sickness and health, and a priori should be a de- sirable form of nutriment, and should be of value at all times. But the experience of every one shows that the contrary is often the case, and one con- tinually meets with those who affirm that they cannot take milk as it makes them “bilious.” The explanation of the observation that so perfectly prepared a food is not always properly assimilated by adults, when in childhood it forms such a precious element of diet, under almost all circumstances, is found probably in the changed character of the diges– tion and metabolic processes in the adult, which gradually lead up to gout, gravel, diabetes, tuberculosis, cancer and many degenerative changes belonging to adult life. Some years ago a number of persons reported the successful intravenous injection of milk, not once but repeat- edly, to the great benefit of depleted patients. In this process the milk enters the veins directly, mingles with the blood, and goes first to the lungs without previous digestion such as takes place in the alimentary canal; of this there can be no doubt, therefore ordinary digestion is not necessary for the assimilation of milk. This observation led to the con- sideration of the possibility of intro- ducing milk otherwise, in such a manner that it could reach the lungs first, without passing through the portal vein to the liver, where in adults it is so liable to excite the condition popularly known as “biliousness.” The chyle, formerly called “milk juice,” and which is hardly dis- tinguishable from milk under the microscope, is taken up by the lacteals, and discharged into the venous blood in the subclavian vein and vena cava, thence reaching the lungs. The ques- tion then arose if the milk, already in a state of perfect emulsion, could not pass through the same channels through which the elements of the chyle were absorbed without the process of coagulation, caseation, and subsequent gastro-intestinal digestion. The problem, then, was to admin- ister the milk at such a time and in such a manner that it would escape the acid and fermentative elements in the stomach during the process of digestion, and so avoid being curdled before it could be absorbed. - The stomach in health does not ordinarily secrete gastric juice except under the stimulus of food. At a varying period after the taking of food, the time being dependent upon the amount and quality of food taken, and the activity of digestion, the stomach has finished its task. Ab- Sorption of certain elements has taken place, other portions have been passed on to the intestines for further action, and the organ is found empty, await- ing cause for further activity. At this period the stomach loses its turgid color, becomes paler and quite flaccid, and its surface is bathed with more or 277 278 CURRENT PHYSIOLOGICAL THERAPY less of an alkaline solution, forming what is known as the “ alkaline tide.” This accurs at varying periods of time after the ingestion of food, dependent upon many circumstances; it may be- gin an hour or so after the ingestion of a very small amount of digestible food, or it may be delayed four, five or even many more hours after a very heavy or unusually indigestible meal, or with very weak or sluggish digestion. The idea is to give milk alone, pure or diluted with boiling water, at the body temperature, just after the alka- line tide has set in, or during its con- tinuance, and to avoid food or any substance which could call forth gastric secretion until after its absorption has been fully accomplished. This plan is entirely opposed to the practice of eating a cracker with the milk, or even to the addition of an egg, whiskey, etc. It repeatedly happens that the milk is taken too soon after a meal, while the stomach is still acid, and so the desired end is defeated. Or, when a long enough interval of time has elapsed, it has happened that, owing to a sluggish digestion, or to some especially indigestible article, the milk has come upon the products of a former meal, and not during the alka- line tide. Thus, patients will often take milk at half past ten or eleven in the morning, or at three or four in the afternoon, because at that time they had experienced a faint and “gone feeling,” and mistook the un- comfortable sensation of delayed di- gestion for hunger. Occasionally, if the digestion is sluggish, it will be necessary to admin- ister pepsin or other digestives very freely and repeatedly in order to en- sure an empty stomach early enough. If there is any doubt as to the alka- linity of the stomach, one or more full doses of bicarbonate of soda may be given half an hour or more before tak- ing the milk; also a little soda may be put in the milk if there is any question as to its alkalinity. The milk need not be taken longer than an hour before the coming meal, and occasionally it can be taken thirty minutes before. It is a very common practice to order the milk taken while the patient is in bed, an hour before breakfast, and then to allow him to lie still for a quarter or a half an hour before dress- ing. In this way many who had pre- viously begun the day tired, find them- selves in a very different condition. The milk one hour before the noon and evening meal also proves most acceptable, and by taking off the fatigue of the day renders the meal less likely to disagree. When feasible it is well for the patient to lie down and rest half an hour after drinking the milk, taking a nap if possible. Milk is also often most serviceable taken later in the night, if the patient is wakeful or restless, provided no food or even medicine shall interfere with the exact operation of the plan recommended. - Milk, when taken successfully on this plan, not only does not interfere with the appetite for the following meal, but often increases it in a sur- prising manner. The process of se- cretion from the glands of the stomach and other organs depends largely upon osmosis and blood pressure. By the quick absorption of the milk the pres- sure in the capillaries is increased, and a richer blood is also offered for the production of gastric juice, while a certain amount of nervous relief is given, enabling a more adequate DIETOTHERAPY 279 supply of nerve energy to the digestive Organs. It is common to meet with those with the most different affections of . the skin who are positively harmed by milk taken in the ordinary way, and who experience the greatest benefit from a proper regulation of the habits in this particular. There are many others who have long avoided milk, because of its deleterious effects, who have gained in every way when this valuable addition has been made to their nutritive elements in the manner described. It is especially in acne that the prejudicial effects of milk as ordinarily used may be seen. In many cases a muddy skin will indicate sluggish digestion and faulty metabolism, and the gain, after correcting the milk error, will be far greater than would be expected from the treatment em- ployed. Eczema also will often be found to be aggravated by the faulty use of milk, likewise urticaria, and indeed all eruptions with any element of a con- gestive or inflammatory character, and even psoriasis will do far better if this matter is attended to. Even in such a matter as excessive loss of hair there is generally a nutritive fault, which can often in a large measure be remedied by the addition of milk to the diet on the plan advocated, and frequently in severe or malignant syphilis the same 1S true. After an experience with this use of milk for over twenty years, and with a most varied and most difficult class of patients to handle, and with some tem- porary failures, it may be asserted that when perfectly carried out, results can be obtained which are often marvel- lous; there is hardly a single fact in anthin, guanin, and adenin. medicine or feature in therapeutics of which I am more confident. Of course this method need not be confined to patients with diseases of the skin, and many physicians have given glowing accounts of its value in many conditions exhibiting depraved InUIt IIt]On. • - Notes on Purin-Free Diets. (W. A. Potts, Birmingham, England, The Lancet, London, October 6, 1906.) The purin bodies include all those con- structed on the base C5N4. Some twelve different combinations of this kind are known to exist in nature, while a large number have been pro- duced in the laboratory. Those of ordinary occurrence are uric acid, caffein, theobromin, xanthein, hypox- These are found in meat and meat extracts, and especially in glandular organs, such as the pancreas and liver; they occur in smaller amount in many vegetables and in certain other articles of diet. The mere fact that a diet is purin- free is of little value unless attention is paid to the other factors essential for healthy digestion. Thus the amount of food should be small, the meals few, and mastication efficient. At the same time the food should be plain. The tendency in some quarters to adopt a fruitarian diet and then spoil it by rich sauces and elaborate cook- ing, to say nothing of spices, pickles, vinegar and condiments, is only likely to breed disappointment and disgust. The man or woman who forswears meat and lives on highly flavored dishes, with cream and other rich accessories, would do much better on a plain mutton chop or a fish dinner. 28o CURRENT PHYSIOLOGICAL THERAPY If, however, simplicity is made the first essential, then much further benefit can be obtained by discarding all those articles of food and drink which contain uric acid and allied bodies in excess. The fact that nearly all foods con- tain minute traces would seem to indi- cate that eliminating them altogether is a counsel of perfection we were not intended to contemplate. What we want to aim at is a reasonable mini- mum. The condition of “hyper- pyraemia,” due to an excess of carbo- hydrates, recently described as the underlying element in many disorders, is not developed on a properly arranged fruitarian diet; all excesses are bad and too much starchy food in conjunction with meat is especially Injurious. - ** Excellent as are the results obtained in chronic mischief they bear no com- parison with those that may be effected in acute illness. The progress of events is often startling to those who have had no previous experience of this system; the course run is benign, out of all proportion to the onset, sup- posing an ordinary diet to have been the previous habit. Many practi- tioners contend that fruit must be avoided in illness. Given with beef- tea and stimulants it does more harm than good, but if the beef-tea and stimulants are entirely discarded, the medicines reduced to a minimum, and all nourishment taken in the form of milk or fruit juice, results are obtained which can never be got by more orthodox treatment. The diet for acute diseases is sim- plicity itself. In the first place we have milk, which may be diluted with soda water and given cold or warm; it should never be boiled, as in the process the antiscorbutic properties are de- stroyed and much of the albumen coagulated. An excellent plan is to give two ounces of milk regularly every two hours from the start. Should the taste pall, varying flavors may be imparted by such methods as heating the milk in the oven instead of a sauce- pan, or cooking slowly with rice and subsequent straining. The feeds of milk may alternate with, or be re- placed by, fresh fruit juice, of which that from grapes or oranges is the best. In cases where generous nourish- ment is required, the most valuable form is white of egg, which may be given beaten up with milk or water and sugar. Many invalids find noth- ing more refreshing and sustaining than egg lemonade, made by shaking up the juice of half a lemon and the white of an egg in a large bottle with half a pint of cold water, and adding sugar as required. Treatment on these lines is not only successful in the first instance, but also obviates those after-consequences, such as acute “ rheumatism,” so fre- quently seen when stimulants and meat extracts are freely administered. For chronic illness and ordinary life the simple diet recommended for acute diseases requires considerable exten- sion on similar lines. The objection has been made that on the new system it is difficult, if not impossible, to take enough nourishment for robust health and active work. The researches of Chittenden and others into the amount of food necessary, and food values, have proved that the majority of people enjoy better health and can do more work after reducing the amount of their food by a third or a half. Just as meat possesses less nutritive value than is popularly supposed, so DIETOTHERAPY 281 many articles in a fruitarian diet con- tain infinitely more. Glandular organs, such as sweet- breads and liver, must be entirely avoided. The least injurious of meats is mutton, and of fish is cod. Coffee must be given up, and only weak China tea may be sparingly used. The best fruits for food are apples, bananas, grapes, nuts, dates, raisins and figs. Nuts are especially valua- ble owing to the large amount of fat they contain, but they require thor- ough mastication. Chestnuts are the easiest to digest and make an excellent food. Stone fruits sometimes disagree and acid fruits should be taken in moderation. Strawberries contain a considerable amount of purin, and should be avoided by all with a gouty or rheumatic tendency. Among fruits should be included those of the cereals such as wheat and rice. White bread is free from purin, but brown contains a varying amount derived from the husk. The most wholesome form is unleavened. Vegetables are less useful articles of diet. Many contain but little nour- ishment and others, such as peas, beans, spinach, asparagus and onions, contain noticeable amounts of uric acid. It must be understood, how- ever, that the purins derived from the vegetable kingdom act less injuriously than those from an animal source; the latter are always combined with ptomaines, for recent experiments have proved that meat, even when freshly killed and immediately placed upon ice, always contains such prod- ucts of decomposition. Potatoes are among the best of the vegetables under Ordinary circumstances. Vinegar is a prolific cause of dyspep- sia, and should never be taken by those who aim at robust health. As an alternative an excellent salad dress- ing is made by a little pure olive oil with a squeeze of lemon juice. Another article of diet free from purins is cheese. Its nutritive value is high, but care must always be taken not to indulge to excess in such a concentrated food. Milk and un- cooked white of egg has already been rcommended. The yelk of egg is prob- ably not free from purin, and is not easy of digestion. Honey contains a considerable amount of nourishment. Oatmeal contains more than a trace of purin, and must therefore be taken in moderation, for it would be a pity to entirely exclude from the diet such an inexpensive, palatable and sustaining article of diet. Mushrooms are not only charged with the offending in- gredient, but in addition are difficult to digest. The splendid appearance and phy- sique of those brought up on this system are in marked contrast to the anaemia and malnutrition so common among meat-eaters. G. E. The Dietetics of Obesity. (Alfred C. Croftan, Chicago, The journal of the American Medical Association, September 15, 1906.) The reduction of obesity is an important therapeutic task, when regarded as a necessary step toward removing adipose tissue which is producing disagreeable or dangerous complications about im- portant organs, notably the heart and arteries, the bronchi, the digestive apparatus and the nervous system. The methods at our disposal for reducing obesity are chiefly dietetic. Second in importance is the regulation of the muscular exercise. These two means, singly or combined, usually 282 CURRENT PHYSIOLOGICAL THERAPY suffice to accomplish the desired result. - It is convenient to distinguish three degrees of obesity. Each requires particular treatment. In the first form no attempt need be made to reduce the amount of fat, but every effort should be put forward to prevent its further development, par- ticularly if premonitory signs of com- plications about the thoracic or ab- dominal organs begin to make their appearance. In the second and third forms it becomes necessary to institute more or less energetic restrictions, with the object in view of causing a loss of fat. Broadly speaking, carbohydrates and fat foods should be reduced and not the albumins. The reduction of the albumin below certain normal average requirements is a dangerous and precarious procedure, whereas the fats and carbohydrates can be con- siderably reduced without much detri- ment to the individual. The diet should be so arranged that the calories furnished in the food should be equal to the number calcu- lated for a person of equal height with the patient but of the average weight for that height, and not for one of his abnormal bulk. A patient, forty years old, of a height of 1.68 meters (five feet and six inches), and of a weight of 63.7 kilo- grammes (one hunderd and forty pounds), may be assumed to normally require food representing 2230 calories a day. - If the patient does not lose weight on such a diet, containing the full normal caloric requirement, then it is necessary to reduce the caloric intake still further. It is convenient to ar- range three degrees of reduction cures. In the first the caloric requirements are reduced to four-fifths of the nor- mal, in the second to three-fifths, and in the third to two-fifths. The popu- lar cures of Banting, Oertel, Epstein, Hirschfeldt and others are cures of the third degree, and are usually far more severe than is safe or necessary. In the first degree the loss is usually very slow, rarely more than two or three pounds a month, even when aided by considerable physical exer- cise. It is chiefly useful in preventing the further increase of fat in subjects who show a tendence to obesity. It is eminently suitable for continued use, and does not require great sacrifice on the part of the patient. One should allow meat only once a day, reduce the amount of fat and starchy and sweet foods somewhat, restrict or for- bid alcoholic beverages, give “filling ‘’ foods of small caloric value in abund- ance, restrict the liquid intake to one or one and a quarter liters of fluid a day, and order abundant physical exercise. - The second degree is also useful for continued use. It should be adopted (1) for very strong and very fat sub- jects, who want to get rid of surplus fat, and who can safely indulge in very active physical exercise; (2) for those who are not only fat, but in whom complicating disorders about the heart, arteries, bronchi or digestive organs render it impossible to work off fat by exercise, so that the necessary reduction must be brought about at first by dietetic restrictions; (3) for strong fat individuals who cannot at once tolerate a third-degree reduction cure without developing alarming symptoms of weakness, particularly about the circulatory and muscular apparatus. This second degree leads DIETOTHERAPY 283 to slight and slow losses of fat, rarely more than from six to ten pounds a month. The third degree is a rapid reduc- tion cure. It is best carried out in an institution. Combined with system- atic exercise and drink restriction as much as thirty pounds a month can be lost with safety. This cure should never be carried out for indefinite periods, and six weeks is the longest time during which this serious restric- tion of the patient’s nourishment should be allowed. This degree may be alternated with the second degree, using each for alternating periods of from four to six weeks. The rapid reduction cures, such as the Banting system, which are so popular among the laity, are rarely without danger to important organs, nor are the results usually permanent. In the very young and the very old rapid reduction cures should be alto- gether eschewed. The albumin content of the body - must never be attacked, hence less than the minimum necessary to main- tain adequate nutrition must never be given. This minimum lies between 60 and 80 grams a day, which corre- sponds to between 400 and 600 grams of lean meat, which should therefore be invariably supplied. Excessive meat feeding is unnecessary. Altough fat does not form fat in the body more than the carbohydrates, practically it is better to reduce the fats, and to give relatively large quantities of such carbohydrate foods as possess bulk, for the latter as a rule have a small caloric value, while they satisfy the patient. The best plan is to give three meals a day, and two or three small meals between, the latter consisting of art- into account. icles like bouillon, coffee or a little fruit, that all possess a small caloric value. They help to keep the patient comfortable, avoiding disagreeable sensations of weakness and gastric emptiness, and at the same time pre- venting him from becoming too rav- enously hungry at meal times and consequently overeating. The total liquid intake should be reduced to from 1 to I 1-2 liters in the 24 hours. A reduction to the minimum rapidly reduces the weight, especially during the first four or five days. The reduction is not perma- nent if the patient increases the water drinking. It is due in part to a direct loss of water from the tissues, and in part to the fact that one drink- ing very little water does not eat as much as one taking a normal amount of liquid. - Alcohol may be allowed, if the caloric value of each gram is taken Of meats that which is lean is preferable. It contains 20 per cent of albumin and 1.5 to 2.0 per cent of fat, so that IOO grams of lean meat, weighed raw, furnish about one hun- dred calories. It should be prepared in a simple way, either stewed, roasted or broiled. All meats pre- pared by frying or served as ragouts or with bread crumbs, sauces and gravies should be avoided. An obese subject may eat small quantities of caviar, Sardines, boiled lobster, crab meat, oysters (I2O grams, equal to 14 to 18 oysters of medium size, contain IOO calories) and pate de foie gras. - Cheese serves a useful purpose, for, even in small quantities, it is very filling. Twenty-five grams fur- nish about one hundred calories. 284 CURRENT PHYSIOLOGICAL THERAPY Milk is useful, if its caloric value and the water it contains are included in the calculation. One hundred c. c. of milk furnish about sixty calories, and a whole quart of butter- milk about two hundred and fifty calories. - - Thin soups, bouillon and beef-tea are exceedingly useful. They are filling, and agreeable to the taste. Potatoes are permitted in small quantities, either baked, boiled or mashed. . . . Other vegetables which grow under- ground or in pods should be for- bidden or restricted. All other veg- etables are useful. They should be boiled in salt water, and served without the addition of cream, butter, flour, etc. Fruits, except bananas, sweet grapes, figs, dates, raisins, are per- mitted freely. About one hundred calories are contained in 220 to 250 grams of fruit. The use of bread should be much restricted. Those varieties made of vegetable albumin (gluten breads, aleuronat bread, etc.) are particularly useful, if they are baked so as to become fluffy and voluminous. A great many mineral waters enjoy deserved popularity in the treatment of obesity, notably those of Kissen- gen, Vichy, Homburg, Carlsbad and Marienbad. It is futile to attempt reduction by these waters alone. The indiscriminate use of mineral waters is to be condemned. The effects attributed to these waters, taken at the resorts, is due only in small part to the particular water used, and in much greater part to the careful and strict regulations in regard to exercise, general mode of life and diet that the patients undergo much more willingly and conscientiously at a watering place than at home. Fully as useful, probably safer, and by all means cheaper is the treatment of obesity in an institution where a like control can be exercised over the patient’s diet and habits. - G. E. HYDROTHERAPY He p a tic Douches. (Drs. Ray- mond and Duchesne, journal de Physiotherapie, fuly 15, 1906.) Up to the present time, hepatic douches seem to have been restricted to Fleury's technic: a strong jet is directed over the liver area during from ten seconds to one minute. This is preceded by a rapid general high pressure application of cold water and followed by a shower on the epigastrium and warm water on the feet. According to the writers, most patients do not tolerate such a reatment and it proves frequently t harmful. Hepatic douches yield ex- cellent results in hepatic congestion, hypertrophy, and biliary stasis. Cold water applications are very powerful, but sometimes too severe; and warm water (IOO degrees to 1 13 degrees F.) is preferable to begin with. The fol- lowing technic is the best: begin with IOO or IO2 degrees F., raise progres- sively to II3 degrees F., at the same time increasing the strength of the jet. Keep at I 13 degrees till the skin becomes dark red (one-half to one minute) and then give a general cold or lukewarm douche. Hepatic con- HYDROTHERAPY 285 gestion, malaria, alcoholism, dyspep- sia, diseases of the nutrition are the chief indications. Chronic jaundice, lithiasis are greatly benefited in all C2S62.S. F. E. G. The Nauheim Bath in Gynecology. (Samuel Wyllis Bandler, The Post- Graduate, September, 1906.) The Nauheim bath as given by Bandler “ consists of a tub full of water, con- taining sea-salt, calcium-chloride and carbonic acid gas in varying pro- portions. The various springs at Nauheim contain these elements in different proportions. The baths are taken at a temperature vary- ing from 95 to 80 degrees Fahren- heit. The duration of the baths varies from eight to twenty min- UteS. . A full bath of water at a temperature less than that of the body, exerts first, a stimulating action on the central nervous system and upon the trophic centres. If, at the same time, it withdraws heat from the body it increases the process of oxidation. A bath of fresh water may be given with benefit or comfort at any temperature which does not produce too great a shock, if it is fol- lowed by a normal reaction or by mechanical rubbing which produces a reaction. Such a reaction results in a change in blood distribution, reliev- ing the interior of the body of con- gestion, increasing the number of red cells in the circulating blood, increas- ing the tone of the heart, the vessels and the tissues, and causing increased tissue metabolism, particularly through the stimulus given to the trophic central nervous system. Baths of a temperature less than that ordinarily borne with comfort may be made not only comfortable but still more valuable by the addition of chemical substances which exert a chemical stimulation upon the skin and the peripheral nerves. x The addition of salt is one of th means of accomplishing this purpose. If five to ten pounds of salt be added to a full bath, such a bath can be taken at a lower temperature because of the chemical stimulation of the salt. An added advantage is the increased oxidation produced by the addition of the sodium-chloride, chem- ical tests having shown that oxidation is increased by this means. Zuntz found that in a three per cent saline bath there was an increase of oxida- tion, as compared with a fresh water bath, so that fifteen per cent more Oxygen was used and twenty-five per cent more CO2 was given off. If to a bath containing salt, calcium- chloride, in amounts varying from two to ten ounces, be added, the baths can be taken at a still lower temperature, because the calcium- chloride by its peripheral chemical stimulation aids in the production of a reaction and brings the circulating blood still more actively to the surface of the body. Further chemical tests have shown that the addition of calcium-chloride to a bath has a marked action in increasing tissue metabolism, and that this action is exerted specifically in the breaking down of old tissues, such as the end results of various inflammations, and likewise such as are included under rheumatic and gouty deposits. The addition of carbonic gas is a most important factor, for it stimu- lates the peripheral nervous system, causing a dilatation of the peripheral capillaries and bringing the blood 286 CURRENT PHYSIOLOGICAL "THERAPY still more readily to the surface of the body, thus relieving congested areas and taking a strain off the cardiac muscle. A further and most impor- tant action of the carbonic acid gas is that to which Graupner has called attention, viz., its reflex action upon the central nervous system, stimu- lating the various transmission fibres, and the trophic centres in the spinal cord. Some of the results of the Nauheim baths include: (1) A slowing of the pulse rate. (2) An increased excretion of UI T11 162. (3) Increased oxidation. (4) Increased metabolism and a breaking down of old tissues. (5) A regulation of the circulation and an even distribution of the blood through the various structures of the body. (6) Increased demand for nutrition. (7) Building up of healthy tissue. 8) Resorption of exudates. (9) The relief of congestions. (IO) Stimulation of the nervous system and the trophic centres. The author defines the class of cases in which these baths are help- ful as follows: “ (1) The baths are of value in certain cases of insufficient develop- ment of the genitalia associated with relative amenorrhea and with dys- menorrhea, especially if complicated by chlorotic symptoms. The giving of iron and arsenic, as well as ovarin, is an added therapeutic measure of very great potency. “ (2) Uterine conditions associated with a lack of tonicity of the muscu- lar and vascular structures, such as are found, for instance, with uterine catarrhs. The immediate effect can be recognized by the large amount of mucus discharged after a bath, which result is produced by the increased circulation and increased stimulation to contraction on the part of the uterus. Therefore, the baths are of great value in cases of subinvolution, and in persistent hyperemia with or without an in- flammatory etiology. “ (3) Cases of inflammatory metri- tis and subinvolution fibrosis may be benefited so long as no great interstitial hypertrophy has taken place. In fact, cases of chronic in- duration of the uterine muscle, espec- ially such as are associated during the climacterium with marked bleedings, should be treated with care, since an increased blood supply is liable to produce exacerbations of hemorrhage. “ (4) A large number of cases of sterility are due to a latent, very subacute, salpingitis, sometimes with and often without closure of the abdominal end of the tube by cobweb peritoneal adhesions. Such instances due to gonococci, in which the in- flammation has followed the course of the mucus membrane from the cervix up, are to be distinguished from septic cases due to streptococci or staphylococci and from tubercular cases in which the peritoneal inflam- mation is primary, and the infection of the tube secondary. We know that cases of salpingitis of the former class, in which the abdominal ends are not absolutely closed, are cases which may be cured. That adhe- sions may be prevented and the organization of adhesions may be avoided by these baths, I believe to be well grounded theoretically, and to be proven practically. The Nau- heim bath by promoting a normal pelvic circulation, by relieving con- HYDROTHERAPY 287 gestion, by toning up the system generally, can cure such cases of salpingitis, and pregnancy may result. The attainment of this desired end is aided by very conservative vaginal treatment of the cervix, of cervical catarrh and of cervical erosions. Great stress is to be laid on the avoidance of intracervical and espec- ially intrauterine treatment of any SOrt. “ (5) A very beneficial action is exerted by the baths in cases of inflammation of the pelvic connective tissue. Cases of cellulitis in early stages, particularly such as occur after labor or abortion, are very much benefited by the administration of the baths. If the baths are given after the pelvic connective tissue is con- tracted and sclerosed, the benefit is much less marked. In all inflam- matory conditions, if the temperature has been reduced to the normal, with or without operative measures, the increased blood supply and the relief of congestion aid the resistance of the patient in overcoming the remaining inflammatory elements, and tend to restoration to the normal with a minimum amount of injury. “ (6) An almost specific action of the baths is to be found in those cases of local pelvic subinvolution and in cases of general subinvolution so frequently associated with gastro- enteroptosis and movable kidney. These conditions are most frequently found in women who have borne children, but occasionally in certain women characterized by a general inelasticity who have not borne chil- dren. The baths increase the tonicity of the various ligaments related to these pelvic and abdominal ptoses. The baths produce an exhilaration temporarily and an increase in strength permanently. “Such cases, called hysteroptosis, are decidedly benefited. The patients gain in strength and weight, the num- ber of red blood cells is greatly increased, appetite improves and a feeling of strength and exhilaration results, such as no treatment can accomplish in the same time. In addition, the local symptoms and, what is more important, the idea that a diseased local state exists, dis- appear. Here, too, the addition of iron, arsenic and ovarin is a valuable therapeutic adjunct. “ (7) There are numerous cases in whom it is desirable before opera- tion to restore to the normal the circulation in the pelvis and to reduce to the greatest possible degree the amount of accessory exudation. I refer to cases of pyosalpinx, and especially to cases of salpingitis. Here a course of baths given before the operation aids permanent con- valescence of the patient and has a tendency to prevent the occurrence of further adhesions. In other cases a course of baths administered after the operation furthers the convales- cence and aids in the resorption of those stump exudates, which so frequently mar the permanent valu- able results of the operative procedure. “ (8) An unrecognized but most valuable field for the administration of the baths is found in the post- partum treatment of women. In my own practice, so soon as mothers are able to walk about, at some period in the third week, a course of these baths is given to aid the involution of the pelvic organs, to assist in the restoration of pelvic and general tonicity, to stimulate the nervous sys- 288 CURRENT PHYSIOLOGICAL THERAPY tem and to aid the secretory function of the breasts. I am sure that with this aid patients suffer less from loose abdominal walls, acquired displace- ments of the uterus, hysteroptosis and physical and mental asthenia. I find that the patients at the end of five or six weeks are almost restored to their normal previous condition of elastic- ity and well-being. “ (9) Certain cases of obesity, and especially such as are accompanied by a diminution in their regular men- strual flow, are benefited by a course of these baths. Not infrequently the patients lose weight, especially on a diet rich in nitrogenous elements and poor in the starchy components. Here, again, the addition of iron, arsenic and ovarin, aids in the desired result. “ (IO) A further and most valuable field for the use of the baths is to be found in the climacteric period. Here the nervous accompaniments of the “change of life " are often a source of annoyance and misery to the pa- tient and her family. In those cases not complicated by climacteric hem- orrhages, I am most enthusiastic about the results to be gained by a course of Nauheim baths. The as- thenic physical condition, the mental depression, the irritability, the ner- vousness, and especially the sleepless- ness, are certainly relieved to a great extent by a judicious use of these car- bonated saline baths. If, with the baths, a thorough course of massage is given, and if at the same time ovarin is administered with or without iron and arsenic, the results in many in- stances are nothing short of astound- ing. “ (II) Though not strictly in the field of gynecology, I must again men- tion the valuable action of the Nau- heim bath in many cases of rheuma- tism and gout. Many gynecological patients suffer from such states, and have gouty or rheumatic nodules in various parts of the body, causing severe pain in various nerves, and causing attacks of marked occipital headache and pain along the vertebra, often associated with mild or severe attacks of migraine or pseudo-mi- graine. Here, Nauheim baths plus massage of the nodules are often pro- ductive of marked relief from the annoyances of this diathesis.” The method of procedure is des- scribed as follows: “Baths when begun contain three to five pounds of sea-salt, two to four ounces of calcium chloride and one- half box of Triton salts. In sensitive cases the Triton salts, which furnish the carbonic acid gas, are omitted from the first few baths. The water is of a temperature of 95 degrees F.; the dur- ation of the bath is eight minutes. The patient lies quietly in the bath. At the expiration of the stated time the body is dried gently, preferably with warm towels, and the patient then lies down in bed for one hour, first taking a cup of hot milk or weak tea. At the expiration of this hour the patient can resume her daily vocation, being careful to avoid great exertion of any sort. Baths are best taken in the morning, at least two hours after the meal. The baths are taken three days in succession, then comes an interval day on which no bath is taken, then three baths more are taken, then comes another interval day, and so on until about twenty baths have been administered. No baths, of course, are given during menstruation. Each set of three MECHANOTHERAPY 289 baths is made a little stronger by the addition of a little more salt, a little more calcium chloride and more of the Triton salts, but only if patients stand the baths well. The last three to six baths con- tain eight to ten pounds of sea- salt, eight to ten ounces of calcium chloride, one box and a half of Triton salts. The temperature by this time has been reduced to 85 degrees and in some instances to 80 degrees. The lowering of the temperature depends upon the manner in which the patient bears the change in temperature. No patient should leave the bath feeling cold or chilly. The last baths should have a duration of 18 to 20 minutes. The beneficial effects of these baths are very much enhanced by a subse- quent change of air for from two to four weeks at an altitude of IOOO to 2OOO feet. In almost all cases, and especially in cardiac cases, the admin- istration of digitalis after a course of baths produces extremely beneficial tonic effect.” He reco, amends a modification of the general Nauheim baths for cases in which it is desired to secure a pure- ly pelvic effect such as mild subacute pelvic inflammations, which consists of sitz baths containing enough water to cover the pelvis up to the umbilicus when the patient is in the sitting position. This bath should contain from three to five pounds of sea-salt and from three to six ounces of cal- cium chloride and should be applied at a temperature of from 95 down to 85 degrees F, lasting for from ten to twenty minutes. This procedure is usually followed by an improvement in the pelvic circulation and relief of congestion and the slighter degrees of pain. . MECHANOTHERAPY The Therapeutic Value of Artificial Localized Hyperemia in the Treat- ment of Ambulatory or Dispensary Cases. (Edwin Bier, Medical Record, August 25, 1906.) A study of inflam- matory diseases caused Bier to come to the conclusion that hyperemia was nature’s most efficient weapon for com bating disease, and that the anti- phlogistic method of treatment gener- ally employed interfered with nature's efforts to effect a cure and was radi- cally wrong. Acting upon this con- clusion he decided that in order to assist nature in overcoming inflam- matory disease processes her phe- nomena must be imitated instead of opposed. There are two kinds of hyperemia, (I) active or arterial, and (2) passive, congestive or venous. In producing the former Bier employs heated air. But the author has not used this method at all in his cases, although he considers it an efficient therapeutic agent. In the production of the venous hyperemia the author has used the same method recommended by Bier, that is, the employment of suc- tion, and constriction of the venous circulation above the lesion. The instrument employed consists of a glass vessel and some means of rarefying the air within the same. Bier has had a large assortment of cups made of different shapes and sizes so that they may readily be adjusted to different surfaces of the 29O CURRENT PHYSIOLOGICAL THERAPY body. Rarefication of the air is ef- fected by the use of a rubber bulb whereby the air is pumped out of the interior of the vessel; in other words, simply dry cups. There have also been constructed large suction appar- atuses so made as to surround large parts of the extremities, for instance, the whole hand, arm, knee joint, etc. These apparatuses should be made so that they can be boiled or rendered aseptic in some way in order that one patient may not be infected from another. In the application of these cups two facts should be borne in mind, (I) the procedure should not be allowed to cause pain, and (2) the suction should be intermittent. The suction should be as strong, however, as the patient can bear without the production of pain and the cup is allowed to remain in place three or four minutes, then removed for one or two minutes, which process is kept up for from thirty to forty minutes. The fre- quency of application will, of course, be governed by the condition and varies from two or three times a day to once every other day. Bier con- siders that the more frequent applica- tion is more beneficial. The author reports twenty-six cases of infected wounds and cellulitis of the fingers or hand, thirty-five cases of abscesses, furuncles and carbuncles, six cases of suppurative adenitis, seven cases of acute bursitis and two cases of contusion of the eye (black eye). The effect in all these was to produce recovery in very much shorter time than under ordinary methods of treat- ment, and in most cases to effect immediate relief of pain. He has also used it in six cases of sinuses of soft parts and bones, producing unusually rapid closure and recovery. * The method of producing venous congestion that has attracted most attention is that by constriction, and for this only a rubber bandage is necessary. This is applied just above the lesion to be treated, and enough tension is employed to produce a marked degree of venous engorgement but the pulse in the arteries should never be obliterated and pain should not be produced. The more pro- found degrees of tension can only be borne with comfort for about an hour, but a milder degree can be borne for the greater part of a day. In all degrees of tension the parts become edematous because of the interference with the return of the circulation, but in the lesser degrees of constriction where the bandage is worn for a longer time the swelling is more marked. After removal of the band- age a reactive arterial hyperemia sets in, such as is seen after the removal of tourniquet. These two degrees of congestion have separate and different fields of action. The more marked degree is particularly valuable in chronic con- ditions, whereas the milder degree is especially useful in acute conditions. As stated above, the first method in- volves leaving the bandage in place at the longest for one hour, but the second demands that the bandage be kept in place for the greater part of the day and night, but shifted, if possible, every ten hours to a new position to avoid excessive localized pressure. It should be removed for three or four hours after twenty hours' action before it is reapplied. Bier has employed the constriction method MECHANOTHERAPY 29I of producing hyperemia in six cases of bone and joint tuberculosis and has been much pleased with his results. The author states that a verdict as to whether the constriction method or the dry hot air method of producing hyperemia is the better cannot at present be rendered, but he considers that the induction of hyperemia is a most important therapeutic method and destined to occupy a prominent place in the future treatment of disease. The Value of the Bier Treatment. (Edward Adams, New York Medical journal, August 18, 1906.) Adams states that the Bier method of treat- ment, which consists of damming back the venous circulation by constricting the vessels above the focus of disease, is of great value if properly used, espe- cially in connection with acute surgical affections of the soft parts. He has applied it with gratifying results in gonorrhoeal infection of the joints, traumatic and tuberculous synovitis; also in one case of inflammation of the right ankle-joint accompanied by swelling, severe pain and stiffness which had been unsuccessfully treated for rheumatism (?) for eleven weeks. This last-mentioned patient was able to walk about all day and the pain and stiffness had entirely disappeared after twenty-two days of treatment. Adams very justly remarks that the technique is of the utmost importance in the use of Bier's constriction and gives the details as follows “In order to produce this damming or passive hyperaemia it is best to use an ordinary Esmarch or Martin thin pliant rubber bandage, about two inches in width. If such a bandage is applied moderately tight in several layers, not necessarily directly over each other, around a limb, and it mat- ters not whether an elbow or ankle- joint is the diseased part, it will soon be noticed that the subcutaneous veins Swell, the skin becomes of a red hue, which is slightly tinged blue; the limb becomes larger and Oedematous and gives a feeling of warmth to the touch. If there is pain it ceases almost imme- diately, and the stiffness in the joint gradually becomes less. The rubber bandage in this case should not cause any uncomfortable feeling, and this degree of hyperaemia (the so-called heisse Stauung) or hot damming, is the only right and proper one that can be used as a remedy. Sometimes it is very difficult to obtain this degree of hyperaemia, and it requires careful attention and some practice to apply the bandage in such a way that the arteries are not compressed, while at the same time the veins are so far com- pressed as to partly check the reflux of blood, so that the flow of blood is re- tarded while the circulation is not entirely suspended. “In applying this treatment to a knee or elbow-joint I find that some- times it is easier to obtain the right degree of hyperaemia by bandaging the distal part of the joint with a flan- nel bandage. Other aids can be used to produce the proper degree of hy- peraemia. Sometimes a heavy coating of tincture of iodine over the diseased joint causes a slight inflammation; then the bandage applied over the affected part causes a very good hy- peraemia. Again, one can make the limb bloodless for a few moments by Esmarch’s method, and after waiting for the reactive hyperaemia, then dam with the bandage the copious amount of blood from the reactive hyperaemia. 292 CURRENT PHYSIOLOGICAL THERAPY In order to prevent any unpleasant results, such as atrophy of the muscles or irritation of the skin at the place where the bandage is applied, a few layers of gauze can be interposed be- tween the skin and the rubber. It is also advisable to change the place of the bandage; for instance, to put it at night directly above the diseased joint, and during the day quite far away from the joint. If the bandage is too tight the skin of the limb looks grayish blue, and there appear whitish or vermilion colored spots, which grow larger and larger so long as the too tightly drawn bandage remains on. The joint is cold to the touch (the so- called kalte Stauung, or cold dam- ming). Even where there is a sub- jective feeling of warmth, there also appear paraethesia and pain under these conditions. All the phenomena indicate that the bandage is too tight and must be loosened. “At first the bandage can only be worn for half an hour in the morning and half an hour in the afternoon, and the length of time can be increased daily. One patient I have in mind wore it for over eighteen hours without any unpleasant effects. The hot dam- ming previously described can only be used as a therapeutical measure, and at the first application of the bandage the patient must be strictly admon- ished to tell at once if more pain is felt, if the joint becomes blue or feels cold or numb. After the removal of the bandage it is well to massage the part and to exercise the joint.” PSYCHOTHERAPY The Induction of Hypnosis. (Ed- win Ash, London Lancet, August 25, 1906.) Hypnosis depends more on the wish of the subject than on the “will " of the operator. The matter of chief importance is to get the sub- ject to fix his attention and to inhibit the natural stream of thought. If the fixation of the attention is great enough, or the subject’s natural power of inhibition is strong enough, a con- dition resembling sleep ensues. Thus there are two phases of hypnosis, one in which the fixation of attention is incomplete, so that the subject, al- though amenable to suggestion, is yet perfectly conscious of his surround- ings, the other in which the inhibition of thought is so complete that he loses touch with his surroundings and is to all intents and purposes asleep. To say that one has inhibited the “supra- liminal consciousness '' or “objective mind ’’ and unmasked the “sublimi- nal consciousness '' or “subjective mind ’’ is really only another way of expressing the above process. It ob- viously requires no particular inherent property or power to help a person to fix his attention so as to stop his train of thought — a process which may be to great extent mechanical and con- sequently will require some adroitness of method. So that anybody who has tried various methods of bringing about this desired object and has studied the best means of distracting a subject’s attention from his sur- roundings and “fixing it,” and has carefully observed the conditions that predispose to success, will be more readily able to induce hypnosis than another who tried at hazard to use a method he has read about but of PSYCHOTHERAPY 293 which he has no technical knowledge. It stands to reason that the conditions that will readily fix one person’s attention will perhaps disturb another person to such an extent that he will think faster than ever, instead of lapsing into a state of mental calm. It should be clearly understood then that an expert hypnotist is not a person endowed with some mysterious power, but somebody who has taken the trouble to study carefully the psy- chology of his subjects, with the ob- ject of ascertaining what means are likely to succeed best in bringing about in them a state of mental rest, suiting his methods to every individual case. Psychologists define “Attention * as mental activity which raises certain sensations or ideas in point of inten- sity and completeness, with a corre- sponding lowering of simultaneously presented impressions—a pro c e s s familiar to everybody in daily life. How many people habitually close their eyes when they wish to appre- ciate music fully, striving to subord- inate all impressions to that of sound, the appreciation of which then rises in intensity above that of the rest. Similarly a surgeon will often fix his eyes on some distant object so as to let nothing distract attention from his tactile sense which is at that moment engaged in giving an impression of Some intra-abdominal disorder. In this fixation of attention we have, the author is convinced, the key to the problems of hypnosis. The attention is fixed on some point—for example, a bright disc—and is then readily trans- ferred to the ideas and sensations suggested by the experimenter. Let us now examine the readiest means of so fixing a person’s attention as to induce hypnosis and consider periment. the experimental phenomena that can be demonstrated in that condition. As a matter of fact, to anybody who has not had previous experience of hypnotic experiments and is anxious to induce hypnosis the subject is at first of greater importance than the method. There are a large number of people who are readily able to “stop thinking ” and to fix their attention at will. Such people are usually in the best of health, unaccus- tomed to worry over trifles, and do not know what it is to have disturbed sleep or difficulty in getting to sleep. They are “susceptible to hypnosis” and may be found most frequently as one would suppose, in the healthy working male population between the ages of I5 and 30 years. The exper- imenter, therefore, should find such a subject and explain to him the nat- ure of the proposed experiments. On no account begin with people in feeble health or who are “neurotic ’’; males being preferable to females. And having made himself familiar with the described phenomena of hypnosis he should decide which of these he wishes to obtain in the first experi- ment. This is where so many fail. Hypnosis may be very roughly divided into three stages, namely— I. A condition of drowsiness and in- ability to open the eyes when forbidden to do so. 2. A dream-state in which various ideas suggested appear to the subject as if in a dream or picture. In both these stages the subject is quite aware of his surroundings and that he is being made the centre of an ex- He feels lethargic and dis- inclined to move and that he cannot move his eyelids or limbs when told not to do so by the operator. 3. In the third stage the attention has been 294 CURRENT PHYSIOLOGICAL THERAPY so completely distracted from present surroundings that the subject has fallen into a condition of sleep. In this state he is peculiarly amenable to suggestion, will talk when spoken to, and will describe various hallucinatory scenes that are suggested to him; and may walk about and take active part in these imaginary scenes. This is what is described as Somnambulism and is a condition in which an in- finite variety of hallucinations may be suggested—visual, auditory, and aes- thetic. When complete the subject has no subsequent recollection of his hallucinations. - r A characteristic condition that can usually be produced in almost any stage is that of catalepsy; if the sub- ject’s attention be directed to any limb and it is suggested that the limb is be- coming stiff an extraordinary rigidity will result, of variable duration, and for the time being quite preventing any voluntary movement of the limb affected. Now it should be obvious that it is too much to expect that the beginner in his first experiment will succeed in producing the deeper stages of hyp- nosis. He must be satisfied if after many attempts he succeeds in prevent- ing the subject opening his eyes when told he cannot do so. Experience shows that some really susceptible subjects are not much influenced at the first sitting. The novelty of the experiment and the unusual requests made as to behaviour tend to produce at first a state of unrest rather than of calm. However, people very soon get accustomed to the process and the deeper stages can often be obtained at the third or fourth sitting. It is best to follow out a scheme in the experi- ments such as the following, which was arranged by the author for the benefit of practitioners who ask for instructions in the technique of hyp- nosis. Instructions for inducing hypnosis. Carry out a series of eight experiments each of which will undoubtedly con- sist of several attempts to obtain cer- tain phenomena; these should be re- peated until the required result has been obtained. The experiments are: (1) to get used to the necessary details as to surroundings and technique of the process, and, further, then to attempt the production of stiffness or immobility in the subject’s eyelids; (2) to induce hypnosis by a modifi- cation of Braid's method of fixed gaz- ing; (3) production of the intermediate dream-state; (4) to obtain passive som- nambulism; (5) to change this passive state into a condition of active som- nambulism (N. B., these experiments include the investigation of altered sensibility, analgesia and anaesthesia) and the production of catalepsy; (6) demonstration of post-hypnotic influ- ence; (7) hypotaxy or fascination; and (8) hypnosis by passes. Space will not permit me to enter into a more de- tailed description. - //. B. N. CLIMATOTHERAPY The Open-Air Treatment of Pneu- monia. (//. P. Northrup, journal of the American Medical Association, October 13, 1906.) For more than eleven years Northrup has been treat- ing pneumonia patients in cool, fresh air, gradually placing their beds nearer and nearer the open window. Last CLIMATOTHERAPY 295 winter in the children’s service at the Presbyterian Hospital he put them out on the roof. His systematic practice was to put all pneumonia patients dur- ing the day for six hours on the roof in the open air in all weather in which harsh, high winds, rain and snow did not prohibit. Indeed the patients were not always brought in for little sprinkling rains or trivial snow-falls, and many times were out when high snow formed a corral about the space in which the beds were grouped. A permanent wind-break formed by the sun-room on the west and a built-up screen on the north protected them somewhat. Much of the time, how- ever, the wind was in the south, and more often in the east. In this case a very inefficient canvas awning par- tially screened the patients, until one night in December high winds wrecked the contrivance, Northrup would not underestimate the use of drugs in infantile pneu- monia, but he wishes to emphasize the therapeutic value of hygienic meas- ures, especially water and fresh air. In his opinion the two most important aids are “plenty of water inside and outside and fresh air everywhere.” Illustrative histories of cases are then presented by the author showing the beneficial effects of his method. In summarizing he states that no cases have been injured and a few have been much aided, possibly saved, by the cold, fresh-air treatment. The only strict regulation is to make the pa- tients comfortable, keeping their feet warm especially. The ears, nose and hands may get cold without harm. Northrup has also tried this treat- ment in other infectious diseases, in- cluding typhoid with severe bron- chitis, and whooping cough with bron- chitis and convulsions, with excellent results. It seems to him to be the ideal treatment in all forms of “sep- tic” fever. - The authorities of the Presbyterian Hospital are so convinced of the per- manent usefulness of the open-air treatment for all infectious diseases that they have already built a roof- garden for the children's ward and are about to construct on the main roof of the medical side of the hospital a second garden of colossal proportions. One-half of this has a “horse-shed” structure, the shed open to the south, and a liberal space in front is enclosed, like a paddock, for a roof-garden. In bad weather the beds of the fever patients are to be wheeled back into the depths of the shed. In good weather they will be advanced more and more to the opening or even out into the garden. They will remain there, night and day, so long as their fever is high. It is to be an open-air ward. j. K. C. A Practical View of Tent Life in the Southwest. (E. E. Elliott, New York Medical journal, October 6, 1906.) Where in the great southwest should a tuberculous patient be sent to obtain the best results? Where will he find open air tent-life most satisfactory? What instructions should he receive to insure the quickest benefit? These questions, says the writer, are asked oftener than they are answered. He has himself from necessity lived for several years in a number of localities in the west and southwest which are popularly regarded as beneficial for consumptive patients, and has met many hundreds of sufferers in every condition, from the so-called incipient stage to the hopelessly incurable. 296 CURRENT PHYSIOLOGICAL THERAPY Many instances have come within the writer’s observation where lives might have been saved had proper, detailed instructions been given in advance in the patient’s home town. For instance, patients with weak hearts and diseased lungs trying to get well in great altitudes where even very slight muscular effort causes suffering, in cold, windy sections in winter time instead of in those of quiet warm sun- shine. Men used to steam-heated rooms advised to live in tents where the temperature was often below the freezing point. The usual result is a rise in the body temperature, pneu- monia, or a further extension of the tubercular process. Information regarding particular localities is reliable only when ob- tained from disinterested persons. Few physicians have the time or opportunity to make personal investi- gations. Unprejudiced facts regard- ing different locations having widely different climatic conditions should be available for every medical prac- titioner. The writer endeavors to supply us with useful hints regarding certain southwestern localities. It is not generally understood that within the boundaries of Arizona and New Mexico conditions are so diverse that, while one location in summer has broiling heat, another may at the same time have very cool weather, or, that in winter one section may enjoy delightfully warm days, while another is wrapped in snow and ice with a temperature below zero. It is thus apparent that great care must be used in placing a patient at any season of the year, especially where tent life is recommended. The altitude of towns in the south- ern portion vary from about sea-level at Yama to I, IOO feet at Phoenix, 2,OOO feet at Castle Hot Springs, 2,500 feet at Tucson and 2,500 feet at Ros- well, New Mexico. These are all practically desert towns, and the humidity in each case is very low under ordinary weather conditions. The total yearly rainfall is compara- tively slight and owing to the limited amount of vegetation any ordinary moisture is quickly absorbed or evap- orated. There are few nights in winter when tent-life is uncomfortable for patients who are naturally robust and used to some exposure. The diurnal range, however, is very con- siderable, the thermometer showing a variation of 30 to 40 degrees Fahren- heit in twenty-four hours. Sudden changes are also met with. Patients who are not naturally strong or who are in a somewhat advanced stage of the disease run great risk in living in tents during this season. Most re- sorts, sanatoria and boarding houses in this region are provided with rooms which have screened porches. On these porches patients may rest and sleep during inclement weather, spend- ing the nights within the rooms or on the porches, as the weather conditions dictate. A large majority of days during the autumn, winter and spring months are warm, delightfully clear and free from wind or humidity. Patients living in tents during proper weather usually make far more rapid gains than those living in hotels or apartments. This section is very agreeable for seven or eight months of the year, but the heat of the summer months is too severe and debilitating for invalids. Tent-life has multiplied with great rapidity during the last three years. Individual tents and tent resorts or CLIMATOTHERAPY 297 settlements are mostly placed outside the town limits, usually several miles out on the desert, where they are free from moisture caused by street sprink- ling, irrigation and contaminating dust from the streets. The town physician should give detailed instruc- tions in matters of personal conduct, hygiene and diet as no rigid rules are enforced at the resorts. Nutritious and well-cooked meats are seldom found in the Southwest, but other food- stuffs of good quality, especially fresh milk and eggs, are usually very abundant. Towns in the northern sections of Arizona and New Mexico, as well as in Colorado, are located in a much higher altitude, and are therefore cooler during the summer months and, of course, much colder in winter than those of the south. Prescott, Albu- querque, Santa Fe, Las Vegas, Silver City, Fort Bayard (further to the south), as well as Colorado Springs and Denver, range in altitude from 4,800 to 7,000 feet. These towns have strong winds almost daily and often rain, snow and very cold weather during all but the warm months, ren- dering the winter season unpleasant to the invalid and often dangerous to tent dwellers. Living in tents durin severely cold weather should be for- bidden. . - These places, however, are delight- ful during the warm summer months. A period of about four months in the northern section and about eight months (October to June) in the southern is as nearly ideal as possible. The cost of living is quite high in the far Southwest, as the region produces but a small portion of what it con- sumes, and owing furthermore to high freight rates and the rapacity of nearly every one with whom the stranger comes in contact, the necessary ex- pense of decent living is 50 per cent or more higher than the average man is accustomed to. Board may be obtained in sanatoria, tent settle- ments, etc., at from $10.OO to $25.OO per week. The best hotels (which should all be classed as second or third rate) charge from $3.00 to $6.00 per day. Wearing apparel, house fur- nishings, etc., are much higher than in the East. “. . A word of warning must be given against sending patients to this coun- try who are not provided with suffi- cient means to carry them over a protracted period. Employment can- not be obtained except for a few skilled mechanics who are strong enough to work. The patient must be given to understand in the first place that no case can be guaranteed within a specified time. He may and often does improve wonderfully in a few months or even weeks, but the road to complete recovery may in any case be long and tedious. J. K. C. 298 THE ARCHIVES OF PHYSIOLOGICAL THERAPY New Combination X-Ray Cabinet for Alternating Current X-Ray High Frequency d'Arsonval Cautery Light Galvanic Faradic Combined Sinusoidal Write for full description and price. 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