By means of this instrument the most intense arc-light containing the greatest number of blue, violet and ultra-violet rays is secured, and experiments show that such a light will kill B. prodigiosus in less than a second, that they will penetrate the two bloodless ears of a rabbit placed in contact, and blacken chloride of silver photographic paper placed on the opposite side in three to THE NEW FINSEN-REVN APPARATUS FOR PRIVATE PRACTICE. (For I patient at time). 55 volts and 20 amperes. four seconds, thus showing the penetrative power of the chemical rays so produced. Since such photographic paper is only in slight degree influenced by the less refrangible rays of the visible spectrum these experiments also show the large number of blue-violet rays contained in this light. The results secured by Finsen in lupus are clearly shown to be due to the two qualities of light demonstrated in these experiments, namely, to the large number of so-called chemical rays present, and to their penetrative power. Comparisons with most of the other phototherapeutic apparatus now on the market (the Bang Lamp and Lortet-Genoud modifications of the same) show that their great weakness lies in their not possessing this latter quality (power of penetration) to a sufficient degree." Finsen's report on 804 cases of lupus treated by light for six years ending with Oct. 1, 1902, shows the following results. I. Cured... 6 (a) Free from relapse 2 to 6 years. .412 124 (b) Observation time less than 2 years.......288 2. Almost cured (only insignificant traces of the 3. Under treatment.. (a) Actually improving or partly cured. 4. Interrupted Treatment-incompletely cured....... 192 .117 91 26 .... 83 16 (b) Died (31), or suffered from other severe Leaving out of account group 4 (b) and (c), there are left 737 cases. Of these group 3 (b) and group 4 (a), in all 42 cases, or 6% are regarded as unsatisfactory, while the remainder, 695, or 94% were greatly benefited, if not entirely cured. When it is considered that patients have flocked to Finsen from all over Europe and America-patients who had passed through all kinds of treat ment, and a large proportion of them of a great many years standing-no cases except 2 or 3 ever having been refused or dismissed as hopeless-these results are certainly marvellous, and have yet to be equalled by any other method of treatment. In lupus erythematosus 14 out of 44 cases have been cured, and 15 much improved, according to Dr. Forchammer's report to the 7th Congress of the German Dermatological Society in 1901. This record has been improved upon since that time, but I have not the figures at hand. Dr. Forchammer, who is Prof. Finsen's chief assistant, in the report quoted above also mentions the following results in other affections. Alopecia areata: 49 cases, of which 30 were cured. (Sabouraud also reports favorable on 40 cases treated). Epithelioma cutaneum : 24 cases, of which 11 were cured. Acne vulgaris: 25 cases, of which I were cured. These cases were particularly severe ones which had resisted all other energetic treatment. Acne rosacea: a few cases treated with favorable results. Naevus vascularis: 19 cases treated with very happy results. Tuberculosis of the skin, Favus, Tricophytia capitis, and Sycosis, were also favorably influenced by the light. Many of the above cases were treated by the old sun-light method, which has not proven so successful as the electric-light treatment, and their later records are even much better than the above. There has been much criticism of the Finsen method both abroad and in this country, both because of expense of installation and maintenance and because some have not been able to secure the results that Finsen reports. The expense item has been very much reduced through the invention of the new Finsen-Reyn's apparatus, which the writer recently brought with him from Copenhagen. As to the second criticism that others cannot secure the results, there is no doubt these reports are due to faulty technique in treatment, and the use of unsatisfactory apparatus. After several weeks experience in the practical use of Prof. Finsen's apparatus in the Finsen Institute, and later a few months' observation of the treatment of lupus, etc. by the Finsen method in other parts of Europe, I am convinced that a preliminary training in the use of the "Finsen Light" is as essential to success in phototherapy as is a course in anatomy and surgery to success in surgery, and that many are using the apparatus, without having sufficient understanding of the principles of its construction and use. Prof. Finsen is very particular about the technique, so as to obtain the effects of all the light, the value of such apparently minor details as the following not being appreciated, the cleaning thoroughly with a cork all the quartzcrystal lenses daily-though nothing but boiled distilled water has come in contact with them; the boiling of the distilled water (used between the lenses in the apparatus for cooling the light) in order to prevent the formation of air-bubbles in the lenses and thus obstruct the light to a certain extent, the methods of applying the compressor-glasses to the skin to insure exact perpendicular application of the rays, so that they will penetrate as deeply as possible into the skin, and not be reflected, or conducted off the side directly on to the skin. All these and many more details require practice and experience in the use of the apparatus in order to become skilled in its use. Using Finsen's work as a basis a great system of phototherapy is being built up which promises much for the future. At present, naturally enough, the Finsen Light, the X-Rays, the Becquerel rays, and the High Frequency are all being used with varying degrees of success to combat what were heretofore considered well nigh or absolutely incurable diseases. No doubt the future will see each of these forms of treatment occupying distinct fields of usefulness according to the indications for each. BIBLIOGRAPHY. 1. Meddelelser fra Finsen's Medicinske Lysinstitute. No. 4. 2. Ibid. 3. Die Dermo-lampe by Hans Jansen, Wiener Klin. Rundschau No. 49. 1902. 4. Eisenbogenlicht contra Konzentriertes Kohlenbogenlicht, by Gunni Busck, Dermatologische Zeitschsift, Bd 10. H. 2. 5. See (3) and (4), 6. Die Bekaempfung des Lupus Vulgaris (presented to the International Central Bureau Zur Bekaempfung der Tuberculose, Berlin, 1902, by Prof. Nils R. Finsen.) 7. Die Finsen-Therapie und ihr gegenwaertiger stand in der Dermatologicby Dr. Forchammer. (Presented to the 7th Congress of the German Dermato, logical Association, Breslau, 1901.) OBSERVATIONS ON THE TREATMENT OF PULMONARY TUBERCULOSIS, WITH A REPORT OF THE TUBERCULOSIS INFIRMARY OF THE METROPOLITAN HOSPITAL.* BY EGBERT GUERNSEY RANKIN, A.M., M.D. Professor of Theory and Practice in the New York Homeopathic Medical College, Physician to the Metropolitan Hospital and Tuberculosis Infirmary, Department of Public Charities and the IN Flower Hospital. N the great conflict against tuberculosis which is now going on,. or rather which has really only just commenced, the most. powerful weapon is prophylaxsis, and as therapeutics now stands, our main hope in eradicating the disease depends upon the rigid and widespread enforcement of preventive measures. There are two aspects to this great question of prevention: the public, or legislative, and the private, or individual. In regard to the former it is gratifying to note that various health boards are awakening to the situation and have enacted laws accordingly. These laws, however, in many respects are inadequate or too. loosely enforced. There are also many problems in regard to isolation and the proper segregation of tuberculous patients which are yet unsolved. For example, what shall be done with that class of patients who are in the early stages and who are yet sufficiently strong to attend to their usual duties? These are doubtless a very fruitful source of infection. Shall a tuberculous man, for instance, * Read before the American Institute of Homeopathy. with a family to support, who is yet able to attend to his work, be re moved and quarantined? Another fruitful source of infection is the patient who, after some months in a hospital, finding himself rather worse, goes home to end his days. These are certainly difficult questions, but they must be answered if tuberculosis is to be stamped out. Pending their solution we must look to the individual side of the question and endeavor to educate the public in regard to the nature of the disease and the means which should be instituted in the household for the prevention of infection. The efforts, therefore, which are now on foot to educate the masses in regard to these great questions. by free lectures and the distribution of literature, should receive the cordial endorsement and encouragement of the profession at large. Up to January of last year, the city of New York in its public institutions paid no heed to the fact that tuberculosis was infectious, and the tuberculous and non-tuberculous were all under the same roofs, and in many instances in the same wards, side by side. The first step to correct this deplorable condition of affairs was witnessed on January 31, 1902, in the opening of the Tuberculosis Infirmary of the Metropolitan Hospital on Blackwell's Island, when certain vacant buildings about a quarter of a mile from the Metropolitan Hospital, at the solicitation of the Metropolitan Medical Board, were set aside for this purpose by the Honorable Homer Folks, Commissioner of Charities. Thus the Honorable Commissioner and the Metropolitan Board share the credit of this initiatory step; and may we not add that branch of the profession of which we are members? The Metropolitan Infirmary accommodates about 450 patients. Besides this municipal institution, there are in the city of New York six other institutions which receive tuberculosis patients with an aggregate capacity of about something less than 1,000 beds. When we take into consideration the fact that it is estimated that there are about twenty-five thousand tuberculosis patients in the city of New York, the inadequacy of the present accommodations speaks for itself. Yet, notwithstanding an annual increase of population of over 100,000, the statistics of the Board of Health for last year show a decrease of 500 in deaths from tuberculous diseases in comparison to the year previous, and there is no doubt that the segregation of tuberculous patients in the new Infirmary, limited though it may be, has been no mean factor in bringing about this result. The next move, which is now under discussion, is the establish |