tioned by some writers on this subject not to set up a dermatitis. I endeavor to bring this condition about as soon as possible, but always tan the parts before I actually attack the growth with a hard tube, if the use of such a tube is thought to be indicated. To avoid unfortunate results, white gangrene, etc., one must proceed with caution. An idiosyncrasy of the

individual to the x-rays is not to be lost sight of. I have noticed a susceptibility to the rays in chronic rheumatism, elderly subjects with faulty vascular conditions, such as senile changes, and certain alcoholics. A single application of ten or twelve minutes, the tube six or eight inches from the body surface, may set up a dermatitis in one individual, and a dozen

applications under the same circumstances may give but little evidence of irradiation further than a slight tanning in another. The practice of using a high tube from time to time often hastens and brings about curative effects in a most rapid and satisfactory manner.

The dictum of some authorities to always use low vacuum tubes, I do not adhere to, as suggested above. The continued

use of low vacuum tubes prolongs the treatment, making it necessary to give a great number of treatments, often taking months to accomplish a desired result, when by careful application of a high tube, from time to time, the same, and even better results would be obtained in a few weeks. The personal equation of the operator is important in the use of high

tubes. In growths of considerable area it is well to direct the rays to the periphery. Personal experience is conclusive that healing commences at the periphery most actively, and not centrally as claimed by some operators.

No hard and fast rules can be laid down as to the length of the exposure and the distance of the tube from the body surface. The treatment of each case is a law unto itself,

For the present the x-ray treatment of internal visceral growths is in the experimental stage. The treatment of surface or external malignant processes has rapidly emerged from the experimental stage, and in all early stages of external. epitheliomas, carcinomas, rodent ulcers, and cases of lupus, a cure may confidently be expected.

[536 NORTH TAYLOR AV.]

D

Gynecologic Diseases Without Local
Symptoms.

By GEORGE GELLHORN, M.D.,

ST. LOUIS, MO.

URING the last five or six years the question whether diseases of the female genital organs are liable to produce disturbances in other distant organs has led to lively discussions. I consider this question to be of farreaching importance to the gynecologist and neurologist as well as to the general practitioner, and shall endeavor to briefly outline what opinions are at present held in this matter.

Relations of gynecologic affections to disturbances in other distant organs may readily be divided into two categories. The first and smaller class finds its explanation in the disturbed mechanics of the pelvic and abdominal visera, and its causes and effects are so clear that there is hardly room for any marked difference of views. The second category embraces the large field of the so-called "reflex-neuroses." These cases have aroused an outspoken dissensus of opinion, and have produced an extraordinarily voluminous literature, published by both neurologists and gynecologists.'

Read before the Medical Society of City Hospital Alumni, June 5, 1902.

One of the main themes of the meeting of the American Medical Association in Denver, June, 1898, was a discussion of the relation of pelvic disease to nervous and mental affections. This discussion, however, did not result in an agreement. On the contrary, the conclusions as drawn by the speakers led to wide divergences. Three neurologists (Peterson, Dercum, Moyer') strictly denied any and every causal connection between disorders of the sexual organs and those of the nervous system, and the favorable effect of gynecological treatment in these cases; while three gynecologists (Dunn, Eastman, Humiston") emphasized that such a relationship exists. Windscheid," in 1897, in his well-known monograph, concedes that at least in some cases a neurosis may originate from the genitalia; but in his latest writings assumes an absolutely adverse position." At the same time we almost daily read of cases in which operations upon the genital organs have been performed by gynecologists for the most varied nervous and psychic ailments and with wonderful success, as they claim.

8

From this chaos what conclusions must be deduced?

I submit that it would be well, when endeavoring to estimate such questions, to abandon the onesided view-point characterized by looking at all ailments only from within the narrow field of vision of the respective specialist and consider one's own specialty the center of universal gravitation. As in most instances, truth is to be found well between the two extremes, rather demanding of us the considerate treatment not only of a diseased organ but of the diseased organism.

In the following statements I entirely omit all reference to psychoses, save hysteria, since I possess no psychiatric knowledge which would enable me to lay down an opinion bearing upon this problem. I desire merely to discuss how neurasthenia and hysteria are connected with gynecological affections. In my judgment this connection can be based upon the following three possibilities:

1. Either neurasthenia or hysteria may be primary affections and may already have been placed in evidence, when a local trouble sets in. The symptoms of the latter will exert a cumulative influence upon the manifestations of the primary neurosis. Therefore, gynecologic treatment may relieve the symptoms, but will not suffice to cure the patient.

2. A patient with a nervous predisposition. If now an