duced occur simultaneously in the blood, in the spleen, in the adenopathies when they exist and their influence is shown upon the general condition. The action upon the blood is very striking. Under the influences of well-directed treatment the white globules are progressively reduced to normal. The number of polynuclears gradually surpasses that of the pathological forms. In the myelogenic leucemia the effect is most intense on the myelocytes; and in the lymphoid leucemia of the lymphocytes. He finds, as described by Senn, that the white globules are decreased and the red are increased. The increase in number is accompanied by the increase in hemoglobin and specific gravity, while the greatly enlarged spleen is greatly reduced in size. He notes that the spleen, filling one-half of the abdomen, from the diaphragm to the pubes, even reaching beyond the umbilicus, will resume almost a normal volume in three months' time. Lymphatic gland tumors are also promptly relieved and it is singular the way radiotherapy suppresses fever, when it exists, and the state of apathy and anorexia are also relieved by its influence. He claims that in fifteen days from the commencement of the treatment the most cachectic leucemics show a better color, their appetite improves, the dyspnea becomes less, pains disappear, sleep becomes possible, and strength returns. Albuminuria sometimes disappears very rapidly. He thinks the Roentgen rays constitute a specific treatment for cases of eczema, especially the myeloid type. In pseudo-leucemia the results are variable. In splenomegaly and anemia there is little or no action, while in polyadenitis results are reversed and incomplete. He thinks all patients should go through a routine examination of the blood just like urine, so that the Roentgen ray can be commenced early in these cases.

X-rays and the Genital Glands. N. Y. Med. Jour., May 4, 1907.

"Ancel and Bouin state that the local action of x-rays on the testicle causes a disappearance of the external and seminal secretion with preservation of the internal interstitial secretion and that on the ovary they cause a disappearance of both the external and internal secretion. The results, therefore, of the x-rays on the testicle are the destruction of the procreative power with preservation of the genital activity and the sexual characteristics, while on the ovary the results are sterility and the appearance of all symptoms which follow castration."

Radiotherapy in Facial Neuralgia. Jour. A. M. A., May 4, 1907.

Haret reports a complete cure for two years to date under radiotherapy of a patient of what he calls "epileptiform facial

neuralgia." The patient, a man, suffered from daily recurring attacks of facial neuralgia, not relieved even by morphine. The teeth had been drawn, the trigeminal nerve had been resected and also the superior cervical ganglion of the sympathetic, with a truce of never more than six months at a time after operation. A number of other cases have been treated in the same way with improvement or cure in all but one. The best results are obtained when the pains radiate from one or more points to which the radiotherapy can be applied. The exposures are made weekly, using three Holzknecht units. The first treatment usually causes transient exacerbations of the pain.

Some Applications of the Roentgen Rays in Dermatology. By Russell H. Boggs, M. D. N. Y. Med. Jour., April 27,

1907.

In this paper Boggs pleads for a more conservative use of the Roentgen rays in dermatology, and insists that more attention be paid to accurate diagnosis and to the pathology of the disease to be treated and to the quality and quantity of the rays with which the condition is treated. He thinks that anyone must understand these factors to be able to use the rays successfully as a remedial agent. He calls attention to the fact of the difficulty in making skiagraphs without experience and with a new machine, but thinks the operator had better spoil the x-ray plates than the patient. Many are able to make an accurate diagnosis but have no idea of the character and dosage required in treating the condition already diagnosed. He is grateful to note that the dermatologists are becoming better recognized, while the x-ray operators are becoming better clinicians. He thinks this will work for the good of both, and that no dermatologist will deny the effect of x-rays in the treatment of acne. Neither should the x-ray operator deny that all predisposing causes should be removed.

Of eczema he gives a graphic description of the various forms, touches on the pathology, and in connection calls attention to the difference in treatment of the various conditions. He decides that the rationale of the Roentgen treatment lies in its stimulation of the metabolic processes, especially in chronic inflammations,-stimulating the bioactivity of the cells. He does not consider that the rays are ordinarily indicated in acute or subacute eczema, unless it be to remove a severe pruritus, but in the chronic and rebellious cases, which resist other therapeutic agents, the rays have proved efficient. In squamous eczema, he considers it most beneficial, as it is usually of a very chronic variety. It requires, sometimes, intense radiation to relieve the pruritus and it is prone to recur. He thinks radiation in eczema of the legs should be applied

very differently from the ordinary treatment of squamous eczema. It improves the nutrition in these cases and adds materially to the successful termination. He reports two cases which are very interesting, and a cure is reported in both. He considers that only the very severe and obstinate cases of acne should be treated with the rays.

The reports on psoriasis have been very, conflicting. One author claims if results are not obtained after two or three exposures, he advises that the rays should be stopped and ordinary methods instituted, while another thinks, as a rule, no results are permanent without an intense use of the rays. The report of the first shows that he knows very little about radiotherapy, for it is known that it takes intense action to produce positive results in psoriasis, and that it is then very liable to recur, but the results have been sufficient to demonstrate its usefulness and it should be persisted in with sufficient dosage to master the trouble.

In keloid, he considers it the most successful agent known at the present time. It requires considerable time to remove the keloid and the rays should be used of such character as to stimulate the normal tissue processes and promote absorption. He does not think, under ordinary conditions, that a keloid should be removed by operation and then treated with the rays, as the knife is very liable to stimulate the activity of the growth.

He describes cutaneous tuberculosis as follows. He describes several forms of the disease, namely: (1) lupus vulgaris, (2) tuberculosis verrucosa, (3) tuberculosis cutis orificialis, and (4) scrofuloderma. He deals quite extensively and minutely with the pathology of these four different types, also, giving minute details of difference between the four varieties. He thinks, that in tuberculosis verrucosa it is often advisable to remove the growth by electrolysis or the knife and then follow with a few intense radiations to destroy the remaining foci. In lupus, he thinks the x-rays are a recognized method of treatment, but must be varied to meet different cases. There are usually two methods of doing it, one by producing a gradual effect and the other by setting up an intense reaction followed by necrosis of the skin. The first is usually preferable. The amount of reaction set up will vary with the disease under treatment. Ordinarily it is useless to produce more than a hyperemia. A slight swelling of the tissue, is always more pronounced in the lupus nodule, is accompanied with a certain amount of burning and itching. The congestion is allowed to pass away in a few days when the nodules are decreased in size and the ulcerated portions will cicatrize. This is repeated from time to time when the disease is cured.

The X-ray Treatment of Hypertrophy of the Prostate and its Technique. N. Y. Med. Jour., April 27, 1907.

"Hanisch describes an apparatus by means of which the x-rays may be applied to the prostate while the patient is in the knee-elbow position. He states that he has found the apparatus to be perfectly satisfactory."

RADIOGRAPHY.

EDITED BY HERMAN GRAD, M. D.

The Value of Skiagraphy in the Surgery of the Nose. By W. G. B. Harland, M. D., and H. K. Pancoast, M. D. The Pennsylvania Medical Journal, April, 1907.

The writers call attention to the value of skiagraphy in giving definite ideas of the shape, size, and location of the accessory sinuses, and in indicating the presence or absence of pathological conditions in rhinology. By the x-ray picture the condition of the frontal sinuses as shown by the skiagraph will reveal the presence of sounds, rudimentary conditions, and an estimate of the depth and extent of the sinusesmatters of considerable importance in operable cases. Investigation concerning pathological changes will discover by the comparison of the other side presence of thickened mucosa or pus, or both. The presence of pus can be easily diagnosed from the blurred condition or darkening of the affected side.

"A clear, clean-cut picture of a sinus affords good evidence of its freedom from serious diseases, and in a number of cases we were able by this means to exclude with certainty the presence of involvement in cases referred for an opinion as to the possibility of accessory sinus disease. In other cases in which a number of cells were diseased, we were enabled to learn which sinuses had escaped infection."

"Although probably more definite information can be obtained from the x-ray pictures than from the lights and shadows of transillumination, this method is nevertheless open to some of the sources of error that detract from the value of transillumination, for pictures will be influenced by such factors as thickness of bone, etc. Another difficulty is the fact that cells and sinuses overlie one another in the picture, and this must be allowed for in studying the skiagraphs." Errors also arise from faulty development and it is therefore best in the judgment of the writers that the skiagraph be employed in connection with the examination by other possible

means.

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Technic. The secret of success in this work lies in the employment of a high vacuum tube and a diaphragm with plenty

of current and short exposure; also much depends upon careful development of the plate.

For lateral views the plate is held on the diseased side of the head.

For antero-posterior views the plate is held in front and close to the face, the patient lying on the abdomen. The clothing is removed from the neck and the tube is held below the occipital protuberance.

The Value of the Roentgen Rays in Diagnosing Certain Conditions. By A. L. Gray, M. D., Richmond, Va. The Virginia Medical Monthly, April, 1907.

The writer calls attention to the lack of conception by the general physician to the possibilities and limitations of the Roentgen rays, and also mentions certain truths which most of our readers will fully appreciate. He explains the difference between a photograph and a radiograph, showing that the one is a shadow while the other is produced by the passage of rays through a prism, one showing a shadow in a plain surface while the other gives the perspective as well. He also calls attention to the fact that for diagnosis it is important as well that the physician intelligently read the radiograph as properly expose and develop the same. Surgeons often fail in this particular for want of experience in reading the radiograph. No one who is not familiar with the character of the radiograph and studies it in two planes can come to correct conclusions as to the correct relation of the fragments as of the fractures of long bones. He calls attention also to the fact that the x-ray finding may be only one link in a chain of signs and symptoms which would alone be of no value but along with others makes a clean clinical picture. He discourages the making of prints for patients to show to friends, as it is a source of advertising that is not free from its dangers both for the surgeon in charge as well as the radiographer.

DIETETICS.

EDITED BY SIGISMUND COHN, M. D.

On Chronic Diseases of the Heart and their Treatment. By Theodore Schott, M. D. New York Medical Journal, May II, 1907.

Under this title Professor Schott read a paper before the medical department of the University of Pennsylvania. In speaking of the physical methods in the treatment of these diseases, he understands by it the mechanical, local, and dietetic therapy. In regard to the latter he wants to forbid the use of