here the success of the treatment is at this time conceded by all who have given it a faithful trial. In sycosis, acne, eczema, psoriasis, and various other skin diseases, good use has also been made of the X-ray. Many instances of epithelioma of the skin are now on record as having been cured by the X-ray, as is also true of sarcoma and carcinoma. The evidence of radiotherapy for internal malignant growths is not yet sufficient to enable one to make an authoritative statement, either for or against its value. In epithelioma of the skin, I think we are justified at least in expecting a good deal; in fact, I believe I am not saying too much when I say I believe the X-ray to be a curative agent. In lupus there is no doubt as to its favorable action. Of course, a statement in favor of radiotherapy in the treatment of malignant growths and lupus is in a way a decision against surgical treatment, and I am going to take the position thus indicated, but not in an extreme manner, please understand, so don't "jump on me" unadvisedly in your discussion. In epithelioma of the skin I believe radiotherapy should as a rule be tried first of all, and with good expectation of a cure; still, these cases will have to be watched for a number of years in order to learn how much liability there is of a recurrence. In the cases which have been operated and in which there has been a recurrence, the X-ray should be faithfully applied, but if after a reasonable length of time, say a month or six weeks, no benefit is apparent, then resort should be had to surgery. In the inoperable cases of external epithelioma the unfortunate victim. should certainly be given the benefit of whatever good may be done by the X-ray. When I speak of epithelioma I mean my remarks to apply to so-called rodent ulcer, also. In glandular sarcoma I am of the belief at the present time that surgical methods should have the preference when there is a possibility that the affected tissue may be totally removed. In inoperable cases the X-ray may be worth while trying. In Hodgkins' disease the reports seem to give us reason for expecting much from the use of the X-ray. After operation it would be well or at least would do no harm to use the X-ray for a time at intervals as a prophylactic measure in many cases of malignant disease. In carcinoma of the breast of course there is only one opinion as to what is best, and that is to operate thoroughly and at once. After the operation the ray may be used as a possible preventive of recurrence. In cancer of viscera I think surgery should be the first resort, and it is possibly the only hope. Some claims have been made that the X-ray will cure internal carcinoma, but it seems to me that the matter is still very much open to doubt. This much may be said in favor of the use of the X-ray in this class of cases: It almost always relieves the pain, and anything that will do that without wrecking the mind of the patient is certainly a godsend. The X-ray surely passes into these internal growths, and it is hard for me to understand why it should not affect them in just the same manner as it does the superficial ones. Perhaps the lack of success is because we do not get these cases for X-ray treatments until all hope of help from any other agency has been given up. I will here briefly report a few cases illustrating some of the types of disease in which the X-ray is being used. J. R. S., male, aged about 45; patient of Dr. McNaught; lupus. The lesions are on the outer side of the right leg, above and below the knee, and involve an area of about fifteen square inches. Duration of disease several years, resisting all treatment. X-ray applied three times a week, five to ten minutes at a time, the tube operated by a static machine and ten inches from the skin. There was relief from pain, drying of the sores and a slight appearance of puckering of their surfaces. Only twenty-seven treatments were given, at which time a good part of the surface was healed. There was an occasional tendency for a small point of the new skin to break down, but these places healed again very soon. This case has been well for nearly a year, now. Mrs. H., aged 53; patient of Drs. Bagot and Atcheson; cancer at base of bladder. During past two years she has had a good deal of pain, difficulty in micturition, considerable hemorrhage at frequent intervals; some pus has appeared at times in the urine; she has failed considerably in health and has a cachectic look that is quite apparent. Three treatments a week were given, at first five minutes, then ten, and now I sometimes make the exposures fifteen minutes long. Her pain was very soon, almost immediately, relieved; the hemorrhages stopped at once, and micturition soon became easier than it had been for a long time; she felt stronger and gained a little in weight; the cachectic appearance soon became much less noticeable. There have been one or two reappearances of blood, but these have lasted but a few hours. Dr. Bagot examined her about a month ago and stated that the growth was increasing in size. The last few days. she has had a return of pain, with indications of extension into the neck of the bladder. I think the prognosis is unfavorable. Mrs. Hy.; referred by Dr. S. G. Mugrage; cancer of cervix; patient very weak and feeble; characteristic pain, discharge and odor. The pain lessened after a few treatments, but later changed in character and location, involving the bladder. The discharge from the uterus lessened and the odor disappeared. She gained three-fourths of a pound in weight during the second week of treatment. Her skin became of a better color and her strength increased. She ceased coming for treatment after sixteen applications and I learned from her husband that she did so on account of incontinence of urine, and from what he said I believe she has developed a vesico-vaginal fistula. I do not think this case offers much hope, owing to the progress already made by the disease. Mr. R.; referred by Drs. Kemble and Lawney; epithelioma of face, several years' duration; operated upon twice, I believe. After some twenty-five treatments I think there is distinct im-. provement and that the prospects for a cure are very good. [Later: The whole area is now covered with what is apparently normal skin.] utes. Mrs. A.; referred by Drs. Freeman and C. G. Hickey; Hodgkins' disease; great mass of glands on left side of neck, which measured fifteen inches in circumference. Treated daily for a few days, then on alternate days; exposures at first five minutes, then ten, and then a few were made of fifteen minutes; the longer exposures soon produced a dermatitis of an erythematous nature, and the time of exposures was reduced to ten minAfter twenty treatments the measurement of the neck was. thirteen inches; at the present time only one gland shows any enlargement and that is about the size of a hazel nut; at first it was about the size of a pigeon's egg. This patient took arsenic part of the time, but soon had to stop it as she was very intolerant to its action; later it was given in smaller doses, but I am inclined to lay all the credit of the result to the X-rays, because we all know what little effect arsenic has had in other cases of Hodgkin's dis- ease. My first experience with the X-ray, lasting six years, was with the current generated by an eight-plate static machine; I mean by this a static machine having eight circular plates; manu 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., 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. |