furthermore, as there is no important tubular structure passing through the inguinal canal, it may be solidly sealed.

2. In infantile umbilical hernias operation should be practised early where they are of considerable volume and incoercible.

3. It is doubtful whether in the reducible, non-complicated and coercible hernias surgery should be invoked for their cure. It remains an open question whether femoral or inguinal hernias are aggravated by labor or pregnancy.

In strangulated femoral hernia Manley believes taxis to be unsurgical except in the hands of experienced men and in exceptional cases. He believes the best way is to divide all tissues from without and carefully inspect the contents of the sac, and to make the period of narcosis as short as possible. He has collected 166 cases of strangulated femoral hernia in both sexes treated by colotomy. Of these, 150 were females and 16 males -a sexual proportion of 10 to 1. There were 59 deaths-35.5 per cent mortality. The females gave 52 deaths, or 34.6 per cent mortality; the males gave 7 deaths, or 43.7 per cent mortality. The average age at the time of operation in both sexes was 40 years and 7 months.-Amer. Journ. of Obst.

Stypticin.-According to Falk (Monatsch. fur Geb. und Gyn.) the action of stypticin is due neither to its causing uterine contraction nor constriction of the blood vessels. The drug controls hemorrhage through its sedative effect upon the circulation and the heart. It retards the heart's action and decreases the force of the blood current. Stypticin is useful in menorrhagia without pathological changes, in anemic young women, and during the climacteric period. In myomata, endometritis, and disease of the adnexa the drug is rarely of benefit. Subcutaneous injections are more efficacious than internal administrations.-Amer. Journ. of Obst.

Cystocele of the Linea Alba.-The case reported by Garulanos (Zeit. fur Chir.) is unique in medical literature. A hernial sac, situated immediately above the symphysis, contain ed a diverticulum of the bladder. A congenital weakness of the linea alba and repeated pregnancies in quick succession were given as the immediate causes of this rare phenomenon. When seen the patient had marked symptoms of strangulation. Extirpation of the diverticulum resulted in complete cure.-Amer. Journ. of Obst.

VOL. XLIII-53.

ELECTRO-THERAPEUTICS.

Under charge of GEO. ADAM, M. D.,

Professor of Electro-Therapeutics, College of Physicians and Surgeons of San Francisco.

Depilation by Roentgen Rays.

(NEVILLE WOOD, M. D.)

I venture to hope that the following case may prove of interest as indicating the value of the treatment by the Roentgen rays, and as a contribution to the study of dosage according to the result which is aimed at.

A woman, aged 22 years, consulted me in November, 1898, on account of a considerable overgrowth of hair on the face. The history given was that fourteen months previously one inferior turbinate bone had been removed, and that about three months subsequently the hair on her face, which was not previously excessive, took an active growth. During the two or three months before her visit it had become sufficiently conspicuous to excite frequent comment by acquaintances and strangers. At the date of her visit the following note was made: "A healthy-looking, fresh-complexioned brunette; all the bodily functions stated to be regularly performed; nothing remarkable about the hairy scalp, and the body hair said not to be in excess. Face: On the upper lip from a point half an inch from the middle line and extending outwards on each side for threequarters of an inch, there is a moderately close growth of dark, rather thick hairs, mostly about one-quarter of an inch long. In front of the ears there is a slight excess of hair, and this growth is continued on each side down to the angle of the jaws, the length of the hairs increasing as this point is reached. On the chin the hairy growth is most conspicuous and disfiguring. From the point, extending one inch upwards, three-quarters of an inch backwards, and one inch transversely, there is a groundwork of closely set down, and in addition numerous thick dark hairs from one-eighth of an inch to one inch in length."

For this reason and on account of the known incidence of dermatitis it was decided to treat first this area, and it was found convenient to begin with the front part of the chin; the rest of the face and neck being protected with a leadfoil mask. The sittings took place, when possible, six times a week, and the duration of each sitting was ten minutes. The distance between the anticathode and the skin was between six and seven inches. The current through the primary coil was maintained

at about five amperes and the number of interruptions varied between 250 and 300 per second. After fourteen exposures it was noticed that the darker hairs had lost some of their luster, and a week later there was an obvious lessening in their number. The shed hairs were brittle and pale in color, with atrophic bulbs, while microscopically the normal striation was indistinct, and the medullary substance appeared to be collected into separate nodes with clear intervening spaces. During this period occasional slight reddening of the skin was noticed. The treatment continued till 45 exposures had been given to the point of the chin, when the whole of the very thick downy and hairy growth had disappeared except nine hairs which remained at least a week after the total removal of the others.

Mechanical interference having previously, for obvious reasons, been avoided, it was now judged right to ascertain the condition of these residual hairs. On applying the gentlest traction to one it was found that it was readily separated at its bulb, which was deeply placed, but was held by a more superficial part of the root-sheath so that the rest were left untouched, and it was now clear that the object aimed at had been attained, and as the skin was somewhat reddened, a message was sent that treatment should be directed only to the under surface of the chin. The message miscarried, so that the front received a few more exposures, and a sharp attack of dermatitis followed, which, however, speedily subsided under simple treatment. Twenty exposures were also given to the under part of the chin and ten consecutively to the cheeks. The result, some eight months after the cessation of treatment, can probably be safely judged, since for more than three months there has been no change in the condition. The front of the chin, which received more than forty exposures, remains quite free from down and hair. The under surface, which had twenty exposures, is cleared of down, but within three months of suspension of treatment a few thick hairs returned. Their number, however, has not since increased, and they are so sparse that electrolysis would seem to be indicated for them. The cheeks, which had a small number of exposures, I am informed, temporarily lost all their hair, but it has now re-grown as before, and this part will not be dealt with till the patient can arrange for continuous sittings.

It would seem, if the above case can be taken as a guide, that ten short exposures are useless; that about twenty exposures will clear the ground for electrolysis or simple traction if for any reason the ray treatment has to be suspended, while some number of exposures between thirty and forty will result in permanent alopecia, though it is to be expected that with further experience this number may be reduced, so that a treatment which neither pains nor disfigures may take its proper position in practical therapeutics.

Treatment of Lupus by the X-rays.-It will be of interest to some of your readers to know what effect may be obtained in the treatment of a serious and disfiguring form of disease— namely, lupus-by the action of the X-rays. The result of sur gical interference with such cases has been uniformly disappointing, not only in often intensifying the virulence of the growth, but in the destruction of the parts which are the seat of the same, and, in the case of the nose-which was affected in my patient-productive of a hideous deformity, which the greatest skill in plastic operations, even if the disease has been completely removed, suffices barely to make presentable. When the patient came under my care the disease was so extensive that, before submitting him to any surgical interference, I decided to try the effect of the rays, of whose efficacy I had read in the annals of the Roentgen Society.

The history of the patient is as follows: B. H. A., aged 18, first noticed the affection of the nose in September, 1897. He then underwent various kinds of treatment, in which the nose was submitted to the action of ointments, powders, douches, etc.; and even on one occasion, in December, 1898, a slight scraping or scarification was undertaken, luckily of a very superficial kind, otherwise a great loss of tissue would, I think, have inevitably followed. For some months before I saw him he had, under the advice of a medical man, been poulticing it, but the disease had steadily advanced from the tip of the nose, where it was first noticed, till both ale and the bridge were affected, and isolated nodules were to be noticed almost as high as both inner canthi.

On June 30 he was first exposed to the rays from a Jackson high-vacuum tube attached to a Newton-Apps coil giving an 18. inch spark, a hammer break of ordinary kind being employed. An important condition in the tube was aimed at—namely, the

so-called "sun effect" first described by Webster in October, 1896, at his demonstration at the Royal Artillery Institute. The rays, under this condition, are capable of taking a photograph of the bones of the hand in a fraction of a second, or of penetrating a -inch steel plate in ten to fifteen minutes' exposure. The face, other than the affected area, was protected by a rubber mask of some thickness, and exposed to the rays for ten minutes at each sitting at about 5 inches to 6 inches distance from the tube. Sittings were given every other day throughout August, and it was noticed that the exposed skin dried into a scaly condition and peeled off, the lupoid area, where thickest, forming a kind of scab.

On September 1, 1899, the patient informed us that the night sweats, which for some months had been profuse, were much alleviated, and though no treatment was undertaken in September, by October 9 they were reported to have quite ceased, and have not reappeared up to the present. There are now no signs of disease in the lungs, though I regret that I did not examine them before the treatment was commenced. On October 9 hardly any trace of lupus was to be found, but as a few pinkish or brownish nodules were to be seen high up on the nose he was exposed on alternate days up to November 12. There was peeling of the skin as in severe sunburn, and the retraction of this hardened layer produced slight ectropion and epiphora. From this he has recovered since.

These results are sufficiently startling in their similarity to those produced by Professor Finsen to make one wonder whether the rays from the tube and the ultra-violet or photochemical rays of the solar spectrum and the electric light may not be identical. Still further, the most important element is the penetrative power of the X-rays, and the conclusion cannot but be drawn from this case that if dermal tuberculosis may be cured, why not pulmonary. Nay, further, may we not take the relief of profuse night sweats as an indication of some such effect? May we not then hope to go even a step further than the fresh-air treatment toward the cure of phthisis and supplement it with either concentrated sunlight or exposure to concentrated X-rays.-R. E. SCHOLEFIELD, M. A., M. B. Oxon.

ONE-THIRD of the mortality occurring in the British army in time of peace is due to enteric fever.