follows: The tube should be from 9 to 10 Wehnelt, and a filter of 1 mm. of aluminum interposed; 0.75 of a pastille dose is given twice weekly up to a maximum of twelve doses, or until a slight degree of hyperemia shows itself. The skin may become "tanned” (see our editorial on “Actinotherapy,” in June WORLD, page 206), but at the first sign of reaction the treatment must be stopped for a week or two. If the condition of the patient and other circumstances permit there is no reason to delay the commencement of the treatment more than two or three days after the operation, and in treating cases of this kind we should not attempt to confine the rays accurately to the site of the operation, but allow as much as possible of the surrounding area to come under the influence of the irradiation.

After three months' interval, if all goes well, a further six applications are to be given, and again after a six months' interval.

If this procedure were carried out for two years in all cases, we should hear less of recurrences.

The great trouble is that post-operative treatment is not begun soon enough in a large proportion of cases, and in many of them deep extension has commenced, making all efforts to prolong life practically futile. There is not the least doubt that immediate post-operative X-ray treatment in carcinoma cases does definitely increase the patient's chance of making a complete recovery, and delay in applying this method not infrequently means that we are throwing away a victim's one chance of escape.

In no class of case is it more difficult to lay down definite rules for treatment; every case must be dealt with according to the conditions present. In most instances, the treatment will be more vigorous than stated above.

Full or even double pastille doses three times a week may be necessary for a time so as to produce a profound impression on the growth more or less quickly. If there seems to be deep extension, this is all the ore necessary, but here we must use a thicker filter-say 2 mm. of aluminum. The risk of dermatitis is very small when using such thick filter, but as we are giving massive doses we must act with all caution and discretion. On the other hand, only massive doses will be of any avail in a serious case, and we have to remember that if let alone the patient's life comes to an end in a short time; so that while we must not do anything to add to his sufferings thru X-ray dermatitis, we are justified in doing anything short of this that gives him a chance of escape or an extension of comparatively comfortable existence.

large indifferent negative electrode. A general anesthetic is required. There is coagulation necrosis or acid necrosis of the tissues for almost 1/2 inch around each metal point connected with the positive pole, and the portion of tissue thus destroyed dries up, and, eventually, after one or more weeks, separates, leaving a granulating surface.

Correct technic is extremely important. The indifferent negative electrode had better be a pad of kaolin laid over a smaller sheet of metal, which it more than covers. Any small area of metallic contact or markedly greater conductivity would permit a more concentrated Aow of the current, and produce, at the indifferent electrode, a negative burn, which is characterized by alkali necrosis or colliquative necrosis-a moist gangrenous process like that produced by the action of a caustic alkali. The patient is under the influence of an anesthetic, and so cannot give warning of the occurrence of a burn. The positive wire may be divided into about five strands, and it is best for the zinc points (pieces of sheet zinc, such as signs are painted on, about 14 of an inch wide at the base, about 3 inches long, and tapering to a very sharp point) to be soldered to the copper wires. If this is inconvenient, they may be bent around the wire and securely pinched. The points are galvanized by dipping them first in dilute acid and then in metallic mercury. The first point should be introduced before the current is turned on, and a rheostat should be used to very gradually increase the strength of the current from zero to 30 or 40 ma. Then another point is gradually introduced, and it will be found that the milliampere-meter registers an increased current, due to the larger area of contact. Other points are introduced so as to transfix the tissues all around, and, if practicable, beneath the growth. The current may then be found to be 50 or 60 ma., the increased area of contact at the metal points having greatly reduced the resistance at the positive pole, while the resistance at the negative pole has not been changed. Additional current is now turned on very gradually until 100 or even 200 ma. are indicated by the milliamperemeter. The flesh is seen to turn white, and a white froth exudes from the different punctures. The exact length of time that the current should be allowed to flow varies with the amount of tissue that is to be destroyed. It is usually between five and ten minutes. The current must be turned off just as gradually as it has been turned on, and the last metal point must not be removed until the current has ceased to flow. The 110-volt direct current is most suitable for the work. This may be obtained from the direct 110 volt electric light circuit, or from the alternating electric light circuit, by a rotary transformer, or a storage battery or a galvanic battery of the necessary number of cells to produce about 110 volts may be used.

This treatment has been applied to cancers of the breast and tongue, localities where turning the current on or off suddenly would cause serious shocks.

The advantages of this treatment are the freedom from hemorrhage, the complete destruction of the part to which it is applied, the presence of a sterilized and usually dry slough, which changes to a dry scab and comes away by natural processes. The disadvantages are that it does

even

Mercuric Cataphoresis in Treatment of

Cancer. The following description of the technic is taken from “Medical Electricity and Roentgen Rays,” by Dr. Sinclair Tousey* :

The term is usually applied to the method introduced by Massey. Extremely heavy currents of about 100 ma. or more are applied from the active positive electrode, consisting of sharp pieces of zinc amalgamated with mercury, thrust into the tissues while the patient lies upon a

not have a selective action upon the morbid tissue, nor one extending beyond the area actually destroyed, and that its cicatrizes are very bad compared with those left after a case has been cured by the x-ray or by surgical removal and a plastic operation.

While the method is certainly a valuable one for use in occasional special cases, it may not be unfair to characterize it in some other cases as an imperfect form of surgery. There is a ques. tion as to whether the destructive effect is at all due to the transportation of mercury into the tissues, or whether it is due altogether to the action of the electric current. The author feels that the latter is the chief factor in the case.

Books on Cancer. The following books, bearing directly upon the principal subject treated on in this issue, will be of interest to those who wish to equip themselves with literature on this vitally important disease:

“The Conquest of Cancer,” Saleeby. Publisht by F. A. Stokes Company, New York, N. Y. $1.75, net; postage, 18 cents. 361 pages. 1907.

“Cancer-Relief of Pain and Possible Cure," Skene Keith and George E. Keith. Publisht by the Macmillan Company, New York, N. Y. $1.25. 155 pages. 1908.

"Medical Electricity and Roentgen Rays," Tousey. Second edition, publisht by W. B. Saunders Company, Philadelphia, Pa. $7.50. 1,165 pages. 1915.

"A Textbook of Radiology," Morton. E. B. Treat & Co., New York, N. Y. 1915. $3. 217 pages. "Medical and Surgical Electricity," Rockwell

. E. B. Treat & Co., New York, N. Y. 1907. $5.

"Therapeutic Action of Light,” C. E. Rodgers, Chicago, Ill. 1910. $3.50. 318 pages. Publisht by the author.

"Radium and Cancer,” Wickham and Degrais. Publisht by Paul B. Hoeber, New York, N. Y. 1913. $1.25, net. 111 pages.

Chronic Gastritis: For years I have prescribed berberin, with nux, xanthoxylum or capsicum, iron carbonate if anemic.-ELLINGWOOD.

In typhoid fever the life-saving power of rhus above all other remedies is many times made manifest.-N. M. DEWEES, Ellingwood's.

When quinin fails to relieve malaria it is because it is not properly given, not absorbed, not continued long enuf, or we have failed to correct something that arrests the action of this greatest of specifics.-J. H. McCURRY, Ellingwood's.

Disease of the heart in children is much more amenable to treatment than in adults. Recovery in the early stages may always be counted upon with proper treatment.--Ellingwood's.

I failed in earlier experience to realize the importance of closed fractures with swelling of the leg even where the main artery was not completely severed.-C. H. LEMON, Wis. Med. Jour.

It is possible in simple leg fracture to have in 48 hours thru hematogenous infection a moist gangrene which with delayed amputation will invariably end in death.—LEMON, Wis. Med. Jour.

Chaney subjected many morphin habitués to immediate withdrawal and never saw dangerous symptoms develop, tho patients reach a very pitiable state.-Wis. Med. Jour.

When a patient emerges from the hyoscin treatment of morphin cure he is in an unfortunate condition and requires care for 4 to 8 weeks.-H. W. POWERS, Wis. Med. Jour.

There is no known malady that is not bettered by removing from its symptom-complex all that is due to fecal toxins in the blood.-Southern Practitioner.

By the time the Widal has satisfied us that we have to do with a typhoid fever all the practical result is to know what we might have done with benefit a week before.-Southern Practitioner.

To strap a swelled testicle use an inch-wide rubber bandage. Never apply adhesive plaster.

Orchitis subsides swiftly under applications of silver nitrate, 25 per cent.; but a cream of bismuth subnitrate and water does about as well and doesn't make the skin sore.

Extragenital syphilitic infections are exceedingly more common in physicians than in any other class of individuals.-HEIDINGSFELD, Am. Jour. Urol.

Oliver says eclampsia is twice more frequent than it was 25 years ago. This he attributes to the change in our foods that has reduced the content of mineral matter, especially phosphates and lime. Practitioner.

Scurvy and beriberi are deficiency diseases. Oliver suggests that not only eclampsia but appendicitis, duodenal ulcer and many others may be found in the same etiologic group.-Practitioner.

In a case of mental derangement due to high pressure Thomson had to give 180 drops of 10% aconite tincture with veratrum viride within 3 hours to get enuf relaxation.

Markt improvement followed.-Am. Jour. Med. Sci.

There is no source of knowledge to the doctor worth nearly as much as the study of the patient. All we get from general information is general.Southern Practitioner.

666 pages.

Gleanings from Current Literature. Which do you prefer-one idea in twenty pages, or twenty ideas in a single page?

Neural pangs subside under atropin or hyoscin. Acute myalgias respond promptly to ammonium chlorid in scruple doses every 8 hours. Many subacute pains fall before iodids. Rheumatic suffering is quelled by salicyl. Glonoin unlocks anginas; spasm relaxes under hyoscin.-Waugh, Southern Practitioner.

Wolbarst admits the value of the Wassermann test, but protests against the tendency to rely wholly on it to the neglect of clinical evidence. Am. Jour. Urol.

The development of an acute traumatic nephritis following a shock is incontestable. Manual exploration of the kidney may cause the appearance in the urin of all the elements found in this malady.-Pousson, Am. Jour. Urol.

Bovrie reports a case of unquestionable syphilis, treated with 606, which was followed by rapid development of general paresis.-Am. Jour. Urol.

Chronic Gastritis: The single remedy which has exercised the most direct influence in relief and cure is hydrastis canadensis.-ELLINGWOOD.

blindness; history of severe cold, many months, headache, dizziness, local tenderness, slight fever, possibly chills.—LEONARD, Med. Herald.

With 100,000,000 population we import 400,000 lbs. opium yearly; 90% used by habitués. Italy, with 30,000,000, uses 6,000 lbs.; Austria-Hungary, with 45,000,000, uses 3,000 yearly.-JEANNETTE Marks, Am. Jour. Pub. Health.

A number of physicians in reporting on lobelia have observed that patients who are addicted to drug habits find themselves relieved of the disease after they have taken a few hypodermics of lobelia.-Ellingwood's Therapeutist.

Avoid all criticism of colleagues in private conversation, and save critical energy for the medical society meeting.-ROBERT T. MORRIS, in Medical Council.

Some of the most obstinate cases of pruritus recti et ani, resisting all external applications, even painting with pure phenol and a 50% solution of silver nitrate, are at once relieved by a few properly performed prostatic massages. We have had several remarkable cases of this kind which we will report at a later date.-Critic and Guide.

EXAMINATION QUESTIONS.

It is so easy to shoot morphin in that it is apt to become a habit to pull out the hypo before the patient is thru the tale of woe.—Southern Practitioner.

The utero-ovarian sedatives are employed almost exclusively in shotgun prescriptions, and this has interfered with the scientific study of the single remedies.-Ellingwood's.

Clinical errors are due to ignorance, faulty judgment, obsession, failure to think anatomically (logically?), and reluctance to accept responsibility.-ABRAHAM.

A doctor, before a 40-mile ride, took a dose of macrotys; and the expected soreness did not materialize.-Ellingwood's.

However learned a man may be, he is not fully equipt as a practitioner until he is acquainted with the native plant remedies.-IRA WARREN.

Relief of any mechanical cause of constipation in an epileptic resulting in restoration of bowel function will temporarily cure the epilepsy.C. A. L. REED.

Kerr has a good word for chewing gum. It keeps the mouth clean and stimulates the flow of saliva; valuable in fevers.-N. Y. Med. Journal.

In 63% of gallstone cases there is a tender point over the interspace of the 9th, 10th or 11th ribs; and pressure on the end of the 11th rib will cause sharp pain.—BINET.

Tuberculosis: Of 373 cases, there were 142 positive X-ray diagnoses in which the sputum, if any, was negative. No case that could be classified as an early tuberculosis was found in which the X-ray report was negative.-GIFFIN AND SHELDON, Journal-Lancet.

If we are to develop a nation of physically sound men and women, more is necessary than action on the part of the public authorities.-L. K. FRANKEL, Am. Jour. Pub. Health.

Jeannette Marks says there are four million drug addicts in the United States. There is no village in which habitués cannot get from druggists all the opiates they want.--Am. Jour. Pub. Health.

Tenderness on percussion over the right kidney is especially valuable in differentiating between disease of the gall bladder, appendix and kidney; over the left, it distinguishes between kidney and pancreas disease.-MURPHY.

Disease is neither medical nor surgical, nor does it hover on the border lines; treatment has become more surgical, and the division is not scientific.-J. W. HEDDENS, Med. Herald.

There is a greater place for usefulness than ever before for the family practician, if he be at the same time a competent diagnostician.—HEDDENS, Med. Herald.

One of the most interesting and annoying things with which a surgeon has to deal is a fecal fistula. The attempt to effect a cure without opening the abdominal cavity as a rule will prove a failure.-T. E. POTTER, Medical Herald.

The Bulgarian bacillus is of benefit in cholecystitis, regulating the bowels and attenuating the action of the colon bacillus, and along with calomel in small doses followed by salines is the necessary treatment of the bowels.-CONRAD, Med. Herald

Sinus suppuration is accompanied by blurred vision, exophthalmos, divergent strabismus and