Case 32.-Mrs. A. T. K. This was a very bad case-very acute. The lungs and bowels were involved, and was compelled to cease treatment on account of fatigue from coming to the office. Case 33.-J. L. M. The whole of the left lung was involved, in which were located two cavities. At two different times he improved for three weeks, and then lost ground for some unaccountable reason. The result was a failure and it was doubtful No other whether it was due to an inherent idiosyncrasy of the patient or to a fault of technique used in the treatment. patient has reacted in the same way as this one. Case 34.-J. M. G. A very bad case; both lungs badly involved. Was obliged to discontinue the treatment, as he was not able to stand the trip to the office. Case 35.-E. A. Was treated for two weeks. There was no improvement, which, I think, was due to continued work and worry. Case 36.-J. L. E. Treated one month; gained 8 pounds; improved. Case 37-Mrs. E. P. Tuberculosis of lungs and bowels; extreme case; treated two weeks; bowels much improved, but had to move to outskirts of city, and it was impossible for her to get to the office and she soon died. Case 38.-T. B. F. six or seven weeks. Involvement of right apex slight; treated Returned to Alabama and is doing well. Case 39.-Miss E. P. Involvement of left apex; gained 10 pounds; feeling splendidly. Returned to work and now, after three months, is doing well. Case 40.-F. O. Right lung almost completely fibrosed and solidified. Upper half of left lung very badly involved; one large cavity in right apex, the smaller one near the base of the upper lobe. He gained 12 pounds; was dismissed from treatment; very much improved. Some time afterwards he contracted pneumonia from exposure at a fire close to his house on a cold night and died very suddenly. Case 41.-Mrs. E. M. Both lungs badly consolidated, the left the worst. Bowels so loose that patient was afraid to risk herself upon the street; she was afraid to eat anything on ac one count of diarrhea. The X-ray checked the bowels, and now, month after the last treatment, she has one to two movements from the bowels in twenty-four hours and eats almost anything she desires. She has gained about 15 pounds. I consider her condition much improved. Case 42.-J. I. Apex of left lung involved and pleura much thickened and painful at the base of same lung. Improved and doing well one month after treatment. Case 43-Mr. A. E. weight and improved. Case 44.-W. S. L. improved. Treatment one month; gained in Treated three weeks Improved Treated two weeks; gained 5 pounds; Case 46.-W. B. H. Left lung badly consolidated; small cavity in outer apex. Greatly improved. Case 47.-S. B. Very severe involvement. Case 48.-Mrs. G. Tuberculosis of the bowels relieved. To these cases can be added eight more who have been dismissed from treatment for from three to five years and are doing well, most of them weighing more than they have ever weighed. To briefly summarize my conclusions, I would say I think these cases demonstrate the undoubted value of X-ray in pulmonary tuberculosis; I do not wish to minimize the other agents employed, but do wish to accentuate the value of X-ray. There are in this report twenty-seven cases, Nos. 4, 8, 12, 13, 15, 16, 17, 18, 19, 20, 22, 23, 24, 26, 29, 30, 31, 32, 36, 37, 39, 40, 41, 42, 46, 47, 48, all in such advanced stages with large. amounts of lung tissues involved as would preclude all hope of recovery by ordinary methods of treatment, therefore I believe they owe their condition of well-being largely to the X-ray. Climate with the usual medicinal care had been tried. in all these cases in periods varying from six months to several years without success. The majority of the other patients noted in this report that have improved would likely have recovered in this climate with medical care without the X-ray. THE ASSOCIATION OF THE VARIOUS PHYSICAL (Continued from page BY PROFESSOR CARLO COLOMBO, M.T The considerations which are aprope uric-acid nature apply to all the oth of the neuro-arthrtic diathesis, gout turbances of the digestive appara various mucous membranes, inclu thenia, piles, hypertention of the factor in arterial sclerosis, etc., All these morbid states can fi cure in a complex treatment cure of the uric-acid diathe treatments directly effective tions. Thus there is reco heat and of massage by th to abdominal massage fc frequency current in ski disturbances of digestion, pneumatotherapy in bronch appropriate hydrotherapy and thenia, to the application loca tention treatments all of wh employed in a single institution in piles, and in general to au cian who prescribes them. dit of office care may be ing tation migh learn where to refer patients who Choice of Educational Format them and c 1 avan among them a stagger cause of the very diversity 0. interest, the general interni placed in a position analogous to starved to ass that dan's because it could make no cho e confronted app sources of nourishment. To 质 equally by gradua ied a list remedy this, the I' the ical ibrar b (Annotated arties in the served all the interest of the patient himself by initiating an Aanized electric treatment or by intrusting the charge to a specialist in electrotherapy. And in this last case the electrotherapeutic treatment will certainly be applied scientifically and regularly with the most perfect apparatus. Well, we ask here, is an electric treatment sufficient, though .it may be applied according to the most scientific of rules? Although the exclusive users of electrotherapy may wish to affirm it, yet we say in brief, no. No electrotherapeutist has ever been able to see to what point it is possible, so to speak, to regenerate a paralytic unless he has been able and willing to use other means besides electricity. If we analyze briefly the anatomical and functional permanent alterations which result from acute anterior poliomyelitis we shall see that they are reduced essentially to these four: (1) Paralysis, with signs of degeneration more or less extended, more or less advanced, of the motor nerves. (2) Disturbances of the circulation, especially venous stasis in the region of the nerves affected. (3) Disordered nutrition, atrophy of the bone and of the muscular masses depending on the paralyzed nerves. (4) Alteration in and around the joints, subsequent to the alteration of elasticity and of tension of the capsule, of the ligaments, and of the tendons, from which results respectively either excessive relaxation or stiffness of the joint. First, as the case stands we admit, nay, affirm, that electrotherapy under the form of cathodic galvanization, or, better yet, with that variety of sinusoidal current which has taken the name of undulatory or pulsating current, can be exercised upon the nerves, and the muscles which do not yet present the total inversion of the formula of galvanic excitability, with such a regenerative action as to not rarely restore them to their normal function. But experience teaches that electrotherapy does not succeed in any way in influencing the profound circulatory alteration, the trophic disorders which attack the bones and the muscles, and those other mechanical disturbances which burden the articulation. That the electrical stimulation of the muscles not yet paralyzed, does not exhaust before it increases the energy and the nutrition is so evident that it has no need of demonstration. The physician therefore ought to introduce other therapeutic |