Progress in Physical Therapeutics.

GYNECOLOGY AND ELECTRO-CHEMICAL

SURGERY.

EDITED BY G. BETTON MASSEY, M. D.

Zinc-Mercury Cataphoresis in the Cure of Piles and Caruncle. By Eugene Carmichael, M. D., Sac City, Ia., in Albright's Office Practitioner, September, 1907.

"In presenting this article I am not claiming originality of method, for to Dr. Massey is the medical world indebted for the discovery and elucidation of this, one of the most, if not the most, potent of electrical modalities.

"I simply desire to show that proper equipment of knowledge, apparatus, and courage may be so combined as to relieve the suffering of thousands who would continue to suffer rather than submit to the use of the knife or a chloroform operation. "In the treatment of hemorrhoids by the zinc-mercury method I have found that the old meaty tumors are the best suited to this treatment. These we find sometimes as internal piles that protrude and remain out after stool, regardless of having been. replaced by the patient. Ofttimes they become eroded and bleed freely; they are very sore and sensitive to touch, and are a source of constant distress which ultimately drives the patient to the office in a state of mental, nervous, and physical wreckage. Another class of cases to which this treatment may be adapted are marginal piles, those olive-shaped tumors that extend from the skin margin up to within the grasp of the external sphincter. You will observe that both varieties mentioned are of easy access, being in plain sight and not requiring the use of a speculum.

"Now, if I have made it plain that it is the more solid visible growth to which this method is specially adaptable, I shall proceed to give you the details of my technic.

"First I saturate a pledget of cotton of sufficient size to cover the protruding pile with a 10 per cent. cocaine solution. A tin or platinum electrode, also covered with cotton wet in the cocaine solution, is placed and held against the cotton covered tumor. This electrode is connected with the positive pole of the continuous current, the negative being connected to a pad wet in hot I per cent. soda solution, and placed on the patient's thigh. Now the current is gradually turned on and increased

to about 10 milliamperes, and left ten or fifteen minutes while the zinc points are being prepared.

"Take ordinary sheet zinc, and with a pair of scissors cut pointed strips one-quarter inch or less wide and one and a half to two inches long. Dip these into a ten per cent. solution of sulphuric acid and immediately into mercury, with which they will at once become perfectly amalgamated. I usually measure with my eye the thickness of the growth I wish to pierce, and amalgamate only sufficient of the point to penetrate it nicely, as the amalgam soon becomes very brittle and is more easily broken if the whole strip is amalgamated. Before inserting the points I inject a solution of 5 per cent. cocaine and adrenalin, equal parts, with my hypodermic syringe. This further anesthetizes the tumor and lessens hemorrhage, which, however, is never much-in fact, in some cases only a few drops. The next step is to insert one, two or three points, held in a needle holder, according to the size of the tumor; usually two is sufficient. If the point does not easily penetrate the tissues I often make a puncture with a small bistoury and then insert the point and immediately turn on the current. With the points connected with the positive and the negative pad as before, I increase the current to twenty-five milliamperes within five or ten minutes, according to the degree of anesthesia produced and the tolerance of the patient, and leave it at that for twenty minutes, or until the tissues around the points appeared blanched, or rather translucent and devitalized. This peculiar appearance is more easily recognized after experience than described. When a sufficient degree of devitalization has taken place the current is slowly turned off, the points. removed, a rectal suppository containing cocaine, morphine, and atropine (Wyeth's No. 47) is inserted, an ointment strong with orthoform applied, and the patient gets up and walks home, having been instructed to keep the parts well anointed and use an enema, when the bowels feel like they want to move. One large tumor or two small ones may be destroyed at each treatment.

"The only case I have had in which any disagreeable symptoms have arisen after this treatment was in an out-of-town patient, a weakly woman, aged sixty-eight. It was the second treatment, ten days from the first, which was painless throughout. Four or five days after this second treatment she developed those after-stool pains of irritable ulcer, which continued two or three days, but which promptly subsided upon using the morphine suppository. Further, this same patient. had a very irritable urethral caruncle, which I treated the next day in the office, after giving the first treatment for the piles. One treatment with two points, using twenty milliamperes for twenty minutes, cured the condition.

I use this method almost exclusively in skin cancers, and have not one failure to my credit so far, with the single exception of a cancer of the lip. In this case I found the patient could not endure a strong enough current long enough to thoroughly devitalize the principal tumor and sufficiently impregnate the surrounding tissues with the oxychloride of zinc and mercury to destroy the few remaining cancer cells. The consequence was recurrence and resort to a cure with a cancer paste. Cancer of the lip should only be undertaken under general anesthesia.

I have purposely omitted all theoretical discussion of this method, as that may be had more profitably from Dr. Massey's book.

RADIOTHERAPY.

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

"Roentgen Treatment of Chronic Bronchitis."

Following up the announcement, by Schilling, in the December Journal of 1906 of his favorable experience with systematic Roentgen-ray treatment of chronic bronchitis and bronchial Asthma, Immelman reports a series of ten patients treated by the Roentgen-ray with a markedly fine result. The asthmatic attacks were aborted and relief was almost immediate. He exposed the front, back, and sides of the thorax in turn, a total exposure of ten minutes. Asthma, due to cardiac or nervous factors, is not amenable to this treatment, which seems to have its specific action on the bronchitic element.

"A Case of Rhinoscleroma Treated by the X-ray." By Milton J. Ballin, M. D. N. Y. M. J., March 16, 1907.

Hebra first drew attention to the fact that rhinoscleroma was a distinct disease characterized by the formation of hard nodules in the mucous membrane of the nose and throat, which eventually break down into ulceration and finally form into bands of connective tissue. Mikulicz has been able to make definite distinction between this disease and granulation, sarcoma and tertiary syphilis, and lupus hypertrophicus or carcinoma and adenoma. This disease has always run its slow insidious course, often lasting months and years. Until cicatrization or the process finds new foci for invasion, it remains localized to the mucous membranes of the nose and throat and never undergoes metastasis to other regions of the body. The

prognosis has been heretofore as incurable, and the latest textbooks agree that medication of all kinds, both internally and externally, have proven failures. The writer reports this case mainly to demonstrate the surprising and beneficial influence of the x-ray treatment upon growths of this nature. It has been only within the last year that the x-ray has been applied to this disease with such gratifying results that we may now say we have at our command an agent by which we can stay the processes of the disease, if not bring about a cure, which was formerly looked upon as hopeless. In this case the x-ray was the only thing used. The author gives several photographs and a brief history of the case. Patient, female, fifty-three years old, Russian birth. No other members of the family had ever had the disease. The patient was sixteen years old before she began to complain of a sore throat and a catarrhal condition of the naso-pharynx. This grew worse until it finally resulted in an ulceration of the pillars of the tonsils and the posterior walls of the pharynx. These were finally healed and left large cicatrices. The uvula disappeared later, after which the posterior nares and the nose itself became involved. A great many operations, as well as much medicine, proved useless. The woman was in perfect health except for the condition of the nose and pharynx. The larynx was absolutely free and not involved in the process. The pharynx was one mass of firm cicatrices, the uvula was entirely gone and presented the appearance of a partial cleft palate. The posterior nares and nose were filled with these bands of tissue. The nose was double its normal size. The nasal passages were entirely occluded so that respiration through the nose was entirely suspended. The nose seemed to be one large mass from which the outlines of the nostrils were entirely obliterated. It looked like one globular mass. The skin was red and tense and the lower part was covered with large ulcerations, which gave forth a watery secretion. The entire nose was tender to the touch. The treatments by the x-ray at first were given at a distance of three to four inches and the rays were allowed to play upon the parts three or four minutes, and she was treated three or four times a week. The patient suffered no inconvenience of any kind from this treatment. In this case the exposures were given with the high-frequency current for a short time instead of a long exposure with low frequency. The results in the cases have been remarkable, even more than was expected. At the fifth treatment the nose was reduced to its normal size, the redness disappeared, the tissues became softer and more pliable, and the outlines of the nostrils returned. The tumefied mass, which protruded at the nostrils, retracted entirely, the ulcerations dried up and the interior part of the tip of the nose, which reached down as far as the lip, resumed its normal position and shape. He thinks the entire condition

will be eradicated. He calls attention to the case of Dr. Pollitzer, showing a large timefaction of the nose and occlusion of its passages, which was greatly benefited by the x-ray.

Catching Cold.

HYDROTHERAPY.

EDITED BY CURRAN POPE, M. D.

In a recent editorial on this subject in the Medical Record, the following interesting observations were made: "The rationale of the causation of the ordinary cold' is pretty well understood at the present day, and it is generally conceded that when circulatory disturbances or vital depression are produced as the result of localized or general chilling of the body surface. newly entered cr already present pathogenic bacteria are enabled to attack the body with very good chances of success. At such times it is said that the powers of resistance are below par, and consequently the bacteria gain an easy victory. This point was illustrated in telling fashion by Durck, who found that rabbits infected with pneumococci developed pneumonia if they were subjected to severe cold, whereas unchilled control animals survived. The mechanism of this weakening of the vital forces has not been satisfactorily explained, however, and considerable interest, therefore, attaches to experimental work on the subject recently done by Franz Nagelschmidt. This observer contributes to the recent Senator Festschrift a description of his studies on the hemolytic and bactericidal power of the blood after the animal has been exposed to cold. Rabbits and goats were used, and the activity of the antibodies of the serum was tested before and after immersion of the whole animal or portions of its body in ice water for varying lengths of time.

"The results obtained showed some curious inconsistencies that still demand explanation, but in general it may be said that by chilling the surface it is possible to reduce the number of antibodies in the blood to a very marked degree. This means that the body is deprived of a goodly proportion of its defensive weapons, and, therefore, under such conditions it easily falls a prey to infections of all sorts.

"The effect of cold in bringing on attacks of paroxysmal hemoglobinuria is well known, and it may be that this obscure condition will be illuminated by further developments along the same line of investigation. A point of practical importance is the fact that it was found that repeated exposure to slight degrees of cold brought about an increase of antibodies, and