Paul E. Malmstrom, M.D. University of Lund, Sweden, 1890, died at his home in Kenosha, Wis., September 13, from heart disease. James K. Griffin, M.D. Columbus (Ohio) Medical College, 1878, died suddenly at his home in Fitzgerald, Ga., September 7. Frank M. Reasner, M.D. Cleveland Medical College, 1865, died at his home in Los Angeles, Cal., September 11, aged about 70. Francis X. Spranger, M.D. Ohio, 1864, died suddenly at his home in San Jose, Cal., from apoplexy, September 3, aged 61 Thomas E. Morris, M.D. McGill University, Montreal, 1899, died at his home in St. John, N. B., September 8, aged 30. Willis Duff Green, M.D. Medical College of Ohio, Cincinnati, 1844, died recently at his home in Mount Vernon, Ill. Albert M. Loop, M.D., a member of the Medical Society of the State of Pennsylvania, died recently at Nelson, Pa. John T. Smith, M.D., died at his home in Cedar Rapids, Iowa, September 2, after an invalidism of ten years. W. E. McBryde, M.D., died at his home in Colmesneil, Texas, September 3, from congestion of the brain. William H. Colvin, M.D. Illinois, 1896, died at his home in Chicago, July 6, from pneumonia, aged 34. John H. Stork, M.D. Kentucky School of Medicine, 1888, died at his home in Stendal, Ind., September 6. Albert D. Moxley, M.D. New York, 1877, died suddenly at his home in Jefferson, N. Y., August 1. A. S. Hayhurst, M.D. Indiana, 1887, died recently at his home in Evansville, Ind., after a long illness. Thomas S. Lackey, M.D., 1849, died at his home in Mayfield, Ky., September 12, aged 82. James A. Taylor, M.D., died at his home in Wayne, W. Va., September 6. RADIOTHERAPY, PHOTOTHERAPY AND HIGH FREQUENCY CURRENTS. The Medical and Surgical Applications of Radiology in Diagnosis and Treatment. By Charles Warren Allen, M.D., Professor of Dermatology in the New York Post-Graduate Medical School. With 131 Engravings and 27 Plates. Cloth. Pp. 618. Price, $4.50 net. Philadelphia and New York: Lea Brothers & Co. The rapidly growing literature on the medical uses of the various forms of radiant force, some of which we have but recently become acquainted with, receives here important additions. Freund's work must be regarded as authoritative and fundamental, especially in so far as concerns the essential scientific principles of radiology. The introductory chapters on physics are more exhaustive than in the other books on radiotherapy. The technic of the practical application of these forces is also comprehensively described. A fully illustrated supplement contains adequate descriptions of the various instruments necessary for using high-frequency currents, x-rays, heat and light rays. The index is full and a complete list of the authors quoted, and the page where each may be found, together with the corresponding references, is given. The indications for and results to be expected from the various radiotherapeutic measures are discussed on the basis of the existing literature, but we miss any statements concerning the diagnostic value of x-rays. We believe we may safely recommend this book to any one who desires to know the fundamental physical laws underlying radiotherapy, as well as its practical application. It should be remembered that Freund is the man to whom we owe more than to any other the introduction of the Roentgen ray in therapy. The work gives every impression of having a commensurate basis of personal theoretical and practical work on the part of the author. Dr. Allen's book deals with the x-ray, light and highfrequency currents. Here the therapeutic and diagnostic aspects are given predominance, the nature of and laws gov erning the forces employed, receiving comparatively little attention. It has seemed to the reviewer that there is an unnecessary diffuseness in some of the parts dealing with the therapeutic results of the x-ray. Surely much of the information here given in regard to the individual cases cited might well have been condensed into smaller space. Both the works are adequately illustrated, Freund's especially from the side of physics and instrumentation, Allen's from the clinical. The suggestion may be allowed that the field for the works of the kind represented by these two books is now well covered by these and other recent publications; it would, therefore, be better if as much energy and attention as possible were given to investigation of the many and important problems of theoretical and fundamental nature that are arising as a result of the introduction of the physical forces considered into medicine. A REFERENCE HANDBOOK OF THE MEDICAL SCIENCES, Embracing the Entire Range of Scientific and Practical Medicine and Allied Science. By Various Writers. A New Edition, Completely Revised and Rewritten. Edited by Albert H. Buck. M.D., New York City. Volume VIII Illustrated by Chromolithographs and 435 Half-ton> end Wood Engravings. Cloth. I'p. 784. Price, $7.00 per volume. New York: Wm. Wood & Co. 1904. This volume completes this issue of the Reference Hand books. Included in this volume is an appendix which contains articles that from one cause or another were omitted from their regular position in the alphabetical order. A most complete index occupying nearly two hundred pages, three columns to a page, closes the work. This index will be found of great value, as it makes reference to any particular subject easy. In the ordinary works arranged alphabetically as is this one, it is not common to go to the expense and trouble of getting out a detailed index. as has been done here, but, if not necessary, it is certainly very convenient. In our notices of the volumes as they came out, we have repeatedly spoken of the excellent manner in which the subjects were covered. We have also called attention to the fact that while the handbook is published as a revised edition of a work which came out some twenty years ago, it is in reality a new book. A few articles appear unaltered, a few others are modified but slightly from those appearing in the former edition, but the great bulk have been entirely rewritten, and many subjects appear that were not treated in the former edition. The work is a complete encyclopedia of modern medicine, for so far as we are able to discover, nothing that belongs to such a work is omitted. As a rule, the topics are considered in an exhaustive manner, and if published in individual books not a few of the articles would be accepted as complete monographs on the subjects treated. The editor is to be congratulated on the good judgment displayed in allotting the amount of space to be given to a given subject, not an easy matter when the whole field of medicine had to be cov ered. He is to be especially congratulated on his selection of the writers for the different subjects. In nearly every in stance the one selected is an authority on the subject on which he writes, thus guaranteeing reliability. The publishers are to be congratulated on their liberality in illustrating the work and on presenting it in such a satisfactory manner, from a mechanical and typographical point of view. This Reference Handbook is a library of itself; at least, it makes a good foundation for a complete library. ADENOIDS. By Wyatt Wingrave. M.D., Physician and Pathologist. Central London Throat and Ear Hospital. Cloth. Pp. 128. Price, $1.00 net. Chicago: W. T. Keener & Co. 1904. In this little book of 194 pages are discussed clearly the various phases of nasopharyngeal adenoids, a subject in which the medical profession has taken an increasing interest, since the attention was definitely directed thereto by Meyer in 1868. Adenoids are described thoroughly from the anatomic, etiologic, and clinical points of view. The operative treatment is given with adequate detail, and a special chapter by Holten George deals with the subject of anesthetics. We can recommend the book to the general practitioner as a trustworthy guide to a thorough understanding of the subject with which it deals. Miscellany. A Charity Patient. A French exchange relates as an anecdote that a woman was given $600 by her husband to pay the expenses of an operation which her physician had declared necessary. She disguised herself as a poor woman and applied to the free public hospital, giving a false address, after having hired the persons at the address given to testify in her favor if questions were asked. She then bought a jewel with the $600 which should have paid for her operation. Growth of Bacteria in Salt Solutions.-F. Lewandowsky of Strasburg tested a micrococcus and a mesentericus from a vegetable and reports that a 25 per cent. solution of table salt inhibited the growth of the bacteria. On the other hand, they continued to grow apparently unaffected in saturated solutions of potassium nitrate. In a communication to the Archiv f. Hygiene, xlix, No. 1, 1904, he ascribes this difference in the action of the solutions to the comparative insolubility of the nitrate and the difference in the molecular concentration and of the specific ions in the two solutions. Intoxication from Unripe Tomatoes. A French physician reports in the Lyon Méd., August 21, some cases of illness traced to the eating of tomatoes not perfectly ripe. The discovery of fragments of the tomatoes was the only hint as to the cause of the trouble in the first case. The dilatation of the pupils in all the sick members of the family was a noticeable symptom. As the tomato belongs to the same family as the potato, the intoxication may have been like the solanum poisoning sometimes observed after ingestion of unripe or spoiled potatoes. Recovery was rapid after emptying the stomach. Automatic Compressive Dressings.--The Gazette Méd. de Paris for August 27 contains an illustrated article by P. Mantel of Saint-Omer describing his method of applying a dressing to obtain automatic compression of the parts without straps of any kind. It is shown applied to the head and to the stump after an amputation. The gauze or cotton are applied as usual. Then four or mole rather wide strips of gauze are placed flat on the vertex or the bottom of the stump, crossing them at right angles to each other. An assistant pulls on the ends of these strips, and another longer strip of gauze is wound around over them from the periphery toward the center. When this is all in place the loose ends of the crossed strips are brought down over the wound bandage and fastened together flat below. A dressing thus applied to the head does not require any further support, but exerts great pressure on the top of the skull, without the necessity for any straps under the chin or elsewhere. The Public Service. Army Changes. Memorandum of changes of station and duties of medical officers, U. S. Army, week ending Sept. 17, 1904 · Field, Peter C., asst.-surgeon, granted thirty days' leave of ab sence. Bratton, Thos. S.. asst. surgeon, relieved from duty at Fort Sam Houston, Texas, and ordered to Chicago for duty as attending surgeon and examiner of recruits. Purviance. Wm. E., surgeon, relieved from duty as attending surgeon and examiner of recruits, Chicago, and ordered to Manila, I. .. for duty. The following named asst.-surgeons are relieved from duty at posts designated after their names, and will report on Oct. 1. 1904. to Col. Charles L. Heizmann. asst.-surgeon general, president of the faculty, Army Medical School, Army Medical Museum Building, Washington. D. C., for a course of instruction at school: Davis. Wm. R., San Francisco: Owen, Leartus J., Fort Myer, Va.; Zinke, Stanley G., Fort Riley. Kan.; Culler, Robert M.. Fort Jay, N. Y.; Weed. Frank W., Fort McHenry, Md.; Wickline, Wm. A.. Fort Ethan Allen, Vt.: Brown. Henry L., Columbus Barracks, Ohio; Baily, Howard H., Plattsburg Barracks. N. Y.; Humphreys, Harry G., Fort Totten. N. Y.; Freeman. Paul L.. Fort Slocum. N. Y. Roberts. Wm. M., asst.-surgeon, granted twenty-one days' leave of absence. Tefft. Wm. H., asst.-surgeon, left Fort Snelling, Minn., for duty at Camp Lakeview, Minn. Barney, Chas. N.. asst.-surgeon, left from duty at Gainesville, Va.. on twenty days' leave of absence. Thornburgh. R. M., asst. surgeon. reports at U. S. Army General Hospital. Washington Barracks, D. C., for temporary duty, from Manassas, Va. Rockhill, E. P., asst.-surgeon, order for temporary duty at Fort Miley, Cal., revoked. Chase, A. M., contract surgeon, reports his return to Fort Reno, Okla., from three months' leave of absence. Burr, R. T., contract surgeon, granted leave of absence for three months. Bailey, Edward B., contract surgeon, granted leave of absence for one month. Griswold, W. Church, contract surgeon, granted leave of absence for one month. Jones, John F., contract surgeon, granted fifteen days' leave of absence. Marshall, John S., supervising and examining contract dental surgeon, leave of absence extended ten days. Treuholtz, C. A., contract surgeon, granted leave of absence for two months. Shellenberger, James E., contract surgeon, granted leave of ab sence for one month and fifteen days. Navy Changes. Changes in the medical corps, U. S. Navy. for the week ending Sept. 17, 1904: Green, F. H.. medical inspector, ordered to the Navy Yard, New York, October 1. Bertolette, D. N., medical inspector, detached from duty as a member of the naval retiring board and of the naval and medical examining boards, Washington, D. C., and ordered to resume other duties. Price, A. F., medical director, detached from the Navy Yard. New York, October 1, and ordered to duty as a member of the Naval retiring board, Washington, D. C. Breck, F. W., pharmacist, ordered to the Naval Hospital, New 1ork. Marine-Hospital Service. List of changes of station and duties of commissioned and noncommissioned officers of the Public Health and Marine-Hospital Service, for the seven days ended Sept. 14, 1904: Purviance. George, asst. surgeon general. granted extension of leave of absence for one month from Sept. 1, 1904, on account of sickness. Vaughan, G. T., asst.-surgeon general, detailed to represent the service at meeting of the Association of Military Surgeons, to be held at St. Louis, Oct. 10-15, 1904. Peckham, C. T., surgeon, granted leave of absence for one month from October 8. Wertenbaker, C. P., surgeon, detailed to represent the service at the meeting of the Association of Military Surgeons, to be held at St. Louis, Mo.. Oct. 10-15. 1904. Wickes, H. W., P. A. surgeon, directed to proceed to Wilmington. Del., for special temporary duty. Parker, H. B., P. A. surgeon, granted leave of absence for one month from October 1. Robertson, H. McG., asst.-surgeon, temporarily relieved from duty at Stapleton, N. Y.. and directed to proceed to Washington, D. C.. and report at the Bureau for temporary duty. Rucker, W. C.. asst.-surgeon, granted leave of absence for fourthree days from September 8. Goldsborough, B. W., A. A. surgeon, granted leave of absence for three days from September 8. Horsey, J. L., A. A. surgeon, granted leave of absence for fourteen days from September 10. Mason, W. C., A. A. surgeon, granted leave of absence for five days from September 19. Stevenson, J. W.. A. A. surgeon, granted leave of absence for seven days from September 3. 1904, on account of sickness. Tuttle, Jay, A. A. surgeon, granted leave of absence for seven days from September 12, Goodman. F. S., pharmacist, granted leave of absence for three days from Sept. 3. 1904, under Paragraph 210 of the Regulations. Scott, E. B., pharmacist, granted leave of absence for twenty-five days from September 19. Slough. Chas.. pharmacist, Department letter of Aug. 3, 1904. granting leave of absence for thirty days from August 10, amended to read nine days from August 17. Great Britain and Ireland: Aug. 20-27, Dublin, 1 case; Leeds, 1 case: Newcastle-on-Tyne, 7 cases; Nottingham, 2 cases; West Hartlepool, 2 cases. India: Bombay, Aug. 9-16, 1 death. Italy: Palermo, Aug. 20-27, 14 cases, 8 deaths. Mexico City of Mexico, Aug. 21-28, 1 case, 4 deaths. Russia Moscow, Aug. 6-20. 15 cases, 2 deaths; St. Petersburg, Aug. 13-20, 1 case, 4 deaths; Warsaw. July 31-Aug. 6, 22 deaths. Turkey Alexandretta, Aug. 13-20, 3 deaths. YELLOW FEVER. Ecuador: Guayaquil, Aug. 8-15, 1 death. Mexico: Aug. 27-Sept. 3, Coatzacoalcos, 4 cases, 1 death; Vera Cruz, 14 cases. CHOLERA. India: Bombay, Aug. 9-16, 33 deaths; Calcutta, Aug. 6-13, 4 deaths. PLAGUE. Africa: Cape Colony, July 23-30, 2 cases. India: Bombay, Aug. 9-16, 44 deaths; Calcutta, Aug. 6-13, 3 leaths: Karachi, Aug. 7-14, 3 cases, 2 deaths. Mauritius: June 17-July 7, 6 cases, 5 deaths. Peru: Callao, Aug. 13, 1 case; Aug. 17. Colan, reported; La Sullana, reported: Sechura, reported: July 31-Aug. 6, Lima, 11 cases, 5 deaths: Salaverry, 2 cases, 1 death; Payta, 4 cases, 2 deaths. Society Proceedings. COMING MEETINGS. AMERICAN MEDICAL ASSOCIATION, Portland, Ore., July 11-14, 1905. Medical Society of the State of Pennsylvania, Pittsburg, September 27-29. Colorado State Medical Society, Denver, October 4-6. Tri-State Medical Society of Alabama, Georgia and Tennessee, Chattanooga, October 12-14. Assn. of Military Surgeons of the U. S., St. Louis, October 10-15. AMERICAN ASSOCIATION OF OBSTETRICIANS AND Seventeenth Annual Meeting, held at St. Louis, Under the presidency of Dr. Walter B. Dorsett, St. Louis. Addresses of welcome were delivered on behalf of the St. Louis Obstetrical and Gynecological Society by Dr. Louis E. Newman, and on behalf of the city and the exposition by David R. Francis, president of the Louisiana Purchase Exposition. The responses to these addresses of welcome were made by Dr. L. H. Dunning, Indianapolis, and Dr. Herman E. Hayd, Buffalo, N. Y. The meeting was very well attended. The papers were of a high scientific character and the discussions on them full and spirited. The association held only one session a day, in the morning, thus giving the members and their guests an opportunity to visit the exposition in the afternoons and evenings. Officers for the Ensuing Year. The following officers were elected for the ensuing year: President, Dr. H. W. Longyear, Detroit; vice-presidents, Dr. D. Tod Gilliam, Columbus, Ohio, and Dr. John Young Brown, St. Louis; secretary, Dr. William Warren Potter, Buffalo, N. Y. (re-elected); treasurer, Dr. X. O. Werder, Pittsburg (reelected). The association will meet in New York City in 1905. (To be continued.) AMERICAN ROENTGEN RAY SOCIETY. The President, Dr. James B. Bullitt, in the Chair. The following officers were elected: President, Charles Lester Leonard, Philadelphia; vice-presidents, Weston A. Price, Cleveland; Henry Hulst, Grand Rapids, Mich.; Gordon G. Burdick, Chicago; secretary, Russell H. Boggs, Pittsburg; treasurer, Leavitt E. Custer, Dayton, O.; member of the executive committee, George C. Johnston, Pittsburg. The following committees, to be appointed later by the president, were provided for: Committee on Histologic, Physiologic and Bacteriologic Influence of the X-Ray, Committee on Technic of Radiotherapy, Committee on Technic of Radiography. The constitution was amended to provide for a Board of Censors, said board to consist of the three last presidents, Drs. George P. Girdwood, Montreal, Canada; A. W. Goodspeed, Philadelphia, and James B. Bullitt, Louisville, Ky. The place of next meeting will be either Detroit or Cleveland, to be determined later by the Executive Committee. The election of officers was followed by the president's address. Comparison of X-Ray and Surgical Treatment for Tuberculosis. DR. BULLITT put two propositions: 1. Is the present surgical treatment of the forms of tuberculosis imminently and entirely successful and satisfactory? 2. What is the probability that the Röntgen ray method of treatment is capable of rendering the treatment of such diseases more rapid and successful? He made inquiry of various operators as to results obtained in the treatment of tuberculosis of long and flat bones, joint structures, tendon sheaths, peritoneum, testicle and lymph glands. No mention was made of the length of time that elapsed between the beginning and the end of the treatment, number of exposures made, conditions of the exposures and technic; nor is it stated that some cases get worse rather than better under the x-ray treatment. A possible mortality from x-ray treatment is out of the question. The reports indicate that in some cases at least the tuberculous process can be cut short by exposure to the x-ray, that a cure can be affected in much shorter time, and, in diseases of the bones and joints, with much better functional results than is to be expected from the usual surgical methods. The Röntgen ray, says the author, is not to be regarded as a perfect method of treatment in tuberculous disease, but may be considered to be of great value. The following summary is presented: Long and flat bonesCases treated, 71; cured, 33 per cent.; improved, 35 per cent. ; not benefited, 29 per cent. Joints-Cases treated, 141; cured, 38 per cent.; improved, 37 per cent.; not benefited, 25 per cent. Tendon sheaths-Cases treated, 27; cured, 70 per cent.; improved, 22 per cent.; not benefited, 0.7 per cent. Peritoneum -Cases treated, 32; cured, 40 per cent.; improved, 25 per cent. not benefited, 35 per cent. Testicle-Cases treated, 21; cured, 33 per cent.; improved, 48 per cent.; not benefited, 19 per cent. Lymph glands-Cases treated, 226; cured, 35 per cent. improved, 40 per cent.; not benefited, 25 per cent. Lupus-Cases treated, 616; cured, 68 per cent.; improved, 24 per cent.; not benefited, 8 per cent. This was followed by a symposium on x-ray in tuberculosis. The X-Ray in Tuberculosis and Malignant Diseases. DR. J. D. GIBSON, Denver, Colo., said that for the treatment of deep-seated growths a light made by a powerful machine and capable of great penetration is required. The X-Ray in the Treatment of Pulmonary Tuberculosis. DR. EMIL GRUBBE, Chicago, has found that the x-ray is particularly valuable in the acute cases, in which prominent symptoms are loss of appetite, weight and strength, slight rise of temperature, cough and expectoration, but no hemorrhage; and in chronic cases, and that the sooner the treatment is begun the better. The Roentgen Ray in the Treatment of Tuberculosis. DR. J. RUDIS-JICINSKY, Cedar Rapids, Iowa, insists on an early diagnosis and plenty of fresh air and sunshine as adjuvants of the x-ray treatment of tuberculosis. He uses a tube which has a prolongation from the middle of the x-ray field proper made of lead glass except the end where the rays emanate, which must be flint glass, enabling the rays to emerge at this point, which is laid right against the lesion. The remainder of the tube is enclosed in a special shield. This does not endanger the patient, and only the diseased area is rayed. Since December, 1902, he has treated 20 cases; 5 were of the hemorrhagic variety and improved in ten weeks and are still doing well; 10 cases were of the fibroid variety, and 3 of them died after six weeks, 2 as the result of intestinal complications and 1 from tubercular meningitis; the remaining 4 are slowly yielding to treatment; 2 cases of mixed infection are gaining steadily in weight. Of 6 cases of tuberculosis of the peritoneum, 1 died, and the other 5 are well and have not had a recurrence. Of 19 cases of lupus, 16 are apparently cured, and in 3 the treatment was negative. In glandular tuberculosis, 8 cases are cured, 6 are benefited, 19 are failures and 4 cases are still under treatment and doing well. In tubercular laryngitis he uses the ray as a prophylactic measure only, and 2 cases out of the 8 seemed benefited. Eight cases of joint tuberculosis were cured in six weeks; 4 chronic cases were benefited in four months; 2 cases of tuberculosis of the testicle were cured and have not recurred in three months. The X-Ray in Tubercular Adenitis. DR. MAY CUSHMAN RICE, Chicago, reported a case of tubercular adenitis in a girl aged 18, who had been operated on five times, the disease recurring again. X-ray treatments were then given three times a week, ten-minute exposures, with a medium vacuum tube, tube distance three inches. After the third treatment the glands began to diminish in size, and at the end of two months the largest gland was about the size of a bean. There was a corresponding increase in weight and improvement in general health. The second case, a woman, aged 32, disease of five years standing, was treated with the highfrequency current by means of the Tesla coil and static machine, with only slight improvement. The x-ray was substituted, and after five months the glands could scarcely be felt. DISCUSSION, DR. G. G. BURDICK, Chicago, emphasized the importance of not restricting the treatment of tuberculosis to the x-ray, but to look on the x-ray as a most valuable agent when used with other remedial agents. DR. GEORGE E. PFAHLER, Philadelphia, suggested that a great many cases of tuberculosis get well without ever seeing a doctor and without ever knowing that they had tuberculosis, a fact of which we must not lose sight when we draw conclusions as to the efficacy of the x-rays in the treatment of tuberculosis. He has had very gratifying results from the use of the x-ray in the treatment of all forms of tuberculosis. In treating tubercular glands, especially those of the neck, we should also expose the lung, because most of these cases have some involvement of this organ. He never protects anything except the hair and face of the patient. DR. C. L. LEONARD, Philadelphia, said that in using the x-ray we must be governed by a dosage which is known and can be measured, and that on this will depend the results that are obtained. Its action in tuberculosis is that of an alterative and a stimulant, but we must not depend on that agent alone. DR. E. G. WILLIAMS, Richmond, Va., emphasized the fact that all his patients had improved in general health under the x-ray treatment. One case gained 70 pounds in nine months. The x-ray stimulates metabolism more than any other agent. DR. HENRY HULST, Grand Rapids, Mich., has had good results in the treatment of tuberculosis of glands, joints and peritoneum. He has never used it in pulmonary tuberculosis because a perusal of the literature has convinced him that when the x-ray is used critically no good results are obtained. DR. S. TOUSEY, New York City, reported a wonderful improvement in a case of tuberculosis of the larynx, using the method advocated by Dr. Rudis-Jicinsky. In four months the ulcerations had healed almost entirely. He also reported considerable improvement in a case of tuberculosis of the prostate gland which was treated by raying the abdomen and by letting the rays shine into the rectum through a specially constructed tube. DR. C. E. SKINNER, New Haven, Conn., used the x-ray in three cases of advanced pulmonary tuberculosis, but was unable to perceive any influence whatever in any of the cases. DR. GEORGE C. JOHNSTON, Pittsburg, reported similar results. His experience leads him to prefer climatic to x-ray treatment. The treatment of tuberculosis under ordinary climatic conditions by means of the x-ray alone is a failure. This was followed by a symposium on the treatment of malignant diseases. The Treatment of Epithelioma. DR. GEORGE C. JOHNSTON, Pittsburg, divides his cases, first. those in which, owing to location, extent, metastasis, condition of the patient, and various other factors, a cure can not be expected, and, therefore, treatment is purely symptomatic: second, those cases in which the location and other conditions are such as to permit of the expectation of a cure. He gives daily treatments for the first ten days, unless an undesirable degree of reaction occurs, when the treatments are given at longer intervals. After the first ten days treatments are giver. every third day until the desired results are obtained. If the results do not appear, the dose may be increased cautiously. bearing in mind the cumulative tendency of the agent em ployed. The degree of success obtained will be in direct proportion to the experience of the operator, the correctness of his technic, his familiarity with the apparatus used and his ability to distinguish an active from a worthless tube. He re ported 44 cases of epithelioma about the face. The average duration of these cases is four years and eight months; 34 were primary and 10 recurrent cases. The average number of treatments in each case was 22. Metastasis occurred in only 3 cases; 30 cases were cured, 8 were benefited, 3 recurred, and 3 died. Radiotherapeutic Nihilism. DR. G. G. BURDICK, Chicago, insists on the importance of having a reliable technic which can be followed by unskilled as well as by skilled operators. He proposes the following In lupus and other forms of local tubercular involvement, the tube distance should be four inches and the penetration regu lated to within half an inch in order to take advantage of the ray of low velocity, which resembles the cathode ray. In carcinoma and epithelioma the tube distance should be ten inches and the penetration calculated to reach the center of the growth, producing irritation at least twice, and then increas ing the degree of penetration to a high velocity, in order to get cellular degeneration. Sarcoma requires a very high degree of penetration, depending on the density of the growth. When it is desired to take advantage of the tonic effect of the ray s high tube should be used. Where the lethal effect is desired a low tube should be used. It must be remembered that the tonic action of the ray is due to its fluorescence, this being understood as a form of motion, and that the lethal effects are the result of chemical radiations. All carcinomata which have not ulcerated should be rayed thoroughly before they are removed by operation. The X-Ray Treatment of Sarcoma. DR. JOSEPH F. SMITH, Chicago, reported 18 cases of deepseated sarcoma in various organs and tissues in which z-ray proved a most severe disappointment. The Results of Treatment of Carcinoma. DR. J. N. SCOTT, Kansas City, Mo., said that one great ad vantage of the x-ray is that it can be applied to large areas and to vital organs, if used with care. One disadvantage is the long period of time over which the treatment must be ex tended. All tumors operated on and found to be malignant should have a course of x-ray treatment, and if at the end of from one to three months no recurrence has set in the patient may be considered as cured, but should be kept under ob r vation. Carcinoma of the Breast. DR. CHARLES L. LEONARD, Philadelphia, said that the essential factor of any successful treatment of malignant disease is that it be radical and used early, its severity to be limited only by the patient's general vitality and of the normal tissues that surround the affected area. Thorough surgical treatment, wherever consistent with the preservation of the function of life of the area involved should be advocated as the primary treatment. If any aid is to be expected from Röntgen ray treatment it must be commenced immediately after the surgical operation, before the patient is out of bed. The healing of wounds and the closing of sinuses are hastened by Röntgen ray treatment. A careful study of the results obtained by this treatment in malignant disease of the breast shows that it has been most affected where it supplements rather than supplants operation. In inoperable and hopeless cases it affords relief from intolerable symptoms, lengthens life and offers the patient the most. The best results are obtained in scirrhus; in fact, the only favorable results of primary treatment have been obtained in these cases. Metastasis can be influenced and held in check by the Röntgen ray treatment. In all other cases surgical removal of the breast and the adjacent lymph glands is always indicated. Technic and experience, as well as local and constitutional treatment, are essential to success in the treatment of malignant disease of the breast. He reported 26 cases treated since 1900. Of this number, 12 are dead, 2 have not been heard from, and the remainder are liv ing. Two had preparatory treatment, and they have lived eighteen and sixteen months respectively. One had a primary inoperable scirrhus; 4 had recurrences, in 3 the recurrence has disappeared entirely and has not recurred in twenty-one, ten and four months respectively. In 1, massive recurrence followed immediately after operation. Of the cases receiving post-operative x-ray treatment, 4 are living and are free from recurrence, nineteen, fourteen, twelve and seven months after operation. Of the 12 patients who died, all except 3 were benefited when first seen. Two of them had post-operative treatment, but died eighteen months after the operation. He considers the results very encouraging and urges further study and observation in the treatment of malignant disease of the breast with the x-ray. Variations of Radiotherapeutic Technic. DR. RUSSELL H. BOGGS, Pittsburg, advocated the employment of more accurate methods and suggested that some perfect results that are reported in the treatment of tuberculosis or malignant disease may be due to the perfect technic employed by the operator or to a wrong diagnosis. He insisted that the most important point is the tube distance, because the intensity of the light varies inversely as the square of the distance. For skin lesions there is no occasion to place the tube more than from 4 to 6 inches from the skin, but that is not the case in the treatment of deep-seated lesions. Another important point is that the x-ray should be of large volume when deep lesions are to be treated. A low-vacuum tube at a distance of from 12 to 16 inches will penetrate the tissues effectively. With reference to cancerous disease, he spoke of cases of small epitheliomata situated on the face, which can be cured in from 6 to 8 weeks, depending on the vitality of the patient. In cases in which the disease appears to be localized, the tumor should be removed at once and followed up by x-ray treatment. Cases having considerable glandular involvement should be treated for a time with the x-ray, then operated on, and treated again with the x-ray. Usually, twenty treatments before and twenty after operation are all that are required. Those cases that are considered inoperable should be treated by the x-ray because of its inhibitory action on the disease and for the comfort it affords the patient. All cases should be given tonic treatment as well. Alcoholics, syphilities and anemic patients in general do not, as a rule, improve rapidly. Such cases should receive individual specific medication in addition to the x-ray treatment. Cases of malignant disease were reported by the following: George C. Johnston, C. L. Leonard, J. F. Smith, J. N. Scott, G. G. Burdick, R. H. Boggs, W. W. Johnson, M. K. Kassabian, G. E. Pfahler and E. G. Williams. The Compression Tube in Skiagraphy of Calculi. DR. HENRY HULST, Grand Rapids, reported the good results he has obtained from the use of his compression tube, a modification of the Albers-Schoenberg "compressions-blende," in -kiagraphy of fat people. The Interpretation of Radiographs of the Chest. DR. P. M. HICKEY, Detroit, Mich., said that in order to secure the best results perfect mastery of the tube and employment of stationary secondary current and the use of developers which will secure the greatest detail and contrast are necessary. It is also necessary that the observer should be experienced in the reading of these negatives. The exposure should be made as rapidly as possible with a view to securing the greatest amount of contrast. To interpret these negatives we should know the position of the target of the tube with reference to the area exposed, and a suitable illumination of the nega tive by means of the illuminating box is essential. Furthermore, careful distinction should be made between physiologic and pathologic conditions, such as a large or vigorously pulsating aorta and an aneurism of the aorta. The X-Ray in Injuries Near the Wrist. MR. M. WILBERT, Philadelphia, called attention to the fact that fractures of the lower end of the radius are frequently complicated by other more or less extensive injuries, and that the other bones entering into the formation of the wrist joint are also subject to fracture. Fractures at or near the wrist joint are extremely common and vary considerably, both in location and direction, and in the nature and extent of the injuries to other structures. Of the 26,011 cases of fracture rayed by him. 660 were at or near the wrist joint. When skiagraphing a joint it is important to include as much of the surrounding tissues as possible so that any fractures near the joint may be detected. In fracture of the wrist joint, fracture of the carpal bone is very common. The Value of Stereoscopic Skiagraphy. Dr. M. K. KASSABIAN, Philadelphia, discussed this subject and exhibited an apparatus which is used for stereoscopic examination. Diagnosis of Brain Tumors and Softening. DR. GEORGE E. PFAHLER, Philadelphia, exhibited a series of skiagraphs made for the purpose of diagnosing and locating brain tumors and abscesses of the brain. He said that he would never take the responsibility of an operation on the brain purely on skiagraphic evidence. On the other hand, all cases of brain lesion should be examined by the x-ray in order to confirm or add to the clinical evidence. Therapeutics. [Our readers are invited to send favorite prescriptions or outlines of treatment, such as have been tried and found useful, for publication in these columns. The writer's name must be attached, but it will be published or omitted as he may prefer. It is the aim of this department to aid the general practitioner by giving practical prescriptions and, in brief, methods of treatment for the diseases seen especially in everyday practice. Proper inquiries concerning general formulae and outlines of treatment are answered in these columns without allusion to inquirer.] Heart Disease. DIET. Schott, in the Lancet, discusses the diet in heart affections, and gives the following two rules: 1. Patients must avoid everything which excites the action of the heart, and 2, they must shun everything which embarrasses the heart's action. The substances which most readily cause excitation of the heart are coffee, strong tea, and alcoholic liquors. These stimu lants should be avoided, even in cases where there has been habitual use of them, except in cases where the withdrawal would result in collapse. In these cases, which have been ac customed to the use of alcohol, it is best to give Rhine wine. Moselle, or Bordeaux, which has been matured for from eight to ten years. If it is found necessary to administer other than the light wines, Cognac or whiskey mixed with plain water may be given. No aromatics should be given with the alcohol because of the danger of irritability of the stomach leading to |