lessened until for the last two minutes of the treatment she could bear it at about eight inches from the face. Other cases will often not bear it nearer than two feet. In frequency, I usually make the applications every other day, the duration is from ten to twenty minutes. In the lupus case I began with twenty-five minutes; then gave but fifteen-minute treatments, and now I am treating with only ten-minute applications.

Dr. C. Am Ende, New York City: I would like to ask the author of the paper whether the bright light has any effect upon the eyes?

Dr. Barrett (replying to Dr. Am Ende): I have used no protection to the eyes, for the reason that the lupus has involved the upper eyelid. I do not see that the light affects the sight of the eye in the least.

Dr. William Benham Snow: In the line of the remarks of the doctor in which he says that there is an opposite effect, I would like to emphasize the fact that if we wish to get inhibiting effect of the x-ray we should not use stimulation of light until we have inhibited sufficiently to secure our object.

FLUID EXTRACT OF SHEEP'S THYROIDS AN AID IN THE TREATMENT OF CANCER.

BY C. AM ENDE, M. D., NEW YORK.

In presenting my second paper upon this subject it should first be stated that its conclusions are derived exclusively from the cases reported below, the special varieties of cancerous disease of which were ascertained by a competent microscopist. No superficial cutaneous cases are included, because of their curability by the Roentgen rays alone; and with one exception all were deep-seated cases.

Concerning the material employed it should be said, that the prolonged use in large doses of this thyroidal fluid extract became possible: (1) through its freedom from those ingredients of the natural gland that cause the severe cardiac disturbances but by raising the blood pressure, especially the intrauterine, it is apt to cause in recurrent uterine cases somewhat persistent hemorrhages but not difficult to check; (2) because there is tendency to induce diarrhea in men, not so noticeable in women, it produces, however, but slight, if any gastric disturbance. The principal reason for the presentation of this paper is to call attention both to the advantages obtainable from this agent and also to show its limitations.

The result at once appearing in all cases reported below, most obviously in Case 5, is the disappearance of the cachexia. The extract undoubtedly acts as an antibody to the cancertoxins. The patients soon again regain strength physically and mentally; they resume work in household or business. With renewed hope (if aware of their disease, though this had better be avoided), they again enjoy life, and become exceedingly grateful to their medical attendant. But considerable enfeeblement may be manifested, a diminished power of resistance to injurious extraneous influences, or to dormant internal pathological conditions or processes.

Prolongation of life with full activity should not escape notice. (See Cases 1, 5, and especially 7.)

* Read at the Sixteenth Annual Meeting of the American Electro-Therapeutic Association at Philadelphia, September 21, 1906.

Another, but more obscure, effect is hardly complete, but there is certainly considerable interference with, and obstruction of, propagation through the lymphatics. (In the adducible cases this appears the most marked, as in the early history of Case 1. The non-adducible, by the way, outnumber the former.)

I

Hand in hand with these goes cessation of pain. As x-rays effect the same to a certain extent, Cases 1 and 5 may be pointed out. For a year the latter patient had contracted the morphine habit by the use of the drug for relief of unceasing intense pains in the arm. Upon their cessation from using the extract with the rays she could voluntarily abandon the habit.

Another result of importance is, that under the combined treatment, x-rays externally and this fluid extract internally,all fresh metastatic tumors, that were softer, even some quite large ones, disappeared in a comparatively short time. (See Cases 1, 3, 4, 5, 6, 7.) Treatment and supervision of the patient, however, should not be discontinued too soon.

Affected foci may exist in the neighborhood, or a protected, deep-seated gland or duct may have escaped destruction.

Case 3 first lost ground under x-ray treatment but improved when the thyroid preparation was added. Three cases, one each of epithelioma, carcinoma, and sarcoma selected by Dr. Judd for Dr. R. T. Morris from his clinics, gave the same result.

In Cases 4 and 6 the early institution of this treatment saved the patient at least much greater troubles.

But cancerous masses protected by bones (intracranial, internal thoracic, etc.), as well as old, firm, or nodular growths have so far resisted this treatment.

One of the causes for this would seem to be the liability to burns by administrations of the x-rays with sufficient energy to penetrate the denser structures.

Dr. Geyser's double-tube rectifier may prove of great value, and it is a pleasant duty to state that one case (No. 7) that began to go wrong completely reversed upon its institution. For the present it assumes a favorable turn. It seems that different apparatus give differing results.

It should also be realized that excepting arsenical preparations any other useful drug may be employed simultaneously. Eimer & Amend of New York supply this fluid extract, as

well as the solid preparation in capsules. The latter, however, does not keep well, it is hygroscopic.

Although the cases described below are few in number, the uniformity of the results as shown, warrant the hope that a conditional favorable prognosis may be given in a series of cases, that have heretofore been declared utterly hopeless by good observers.

This series comprises most post-operative recurrent, and some primary mammary, a portion of similar uterine, and cases not protected by bones. The hyoid bone and thyroid cartilage seem penetrable.

The principal conditions upon which the prognosis, whether favorable or unfavorable, depends, are absence or presence, and accessibility or non-accessibility of metastastic or contiguous infiltrations.

Further improvement in apparatus, and perhaps in technic as well, and possibly too in the administration of medication should strengthen the feeling, acquired by many years of slow but gradual progress, that with increased experience the described limitations may furthermore recede.

Case 1.-Mrs. W. G., æt. forty. Hysterectomy in fall of 1900. Recurrence early in 1902. Thyroids in capsules, about one dram daily, were given under the observation of the late Dr. Pryor. The administrations were often interrupted upon cessation of pain or when traveling. Sporadic hemorrhages in June, 1903; continuous from October, 1903, until July, 1904.

After thermocautery by Dr. J. C. Taylor, the patient came under the care of the writer; the cicatrix was eroded with a large mass in the recto-vaginal septum and a smaller one in the vesico-vaginal wall. The patient was for a while too weak to get from a couch upon a table alongside of it. Under local hemostasis by ergot with adrenalin, 8o grains of thyroid daily, and the employment of radium of 7000 radio-activity three times weekly, there was a gradual return of strength. She was able to walk first about the flat, and then out on the street. On September 28 she rode four miles to the office for x-ray treatment, which was substituted in place of radium. There was gradual complete disappearance of the anterior tumor; diminution in size of the posterior so as to admit freer passages; cessation of the hemorrhages. The patient later walked to church, visited friends and theaters. She was

caught in the blizzard of February, 1905, and obliged to walk about 1 1-4 miles through driving snow, when her clothes became wet and she was thoroughly chilled. A few days later a general peritonitis developed which baffled all efforts and became fatal in ten days.

Case 2.-Mrs. H. K., æt. sixty-six. Hysterectomy October 22, 1901. Scirrhous carcinoma. March, 1904, showed fetid leucorrhea and some hemorrhage. There was also chronic gastritis with gastralgia and locomotion was impossible for more than a city block. The x-rays were forbidden. At first two, and later, four teaspoonfuls of fluid extract, and some solid were given, and she walked, in November, fourteen blocks, and later the entire length of Central Park. Some hemorrhages occurred late in November. Now x-rays were employed. In February, 1905, the ulceration closed and the labia were dry with a cessation of all symptoms. In March she developed a nephritis that became fatal in three months.

Case 3.-Mrs. A. A., æt. fifty-two. Amputation of right breast in November, 1901, for carcinoma. A second operation was performed in May, 1902. The x-rays were employed in the winter of 1903 and 1904, three times weekly at the clinic, but there was a gradual increase of all morbid processes. She came under the care of the writer in February, 1904. There was considerable swelling of the right arm, neck, and face, and some of the tongue; mastication was painful; speech difficult, and mouth and nose dry. The breast was hardened and presented a number of suppurating scabs. There was a chain of indurated glands in the axilla, and the arm was quite immovable. A metastasis developed in the right breast. Under the x-rays employed by the writer, and 200 grains of the solid extract three times weekly, by June there was a complete subsidence of the swelling of the face and neck and considerable diminution also of arm. The pressure symptoms of the seventh nerve disappeared. Also quite free use of the arm; and there. was considerable softening of the fleshy parts of the chest and indurations. All scabs were dry, some having healed. The tumor of the left breast continuing to grow, it was amputated. Suspension of all anti-treatment was taken for two months, followed by extended intermissions because of outside discouragement. There was gradual sinking, death following.

Case 4.-Mrs. D. I., æt. forty-two. Amputation of right