Progress in Physical Therapeutics.

CONSTITUTIONAL DISEASES.

EDITED BY FRANCIS B. BISHOP, M. D.

Treatment of Pulmonary Tuberculosis in Children. By James Burnett, M. A., M. D., M. R. C. P. E., Archives of the Roentgen Ray, December, 1906.

The writer lays particular stress upon the importance of prophylaxis. In children pulmonary tuberculosis is often induced by infection of the bronchial and mediastinal glands, during convalescence from the measles and whooping-cough, more particularly when complicated by bronchitis or bronchopneumonia, consequently prophylactic treatment of pulmonary tuberculosis requires due care in the management of the diseases referred to. The cases should be watched and the chest thoroughly examined from time to time. The question of treatment when the disease is present, calls at first entirely for fresh air. A low temperature is not objectionable when there are not sudden or great extremes of change of temperature. The soil of the locality should be dry and the exposure sheltered from east and north winds (referring to the climate of Great Britain). "A relaxing atmosphere should be avoided and a bracing, dry situation be selected. The patient should spend the day entirely out of doors, except in very wet weather, and sleep in a large well-ventilated room by himself. He should amuse himself with hoop-rolling, skipping, avoiding, however, fatiguing exercises such as running, and should be given a cold or tepid bath every morning, followed by a brisk rubbing imparting a warm glow to the skin." The writer puts particular stress upon the fact that a low temperature is most beneficial in the majority of the cases of this disease; and the climatotherapy is undeniably of great importance. The temperature of the locality should be practically invariable, extremes of temperature are not at all suitable for these patients. Sheltered. regions with pine forests are ideal. The dietotherapy he considers of great importance; very often feeding is difficult owing to the tendency to gastric acidity and fermentation. Milk and cream should be given regularly. Eggs, fish, fowl, roast mutton, and clear soups are very nutritious as well as stimulating. Avoid foods which produce fermentation. In

the early stages of the disease the child should be fed up, and in the latter stages the appetite tends to fall off, and must be stimulated by simple bitter tonics combined with malt

extract.

Drug treatment in this disease is a vexed question, for there is practically no remedy which will cure, though there are several which may improve the patient's condition. Cod-liver oil in not too large doses-to a child five years old, 30 drops, 2 or 3 times a day, 1-2 hour after eating. It is best given combined with malt extract which serves to disguise the taste.

The writer refers to several other of the drugs indicated but fails to observe the great value of radiant light and highfrequency currents with these little patients, which probably when judiciously administered are capable of instituting an increased general metabolism as well as raising the general resistance of the patient. There are few of these little sufferers that cannot be treated successfully by the combined applications of these two agents, to which may be added the application of the wave current over the abdomen in connection with the hygienic measures suggested. (Editor.)

Some Points in the Sanatorium Treatment of Pulmonary Tuberculosis. By C. Muthu, M. D., M. R. C. S., L. R. C. P., Archives of the Roentgen Ray, December, 1906.

The writer speaks with pride of the success obtained by the pioneers of the open-air treatment during the last nine years in private sanatoriums. The expectations, however, of the public and the profession are placed too high as to the average result that should be obtained, consequently discredit unjustly falls on the whole movement. Speaking from the writer's point of view, from his own institution in which he has carried out the open-air treatment, in at least 50 per cent of the cases, life and health are restored by the open-air treatment—that is, about one-half of the patients that enter the sanatorium either get well completely, or their diseases are arrested so as to enable them to return to work. He deplores the fact that many patients return to unhealthy surroundings when partially patched up, and soon relapse, also that the medical men do not send them over at an early stage of the disease, that too many patients at the first sign of return of health, go home thinking they are cured; the institutions which cannot keep patients for more than two to four months, then send them back to their

former surroundings, and treatment of patient at home; where no medical supervision or discipline is possible. Such cases result unfavorably. The most important cause of failure is discontinuance of treatment too soon from various causes. Rigid discipline, absence from home and friends, etc., are unpalatable, and it is most difficult to convince patients that health can only be got back by great sacrifice, and that Nature demands strict conformity to her laws. Patients have not the strength of character or stamina to stand fast or strenuously continue in the fight against the disease. The article is illustrated, showing the interior and exterior of the châlets, or small open houses in which these patients are sheltered. The open-air treatment is, after all, a palliative remedy. It is not a specific against consumption. He deplores the fact that such centers as London, Glasgow, and Manchester, which are breeding places for dust and microbes, remove any hope of eradicating the disease; deploring also the evil factors of drink, overcrowding, poverty, competition, etc., which sap the vitality, energy, and resisting forces, and do not permit the hope of eradicating the disease, in the future years. The writer refers to no other therapeutic measure whatever in his work except the open-air treatment.

RADIOTHERAPY.

EDITED BY J. D. GIBSON, M. D.

Exophthalmic Goiter Treated by the Roentgen Rays.

Drs. G. E. Pfahler and Thrush (New York Medical Journal, November 17, 1906) furnishes notes of exophthalmic goiter treated by X-rays. The symptoms were well developed in a woman of thirty-six years old, and she was given twenty-two applications of ten minutes each spread over twelve weeks. Improvement was noted in the fourth week and resulted in a cure in the twelfth week. In addition to X-ray, iodine, valerian, sumbul, asafetida, nitro-glycerin were used. Pfahler bases his remarks on thirty-one goiter cases treated by the X-rays, which treatment he thinks is proper and effective.

Effects of X-rays upon Ague. N. Y. Med. Jour., November 10, 1906.

A case has been reported in which a quotidian intermittent was apparently cured by X-rays. Demarchi, after applying this method in eight cases, was unsuccessful in obtaining only

negative results. He demonstrated to his own satisfaction that the exposure of the splenic region to X-rays did not in any way modify the course of the malarial infection nor the cycle of evolution of the pathogenic agent. However, in cases of chronic enlargement of the spleen, radiotherapy brought about the manifest diminution of this organ, but only after the spontaneous cessation of the fever, or as a result of the administration of quinine. The possibility of a preventive influence of the X-rays against recrudescence of the fever is admitted by the author.

Treatment of Venereal Buboes by X-rays.

Merxheimer and Hubner have obtained positive results by radiation in the treatment of enlarged lymphatic glands, both venereal and strumous. The application of the X-rays should be energetic and be made with a high vacuum tube; the exposures of half an hour are repeated twice a week. The testicles are to be protected with a plate of lead and the bubo also covered with a sheet of tin in order to protect the skin from injury from the low vacuum rays which might escape from the tube. Two exposures are all that is sufficient to cause the disappearance of a gland as large as a hen's egg. The treatment is not effective after suppuration has occurred, but after the evacuation of the collection the application of the X-rays can take the place of the curette and the wound generally granulates very quickly.

The Cosmetic Advantages of Treating Malignant Growths of the Eyelids with Radium. New York Med. Jour., December 22, 1906.

Kirchner has reported in Archives d'Electricité Médicale, to have cured two relapses of epithelioma of the eyelids with one milligram of radium bromide. In the two cases the whole thickness of the eyelid was involved in the growth. The first case Kirchner treated by a series of sittings each lasting twenty minutes. The second case was treated in one sitting. Each case was cured without a cicatrix and the function of the eyelid was retained.

Errors in the Treatment of Cutaneous Cancer. By A. R. Robinson, M. D., New York, N. Y. Med. Jour., December 29. 1906.

This very learned article by its eminent author well deserves careful perusal by every man who pretends to treat malignant

diseases. He is certainly correct in his dictum that there is at present no one agent that should have absolute and untrammeled sway in the treatment of malignant disease. He thinks that the thyroid extract with other internal means is very useful as an adjunct to the X-ray and other agents in the treatment of many cancerous conditions. He makes mention of one case in which a carcinoma appeared and grew very rapidly after high-frequency applications. He had found previously in this same case while under his care that the X-ray had not affected it favorably. The case progressed to an unfavorable termination in spite of thyroid extract and trypsin. The thyroid extract in the early days of this case had acted favorably. He considers the use of toxins and serums to be useless and where used usually cause loss of valuable time. He believes that the most favorable methods for the removal of cancer at the present time are excision by the knife, destruction by thermo-cautery or by galvano-cautery, radiotherapy, curetting and caustics. He holds that that method of treatment is best which removes with the greatest certainty all of the pathological tissues, even if the resulting deformity is greater than that caused by some other and less effective method. He does not believe that cancer depends in all cases upon a specific organism. He thinks if the lesion is smaller than a pea in size and deep-seated and not located upon a part as the end of the nose, the eyelid, etc., it can be removed by excision or by cautery. If it is on the scrotum, excision is the proper method. He thinks that an epithelioma of the same size if located upon the face, and superficial, should be treated by the X-ray, as the scar is less and a permanent cure is much more probable. In all cases where flat epitheliomata are larger in size than a bean, unaccompanied with lymph or gland infection, excision should. not be employed, unless the deformity is of no consequence. In rapidly spreading epitheliomata, a rare form of cancer, operation by excision offers the most favorable prognosis, and should invariably be the method used, even if the results are not successful. In these cases, he considers caustics and radiotherapy should not be depended upon, but should be used after extirpation.

Large, flat epitheliomata, occupying areas of two inches or more in diameter should not be treated by the knife, as caustics or the X-ray or both combined, as indicated by the case, will give results which could not possibly be obtained by attempted excision. I may safely say that excision should never be attempted in a case of this kind. He says that cancers of the lower lip, unless they are very superficial, should be excised. Caustics or the X-ray are inefficient in the majority of these cases. Cancer of the upper lip is much more amenable to caustics and X-rays and should be used in these cases. In the