facturers have lately taken to counting the stationary plates in the machines too. The case of lupus reported above was treated during this time and the lady with the bladder-cancer received part of her treatment from the statically excited tube. I am now using a Tesla coil; this gives an extremely powerful ray. The bones of the hand can be seen in the fluroscope at a distance of twenty feet from the tube, the light passing also through a pine door, covered with five coats of lead paint. A half dollar held against the fluoroscope can be seen at a distance of five feet from the tube, the head of a patient and one layer of sheet lead being interposed between the tube and the screen. I tried this the other day, using an exciting current of only seventy-five volts and my machine is made to take 110 volts if desired. The tubes I use are of the adjustable vacuum type; that is, the vacuum can be varied at will, thus increasing or decreasing the penetration of the rays.

There is an impression abroad that rays from the coil are more apt to cause burns than those from the static machine; other things being equal, I do not believe this to be so. I have a dermatitis of the left hand of some five years standing, and I believe it is better than it used to be, though I am using the rays more and more every day and I take no precautions to prevent dermatitis. The most that I have ever produced on the skin of a patient has been a slight erythema.

In the therapeutic application of the rays in cases of superficial disease I cover the unaffected parts with lead foil, so as not to expose them to the action of the rays; the tube is brought as close as possible to the skin; a moderately low vacuum is used, and the first exposures are five minutes in duration, this time I soon increase to ten minutes, and later, if the case and the texture of the patient's tissues seem to warrant it, I make the time fifteen minutes; with the last time-length I am apt to get a slight dermatitis, then the time is made a trifle shorter.

In treating internal growths I cover the body with a layer of lead foil, leaving an opening for the rays over the affected part; using a fairly high vacuum, I send the rays in for from five to fifteen minutes.

One of the earliest actions of the X-ray is the relief of pain. The length of the course of treatments varies, of course, according to the conditions present.

The treatment seems expensive to some, but it is little enough if it will cure any of the conditions for which it is being tried; I do not know of any operator who has made a cent on his

X-ray work so far; the cost of new tubes is so much as to eat up all the profits; sometimes a tube will last a month, and many times one will last fifteen minutes or less. The makers do not guarantee them. The supplying of tubes to a machine reminds me of feeding eggs to an elephant, and if the eggs cost $20 apiece, the similarity would be still greater.

In conclusion I will say that in the X-ray we undoubtedly have a valuable addition to our resources as physicians and surgeons, and that the outlook for its usefulness is very encouraging.

REPORT OF TWO UNUSUAL CASES OF MULTIPLE NEURITIS IN CHILDREN.*

By EDWARD DELEHANTY, M.D.,
Denver, Colorado.

During the past few months I have had an opportunity of studying two cases of multiple neuritis in children, in which the disease not only affected the distal extremities but involved the nerves supplying the muscles of respiration. Very little has been written on this unusual complication, as the disease itself is rare in children and the complication seldom seen, but you will observe from the following cases that these conditions do exist, and when present an extremely guarded prognosis should be given.

The first case is that of a boy ten years old with a good family history except extreme excitability on part of mother. Barring some of the diseases of childhood, the boy had always been well until October, 1900, when he suffered a mild attack of typhoid fever, from which he recovered in about twenty-one days. He was sent to school, but in two weeks began to have involuntary and irregular movements in the muscles of his arms and legs, and in the course of a few days had a well developed case of chorea.

He received the usual treatment for this disease, including absolute rest in bed, and it was three weeks before the twitching was entirely controlled; in the meantime he had developed mitral regurgitation of the heart.

One month after the beginning of the chorea the patient suffered a violent hemorrhage from the nose, and being already

Read before the Rocky Mountain Inter-State Medical Association, Denver, Colorado, September 3 and 4, 1901.

anæmic from the effects of the disease he became almost exsanguinated.

Two weeks later he began to complain of pains in his feet and hands; burning, tingling sensations with feeling of pins and needles were experienced and the weakness in the extremities became pronounced. These subjective symptoms of gradual onset, with wrist drop and foot drop, with anesthesia of the fingers and toes, with wasting of the extensors of the lower legs and arms, with reaction of degeneration, presented a typical clinical picture of multiple neuritis.

These conditions remained about the same for several weeks, when it was noticed that the patient had considerable difficulty in relieving mucus from his bronchial tubes, and his breathing became rapid and superficial. This was thought to be due to his extreme general weakness, but on closer examination it was found that the muscles of his chest moved very slightly during the act of respiration, and in the course of forty-eight hours his breathing became distressed and entirely diaphragmatic.

Dr. Eskridge saw him in this condition and gave it as his opinion that the neuritis had involved the nerves supplying the muscles of respiration, particularly those of the thorax, and that there was little hope of recovery.

The prognosis proved to be correct, for on the following morning the patient died very suddenly while being raised from his pillow to take nourishment.

The immediate cause of death was no doubt due to heart failure, but whether this was due to a neuritis of the pneumogastric nerve or to a degeneration of the heart muscle itself is hard to determine, but I would incline to the former, as the heart had been rapid and at times irregular, prominent symptoms of vagus affections.

The question might be asked, "Could not this have been a case of poliomyelitis, which is the common form of paralysis in children when not preceded by diphtheria and for which it is so often mistaken ?"

In this case the palsy and wasting came on gradually and were symmetrical, the arms and legs being affected the same, while in poliomyelitis they are characteristically irregular in their distribution and are marked by an onset more or less acute.

There was anesthesia of the fingers and toes, a symptom which, according to all authorities, is never present in poliomyelitis unless there is a neuritis associated with it.

Several cases have been reported of multiple neuritis in children following the long continued administration of large doses of arsenic for chorea, and I have seen two cases in adults caused by a single toxic dose.

This patient had received 15 minims of Fowler's solution. three times daily, but as it was continued at no time for longer than ten days in succession, I feel that that cause can be safely excluded.

The next case is that of a boy nine years old, an inmate of the State Home for Dependent Children. There was a history of tuberculosis on the mother's side and one sister died of spinal meningitis. Otherwise his family history was negative. The boy had always been in good health except an occasional attack of tonsillitis. Last June he suffered a severe attack of t diphtheria, for which he was confined in the Steele Memorial Hospital for a month. He made a good recovery and was sent home, but soon began to have double vision and at times regurgitated liquids through his nose. Three weeks later he began to complain of numb, tingling sensations in feet and hands, accompanied by their gradual increasing weakness, on account of which he was obliged to go to bed.

Dr. Pershing, who saw him at the State Home, recognized the condition as multiple neuritis, had him transferred to the County Hospital, where he came under my care August 6, 1901.

On examination I found the patient anæmic and too weak to stand without support. There was considerable wasting in the extensor muscles of the fore-arm with consequent wrist drop. There was no appreciable wasting of peronei groups, but considerable weakness and a tendency to foot drop. There was no loss of tactile sense except on extreme ends of fingers.

The superficial reflexes, including the lower abdominal and epigastric, were absent. Knee jerks were abolished; no affection of bladder or bowels. Hearing was normal in both ears and tongue protruded in median line.

There was paralysis of the soft palate on the right side, which explains the regurgitation of liquid through the nose only at times. The pupils were dilated but equal in size. They reacted sluggishly to light but not to accommodation.

The fields of vision were normal, but there was convergent strabismus, due to a paralysis of the external rectus of right eye. Ophthalmoscopic examination revealed no change in the optic

His breathing on entering hospital was natural, but in a few days it became superficial and he experienced much difficulty in relieving mucus from his trachea and bronchial tubes, having no power in chest muscles to aid in coughing.

Several times he became cyanotic and was relieved by the timely action of the house physician in inverting the patient and allowing the mucus to escape.

The chest movements became less perceptible and breathing was almost entirely diaphragmatic.

As his death came suddenly and unwitnessed it is unknown whether the patient died of cardiac failure or strangulation. Dr. Levy had made a laryngoscopic examiantion of his throat and found no affection except a paralysis of the right side only of soft palate, a very unusual condition even after diphtheria.

The palsy and wasting of the extremities in this case, following as it did diphtheria and associated with neuritis of other nerves, evidenced by paralysis of the palate and external rectus of right eye, would prove their neuritic nature.

Unfortunately in both of these cases I had in the beginning given a rather favorable prognosis, and especially the latter, knowing that a great majority of cases with diphtheritic paralysis recover even without treatment.

Hereafter the complication which proved so quickly fatal

in these cases shall be kept in mind.

A FEW PRACTICAL SUGGESTIONS.

By D. W. TOWNS, M.D.,

Fond du Lac, Wisconsin.

In the treatment of epilepsy, there is one point on which I am accustomed to insist and to place emphasis, and to which I desire to call particular attention as being of the greatest practical importance. In nine cases out of every ten-and inferentially in the tenth case-the epileptic himself, or his friends, or both, express fear or dread of the mental faculties becoming impaired. Now it is an item in the prognosis which is of prime value, as we all know; but, instead of humoring it, I make it my initial act to disabuse the parties concerned of that one idea. It makes no difference to the patient as to the caliber of my own mental reservations in the matter, and in the most deliberate