fore determined upon heroic measures, and applied with a nail brush soapsuds, and continued to rub the part until I was satisfied. that I had it perfectly clean. I next irrigated the portion of brain which had been injured by spicule of bones driven into it with sterilized water at a temperature of one hundred and twenty degrees, and continued this irrigation for ten or fifteen minutes. After this irrigation, a light gauze pack was placed in the wound, both for the purpose of controlling some hemorrhage which still continued and also for drainage. Although my patient was profoundly shocked and continued in this condition for twenty-four hours, I had the satisfaction of seeing him make an uninterrupted recovery, without a drop of pus appearing at any dressing.

I recall another case which has recently come under my observation, and was kindly sent me by Dr. J. W. Maddin, Sr., who treated the case in conjunction with me. A young man, twenty-four years of age, of fairly good health, had received an injury on the back of his head (at the right side) by being struck with a large piece of iron. The fracture was a compound one, the dura mater being literally torn into shreds so that it could not be detected. At the seat of the wound some brain substance had escaped, and he lost a considerable amount more during the operation. The bones were elevated, and a large spicula was found to have passed about an inch and a half into the brain substance. Upon removing this spicula, quite an excessive hemorrhage occurred; and with a view of both arresting the hemorrhage and also to remove any cause for sepsis, the wound was irrigated with a normal hot saline solution, at a temperature of one hundred and twenty degrees. The patient stood the operation fairly well, and for fourteen days no suppuration was discovered, he being allowed to return home at that time, the only symptoms developing during this time being some hallucinations, which, however, passed away, the wound giving every promise of rapid healing. Four weeks after the operation a little pus was discovered coming from the bottom of the wound, and continued to discharge every now and then for a month and a half. Thinking after this time that this was probably due to diseased bone, with his consent I performed a second operation, when, to my surprise, instead of finding any trouble at the bone, I discovered a large abscess in the brain about an inch and a half long and three-quarters of an inch wide. This abscess was evacuated and drained, and the

patient is now on a fair road to recovery. I consider this case as one of secondary, and not primary, infection. I shall burden you with a report of only two other cases before drawing my conclusions. They are as follows: The first was an engineer on the N., C., & St. Louis Ry., who, while in the discharge of his duty, happened to place his head too far out of the cab window of the engine, and was struck in the forehead by a mail crane. After his injury, he continued his run from near Kingston Springs to this city. When he arrived, he walked from the depot to my office, and when questioned, stated that he believed that he had broken some bones of his head, but did not feel any bad effects from them. The patient was removed to the infirmary for treatment, and an examination revealed a compound fracture of the frontal bone above the orbit, which led into the frontal sinus; the dura mater was lacerated, but not punctured. After elevating these depressed bones, the wound was thoroughly irrigated with a normal saline solution at a temperature of one hundred and twenty degrees, and the frontal sinus. packed. Not a drop of pus was seen during any of the dressings, and the patient made an uneventful recovery.

My second case was brought to me by Dr. Goodwin, of West Nashville. He received an injury of the skull by being struck upon the left side of the head with a large lump of coal. He seemed to complain but little of his injury, and although the Doctor had detected a compound fracture of both bones of the skull, he was enabled to bring him on the street car from his home in West Nashville to my office, when he was afterwards removed to the infirmary. No symptoms of any character developed until the patient was being prepared for operation, when he was seized by several convulsions of an epileptiform character. The bones were elevated, the dura mater found intact with only a slight laceration, and a normal saline solution at a temperature of one hundred and twenty degrees was used to irrigate the wound. No symptoms of pus ever showed themselves, and the patient was enabled to be removed to his home on the twelfth day, the wound healing kindly, with a complete recovery.

From the above remarks, and also the cases cited, I draw the following conclusions:

First, that in all cases of injury to the vault of the cranium, and where suspicion of any kind would lead to a belief of fracture, or

where there is any doubt, it is the duty of every surgeon, even in cases where there is no external wound, to cut down and thoroughly investigate the seat of the injury. Should there be a small external wound, this should be enlarged and careful inspection made. If there is a fracture of the skull, whether lineal or otherwise, the operation of trephining should be performed at as early a date as possible.

Secondly, on account of the number of cases which have proved fatal from sepsis, I think a thorough irrigation with a normal saline solution should be used, this irrigation to continue from ten to twenty minutes, and where spiculæ of bone are driven into the brain tissue, this irrigation should be carried to the very bottom of such wounds.

And lastly, there should always be drainage, either by catgut, gauze, or tube; and should no pus present itself at the end of the third day, this drainage can be dispensed with. Should there be hemorrhage, it should be arrested, either by a normal saline solution at a temperature of one hundred and twenty degrees, or by a light gauze pack.

In the treatment of fractures at the base of the skull (as many of these fatalities occur from sepsis), I believe they can to some extent be prevented by a thorough irrigation with a warm normal saline solution, say at a temperature of from one hundred and fifteen to one hundred and twenty degrees. This irrigation should be placed either in the nasal cavity or the ear-the hemorrhage which occurs in such cases being at these points, where bacteria usually gain entrance. It has been my plan of treatment for some years, when I meet with such injuries, to irrigate as far into these cavities as I possibly can, and to continue this irrigation from ten to twenty minutes. After irrigating, a small gauze pack is inserted into the nasal cavity or ear, and a cotton pledget placed over this gauze, so as to keep infection from without. It is unnecessary to say that in all such cases strychnia should be administered for combating shock, and bromides with a view to place the brain as it were in a splint. The salt of bromide which I most frequently rely upon is the bromide of ammonium, as I have found better results in its administration. In some few cases I have been compelled to give opium. The form of this drug which I most rely upon, and which I believe give the least objections, is either hypodermic injection

of codeine or heroin. I place great stress upon the position of my patients, having those who have fractures at the anterior fossæ lie almost upon the abdomen, while those with fractures of the middle or posterior fossæ lie upon the ear from which the bleeding occurs. The irrigation in these cases should be done every two or three hours, and be conducted as gently as possible.

THE FINSEN LIGHT CURE.

BY H. JOHN STEWART, M.D., CHICAGO, ILL.

Having read and heard so much about the Finsen light treatment in the cure of disease, I decided in April of this year to make a personal investigation to see and learn for myself if it were true that such diseases as lupus and rodent ulcer could be cured by light. I visited several institutions where the Finsen lamp was in operation. In Manchester, England, in the Salford Skin Hospital, they had a Finsen Light Department under the supervision of Prof. Brooke, who informed me they were unable to treat half the sufferers who applied for treatment, and they had solicited by public subscription $125,000 for the erection of a new hospital for skin diseases, where they would be able to enlarge the "light department" so that at least two hundred people could be treated daily, as there were people on their waiting list whom they would be unable to treat with their present facilities for an indefinite time. Prof. Brooke was most enthusiastic over the wonderful results they were obtaining there.

I next visited the London General Hospital, of London, England, and found they were just completing an immense light department, that had been established by the present Queen of England, then Princess of Wales, in 1900, who presented the first lamp at that time, and as it was found to be far too inadequate, she had just given a second lamp, and Alfred Harmsworth had also given. $50,000 for the perpetual endowment of another Finsen lamp in this department, and they were then building a platform to receive. the king and queen, whom they expected to come June I to dedicate this new department. And even with these increased facilities, I was informed by Prof. Sequirey that there were patients on the waiting list who were unable to receive treatment.

I next visited the Light Institute at Copenhagen, and found that all the statements that had been made regarding it were not in the least exaggerated. I had the pleasure of meeting and studying under Prof. Finsen himself, and was extended every courtesy by him and his assistants at this institution. He seemed very much pleased to describe in the minutest detail the apparatus, treatment, etc., and gave me a detailed history of the lamp.

The Finsen light is a large specially constructed arc lamp of twenty thousand candle power, or twenty times stronger than an ordinary street lamp, and uses from sixty to eighty amperes of current. This lamp burns a specially made carbon, which can be procured only at Copenhagen. In the upper holder is a large carbon, while a smaller one is used in the bottom holder. When properly adjusted for arcing a maximum number of violet and ultra violet rays are produced. The advantage of the Finsen lamp over others, is in the greater number of violet rays produced. The Finsen lamp produces a much greater number of chemical rays than sunlight, as the atmosphere absorbs a large percentage of these rays. The light is so intense it is impossible to look at it with the naked eye, and it is necessary for all the attendants and patients to wear dense smoked glasses while the lamp is in operation. An aluminum hood about two feet wide surrounds the lamp, which hood is fringed on its lower border with a deep crimson-colored paper skirt to further aid in excluding the diffused light from the patients.

The concentrated rays are carried from the arc to the patients through four telescopic tubes, known as converging tubes, suspended at an angle of forty-five degrees, the tubes containing a series of rock crystal lenses so arranged that reservoirs for running water exist between them. By means of the water screen and rock crystal lenses, all rays but the violet are eliminated, and these rays are converged and concentrated, thus vastly increasing the healing and bactericidal effects.

The heat from the original arc is so intense that, to prevent cracking of the lenses and discomfort to the patients, a stream of cold water is kept constantly circulating through the reservoirs or

water screens.

To further concentrate and cool the rays, compressor is provided which consists of two rock crystal lenses so arranged that a chamber for running water exists between them. This part of the apparatus is used to compress the affected area and make it blood