Among the Journals.

RADIUM AND ITS THERAPEUTIC POSSIBILITIES.

Radium produces effects upon the tissues closely analogous to, if not identical with. those produced by x-rays. The indications, accordingly, for its therapeutic uses are along the same lines as those for x-rays, viz.: in certain inflammatory diseases of the skin, like eczema, psoriasis, lupus erythematosus, and lichen planus; in certain bacterial diseases of the skin, like acne, sycosis, lupus vulgaris, and blastomycosis; in certain diseases where destruction of tissues of low resistance is desired, as inlupus vulgaris, carcinoma, and carsoma.

These are exactly the indications for the therapeutic use of x-rays, and future experience alone can determine which of the two agents will prove of the greater practical value in meeting these indications. In some respects the writer believes radium will prove superior; in the far greater number x-rays will have the larger field of usefulness. In the treatment of lupus and cutaneous carinoma there is sufficient experience to give a fairly accurate technique in the use of radium. For its use in affections other than those which are sharply circumscribed to small areas the technique has not yet been developed.

It is probable that Becquerel rays will be efficient only to a very limited depth. This conclusion is based, first, on the fact that the greatest effect on the tissues is produced by the x-rays, which have a relatively slight penetration, and, second, on the studies made by Halkin on the effect of radium on tissues. On account of lack of depth of effect it is not likely that radium will be as effective as x-rays against lesions of more than half an inch in thickness or subcutaneous in situation. Becquerel rays have theoretical advantages over x-rays in the accuracy of dosage which will be possible after experience has been obtained in their use. They also have advantage in their ease of application at inaccessible points. They have a disadvantage in the relatively small quantity of energy available, and in the limitation accordingly of any single efficient exposure to a very small area.

It is highly improbable that the use of radium is going to be of epoch-making importance in therapeutics. It supplements and it may add materially to the methods now at command for using actinic radiant energy in therapeutics. If it becomes less expensive and obtainable in relatively larger quantities, it may supplant to a limited extent the use of x-rays and ultraviolet light although it is not probable. At the present time it is not an entire substitute for either of

them, and is to a very great degree less efficient than x-rays in its general therapeutic usefulness.-W. A. Pusey (Journal of the Ameri can Medical Association, July 16, 1904).

PERSPIRATION.

Holescher reports experiments on human perspiration under the influence of drugs and in certain pathological conditions. After a thorough cleansing he enveloped his patients in a sterile gauze, and over this secured an oil cloth. The subject was then subjected to dry heat, not over 120° F., for one or two hours. When point of tolerance had been reached, the soaked gauze was quickly removed and subjected to pressure, the sweat collected ranging in amounts from 3 to 32 ounces. He offers the following conclusions from his experiments:

1. The hot air causes an aseptic fever or thermic fever, despite the antipyretic action of certain drugs. He could not understand why the antipyretics could not reduce the fever.

Acetanilid has no effect on the normal temperature in healthy persons and acts only in fever. It generally lessens the pulse-rate, decreases heat production and sometimes increases arterial tension.

2. The hot-air bath is of decided value in acute and chronic uræmia, shown by the fact that the perspiration contains a considerable excess of urea and nitrogen. He does not recommend it to the exclusion of all other remedies, but only as an adjuvant. The secondary effect on nutrition should not be forgotten.

3. In articular rheumatism the hot air seems to give beneficial results.

4.

Certain types of myocarditis seem to be benefited also (a case is reported).

5. Pilocarpin should never be used without the aid of hot applications to the body. So applied, there is far more sweating than otherwise.

6. Three cases of catarrhal jaundice were sweated; all tests failed to show bile pigments, only the epithelial debris showing bile pigments.

7. Modern sugar tests failed to reveal the presence of sugar in the sweat of diabetics.

8. A case of chronic constipation and indicanuria did not disclose the presence of indol and skatol in the sweat.

9. As regards the function of eliminating normal and abnormal substances, the skin is not to be compared with the kidney,

10. Free sweating seems to favorably affect psoriasis, though further study is required as to its further effect in skin diseases.

11. Lastly, 1000 c.c. of sweat contains about 11.5 gms. solids (nearly 3 drachms), one-half inorganic and one-half organic, and about 6 gms. (9 grs.) of urea and .47 gms. (8 grs.) of nitrogen.New York Medical Journal, February 13, 1904.

SURGICAL HINTS.

Thick glue placed on a camel's hair brush, and then left for a few hours in contact with a foreign body in the ear, will often enable you to remove it quite easily.

In fractures and dislocations, one of the advantages of early passive motion is that it can be exerted much more gently than at a later date, when the stiffness has increased.

High rectal injections of normal salt solution are the best means of combating excessive thirst after abdominal operations. Washing out the stomach just before the patient awakens from anesthesia has a happy effect in preventing, to a great extent, the nausea following ether.

Small abdominal incisions are of advantage whenever not too small to permit the operation to be easily done, but it must be remembered that, in the presence of inflammatory conditions, the incision. should never be so small that it will not admit at least the entire hand for purposes of exploration.

In operations on the gall-bladder, it is well to remember that jaundice, particularly when it has lasted a long time, is attended with an increased tendency to hemorrhage. In this class of operations we must always remember that the bile is presumably infected, and that it must be kept away from the general peritoneal cavity and its con

tents.

In surgery it is always important to beware of oft-repeated efforts. Never try too often to catheterize a distended bladder if you don't succeed soon. It is better to tap. Never try too long to reduce a strangulated hernia. It is better to cut. Never try too often to intubate a child; if you are not very familiar with the operation it is better to tracheotomize.

How long shall we wash our hands before operating? The only answer to this is that we can never wash them long enough, since there is evidence that we have no means of entirely sterilizing them. Rubber gloves form the only logical remedy, and should be always used

unless there is good reason to avoid them, either because the operator cannot as easily feel tissues and handle needles with them, or because the surgeon is so careful of his hands that he has a legitimate belief that they are as nearly sterile as possible.-Exchange.

RADIUM ABANDONED-DISSAPPOINTING RESULTS AT THE CANCER HOSPITAL, LONDON, ENGLAND.

The radium treatment has now been entirely abandoned at the Cancer Hospital. It was never viewed with much hope there, and a few days ago the last experiments with it were abandoned.

Trials were made at the end with a case containing five grains, covered only with mica-sheeting, probably the largest morsel in any hospital in Europe, and the effect was always the same, though it might vary in degree. The surface of the skin became inflamed, a blister formed and dried up, and that was all.

Sixteen cases have been under treatment, the longest period of a single application having been three hours, and the longest total time of application having been about twenty-five hours; and the only favorable result has been an occasional cessation of pain. On the other hand, several patients have complained of an increase of pain.

The authorities of the Cancer Hospital are now devoting all their money and time to improving the high frequency treatment, especially as regards the enormous waste of electrical power which distinguishes the present use of the Roentgen rays. A current of 200 volts is to be transformed into a fifty-volt current, and this again reduced without wastage to a twenty-five-volt current, the latter being the pressure used in the present application of the rays.

For cases of internal cancer experiments are being made with certain new lamps which can be inserted into a cooling tube containing water and then introduced into the body. Both these and the new electrical machinery will, however, require some weeks to perfect.

ILLUMINATING GAS POISONING.

The author draws the following conclusions from a study of comatose cases of illuminating gas poisoning:

Leucocytosis is both high and persistent, rising in many cases above 18,000, and in a few fatal cases as high as 50,000. A differential leucocyte count shows preponderance of the polymorphonuc

lear cells. A high degree of leucocytosis is a very unfavorable prog

nostic symptom.

Elevation of temperature is observed in nearly all cases. The fever is usually moderate and of very irregular type. In many cases. a subnormal temperature precedes the elevation, and it is often observed also in convalescence. The pulse is disproportionately rapid, as compared with the temperature.

The nervous symptoms are both varied and inconstant. Convulsions occur in about 7 per cent of all cases and muscular rigidity in a slightly larger proportion. The reflexes and pupil symptoms show great variability. The coma bears no definite relation to the intensity or duration of the fever. Coma lasting four or five days is not invariably fatal. In the series of ninety comatose cases only seventeen cases, or 18.8 per cent, were fatal.

The results of combined phlebotomy and saline infusion justify the prompt and thorough employment of these measures.

Pneumonia is an infrequent complication, and in a large percentage of fatal cases the cause of death may be referred to cerebral lesions, such as congestion of the meninges and brain substance, hæmorrhage of the cerebral capillaries, or hæmorrhage into and softening of the internal capsule, lenticular nucleus, and adjacent structures.W. Gilman Thompson (Medical Record, July 9, 1904).

LEUCOCYTE COUNT, DIFFERENTIAL, AS AN AID TO THE
DIAGNOSIS OF FEVERS.

It is not so much the absolute increased percentage of large lymphocytes which is diagnostic of malarial infection as the relative increase over the small lymphocytes. In cases of malarial infection without much fever and without quinine history, the polynuclears are markedly diminished and the large lymphocytes very much increased in proportion. In the absence of an adenopathy, possibly also of influenza and measles, the above finding is positive evidence of present or very recent malarial infection. During the rise of a malarial fever, or as aresult of quinine therapy, the polynuclear leucocytes may reach 80 per cent, but in that event the large lymphocytes exceed in number the small ones. In malarial hæmoglobinuria any of the various blood-findings characteristic of malarial fever may be present in any stage, and there is no evidence now at hand to explain this. Malarial and typhoid fevers can be more positively differentiated from fevers of sepsis, pneumonia, rheumatism, malignant tumors, etc...