On

a water-bath at a temperature varying from 150° to 160° F., and the syringe, previously warmed, is charged with the paraffin, the quantity taken up being from 6 to 8 c.c. attempting injection, the paraffin, as it enters the needle, is apt to cool and become solid, and thus block the needle. This Dr. Downie prevents by having a coil of platinum wire wound round the needle, carrying an electric current the strength of which can, through a rheostat, be easily regulated, the wire in turn being surrounded by moist gauze, which ensures the more equable distribution of the heat. In making the injection, the skin is punctured by the needle, without any preliminary incision, near to the middle line, and the point of the needle is then pushed subcutaneously to the centre of the most depressed area.

The fluid paraffin is then slowly injected, care being taken during the injection to have the root and sides of the nose firmly compressed by the fingers of an assistant to prevent the escape of the molten paraffin beyond the confines of the nose into the loose surrounding cellular tissue. As soon as the paraffin enters the tissues it should be moulded by the surgeon's fingers. Before the needle is withdrawn, cold sterilised water is poured over the surface to prevent the escape of paraffin through the puncture opening, and to hasten the setting of the paraffin.

The quantity injected varies, but in all cases it should be just sufficient to remove the deformity. The introduction of a larger quantity calls for force in its introduction, which in turn increases the risk of the paraffin being forced in all directions while in a fluid state. Dr. Downie showed a case which had been operated upon south of the Border in illustraof the serious and painful results which may follow the injection of an excessive quantity.

The results shown by Dr. Downie were entirely satisfactory, the paraffin causing no irritation nor discomfort, but remaining inert and stationary. In the majority of his cases, both in private and in hospital, Dr. Downie was assisted by Dr. W. W. Christie, and the paraffin was prepared by Mr. John Neil, chemist, Charing Cross, Glasgow.

A question having been asked regarding the behaviour of the paraffin in the tissues when exposed to heat, and when the patient contracted any illness accompanied by a high temperature, Dr. Downie replied that he did not think the paraffin could be influenced in any way by exposure of the patient's face to excessive heat, either by radiation from a fire or in a hot climate. He had as yet no experience of the

effect of a high body temperature; but Gersuny reports that his first patient contracted typhoid fever thirteen months after injection-operation, with the result that, when his temperature rose to 105° F., the vaseline in the scrotum became soft, but again became firm when the high temperature subsided. The vaseline used in this case is said to have had a melting point of something below 104° F.

GLASGOW PATHOLOGICAL AND CLINICAL SOCIETY.

SESSION 1902-1903.

MEETING V.-9TH FEBRUARY, 1903.

The President, MR. A. E. MAYLARD, in the Chair.

I. EIGHT CASES OF RODENT ULCER UNDER RADIO-THERAPEUTIC

TREATMENT.

SHOWN BY DR. JAMES R. RIDDELL.

CASE I. Mrs. H., æt. 46 years. The ulcer was situated above the right orbit, near the outer angle. It was about the size of a shilling. It had been present for over a year. The symptoms were-(1) Occasional bleedings, (2) sometimes pain, and (3) often itching. It was treated with x-rays. The treatment was begun on 13th August, 1902. On an average, two exposures were made weekly, of ten minutes each, and by 11th November the ulcer was healed. Patient had twentyfour exposures. The total time was four hours and ten minutes. Patient ceased attending of her own accord.

CASE II.-R. W., æt. 70 years. The ulcer was situated on the right cheek, and measured about 2 inches by 1 inch. It began as a mole about twenty-five years ago, and has had various caustic applications during that time. There was never much pain, but bleeding and itching were prominent symptoms; these are now absent. The treatment was with x-rays. It was begun in March, 1902, and patient is still under treatment. One hundred and forty exposures have been made, amounting to thirty-four hours, the average time for each being fifteen minutes. After the first thirty-four applications the ulcer began to heal rapidly, but at the same

time ulcerations appeared inside the mouth at the angle of the lip and also at the level of the last molar tooth. These kept enlarging for some months, and then began getting less in size. Now they are each about the size of the tip of the little finger. The ulcer on the cheek has disappeared.

CASE III.-W. B., æt. 56 years. The ulcer is situated about the centre of the left cheek. It is about the size of a florin. It began ten years ago as a small blister, and has steadily increased in size. Treatment with x-rays began on 3rd May,

1902, and was continued almost daily till 10th November. Patient had one hundred and thirty-four exposures of about ten minutes each-in all, twenty-six and a half hours. Ulcer has disappeared.

CASE IV.-J. M'C., æt. 50 years. The ulcer is situated at the angle of nose and lip on left side. It has been present for four years. At its worst, it was about the size of a threepennypiece. There was a good deal of itching and pain occasionally. The case was first referred to the Electric Department of the

Royal Infirmary on 4th December, 1901. Just before that date the ulcer had been cauterised with chlorate of potash. After sixteen applications of fifteen minutes each of Finsen's treatment, it was covered with skin, and on 7th January, 1902, patient ceased attending, but the edges were still raised. Itching began again early in March, and by the middle of that month ulceration appeared. When I first saw the case on 25th March the ulcer was about half the size of a threepenny-piece. Finsen's treatment was begun on 25th March and continued till 8th May-time, four and a half hours in

twenty-five sittings. Although the itching and pain were relieved, the ulcer had increased slightly in size. On 8th May the treatment was changed to x-rays, and by the end of June the part was completely covered with skin, having had forty applications of ten minutes each. Still there was pain occasionally. Since then patient has had thirteen hours' exposure in seventy-eight sittings. Pain is now absent, the ulcer covered with skin, and the edges flat except at one. point about the size of a pin-head. For this, treatment is still continued.

CASE V.-Mrs. H., æt. 48 years. The ulcer is situated on the point of the nose. It is about the size of a threepennypiece, and very superficial. It has been present for about three and a half years. It bleeds readily. There is a little itching occasionally, but no pain. Finsen's treatment was begun on 20th May, 1902, and by 10th October one hundred and twenty applications of fifteen minutes each had been made. Under this treatment the ulcer had several times been almost healed, but broke down again each time. It was slightly sinaller, and itching and bleeding had disappeared. The total time of exposure had been thirty hours. The treatment was changed to x-rays on 11th October, 1902. Since then patient has had forty-six exposures of five ininutes and thirty-six of ten minutes—in all, ten hours. The ulcer is now covered with skin, and has almost disappeared.

CASE VI.-Mrs. S., æt. 51 years. The ulcer is situated on the lip on the right side close to the nose. It began as a red spot; then a scab formed. At the largest, it was about the size of a sixpenny-piece. Treatment by x-rays was begun in January, 1902, but the patient has not been able to attend regularly. At that time the ulcer had been present for about eight months. From January, 1902, till 17th January, 1903, patient has had thirty exposures of five minutes each and twenty exposures of ten minutes each, the fifty occupying almost eleven hours. On 17th January the treatment was changed to ultra-violet rays from the condenser spark lamp. Patient has had twelve exposures. The ulcer now is about half the original size.

CASE VII.-Mrs. M., æt. 63 years. The ulcer is situated on the forehead just over the right frontal eminence. It has been present about seven years. It began as a small wart,

and has been often treated with caustics and ointments. It was fully larger than a shilling, and was deep, the edges being thick and raised. Treatment by x-rays was begun on 18th November last, and up to 8th February there have been sixteen exposures, amounting to one hour and fifty-seven minutes. It is now all but healed.

CASE VIII.-Mrs. K., æt. 60 years. The ulcer is situated at the side of the nose. It began about twenty years ago as a small black mole on the cheek close to the eyelid. This was itchy, and was often rubbed till the top came off, leaving a discharging surface. It gradually increased in size till 4th